Dietary pattern, height, weight centile and BMI of affluent school children and adolescents from three major cities of Pakistan.

OBJECTIVE: To compare the dietary pattern, height, weight centile and BMI of affluent school children and adolescents from three major cities of Pakistan. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Private Schools of Karachi, Quetta and Lahore, from September 2007 to March 2008. METHODOLOGY: The affluent socioeconomic group was identified by the monthly income of the parents (average>Rs.15,000 per month, $246); school fees of child (average>Rs.1,500 per month, $25) and household items such as computer, refrigerator, washing machine, television, car etc. A total of 652 healthy immunized children with no history of chronic infection, inducted through multistage stratified sampling were divided into groups A, B, and C by ages of 6-9, 10-13, and 14-17 years respectively. Height, weight and 24 hours diet recall was obtained. Centre for Disease Control and prevention (CDC), clinical charts with 5th and 95 percentile for standard height and weight were used. Food records subjected to USDA food exchange list were used. Forms were used as inputs to generate tables for Statistical Package for social sciences -SPSS, Window 13.0. RESULTS: In girls calories and food intake in group A and B of Quetta was lower (p<.005) vs. other cities. No significant difference was seen in group C. Fat intake was the same in the girls of all 3 groups. In boys caloric carbohydrates and protein intake of group A of Quetta vs. groups B and C was significant by different National Centre for Health Statistics (NCHS) height and weight in groups A and B were at the 50-90 centile and at 25-50 in group C, centile. BMI (kg/m2) in girls and boys of group A were not different. BMI was highest in group B girls (mean 22+/-5) and group C boys (25+/-4) of Quetta. CONCLUSION: Children of affluent schools of Karachi compared to Quetta are taking more junk food but their consumption of protein is lowered and of a poor quality. Overall fat is below normal recommended standards. However, minimum fat intake was seen in school children of Quetta when compared with Karachi and Lahore. Carbohydrate consumption was adequate. BMI was highest in boys of Quetta than Lahore and Karachi. Majority of children on NCHS centile charts plotted between the 50th-90th centiles.

Prevalence of overweight and obesity among children and adolescents of affluent schools in Karachi.

OBJECTIVE: To estimate the prevalence of overweight and obesity among children and adolescents of affluent schools of Karachi. METHOD: This descriptive study is part of an ongoing nationwide project funded by Higher Education Commission (HEC) Pakistan, to develop growth centile charts of our children. This survey of three affluent schools of Karachi was done over a period of three months (from Sept to end Nov, 2007) including 398 children. Socio-economic group was decided based on monthly income and items such as computer, fridge, television, car etc. Students from Class 1-10 representing age group 6 to 17 years were included; children were divided into groups A, B, and C representing age of 6-9, 10-13, and 14-17 years respectively. The children included were healthy with no history of chronic infection and immunization up-to-date as per the Expanded Program of Immunization (EPI) schedule of the country. Body weight was measured in minimum clothing to the nearest 0.1 kg using a weight scale with calibration done after every 25 readings. Body height was measured in the erect position without shoes to the nearest 0.1 cm using wall mounted stadiometers. A twenty four hour diet chart was obtained using specially designed questionnaires. The reference definitions used were those given by the Center for Disease Control (CDC) according to which children having their BMI plotted above 95th centile are obese and BMI between 85th-95th centiles were "at risk for overweight." RESULTS: Data of 398 students belonging to affluent schools is presented. Out of these 398, 24 (6%) were above the 95th centile (obese) while 77 (19.35%) were between 85th-95th centiles on NCHS charts (at risk for overweight). The children in group A (6-9 years) showed daily caloric intake of 2220+/-816 kcal/day, group B showed caloric intake of 2133+/-942 kcal/day and group C a caloric intake of 1976+/-873 kcal/day. Apart from the overall data, children above 95th centile and between 85th to 95th centile showed a daily caloric intake of 1861+/-849 and 2056+/-895 kcal per day, respectively. Approximately 85% of the students when asked about their daily schedule were leading a predominantly sedentary life style, due to tuitions, television viewing or internet surfing or indoor games like play stations (not requiring physical activity). CONCLUSION: Even with our small sample size the percentage of obese and overweight children were 6% and 19% of the population studied. This study suggests that overweight and obesity among these children maybe due to their sedentary lifestyle and/or lack of intake of proper food (imbalance in the intake of daily calories, carbohydrate, fat and protein).

Kirschner wire pin tract infection rates between percutaneous and buried wires in treating metacarpal and phalangeal fractures.

OBJECTIVE: To compare pin tract infection rate between percutaneous and buried placement of Kirschner (K-) wiring for hand fractures. STUDY DESIGN: Quasi--experimental study. PLACE AND DURATION: Plastic, Reconstructive, Hand and Burn Surgery Unit, Liaquat National Hospital, Karachi, from September 2005--February 2006. PATIENTS AND METHODS: Patients with fractures of metacarpals and phalanges of hand were selected by non-probability purposive method. Assessment of pin tract infection by clinical examination and pin tract scoring was done by modification of Oppenheim classification. Statistical analysis was done using Chi-square test. RESULTS: Ten out of 55 percutaneous and 2 out of 45 buried wires were infected. The difference in infection rates of two groups was statistically significant at p<0.05. Three percutaneous, but not buried Kirschner wires, had to be removed before 4 weeks because of failure to respond to local wound care and oral antibiotics. CONCLUSION: Percutaneous K- wires had significantly greater infection rate than wires which were buried deep to the skin.

Gender difference in metacarpal descent of fifth metacarpal.

OBJECTIVE: To determine the difference in metacarpal descent of fifth metacarpal between men and women. STUDY DESIGN: Descriptive study. PLACE AND DURATION: The outpatient department of plastic, reconstructive and hand surgery at Liaquat National Hospital, Karachi, from August 2005 to February 2006. PATIENTS AND METHODS: Skyline of the 2nd and 3rd metacarpals were used as reference line, from which the descent of the 5th metacarpal head was measured. The position of 5th metacarpal head was documented as angle X. Metacarpal descent was defined as the difference between angle "X" in relaxed and clenched fist position. The relaxed position was standardized by placing the forearm, wrist and palm on a shaped woodblock such that the wrist would be held in 25 - 30 degree in extension by a triangular spur, supported the 3rd metacarpal only. It was ensured that the movement of 4th and 5th metacarpals were not impaired. Analysis of variance was performed to compare the significance of means between genders at p<0.05 level of significance. RESULTS: Metacarpal descent of the 5th metacarpal of both hands was significantly greater for women, with a mean of 7 degree as compared with a mean of 4 degree for the men. This decrease in angle "X" was significant for the right 5th metacarpal relaxed and fist position and the fist position on the left. In contrast, women showed no significant differences between the various age groups for any of the variables tested. There was no relationship between metacarpal descent and hand dominance. CONCLUSION: Difference in metacarpal descent between men and women is significant and must be kept in mind when hand function is evaluated in both genders to assess the outcome of treatment and rehabilitation.