Tinku Thomas

Assessment of self-reported emotional and behavioral difficulties among pre-university college students in Bangalore, India

Background: The understanding of youth mental health needs and development of service delivery models is a national public health challenge. Objectives: The rates and predictors of emotional and behavioral problems among 1087 youth were assessed in a pre-university college in Bangalore, India. Variations in rates of disturbance, identified by using different cut-off points, were also examined. Materials and Methods: The Strengths and Difficulties Questionnaire was used as a self-report screening tool. Results: Results indicated that 10.1% of adolescents had total difficulty levels in the abnormal range, with 9% at risk for emotional symptoms, 13% for conduct problems, 12.6% for hyperactivity/inattention and 9.4% for peer problems. Select gender differences were present. Cut-off scores derived from the sample yielded lower estimates of disturbance than the published cut-offs. Regression analysis identified predictors of total difficulty levels. Conclusions: Implications for assessment of youth mental health and planning targeted services in educational institutions are discussed.

Vitamin B-12 Supplementation during Pregnancy and Early Lactation Increases Maternal, Breast Milk, and Infant Measures of Vitamin B-12 Status

Pregnant women in resource-poor areas are at risk of multiple micronutrient deficiencies, and indicators of low vitamin B-12 status have been associated with adverse pregnancy outcomes, including anemia, low birth weight, and intrauterine growth retardation. To evaluate whether daily oral vitamin B-12 supplementation during pregnancy increases maternal and infant measures of vitamin B-12 status, we performed a randomized, placebo-controlled clinical trial. Pregnant women <14 wk of gestation in Bangalore, India, were randomly assigned to receive daily oral supplementation with vitamin B-12 (50 μg) or placebo through 6 wk postpartum. All women were administered iron and folic acid supplements throughout pregnancy. One hundred eighty-three women were randomly assigned to receive vitamin B-12 and 183 to receive placebo. Compared with placebo recipients, vitamin B-12-supplemented women had significantly higher plasma vitamin B-12 concentrations at both the second (median vitamin B-12 concentration: 216 vs. 111 pmol/L, P < 0.001) and third (median: 184 vs. 105 pmol/L, P < 0.001) trimesters. At 6 wk postpartum, median breast milk vitamin B-12 concentration was 136 pmol/L in vitamin B-12-supplemented women vs. 87 pmol/L in the placebo group (P < 0.0005). Among vitamin B-12-supplemented women, the incidence of delivering an infant with intrauterine growth retardation was 33 of 131 (25%) vs. 43 of 125 (34%) in those administered placebo (P = 0.11). In a subset of infants tested at 6 wk of age, median plasma vitamin B-12 concentration was 199 pmol/L in those born to supplemented women vs. 139 pmol/L in the placebo group (P = 0.01). Infant plasma methylmalonic acid and homocysteine concentrations were significantly lower in the vitamin B-12 group as well. Oral supplementation of urban Indian women with vitamin B-12 throughout pregnancy and early lactation significantly increases vitamin B-12 status of mothers and infants. It is important to determine whether there are correlations between these findings and neurologic and metabolic functions. This trial was registered at clinicaltrials.gov as NCT00641862.

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.

Effect of fortification with multiple micronutrients and n−3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (Children's Health and Mental Performance Influenced by Optimal Nutrition) Study

BACKGROUND Fortification with multiple micronutrients has been shown to improve growth and cognitive performance among children in developing countries, but it is unknown whether higher concentrations are more effective than lower concentrations. OBJECTIVE We compared the effect of 2 different concentrations of a combination of micronutrients and n-3 (omega-3) fatty acids on indicators of growth and cognitive performance in low-income, marginally nourished schoolchildren in Bangalore, India. DESIGN In a 2-by-2 factorial, double-blind, randomized controlled trial, 598 children aged 6-10 y were individually allocated to 1 of 4 intervention groups to receive foods fortified with either 100% or 15% of the Recommended Dietary Allowance of micronutrients in combination with either 900 mg alpha-linolenic acid plus 100 mg docosahexaenoic acid or 140 mg alpha-linolenic acid for 12 mo. Anthropometric and biochemical assessments were performed at baseline and 12 mo. Cognitive performance was measured at baseline and at 6 and 12 mo. RESULTS The high micronutrient treatment significantly improved linear growth at 12 mo (0.19 cm; 0.01, 0.36) and short-term memory at 6 mo (0.11 SD; 0.01, 0.20) and was less beneficial on fluid reasoning at 6 (-0.10 SD; -0.17, -0.03) and 12 (-0.12 SD; -0.20, -0.04) mo than was the low micronutrient treatment, whereas no differences were observed on weight, retrieval ability, cognitive speediness, and overall cognitive performance. No significant differences were found between the n-3 treatments. CONCLUSIONS The high micronutrient treatment was more beneficial for linear growth than was the low micronutrient treatment. However, with some small differential effects, higher micronutrient concentrations were as effective as lower concentrations on cognitive performance. This trial was registered at clinicaltrials.gov as NCT00467909.

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).

Muscle mass and functional correlates of insulin sensitivity in lean young Indian men.

Background/Objectives:There is a high prevalence of diabetes mellitus associated with insulin resistance in Indian adults, probably due to an inappropriately high accumulation of body fat at lower body mass indices (BMIs, kg/m2), as well as to a lower skeletal muscle mass. Although skeletal muscle is an important site of glucose disposal, the strength of its association with insulin sensitivity (IS) is unknown in the Indian population.Subjects/Methods:This was a cross-sectional study performed to assess the association of body fat, muscle and muscle function with IS in 51 young, healthy, nonobese Indian men with BMI ranging from 15 to 25 kg/m2, using hyperinsulinemic euglycemic clamp method.Results:The median IS was 5.32 (mg/(kg min))/(μU/ml), lower, upper quartile, 4.03, 6.56); (SI units: 4.25, lower, upper quartile, 3.22, 5.24 (μmol/(kg min))/(pmol/l)). A multiple linear regression of the natural log transformed value of IS on BMI and body muscle mass measured as the appendicular lean soft tissue (expressed as a percentage of body weight) explained 49% of the variance in IS. Independently, body fat percent and muscle (handgrip) strength showed significant bivariate correlations with IS (ρ=−0.61, P<0.001; ρ=0.32, P=0.027, respectively), although these variables did not enter into the multiple regression.Conclusions:BMI and body fat have been shown to be inversely related to IS at higher BMIs. This study indicates that a relative increase in BMI and reduced muscle mass and possibly function are also associated with reduced IS in lean Indian men.

Poverty and the state of nutrition in India

India is often thought of as a development paradox with relatively high economic growth rates in the past few years, but with lower progress in areas of life expectancy, education and standard of living. While serious inequalities in growth, development and opportunity explain the illusion of the paradox at the country level, still, a significant proportion of the worlds poor live in India, as do a significant proportion of the worlds malnourished children. Poverty and undernutrition coexist, and poor dietary quality is associated with poor childhood growth, as well as significant micronutrient deficiencies. Food security is particularly vulnerable to changes in the economic scenario and to inequities in wealth distribution. Migration from rural to urban settings with a large informal employment sector also ensures that migrants continue to live in food insecure situations. While food production has for the most part kept pace with the increasing population, it has been with regard to cereal rather than of pulses and millet production. Oil seeds, sugar cane and horticultural crops, along with non-food crops are also being promoted, which do not address nutrition security, and, coupled with the increase in the consumption of pre-prepared food, may indeed predispose towards the double burden of malnutrition. Access to food is also particularly susceptible to poverty and inequality. Many strategies and policies have been proposed to counter undernutrition in India, but their implementation has not been uniform, and it is still too early to assess their lasting impact at scale.

Consumption of a mid-morning snack improves memory but not attention in school children

Muthayya, S., T. Thomas, K. Srinivasan, K. Rao, A. V. Kurpad, J.-W. Van Klinken, G. Owen and E.A. de Bruin: Consumption of a mid-morning snack improves memory but not attention in school children. Physiol Behav 00(0) 000-000, 2006.--This study aimed to determine whether consumption of a mid-morning snack with appropriate energy compensation through a smaller breakfast or lunch, resulted in improved cognitive performance of 7-9 year old children with a low and high socioeconomic status (LSES and HSES, n=35 and 34 respectively). The children were each randomly assigned to three iso-caloric dietary interventions: control (standard breakfast, no snack and standard lunch), intervention A (small breakfast, snack, and standard lunch) and intervention B (standard breakfast, snack, and small lunch), using a cross-over design. The children were tested on three different days, each one week apart. Computerised tests of cognitive performance, consisting of memory, sustained attention and psychomotor speed, were performed during four sessions, i.e., prior to breakfast, after breakfast, after a mid-morning snack and after lunch. Having a mid-morning snack resulted in a smaller decline in immediate and delayed memory in LSES but not in HSES children. Having a snack did not influence sustained attention and psychomotor speed in either LSES or HSES children. This study shows that a more evenly distributed energy intake throughout the morning by consuming a mid-morning snack improves memory performance in school-age LSES children even when the total amount of energy consumed during the morning is not altered.