Sumithra Selvam

Effect of Yoga on Cognitive Abilities In Schoolchildren from a Socioeconomically Disadvantaged Background: A Randomized Controlled Study

OBJECTIVE The objective of this study was to assess the effect of yoga, compared to physical activity on the cognitive performance in 7-9 year-old schoolchildren from a socioeconomic disadvantaged background. DESIGN Two hundred (200) schoolchildren from Bangalore, India, after baseline assessment of cognitive functioning were randomly allocated to either a yoga or a physical-activity group. Cognitive functions (attention and concentration, visuo-spatial abilities, verbal ability, and abstract thinking) were assessed using an Indian adaptation of the Wechsler Intelligence Scale for Children at baseline, after 3 months of intervention, and later at a 3-month follow-up. RESULTS Of the 200 subjects, 193 were assessed at 3 months after the study, and then 180 were assessed at the 3-month follow-up. There were no significant differences in cognitive performance between the two study groups (yoga versus physical activity) at postintervention, after controlling for grade levels. Improvement in the mean scores of cognitive tests following intervention varied from 0.5 (Arithmetic) to 1.4 (Coding) for the yoga group and 0.7 (Arithmetic) to 1.6 (Vocabulary) in the physical-activity group. CONCLUSIONS Yoga was as effective as physical activity in improving cognitive performance in 7-9 year old schoolchildren. Further studies are needed to examine the dose-response relationship between yoga and cognitive performance.

Multiple Micronutrient-Fortified Rice Affects Physical Performance and Plasma Vitamin B-12 and Homocysteine Concentrations of Indian School Children

Fortifying rice with multiple micronutrients could be a promising strategy for combat micronutrient deficiencies in developing countries. We determined the efficacy of extruded rice grains fortified with multiple micronutrients on the prevalence of anemia, micronutrient status, and physical and cognitive performance in 6- to 12-y-old, low-income school children in Bangalore, India. In a randomized, double-blind, controlled trial, 258 children were assigned to 1 of 3 intervention groups to receive rice-based lunch meals fortified with multiple micronutrients with either low-iron (6.25 mg) or high-iron (12.5 mg) concentrations or identical meals with unfortified rice. The meals were provided 6 d/wk for 6 mo. Anthropometric, biochemical, physical performance, and cognitive assessments were taken at baseline and endpoint. At baseline, study groups were comparable, with 61% of the children being anemic. However, only <10% were deficient in iron, vitamin A, and zinc. After 6 mo, plasma vitamin B-12 and homocysteine concentrations (both P < 0.001) as well as physical performance (P < 0.05) significantly improved in the intervention arms. No between-group differences were observed in hemoglobin concentration, anemia, and deficiencies of other micronutrients or cognitive function after 6 mo, but paired analyses revealed a small reduction in anemia prevalence in children in the low-iron group. The fortified rice was efficacious in improving vitamin B-12 status and physical performance in Indian school children.

Influence of Age and Nutritional Status on the Performance of the Tuberculin Skin Test and QuantiFERON®-TB Gold In-Tube in Young Children Evaluated for Tuberculosis in Southern India.

Background: Reliable identification of Mycobacterium tuberculosis infection or tuberculosis (TB) disease in young children is vital to assure adequate preventive and curative treatment. The tuberculin skin test (TST) and IFN&ggr;-release assays may supplement the diagnosis of pediatric TB as cases are typically bacteriologically unconfirmed. However, it is unclear to what extent the performance of TST and QuantiFERON-TB Gold In-Tube (QFT; Cellestis’ IFN&ggr;-release assay test) depends on the demographic, clinical and nutritional characteristics of children in whom they are tested. Methods: During a 2-year prospective observational study of 4382 neonates in Southern India, children with suspected TB were investigated and classified by a standard TB diagnostic algorithm. Results: Clinical TB was diagnosed in 13 of 705 children referred for case verification with suspected TB. TST and QFT had a susceptibility for clinical TB of 31% and 23%, respectively, in this group. Children <2 years were more likely to test QFT indeterminate. A height-for-age Z score within the lowest quartile increased the odds ratio (OR) for a positive or indeterminate QFT result [OR 2.46 (1.19–5.06), OR 3.08 (1.10–8.58)], whereas the OR for a positive TST was reduced with a weight-for-height Z score within the lowest quartile [OR 0.17 (0.06–0.47)]. Conclusion: The sensitivities of the TST and QFT for clinical TB in children <3 years of age were equally poor in this population. Stunted children were more susceptible to Mycobacterium tuberculosis infection and more prone to indeterminate QFT results. TST was less reliable in children with wasting.

Catch-up growth does not associate with cognitive development in Indian school-age children

Background/objectives:Stunting is significantly associated with lifetime morbidity and poorer cognitive outcomes in children. Although several studies have examined the relationship between stunting, catch-up growth and cognitive performance in young populations, this relationship has not yet been explored in school-aged children. In this study, we used data from three different nutritional intervention studies conducted over a 4-year period on school-age children in Bangalore, India to assess these relationships.Subjects/methods:A battery of cognitive tests was conducted before each intervention to determine whether stunting status at baseline was related to cognitive performance across four separate domains, and repeated after a 6-month period to assess whether changes to stunting status is related to cognitive advancement.Results:Results of independent t-tests showed that while stunted children had significantly poorer performance on short-term memory, retrieval ability and visuospatial ability tests (P=0.023, 0.026 and 0.028, respectively), there was no significant difference in the change in cognitive scores following nutritional interventions over a 6-month period between those who remained stunted and those who were no longer stunted (P>0.10).Conclusions:Evidently, stunting remains associated with cognitive ability in school-age children; however, the reversal of these effects in this age group may be quite difficult.

Body weight perception is associated with socio-economic status and current body weight in selected urban and rural South Indian school-going children

OBJECTIVE To evaluate the current and ideal body weight perceptions of schoolchildren in relation to their actual body weight and socio-economic status (SES). DESIGN Baseline evaluation of schoolchildren from January 2008 to April 2008 as part of a 3-year longitudinal study. SETTING City and non-city locations, Karnataka State, South India. SUBJECTS Schoolchildren (n 1877) aged between 8 and 14 years. RESULTS Girls, children of more educated parents and city dwellers were more likely to be overweight (P < 0.001). Younger children aged <10 years and those of lower SES were more likely to perceive themselves as underweight (adjusted OR = 1.63, 95 % CI 1.25, 2.11 and adjusted OR = 1.87, 95 % CI 1.32, 2.65). Underweight children were ten times more likely to overestimate their current weight status, while overweight children were four times more likely to underestimate it. The odds of children of lower SES underestimating their weight, as well as desiring a higher weight, were higher than those of higher-SES children. CONCLUSIONS SES is associated with body weight perception. Underweight children are more likely to overestimate their weight status and overweight children more likely to underestimate it.

Maternal prenatal psychological distress and temperament in 1–4 month old infants – A study in a non-western population

In this longitudinal study, conducted in women attending antenatal visits at the obstetrics and gynecology clinic of a general hospital in Bangalore, India, we aimed to assess the relationship between prenatal distress in mothers, and maternal report of infant temperament at four months. 100 mothers with normal full term deliveries completed the General Health Questionnaire-28 item version (GHQ) in the third trimester and postnatally. Salivary cortisol and temperament (using the Early Infancy Temperament Questionnaire - EITQ) were assessed in their infants aged 1-4 months. In this study, maternal prenatal psychological distress was not significantly associated with maternal report of difficult temperament in infants. Infants of mothers who were a negative screen for psychological distress (GHQ<7), n=85 had higher scores on the adaptability and approach dimensions of temperament. Infant salivary cortisol was significantly higher in infants with higher intensity scores. These results introduce the possibility of cultural differences in the relationship between prenatal distress in the mother and infant temperament. These could be factors linked to child rearing practices or to the measures employed to study infant temperament. These findings derive from a small sample with few mothers with psychological distress, and need replication in a larger sample.

Reconstruction of large composite buccal defects using single soft tissue flap—analysis of functional outcome

Resection of advanced gingivo‐buccal tumors results in a posterolateral mandibular and large soft tissue defect. Because of large soft tissue requirement, these defects are difficult to reconstruct using a single osteocutaneous flap. A double free flap reconstruction of such defects is recommended. However, double flap may not be feasible in certain situations. In this study, we objectively evaluated functional and cosmetic outcomes following single soft‐tissue flap reconstruction in a group of patients where double flap reconstruction was not feasible. Patient and defect characteristics were obtained from charts. The speech and swallowing functions of patients were prospectively assessed by a dedicated therapist. The cosmetic outcome of reconstruction was evaluated by an independent observer. Fifty‐six patients with large soft tissue and segmental posterolateral mandible defect, reconstructed with anterolateral thigh or pectoralis major flap from May 2009 till December 2010 were included. In this series, none of the flaps were lost; two patients with pectoralis major flap developed partial skin paddle loss. Most of the patients developed mandibular drift; however, majority of these patients had no postoperative trismus. All patients resumed regular or soft solid oral diet. The mean speech intelligibility was more than 70%. Majority of patients had satisfactory cosmetic outcome. The defects were classified into regions resected to develop a reconstruction algorithm for optimal reconstruction using a free or pedicle flap. In conclusion, patients with large oro‐mandibular defect undergoing single soft tissue flap reconstruction have satisfactory functional and cosmetic outcome.

Associations between body weight perception and weight control behaviour in South Indian children: a cross-sectional study.

Objective To examine the patterns of weight loss behaviour and the association between weight loss attempts with actual weight status and childrens and parental perceptions of weight status. Design A cross-sectional study. Setting Karnataka, South India. Participants 1874 girls and boys aged 8–14 years from seven schools in Karnataka, South India. Main outcome measures The association between weight loss attempts and sociodemographic factors, weight status and the childs or the parents perception of weight status. Results Approximately 73% of overweight and obese, 35% of normal weight and 22% of underweight children attempted to lose weight. Children of lower socioeconomic groups studying in schools in the local vernacular and overweight/obese children were more likely to attempt to lose weight (adjusted OR ie, AOR=1.57, 95% CI 1.11 to 2.25; AOR=4.38, 95% CI 2.64 to 7.28, respectively). Perception of weight status was associated with weight loss attempts. Thus, children who were of normal weight but perceived themselves to be overweight/obese were three times more likely to attempt weight loss compared with those who accurately perceived themselves as being of normal weight, while the odds of attempting weight loss were the highest for those who were overweight and perceived themselves to be so (AOR∼18). Conclusions Children are likely to attempt weight loss in India irrespective of their weight status, age and gender. Children who were actually overweight as well as those who were perceived by themselves or by their parents to be overweight or obese were highly likely to try to lose weight. It is necessary to understand body weight perceptions in communities with a dual burden of being overweight and undernourished, if intervention programmes for either are to be successful.

The relationship of endogenous plasma concentrations of β-Hydroxy β-Methyl Butyrate (HMB) to age and total appendicular lean mass in humans

The maintenance of muscle mass and muscle strength is important for reducing the risk of chronic diseases. The age- related loss of muscle mass and strength is associated with adverse outcomes of physical disability, frailty and death. β-Hydroxy β-Methyl Butyrate (HMB), a metabolite of leucine, has beneficial effects on muscle mass and strength under various catabolic conditions. The objectives of the present study were to determine if age- related differences existed in endogenous plasma HMB levels, and to assess if HMB levels correlated to total appendicular lean mass and forearm grip strength. Anthropometry, dietary and physical activity assessment, and the estimation of fasting plasma HMB concentrations and handgrip strength were performed on the 305 subjects (children, young adults and older adults). Lean mass, which serves as a surrogate for muscle mass was measured using dual energy X-ray absorptiometry (DEXA). Mean plasma HMB concentrations were significantly lower with increasing age groups, with children having highest mean HMB concentration (p<0.01) followed by young adults and older adults. Female subjects (across all ages) had significantly lower plasma HMB concentrations. A significant positive correlation between HMB concentrations and appendicular lean mass normalized for body weight (%), appendicular lean mass (r=0.37; p<0.001) was observed in the young adults and older adults group. Handgrip strength was positively associated with plasma HMB concentrations in young adults (r=0.58; p<0.01) and the older adults group (r=0.28; p<0.01). The findings of the present study suggest that there is an age- related decline in endogenous HMB concentrations in humans and the HMB concentrations were positively correlated with appendicular lean mass and hand grip strength in young adults and older adults group.

The effects of regular consumption of a multiple micronutrient fortified milk beverage on the micronutrient status of school children and on their mental and physical performance

Multiple micronutrient deficiencies exist in school going children in India and bridging the gap between nutrient intake and requirements is an effective way to combat the deficiencies. This study aimed to test the effect of a multi-micronutrient fortified malt and cocoa based milk beverage on the micronutrient status, cognition, physical performance and nutritional deficiencies of 7-10 years old south Indian children. A randomized, double blind placebo controlled study design was used with normal healthy children from low to middle income families, aged 7-10 years randomly assigned to receive either a multi-micronutrient fortified or an unfortified milk based control drink. The drinks were provided 6 days/week for 5 months. Assessments included anthropometry, blood biochemistry, physical performance and cognition at baseline and endline. The baseline characteristics of the study groups were similar. The changes in body weight and height were similar between the groups at the end of the study. Levels of vitamin B12, red cell folate and vitamin B2 significantly improved in the intervention group, while vitamin D, selenium and body iron showed no difference. The Hemoglobin (Hb) and serum ferritin levels of the control group decreased at endline, while those in the intervention group maintained their levels. The serum transferrin receptor levels increased in both the groups. The prevalence of iron deficiency and Vitamin B2 deficiency were significantly lower in the intervention group at endline. Overall improvement in cognitive and physical performance was seen in both the groups at endline, with no significant differences between the groups. The micronutrient fortified milk based drink was efficacious in improving the micronutrient status of Vitamin B2, Vitamin B12 and red cell folate and in preventing a decline in Hb level compared to an unfortified milk based drink. It also reduced anemia and the risk of deficiencies of iron, and B12, in apparently healthy children. ClinicalTrials.gov IdentifierNCT01415557. Clinical Trial RegistryIndia - REF/2012/12/004332.