Perception of Curability Among Advanced Cancer Patients: An International Collaborative Study.

BACKGROUND: There are limited data on illness understanding and perception of cure among advanced cancer patients around the world. The aim of the study was to determine the frequency and factors associated with inaccurate perception of curability among advanced cancer patients receiving palliative care across the globe. MATERIALS AND METHODS: Secondary analysis of a study to understand the core concepts in end-of-life care among advanced cancer patients receiving palliative care from 11 countries across the world. Advanced cancer patients were surveyed using a Patient Illness Understanding survey and Control Preference Scale. Descriptive statistics and multicovariate logistic regression analysis were performed. RESULTS: Fifty-five percent (763/1,390) of patients receiving palliative care inaccurately reported that their cancer is curable. The median age was 58, 55% were female, 59% were married or had a partner, 48% were Catholic, and 35% were college educated. Sixty-eight percent perceived that the goal of therapy was "to get rid of their cancer," and 47% perceived themselves as "seriously ill." Multicovariate logistic regression analysis shows that accurate perception of curability was associated with female gender (odds ratio [OR] 0.73, p = .027), higher education (OR 0.37, p < .0001), unemployment status (OR 0.69, p = .02), and being from France (OR 0.26, p < .0001) and South Africa (OR 0.52, p = .034); inaccurate perception of curability was associated with better Karnofsky performance status (OR 1.02 per point, p = .0005), and being from Philippines (OR 15.49, p < .0001), Jordan (OR 8.43, p < .0001), Brazil (OR 2.17, p = .0037), and India (OR 2.47, p = .039). CONCLUSION: Inaccurate perception of curability in advanced cancer patients is 55% and significantly differs by gender, education, performance status, employment status, and country of origin. Further studies are needed to develop strategies to reduce this misperception of curability in advanced cancer patients. IMPLICATIONS FOR PRACTICE: The findings of this study indicate that inaccurate perception of curability among advanced cancer patients is 55%. Inaccurate perception of curability significantly differs by gender, education, performance status, employment status, and country of origin. There is great need to facilitate improved patient-physician communication so as to improve health care outcomes and patient satisfaction.

Differential Risk of Hypertension Among Lean and Nonlean Rural Subjects in Relation to Decadal Changes in Anthropometry.

OBJECTIVE: Assessing risk of hypertension in relation to decadal changes in anthropometry among cohort of young rural Indian men. METHODS: Subjects (n = 140) were measured in 2005 and 2015 for blood pressure, body mass index (BMI), body fat (BF), waist circumference (WC), waist-to-hip ratio (WHR), and additionally for visceral fat (VF) at follow-up. RESULTS: Decadal changes showed significant (p < 0.001) increase in mean anthropometric measures and in prevalence of overall obesity (BMI ≥25 kg/m2) from 3.6% to 37.1%; adiposity (BF ≥25%) from 5.1% to 40.9%; and central obesity (WHR ≥0.9) from 0.7% to 24.3%. Prevalence of hypertension increased (20.7% to 27.1%) but was not statistically significant. VF correlated significantly (p < 0.001) with decadal changes (Δ) in BMI, BF, WC, and WHR, and the correlations were stronger (r = 0.90, 0.78, 0.84, and 0.56, respectively) for lean (baseline BMI < median) subjects than nonlean (baseline BMI ≥median) subjects (r = 0.68, 0.40, 0.61, and 0.43, respectively). Risk of hypertension was significant (odds ratio [OR] = 11.0, 95% confidence interval [CI]: 2.8-42.8) for subjects with higher ΔBMI (≥4.7 kg/m2) compared with those with lower ΔBMI (<4.7 kg/m2) among lean but was not significant among nonlean subjects. This was also true for change in other adiposity indicators, indicating greater vulnerability of lean subjects. Further, among lean subjects, ORs reduced considerably after adjusting for VF, whereas among nonlean subjects ORs continued to remain nonsignificant but showing independent significance for VF. CONCLUSIONS: For similar level of change in adiposity indicators, lean subjects were at greater risk of hypertension than nonlean subjects, probably due to higher VF deposition.

Decisional control preferences among patients with advanced cancer: An international multicenter cross-sectional survey.

BACKGROUND: Understanding patients' decision control preferences is important in providing quality cancer care. Patients' decisional control preference can be either active (patients prefer to make decisions themselves), shared (collaborative between patient, their physician, and/or family), or passive (patients prefer that the decisions are made by either the physician and/or their family). AIM: To determine the frequency and predictors of passive decision control preferences among advanced cancer patients. We also determined the concordance between actual decision-making and decision control preferences and its association with patient satisfaction. DESIGN: In this cross-sectional survey of advanced cancer patients referred to palliative care across 11 countries, we evaluated sociodemographic variables, Control Preference Scale, and satisfaction with the decisions and care. RESULTS: A total of 1490 participants were evaluable. Shared, active, and passive decision control preferences were 33%, 44%, and 23%, respectively. Passive decision control preferences (odds ratio, p value) was more frequent in India (4.34, <0.001), Jordan (3.41, <0.001), and France (3.27, <0.001). Concordance between the actual decision-making and decision control preferences was highest in the United States ( k = 0.74) and lowest in Brazil (0.34). Passive decision control preference was significantly associated with (odds ratio per point, p value) better performance status (0.99/point, 0.017), higher education (0.64, 0.001), and country of origin (Brazil (0.26, <0.0001), Singapore (0.25, 0.0003), South Africa (0.32, 0.0002), and Jordan (2.33, 0.0037)). CONCLUSION: Passive decision control preferences were less common (23%) than shared and active decision control preference even among developing countries. Significant predictors of passive decision control preferences were performance status, education, and country of origin.

Dietary diversification for prevention of anaemia among women of childbearing age from rural India.

OBJECTIVE: To assess the impact of an intervention modifying dietary habits for the prevention of anaemia in rural India. DESIGN: Intervention study with data on anthropometric (weight, height) measurements, Hb and diet pattern. As per the cut-off for Hb in the government programme, women with Hb <11 g/dl had to be given Fe tablets and formed the supplemented group while those with Hb > 11 g/dl formed the non-supplemented group. Settings Three villages near Pune city, Maharashtra, India. SUBJECTS: Rural non-pregnant women (n 317) of childbearing age (15-35 years). RESULTS: After 1 year of intervention, mean Hb increased (from 10.94 (sd 1.22) g/dl to 11.59 (sd 1.11) g/dl) significantly (P < 0.01) with a consequent reduction in the prevalence of anaemia (from 82.0% to 55.4%) as well as Fe-deficiency anaemia (from 30.3% to 10.8%). Gain in Hb was inversely associated with the initial level of Hb. Significant gain in Hb (0.57 g/dl) was observed among women attending >50% of the meetings or repeating >50% of the recipes at home (0.45 g/dl) in the non-supplemented group and was smaller than that observed in the supplemented group. Consumption of green leafy vegetables more than twice weekly increased substantially from 44.7% to 60.6%, as did consumption of seasonal fruits. Logistic regression showed that women with lower participation in the intervention had three times higher risk (OR = 3.08; 95% CI 1.04, 9.13; P = 0.04) for no gain in Hb compared with those having high participation. CONCLUSIONS: Developing action programmes for improving nutritional awareness to enhance the consumption of Fe-rich foods has great potential for preventing anaemia in rural India.

Synthesis and pharmacological evaluation of novel N-aryl-3,4-dihydro-1'H-spiro[chromene-2,4'-piperidine]-1'-carboxamides as TRPM8 antagonists.

A novel series of N-aryl-3,4-dihydro-1'H-spiro[chromene-2,4'-piperidine]-1'-carboxamides was identified as transient receptor potential melastatin 8 (TRPM8) channel blockers through analogue-based rational design, synthesis and screening. Details of the synthesis, effect of aryl groups and their substituents on in-vitro potency were studied. The effects of selected functional groups on the 4-position of the chromene ring were also studied, which showed interesting results. The 4-hydroxy derivatives showed excellent potency and selectivity. Optical resolution and screening of alcohols revealed that (R)-(-)-isomers were in general more potent than the corresponding (S)-(+)-isomers. The isomer (R)-(-)-10e (IC50: 8.9nM) showed a good pharmacokinetic profile upon oral dosing at 10mg/kg in Sprague-Dawley (SD) rats. The compound (R)-(-)-10e also showed excellent efficacy in relevant rodent models of neuropathic pain.

A question module for assessing community stigma towards HIV in rural India.

This paper describes a simple question module to assess community stigma in rural India. Fear of stigma is known to prevent people from seeking HIV testing and to contribute to further disease transmission, yet relatively little attention has been paid to community stigma and ways of measuring it. The module, based on a vignette of a fictional HIV-positive woman, was administered to 494 married women and 186 unmarried male and female adolescents in a village in rural Maharashtra, India. To consider the usefulness of the question module, a series of hypotheses were developed based on the correlations found in other studies between HIV-related stigma and socio-demographic characteristics (age, education, discussion of HIV with others, knowing someone living with HIV, knowledge about its transmission and whether respondents acknowledged stigmatizing attitudes as their own or attributed them to others). Many of the study's hypotheses were confirmed. Among married women, correlates of stigma included older age, lack of discussion of HIV and lack of knowledge about transmission; among adolescents, lower education and lack of discussion of HIV were the most significant correlates. The paper concludes that the question module is a useful tool for investigating the impact of interventions to reduce stigma and augment social support for people living with HIV in rural India.

Population-based intervention for cardiovascular diseases related knowledge and behaviours in Asian Indian women.

BACKGROUND & OBJECTIVES: There is poor knowledge and behaviors regarding chronic diseases related nutritional and lifestyle factors among women in low income countries. To evaluate efficacy of a multilevel population-based intervention in improving knowledge and practices for related factors we performed a study in India. METHODS: Population based study among women 35-70 years was performed in four urban and five rural locations. Stratified sampling was performed and we enrolled 4624 (rural 2616, urban 2008) of eligible 8000 women (58%). Demographic details, medical history, diet, physical activity and anthropometry were recorded and blood hemoglobin, glucose and total cholesterol determined. Knowledge and behaviors regarding diet in chronic diseases were inquired in a randomly selected 100 women at each site (n = 900). A systematic multilevel population based intervention (using posters, handouts, street plays, public lectures, group lectures and focused group discussions) was administered over 6 months at each site. The questionnaire was re-administered at the end in random 100 women (n = 900) and differences determined. Descriptive statistics are reported. Comparison of parameters before and after intervention was assessed using Mann Whitney test. RESULTS: Prevalence (%) of chronic disease related lifestyles and risk factors in rural/urban women, respectively, was illiteracy in 63.6/29.4, smoking/tobacco use 39.3/18.9, high fat intake 93.6/93.4, high salt intake 18.2/12.6, low physical activity 59.5/70.2, overweight/obesity 22.5/45.6, truncal obesity 13.0/44.3, hypertension 31.6/48.2, hypercholesterolemia 13.5/27.7, and diabetes in 4.3/15.1 percent. Composite chronic diseases knowledge at baseline vs after intervention increased significantly in overall (32.0 vs 62.0), rural (29.0 vs 63.5) and urban (39.5 vs 60.5) groups (p < 0.001). Significant increase in knowledge regarding diet in hypertension, diabetes, heart disease and anemia as well as importance of dietary proteins, fats, fibres and fruits was observed (p < 0.001). There was insignificant change in most of the practices regarding intake of low fat, high protein, high fibre diet except sieving the flour which declined significantly (80.1 vs 53.6, p < 0.001). CONCLUSIONS: A short-term multilevel population-wide intervention among women in rural and urban locations in India increased chronic disease knowledge but failed to influence practices.

HIV-related stigma in rural and tribal communities of Maharashtra, India.

Stigma is a recognized barrier to early detection of HIV and causes great suffering for those affected. This paper examines HIV-related stigma in rural and tribal communities of Maharashtra, an area of relatively high HIV prevalence in India. The study used a mix of qualitative and quantitative methods to compare adult women and adolescents in a rural area, women in a rural area, and women in a tribal area. The respondents included 494 married women and 186 adolescents in a rural community and 49 married women in six tribal villages. HIV-related stigma was prevalent in all communities and was the highest among tribal and older respondents. High-risk behaviour was reported in both areas, accompanied with denial of personal risk. Our findings suggest that HIV may be spreading silently in these communities. To our knowledge, this is the first community-based study to make an in-depth assessment of HIV-related stigma in rural and tribal areas of India. By situating our findings within the broader discourse on stigma in the national and state-level data, this study helps explain the nature and persistence of stigma and how to address it more effectively among subcultural groups in India.

Secular trends in growth of preschool children from rural Maharashtra, India.

The study examined the secular trends in growth of preschool children from rural Maharashtra, India, during 1985-2001. Anthropometric data collected on preschool (< 6 years old) children during 2001 (n = 1,171) and 1985 (n = 979) from the same villages were compared. Decadal change increased with age and was marginally higher in boys than girls. It was the lowest among infants (-0.1 to 0.1 kg and 0.4 to 0.7 cm in both sexes) and the highest among boys of 4+ years (1.3 kg and 2.9 cm) and girls of 5+ years (1.2 kg and 2.1 cm). Increase in weight was higher (10-15%) compared to that in height (3-5%) and, consequently, reduction in the prevalence of wasting was marked (around 68% in boys and 48% in girls) than that in stunting (42% in boys and 27% in girls) among these children. The improvement was higher in boys than in girls. Negligible secular changes in younger children indicate the need for creating health and nutritional awareness among rural mothers while relatively higher improvement in weight than height among older children warns the future possibility of childhood adiposity even among rural populations.

Socio-economic and socio-demographic determinants of diet diversity among rural pregnant women from Pune, India.

BACKGROUND: Diet diversity signifies the nutrient adequacy of an individual and thus has gained widespread significance in recent times. In developing countries achieving maximum diet diversity, especially among pregnant women from rural areas is challenging although of great importance. However, to do so understanding the primary factors associated with diet diversity is important. This paper, therefore, assessed the socio-demographic and socio-economic determinants of diet diversity among rural pregnant women in India. METHODS: The study consisted of a community-based prospective cohort of n = 204 pregnant women attending primary healthcare centers (PHC) across 14 villages in Mulshi Taluka, Pune, Maharashtra, India. The data was collected using a structured questionnaire through a one-to-one interview method. RESULTS: The prevalence of low, medium and high diet diversity was 56.4%, 33.3%, and 10.3% respectively. Minimum diversity in the diet was achieved among 73.5% of pregnant women. The mean diet diversity score (DDS) was 3.6 ± 1.3 with starchy staples being (100%) of commonly consumed foods. Young (< 20 years) women (OR = 5.2; CI:1.9- 13.8), housewives (OR = 3; CI:1.4-6.7), husbands working as skilled laborers (OR = 2.5; CI:1.2-5.5) were at significant risk of having low diet diversity scores. Whereas, those living in a joint family (OR = 0.3; CI:0.1-0.6), not owning a house (OR = 0.5; CI:0.2-0.9), and having a poor income (OR = 1.9; CI: 0.9- 3.7) were less likely to have low diet diversity. CONCLUSION: Socio-economic and demographic factors (maternal age, mother's occupation, and husband's occupation) influenced the diet diversity among pregnant women. Monotonous diets are commonly seen in developing countries, especially in rural areas which can be a risk factor for poor nutrient adequacy and health of pregnant women. Policies and programs about these determinants of diet diversity should be enacted to replace the poor quality diets to ensure improved diet diversity and nutrient adequacy.

Prevalence of high blood pressure among young rural adults in relation to height in childhood and adult body mass index.

OBJECTIVE: Evidence, mostly based on developed countries, indicates that disease risks may be associated with changes in growth processes rather than a one-point phenomenon. In view of the increasing prevalence of hypertension in India, there is a need to understand how patterns of growth during early childhood and adolescence influence blood pressure in adulthood, particularly among rural populations in India. METHODS: The risk of hypertension was examined in 378 rural men older than 20 years who were measured for anthropometry during early childhood, adolescence, and as young adults in a community-based cohort study. RESULTS: At the young age of 24 years, 33.9% of men had either high systolic blood pressure (≥130 mmHg) or high diastolic blood pressure (≥85 mmHg), even in absence of obesity. The growth of the subjects during childhood, in whom blood pressure developed later in young adulthood, was characterized by higher body mass index (BMI) throughout early childhood and adolescence as compared with those who had normal blood pressure. The prevalence of high blood pressure, especially diastolic, at this adult age was strongly associated with stunting at 3+ years of age (<-2 SD height of the World Health Organization standard), and risk increased (odds ratio, 12.21; 95% confidence interval, 2.93-50.90; p < 0.001) among those having high BMI (≥23 kg/m(2)) at adult age as compared with those who were not stunted in early life with a low BMI at adult age. CONCLUSIONS: The primary prevention of the epidemic of high blood pressure in India may require measures to prevent children from being stunted in early childhood and also prevent them from being overweight at young adulthood.

Social dimensions related to anaemia among women of childbearing age from rural India.

OBJECTIVE: To examine various sociodemographic aspects related to consumption of micronutrient-rich foods like green leafy vegetables (GLV), which will be helpful in modifying dietary habits, a strategy that merits consideration for prevention of anaemia. DESIGN: Cross-sectional study for collecting data on socio-economic and anthropometric (weight, height) variables, Hb, dietary pattern (FFQ) and peripheral smear examination for classifying nutritional and iron-deficiency anaemia (IDA). SETTING: Three villages near Pune city, Maharashtra, India. SUBJECTS: Rural women (n 418) of childbearing age (15-35 years). RESULTS: Mean Hb was 11·07 g/dl. Seventy-seven per cent of the women were anaemic (Hb < 12 g/dl) and 28 % had IDA, indicating that a large proportion of the women had nutritional anaemia. Higher prevalence of IDA was associated with several sociodemographic and maternal parameters, but multiple logistic regression analysis showed significant (P < 0·05) risk of IDA with lower body weight (<40 kg), short maternal height (<145 cm), younger age at marriage (<19 years) and higher parity (≥ 2). Various socio-cultural reasons associated with low consumption of GLV included non-cultivation of GLV, priority for selling them rather than home consumption, dislike of GLV by husband and children, and lack of awareness about different recipes for GLV. CONCLUSIONS: Our findings highlight that low consumption of GLV, which are treasures of micronutrients including Fe, is associated with genuine social reasons. This indicates a need for developing action programmes to improve nutritional knowledge and awareness leading to enhanced consumption of Fe-rich foods for preventing anaemia in rural India.

Compromised maternal nutritional status in early pregnancy and its relation to the birth size in young rural Indian mothers.

BACKGROUND: Low birth weight is highly prevalent in rural India. As a chronic undernutrition problem, poor birth outcomes are closely related to various nutritional factors more prominently the poor maternal anthropometry at conception. The purpose of the study was to identify how compromised maternal nutritional status in early pregnancy affects the birth size of rural Indian mothers. METHODS: It was a prospective observational study on singleton pregnant women (n = 204) from 14 villages in Mulshi Taluka of Pune District, Maharashtra, India. Maternal weight (Wt), height (Ht), body fat percent (BF%), head circumference (HC), and sitting height (SHT) were measured at early pregnancy (< 13 weeks of gestation) and infants' weight and length were measured within 24 h of birth. Groups means were tested using a 't' test while the trend in means was tested using ANOVA. RESULTS: Mothers were young (21.46 ± 2.09 yrs), thin (46.46 ± 6.1 kg), short (153.39 ± 5.79 cm), and poorly nourished (19.74 ± 2.41 kg/m2). Mean birth weight was low (2655 ± 507 g) and prevalence of LBW and stunting at birth was highest among mothers in the lower tertile of each of the anthropometric indicators. In particular, stunting was significantly higher for mothers in lower tertile compared to higher tertile of Wt (44.6 Vs 64.6%) and was also true for HC (43.7 Vs 60.6%). Risk for LBW and stunting at birth was almost similar and was significant (p < 0.01) for mothers in the lower tertile of Wt, Ht, BMI, SHT, HC, and BF% as compared to those in the higher tertile of these measurements. CONCLUSION: All the anthropometric indicators of current undernutrition at first trimester as well as that in utero reflected by smaller HC, impose risk for LBW and stunting at birth especially among young rural mothers.

Parental history lowers body mass index risk cutoff for hypertension among urban Indian adults.

OBJECTIVE: Parental history of hypertension, a commonly occurring nonmodifiable genetic risk factor, was examined for its influence on cutoff for body mass index (BMI) for identifying risk of hypertension. DESIGN: Data on BMI, body fat (%), blood pressure (BP), parental history of hypertension, and lifestyle factors were collected through a cross-sectional study. SETTING: Pune City, Maharashtra, India. SUBJECTS: Urban Indian adults (330 men and 306 women, aged 30-60 years). RESULTS: Age-related increases in prevalence of obesity and of hypertension (BP ≥ 140/90 mmHg or antihypertensive medication) were significant (p < 0.01 for all) in both sexes. Among nonobese subjects, age-adjusted systolic (SBP) and diastolic (DBP) blood pressure levels were significantly (p < 0.01) higher for those with positive parental history than for those without parental history, in both sexes. Adjusted odds ratios showed that obesity or positive parental history when considered in isolation increased the risk of hypertension (by 3 times in men and 5 times in women), while the presence of both increased it further (by 4 times in men and 10 times in women), indicating their synergistic influence. Further, the BMI cutoff obtained from receiver operating characteristic (ROC) analysis was lower by 1 to 1.5 units for subjects with parental history than for those without parental history, across different levels of sensitivity. CONCLUSIONS: Positive parental history lowers the BMI risk cutoff for hypertension. The implication is that parental history could be an important aid in developing preventive strategy for timely and early screening of individuals at risk of hypertension in many Asian populations in similar settings.

Osteoporosis in men.

Osteoporosis is an important and often overlooked problem in men. Although the lifetime risk of hip fracture is lower in men than in women, men are twice as likely to die after a hip fracture. Bone mineral density measurement with a T-score of -2.5 or less indicates osteoporosis. The American College of Physicians recommends beginning periodic osteoporosis risk assessment in men before 65 years of age and performing dual-energy x-ray absorptiometry for men at increased risk of osteoporosis who are candidates for drug therapy. All men diagnosed with osteoporosis should be evaluated for secondary causes of bone loss. The decision regarding treatment of osteoporosis should be based on clinical evaluation, diagnostic workup, fracture risk assessments, and bone mineral density measurements. Pharmacotherapy is recommended for men with osteoporosis and for high-risk men with low bone mass (osteopenia) with a T-score of -1 to -2.5. Bisphosphonates are the first-line agents for treating osteoporosis in men. Teriparatide (i.e., recombinant human parathyroid hormone) is an option for men with severe osteoporosis. Testosterone therapy is beneficial for men with osteoporosis and hypogonadism. Adequate intake of calcium and vitamin D should be encouraged in all men to maintain bone mass. Men should be educated regarding lifestyle measures, which include weight-bearing exercise, limiting alcohol consumption, and smoking cessation. Fall prevention strategies should be implemented in older men at risk of falls.

Early life undernutrition and adolescent pregnancy outcome in rural India.

BACKGROUND: In poor communities of the Third World, adolescent pregnancy outcomes are likely to be worse in view of the prevailing chronic undernutrition. AIM: The study examined the confounding effect of early life undernutrition on adolescent pregnancy outcome in rural India. SUBJECTS AND METHODS: Retrospective information on socio-economic, demographic and anthropometric variables, gynaecological and obstetric history, pregnancy outcome and birth weight was obtained on 326 primigravid young married rural girls during 1998-2001. RESULTS: Prevalence of pregnancy wastage (stillbirths and abortions) reduced significantly (p < 0.01) with increase in age at first conception. The risk for pregnancy wastage observed (OR = 1.95, 95% CI = 0.91-4.21) in mothers with early conception (<17.25 years) increased significantly to 4.24 (95% CI = 1.4-12.86) in case of girls with delayed menarcheal age (>or=14.5 years) or to 14.2 (95% CI = 1.17-173.2) if they had higher post-menarcheal stature growth (>or=4 cm). Similarly, risk for preterm delivery (OR = 2.18, 95% CI = 0.88-5.42) observed among mothers with early conception increased to 36.6 (95% CI = 3.57-374.0) if they had significant post-menarche gain in height. Our findings thus indicate that pregnancy outcome was adversely affected by early conception and prolonged adolescent growth, which are the features of biological immaturity in undernourished populations. CONCLUSION: Our findings indicate that in view of prevailing socio-cultural conditions, good nutrition in early life for girls is essential to prevent post-menarcheal height growth while health education programmes are essential to prevent early conception in rural India. These observations have wider implications for similar rural settings especially in other developing countries.

Adverse Maternal Nutritional Status Affects Birth Weight among Rural Mothers of Maharashtra.

Maternal anthropometry and its influence on the birth weight has been studied widely, but effects of maternal undernutrition in-utero depicted by surrogate measures of sitting height and head circumference are largely unknown. We have studied the maternal sitting height along with other conventional nutritional status indicators at registration in predicting the risk of low birth weight (LBW) among 204 young rural women. Information on socio-demographic and economic profile, anthropometric measurements at registration and neonatal birth weight after delivery was recorded. Mothers were thin (mean weight; 46.4±6.1 kg), had short stature (mean height: 153.3±5.7 cm) and 33.8% were undernourished (body mass index (BMI) <18.5 kg/m2). Prevalence of LBW was 27.5%. Maternal weight, height, BMI, head circumference, sitting height and %body fat at registration were significantly (p<0.05) associated with birth weight. Significant risks for LBW were observed for low (<42.26 kg) weight (OR=3.69; CI: 1.6-8.1), short (<150 cm) height (OR=2.3; CI: 1-5.1), low (<18.5 kg/m2) BMI (OR=3.27; CI: 1.4-7.3), low (<70 cm) sitting height (OR=2.3; CI: 1.0-5.1), small (<52 cm) head circumference (OR=3.3; CI: 1.6-7.1), and low (<22.7%) %body fat (OR=4.98; CI: 2.2-11.2). Interestingly, these risks remained significant for sitting height (OR=3.4; CI: 1.5-7.6, OR=2.5; CI: 1.1-5.8) and head circumference (OR=2.4; CI: 1.1-5.6, OR=2.2; CI: 0.9-5.03) even after adjusting for BMI and %body fat respectively indicating their independent influence. Our findings highlight that in addition to the current maternal undernourishment, maternal undernourishment in-utero (small head circumference and short sitting height) imposes risk for LBW.

Social class-related gradient in the association of skeletal growth with blood pressure among adolescent boys in India.

OBJECTIVE: In view of the fact that height differences between socio-economic groups are apparent early in childhood, it is of interest to examine whether skeletal growth is reflective of the social class gradient in CVD risk. The present study examined blood pressure levels, adiposity and growth of adolescent boys from high and low social classes. DESIGN: In a cross-sectional study, skeletal growth (height and sitting height), adiposity (weight, BMI and body fat) and blood pressure levels of the adolescents were measured. SETTING: Pune, India. SUBJECTS: Adolescent schoolboys (9-16 years) from high socio-economic (HSE; n 1146) and low socio-economic (LSE; n 932) class. RESULTS: LSE boys were thin, short and undernourished (mean BMI: 15.5 kg/m2 v. 19.3 kg/m2 in HSE boys, P = 0.00). Social gradient was revealed in differing health risks. The prevalence of high systolic blood pressure (HSBP) was high in HSE class (10.5 % v. 2.7 % in LSE class, P = 0.00) and was associated with adiposity, while the prevalence of high diastolic blood pressure (HDBP) was high in LSE class (9.8 % v. 7.0 % in HSE class, P = 0.00) and had only a weak association with adiposity. Despite this, lower ratio of leg length to height was associated with significantly higher respective health risks, i.e. for HDBP in LSE class (OR = 1.99, 95 % CI 1.14, 3.47) and for HSBP in HSE class (OR = 1.69, 95 % CI 1.02, 2.77). CONCLUSIONS: As stunting in childhood is a major problem in India and Asia, the leg length to height indicator needs to be validated in different populations to understand CVD risks.

Somatic disproportion predicts risk of high blood pressure among adolescent girls in India.

OBJECTIVES: To examine the importance of somatic disproportion rather than absolute values of leg height and trunk height for predicting risk of high blood pressure among adolescents. METHODS: Adolescent girls (9-16 years old) from high (HSE) and low socio-economic (LSE) classes were examined (n = 1036 and n = 1040, respectively) in a cross-sectional study, for skeletal growth (height and sitting height), adiposity [weight, body mass index (BMI) and body fat] and blood pressure levels. RESULTS: Girls from LSE class were thin, short and undernourished compared to those from HSE class (average age-adjusted BMI, 16.47 +/- 2.61 versus 19.77 +/- 3.85, P < 0.000). A high prevalence of high systolic blood pressure (HSBP) was a problem in girls of the HSE (9.7 versus 4.4%, P < 0.001) class, while a high prevalence of high diastolic blood pressure (HDBP) was seen in girls of the LSE (15.3 versus 2.7%, P < 0.001) class. Further, in the HSE class, the prevalence of HSBP was higher only among girls in the third tertile of BMI and body fat, while in the case of the LSE class the prevalence of HDBP was higher (7-11%) even in the lowest tertile of these measures. The odds ratio (OR) for HDBP (2.28) in the LSE class and that for HSBP (2.27) in the HSE class were significantly higher for girls in the lower tertile of leg height to height ratio. This was also true in the case of leg height to sitting height ratio. CONCLUSIONS: Our findings showed that rather than absolute leg or trunk length, somatic disproportion may be a relevant biomarker associated with cardiovascular disease (CVD) risk, especially in an adolescent population.

Sensitivity of fetus and pups to excess levels of maternal intakes of alpha linolenic acid at marginal protein levels in Wistar rats.

There is growing interest in the role omega 3 fatty acids (n3), in promoting fetal growth. Present study examined whether alpha linolenic acid, primary vegetarian dietary omega 3 fatty acid source and precursor to cellular membrane phospholipid eicosapentaenoic acid and docosahexaenoic acid, can improve birth outcome. Pregnant dams from three groups (seven in each) were fed: control diet (18% protein with 7% soybean oil, normal alpha linolenic acid), or two treatment diets at marginal protein level of 12%; one with 7% soybean oil (Treatment I, normal alpha linolenic acid), and other with 3% flax oil and 4% soybean oil (Treatment II, four times normal alpha linolenic acid) during gestation. There was a reduction in litter size and litter weight (p<0.05) at birth in the Treatment II group as compared to the Control group. Alpha linolenic acid (p<0.05), eicosapentaenoic acid (p<0.05) levels increased while arachidonic acid levels (p<0.05) reduced in gastric milk at birth and blood at end of lactation in Treatment II as compared to Treatment I group. Brain fatty acid levels showed reduction (p<0.05) only in docosahexaenoic acid levels in dams from Treatment I and Treatment II, at the end of lactation. Results suggest sensitivity of fetus and pups for excess levels of alpha linolenic acid 'in a diet at marginal protein level'.