Socioeconomic differences in prevalence of biochemical, physiological, and metabolic risk factors for non-communicable diseases among urban youth in Delhi, India

Effect of an educational intervention on diet and physical activity among school-aged adolescents in Delhi -The i-PROMISe (PROMoting health literacy in Schools) Plus Study

Purpose

Emerging lifestyle changes due to rapid urbanization have led to an epidemiological transition and the rising prevalence of obesity is responsible for major non-communicable diseases (NCDs) which have further aggravated due to the COVID-19 pandemic. This study aims to assess the effectiveness of a comprehensive school-based intervention on diet and physical activity-related behavior of adolescents.

Methods

In 2019, a cluster-randomized controlled trial was conducted in randomly selected (n = 8) private schools. A 2-year intervention program was implemented over consecutive academic years (2019-2020 and 2020-2021) with students who were in the 6th and 7th grades when the study began. Four schools were randomly assigned to the intervention (n = 794) and four schools to the control group (n = 774).

Results

The difference in changes in diet and physical-activity-related behaviors of the students between the intervention and control schools were not significant in the intention to treat analysis probably due to the large drop-out due to COVID-19 measures: 304 students were available for follow-up in the intervention group and 122 in the control group (391 cases were excluded to make data comparable with baseline survey). The intake of vegetables (once a day) [β = 0.35, OR = 1.42, 95% CI (1.03, 1.95)] in the per-protocol analysis has increased among adolescents in the intervention group as compared to the control group.

Conclusion

The findings of this study indicated a positive effect of the intervention on diet and physical-activity-related changes in the expected direction and highlights the importance of addressing such behavior to prevent obesity among adolescents and thus NCDs in the later stage of life.

Status and correlates of non-communicable diseases among children and adolescents in slum and non-slum areas of India's four metropolitan cities

The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.

Food environment in and around schools and colleges of Delhi and National Capital Region (NCR) in India

Background

Food policies and environment (availability, accessibility, affordability, marketing) in and around educational institutes can influence food choices and behaviours of children and adolescents.

Methods

Cross-sectional, mixed-methods study was implemented in schools (n = 9; Private = 6, Public = 3) and colleges (n = 4) from Delhi and National Capital Region (India). The data was collected from students of schools (n = 253) and colleges (n = 57), parents of school students (n = 190), teachers (n = 12, schools = 9, colleges = 3) and canteen operators of Private schools and colleges (n = 10; schools = 6, and colleges = 4). The primary and secondary data was collected to: 1) identify the strengths and weaknesses of the existing guidelines and directives (desk review); 2) examine food environment, existing policies and its implementation (structured observations, in-depth interviews, surveys, focus group discussions), and; 3) assess food choices, behaviours of students (focus group discussions). The thematic analysis was used for qualitative data and descriptive analysis for quantitative data.

Results

The available food and beverage options, in and around the participating educational institutes were either high in fat, salt and sugar (HFSS), despite government and educational institute guidelines on restricting the availability and accessibility of HFSS foods. The healthy food and beverage options were expensive compared to HFSS foods both inside and outside educational institutes. In total, 37 vendors (Private = 27; Public:10) were observed outside schools at dispersal and twelve at lunchtime. Around colleges, vendors (n = 14) were seen throughout the day. Students from all Private schools (n = 6) and colleges (n = 2) were exposed to food and beverage advertisements either HFSS (Private schools = 1–3 and colleges = 0–2 advertisements), whereas no advertisements were observed around Public schools.

Conclusion

It is imperative to implement food policies to improve the food environment in and around educational institutes to ensure the availability of healthy foods to establish and sustain healthy eating behaviours among students. Thus, the study findings emphasise stringent implementation, regular monitoring and surveillance of recently introduced Food Safety and Standards (Safe food and balanced diets for children in school) Regulation 2020, ensuring its compliance through effective enforcement strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11778-6.

Prevalence of Excessive Weight and Underweight and Its Associated Knowledge and Lifestyle Behaviors among Urban Private School-Going Adolescents in New Delhi

With rapid urbanization and the Indian nutrition transition, Indian adolescents face a high risk of developing an energy imbalance. This study aims to assess the prevalence of excessive weight, underweight, and associated knowledge and lifestyle behaviors among private school-going adolescents in Delhi. A cross-sectional study was conducted in students (6th–7th grades) of eight randomly selected private schools in Delhi, India in 2019. A self-administered survey was used to assess students’ dietary-and-physical-activity-related knowledge and behavior. Anthropometric measurements (height, weight, and waist circumference) were also conducted. Out of 1567 participants, 7.2% were underweight, 61.3% normal, and 31.5% excess in weight. Underweight was associated with significantly more eating whilst studying for exams (relative risk ratio (RRR) 1.7 (1.0–2.9)). Excessive weight was associated with less incorrect knowledge on behaviors causing overweight (RRR 0.7 (0.5–0.9)), more often reading nutritional labels of packed food items (RRR 0.6 (0.4–0.9)), and less frequent vegetable-intake (RRR 0.7 (0.4–0.9)). Underweight students showed more suboptimal knowledge and unhealthy behaviors, whilst students with excessive weight showed more correct knowledge and healthy behaviors. This study highlights the immediate need for effective health-promoting interventions focused on the importance of healthy lifestyle at least in underweight adolescents.