Supreet Kaur

Thirty years of a Ban on the Sale of Noniodized Salt: Impact on Iodine Nutrition in Children in Himachal Pradesh, India

Background A survey conducted by the central iodine-deficiency disorders team in Himachal Pradesh, a state in the goiter-endemic belt of India, revealed that 10 of its 12 districts have an endemic prevalence of goiter. The survey was conducted to provide health program managers data to determine whether it would be necessary to initiate intervention measures. Objective To assess the status of urinary iodine excretion and household salt iodization levels after three decades of a complete ban on the sale of noniodized salt in this goiter-endemic state in India as measured by assessment of urinary iodine excretion levels and iodine content of salt at the household level. Methods The guidelines recommended by WHO/UNICEF/ICCIDD for a rapid assessment of salt iodization were adopted. In each of the 12 studied districts, all senior secondary schools were enlisted and one school was selected by using a random sampling procedure. Two hundred fifty children 11 to 18 years of age were included in the study. Urine samples were collected from a minimum of 170 children and analyzed using the wet digestion method. Salt samples were also collected from a minimum of 170 children and analyzed using the spot testing kit. Results All districts had a median urinary iodine excretion level > 200 μg/L and 82% of the families were consuming salt with an iodine content of 15 ppm or higher. Conclusions The results of the present study highlight the successful implementation of the salt iodization program in the state of Himachal Pradesh. This positive impact may be due to the comprehensive strategy adopted by the state government to improve the quality of salt, development of an effective monitoring information system and effective information, education, and communication activities.

Variability of Thinness and its Relation to Cardio-metabolic Risk Factors using Four Body Mass Index References in School-children from Delhi, India.

ObjectivesTo compare: (i) prevalences of thinness in schoolchildren by four body mass index references in common use viz., Centre for Disease Control (CDC); Cole; Indian Academy of Pediatrics (IAP); World Health Organization (WHO); and (ii) relationship of thinness with absence of cardio-metabolic risk factors in these BMI references.DesignCross-sectional.SettingSchools in Delhi.ParticipantsAnthropometry and blood pressure were measured in 16,245 school children aged 5 to 18 years. Fasting lipids and blood sugar were estimated in 2796 subjects.Outcome measuresAge and sex-specific prevalences of thinness and predictive ability of reference cut-off for detecting any cardio-metabolic risk factor were compared.ResultsPrevalence of thinness varied with the reference employed; more so for boys. Overall prevalence of thinness was least with IAP reference and highest with CDC cut-offs (6.6% to 16.9% in boys, 6.5% to 10.3% in girls). Children identified as thin by any reference had comparable, significantly lower risks (OR 0.59 to 0.73) of associated cardio-metabolic aberrations. In subjects with any cardio-metabolic or blood pressure aberration, the prevalence of thinness was highest with CDC and least with IAP definition.ConclusionPrevalence of thinness varies considerably with the reference employed. Thin children, identified by any reference, have a lower risk of associated cardio-metabolic aberrations; however, thinness is a poor diagnostic test for this purpose. In populations undergoing nutrition transition, there is a need to link cardio-metabolic risk factors with recommended anthropometric criteria to define undernutrition.

Association of Obesity with Hypertension Amongst School-Age Children Belonging to Lower income group and middle income group in national capital territory of Delhi

Background and Objectives: Hypertension is one of the most common diseases world-wide and the prevalence in school-aged children appears to be increasing perhaps as a result of increased prevalence of obesity. Thus, the present study was planned to establish an association between body mass index (BMI) and waist circumference (WC) with hypertension amongst school children in the age group of 5-16 years belonging to lower income group (LIG) and middle income group (MIG) in National Capital Territory of Delhi. Subjects and Methods: Population proportionate to size methodology was adopted to select 30 clusters/schools in each LIG and MIG category. About 170 children from each school were selected randomly with the help of random number tables. Anthropometric measurements of weight, height and WC and blood pressure measurements were taken by using the standard methodology. Results and Interpretation: t0 he prevalence of high systolic blood pressure (SBP) in LIG and MIG school population was 3.8 and 4.4% with high WC and BMI are more likely to have hypertension. Subjects and Methods: Population proportionate to size methodology was adopted to select 30 clusters/schools in each LIG and MIG category. About 170 children from each school were selected randomly with the help of random number tables. Anthropometric measurements of weight, height and WC and blood pressure measurements were taken by using the standard methodology. Results and Interpretation: t0 he prevalence of high systolic blood pressure (SBP) in LIG and MIG school population was 3.8 and 4.4% with high WC and BMI are more likely to have hypertension.

Dyslipidemia amongst Obese Children in National Capital Territory (NCT) of Delhi

ObjectiveChildhood obesity is associated with unfavorable lipid profile. Obese children have increased risk of development of coronary heart disease (CHD) in adult life. There is lack of data on association of dyslipidemia with obesity in children from India, hence, the present investigation was undertaken.MethodsStudy was conducted in NCT of Delhi. Thirty schools in each of the 3 socio economic groups i.e., LIG, MIG and HIG were selected. From each school, 170 children were included in the survey. A total of 16,585 children were studied. Anthropometric measurements of weight and height were taken using standard methodology Four hundred and fifty one obese children (cases) were identified using IOTF classification. Equal number of children, matched for age, sex and socio-economic status, with optimal body weight were selected as control. The blood samples were collected for lipid profile estimation. Same investigations were undertaken, both in cases and controls.ResultsIn obese children, mean total cholesterol, triglyceride and LDL-C levels were significantly higher as compared to their matched controls (p < 0.001). BMI was significantly correlated with lipid profile.ConclusionsObesity amongst children was associated with unfavorable lipid profile.

Association of body mass index and waist circumference with hypertension among school children in the age group of 5-16 years belonging to lower income group and middle income group in National Capital Territory of Delhi.

Background and Objectives: Hypertension is one of the most common diseases world-wide and the prevalence in school-aged children appears to be increasing perhaps as a result of increased prevalence of obesity. Thus, the present study was planned to establish an association between body mass index (BMI) and waist circumference (WC) with hypertension amongst school children in the age group of 5-16 years belonging to lower income group (LIG) and middle income group (MIG) in National Capital Territory of Delhi. Materials and Methods: Population proportionate to size methodology was adopted to select 30 clusters/schools in each LIG and MIG category. About 170 children from each school were selected randomly with the help of random number tables. Anthropometric measurements of weight, height and WC and blood pressure measurements were taken by using standard methodology. Results: The prevalence of high systolic blood pressure (SBP) in LIG and MIG school population was 2.8% and 4.1% respectively. Similarly, the prevalence of high diastolic blood pressure (DBP) in LIG and MIG school population was 2.7% and 4.2%, respectively. Statistical positive correlation was observed between BMI and WC with SBP and DBP. Thus, it can be inferred that children with high WC and BMI are more likely to have hypertension.

Prevalence of Pediatrics Metabolic Syndrome (PMS) Amongst Children in the Age Group of 6–18 Years Belonging to High Income Group Residing in National Capital Territory (NCT) of Delhi

Sir, We would like to share findings on prevalence of pediatrics metabolic syndrome (PMS) amongst children in the age group of 6–18 yrs belonging to high income group residing in national capital territory (NCT) of Delhi with the readers of the Indian Journal of Pediatrics. The studies conducted in developed countries have reported the overall prevalence of PMS as 6.4%, 3.1%, 12.7% utilizing the criteria of hypertension, impaired fasting glucose, Hypertriglyceridemia, abnormal high density lipoprotein (HDL) and central obesity as measured by waist circumference [1–3]. Here it is reported here the prevalence of PMS in 1,331 children belonging to high income group. This data is a part of a larger study published earlier [4]. The children were selected by population proportion to size (PPS) sampling methodology from a list of all public schools with the fees of Rs. 1,000 and above per month in NCT of Delhi. The measurement of blood pressure, serum triglyceride, serum HDL, fasting blood glucose levels and waist circumference was conducted by utilizing the standard methods [5]. The authors considered the presence of PMS when three or more of following risk factors were present in a child. The cut-off for presence risk factors were hypertension (systolic or diastolic blood pressure ≥95th percentile for age and sex) [6], impaired fasting glucose (fasting blood glucose level of 100 mg/dl and more), hypertriglyceridemia (150 mg/dl and more), abnormal HDL (<40 mg/dl), and central obesity as measured by waist circumference (≥90th percentile for age and sex) [7]. The authors have found the prevalence of PMS as 6.5% (males 6.9% and females 5.9%). The PMS is known to a pre-cursor of adult metabolic syndrome in a population. The findings of the present study indicate that PMS is significant but hidden public health problem, which requires urgent attention of the programme managers and administrators in the health sector.