Shashi Chiplonkar

Overweight and obesity prevalence and body mass index trends in Indian children

OBJECTIVESnTo estimate prevalence of overweight and obesity in apparently healthy children from five zones of India in the age group of 2 to 17 years and to examine trends in body mass index (BMI) during the last two decades with respect to published growth data.nnnMETHODSnA multicentric study was conducted in eleven affluent urban schools from five geographical zones of India. A total of 20 243 children (1 823 - central zone, 2 092 - east zone, 5 526 - north zone, 3 357 - south zone, and 7 445 - west zone) in the age group of 2-17 years were studied. Height and weight were measured and BMI was calculated (kg/m(2)). WHO Anthro plus was used to calculate Z-scores for height, weight and BMI. A comparison between study population and previously available nationally representative (1989) data was performed for each age-sex group. International Obesity Task Force (IOTF) and WHO cut-offs were used to calculate the percentage prevalence of overweight and obesity.nnnRESULTSnThe overall prevalence of overweight and obesity was 18.2% by the IOTF classification and 23.9% by the WHO standards. The prevalence of overweight and obesity was higher in boys than girls. Mean BMI values were significantly higher than those reported in the 1989 data from 5-17 years at all ages and for both sexes.nnnCONCLUSIONnThe rising trend of BMI in Indian children and adolescents observed in this multicentric study rings alarm bells in terms of associated adverse health consequences in adulthood.

Normative data and percentile curves for Dual Energy X-ray Absorptiometry in healthy Indian girls and boys aged 5–17 years

For the correct interpretation of Dual Energy X-ray Absorptiometry (DXA) measurements in children, the use of age, gender, height, weight and ethnicity specific reference data is crucially important. In the absence of such a database for Indian children, the present study aimed to provide gender and age specific data on bone parameters and reference percentile curves for the assessment of bone status in 5-17 year old Indian boys and girls. A cross sectional study was conducted from May 2006 to July 2010 on 920 (480 boys) apparently healthy children from schools and colleges in Pune City, India. The GE-Lunar DPX Pro Pencil Beam DXA scanner was used to measure bone mineral content (BMC [g]), bone area (BA [cm(2)]) and bone mineral density (BMD [g/cm(2)]) at total body, lumbar spine and left femur. Reference percentile curves by age were derived separately for boys and girls for the total body BMC (TBBMC), total body BA (TBBA), lumbar spine bone mineral apparent density (BMAD [g/cm(3)]), and left femoral neck BMAD. We have also presented percentile curves for TBBA for height, TBBMC for TBBA, LBM for height and TBBMC for LBM for normalizing bone data for Indian children. Mean TBBMC, TBBA and TBBMD were expressed by age groups and Tanner stages for boys and girls separately. The average increase in TBBMC and TBBA with age was of the order of 8 to 12% at each age group. After 16 years of age, TBBMC and TBBA were significantly higher in boys than in girls (p<0.01). Maximal increase in TBBMD occurred around the age of 13 years in girls and three years later in boys. Reference data provided may be used for the clinical assessment of bone status of Indian children and adolescents.

Vitamin profile of cooked foods: how healthy is the practice of ready-to-eat foods?

During recent years importance of B complex vitamins, beta-carotene and vitamin C has been realised in terms of their antioxidative and anticarcinogenic properties. Fruits and vegetables are the rich sources of these vitamins. However, there are considerable cooking losses of vitamins, and information on vitamin contents of cooked foods is essential for assessing the adequacy of vitamin intakes. Secondly, there is a growing trend to consume ready-to-eat foods such as stuffed pancakes (samosa, patties), pastries, French fries; replacing traditional foods for lunch or dinner like roti, vegetable curry, bread, non-vegetarian items. Ready-to-eat foods are considered to give empty calories rather than a balanced diet. A study was undertaken to estimate ascorbic acid, folic acid, riboflavin, thiamine and betacarotene of 263 cooked food samples and 260 meals representing dietary patterns of Asia, Africa, Europe, USA and Latin America by spectrophotometry and photoflurometry. A broad range of beta-carotene (84-2038 mcg%), riboflavin (0.01-0.48 mg%), thiamine (0.04-0.36 mg%), vitamin C (1-28 mg%) and folate (26-111mcg%) was observed in individual foods. Bakery products and sweets were found to be poor sources and green leafy vegetables and fruits were good sources of these five vitamins. The differences between ready-to-eat foods and meals consumed during lunch or dinner were prominent for beta-carotene, ascorbic acid, riboflavin and folic acid (P < 0.05). The cooking losses were 34.6, 30, 52.2, 45.9 and 32.2% in case of ascorbic acid, thiamine, riboflavin, beta-carotene and folic acid respectively. Irrespective of whether it is ready-to-eat or a lunch/dinner food item, the contribution of vegetables in the preparations was found to make a marked impact on the vitamin profile. While results justify the concept of a food pyramid, emphasis needs to be given to types of fruits and vegetables rich in vitamins; preferably in their uncooked form, rather than considering their total consumption.

Body mass index cut-offs for screening for childhood overweight and obesity in Indian children.

ObjectiveTo develop age and sex specific cut-offs for BMI to screen for overweight and obesity in Indian children linked to an adult BMI of 23 and 28 kg/m2 respectively, using contemporary Indian data.DesignCross-sectional.SettingMulticentric, School based.Participants19834 children were measured from 11 affluent schools from five major geographical regions of India. Data were analyzed using the LMS method, which constructs growth reference percentiles adjusted for skewness.ResultsCompared to the cut-offs suggested for European populations and those by the Indian Academy of Pediatrics 2007 Guidelines, the age and sex specific cut off points for body mass index for overweight and obesity for Indian children suggested by this study are lower.ConclusionsContemporary cross-sectional age and sex specific BMI cut-offs for Indian children linked to Asian cutoffs of 23 and 28 kg/m2 for the assessment of risk of overweight and obesity, respectively are presented.

Relationship between body mass index, fat distribution and cardiometabolic risk factors in Indian children and adolescents

Studies assessing the relationship of BMI and BF with cardiometabolic (CM) risks in Indian children are scarce.

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.

Effect of zinc- and micronutrient-rich food supplements on zinc and vitamin A status of adolescent girls

OBJECTIVESnThe present study was aimed at assessing the effect of zinc- and micronutrient-rich food supplementation compared with ayurvedic zinc tablets on the blood levels of zinc and vitamin A in adolescent girls.nnnMETHODSnOne hundred eighty apparently healthy schoolgirls (12.5 ± 0.85 y old) were recruited for a 10-wk intervention trial. They were randomized to three groups: one group received a food supplement that was prepared using zinc- and micronutrient-rich foods and by adopting food-processing methods that increase zinc bioavailability; the second group received ayurvedic zinc (Jasad) tablets as a natural elemental zinc supplement; and the third group served as the control without any supplementation. Diet was assessed by 24-h recall on 3 non-consecutive days. Fasting blood samples were analyzed for plasma levels of zinc, β-carotene, retinol, vitamin C, and hemoglobin at baseline and the end of the study period.nnnRESULTSnFood supplementation showed a significant increase in plasma levels of zinc (9.9%), β-carotene (56.2%), and vitamin C (28.0%, P < 0.05) and a non-significant increase in hemoglobin (1.7%), although small, non-significant changes in blood micronutrient levels were observed in the control group (P > 0.1). Food supplementation decreased the prevalence of zinc deficiency (73% to 53.1%), β-carotene deficiency (31.1% to 17.4%), and mild anemia (32.2% to 23.7%). Ayurvedic zinc supplementation significantly improved plasma zinc (61.3%) and plasma retinol (38.2%) and decreased the prevalence of zinc deficiency (73.7% to 36.2%) and vitamin A deficiency (65.4% to 20.4%, P < 0.05).nnnCONCLUSIONnZinc- and micronutrient-rich food supplementation was effective in improving the zinc and vitamin A status of adolescent girls.

Determinants of bone mineral content and bone area in Indian preschool children

The objective of this study was to examine the lifestyle factors that influence total body bone mineral content (TB BMC) and total body bone area (TB BA) in Indian preschool children. TB BMC and TB BA were measured by dual-energy X-ray absorptiometry (Lunar DPX PRO) in 71 apparently healthy children aged 2–3xa0years. A fasting blood sample was analyzed for serum concentrations of ionized calcium (iCa), intact parathyroid hormone (iPTH), phosphorus (iP) and 25-hydroxyvitamin D3 (25 OHD). Dietary intake of energy, protein, calcium and phosphorus was estimated from a 3-day diet recall. The daily physical activity and sunlight exposure were recorded by a questionnaire. The study children were shorter than their age-gender matched WHO counterparts with a mean height for age Z score of –1.3xa0±xa01.5. The mean dietary intake of calcium was 46% of the Indian recommended dietary intakes (RDI). Seventy-three percent of children had low iCa concentrations, and 57% were deficient in vitamin D. Generalized linear model analysis revealed that height, lean body mass, weight, activity, sunlight exposure in minutes and dietary intakes of calcium, zinc and iron were the significantly influencing factors (pxa0<xa00.05) of TB BMC and TB BA. In conclusion, attaining optimal height for age, achieving the goals of overall nutrition with adequate calcium, iron and zinc intakes as well as adequate physical activity and sunlight exposure play an important role in achieving better TB BMC and TB BA in preschool children.

Enhanced effect of zinc and calcium supplementation on bone status in growth hormone-deficient children treated with growth hormone: a pilot randomized controlled trial

Reduced bone mineral content in growth hormone-deficient children (GHD) has been reported. Calcium, zinc, and vitamin D play an important role in bone formation. Hence, the aim of this pilot randomized controlled study was to evaluate the effect of calcium, vitamin D, and zinc supplementation in prepubertal GHD children treated with GH on bone health parameters. After 1xa0year of treatment with GH (20xa0mg/m2/week), 31 GHD (mean age 8.7xa0±xa02.8xa0years, 18 boys) prepubertal children were randomised to receive calcium (500xa0mg/day) and vitamin D (60,000xa0IU/3xa0months) [Group A] or a similar supplement of calcium, vitamin D, and zinc (as per Indian Recommended Allowance) [Group B] along with GH therapy for the next 12xa0months. The two groups were similar in anthropometric and body composition parameters at baseline (pxa0>xa00.1). After 1xa0year of GH therapy, height-adjusted % gain was similar in both groups, 48xa0% in bone mineral content (BMC) and 45xa0% in bone area (BA). Height-adjusted % increase in BMC was significantly (pxa0<xa00.05) higher in the second year than in the first in both the groups. This % increase in BMC and BA was greater in Group B (51 and 36xa0% respectively) than in Group A (49 and 34xa0%), although marginally (pxa0<xa00.05). Supplementation of calcium and vitamin D along with GH therapy in GHD Indian children has the potential for enhancing bone mass accrual; this effect was further enhanced through the addition of zinc supplement.