Nimmathota Arlappa

Background: Excess dietary sodium intake is a major modifiable risk factor for hypertension and cardiovascular disease (CVD) globally. Potassium-Enriched Low-Sodium Salt Substitutes (LSSS), which partially replace sodium chloride with potassium chloride, are recommended as a population-level sodium-reduction strategy. However, sensory acceptability remains a key barrier to their adoption, particularly in India where discretionary salt use predominates. Objective: To assess whether potassium-enriched low-sodium salt substitutes (15% and 30% potassium chloride) differ from regular salt in perceived saltiness intensity when added to commonly consumed Indian food matrices. Methods: A controlled taste perception assessment was conducted using a screened analytical panel (N = 25) selected according to ISO 8586:2012 standards. Three salt formulations (100% NaCl, 85% NaCl & 15% KCl, and 70 % NaCl+30% KCl) were evaluated across three food matrices representing liquid (buttermilk), semi-solid (dal with roti), and surface-salted (French fries) foods. Saltiness intensity was rated on a five-point ordinal scale. Differences were analysed using Friedman’s test. Results: Across all three food matrices, no statistically significant differences in saltiness intensity were observed between regular salt and potassium-enriched formulations (p > 0.05). Although minor numerical variations in mean ratings and distribution patterns were noted, these differences were inconsistent and did not indicate systematic changes in perceived saltiness. Conclusions: Potassium-enriched LSSS containing up to 30% potassium chloride produced similar saltiness perception to regular salt across representative Indian food matrices when evaluated by trained assessors. These findings support the sensory feasibility of LSSS as a strategy for population-level sodium reduction in India.

A multicentric study is being conducted in which children with severe acute malnutrition (SAM) aged 6–59 months are identified with only weight-for-height z-score (WHZ) < − 3 criteria. The present study aimed to assess associations of anthropometric parameters and body composition parameters, to improve treatment of SAM. We conducted a cross-section assessment using the enrolment data of children who participated in a multi-centric longitudinal controlled study from five Indian states. Fat-free mass (FFM) and fat mass (FM) were determined by bio-electrical impedance analysis (BIA). Six hundred fifty-nine children were enrolled in the study using WHZ < -3 criteria. Available data shows that WHZ, WAZ and BMIZ were significantly associated with FFMI while MUACZ was significantly associated with both FMI and FFMI. Children with both severe wasting and severe stunting had significantly lower FFMI compared to those who were only severely wasted. All forms of anthropometric deficits appear to adversely impact FFM and FM. Trial registration The study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013 dated 24/09/2020).

An unhealthy dietary habit leads to excess calorie consumption (overnutrition) or inadequate supply of one or more essential micronutrients (undernutrition).This nutritional imbalance is assessed by Anthropometric measurements, Biochemical estimations, Clinical examination and assessment of Dietary intakes. Anthropometry is an inexpensive, rapid and non-invasive method that provides details on different components of body structure and is highly sensitive to the broad spectrum of nutritional status. Hence, it has always been an important tool for screening and early diagnosis of malnutrition. Undernutrition in below 5 year children is life-threatening epidemic contributing to about 45% of under 5 child deaths. Children with Severe Acute Malnutrition (SAM) are nine times more likely to die, compared to their healthy counterparts. Therefore, early and accurate diagnosis of children with SAM is crucial for its management and prevention of morbidity and mortality from the same. SAM is defined as weight-for-height Z scores (WHZ) below -3SD of the median or a mid upper arm circumference (MUAC) of <115mm in children of 6-59 months age. The cut-offs for MUAC and WHZ are scientifically approximated to each other and both are used to diagnose children with SAM (Severe Wasting). However, the research findings from various countries revealed that the agreement between WHZ and MUAC is poor as both indices classify the children with SAM differently, with a small overlap, which varies greatly among countries. These discrepancies have an implication when using either one alone for measuring the prevalence of acute malnutrition. Therefore, it is pertinent to adopt both WHZ and MUAC indices to assess the burden of severe acute malnutrition (SAM) in the community.

Background: Severe acute malnutrition (SAM) is a major underlying cause of mortality among children. Around one third of the world’s acutely malnourished children live in India. The WHO recommends community-based management of acute malnutrition (CMAM) for managing children with SAM. In India, different states are implementing community-based SAM treatment programme, hereinafter called CSAM, using varieties of locally produced nutrient dense food items with different nutrient compositions. The study will assess the effectiveness of these state specific CSAM interventions. Methods: The longitudinal quasi-experimental study will be undertaken in two purposively selected blocks of one district each in the four intervention states and one comparison state. From each state, 200 SAM children identified using weight-for-length/height z-score (WHZ) < − 3 criteria will be enrolled in the study. Their anthropometric data and skinfold thickness will be taken on admission, at sixth week and at discharge by trained field investigators. Other child details, incidence of morbidity and socio-economic details will be collected on admission. To assess food consumption pattern including consumption of locally produced nutrient dense food supplements, dietary assessment, using 24-h dietary recall will be conducted on admission, at sixth week and at discharge. In addition, body composition parameters will be assessed for a sub-set of children using bio-electrical impedance analysis on admission and at discharge to analyse changes in total body water, fat-free mass, and fat mass. Post discharge, all study participants will be followed up monthly until 6 months. Atleast 10% of the sample will be checked for quality assessment. The study’s primary outcome is cure rate defined as children attaining WHZ ≥ -2. Secondary outcomes include mean weight gain, mean length of stay, body composition parameters, relapse and mortality rates. Additionally, process evaluation and cost effectiveness analysis will be conducted. Discussion: There is a shortage of robust evidence regarding the effectiveness of locally produced nutrient dense food supplements provided as part of the CSAM intervention in India. This study will contribute to evidence on effective strategies to manage children with uncomplicated SAM in India. The study protocol has all necessary ethical approvals. Written informed consent will be obtained from caregivers of the children. Trial registration: The study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013) Date of registration 24/09/2020.

Aim: To assess the association of mother’s literacy status with infant & young child feeding (IYCF) practices and nutritional status of urban under 5 year children. Methods: A community based cross- sectional study was carried out among 356 urban children under 5 years from 30 randomly selected Anganwadi Centres (AWCs) in Hyderabad, during 2017-18. The information regarding infant & young child feeding (IYCF) practices was obtained from the mothers of under 5 year children. Anthropometric measurements such as height and weight of all the children were measured adopting standard procedures and using standard anthropometric equipment. Results: About half of the mothers reportedly initiated breast feeding to their newborns within one hour of birth. The proportion of mothers fed pre-lacteals and colostrum to newborn was 35% and 96% respectively. A higher proportion of literate mothers (45.1%) exclusively breast fed their infants for the first 6 months as compared to their illiterate counterparts (32.9%). Significantly a higher proportion (63.3%) of literate mothers initiated complementary feeding to their infants soon after completion of 6 months as against 50% in illiterate mothers (p<0.05). The proportion of children with undernutrition i.e. underweight, stunting and wasting was 38.5%, 40.6% and 16.8%, respectively. The prevalence of underweight and stunting was significantly (p<0.05) higher among the children of illiterate mothers as compared to literate mothers. Conclusion: In general, mother’s literacy was significantly associated with the IYCF practices as well as nutritional status of their children. Therefore, respective Governments should initiate appropriate measures to increase female literacy levels in India.

Background: Deficiency of vitamin D has been associated with various health conditions. However, vitamin D deficiency (VDD) and factors associated with VDD are not well studied, especially among the urban elderly population of India. Aim: To assess the prevalence of VDD and its associated factors among the urban free-living elderly population in Hyderabad. Subjects and methods: A community-based cross-sectional study was conducted among 298 urban elderly (≥60 years) by adapting a random sampling procedure. Demographic particulars were collected. Blood pressure and anthropometric measurements were recorded using standard equipment. Fasting glucose, lipid profile and 25-hydroxy vitamin D [25(OH) D] were estimated in plasma samples. Results: The mean ± SE plasma vitamin D and the prevalence of VDD among the urban elderly population were 19.3 ± 0.54 (ng/ml) and 56.3%, respectively. The prevalence of VDD was significantly associated with education, high body mass index (BMI), hypertension (HT) and metabolic syndrome (MS). Multiple logistic regression analysis revealed HT as a significant predictor of vitamin D deficiency and the risk of VDD was double among the elderly with hypertension. Conclusions: The prevalence of VDD was high among the urban elderly population in the south Indian city of Hyderabad. High BMI, MS, HT and education are significant associated factors of VDD.