Assessment of body composition in Indian adults: comparison between dual-energy X-ray absorptiometry and isotope dilution technique.

Dual-energy X-ray absorptiometry (DXA) and isotope dilution technique have been used as reference methods to validate the estimates of body composition by simple field techniques; however, very few studies have compared these two methods. We compared the estimates of body composition by DXA and isotope dilution (18O) technique in apparently healthy Indian men and women (aged 19-70 years, n 152, 48 % men) with a wide range of BMI (14-40 kg/m2). Isotopic enrichment was assessed by isotope ratio mass spectroscopy. The agreement between the estimates of body composition measured by the two techniques was assessed by the Bland-Altman method. The mean age and BMI were 37 (sd 15) years and 23·3 (sd 5·1) kg/m2, respectively, for men and 37 (sd 14) years and 24·1 (sd 5·8) kg/m2, respectively, for women. The estimates of fat-free mass were higher by about 7 (95 % CI 6, 9) %, those of fat mass were lower by about 21 (95 % CI - 18, - 23) %, and those of body fat percentage (BF%) were lower by about 7·4 (95 % CI - 8·2, - 6·6) % as obtained by DXA compared with the isotope dilution technique. The Bland-Altman analysis showed wide limits of agreement that indicated poor agreement between the methods. The bias in the estimates of BF% was higher at the lower values of BF%. Thus, the two commonly used reference methods showed substantial differences in the estimates of body composition with wide limits of agreement. As the estimates of body composition are method-dependent, the two methods cannot be used interchangeably.

Complementary feeding patterns in India.

There are far too many children in the world who suffer from under-nutrition and growth faltering, with life time consequences such as reduced work capacity, increased infections, impaired intellectual performance and an increased risk of non communicable diseases later in life. These changes occur early in life, and consequently, complementary feeding has been receiving increased attention in the international nutrition community. In India, common problems relate not only to insufficient breastfeeding, but also to detrimental feeding practices. Only about 20% of children aged 6-23 months were fed according to the three recommended Infant and Child Feeding practices. The most common types of solid or semi-solid foods fed to both breastfeeding and non-breastfeeding children under 3 years of age were foods made from grains and roots. These complementary feeding practices were found to be significantly associated with poor socioeconomic status, undesirable socio-cultural beliefs, maternal illiteracy, and ignorance. Although many initiatives have been carried out in India to promote Infant and Young Child Feeding, the progress in reducing the number of undernourished children in India over the last decade has been slow and modest. Equally, with the growing evidence and interest in the role of infant nutrition in the development of over nutrition and non-communicable disease, it is important to plan appropriate complementary feeding interventions that result in optimal growth. Contact opportunities with parents, specifically mothers, must be used for counseling through multiple communication channels such as local media, in order to constantly educate the population with consistent and simple messages on child feeding.

Placental expression of miR-21-5p, miR-210-3p and miR-141-3p: relation to human fetoplacental growth.

BACKGROUND/OBJECTIVES: Dysregulation of microRNAs (miRNAs) and their target genes in placental tissue is associated with foetal growth restriction. We aimed to evaluate associations of placental miR-21-5p, miR-141-3p and miR-210-3p expression with maternal, placental and newborn parameters and with placental expression of their potential target genes PTEN, VEGF, FLT and ENG in a set of well-characterized small- (SGA) and appropriate- (AGA) for gestational age full-term singleton pregnancies. SUBJECTS/METHODS: Placental samples (n = 80) from 26 SGA and 54 AGA were collected from full-term singleton pregnancies. Placental transcript abundances of miR-21-5p, miR-141-3p and miR-210-3p were assessed after normalization to a reference miRNA, mir-16-5p by real-time quantitative PCR. Placental transcript abundances of PTEN, VEGF, FLT and ENG were assessed after normalizing to a panel of reference genes. RESULTS: Placental miR-21-5p transcript abundance was negatively associated with placental weight (n = 80, r = -0.222, P = 0.047) and this association was specific to the AGA births (n = 54, r = -0.292, P = 0.032). Placental transcript abundances of miR-210-3p and miR-141-3p were not associated with placental weight or birth weight in all 80 births. However, placental miR-210-3p transcript abundance was positively associated with birth weight specifically in the SGA births (n = 26, r = 0.449, P = 0.021). Placental transcript abundance of miR-21-5p was negatively associated with PTEN transcript abundance (Spearman's ρ = -0.245, P = 0.028) while that of miR-141-3p was positively associated with FLT (Spearman's ρ = 0.261, P = 0.019) and ENG (Spearman's ρ = 0.259, P = 0.020) transcript abundances in all 80 births. CONCLUSION: We conclude that placental miR-21-5p and miR-210-3p may be involved in fetoplacental growth. However, this regulation is unlikely to be mediated through placental expression of PTEN, VEGF, FLT or ENG.

Placental expression of RNU44, RNU48 and miR-16-5p: stability and relations with fetoplacental growth.

BACKGROUND/OBJECTIVES: The current study aimed to identify suitable reference miRNA for placental miRNA expression analysis in a set of well-characterized and fetal-sex balanced small- (SGA) and appropriate- (AGA) for gestational age full-term singleton pregnancies. SUBJECTS/METHODS: In this retrospective study, placental samples (n = 106) from 35 SGA (19 male and 16 female) and 71 AGA (30 male and 41 female) full-term singleton pregnancies were utilized. Placental transcript abundance of three widely used reference miRNAs [miR-16-5p and Small nucleolar RNAs (snoRNAs) RNU44 and RNU48] were assessed by real-time quantitative PCR. Raw cycle threshold (Ct) analysis and RefFinder tool analysis were conducted for evaluating stability of expression of these miRNAs. RESULTS: Raw Ct values of miR-16-5p were similar between SGA and AGA births (P = 0.140) and between male and female births within SGA (P = 0.159) and AGA (P = 0.060) births while that of RNU44 and RNU48 were higher in SGA births (P = 0.008 and 0.006 respectively) and in male births within the SGA group (P = 0.005) for RNU44 and in female births within the AGA group (P = 0.048) for RNU48. Across all 106 samples tested using the RefFinder tool, miR-16-5p and RNU44 were equally stable reference miRNAs. CONCLUSION: We recommend miR-16-5p and RNU44 as suitable reference miRNAs for placental samples from settings similar to our study.

Childhood cognitive ability: relationship to gestational diabetes mellitus in India.

AIMS/HYPOTHESIS: Our aim was to test the hypothesis that gestational diabetes mellitus (GDM) in mothers is associated with poorer cognitive ability in their offspring in India. METHODS: During 1997 to 1998 maternal GDM status was assessed by OGTT at 30 +/- 2 weeks of gestation. Between 2007 and 2008, at a mean age of 9.7 years, 515 children (32 offspring of GDM mothers [ODM]; 483 offspring of non-GDM mothers [controls]) from the Mysore Parthenon birth cohort underwent cognitive function assessment using tests from the Kaufman Assessment Battery for Children--Second Edition and additional tests measuring learning, long-term storage/retrieval, short-term memory, reasoning, attention and concentration, and visuo-spatial and verbal abilities. RESULTS: Compared with controls, ODM scored higher in tests for learning, long-term retrieval/storage (p = 0.008), reasoning (p = 0.02), verbal ability (p = 0.01), and attention and concentration (p = 0.003). In multiple regression, adjusted for the child's age, sex, gestation, neonatal weight and head circumference, maternal age, parity and BMI, and the parent's socioeconomic status, education and rural/urban residence, this difference remained significant only for learning, long-term retrieval/storage (beta = 0.4 SD (95% CI 0.01-0.75); p = 0.04) and verbal ability (beta = 0.5 SD (95% CI 0.09-0.83); p = 0.02), and not with other test scores. CONCLUSIONS/INTERPRETATION: In this population of healthy Indian children, there was no evidence of lower cognitive ability in ODM. In fact some cognitive scores were higher in ODM.

Placental expression of leptin: fetal sex-independent relation with human placental growth.

OBJECTIVES: Leptin (LEP) is a vital placental hormone that is known to affect different aspects of placental function and fetal development. The present study aimed to determine the association of placental LEP transcript abundance with maternal, placental, and newborn parameters. SUBJECTS/METHODS: In this retrospective case-control study, placental samples (n = 105) were collected from small (SGA) and appropriate (AGA) for gestational age full-term singleton pregnancies (n = 44 SGA and n = 61 AGA). Placental transcript abundance of LEP was assessed by real-time quantitative PCR after normalization to a reference gene panel. LEP methylation was measured using a quantitative MethyLight assay in a subset of samples (n = 54). RESULTS: Placental LEP transcript abundance was negatively and significantly associated with placental weight (ß = -3.883, P = 0.015). This association continued to be significant in the SGA group (ß = -10.332, P = 0.001), both in female (ß = -15.423, P = 0.021) and male births (ß = -10.029, P = 0.007). LEP transcript abundance was not associated with LEP methylation levels (Spearman's ρ = 0.148, P = 0.287). CONCLUSION: We conclude that placental upregulation of LEP is an integral and fetal sex-independent component of placental growth restriction, which can be potentially targeted through maternal dietary modifications to improve fetoplacental growth.

Placental expression of ENG, VEGF, and FLT: Gender-specific associations with maternal vitamin B12 status.

OBJECTIVES: Adequate vitamin B12 is a requisite during pregnancy and its deficiency is linked with increased risk for adverse outcomes, likely mediated by impaired placental angiogenesis. Thus, we aimed to test associations of maternal vitamin B12 status with the placental expression of angiogenesis-associated genes ENG, VEGF, and FLT. SUBJECTS/METHODS: In this retrospective case-control study, placental and maternal trimester 1 blood samples (n = 104) were collected from small for gestational age (SGA) and appropriate for gestational age (AGA) full-term singleton pregnancies. Maternal trimester 1 vitamin B12 status was measured. Placentae and neonates were weighed at birth. Realtime quantitative PCR was performed to assess placental transcript abundance of ENG, VEGF, and FLT normalized to a panel of reference genes. Associations of placental transcript abundance of the genes with maternal trimester 1 vitamin B12 status were evaluated. RESULTS: Placental ENG transcript abundance associated negatively with maternal trimester 1 vitamin B12 status (ß = -0.461, P = 0.017, n = 104). This association was specific to the female births (ß = -0.590, P = 0.014, n = 60). Placental VEGF transcript levels were negatively associated with maternal trimester 1 vitamin B12 status only in the female births (ß = -1.995, P = 0.029). Placental FLT transcript levels were not associated with maternal trimester 1 vitamin B12 status. CONCLUSION: Maternal trimester 1 vitamin B12 status was associated negatively with placental ENG and VEGF expression predominantly in the female births. Therefore, we hypothesize that the placenta adapts to low maternal vitamin B12 status by up-regulating angiogenic pathways in a gender-specific manner.

Evidence of higher intramyocellular fat among normal and overweight Indians with prediabetes.

BACKGROUND: The rise in prevalence rates of Type 2 Diabetes among Indians is well recognized. The research focus has been primarily to understand the changes in insulin sensitivity and beta cell dysfunction among Indians with Type 2 Diabetes. However, no data are available on the role of peripheral tissue, in particular intramyocellular lipid (IMCL) content and its impact on glucose homeostasis among Indians with prediabetes. METHODS: 28 male subjects (20-40 year) were studied. 13 with prediabetes (BMI ranging from 25.4 ± 2.9 kg/m2) and 15 controls (BMI ranging from 24.6 ± 2.8 kg/m2) were recruited. Body composition by dual energy X-ray absorptiometry (DXA), insulin sensitivity, insulin secretion rates were derived using the minimal model of C-peptide secretion and kinetics rates and skeletal muscle strength of the lower limb (quadriceps) was assessed using Isokinetic dynamometry. From muscle biopsy samples of the vastus lateralis, IMCL fat content (Oil red O staining) was determined. RESULTS: The prediabetes group were older compared to controls (P < 0.01), but had similar BMI. The muscle to fat ratio, plasma Insulin, C peptide, HOMA-IR and HOMA % B were also comparable between the groups. IMCL fat content (%) was significantly higher in the prediabetes group compared to controls (7.0 ± 0.7% vs. 2.0 ± 0.3%, P < 0.01). This difference persisted even after controlling for age. Overall the IMCL fat content (%) was positively and significantly associated with HbA1c (r = 0.76, P < 0.01). HOMA-IR was significantly correlated with central (android, trunk) adiposity (kg) (r = 0.71, P < 0.01) but not with IMCL (%). CONCLUSIONS: This is the first direct evidence of existence of significantly higher lipid levels within skeletal muscle cells among normal and overweight young Indians with prediabetes. However, there was no association between IMCL and HOMA-IR among the prediabetes group.

Total body muscle mass estimation from bioelectrical impedance analysis & simple anthropometric measurements in Indian men.

BACKGROUND & OBJECTIVE: Skeletal muscle mass represents about 30-40 per cent of the total body weight, and has important roles in function and metabolism. Although newer methods of measuring muscle mass are accurate and sophisticated, there is a need for methods that can be used in low resource settings. Existing methods of predicting muscle mass are based on mid upper arm circumference (MUAC) measurements, sometimes corrected for triceps skinfold fat. The present study was undertaken to develop predictive equations for estimating muscle mass from simple and non-invasive methods such as bioelectrical impedance (BIA) and anthropometric measurements (circumferences and skinfold thickness) in Indian men. METHODS: BIA measurements and anthropometric measurements were carried out on 67 normal, healthy men between the ages of 18 and 45 yr. True muscle mass was measured from 24 h creatinine excretion. Multiple linear regression with step-wise forward selection was used to predict total muscle mass using measurements like height(2)/impedence, height and weight and using arm muscle area (AMA), thigh muscle area (TMA) and calf muscle area (CMA). RESULTS: The prediction equation for muscle mass (kg) using height(2)/impedance and height was - 12.347+ (0.363 x height(2)/impedance) + (0.122 x height) [R(2) = 0.55; Standard error of estimate (SEE) = 2.58 kg], while the equation using appendicular muscle area was 10.122 + (0.23 x AMA)+ (0.049 x TMA) [R(2) 0.36; SEE 3.07 kg]. INTERPRETATION & CONCLUSION: This study provides prediction equations for estimating muscle mass in healthy Indian males from simple non invasive methods such as BIA and anthropometric measurements such as circumferences and skinfold thickness. Further studies need to be done on a larger sample size and using an external group to validate the equations.

Insulin sensitivity and cardiac autonomic function in young male practitioners of yoga.

BACKGROUND: While yoga is thought to reduce the risk of chronic non-communicable diseases such as diabetes, there are no studies on insulin sensitivity in long term practitioners of yoga. We assessed insulin sensitivity and cardiac autonomic function in long term practitioners of yoga. METHODS: Fifteen healthy, young, male practitioners of yoga were compared with 15 young, healthy males who did not practice yoga matched for body-mass index. Fasting insulin sensitivity was measured in the fasting state by the hyperinsulinaemic-euglycaemic clamp. RESULTS: There were no significant differences between the groups in their anthropometry or body composition. However, the fasting plasma insulin was significantly lower in the yoga group. The yoga group was also more insulin sensitive (yoga 7.82 [2.29] v. control 4.86 [11.97] (mg/[kg.min])/(microU/ml), p < 0.001). While the body weight and waist circumference were negatively correlated with glucose disposal rate in the controls, there were no similar correlations in the yoga group. The yoga group had significantly higher low-frequency power and lower normalized high-frequency power. CONCLUSION: Long term yoga practice (for 1 year or more) is associated with increased insulin sensitivity and attenuates the negative relationship between body weight or waist circumference and insulin sensitivity.

Fetal sex modifies the effect of maternal macronutrient intake on the incidence of small-for-gestational-age births: a prospective observational cohort study.

Background: Maternal macronutrient intake is likely to play a pivotal role in fetoplacental growth. Male fetuses grow faster and their growth is more responsive to maternal size. Objective: We assessed the role of fetal sex in modifying the effect of maternal macronutrient intake on the risk of small-for-gestational-age (SGA) birth. Design: This was a prospective, observational cohort study of 2035 births from an urban South Asian Indian population. Maternal intakes of total energy and macronutrients were recorded by validated food-frequency questionnaires. The interaction of trimester 1 macronutrient intake with fetal sex was tested on the outcome of SGA births. Results: The prevalence of SGA was 28%. Trimester 1 macronutrient composition was high in carbohydrate and low in fat (means ± SDs-carbohydrate: 64.6% ± 5.1%; protein: 11.5% ± 1.1%; and fat: 23.9% ± 4.4% of energy). Higher carbohydrate and lower fat consumption were each associated with an increased risk of SGA [adjusted OR (AOR) per 5% of energy (95% CI): carbohydrate: 1.15 (1.01, 1.32); fat: 0.83 (0.71, 0.97)] specifically among male births (males: n = 1047; females: n = 988). Dietary intake of >70% of energy from carbohydrate was also associated with increased risk (AOR: 1.67; 95% CI: 1.00, 2.78), whereas >25% of energy from fat intake was associated with decreased risk (AOR: 0.61; 95% CI: 0.41, 0.90) of SGA in male births. Conclusions: Higher carbohydrate and lower fat intakes early in pregnancy were associated with increased risk of male SGA births. Therefore, we speculate that fetal sex acts as a modifier of the role of maternal periconceptional nutrition in optimal fetoplacental growth.

Eccentric placentae have reduced surface area and are associated with lower birth weight in babies small for gestational age.

Placental structure and function determine birth outcomes. Placental mass does not always correlate with fetal birth weight (BW) in uncomplicated pregnancies which raises the possibility of other variables such as placental shape and cord insertion being the determinants of placental efficiency. In total, 160 women with singleton pregnancy, recruited into a pregnancy cohort were studied. Placental weight (PW) was measured and other data were obtained from clinical records. Birth outcomes were classified as small for gestational age (SGA) and appropriate for gestational age (AGA) based on fetal gender, gestational age (GA) and BW. High-resolution images of the chorionic plate were recorded. The shape of the placenta and the insertion of the cord were measured using eccentricity index (EI) and cord centrality index (CCI). Only placentae with eccentrically inserted cords (n=136) were included. The mean BW and PW were 2942 (±435) g and 414 (±82) g with average GA of 38.6 weeks. The mean CCI and EI was 0.483 (±0.17) and 0.482 (±0.16). Neither of these correlated with placental efficiency. However, EI showed negative correlation with placental surface area and breadth. Upon sub-grouping the cohort into SGA (n=32) and AGA (n=104), the SGA babies with the highest EI (third tertile) had significantly lower BW than those with the least eccentric placentae (first tertile). Although eccentric-shaped placentae were present in both SGA and AGA groups, the effect on BW was observed only in the SGA group.

Maternal intake of milk and milk proteins is positively associated with birth weight: A prospective observational cohort study.

BACKGROUND: A striking number of low birth weight (LBW) Indian babies are born annually. Previous studies have confirmed the positive association between milk intake and birth weight. However, the relations between protein and vitamin B12 from milk and birth weight have not been systematically explored. AIMS: We examined the relations between birth weight and maternal intake of milk, protein from milk and vitamin B12 from milk. METHODS: This prospective, observational cohort study was conducted in an urban South Indian hospital. The dietary intakes of milk and milk products were assessed using validated food frequency questionnaire and at delivery birth outcomes were measured. The relations between milk products, milk protein, and vitamin B12 from milk with birth weight and gestational weight gain were assessed in 2036 births with first trimester dietary and delivery data. RESULTS: Median consumption of milk products in the first trimester was 310 g·day-1 and average birth weight was 2876 g. Birth weight was positively associated with intake of milk products and of % protein from milk products (%milk protein) in the first trimester [ß = 86.8, 95% confidence interval (CI): 29.1, 144.6; ß = 63.1, 95% CI: 10.8, 115.5; P < 0.001 for both]. Intake of milk products and of %milk protein in the third trimester was positively associated with gestational weight gain (GWG) between the second and third trimester (One-way ANOVA, P < 0.001 and = 0.001, respectively). Neither birth weight nor GWG were associated with %vitamin B12 from milk products. CONCLUSIONS: These findings indicate that intake of milk products in the first trimester and especially, protein from milk products is positively associated with birth weight in this South Asian Indian population.

Low anemia prevalence in school-aged children in Bangalore, South India: possible effect of school health initiatives.

OBJECTIVE: Anemia is a serious public health problem in Indian school children. Since 2003, simple health intervention programs such as antihelminthic treatment and vitamin A supplementation have been implemented in primary schools in the Bangalore region, Karnataka, India. This study examines the prevalence of anemia in school children who are beneficiaries of this program. DESIGN: Cross-sectional survey. SETTING: Bangalore district, South India. SUBJECTS: A total of 2,030 boys and girls, aged 5-15 years, attending schools in the Bangalore district. INTERVENTIONS: School-based, twice yearly intervention: deworming (albendazole 400 mg, single oral dose) and vitamin A supplementation (200,000 IU, single oral dose). MAIN OUTCOME MEASURES: Anemia prevalence based on measure of blood hemoglobin (Hb). RESULTS: Mean age and blood Hb concentration of all children were 9.5+/-2.6 years and 12.6+/-1.1 g/dl (range 5.6-16.7), respectively. The overall anemia prevalence in this group was 13.6%. Anemia prevalence was lower in boys than girls (12.0%; n=1037 vs 15.3%; n=993 respectively, P<0.05). There was no significant difference in anemia prevalence between children in urban and rural locations (14.6 and 12.3%, respectively). CONCLUSIONS: The current low anemia prevalence in Bangalore could be due to the impact of school-based intervention programs that have been in place since 2003. The beneficial interactions of deworming and vitamin A supplementation could have widespread implications for current preventive public health initiatives. There is now need for the development of clear policy guidelines based on these simple and integrated interventions.

Nutritional status of affluent Indian school children: what and how much do we know?

OBJECTIVE: This paper reviews available literature on nutritional status of Indian school children 6-18 years from middle and high socio economic status (MHSES). METHODS: Literature search was conducted using Medline literature database search, followed by review of full length journal papers and unpublished materials such as research reports. RESULTS: Studies showed that anemia prevalence (hemoglobin concentration <120 g/L) ranged from 19 to 88% across five different cities in India. Other micronutrient deficiencies including, folate, riboflavin, niacin, vitamin C, vitamin A, and vitamin B12 were also present based on biochemical parameters in one study and clinical signs of deficiency in three other studies. Overweight and obesity were prevalent among 8.5-29.0% and 1.5-7.4% respectively among school children, as indicated by 11 studies. Predominant components in children's diet were cereals and pulses, followed by milk and milk products; the fruits and vegetables component was comparatively lower. CONCLUSION: Nutritional status of MHSES children in India needs attention especially with respect to the high prevalence of anemia, overweight and obesity. There are indications that micronutrient deficiencies exist, but sufficient data are lacking, in particular biochemical data. A current estimate, using well designed methodologies, of prevalence of micronutrient deficiencies and information on the etiology of anemia among children of MHSES groups would be valuable to help understand the nutritional status and extent of micronutrient malnutrition.

Vitamin B12 status in pregnant women and their infants in South India.

BACKGROUND/OBJECTIVES: Vitamin B12 deficiency during pregnancy has been associated with increased risk of adverse perinatal outcomes. However, few studies have investigated the burden and determinants of vitamin B12 status in young infants. This study was conducted to determine the associations between maternal and infant vitamin B12 status. SUBJECTS/METHODS: Pregnant women participating in a vitamin B12 supplementation trial in Bangalore, India, were randomized to receive vitamin B12 (50 µg) or placebo supplementation daily during pregnancy through 6 weeks postpartum. All women received 60 mg of iron and 500 µg of folic acid daily during pregnancy, as per standard of care. This prospective analysis was conducted to determine the associations between maternal vitamin B12 biomarkers (that is, plasma vitamin B12, methylmalonic acid (MMA) and tHcy) during each trimester with infant vitamin B12 status (n=77) at 6 weeks of age. RESULTS: At baseline (⩽14 weeks of gestation), 51% of mothers were vitamin B12 deficient (vitamin B12<150 pmol/l) and 43% had impaired vitamin B12 status (vitamin B12<150 pmol/l and MMA>0.26 µmol/l); 44% of infants were vitamin B12 deficient at 6 weeks of age. After adjusting for vitamin B12 supplementation, higher vitamin B12 concentrations in each trimester were associated with increased infant vitamin B12 concentrations and lower risk of vitamin B12 deficiency in infants (P<0.05). After adjusting for vitamin B12 supplementation, infants born to women with vitamin B12 deficiency had a twofold greater risk of vitamin B12 deficiency (P<0.01). Higher maternal folate concentrations also predicted lower risk of vitamin B12 deficiency in infants (P<0.05). Impaired maternal vitamin B12 status, which combined both circulating and functional biomarkers, was the single best predictor of infant vitamin B12 status. CONCLUSIONS: Impaired maternal vitamin B12 status throughout pregnancy predicted higher risk of vitamin B12 deficiency in infants, after adjusting for vitamin B12 supplementation. Future interventions are needed to improve vitamin B12 status periconceptionally, and to ensure optimal vitamin B12 status and health outcomes in pregnant women and their children.

Estimation of deep-abdominal-adipose-tissue (DAAT) accumulation from simple anthropometric measurements in Indian men and women.

OBJECTIVE: To develop gender-specific predictive equations to measure the amount of deep-abdominal-adipose-tissue (DAAT) accumulation from simple anthropometric measurements. DESIGN: Cross-sectional study. SUBJECTS: A total of 120 healthy men and women (40-79 years). MEASUREMENTS: Body weights, circumferences, skinfolds, computed-Tomography (CT)-derived sagittal-diameters and the DAAT areas. RESULTS: High significant correlations are seen between the indices of waist-circumferences, sagittal diameters and body weights to DAAT areas in both the sexes. Stepwise multiple regression analysis with all anthropometric measures gave 84% (SEE 38.7 cm(2)) of the variance in men and 72% (SEE 29 cm(2)) in women. Body weights, waist-circumferences and sagittal-diameters had more predictive power in men, and in women, the arm-circumferences replaced the sagittal diameters. Five models with categorical measures of circumferences, skinfolds, and sagittal diameters explained 74.8-82% of the variance in men and 62-70% in women. The simplest equation with least measurement indices, that is, body-weight, waist-circumference and body mass index explained 74% (SEE 27.7 cm(2)) of the variance in men: DAAT (cm(2))= -382.9+(1.09 x weight-(kg))+(6.04 x waist-(cm))+(-2.29 x BMI). For women, body-weight and waist-circumference explained 63% (SEE 31.79 cm(2)) of the variance: DAAT (cm(2))= -278+(-0.86 x weight-(kg))+(5.19 x waist-(cm)). CONCLUSION: Body weight emerged as the outstanding index to measure the DAAT areas. Following anthropometric measures are the waist circumferences, sagittal diameters and BMI. Although the ability to estimate the amount of DAAT from anthropometry is limited, practical predictive models have been developed.

A simple method of measuring total daily energy expenditure and physical activity level from the heart rate in adult men.

OBJECTIVE: To evaluate a simple method that uses only a heart rate monitor to predict total energy expenditure (TEE) and physical activity level (PAL) from 24 h heart rate (HR) measurements. DESIGN: The simple method involved the determination of the physical activity ratio (PAR) from corresponding heart rate ratios (HRR) (ratio of observed to resting HR), from an individualized calibration curve relating activities with known PAR to the HRR. Several curve fits were evaluated for this curve. The PAL was calculated from minute to minute PAR. The TEE was computed as the product of the PAL and the predicted basal metabolic rate (BMR). The accuracy of the simple method was assessed by within-subject comparisons of the simple method versus the oxygen consumption - HR method and a time and motion study. SETTING: Bangalore City, India. SUBJECTS: In all, 17 healthy male subjects between 18 and 44 years were recruited for the study. INTERVENTIONS: None. RESULTS: The simple method correlated well with both the reference methods when using a calibration curve that involved the fitting of two straight lines at low and high PAR activities, respectively, to the PAR and HRR data. The mean error in TEE, as a product of BMR and PAL, was about 1%, but with limits of agreement between the methods that were about 20% of the TEE. However, the low mean error could have been due to a canceling of errors in the determination of BMR and PAL. CONCLUSIONS: The simple method is a relatively cheap, useful technique for evaluating TEE and PAL in resource-poor situations. It may particularly be of use in epidemiological investigations where population estimates of TEE and PAL are required.

Low maternal vitamin B12 status is associated with intrauterine growth retardation in urban South Indians.

OBJECTIVE: To assess the maternal sociodemographic, anthropometric, dietary and micronutrient status in apparently healthy pregnant women in order to determine their associations with intrauterine growth retardation (IUGR). DESIGN: Prospective observational study. SETTING: Bangalore City, India. SUBJECTS: A total of 478 women were recruited at 12.9+/-3.3 weeks of gestation and followed up at the first, second and third trimesters of pregnancy and at delivery. The dropout rate was 8.5%. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Birth weight was measured at hospital delivery. RESULTS: The mean birth weight was 2.85+/-0.45 kg. In all, 28.6% of newborns were IUGR. There was a strong inverse relationship between maternal educational level and risk of IUGR. A low body weight at baseline was also associated with a high risk of IUGR. Compared with women in the highest quartile for second trimester weight gain, those in the lowest quartile had a significantly higher adjusted odds ratio (AOR: 3.98; 95% CI: 1.83, 8.65) for IUGR. Women in the lowest tertile for serum vitamin B(12) concentration during each of the three trimesters of pregnancy had significantly higher risk of IUGR (AOR: 5.98, 9.28 and 2.81 for trimesters 1-3, respectively). CONCLUSIONS: The present study demonstrates associations between educational status, maternal weight and gestational weight gain with IUGR. Importantly, in a subsample, there were strong associations of vitamin B(12) status with IUGR, suggesting that better socioeconomic conditions, improved nutritional status and early detection of vitamin B(12) deficiency in pregnancy combined with appropriate interventions are likely to play an important role in reducing IUGR.