Mulitphase Atmospheric Chemistry in Liquid Water: Impacts and Controllability of Organic Aerosol.

Liquid water is a dominant and critical tropospheric constituent. Over polluted land masses low level cumulus clouds interact with boundary layer aerosol. The planetary boundary layer (PBL) is the lowest atmospheric layer and is directly influenced by Earth's surface. Water-aerosol interactions are critical to processes that govern the fate and transport of trace species in the Earth system and their impacts on air quality, radiative forcing, and regional hydrological cycling. In the PBL, air parcels rise adiabatically from the surface, and anthropogenically influenced hygroscopic aerosols take up water and serve as cloud condensation nuclei (CCN) to form clouds. Water-soluble gases partition to liquid water in wet aerosols and cloud droplets and undergo aqueous-phase photochemistry. Most cloud droplets evaporate, and low volatility material formed during aqueous phase chemistry remains in the condensed phase and adds to aerosol mass. The resulting cloud-processed aerosol has different physicochemical properties compared to the original CCN. Organic species that undergo multiphase chemistry in atmospheric liquid water transform gases to highly concentrated, nonideal ionic aqueous solutions and form secondary organic aerosol (SOA). In recent years, SOA formation modulated by atmospheric waters has received considerable interest.Key uncertainties are related to the chemical nature of hygroscopic aerosols that become CCN and their interaction with organic species. Gas-to-droplet or gas-to-aqueous aerosol partitioning of organic compounds is affected by the intrinsic chemical properties of the organic species in addition to the pre-existing condensed phase. Environmentally relevant conditions for atmospheric aerosol are nonideal. Salt identity and concentration, in addition to aerosol phase state, can dramatically affect organic gas miscibility for many compounds, in particular when ionic strength and salt molality are outside the bounds of limiting laws. For example, Henry's law and Debye-Hückel theory are valid only for dilute aqueous systems uncharacteristic of real atmospheric conditions. Chemical theory is incomplete, and at ambient conditions, this chemistry plays a determining role in total aerosol mass and particle size, controlling factors for air quality and climate-relevant aerosol properties.Accurate predictive skill to understand the impacts of societal choices and policies on air quality and climate requires that models contain correct chemical mechanisms and appropriate feedbacks. Globally, SOA is a dominant contributor to the atmospheric organic aerosol burden, and most mass can be traced back to precursor gas-phase volatile organic compounds (VOCs) emitted from the biosphere. However, organic aerosol concentrations in the Amazon Rainforest, the largest emitter of biogenic VOCs, are generally lower than in U.S. national parks. The Interagency Monitoring of Protected Visual Environments (IMPROVE) air quality network, with sites located predominantly in national parks, provides the longest continuous record of organic aerosol measurements in the U.S. Analysis of IMPROVE data provides a useful chemical climatology of changing air resources in response to environmental rules and shifting economic trends. IMPROVE data provides an excellent test bed for case studies to assess model skill to accurately predict changes in organic aerosol concentrations in the context of a changing climate.

WASH practices and its association with nutritional status of adolescent girls in poverty pockets of eastern India.

BACKGROUND: Water, Sanitation, and Hygiene (WASH) practices may affect the growth and nutritional status among adolescents. Therefore, this paper assesses WASH practices and its association with nutritional status among adolescent girls. METHODS: As a part of an intervention programme, this study is based on baseline cross-sectional data. It was conducted between May 2016-April 2017 in three Indian states (Bihar, Odisha, and Chhattisgarh). From a sample of 6352 adolescent girls, information on WASH practices, accessibility to health services and anthropometric measurements (height, weight and mid upper arm circumference (MUAC)) was collected. Descriptive statistics were used to examine WASH practices, and nutritional status among adolescent girls. Determinants of open defecation and menstrual hygiene were assessed using logistic regression. Association between WASH and nutritional status of adolescent girls was determined using linear regression. RESULTS: Findings showed 82% of the adolescent girls were practicing open defecation and 76% were not using sanitary napkins. Significant predictors of open defecation and non use of sanitary napkin during menstruation were non Hindu households, households with poorer wealth, non availability of water within household premise, non visit to Anganwadi Centre, and non attendance in Kishori group meetings. One-third of adolescent girls were stunted, 17% were thin and 20% had MUAC < 19 cm. Poor WASH practices like water facility outside the household premise, unimproved sanitation facility, non use of soap after defecation had significant association with poor nutritional status of adolescent girls. CONCLUSIONS: Concerted convergent actions focusing on the provision of clean water within the household premise, measures to stop open defecation, promotion of hand washing, accessibility of sanitary napkins, poverty alleviation and behavior change are needed. Health, nutrition and livelihood programmes must be interspersed, and adolescents must be encouraged to take part in these programmes.

Prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of rural Uttarakhand, India.

OBJECTIVE: To assess the prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of India. DESIGN: Community-based cross-sectional study. Data were collected on sociodemographic profile and anthropometric parameters. Weight and height measurements were utilized for calculation of BMI. Nutrient intake data were collected using 24 h dietary recall. SETTING: High-altitude region of Nainital District, Uttarakhand State, North India. SUBJECTS: Community-dwelling geriatric subjects (n 981) aged 60 years or above. RESULTS: We found that 26·6 % of the elderly subjects were underweight (BMI<18·5 kg/m2). Overweight (BMI 25·0-29·9 kg/m2) and obesity (BMI≥30·0 kg/m2) was seen among 18·0 % and 4·6 %, respectively. After controlling for potential cofounders, risk factors such as low level of education and income, chewing problems and lower number of daily meals were found to be associated with underweight. On the other hand, risk factors for overweight/obesity were lower age, high income and unskilled work. CONCLUSIONS: There is a need to develop and implement intervention strategies to prevent underweight, overweight and obesity among the geriatric population of India.

Mid-upper arm circumference in detection of weight-for-height Z-score below -3 in children aged 6-59 months.

OBJECTIVE: To evaluate the predictive ability of mid-upper arm circumference (MUAC) for detecting severe wasting (weight-for-height Z-score (WHZ) <-3) among children aged 6-59 months. DESIGN: Cross-sectional survey. SETTING: Rural Uttar Pradesh, India. SUBJECTS: Children (n 18 456) for whom both WHZ (n 18 463) and MUAC were available. RESULTS: The diagnostic test accuracy of MUAC for severe wasting was excellent (area under receiver-operating characteristic curve = 0·933). Across the lower range of MUAC cut-offs (110-120 mm), specificity was excellent (99·1-99·9 %) but sensitivity was poor (13·4-37·2 %); with higher cut-offs (140-150 mm), sensitivity increased substantially (94·9-98·8 %) but at the expense of specificity (37·6-71·9 %). The optimal MUAC cut-off to detect severe wasting was 135 mm. Although the prevalence of severe wasting was constant at 2·2 %, the burden of severe acute malnutrition, defined as either severe wasting or low MUAC, increased from 2·46 to 17·26 % with cut-offs of <115 and <135 mm, respectively. An MUAC cut-off <115 mm preferentially selected children aged ≤12 months (OR=11·8; 95 % CI 8·4, 16·6) or ≤24 months (OR=23·4; 95 % CI 12·7, 43·4) and girls (OR=2·2; 95 % CI 1·6, 3·2). CONCLUSIONS: Based on important considerations for screening and case detection in the community, modification of the current WHO definition of severe acute malnutrition may not be warranted, especially in the Indian context.

Potential of Aerosol Liquid Water to Facilitate Organic Aerosol Formation: Assessing Knowledge Gaps about Precursors and Partitioning.

Isoprene epoxydiol (IEPOX), glyoxal, and methylglyoxal are ubiquitous water-soluble organic gases (WSOGs) that partition to aerosol liquid water (ALW) and clouds to form aqueous secondary organic aerosol (aqSOA). Recent laboratory-derived Setschenow (or salting) coefficients suggest glyoxal's potential to form aqSOA is enhanced by high aerosol salt molality, or "salting-in". In the southeastern U.S., aqSOA is responsible for a significant fraction of ambient organic aerosol, and correlates with sulfate mass. However, the mechanistic explanation for this correlation remains elusive, and an assessment of the importance of different WSOGs to aqSOA is currently missing. We employ EPA's CMAQ model to the continental U.S. during the Southern Oxidant and Aerosol Study (SOAS) to compare the potential of glyoxal, methylglyoxal, and IEPOX to partition to ALW, as the initial step toward aqSOA formation. Among these three studied compounds, IEPOX is a dominant contributor, ∼72% on average in the continental U.S., to potential aqSOA mass due to Henry's Law constants and molecular weights. Glyoxal contributes significantly, and application of the Setschenow coefficient leads to a greater than 3-fold model domain average increase in glyoxal's aqSOA mass potential. Methylglyoxal is predicted to be a minor contributor. Acid or ammonium - catalyzed ring-opening IEPOX chemistry as well as sulfate-driven ALW and the associated molality may explain positive correlations between SOA and sulfate during SOAS and illustrate ways in which anthropogenic sulfate could regulate biogenic aqSOA formation, ways not presently included in atmospheric models but relevant to development of effective control strategies.

Surfactants from the gas phase may promote cloud droplet formation.

Clouds, a key component of the climate system, form when water vapor condenses upon atmospheric particulates termed cloud condensation nuclei (CCN). Variations in CCN concentrations can profoundly impact cloud properties, with important effects on local and global climate. Organic matter constitutes a significant fraction of tropospheric aerosol mass, and can influence CCN activity by depressing surface tension, contributing solute, and influencing droplet activation kinetics by forming a barrier to water uptake. We present direct evidence that two ubiquitous atmospheric trace gases, methylglyoxal (MG) and acetaldehyde, known to be surface-active, can enhance aerosol CCN activity upon uptake. This effect is demonstrated by exposing acidified ammonium sulfate particles to 250 parts per billion (ppb) or 8 ppb gas-phase MG and/or acetaldehyde in an aerosol reaction chamber for up to 5 h. For the more atmospherically relevant experiments, i.e., the 8-ppb organic precursor concentrations, significant enhancements in CCN activity, up to 7.5% reduction in critical dry diameter for activation, are observed over a timescale of hours, without any detectable limitation in activation kinetics. This reduction in critical diameter enhances the apparent particle hygroscopicity up to 26%, which for ambient aerosol would lead to cloud droplet number concentration increases of 8-10% on average. The observed enhancements exceed what would be expected based on Köhler theory and bulk properties. Therefore, the effect may be attributed to the adsorption of MG and acetaldehyde to the gas-aerosol interface, leading to surface tension depression of the aerosol. We conclude that gas-phase surfactants may enhance CCN activity in the atmosphere.

Iodine Nutritional Status among Adolescent Girls in Uttarakhand, India.

INTRODUCTION: Uttarakhand (UK) state is a known endemic region for Iodine deficiency. OBJECTIVE: To assess iodine nutritional status among adolescent girls in districts: Udham Singh Nagar (USN), Nainital (N) and Pauri (P) of UK state. METHODS: In each district, 30 clusters (schools) were identified by using population proportionate to size cluster sampling. In each school, 60 girls (12-18 years) attending the schools were included. Total of 5430 girls from USN (1823), N (1811) and P (1796) were studied. Clinical examination of thyroid of each girl was conducted. From each cluster, spot urine and salt samples were collected. RESULTS: Total goiter rate was found to be 6.8% (USN), 8.2% (N) and 5.6% (P). Median urinary iodine concentration levels were 250 µg/l (USN), 200 µg/l (N) and 183 µg/l (P). CONCLUSION: Findings of the study documented that adolescent girls had adequate iodine nutritional status in the three districts of UK.

Reappearance of Bitot's spots after complete resolution in children between 1 and 5 years of age.

There is limited data on proportion of Bitot's spots (BS), which could reappear after receiving mega dose of Vitamin A (MDVA), and their complete resolution. A prospective, community-based, cohort study with 12 months follow-up was conducted among children (1-5 years) with BS at a district from North India. On diagnosis, 200,000 IU of vitamin A was administered on the same day, then after 4 weeks and subsequently after 6 months. Out of 262 children with BS, 157 (59.9%, 95% CI: 54.1-65.9) children had shown resolution of BS after the MDVA supplementation. Out of 157 children, 97 (61.8%, 95% CI: 54.2-69.4) had reappearance of BS after complete resolution. Kaplan-Meir analysis found that median duration of reappearance of BS was 5 months (95% CI: 3.8-6.2) after their complete resolution. The reappearance of BS after administration of two MDVA within 12 months suggests that children with possibly adequate serum retinol level status may have reappearance of BS.

Surface-active organics in atmospheric aerosols.

Surface-active organic material is a key component of atmospheric aerosols. The presence of surfactants can influence aerosol heterogeneous chemistry, cloud formation, and ice nucleation. We review the current state of the science on the sources, properties, and impacts of surfactants in atmospheric aerosols.

Status of iodine deficiency among pregnant mothers in Himachal Pradesh, India.

OBJECTIVE: Iodine is an essential micronutrient needed for the production of thyroid hormones. Pregnant mothers who are deficient in iodine provide less iodine to the fetal thyroid. This results in low production of thyroid hormones by the fetal thyroid, thereby leading to compromised mental and physical development of the fetus. The current study aimed to assess the current status of iodine nutrition among pregnant mothers in Himachal Pradesh, India, a known endemic region for iodine deficiency. DESIGN: Three districts, namely Kangra, Kullu and Solan, were selected. SETTING: In each district, thirty clusters (villages) were identified by utilizing the population-proportional-to-size cluster sampling methodology. In each cluster, seventeen pregnant mothers attending the antenatal clinics were included. SUBJECTS: A total of 1711 pregnant mothers (647 from Kangra, 551 from Kullu and 513 from Solan) were studied. Clinical examination of the thyroid of each pregnant mother was conducted. Spot urine samples were collected from ten pregnant mothers in each cluster. Similarly, salt samples were collected from eleven pregnant mothers in each cluster. RESULTS: Total goitre rate was 42·2 % (Kangra), 42·0 % (Kullu) and 19·9 % (Solan). The median urinary iodine concentration was 200 µg/l (Kangra), 149 µg/l (Kullu) and 130 µg/l (Solan). The percentage of pregnant mothers consuming adequately iodized salt (iodine content of 15 ppm and more) was found to be 68·3 % (Kangra), 60·3 % (Kullu) and 48·5 % (Solan). CONCLUSION: Pregnant mothers in Kullu and Solan districts had iodine deficiency as indicated by a median urinary iodine concentration less than 150 µg/l.

Iodine nutritional status among neonates in the Solan district, Himachal Pradesh, India.

Iodine nutrition status amongst neonates can be assessed by estimating thyroid stimulating hormone (TSH). According to WHO, if more than 3 % of the neonates have TSH levels of 5 mlU/l and more in a population, it indicates presence of iodine deficiency (ID). Iodine deficiency is an endemic health problem in Solan district, Himachal Pradesh (HP) state. ID leads to mental retardation, deaf mutism, squint, dwarfism, spastic diplegia, neurological defects and congenital anomalies. The aim is to determine iodine nutrition status of neonates of Solan district. In Solan district, six hospitals/community health centers providing obstetric services and conducting more than 100 deliveries per annum were identified and enlisted. Two hospitals were selected keeping in view of operational feasibility. A total of 683 umbilical cord blood samples of neonates were collected on filter paper and analyzed for TSH. It was found that 63.2 % of the neonates had TSH levels of more than 5 mlU/l indicating iodine deficiency in the Solan district. Iodine deficiency was a public health problem in Solan district, HP.

Bridging the vitamin A and deworming coverage gap among underserved populations in India through government and civil society organization partnerships.

BACKGROUND: Vitamin A deficiency (VAD) is a major public health problem in India, where approximately 62% of children under five have low retinol levels (< 70 µmol/L). This study aims to (1) evaluate vitamin A supplementation (VAS) and deworming (VAS + D) coverage in Nagaland state through government and civil society organization (CSO) partnerships, (2) examine socio-demographic barriers and facilitators to VAS + D coverage, (3) examine associations between socio-demographic characteristics and source of VAS coverage (i.e., government vs. CSOs), and (4) estimate the impact of VAS on health outcomes due to increased coverage through government and CSO partnerships. METHODS: A cross-sectional statewide coverage survey was conducted in Nagaland, India with 1,272 caregivers of children 6-59 months. Household socio-demographic data and VAS + D exposure variables were collected via quantitative survey. Univariate analyses were used to assess the associations between the independent and outcome variables; odds ratios were computed to measure the strength of the association at a significance level of < 0.05. The Lives Saved Tool (LiST) was used to estimate the impact of increased VAS coverage on child undernutrition, morbidity and mortality. RESULTS: Most children (77.2%) received VAS in the past six months, with 28.1% receiving VAS in capsule form (provided primarily by CSOs) and 70.2% received VAS in syrup form (provided primarily by government). Total deworming coverage was 74.2%, with 43.5% receiving both VAS and deworming. Lower pre-school enrollment was a barrier to receiving VAS (47.4% not enrolled vs. 80.9% enrolled, p < 0.001). A barrier to receiving VAS + D was lack of knowledge of benefits (p < 0.001). Based on LiST modeling, increasing VAS coverage by 22% through CSOs resulted in an estimated 114 stunting cases averted, 25,017 diarrhea cases averted, and 9 lives saved in 2019 in Nagaland State. CONCLUSIONS: Government and CSO partnerships can reduce disparities in VAS coverage and decrease under-five child morbidity and mortality.

Photochemical aging of light-absorbing secondary organic aerosol material.

Dark reactions of methylglyoxal with NH4(+) in aqueous aerosols yield light-absorbing and surface-active products that can influence the physical properties of the particles. Little is known about how the product mixture and its optical properties will change due to photolysis as well as oxidative aging by O3 and OH in the atmosphere. Here, we report the results of kinetics and product studies of the photochemical aging of aerosols formed by atomizing aqueous solutions of methylglyoxal and ammonium sulfate. Experiments were performed using aerosol flow tube reactors coupled with an aerosol chemical ionization mass spectrometer (Aerosol-CIMS) for monitoring gas- and particle-phase compositions. Particles were also impacted onto quartz windows in order to assess changes in their UV-visible absorption upon oxidation. Photooxidation of the aerosols leads to the formation of small, volatile organic acids including formic acid, acetic acid, and glyoxylic acid. The atmospheric lifetime of these species during the daytime is predicted to be on the order of minutes, with photolysis being an important mechanism of degradation. The lifetime with respect to O3 oxidation was observed to be on the order of hours. O3 oxidation also leads to a net increase in light absorption by the particles due to the formation of additional carbonyl compounds. Our results are consistent with field observations of high brown carbon absorption in the early morning.

Status of iodine deficiency among children in national capital territory Of Delhi--a cross-sectional study.

Iodine deficiency disorder is a public health problem in NCT of Delhi. The present study was conducted in NCT of Delhi to assess the current iodine nutrition status among school age children (6-11 years). Thirty clusters (schools) were selected by utilizing the population proportionate to size (PPS) cluster sampling methodology. A total of 1393 school age children were included. Urine samples were collected and tested for urinary iodine excretion (UIE). The Median UIE was found to be 200 µg/L. The salt samples collected from study subjects revealed that 87% of salt samples had stipulated level of iodine of 15 ppm and more. In order to eliminate IDD, there is a need to sustain the supply of iodized salt and monitor its iodine content regularly.

Increase in iodine deficiency disorder due to inadequate sustainability of supply of iodized salt in District Solan, Himachal Pradesh.

Himachal Pradesh is a known endemic area for iodine deficiency disorders. A study was conducted in district Solan with the objective of assessing the prevalence of iodine deficiency disorders in school-age children. Thirty clusters were selected by using the probability-proportionate-to-size cluster sampling methodology. Clinical examination of the thyroid of 1898 children in the age-group of 6-12 years was conducted. Urine and salt samples were collected. The total goiter rate was found to be 15.4%. Median urinary iodine excretion level was 62.5 µg/l. Only 39% of the salt samples had iodine content of ≥15 ppm. Mild iodine deficiency was present in the subjects studied.

Glyoxal-methylglyoxal cross-reactions in secondary organic aerosol formation.

Glyoxal (G) and methylglyoxal (MG) are potentially important secondary organic aerosol (SOA) precursors. Previous studies of SOA formation by G and MG have focused on either species separately; however, G and MG typically coexist in the atmosphere. We studied the formation of secondary organic material in aqueous aerosol mimic mixtures containing G and MG with ammonium sulfate. We characterized the formation of light-absorbing products using UV-vis spectrophotometry. We found that absorption at 280 nm can be described well using models for the formation of light-absorbing products by G and MG in parallel. Pendant drop tensiometry measurements showed that surface tension depression by G and MG in these solutions can be modeled as a linear combination of the effects of G and MG alone. Product species were identified using chemical ionization mass spectrometry with a volatilization flow tube inlet (Aerosol CIMS). Peaks consistent with G-MG cross-reaction products were observed, accounting for a significant fraction of detected product mass, but most peaks could be attributed to self-reaction. We conclude that cross-reactions contribute to SOA mass from uptake of G and MG, but they are not required to accurately model the effects of this process on aerosol surface tension or light absorption.

Incidence of Side-effects After Weekly Iron and Folic Acid Consumption Among School-going Indian Adolescents.

OBJECTIVE: To estimate incidence of side effects after weekly iron and folic acid supplementation (WIFS) in Delhi and Haryana. METHODS: In this cross-sectional school-based study, data were collected from 4,183 adolescents on WIFS consumption and side effects experienced first time of receipt of WIFS (week 1), and in last two consecutive weeks (week 2,3). Week 3 was 48 hours preceding the survey. RESULTS: WIFS consumption in week 1, 2 and 3 was 85%, 63% and 52%, respectively. Side effects reported were highest in first week (25%) and reduced to 7% (week 2) and 5% (week 3). Side effects most reported were abdominal pain (80%) and nausea (10%). Adolescents (45%) who faced a side-effect in week 1 did not consume WIFS in subsequent week. CONCLUSIONS: Incidence of side effects was low, but it affected compliance. Positive reinforcement to students who face side effects requires strengthening by teachers.

Delivering an Integrated Package of Maternal Nutrition Services in Andhra Pradesh and Telangana (India).

BACKGROUND: Maternal spot feeding programs operational in southern Indian States are providing a package of nutrition services (food, micronutrient supplementation, deworming, gestation weight gain monitoring, and fortnightly nutrition health education) to pregnant women. These remain to be evaluated. OBJECTIVE: We evaluated the maternal spot feeding programs in 2 Southern Indian states. METHODS: Study design was cross-sectional entailing primary data collection (July to November 2016) on 360 pregnant and lactating women (of infants aged 0-6 months) per state and a review of the scheme's management information system (MIS) beneficiaries' records for the time period April 2014 to August 2017. To gain program functioning insights, open-ended interviews (n = 252) with state, district, and block program managers a state-level open space technology workshop was conducted. RESULTS: Average days of meal consumption ranged from 19 to 21 days per month; spot meal enhanced high dietary diversity (≥6 food groups; 57%-59%) and consumption of eggs and milk (74%-96%) among pregnant and lactating women. On-the-spot consumption of iron, folic acid, calcium, and deworming was 18%, 87%, and 56%, respectively; 94% attended at least 1 of the 2 nutrition monthly counseling sessions. Majority (68%) of the beneficiaries were motivated to enroll by self-help groups or family members, suggesting the crucial persuasive role of peers and family members. CONCLUSION: Maternal spot feeding schemes can potentially deliver nutrition interventions outlined in the World Health Organization antenatal care guidelines 2016 for a positive pregnancy outcome. Research on schemes' impact on birth outcomes, maternal depression, social norms, and its cost-effectiveness is needed.

Prevalence of Vitamin D Deficiency in Children (6-18 years) Residing in Kullu and Kangra Districts of Himachal Pradesh, India.

OBJECTIVE: To assess the prevalence of Vitamin D deficiency (VDD) and associated risk factors amongst children in the age group of 6-18 y residing at an altitude of 1000 mts and above. METHODS: A community based cross-sectional study was conducted in the year 2015-2016. Two districts (namely: Kangra and Kullu) of Himachal Pradesh state, India was selected for the present study. In each district thirty clusters/schools were identified using Population Proportionate to Size (PPS) sampling methodology. In the identified school, all the children in schools were enlisted. Twenty children per school were selected by using random number tables. A total of 1222 children (Kangra: 610; Kullu: 612) in the age group of 6-18 y were enrolled. The data on socio economic status, physical activity and sunlight exposure was collected. The blood samples were collected and serum 25-hydroxyvitamin D, intact parathyroid hormone, serum calcium, phosphorous, albumin and alkaline phosphate were assessed using standard procedures. RESULTS: Eighty one percent (Kangra) and 80.0% (Kullu) of school age children were found Vitamin D deficient as per serum 25(OH) D levels (less than 20 ng/ml). CONCLUSIONS: A high prevalence of VDD was found in children residing in 2 districts located at high altitude regions of Himachal Pradesh, India.

Reproductive factors, nutritional status and serum 25(OH)D levels in women with breast cancer: A case control study.

The study was conducted with an objective to investigate the association between reproductive factors, nutritional status and serum 25(OH)D levels among women diagnosed with breast cancer (BC). A total of 200 women with BC attending a tertiary healthcare institute of Delhi, India matched with 200 healthy women for age (±2years) and socio economic status were included in the study. Data was collected on socio-demographic profile, reproductive factors, physical activity and dietary intake (24h dietary recall and food frequency questionnaire) using interviewer administered structured questionnaires and standard tools. Non fasting blood samples (5ml) were collected for the biochemical estimation of serum 25(OH)D and calcium levels by chemiluminescent immunoassay and colorimetric assay technique. Data was analyzed by univariable conditional logistic regression and significant variables with (p<0.05), were analyzed in final model by conditional multivariable logistic regression analysis. The mean age of patients at diagnosis of BC was 45±10years. Results of multivariable conditional logistic regression analysis revealed significantly higher odds of BC for reproductive factors like age at marriage (more than 23 years), number of abortions, history or current use of oral contraceptive pills (OCP), with [OR (95% CI)] of [2.4 (1.2-4.9)], [4.0 (1.6-12.6)], [2.4 (1.2-5.0)]. Women with physically light activities and occasional consumption of eggs were found to have higher odds of BC [4.6 (1.6-13.0)] and [3.2 (1.6-6.3)]. Women with serum 25(OH)D levels less than 20ng/ml and calcium levels less than 10.5mg/dl had higher odds of having BC [2.4 (1.2-5.1)] and [3.7 (1.5-8.8)]. A protective effect of urban areas as place of residence and energy intake greater than 50% of Recommended Dietary Allowance (RDA) per day against BC was observed (p<0.05). The findings of the present study revealed a significant association of reproductive and dietary factors in addition to sedentary physical activity and low serum 25(OH)D levels in women diagnosed with BC.