If you can't fix the problem change the standards.

Over the last few months, established data systems in India have been the target of heated dispute, chiefly by members of the Economic Advisory Council to the Prime Minister, ranging from the inflation numbers [1], to the sampling frame for surveys done by the National Sample Survey Organisation (NSS), the National Family Health Survey (NFHS) and the Periodic Labour Force Survey (PLFS)[2], haemoglobin cut-offs for anaemia [3] and childhood growth standards, female labour force participation rate and life expectancy at birth [4]. The attempts to revise economic data systems has invited a raging debate [5, 6], prompting the government to set up a panel to review the NSS's methodology. However, the arguments being made in favor of downward revision of nutritional standards have received much less scrutiny, except for a recent editorial which comments on the general problem of drawing up standards [7]. This is despite the fact that these proposals have already caught the fancy of the government. A policy decision has already been taken to discontinue gathering of data on Hb-levels as part of the quinquennial National Family Health Surveys, which would now be collected as part of a new Dietary and Bio-markers Survey. Neither the rationale for such a move, nor the details of the methodology of the new survey, or the time-frame within which such data would be released have been made available for public deliberation. Similarly, discussions have been initiated on devising "indigenous" growth standards for children [8]. Hence, it becomes imperative to examine the basis of these renewed calls for revision of existing standards.

Joint study led by International Food Policy Research Institute (IFPRI) puts meat-eating women's lives at risk.

The findings of a collaborative study in Uttar Pradesh, India, by the International Food Policy Research Institute (IFPRI), Family Health International (FHI) and Johns Hopkins (JH), and funded by the Bill and Melinda Gates Foundation (BMGF), have been tweeted out from the IFPRI Twitter handle (See: https://twitter.com/POSHANsm/status/1268074050468712449) on June 4, 2020, along with a graph, stating.

Effectiveness of zinc supplementation to full term normal infants: a community based double blind, randomized, controlled, clinical trial.

UNLABELLED: The study was aimed to test whether zinc supplementation, if initiated early, can prevent stunting and promote optimum body composition in full term infants. For this, full term pregnant women from low income urban community were enrolled and were followed-up for 24 months postpartum. Body mass index (BMI) was calculated from maternal weight and height that were collected one month after delivery. Infants' weight, and length, head, chest and mid upper arm circumferences and skin fold thicknesses at triceps, biceps and subscapular area were collected at baseline (before randomization) and once in three months up till 24 months. Three hundred and twenty four infants were randomized and allocated to zinc (163) or placebo (161) groups respectively. Supplementation of zinc was initiated from 4 months of age and continued till children attained 18 months. The control (placebo) group of children received riboflavin 0.5 mg/day, whereas the intervention (zinc) group received 5 mg zinc plus riboflavin 0.5 mg/day. When infants were 18 months old, dietary intakes (in 78 children) were calculated by 24 hour diet recall method and hemoglobin, zinc, copper and vitamin A were quantified in blood samples collected from 70 children. The results showed prevalence of undernutrition (body mass index <18.5) in 37% of the mothers. Mean±SD calorie consumption and zinc intakes from diets in infants were 590±282.8 Kcal/day and 0.97±0.608 mg/day respectively. Multiple linear regression models demonstrated maternal weight as a strong predictor of infants' weight and length at 18 months of age. As expected, diarrhea duration impacted infants' linear growth and weight gain adversely. Zinc supplementation for a mean period of 190 days, starting from 4 months up to 18 months of age, in full term normal infants, consuming an average energy of 590 Kcal/day, had significant effect on the skin fold thicknesses, but not on their linear growth. TRIAL REGISTRATION: Clinical Trail Registration India (CTRI) CTRI/2012/08/002884.

Regional body composition changes during lactation in Indian women from the low-income group and their relationship to the growth of their infants.

BACKGROUND: Increased energy requirement during lactation may lead to maternal tissue depletion in women from poor subsistence communities. OBJECTIVES: To examine the regional body composition changes in undernourished lactating women and to assess the relationship of maternal body composition changes with weight gain of the infants. SUBJECTS AND METHODS: Body composition was assessed using dual energy x-ray absorptiometry in 35 lactating women at 4 time points: within 1 month after delivery (baseline) and at 6, 12, and 18 months postpartum. RESULTS: The mean age, height, and body mass index of the women were 23.5 years, 150.7 cm, and 20.0 kg/m(2), respectively. There were no significant differences in body weight or whole-body lean as well as fat mass at 4 time points, but the percentage fat decreased significantly during lactation. There was selective mobilization of fat mass from the leg region, whereas the appendicular skeletal mass (ASM) increased significantly. When the growth of the infants in the first 6 months (proxy for the lactation performance) was assessed in relation to the maternal body composition changes during that period, it was observed that the change in fat mass had a negative relationship to the weight gain of the infant. Change in the ASM during this period, however, had a significant positive relationship with the weight gain of the infants. CONCLUSION: There were important differences in the lactation-related changes in the regional body composition parameters of these undernourished women. Regional body composition changes may be related to the weight gain of the breast-fed infants.

Hospital based nutrition rehabilitation of severely undernourished children using energy dense local foods.

OBJECTIVE: To examine the catch up growth in severely wasted children using energy dense local foods at a hospital based nutrition rehabilitation unit. DESIGN: Retrospective cohort. SETTING: In-patient ward at a tertiary care government pediatric hospital in Hyderabad. PATIENTS: Children with severe malnutrition (n=309) admitted to nutrition ward from January 2001 to December 2005. INTERVENTION: A diet based on energy dense local foods along with multivitamin-multimineral supplements. MAIN OUTCOME MEASURES: Catch up growth (g/kg/day) during each week of hospital stay. RESULTS: Mean age of the children was 25 months (range 2-60). Their baseline weight for height (WHZ) Z score was -4.1. Mean weight gain was moderate (5g/kg/day) and baseline WHZ score had a significant negative relationship to the weight gain. The prevalence of morbidities was high and the commonest morbidity was fever. Weight gain was higher by almost 40% in the absence of morbidities in any week. CONCLUSIONS: The diet based on local energy dense foods was found to be suitable for the nutrition rehabilitation of severely malnourished children though the rate of weight gain was moderate.

Composition of weight gain during nutrition rehabilitation of severely under nourished children in a hospital based study from India.

Concerns are raised that rapid catch up growth during nutrition rehabilitation of severely malnourished children may be associated with disproportionately higher amounts of body fat deposition. This study examined the composition of weight gain in severely undernourished children who underwent nutrition rehabilitation in a hospital from India. Body composition of 80 severely malnourished children (age 6-60 months) was assessed using skin-fold thickness measurements on admission and after 1 month of supplementary feeding. On admission, children had severe weight and height deficits and were severely wasted. The mean weight for age z score, height for age z score and weight for height z score (WHZ) were -5.0, -4.2 and -4.1 respectively. Children consumed a mixed diet and mean energy intake was 177 kcal/kg/day with a protein energy ratio of 13. Overall, the mean weight gain was 6.1 g/kg/day and fat mass contributed to about 40% of the weight gain. When the composition of weight gain was analysed in tertiles of baseline WHZ score, children in the lowest tertile of WHZ score had significantly higher weight gain and fat free mass (FFM) gain. Gain in fat mass did not differ in relation to the baseline WHZ score. The study demonstrates that it is possible to achieve rapid weight gain with recovery of lost tissue in severely malnourished children with mixed diets. Children with lowest WHZ scores at baseline gained higher FFM during nutrition rehabilitation when compared to the children with relatively higher WHZ score probably in an attempt to recover the lost tissue.

Regional body composition of Indian women from a low-income group and its association with anthropometric indices and reproductive events.

BACKGROUND AND AIMS: The study examined the body composition of women from an urban slum who have a low prevalence of obesity. Since the quantification of regional fat distribution is important for evaluating health risks, the regional body composition was assessed in relation to anthropometric indices and reproductive events. METHODS: The body composition of 278 women was assessed using dual energy X-ray absorptiometry. RESULTS: Their mean age, height, body mass index, percentage of whole body fat and trunk fat mass to leg fat mass ratio (an indicator of android obesity) were 40.8 years, 149 cm, 22, 33 and 1.22, respectively. Receiver-operating characteristic analyses indicated that a body mass index of 20 and 22 corresponded to a percentage of whole body fat of 30 and 35, respectively. Higher weight was associated with increased android fat distribution and taller height was associated with higher lean body mass and gynoid fat distribution. Multiple linear regression analyses indicated that menopausal status was associated with lower lean mass and higher android obesity whereas breast-feeding was related to lower leg fat mass. Heavy occupational work was associated with higher lean mass. CONCLUSION: The study women had a 'high fat muscle poor' phenotype. The association of regional body composition with anthropometric indices and reproductive events provided important insights.

Maternal weight and lean body mass may influence the lactation-related bone changes in young undernourished Indian women.

Lactation is known to be associated with a transient loss of bone mineral density (BMD) during 3-6 months post-partum. Bone changes during lactation in women consuming low dietary calcium are not sufficiently studied. The present longitudinal study examined the BMD changes during lactation in undernourished women and the relationship of bone changes to the nutritional status. Whole-body bone mineral content and BMD at hip, lumbar spine and forearm were assessed using dual-energy X-ray absorptiometry in thirty-six lactating women from the low socio-economic group at four time points -- within 1 month after delivery (baseline), and at 6, 12 and 18 months after delivery. Maternal body composition and biochemical parameters of bone metabolism were estimated at the same time. It was observed that femoral neck BMD reduced by 4.6 % at 6 months, but recovery to the baseline was incomplete at 18 months with a deficit of 2 %. Hip BMD reduction at 6 months was transient. Lumbar spine BMD did not show significant loss at 6 months and BMD increased by 3.6 and 6.3 % at 12 and 18 months, respectively. Regression analyses indicated that baseline lean mass was the most important determinant of bone preservation at femoral neck, hip as well as whole body, whereas baseline body weight was the most important determinant of per cent gain in lumbar spine. Maternal nutritional status as indicated by body weight and lean mass appears to influence the lactation-related BMD changes in undernourished women from the low socio-economic group in India.

Bone mass of overweight affluent Indian youth and its sex-specific association with body composition.

SUMMARY: The study assessed whether overweight is associated with better bone densities in healthy youth. It was observed that overweight individuals had better BMDs at the hip but not at other sites after controlling for the bone area. Lean body mass was an important determinant of BMDs in men, but both lean and fat mass were important for BMDs in women. INTRODUCTION: The study assessed the relationship of overweight and obesity to the bone mass in young men and women consuming adequate calcium. METHODS: Bone and body composition parameters were measured using dual energy X-ray absorptiometry in overweight men (n = 74) and women (n = 77) in the age group of 20-35 years and compared with controls having normal body mass index (BMI). Biochemical parameters of bone metabolism were also assessed. RESULTS: After adjustment for whole body bone area, bone mineral densities (BMDs) at femoral neck and hip were significantly higher in overweight individuals when compared with controls. However, BMD at lumbar spine, forearm, and whole body were not significantly different in the two BMI groups. Overweight women had lower vitamin D and higher parathormone levels than controls. Regression analyses indicated that height was an important determinant of BMD at most of the skeletal sites in both men and women. Lean body mass was an important determinant of BMDs in men, but both lean and fat mass were important for BMDs in women. CONCLUSION: Overweight may be associated with better BMDs at the hip but not at other sites after controlling for the bone area. Body composition parameters may have sex-specific associations with BMD.

Relationship between women's occupational work and bone health: a study from India.

Physical activity is known to influence the bone mass of an individual. Few studies have examined the effect of occupational activities on bone health. The present study investigated the relationship between occupational activities and the bone parameters measured by dual-energy X-ray absorptiometry in 158 women from a low-income group in India. Women involved in three occupations with different bone-loading patterns (beedi (cigarette) makers, sweepers and construction workers) were included in the study. Anthropometric parameters, parity and percentage of menopausal women did not differ significantly between the three groups and dietary intake of Ca was low in all the groups. Bone mineral density (BMD) values of the overall group at all the sites were much lower than those reported from developed countries, possibly due to different body sizes in these regions. Femoral neck and hip BMD were not different in the three groups in spite of marked differences in activity patterns. However, bone area in the femoral neck was higher in the beedi makers compared with sweepers probably due to the squatting position adopted by beedi makers. Lumbar spine BMD was significantly lower among the sweepers when compared with the beedi makers and the groups performing walking and weight-bearing activities (sweepers and construction workers) had a higher prevalence of osteoporosis in the lumbar spine. However, weight-bearing effects of the upper body due to a squatting position were associated with better lumbar spine BMD in the beedi makers. The present study thus indicates that undernutrition might affect the relationship between occupational activities and bone parameters.

Effect of micronutrient supplement on health and nutritional status of schoolchildren: study design.

OBJECTIVE: We tested the hypothesis that supplementation with a micronutrient-fortified beverage improves micronutrient status and physical and mental development in apparently healthy schoolchildren. METHODS: The study was carried out in middle-income students in two residential schools that catered to children from a semi-urban population near Hyderabad, India. Included were 869 children who were 6 to 16 y of age in grades 1 to 10. Because children at each grade were distributed across two classrooms (clusters) and were homogeneous, each grade was considered to consist of a matched pair. There were thus 10 pairs available for the study. Classes in each grade were randomized to receive a micronutrient-enriched beverage or a placebo without added micronutrients. The study was double blinded and the duration was 14 mo, with supervised feeding of the micronutrient-enriched beverage. The effect of the micronutrients on the outcome variables growth, biochemical status, mental function, and bone health were assessed. RESULTS: The number of matched pairs varied between seven and eight, and the required number of children per treatment group ranged from 32 in the case of bone heath to 177 for body weight. The power of the outcome variables ranged from 74% to 100% and was adequate for successful pairing. The effect assessed at the end of supplementation showed that the intervention was beneficial. CONCLUSIONS: Designing an intervention, choosing outcome variables, and implementing the protocol in a typical Indian school setting were achieved.

Effect of micronutrient supplement on health and nutritional status of schoolchildren: biochemical status.

OBJECTIVE: We assessed the effect of a daily intake of a micronutrient-fortified beverage for 14 mo on indicators of biochemical status of important micronutrients in schoolchildren. METHODS: A double-blind, placebo-controlled, matched-pair, cluster, randomization study design was used. Biochemical indicators of micronutrient status were evaluated at baseline and at the end of 14 mo on a subsample in nine matched pairs. Prevalence (percentage) of subclinical deficiency, mean, and mean increments of each indicator were compared between supplemented and placebo groups. RESULTS: Extent of inadequacy at baseline was more or less 100% for folic acid, 65% for vitamins B2 and B6, and 55% for vitamins C and A. Prevalence of anemia among subjects was 55%, with inadequacy of vitamin B12 being 40% and that of vitamin D being 30%. No subject had inadequacy of iodine based on urinary iodine. Supplementation of a micronutrient-enriched beverage for 14 mo significantly improved the status of many of the nutrients. The effect was significant with respect to vitamins A, B2, and B12, folic acid, vitamin D, parathyroid hormone, and thyroid-stimulating hormone in children who received the supplement compared with those who received only placebo. Hemoglobin status improved only in children who had anemia in the supplemented group. CONCLUSIONS: Prevalence of multiple subclinical micronutrient deficiencies are high in middle-income Indian school children. Daily consumption of a micronutrient-enriched beverage had positive effects that were confined to those nutrients that were inadequate at baseline.

Effect of micronutrient supplement on health and nutritional status of schoolchildren: bone health and body composition.

OBJECTIVE: We investigated the effect of a micronutrient-enriched beverage on body composition, bone mineral content (BMC), bone area, and bone mineral density (BMD) at various sites in schoolchildren. METHODS: A double-blind, placebo-controlled, matched-pair, cluster, randomization study was carried out in residential schoolchildren 6 to 16 y of age who lived near Hyderabad, India. Children (n = 268) were selected randomly from two classes of each grade (1 to 9) and were provided a micronutrient-enriched beverage (n = 146) or a placebo drink (n = 122). Bone parameters such as BMC, BMD, and bone area at various sites and the entire body were measured with dual-energy X-ray absorptiometry at the beginning and end of the study. Increments of outcome variables were subjected to paired t test with appropriate corrections to assess the effect of the supplement on bone health. RESULTS: After 14 mo, increments for height, weight, fat-free mass, percentage of fat, whole-body BMC, whole-body bone area, and BMD at the neck of the femur were significantly greater (P < 0.05) in the supplemented group than in the placebo group. CONCLUSIONS: The micronutrient-rich supplement increased tissue growth and skeletal shell in apparently normal children in the 14-mo period. It did not increase whole-body or site-specific BMD except at the neck of the femur. Amounts of calcium and other nutrients contained in the supplement were inadequate for tissue growth with density increases. This study raises important questions about the nutrient requirements of Indian children who consume a diet of cereals and pulses.

Bone status of Indian women from a low-income group and its relationship to the nutritional status.

Indian women from low-income groups consume diets that have inadequate calcium coupled with too few calories, proteins and micronutrients. Hospital-based data suggest that these women have osteoporotic hip fractures at a much earlier age than Western women. Studies reporting bone parameters of the Indian population involving large sample sizes are not available. This study was therefore carried out with 289 women in the 30-60-year age group to estimate the prevalence of osteoporosis and measure the bone parameters by dual energy X-ray absorptiometry (DXA). Their mean (+/- SD) age was 41.0+/-8.60 years. Their mean (+/- SD) height, weight and body mass index (BMI) were 149.1+/-5.49 cm, 49.2+/-9.85 kg and 22.1+/-3.99, respectively. Dietary intake of calcium was estimated to be 270+/-57 mg/day. The prevalence of osteoporosis at the femoral neck was around 29%. Bone mineral density (BMD) and T scores at all the skeletal sites were much lower than the values reported from the developed countries and were indicative of a high prevalence of osteopenia and osteoporosis. BMD showed a decline after the age of 35 years in cases of the lumbar spine and femoral neck. This was largely due to a decrease of bone mineral content (BMC). The nutritional status of women appears to be an important determinant of bone parameters. BMD and BMC at all the skeletal sites and whole body increased significantly with increasing body weight and BMI of women (P<0.05). However, bone area (BA) did not change with an increase in BMI. In the multiple regression analysis, apart from body weight, age, menopause and calcium intake were the other important determinants of BMD (P<0.05). In addition to these, height was also an important determinant of WB-BMC. This study highlights the urgent need for measures to improve the nutritional status, dietary calcium intake and thus the bone health of this population.

Timed activity studies for assessing the energy expenditure of women from an urban slum in south India.

Time-disposition studies are necessary for computing energy requirements of populations. This study captures the rich information on the timed activity pattern of adult women from poor households engaged in home-based work. We studied 34 women beedimakers (cigarette makers), 21 tailors, and 34 homemakers. Data were collected by direct observation of the women's activities on a typical day. Time spent on related activities was pooled and classified as sleep, household work, child care, occupational work, and residual work. These were further categorized on the basis of our published work on the energy cost of women's activities and the World Health Organization (WHO) classification of occupational activities as sedentary, moderate, and heavy. Most of the household activities could be classified as moderate to heavy (> 2.2 times basal metabolic rate [BMR]). Childcare activities were distributed on a scale from sedentary to heavy, whereas occupational activities, such as beedimaking and tailoring, were sedentary (< 2.2 BMR). Homemakers spent significantly more time on moderate to heavy work (p < .05) than beedimakers and tailors. Women working for income spent only four to six hours on occupational work, which was possible because they reduced the time spent on heavy work (i.e., housework), and reduced the time on personal care. Still, more than 80% of women could not put in eight hours of paid work. Thus, women in the home-based sector constantly negotiate among time spent on heavy household work, child care, and occupational work in order to continue in the labor market.