Impact of Adolescent Pregnancy on Bone Density in Underprivileged Pre-Menopausal Indian Women.

High prevalence (31.5%) of adolescent pregnancies (AP) have been reported in India. Reports suggest that pregnancy during adolescence may have deleterious effects on peak bone mass. Very few studies have described the long-term effects of a history of AP on bone mass. The objective of this study was to compare bone mineral density (BMD) and bone geometry of premenopausal women with first childbirth during adolescence (i.e., before age of 19 years) or after 20 years. A cross-sectional study was conducted in 242 women (age 28.0-54.5 years) from Pune, India (November, 2015 to November, 2017). Women were divided into 2-groups: Group-1: women-who had 1st-pregnancy and childbirth before 19 years of age (AP n = 131) and Group-2: women-who had 1st pregnancy after 20 years of age (non-AP n = 111). Demographic data, anthropometric measurements, and biochemical tests were performed using standard protocols. Physical activity and nutrient intakes were recorded using validated questionnaires. Areal BMD and bone geometry were measured using Dual-Energy-Absorptiometry-DXA (Lunar-iDXA, GE Healthcare) and peripheral-quantitative-computed-tomography-pQCT (XCT2000, Stratec Inc.). Mean age of the study group was 37 ± 4.6 years; in women from group-1 mean age at first delivery was 16.9 ± 1.6 years as against 22.6 ± 3.1 years in group-2. Both groups were similar in body mass index and socioeconomic status. pQCT measured radial diaphyseal cortical thickness (1.97 ± 0.3 mm vs 1.88 ± 0.3 mm resp., p = 0.016, periosteal circumference (38.0 ± 3.6 mm vs 36.7 ± 2.5 mm, resp. p = 0.016), total bone area (114.3 ± 24.8 mm2 vs 108.7 ± 14.7 mm2 resp. p = 0.026) and stress-strain index (SSI = 217 ± 75 vs 201 ± 40 mm3 resp. p = 0.042) were significantly higher in group-1 than group-2. After adjusting for anthropometric and lifestyle parameters, pQCT measured cortical thickness (1.98 ± 0.03 mm in group-1, 1.87 ± 0.03 mm group-2, p = 0.01, mean ± SE) and iDXA derived aBMD at forearm were still significantly higher (0.599 ± 0.006 g/cm3 vs 0.580 ± 0.006 g/cm3, p = 0.023) in Group-1. Our data suggest that women with a history of adolescent pregnancy had better bone geometry and higher aBMD at radius in later years. We speculate that early exposure to pregnancy resulted in higher aBMD at the radius and induced changes at radial diaphysis with bones becoming thicker and wider among these women.

To study impact of treatment with Rosuvastatin versus Atorvastatin on 25 hydroxy Vitamin D concentrations among adult Indian men- a randomized control trial.

BACKGROUND: Dyslipidemias are on the rise and are increasingly being treated with statins. As the metabolism of cholecalciferol and cholesterol are interrelated, reduction in cholesterol synthesis by statins is likely to affect Vitamin D status. OBJECTIVES: (1) The aim is to study the effect of treatment with statins (Atorvastatin/Rosuvastatin) on 25-hydroxy-Vitamin-D (25OHD) among newly detected subjects with dyslipidemia for 6 months (2) To study the impact of 25OHD concentrations on the efficacy of statin treatment. MATERIALS AND METHODS: This was a prospective, balanced randomized (1:1), open-label, parallel-group study, in apparently healthy Indian adult men (south Asian, 40-60 years). At baseline, serum lipids and 25OHD concentrations were measured. Based on the Adult Treatment Panel III guidelines, subjects were divided as per lipid concentrations into controls (who did not require statin treatment) and intervention (who required statin treatment) groups. Random allocation of subjects was done in two groups for receiving intervention for 6 months: Atorvastatin group (n = 52, received Atorvastatin) or Rosuvastatin group (n = 52, received Rosuvastatin). Lipids and 25OHD concentrations were measured at the end line. RESULTS: Atorvastatin group presented significant reduction (P < 0.05) in 25OHD, total cholesterol (TC) and low-density-lipoprotein-cholesterol (LDL-C) concentrations at the end line. In the Rosuvastatin group, significant drop in TC, LDL-C and high-density lipoprotein cholesterol (concentrations (P < 0.05) was observed, while 25OHD concentrations showed no significant change. Mean 25OHD concentrations were significantly correlated with a reduction in LDL-C concentrations in Atorvastatin group. CONCLUSIONS: Treatment with Atorvastatin resulted in a reduction in 25OHD concentrations; further, its efficacy in reducing LDL-C concentrations was related to the 25OHD concentrations.

Body Mass Index Quick Screening Tool for Indian Academy of Pediatrics 2015 Growth Charts.

OBJECTIVE: To develop gender-specific graphic tool in which BMI cut offs can be read from height and weight, without need for calculating BMI and to validate the tool against Indian Academy of Pediatrics (IAP) 2015 BMI charts. METHODS: Validation of tool was performed using de-identified data on children from school health surveys. RESULTS: For detection of overweight and obesity, the BMI tool had sensitivity of 95.7% and specificity of 85.7% for boys, and 95.7% and 89.7% for girls, respectively. For underweight, sensitivity of 100% for boys and girls, and specificity of 88.9% for boys and 82.4% for girls was observed. CONCLUSION: We present a graphic BMI tool for screening for underweight, overweight and obesity, which complements the existing IAP charts.

Occurrence of infections in schoolchildren subsequent to supplementation with vitamin D-calcium or zinc: a randomized, double-blind, placebo-controlled trial.

BACKGROUND/OBJECTIVES: Vitamin D and zinc are recognized for their roles in immune-modulation, and their deficiencies are suggested to be important risk factors for childhood infections. This study, therefore, undertook to assess the occurrence of infections in rural Indian schoolchildren, subsequent to daily supplementation with vitamin D-calcium or zinc for 6 months. MATERIALS/METHODS: This was a randomized, double-blind, placebo-controlled trial in apparently healthy 6-12 year-old rural Indian children, recruited to 3 study arms: vitamin D arm (1,000 IU D3 - 500 mg calcium, n = 135), zinc arm (10 mg, n = 150) and placebo arm (n = 150). The infection status was assessed using a validated questionnaire, and the biochemical parameters of serum 25(OH)D and serum zinc were measured by ELISA and colorimetry, respectively. The primary outcome variable was occurrence of infections (upper respiratory and total infections). RESULTS: Serum 25(OH)D concentration in the vitamin D arm improved significantly by 34%, from 59.7 ± 10.9 nmol/L to 80 ± 23.3 nmol/L (P < 0.0001), but no improvement was observed for serum zinc concentration. While there was significant increase in the percentage of children reporting no or mild upper respiratory tract infections (URTI) and total infections (TI) in all three groups, improvements in the supplemented groups were similar to the placebo group. However, the vitamin D arm reported lower URTI and TI status in the vitamin D sufficient versus insufficient children. Also, URTI and TI status were found to be significantly (P < 0.0001) lower in children with improved 25(OH)D versus unchanged 25(OH)D. CONCLUSIONS: Vitamin D-calcium supplementation helped to improve the vitamin D status but exerts no effect on the occurrence of infections when compared to the placebo group. Improvement in the serum 25(OH)D concentrations and attainment of vitamin D sufficiency may exert a beneficial effect on the infection status and needs to be investigated further. To evaluate the efficacy of zinc supplementation, higher dosages need to be administered in future studies.

Inter-regional differences in body proportions in Indian children and adolescents-a cross-sectional multicentric study.

Background: Sitting height (SH) and leg length (LL) help in assessing disproportionate growth. Anthropometric dissimilarity has been observed in different ethnicities.Aim: To (1) study sitting height and body proportions in children from different regions of India; and (2) compare sitting height and body proportions with data from other countries.Subjects and methods: This was a cross-sectional multicentric observational study, where 7961 (4328 boys) 3-18 year old children from five regions (north, south, east, west and central) were measured (height, weight and SH).Results: Boys from north India and girls from central India were taller and heavier (mean height 153.2 ± 18, 146.4 ± 11), while western boys and girls were the shortest (131.1 ± 20.7, 129.8 ± 19.5) (p < 0.05 for all). The highest SH was observed in the north (79.2 ± 8.5) and the lowest in the west (68.8 ± 9.1). Mean SH:LL ratio was highest in children from the northeast (1.13) followed by those from western, northern and central India (1.12, 1.10 and 1.07, respectively) and the ratio was the least in children from south India (1.05) (p < 0.0.5 for all except northeast and west). Children from the north and west were similar to the Dutch, children from the south were similar to South (black) Africans and the north-eastern children were similar to Chinese children.Conclusion: There were inter-regional differences in body proportions; similarities in body proportions with children from other ethnicities may throw light on the migration history of Indian people.

Body mass index percentiles and elevated blood pressure among children and adolescents.

It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted normal range. Data were available for 58 899 children and adolescents aged 6-17 years from seven national cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. The subjects were divided into eight percentile subgroups according to their BMI levels based on the World Health Organization recommendations. Elevated BP and high BP were defined using the 2016 international child BP criteria. Compared with the reference subgroup of the 5th-24th percentiles, the odds ratios (ORs) for high BP were 1.27 (95% confidence interval [CI], 1.14-1.41; P < 0.001) in the 25th-49th percentile subgroup, 1.55 (95% CI, 1.39-1.73; P < 0.001) in the 50th-74th percentile subgroup, and 2.17 (95% CI, 1.92-2.46; P < 0.001) in the 75th-84th percentile subgroup, respectively, after adjustment for sex, age, race/ethnicity, height and country. Additionally, the corresponding ORs for elevated BP were 1.21 (95% CI, 1.10-1.32; P < 0.001), 1.55 (95% CI, 1.42-1.69; P < 0.001), and 1.80 (95% CI, 1.62-2.01; P < 0.001), respectively. In conclusion, a BMI in the 25th-84th percentiles, within the accepted normal weight range, was associated with an increased risk of elevated and high BP among children and adolescents. It is important for children and adolescents to keep a BMI at a low level in order to prevent and control hypertension.

A Cross-Calibration Study of GE Lunar iDXA and GE Lunar DPX Pro for Body Composition Measurements in Children and Adults.

OBJECTIVE: To cross-calibrate dual energy X-ray absorptiometry machines when replacing GE Lunar DPX-Pro with GE Lunar iDXA. METHODS: A cross-sectional study was conducted in 126 children (3-19 years) and 135 adults (20-66 years). Phantom cross calibration was carried out using aluminum phantom provided with each of the machines on both machines. Total body less head (TBLH), lumbar spine (L2-L4) and left femoral neck bone mineral density (BMD), bone mineral content (BMC), and bone area were assessed for each patient on both machines. TBLH lean and fat mass were also measured. Bland-Altman analysis, linear regressions, and independent sample t test were performed to evaluate consistency of measurements and to establish cross-calibration equations. RESULTS: iDXA measured 0.33% lower BMD and 0.64% lower BMC with iDXA phantom as compared to DPX-Pro phantom (p < 0.001). In children, TBLH-BMC, femoral BMC and area were measured 10%-14% lesser, TBLH area was higher by 1%-2% and L2-L4 area by 10%-14% by iDXA as compared to DPX-Pro. iDXA measured higher TBLH fat [15% (girls), 31% (boys)] than DPX-Pro. In adults, TBLH-BMD (1.7%-3.4%), BMC (6.0%-10.9%) and area (4.2%-7.6%) were measured lesser by iDXA than DPX-Pro. L2-L4 BMD was higher [2.7% (men), 1.8% (women)] by iDXA than DPX-Pro. Femoral BMC was 2.11% higher in men and 4.1% lower in women by iDXA as compared to DPX-Pro. In children, R2 of cross-calibration equations, ranged from 0.91 to 0.96; in adults, it ranged from 0.93 to 0.99 (p < 0.01). After the regression equations were applied, differences in BMD values between both machines were negligible. CONCLUSION: A strong agreement for bone mass and body composition was established between both machines. Cross-calibration equations need to be applied to transform DPX-Pro measurements into iDXA measurements to avoid errors in assessment. This study documents a need for use of cross-calibration equations to transform DPX-Pro body composition data into iDXA values for clinical diagnosis.

Muscle and bone parameters in underprivileged Indian children and adolescents with T1DM.

BACKGROUND: The incidence of Type 1 diabetes mellitus (T1DM) is increasing and sarcopenia and osteoporosis have been reported to be associated with long standing diabetes. There is scarcity of data on bone health status of children with T1DM. Our aim was to assess bone health parameters [by Dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT)] and muscle strength (by hand grip) in underprivileged Indian children with T1DM. MATERIAL AND METHODS: A cross sectional, observational study was conducted in underprivileged children with diabetes attending the out patient clinic for T1DM at a tertiary care hospital. Children with T1DM with disease duration more than 1 year were included in the study. Age and gender matched controls were also enrolled. Data on age, gender, disease duration, anthropometric parameters and HbA1c were collected. Bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry (Lunar iDXA) and peripheral quantitative computed tomography (pQCT, Stratec XCT 2000) and muscle strength by handgrip. Data were analysed using SPSS 25.0. RESULTS: 251 children with T1DM and 250 age gender matched controls were studied. Mean age of T1DM children was 10.8 ± 4.3yrs (controls 10.3 ± 3.6). Mean HbA1C was 9.7 ± 2.1%. The total body less head areal BMD (TBLH aBMD) and lumbar spine bone mineral apparent density (LSBMAD) Z-scores were significantly lower in children with T1DM (-1.5 ± 1.3, -1.3 ± 1.6 respectively) as compared to controls (-0.5 ± 1.3, -0.64 ± 1.5 respectively) (p < 0.05 for both). Z-scores for trabecular and total density (vBMD) were significantly lower in patients with T1DM (-0.7 ± 1.0, -0.7 ± 1.0 respectively) than controls (-0.15 ± 1.2, -0.31 ± 1.1), (p < 0.05) and trabecular density was lower at distal radius with increasing disease duration. Hand-grip strength Z-score was lower in children with T1DM (-3.0 ± 0.5) as compared to controls (-2.8 ± 0.5). Trabecular density and HbA1C concentrations were negatively correlated (R = -0.18, p < 0.05) as was muscle area and HbA1C concentrations (R = -0.17, p < 0.05,). CONCLUSION: Bone and muscle health were affected in children with poorly controlled T1DM. With increasing disease duration, attention is required for optimising musculoskeletal health.

Random Blood Glucose Concentrations and their Association with Body Mass Index in Indian School Children.

OBJECTIVE AND AIMS: Overweight/obese children are at risk of developing type 2 diabetes mellitus. Random glucose elevations provide early warning signs of glycemic dysregulation. To assess random blood glucose (RBG) concentrations and risk factors associated with prediabetes in children aged 3-18 years from six Indian regions. METHOD: Multicenter, cross sectional, observational school-based study; multi-stage stratified random sampling was carried out. Height and weight measured; body mass index (BMI) was computed. RBG measured using a glucometer. National sample survey was used for dietary patterns. Data were analyzed using SPSS 25.0 for Windows. SETTING: Study centers were from Maharashtra, Gujarat, Chhattisgarh, Assam, Tamil Nadu and Punjab from 40 selected schools. PARTICIPANT: Children aged 3-18 years were measured. RESULTS: Data on 14339 subjects (7413 boys) were analyzed. Prevalence of obesity was 5.8% and overweight-10.6%. Overall, 1% had low (<3 mmol/L), 93.7% in reference range (3.9-7.2 mmol/L) and 5.3% had elevated RBG (>7.2 mmol/L). With increasing mean BMI, there was increase in RBG concentrations. Children from Tamil Nadu were more likely to have RBG outside reference range compared to other regions (P < 0.05). Assam and Punjab had highest prevalence of RBG and BMI within reference range. Energy intake partly explained regional variations. Multivariate analysis showed male gender, urban residency, age >10 yrs (girls) and 13 yrs (boys), and overweight or obesity were predictive of prediabetes. CONCLUSION: Increased prevalence of overweight, obesity and prediabetes in Indian children are a matter of concern. Regional differences suggest that strategies to prevent obesity and combat perturbations in blood sugar may have to be customized.

Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort.

In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Dyslipidemia and Fat Distribution in Normal Weight Insulin Resistant Men.

BACKGROUND: Although less common, insulin resistance and deranged lipids are also observed in normal weight individuals. Few studies have assessed body composition and lipid profiles in normal weight insulin resistant individuals. OBJECTIVE: To assess differences in body composition and lipid profile in normal weight and overweight 40-60 years apparently healthy men with special reference to insulin resistance. DESIGN: Cross-sectional observational study in apparently healthy men (40-60 yrs) was performed. Anthropometry, body composition (Dual Energy X-ray Absorptiometry scan), biochemical parameters (lipids, sugar and Insulin) were assessed. HOMA_IR was calculated. Subjects were grouped based on BMI and HOMA-IR for comparison. RESULTS: Of the 286 subjects 152 (53%) had BMI < 25 (group A) and 134 (47%) had BMI > 25 (group B). Homa-IR was more than 3 in 18% in and in 36% in B. Group B had significantly higher fat, waist circumference, systolic blood pressure, insulin and HOMA-IR. In subgroup analysis in group A, subjects with HOMA IR>3 (group A2) had significantly higher BMI, waist, TG, TG: HDL ratio, android and total fat and lower HDL as compared sub-group A1(HOMA IR<3) (p< 0.05). Mean BMI, waist circumference and systolic blood pressure were significantly higher in B2 than A2 group (p< 0.05). Although total, android and gynoid fat percentage were significantly higher in group B2, android to gynoid ratio was significantly higher in A2 (p< 0.05). CONCLUSION: No significant difference in lipids and fat distribution between insulin resistant and non-resistant subjects in overweight groups suggests that insulin resistance in overweight may be an extension of the pathological state related to obesity. In contrast, significant differences in lipid and fat distribution in normal weight insulin resistant individuals may likely be due to a different mechanism.

Sitting height percentiles in 3-17-year-old Indian children: a multicentre study.

Background: Sitting height (StH) percentiles are not described for the Indian paediatric population.Aim: To generate multicentre StH percentile values for Indian children.Subjects and methods: A total of 7961 apparently healthy children (3-17 years old, Boys: 4328) randomly selected from 10 schools from six states of India were measured for height (ht), StH and weight during July 2016-October 2017.Results: The StH:Ht ratio was 0.52 (0.02) and was similar between boys and girls (p > 0.1). The ratio decreased in boys until the age of 14 years and then slightly increased; the lowest ratio was observed during 13-15 years. In girls, however, the StH:Ht ratio decreased until the age of 9 years and then plateaued until 15 years of age with a slight increase at 16 years; the lowest ratio was observed at the age of 12-13 years. Sitting height percentiles (3rd, 10th, 25th, 50th, 75th, 90th and 97th) were computed using LMS chartmaker.Conclusions: The results indicate that, during the pubertal years, the lower limb growth is more predominant than trunk growth. Further, this study provides smoothened percentile curves for sitting height in Indian children for the first time.

Parental Education, Children's Nutritional Status and Non-verbal Intelligence in Rural School-children.

OBJECTIVE: To assess non-verbal intelligence and its relationship with nutritional status, nutrient intakes and parents' education in school-children. METHODS: A cross-sectional, observational study was conducted in children between 6-11 years, without any known chronic disorder or intellectual disability. Data were collected regarding parents' education, anthropometry and dietary intakes. Non-verbal intelligence was assessed by Raven's Coloured Progressive Matrices (RCPM). RESULTS: In 323 enrolled children (52.9% boys), a significant positive association was observed between RCPM scores and parents' education (father's rs=0.14, mother's rs=0.22), height Z-scores (rs=0.14) and dietary intakes of zinc (rs=0.14), iron (rs=0.12) and folate (rs=0.14). CONCLUSIONS: Height in normal range, higher zinc, iron and folate intakes, and parental higher educational levels were associated with higher non-verbal intelligence scores.

Infection Status of Rural Schoolchildren and its Relationship with Vitamin D Concentrations.

OBJECTIVES: To assess the nutritional and infection status of rural schoolchildren and to study the relationship of infection status with serum 25(OH)D concentrations. METHODS: This study was carried out in a primary school, in a rural setting, near Pune (18°N), Maharashtra. Data collected from 387 children included anthropometric, clinical, infection-related data (using a validated questionnaire) and dietary data (by 24-h recall method over 3 non-consecutive days, including a holiday) and serum 25(OH)D estimations (by ELISA). RESULTS: Prevalence of underweight and stunting were 18% and 11% respectively. Upper respiratory tract infection (URTI) related symptoms were commonly reported. Episodes of URTI were found to be significantly and negatively correlated with serum 25(OH)D concentrations (rs = -0.14, p < 0.05) and lesser URTI episodes and duration were reported by children who were vitamin D sufficient as compared to those who were insufficient. No association of total infections was found with vitamin D status. CONCLUSIONS: Moderate prevalence of underweight and stunting and frequent URTIs were observed in this population. Higher serum 25(OH)D concentrations and vitamin D sufficiency may be important for prevention of upper respiratory tract infections in rural children.

Association of body fat with stress levels and dietary intakes in Indian women.

A cross-sectional study of 605 women (aged 18-50 years) conducted from January 2013 to June 2014 in Gujarat, India assessed stress, dietary intakes and body fat percentage (PBF), and the inter-relationship of PBF with stress, dietary fat, and carbohydrates. The population was categorized according to PBF cutoffs for Asians. A generalized linear regression model adjusted for age was performed to assess the relationship of stress, fat, and carbohydrate intakes with PBF. PBF had a significant positive association with stress level (p = .02) and carbohydrate intake (p = .008); fat intake was not significantly associated (p = .8). Women with moderate PBF consumed significantly less carbohydrates (mean = 152.3 ± 13.3 gm/1000 kcal/day, p < .05) and had lower stress scores (mean = 9.7 ± 4.2, p < .05) than women with high PBF (mean carbohydrate intake = 156.2 ± 10.8 gm/1000 kcal/day; mean stress score = 10.9 ± 4.4) and very high PBF (mean carbohydrate intake = 156.8 ± 11.6 gm/1000 kcal/day; mean stress score = 11.2 ± 4.2). We conclude that PBF has a positive association with stress and dietary carbohydrate; women with higher stress and carbohydrate intake are more likely to accumulate higher body fat as compared to women with less stress and low carbohydrate intake.

Height Velocity Percentiles in Indian Children Aged 5-17 Years.

OBJECTIVE: To assess height velocity and develop height velocity percentiles in 5-17-year-old Indian children; and to study the magnitude and age at peak height velocity. DESIGN: Mixed longitudinal study. SETTING: Private schools at Pune and Delhi. PARTICIPANTS/PATIENTS: 2949 children (1681 boys) belonging to affluent class aged 5-17 years (1473-Pune, 1476-Delhi). METHODS: Annual height and weight measurements from 2007 to 2013. Total 13214 height velocity measurements (7724 on boys). OUTCOME MEASURES: Height velocity percentiles (3rd, 10th, 25th, 50th, 75th, 90th and 97th) constructed using LMS chart maker. RESULTS: Age- and gender-specific height velocity percentiles were generated. Median height velocity in girls decreased from 5 to 8 years, increased to a peak of 6.6 cm at 10.5 years and then declined to 0.3 cm at 17.5 years. In boys, median height velocity reduced till 10.5, increased to a peak of 6.8 cms at 13.5 years and then declined to 1cm by 18 years. CONCLUSIONS: Height velocity percentiles in 5-17-year-old urban Indian children were constructed.

Low knowledge of osteoporosis and its risk factors in urban Indian adults from Pune city, India.

OBJECTIVE: To assess knowledge of osteoporosis and its risk factors and to explore associations between knowledge and various sociodemographic factors in Indian adults. DESIGN: Cross-sectional study. The Revised Osteoporosis Knowledge Test (OKT) was used to assess knowledge of osteoporosis. Four scores (OKT-total, range 0-32; OKT-exercise, range 0-20; OKT-nutrition, range 0-26; OKT-risk factors, range 0-14) were generated by giving 1 point to every correct answer and 0 points for incorrect or 'not known' answers. SETTING: Tertiary-care hospital in Pune city, India.ParticipantsAdults aged 40-75 years (n 477; 234 males) enrolled through voluntary routine health checks and health camps. RESULTS: Mean age of the study population was 54·6 (sd 9·5) years. Half the participants were aware of osteoporosis and could correctly define it. Women showed significantly higher median OKT-total and OKT-nutrition scores than men (P0·1). CONCLUSIONS: Understanding about osteoporosis and its risk factors is low in the present cohort of Indian men and women. There is need to create awareness programmes aimed at both men and women especially targeting those with lower education, lower socio-economic status and no previous exposure to osteoporosis.

Effect of Antioxidant Supplementation on Total Antioxidant Status in Indian Children with Type 1 Diabetes.

Hyperglycemia results in the overproduction of free oxygen radicals that impair the endogenous antioxidant defenses. A randomized controlled trial was conducted to compare the effect of 3 months of antioxidant supplementation in the form of foods rich in micronutrients with pharmacological supplement on total antioxidant status of Indian children with type 1 diabetes. Ninety children with diabetes (mean age 11.5 ± 3.6 yrs, 37 boys) were randomly allocated to three groups: Group 1 (n = 31) = DM controls; Group 2 (n = 30) = multimicronutrient syrup; and Group 3 (n = 29) = dietary supplements (nine snack recipes rich in micronutrients). They received intervention for 3 months. Healthy controls were enrolled from local schools. Fasting blood was tested for total antioxidant status (TAS) and glycosylated hemoglobin (HbA1C). Children with diabetes had lower TAS (0.70 ± 0.2 vs. 1 ± 0.24 mmol/l, p = .0001) compared to healthy controls. Anthropometric and biochemical parameters were similar at baseline for all groups of diabetic children. Group 1 showed significant deterioration in TAS at endline (0.72 ± 0.16 vs. 0.60 ± 0.17 mmol/l, p = .008). Increase in TAS recorded in Group 2 was from 0.66 ± 0.21 to 0.70 ± 0.16 mmol/l and in Group 3 was from 0.68 to 0.73 mmol/l. There was a significant difference between Group 1 and Group 3 for percentage change in TAS (-13% vs. 16%, p = .035). Postsupplementation there was an increase in TAS values in children with diabetes, but they were still lower than in healthy controls. Indian diabetic children have compromised antioxidant status, which may be improved by incorporation of multimicronutrient-rich recipes in their diets.

Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study.

Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.

Determinants of Vitamin D Status in Indian School-children.

INTRODUCTION: Due to the high prevalence of Vitamin D deficiency in spite of abundant sunshine and scarcity of studies investigating Vitamin D status in Indian children from rural and semirural areas, the objectives of this cross-sectional study were to: (1) assess the Vitamin D status of school-children in a semi-rural setting and (2) identify the determinants of Vitamin D status in these children. MATERIALS AND METHODS: Data collected included anthropometric measurements (height and weight), body composition, three-one-day dietary recall method, demographic data, and sunlight exposure. Serum 25-hydroxyVitamin D (25(OH)D) was estimated by enzyme-linked immunosorbent assay (ELISA) technique. SPSS software was used for statistical analysis. RESULTS: Anthropometric characteristics of the children were similar and mean serum 25(OH)D concentration was 58.5 ± 10.3 nmol/L with no significant differences between genders. Around 80% children reported sunlight exposure of 2 h or more. A majority (71%) of children were Vitamin D insufficient with serum 25(OH)D concentrations between 50 and 74.9 nmol/L. Determinants of Vitamin D identified were duration of sunlight exposure and body fat percent. Significant (P < 0.05) positive association of duration of sunlight exposure was observed with serum 25(OH)D concentrations, while BF% showed a negative association with serum 25(OH)D (ß = -0.307; standard error = 0.1388; P < 0.05). DISCUSSION: We have reported a high prevalence of Vitamin D insufficiency in school-children aged 6-12 years, from a semirural setting, in spite of a majority (80%) reporting >2 h of sunlight exposure. We have also demonstrated that duration of sunlight exposure and body fat percentage are the two important determinants of serum 25(OH)D concentrations in these children.