Shobha Rao

Objective: Assessing risk of hypertension in relation to decadal changes in anthropometry among cohort of young rural Indian men.Methods: Subjects (n = 140) were measured in 2005 and 2015 for blood pressure, body mass index (BMI), body fat (BF), waist circumference (WC), waist-to-hip ratio (WHR), and additionally for visceral fat (VF) at follow-up.Results: Decadal changes showed significant (p < 0.001) increase in mean anthropometric measures and in prevalence of overall obesity (BMI 25kg/m(2)) from 3.6% to 37.1%; adiposity (BF 25%) from 5.1% to 40.9%; and central obesity (WHR 0.9) from 0.7% to 24.3%. Prevalence of hypertension increased (20.7% to 27.1%) but was not statistically significant. VF correlated significantly (p < 0.001) with decadal changes () in BMI, BF, WC, and WHR, and the correlations were stronger (r = 0.90, 0.78, 0.84, and 0.56, respectively) for lean (baseline BMI < median) subjects than nonlean (baseline BMI median) subjects (r = 0.68, 0.40, 0.61, and 0.43, respectively). Risk of hypertension was significant (odds ratio [OR] = 11.0, 95% confidence interval [CI]: 2.8-42.8) for subjects with higher BMI (4.7kg/m(2)) compared with those with lower BMI (<4.7kg/m(2)) among lean but was not significant among nonlean subjects. This was also true for change in other adiposity indicators, indicating greater vulnerability of lean subjects. Further, among lean subjects, ORs reduced considerably after adjusting for VF, whereas among nonlean subjects ORs continued to remain nonsignificant but showing independent significance for VF.Conclusions: For similar level of change in adiposity indicators, lean subjects were at greater risk of hypertension than nonlean subjects, probably due to higher VF deposition.

To develop and determine validity and reliability of the Knowledge, Attitude and Practice on Healthy Lifestyle Questionnaire (KAP-HLQ) among lower secondary adolescents.

Objective: To assess the impact of an intervention modifying dietary habits for the prevention of anaemia in rural India.Design: Intervention study with data on anthropometric (weight, height) measurements, Hb and diet pattern. As per the cut-off for Hb in the government programme, women with Hb 11 g/dl formed the non-supplemented group.Settings: Three villages near Pune city, Maharashtra, India.Subjects: Rural non-pregnant women (n 317) of childbearing age (15–35 years).Results: After 1 year of intervention, mean Hb increased (from 10·94 (sd 1·22) g/dl to 11·59 (sd 1·11) g/dl) significantly (P < 0·01) with a consequent reduction in the prevalence of anaemia (from 82·0 % to 55·4 %) as well as Fe-deficiency anaemia (from 30·3 % to 10·8 %). Gain in Hb was inversely associated with the initial level of Hb. Significant gain in Hb (0·57 g/dl) was observed among women attending >50 % of the meetings or repeating >50 % of the recipes at home (0·45 g/dl) in the non-supplemented group and was smaller than that observed in the supplemented group. Consumption of green leafy vegetables more than twice weekly increased substantially from 44·7 % to 60·6 %, as did consumption of seasonal fruits. Logistic regression showed that women with lower participation in the intervention had three times higher risk (OR = 3·08; 95 % CI 1·04, 9·13; P = 0·04) for no gain in Hb compared with those having high participation.Conclusions: Developing action programmes for improving nutritional awareness to enhance the consumption of Fe-rich foods has great potential for preventing anaemia in rural India.

Long-chain PUFA (LC-PUFA) are important for fetal and neonatal brain development. However, their accretion in the brain is compromised during maternal protein restriction. Hence, we investigated the effect of maternal supplementation with n-3 DHA plus n-6 arachidonic acid (ARA) at a low protein level (9 %) on offspring brain fatty acid accretion using Wistar rats (nine rats per group) randomly fed a control (C), a low-protein (LP) or a low-protein DHA + ARA-supplemented (LPS) diet during gestation and lactation. At birth, pups from the LPS group had the highest brain DHA and n-3 fatty acid levels (P = 0·001), whereas pups from the LP group had the highest MUFA (P = 0·05) but the lowest DHA and total n-3 PUFA levels (P = 0·000). During lactation, pups from the LPS group accrued significantly more α-linolenic acid (P = 0·003), EPA (P = 0·02) and DHA (P = 0·000) in brain lipids than pups from the LP group, whereas brain lipids of pups from the LP group had markedly increased levels of the n-3 deficiency marker docosapentaenoic acid and n-6:n-3 ratio (P = 0·000). Owing to supplementation, milk from LPS dams had the highest DHA and ARA, but lower SCFA and medium-chain fatty acids as compared with milk from C and LP dams during early lactation, but normalised by mid-lactation. To conclude, adverse effects of restricted maternal protein intake on LC-PUFA accretion in the brain of offspring were ameliorated by alterations in maternal milk fatty acid profile due to supplementation. Results underscore the importance of LC-PUFA for protein-deficient mothers during gestation as well as lactation to achieve the optimum brain LC-PUFA status of progeny.

Secular Trends in Growth of Preschool Children from Rural Maharashtra, India

Objective: To examine various sociodemographic aspects related to consumption of micronutrient-rich foods like green leafy vegetables (GLV), which will be helpful in modifying dietary habits, a strategy that merits consideration for prevention of anaemia.Design: Cross-sectional study for collecting data on socio-economic and anthropometric (weight, height) variables, Hb, dietary pattern (FFQ) and peripheral smear examination for classifying nutritional and iron-deficiency anaemia (IDA).Setting: Three villages near Pune city, Maharashtra, India.Subjects: Rural women (n 418) of childbearing age (15–35 years).Results: Mean Hb was 11·07 g/dl. Seventy-seven per cent of the women were anaemic (Hb < 12 g/dl) and 28 % had IDA, indicating that a large proportion of the women had nutritional anaemia. Higher prevalence of IDA was associated with several sociodemographic and maternal parameters, but multiple logistic regression analysis showed significant (P < 0·05) risk of IDA with lower body weight (<40 kg), short maternal height (<145 cm), younger age at marriage (<19 years) and higher parity (≥2). Various socio-cultural reasons associated with low consumption of GLV included non-cultivation of GLV, priority for selling them rather than home consumption, dislike of GLV by husband and children, and lack of awareness about different recipes for GLV.Conclusions: Our findings highlight that low consumption of GLV, which are treasures of micronutrients including Fe, is associated with genuine social reasons. This indicates a need for developing action programmes to improve nutritional knowledge and awareness leading to enhanced consumption of Fe-rich foods for preventing anaemia in rural India.

Objective: Parental history of hypertension, a commonly occurring nonmodifiable genetic risk factor, was examined for its influence on cutoff for body mass index (BMI) for identifying risk of hypertension. Design: Data on BMI, body fat (%), blood pressure (BP), parental history of hypertension, and lifestyle factors were collected through a cross-sectional study. Setting: Pune City, Maharashtra, India. Subjects: Urban Indian adults (330 men and 306 women, aged 30–60 years). Results: Age-related increases in prevalence of obesity and of hypertension (BP ≥ 140/90 mmHg or antihypertensive medication) were significant (p < 0.01 for all) in both sexes. Among nonobese subjects, age-adjusted systolic (SBP) and diastolic (DBP) blood pressure levels were significantly (p < 0.01) higher for those with positive parental history than for those without parental history, in both sexes. Adjusted odds ratios showed that obesity or positive parental history when considered in isolation increased the risk of hypertension (by 3 times in men and 5 times in women), while the presence of both increased it further (by 4 times in men and 10 times in women), indicating their synergistic influence. Further, the BMI cutoff obtained from receiver operating characteristic (ROC) analysis was lower by 1 to 1.5 units for subjects with parental history than for those without parental history, across different levels of sensitivity. Conclusions: Positive parental history lowers the BMI risk cutoff for hypertension. The implication is that parental history could be an important aid in developing preventive strategy for timely and early screening of individuals at risk of hypertension in many Asian populations in similar settings.

Background: In poor communities of the Third World, adolescent pregnancy outcomes are likely to be worse in view of the prevailing chronic undernutrition. Aim: The study examined the confounding effect of early life undernutrition on adolescent pregnancy outcome in rural India. Subjects and methods: Retrospective information on socio-economic, demographic and anthropometric variables, gynaecological and obstetric history, pregnancy outcome and birth weight was obtained on 326 primigravid young married rural girls during 1998–2001. Results: Prevalence of pregnancy wastage (stillbirths and abortions) reduced significantly (p < 0.01) with increase in age at first conception. The risk for pregnancy wastage observed (OR = 1.95, 95% CI = 0.91–4.21) in mothers with early conception (Conclusion: Our findings indicate that in view of prevailing socio-cultural conditions, good nutrition in early life for girls is essential to prevent post-menarcheal height growth while health education programmes are essential to prevent early conception in rural India. These observations have wider implications for similar rural settings especially in other developing countries.

Objective: To introduce community-specific modifications in the conventional 24 h recall method for objectively estimating maternal dietary intake and validate it with a reference method.Design: A modified 24 h recall method was developed with the visit of trained local girls at the subject’s home to weigh portion sizes at each mealtime over the 24 h recall period. This was validated with the reference method in which weighed records of the foods consumed were obtained and their laboratory analysis was done to obtain nutrient intakes.Setting: Rural areas located 40–50 km from Pune City, India.Subjects: Forty-one pregnant women participated willingly.Results: The estimates of intake obtained from the reference method were comparable to those obtained from the modified 24 h recall method for energy (7795 (sd1841) kJ (1863 (sd440) kcal)v. 7615 (sd1824) kJ (1820 (sd436) kcal), respectively), protein (48·6 (sd12·9) gv. 45·3 (sd12·6) g, respectively) and fat (35·3 (sd16·6) gv. 36·0 (sd14·2) g, respectively). Significant correlation was observed between the estimates obtained by the two methods for energy (0·75,P< 0·001), protein (0·71,P< 0·001) and fat (0·56,P< 0·001) and differences in nutrient intake did not reveal any systematic bias. When compared with the reference method, the modified method showed >80 % sensitivity and specificity for identifying inadequate maternal energy intakes.Conclusions: Simple modifications to conventional methods backed by understanding of community specifics and nutritional peculiarities are of immense importance in obtaining objective estimates of daily nutritional intakes of individuals in free-living populations. The approach would be adaptable in similar settings in other developing countries.