Neha Kajale

Waist Circumference Percentiles in 2-18 Year Old Indian Children

OBJECTIVESnTo develop reference percentile curves in Indian children for waist circumference (WC), and to provide a cutoff of WC percentile to identify children at risk for metabolic syndrome (MS).nnnSTUDY DESIGNnA multicenter, cross-sectional study was performed in 5 major Indian cities. Height, weight, and blood pressure (BP) were measured in 10,842 children (6065 boys). Elevated BP was defined as either systolic BP or diastolic BP >95th percentile. WC was measured with the child standing using a stretch-resistant tape. Sex-specific reference percentiles were computed using the LMS method which constructs reference percentiles adjusted for skewness. To determine optimal cutoffs for WC percentiles, a validation sample of 208 children was assessed for MS risk factors (ie, anthropometry, BP, blood lipids), and receiver operating characteristic (ROC) curve analysis was performed.nnnRESULTSnAge- and sex-specific WC percentiles (5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, and 95th) are presented. WC values increased with age in both the boys and the girls. The median WC at age >15 years was greater in boys compared with girls. ROC analysis suggested the 70th percentile as a cutoff for MS risk (sensitivity, 0.84 in boys and 0.82 in girls; specificity, 0.85 in both boys and girls; area under the ROC curve, 0.88 in boys and 0.92 in girls).nnnCONCLUSIONnAge- and sex-specific reference curves for WC for Indian children and cutoff values of 70th WC percentile for screening for MS risk are provided.

Body fat indices for identifying risk of hypertension in Indian children

BackgroundHigh adiposity is major risk factor for hypertension. Various anthropometric indices are used to assess excess fatness.Objectives(1) To examine relationship of body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), triceps skin fold thickness (TSFT) and wrist measurements with blood pressure in children and adolescents 2) to suggest age- and gender-specific cutoffs for these indices in Indian children.MethodsCross-sectional school-based study on a random sample of 6380 children (6–18 yr old, 3501 boys) from five major cities in India. Height, weight, waist and wrist circumference, TSFT, and blood pressure were recorded. Children with systolic blood pressure (BP) and/or Diastolic BP >95th percentile were classified as hypertensive.ResultsPrevalence of overweight and obesity was 23.5% and 9.7%, respectively. Hypertension was observed in 5.6%. Multiple logistic regression (adjustments: age, gender) indicated double risk of hypertension for overweight and 7 times higher odds for obese than normal-weight children. Children with TSFT >95th centile for US children showed three times risk and with TSFT from 85th to 95th double risk of hypertension. Higher WC and WHtR exhibited 1.5 times risk and larger Wrist 1.3 times higher risk of hypertension (P<0.001). Receiver operating curve (ROC) analysis provided age-gender specific cut offs for the five indices to detect the risk of high BP. Area under ROC curves (AUC) for five indices were similar and greater in older age groups indicating equal sensitivity and specificity.ConclusionUsing age- and gender-specific cutoffs for BMI, TSFT, WC or WHtR may offer putative markers for early detection of hypertension.

Dietary calcium intake influences the relationship between serum 25-hydroxyvitamin D3 (25OHD) concentration and parathyroid hormone (PTH) concentration

Objectives To investigate whether dietary calcium intake will modify the relationship between serum 25-hydroxyvitamin D3 (25OHD) with intact serum parathyroid hormone (PTH) concentrations in apparently healthy Indian adolescents. Study design Cross-sectional study. Setting and participants Apparently healthy adolescents aged 10–14u2005years (n=181), from Gujarat, western India. Study conducted from January 2012 to March 2014. Methods Serum 25OHD concentrations and intact serum PTH concentrations (both using chemiluminescent microparticle immunoassay) were measured. Diet was recorded through 24u2005h diet recall and calcium intake was computed (C-diet V.2.1). To assess relationship between 25OHD and PTH, data were dichotomised according to median calcium intakes (520u2005mg/day) and relationship between serum 25OHD and PTH in the two subgroups was plotted. Results Subjects with calcium intakes above median (>520u2005mg/day) had lower intact serum PTH values for given serum 25OHD concentration while those with calcium intakes below median (<520u2005mg/day) had higher intact serum PTH values for given serum 25OHD concentration. Serum 25OHD concentration was negatively correlated with intact serum PTH concentration at lower as well as higher calcium intakes (r=− 0.606 and −0.483, respectively, p<0.01 for both). Using a regression analysis, predicted values for intact serum PTH concentration for the given serum 25OHD concentrations were plotted. The plot revealed a negative shift with increasing calcium intake. Conclusions Dietary calcium intake modifies the relationship between serum 25OHD concentrations and intact serum PTH concentrations. Thus, dietary calcium intake should be taken into account when assessing an individuals vitamin D status.

Validation of Bioelectric Impedance Analysis against Dual-Energy X-ray Absorptiometry for assessment of body composition in Indian children aged 5 to 18 years

ObjectiveTo validate body composition measurements by Bioelectric Impedance Analysis (BIA) against Dual-Energy X-ray Absorptiometry (DXA) as the reference method in healthy children and adolescents.DesignCross-sectionalSettingSchools in and around Pune city, India.ParticipantsA random sample of 210 (114 boys, 96 girls) apparently healthy Indian children and adolescents (5–18 y).MethodsWeight, height, Tanner stage (TS) were recorded. Body composition measures: fat-free mass (FFM), fat mass (FM), lean mass (LM), bone mineral content (BMC) and body fat percentage (%BF) were assessed by BIA and DXA on a single day. Agreement between the methods was estimated by Pearson’s correlation, and Bland and Altman analysis.Main outcome measures%BF, FM, FFM, LM, BMC.ResultsBIA underestimated %BF by 6.7 (3.7)% as compared to DXA. Mean FFM, BMC and LM by BIA were significantly higher than by DXA (P<0.001). These differences remained similar after adjusting for age, BMI and TS. Mean differences between FFM (−2.32 (1.39) kg), BMC (−0.18 (0.15) kg), and LM (−2.15 (1.34) kg) by DXA and BIA were significant (P<0.01). Correlations between BIA and DXA were 0.92 for %BF, 0.96 for LM and 0.98 for FFM and BMC. Both the methods were similar in identifying normal and overfat children as per their respective cut-offs.ConclusionBIA and DXA techniques are not interchangeable for assessment of body composition. However, BIA may be used in the field/clinical setting preferably with ethnicity specific references.

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 IUu202f+u202f500u202fmg 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 ≥75u202fnmol/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 -u2009<50u202fnmol/L; insufficiency - 50.0-74.9u202fnmol/L; sufficiency - ≥75u202fnmol/L. Statistical analysis was performed using SPSS software. Mean baseline serum vitamin D concentration was 59.7u202f±u202f11.2u202fnmol/L; this rose to 79.8u202f±u202f23.3u202fnmol/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 (ru202f=u202f-u202f0.96, pu202f<u202f0.0001). Greatest benefit of change in serum vitamin D concentrations after supplementation was experienced by children with basal concentrations of <45u202fnmol/L. Daily vitamin D supplementation was effective in improving serum 25(OH)D to ≥75u202fnmol/L in 44% of children. Significantly higher percentage of children who were deficient at baseline (64%) were able to attain serum concentrations of ≥75u202fnmol/L as compared to children who were vitamin D insufficient (43%) (pu202f<u202f0.001). Thus, daily supplementation with 1000 IU of vitamin D along with 500u202fmg of calcium helped in improving serum vitamin D concentrations to ≥75u202fnmol/L. Children who were vitamin D deficient particularly experienced these benefits.

Association of dental and skeletal fluorosis with calcium intake and serum vitamin D concentration in adolescents from a region endemic for fluorosis

Context: Fluorosis is controlled by the duration of fluoride exposure and calcium and Vitamin D nutrition status. Aim: To examine (a) prevalence of dental and skeletal fluorosis in adolescents from upper, middle, and lower socioeconomic strata (SES) and (b) association of fluorosis with calcium intake and Vitamin D status. Settings and Design: A cross-sectional study conducted in 10–13.9 years apparently healthy adolescents (n = 90), from different SES of Patan (Gujarat, India). Materials and Methods: Dental fluorosis was graded as mild, moderate, and severe. Radiographs of the right hand and wrist were examined and graded. Serum 25 hydroxyvitamin D3 (25OHD) and parathyroid hormone concentrations were measured. Diet was recorded (24 h recall) and calcium intake was computed (C-diet V-2.1, 2013, Xenios Technologies Pvt. Ltd). Statistical Analysis: Generalized linear model was used to analyze relationships between fluorosis, SES, serum 25OHD concentration, and calcium intake. Results: Fluorosis was predominant in lower SES (17% had both dental and radiological features whereas 73% had dental fluorosis); no skeletal deformities were observed. Mean 25OHD concentrations and dietary calcium were 26.3 ± 4.9, 23.4 ± 4.7, and 18.6 ± 4 ng/ml and 441.2 ± 227.6, 484.3 ± 160.9, and 749.2 ± 245.4 mg/day, respectively, for lower, middle, and upper SES (P < 0.05). Fluorosis and SES showed a significant association (exponential β = 2.5, P = 0.01) as compared to upper SES, middle SES adolescents were at 1.3 times while lower SES adolescents were at 2.5 times higher risk. Serum 25OHD concentrations (P = 0.937) and dietary calcium intake (P = 0.825) did not show a significant association with fluorosis. Conclusion: Fluorosis was more common in lower SES adolescents, probably due to the lack of access to bottled water. Relatively adequate calcium intake and serum 25OHD concentrations may have increased the efficiency of dietary calcium absorption, thus preventing severe fluorosis.

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 (β = –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 body fat percentage, fat-free mass, muscle mass and bone mass measured by bioelectrical impedance in Asian Indian children and adolescents

ObjectivesTo 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.DesignSecondary analysis of data from previous multicenter cross-sectional studies.SettingPrivate schools from five regions of India.ParticipantsA random sample of 3850 healthy school children (2067 boys) (5-17 yr) from private schools in five major Indian cities.MethodsAnthropometry, 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 BPResultsMedian %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.ConclusionsReference curves for percent body fat for Indian children would be useful to screen children for health risk in clinical set up.

Prevalence of metabolic syndrome markers among women at 1-year postpartum as per prepregnancy body mass index status: A longitudinal study

Introduction: Maternal body composition (BC) changes during lactation. Increased prepregnancy obesity is associated with poor obstetric outcomes. The aim was to study changes in maternal BC postpartum (PP) to 1-year PP with reference to their prepregnancy body mass index (BMI) status. Methods: The study design was a 1-year follow-up study. Sixty-five apparently healthy primiparous women (28.6 ± 3.4 years delivered full-term infants) were randomly selected from December 2010 to June 2013 and postclassified on the basis of their prepregnancy BMI status. Anthropometry, sociodemographic status, physical activity, diet, clinical examination, biochemical tests, and BC at total body (dual energy X-ray absorptiometry, GE, Lunar DPX) were collected using standardized protocols. Results: Forty-one women were classified in Group A with normal prepregnancy BMI (20.4 ± 2.0 kg/m2) and 24 women in Group B with overweight/obese (OW/OB) prepregnancy BMI (26.1 ± 1.9 kg/m2). At 1 year, 75% of women returned to normal BMI in Group A, whereas all 100% of women from Group B remained in OW category at 1-year PP. Nearly 43% of Group B women showed the presence of at least two metabolic syndrome risk factors as compared to 36% in Group A at 1 year. Conclusion: Women with OW/OB prepregnancy BMI accumulated higher visceral fat with a higher prevalence of metabolic risk factors at 1-year PP. Our study underlines the importance of maintaining BMI status in reference range in reproductive years.

Effect of Breastfeeding Practices and Maternal Nutrition on Baby's Weight Gain During First 6 Months.

Objective To study cross-sectionally, effect of early feeding practices and maternal nutrition, with special reference to traditional food supplements (TFSs), on baby’s weight gain during first 6xa0months.MethodsDesign: Cross-sectional observational study design. Settings: Urban tertiary healthcare centre, India. Participants: One hundred and fifteen primiparous mother–infant pairs within 6xa0months of delivery. Outcome measures: We studied the subjects for anthropometry, feeding practices and nutrient intakes after delivery, and their baby’s weights were measured, and WAZ scores from WHO Anthro software and weight gain from birth were calculated.ResultsEighty per cent women from partial breastfeeding (PBF) group were either overweight or obese, while 33xa0% of exclusively breastfeeding (EBF) group were normal weight. To further explore relationship between TFS intakes and babies’ feeding status, study population were divided into four groups based on consumption of TFS and feeding practices. General linear univariate model analysis adjusted with pre-pregnancy BMI, gestational weight gain, infant age and birth weight showed highest weight gain (3.8xa0±xa00.3xa0kg) for TFSxa0+xa0PBF group, than other groups such as TFSxa0+xa0EBF group (2.9xa0±xa00.3xa0kg, pxa0=xa00.043) and NTSxa0+xa0EBF (2.7xa0±xa00.3xa0kg, pxa0=xa00.017), though NTSxa0+xa0PBF group also had lower weight gain, but this difference was not significant (3.4xa0±xa00.3xa0kg, pxa0=xa00.489).ConclusionHigher baby’s weight gain was seen among partially breastfed babies. Rather than TFS, type of feeding affected baby weight gain to a greater extent which may increase baby’s risk of obesity in future.