Impact of occupation on stress and anxiety among Indian women.

The objectives of this study were to: (1) assess the prevalence of anxiety and stress in Indian women; and (2) evaluate the relationship of occupation to the prevalence of anxiety and stress. A cross-sectional study was performed from January 2013 to June 2014, on women (aged 18-50 years) randomly selected from different occupations in Gujarat, India. Anxiety was evaluated using Spielberg's State and Trait Anxiety Inventory scale and stress was assessed using the International Stress Management Association questionnaire. Serum cortisol concentration was measured in a sub-sample. The association of occupation with stress and anxiety was analyzed by a generalized linear model adjusted for age. Among all participants, 26% were the most prone and 66% were somewhat more prone to stress; 35% of women showed high anxiety levels. Homemakers had 1.2 times higher anxiety and 1.3 times higher stress than working women (p < .05). Prevalence of stress (37%, p < .001) and anxiety (40%, p = .068) were also higher in homemakers compared to working women and students. Serum cortisol levels did not differ significantly (p > .05) by occupation. This study revealed high prevalence rates of stress and anxiety in Indian women. Involvement in activities outside the home may help women to reduce stress.

Body fat indices for identifying risk of hypertension in Indian children.

BACKGROUND: High adiposity is major risk factor for hypertension. Various anthropometric indices are used to assess excess fatness. OBJECTIVES: (1) To examine relationship of body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), triceps skin fold thickness (TSFT) and wrist measurements with blood pressure in children and adolescents 2) to suggest age- and gender-specific cutoffs for these indices in Indian children. METHODS: Cross-sectional school-based study on a random sample of 6380 children (6-18 yr old, 3501 boys) from five major cities in India. Height, weight, waist and wrist circumference, TSFT, and blood pressure were recorded. Children with systolic blood pressure (BP) and/or Diastolic BP >95th percentile were classified as hypertensive. RESULTS: Prevalence of overweight and obesity was 23.5% and 9.7%, respectively. Hypertension was observed in 5.6%. Multiple logistic regression (adjustments: age, gender) indicated double risk of hypertension for overweight and 7 times higher odds for obese than normal-weight children. Children with TSFT >95th centile for US children showed three times risk and with TSFT from 85th to 95th double risk of hypertension. Higher WC and WHtR exhibited 1.5 times risk and larger Wrist 1.3 times higher risk of hypertension (P<0.001). Receiver operating curve (ROC) analysis provided age-gender specific cut offs for the five indices to detect the risk of high BP. Area under ROC curves (AUC) for five indices were similar and greater in older age groups indicating equal sensitivity and specificity. Conclusion: Using age- and gender-specific cutoffs for BMI, TSFT, WC or WHtR may offer putative markers for early detection of hypertension. CONCLUSION: Using age- and gender-specific cutoffs for BMI, TSFT, WC or WHtR may offer putative markers for early detection of hypertension.

Body fat reference percentiles on healthy affluent Indian children and adolescents to screen for adiposity.

BACKGROUND: Indian children and adolescents have higher body fat percentage at a given body mass index than their Western counterparts. OBJECTIVE: To create gender-specific percentile curves for total body fat percentage (TBFP), total body fat mass (TBFM), fat mass index (FMI) and android:gynoid (A:G) ratio for screening adiposity in healthy Indian children. METHODS: Data on body composition by dual-energy X-ray absorptiometry were obtained from a cross-sectional study conducted from May 2006-July 2010 on 888 (462 boys) apparently healthy children from affluent area schools and colleges in Pune city, India. Reference percentile curves were derived for boys and girls for TBFP, TBFM, FMI and A:G ratio. These percentile curves were validated using data on metabolic syndrome risk components in separate sample of 332 (148 boys) children. RESULTS: The median TBFP increased little (4%) from 5 to 18 years of age in boys compared with that in girls (19%). TBFP percentiles showed plateau after 13 years of age in boys, whereas a steady increase was seen till 18 years in girls. The median TBFM increased less (7 kg) from 5 to 18 years in boys compared with that in girls (13.4 kg). The curve for median FMI in boys was relatively flat with FMI remaining near 3 kg m(-2) after 13 years of age, whereas in girls median FMI increased with age till about 15 years of age. A:G ratio curves increased with age in both boys and girls up to 18 years of age. In a separate sample of 332 children, according to percentiles developed in the current study, children with TBFP/TBFM/FMI percentiles between 85th and 95th or >95th percentile had significantly higher metabolic risk parameters as compared with those with <85th percentile (P<0.05). CONCLUSIONS: Percentile curves developed in the current study would be useful in assessment of adiposity and thus cardiometabolic risk in Indian children.

Relationship between body mass index, fat distribution and cardiometabolic risk factors in Indian children and adolescents.

BACKGROUND: Studies assessing the relationship of BMI and BF with cardiometabolic (CM) risks in Indian children are scarce. OBJECTIVE: To assess the occurrence of cardiometabolic risk factors in Indian children and adolescents in relation to BMI and body fat and to study their association with body fat distribution. METHODS: 286 children and adolescents (mean age 11.2 ± 2.6 years, 139 boys) were recruited from routine health checks and schools. Anthropometry and blood pressure were recorded, total body fat (BF) and fat distribution (android and gynoid) were measured by Dual Energy X-ray Absorptiometry. Fasting plasma glucose, lipid profile and insulin were also measured. RESULTS: When the study cohort was divided as per their BMI and biochemical cardiometabolic risk factors, 8% children had normal BMI with abnormal biochemical parameters while 40% children had abnormal BMI but normal biochemical parameters. CONCLUSION: There are normal weight children with cardiometabolic risks. There was an increase in the occurrence of cardiometabolic risk factors with increased android distribution of fat (p-value < 0.05).

Body mass index cut-offs for screening for childhood overweight and obesity in Indian children.

OBJECTIVE: To develop age and sex specific cut offs for BMI to screen for overweight and obesity in Indian children linked to an adult BMI of 23 and 28 kg/m2 respectively, using contemporary Indian data. DESIGN: Cross-sectional. SETTING: Multicentric, School based. PARTICIPANTS: 19834 children were measured from 11 affluent schools from five major geographical regions of India. Data were analyzed using the LMS method, which constructs growth reference percentiles adjusted for skewness. RESULTS: Compared to the cut-offs suggested for European populations and those by the Indian Academy of Pediatrics 2007 Guidelines, the age and sex specific cut off points for body mass index for overweight and obesity for Indian children suggested by this study are lower. CONCLUSIONS: Contemporary cross-sectional age and sex specific BMI cut-offs for Indian children linked to Asian cut-offs of 23 and 28 kg/m2 for the assessment of risk of overweight and obesity, respectively are presented.

A pilot randomized controlled trial of oral calcium and vitamin D supplementation using fortified laddoos in underprivileged Indian toddlers.

BACKGROUND/OBJECTIVES: Low habitual dietary calcium intake and vitamin D deficiency are common among Indian children. Using 'laddoo', an Indian snack, as a vehicle for administering calcium and vitamin D supplements, a randomized double-blind controlled trial was conducted for 12 months to assess its efficacy on total body less head (TBLH) bone mineral content (BMC) in underprivileged toddlers. SUBJECTS/METHODS: A total of 60 toddlers (mean age 2.7±0.52 years, boys=31) were randomized to two groups, (i) study group receiving one calcium fortified laddoo (cereal-legume snack) containing 405 mg calcium per day and (ii) control receiving a non-fortified laddoo, containing 156 mg of indigenous calcium. Both groups also received a laddoo fortified with 30,000 IU of vitamin D(3) per month. Outcome measures included TBLH bone area (BA) and TBLH BMC by GE-Lunar DPX Pro Pencil Beam Dual-Energy X-ray absorptiometry. RESULTS: At baseline, mean energy, protein and calcium intakes were 71, 72 and 47% of Indian Recommended Dietary allowances. In all, 87 and 83% toddlers were hypocalcaemia and vitamin D deficient, respectively. Mean TBLH BMC was 289.5±45.8 g. Post supplementation, mean TBLH BMC of study group showed a significantly greater (P<0.01) increase of 35% as against 28% in controls and the difference remained significant after adjusting for vitamin D status, calcium intake, height and TBLH BA. CONCLUSIONS: Daily supplementation with calcium fortified laddoo, and monthly vitamin D supplement resulted in a significant increase in TBLH BMC of underprivileged toddlers. We believe that such strategies have the potential of addressing nutritional problems in developing countries.

Overweight and obesity prevalence and body mass index trends in Indian children.

OBJECTIVES: To estimate prevalence of overweight and obesity in apparently healthy children from five zones of India in the age group of 2 to 17 years and to examine trends in body mass index (BMI) during the last two decades with respect to published growth data. METHODS: A multicentric study was conducted in eleven affluent urban schools from five geographical zones of India. A total of 20 243 children (1 823 - central zone, 2 092 - east zone, 5 526 - north zone, 3 357 - south zone, and 7 445 - west zone) in the age group of 2-17 years were studied. Height and weight were measured and BMI was calculated (kg/m(2)). WHO Anthro plus was used to calculate Z-scores for height, weight and BMI. A comparison between study population and previously available nationally representative (1989) data was performed for each age-sex group. International Obesity Task Force (IOTF) and WHO cut-offs were used to calculate the percentage prevalence of overweight and obesity. RESULTS: The overall prevalence of overweight and obesity was 18.2% by the IOTF classification and 23.9% by the WHO standards. The prevalence of overweight and obesity was higher in boys than girls. Mean BMI values were significantly higher than those reported in the 1989 data from 5-17 years at all ages and for both sexes. CONCLUSION: The rising trend of BMI in Indian children and adolescents observed in this multicentric study rings alarm bells in terms of associated adverse health consequences in adulthood.

Growth performance of affluent Indian preschool children: a comparison with the new WHO growth standard.

This study was conducted to evaluate the nutritional status of 2-5 year old affluent, urban children using the new WHO 2006 standards. A cross-sectional, multicentric preschool-based study was conducted on 1493 children (727 boys). Mean Z scores for height, weight, body mass index and weight for height(-0.75(1.1), -0.59(1.1), -0.19(1.22) and -0.26(1.18), respectively) were below the WHO standard median.

Sunlight exposure and development of rickets in Indian toddlers.

OBJECTIVE: To study the role of sunlight exposure in determining the vitamin D status of underprivileged toddlers. METHODS: Height and weight were measured, clinical examination was performed, Food Frequency Questionnaire was administered and history of sunlight exposure was obtained in all (61) toddlers attending daytime crèche (Group B). Ionised calcium (iCa), inorganic Phosphorous (iP), alkaline phosphatase activity (ALP), serum parathyroid hormone (PTH) and 25 Hydroxy vitamin D (25OHD) were measured. Data were compared with results of a survey measuring similar parameters in 51 (of 251 eligible) toddlers from the same slum (Group A). RESULTS: 111 children (mean age 2.6 yr (0.7), boys 56) were studied. Prevalence of hypovitaminosis D was 77% in group B toddlers (46 of 60) and 16.4% (10 of 61) had rickets, while none of the group A toddlers had 25OHD levels below 30 nmol/L. Four children (7.8%) from Group A as against 24 (42.9%) from Group B, had sunshine exposure of < 30 minutes per day. CONCLUSION: Underprivileged toddlers who were deprived of sunlight had a much greater incidence of hypovitaminosis D and frank rickets. The study has important public health implications and underscores the necessity for sunlight exposure in young children.

Upflow anaerobic filter for the degradation of adsorbable organic halides (AOX) from bleach composite wastewater of pulp and paper industry.

The removal of AOX from bleach plant effluent of pulp and paper industry was studied using upflow anaerobic filter. In this paper biodegradation of AOX at different concentrations and effect of electron donors like acetate and glucose thereon in an upflow anaerobic filter at 20 d HRT is described. Results showed significant improvement in AOX degradation when electron donors such as acetate and glucose were supplemented to the influent. AOX degradation was 88% at 28 mg AOX L(-1) and 28% at 42 mg AOX L(-1). The percent degradation efficiency was enhanced to 90.7, 90.2, and 93.0 at 28 mg AOX L(-1) when the influent was supplemented with glucose, acetate and both glucose and acetate, respectively. Similarly, the efficiency was 57, 56.6 and 79.6 at 42 mg AOX L(-1) when the influent was supplemented with glucose, acetate and both glucose and acetate, respectively. The GC-MS analysis data indicated that supplementation of the influent with electron donor increased the biodegradability of number of chlorinated organic compounds.

Effect of microbial activities on stored raw buffalo hide.

'Keeping qualities' of hides are dependent on the total microbial flora associated with the hides and the biochemical changes brought about by these microorganisms during short-term storage at ambient temperature (28 +/- 2 degrees C). It was evident that within first 24 hr of hide's ambient storage, bacterial load was raised to 8.8 log cfu g(-1) hide from 6.1 log cfu g(-1) hide. Nonlinear parabolic increase in release of hydroxyproline and tyrosine from stored hide was observed starting from 0 hr and confirming proteolytic activities. Continuous release of CO2 from the stored hide suggested its mineralization. Exponential release of free fatty acids during storage indicated simultaneous lipolysis. Thus the process of biodegradation during the course of ambient storage of hide piece was found to progress steadily and seems to be interrelated as well as very complex. During the storage period, the liquefaction of hide piece was also observed visually within 96 hr. Present studies of assessment of bacterial activities on hide with respect to total bacterial load, release of amino acids, free fatty acids and evolved CO2 provide data that can be used to formulate and evaluate hide curing agent(s) other than salt, thus rendering leather industry a platform to design bio-based technologies for efficient and ecofriendly preservation of raw materials.

Changes in zinc uptake in response to ascorbic acid and folic acid in rat liver slices under normal and oxidative stress conditions.

Zinc plays a dual role, as an integral part of metabolic machinery and in defense against reactive oxygen species. Hepatocytes are important sites for zinc metabolism for synthesis of zinc metalloproteins and maintaining its homeostasis. However, the factors influencing post absorptive zinc metabolism under normal and oxidative stress (OS) conditions are not well understood. Using rat liver slices, we conducted a series of four in vitro zinc uptake experiments to study influence of ascorbic acid and folic acid in normal and oxidative stress conditions with Zn concentrations representing deficient to excess states (7.7-30.7 millimole/L). Zinc uptakes under OS at these four zinc levels were lower than the normal conditions. Folic acid showed significant inhibitory effect on zinc uptake under both normal and OS conditions in a dose response manner. Nevertheless, dose response of ascorbic acid at four zinc levels indicated its marked enhancing effect under OS condition. Differences in zinc uptake trend lines between the normal and OS conditions for interaction of both the vitamins narrowed down as the zinc levels increased. Our results suggest that folic acid causes inhibitory effect, while ascorbic acid may be protective in OS with reference to zinc uptake.

Are lifestyle factors good predictors of retinol and vitamin C deficiency in apparently healthy adults?

OBJECTIVE: To examine interrelationships between (1) dietary habits, (2) socioeconomic and (3) environmental factors, and their impact on plasma retinol and plasma ascorbic acid. DESIGN: Cross-sectional study on adults from Western India. SETTING: Rural, semi urban, urban higher/middle/lower socioeconomic regions (HSE/MSE/LSE) having diverse dietary habits and environmental conditions. SUBJECTS: A total of 214 men and 108 women (20-50 y), apparently healthy and non-anemic. MAIN OUTCOME MEASURES: Food intake by food frequency questionnaire, weight, height, age, smoking, environmental score, education, income, plasma retinol and plasma ascorbic acid. RESULTS: Mean plasma retinol in women (24.84+/-5.1 microg/dl) and men (24.75+/-4.53 microg/dl) were not significantly different and 21% had plasma retinol below 20 microg/dl. Mean plasma ascorbic acid in women (0.35+/-0.12 mg/dl) and men (0.30+/-0.12 mg/dl) was similar with 75% having plasma ascorbic acid below 0.4 mg/dl. Vitamin A intake (as retinol equivalent) and plasma retinol showed a significant dose response (P<0.05) but not vitamin C intake and plasma ascorbic acid. Plasma retinol showed significant correlation with income (rho=0.24), education (rho=0.27), and environment (rho=0.21; rho=0.0001). Similar correlations with plasma ascorbic acid were 0.29, 031, -0.23 respectively (P=0.0001). Logistic regression showed education, environment, green leafy vegetables (GLV) and milk intake as predictors of plasma retinol deficiency, while non-sweet fruit intake, education and passive smoking for plasma ascorbic acid deficiency (P<0.05). CONCLUSIONS: Subnormal status of retinol and vitamin C emphasizes the need to increase consumption of fruit, GLV and milk products, and also better education and environment. Avoiding passive smoking demands attention in order to improve levels of these vitamins. SPONSORSHIP: Department of Science and Technology, India (project no. SP/SO/B39/94).

In vitro dialyzability using meal approach as an index for zinc and iron absorption in humans.

With a standardized protocol under simulated gastrointestinal conditions, 65Zn and 59Fe dialyzability was measured for 38 diets from 7 different published studies on human absorption. The compositions of these diets were available in the form of the amounts of food ingredients used for breakfast, lunch, and dinner. Considering each of these types as a separate meal, percent dialyzability was measured. The weighted average of breakfast, lunch, dinner, and snacks, if any, was taken to represent the entire day's bioavailability. The correlation between in vitro percent dialyzability and reported human absorption was 0.92 for zinc and 0.96 for iron and both were statistically significant (p = 0.0001). The prediction equations for zinc and iron were obtained as y = -0.7718 + 1.1038x and y = 0.3197 + 0.9084x, respectively. This indicated that in vitro dialyzability using the meal approach can be used as an index with good discriminating power for different levels of human absorption.

Comparative performance of pearl millet- and sorghum- based diets vs. wheat- and rice-based diets for trace metal bioavailability.

Pearl millet and sorghum offer a cheap source of energy compared to wheat and rice and are widely consumed by rural communities in many parts of the world. Due to the low consumption of vegetables and animal foods, millets also are the major suppliers of micronutrients especially for low-income groups. It is of prime importance to study how millets perform in terms of bioavailable contents of trace metals. Investigations were carried out using weanling mice which offer a model for the initial testing of bioavailability of trace metals before human trials. Four isocaloric diets differing only in the type of cereal, i.e. pearl millet, sorghum, wheat and rice, were prepared representing habitual dietary patterns observed by National Nutrition Monitoring Bureau (NNMB) of India. Mice were allocated randomly to 4 groups of 8 mice each, and housed individually in metal free metabolic cages. A fifth group of 8 mice fed a balanced synthetic diet served as control. All the groups were fed ad libitum. The absorption of zinc and iron averaged for 3 periods of 5 days each was significantly higher for the wheat and pearl millet group than for the other 2 experimental groups (p < 0.05), as were also the levels of liver zinc and iron. The weight gain was also highest (6.9 +/- 1.2 g) in the pearl millet group as compared to sorghum (1.58 +/- 0.59 g), wheat (1.66 +/- 1.27 g) and rice (-0.72 +/- 0.62 g) groups. The levels of liver copper were comparable in all the 5 groups. These results further confirm our earlier in vitro results indicating the superiority of pearl millet but not sorghum in bioavailability of zinc and iron.

Effect of riboflavin supplementation on zinc and iron absorption and growth performance in mice.

Diets prevalent in vegetarian populations using rice and other whole grains as staples with little consumption of yellow vegetables are low in riboflavin. These diets have poor bioavailability of iron and zinc because metals are present as inorganic salts with low solubility. Riboflavin has the capacity to form complexes, and supplementation of riboflavin may result in increased absorption of zinc and iron, thus increasing the cellular transport. Therefore, riboflavin may have direct as well as indirect effects on growth. Using this as the conceptual basis, experiments were conducted on pregnant and lactating mice. Two groups, each of 12 mice (9 females and 3 males), were observed on a low-riboflavin rice-based diet (adequate in all other nutrients), one with and one without supplementation of 10 mg riboflavin/kg diet. There was significant improvement in the growth parameters like percent conception, mean weight gain in pregnancy, mean weight of pups at the age of 21 d, and percentage hemoglobin due to riboflavin supplementation (p < 0.05). Percent zinc absorption, for the low-riboflavin diet, the supplemented diet, and the synthetic control diet were 16.4+/-5.7, 33.7+/-8.9, and 44.6+/-4.0, respectively, indicating the beneficial effect of riboflavin supplementation on iron and zinc utilization.

Inactivation of Salmonella typhi by high levels of volatile fatty acids during anaerobic digestion.

Survival of Salmonella typhi was investigated in an anaerobic digester for cattle dung with volatile fatty acid (VFA) levels of 5000 mg l(-1) and pH 6.0. The organism was added to the digester only once in the first experiment and daily in the other. Survival was monitored on alternate days. In the single dose experiment, the counts of Salm. typhi declined rapidly and the pathogen was completely eliminated within 12 d in the experimental digester (VFA ca 5000 mg l(-1) and pH 6.0), whereas 26 d were required in the control digester (VFA ca 100 mg l(-1) and pH 6.8). T90 values for the experimental and control digesters were 2.44 d and 4.80 d, respectively. In the daily dose experiment, a four log reduction in the pathogen count was observed in the experimental digester, but only a two log reduction in the control digester at the end of the experimental period. The mean T90 values for the experimental and the control digester were 4.22 d and 18.63 d, respectively. In both the experiments, statistical analysis of the data showed significant differences in the survival pattern of Salm. typhi in the two digesters.

Effect of nicotinic acid on zinc and iron metabolism.

Nicotinic acid has functional groups capable of forming complexes with trace metals. The present study examines the effect of nicotinic acid supplementation on absorption and utilization of zinc and iron. In vitro zinc uptake by human erythrocytes was studied using blood samples of 10 healthy subjects. It was found that 8 mumoles nicotinic acid or NADP increased 65Zn uptake by 38.9% and 43.1% in fasting, and by 70.9% and 28.1% in postprandial conditions. In animal experiments, nicotinic acid supplementation to finger millet based diet resulted in significant enhancement of percent zinc absorption, liver zinc and growth of weanling mice (P < 0.05). When mice were fed with nicotinic acid-deficient, -adequate and -excess synthetic diets for four weeks it was observed that, in comparison with the nicotinic acid-deficient diet, percent zinc absorption, intestinal zinc, percent haeomoglobin and liver iron increased significantly under nicotinic acid-adequate and -excess conditions. The results obtained suggested that nicotinic acid, in addition to its known effect on growth and metabolism, may be playing an important role in enhancing zinc and iron utilization.

Assessment of pearl millet vs rice based diets for bioavailability of four trace metals.

Cereals including millets are consumed in India as a staple with wide variety of pulses and vegetables in varying proportions. Trace mineral contents of pearl millet are two to ten times higher than that of rice. Comparative performance of pearl millet based (PM) diets as against rice based (RB) diets in terms of trace mineral bioavailability was studied, based on the prevailing dietary patterns in India. In vitro percent dialysability of zinc, iron, copper and manganese under simulated gastrointestinal conditions was considered as indicator of metal bioavailability. Dialysable zinc and iron were estimated using 65 Zn and 59 Fe as tracers, while dialysable copper and manganese were measured by Atomic absorption spectrophotometer for 20 food items and 15 RB and 17 PM diets prepared from these items. Results indicated that percent dialysability of zinc and copper was higher for RB diets than PM diets, while that of iron and manganese were comparable. Total dialysable iron, copper and manganese in PM diet was 2 to 4 times higher than RB diet.

Zinc, copper & iron contents in cooked foods & estimates of their daily intakes in young hostel residents.

Dietary zinc, copper and iron intakes of 19 men and 11 women (aged 18-25 yr) were determined during three periods of five consecutive days each, using, weighment method and atomic absorption analysis of food samples. Daily zinc, copper and iron intakes of men ranged from 13.1 +/- 1.2 to 15.3 +/- 1.4 mg/d, 1.62 +/- 0.15 to 1.84 +/- 0.17 mg/d and 20.5 +/- 2.8 to 29.1 +/- 4.5 mg/d and of women 8.8 +/- 2.0 to 9.0 +/- 1.6, 1.42 +/- 0.23 to 1.69 +/- 0.62, and 10.0 +/- 2.4 to 14.7 +/- 2.6 mg/d respectively. Cereals provided 67.7 per cent of dietary zinc, 47.7 per cent copper and 62 per cent iron in men and 60 per cent of Zn, 44 per cent of Cu and 59 per cent of Fe in women, suggesting lower contribution of cereals to Cu intakes than Zn and Fe. Men had mineral intakes close to the recommended allowances for Indians, whereas the intakes of women were 30 to 60 per cent lower. When expressed as mg/1000 kcal, lower calorie intakes of women were responsible for their low mineral intakes. Intra-individual variation in mineral intakes was higher (18.39%) than that of energy intakes (14-17%) in both men and women. Phytate: Zn molar ratios were > 15 indicating risk of zinc deficiency in these students.