Aakriti Gupta

Prevalence of Vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India

Introduction: Vitamin D is important for bone development in children. A high prevalence of Vitamin D deficiency (VDD) has been documented from different parts of India. However, limited data are available on VDD among children residing at high altitude region of country. Objectives: To assess the prevalence of VDD and associated risk factors among children in the age group of 6–18 years in Shimla, Himachal Pradesh. Methods: A community-based cross-sectional study was conducted in the year 2014–2015. A total of 626 children in the age group of 6–18 years were enrolled from 30 clusters which were identified using population proportionate to size sampling method. A minimum of 20 children in the age group of 6–18 years per cluster were selected using random number tables. The data on socioeconomic status, physical activity, sunlight exposure, and biochemical parameters of bone and mineral metabolism were assessed. Results: Ninety-three percent of school-age children were found Vitamin D deficient as per serum 25(OH) D levels of <20 ng/ml. The prevalence was significantly higher among females. Conclusion: A high prevalence of VDD was found in children residing in high altitude region.

Consumption of junk foods by school-aged children in rural Himachal Pradesh, India

There has been an increase in the consumption of junk food (JF) among school-aged children (SAC) possibly leading to obesity and diet-related diseases among them. We do not have evidence on consumption of JF in rural areas; hence, we conducted a study to assess the consumption of JF by SAC in rural, Himachal Pradesh. A total of 425 children in the age group of 12–18 years studying in 30 government schools (clusters) were included. The clusters were selected using population proportionate to size sampling methodology. We found high prevalence (36%) of consumption of JF among SAC during the last 24 h. Efforts should be taken to reduce the consumption of JF by promotion of healthy dietary habits and educating children about the ill effects of JF.

Low-quality scientific evidence for the continuation of universal Vitamin A supplementation among under 5 children in India

Vitamin A supplementation (VAS) is presently being undertaken in India among under 5 (U5) children for two possible benefits (i) to prevent nutritional blindness due to Vitamin A deficiency (VAD) and (ii) to reduce U5 mortality. The existing scientific evidence suggests that nutritional blindness due to VAD has been virtually eliminated and also the difference between U5 mortality rate and infant mortality rate is very low for VAS to have any meaningful impact. On the contrary, scientific evidence indicates that there could be side effects of the administration of mega dose of Vitamin A (MDVA). These side effects of MDVA have not been systematically investigated. The universal VAS should be discontinued immediately as there are no likely benefits to U5 children.

Prevalence of metabolic syndrome and associated risk factors among geriatric population living in a high altitude region of rural Uttarakhand, India

Introduction: Metabolic syndrome (MetS) is responsible for 2.5-fold increase in cardiovascular mortality and a 5-fold higher risk of developing diabetes. Materials and Methods: A community-based cross-sectional study was conducted during 2015–2016 in District Nainital. A list of all villages was developed. From this list, thirty villages were identified using population proportionate to size sampling method. From each village, thirty geriatric subjects (GSs) were selected. The study population included 979 GSs aged 60 years and above. The data were collected on anthropometry, blood pressure, blood glucose, and lipid profile from all the enrolled subjects. The prevalence of MetS was estimated using International Diabetes Federation criteria. Univariate and multivariate analysis was done to identify factors associated with MetS. Results: The prevalence of MetS was found to be 28.6%. Step-wise multivariate logistic regression analysis found that female gender, higher income, and body mass index ≥25 were significant and independent risk factors of MetS amongst GP. Conclusion: There is a need for screening of GP living in high altitude region so that efforts can be initiated to prevent complications of MetS.

Effectiveness of iron supplementation in reducing iron deficiency anemia in India

The authors provided weekly supplementation with iron folic acid (IFA) tablets (100 mg elemental iron and 500 μg folic acid) for a period of 3 months, that is, April, May, and June 2013 to 117 girls and 127 boys. A total of 12 doses of IFA were administered. However, in the abstract under the head of “Methods,” it is mentioned that the supplementation was given for a period of 52 weeks. The actual duration of supplementation needs to be clarified.

Dietary Intake of Minerals, Vitamins, and Trace Elements Among Geriatric Population in India

The geriatric population is at a high risk of developing deficiencies of essential micronutrients such as minerals, vitamins, and trace elements and their related deficiency signs and symptoms. Scarce data is available on the dietary intake of essential micronutrients among geriatric subjects in India. Hence, to fill the gap in the existing knowledge, a community-based cross-sectional study was conducted during 2015–2016 in District Nainital, Uttarakhand State, India. A total of 255 geriatric subjects were enrolled from 30 clusters (villages) identified by using population proportionate to size sampling methodology. Data were collected on sociodemographic profile and dietary intake of essential micronutrients (24-h dietary recall, food frequency questionnaire) from all the geriatric subjects. A high percentage of geriatric subjects did not consume the recommended daily intake for essential micronutrients such as energy (78%), protein (78%), calcium (51%), thiamine (33%), riboflavin (64%), niacin (88%), vitamin C (42%), iron (72%), folic acid (72%), magnesium (48%), zinc (98%), copper (81%) and chromium (89%) adequately. Food groups rich in essential micronutrients such as pulses, green leafy vegetables, roots and tubers, other vegetables, fruits, nonvegetarian food items, and milk and milk products were consumed irregularly by the subjects. The overall intake of energy and essential micronutrients was inadequate among the geriatric population in India, possibly due to poor quality and quantity of the diet consumed.

Effect of Supplementation with Iron Fortified Biscuits on the Hemoglobin Status of Children in Rural Areas of Shimoga, Karnataka: Correspondence

To the Editor:We read with great interest, the article entitled ‘Effect of supplementation with iron fortified biscuits on the hemoglobin status of children in rural areas of Shimoga, Karnataka’ [1]. There are few following methodological issues which need to be clarified by the authors of this publication so that the readers of the IJP are benefitted. The authors have taken hemoglobin cut-offs of 11.5 g/dl for all children in the age group of 6–12 y. According to WHO, the hemoglobin cut-offs to be utilized for classification of anemia is 11.5 g/dl for children in the age group of 5–11 y and 12.0 g/dl for children 11– < 14 y. The anemia classification utilized in the study is not valid [2]. The Recommended Dietary Allowances (RDA) of iron for children as per Indian Council of Medical Research, 2010, for the age group of 7–9 y is 16 mg/d. Similarly, the RDA for children in the age group of 10–12 y for boys and girls is 21mg/d and 27mg/d, respectively [3]. According to the study, children in Group 1 were given 30 mg of iron (30 mg/6 biscuits). The supplemental dose was more than 200 % of the RDA for children in 7–9 y. Hence, in this study, a high dose of supplementation of iron was administered. The food fortification strategies recommend only 30 % of the RDA for a nutrient to be added under the fortification program with micronutrients. It is not clear from the research methodology, whether it was supervised administration consumption of biscuits by students, especially on holidays. The mean weight gain in the Group I with high doses of iron fortified biscuits was 1.7 kg in 120 d. It is an interesting finding as this was achieved without significant increase in nutrients like calories, protein and fats. The increase in hemoglobin amongst children with 7, 8, 9, 10 and 11 g of Hb/dl at the baseline survey may be shared. This could actually reveal the benefits to the children with moderate and mild levels of anemia. This intervention study does not document the impact of fortification of biscuits with iron, as more than 200 % of RDA of iron was administered to the children in 7–9 y of age.

Reduction in the Prevalence of Underweight, Stunting and Wasting in Selected States of India

To the Editor : Malnutrition is one of the major underlying causes of mortality and morbidity in children under 5 y of age. Malnutrition amongst under 5 children (U5C) has been a cause of concern to health planners and administrators in India. We analyzed the datasets of NFHS-3 (National Family Health Survey-3) (2005– 2006) [1] and NFHS-4 (2015–2016) [2] to assess the progress in reduction of underweight, stunting and wasting for 13 states namely Bihar, Goa, Haryana, Karnataka, Madhya Pradesh, Maharashtra, Manipur, Meghalaya, Sikkim, Tamil Nadu, Tripura, Uttrakhand and West Bengal. We would like to share the findings of this analysis with the readers of Indian Journal of Pediatrics. A reduction in the prevalence of underweight and stunting amongst U5C in all 13 states was found. The percentage reduction in underweight and stunting across various states ranged from 1–20 % and 4–12 % respectively during the year 2005–2006 to 2015–2016 (Table 1). The prevalence of wasting amongst U5C decreased in 6 states over a decade. However, an increase in the prevalence of wasting was observed in 7 states (Table 1). The reduction in the rates of underweight, stunting and wasting could be attributed to the investment in the social sector including health. India has made a gradual and steady reduction in the prevalence of underweight, stunting and wasting amongst U5C. Scientific evidence suggests that no single stand alone intervention has been able to achieve substantive, rapid and sustainable reductions in maternal and child malnutrition. The nutrition specific interventions addressing the immediate causes of undernutrition can lead to slow and steady decrease in malnutrition [3, 4]. In order to accelerate the pace of the reduction in malnutrition amongst U5C in India, we need to increase the investment in both direct and indirect nutrition sensitive interventions such as education of mothers, delay in age of marriage, increase in birth interval, improved hygiene and sanitation, safe drinking water and reduction in open defecation, prevention of childhood illnesses, improvement in nutritional status and health care of pregnant mothers and adolescent girls and improvement in IYCF (Infant and Young Child Feeding) practices. * Umesh Kapil umeshkapil@gmail.com