Veena Ekbote

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.

Body Fat Percentages by Dual-energy X-ray Absorptiometry Corresponding to Body Mass Index Cutoffs for Overweight and Obesity in Indian Children

Background Indians are suspected to have higher body fat percent at a given body mass index (BMI) than their western counterparts. Objective To estimate percent body fat in apparently healthy Indian children and adolescents by dual-energy X-ray absorptiometry (DXA) and explore linkages of BMI with body fat percent for better health risk assessment. Methods Age, weight, height of 316 boys and 250 girls (6–17 years) were recorded. Body composition was measured by dual-energy X-ray absorptiometry (DXA). High adiposity was defined as body fat percent (BF%) > McCarthys 85th percentile of body fat reference data. Receiver operating characteristic analysis (ROC) was carried out for CDC BMI Z score for its ability to judge excess fatness. Results High BF% was seen in 38.5% boys and 54.0% girls (p < 0.05). Percentage of obese children as defined by the BMI cutoffs of International Obesity Task Force (IOTF) (2.1% for boys and 6.9% for girls) was lower than that using Indian (13.7% for boys and 20.9% for girls) and CDC (14.1% for boys and 20.9% for girls) cutoffs. The point closest to one on the ROC curves of CDC BMI Z-scores indicated high adiposity at BMI cutoff of 22 at the age of 17 yr in both the genders. Conclusions Higher body fat percentage is associated with lower BMI values in Indian children.

Effect of one-year growth hormone therapy on body composition and cardio-metabolic risk in Indian children with growth hormone deficiency

Abstract Growth hormone (GH) deficiency in children manifests as short stature but is also associated with metabolic disturbances. Paucity of GH is also likely to be associated with increased intima media thickness. Data on body composition (BC) and carotid intima media thickness (cIMT) in children with growth hormone deficiency (GHD) from developing countries are very scarce. Therefore, objectives of present study were to assess effect of 1 year of rhGH therapy on (i) BC and lipid profile (LP) in a cohort of Indian GHD children and (ii) effect on atherosclerotic markers – cIMT in subsample. Anthropometry, BC [% body fat (BF), % lean body mass (LBM), bone mineral content (BMC)] (DXA) and LP were measured in 49 pre-pubertal GHD-children (9.3 ± 3.1 years) at baseline and after 1 year of rhGH therapy. On subset of 20 children, cIMT of right common carotid artery was also measured. Baseline BC parameters were compared with age-gender matched healthy controls (n = 49). At baseline % BF was 23 ± 9 %, LBM was 9 ± 3 kg and BMC was 0.306 ± 0.15 kg in GHD- children; BF was comparable, while lean and bone were less than controls (p < 0.05). Post therapy, significant reduction in fat (15%), and cIMT (7%) and increase in LBM and BMC by 40% and 44%, respectively (p < 0.05) was seen. Our cohort of untreated GHD children had abnormal BC and cIMT as compared to controls. rhGH therapy for 1 year had beneficial effect on BC and cardiovascular risk factors.

Low bone status in Indian growth hormone-deficient children

Abstract Background: Growth hormone (GH) is critical for linear bone growth, skeletal maturation and mineralization during childhood. Aims: The aim of this study is to examine the impact of bone size and lean body mass (LBM) adjusted less head (LH) total body bone mineral content (TBBMC) in 50 prepubertal GH-deficient children. Results: The mean height (Ht) for age Z-score was –5.0±1.7. The mean total body less head (TBLH) BMC for Ht age Z-score after adjusting for TBLH LBM and TBLH BA was –3.27±0.27. The mean TBLH BMC Z-score remained below –2 even after adjustments for TBLH LBM, bone age, and Ht age, suggesting a deficit of BMC in spite of all adjustments. Applying the Molgaard approach, all children had “short bones,” 86% had “narrow bones,” and 72% had “light bones.” When adjusted for LBM, 87% of the children had low LBM for Ht and 33% had low TBLH BMC for TBLH LBM. Conclusion: LH TBBMC of children remained low, even after adjustment for bone size and LBM.

Reference centile curves for triceps skinfold thickness for Indian children aged 5–17 years and cut-offs for predicting risk of childhood hypertension: A multi-centric study

ObjectivesTo create age- and gender-specific Triceps Skinfold Thickness percentile curves for Indian children; and to determine cut-offs for predicting the risk of childhood hypertension.DesignCross-sectional.SettingMulticentric, school-based, 5 major Indian citiesParticipants13375 children (7590 boys) aged 5-17 yearsProcedureData on height, weight, blood pressure, triceps skinfold thickness (using Harpenden Skinfold caliper) were collected. Reference triceps skinfold thickness percentile curves were derived for boys and girls by LMS (lambda-mu-sigma) method. Receiver operating curve analyses were performed to determine the optimal cut-off of triceps skinfold thickness centile for predicting the risk of hypertension.ResultsPercentile curves for boys plateau around 13 years whereas for girls the curves increase steadily till the age of 17 years. Median triceps skinfold thickness increased by 7% to 9% till the age of 9 years in boys and girls. After 12 years, median triceps skinfold thickness decreased by 1% to 2% in boys but increased by 3% to 4% in girls. The optimal cut-off percentile yielding maximal sensitivity (68%) and specificity (74-78%) for predicting high blood pressure was the 70th triceps skinfold thickness percentile in both genders.ConclusionsPercentile curves for triceps skinfold thickness developed in the present study would be useful in the assessment of adiposity and the risk of hypertension in Indian children.

Bone Status of Women Over 40 Years of Age from Two Socioeconomic Strata

Background. Literature reports examining the association of bone mineral density (BMD) and socioeconomic status suggest of an inconclusive relation. Methods. We studied 58 and 54 women (mean age 49.5 ± 7.2 years) from upper socioeconomic class (USC) and lower socioeconomic class (LSC), respectively, for their BMD at lumber spine and total femur by Lunar DPX-PRO dual-energy X-ray absorptiometry. Socioeconomic, lifestyle and biochemical data were collected. Results. Percent prevalence of osteoporosis in USC women was 12% and 0% at lumber spine and total femur, respectively, while it was 33% and 11%, respectively, in LSC women. When the mean BMD values were adjusted for the effect of body mass index, protein and calcium intake, physical activity, and sunlight exposure, only the total femoral BMD of USC premenopausal women was significantly greater. Conclusion. Our data suggest that bone health of our LSC women was poor possibly due to the influence of socioeconomic and lifestyle factors.

Validation of Bioelectric Impedance Analysis against Dual-Energy X-ray Absorptiometry for assessment of body composition in Indian children aged 5 to 18 years

ObjectiveTo validate body composition measurements by Bioelectric Impedance Analysis (BIA) against Dual-Energy X-ray Absorptiometry (DXA) as the reference method in healthy children and adolescents.DesignCross-sectionalSettingSchools in and around Pune city, India.ParticipantsA random sample of 210 (114 boys, 96 girls) apparently healthy Indian children and adolescents (5–18 y).MethodsWeight, height, Tanner stage (TS) were recorded. Body composition measures: fat-free mass (FFM), fat mass (FM), lean mass (LM), bone mineral content (BMC) and body fat percentage (%BF) were assessed by BIA and DXA on a single day. Agreement between the methods was estimated by Pearson’s correlation, and Bland and Altman analysis.Main outcome measures%BF, FM, FFM, LM, BMC.ResultsBIA underestimated %BF by 6.7 (3.7)% as compared to DXA. Mean FFM, BMC and LM by BIA were significantly higher than by DXA (P<0.001). These differences remained similar after adjusting for age, BMI and TS. Mean differences between FFM (−2.32 (1.39) kg), BMC (−0.18 (0.15) kg), and LM (−2.15 (1.34) kg) by DXA and BIA were significant (P<0.01). Correlations between BIA and DXA were 0.92 for %BF, 0.96 for LM and 0.98 for FFM and BMC. Both the methods were similar in identifying normal and overfat children as per their respective cut-offs.ConclusionBIA and DXA techniques are not interchangeable for assessment of body composition. However, BIA may be used in the field/clinical setting preferably with ethnicity specific references.

Evaluation of insulin-like growth factor-1 in Indian growth hormone-deficient children on growth hormone therapy.

Objective. To evaluate the impact of recombinant human growth hormone therapy (GHT) on serum insulin-like growth factor 1 (IGF-1) concentrations in Indian children with growth hormone deficiency. Methods. Data on anthropometry and serum IGF-1 concentrations were collected from 28 growth hormone-deficient prepubertal children (8.6 ± 2.9 years) on growth hormone therapy, 6 monthly over the period of 2 years. Results. Height z-scores showed a steady increase from baseline to 24 months. However, IGF-1 z-scores showed a plateau after the first 6 months and then a small dip followed by a rise. The pattern of increase of IGF-1 z-scores was dissimilar to that of the height z-scores. Conclusion. The change in serum IGF-1 z-scores in response to GHT in Indian children may not be a good indicator for monitoring growth hormone responsiveness.

Impact of dietary nutrient intake and physical activity on body composition and growth in Indian children

BackgroundTo investigate interrelationships of dietary composition and physical activity (PA) with growth and body composition (BC) in urban Indian school children.MethodsA cross-sectional study was performed in 4,747 Indian school children (2,623 boys) aged 3–18 years. Weight, height, BC by body impedance analyzer, PA and dietary food intakes by questionnaire method were recorded.ResultsMean daily energy and protein intakes as recommended dietary allowance were significantly lower in both boys and girls (P<0.01) above 6 years, with 55% reduction in micronutrient intakes in older children. When compared with World Health Organization references, lower heights in pubertal boys and girls were related to dietary energy and protein intake. Multiple regression analysis showed positive association of height for age z-scores (HAZ) with midparental height z-scores (β=0.45, P=0.0001) and protein density (β=0.103, P=0.014). HAZ was negatively associated with inactivity (β=−0.0001, P=0.049) in boys and girls (R2=0.104, P<0.01). Further, body fat percentage was negatively correlated with moderate or light activity and antioxidant intakes (P<0.01) but not with dietary fat intake. Percentage muscle mass was positively correlated with moderate activity and negatively with inactivity (P<0.05).ConclusionAdequacy of protein and antioxidant intakes, reducing inactivity and increasing moderate activity are essential for optimal growth and body composition in Indian children.

Response of serum 25(OH)D to Vitamin D and calcium supplementation in school-children from a semi-rural setting in India

The objectives of this study were to: 1) Determine the impact of varying baseline serum 25OHD on increase in vitamin D concentrations after daily supplementation with vitamin D and calcium (1000 IU + 500 mg respectively) for six months in school-children from a semi-rural setting 2) Test the efficacy of daily vitamin D-calcium supplementation on improvement in serum vitamin D concentrations to ≥75 nmol/L. Data collected from 106 subjects (58 boys, 48 girls), aged 6-12 years, included anthropometric measures like height and weight, body composition analysis, three one-day dietary recalls and sunlight exposure (by questionnaire). Blood was collected at baseline and endline and estimated for serum vitamin D by ELISA technique using standard kits. Classification of Vitamin D status was performed according to the 2011 Endocrine Society Practice Guidelines: vitamin D deficiency - <50 nmol/L; insufficiency - 50.0-74.9 nmol/L; sufficiency - ≥75 nmol/L. Statistical analysis was performed using SPSS software. Mean baseline serum vitamin D concentration was 59.7 ± 11.2 nmol/L; this rose to 79.8 ± 23.3 nmol/L with no significant differences between genders at the two time-points. Inverse relationship was obtained between baseline serum 25(OH)D concentrations and change in serum concentrations after supplementation, implying that with increasing baseline serum concentrations of 25(OH)D, increase in vitamin D levels post supplementation were significantly lower (r = - 0.96, p < 0.0001). Greatest benefit of change in serum vitamin D concentrations after supplementation was experienced by children with basal concentrations of <45 nmol/L. Daily vitamin D supplementation was effective in improving serum 25(OH)D to ≥75 nmol/L in 44% of children. Significantly higher percentage of children who were deficient at baseline (64%) were able to attain serum concentrations of ≥75 nmol/L as compared to children who were vitamin D insufficient (43%) (p < 0.001). Thus, daily supplementation with 1000 IU of vitamin D along with 500 mg of calcium helped in improving serum vitamin D concentrations to ≥75 nmol/L. Children who were vitamin D deficient particularly experienced these benefits.