ANEMIA AND VITAMIN B12 DEFICIENCY IN ELDERLY.

 Objective: The present study was carried out to assess the prevalence of anemia, vitamin B12 deficiency and hyperhomocysteinemia among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 234 elderly aged 60 and above in slums of West Delhi. 5 ml blood was collected from 116 elderly and was analyzed for hemoglobin, Vitamin B12 and homocysteine. Anemia was defined as hemoglobin <130 g/L and <120 g/l for male and female, respectively, Vitamin B12 deficiency as serum Vitamin B12 <203 pg/ml and hyperhomocysteinemia as serum homocysteine >15 μmol/l.Results: The overall prevalence of anemia, Vitamin B12 deficiency, and hyperhomocysteinemia among elderly was 57.76%, 36.36%, and 57.57%, respectively. Among anemic elderly, 33.33% and 64.15% had Vitamin B12 deficiency and hyperhomocysteinemia, respectively.Conclusion: More than half of the elderly population was anemic, while one-third was having Vitamin B12 deficiency

IODINE STATUS OF PREGNANT WOMEN RESIDING IN URBAN SLUMS IN DELHI

Objectives: The present study was carried out to determine the iodine nutrition status among pregnant women in slums of West Delhi.Methods: A community-based cross-sectional study was carried out among the third-trimester pregnant women residing in urban slums of West Delhi. Urinary iodine concentration was estimated using ammonium persulfate method, and salt iodine was estimated using iodometric titration.Results: Of the total 180 pregnant women, 70.6% were consuming adequately iodized salt (iodine levels ≥15 ppm). Median urinary iodine level for the pregnant women was 147.5 μg/L indicating iodine deficiency among this group. A total of 51.1% of women had urinary iodine levels <150 μg/L.Conclusion: Pregnant women belonging to slum community from Delhi have a suboptimal iodine status. Further, the proportion of women consuming iodized salt is less than the national average indicating the need to educate these women about the importance of iodine during pregnancy

PREVALENCE OF HYPERTENSION AMONG ADULT POPULATION IN SLUMS OF WEST DELHI

Objective: The present study was conducted to assess the prevalence of hypertension in adult population residing in slums of West Delhi.Methods: A cross-sectional study was conducted among adult population of 18-59 years residing in urban slums of West Delhi. Blood pressure was measured using digital machine (OMRON). The data obtained were analyzed for percent prevalence, mean, standard deviation, and median. Joint National Committee (JNC)on prevention, detection, evaluation, and treatment of high blood pressure (JNC)VI and JNC VII criteria were used to classify hypertension.Results: The overall prevalence of hypertension was 25.3%. The prevalence was higher (27.9%)in males than females (22.8%)and also in the age group 46-59 years (43.0%)as compared to 18-45 years (19.8%). The overall prevalence of prehypertension, Stage I and Stage II hypertension, respectively, was 35.2%, 16.1% and 9.2%.Conclusion: A one-fourth of the adult population is hypertensive. Early diagnosis and treatment are advisable, besides awareness about dietary and lifestyle modification

ASSESSMENT OF RISK FACTORS OF HYPERTENSION AMONG ADULTS RESIDING IN URBAN SLUM OF DELHI.

 Objective: The objective of this study is to assess the risk factors of hypertension among adults residing in urban slums of West Delhi.Methods: A cross-sectional study was carried out among adult population of 18–59 years residing in urban slums of West Delhi. Blood pressure was measured twice using digital machine (OMRON). Height, waist circumference, and hip circumference were measured, weight was taken, and body mass index (BMI) was calculated. The Joint National Committee VII criteria were used to define hypertension, and the National Cholesterol Education Program and Adult Treatment Panel-III guidelines were used to define different categories of dyslipidemia. The World Health Organization (2014) criteria were used to classify the BMI.Results: The overall prevalence of hypertension among adults (n=423) was 25.3%. Among hypertensive adults, the prevalence of obesity was 22.7%, while among non-hypertensives, it was 10.9%. Similarly, overweight prevalence was higher (27.3%) in hypertensive adults compared to non-hypertensive adults (20.6%). The overall prevalence of hypercholesterolemia, hypertriglyceridemia, high-density lipoprotein-cholesterol <40/<50 mg/dl, and low-density lipoprotein-cholesterol (LDL-C) ≥130 was 19.7%, 33.7%, 75.7%, and 21.8%, respectively. The prevalence of hypercholesterolemia, hypertriglyceridemia, and serum LDL-C ≥130 mg/dl was 38%, 50%, and 32% among hypertensive adults, while among non-hypertensive adults, it was 15%, 29%, and 19%, respectively.Conclusion: Hypertensive adults had higher BMI, serum cholesterol, triglycerides, and LDL-C compared to non-hypertensives

PREVALENCE OF HYPERTENSION AMONG ELDERLY RESIDING IN SLUMS OF WEST

 Objective: The present study was carried out to assess the prevalence of hypertension among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 202 elderly residing in urban slums of West Delhi. Hypertension was classified as per JNC VII criteria. Blood pressure was measured twice using digital machine (OMRON) after an interval of 5 min. The data obtained were analyzed for percent prevalence, mean, standard deviation, and median.Results: The overall prevalence of hypertension was 49.1%; higher among male (56.0%) than female (41.9%). The prevalence of Stage I, Stage II, and isolated systolic hypertension was 30.7%, 18.8%, and 47%, respectively.Conclusion: Almost half of the elderly population in slums was hypertensive. Periodical health checkup and management through treatment and dietary and lifestyle modification is needed.Â

HOMOCYSTEINE STATUS OF ELDERLY SLUM WOMEN IN DELHI

Objective: The study was undertaken to assess homocysteine levels among economically deprived elderly women in Delhi.Methods: The study was carried out among elderly women aged 60–70 years residing in Kirti Nagar slums of West Delhi. Blood samples were collected, and serum homocysteine was analyzed using chemiluminescent immunometric assay. Hyperhomocysteinemia was defined as serum homocysteine >15 μmol/l. Dietary information was also collected using 24 h dietary recall method and food frequency questionnaire.Results: The prevalence of hyperhomocysteinemia was 16.9%. The mean serum homocysteine was 12.35±6.43 μmol/l. Serum homocysteine levels ranged from 3.84 to 35.20 μmol/l. It was observed that hyperhomocysteinemia was higher in vegetarians (31.2%) compared to non-vegetarians (6.7%).Conclusion: The prevalence of hyperhomocysteinemia is higher among vegetarians than non-vegetarians. Further, research is necessary to see the effect of elevated homocysteine in multiple age-related diseases

DYSLIPIDEMIA AMONG THE ELDERLY IN SLUMS OF WEST DELHI

  Objective: The objective of this study is to assess the prevalence of dyslipidemia among the elderly in slums of West Delhi.Methods: A cross-sectional study was carried out in slums of West Delhi covering a total of 234 elderly aged 60 and above. 5 ml blood was collected from 103 elderly and was analyzed for serum total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol by enzymatic method using fully automatic analyzer (Roche Hitachi-902). Dyslipidemia was defined using the National Cholesterol Education Program, ATP-III guidelines.Results: The overall prevalence of high cholesterol (≥200 mg/dl), high triglyceride (≥150 mg/dl), low HDL cholesterol (male - <40 mg/dl; female - <50 mg/dl), and high LDL cholesterol (≥130 mg/dl) was 20.39%, 45.63%, 64.08%, and 17.31%, respectively.Conclusion: Low HDL cholesterol and high triglyceride were the most form of dyslipidemia among the elderly. Awareness on dietary and lifestyle modification for management of dyslipidemia needs to be imparted

Comparison of haemoglobin estimates using direct & indirect cyanmethaemoglobin methods

Background & objectives: Estimation of haemoglobin is the most widely used method to assess anaemia. Although direct cyanmethaemoglobin method is the recommended method for estimation of haemoglobin, but it may not be feasible under field conditions. Hence, the present study was undertaken to compare indirect cyanmethaemoglobin method against the conventional direct method for haemoglobin estimation. Methods: Haemoglobin levels were estimated for 888 adolescent girls aged 11-18 yr residing in an urban slum in Delhi by both direct and indirect cyanmethaemoglobin methods, and the results were compared. Results: The mean haemoglobin levels for 888 whole blood samples estimated by direct and indirect cyanmethaemoglobin method were 116.1 ± 12.7 and 110.5 ± 12.5 g/l, respectively, with a mean difference of 5.67 g/l (95% confidence interval: 5.45 to 5.90, P<0.001); which is equivalent to 0.567 g%. The prevalence of anaemia was reported as 59.6 and 78.2 per cent by direct and indirect methods, respectively. Sensitivity and specificity of indirect cyanmethaemoglobin method were 99.2 and 56.4 per cent, respectively. Using regression analysis, prediction equation was developed for indirect haemoglobin values. Interpretation & conclusions: The present findings revealed that indirect cyanmethaemoglobin method overestimated the prevalence of anaemia as compared to the direct method. However, if a correction factor is applied, indirect method could be successfully used for estimating true haemoglobin level. More studies should be undertaken to establish agreement and correction factor between direct and indirect cyanmethaemoglobin methods

Poor zinc status in early infancy among both low and normal birth weight infants and their mothers in Delhi

Background: Low birth weight (LBW) infants are at high risk of zinc deficiency, but there is a paucity of data on their zinc status. Objective: To evaluate zinc status of LBW (BW &#60; 2,500 g) and normal birth weight (NBW; BW ≥2,500 g) infants at birth and in early infancy. Methods: A total of 339 infants (LBW, n = 220; NBW, n = 119) were enrolled, and venous blood samples of mother-infant dyad were taken within 48 h of birth. Infants’ levels were repeated between 2 and 10 months of age. Serum zinc levels were estimated using an inductively coupled plasma mass spectrometer. Primary outcome was zinc deficiency, defined as serum zinc &#60; 65 µg/dl. Results: Zinc results were available for 182 LBW and 103 NBW infants at birth and for 100 LBW and 66 NBW infants at follow-up with a median postnatal age of 14 and 15.5 weeks, respectively. Median zinc levels were low and comparable at birth as well as at follow-up, with zinc deficiency being present in 51.0% of LBW and 42.4% of NBW infants at birth and in 79.0% of LBW and 66.7% of NBW infants at follow-up. Zinc levels decreased significantly in both groups from birth to follow-up, irrespective of zinc multivitamin supplementation. Zinc levels of infants with BW &#60; 2,000 g at follow-up were significantly lower compared to infants with higher BW. Conclusion: Zinc status was poor in many infants at birth irrespective of BW. Zinc status worsened significantly during early infancy, with infants with BW &#60; 2,000 g having the lowest zinc levels

Structured Lifestyle Modification Interventions Involving Frontline Health Workers for Population-Level Blood Pressure Reduction: Results of a Cluster Randomized Controlled Trial in India (DISHA Study).

Background: Population-wide reduction in mean blood pressure is proposed as a key strategy for primary prevention of cardiovascular disease. We evaluated the effectiveness of a task-sharing strategy involving frontline health workers in the primary prevention of elevated blood pressure. Methods and Results: We conducted DISHA (Diet and lifestyle Interventions for Hypertension Risk reduction through Anganwadi Workers and Accredited Social Health Activists) study, a cluster randomized controlled trial involving 12 villages each from 4 states in India. Frontline health workers delivered a custom-made and structured lifestyle modification intervention in the selected villages. A baseline survey was conducted in 23 and 24 clusters in the control (n=6663) and intervention (n=7150) groups, respectively. The baseline characteristics were similar between control and intervention clusters. In total 5616 participants from 23 clusters in the control area and 5699 participants from 24 clusters in the intervention area participated in a repeat cross-sectional survey conducted immediately after the intervention phase of 18-months. The mean (SD) systolic blood pressure increased from 125.7 (18.1) mm Hg to 126.1 (16.8) mm Hg in the control clusters, and it increased from 124.4 (17.8) mm Hg to 126.7 (17.5) mm Hg in the intervention clusters. The population average adjusted mean difference in difference in systolic blood pressure was 1.75 mm Hg (95% CI, -0.21 to 3.70). Conclusions: Task-sharing interventions involving minimally trained nonphysician health workers are not effective in reducing population average blood pressure in India. Expanding the scope of task sharing and intensive training of health workers such as nurses, nutritionists, or health counselors in management of cardiovascular risk at the population level may be more effective in primary prevention of cardiovascular disease. Registration: URL: https://www.ctri.nic.in; Unique identifier: CTRI/2013/10/004049