Sudha Ramachandra Rao

Neonatal anthropometry: the thin–fat Indian baby. The Pune Maternal Nutrition Study

OBJECTIVE: To examine body size and fat measurements of babies born in rural India and compare them with white Caucasian babies born in an industrialised country.DESIGN: Community-based observational study in rural India, and comparison with data from an earlier study in the UK, measured using similar methods.SUBJECTS: A total of 631 term babies born in six rural villages, near the city of Pune, Maharashtra, India, and 338 term babies born in the Princess Anne Hospital, Southampton, UK.MEASUREMENTS: Maternal weight and height, and neonatal weight, length, head, mid-upper-arm and abdominal circumferences, subscapular and triceps skinfold thicknesses, and placental weight.RESULTS: The Indian mothers were younger, lighter, shorter and had a lower mean body mass index (BMI) (mean age, weight, height and BMI: 21.4 y, 44.6 kg, 1.52 m, and 18.2 kg/m2) than Southampton mothers (26.8 y, 63.6 kg, 1.63 m and 23.4 kg/m2). They gave birth to lighter babies (mean birthweight: 2.7 kg compared with 3.5 kg). Compared to Southampton babies, the Indian babies were small in all body measurements, the smallest being abdominal circumference (s.d. score: −2.38; 95% CI: −2.48 to −2.29) and mid-arm circumference (s.d. score: −1.82; 95% CI: −1.89 to −1.75), while the most preserved measurement was the subscapular skinfold thickness (s.d. score: −0.53; 95% CI: −0.61 to −0.46). Skinfolds were relatively preserved in the lightest babies (below the 10th percentile of birthweight) in both populations.CONCLUSIONS: Small Indian babies have small abdominal viscera and low muscle mass, but preserve body fat during their intrauterine development. This body composition may persist postnatally and predispose to an insulin-resistant state.

Maternal activity in relation to birth size in rural India. The Pune Maternal Nutrition Study.

Objective: To describe the relationship of the mothers physical activity to the birth size of her baby in a rural Indian population.Design: Prospective observational study.Setting: Six villages near Pune, Maharashtra, India.Subjects: A total of 797 women were studied after excluding abortions and termination of pregnancies (112), foetal anomalies (8), multiple pregnancies (3), incomplete pre-pregnancy anthropometry (14) and pregnancies detected later than 21 weeks of gestation (168).Method: An activity questionnaire was developed after focus group discussions and incorporated community-specific activities. It was validated against an observer-maintained diary. Activity scores were derived using published data on energy costs to weight the contributions of various activities. It was then administered to assess physical activity at 18 (±2) and 28 (±2) weeks of gestation.Outcome measures: Birth outcome, maternal weight gain and neonatal anthropometry.Results: The activity questionnaire was used to classify women into light, moderate and heavy activity categories. Maternal activity did not influence the incidence of prematurity or stillbirth, or the duration of gestation. It was inversely related to maternal weight gain up to 28 weeks of gestation (P=0.002). Higher maternal activity in early, as well as mid gestation, was associated with lower mean birth weight (P=0.05 and 0.02, respectively), and smaller neonatal head circumference (P=0.005 and 0.009) and mid-arm circumference (P=0.03 and 0.01) after adjusting for the effect of major confounding factors.Conclusions: The Findings suggest that excessive maternal activity during pregnancy is associated with smaller foetal size in rural India, The approach described for developing an activity questionnaire has potential for adoption in other settings.Sponsorship: Wellcome Trust, London, UK, and the Medical Research Council, UK.

High prevalence of tobacco use, alcohol use and overweight in a rural population in Tamil Nadu, India

BACKGROUND Cardiovascular diseases are one of the leading causes of death in India. There is high prevalence of cardiovascular risk factors in urban Tamil Nadu. There are limited data on the prevalence of behavioral risk factors and overweight in rural Tamil Nadu. AIM We estimated prevalence of behavioral risk factors, overweight and central obesity in a rural population in Tamil Nadu, India. SETTING AND DESIGN We conducted a cross-sectional survey in 11 villages in Kancheepuram/Thiruvallur districts, Tamil Nadu. MATERIALS AND METHODS Study population included 10,500 subjects aged 25-64 years. We collected data on behavioral risk factors and anthropometric measurements. Body mass index (BMI) was categorized using the classification recommended for Asians. Central obesity was defined as waist circumference ≥90 cm for men and ≥80 cm for women. We computed proportions for all risk factors and used trend chi-square to examine trend. RESULTS Among the 10,500 subjects, 4927 (47%) were males. Among males, 1852 (37.6%) were current smokers and 3073 (62.4%) were current alcohol users. Among females, 840 (15.1%) were smokeless tobacco users. BMI was ≥23.0 kg/m 2 for 1618 (32.8%) males and 2126 (38.2%) females. 867 (17.6%) males and 1323 (23.7%) females were centrally obese. Most commonly used edible oil was palm oil followed by sunflower oil and groundnut oil. CONCLUSION We observed high prevalence of tobacco use, alcohol use and central obesity in the rural population in Tamil Nadu. There is need for health promotion programs to encourage adoption of healthy lifestyle and policy interventions to create enabling environment.

Non-communicable disease comorbidities and risk factors among tuberculosis patients, Meghalaya, India

We did cross-sectional study to estimate the prevalence of tobacco, alcohol use, hypertension and diabetes among tuberculosis (TB) patients in comparison to the non-TB patients in East Garo Hills District, Meghalaya, India. We surveyed 110 TB patients attending outpatient TB clinic and 110 age/sex matched non-TB subjects from the general outpatient department as comparison group. Prevalence of ever smoking was 74.5% and 55.4%; alcohol consumption 31.0% and 22.3%; hypertension 24.5% and 17.3%; diabetes 7.5%, 4.5% among TB patients and non-TB subjects, respectively. NCD and TB programmes need integration in the primary care for screening, counselling and treatment of NCD comorbidities.

Hypertension treatment and control in a rural cohort in Thiruvallur, Tamil Nadu, India

Hypertension is a public health problem with low detection and treatment rates in India. We resurveyed 1284 patients with hypertension already identified in baseline survey of the cohort in Thiruvallur district, Tamil Nadu, India. The objective was to estimate the proportion of patients with drug treatment, hypertension control and lifestyle modification at follow-up (median follow-up 27 months). Overall, only 19.9% of the patients took drugs and 45.3% had blood pressure under control. Among 256 patients on drugs, 179 (69.9%) were on a single drug, 71 (27.7%) on two drugs, and six (2.3%) on three drugs. Commonly prescribed drugs based on the prescription review were beta blockers (50.4%), calcium channel blockers (36.7%), angiotensin-converting-enzyme inhibitor (18.4%), and diuretics (11.7%). Salt reduction was reported by 49.7% of the patients. There is a need for strengthening the health systems for effective management of hypertension and patient education to ensure active involvement in the long-term care.

Dietary intakes of folate and vitamin B12 in female urban slum-dwellers in Mumbai, India

Aims: To estimate dietary intakes of folate and vitamin B12 (vital nutrients during the early stages of human development) in women of childbearing age (15 40 years). Study design: Baseline data were collected from 1668 women recruited to an intervention trial. Materials: An interviewer-administered food frequency questionnaire (101 items, 15 food-groups) was developed to obtain intakes in the past month. Data were recorded as frequencies ranging from three times/day to once/month or less. Daily folate and B12 intakes were calculated, assuming standard portion sizes, and using published nutrient-content tables and (for GLVs) laboratory analysis. Outcome measures: Adequacy of intakes according to ICMR Recommended Daily Allowances (RDAs; folate 100 mg/day; B12 1 mg/day).