Adolescent undernutrition and early adulthood bone mass in an urbanizing rural community in India.

The long-term effects on bone health of nutritional status in adolescence are unclear. The impact of adolescent and current body mass on bone mass in young adulthood in rural India was assessed. Current lean mass was a more important determinant of bone mass than thinness during adolescence in this population. PURPOSE/INTRODUCTION: Adolescence is a crucial period for skeletal growth. However, the long-term effects on bone health of nutritional status in adolescence, particularly in the context of nutritional transition, are unclear. The current manuscript assessed the impact of adolescent and current body size on bone mass in young adulthood in an Indian rural community that is undergoing rapid socioeconomic changes. METHODS: The Andhra Pradesh Children and Parents Study is a prospective cohort study in Hyderabad, India. In 2003-2005, the study collected anthropometric and cardiovascular data on adolescents (mean age = 16 years old). The second and third waves of the study in 2009-2012 collected data on current anthropometric measures, areal bone mineral density (aBMD) in hip and lumbar spine (L1-L4) measured by dual-energy X-ray absorptiometry, and living standards of the trial participants who were now young adults (mean age = 22 years old). RESULTS: The median body mass index (BMI) of the 722 participants included in this analysis was 16.8 kg/m(2) during adolescence, while the median BMI as young adults was 19.3 kg/m(2). Lower aBMD during adulthood was associated with lower adolescent BMI (ß (95 % confidence interval) for hip aBMD 0.017 (0.013 to 0.022) and LS aBMD 0.012 (0.008 to 0.016)). This association was attenuated upon adjustment for current fat and lean mass (ß (95 % CI) for hip aBMD 0.00 (-0.005 to 0.005) and LS aBMD 0.005 (0.000 to 0.01)). There was clear evidence for positive associations between aBMDs and current lean mass. CONCLUSIONS: Current lean mass was a more important determinant of bone mass than thinness during adolescence in this population. Weight gain during late adolescence and young adulthood coupled with improvement in lean mass may help to mitigate any adverse effects that pre-adulthood undernutrition may have on bone mass accrual.

Socio-economic position and cardiovascular risk in rural Indian adolescents: evidence from the Andhra Pradesh children and parents study (APCAPS).

OBJECTIVES: This study examined association between socio-economic position and cardiovascular risk factors in adolescents to investigate whether childhood socio-economic position is a risk factor for future cardiovascular disease, independently of adult behaviours. STUDY DESIGN AND METHODS: Participants (n = 1128, 46% girls, aged 13-18 years) were members of a birth cohort (Andhra Pradesh Children and Parents Study or APCAPS) established to investigate long-term effects of a pregnancy and childhood nutritional supplementation trial conducted in 29 villages near Hyderabad in South India. Cross-sectional associations between socio-economic position and cardiovascular risk factors were examined using linear regression models. RESULTS: The mean BMI was 16.7 kg/m(2) for boys and 17.8 kg/m(2) for girls. Socio-economic position was positively associated with fat mass index (0.15 kg/m(2); 95% CI: 0.05-0.25) and inversely associated with central-peripheral skinfold ratio (-0.04; 95% CI: -0.06 to -0.01) and, in boys, fasting triglycerides (-0.05; 95% CI: -0.09 to -0.01). Association of socio-economic position with other risk factors (blood pressure, arterial stiffness, fasting glucose, insulin and cholesterol) was weak and inconsistent, and did not persist after adjustment for potential confounders, including age, sex, pubertal stage, height, adiposity and nutrition supplementation. CONCLUSIONS: The study thus showed that lower socio-economic position may be associated with greater central adiposity and higher triglyceride levels in these settings. Socio-economic gradient in cardiovascular risk may strengthen in future with later economic and lifestyle changes. Cardiovascular disease prevention strategies should therefore focus on the youth from the low income group.

Cohort profile: Andhra Pradesh Children and Parents Study (APCAPS).

The Andhra Pradesh Children and Parents Study (APCAPS) was originally established to study the long-term effects of early-life undernutrition on risk of cardiovascular disease. Its aims were subsequently expanded to include trans-generational influences of other environmental and genetic factors on chronic diseases in rural India. It builds on the Hyderabad Nutrition Trial (HNT) conducted in 1987-90 to compare the effects on birthweight of a protein-calorie supplement for pregnant women and children. The index children of HNT and their mothers were retraced and examined in 2003-05, and the children re-examined as young adults aged 18-21 years in 2009-10. The cohort was expanded to include both parents and siblings of the index children in a recently completed follow-up conducted in 2010-12 (N=∼6225 out of 10,213 participants). Recruitment of the remaining residents of these 29 villages (N=∼55,000) in Ranga Reddy district of Andhra Pradesh is now under way. Extensive data on socio-demographic, lifestyle, medical, anthropometric, physiological, vascular and body composition measures, DNA, stored plasma, and assays of lipids and inflammatory markers on APCAPS participants are available. Details of how to access these data are available from the corresponding author.

Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: long term follow-up of Hyderabad nutrition trial.

OBJECTIVE: To determine whether integration of nutritional supplementation with other public health programmes in early life reduces the risk of cardiovascular disease in undernourished populations. DESIGN: Approximately 15 years' follow-up of participants born within an earlier controlled, community trial of nutritional supplementation integrated with other public health programmes. SETTING: 29 villages (15 intervention, 14 control) near Hyderabad city, south India. PARTICIPANTS: 1165 adolescents aged 13-18 years. INTERVENTION: Balanced protein-calorie supplementation (2.51 MJ, 20 g protein) offered daily to pregnant women and preschool children aged under 6 years, coupled with integrated delivery of vertical public health programmes. MAIN OUTCOME MEASURES: Height, adiposity, blood pressures, lipids, insulin resistance (homoeostasis model assessment (HOMA) score), and arterial stiffness (augmentation index). RESULTS: The participants from the intervention villages were 14 mm (95% confidence interval 4 to 23; P=0.007) taller than controls but had similar body composition. The participants from the intervention villages had more favourable measures of insulin resistance and arterial stiffness: 20% (3% to 39%; P=0.02) lower HOMA score and 3.3% (1% to 5.7%; P=0.008) lower augmentation index. No strong evidence existed for differences in blood pressures and serum lipids. CONCLUSIONS: In this undernourished population, integrated delivery of supplemental nutrition with other public health programmes in pregnancy and early childhood was associated with a more favourable profile of cardiovascular disease risk factors in adolescence. This pragmatic study provides the most robust evidence to date on this important hypothesis for which classic trials are unlikely. Improved maternal and child nutrition may have a role in reducing the burden of cardiovascular disease in low income and middle income countries.

Iron fortified salt distribution through integrated child development services in Orissa - an assessment.

The present study was undertaken in two backward districts namely Phulbani and Sundargarh, of Orissa State, India, to study operational aspects of the distribution programme of iron fortified salt (IFS), and the extent of any overlap with the ongoing National Nutritional Anaemia Control Programme (NNACP) and possible toxic effects thereof. All IFS samples tested showed iron levels in the range of 800-1000 mg of elemental iron per I kg of iron fortified salt. Distribution of IFS to households was irregular and only 40% of the households had stocks of IFS at the time of home visits. None of the households using IFS reported any kind of adverse effects. Prevalence of anaemia (blood haemoglobin level of less than 11 g/dl) was highest among pregnant women (90.9%) followed by lactating women (88.7%), school aged children (84.4%) and preschool children (77.9%) respectively. Folifer tablets are being distributed to pregnant, lactating women and preschool children. Adult tablets contain 60 mg of elemental iron in the form of ferrous sulphate (FeSO4) and 500 m g of folic acid. Tablets distributed to children contain 20 mg of elemental iron and 100 m g of folic acid. Enquires regarding distribution of folifer tablets showed that 71% of pregnant women, 22% of lactating women and 22% of children received the folifer tablets at sometime or other and no toxic effects were reported. These results indicate the necessity for some modifications in existing strategies for distribution of IFS in order that it be effective in the prevention of widespread anaemia.

Vitamin B-complex deficiency and visual acuity.

1. A study was carried out on 973 school children to find out any relationship between vitamin B-complex deficiency signs and defective vision, and the effect of supplementation of B-complex vitamins on visual acuity. 2. The results of the study showed a significant association between presence of clinical signs of vitamin B-complex deficiency and defective vision. 3. Supplementation with vitamin B-complex was found to have a beneficial effect in improving the visual-acuity status of defective children and in preventing visual defects from developing. 4. It is concluded, therefore, that from the present study it appears that the relationship between vitamin B-complex deficiency and visual defects could be one of 'cause and effect'.