A randomized trial of iron- and zinc-biofortified pearl millet-based complementary feeding in children aged 12 to 18 months living in urban slums.

BACKGROUND & AIMS: Biofortification of staple crops with higher levels of micronutrients via traditional breeding methods is a sustainable strategy and can possibly complement fortification and other interventions to target micronutrient deficiencies in low resource settings, particularly among vulnerable populations such as children. We aimed to determine if iron- and zinc-biofortified pearl millet (FeZnPM, Dhanashakti, ICTP-8203Fe)-based complementary feeding improves nutritional status, including iron biomarkers and growth, in children living in urban slums of Mumbai. METHODS: We conducted a randomized controlled trial of FeZnPM among 223 children aged 12-18 months who were not severely anemic at baseline (hemoglobin ≥9.0 g/dL). Children were randomized to receive either FeZnPM or conventional non-biofortified pearl millet (CPM) daily for 9 months. Iron status (hemoglobin, serum ferritin), plasma zinc, and anthropometric indicators (length, weight, mid-upper arm circumference, triceps and subscapular skinfolds) were evaluated at enrollment and throughout the trial. World Health Organization (WHO) anthropometric z-scores were calculated using WHO growth standards. Primary outcomes were hemoglobin and serum ferritin concentrations, and growth, defined as WHO z-scores. An intent to treat approach was used for analyses. We used the Hodges-Lehmann-Sen test to assess the change in primary outcomes between baseline and the last visit and report corresponding 95% confidence intervals. RESULTS: At baseline, 67.7% of children were anemic (hemoglobin <11.0 g/dL) and 59.6% were iron deficient (serum ferritin <12.0 µg/L). FeZnPM did not significantly increase iron biomarkers or improve growth, compared to CPM. In subgroup analyses, FeZnPM improved hemoglobin concentrations in male children, and in children with iron deficiency or iron depletion (serum ferritin <25.0 µg/L) at baseline, relative to CPM. CONCLUSIONS: Daily consumption of FeZnPM-based complementary foods did not significantly impact iron and zinc status or growth in children living in Mumbai's urban slums. However, the intervention significantly improved hemoglobin concentrations among male children and among individuals who were iron-deficient or iron-depleted at baseline. TRIAL REGISTRATION: This trial is registered with Clinicaltrials.gov (ID: NCT02233764), and Clinical Trials Registry of India (ID: REF/2014/10/007731).

Sustainability of integrated anaemia prevention activities implemented through non-government organizations and schools, and its effect on haemoglobin status of adolescent girls in urban slums of Pune, in Maharashtra, India.

BACKGROUND: Programmes for the prevention of iron deficiency anaemia among adolescent girls need sustainable inputs for maximum benefits. AIM: To assess the interventions sustained for anaemia prevention implemented through NGOs and schools. METHODS: An intervention study followed longitudinally in three phases. Phase I comprised (a) needs assessment of the community and (b) capacity assessment of service providers through a cross-sectional survey in nine slums, through six NGOs and three schools. Based on needs assessment, an integrated intervention for anaemia prevention was provided for adolescent girls (n = 384) in the community. To ensure sustainability the capacity of stakeholders (n = 67) was built by providing training in the components of the integrated intervention and establishing linkages with the public health system. Refresher training was conducted during phase II (n = 69) for reinforcing and strengthening of activities introduced in phase I. In phase II and III continuations of activities by the NGOs and schools that were initiated in phase I were monitored. Sustainability of activities was measured using an index that comprised technical, programmatic, social, and financial indicators. The impact of sustained interventions was assessed by comparing the mean rank haemoglobin concentrations of centres with varying levels of coverage. RESULTS: Scores of sustainability indicators decreased from phase II to phase III. Organizations that showed > 50% coverage showed significantly higher mean rank haemoglobin (p = < 0.05) during phases II and III. CONCLUSION: There is a need to identify and address barriers that prevent sustainable interventions for anaemia control.

Iron-biofortified pearl millet consumption increases physical activity in Indian adolescent schoolchildren after a 6-month randomised feeding trial.

Fe deficiency has negative effects on voluntary physical activity (PA); however, the impact of consuming Fe-biofortified staple foods on voluntary PA remains unclear. This study compared the effects of consuming Fe-biofortified pearl millet or a conventional pearl millet on measures of voluntary PA in Indian schoolchildren (ages 12-16 years) during a 6-month randomised controlled feeding trial. PA data were collected from 130 children using Actigraph GT3X accelerometers for 6 d at baseline and endline. Minutes spent in light and in moderate-to-vigorous PA were calculated from accelerometer counts using Crouter's refined two-regression model for children. Mixed regression models adjusting for covariates were used to assess relationships between intervention treatment or change in Fe status and PA. Children who consumed Fe-biofortified pearl millet performed 22·3 (95 % CI 1·8, 42·8, P = 0·034) more minutes of light PA each day compared with conventional pearl millet. There was no effect of treatment on moderate-to-vigorous PA. The amount of Fe consumed from pearl millet was related to minutes spent in light PA (estimate 3·4 min/mg Fe (95 % CI 0·3, 6·5, P = 0·031)) and inversely related to daily sedentary minutes (estimate -5·4 min/mg Fe (95 % CI -9·9, -0·9, P = 0·020)). Consuming Fe-biofortified pearl millet increased light PA and decreased sedentary time in Indian schoolchildren in a dose-dependent manner.

Nutrition and the Gut Microbiota in 10- to 18-Month-Old Children Living in Urban Slums of Mumbai, India.

In this cross-sectional study, we describe the composition and diversity of the gut microbiota among undernourished children living in urban slums of Mumbai, India, and determine how nutritional status, including anthropometric measurements, dietary intakes from complementary foods, feeding practices, and micronutrient concentrations, is associated with their gut microbiota. We collected rectal swabs from children aged 10 to 18 months living in urban slums of Mumbai participating in a randomized controlled feeding trial and conducted 16S rRNA sequencing to determine the composition of the gut microbiota. Across the study cohort, Proteobacteria dominated the gut microbiota at over 80% relative abundance, with Actinobacteria representation at <4%, suggesting immaturity of the gut. Increased microbial α-diversity was associated with current breastfeeding, greater head circumference, higher fat intake, and lower hemoglobin concentration and weight-for-length Z-score. In redundancy analyses, 47% of the variation in Faith's phylogenetic diversity (Faith's PD) could be accounted for by age and by iron and polyunsaturated fatty acid intakes. Differences in community structure (ß-diversity) of the microbiota were observed among those consuming fats and oils the previous day compared to those not consuming fats and oils the previous day. Our findings suggest that growth, diet, and feeding practices are associated with gut microbiota metrics in undernourished children, whose gut microbiota were comprised mainly of Proteobacteria, a phylum containing many potentially pathogenic taxa.IMPORTANCE The impact of comprehensive nutritional status, defined as growth, nutritional blood biomarkers, dietary intakes, and feeding practices, on the gut microbiome in children living in low-resource settings has remained underreported in microbiome research. Among undernourished children living in urban slums of Mumbai, India, we observed a high relative abundance of Proteobacteria, a phylum including many potentially pathogenic species similar to the composition in preterm infants, suggesting immaturity of the gut, or potentially a high inflammatory burden. We found head circumference, fat and iron intake, and current breastfeeding were positively associated with microbial diversity, while hemoglobin and weight for length were associated with lower diversity. Findings suggest that examining comprehensive nutrition is critical to gain more understanding of how nutrition and the gut microbiota are linked, particularly in vulnerable populations such as children in urban slum settings.

Anthropometry, body fat and central adiposity in LBW and NBW Indian children aged 3.5 to 4 years.

BACKGROUND: India has a high prevalence of low birth weight. Evidence indicates that poor fetal growth and rapid postnatal weight gain are associated with adiposity. OBJECTIVES: (i) To study the differences between the anthropometry, body fat measures of LBW and NBW children and (ii) To find out if there is any relationship between birth weight, change in weight SD and body fat measures of these children. STUDY DESIGN: Cross-sectional study. SUBJECTS: We studied 396 children aged between 3.5 and 4 years who were beneficiaries of government-run anganwadis in urban slums of Mumbai city, India. OUTCOME MEASURES: Birth weight, current weight, height, skinfold thicknesses and waist circumference. Change in weight SD and body fat (%) were calculated. WHOAnthro was used to compute the z scores. Parent's education, income and breastfeeding history was recorded. RESULTS: The mean change in weight SD of LBW and NBW groups were 1.01 ±â€¯1.4 and -0.73 ±â€¯1.13 respectively (p < 0.001). LBW children were lighter and shorter than NBW ones but had similar body fat (%) and central adiposity measures. In LBW and NBW children, birth weight Z score and change in weight SD were positively related to body fat (%) and waist circumference. CONCLUSION: Children in this study belonged to low socioeconomic section. Despite this, LBW displayed a tendency towards accumulating body fat particularly, abdominal fat for lower body weight. Birth weight and postnatal weight change predict body fat and waist circumference in LBW and NBW children.

Prevalence and Correlates of Undernutrition in Young Children Living in Urban Slums of Mumbai, India: A Cross Sectional Study.

Background: Young children living in urban slums are vulnerable to malnutrition and subsequently poor health outcomes, but data on the correlates of stunting, underweight, wasting, and anemia specifically among 10-18 month-old children in India remain limited. Objective: In this analysis, we sought to describe the prevalence of and examine correlates for different markers of undernutrition, including stunting, underweight, and anemia among 10-18 month-old children living in urban slums, an understudied vulnerable group. Methods: Children and their mothers (n = 323) were screened for anthropometry, demographics, and complete blood counts for hemoglobin concentration between March and November 2017 (Clinicaltrials.gov ID: NCT02233764). Correlates included child and mother's age, sex, birth order, birth weight, illness episodes, hemoglobin concentration, family income, maternal height, and maternal education level. Risk ratios (RR, 95% CI) for binary outcomes (stunting, underweight, wasting and anemia) and mean differences (ß, 95% CI) for continuous outcomes (anthropometric Z-scores, hemoglobin concentration) were calculated using multivariate binomial and linear regression (SAS 9.4). Results: The prevalence of stunting was 31.2%, underweight 25.1%, wasting (9.0%), and anemia (76%) among all children. Male children had a higher prevalence of poor growth indices and lower anthropometric Z-scores than females. Male sex, low birthweight, shorter maternal height, report of ≥1 episodes of illness within the past month, older maternal age, and birth order ≥2 were also associated with poor growth and anemia in multivariate models. Correlates of undernutrition were different among females and males. Female children had a 40% (20, 60%) higher risk of anemia associated with diarrhea, and male children who were firstborn had a 20% (0, 70%) lower risk of anemia. Conclusions: These results show that poor growth and anemia among young children is prevalent in urban slums of Mumbai, and that sex of the child may play an important role in informing interventions to address undernutrition.

Corrigendum: Acceptability of Iron- and Zinc-Biofortified Pearl Millet (ICTP-8203)-Based Complementary Foods among Children in an Urban Slum of Mumbai, India.

[This corrects the article DOI: 10.3389/fnut.2017.00039.].

Cognitive Performance in Indian School-Going Adolescents Is Positively Affected by Consumption of Iron-Biofortified Pearl Millet: A 6-Month Randomized Controlled Efficacy Trial.

BACKGROUND: Iron deficiency remains the most prevalent micronutrient deficiency globally, but few studies have examined how iron status relates to cognition in adolescents. Iron biofortification of staple food crops is being scaled up, yet it is unknown whether consuming biofortified crops can benefit cognition. Objective: Our objective was to determine the efficacy of iron-biofortified pearl millet in improving attention and memory in Indian school-going adolescents. Methods: A double-blind, randomized, intervention study was conducted in 140 Indian boys and girls, aged 12-16 y, who were assigned to consume iron-biofortified [Fe = 86 parts per million (ppm)] or conventional (Fe = 21-52 ppm) pearl millet. Hemoglobin, ferritin, and transferrin receptor (TfR) were measured and body iron (BI) was calculated at baseline and after 4 and 6 mo. Five measures of cognitive function were obtained at baseline and 6 mo: simple reaction time (SRT), Go/No-Go (GNG) task, Attentional Network Task (ANT), Composite Face Effect (CFE) task, and Cued Recognition Task (CRT). Intention-to-treat analysis was used. Results: Daily iron intake from pearl millet was higher in those consuming biofortified compared with conventional pearl millet (19.6 compared with 4.8 mg/d). Effects on ferritin, TfR, and BI at 4 mo, and on TfR at 6 mo (all P < 0.05), indicated efficacy of biofortified pearl millet over conventional pearl millet in improving iron status. Compared with conventional pearl millet, the consumption of biofortified pearl millet resulted in greater improvement in attention (SRT, GNG, and ANT) and memory (CFE and CRT). Reaction time decreased twice as much from 0 to 6 mo in those consuming biofortified compared with conventional pearl millet on attention tasks (SRT: -123 compared with -63 ms; GNG: -67 compared with -30 ms; ANT double cue: -74 compared with -32 ms; all P < 0.01). Conclusion: Consuming iron-biofortified pearl millet improves iron status and some measures of cognitive performance in Indian adolescents. This trial was registered at http://www.clinicaltrials.gov as NCT02152150.

Effect of iron and zinc-biofortified pearl millet consumption on growth and immune competence in children aged 12-18 months in India: study protocol for a randomised controlled trial.

INTRODUCTION: Biofortified crops represent a sustainable agricultural solution for the widespread micronutrient malnutrition in India and other resource-limited settings. This study aims to investigate the effect of the consumption of foods prepared with iron- and zinc-biofortified pearl millet (FeZn-PM) by children on biomarkers of iron and zinc status, growth, and immune function. METHODS AND ANALYSIS: We will conduct a randomised controlled feeding trial in identified slums of Mumbai, India among 200 children aged between 12 and 18 months. Children will be randomised to receive foods prepared with the biofortified PM (FeZn-PM, ICTP8203-Fe) or non-biofortified PM. Anthropometric and morbidity data will be gathered every month for 9 months. Biological samples will be collected at baseline, midline and endline to assess iron and zinc status, including haemoglobin, serum ferritin, serum transferrin receptor, serum zinc, C-reactive protein and alpha-1 acid glycoprotein. Biological samples will be archived for future analyses. The midline measurement will be a random serial sample between baseline and endline. Immune function will be assessed at each time point by the measurement of T cell counts and vaccine responses in a subset, respectively. ETHICS AND DISSEMINATION: This study has obtained clearance from the Health Ministry Screening Committee of the Indian Council of Medical Research. Ethical clearance has been obtained from Cornell University's Institutional Review Board, the Inter System Biomedica Ethics Committee and St John's Research Institute's Institutional Ethics Review Board. The results of this study will be disseminated at several research conferences and as published articles in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Clinical trial registration number NCT02233764. CTRI registration number REF/2014/10/007731.

Nutritional Status and Physical Fitness of Tribal Adolescents in Ahmednagar District of Maharashtra.

We examined the influence of nutritional status, body fat, and anemia on the physical fitness (PFI) of tribal adolescents. Weight, height, skinfold thickness, PFI, and hemoglobin levels of 147 adolescents (11 to 16 years) were measured. The experience of cycling was recorded. Overall, 31.3% were mildly, 12.9% were moderately, and 10.9% were severely thin. The majority (81.6%) were nonanemic. All had "poor" PFI scores. Hemoglobin levels were significantly associated with PFI scores in boys and girls. Experience of cycling also predicted PFI in girls. Nutritional status, hemoglobin level, and physical activity were associated with the fitness levels of these adolescents.

Acceptability of Iron- and Zinc-Biofortified Pearl Millet (Dhanashakti)-Based [corrected] Complementary Foods among Children in an Urban Slum of Mumbai, India.

Biofortification, a method for increasing micronutrient content of staple crops, is a promising strategy for combating major global health problems, such as iron and zinc deficiency. We examined the acceptability of recipes prepared using iron- and zinc-biofortified pearl millet (FeZnPM) (~80 ppm Fe, ~34 ppm Zn, varietal Dhanashakti), [corrected] compared to conventional pearl millet (CPM) (~20 ppm Fe, ~19 ppm Zn) in preparation for an efficacy trial. Our objective was to examine the acceptability of FeZnPM compared to CPM among young children and mothers living in the urban slums of Mumbai. Standardized traditional feeding program recipes (n = 18) were prepared with either FeZnPM or CPM flour. The weight (g) of each food product was measured before and after consumption by children (n = 125) and the average grams consumed over a 3-day period were recorded. Mothers (n = 60) rated recipes using a 9-point hedonic scale. Mean intakes and hedonic scores of each food product were compared using t-tests across the two types of pearl millet. There were no statistically significant differences in consumption by children (FeZnPM: 25.27 ± 13.0 g; CPM: 21.72 ± 6.90 g) across the food products (P = 0.28). Overall mean hedonic scores for all recipes were between 7 to 9 points. CPM products were rated higher overall (8.22 ± 0.28) compared to FeZnPM products (7.95 ± 0.35) (P = 0.01). FeZnPM and CPM were similarly consumed and had high hedonic scores, demonstrating high acceptability in this population. These results support using these varieties of pearl millet in a proposed trial [http://Clinicaltrials.gov ID: NCT02233764; Clinical Trials Registry of India (CTRI), reference number REF/2014/10/007731, CTRI number CTRI/2015/11/006376] testing the efficacy of FeZnPM for improving iron status and growth.

Is lack of breakfast contributing to nutrient deficits and poor nutritional indicators among adolescent girls?

BACKGROUND: Breakfast is considered the first and most important meal of the day. Missing the first meal may result in significant nutritional deficits, if not compensated in subsequent meals. AIM: To describe the nutrient intake through breakfast and to study its association with nutritional indicators among adolescent girls. METHODS: A cross-sectional study among adolescent girls ( n = 565) 16-18 years was carried out in urban slums of Pune, Maharashtra, India. Haemoglobin was assessed by cyanmethemoglobin method. Nutritional status was assessed through anthropometry and three 24-hours diet recall. Z scores, independent sample test, and linear logistic regression were used to assess undernutrition, to compare means of nutrient intake and to associate nutrient intake with nutritional status, respectively. RESULTS: Almost 50% did not consume solid food for breakfast and 99% of the participants consumed inadequate breakfast (<610 kcal). Two types of breakfast emerged: I (bakery products + beverage) and II (traditional breakfast + beverage). Although the mean energy intake of type II breakfast (235±100.55 kcal) and the mean micronutrient intake was significantly higher than type I (micronutrients: vitamin C and folate ( p = 0.001), iron ( p = 0.01)) it did not meet the adequacy norms for breakfast. Among nutritional indicators breakfast intake was not directly associated with body mass index. However, mean intake of nutrients such as energy, protein and iron through the day were significantly lesser ( p = 0.001, p = 0.01 and p = 0.01 respectively) among anaemic adolescents. Linear regression showed significant association between energy, fat intake and BAZ scores. CONCLUSIONS: Compensating dietary deficits that arise in the first meal would directly address the day's nutrient deficit. The results highlight the need for a food-based approach to address undernutrition among adolescent girls in resource-poor settings.

BMI, body fat and waist-to-height ratio of stunted v. non-stunted Indian children: a case-control study.

OBJECTIVE: To compare the BMI, body fat and waist-to-height ratio (WHtR) of stunted and non-stunted children following different growth trajectories from low socio-economic strata in Mumbai, India. DESIGN: Cross-sectional, case-control study. Weight, height, skinfold thicknesses and waist circumference were measured. Information regarding the duration of breast-feeding, age at initiation of complementary feeding and income was obtained. Birth weight was obtained from records. BMI, body fat, WHtR and change in weight sd were calculated. SETTING: Children who were beneficiaries of anganwadis, Mumbai city, India. SUBJECTS: Three hundred and thirty children aged 2-4 years were selected in each of the stunted and non-stunted groups after matching for age and sex. RESULTS: After adjusting for birth weight, change in weight sd, duration of breast-feeding, age at complementary feeding initiation and income, stunted children had significantly higher body fat, WHtR and BMI than the non-stunted (P<0·01). The stunted and non-stunted children were classified based on their change in weight sd. Stunted children with no change in weight sd had higher mean body fat, BMI (P<0·01) and WHtR (P<0·05) than their non-stunted counterparts. In the catch-up growth group, stunted children had higher BMI and WHtR than the non-stunted (both P<0·001). In the catch-down growth group, stunted children had higher BMI than the non-stunted (P<0·001). CONCLUSIONS: Stunting was seen to increase the tendency of conserving body fat in young children. Such a tendency, if continued during later childhood and adolescence, can increase the risk of obesity and non-communicable diseases.

A Randomized Trial of Iron-Biofortified Pearl Millet in School Children in India.

BACKGROUND: Iron deficiency is the most widespread nutritional deficiency in the world. OBJECTIVE: The objective of this randomized efficacy trial was to determine the effects of iron-biofortified pearl millet (Fe-PM) on iron status compared with control pearl millet (Control-PM). METHODS: A randomized trial of biofortified pearl millet (Pennisetum glaucum), bred to enhance iron content, was conducted in 246 children (12-16 y) for 6 mo in Maharashtra, India. Iron status [hemoglobin, serum ferritin (SF), soluble transferrin receptor (sTfR), and total body iron (TBI)], inflammation (C-reactive protein and α-1 acid glycoprotein), and anthropometric indices were evaluated at enrollment and after 4 and 6 mo. Hodges-Lehmann-Sen 95% CIs were used to examine the effect of the Fe-PM on iron status compared with commercially available Control-PM. Linear and binomial regression models were used to evaluate the effects of Fe-PM on iron status and incidence of anemia and iron deficiency, compared with Control-PM. RESULTS: At baseline, 41% of children were iron deficient (SF <15 µg/L) and 28% were anemic (hemoglobin <12.0 g/dL). Fe-PM significantly increased SF concentrations and TBI after 4 mo compared with Control-PM. Among children who were iron deficient at baseline, those who received Fe-PM were 1.64 times more likely to become iron replete by 6 mo than were those receiving Control-PM (RR: 1.64, 95% CI: 1.07, 2.49, P = 0.02). The effects of Fe-PM on iron status were greater among children who were iron deficient at baseline than among children who were not iron deficient at baseline. CONCLUSIONS: Fe-PM significantly improved iron status in children by 4 mo compared with Control-PM. This study demonstrated that feeding Fe-PM is an efficacious approach to improve iron status in school-age children and it should be further evaluated for effectiveness in a broader population context. This trial was registered at clinicaltrials.gov as NCT02152150.

Folate status and intake of tribal Indian adolescents aged 10 to 17 years.

BACKGROUND: Adequate folate intake and levels are advisable throughout life but are of particular importance during adolescence, a period of rapid growth. However, folate insufficiency in economically deprived Indian adolescents is understudied. OBJECTIVE: This cross-sectional study examined the prevalence of folate deficiency and adequacy of folate intake of 224 tribal Indian adolescents (10 to 17 years of age). The secondary aim was to study the association between anemia status and folate status. METHODS: Radioimmunoassay, multiple-pass 24-hour dietary recall, and HemoCue were used to measure red blood cell (RBC) folate, folate intake, and anemia status, respectively. RESULTS: The geometric mean (95% CI) RBC folate concentration (nmol/L) was 360.2 (329.7 to 393.6), and the mean ± SD folate intake (µg/day) and hemoglobin level (g/L) were 159.9 ± 44.7 and 125.4 ± 13.0, respectively. Almost half of boys and girls aged 10 to 12 and 13 to 15 years and 66.7% of girls aged 16 to 17 years were deficient in RBCfolate (< 340 nmol/L). The mean ± SD folate intake (µg/day) of girls (139.4 ± 34.5) was lower than that of boys (173.8 ± 45.5) (p < .001). With respect to adequacy of folate intake, a greater proportion of girls in the age group of 13-15 years (78.5% vs 38.6%, p < 0.001) and 16-17 years (100.0% vs 76.9%, p = 0.04) had intakes below their Recommended Dietary Allowance (RDA). No association was observed between folate intake and RBC folate deficiency or between anemia status and RBC folate deficiency. CONCLUSIONS: Folate insufficiency was widespread in tribal Indian adolescents. There is an urgent need to develop culturally sensitive strategies for improvement.

Magnitude of undernutrition in children aged 2 to 4 years using CIAF and conventional indices in the slums of Mumbai city.

Conventional indicators - weight-for-age, height-for-age, weight-for-height and mid-upper arm circumference (MUAC) reflect different facets of the nutritional status. Weight-for-age is the most commonly used indicator. When used individually or in combination, conventional indices fail to depict the overall magnitude of undernutrition in the population. Composite Index of Anthropometric Failure (CIAF) is an alternative classification system which attempts to fill this lacuna. Thus, we undertook this study with the objective to compare the prevalence of undernutrition using CIAF and the conventional indices. We included 634 children aged between 2 to 4 years from anganwadis located in three areas of Mumbai. Weight, height and MUAC measurements were taken. Z scores were computed for weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) using WHO Anthro software. Children were classified as per the conventional indices and CIAF. The prevalence of underweight, stunting and wasting was 35.7%, 33.8% and 18.5% respectively. None of the children had MUAC < 11.5 cm. About 1% of the children were moderately wasted according to MUAC. As per CIAF, 47.8% children were undernourished. According to CIAF, one-third of the undernourished children had single anthropometric failure while half of them had dual failure and 17.1% had multiple failures. When compared with the conventional indices, CIAF could recognize 12.1%, 14.0%, 29.3% and 46.7% more undernourished children than WAZ, HAZ, WHZ and MUAC respectively. In conclusion, CIAF is seen to have many advantages over the conventional indices. CIAF is useful in assessing the overall magnitude of undernutrition and identifying children with multiple anthropometric failures. It also recognizes more undernourished children than all the conventional indices. Therefore, CIAF should be used more widely as a tool for nutritional assessment particularly in developing countries where the burden of undernutrition is high.

Widespread 25-hydroxyvitamin D deficiency in affluent and nonaffluent pregnant Indian women.

OBJECTIVES: This cross-sectional study primarily aimed to assess vitamin D adequacy in the third trimester of pregnancy using 25-hydroxyvitamin D (25(OH)D) and explore lifestyle characteristics (sun exposure index, diet, and economic indicators) associated with serum 25(OH)D. The secondary aim was to examine the relationship of serum 25(OH)D with birth weight and gestational age. METHODS: Serum 25(OH)D was measured by chemiluminescent immunoassay in 150 pregnant women from Mumbai. Sun exposure index was computed. Dietary calcium, phytate : calcium ratio, and dietary phosphorus was calculated using the 24-hour diet recall method. RESULTS: All women had 25(OH)D levels < 30.00 ng/ml. Multivariable linear regression showed that nonaffluent women had poorer 25(OH)D status than their affluent counterparts (ß = -0.20; P = 0.03). Higher sun exposure index was associated with higher 25(OH)D concentrations (ß = 0.31; P < 0.001), which remained significant after controlling for covariates. At the bivariate level, mothers of infants weighing <2500 g had lower serum 25(OH)D concentrations compared to mothers whose infants weighed ≥ 2500 g (P = 0.02). This association became non-significant after controlling for covariates. CONCLUSIONS: Vitamin D deficiency was universally prevalent in the cohort studied. There is a need to develop culturally sensitive strategies for improving the 25(OH)D status.

Serum retinol, alpha-tocopherol, and lipid peroxide concentrations in low-income indian pregnant mothers.

Serum alpha-tocopherol, retinol, and malondialdehyde concentrations were measured at 7(th) month of pregnancy in 122 women from low socio-economic background. Maternal anthropometric measurements, 24-hour nutrient intakes, and pregnancy outcome were recorded. One-third (34.3 %) of mothers had low birth weight babies and 10 % delivered preterm. Maternal diets were inadequate in all the nutrients, the most limiting being vitamin A. Three-fourths of mothers had intakes less than 25 % of the Indian recommended daily intake (RDI) of 600 microg retinol equivalents/day. Serum alpha-tocopherol concentrations of 98 % were indicative of deficiency and almost half the mothers had low serum retinol concentrations (< or =10 microg/dL). Mean malondialdehyde level was 7.0 +/- 1.4 nmoles/mL. These values are higher than reports in the literature and were attributable to poor intake of most dietary antioxidants. Malondialdehyde concentrations were negatively correlated with serum alpha-tocopherol. Birth weight was positively correlated with maternal weight and biceps skinfold thickness, macronutrient intakes, serum retinol, and alpha-tocopherol concentrations. Preterm delivery was associated with low anthropometric measurements and low nutrient intakes especially vitamin A. Mothers who delivered preterm had significantly lower malondialdehyde concentrations than those who delivered at term. The role of antioxidant nutrients, especially vitamin A and oxidative stress in relation to fetal growth and pregnancy outcome among mothers from low socioeconomic settings requires attention.

Nutritional quality of diets fed to young children in urban slums can be improved by intensive nutrition education.

BACKGROUND: Almost half of India's children under 3 years of age are undernourished and at risk for illness and death. Poor complementary feeding practices contribute substantially to the problem. Promoting appropriate feeding practices is critical for ensuring child survival, health, and nutrition. Nutrition education is a feasible intervention and has the potential to help achieve the Millennium Goals, provided it is implemented appropriately. However, in existing programs, education is too generalized and based on information transfer. OBJECTIVE: To develop and implement a need-based, situation-specific education program for mothers to bring about changes in complementary feeding practices, with emphasis on the quantity and nutritional quality of complementary feeds. METHODS: Four hundred fourteen mothers or caregivers from five slums in Mumbai participated in a 3-month intervention study. Gaps in complementary feeding practices were identified at baseline. Education was given by trained fieldworkers, first to groups of 8 to 10 mothers or caregivers using innovative modules and demonstrations, followed by weekly monitoring and reinforcement. A simple checklist was used at each follow-up to assess impact, identify practices not adopted, and provide further inputs. Data collected at three follow-ups were compared with baseline and analyzed by SPSS using the chi-square test, the t-test, and ANOVA to assess whether feeding practices of the mothers or caregivers were altered favorably. CONCLUSIONS: The intervention process used in this study, the modules used, and the use of the checklist as a monitoring tool were successful in favorably changing complementary feeding practices. Incorporation of these in existing Growth Monitoring and Promotion programs would help to improve child nutrient intakes and thus reduce the prevalence of undernutrition.

Grip strength as an index for assessment of nutritional status of children aged 6-10 years.

The purpose of this study was to evaluate the use of grip strength as an index of nutritional status in 6-10 y old children. Seven hundred and eighty seven children (364 boys and 423 girls) in the age group of 6 to 10 y were selected from private and municipal schools, orphanages and slums in the cities of Mumbai and Pune, India. Grip strength was measured using the dominant hand. Height, weight, mid-arm circumference and triceps skinfold were also measured in all subjects. A significantly high correlation (p<0.01) was observed between grip strength and age for both sexes. Boys had a higher grip strength than girls at all ages. Grip strength was significantly correlated with height, weight, mid arm circumference, triceps skinfold, arm fat and arm muscle areas (p<0.01). Stepwise multiple regression analyses showed height, weight, triceps skinfold and age to be independent variables influencing grip strength. Grip strength was found to be a specific measure of lean body mass (75 to 94%), but sensitivity was quite low (about 25%). The positive predictive value was variable, ranging from 54.6 to 21.5%. The specificity, sensitivity and positive predictive values were very high when compared with arm muscle area. Grip strength may have a potential value as an additional test for nutritional assessment in field situations and clinical settings.