The Need for Food Fortification With Zinc in India: Is There Evidence for This?

There has been recent advocacy for food fortification with zinc in India. However, there are three important conditions that should be established before fortifying food with any micronutrient, which requires that there should be i) Established high prevalence of biochemical or sub-clinical deficiency (?20%), ii) Low dietary intakes that increase the risk of deficiency, and iii) Evidence of efficacy of supplementation from clinical trials. For zinc, all three conditions are not satisfied. The prevalence of low serum zinc concentrations in Indian children is well below 20% (~6%), signifying that zinc deficiency is not a public health problem. There is no risk of dietary zinc inadequacy in Indian populations where intake has been measured. Finally, there is no robust evidence that zinc-fortified foods improve functional outcomes, even if the serum zinc concentration is increased. Thus, contemporary evidence does not justify the need for food fortification with zinc in India.

Relationship of Vitamin D Status with Muscle Mass and Muscle Strength in Young Indian Adults – Evidence from Andhra Pradesh Children and Parents Study Cohort.

Objectives: Positive relationship of vitamin D status with muscle mass and strength has been observed in studies from the developed countries but evidence from the developing countries is sparse. This study assessed the relationship of vitamin D status with muscle mass and muscle strength in rural young adults from Hyderabad, India. Methods: The study participants (n=956; age 18-20 years; 42% women) were a part of Andhra Pradesh Children and Parents Study cohort which was established to assess the long term impact of early nutrition supplementation provided through a government programme. Their serum 25- hydroxyvitamin D was assessed using HPLC, appendicular skeletal muscle mass (ASM) was assessed using dual energy X-ray absorptiometry and grip strength was assessed using grip dynamometer. Results: The participants were lean with average body mass index of 19.5 kg/m2. Prevalence of vitamin D deficiency (serum 25(OH) vitamin D3 < 20 ng/ml) was 33.6% in men and 51.4% in women. Vitamin D deficiency was associated with lower ASM (β (95% CI): - 0.38 (-0.72 to -0.05) kg; p = 0.02) with a trend of lower muscle strength in unadjusted analyses. After adjustment for relevant confounders, the relationship of vitamin D deficiency with lower ASM (β (95% CI): -0.21 (- 0.37 to - 0.05) kg; p =0.01) persisted but not with lower grip strength. Conclusions: Prevalence of vitamin D deficiency was high in these rural young adults. Vitamin D deficiency was associated with lower muscle mass but not with lower muscle strength in this cohort. Alleviation of vitamin D deficiency may improve muscle mass.

Prevalence of prehypertension in young military adults & its association with overweight & dyslipidaemia.

Background & objectives: Estimation of prevalence of prehypertension in a population and its association with risk factors of cardiovascular disease is important to design preventive programmes. This cross-sectional study was carried out in a healthy military population to assess the prevalence of prehypertension and its association with risk factors such as overweight, abdominal adiposity and dyslipidaemia. Methods: The study included 767 participants (130 officers and 637 from other ranks). The blood pressure, serum triglycerides and serum cholesterol (total, HDL and LDL) were assessed along with anthropometric measurements such as height, weight, waist-hip ratio in apparently healthy military personnel. Information on smoking, alcohol intake, dietary habits and physical activity was collected using pretested questionnaire. Prehypertension was defined as systolic blood pressure (SBP) 120-139 mm Hg and diastolic blood pressure (DBP) 80-89 mm Hg. Results: The overall prevalence of prehypertension was high (about 80%). The prevalence of other risk factors such as overweight (BMI>23 kg/m2), serum total cholesterol > 200 mg/dl, serum LDL cholesterol > 130 mg/dl, serum HDL cholesterol <40 mg/dl, serum triglyceride > 150 mg/dl in the total group was 30, 22, 22, 67, and 14 per cent, respectively. Most of the personnel undertook moderate or heavy exercise. A significantly higher proportion of individuals with prehypertension had clinical and behavioural risk factors such as overweight, dyslipidaemia and adverse dietary practices like saturated fat and added salt intake. On multivariate logistic regression analysis, prehypertension had significant positive association with BMI>23 kg/m2 (OR 1.75), age (OR 1.89), serum triglyceride >150 mg/dl (OR 2.25)and serum HDL cholesterol <40 mg/dl (OR 1.51). Interpretation & conclusions: The high prevalence of prehypertension and its association with overweight and dyslipidaemia in this young, physically active military population indicates an urgent need for targeted interventions to reduce the cardiovascular risk.

Hospital Based Nutrition Rehabilitation of Severely Undernourished Children Using Energy Dense Local Foods.

Objective: To examine the catch up growth in severely wasted children using energy dense local foods at a hospital based nutrition rehabilitation unit. Design: Retrospective cohort. Setting: In-patient ward at a tertiary care government pediatric hospital in Hyderabad. Patients: Children with severe malnutrition (n=309) admitted to nutrition ward from January 2001 to December 2005. Intervention: A diet based on energy dense local foods along with multivitamin-multimineral supplements. Main outcome measures: Catch up growth (g/kg/day) during each week of hospital stay. Results: Mean age of the children was 25 months (range 2-60). Their baseline weight for height (WHZ) Z score was –4.1. Mean weight gain was moderate (5g/kg/day) and baseline WHZ score had a significant negative relationship to the weight gain. The prevalence of morbidities was high and the commonest morbidity was fever. Weight gain was higher by almost 40% in the absence of morbidities in any week. Conclusions: The diet based on local energy dense foods was found to be suitable for the nutrition rehabilitation of severely malnourished children though the rate of weight gain was moderate.

Tubularized incised plate urethroplasty with de-epithelialized flap

Aim: To improve the results of tubularized plate urethroplasty by adding de-epithelized flap. Patients and Methods: Twenty-five cases of hypospadias who underwent Snodgrass urethroplasty using de-epithelialized flap were studied. The minimum period of follow-up in this series was 1 year. Results: The resultant neo-meatus was vertically oriented and slit like. Glans was conical which is cosmetically well accepted. Penile raphe was in the midline. None of the patient had residual chordee; penile torsion; or glans dehiscence. Excellent cosmetic results were observed in all cases. The complication rate in our series was 8(two cases). Two patients developed fistula. Conclusion: De-epithelialized flap is a simple method to provide additional covering to the constructed neourethra after Snodgrass urethroplasty. It achieves our goal of noncrossing suture lines and providing maximum vascularity

Congenital paraesophageal hernia presenting with severe gastroesophageal reflux.

Paraesophageal hernia in children is relatively rare entity. These children usually present with recurrent respiratory tract infection or vague GI symptoms. An 11 year female presented with episodic vomiting, heartburn and features of hypocalcemic tetany. Investigations revealed right paraesophageal hernia. Reduction of the contents and repair of the defect with fundoplication was done. Patient is asymptomatic on follow-up.

Atypical presentation of Tuberculosis.

Incidence of tuberculosis is increasing with emergence of many cases of multi-drug resistance and extrapulmonary manifestation. We report three cases of tuberculosis presenting in very atypical ways.

ABCD syndrome revisited.

A four-day-old neonate presented with severe abdominal distention, intermittent bilious vomiting, typical black lock, partial albinism and heterochromatic iris. Ileostomy was done proximal to the transition zone at mid-ileal region (50 cms proximal to ileo-cecal region) All biopsy specimens till the transitional zone were negative for ganglion cells. Distinct features of total colonic aganglionosis and recto-sigmoid Hirschsprung's disease are delineated here.

Neonatal lower extremity gangrene.

Four neonates suffering from bilateral lower limb gangrene were referred to us for further management. Two neonates had no contributory etiology. All four received appropriate treatment thus avoiding mortality but morbidity could not be avoided. All four neonates recovered uneventfully.

Congenital segmental dilatation of colon with colonic atresia.

Congenital segmental dilatation of the colon belongs to a group of Hirschsprung's-like diseases with normal ganglion cells. The presentation is with chronic constipation affecting older children. We report a neonate with congenital segmental dilatation of the colon associated with sigmoid atresia. The child is well after a colostomy.

Multiple tubular and cystic intestinal duplications.

Duodenal and colonic duplication presenting as mass in a neonate is rare. We report a 52-cm-long tubular, total colonic and 5-cm-long cystic duodenal duplication in a two-day-old neonate. Both the duplications could be excised without resection of the normal bowel.

Disseminated spina ventosa.

Spina Ventosa is a rare condition. A rare case of disseminated tuberculosis of bones and skin without primary foci is presented. Gross sclerosis of the short bones of hand and leg were noted.

Perforation in a jejunal duplication lined by ectopic gastric mucosa.

We report a 3-year-old child with jejunal duplication with localized perforation and bleeding in the adjacent normal intestine. The entire duplicated jejunum was lined by gastric mucosa. This was successfully treated by mucosal excision of the duplicated intestine and resection of a short segment of normal jejunum.

Pulmonary gangrene complicating bacterial pneumonia.

Two cases of pulmonary gangrene involving left lower lobe in an 18-month and 4-year-old female children are reported. The patients looked like having empyema following Klebsiella pneumonia. The diagnosis was made following computerized tomography scan and during decortication respectively.

Perineal canal: an uncommon entity with good prognosis.

This article reports two patients with perineal canal (anovestibular fistula) who were treated at Dept. of Pediatric Surgery, LTMG Hospital, Mumbai. Both the patients had normal anus and a fistula between the anal canal and the vestibule. They were treated by vestibulo anal pull through procedure. The pathogenesis of this condition and the pertinent literature is reviewed.