Community-specific modifications are essential for objective assessment of maternal dietary intake--Pune Maternal Nutrition Study.

OBJECTIVE: To introduce community-specific modifications in the conventional 24 h recall method for objectively estimating maternal dietary intake and validate it with a reference method. DESIGN: A modified 24 h recall method was developed with the visit of trained local girls at the subject's home to weigh portion sizes at each mealtime over the 24 h recall period. This was validated with the reference method in which weighed records of the foods consumed were obtained and their laboratory analysis was done to obtain nutrient intakes. SETTING: Rural areas located 40-50 km from Pune City, India. SUBJECTS: Forty-one pregnant women participated willingly. RESULTS: The estimates of intake obtained from the reference method were comparable to those obtained from the modified 24 h recall method for energy (7795 (sd 1841) kJ (1863 (sd 440) kcal) v. 7615 (sd 1824) kJ (1820 (sd 436) kcal), respectively), protein (48.6 (sd 12.9) g v. 45.3 (sd 12.6) g, respectively) and fat (35.3 (sd 16.6) g v. 36.0 (sd 14.2) g, respectively). Significant correlation was observed between the estimates obtained by the two methods for energy (0.75, P < 0.001), protein (0.71, P < 0.001) and fat (0.56, P < 0.001) and differences in nutrient intake did not reveal any systematic bias. When compared with the reference method, the modified method showed >80% sensitivity and specificity for identifying inadequate maternal energy intakes. CONCLUSIONS: Simple modifications to conventional methods backed by understanding of community specifics and nutritional peculiarities are of immense importance in obtaining objective estimates of daily nutritional intakes of individuals in free-living populations. The approach would be adaptable in similar settings in other developing countries.

Maternal nutrition and birth size among urban affluent and rural women in India.

BACKGROUND: Varying results of worldwide intervention programs to pregnant mothers necessitate the need to understand the relationship between maternal nutrition and birth size among well nourished and undernourished mothers. OBJECTIVE: To examine this relationship among urban affluent mothers and to compare the findings with those on rural Indian mothers. SUBJECTS: Data collected on urban affluent mothers (n = 236) was compared with rural mothers (n = 633). DESIGN: Mothers were contacted at 18 +/- 2 and 28 +/- 2 wk of gestation for anthropometry, dietary intakes [24-hr recall, Food Frequency Questionnaire (FFQ)] and after delivery for neonatal anthropometry. RESULTS: Despite large differences in nutritional status of urban and rural mothers ( pre-pregnant weight 55.9 +/- 9.2 Vs 41.5 +/- 5.2 kg, respectively) maternal fat intakes at 18 wk were associated with birth weight (p < 0.05), length (p < 0.01) and triceps skin fold thickness (p < 0.05) of the newborn in urban and rural mothers. Consumption of fruits was associated with birth length (p < 0.05) in urban (18wk) and with birth weight (p < 0.01) and length (p < 0.01) in rural (28wk) mothers, when their energy intakes were low. Maternal consumption of milk too, was associated with newborn's triceps (p < 0.01) in urban (28wk) while with birth weight (p < 0.05) and length (p < 0.05) in rural (18wk) mothers. The findings mainly underscore the importance of consumption of micronutrient rich foods, when energy intakes are limiting during pregnancy, for improving birth size. CONCLUSIONS: Creating nutritional awareness and motivating rural mothers for consuming micronutrient rich foods like green leafy vegetables and seasonal fruits that are easily available in rural areas, will be a much affordable solution for combating the problem of low birth weight rather than waiting for improvement in the existing nationwide programs for pregnant women.

Rapid assessment of maternal activity among rural Indian mothers (Pune Maternal Nutrition Study).

OBJECTIVE: To develop an activity questionnaire for objective and rapid assessment of maternal habitual physical activity with the aim of describing its relationship with birth size. DESIGN: Prospective observational study. SETTING: Six villages near Pune, Maharashtra, India. SUBJECTS: Seven hundred and ninety-seven rural Indian mothers were studied after excluding abortions and termination of pregnancies, foetal anomalies, etc. METHOD: Principal components analysis (PCA) was used to identify a few leading questions from an elaborate questionnaire involving 36 questions related to 14 typical maternal activities. RESULTS: On the basis of high loading (>0.8), PCA identified three activities, i.e. farming, fetching water and washing clothes. Questions and sub-questions related to these activities only were considered for defining an activity score for rapid assessment. Validation of this new activity score, with the score based on the elaborate questionnaire, showed 70% sensitivity as well as specificity. New activity scores showed strong inverse relationships similar to those observed using the elaborate questionnaire, at early as well as late gestation, with neonatal head circumference (P=0.001 and 0.055) and mid-arm circumference (P=0.02 and 0.03). CONCLUSIONS: Simple questionnaires, based on leading activities identified by PCA, can be as informative as longer and detailed questionnaires. This method has potential for adaptation, especially in rural communities in developing countries.

Energy costs of standard activities among Indian adults.

OBJECTIVES: To estimate the energy cost of resting (RMR), sitting and standing for urban Indian adults and compare these estimates with the reported values. DESIGN: Energy costs were measured using oxylog while body fat was estimated using equipment (HBF300, OMRON Corporation, Japan) that works on the principle of bioelectrical impedance, for 24 men and 40 women, aged 20-50 y, engaged in sedentary activities. SETTINGS: Agharkar Research Institute, Pune, India. RESULTS: Mean energy cost (kJ/min) of resting (RMR), sitting and standing were significantly (P<0.01, for all) higher for men (4.01+/-0.42, 5.0+/-0.72 and 5.74+/-0.69, respectively) than women (3.54+/-0.28, 4.03+/-0.41 and 4.35+/-0.52, respectively). Gender difference increased with the level of activity, from 13% for RMR to 32% for standing. These differences reduced when adjusted (using analysis of covariance) for body weight and became non-significant on adjusting for fat-free mass (FFM) in the case of RMR and sitting activity. The measured values of energy cost (absolute and per kg weight) for these activities were similar to African subjects but lower compared to Asian or European subjects for both sexes. The stepwise regression analysis done separately by sexes showed weight (29%) in men and body mass index (44%) in women to be the best predictors of RMR, while regression analysis for combined sexes indicated FFM and height as predictors of RMR (r(2)=56%, P<0.01). If means to estimate body fat were not available, RMR could best be predicted with BMI and sex as predictors (r(2)=55%; P<0.01). This was mainly due to the fact that the sex differences in our population were more prominent in FFM than that in BMI. Our observations thus indicate the need to develop prediction equations separately for different populations owing to differences in their body compositions, especially in fat mass (FM) or FFM. CONCLUSION: The energy costs of activities were associated with body composition, especially with absolute fat-free mass, which may vary even with the same body fat percentage. Therefore, there is a need to develop separate prediction equations for different communities.

Undernutrition and adolescent growth among rural Indian boys.

OBJECTIVE: To evaluate impact of undernutrition on various adolescent growth parameters among rural Indian boys. DESIGN: Adolescent boys covering 8-18 yr age group were observed longitudinally for a period of 3 years. SETTING: Adolescent boys (n=673) from seven different villages within 30 to 40 km from Pune were studied. METHOD: Six monthly measurements on weight (upto 50 g) and height (upto 0.1 cm) were recorded and age assessment was done from school records with reasonable accuracy. RESULTS: Stunted and underweight boys were lighter (by 4 kg) and shorter (by 8 cm) at 10 yr age compared to their normal counterparts but this difference increased to 12 kg and 10 cm respectively by adulthood. Undernourished boys however, revealed significant height gains at later ages especially beyond 14+ yr, compared to normals suggesting slow, gradual but continual growth. Undernutrition delayed age at take-off and age at PHV by about 2 yr, and lowered attained height at PHV (by 5 cm) and adult height (by 7 cm). CONCLUSION: Normal and maluourished children from the same rural community show wide differences in their adolescent growth performance. Nutritional deprivation thus seems to affect almost all growth parameters and final adult size too.

Prolonged breast-feeding and malnutrition among rural Indian children below 3 years of age.

Long periods of exclusive as well as partial breast-feeding in poor communities are of considerable importance from a nutritional standpoint, as it is in these communities that malnutrition is predominant. Although benefits of exclusive breast feeding have been well documented, those for partial breast-feeding have not been examined. The present study in particular examines the effects of prolonged breast-feeding, i.e. exclusive breast-feeding beyond 6 months or partial breast-feeding up to 2-3 years, in terms of prevalent malnutrition and morbidity among rural children. A total of 395 children were observed for weight, height, information on duration of breast-feeding, age at weaning and morbidity in terms of recent illness in the 7 days prior to the day of visit. Exclusive breast-feeding beyond 6 months and up to 12 months appeared beneficial in terms of reduced morbidity. Beyond infancy, there was no evidence of any protective effect of partial breast-feeding. This could be due to poor lactational performance of mothers and their unawareness about it resulting in inadequate weaning foods being offered to partially breast-fed children. Significant differences in male and female children in the extent of malnutrition pointed towards discrimination against girls even in respect of exclusive breast-feeding. The study highlights the need for advocating proper weaning practices while recommending prolonged breast-feeding in poor communities.