Body fat reference percentiles on healthy affluent Indian children and adolescents to screen for adiposity.

BACKGROUND: Indian children and adolescents have higher body fat percentage at a given body mass index than their Western counterparts. OBJECTIVE: To create gender-specific percentile curves for total body fat percentage (TBFP), total body fat mass (TBFM), fat mass index (FMI) and android:gynoid (A:G) ratio for screening adiposity in healthy Indian children. METHODS: Data on body composition by dual-energy X-ray absorptiometry were obtained from a cross-sectional study conducted from May 2006-July 2010 on 888 (462 boys) apparently healthy children from affluent area schools and colleges in Pune city, India. Reference percentile curves were derived for boys and girls for TBFP, TBFM, FMI and A:G ratio. These percentile curves were validated using data on metabolic syndrome risk components in separate sample of 332 (148 boys) children. RESULTS: The median TBFP increased little (4%) from 5 to 18 years of age in boys compared with that in girls (19%). TBFP percentiles showed plateau after 13 years of age in boys, whereas a steady increase was seen till 18 years in girls. The median TBFM increased less (7 kg) from 5 to 18 years in boys compared with that in girls (13.4 kg). The curve for median FMI in boys was relatively flat with FMI remaining near 3 kg m(-2) after 13 years of age, whereas in girls median FMI increased with age till about 15 years of age. A:G ratio curves increased with age in both boys and girls up to 18 years of age. In a separate sample of 332 children, according to percentiles developed in the current study, children with TBFP/TBFM/FMI percentiles between 85th and 95th or >95th percentile had significantly higher metabolic risk parameters as compared with those with <85th percentile (P<0.05). CONCLUSIONS: Percentile curves developed in the current study would be useful in assessment of adiposity and thus cardiometabolic risk in Indian children.

Sunlight exposure and development of rickets in Indian toddlers.

OBJECTIVE: To study the role of sunlight exposure in determining the vitamin D status of underprivileged toddlers. METHODS: Height and weight were measured, clinical examination was performed, Food Frequency Questionnaire was administered and history of sunlight exposure was obtained in all (61) toddlers attending daytime crèche (Group B). Ionised calcium (iCa), inorganic Phosphorous (iP), alkaline phosphatase activity (ALP), serum parathyroid hormone (PTH) and 25 Hydroxy vitamin D (25OHD) were measured. Data were compared with results of a survey measuring similar parameters in 51 (of 251 eligible) toddlers from the same slum (Group A). RESULTS: 111 children (mean age 2.6 yr (0.7), boys 56) were studied. Prevalence of hypovitaminosis D was 77% in group B toddlers (46 of 60) and 16.4% (10 of 61) had rickets, while none of the group A toddlers had 25OHD levels below 30 nmol/L. Four children (7.8%) from Group A as against 24 (42.9%) from Group B, had sunshine exposure of < 30 minutes per day. CONCLUSION: Underprivileged toddlers who were deprived of sunlight had a much greater incidence of hypovitaminosis D and frank rickets. The study has important public health implications and underscores the necessity for sunlight exposure in young children.

Oral calcium supplementation reverses the biochemical pattern of parathyroid hormone resistance in underprivileged Indian toddlers.

BACKGROUND: Toddlers in Pune, India, accustomed to low dietary calcium intake but vitamin D replete have low serum ionised calcium and inappropriately raised serum inorganic phosphorus concentrations together with elevated serum parathyroid hormone (PTH) concentrations. We hypothesised that dietary calcium deficiency leads to end organ resistance to PTH, thus resulting in mild hypocalcaemia and hyperphosphataemia, and that this would be reversed by oral calcium supplementation. METHODS: 51 subjects (25 male; mean (SD) age 2.4 (0.8) years) from an urban slum in Pune were randomised to 500 mg of oral calcium supplement or placebo, daily, for 8 weeks. All subjects received 20 mg of oral elemental iron, daily, as 90% had a serum ferritin concentration <12 microg/l. All subjects were examined for clinical stigmata of rickets and had a wrist radiograph performed. Serum concentrations of ionised calcium, phosphorus, PTH and fibroblast growth factor-23 (FGF-23) were measured at the start and end of the trial. RESULTS: No subject had clinical or radiological evidence of rickets. There was a significant increase in mean serum ionised calcium concentration (p<0.001) in the supplemented but not the placebo group (p = 0.32). The decrease in mean serum phosphorus concentration in the supplemented group was greater (p<0.001) than in the placebo group (p = 0.003). Mean serum PTH fell in the calcium supplemented (p = 0.001) but not in the placebo (p = 0.303) group. The mean serum FGF-23 concentration did not change in response to calcium supplementation. CONCLUSIONS: From these data the authors conclude that low dietary calcium intake is associated with resistance to PTH.

Vitamin B12 and homocysteine status in asymptomatic Indian toddlers.

Low serum vitamin B(12) (V B(12)) and hyperhomocysteinemia have been reported in asymptomatic Asian Indian men. We studied the prevalence of V B(12) deficiency and hyperhomocysteinemia in 51 asymptomatic toddlers, from Pune, India. V B(12) levels were low and total serum homocysteine was high in 14% and homocysteine levels were significantly higher in boys. Programming for cardiovascular risk in adulthood possibly starts at a very young age through the homocysteine axis.

Iron deficiency anemia in an urban slum.

OBJECTIVE: Of this pilot study was to assess the iron status and dietary intake of 1-3 year-old apparently healthy toddlers of the lower socio-economic class, and the effect of eight weeks intervention with liquid oral iron in an urban slum in Pune, India. METHODS: 50 toddlers (M= 25, F= 25) with mean age of 2.4 years (SD 0.82) were evaluated. Anthropometry, Food Frequency Questionnaire, a hemogram and ferritin were measured. Twenty mg of elemental iron was given to all toddlers. After 8 weeks clinical examination, anthropometry, hemoglobin (HGB) and Ferritin were measured. RESULTS: Prevalence of anemia was 66% (HGB <11 gm %) and ferritin (iron stores) were low (< 12 microgm/L) in 45 (90%). After therapy prevalence of anemia was 30%. There was a significant difference in the HGB and ferritin levels of children after eight weeks of therapy (p<0.001). CONCLUSION: The prevalence of anemia decreased from 66 to 30% after treatment with liquid iron. We propose that all concerned in the care of toddlers should join the fight against anemia and prescribe iron to all toddlers when they are seen for minor ailments.