The role of dairy consumption in the relationship between wealth and early life physical growth in India: evidence from multiple national surveys.

INTRODUCTION: Prevalence of undernutrition continues to be high in India and low household wealth is consistently associated with undernutrition. This association could be modified through improved dietary intake, including dairy consumption in young children. The beneficial effect of dairy on child growth has not been explored at a national level in India. The present analyses aimed to evaluate the direct and indirect (modifying association of household level per adult female equivalent milk and milk product consumption) associations between household wealth index on height for age (HAZ) and weight for age (WAZ) in 6-59 months old Indian children using data from of nationally representative surveys. METHODS: Two triangulated datasets of two rounds of National Family Health Survey, (NFHS-3 and 4) and food expenditure (National Sample Survey, NSS61 and 68) surveys, were produced by statistical matching of households using Non-Iterative Bayesian Approach to Statistical Matching technique. A Directed Acyclic Graph was constructed to map the pathways in the relationship of household wealth with HAZ and WAZ based on literature. The direct association of wealth index and its indirect association through per adult female equivalent dairy consumption on HAZ and WAZ were estimated using separate path models for each round of the surveys. RESULTS: Wealth index was directly associated with HAZ and WAZ in both the rounds, but the association decreased from NFHS-3 (ßHAZ: 0.145; 95% CI: 0.129, 0.16) to NFHS-4 (ßHAZ: 0.102; 95%CI: 0.093, 0.11). Adult female equivalent milk intake (increase of 10gm/day) was associated with higher HAZ (ß_NFHS-3=0.001;95% CI: 0, 0.002; ß_NFHS-4=0.002;95% CI: 0.002, 0.003) but had no association with WAZ. The indirect association of wealth with HAZ through dairy consumption was 2-fold higher in NFHS-4 compared to NFHS-3. CONCLUSIONS: The analysis of triangulated survey data shows that household level per- adult female equivalent dairy consumption positively modified the association between wealth index and HAZ, suggesting that regular inclusion of milk and milk products in the diets of children from households across all wealth quintiles could improve linear growth in this population.

Atoms for Nutrition: IAEA's Contribution to Tackling Malnutrition.

Nuclear techniques, including stable isotope techniques, provide great potential for understanding nutrition and human health with better accuracy and precision compared with other routine techniques. The International Atomic Energy Agency (IAEA) has been at the forefront for more than 25 y to offer guidance and support on the use of nuclear techniques. This article demonstrates how the IAEA has enabled its Member States to contribute to good health and well-being in their countries and to assess progress toward achieving global nutrition and health targets to combat malnutrition in all its forms. Support is provided in several ways including research, capacity building, education, and training as well as the provision of guidance materials. The nuclear techniques help to objectively measure nutritional and health-related outcomes such as body composition, energy expenditure, nutrient uptake, and body stores and assess breastfeeding practices as well as environmental interactions. These techniques are continuously improved to make nutritional assessments more affordable and less invasive with wide use in field settings. New research areas are emerging to assess diet quality with changing food systems and to explore stable isotope-assisted metabolomics to address key questions on nutrient metabolism. Through a deeper understanding of mechanisms, nuclear techniques can contribute to eradicating malnutrition worldwide.

Revisiting Dietary Iron Requirement and Deficiency in Indian Women: Implications for Food Iron Fortification and Supplementation.

Anemia in Indian women continues to be highly prevalent, and is thought to be due to low dietary iron content. The high risk of dietary iron deficiency is based on the Indian Council of Medical Research recommendation of 21 mg/d, but there is a need for a secure and transparent determination of the Estimated Average Requirement (EAR) of iron in this population. In nonpregnant, nonlactating women of reproductive age (WRA), the EAR of iron was determined to be 15 mg/d. Applying this value to daily iron intakes among WRA in nationally representative Indian state-based data showed that the median risk of dietary iron deficiency was lower than previously thought (65%; IQR: 48-78%), with considerable heterogeneity between states (range: 25-93%). However, in a validation, this risk matched the risk of iron deficiency as defined by blood biomarkers in a recently completed survey. When the risk of dietary iron deficiency was modelled for an increase in iron intake through food fortification of a single dietary staple, that provided 10 mg/d, the median risk reduced substantially (from 65% to 20%), and it virtually disappeared when supplementary iron intakes through the national iron supplementation program were considered. The risk of exceeding the tolerable upper level (TUL) of intake of iron remains low in the population when receiving fortification of 10 mg/d, but is much higher if they consume greater amounts of iron through supplements (range: 0-54%). This newly and transparently defined Indian EAR of iron should be used to evaluate, with precision, the benefits and risks of iron fortification and supplementation policies.

Total daily energy expenditure has declined over the past three decades due to declining basal expenditure, not reduced activity expenditure.

Obesity is caused by a prolonged positive energy balance1,2. Whether reduced energy expenditure stemming from reduced activity levels contributes is debated3,4. Here we show that in both sexes, total energy expenditure (TEE) adjusted for body composition and age declined since the late 1980s, while adjusted activity energy expenditure increased over time. We use the International Atomic Energy Agency Doubly Labelled Water database on energy expenditure of adults in the United States and Europe (n = 4,799) to explore patterns in total (TEE: n = 4,799), basal (BEE: n = 1,432) and physical activity energy expenditure (n = 1,432) over time. In males, adjusted BEE decreased significantly, but in females this did not reach significance. A larger dataset of basal metabolic rate (equivalent to BEE) measurements of 9,912 adults across 163 studies spanning 100 years replicates the decline in BEE in both sexes. We conclude that increasing obesity in the United States/Europe has probably not been fuelled by reduced physical activity leading to lowered TEE. We identify here a decline in adjusted BEE as a previously unrecognized factor.

Total energy expenditure (TEE) of young adults from urban South India: revisiting their daily energy requirement.

BACKGROUND/OBJECTIVES: Young Indian adults are at greater risk of overweight/obesity due to their high energy intake and sedentary lifestyle. Their energy requirement (ER) is based on their total energy expenditure (TEE) estimated from factorial method, which possibly overestimates their basal metabolic rate (BMR) and physical activity level (PAL). This study aimed to compare the accurately measured TEE with ER in young adults. Secondarily, to compare measured with predicted BMR and guideline PAL with that obtained from questionnaire and step counts. SUBJECTS/METHODS: TEE was measured in 19 male adults (18-30 years), using the doubly labeled water technique, over 14 days. Indirect calorimetry was used to measure BMR, while the PAL was estimated by (a) the ratio of measured TEE and BMR, (b) step counts over 7 days measured using tri-axial accelerometers and (c) a physical activity questionnaire (PAQ). RESULTS: The measured TEE (9.11 ± 1.30 MJ/d) was significantly lower than the ER using either the Indian (15.2%) or the FAO/WHO/UNU (11.9%, both p < 0.01) recommendations. The measured BMR (6.90 ± 0.65 MJ/d) was significantly lower than that predicted using the FAO/WHO/UNU equation (6.5%, p < 0.01) but not for the Indian equation. The estimated PAL from measured TEE and BMR (1.35 ± 0.18), and from accelerometers (1.33 ± 0.11) was significantly lower than PAL obtained from PAQ (1.53 ± 0.17) or the guideline of 1.53 for Indians. CONCLUSIONS: The predicted BMR and PAL guideline value was higher than that measured in young Indian adults, resulting in a ~13% lower measured TEE. This emphasizes the need to revisit the guidelines for predicting ER for this population.

A Novel High-Intensity Short Interval Dance Intervention (THANDAV) to Improve Physical Fitness in Asian Indian Adolescent Girls.

Background: There exist several barriers to physical activity (PA) among adolescent girls. We therefore developed a culturally acceptable dance/fitness intervention called THANDAV (Taking High-Intensity Interval Training [HIIT] ANd Dance to Adolescents for Victory over noncommunicable diseases [NCDs]). The main aim of this study was to evaluate the THANDAV protocol among Asian Indian girls aged 10 to 17 years. Materials and Methods: THANDAV consisted of a 10-min routine with high- and low-intensity dance steps that was taught to 23 adolescent girls. Heart rate (HR), energy expenditure, body mass index (BMI), and blood pressure (BP) were recorded. Focused group discussions (FGDs) were conducted after the quantitative measurements were completed. Results: The average age of the girls was 13.9 ± 2.1 years, and the mean BMI and BP were 19.8 ± 3.3 kg/m2 and 107/68 (±8/7) mm/Hg, respectively. All participants achieved 80% of their maximum HR during the first dance and managed to sustain this HR throughout the 10-min routine. There was a significant increase in the HR (bpm) [88.7 ± 8.4 to 195.6 ± 11.8, P < 0.001] and VO2 (L/min) [0.025 ± 0.0 to 0.395 ± 0.1, P < 0.001] postintervention. The average energy cost of the activity (metabolic equivalent) was 6.3. The FGDs revealed that THANDAV was a socially acceptable, fun, and energetic form of PA. Conclusions: The THANDAV intervention meets HIIT norms and is a novel culturally appropriate form of PA that is enjoyable, takes little time, and can be done at home. It has the potential to be a sustainable intervention to improve cardiorespiratory fitness and prevent NCDs in Asian Indian adolescent girls. Clinical Trials Registry of India: CTRI/2020/02/023384.

Daily Iron Requirements in Healthy Indian Children and Adolescents.

OBJECTIVE: This study aimed to define the estimated average requirement and the recommended dietary allowance of iron for Indian children and adolescents. Methods: The Estimated average requirement was derived for children aged 1-17y, from the mean bioavailability-adjusted daily physiological iron requirement, which in turn was estimated using a factorial method. This consisted of mean daily iron losses from the body and additional iron required for tissue growth and storage, while also defining the variance of each factor to derive the Recommended dietary allowance. RESULTS: Results: The estimated average requirement of iron for children ranged from 5.6 to 11.0 mg/d in children aged 1-9y. For adolescents aged 10-17y, these ranged from 10.8 to 18.4 mg/d and 15.4 to 18.5 mg/d for adolescent boys and girls, respectively. CONCLUSIONS: New estimates of estimated average requirement for iron in Indian children are presented, and same may be used to inform iron supplementation and food fortification policies.

Antidepressant drug-protein interactions studied by spectroscopic methods based on fluorescent carbon quantum dots.

A highly sensitive fluorescent carbon quantum dots (CDs) was designed to measure the interaction of antidepressant drugs and serum albumins (SA). In present investigation the interaction of bovine serum albumin (BSA) and human serum albumin (HSA) with antidepressant drugs viz. amitryptiline hydrochloride (AMT), chlorpromazine hydrochloride (CPZ) and desipramine hydrochloride (DSP) bioconjugated on CDs have been studied by different spectroscopic techniques i.e., Fluorescence, UV-Visible, Dynamic light scattering (DLS) and FT-IR. The CDs were prepared by one-pot method using glucose and PEG-200. The developed CDs showed blue luminescence under irradiation with ultra-violet. The Stern-Volmer quenching constant (K sv ) indicates the presence of static quenching mechanism. The apparent binding constant K a between antidepressant drugs with complex of SA-CDs have been determined. These results illustrated that CPZ shows strong binding with HSA. As further analyzed by FT-IR spectroscopy and DLS technique, the results suggested induced conformational changes on SA, thus confirming the experimental and theoretical results. Thus, a thorough knowledge of the energetics of drug-protein affinities in presence of CDs as attempted in this work is vital in giving way for appropriate drug delivery.

Effect of a cereal and milk meal with or without fruits and nuts on the postprandial glycemic response in Indian men.

BACKGROUND AND OBJECTIVES: Some cereals, consumed at breakfast, have shown lower glycemic responses. Limited data exist in the Indian context, where the effect could be modified due to genetic or racial differences. This study aimed to investigate the effect of cereal and milk, with or without fruits/nuts, on the glycemic response in healthy Indian men. METHODS AND STUDY DESIGN: A randomized cross-over study was carried out on 16 men (18 - 45 years), with 3 interventions providing equal amounts of glycemic carbohydrate: a glucose drink (Reference), cereal and milk (CM), and cereal, milk, fruits and nuts (CMO), on separate days. Plasma glucose, serum insulin, C-peptide, ghrelin, energy expenditure (EE), substrate oxidation and appetite/satiety were measured repeatedly over 3 hours post meal. RESULTS: A significant time effect and time x meal interaction between the meals, higher for the Reference meal, was observed for plasma glucose (p<0.001), insulin (p<0.001), C-peptide (p<0.001), and carbohydrate oxidation (p<0.001); while lower for satiety (p<0.001). The plasma glucose concentrations of CM and CMO meals returned to baseline 60 min postprandially, then remained there, unlike the Reference meal, where the plasma glucose values returned to baseline at 120 min and dipped significantly below baseline at 150 and 180 min. A significant effect of time (p<0.001) was observed for EE between meals. Ghrelin levels did not differ significantly between the test meals. CONCLUSIONS: Cereal with milk, along with fruits and nuts at breakfast, has a lower and stable glycemic response, along with increased satiety among healthy male subjects.