Effect of supplemental nutrition in pregnancy on offspring's risk of cardiovascular disease in young adulthood: Long-term follow-up of a cluster trial from India.

BACKGROUND: Undernutrition during intrauterine life and early childhood is hypothesised to increase the risk of cardiovascular disease (Developmental Origins of Health and Disease Hypothesis), but experimental evidence from humans is limited. This hypothesis has major implications for control of the cardiovascular disease epidemic in South Asia (home to a quarter of world's population), where a quarter of newborns have low birth weight. We investigated whether, in an area with prevalent undernutrition, supplemental nutrition offered to pregnant women and their offspring below the age of 6 years was associated with a lower risk of cardiovascular disease in the offspring when they were young adults. METHODS AND FINDINGS: The Hyderabad Nutrition Trial was a community-based nonrandomised controlled intervention trial conducted in 29 villages near Hyderabad, India (1987-1990). Protein-calorie food supplement was offered daily to pregnant and lactating women (2.09 MJ energy and 20-25 g protein) and their offspring (1.25 MJ energy and 8-10 g protein) until the age of six years in the 15 intervention villages, but not in the 14 control villages. A total of 1,826 participants (949 from the intervention villages and 877 from the control villages, representing 70% of the cohort) at a mean age of 21.6 years (62% males) were examined between 2009 and 2012. The mean body mass index (BMI) of the participants was 20 kg/m2 and the mean systolic blood pressure was 115 mm Hg. The age, sex, socioeconomic position, and urbanisation-adjusted effects of intervention (beta coefficients and 95% confidence intervals) on outcomes were as follows: carotid intima-media thickness, 0.01 mm (-0.01 to 0.03), p = 0.36; arterial stiffness (augmentation index), -1.1% (-2.5 to 0.3), p = 0.097; systolic blood pressure, 0.5 mm Hg (-0.6 to 1.6), p = 0.36; BMI, -0.13 kg/m2 (-0.75 to 0.09), p = 0.093; low-density lipoprotein (LDL) cholesterol, 0.06 mmol/L (-0.07 to 0.2), p = 0.37; and fasting insulin (log), -0.06 mU/L (-0.19 to 0.07), p = 0.43. The limitations of this study include nonrandomised allocation of intervention and lack of data on compliance, and potential for selection bias due to incomplete follow-up. CONCLUSIONS: Our results showed that in an area with prevalent undernutrition, protein-calorie food supplements offered to pregnant women and their offspring below the age of 6 years were not associated with lower levels of cardiovascular risk factors among offspring when they were young adults. Our findings, coupled with evidence from other intervention studies to date, suggest that policy makers should attach limited value to cardiovascular health benefits of maternal and child protein-calorie food supplementation programmes.

Is increasing urbanicity associated with changes in breastfeeding duration in rural India? An analysis of cross-sectional household data from the Andhra Pradesh children and parents study.

OBJECTIVE: To investigate whether village-level urbanicity and lower level socioeconomic factors are associated with breastfeeding practices in transitioning rural communities in India. SETTING: 29 villages in Ranga Reddy district, southern India between 2011 and 2014. PARTICIPANTS: 7848 children under 6 years identified via a cross-sectional household survey conducted as part of the Andhra Pradesh Children and Parents Study. OUTCOME MEASURES: Two key indicators of optimal breastfeeding: termination of exclusive breastfeeding before 6 months and discontinuation of breastfeeding by 24 months. Village urbanicity was classified as low, medium or high according to satellite assessed night-light intensity. RESULTS: Breastfeeding initiation was almost universal, and approximately two in three children were exclusively breastfed to 6 months and a similar proportion breastfed to 24 months. Using multilevel logistic regression, increasing urbanicity was associated with breastfeeding discontinuation before 24 months (medium urbanicity OR 1.45, 95% CI 0.71 to 2.96; high urbanicity OR 2.96, 95% CI 1.45 to 6.05) but not with early (<6 months) termination of exclusive breastfeeding. Increased maternal education was independently associated with both measures of suboptimal breastfeeding, and higher household socioeconomic position was associated with early termination of exclusive breastfeeding. CONCLUSION: In this transitional Indian rural community, early stage urbanicity was associated with a shorter duration of breastfeeding. Closer surveillance of changes in breastfeeding practices alongside appropriate intervention strategies are recommended for emerging economies.

Prevalence and severity of depressive symptoms in relation to rural-to-urban migration in India: a cross-sectional study.

BACKGROUND: Migration is a major life event, which may also be a risk factor for depression. However, little is known regarding the relationship between these phenomena in low and middle income settings. This study explores the frequency and severity of depressive symptoms among rural-to-urban migrants compared to permanent rural and to urban residents in India. METHODS: We assessed 884 subjects; urban non-migrants (n = 159), urban migrants (n = 461) and rural non-migrants (n = 264) in Hyderabad, India, in 2009-2010. The frequency and severity of depressive symptoms was assessed with the validated Telugu version of the Brief Patient Health Questionnaire. Multivariable logistic regression was used to examine the association between the presence of depressive symptoms and migration status while adjusting for gender, age and several sociodemographic and health-related parameters using Stata v.12. RESULTS: The prevalence of mild to severe depressive symptoms was higher in women (11.3, 95 % confidence interval (CI) 8.3-14.3 %) compared to men (5.8 %, 95 % CI 3.7-7.9 %). Rural residents reported the highest prevalence of mild to severe depressive symptoms (women: 16.7 %, 95 % CI 9.8-23.5 %; men: 8.0 %, 95 % CI 3.7-12.3 %). Among women, the lowest prevalence was reported by migrants (8.2 %, 95 % CI 4.6-11.9 %). Among men, prevalence was similar in migrants (5.0 %, 95 % CI 2.2-7.7 %) and urban residents (3.9 %, 95 % CI 0-8.3 %). Multivariable logistic regression analyses showed no evidence for increased prevalence of mild to severe depressive symptoms among migrants compared to either rural or urban residents. CONCLUSIONS: There was no evidence for an increased prevalence of mild to severe depressive symptoms among rural-urban migrants compared to rural or urban residents.

Cohort profile: Andhra Pradesh Children and Parents Study (APCAPS).

The Andhra Pradesh Children and Parents Study (APCAPS) was originally established to study the long-term effects of early-life undernutrition on risk of cardiovascular disease. Its aims were subsequently expanded to include trans-generational influences of other environmental and genetic factors on chronic diseases in rural India. It builds on the Hyderabad Nutrition Trial (HNT) conducted in 1987-90 to compare the effects on birthweight of a protein-calorie supplement for pregnant women and children. The index children of HNT and their mothers were retraced and examined in 2003-05, and the children re-examined as young adults aged 18-21 years in 2009-10. The cohort was expanded to include both parents and siblings of the index children in a recently completed follow-up conducted in 2010-12 (N=∼6225 out of 10,213 participants). Recruitment of the remaining residents of these 29 villages (N=∼55,000) in Ranga Reddy district of Andhra Pradesh is now under way. Extensive data on socio-demographic, lifestyle, medical, anthropometric, physiological, vascular and body composition measures, DNA, stored plasma, and assays of lipids and inflammatory markers on APCAPS participants are available. Details of how to access these data are available from the corresponding author.

Automated IMT estimation and BMI correlation using a low-quality carotid ultrasound image database from India.

This paper presents AtheroEdgeLowRes (AELR), an extention of AtheroEdge™ from AtheroPoint™, and a solution to carotid ultrasound IMT measurement in low-resolution and overall low quality images. The images were collected using a low-end ultrasound machine during a screening study in India. We aim to demonstrate the accuracy and reproducibility of the AELR system by benchmarking it against an expert Reader's manual tracing and to show the correlation between the automatically measured intima media thickness (IMT) and the subjects' cardiovascular risk factors (i.e. body mass index--BMI). We introduced an innovative penalty function (PF) to our dual-snake segmentation technique, necessary due to the low image resolution. We processed 512 images from 256 patients, and correlated the AELR IMT values with the patients' age and BMI. AELR processed all 512 images, and the IMT measurement error was 0.011±0.099 mm with the PF correction and 0.173±0.127 mm without. AELR IMT values correlated with the Reader's values (r = 0.883) and also correlated with the subject's BMI and age. The AELR system showed accuracy and reproducibility levels that make it suitable to be used in large epidemiological and screening studies in emerging countries.

Lead and essential trace element levels in school children: a cross-sectional study.

BACKGROUND: Nutritional status is thought to modulate susceptibility to lead (Pb) toxicity. The type and nature of these interactions needs to be investigated. AIM: To assess the prevalence of sub-clinical Pb toxicity (defined by ≥ 10 µ_rm;g/dL blood levels) and trace element deficiencies (Iron (Fe), Zinc (Zn), Copper (Cu) and Magnesium (Mg)) and to find out their possible relationship, if any. SUBJECTS AND METHODS: A cross-sectional survey was carried out in a total of 195 school children residing in urban (n = 65), urban heavy traffic (n = 65) and urban industrial (n = 65) zones of Hyderabad, India. Blood Pb, trace element levels, haemoglobin and δ-aminolevulinate dehydratase (δ-ALAD) activity was measured. RESULTS: High blood lead levels ( ≥ 10 µ_rm;g/dL) were observed in 54.3% of children while percentage prevalence of trace element deficiencies such as Fe (16.2%), Zn (68.6%), Mg (41.7%) and Cu (25%) were also high in children included in the study. Higher blood Pb levels and reduced δ-ALAD activity was observed in children residing in heavy traffic and industrial areas. Blood Pb levels but not δ-ALAD activity correlated inversely with serum Fe in heavy traffic and industrial children, respectively. Interestingly, δ-ALAD activity but not blood Pb levels correlated inversely with trace element levels only in urban children. CONCLUSIONS: These results suggest higher prevalence of sub-clinical Pb toxicity and trace element deficiencies in urban children. Further, high blood Pb levels appear to be correlated with reduced δ-ALAD activity and iron status in Pb exposed children.