Kaushik Bose

Anthropometric Assessment of Nutritional Status of Adolescents of Kolkata, West Bengal

Abstract A cross-sectional study of 559 Bengalee adolescents (314 boys and 245 girls) of North 24 Parganas, West Bengal, was undertaken to study their age and sex differences in nutritional status. The subjects were classified into four age groups with one-year intervals. Individuals falling below the age and sex specific fifth percentile of the World Health Organization (WHO) recommended National Health and Nutrition Examination Survey (NHANES I) were defined as undernourished. The overall rate of undernutrition was 36.49%. Regardless of sex, the rate of undernutrition progressively increased from 31.88% to 39.80% with the advancement of age. However, a clear-cut age variations in the change of the rate of undernutrition have been observed in both the sexes. The prevalence of undernutrition (combining all ages) varied between boys (41.08%) and girls (30.61%). In general, this study provided evidence that the Bengalee adolescents had moderate rates of undernutrition. These rates were, in general, lower than those reported in other developing countries including previous Indian studies.

Body mass index and nutritional status of adult Savar tribals of Keonjhar District, Orissa, India.

A cross-sectional study was undertaken to determine sex differences in mean body mass index (BMI) and nutritional status (based on BMI), as well as the effect of age on BMI and nutritional status of adult Savars, a tribal population of Orissa, India. A total of 600 adult (aged > 18 years) Savars of four villages, namely, Bonianiposi, Morabali, Panchapolli and Sailong of Keonjhar District, Orissa, India, were studied. Height and weight were measured and BMI computed. Mean ages of both sexes were similar (men: mean = 38.9 years, sd = 15.3; women: mean = 38.0, sd = 13.9). Men had significantly greater mean height (p < 0.001), weight (p < 0.001) and BMI (p < 0.05). The prevalence (sex combined) of undernutrition (BMI < 18.5) was found to be very high (43.5%). Moreover, there was a significant (chi2 = 7.39, p = 0.025) difference in the prevalence of undernutrition between men (38%) and women (49%). Age was significantly (p < 0.001) negatively correlated with BMI in both sexes (men: r = -0.20; women: r = -0.16). In general, the frequency of undernutrition increased with increasing age. In conclusion, this study demonstrated that the prevalence of adult undernutrition was very high among Savar women and high among Savar men. These rates increased with increasing age. Therefore, from the public health point of view, immediate nutritional intervention programmes are needed for implementation among Savars, especially among older individuals. Moreover, further research is needed not only among this ethnic group but also other tribal populations of India to fully understand the causes and consequences of adult undernutrition.

Undernutrition in the Kora Mudi tribal population, West Bengal, India: a comparison of body mass index and mid-upper-arm circumference.

Background Undernutrition among adult tribal women is a major health problem in India. Objectives To compare the utility of two different anthropometric indicators of chronic energy deficiency (CED) among tribal Kora Mudi women and to determine which of these two is a better indicator of undernutrition. Methods A cross-sectional study of 123 individuals was conducted. The body mass index (BMI) and mid-upper-arm circumference (MUAC) were used to evaluate CED. Results The prevalence of CED based on BMI less than 18.5 was 55.3%, and the prevalence of CED based on MUAC less than 22.0 cm was 51.2%. Both of these prevalence rates are classified in the very high-prevalence category (≥ 40%) and indicate a critical situation according to World Health Organization recommendations. Mean BMI increased significantly with higher quartile of MUAC. There was a significant difference in the prevalence of CED between the MUAC quartiles. The risk ratio for CED for women in the lowest quartile of MUAC was 9.33 compared with those in the highest quartile. There was a significant positive association between MUAC and BMI. Regression analysis demonstrated that MUAC had a significant positive impact on BMI; the percentage of the variation in BMI explained by MUAC was 52%. Logistic regression analysis demonstrated that overall, 82.11% of cases of CED were correctly classified with the use of MUAC. The use of MUAC correctly diagnosed 82.35% of cases of CED and 81.82% of women with normal nutritional status. Conclusions This population was facing severe nutritional stress. With limited resources and in the absence of skilled manpower, it may be more appropriate to use MUAC for human population surveys, particularly among tribal populations of developing countries.

Undernutrition among Adult Dhimals of Naxalbari, West Bengal: Comparison with other Tribes of Eastern India

Background The tribes of India comprise approximately 8% of the total population of the country, which probably has the largest number of tribal communities in the world. In general, the tribal populations are among the most underprivileged and undernourished people in India. Objectives To determine the anthropometric characteristics and prevalence of undernutrition, based on body mass index (BMI), of adult Dhimals, a tribal population of Naxalbari, West Bengal, India, and to compare these results with those from four other tribes of Eastern India: the Bathudis, Kora Mudis, Santals, and Savars. Methods A total of 305 adult (18 years or older) Dhimals (159 men and 146 women) from three villages (Maniram, Hatighisa, and Buraganj) in the Mallabari area of Naxalbari were studied. These villages are located 5 km from Siliguri town, which is approximately 580 km from Kolkata, the provincial capital of West Bengal. Anthropometric measurements included height and weight. BMI was calculated by the standard equation. Undernutrition was evaluated according to World Health Organization (WHO) cutoff points. Results The overall prevalence of undernutrition (BMI < 18.5) was very high (36.4%). The prevalence was significantly higher in women than in men (46.4% vs. 27.0%; χ2 = 12.54; p < .001; odds ratio, 2.35). According to the WHO criterion, the prevalence of undernutrition was high and the situation was serious in men. Among women, the prevalence of undernutrition was very high and the situation was critical. However, in general, compared with other tribal people of eastern India except the Santals, adult Dhimals had better anthropometric and nutritional profiles. Conclusions This study provides evidence that although the anthropometric and nutritional profiles of adult Dhimals are better than those of some of the other tribal populations of eastern India, immediate appropriate nutritional intervention programs are needed for implementation among this ethnic group.

Central obesity and coronary risk factors

A cross-sectional study of 130 Bengalee Hindu men (mean age=50.3 years; SD=10.5 years) was undertaken to investigate the relationship of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) with total cholesterol (TC), high density (HDL-C), low density (LDL-C) and very low-density (VLDL-C) lipoprotein cholesterol, fasting plasma glucose (FPG) and triglycerides (FTG). Correlation studies revealed that WHR was significantly correlated (r=0.245, p<0.01) with TC. WC and WHR had significant correlations with VLDL-C, FPG and FTG. All subjects were further divided into two groups based on WHR<0.95 (centrally non-obese, CNO) and WHR>0.95 (centrally obese, CO) following the US Joint National Committee (JNC) guidelines. Students’ t-test revealed that CO subjects (n=83) had a significantly higher mean TC (p<0.05), VLDL (p<0.05), FPG (p<0.01) and FTG (p<0.05) compared with CNO individuals (n=47). Results of analysis of variance (ANOVA) of central obesity status (CNO=no, CO=yes) and BMI (BMI tertiles used as a categorical variable) with these metabolic variables revealed that CO status had a significant effect (p<0.05) on TC, VLDL-C, FPG and FTG. BMI tertiles did not a have significant effect on any of these metabolic variables. There was no significant BMI tertile-central obesity status interaction. It can therefore be concluded that the JNC guidelines of WHR>0.95 to define central obesity can be used, irrespective of BMI, among this population, to identify individuals who have enhanced metabolic risk factors of coronary heart disease (CHD). Furthermore, it can be routinely used for health promotion purposes among Bengalee men.

Comparison of anthropometric characteristics between normotensive and hypertensive indi viduals among a population of Bengalee Hindu elderly men in Calcutta, India

A comparative investigation of 99 normotensive and 111 hypertensive Bengalee Hindu elderly men (aged 55 years and above) of Kalighat, South Cal cutta, India, was undertaken to study differences in levels of adiposity, body fat distribution and body composition between these two groups. Results revealed that there were significant differences between normotensive (NT) and hypertensive (HT) subjects in the mean values for weight (p < 0.05), body mass index (BMI, p < 0.01); waist (p < 0.001) and hip circumferences (p < 0.05); waist-hip ratio (WHR, p < 0.001), conicity index (CI, p < 0.01) and fat free mass (FFM, p < 0.001). Percentile dis tributions for all these variables and indices showed consistently higher values among the HT patients as compared with NT subjects. However, the frequen cy of obesity (BMI ≥25) was similar (NT = 6.1 %, HT = 11.7%) in both groups. Thus, these results indicated that there existed significant differences in central adiposity and FFM between NT and HT subjects although their level of obesity was simi lar. Hypertensive individuals have significantly enhanced levels of central body fat distribution.

Undernutrition among Integrated Child Development Services (ICDS) Scheme Children aged 2-6 years of Arambag, Hooghly District, West Bengal, India: A serious public health problem

Background : Childhood undernutrition is a major public health problem in developing countries. In view of this, the objective of the present study was to evaluate the rates of stunting, underweight and wasting among 2-6 year old rural children of Bengalee ethnicity. Methods : In this study, 20 Integrated Child Development Services (ICDS) Centres of Bali gram panchayet, Arambag, Hooghly District, West Bengal, India, were selected. A total of 1012 (boys = 498; girls = 514) 2-6 year old children were studied. Height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) < -2 z-scores were used to evaluate stunting, underweight and wasting, respectively, following the National Center for Health Statistics (NCHS) Guidelines. Classification of severity of malnutrition was done based on the World Health Organization recommendations. Results : Boys were significantly heavier than girls at ages 2-4 years; they were significantly taller at ages 2 and 4. Significant age differences existed in mean height and weight in both sexes. Mean HAZ, WAZ and WHZ were less than those of NCHS for both sexes at all ages. The overall (age and sex combined) rates of stunting, underweight and wasting were 26.6 %, 63.3 % and 50.0 %, respectively. The prevalence of stunting (boys = 24.9 %; girls = 28.2 %), and underweight (b = 62.2 %; g = 64.4 %) was higher among girls whereas that of wasting was higher among boys (b = 52.4 %; g = 47.4 %). Based on World Health Organization classification of severity of malnutrition, the overall prevalence of stunting was medium (20 . 29 %), whereas those of underweight (. 30 %) and wasting (. 15 %) were very high, in both sexes. Conclusions : The nutritional status of the subjects was unsatisfactory indicating a major public health problem. There is scope for much improvement in the form of enhanced supplementary nutrition.

Evaluation of equations for fat-free mass based on anthropometry in infants and young children in South Asia

Rapid postnatal growth in low-birth weight infants increases the risk of hypertension, CHD and type 2 diabetes in adult life. To provide validated tools to study the growth in South Asian infants, we evaluated two published equations to measure total body water (TBW) and fat-free mass (FFM) based on anthropometry in 6- to 24-month-old infants, using 2H2O dilution. In a method-comparison study in seventy-eight infants aged 6-24 months (forty-two girls and thirty-six boys) from the urban poor attending an immunisation clinic of a hospital in Kolkata, we measured their length to the nearest 0.1 cm, weight to the nearest 10 g and TBW using 2H2O dilution. The calculated TBW in kg (TBWkg) and FFM in kg (FFMkg) using two equations based on the length and weight were each compared with TBWkg and FFMkg calculated from 2H2O dilution. The mean FFMkg were 7.31 (sd 1.11), 7.13 (SD 1.08) and 7.26 (SD 1.13) by the 2H2O dilution method, and the anthropometry equations of Mellits and Cheek (AN-1) and Morgenstern et al. (AN-2), respectively. The mean of the paired difference in FFMkg was 0.18 (SEM 0.06) and 0.04 (SEM 0.07) between 2H2O, and AN-1 and AN-2, respectively. There is a good agreement for FFM derived by AN-2 with 2H2O dilution. The former is 1% lower than that obtained from the reference method (P=0.28). The AN-2 equation is useful for evaluating FFM in infants in India.

Maternal early second trimester pregnancy weight in relation to birth outcome among Bengalee Hindus of Kolkata, India

Objective: The study examined to what degree maternal early second trimester pregnancy weight is useful and efficient in predicting birth outcome of Bengalee women. Subjects and methods: The cross-sectional retrospective study was conducted in a government general hospital in South Kolkata, India. This hospital serves the needs of people belonging to lower and lower middle class socio-economic groups. Data were collected by one-to-one interview for confirmation of age, history of last menstrual period (LMP) including medical disorders. Mothers weight was recorded at 14–18 weeks of pregnancy from the history of LMP. Birth weight was measured within 24 h of delivery and gestational age was assessed by Ballards method using newborn physical and neurological maturity scoring. Of the 331 Bengalees, 295 mother–baby pairs met the recruitment criteria and were included in this study. Result: Mean ± SD maternal early second trimester pregnancy weight and birth weight were 45.9 ± 7.0 kg and 2612 ± 371 g, respectively. The difference in mean weight (3.74 kg) between mothers who delivered low birth weight (LBW) and normal birth weight (NBW) babies was statistically significant (t = 4.497, p < 0.001). Overall, the prevalence of LBW was nearly 34%. A higher incidence of LBW and lower mean birth weight was observed in first quartile or low weight (≤40 kg) mothers. The rate of LBW decreased (χ2 = 14.47, p < 0.01) and mean birth weight increased significantly with increasing maternal weight (F = 9.218, p < 0.001). Risk ratio (RR) for LBW, intrauterine growth retardation (IUGR) and preterm birth in low weight (first quartile or <40.0 kg) mothers were 2.72 (95% confidence interval (CI): 1.45–5.10), 3.54 (95% CI: 1.17–10.74) and 1.97 (95% CI: 0.56–6.90), respectively, compared with heavier (>50.0 kg) mothers. Finally, the present data showed that the maternal weight of <46.0 kg is the best cut-off for detecting LBW with 66% sensitivity and 75% negative predictive power. Conclusion: The findings suggest a positive association between maternal early second trimester pregnancy weight and birth outcome. The present study provided an efficient cut-off point for detecting LBW. Antenatal caregivers in health institutions and community health workers in the field can use this cut-off value for screening pregnant women at early second trimester.

Lean Body Mass in Indian Infants and Young Children and Variation by Sex

Abstract Aim of the study was to explore the lean body mass (LBM%) and fat mass (FM%) percent of weaning age children from among the urban poor in Kolkata, India. We used a cross sectional study design. A convenience sample of apparently healthy infants aged 6 month to 24 month were evaluated for LBM% derived by an anthropometry based and a Bioelectrical Impedance analysis (BIA) based equations, validated earlier on a sample of weaning age infants from this study population. Four hundred children (200 boys and 200 girls) from among the urban poor participated in this study. We measured their length to the nearest 0.1 cm and weight to the nearest 10 gm. Total body resistance was measured by a multifrequency BIA at 50 KHz. The calculated mean LBM% were 85.21 and 81.62 by anthropometry equation and, 82.72 and 82.56 by BIA equation in boys and girls respectively. LBM% values were considerably higher for both boys and girls compared to reference data on infants from USA. Based on weight for length, weight for age, length for age SD-scores stunting (21% boys, 11% girls), underweight (32.5% boys, 25.5% girls) and wasting (17% boys, 13.5% girls) were present using <-2 SD score as cut off for each. The LBM% was consistently higher in these infants aged 6 to 24 month compared to reference data on well infants in the West. Significantly higher proportion of boys had severe wasting than girls in weaning age infants in India.