Vaman Khadilkar

Overweight and obesity prevalence and body mass index trends in Indian children

OBJECTIVES To estimate prevalence of overweight and obesity in apparently healthy children from five zones of India in the age group of 2 to 17 years and to examine trends in body mass index (BMI) during the last two decades with respect to published growth data. METHODS A multicentric study was conducted in eleven affluent urban schools from five geographical zones of India. A total of 20 243 children (1 823 - central zone, 2 092 - east zone, 5 526 - north zone, 3 357 - south zone, and 7 445 - west zone) in the age group of 2-17 years were studied. Height and weight were measured and BMI was calculated (kg/m(2)). WHO Anthro plus was used to calculate Z-scores for height, weight and BMI. A comparison between study population and previously available nationally representative (1989) data was performed for each age-sex group. International Obesity Task Force (IOTF) and WHO cut-offs were used to calculate the percentage prevalence of overweight and obesity. RESULTS The overall prevalence of overweight and obesity was 18.2% by the IOTF classification and 23.9% by the WHO standards. The prevalence of overweight and obesity was higher in boys than girls. Mean BMI values were significantly higher than those reported in the 1989 data from 5-17 years at all ages and for both sexes. CONCLUSION The rising trend of BMI in Indian children and adolescents observed in this multicentric study rings alarm bells in terms of associated adverse health consequences in adulthood.

Normative data and percentile curves for Dual Energy X-ray Absorptiometry in healthy Indian girls and boys aged 5–17 years

For the correct interpretation of Dual Energy X-ray Absorptiometry (DXA) measurements in children, the use of age, gender, height, weight and ethnicity specific reference data is crucially important. In the absence of such a database for Indian children, the present study aimed to provide gender and age specific data on bone parameters and reference percentile curves for the assessment of bone status in 5-17 year old Indian boys and girls. A cross sectional study was conducted from May 2006 to July 2010 on 920 (480 boys) apparently healthy children from schools and colleges in Pune City, India. The GE-Lunar DPX Pro Pencil Beam DXA scanner was used to measure bone mineral content (BMC [g]), bone area (BA [cm(2)]) and bone mineral density (BMD [g/cm(2)]) at total body, lumbar spine and left femur. Reference percentile curves by age were derived separately for boys and girls for the total body BMC (TBBMC), total body BA (TBBA), lumbar spine bone mineral apparent density (BMAD [g/cm(3)]), and left femoral neck BMAD. We have also presented percentile curves for TBBA for height, TBBMC for TBBA, LBM for height and TBBMC for LBM for normalizing bone data for Indian children. Mean TBBMC, TBBA and TBBMD were expressed by age groups and Tanner stages for boys and girls separately. The average increase in TBBMC and TBBA with age was of the order of 8 to 12% at each age group. After 16 years of age, TBBMC and TBBA were significantly higher in boys than in girls (p<0.01). Maximal increase in TBBMD occurred around the age of 13 years in girls and three years later in boys. Reference data provided may be used for the clinical assessment of bone status of Indian children and adolescents.

Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children

JustificationThe need to revise Indian Academy of Pediatrics (IAP) growth charts for 5- to 18-year-old Indian children and adolescents was felt as India is in nutrition transition and previous IAP charts are based on data which are over two decades old.ProcessThe Growth Chart Committee was formed by IAP in January 2014 to design revised growth charts. Consultative meeting was held in November 2014 in Mumbai. Studies performed on Indian children’s growth, nutritional assessment and anthropometry from upper and middle socioeconomic classes in last decade were identified. Committee contacted 13 study groups; total number of children in the age group of 5 to 18 years were 87022 (54086 boys). Data from fourteen cities (Agartala, Ahmadabad, Chandigarh, Chennai, Delhi, Hyderabad, Kochi, Kolkata, Madurai, Mumbai, Mysore, Pune, Raipur and Surat) in India were collated. Data of children with weight for height Z scores >2 SD were removed from analyses. Data on 33148 children (18170 males, 14978 females) were used to construct growth charts using Cole’s LMS method.ObjectivesTo construct revised IAP growth charts for 5–18 year old Indian children based on collated national data from published studies performed on apparently healthy children and adolescents in the last 10 years.RecommendationsThe IAP growth chart committee recommends these revised growth charts for height, weight and body mass index (BMI) for assessment of growth of 5–18 year old Indian children to replace the previous IAP charts; rest of the recommendations for monitoring height and weight remain as per the IAP guidelines published in 2007. To define overweight and obesity in children from 5–18 years of age, adult equivalent of 23 and 27 cut-offs presented in BMI charts may be used. IAP recommends use of WHO standards for growth assessment of children below 5 years of age.

Body mass index cut-offs for screening for childhood overweight and obesity in Indian children.

ObjectiveTo develop age and sex specific cut-offs for BMI to screen for overweight and obesity in Indian children linked to an adult BMI of 23 and 28 kg/m2 respectively, using contemporary Indian data.DesignCross-sectional.SettingMulticentric, School based.Participants19834 children were measured from 11 affluent schools from five major geographical regions of India. Data were analyzed using the LMS method, which constructs growth reference percentiles adjusted for skewness.ResultsCompared to the cut-offs suggested for European populations and those by the Indian Academy of Pediatrics 2007 Guidelines, the age and sex specific cut off points for body mass index for overweight and obesity for Indian children suggested by this study are lower.ConclusionsContemporary cross-sectional age and sex specific BMI cut-offs for Indian children linked to Asian cutoffs of 23 and 28 kg/m2 for the assessment of risk of overweight and obesity, respectively are presented.

Carotid arterial stiffness in overweight and obese Indian children

Abstract Objective: The aim of the study was to evaluate carotid arterial stiffness and intima media thickness (IMT) in obese children in comparison with healthy children, and to examine associations of lipid profile and blood pressure with carotid artery morphology. Methods: Anthropometric and blood parameters were assessed in 44 overweight, 95 obese (6–17 years) and 69 healthy age-matched normal children. Percent body fat was measured by dual-energy X-ray absorptiometry and stiffness and IMT of the common carotid artery were evaluated using Aloka α 10 equipment. Results: Anthropometric and lipid parameters were significantly higher in overweight and obese than in normal children (p<0.05). Stiffness (β), pulse wave velocity (PWV), elastic modulus (Ep) and blood pressure were significantly higher in obese and overweight children than in normal children (p<0.05). However, overweight and obese children did not show any significant difference in IMT compared with normal children (p>0.1). Significant positive correlation of PWV, β and Ep and negative correlation of arterial compliance with body fat and triglyceride was noted (p<0.05). Different multinomial regression models for each e-Tracking parameter indicated that the relative risk of hypertension was highest with high PWV, followed by LDL cholesterol, Ep and body fat. Conclusion: PWV may be considered an important marker for evaluation of early functional changes of the carotid artery in children and adolescents.

Growth charts: A diagnostic tool

Context: Assessment of growth by objective anthropometric methods is crucial in child care. India is in a phase of nutrition transition and thus it is vital to update growth references regularly. Objective: To review growth standards and references for assessment of physical growth of Indian children for clinical use and research purposes. Materials and Methods: Basics of growth charts and importance of anthropometric measurements are described. A comparison between growth standards and references is provided. Further, Indian growth reference curves based on the data collected by Agarwal et al. and adopted by the Indian Academy of Pediatrics, World Health Organization growth standards for children under the age of 5 years (2006) and contemporary Indian growth references published on apparently healthy affluent Indian children (data collected in 2007-08) are discussed. The article also discusses the use of adult equivalent body mass index (BMI) cut-offs for screening for overweight and obesity in Indian children. Results and Conclusions: For the assessment of height, weight and BMI, WHO growth standards (for children < 5 years) and contemporary cross sectional reference percentile curves (for children from 5-18 years) are available for clinical use and for research purposes. BMI percentiles (adjusted for the Asian adult BMI equivalent cut-offs) for the assessment of physical growth of present day Indian children are also available. LMS values and Microsoft excel macro for calculating SD scores can be obtained from the author (email: vamankhadilkar@gmail.com). Contemporary growth charts can be obtained by sending a message to 08861201183 or email: gntd@novonordisk.com.

Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years

Background— Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). Methods and Results— Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. Conclusions— These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.

Sunlight Exposure and Development of Rickets in Indian Toddlers

ObjectiveTo study the role of sunlight exposure in determining the vitamin D status of underprivileged toddlers.MethodsHeight and weight were measured, clinical examination was performed, Food Frequency Questionnaire was administered and history of sunlight exposure was obtained in all (61) toddlers attending daytime crèche (Group B). Ionised calcium (iCa), inorganic Phosphorous (iP), alkaline phosphatase activity (ALP), serum parathyroid hormone (PTH) and 25 Hydroxy vitamin D (25OHD) were measured. Data were compared with results of a survey measuring similar parameters in 51 (of 251 eligible) toddlers from the same slum (Group A).Results111 children (mean age 2.6 yr (0.7), boys 56) were studied. Prevalence of hypovitaminosis D was 77% in group B toddlers (46 of 60) and 16.4% (10 of 61) had rickets, while none of the group A toddlers had 25OHD levels below 30nmol/L. Four children (7.8%) from Group A as against 24 (42.9%) from Group B, had sunshine exposure of < 30 minutes per day.ConclusionUnderprivileged toddlers who were deprived of sunlight had a much greater incidence of hypovitaminosis D and frank rickets. The study has important public health implications and underscores the necessity for sunlight exposure in young children.

Revised Indian Academy of Pediatrics 2015 growth charts for height, weight and body mass index for 5-18-year-old Indian children

Growth chart committee of Indian Academy of Pediatrics (IAP) has revised growth charts for 5–18-year-old Indian children in Jan 2015. The last IAP growth charts (2007) were based on data collected in 1989–92 which is now >2 decades old. India is in an economic and nutrition transition and hence growth pattern of Indian children has changed over last few years. Thus, it was necessary to produce contemporary, updated growth references for Indian children. The new IAP charts were prepared by collating data from nine groups who had published studies in indexed journals on growth from India in the last decade. Growth charts were constructed from a total of 87022 middle and upper socioeconomic class children (m 54086, f 32936) from all five zones of India. Data from middle and upper socioeconomic class children are likely to have higher prevalence of overweight and obesity and hence growth charts produced on such populations are likely to “normalize” obesity. To remove such unhealthy weights form the data, method suggested by World Health Organization was used to produce weight charts. Thus, the new IAP weight charts are much lower than the recently published studies on affluent Indian children. Since Indians are at a higher risk of obesity-related cardiometabolic complications at lower body mass index (BMI), BMI charts adjusted for 23, and 27 adult equivalent cut-offs as per International obesity task force guidelines were constructed. IAP now recommends use of these new charts to replace the 2007 IAP charts.

Relationship between body mass index, fat distribution and cardiometabolic risk factors in Indian children and adolescents

Studies assessing the relationship of BMI and BF with cardiometabolic (CM) risks in Indian children are scarce.