Swarnarekha Bhat

Television viewing and sleep are associated with overweight among urban and semi-urban South Indian children

BackgroundChildhood obesity is an emerging problem in urban Indian children and increases in childhood overweight and obesity may be major contributors to the adult obesity epidemic. Thus, identifying potential risk factors for childhood obesity and formulating early interventions is crucial in the management of the obesity epidemic. The present study was aimed at evaluating dietary and physical activity patterns as determinants of overweight in a sample of children.MethodsFive hundred and ninety eight children aged 6–16 years, visiting St. Johns Medical College Hospital, Bangalore City, India for minor complaints or routine checkups were recruited into the study. These children were studied for their physical activity patterns, sleep duration, sedentary habits and eating behaviours as potential determinants of overweight.ResultsDecreased duration of sleep and increased television viewing were significantly associated with overweight. Among the eating behaviours, increased consumption of fried foods was significantly associated with overweight.ConclusionOur data suggests that duration of sleep, television viewing and consumption of fried foods may be significant factors that contribute to overweight. Further longitudinal studies are needed to confirm these findings.

High folate and low vitamin B-12 intakes during pregnancy are associated with small-for-gestational age infants in South Indian women: a prospective observational cohort study

BACKGROUND Folic acid supplementation in those with a low vitamin B-12 intake or status may have adverse effects. These effects are unknown with regard to birth outcome in pregnant Indian women who are routinely supplemented with high doses of folic acid. OBJECTIVE The objective was to examine the association of unbalanced vitamin B-12 and total folate (folic acid supplement + dietary folate) intakes during pregnancy with outcomes in small-for-gestational-age (SGA) infants. DESIGN This was a prospective observational cohort study of 1838 pregnant women in South India. Low intake of dietary vitamin B-12 in the presence of high total folate intake was examined as the ratio of vitamin B-12 intake to total folate intake. RESULTS The inadequacy of vitamin B-12 intake (<1.2 μg/d) assessed by a food-frequency questionnaire in the first, second, and third trimesters of pregnancy was 25%, 11%, and 10%, respectively. Multivariate log binomial regression showed that low vitamin B-12 and folate intakes in the first trimester were independently associated with a higher risk of SGA. In a subgroup of women with high supplemental folic acid intakes in the second trimester, those with the lowest tertile of vitamin B-12:folate ratio had a higher risk of SGA outcome than did those in the highest tertile (adjusted RR: 2.73; 95% CI: 1.17, 6.37). A similar trend was observed in the analysis of blood micronutrient status in a random subset (n = 316) of the sample. CONCLUSIONS These findings suggest that, in addition to vitamin B-12 and folate deficiencies alone, there may be adverse birth outcomes associated with unbalanced vitamin B-12 and folate intakes or status during pregnancy. These findings have important implications for the antenatal B vitamin supplementation policy in India. This trial was registered at the Clinical Trial Registry of India as 2013/07/005342.

The effect of fish and ω-3 LCPUFA intake on low birth weight in Indian pregnant women

Background:Inadequate consumption of fish could be a risk factor for low birth weight (LBW). This study assessed fish intake and ω-3 LCPUFA intake and status for their association with LBW in a cohort of urban, south Indian pregnant women.Subjects/methods:In a prospective cohort study, data on maternal fish intake and ω-3 LCPUFA intake and status of 676 women were obtained at baseline (first trimester), the second and third trimesters of pregnancy. Infant birth weight was measured immediately following hospital delivery. The dropout rate was 7.6%.Results:Fifty-six percent of the study women consumed fish with low daily median intakes (3.4, 4.1 and 3.8 g day−1 at the three trimesters, respectively). Consequently, the median intakes of EPA and DHA during pregnancy were also low at 2.1 and 10.1 mg day−1, respectively. EPA and DHA intakes were associated with their status in erythrocyte membrane phospholipids during pregnancy (r=0.40 and 0.36, r=0.34 and 0.32 and r=0.37 and 0.41, at the three trimesters, respectively, all P<0.001). Women who did not eat fish during the third trimester had a significantly higher risk of LBW (OR: 2.49, P=0.019). Similarly, low EPA intake during the third trimester had an association with a higher risk of LBW (OR: 2.75, P=0.011).Conclusions:Among low fish-eating pregnant women, fish intake in the third trimester was closely associated with birth weight. Supplementation with ω-3 LCPUFA during pregnancy may have important implications for fetal development in India.

Anthropometry and body composition of south Indian babies at birth

OBJECTIVES To assess the consequences on body composition of increasing birth weight in Indian babies in relation to reported values in Western babies, and to assess the relationship between maternal and neonatal anthropometry and body composition. DESIGN Prospective observational study. SETTING Bangalore City, India. SUBJECTS A total of 712 women were recruited at 12.5+/-3.1 weeks of gestation (mean+/-standard deviation, SD) and followed up until delivery; 14.5% were lost to follow-up. Maternal body weight, height, mid upper-arm circumference and skinfold thicknesses were measured at recruitment. Weight and body composition of the baby (skinfold thicknesses, mid upper-arm circumference, derived arm fat index and arm muscle index; AFI and AMI, respectively) were measured at birth in hospital. RESULTS The mean+/-SD birth weight of all newborns was 2.80+/-0.44 kg. Birth weight was significantly related to the triceps and subscapular skinfold thickness of the baby. In a small number of babies with large birth weight for gestational age, there was a relatively higher normalised AFI relative to AMI than for babies with lower or appropriate birth weight for gestational age. Maternal height and fat-free mass were significantly associated with the babys length at birth. CONCLUSIONS Skinfold thicknesses in Indian babies were similar to those reported in a Western population with comparable birth weights, and the relationship of AFI to birth weight appeared to be steeper in Indian babies. Thus, measures to increase birth weight in Indian babies should take into account possible adverse consequences on body composition. There were no significant relationships between maternal anthropometry and body composition at birth on multivariate analysis, except for sum of the babys skinfold thicknesses and maternal fat-free mass (P<0.02).

Potential factors related to waist circumference in urban South Indian children.

ObjectivesTo identify important factors (linked to lifestyle, eating and sedentary behaviors) relating to waist circumference among urban South Indian children aged 3 to 16 years.DesignCross sectional.SettingUrban schools of Bangalore, from August 2008 to January 2010.Participants8444 children; 4707 children aged 3–10 years and 3737 children aged 10–16 years.MethodsData were collected on the frequency of consumption of certain foods, physical activity patterns, sedentary habits at home, sleep duration and behaviors such as habits of snacking, skipping breakfast, eating in front of television and frequency of eating out. Simple linear regression analysis of waist circumference on various food items, physical activity, behavior and parental BMI were performed. A path model was developed to identify potential causal pathways to increase in waist circumference.ResultsIncreased consumption of bakery items, non vegetarian foods, increased television viewing, decreased sleep duration, eating while watching television, snacking between meals, family meals, skipping breakfast (in older children), and parental BMI were found to be related to waist circumference. Older children possibly underreported their intake of “unhealthy” foods, but not behaviors.ConclusionsThis study identified potential behaviors related to waist circumference in urban school children in India. Longitudinal studies with better measures of morbidity and adiposity are warranted in order to derive casual relationships between various determinants and waist circumference.

Expressed breast milk vs 25% dextrose in procedural pain in neonates, a double blind randomized controlled trial.

ObjectiveTo compare the effect of expressed breast milk (EBM), 25% dextrose (25 D) and sterile water (SW) on procedural pain in neonates as assessed by the premature infant pain profile (PIPP), changes in heart rate (HR), oxygen saturation (SpO2) and duration of crying.DesignProspective, double blind, randomized controlled trial.SettingPostnatal ward of a tertiary-care hospital.Participants210 babies who required venipuncture for blood sampling and who were on oral feeds were recruited into the study after parental informed consent.MethodsThe enrolled babies were randomized into intervention groups (EBM, 25% dextrose) and control group (sterile water). Two ml of test solution was given to baby by paladay (a traditional cup with a spout) 2 min before venipuncture. The face and crying of baby were video graphed by an independent, blinded observer. The facial response to pain (brow bulge, eye squeeze, nasolabial furrow) was analysed from the video. Maximum HR and minimum SpO2 were recorded during, and 1, 3 and 5 min after venipuncture by another blinded observer.Outcome variablePIPP score, HR, SpO2 and crying time at 0/1/3/5 min after sampling.Results160 babies were considered for final analysis with 50 in 25 D, 62 in EBM and 48 in SW group. The mean PIPP score in the 3 groups were 5.22, 6.84 and 11.22 at 0–30 sec after venipuncture; 4.52, 6.34, and 10.88 at 1–1 ½ min; 3.96, 6.15 and 9.35 at 3–3 ½ min; and 3.12, 4.68 and 7.83 at 5–5 ½ min; respectively (P< 0.001). The median crying time was 10,37.5 and 162 seconds in 25 D, EBM and SW groups, respectively (P< 0.001).ConclusionsEBM significantly reduces procedural pain in neonates though to a lesser extent as compared to 25% dextrose.

Are infants born in baby-friendly hospitals being exclusively breastfed until 6 months of age?

Background/Objectives:To objectively measure rates of breast-feeding to infants born in a baby-friendly hospital in Bangalore, India, and to capture home-based compliance to exclusive breastfeeding (EBF).Subjects/Methods:Breast-milk (BM) and non-breast-milk (NBM) water intake were assessed in 50 mother–infant pairs using a deuterium dilution technique at months 1, 3 and 6.Results:Complementary feeding (CF) was introduced as early as 1 month among 44% of the infants, and only 14.2% remained as exclusively breastfed by month 6. Intake of BM significantly declined from 166 to 87 ml/kg/day and NBM significantly increased from 23 to 51 ml/kg/day from month 1–6 (P<0.01). There was a significant negative correlation between BM and NBM at months 3 (r=−0.59, P<0.001) and 6 (r=−0.61, P<0.001). The most common barrier to EBF was ‘a persistently crying infant’. BM intake significantly correlated with weight for age (WAZ; month 1: r=0.56, P<0.001; month 3: r=0.60, P<0.001) and weight for height (WHZ; month 1: r=0.59, P<0.001; month 3: r=0.57, P<0.001). NBM intake showed a significant negative correlation with WHZ (r=−0.33, P=0.02) at month 3 and correlated positively with WAZ (r=0.37, P=0.01) and height for age (r=0.30, P=0.03) at month 6.Conclusions:Despite intensive counseling at birth and during the immediate postnatal period in a baby-friendly hospital, early CF was observed at home. Reason for the early introduction of CF was primarily a crying infant. Home- and community-oriented approaches should be designed to address barriers and improve EBF rates.

PAIN—Perception and Assessment of Painful Procedures in the NICU

This prospective cross-sectional study was undertaken to determine the frequency of procedural pain among 101 neonates in the first 14 days of admission to a neonatal intensive care unit (NICU) in South India and to study the perception of health-care professionals (HCP) about newborn procedural pain. The total number of painful procedures was 8.09 ± 5.53 per baby per day and 68.32 ± 64.78 per baby during hospital stay. The most common procedure was heel prick (30%). The HCP were administered a questionnaire to assess their perception of pain for various procedures. Procedures were perceived as more painful by nurses than by doctors. Chest tube placements and lumbar puncture were considered most painful. This study shows that the neonates in the NICU in developing countries experience many painful procedures. The awareness about this intensity of pain should provide a valuable tool in formulating pain-reduction protocols for management in low resource settings.

Efficacy of expressed breast milk in reducing pain during ROP screening--a randomized controlled trial.

OBJECTIVE To assess the effectiveness of expressed breast milk (EBM) on neonatal pain during screening for retinopathy of prematurity (ROP). METHODS Neonates who were on oral feeds undergoing ROP screening were included. Babies were randomized into intervention group (EBM + Standard practice) and control group. The standard practice is proparacaine, nesting and swaddling. Pain was assessed by PIPP scale, during and at 1 and 5 min after the procedure by the principal investigator who was blinded. RESULTS The groups were similar in baseline characteristics. The group receiving EBM had significantly lower PIPP scores during the procedure 12.7 ± 1.69 compared to the control group 15.5 ± 1.78 (p < 0.05). The beneficial effect persisted at 1 min and 5 min after the procedure 6.20 ± 1.9 vs. 12.4 ± 2.54 (p ≤ 0.05) at 1 min; 3.2 ± 1.5 and 6.85 ± 2.4 (p < 0.05) at 5 min. CONCLUSION Oral EBM significantly reduces pain during and after ROP screening.

Breast milk zinc transfer and early post-natal growth among urban South Indian term infants using measures of breast milk volume and breast milk zinc concentrations

Zinc (Zn) deficiency in infancy and early childhood is of public health concern in developing countries. This study aimed to longitudinally assess Zn intake of urban South Indian term infants in the first 6 months of life using measures of breast milk (BM) volume and BM Zn concentrations and, additionally, to study the effect of BM Zn intake on infant length and weight gain. BM intake by the deuterium dilution technique, BM Zn concentration at months 1, 3 and 6, as well as serum Zn level at months 3 and 6 were assessed in 50 mother-infant pairs. BM intake significantly declined from 627 mL day(-1) at month 1 to 608 mL day(-1) at month 6 (P < 0.01). BM Zn concentration and intake significantly declined from month 1 to month 6 (P < 0.001 for both). Mean infant serum Zn level at months 3 and 6 were 93.0 ± 27.1 and 99.6 ± 30.1 µg dL(-1), respectively. Infant BM Zn intake at months 1 and 3 was not associated with the weight and length gain between 1-3 and 3-6 months, respectively. Zn intake from BM, maternal BM Zn content and serum Zn levels were not significantly different between small-for-gestational age and appropriate-for-gestational age infants. Therefore, among urban south Indian term infants less than 6 months of age, BM Zn intakes were low, owing to low volumes of BM intake, despite BM Zn concentrations being in the normal range. Promotion of breastfeeding and thereby increasing the volumes of milk produced is a first important step towards improving Zn intake among infants.