Hyperinsulinemia: an early biomarker of metabolic dysfunction.

Introduction: Hyperinsulinemia in the absence of impaired glucose tolerance and normal HbA1c is considered indicative of pre-diabetes. Very few Indian studies have focused on hyperinsulinemia particularly in young adults. The present study aimed to determine whether hyperinsulinemia may be present despite HbA1c being normal. Methods: This was a cross-sectional study conducted on adolescents and young adults aged 16-25 years living in Mumbai, India. The participants attended various academic institutions and were those who underwent screening as the first step of a clinical trial for studying the efficacy of almond intake in prediabetes. Results: Among this young population (n=1313), 4.2% (n=55) of the participants were found to be prediabetic (ADA criteria) and 19.7% of them had HbA1c levels between 5.7%-6.4%. However, almost, 30.5% had hyperinsulinemia inspite of normal blood glucose levels and normal HbA1c. Among those with HbA1c<5.7 (n=533), 10.5% (n=56) participants had fasting insulin>15 mIU/L and a higher percentage (39.4%, n=260) had stimulated insulin above 80 mIU/L. These participants had higher mean anthropometric markers than those with normal fasting and/or stimulated insulin. Conclusion: Hyperinsulinaemia in the absence of impaired glucose tolerance and normal HbA1c may provide a much earlier indicator of detection for risk of metabolic disease and progression to metabolic syndrome and diabetes mellitus.

Socioeconomic, intrapersonal and food environmental correlates of unhealthy snack consumption in school-going adolescents in Mumbai.

BACKGROUND: Unhealthy snacking habits in adolescents are typically triggered by obesogenic food environments and possibly perpetuated through interactions between socio-environmental factors and personal perceptions, attitudes, and motivations to change eating behaviors. This study attempted to address the knowledge gap regarding the association of intrapersonal, socioeconomic, and food environmental characteristics with unhealthy snack consumption in Indian adolescents, presenting several targets for effective interventions. METHODS: A representative sample of 10-12 years old adolescents (n 712) completed a cross-sectional survey including eating habits, characteristics of school and home food environments, and perceptions related to affordability, convenience, and barriers within the food environments. The frequency of unhealthy snack consumption was assessed using a validated qualitative food frequency questionnaire. Multivariate regression analyses determined the associated factors of unhealthy snack consumption in adolescents attending private and public schools. RESULTS: The mean age of adolescents was 10.9 (1.1) years, 48.2% were girls and 53.9% attended private schools. The most frequently consumed unhealthy snacks were biscuits/ cookies (5.2d/wk) followed by wafers (3.4d/wk) and Indian fried snacks- samosa/ vada pav (2.8 d/wk). Among the public-school adolescents, the odds of unhealthy snack consumption were 0.89 times lower when meals were had frequently at the dinner table and 4.97 times higher when the perceived barriers related to the affordability of healthy snacks were greater. Maternal education (OR 0.78, 95% CI 0.66-0.82, p < 0.001), family income (OR 2.15, 95% CI 1.98-2.32, p < 0.001), availability of unhealthy snacks (OR 2.98, 95% CI 1.36-3.46, p < 0.001) and fruits (OR 0.57, 95% CI 0.49-0.69, p < 0.001) at home, having evening meals together (OR 0.71, 95% CI 0.63-0.81, p 0.031), and perceived parental control during mealtimes (OR 0.67, 95% CI 0.62-0.72, p < 0.001) were associated with unhealthy snack consumption in adolescents attending private schools. CONCLUSIONS: The results highlighted a pervasiveness of unhealthy snacks in adolescents' food environments. Improving provisions and affordability of fruits and healthy snacks at schools, encouraging family mealtimes, and limiting the availability of unhealthy snacks at home whilst addressing the perceived barriers within food environments, and inculcating self-efficacy skills can improve snacking habits in Indian adolescents, irrespective of socioeconomic backgrounds.

Executive Summary of Evidence and Consensus-Based Clinical Practice Guidelines for Management of Obesity and Overweight in Midlife Women: An AIIMS-DST Initiative.

Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. The key clinical questions specific to weight management in midlife women were finalized with the help of a multidisciplinary team of experts in the guideline development group. Phase I including a systematic and/or narrative review, grading of evidence, and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method, and GRADE approach. The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the health-care provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviors. Before initiating the management, a comprehensive assessment of clinical and lifestyle-related parameters should be completed. A personalized behavioral lifestyle modification program addressing the midlife-specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife-specific barriers for sustenance of healthy weight. These recommendations will be useful in opportunistic screening and management of obesity in midlife women across health-care settings.

A Stepwise Approach to Prescribe Dietary Advice for Weight Management in Postpartum and Midlife Women.

Weight retention and weight gain during the postpartum and midlife period subsequently increase the risk of chronic health conditions, thereby deteriorating the overall health. Dietary intervention is the pivotal component of sustainable weight management. However, in resource restricted settings, where dietitians may not be present, other healthcare professionals such as physicians, obstetricians, and paediatricians should play a vital role in providing timely weight management advice to these women. Therefore, this article provides dietary advice including the setting of realistic weight loss goals, identifying an individual's calorie needs, distribution of macronutrients and consideration of important micronutrients. Healthcare professionals can follow the stepwise approach to prescribe dietary advice to postpartum and midlife women for their weight management. Various dietary principles such as cultural and regional preferences of an individual, portion size, hypocaloric diets, nutrient-dense meals, eating habits, cultural beliefs and myths along with co-morbid conditions should be taken into consideration by healthcare professionals while providing the dietary prescription. Supplementary Information: The online version contains supplementary material available at 10.1007/s13224-022-01643-w.

Executive summary of evidence and consensus-based clinical practice guideline for management of obesity and overweight in postpartum women: An AIIMS-DST initiative.

INTRODUCTION: Postpartum obesity is a public health concern. There is a need to counsel women about their postpartum weight management, accounting for various barriers they face. Limited literature in the Indian context underscored the need to develop the clinical practice guideline to be used by healthcare providers in Indian healthcare settings. METHODS: The guideline was formulated by following the standardised methodology proposed by the National Health and Medical Research Council. Various steps such as identification of the patient population, assembly of the guideline development groups, identification of the key clinical questions, guideline development methods, grading the quality of evidence and recommendations and guideline translation were carried out to develop and validate the clinical practice recommendations. RESULTS: The evidence and consensus-based clinical practice guideline has been developed, providing recommendations for key topics of interest for first-line treatment of obesity (lifestyle-related management). Recommendations focus on screening and initiating discussion with overweight and obese postpartum women as well as those who had normal pre-pregnancy body mass index but have retained excessive weight in the postpartum period. Recommendations highlight the evaluation and management of dietary, physical activity and breastfeeding behaviour. Recommendations also account for behavioural modification techniques to improve adherence to the prescribed weight management advice. Duration and frequency of follow-ups as well as the advice to be disseminated have also been discussed in the recommendations. CONCLUSION: The guideline provides clinical practice points that can be used by healthcare providers, postpartum women and policymakers for opportunistic screening and management of postpartum obesity.

Executive summary of evidence and consensus-based Clinical Practice Guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative.

BACKGROUND AND AIMS: Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. METHODS: The key clinical questions specific to weight management in midlife women were finalised with the help of a multidisciplinary team of experts in the guideline development group (GDG). Phase I included a systematic and/or narrative review to gather evidence, grading of evidence and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method and GRADE approach. RESULTS: -The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the healthcare provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviours. Before initiating the management, a comprehensive assessment of clinical and lifestylerelated parameters should be completed. A personalised behavioural lifestyle modification program addressing the midlife specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife specific barriers for sustenance of healthy weight. CONCLUSION: These recommendations will be useful in opportunistic screening and management of obesity in midlife women across healthcare settings.

Impact of screen time during COVID-19 on eating habits, physical activity, sleep, and depression symptoms: A cross-sectional study in Indian adolescents.

OBJECTIVE: This study attempted to address the limited knowledge regarding the impact of screen time (ST) on lifestyle behaviors in Indian adolescents during the ongoing COVID-19 pandemic. The objectives were to 1) evaluate frequency and duration of using screens, and screen addiction behaviors in 10-15 years old adolescents in Mumbai during the COVID-19 pandemic and 2) examine the association of ST with lifestyle behaviors- eating habits, snacking patterns, physical activity (PA) levels, sleep quality and depression symptoms. METHODS: An online survey was completed between January and March 2021. Eating habits, snacking patterns, time spent in different screen-based activities, and screen addiction behaviors were reported. The PA levels, sleep quality, and depression symptoms were evaluated using the Physical Activity Questionnaire for Children/Adolescents (PAQ C/A), Pittsburg Sleep Quality Index (PSQI), and Patient Health Questionnaire-2 (PHQ-2) respectively. Multiple linear regression analyses were performed to determine the impact of ST on lifestyle behaviors. RESULTS: Adolescents (n = 1298, Mage 13.2(1.1), 53.3% boys) reported the mean weekday and weekend ST as 442.3 (201.5) minutes/d and 379.9 (178.2) minutes/d respectively. Overall, 33.4% spent > 6hours/d for studying or doing homework, 65.4% used social networking sites for at least 2-3 hours/d, and 70.7% agreed that ST had taken up the majority of their leisure time. Only 12% engaged in moderate to vigorous PA (PAQ C/A scores <2). More than half (52.5%) reported PSQI >5 indicating poor sleep quality and 8.6% scored ≥ 3 on PHQ-2 to suggest a risk of depression. A higher ST was associated with lower PA and increased sleep problems and a greater screen addiction was inversely associated with the eating habit, PA, and sleep-related variables. CONCLUSION: The study draws attention to a high prevalence of excess ST and its impact on eating habits, PA levels, and sleep quality in Indian adolescents during the COVID-19 pandemic. Targeted health promotion interventions that encourage judicious use of screens for education and entertainment and emphasize the adverse health effects of excess ST are required.

Independent and combined influences of physical activity, screen time, and sleep quality on adiposity indicators in Indian adolescents.

BACKGROUND: Inadequate physical activity (PA), excess screen time (ST), and sub-optimal sleep quality tend to co-occur during adolescence. Yet, little is known about the associations of these behaviors as a cluster with adiposity indicators in Indian adolescents. This study aimed to evaluate the independent and combined influences of PA, ST, and sleep quality on body mass index (BMI) and waist to height ratio (WHtR) in 10-15 years old adolescents in Mumbai, India. A secondary aim was to explore if these influences vary between sexes. METHODS: Cross-sectional study. Adolescents (n = 772, mean age 13.2 (1.4) years) reported frequency and duration of moderate to vigorous PA (MVPA) and time spent using screens on a previously validated instrument. Sleep quality was estimated using the Pittsburg Sleep Quality Index (PSQI). Weight, height, and waist circumference were measured. Mixed effect logistic regression analyses were performed to explore associations between adiposity indicators (BMI z scores > +1SD and WHtR > 0.5) and unhealthy behaviors (PA < 60 min/d, ST > 120 min/d and PSQI scores > 5), stratified by sex. RESULTS: The combined prevalence of overweight and obesity was 38.3%. Overall, 62.0 and 85.0% reported MVPA< 60 min/d and ST > 120 min/d respectively. Girls reported higher ST (218.21 (69.01) min/d) as compared to boys (165.3 (101.22) min/d, p < 0.001). Clustering of low PA and excess ST was observed in 69.2% and of all three unhealthy behaviors in 18.8%. Among girls, MVPA < 60 min/d (OR = 1.78, 95% CI 1.54-1.92, p < 0.001) and PSQI scores > 5 (OR = 2.01, 95% CI 1.78-2.25, p < 0.001) predicted increased BMI. The odds of overweight/obesity were 2.10 times higher in boys reporting low PA and 4.13 times higher in those with low PA+ ST > 120 min/d. Clustering of all three unhealthy behaviors increased prevalence of obesity in both sexes. CONCLUSIONS: The results indicated a co-existence of multiple unhealthy lifestyle factors of obesity and that clustering of these behaviors can further aggravate obesity risk as compared to their independent effects. Integrated interventions that leverage the cumulative benefits of being active, less sedentary and sufficient sleep are warranted to facilitate greater improvements in obesity risk behaviors.

Effect of COVID-19 Pandemic-Induced Dietary and Lifestyle Changes and Their Associations with Perceived Health Status and Self-Reported Body Weight Changes in India: A Cross-Sectional Survey.

Home confinement during the COVID-19 pandemic is accompanied by dramatic changes in lifestyle and dietary behaviors that can significantly influence health. We conducted an online cross-sectional survey to assess COVID-19 pandemic-induced dietary and lifestyle changes and their association with perceived health status and self-reported body weight changes among 1000 Indian adults in early 2021. Positive improvements in dietary habits, e.g., eating more nutritious (85% of participants) and home-cooked food (89%) and an increase in overall nutrition intake (79%), were observed. Sixty-five percent of participants self-reported increased oat consumption to support immunity. There were some negative changes, e.g., more binge eating (69%), eating more in between meals (67%), and increasing meal portion size (72%). Two-thirds of participants reported no change in lifestyles, whereas 21 and 23% reported an increase, and 13 and 10% reported a decrease in physical activity and sleep, respectively. Overall, 64 and 65% of participants reported an improvement in perceived health and an increase in body weight during the COVID-19 period compared to pre-COVID-19, respectively. The top motivations for improving dietary habits included improving physical and mental health and building immunity. In conclusion, the overall perceived health was improved and there was an increase in self-reported body weight in most participants during COVID-19. Diet emerged as the most crucial determinant for these changes.

Perspective: When the cure might become the malady: the layering of multiple interventions with mandatory micronutrient fortification of foods in India.

When public health programs with single nutrients are perceived to have a poor impact on the target health outcome, the policy response can be to supply more, by layering additional mandatory programs upon the extant programs. However, we argue for extreme caution, because nutrients (like medicines) are beneficial in the right dose, but potentially harmful when ingested in excess. Unnecessary motivations for the reactionary layering of multiple intervention programs emerge from incorrect measurements of the risk of nutrient inadequacy in the population, or incorrect biomarker cutoffs to evaluate the extent of nutrient deficiencies. The financial and social costs of additional layered programs are not trivial when traded off with other vital programs in a resource-poor economy, and when public health ethical dilemmas of autonomy, equity, and stigma are not addressed. An example of this conundrum in India is the perception of stagnancy in the response of the prevalence of anemia to the ongoing pharmacological iron supplementation program. The reaction has been a policy proposal to further increase iron intake through mandatory iron fortification of the rice provided in supplementary feeding programs like the Integrated Child Development Services and the School Mid-Day Meal. This is in addition to the ongoing pharmacological iron supplementation as well as other voluntary iron fortifications, such as those of salt and manufactured food products. However, before supplying more, it is vital to consider why the existing program is apparently not working, along with consideration of the potential for excess intake and related harms. This is relevant globally, particularly for countries contemplating multiple interventions to address micronutrient deficiencies. Supplying more by layering multiple nutrient interventions, instead of doing it right, without thoughtful considerations of social, biological, and ethics frameworks could be counterproductive. The cure, then, might well become the malady.

Effect of Almond Consumption on Metabolic Risk Factors-Glucose Metabolism, Hyperinsulinemia, Selected Markers of Inflammation: A Randomized Controlled Trial in Adolescents and Young Adults.

A large percentage of the Indian population has diabetes or is at risk of pre-diabetes. Almond consumption has shown benefits on cardiometabolic risk factors in adults. This study explored the effect of almond consumption on determinants of metabolic dysfunction-blood glucose, lipids, insulin and selected inflammatory markers in adolescents and young adults aged 16-25 years from Mumbai city. This randomized controlled trial was conducted for a period of 90 days on individuals with impaired levels of fasting glucose levels between 100-125 mg/dL (5.6-6.9 mmol/L) and 2-h post-glucose value 140-199 mg/dL (7.8-11.0 mmol/L) and/or fasting insulin (≥15 mIU/ml)/stimulated insulin (≥80 mIU/ml). Of 1,313 individuals screened, 421 met the inclusion criteria, of which 275 consented to participate and 219 completed the trial. The trial was registered with Clinical Trials Registry India (CTRI) CTRI/2018/02/011927. The almonds group (n = 107) consumed 56 g almonds daily, the control group (n = 112) was provided an iso-caloric cereal-pulse based snack. At baseline and endline, blood glucose, insulin, HbA1c, LDL-c, HDL-c, total and ox-cholesterol, triglycerides, hs-CRP, IL-6, TNF-α, adiponectin, leptin were measured and HOMA-IR and FG:FI ratios were calculated. Dietary intakes were assessed. The anthropometric measurements, biochemical markers as well as macronutrient intakes did not differ significantly between the two groups at baseline. Almond consumption significantly decreased HbA1c, total cholesterol and LDL-c. Stimulated insulin decreased post-intervention in both groups, but the decrease was greater in the almonds group. Fasting glucose was reduced post intervention in the controls with no change in the almonds group. FG:FI ratio decreased in the almonds group. TNF-α and IL-6 decreased in the almonds group, while it increased in the control group. Our results showed that almonds reduced HbA1c, LDL-c and total cholesterol levels in just 12 weeks of consumption in these adolescents and young adults who were at risk for developing diabetes. Almonds can be considered as part of food-based strategies for preventing pre-diabetes. Clinical Trial Registration: ClinicalTrials.gov, identifier: CTRI/2018/02/011927.

Development and validation of a questionnaire measuring knowledge, attitudes, and practices (KAP) to healthy eating and activity patterns in school children (HEAPS).

BACKGROUND: Development of culturally appropriate and psychometrically sound instruments that measure knowledge and health behaviors of children will help to inform appropriate interventions. AIM: To develop and test the validity and reliability of a questionnaire measuring knowledge, attitudes, and practices to healthy eating and activity patterns in school children in India. METHODS: Review of literature, focus-group discussions, and theoretical constructs of the Health Belief Model guided the development of an item pool. Face and content validity were assessed by children and a panel of experts and the item content validity, item difficulty, and discrimination indices were calculated. Construct validity was determined using the principal axis method of exploratory factor analysis among a cross-sectional sample of children (n=252). Internal consistency (Cronbach α values >0.7) and test-retest reliability (intraclass correlation coefficient values >0.75) were estimated. RESULTS: Item content validity index for clarity and relevance were satisfactory (>0.80) and internal consistency for knowledge (Kuder-Richardson 20 = 0.832), attitude (Cronbach's α = 0.912), and practice items (Cronbach's α = 0.769) were good. Four factors (children's eating habits, family dietary practices, and consumption of healthy and unhealthy foods) and two factors (moderate to vigorous activities and sedentary activities) explained 67.7% and 48.2% of the total variance in practice items. Intraclass correlation coefficient estimates ranged from good to excellent (0.72-0.99). CONCLUSIONS: The results of the validity and reliability of the 84-item knowledge, attitudes, and practices to healthy eating and activity patterns in schoolchildren questionnaire were promising. The detailed description of the methodology employed may prove useful to researchers conducting similar studies in children.

Impact of a behaviourally focused nutrition education intervention on attitudes and practices related to eating habits and activity levels in Indian adolescents.

OBJECTIVE: To evaluate the effectiveness of a behaviourally focused nutrition education (NE) intervention based on the Health Belief Model (HBM) to improve knowledge, attitudes and practices (KAP) related to eating habits and activity levels in 10­12-year-old adolescents in Mumbai, India. DESIGN: School-based cluster randomised controlled trial. The experimental group (EG) received weekly NE and three parent sessions over 12 weeks; no sessions were conducted for the control group (CG). The theoretical framework of HBM and focus group discussion results guided the development of behaviour change communication strategies and NE aids. KAP were measured using a validated survey instrument, administered at baseline and endline in EG and CG. Paired and independent t tests determined within-group and between-group changes in pre­post scores. SETTING: Two aided and two private schools that were randomly allocated to either an EG or CG. PARTICIPANTS: Adolescent boys and girls (n 498; EG n 292 and CG n 206). RESULTS: EG reported improvements in mean knowledge (39·3%), attitude (7·3 %), diet (9·6 %) and activity practice (9·4%) scores from pre to post intervention. No significant changes were observed in CG. Significant improvements in scores associated with perceived benefits, barriers and self-efficacy, breakfast and vegetable consumption, and moderate-to-vigorous activities were observed in EG. CONCLUSIONS: Integrating NE into the academic curriculum and adopting evidence-based lessons that entail targeted information delivery and participatory activities can improve knowledge, foster right attitudes and facilitate better eating and activity-related practices in Indian adolescents.

Eating habits and sleep patterns of adolescents with depression symptoms in Mumbai, India.

Adolescents with depression engage in unhealthy eating habits and irregular sleep patterns and are often at an increased risk for weight-related problems. Improvement in these lifestyle behaviours may help to prevent depression, but knowledge about the associations between depression, sleep, eating habits and body weight among adolescents in India is limited. This cross-sectional study investigated the prevalence of depression and its association with sleep patterns, eating habits and body weight status among a convenience sample of 527 adolescents, ages 10-17 years in Mumbai, India. Participants completed a survey on sleep patterns such as sleep duration, daytime sleepiness and sleep problems and eating habits such as frequency of breakfast consumption, eating family meals and eating out. Depression was assessed using the Patient Health Questionnaire modified for Adolescents (PHQ-A). Anthropometric measurements were also taken. Within this sample, 25% had moderate to severe depression (PHQ-A ≥ 10) and 46% reported sleeping less than 6 h > thrice a week. Adolescents with moderate to severe depression had significantly higher body mass index than those with minimal depression (26.2 ± 6.6 vs. 20.2 ± 4.8 kg/m2 ). The odds of having clinically significant depression (PHQ-A ≥ 10) was 4.5 times higher in adolescents who had family meals ≤ once a week, 1.6 times higher among those who were sleeping <6 h and 2.3 times higher among participants having trouble falling to sleep more than thrice a week. The findings indicated that a significant proportion of adolescents had depression symptoms; improving sleep and eating habits may present potential targets for interventions.

Almonds and Cardiovascular Health: A Review.

Several preventive strategies to reduce dyslipidemia have been suggested, of which dietary modification features as an important one. Dyslipidemia is a major risk factor for coronary heart disease and strategies to manage dyslipidemia have been shown to reduce the incidence of cardiovascular disease (CVD). Although there are proven pharmacological therapies to help manage this condition, nutritional interventions are a safer option to help prevent and manage dyslipidemia. Addition of almonds in the daily diet has been proposed to beneficially impact the lipid profile. This review critically examines the available evidence assessing the effect of almonds on dyslipidemia in the South Asian (particularly Indian) context. An extensive review comprised of epidemiological studies, clinical trials, meta-analyses, and systematic reviews was conducted from published literature from across the world. Studies examining the effect of almonds on different aspects of dyslipidemia viz. high low-density lipoprotein-cholesterol (LDL-C), low high-density lipoprotein-cholesterol (HDL-C), triglyceridaemia, and high total cholesterol levels have been included. In several studies, almonds have been shown to reduce LDL-C-which is a known risk factor for CHD-and the effect of almonds has been well documented in systematic reviews and meta-analysis of clinical trials. Addition of almonds in the diet has been shown to not only to reduce LDL-C levels, but also to maintain HDL-C levels. This review provides information about the use of this simple nutritional strategy which may help manage known major risk factors for heart disease, such as high LDL-C and low HDL-C levels especially in the context of South Asians.

The high burden of obesity and abdominal obesity in urban Indian schoolchildren: a multicentric study of 38,296 children.

AIMS: The objective of this study was to assess the prevalence of overweight, obesity and abdominal obesity and their associated factors in a large sample of urban Indian schoolchildren. METHODS: This is a cross-sectional study conducted in 5 cities in India. Height and weight were measured in 38,296 children and waist circumference was measured in 29,244 children aged 8-18 years. The prevalence was compared with respect to age, gender, type of school and city of residence. RESULTS: The mean ± standard deviation for age was 13.3 ± 2.4 years and 18.3 ± 4.3 kg/m(2) for BMI. The prevalence of overweight and obesity in 8- to 18-year-old children, respectively, was 14.4 and 2.8% by IOTF cutoffs, 14.5 and 4.8% by CDC cutoffs and 18.5 and 5.3% by WHO cutoffs. When applying the cutoffs specific for Indian ethnicity in 14- to 18-year-old children, the prevalence was higher (21.1 and 12.3%, respectively) as compared to the IOTF, WHO and CDC cutoffs. The overall prevalence of abdominal obesity in urban Indian schoolchildren was 4.5%. The prevalence of overweight and abdominal obesity was significantly higher in females than males (p < 0.001). High socioeconomic status and residing in cities with a population greater than 4 million were independently associated with overweight and abdominal obesity (p < 0.001). On extrapolating these data, more than 15 million children would currently be overweight and 4 million abdominally obese in urban India. CONCLUSIONS: There is a substantial burden of childhood obesity in India, which necessitates comprehensive urban-based campaigns for its prevention and control.

Consensus dietary guidelines for healthy living and prevention of obesity, the metabolic syndrome, diabetes, and related disorders in Asian Indians.

India is undergoing rapid nutritional transition, resulting in excess consumption of calories, saturated fats, trans fatty acids, simple sugars, salt and low intake of fiber. Such dietary transition and a sedentary lifestyle have led to an increase in obesity and diet-related non-communicable diseases (type 2 diabetes mellitus [T2DM], cardiovascular disease [CVD], etc.) predominantly in urban, but also in rural areas. In comparison with the previous guidelines, these consensus dietary guidelines include reduction in the intake of carbohydrates, preferential intake of complex carbohydrates and low glycemic index foods, higher intake of fiber, lower intake of saturated fats, optimal ratio of essential fatty acids, reduction in trans fatty acids, slightly higher protein intake, lower intake of salt, and restricted intake of sugar. While these guidelines are applicable to Asian Indians in any geographical setting, they are particularly applicable to those residing in urban and in semi-urban areas. Proper application of these guidelines will help curb the rising "epidemics" of obesity, the metabolic syndrome, hypertension, T2DM, and CVD in Asian Indians.