Umesh Kapil

Prevalence of multiple micronutrient deficiencies amongst pregnant women in a rural area of Haryana

Deficiencies of micronutrients (zinc, iron, folic acid and iodine) during pregnancy are known causes of Low Birth Weight (LBW). Studies have documented status of one or two micronutrients amongst pregnant women (PW). However, no attempt has been made to concurrently assess the prevalence of multiple micronutrient deficiencies and the factors associated with them amongst PW.Objective: The present study was undertaken to assess the prevalence of multiple micronutrient deficiencies amongst PW in a rural area.Methods: A community based cross sectional survey was conducted in six villages of a rural area of district Faridabad in Haryana state, India during November 2000 and October 2001. All PW aged 18 years or more, with pregnancy duration of more than 28 weeks were enrolled. Data were collected on socio-economic status and other demographic parameters. Serum zinc, copper and magnesium levels were estimated by utilizing the Atomic absorption spectrophotometry (AAS); serum ferritin and folate was estimated by Enzyme Linked Immuno Sorbent Assay (ELISA) method and the Radio-lmmuno Assay (RIA) method, respectively and serum thyroid stimulating hormone (TSH) level was estimated by the Abbot AxSYM System. Serum zinc, copper, magnesium, ferritin, and folate levels less than 70.0 μg/dl, 80.0 μg/dl, 1.80 mg/dl, 15 ng/ml, and 3 ng/ml, respectively were considered as indicative of deficiency for respective micronutrients. The TSH levels of 4.670 and more indicated iodine deficiency status. Dietary intake of micronutrients was assessed utilizing 1-day 24-hour dietary recall methodology. Food consumption pattern was assessed utilizing the food frequency questionnaire methodology.Results: Nearly 73.5, 2.7, 43.6, 73.4, 26.3, and 6.4 percent PW were deficient in zinc, copper, magnesium, iron, folic acid and iodine, respectively. The highest concurrent prevalence of two, three, four and five micronutrient deficiency was of zinc and iron (54.9%); zinc, magnesium and iron (25.6%); zinc, magnesium, iron and folic acid (9.3%) and zinc, magnesium, iron, folic acid and iodine (0.8%), respectively. No pregnant woman was found to have concomitant deficiencies of all the six micronutrients. Dietary intake data revealed an inadequate nutrient intake. Over 19% PW were consuming less than 50% of the recommended calories. Similarly, 99, 86.2, 75.4, 23.6, 3.9 percent of the PW were consuming less than 50% of the recommended folic acid, zinc, iron, copper, and magnesium. The consumption of food groups rich in micronutrients (pulses, vegetables, fruits, nuts and oil seeds, animal foods) was infrequent. Univariate and Multivariate logistic regression analysis revealed that low dietary intake of nutrients, low frequency of consumption of food groups rich in micronutrients and increased reproductive cycles with short interpregnancy intervals were important factors leading to micronutrient deficiencies.Conclusion: There was a high prevalence of micronutrient deficiencies amongst the PW of the area, possibly due to the poor dietary intake of food and low frequency of consumption of food groups rich in micronutrients. The concurrent prevalence of two, three, four and five micronutrient deficiencies were common.

Role of trace elements zinc, copper and magnesium during pregnancy and its outcome.

Trace element deficiencies have been documented to play an important role in determination of the fetal outcome. Pregnant women in developing countries have been reported to consume diets with a lower density of minerals and vitamins. Deficiencies of trace elements like zinc, copper and magnesium have been implicated in various reproductive events like infertility, pregnancy wastage, congenital anomalies, pregnancy induced hypertension, placental abruption, premature rupture of membranes, still births and low birth weight. The present review article highlights the important of role played by zinc, copper and magnesium during pregnancy and its outcome. The role of individual trace elements and in combination with other trace elements has not been completely documented. There is a need to undertake further studies in this field.

Iron, folate, and vitamin B12 stores among pregnant women in a rural area of Haryana State, India.

Background Iron, folate, and vitamin B12 deficiencies have adverse effects on pregnancy outcome. In India, data on the concomitant prevalence of these deficiencies among pregnant women are meager. Objective We conducted a community-based study to assess the prevalence of deficiencies of iron, folate, and vitamin B12 among pregnant women in a rural block of Haryana State. Methods The study was approved by the ethics committee of the All India Institute of Medical Sciences, New Delhi. A total of 283 pregnant women were enrolled in the study. After oral informed consent had been obtained from the women, blood was drawn from the antecubital vein for estimation of the levels of serum ferritin by enzyme-linked immunosorbent assay (levels < 12 ng/mL were considered as indicative of poor iron stores); serum folate was determined by radioimmunoassay (levels < 3 ng/mL were considered as indicative of poor folate stores); and serum vitamin B12 was estimated by the microbiologic method (levels < 200 pg/mL were considered as indicative of poor vitamin B12 stores). Results The results indicated that 67.7%, 26.3%, and 74.1% of the women had poor iron, folate, and vitamin B12 stores, respectively. Concomitant deficiencies of iron, folate, and vitamin B12 occurred in 16.2% of the women. We found that 59.9% of the women were consuming less than 75% of the recommended daily caloric allowance (2,175 kcal), indicating an overall poor food intake. This could be one of the predominant reasons for poor iron, folate, and vitamin B12 stores among the women. Conclusions Our findings suggest that apart from iron and folate, vitamin B12 deficiencies may play an important role in causing anemia.

Prevalence of iron, vitamin A, and iodine deficiencies amongst Adolescent Pregnant Mothers

Objective : The present study was undertaken to assess the prevalence of iron, vitamin A and iodine deficiencies amongst rural Adolescent Pregnant Mothers (APM).Methods : Survey was conducted amongst APM in a rural block; district Udham Singh Nagar, Uttaranchal State. In the district, all blocks were enlisted and one block was randomly selected. Further, villages in the block were listed (n=64) and five villages were randomly selected for the detailed study. All APM residing in the selected villages were included for the detailed study. The data on socio demographic parameters was collected utilizing a pretested semi-structured questionnaire. Anaemia was assessed by hemoglobin estimation with the help of the HemoCue instrument. Vitamin-A deficiency (VAD) was assessed by presence of night blindness utilizing a pre-tested semi structured proforma. Iodine Deficiency was assessed by the clinical examination of the thyroid gland and estimating the Urinary Iodine Excretion (UIE) levels of each subject. Nutrient intake was assessed by the 24-hr dietary recall method.Results : One hundred and fifty one APM, belonging to low socio economic group, were selected for the study. The occupation of the families was farming, but the APM were housewives. The mean age of the APM was 17.8 ±1.5 yr. Eighty nine percent of the APM were in the age group 16–19 yr. Sixty percent of the APM were in the gestational age of 24 weeks and more. It was found that 46.0% of the APM were anaemic (Hb <11.0 gm/dl). Sixteen percent of the study subjects had presence of night blindness. Fifteen percent of the subjects had Goiter. Median UIE level in the subjects studied was 95.0 μg/l. Concomitant prevalence of the three deficiencies was amongst 2.0% of the population. The 24-hour dietary intake revealed that the mean consumption of retinol and iron was only 13 and 28% of the recommended dietary allowance, respectively.Conclusion : The findings of the present study indicated that Anaemia, Vitamin A, and Iodine deficiency existed as public health problems in the APM of the study area.

Integrated child development services (ICDS) scheme : A program for holistic development of children in India

The Integrated Child Development Services (ICDS) scheme is the largest program for promotion of maternal and child health and nutrition not only in India but in the whole world. The scheme was launched in 1975 in pursuance of the National Policy for Children. The scheme has expanded in the last twenty-seven years form 33 projects to 5171 blocks. ICDS is a multi-sectoral program and involves several government departments. The program services are coordinated at the village, block, district, state and central government levels. The primary responsibility for the implementation of the program lies with the Department of Women & Child Development at the Centre and nodal department at the states, which may be Social Welfare, Rural Development, Tribal Welfare or Health Department or an independent Department. The beneficiaries are children below 6 years, pregnant and lactating women and women in the age group of 15 to 44 yrs. The beneficiaries of ICDS are to a large extent identical with those under the Maternal and Child Health Program. The program provides an integrated approach for converging all the basic services for improved childcare, early stimulation and learning, health and nutrition, water and environmental sanitation aimed at the young children, expectant and lactating mothers, other women and adolescent girls in a community. ICDS program is the reflection of the Government of India to effectively improve the nutrition and health status of underprivileged section of the population through direct intervention mechanism. The program covers 27.6 million beneficiaries with supplementary nutrition. The program services and beneficiaries has essentially remained the same since 1975. Recently a review of the scheme was held, sponsored by Government of India, which suggested modifications in the health and nutrition component of ICDS scheme to improve the program implementation and efficiency

Risk factors for gallbladder cancer: A case–control study

Risk factors for gallbladder cancer (GBC) except gallstones are not well known. The objective was to study the risk factors for GBC. In a case–control study, 200 patients with GBC, 200 healthy controls and 200 gallstones patients as diseased controls were included prospectively. The risk factors studied were related to socioeconomic profile, life style, reproduction, diet and bile acids. On comparing GBC patients (mean age 51.7 years; 130 females) with healthy controls, risk factors were chemical exposure [odd ratios (OR): 7.0 (2.7–18.2); p < 0.001)], family history of gallstones [OR: 5.3 (1.5–18.9); p < 0.01)], tobacco [OR: 4.1 (1.8–9.7); p < 0.001)], fried foods [OR: 3.1 (1.7–5.6); p < 0.001], joint family [OR: 3.2 (1.7–6.2); p < 0.001], long interval between meals [OR: 1.4 (1.2–1.6); p < 0.001] and residence in Gangetic belt [OR: 3.3 (1.8–6.2); p < 0.001]. On comparing GBC cases with gallstone controls, risk factors were female gender [OR: 2.4 (1.3–4.3); p = 0.004], residence in Gangetic belt [OR: 2.3 (1.2–4.4); p = 0.012], fried foods [OR: 2.5 (1.4–4.4); p < 0.001], diabetes [OR: 2.7 (1.2–6.4); p = 0.02)], tobacco [OR 3.8 (1.7–8.1); p < 0.001)] and joint family [OR: 2.1 (1.2–3.4); p = 0.004]. The ratio of secondary to primary bile acids was significantly higher in GBC cases than gallstone controls (20.8 vs. 0.44). Fried foods, tobacco, chemical exposure, family history of gallstones, residence in Gangetic belt and secondary bile acids were significant risk factors for GBC.

Serum magnesium level among pregnant women in a rural community of Haryana State, India

Objective: Assessment of serum magnesium levels among pregnant women in a rural community.Design: A community-based cross-sectional study.Setting: Investigation was conducted in six villages of a rural block of District Faridabad, Haryana State, India.Subjects: In total, 283 pregnant women with pregnancy duration of 28 weeks and more were enrolled for the detailed study. Blood from the antecubital vein was drawn and serum magnesium levels were estimated by the atomic absorption spectrophotometric method.Results: In all, 44% of the pregnant women had serum levels less than the normal level (1.80 mg/dl). There was a significant decrease (P=0.01) in serum magnesium levels with the increase in parity.Conclusion: A high prevalence of magnesium deficiency was found among the pregnant women.Sponsorship: Indian Council of Medical Research, New Delhi.

Iodine deficiency and development of brain.

Iodine is a trace element essential for the synthesis of triodothyronine (T3) and thyroxine (T4). Inadequate intake of iodine leads to insufficient production of these hormones, which play a vital role in the process of early growth and development of most organs, especially the brain. The neurological sequele of iodine deficiency are mediated by thyroid hormone deficiency, varying from minimal brain function to a syndrome of severe intellectual disability. All the basic processes of neurogenesis: cellular proliferation, differentiation, migration, and selective cell death are impaired during period of brain growth spurt. Evidence suggests alterations in synaptology, neurons, myelin sheaths, glial cells, and morphology of cerebrum and cerebellum in severe iodine deficiency. Foetal thyroid ontogenesis occurs after the first trimester. Until then foetus is dependent on maternal T4. A thyroid dependent event important for subsequent brain development occurs in the beginning of the third trimester of pregnancy

Magnitude of Zinc Deficiency among Nulliparous Nonpregnant Women in a Rural Community of Haryana State, India

Zinc deficiency during pregnancy affects the outcome of pregnancy. A high prevalence of zinc deficiency (55.5%) has been reported among pregnant women. It is not known whether pregnancy leads to zinc deficiency due to the increased fetal needs or whether the women are zinc deficient when they become pregnant. No data are available on the zinc status of nulliparous nonpregnant women from India. To assess the magnitude of zinc deficiency among nulliparous nonpregnant women in a rural community of Haryana State, India. A community-based cross-sectional survey was conducted in six villages of a rural area in a district of Haryana State, India. All nulliparous nonpregnant women aged 18 years or over who were willing to participate in the study were enrolled. Each woman was questioned about her age, socioeconomic status, and dietary pattern with the use of a pretested semistructured questionnaire. Blood from the antecubital vein was drawn to assess the serum zinc levels using an atomic absorption spectrophotometer. Serum zinc levels less than 70.0 μg/dl were considered to indicate zinc deficiency. The dietary intakes of zinc, protein, and calories were assessed by the 24-hour dietary recall method. Two hundred eighty-eight nulliparous nonpregnant women were enrolled. Forty-one percent had zinc deficiency, and 75.7%, 1.4%, and 7.3% of the women consumed less than 50% of the recommended intake of zinc, protein, and calories, respectively. Women who consumed less than 50% of the recommended intake of calories (1,875 kcal) were at a 4.9 times higher risk of zinc deficiency than women who consumed more than 50% of the recommended intake. A high prevalence of zinc deficiency was found among the nulliparous nonpregnant women in the area studied.

Reproductive factors and breast cancer: A case-control study in tertiary care hospital of North India

BACKGROUND Clinical, animal, and epidemiological studies have clearly demonstrated that cancer is a hormonally mediated disease and several factors that influence hormonal status or are markers of change in hormonal status have been shown to be associated with the risk of breast cancer. AIMS To identify the association of various reproductive factors with breast cancer. SETTINGS AND DESIGN A hospital-based, matched, case-control study. MATERIALS AND METHODS Three hundred and twenty newly diagnosed breast cancer cases and three hundred and twenty normal healthy individuals constituted the study population. The subjects in the control group were matched individually with the cases for their age ± 2 years and socioeconomic status. A pre-tested, semi-structured questionnaire was administered to each individual to collect information on identification data, socio-demographic profile, and reproductive factors. STATISTICAL ANALYSIS USED The Chi-square test and unpaired t-test were used. The conditional univariate logistic regression analysis (unadjusted odds ratio and confidence intervals) was used to calculate the significance level of each variable followed by multivariate regression analysis. RESULTS AND CONCLUSIONS The cases had a lower mean age at menarche, higher age at marriage, higher mean age at last child birth, lower mean duration of breastfeeding, higher number of abortions, late age at menopause, history of oral contraceptive pills, and a family history of breast cancer as compared to the controls. The results of the present study revealed a strong association of reproductive factors with breast cancer in the Indian population.