Evaluation of quality of life in indian children with bronchial asthma using a disease-specific and locally appropriate questionnaire.

AIM: To evaluate quality of life (QOL) in Indian children with bronchial asthma. METHODS: A disease-specific, locally appropriate QOL questionnaire was administered in asthmatic children and compared with FEV1, FVC, PEFR and asthma symptom score, on three occasions. RESULTS: QOL score had strong negative correlation with symptom score and weaker positive correlation with pulmonary function tests. CONCLUSION: Disease-specific QOL score correlates inversely with symptom score in children with bronchial asthma.

Inhibition of B(a)P induced strand breaks in presence of curcumin.

Incidence of cancer at different sites may be related to oxidative damage to host genome by genotoxicants. These oxidative actions may be modified by phytochemicals present in foods. The non-nutritive dietary constituents which possess antimutagenic property appear to be promising chemopreventive agents. This study reports the protective effect of curcumin on B(a)P induced DNA damage in human peripheral blood lymphocyte cells. The study group consisted of 10 male smokers, 10 non-smokers and 10 non-smoking females aged between 25 and 45. The DNA damage was assessed using comet assay. In all the groups curcumin showed a dose-dependent inhibitory effect. The effect appeared to be sex dependent. There was no correlation between DNA damage and GST-Mu levels and levels of micronutrients namely Vitamins A, E and beta carotene. The results of this study are in line with our earlier observations on turmeric/curcumin as a potential chemopreventer.

Fetal malnutrition and adult chronic disease.

Since the fetal origins of adult disease hypothesis was put forward, more than 30 studies around the world have indicated low-birth-weight (LBW) infants have a higher incidence of hypertension and impaired glucose tolerance. India ranks second in incidence of LBW among South East Asian countries and is experiencing a transition of disease pattern from communicable disease to non-communicable disease. Whether this could be explained in part by LBW infants who experienced better nutrition at a later age is explored here. An earlier cohort with accurate birth weights was traced and enrolled into the study. A sample of 50 LBW and 78 normal birth weight (NBW) individuals are reported on here. Though the odds ratio (OR) estimates of risk factors for coronary heart disease and diabetes tended to be higher in LBWs who were better nourished at the time of the study, they were not statistically different. Similarly, OR estimates for risk factors tended to be higher in LBWs who put on more weight than the median of NBWs, but they were not significant. Logistic regressions with several variables indicated significant influence of body mass index on systolic (P <0.007) and diastolic (P <0.004) blood pressures. Since the risk associations are weak, more studies are needed to put the hypothesis on a firm footing.

Prevalence of specific IGM due to toxoplasma, rubella, CMV and c.trachomatis infections during pregnancy.

One hundred and seventy five apparently normal asymptomatic pregnant women were studied prospectively and 247 women with different complications of pregnancy were screened at the time of delivery for infections like Chlamydia trachomatis, Toxoplasma, Rubella and cytomegalovirus (CMV). One hundred and forty two women with normal outcome of pregnancy served as controls. Specific IgM due to these agents were determined in the sera using commercial diagnostic kits. Results of the study showed that chlamydial infection was the most prevalent (29.8%) followed by Toxoplasmosis (13.1), Rubella (6.5%) and CMV (5.8%). Adverse outcome was seen among those seropositive for Chlamydia, Toxoplasmosis and Rubella. CMV showed no association with adverse outcome of pregnancy. Since Chlamydia and Toxoplasmosis are amenable to treatment with antibiotics, screening for these infections and appropriate treatment would improve outcome of pregnancy.

Nutritional status, psychosocial development and the home environment of Indian rural children.

OBJECTIVE: To assess the psychosocial development of well nourished and malnourished children aged 0-6 years and to identify the microenvironmental factors influencing their growth and development. DESIGN: Multicentric cross-sectional. SETTING: Rural Communities. SUBJECTS: Total of 3668 children of whom 2212 were well nourished and 1456 were malnourished. METHODS: Weight for age index to assess nutritional status. Cut-off < 75% NCHS standards used based on Gomez grades II and III being malnourished and Normal and grade I being well nourished. ICMR Developmental Screening Test to assess psychosocial development and modified WHO parental interview schedule to assess family and micro-environmental factors. RESULTS: Malnourished children attained developmental milestones at a later age. Developmental delay among the malnourished was especially observed in areas like vision and fine motor, language and comprehension and personal social. The delay was to the extent of 7-11 months in these areas in different age groups. Paternal involvement with child care especially, father spending time, telling stories and taking child for outing was found to be important for positive psychosocial development. Other significant factors included parents teaching child, small family size and paternal occupation. Child's appetite, absence of health problems, parental age and family having own house and electricity were the factors significantly related to better nutritional status of children. CONCLUSION: Factors identified in the study are important for the development of relevant intervention at the home level. Appropriate multifaceted community based programmes such as the ICDS are also required for stimulating growth and development of backward rural children.

Screening test battery for assessment of psychosocial development.

A multicentric cross-sectional collaborative study was undertaken in 3 centres in India with the main aim of developing simple and reliable indicators for the early detection of developmental disabilities in children under 6 years of age and to compare the age of attainment of developmental milestones in children in the three regions. The study provided a simple low-cost and culture-appropriate psychosocial developmental screening test battery which can be used with ease by trained public health grass-roots functionaries. This instrument was standardized on a large rural, tribal and urban sample comprising more than 13,000 children from 3 regions in India. The procedure for sampling, selection of items and methodology for standardization of the instrument in the Hyderabad region detailed in this paper were replicated in other centres as well. Quality control of data was ensured through inter-rater and test-retest measures of reliability. During pre-testing, 66 culture-appropriate milestones were selected finally from a larger item pool. The 50th centile age reference values of the Hyderabad study children and those obtained by other 2 centres were comparable.

Body mass index: a measure of the nutritional status in Indian populations.

Anthropometric data available through National Nutrition Monitoring Bureau surveys/studies conducted by the National Institute for Nutrition were analysed to study body mass index (BMI:kg/m2) profiles of adults and relate them to various parameters such as the nutritional status of preschool children, socio-economic status, low birth weight and mortality. The results show that nearly one-half (49%) of adult Indian rural population is suffering from some grade of chronic energy deficiency (CED). The adults' household BMI and child's nutritional status are associated. Mean BMI values were lower in landless agricultural occupational groups and in low per capita income group households compared with cultivators, artisan and higher income groups. Mean birth weights showed definite differences between BMI classes (2500 g in grade III CED and 2800 g in the normal BMI group). The odds ratio for low birth weight (LBW) was found to be three times more in severe CED groups compared to normal BMI groups of mothers. The influence of BMI on the incidence of LBW was evident despite the confounding factors of parity and maternal age. The frequency distribution of BMI values of adults who had been malnourished at the age of 5 years was distinctly different from that of the well-nourished group. The mean BMI of the group who were malnourished as children was 16, while those who had been well nourished was now 21 on average. Data from affluent and well-grown Indians suggests that a cut-off point of 18 rather than 18.5 would be more appropriate to distinguish the nutritionally normal groups from the energy deficient group (CED).

Mild vitamin A deficiency and childhood morbidity--an Indian experience.

Over 1500 preschool urban Indian children were followed weekly for morbidity from 12 to 18 mo. Examination for mild xerophthalmia (Bitot's spots and night blindness) was done initially and at 6 and 12 mo. Children with mild xerophthalmia at the start of a 6-mo interval developed respiratory disease in the interval twice as often as children with normal eyes at the start of the interval. No association was found between mild xerophthalmia and incidence of diarrhea.

Nutritional status and diarrhoeal morbidity: a longitudinal study in rural Indian preschool children.

Malnutrition and diarrhoeal diseases are important interrelated health problems of preschool children in the developing countries. For a prospective study to determine the effect of malnutrition on diarrhoeal morbidity 721 children under 5 years, living in two villages near Hyderabad were registered. The children were classified into different nutritional grades based on initial body weights and heights; and diarrhoea morbidity was recorded during the subsequent one year. The aetiology of diarrhoea was determined in a subsample. The incidence of diarrhoea was observed to be about 1.6 episodes/child/year and was similar in children with different nutritional grades. The percentage of episodes leading to severe dehydration was, however, significantly higher (P less than 0.05) in children with grade III malnutrition. The isolation of ETEC was also higher in this group indicating a greater bacterial load in the gut. Although pre-existing malnutrition did not affect the incidence of diarrhoea it seems to have a significant impact on the severity of the disease.

Nutrition--fertility interaction in lactating women of low income groups.

1. Duration of lactational amenorrhoea and interpregnancy interval were related to maternal body-weight in an urban low-income group population of 2250 women. 2. Breast-feeding practices were similar in all the women, none of whom had received any nutritional intervention. 3. In the study group the mean duration of lactation, lactational amenorrhoea and interpregnancy interval (months) were 20.7, 11.2 and 24.2 respectively. 4. Mean duration of lactation was significantly shorter in women whose body-weights were over 55 kg. Duration of lactational amenorrhoea increased with increasing duration of lactation (r 0.5164). 5. The duration of lactational amenorrhoea showed a progressive fall with increasing body-weight (r --0.8139) even when duration of lactation was kept constant. 6. The mean duration of post-partum amenorrhoea in women who did not lactate remained unaltered irrespective of body-weight. 7. The findings suggest that maternal nutritional status modifies return of menstruation only in lactating women.

Studies on the effect of nutritional deprivation during childhood on body composition of adolescent boys: creatinine excretion.

Forty-eight hour urinary creatinine excretion was measured in 50 boys aged 14 yr. who had had varying degrees of growth retardation during their preschool years. Subjects with growth retardation continued to be shorter and lighter and also had lower urinary creatinine excretion values per cm height or per kg weight. Creatinine height index values showed a deficit of about 40%. It is not clear whether this reduction in creatinine index represents a reduction in muscle mass or an altered creatine turnover. There is a need to study the body composition pattern among undernourished communities using direct methods.

The use of common salt (sodium chloride) fortified with iron to control anaemia: results of a preliminary study.

1. Iron-deficiency anaemia continues to be a major public health problem in all developing countries. Fortification of commonly consumed food items has been suggested as an effective method of preventing anaemia. Common salt (sodium chloride) has been identified as a suitable vehicle to be fortified with Fe in India. 2. Common salt was fortified with ferric orthophosphate (3500 mg/kg) and sodium hydrogen sulphate (5000 mg/kg) to provide an additional 1 mg elemental Fe/g common salt consumed. 3. After ascertaining the acceptability of the fortified salt with respect to its colour, taste and bioavailability a pilot feeding trial was conducted among residential schoolchildren in Hyderabad. Feeding of the fortified salt for a period of 1 year resulted in a significant increase in the haemoglobin level of these children. There was also a significant reduction in the prevalence of anaemia among children given the fortified salt. 4. Before the same fortified salt is recommended as a public health measure to prevent Fe-deficiency anaemia among our population it is necessary that further large-scale community trials with this fortified salt are carried out particularly among the rural population.

Nutritional deprivation in childhood and the body size, activity, and physical work capacity of young boys.

Clinical nutritional status and physical work capacity at submaximal level were assessed in 96 rural Hyderbad boys, 14 to 17 years of age. Data available on the previous nutritional status of these children when they were 5 years of age were used for classifying them into different nutritional grades. Factors responsible for undernutrition childhood continued to operate on later growth. Both height and weight at 5 years correlated well (P less than 0.001) with current height and weight. About 64% (P less than 0.001) of the variation in physical work capacity at a heart rate of 170/min (physical work capacity 170 kpm/min) could be explained by the differences in current body weight; habitual physical activity explained another 10% (P less than 0.001) of the variation. Malnutrition in early childhood continuing into adolescence could be considered to have adversely affected their work capacity by influencing their body weight. However, even severe undernutrition during childhood had no effect on work performance, when expressed in terms of unit weight. But for the same work load, undernourished subjects had to use significantly higher heart rate at moderate work level as compared to their counterparts.

Lactation and fertility.

During the last decade there have been many reports indicating a decline in breast feeding practices in the urban areas of developing countries. This decline might have adverse effects on maternal and child health. A study of 1079 urban hospital attending women was undertaken to evaluate their breast feeding practices. Prolonged (mean duration of lactation 19.8 months) and successful lactation (failure of lactation occurred in only 3.5%) was common among this group. But a trend toward shorter duration of breast feeding was found among educationally and economically better off segment. There was very good correlation between mean duration of lactation, lactational amenorrhea, and interpregnancy interval. Therefore, it is possible that decrease in duration of lactation might result in shorter interpregnancy interval. The duration of lactation appeared to be "fixed" for each individual irrespective of age and parity. This in turn resulted in "fixed" duration of lactational amenorrhea and interpregnancy interval under conditions of unhindered lactation and uncontrolled fertility. Conception during lactational amenorrhea was low (7.7%) but once periods were reestablished lactation offered very little protection against conception.

Nutrition and menarche in rural Hyderabad.

Mean age at menarche was estimated in 739 rural Hyderabad girls aged 12 to 18 years using the status-quo method. These girls had been previously measured and were divided into four groups according to their height at age five. Those who were short at age five had a significantly later menarche (15.2+/-0.13) than those who were tall at age five (13.7+/-0.19). Since 14% of the short-at-five girls had had signs of severe undernutrition and none of the tall had had these, the shortness and late menarche are both attributed to undernutrition.