Association between anthropometric-based and food-based nutritional failure among children in India, 2015.

Inadequate dietary intake is a critical underlying determinant of child undernutrition. This study examined the association between anthropometric-based and food-based nutritional failure among children in India. We used the 2015-2016 National Nutrition Monitoring Bureau data where anthropometric outcomes and food intake were both measured for each child. We followed the World Health Organization child growth reference standards to define anthropometric failures (i.e., height-for-age z score < -2 SD for stunting, weight-for-age z score < -2 SD for underweight, and weight-for-height z score < -2 SD for wasting), and the Indian Council of Medical Research recommended dietary allowance (RDA) to define adequacy in intake of calorie, protein, and fat. We used descriptive and regression-based assessments to test the association between the two indicators of nutritional failure and also computed the area under the receiver operating characteristic curve (AUC). The prevalence of stunting, underweight, and wasting was 28.6%, 24.3%, and 12.8%, respectively, whereas 78.2%, 27.4%, and 50.8% of the children had below RDA norms consumption of calorie, protein, and fat, respectively. We found weak-to-null correlation between anthropometric failures and food failures (Pearson correlation ranging from -0.013 to 0.147) and poor discriminatory accuracy (AUC < 0.62), suggesting that in the Indian context, anthropometric failures are not directly associated with food intake. This finding highlights the need for improving adequate intake of macronutrients and draws attention toward adopting a multifactorial approach to improve child nutrition in India. Poor food intake itself merits exclusive policy focus as it is an important nutrition and health concern.

Validation of APLS, Argall and Luscombe Formulae for Estimating Weight among Indian Children.

Weight estimation in pediatric emergencies is often required for calculation of drug dosages, fluid therapy and defibrillation. The 'gold standard' of actually weighing the patient is not practically possible in emergency conditions. The aim of this study is to validate common age-based formulae (APLS, Luscombe and Argall's) and their accuracy in estimating weight of under 5-y-old Indian children by secondary data analysis from a cross-sectional study conducted by the National Nutrition Monitoring Bureau (NNMB), National Institute of Nutrition, Hyderabad, in 10 states of India in 2011-12 among under five-year-old children. Their measured weights were compared to their estimated weights as calculated using the APLS formula, the Luscombe and Argall formulae. There is a need to adjust the formulae for accurate estimation of weight among Indian children as all the three age-based weight formulae namely APLS, Argyll and Luscombe overestimated the weight among the Indian children.

Prevalence of vitamin D deficiency and its associated factors among the urban elderly population in Hyderabad metropolitan city, South India.

BACKGROUND: Deficiency of vitamin D has been associated with various health conditions. However, vitamin D deficiency (VDD) and factors associated with VDD are not well studied, especially among the urban elderly population of India. AIM: To assess the prevalence of VDD and its associated factors among the urban free-living elderly population in Hyderabad. SUBJECTS AND METHODS: A community-based cross-sectional study was conducted among 298 urban elderly (≥60 years) by adapting a random sampling procedure. Demographic particulars were collected. Blood pressure and anthropometric measurements were recorded using standard equipment. Fasting glucose, lipid profile and 25-hydroxy vitamin D [25(OH) D] were estimated in plasma samples. RESULTS: The mean ± SE plasma vitamin D and the prevalence of VDD among the urban elderly population were 19.3 ± 0.54 (ng/ml) and 56.3%, respectively. The prevalence of VDD was significantly associated with education, high body mass index (BMI), hypertension (HT) and metabolic syndrome (MS). Multiple logistic regression analysis revealed HT as a significant predictor of vitamin D deficiency and the risk of VDD was double among the elderly with hypertension. CONCLUSIONS: The prevalence of VDD was high among the urban elderly population in the south Indian city of Hyderabad. High BMI, MS, HT and education are significant associated factors of VDD.

Metabolic syndrome among elderly care-home residents in southern India: A cross-sectional study.

BACKGROUND: The health of the elderly population and the emergence of noncommunicable diseases have become major public health issues in recent years. Metabolic syndrome is thought to be the main driving force for the global epidemic of cardiovascular diseases, as well as for type 2 diabetes. This cross-sectional study aimed to determine the prevalence of metabolic syndrome and its correlates among the residents of care homes for the elderly in Hyderabad city, India. METHODS: A total 114 elderly persons (aged ≥60 years) were evaluated in a cross-sectional study. Metabolic syndrome was defined by the 2005 criteria of the International Diabetes Federation. Data were collected on selected sociodemographic, behavioural and nutritional variables and cardiometabolic risk factors. Blood pressure and anthropometric measurements were also recorded. Fasting blood samples were collected for measurement of blood glucose and serum lipid levels. Univariable logistic regression was applied to investigate the associations between metabolic syndrome and known risk factors; adjusted analysis was then done by multivariable logistic regression for significant variables. RESULTS: The overall prevalence of metabolic syndrome was 42.1% (48/114) among the study population. A higher prevalence (50.9%; 27/53) was found among women. High blood pressure or taking antihypertensive medication was found to be the most common (95.8%; 46/48) cardiometabolic component. The risk of metabolic syndrome did not differ significantly by age group, sex, caste, religion, type of diet (vegetarian or non-vegetarian), educational status, behavioural factors such as tobacco use and alcohol intake, physical activity (assessed by modified Eastern Cooperative Oncology Group [ECOG] scale), or physical exercise. However, a body mass index ≥23 kg/m2 was associated with metabolic syndrome (unadjusted odds ratio [OR]: 8.97; 95% confidence interval [CI]: 3.78-21.28); adjusted OR: 9.31; 95% CI: 4.12-22.14) Conclusion: The overall prevalence of metabolic syndrome in this study population of elderly care-home residents in India was more than 40%. Further research on the burden of metabolic syndrome in the elderly population is warranted.

Case Report: Gollop-Wolfgang Complex in a 5 month old baby.

Skeletal dysplasias are disorders associated with a generalized abnormality in the skeleton. The Gollop-Wolfgang complex (GWC) is a limb deficiency disorder and an unusual limb malformation with highly variable manifestations. Here we report an interesting case of a 5-month old male baby from India with Gollop-Wolfgang Complex showing bifurcation of the right femur, ectrodactyly of both feet, ectrodactyly of left hand, syndactyly of right hand and unusual presentation of bilateral fibular agenesis and caudal (Sacrococcygeal) agenesis. The etiology of GWC in this 5 month old male baby could possibly be attributed to spontaneous gene mutation. The clinical, radiographic findings and the unusual presentation are presented in detail.

Vitamin A deficiency control measures: importance of vitamin A supplementation as a public health policy in the Indian context.

Recently prominent nutrition scientists across the world have opposed continuation of vitamin A supplementation (VAS) programmes and recommended gradual phasing out VAS for pre-school children. A few eminent nutrition scientists in India have echoed this view, arguing that vitamin deficiency (VAD) is no longer a public health problem in India. We review the evidence, highlighting the high rates of VAD among pre-school children in India, (clinical, subclinical, and dietary deficiency) and argue that in India VAD remains an immensely important public health problem and it is crucial to strengthen and continue the existing VAS programme in India, and in other developing countries until such time as their children's dietary consumption of vitamin A is improved adequately and blood vitamin A levels reach optimal levels.

Prevalence and determinants of micronutrient deficiencies among rural children of eight states in India.

BACKGROUND/AIMS: Micronutrient deficiencies continue to be a major public health problem in India. The aim of this study was to assess the prevalence and determinants of micronutrient deficiencies among rural children. METHODS: A community-based cross-sectional study was carried out by adopting a multistage stratified random sampling procedure. A total of 71,591 preschool children were included for ocular signs, 3,291 preschool children and 6,616 adolescents for hemoglobin, and 28,437 school-age children for iodine deficiency disorders. RESULTS: The prevalence of Bitot's spots was 0.8% (CI = 0.6-0.9) and anemia among preschool children and adolescents was 67% (CI = 64.4-69.5) and 69% (CI = 67.0-71.4), respectively. The prevalence of total goiter was 3.9% (CI = 3.4-4.6). The risk of Bitot's spots was 2.4 times higher among preschool children of Scheduled Caste (SC) or Scheduled Tribes (ST) than others and risk of anemia was twice as high (CI = 1.5-2.6) among adolescents of SC and ST. The micronutrient deficiencies were significantly lower in children who used sanitary latrines. CONCLUSIONS: Micronutrient malnutrition is a public health problem among rural children, and it was higher among children of SC/ST, illiterate parents and those not possessing a sanitary latrine. Thus, there is a need to improve environmental sanitation; fortification of foods could also help in mitigating the problem.

Prevalence of vitamin A deficiency in South Asia: causes, outcomes, and possible remedies.

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot's spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stem efforts are needed to address this issue of public-health significance at local and international level in lower- and middle-income countries of South Asia.

Trends in the prevalence of undernutrition, nutrient and food intake and predictors of undernutrition among under five year tribal children in India.

Undernutrition among children under five year is a significant public health problem in India. The present study was carried out to assess trends in nutritional status, nutrient and food intake among children under five year over two time periods. It was a community-based cross-sectional study, carried out in tribal areas of India. A total of 14,587 children, 0-5 years old were covered for nutritional assessment in terms of underweight, stunting and wasting. A 24 hour diet survey was carried out in a sub-sample of households surveyed. Wealth index was constructed using principle component analysis. The prevalence of underweight and stunting had declined significantly over the periods (49% vs 57%, 51% vs 58%, respectively), while the prevalence of wasting remained similar (22% vs 23%). There was marginal decrease in the intake of foods and nutrients over the periods, and was below recommended levels. Stepwise regression showed that the risk of underweight and stunting was significantly (p<0.01) higher among children of illiterate mothers and children from lowest and middle households wealth index. Morbidities during preceding fortnight had 1.3 times higher risk of underweight and wasting. In conclusion, undernutrition is a significant health problem among tribal children and is associated with literacy status of mothers, household wealth index and morbidities. Therefore implementation of appropriate nutritional intervention strategies and improvement in households food security through public distribution systems, food intakes, socioeconomic condition, literacy of parents and personal hygiene may help in improving the nutritional status of tribal children.

Prevalence of ocular signs and subclinical vitamin A deficiency and its determinants among rural pre-school children in India.

OBJECTIVE: To assess the magnitude and determinants of vitamin A deficiency (VAD) and coverage of vitamin A supplementation (VAS) among pre-school children. DESIGN: A community-based cross-sectional study was carried out by adopting a multistage, stratified, random sampling procedure. SETTING: Rural areas of eight states in India. SUBJECTS: Pre-school children and their mothers were covered. RESULTS: A total of 71,591 pre-school children were clinically examined for ocular signs of VAD. Serum retinol concentrations in dried blood spots were assessed in a sub-sample of 3954 children using HPLC. The prevalence of Bitot spots was 0·8%. The total ocular signs were significantly higher (P < 0·001) among boys (2·6%) compared with girls (1·9%) and in older children (3-4 years) compared (P < 0·001) with younger (1-2 years), and were also high in children of labourers, scheduled castes and illiterate mothers. The odds of having Bitot spots was highest in children of scheduled caste (OR = 3·8; 95% CI 2·9, 5·0), labourers (OR = 2·9; 95% CI 2·1, 3·9), illiterate mothers (OR = 2·7; 95% CI 2·2, 2·3) and households without a sanitary latrine (OR = 5·9; 95% CI 4·0, 8·7). Subclinical VAD (serum retinol level <20 µg/dl) was observed in 62% of children. This was also relatively high among scheduled caste and scheduled tribe children. The rate of coverage of VAS was 58%. CONCLUSIONS: The study revealed that VAD is a major nutritional problem and coverage of VAS was poor. The important determinants of VAD were illiteracy, low socio-economic status, occupation and poor sanitation. Strengthening the existing VAS programme and focused attention on dietary diversification are essential for prevention of VAD.