Veena Shatrugna

Concerns are raised that rapid catch up growth during nutrition rehabilitation of severely malnourished children may be associated with disproportionately higher amounts of body fat deposition. This study examined the composition of weight gain in severely undernourished children who underwent nutrition rehabilitation in a hospital from India. Body composition of 80 severely malnourished children (age 6-60 months) was assessed using skin-fold thickness measurements on admission and after 1 month of supplementary feeding. On admission, children had severe weight and height deficits and were severely wasted. The mean weight for age z score, height for age z score and weight for height z score (WHZ) were -5.0, -4.2 and -4.1 respectively. Children consumed a mixed diet and mean energy intake was 177 kcal/kg/day with a protein energy ratio of 13. Overall, the mean weight gain was 6.1 g/kg/day and fat mass contributed to about 40% of the weight gain. When the composition of weight gain was analysed in tertiles of baseline WHZ score, children in the lowest tertile of WHZ score had significantly higher weight gain and fat free mass (FFM) gain. Gain in fat mass did not differ in relation to the baseline WHZ score. The study demonstrates that it is possible to achieve rapid weight gain with recovery of lost tissue in severely malnourished children with mixed diets. Children with lowest WHZ scores at baseline gained higher FFM during nutrition rehabilitation when compared to the children with relatively higher WHZ score probably in an attempt to recover the lost tissue.

Physical activity is known to influence the bone mass of an individual. Few studies have examined the effect of occupational activities on bone health. The present study investigated the relationship between occupational activities and the bone parameters measured by dual-energy X-ray absorptiometry in 158 women from a low-income group in India. Women involved in three occupations with different bone-loading patterns (beedi (cigarette) makers, sweepers and construction workers) were included in the study. Anthropometric parameters, parity and percentage of menopausal women did not differ significantly between the three groups and dietary intake of Ca was low in all the groups. Bone mineral density (BMD) values of the overall group at all the sites were much lower than those reported from developed countries, possibly due to different body sizes in these regions. Femoral neck and hip BMD were not different in the three groups in spite of marked differences in activity patterns. However, bone area in the femoral neck was higher in the beedi makers compared with sweepers probably due to the squatting position adopted by beedi makers. Lumbar spine BMD was significantly lower among the sweepers when compared with the beedi makers and the groups performing walking and weight-bearing activities (sweepers and construction workers) had a higher prevalence of osteoporosis in the lumbar spine. However, weight-bearing effects of the upper body due to a squatting position were associated with better lumbar spine BMD in the beedi makers. The present study thus indicates that undernutrition might affect the relationship between occupational activities and bone parameters.

This study explored the relationship of maternal body composition parameters to the birth weight of the offspring. Maternal anthropometric parameters (weight, height) and body composition by dual energy X-ray absorptiometry were measured in 76 women from low-income group during 12–21 days postpartum. The means.d. height, weight of the mothers and birth weight of the newborns were 151.55.29 cm, 46.76.04 and 2.840.358 kg, respectively. When the relationship of maternal anthropometric and body composition parameters to the infants' birth weight was studied, maternal lean body mass was found to be the most important determinant of birth weight (R² (%)=21.3) (P<0.001). This study highlights the importance of increasing lean body mass in young women for better pregnancy outcome.

Indian women from low-income groups consume diets that have inadequate calcium coupled with too few calories, proteins and micronutrients. Hospital-based data suggest that these women have osteoporotic hip fractures at a much earlier age than Western women. Studies reporting bone parameters of the Indian population involving large sample sizes are not available. This study was therefore carried out with 289 women in the 30–60-year age group to estimate the prevalence of osteoporosis and measure the bone parameters by dual energy X-ray absorptiometry (DXA). Their mean (± SD) age was 41.0±8.60 years. Their mean (± SD) height, weight and body mass index (BMI) were 149.1±5.49 cm, 49.2±9.85 kg and 22.1±3.99, respectively. Dietary intake of calcium was estimated to be 270±57 mg/day. The prevalence of osteoporosis at the femoral neck was around 29%. Bone mineral density (BMD) and T scores at all the skeletal sites were much lower than the values reported from the developed countries and were indicative of a high prevalence of osteopenia and osteoporosis. BMD showed a decline after the age of 35 years in cases of the lumbar spine and femoral neck. This was largely due to a decrease of bone mineral content (BMC). The nutritional status of women appears to be an important determinant of bone parameters. BMD and BMC at all the skeletal sites and whole body increased significantly with increasing body weight and BMI of women (PP<0.05). In addition to these, height was also an important determinant of WB-BMC. This study highlights the urgent need for measures to improve the nutritional status, dietary calcium intake and thus the bone health of this population.