Effect of mid-day meal on nutritional status of adolescents: A cross-sectional study from Gujarat

Objective: To evaluate the effect of mid-day meal (MDM) on the nutritional status of adolescents and compare it with healthy comparison group. Settings and Design: A cross-sectional study on apparently healthy adolescents (10-14 years) receiving MDM and not receiving MDM (comparison group) was conducted in two cities (Ahmedabad and Patan) of Gujarat, Western India, from January 2012 to March 2014. Materials and Methods: A total of 401 adolescents (200 boys) were selected randomly, using computerized random number generation, from two private and two municipal/government schools. Anthropometric measurements were performed. Height, weight, and body mass index Z scores were computed using ethnic data. Diet was recorded by 24 h recall and nutrient intakes were computed (C-diet V-2.1) as a percentage of the recommended dietary allowance (RDA). Student’s t-test and Chi-square tests were used to compare differences in nutritional status. Results: Percentage of stunting (24% boys and 19% girls) and wasting (17% boys and 18% girls) was significantly higher in adolescents receiving MDM (p<0.001), while the percentage of risk of being overweight, i.e., BMI for age Z (BAZ) >1 or above 85th percentile (18% boys and 12% girls) was predominant in non-MDM receiving adolescents (p<0.001). Compared to non-MDM, MDM receiving adolescents consumed significantly reduced quantity of nutrients (p<0.05). On comparing RDA based on the 24 h dietary recall, it was seen that MDM receiving boys met 60% energy, 78% protein, 50% calcium, and 53% of micronutrient requirements while MDM receiving girls met 59% energy, 67% protein, 44% calcium, and 48% of micronutrient requirements. Non-MDM receiving adolescents had close to RDA or above intake for the most nutrients (p<0.05 for all). Conclusion: Although MDM scheme restricted the percentage of stunting to some extent, the percentage of wasting was critical in terms of public health significance. MDM receiving adolescents were vulnerable to energy, protein, and micronutrient deficiencies.Key words: Adolescents, Nutritional status, Micronutrients, Mid-da

Changes in body composition in apparently healthy urban Indian women up to 3 years postpartum

Introduction: Dietary and life style practices differ in postpartum (PP) and nonpregnant Indian women. Effect of these practices on postpartum weight retention (PPWR) and development of cardio-metabolic risk (CMR) has been scarcely studied in urban women. Aims of this study were to (i) compare anthropometry, biochemical parameters and body composition up to 3 years PP (ii) effect of PPWR, dietary fat intake and physical activity on CMR factors. Methods: Design: Cross-sectional, 300-fullterm, apparently healthy primi-parous women (28.6 ± 3.4 years) randomly selected. 128 women within 7-day of delivery (Group-A), 88 with 1-2 years (Group-B) and 84 with 3-4-year-old-children (Group-C) were studied. Anthropometry, sociodemographic status, physical activity, diet, clinical examination, biochemical tests, body composition, at total body (TB), by dual energy X-ray absorptiometry (GE-Lunar DPX) were collected. Results: Women at 3-year PP showed higher weight retention (6.5[10] kg) than at 1-year (3.0[7] kg) (median [IQR]). Android fat % (central obesity) increased (P < 0.05) at 1-year PP (47 ± 10.0%) when compared to 1-week PP (44.3 ± 6.7%) and remained elevated at 3-year PP (45.6 ± 10.2%). Regression analysis revealed that at 1-year PP, increase in PPWR (Odd Ratio [OR] 1.8, 95% confidence interval [CI] = [1.2, 2.5], P < 0.001) and inactivity (OR 1.4, 95% CI= (0.97, 2.0), P < 0.1) were predictors for CMR. At 3-year PP, only PPWR was responsible for increase in CMR parameters (OR 1.6, 95% CI = (1.3, 2.3), P < 0.001) and not inactivity (P > 0.1). Conclusion: Postdelivery, low physical activity and higher PPWR may increase CMR in Indian women

Prevalence of osteoporosis in apparently healthy adults above 40 years of age in Pune City, India

Purpose: The aim of study was to assess the prevalence of osteoporosis and changes in bone mass with increasing age and compare bone health status of apparently healthy men, premenopausal and postmenopausal women. Methods: Data were collected on anthropometric and sociodemographic factors in 421 apparently healthy Indian adults (women = 228), 40–75 years of age, in a cross-sectional study in Pune city, India. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at two sites-lumbar spine (LS) and left femur. Individuals were classified as having osteoporosis or osteopenia based on the World Health Organization criteria of T-scores. Results: Mean age of study population was 53.3 ± 8.4 years. Of the total women, 44.3% were postmenopausal with 49.2 ± 3.5 years as mean age at menopause. Postmenopausal women showed a rapid decline in BMD with age till 50 years while men showed a gradual decline. Premenopausal women showed no significant decline in BMD with age (P > 0.1). Significantly lower T-scores were observed at LS in men compared to premenopausal (P 0.1). The prevalence of osteoporosis in men at LS was lower than postmenopausal women but higher than premenopausal women. Conclusion: In Indian men, a low T-score compared to women indicates higher susceptibility to osteoporosis. In women, menopause causes a rapid decline in BMD. Therefore, both Indian men and postmenopausal women require adequate measures to prevent osteoporosis during later years in life

Antioxidant and trace element potential of Chyavanpraash and some Ayurvedic preparations

215-223Importance of antioxidants such as vitamin C and zinc in treatment of diabetes mellitus and hypertension is being recognised. There is a growing interest to find naturally occurring antioxidants rather than synthetic ones for their use in medicinal material. Therefore a study was undertaken a) to assess antioxidant and trace metal potential of five brands of Chyavanpraash and eight marketed Ayurvedic preparations (AP) at their prescribed dose level along with their major nine ingredients; b) to measure bioavailable amounts of trace metals; and c) to examine toxicity of lead in these AP. Trivang, Abhrak and Loha bhasma had high levels of copper, cobalt and nickel. Manganese contents were high in Trivang and Abhrak but zero in Lohabhasma. Even though amalaki is one of the main ingredients of Chyavanpraash and Raktavardhak, their vitamin C content was quite low. Tannic acid was marginal in these two preparations. Three types of amalaki showed variable contents of iron, zinc, copper, lead, manganese and ascorbic acid. Tannic acid was highest in small amalaki. Sun drying reduced vitamin C content by seventy five percent of the fresh amalaki. Lohabhasma showed highest bioavailable iron followed by Lohachurna. The bioavailable iron was negligible in Chyavanpraash and Raktavardhaka as compared to Lohabhasma and Abhrak bhasma. Bioavailable zinc content was high in Trivang bhasma and is a promising zinc supplement. Mineral iron treated with Gomutra decreased % iron bioavailability by one third but % zinc bioavailabiliy increased twofold. Lead content was highest in Trivang bhasma. The content of lead in daily dose of Chyavanpraash and Raktavardhak was high, but within the prescribed safe limits for lead. Further the bioavailable amount of lead for all these preparations was also very low

Arterial stiffness in obese children: Role of adiposity and physical activity

Objective: To explore association of adiposity and physical activity with arterial stiffness and to propose optimal waist circumference cutoffs, corresponding to 90 th percentile of NHANES (National Health and Nutrition Examination Survey) for Indian children and adolescents. Materials and Methods: Data on weight, height, waist circumference, physical activity and right Carotid artery Intima-Media-Thickness (CIMT), pulse wave velocity (PWV), elasticity modulus (Ep), stiffness index(β), arterial compliance (AC) were assessed in 250 children (72 normal-weight and 178 overweight/obese) aged 6-17 years from Pune city, India. Body composition was measured using Dual energy X-ray absorptiometry. Results: Total, 37.1% normal-weight and 98.2% overweight/obese children had high adiposity (>95 th body fat percentile). Positive association of PWV and Ep (r = 0.5) also β(r = 0.25) with BMI (Body Mass Index), waist circumference and body fat (P < 0.05) was observed. Physical activity was inversely associated with PWV (r =-0.2), β(r =-0.13), Ep (r =-0.12) and positively with AC (r = 0.12) (P < 0.05). PWV significantly increased with increasing body fat for each tertile of physical activity (P < 0.05). Regression analysis revealed waist circumference, BMI, body fat and physical activity as independent associates for PWV after adjusting for age (P < 0.05). The cutoff of waist circumference yielding sensitivity and specificity for predicting the risk of high PWV was (−0.43, −0.44) for boys and girls with sensitivity in boys (girls) of 78% (87%) and specificity in boys (girls) 51% (70%). The observed cutoffs are less than the NHANES-III cutoff values of waist circumference for 90 th percentiles according to age and sex. Conclusion: High adiposity and low physical activity are adversely related to arterial stiffness in Indian children

Dietary patterns with special reference to calcium intake in 2–16-year-old Urban Western Indian children

Background: It is important to establish good dietary practices in childhood that promote adequate calcium intake throughout life and reduce the risk of osteoporotic fractures in later life. Objectives: To assess dietary patterns of 2–16-year-old children with special reference to calcium and suggest strategies and develop recipes suitable to identified patterns to increase dietary calcium intake. Methods: We studied 220 schoolchildren (2–16 years) around Pune city, India. The study duration was June 2013–July 2014. Height and weight were measured using standard protocols. Dietary intake was assessed by 24-h diet recall on 3 nonconsecutive days. Dietary patterns were derived by cluster analysis in two age groups; children (2–9 years) and adolescents (10–16 years). As per the dietary patterns, calcium-rich recipes were developed. Results: Among children, “rice-pulse” (RP) and “wheat, milk, and milk products” (WM) patterns were observed. Among adolescents, RP, “wheat, milk, and bakery” (WMB), and “mixed food” patterns were observed. Children who consumed “WM” and “WMB” patterns had greater intake of calcium (P < 0.05) than children consuming other dietary patterns. The daily calcium intake of whole group was 53% of the recommended dietary allowance. From this, 30% calcium came from milk. Each serve of the developed recipe provided an average of 254 mg of calcium. Conclusion: Majority of children had cereal-pulse-based dietary patterns. By replacing foods from existing dietary patterns with calcium-rich foods, the dietary calcium content may be increased in a sustainable manner

Growth status of children and adolescents with type 1 diabetes mellitus

Background and Objectives: Growth parameters are important indicators of a child′s overall health, and they are influenced by factors like blood glucose control in diabetic children. Data on growth parameters of Indian diabetic children is scarce. This retrospective, cross-sectional, case control study was conducted at diabetes clinic for children at a tertiary care center at Pune, to study growth parameters of diabetic children in comparison with age-gender matched healthy controls and evaluate effect of different insulin regimes and age at diagnosis of diabetes on growth. Materials and Methods: One twenty five diabetic children (boys: 50) and age gender matched healthy controls were enrolled. All subjects underwent anthropometric measurements (standing height and weight). Mean height (HAZ), weight (WAZ) and body mass index (BAZ) for age Z scores were calculated. Diabetes control was evaluated by measuring glycosylated hemoglobin (HbA1C). Statistical analysis was done by SPSS version 12. Results: Mean age of diabetic children and age gender matched controls was 9.7 ± 4.4 years. Diabetic children were shorter (128.3 ± 24.3 cm vs. 133.6 ± 24.7 cm) and lighter (29.2 kg ± 15.3 vs. 31.3 ± 15.4 kg). HAZ (−1.1 ± 1.2 vs. −0.2 ± 0.8) and WAZ (−1.2 ± 1.3 vs. −0.7 ± 1.3) were significantly lower in diabetic children (P 14 years) were comparable to healthy controls. Conclusions: Growth was compromised in diabetic children in comparison to controls. Children diagnosed at younger age need more attention to optimize growth

Growth status of small for gestational age Indian children from two socioeconomic strata

Aims: To assess growth and factors associated with growth in children born small for gestational age (SGA) from two socioeconomic strata in comparison to age- and sex-matched healthy controls. Methods: Retrospective study conducted at two hospitals in Pune, 0.5–5 years, 618 children: 189-SGA from upper socioeconomic strata (USS), 217-SGA from lower socioeconomic strata (LSS), and 212 appropriate for gestational age healthy controls were randomly selected. Birth and maternal history, socioeconomic status, length/height, and weight of children were recorded. Anthropometric data were converted to Z scores (height for age Z-score [HAZ], weight for age Z-score [WAZ]) using WHO AnthroPlus software. Results: The HAZ and WAZ of the SGA group were significantly lower as compared to the controls and that of the LSS SGAs were lower than USS SGAs (P < 0.05). Thirty two percent children were stunted (HAZ <−2.0) in USS and 49% in LSS (P < 0.05). Twenty nine percent children in the USS SGA group were stunted at 2 years and 17% at 5 years. In the LSS SGA group, 54% children were stunted at 2 years and 46% at 5 years. Generalized linear model revealed normal vaginal delivery (β = 0.625) and mother's age (β =0.072) were positively associated and high SES (β = −0.830), absence of major illness (β = −1.01), higher birth weight (β = −1.34) were negatively associated for risk of stunting (P < 0.05). Conclusion: Children born SGA showed poor growth as compared to controls. Special attention to growth is necessary in children from LSS, very low birth weight babies, and those with major illnesses during early years of life