Dietary diversity and food variety scores and their association with nutrition and health status of Indian children and adolescents: A multicenter study.

BACKGROUND: The objectives of this study were to 1) evaluate the dietary diversity scores (DDS) and food variety scores (FVS) among Indian children and adolescents aged 9-18 y; 2) compare the DDS and FVS in association with demographic, socioeconomic, and health characteristics (growth and hemoglobin [Hb] concentrations); and 3) determine DDS and FVS cutoffs to identify dietary micronutrient adequacy. METHODS: This study was performed in a subset (n = 1845) of children and adolescents enrolled in a multicenter study (2016-2017) from urban and rural areas of six Indian states. Height, weight, and Hb were measured, and anthropometric Z-scores were computed. Sociodemographic data were collected using a structured questionnaire. Dietary data collected by 24-h dietary recall were used to calculate the DDS and FVS. The mean adequacy ratio (MAR) for 10 micronutrients was computed. Receiver operating characteristic analysis was performed to define cutoffs of DDS and FVS. RESULTS: In comparison with children and adolescents from rural areas, urban children and adolescents consumed more diverse diets (urban, 4.1 ± 1.1; rural, 3.5 ± 1; P < 0.01) and had a higher mean FVS (urban, 19.9 ± 5.7; rural, 15.9 ± 4.5; P < 0.01). Both the DDS and FVS were significantly correlated with each other (r = 0.860; P < 0.01) and were positively correlated with MAR, growth, and Hb (P < 0.001) and mother's educational level (P < 0.01). The cutoffs of ≥6.5 (DDS) and ≥17 (FVS) were determined to predict micronutrient adequacy. CONCLUSIONS: Both the DDS and FVS can be used interchangeably for assessing growth, health status, and nutritional adequacy. Single cutoff values of the DDS and FVS may aid in prompt identification of children and adolescents with micronutrient inadequacy.

Contribution of Vitamin D Metabolites to Vitamin D Concentrations of Families Residing in Pune City.

The objective was to explore the patterns of contribution from vitamin D metabolites (D2 and D3) to total vitamin D concentrations in Indian families. This cross-sectional study was carried out in slum-dwelling families residing in Pune city. Data on demography, socio-economic status, sunlight exposure, anthropometry, and biochemical parameters (serum 25OHD2, 25OHD3) via the liquid chromatography-tandem mass spectrometry method were collected. The results are presented for 437 participants (5 to 80 years). One-third were vitamin-D-deficient. Intake of foods containing vitamin D2 or D3 was rarely reported. Irrespective of gender, age, and vitamin D status, the contribution of D3 to total 25OHD concentrations far exceeded that of D2 (p < 0.05). The contribution of D2 ranged from 8% to 33% while that of D3 to 25OHD concentrations ranged from 67% to 92%. 25OHD3 is a major contributor to overall vitamin D concentrations, and the contribution of 25OHD2 was found to be negligible. This implies that sunlight and not diet is currently the major source of vitamin D. Considering that lifestyle and cultural practices may lead to insufficient sunlight exposure for large sections of the society, especially women, dietary contribution to vitamin D concentrations through fortification may play an important role in improving the vitamin D status of Indians.

Influence of ecoregional and lifestyle factors on growth and body composition of Indian children and adolescents aged 9-18 years-A multicenter study.

OBJECTIVES: Ecoregion comprises all the environmental factors such as climate, vegetation, geomorphology, and soil taken together. The objectives of this study were to (1) assess differences in growth and body composition (BC) in 9-18-year-old children and adolescents (CA), across six ecoregions of India, (2) evaluate and compare the magnitude of the effect of ecoregional and lifestyle factors (LSF) on growth and BC in urban (U) and rural (R) children and adolescents, and (3) reassess the applicability of Bergmann's Rule and Allen's Rule to humans. SUBJECTS AND METHODS: Data on 1845 CA (925 boys; 920 girls) were collected (2016-2017) from urban and rural areas of six ecoregions of India. Anthropometric and BC parameters were measured; Z-scores were computed. Lifestyle Index score (LIS) based on LSF-(socioeconomic status [SES], diet, physical activity) was computed (categorized as low, medium, high-indicates better LSF). Univariate analysis was performed to estimate effect size. RESULTS: Significant differences were observed in growth and BC across urban and rural ecoregions. CA with high LIS were taller and heavier than those with low LIS (p < .05). Ecoregion had greater effect on growth (Partial eta square (η2 ) for R = 0.136 vs. U = 0.057) and BC (η2 for R = 0.094 vs. U = 0.058) of rural CA than urban (p < .01). LSF had more effect on the BC of urban CA (η2  = 0.017) than rural (η2  = 0.002, p < .01). CONCLUSION: Disparities among the six ecoregions were not large enough to fully support Bergmann's Rule and Allen's Rule. Ecoregion had greater effect on growth and BC of rural CA than urban, while lifestyle factors had more effect on the BC of urban CA.

Establishing a Unique, Single Cutoff Value for Body Frame Size for Screening for Risk of Hypertension in Indian Children and Adolescents-A Multicenter Study.

OBJECTIVES: To evaluate the strength of association of two measures of BFS: frame-size one (FS1; height ÷ wrist circumference) and frame-size two (FS2; elbow breadth), with body-fat indices, body composition, and hypertension in Indian children and adolescents, and to determine age and sex-specific cutoffs of BFS to predict hypertension. METHODS: This was a cross-sectional, multicenter, school-based study in 9- to 18-y-old healthy children (n = 1423) randomly selected from 3 Indian states. Based on tertiles, FS1 and FS2 were categorized as small, medium, and large. RESULTS: Greater BFS (both FS1 and FS2) was associated with higher body-fat indices, BP (r = -0.424 for FS1 and r = 0.282 for FS2, p < 0.01) and lower muscle mass (MM). A significantly greater percentage of children classified as having large BFS according to FS1 were found to be overweight/obese (46% vs. 25%), hypertensive (34% vs. 17%) than FS2 (p < 0.01). FS1 showed strong to very strong association (Cramer's V 0.15 to > 0.25) with body-fat indices, MM, and BP as opposed to FS2 (For BP X2 = 120.9 for FS1 vs. 9.06 for FS2). FS1 better identified obesity and hypertension, and a value of 10.6 was determined to be the optimum cutoff for predicting hypertension in both genders (sensitivity 71%, specificity 75%, AUC 0.795, and NPV 95%). CONCLUSIONS: Height-to-wrist circumference is a novel, simple, and precise BFS measure for predicting hypertension and muscle mass (9-18 y) and a single cutoff value (< 10.6) may contribute to rapid screening and prompt identification of children at risk of hypertension.

Calcium status assessment at the population level: Candidate approaches and challenges.

Inadequate dietary calcium intake is a global public health problem that disproportionately affects low- and middle-income countries. However, the calcium status of a population is challenging to measure, and there are no standard methods to identify high-risk communities even in settings with an elevated prevalence of a disease caused or exacerbated by low calcium intake (e.g., rickets). The calcium status of a population depends on numerous factors, including intake of calcium-rich foods; the bioavailability of the types of calcium consumed in foods and supplements; and population characteristics, including age, sex, vitamin D status, and genetic attributes that influence calcium retention and absorption. The aim of this narrative review was to assess candidate indicators of population-level calcium status based on a range of biomarkers and measurement methods, including dietary assessment, calcium balance studies, hormonal factors related to calcium, and health outcomes associated with low calcium status. Several promising approaches were identified, but there was insufficient evidence of the suitability of any single indicator to assess population calcium status. Further research is required to develop and validate specific indicators of calcium status that could be derived from the analysis of data or samples that are feasibly collected in population-based surveys.

Prevalence and determinants of primary hypertension in urban and rural children from six Indian states: A multicenter study.

OBJECTIVES: Among urban and rural Indian children ages 9 to 18 y, we aimed to assess the prevalence and determinants of primary hypertension (PH), and explore the relationship of fat indices and body composition with hypertension. METHODS: Data from a multicenter study (2016-2017), representative of children (age 9-18 y) from six states were analyzed (n = 1818; urban n = 895). All anthropometric parameters (Z-scores), blood pressure (BP), body composition, and resting metabolic rate (RMR) were measured. Information from a 2-d 24-h diet recall was collected, nutrient and food group intakes were calculated, and physical activity (PA) was assessed. Children were categorized as normotensive or pre-/hypertensive (>90th percentile), and a regression analysis was carried out for determinants. RESULTS: Urban children were significantly taller, heavier, more overweight or obese (25% vs. 11%), pre-/hypertensive (18% vs. 10%), adipose, and had lower RMR/weight than rural children. All hypertensive children had higher fat indices, lower muscle mass, and RMR/weight than those who were normotensive (P < 0.05). Rural hypertensive children consumed more junk food, simple carbohydrate (CHO), fat, and sodium than those who were normotensive. RMR (R2 = 33%) was found to be an important predictor of BP in rural children and body mass index (R2 = 46%) in urban children, followed by central and peripheral obesity, PA, and diet. CONCLUSIONS: Our study highlights that rural children are also at risk of developing PH, especially those with a higher intake of junk food and carbohydrate. Another interesting finding was the negative association of PH with RMR/weight, increasing PA, as well as a micronutrient-rich diet with calcium and magnesium vital to prevent PH. Health care policies need to focus on the increasing prevalence of obesity and PH, not only in urban, but also rural children where different strategies may have to be applied.

Calcium deficiency worldwide: prevalence of inadequate intakes and associated health outcomes.

Dietary calcium deficiency is considered to be widespread globally, with published estimates suggesting that approximately half of the world's population has inadequate access to dietary calcium. Calcium is essential for bone health, but inadequate intakes have also been linked to other health outcomes, including pregnancy complications, cancers, and cardiovascular disease. Populations in low- and middle-income countries (LMICs) are at greatest risk of low calcium intakes, although many individuals in high-income countries (HICs) also do not meet recommendations. Paradoxically, many LMICs with lower calcium intakes show lower rates of osteoporotic fracture as compared with HICs, though data are sparse. Calcium intake recommendations vary across agencies and may need to be customized based on other dietary factors, health-related behaviors, or the risk of calcium-related health outcomes. The lack of standard methods to assess the calcium status of an individual or population has challenged efforts to estimate the prevalence of calcium deficiency and the global burden of related adverse health consequences. This paper aims to consolidate available evidence related to the global prevalence of inadequate calcium intakes and associated health outcomes, with the goal of providing a foundation for developing policies and population-level interventions to safely improve calcium intake and status where necessary.

Calcium supplementation for the prevention of hypertensive disorders of pregnancy: current evidence and programmatic considerations.

Most low- and middle-income countries present suboptimal intakes of calcium during pregnancy and high rates of mortality due to maternal hypertensive disorders. Calcium supplementation during pregnancy is known to reduce the risk of these disorders and associated complications, including preeclampsia, maternal morbidity, and preterm birth, and is, therefore, a recommended intervention for pregnant women in populations with low dietary calcium intake (e.g., where ≥25% of individuals in the population have intakes less than 800 mg calcium/day). However, this intervention is not widely implemented in part due to cost and logistical issues related to the large dose and burdensome dosing schedule (three to four 500-mg doses/day). WHO recommends 1.5-2 g/day but limited evidence suggests that less than 1 g/day may be sufficient and ongoing trials with low-dose calcium supplementation (500 mg/day) may point a path toward simplifying supplementation regimens. Calcium carbonate is likely to be the most cost-effective choice, and it is not necessary to counsel women to take calcium supplements separately from iron-containing supplements. In populations at highest risk for preeclampsia, a combination of calcium supplementation and food-based approaches, such as food fortification with calcium, may be required to improve calcium intakes before pregnancy and in early gestation.

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.

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.

Paradoxical Response of Parathyroid Hormone to Vitamin D-Calcium Supplementation in Indian Children.

OBJECTIVES: To investigate the effect of oral vitamin D-calcium supplementation on serum intact parathyroid hormone (PTH), calcium, phosphorous, and alkaline phosphatase (ALK-P) concentrations in children with habitually low calcium intakes. STUDY DESIGN: In this follow-up study to a randomized controlled trial that aimed to assess the effect of vitamin D-calcium supplementation on immunity, data related to dietary intake, anthropometry, and biochemistry [serum 25(OH)D and bone profile] were collected from 178 children-79 in the vitamin D group and 99 in the non-vitamin D group. RESULTS: Dietary calcium to phosphorus intake ratio was 0.4:1. Baseline serum 25(OH)D concentration was 58.2 ± 10.9 nmol/L; 66% children were vitamin D sufficient and none deficient. After supplementation, vitamin D group, compared with the non-vitamin D group, had significantly (P < .05) greater 25(OH)D (83.9 ± 30.1 nmol/L vs 58.3 ± 15.7 nmol/L), significantly greater PTH (6.7 ± 3.6 pmol/L vs 5.5 ± 3.2 pmol/L), and positive correlation (rs = 0.24) between serum 25(OH)D and PTH (vs negative correlation [rs = -0.1] in non-vitamin D group). Mean concentrations of serum bone measures in the vitamin D group were calcium (2.2 ± 0.1 mmol/L), phosphorus (1.7 ± 0.2 mmol/L), and ALK-P (178.7 ± 40.7 IU/L). At follow-up, 1-year post-supplementation, in the vitamin D group, PTH concentrations continued to remain high (but not significantly different from levels at 6 months), with low normal serum calcium, high normal phosphate, and ALK-P in reference range. CONCLUSIONS: In children who are vitamin D sufficient but with habitually low dietary calcium intake, vitamin D-calcium supplementation paradoxically and significantly increased serum PTH concentrations with no apparent effect on other bone biochemistry. Chronic low dietary calcium to phosphorus ratio is likely to have caused this paradoxical response.

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.

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.

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.

Reference centile curves for wrist circumference for Indian children aged 3-18 years.

BACKGROUND: Childhood obesity and its consequences have reached alarming proportions worldwide and in India. Wrist circumference is emerging as an easily measurable reproducible parameter for screening children at risk of obesity-related morbidities such as hypertension and insulin resistance. The objectives of this study were: (1) to compute age and gender-specific wrist circumference percentiles for 3-18-year-old apparently healthy Indian children and adolescents; (2) to assess the relationship of wrist circumference with measures of obesity and adiposity such as body mass index (BMI), fat percentage and blood pressure (BP) and (3) to suggest age and gender-specific cut-offs for wrist circumference percentile for the risk of hypertension in Indian children and adolescents. METHODS: This was a cross-sectional study on samples of 10,199 3-18-year-old children (5703 boys) from randomly selected schools from five major cities in India. Height, weight, waist and wrist circumference and BP were recorded. Body composition was measured using bioelectrical impedance analysis (BIA). Wrist circumference percentiles were computed using the LMS method. RESULTS: The average wrist circumference of boys and girls was 10.4 cm and 10.0 cm at 3 years and increased to 15.1 cm and 13.9 cm, respectively, at 18 years. Compared to their Caucasian counterparts, Indian children's wrists were smaller. Receiver operating characteristic (ROC) curve analysis derived the 70th percentile of wrist circumference as the cut-off for identifying the risk of hypertension. CONCLUSIONS: Contemporary cross-sectional reference percentile curves for wrist circumference for 3-18-year-old Indian children are presented. The 70th percentile of the current study is proposed as the cut-off to screen children for cardiometabolic risk factors such as hypertension.

Response of serum 25(OH)D to Vitamin D and calcium supplementation in school-children from a semi-rural setting in India.

The objectives of this study were to: 1) Determine the impact of varying baseline serum 25OHD on increase in vitamin D concentrations after daily supplementation with vitamin D and calcium (1000 IU + 500 mg respectively) for six months in school-children from a semi-rural setting 2) Test the efficacy of daily vitamin D-calcium supplementation on improvement in serum vitamin D concentrations to ≥75 nmol/L. Data collected from 106 subjects (58 boys, 48 girls), aged 6-12 years, included anthropometric measures like height and weight, body composition analysis, three one-day dietary recalls and sunlight exposure (by questionnaire). Blood was collected at baseline and endline and estimated for serum vitamin D by ELISA technique using standard kits. Classification of Vitamin D status was performed according to the 2011 Endocrine Society Practice Guidelines: vitamin D deficiency - <50 nmol/L; insufficiency - 50.0-74.9 nmol/L; sufficiency - ≥75 nmol/L. Statistical analysis was performed using SPSS software. Mean baseline serum vitamin D concentration was 59.7 ±â€¯11.2 nmol/L; this rose to 79.8 ±â€¯23.3 nmol/L with no significant differences between genders at the two time-points. Inverse relationship was obtained between baseline serum 25(OH)D concentrations and change in serum concentrations after supplementation, implying that with increasing baseline serum concentrations of 25(OH)D, increase in vitamin D levels post supplementation were significantly lower (r = - 0.96, p < 0.0001). Greatest benefit of change in serum vitamin D concentrations after supplementation was experienced by children with basal concentrations of <45 nmol/L. Daily vitamin D supplementation was effective in improving serum 25(OH)D to ≥75 nmol/L in 44% of children. Significantly higher percentage of children who were deficient at baseline (64%) were able to attain serum concentrations of ≥75 nmol/L as compared to children who were vitamin D insufficient (43%) (p < 0.001). Thus, daily supplementation with 1000 IU of vitamin D along with 500 mg of calcium helped in improving serum vitamin D concentrations to ≥75 nmol/L. Children who were vitamin D deficient particularly experienced these benefits.

Reference Centile Curves for Body Fat Percentage, Fat-free Mass, Muscle Mass and Bone Mass Measured by Bioelectrical Impedance in Asian Indian Children and Adolescents.

OBJECTIVE: To create gender-specific percentile curves for percent body fat (%BF) by Bio electrical Impedance Analysis (BIA) for screening adiposity and risk of hypertension in Indian children and generate reference curves for percent fat-free mass (%FFM), muscle mass (%LM) and bone mineral content (BMC) by using bioelectrical impedance. DESIGN: Secondary analysis of data from previous multicenter cross-sectional studies. SETTING: Private schools from five regions of India. PARTICIPANTS: A random sample of 3850 healthy school children (2067 boys) (5-17 yr) from private schools in five major Indian cities. METHODS: Anthropometry, blood pressure (BP) and body composition were measured by bioelectrical impedance. Reference curves were generated by the LMS method. MAIN OUTCOME MEASURES: %BF, %FFM, %LM, BMC and BP. RESULTS: Median %BF increased by 6% from 5 to 13 years of age and declined (around 2%) up to 17 years in boys. In girls, %BF increased by 8% from 5 to 14 years and thereafter declined by 3%. Based upon the risk of hypertension, the new cut-offs of 75th and 85th percentile of %BF were proposed for detecting over fatness and excess fatness in children. Median %FFM was 90% at 5 yrs and decreased till 12 years, and then showed a slight increase to 84% at 17 yrs in boys. In girls, it was 86% at 5 yrs and decreased till 15 yrs, and plateaued at 71.8% at 17 yrs. CONCLUSIONS: Reference curves for percent body fat for Indian children would be useful to screen children for health risk in clinical set up.