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Sachdev HS, Reddy GB, Pullakhandam R, Ghosh S, Rajkumar H, Kurpad AV. A vicious turn to the saga of vitamin A deficiency in India. Eur J Clin Nutr 2024; 78:360-361. [PMID: 38135710 DOI: 10.1038/s41430-023-01389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/16/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Affiliation(s)
- H S Sachdev
- Sitaram Bhartia Institute of Science and Research, New Delhi, India.
| | - G B Reddy
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - R Pullakhandam
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - S Ghosh
- St. John's Medical College, Bengaluru, India
| | - H Rajkumar
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - A V Kurpad
- St. John's Medical College, Bengaluru, India.
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Majumder R, Kurpad AV, Sachdev HS, Thomas T, Ghosh S. Anthropometric Growth Reference for Indian Children and Adolescents. Indian Pediatr 2024:S097475591600615. [PMID: 38517004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVES We aimed to develop anthropometric growth references for Indian children and adolescents, based on available 'healthy' child data from multiple national surveys. METHODOLOGY Data on 'healthy' children, defined by comparable WHO's Multicentre Growth Reference Study (MGRS) selection criteria, were extracted from four Indian surveys over the last 2 decades, viz, NFHS-3, 4, and 5 and Comprehensive National Nutrition Survey (CNNS). Reference distributions of height-for-age for children up to 19 years, weight-for-age for children up to 9y, weight-for height for children less than 5 years and BMI for age for children between 5-19 y were estimated by GAMLSS with Box-Cox Power Exponential (BCPE) family. The national prevalence of growth faltering was also estimated by the NFHS-5 and CNNS data. RESULTS The distributions of the new proposed Indian growth references are consistently lower than the WHO global standard, except in the first 6 months of age. Based on these references, growth faltering in Indian children and adolescents reduced > 50% in comparison with the WHO standard. CONCLUSION The study findings revealed that the WHO one-standard-fits-all approach may lead to inflated estimates of under nutrition in India and could be a driver of misdirected policy and public health expenditure in the Indian context. However, these findings need validation through prospective and focussed studies for more robust evidence base.
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Affiliation(s)
- Rajesh Majumder
- Division of Epidemiology, Biostatistics and Population Health, St John's Research Institute, Bangalore, Karnataka, India
| | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, Karnataka, India
| | | | - Tinku Thomas
- Department of Biostatistics, St John's Medical College, Bengaluru, Karnataka, India
| | - Santu Ghosh
- Department of Biostatistics, St John's Medical College, Bengaluru, Karnataka, India. Correspondence to: Dr. Santu Ghosh, Department of Biostatistics, St John's Medical College, Bengaluru, Karnataka, India.
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Ware L, Vermeulen B, Maposa I, Flood D, Brant LC, Khandelwal S, Singh K, Soares S, Jessen N, Perman G, Riaz BK, Sachdev HS, Allen NB, Labarthe DR. Comparison of Cardiovascular Health Profiles Across Population Surveys From 5 High- to Low-Income Countries. CJC Open 2024; 6:582-596. [PMID: 38559335 PMCID: PMC10980894 DOI: 10.1016/j.cjco.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024] Open
Abstract
Background To facilitate the shift from risk-factor management to primordial prevention of cardiovascular disease, the American Heart Association developed guidelines to score and track cardiovascular health (CVH). How the prevalence and trajectories of a high level of CVH across the life course compare among high- and lower-income countries is unknown. Methods Nationally representative survey data with CVH variables (physical activity, cigarette smoking, body mass index, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the US for adults (aged 18-69 years and not pregnant). Data were harmonized, and CVH metrics were scored using the American Heart Association guidelines, as high (2), moderate (1), or low (0), with the prevalence of high scores (better CVH) across the life course compared across countries. Results Among 28,092 adults (Ethiopia n = 7686, 55.2% male; Bangladesh n = 6731, 48.4% male; Brazil n = 7241, 47.9% male; England n = 2691, 49.5% male, and the US n = 3743, 50.3% male), the prevalence of high CVH scores decreased as country income level increased. Declining CVH with age was universal across countries, but differences were already observable in those aged 18 years. Excess body weight appeared to be the main driver of poor CVH in higher-income countries, and the prevalence of current smoking was highest in Bangladesh. Conclusions Our findings suggest that CVH decline with age may be universal. Interventions to promote and preserve CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where the level of CVH remains relatively high, protection of whole societies from risk-factor epidemics may still be feasible.
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Affiliation(s)
- Lisa Ware
- South African Medical Research Council Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bridget Vermeulen
- South African Medical Research Council Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Luisa C.C. Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Kavita Singh
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Sara Soares
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Public Health (ITR), University of Porto, Porto, Portugal
| | - Neusa Jessen
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Research Unit of the Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Gastón Perman
- Department of Public Health, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Baizid Khoorshid Riaz
- National Institute of Preventive & Social Medicine (NIPSOM), Ministry of Health & Family Welfare, Mohakhali, Dhaka, Bangladesh
| | | | - Norrina B. Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Darwin R. Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
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George F, Rajeev LN, Bandyopadhyay S, Baby J, Sinha S, Sachdev HS, Kurpad AV, Thomas T. The role of dairy consumption in the relationship between wealth and early life physical growth in India: evidence from multiple national surveys. BMC Public Health 2024; 24:96. [PMID: 38183073 PMCID: PMC10768164 DOI: 10.1186/s12889-023-17520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION Prevalence of undernutrition continues to be high in India and low household wealth is consistently associated with undernutrition. This association could be modified through improved dietary intake, including dairy consumption in young children. The beneficial effect of dairy on child growth has not been explored at a national level in India. The present analyses aimed to evaluate the direct and indirect (modifying association of household level per adult female equivalent milk and milk product consumption) associations between household wealth index on height for age (HAZ) and weight for age (WAZ) in 6-59 months old Indian children using data from of nationally representative surveys. METHODS Two triangulated datasets of two rounds of National Family Health Survey, (NFHS-3 and 4) and food expenditure (National Sample Survey, NSS61 and 68) surveys, were produced by statistical matching of households using Non-Iterative Bayesian Approach to Statistical Matching technique. A Directed Acyclic Graph was constructed to map the pathways in the relationship of household wealth with HAZ and WAZ based on literature. The direct association of wealth index and its indirect association through per adult female equivalent dairy consumption on HAZ and WAZ were estimated using separate path models for each round of the surveys. RESULTS Wealth index was directly associated with HAZ and WAZ in both the rounds, but the association decreased from NFHS-3 (βHAZ: 0.145; 95% CI: 0.129, 0.16) to NFHS-4 (βHAZ: 0.102; 95%CI: 0.093, 0.11). Adult female equivalent milk intake (increase of 10gm/day) was associated with higher HAZ (β_NFHS-3=0.001;95% CI: 0, 0.002; β_NFHS-4=0.002;95% CI: 0.002, 0.003) but had no association with WAZ. The indirect association of wealth with HAZ through dairy consumption was 2-fold higher in NFHS-4 compared to NFHS-3. CONCLUSIONS The analysis of triangulated survey data shows that household level per- adult female equivalent dairy consumption positively modified the association between wealth index and HAZ, suggesting that regular inclusion of milk and milk products in the diets of children from households across all wealth quintiles could improve linear growth in this population.
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Affiliation(s)
- Franciosalgeo George
- Division of Epidemiology, Biostatistics, and Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - L Naga Rajeev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Sulagna Bandyopadhyay
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Jeswin Baby
- Division of Epidemiology, Biostatistics, and Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
- Department of Statistical Sciences, Kannur University, Kerala, India
- Research and Development Cell, Caritas Hospital and Institute of Health Sciences, Kottayam, India
| | - Srishti Sinha
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, India
| | - Tinku Thomas
- Department of Biostatistics, St John's Medical College, Bengaluru, India.
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Kaur M, Trilok Kumar G, Sinha S, Filteau S, Kurpad AV, Osmond C, Sachdev HS. Longitudinal Growth and Undernutrition Burden Among Term Low Birth Weight Newborns Reared in Adverse Socioeconomic Conditions in Delhi. Indian Pediatr 2023; 60:899-907. [PMID: 37700585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND There is limited data in term low birth weight neonates from urban poor settings on the incidence of and recovery from undernutrition and co-existence of its different forms, under conditions of appropriate health and nutrition care counselling. OBJECTIVES To determine the longitudinal growth and undernutrition burden among term low birth weight newborns reared in adverse conditions, but with appropriate counselling. METHODS The study reports follow-up data from DIVIDS trial. 2079 term low birth weight (1800-2499 grams) newborns from an urban poor setting were followed-up for growth from 0 to 26 weeks (n=1282) and at 2.8-6.8 years (n=912). Using Cole LMS approach, age- and sex-specific internal z scores were computed and subsequently adjusted for the effect of a vitamin D intervention and potential bias due to attrition. Back-transformed measurements were then used to compute WHO z scores for height for age (HAZ), weight for age (WAZ), and BMI for age (BMIZ). RESULTS HAZ remained fairly stable: mean changes from birth till 6 weeks, 26 weeks and 3-7 years were 0.07, 0.04 and 0.2 SD, respectively. BMIZ and WAZ showed considerable catch-up; 0.69 SD, 1.84 SD and 1.38 SD for BMIZ, and 0.25 SD, 0.89 SD and 0.60 SD for WAZ, respectively. 60-92% had at least one form of undernutrition and co-existence was frequent. Half the children remained stunted till 5 years, while underweight and wasting declined considerably from 0-6 months. CONCLUSION With appropriate counselling of parents, term low birth weight infants reared under adverse socioeconomic conditions show substantial catch-up growth in BMIZ and WAZ but not in HAZ. The long-term consequences of this excess weight over length gain need focused evaluation.
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Affiliation(s)
- Manpreet Kaur
- Global Clinical Development Statistics and Data Management, Veterinary Medicine Research and Development, Zoetis, Zaventem, Belgium
| | | | - Sikha Sinha
- Division of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, Karnataka, India
| | - Clive Osmond
- Biostatistics, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Harshpal Singh Sachdev
- Division of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India. Correspondence to: Prof Harshpal Singh Sachdev, Senior Consultant, Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi 110 016, India.
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Sachdev HS, Mondal A, Kurpad A. Contextual diets or chemical nutrient products for preventing malnutrition in low- and middle-income countries? Arch Dis Child 2023:archdischild-2023-325734. [PMID: 37890959 DOI: 10.1136/archdischild-2023-325734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Harshpal Singh Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India
| | - Ankita Mondal
- Nutrition, St John's Research Institute, Bangalore, Karnataka, India
| | - Anura Kurpad
- Department of Physiology, St John's Medical College, Bangalore, Karnataka, India
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Ghosh S, Majumder R, Sachdev HS, Kurpad AV, Thomas T. Customization of WHO Under-five Growth Standards for an Appropriate Quantification of Public Health Burden of Growth Faltering in India. Indian Pediatr 2023; 60:804-810. [PMID: 37551873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To examine the accuracy of World Health Organization (WHO) growth standard in under-5 year Indian children, and identify a method to contextualize the WHO standard for India. PARTICIPANTS Data of Healthy children, defined by WHO selection criteria, extracted from nationally representative Indian surveys (National Family Health Surveys, NFHS-3, NFHS-4, NFHS-5 and Comprehensive National Nutrition Survey, CNNS). DESIGN Height for age z score (HAZ) and weight for age z score (WAZ) and weight for height z score (WHZ) distributions in healthy sample were compared against the standard normal. If deviant, age-specific correction factors for z scores were estimated by hierarchical linear mixed effects mean and variance polynomial models. A new term, excess mean risk of growth faltering (EMRGF), was introduced to describe growth faltering. MAIN OUTCOME Measure of deviation of HAZ, WAZ and WHZ from standard normal distribution. Correction of WHO growth standards for India leading to accurate prevalence of stunting, underweight and wasting in Indian children using NFHS-5 data. RESULTS Data on 10,384 healthy under-5 year children were extracted, of which 5377 were boys. Across surveys and metrics, the mean z scores were significantly lower than zero (-0.52 to -0.79). HAZ and WHZ variability (1.16, 1.07) were significantly higher than 1. Derived age-specific corrections reduced the NFHS-5 prevalence of growth faltering by 50%. The national EMRGF (after applying the age-specific correction) for height for age was 15.5% (95%CI:15.3-15.8), and weight for age was 15.0% (95%CI:14.8-15.3), respectively, in NFHS-5. CONCLUSION The WHO growth standards need contextual customization for accurate estimation of the burden of growth faltering in under-5 year children in India. When corrected, the burden of growth faltering is lower, by half or more, in all the three indices.
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Affiliation(s)
- Santu Ghosh
- Department of Biostatistics, St John's Medical College, Bengaluru, Karnataka
| | - Rajesh Majumder
- Division of Epidemiology, Biostatistics and Population Health, St John's Research Institute, Bengaluru, Karnataka
| | | | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, Karnataka
| | - Tinku Thomas
- Department of Biostatistics, St John's Medical College, Bengaluru, Karnataka. Correspondence to: Dr Tinku Thomas, Department of Biostatistics, St John's Medical College, Bengaluru 560 034, Karnataka.
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Gupta A, Sachdev HS, Kapil U, Prakash S, Pandey RM, Sati HC, Sharma LK, Lal PR. Characterisation of anaemia amongst school going adolescent girls in rural Haryana, India - CORRIGENDUM. Public Health Nutr 2023; 26:2181. [PMID: 37565428 PMCID: PMC10564590 DOI: 10.1017/s1368980023001465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
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Fewtrell M, Bandsma RHJ, Baur L, Duggan CP, Dumrongwongsiri O, Hojsak I, Khatami K, Koletzko B, Kovalskys I, Li Z, Mouane N, Nel E, Sachdev HS, Spolidoro JV. Role of Pediatricians in Promoting and Supporting Breastfeeding: A Position Paper of the International Pediatric Association Strategic Advisory Group on Infant, Child, and Adolescent Nutrition. Ann Nutr Metab 2023; 79:469-475. [PMID: 37673040 DOI: 10.1159/000534004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Promoting and supporting breastfeeding is an important public health intervention with multiple benefits for both infants and mothers. Even modest increases in the prevalence and duration of breastfeeding could significantly reduce healthcare costs and improve maternal and child health outcomes. However, widespread adoption of breastfeeding recommendations remains poor in most settings, which contributes to widening health and social inequalities. Pediatricians have a duty to advocate for improving child health, including promoting and supporting breastfeeding. SUMMARY This paper, from the International Pediatric Association Special Advisory Group on Nutrition, considers common barriers to breastfeeding and addresses how pediatricians can better promote and support breastfeeding, both at an individual level and by influencing practice and policy. All pediatricians need to understand the basics of breastfeeding, including lactation physiology, recognize common breastfeeding problems, and advise mothers or refer them for appropriate support; training curricula for general pediatricians and all pediatric subspecialties should reflect this. Even in the situation where their day-to-day work does not involve direct contact with mothers and infants, pediatricians can have an important influence on policy and practice. They should support colleagues who work directly with mothers and infants, ensuring that systems and environments are conducive to breastfeeding and, where appropriate, milk expression. Pediatricians and pediatric organizations should also promote policies aimed at promoting and supporting breastfeeding at local, regional, national, and international levels. KEY MESSAGES Pediatricians have a duty to promote and support breastfeeding, regardless of their day-to-day role and responsibilities. Pediatric training curricula should ensure that all trainees acquire a good understanding of breastfeeding so they are able to effectively support mothers in their personal practice but also influence breastfeeding practice and policy at a local, regional, national, and international level.
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Affiliation(s)
- Mary Fewtrell
- Childhood Nutrition Research Group, Population, Practice and Policy Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robert H J Bandsma
- Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, Toronto, Ontario, Canada
| | - Louise Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher P Duggan
- Division of Gastroenterology, Hepatology and Nutrition, Division of Nutrition, Harvard Medical School, Department of Nutrition, Harvard TH Chan School of Public Health, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Oraporn Dumrongwongsiri
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Iva Hojsak
- Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia
| | - Katayoun Khatami
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospitals, LMU - Ludwig Maximillians Universität Munich, Munich, Germany
| | - Irina Kovalskys
- Faculty of Medical Sciences, Argentine Pontifical Catholic University, Buenos Aires, Argentina
- Maestría en Nutrición Humana, IDIP Instituto de Desarrollo e Investigaciones Pediátricas del Hospital de Niños de La Plata, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Zhenghong Li
- Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Nezha Mouane
- Academic Children's Hospital Ibn Sina, Mohammed V University, Rabat, Morocco
| | - Etienne Nel
- FMHS, Stellenbosch University, Stellenbosch, South Africa
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Ware L, Vermeulen B, Maposa I, Floo D, Brant LCC, Khandelwal S, Singh K, Soares S, Jessen N, Perman G, Riaz BK, Sachdev HS, Allen NB, Labarthe DR. Comparison of cardiovascular health profiles across population surveys from five high- to low-income countries. medRxiv 2023:2023.07.26.23293185. [PMID: 37546768 PMCID: PMC10402230 DOI: 10.1101/2023.07.26.23293185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Aims With the greatest burden of cardiovascular disease morbidity and mortality increasingly observed in lower-income countries least prepared for this epidemic, focus is widening from risk factor management alone to primordial prevention to maintain high levels of cardiovascular health (CVH) across the life course. To facilitate this, the American Heart Association (AHA) developed CVH scoring guidelines to evaluate and track CVH. We aimed to compare the prevalence and trajectories of high CVH across the life course using nationally representative adult CVH data from five diverse high- to low-income countries. Methods Surveys with CVH variables (physical activity, cigarette smoking, body mass, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the United States (US). Participants were included if they were 18-69y, not pregnant, and had data for these CVH metrics. Comparable data were harmonized and each of the CVH metrics was scored using AHA guidelines as high (2), moderate (1), or low (0) to create total CVH scores with higher scores representing better CVH. High CVH prevalence by age was compared creating country CVH trajectories. Results The analysis included 28,092 adults (Ethiopia n=7686, 55.2% male; Bangladesh n=6731, 48.4% male; Brazil n=7241, 47.9 % male; England n=2691, 49.5% male, and the US n=3743, 50.3% male). As country income level increased, prevalence of high CVH decreased (>90% in Ethiopia, >68% in Bangladesh and under 65% in the remaining countries). This pattern remained using either five or all six CVH metrics and following exclusion of underweight participants. While a decline in CVH with age was observed for all countries, higher income countries showed lower prevalence of high CVH already by age 18y. Excess body weight appeared the main driver of poor CVH in higher income countries, while current smoking was highest in Bangladesh. Conclusion Harmonization of nationally representative survey data on CVH trajectories with age in 5 highly diverse countries supports our hypothesis that CVH decline with age may be universal. Interventions to promote and preserve high CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where CVH remains relatively high, protection of whole societies from risk factor epidemics may still be feasible.
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Affiliation(s)
- Lisa Ware
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bridget Vermeulen
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Floo
- Wuqu’ Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Luisa CC Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Brazil
| | | | - Kavita Singh
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Sara Soares
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Portugal
| | - Neusa Jessen
- Faculty of Medicine, Eduardo Mondlane University, Mozambique
- Research Unit of the Department of Medicine, Maputo Central Hospital, Mozambique
| | - Gastón Perman
- Department of Public Health. Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| | - Baizid Khoorshid Riaz
- National Institute of Preventive & Social Medicine (NIPSOM), Ministry of Health & Family Welfare, Mohakhali, Dhaka, Bangladesh
| | | | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Darwin R Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
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Gupta A, Bidla N, Joshi Y, Prasad V, Sachdev HS, Kumar P. Advertising of Pre-Packaged Foods in India: A Qualitative Analysis. Indian Pediatr 2023; 60:549-552. [PMID: 37078482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVE We examined the 'nutrients of concern' in pre-packaged food products that are commonly advertised, as per WHO standards and Nova Classification. METHODS This was a qualitative study, using a convenience sampling method, to identify advertisements of pre-packaged food products. We also analyzed their content from information on the packets, and their compliance with applicable Indian laws. RESULTS We found that all the advertisements of the food products in this study did not provide important information about the amount of nutrients of concern i.e., total fat, sodium, and total sugars. These advertisements mostly targeted children, made health claims, and used endorsements of celebrities. All the food products were also found to be ultra-processed in nature and high in one or more nutrients of concern. CONCLUSION Most of the advertisements are misleading, needing effective monitoring. Health warnings on the front-of- pack label and restrictions on marketing of such food products may go a long way in reducing non-communicable diseases.
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Affiliation(s)
- Arun Gupta
- Breastfeeding Promotion Network of India, Pitampura, Delhi. Correspondence to: Dr. Arun Gupta, Breastfeeding Promotion Network of India, Pitampura, Delhi.
| | - Nupur Bidla
- Breastfeeding Promotion Network of India, Pitampura, Delhi
| | - Yashika Joshi
- Breastfeeding Promotion Network of India, Pitampura, Delhi
| | | | - Harshpal Singh Sachdev
- Department of Pediatrics and Epidemiology, Sitaram Bhartia Institute of Science and Research, Delhi
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi
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Vasan SK, Alex AG, Roy A, Gowri M, Sinha S, Suresh J, Philip RS, Kochumon J, Jaiswal N, Arulappan G, Ramakrishnan L, Sachdev HS, Tandon N, Thomas N, Jebasingh F, Osmond C, Karpe F, Bhargava SK, Antonisamy B, Prabhakaran D, Fall CH, Thomson VS. Echocardiography protocol and cardiometabolic phenotyping in Indian birth cohorts-the IndEcho study. Front Cardiovasc Med 2023; 10:1055454. [PMID: 37522075 PMCID: PMC10372793 DOI: 10.3389/fcvm.2023.1055454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Background Asian Indians are at higher risk of cardiometabolic disease compared to other ethnic groups, and the age of onset is typically younger. Cardiac structure and function are poorly characterized in this ethnic group. In this study, we describe image-acquisition methods and the reproducibility of measurements and detailed echocardiography characteristics in two large Indian population-based cohorts (the New Delhi and Vellore Birth Cohorts) from India. Methods The IndEcho study captured transthoracic echocardiographic measurements of cardiac structure and function from 2,322 men and women aged 43-50 years. M-mode measurements in the parasternal long axis (PLAX) and 2-dimensional (2D) short axis recordings at the mitral valve, mid-papillary and apical level were recorded. Apical 2D recordings of two- three- and four-chamber (2C, 3C and 4C) views and Doppler images (colour, pulsed and continuous) were recorded in cine-loop format. Left ventricular (LV) mass, LV hypertrophy, and indices of LV systolic and diastolic function were derived. Results Echocardiographic measurements showed good/excellent technical reproducibility. Hetero-geneity across sites, sex and rural/urban differences in cardiac structure and function were observed. Overall, this cohort of South Asian Indians had smaller LV mass and normal systolic and diastolic function when compared with published data on other Asian Indians and the West, (LV mass indexed for body surface area: Delhi men: 68 g/m2, women 63.9; Vellore men: 65.8, women 61.6) but were within ethnic-specific reference ranges. The higher prevalence of obesity, diabetes and hypertension is reflected by the higher proportion of LV remodelling and lesser hypertrophy. Conclusions Our study adds to scarce population-based echocardiographic data for mid-life Asian Indians. Compared to published literature on other ethnic groups, the Asian Indian heart is characterised by smaller cardiac dimensions and normal range systolic and diastolic function on a background of a high prevalence of hypertension, diabetes and cardiac disease at a relatively young age. This data will form the basis for further analyses of lifecourse, metabolic and body composition predictors of cardiac structure and function, and echocardiographic predictors of future mortality. ISRCTN registration number 13432279.
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Affiliation(s)
- Senthil K. Vasan
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Centre for Chronic Disease Control, Gurgaon, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Sikha Sinha
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research Institute, New Delhi, India
| | - Jenifer Suresh
- Department of Cardiology, Christian Medical College, Vellore, India
| | | | | | | | | | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research Institute, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Felix Jebasingh
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, New Delhi, India
| | - Caroline H.D. Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Viji S. Thomson
- Department of Cardiology, Christian Medical College, Vellore, India
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Thiruvengadam R, Desiraju BK, Sachdev HS, Bhatnagar S. The challenges in gestational weight gain monitoring in low and middle income settings. Eur J Clin Nutr 2023; 77:764-765. [PMID: 37316558 DOI: 10.1038/s41430-023-01292-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/22/2023] [Accepted: 05/03/2023] [Indexed: 06/16/2023]
Affiliation(s)
| | | | | | - Shinjini Bhatnagar
- Translational Health Science and Technology Institute, Faridabad, Haryana, India.
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Nema J, Wadhwani N, Randhir K, Dangat K, Pisal H, Kadam V, Mehendale S, Wagh G, Kulkarni B, Sachdev HS, Fall C, Gupte S, Joshi S. Association of maternal vitamin D status with the risk of preeclampsia. Food Funct 2023; 14:4859-4865. [PMID: 37129568 DOI: 10.1039/d3fo00007a] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The aim of this study was to examine serum vitamin D concentrations from early pregnancy until delivery in women who did and did not develop preeclampsia. This longitudinal study was carried out in Pune, India. A total of 1154 women with singleton pregnancies were recruited in early pregnancy from two hospitals. Blood samples were collected and stored at four time points across gestation: V1 = 11-14 weeks, V2 = 18-22 weeks, V3 = 26-28 weeks and V4 = at delivery. 108 women who developed preeclampsia (PE) and 216 who did not develop PE (Non-PE) were randomly selected from the remainder. Serum 25-hydroxy vitamin D concentrations (25(OH)D) were estimated in their samples using commercially available ELISA kits. Independent t-tests were used to compare 25(OH)D between PE and non-PE groups. Logistic and linear regressions were used to examine associations of 25(OH)D with the risk of preeclampsia and birth outcomes, respectively, after adjusting for confounders. The mean (SD) 25(OH)D at V1 was 21.95 (19.64) in the Non-PE group and 17.76 (13.21) in the PE group. A decrease in the concentrations of vitamin D (ng ml-1) in mid-pregnancy (V2) and at delivery was associated with an increased risk of preeclampsia (0.31 [95% CI 0.11, 0.86], p = 0.024 and 0.24 [95% CI 0.08, 0.77], p = 0.016), respectively. Our finding of lower vitamin D concentrations in mid-pregnancy, before women developed clinical preeclampsia, suggests that vitamin D may have a role in its pathophysiology.
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Affiliation(s)
- Juhi Nema
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Nisha Wadhwani
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Karuna Randhir
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Kamini Dangat
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Hemlata Pisal
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Vrushali Kadam
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Savita Mehendale
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune 411043, India
| | - Girija Wagh
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune 411043, India
| | - Bharati Kulkarni
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research (ICMR) - Headquarters, New Delhi 110029, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Caroline Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sanjay Gupte
- Gupte Hospital and Research Centre, Pune 411004, India
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
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15
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Kurpad AV, Singh Sachdev H. Efficacy of maternal vitamin B12 supplementation for improving infant outcomes in settings with high deficiency. Lancet 2023; 401:1476-1478. [PMID: 37031692 DOI: 10.1016/s0140-6736(23)00511-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, India
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Rana G, Abraham RA, Sachdev HS, Nair KM, Kumar GT, Agarwal PK, Johnston R, Wagt AD, Sarna A, Acharya R, Porwal A, Khan N, Ramesh S, Bharti R, Kalaivani M, Ramakrishnan L. Prevalence and Correlates of Vitamin D Deficiency Among Children and Adolescents From a Nationally Representative Survey in India. Indian Pediatr 2023; 60:202-206. [PMID: 36604939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the prevalence of vitamin D deficiency (VDD) and its correlates among apparently healthy children and adolescents. METHODS We carried out a secondary analysis of data of Comprehensive National Nutrition Survey 2016-18 to analyze the pre-valence and predictors of VDD among Indian children and adolescents. RESULTS The over-all prevalence of VDD in preschool children (1-4 years), school age (5-9 years) children, and adolescents (10-19 years) was 13.7%, 18.2%, and 23.9%, respectively. Age, living in urban area, and winter season were significantly associated with VDD. Vegetarian diet and high-income households were the main risk factors observed in 5-19 years age category. Female sex and less than three hour of physical activity/week were independent risk factors among adolescents. CONCLUSION The prevalence and determinants of VDD across different age-groups are reported, and these should be interpreted and addressed to decrease the burden of VDD in India.
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Affiliation(s)
- Garima Rana
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi
| | - Ransi Ann Abraham
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi
| | | | | | | | | | | | | | | | | | | | | | - Rahul Bharti
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi
| | - M Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi. Correspondence to: Dr Lakshmy Ramakrishnan, Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi 110 029.
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Rana G, Abraham RA, Sachdev HS, Nair KM, Kumar GT, Agarwal PK, Johnston R, De Wagt A, Sarna A, Acharya R, Porwal A, Khan N, Ramesh S, Bharti R, Kalaivani M, Ramakrishnan L. Prevalence and Correlates of Vitamin D Deficiency Among Children and Adolescents From a Nationally Representative Survey in India. Indian Pediatr 2023. [DOI: 10.1007/s13312-023-2835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Ghosh S, Thomas T, Kurpad A, Sachdev HS. Is iron status associated with markers of non-communicable disease in adolescent Indian children? Eur J Clin Nutr 2023; 77:173-181. [PMID: 36280731 DOI: 10.1038/s41430-022-01222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND High body iron status has been associated with non-communicable diseases (NCD) like diabetes (high fasting blood glucose, FBG), hypertension (HTN) or dyslipidaemia (high total cholesterol, TC) in adults, but this has not been examined in adolescent children. This is relevant to iron supplementation and food iron fortification programs that are directed at Indian children. METHODS The association of NCD with Serum Ferritin (SF) was examined using logistic additive models, adjusted for confounders such as age, body mass index, C-Reactive Protein, haemoglobin and sex, in adolescent (10-19 years old) participants of the Indian Comprehensive National Nutrition Survey. The interaction of these associations with wealth and co-existing prediabetes was also examined. A scenario analysis was also done to understand the impact of iron fortification of cereals on the prevalence NCD among adolescents. RESULTS The odds ratio (OR) of high FBG, HTN and TC were 1.05 (95% CI: 1.01-1.08), 1.02 (95% CI: 1.001-1.03) and 1.04 (95% CI: 1.01-1.06) respectively for every 10 µg/L increase in SF. The odds for high TC increased with co-existing prediabetes. The scenario analysis showed that providing 10 mg of iron/day by fortification could increase the prevalence of high FBG by 2-14% across states of India. Similar increments in HTN and TC can also be expected. CONCLUSIONS High SF is significantly associated with NCD in adolescents, dependent on wealth and co-existing prediabetes. This should be considered when enhancing iron intake in anaemia prevention programs, and the NCD relationship with body iron stores should be studied.
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Affiliation(s)
- S Ghosh
- St John's Medical College, Bengaluru, India
| | - T Thomas
- St John's Medical College, Bengaluru, India
| | - A Kurpad
- St John's Medical College, Bengaluru, India.
| | - H S Sachdev
- Sitaram Bhartia Institute of Science and Research, New Delhi, India.
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Naga Rajeev L, Saini M, Kumar A, Osmond C, Sachdev HS. Comparison of Weight for Height and BMI for Age for Estimating Overnutrition Burden in Under-Five Populations With High Stunting Prevalence. Indian Pediatr 2023. [DOI: 10.1007/s13312-023-2689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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20
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Kurpad AV, Sachdev HS. Childhood and Adolescent Anemia Burden in India: The Way Forward. Indian Pediatr 2022; 59:837-840. [PMID: 36036186 PMCID: PMC9748895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The burden of anemia in Indian children, based on capillary blood sampling, is believed to be profound and worsening (67.1%) according to the successive National Family Health Surveys (NFHS). This might be an overestimate. The recent Comprehensive National Nutrition Survey of Indian children, that used venous blood sampling, found only less than half (30.7%) the NFHS prevalence, of which only one third was due to iron deficiency (ID). Unfortunately, the apparently worsening NFHS anemia burden estimate has been interpreted as an inadequacy of the present iron supplementation policy. This has led to additional iron supply through mandatory rice fortification. However, the lack of efficacy of iron supplementation appears inevitable, if the true prevalence of iron deficiency anemia is only about 10%. Thus, etiology is a critical consideration when devising appropriate and effective prevention policies. Future policies must focus on precision, thoughtfulness, restraint, and community engagement.
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Affiliation(s)
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi. Correspondence to: Prof Harshpal Singh Sachdev, Senior Consultant Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi 110 016.
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21
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Kurpad AV, Sachdev HS. Micronutrient supplements in pregnancy: an urgent priority. Lancet Glob Health 2022; 10:e1563. [PMID: 36240822 DOI: 10.1016/s2214-109x(22)00382-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru 560034, India.
| | - Harshpal Singh Sachdev
- Department of Paediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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22
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Naga Rajeev L, Saini M, Kumar A, Sachdev HS. Dissimilar Associations Between Stunting and Low Ponderosity Defined Through Weight for Height (Wasting) or Body Mass Index for Age (Thinness) in Under-Five Children. Indian Pediatr 2022; 59:757-762. [PMID: 35822490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Wasting and stunting commonly coexist, sup-posedly due to biological and social mechanisms. In under-five children, low-ponderosity is defined as <-2SD of WHO standards for either weight for height (wasted) or body mass index for age (thin) metrics. Unlike body mass index for age, weight for height ignores physiological changes in ponderosity with age, resulting in overestimation of wasting in comparison to thinness in under-5 populations with high stunting prevalence. This suggests a plausi- ble statistical explanation for the wasting-stunting association. AIM To test the null hypothesis that wasting-stunting (WaSt) and thinness-stunting (ThSt) associations are similar. METHODS Demographic Health Survey datasets (2010-2020) from South and South-East Asia (7 countries) and Sub-Saharan Africa (13 countries) were evaluated. WaSt and ThSt asso-ciations were estimated as odds ratio (OR) for individual data-sets, which was pooled (random-effects meta-analysis). Strati-fied analyses were done for sex, age and region. RESULT Young infants (0-6 months) comprised 8-14% of under-five children, with equal representation of boys and girls. Participants, especially Asians, were mostly shorter with lower ponderosity than WHO standards. WaSt prevalence was higher than ThSt in the 6-59 months age group, but lower in young infants. Pooled WaSt estimates were not significant: Asia (OR 0.95; 95% CI 0.75-1.14), Africa (1.17; 0.95-1.40), and combined (1.09; 0.93-1.24). In contrast, pooled ThSt associations were significantly negative: Asia (0.63; 0.50-0.76), Africa (0.82; 0.68-0.96), and combined (0.75; 0.65-0.85). In girls, these associations were attenuated for WaSt (0.96; 0.8-1.1), but enhanced for ThSt (0.6; 0.5-0.7). CONCLUSION WaSt and ThSt associations are dissimilar. This suggests a primary statistical explanation for the reported was-ting-stunting association, originating from ignoring physiological changes with age.
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Affiliation(s)
- L Naga Rajeev
- Department of Mathematics and Statistics, Manipal University Jaipur Rajashtan and Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi
| | - Monika Saini
- Department of Mathematics and Statistics, Manipal University Jaipur, Rajashtan
| | - Ashish Kumar
- Department of Mathematics and Statistics, Manipal University Jaipur, Rajashtan
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi. Correspondence to: Prof Harshpal Singh Sachdev, Senior Consultant, Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi 110 016.
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Wadhwani N, Dangat K, Randhir K, Poddar A, Joshi P, Pisal H, Kadam V, Bakshi R, Chandhiok N, Lalwani S, Mehendale S, Wagh G, Gupte S, Sachdev HS, Fall C, Joshi S. Longitudinal Assessment of Calcium and Magnesium Levels in Women with Preeclampsia. Biol Trace Elem Res 2022; 201:3245-3255. [PMID: 36214957 DOI: 10.1007/s12011-022-03440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/03/2022] [Indexed: 11/02/2022]
Abstract
The present study reports the levels of maternal serum calcium and magnesium from early pregnancy until delivery, along with cord levels, in women who developed preeclampsia (PE) and compares them with those without PE. A total of 324 pregnant women (216 non-PE and 108 PE women) were included in this retrospective case-control study of prospectively collected data nested in an observational cohort study. Maternal blood was collected at 4 time points during pregnancy (V1 = 11-14 weeks, V2 = 18-22 weeks, V3 = 26-28 weeks, and V4 = at delivery) and umbilical cord blood at delivery. Independent t tests were used to compare calcium, magnesium, and their ratio between two groups, and their associations with PE were studied using regression models. Calcium levels were similar between groups at all time points. Magnesium levels were lower (p = 0.021) at V2 in PE group as compared with non-PE group. Maternal calcium and magnesium levels were negatively associated, with blood pressure in early pregnancy. In fully adjusted logistic regression analysis, lower magnesium levels were associated with an increased risk of PE at V2 (OR 0.25 [95% CI 0.07, 0.94] p = 0.04). Lower magnesium in mid-pregnancy was associated with higher risk of PE. These changes were observed before the diagnosis of PE, thereby suggesting that they may have a role in the etiology of PE.
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Affiliation(s)
- Nisha Wadhwani
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Kamini Dangat
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Karuna Randhir
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Anupam Poddar
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Prachi Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Hemlata Pisal
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Vrushali Kadam
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Ravleen Bakshi
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research - Headquarters, New Delhi, India
| | - Nomita Chandhiok
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research - Headquarters, New Delhi, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Savita Mehendale
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Girija Wagh
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | | | | | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India.
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Dangat K, Gupte S, Wagh G, Lalwani S, Randhir K, Madiwale S, Pisal H, Kadam V, Gundu S, Chandhiok N, Kulkarni B, Joshi S, Fall C, Sachdev HS. Gestational weight gain in the REVAMP pregnancy cohort in Western India: Comparison with international and national references. Front Med (Lausanne) 2022; 9:1022990. [PMID: 36275827 PMCID: PMC9579320 DOI: 10.3389/fmed.2022.1022990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the trimester specific gestational weight gain (GWG) in a population of pregnant women from Western India and compare it with the Intergrowth-21st international and an Indian reference (GARBH-Ini cohort-Group for Advanced Research on BirtH outcomes). Study design A prospective longitudinal observational study was undertaken in Pune, West India and data for gestational weight gain was collected [the REVAMP study (Research Exploring Various Aspects and Mechanisms in Preeclampsia)]. Generalized Additive Models for Location, Scale and Shape method (GAMLSS model) were used to create GWG centile curves according to gestational age, stratified by BMI at recruitment (n = 640) and compared with Intergrowth-21st reference and GARBH-Ini cohort. Multivariable regression analysis was used to evaluate the relationship between GWG and antenatal risk factors. Results The median GWG was 1.68, 5.80, 7.06, and 11.56 kg at gestational ages 18, 26, 30, and 40 weeks, respectively. In our study, pregnant women gained less weight throughout pregnancy compared to Intergrowth-21st study, but more weight compared to the GARBH-Ini cohort centile curves in all the BMI categories. GWG in overweight/obese women (BMI ≥ 25) was significantly lower (<0.001) as compared to underweight (BMI < 18.5), or normal weight women (BMI ≥ 18.5 and <25). The median GWG at 40 weeks in underweight, normal and overweight/obese women was 13.18, 11.74, and 10.48 kg, respectively. Higher maternal BMI, older maternal age, higher parity and higher hemoglobin concentrations were associated with lower GWG, while taller maternal height was associated with greater GWG. Conclusion GWG of Indian women is lower than the prescriptive standards of the Intergrowth charts.
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Affiliation(s)
- Kamini Dangat
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | | | - Girija Wagh
- Department of Obstetrics and Gynecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Karuna Randhir
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shweta Madiwale
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Hemlata Pisal
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Vrushali Kadam
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shridevi Gundu
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Nomita Chandhiok
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Bharati Kulkarni
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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Devi S, Sachdev HS, Kurpad AV. Mysteries of Dosing Vitamin B12 and Much More! Indian Pediatr 2022; 59:677-678. [PMID: 36101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Sarita Devi
- St. John's Medical College, Bengaluru, Karnataka
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Devi S, Sachdev HS, Kurpad AV. Mysteries of Dosing Vitamin B12 and Much More! Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chevvu V, Kilpady CA, Kamath AA, Joseph S, Das R A, Sachdev HS, Banapurmath CR, Thomas T, Kurpad AV, Shivakumar N. Estimated Deficits in Nutrient Intake of ICDS Beneficiaries Who Receive Take Home Ration at Two Districts in Karnataka. Indian Pediatr 2022; 59:524-530. [PMID: 35596649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The current estimates of energy and protein to bridge nutrient gap in the beneficiaries of the Integrated Child Development Services (ICDS) supplementary nutrition program use sub-optimal methodology for deficit calculation. OBJECTIVE To estimate the nutrient deficit and the risk of inadequate nutrient intake in beneficiaries of the ICDS, aged 6-36 months, using individual 24-hour diet recalls, from districts of Chitradurga and Davanagere in Karnataka. STUDY DESIGN Cross-sectional design. PARTICIPANTS Children (aged 6 to 36 months) registered as beneficiaries of the ICDS in these districts. METHODS Data were collected on socio-demographic factors, child feeding patterns, perception and usage of take home ration (THR), between August to October, 2019. Three non-consecutive days' 24-hour diet recall data of children were obtained from mothers, and anthropometric measurements were taken. The proportion of children at risk of inadequate nutrient intakes was estimated using the probability approach. Assuming that 50% of a healthy population will be at risk of nutrient inadequacy such that intake and requirement distributions overlap, the proportion at actual risk of nutrient inadequacy (≥50%) was calculated. RESULTS A combined district analysis showed a median energy deficit of 109 kcal and 161 kcal in children belonging to the age groups of 6-12 month and 13-36 month, respectively. The actual risk of inadequate intake for both age groups ranged between 12-47% for fat and other micronutrient (iron, calcium, zinc, folate, vitamin B12 and vitamin A), despite breastfeeding, complementary feeding and reported THR use. CONCLUSION Children who receive supplementary nutrition as part of the national program fail to meet their nutrient requirements that are essential for growth and development. The study results may help in strengthening the IYCF counselling and in modification of the existing THR, with quality and cost implications.
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Affiliation(s)
- Vaishnavi Chevvu
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka
| | - Chaitra A Kilpady
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka
| | - Akshata A Kamath
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka
| | - Smitha Joseph
- Department of Biostatistics, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, Karnataka
| | - Arun Das R
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi
| | | | - Tinku Thomas
- Department of Biostatistics, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, Karnataka
| | - Anura V Kurpad
- Department of Physiology and Division of Nutrition, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, Karnataka
| | - Nirupama Shivakumar
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka. Correspondence to: Dr Nirupama Shivakumar, Division of Nutrition, St. John's Research Institute, Bangalore, Karnataka.
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Duke T, AlBuhairan FS, Agarwal K, Arora NK, Arulkumaran S, Bhutta ZA, Binka F, Castro A, Claeson M, Dao B, Darmstadt GL, English M, Jardali F, Merson M, Ferrand RA, Golden A, Golden MH, Homer C, Jehan F, Kabiru CW, Kirkwood B, Lawn JE, Li S, Patton GC, Ruel M, Sandall J, Sachdev HS, Tomlinson M, Waiswa P, Walker D, Zlotkin S. World Health Organization and knowledge translation in maternal, newborn, child and adolescent health and nutrition. Arch Dis Child 2022; 107:644-649. [PMID: 34969670 PMCID: PMC7613575 DOI: 10.1136/archdischild-2021-323102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022]
Abstract
The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important part of this. Countries need effective and responsive structures for adaptation and implementation of evidence-based interventions, strategies to improve guideline uptake, education and training and mechanisms to monitor quality and safety. This paper summarises STAGE's recommendations on how to improve knowledge translation in MNCAHN. They include support for national and regional technical advisory groups and subnational committees that coordinate maternal and child health; support for national plans for MNCAHN and their implementation and monitoring; the production of a small number of consolidated MNCAHN guidelines to promote integrated and holistic care; education and quality improvement strategies to support guidelines uptake; monitoring of gaps in knowledge translation and operational research in MNCAHN.
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Affiliation(s)
- Trevor Duke
- Intensive Care Unit and University of Melbourne Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia
- Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, NCD, Papua New Guinea
| | - Fadia S AlBuhairan
- Leadership, Learning, and Development, Health Sector Transformation Program, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Koki Agarwal
- USAID Maternal Child Survival Program, Washington, District of Columbia, USA
| | | | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Fred Binka
- University of Health and Allied Sciences (UHAS), Ho, Ghana
| | - Arachu Castro
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Mariam Claeson
- Department of Global Health, Karolinska Institute, Stockholm, Sweden
| | - Blami Dao
- Western and Central Africa, Jhpiego, Ouagadougou, Burkina Faso
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Mike English
- Kemri-Wellcome Trust, Nairobi, Kenya
- Oxford University, Oxford, UK
| | | | - Michael Merson
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Alma Golden
- US Agency for International Development, Washington, District of Columbia, USA
| | | | | | - Fyezah Jehan
- Pediatrics, Aga Khan University, Karachi, Sindh, Pakistan
| | - Caroline W Kabiru
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Betty Kirkwood
- London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- MARCH Centre, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Song Li
- National Health Commission of the People's Republic of China, Beijing, China
| | - George C Patton
- Adolescent Health, Murdoch Children's Research Institute and The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Ruel
- International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College, London, UK
| | - Harshpal Singh Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, India
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | | | - Dilys Walker
- Department of Obstetrics, Gynecology and Reproductive Sciences, Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Stanley Zlotkin
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Chevvu V, Kilpady CA, Kamath AA, Joseph S, Das A, Sachdev HS, Banapurmath CR, Thomas T, Kurpad AV, Shivakumar N. Estimated Deficits in Nutrient Intake of ICDS Beneficiaries Who Receive Take Home Ration at Two Districts in Karnataka. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2553-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kurpad AV, Sachdev HS. Precision in prescription: multiple micronutrient supplements in pregnancy. Lancet Glob Health 2022; 10:e780-e781. [PMID: 35561708 PMCID: PMC7612989 DOI: 10.1016/s2214-109x(22)00207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/30/2022]
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Kurpad AV, Sachdev HS. Commentary: Time for precision in iron supplementation in children. Int J Epidemiol 2022; 51:1543-1545. [PMID: 35551396 DOI: 10.1093/ije/dyac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/23/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anura V Kurpad
- Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Harshpal Singh Sachdev
- Division of Clinical Epidemiology and Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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Gupta P, Sachdev HS. The Escalating Health Threats from Ultra-processed and High Fat, Salt, and Sugar Foods: Urgent Need for Tailoring Policy. Indian Pediatr 2022. [PMID: 35315348 PMCID: PMC8964373 DOI: 10.1007/s13312-022-2463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
With its colonial past, and a glaring problem of poverty and hunger, India oft fails to acknowledge a new, rapidly growing problem of overnutrition. With the economic boost and entry of various foreign players from the food industry, Indian citizens have been increasingly exposed to ultra-processed, high in sugar, salt and fat foods (HFSS foods). The last decade or so has seen an exponential rise in the consumption of such foods, leading to increasing prevalence of overweight- and obesity-related illnesses like diabetes, hypertension, etc. In this scenario, examining the efficacy of policy-related measures in reducing consumption of these harmful foods and preventing the associated health issues is paramount. Across the globe, several countries have explored options from taxation on HFSS foods to restricting marketing to children, as well as different practices for front of the pack labeling. In the context of India and its increasing burden of preventable, diet-related illnesses, the urgent need of instituting these preventive policies at national scale cannot be neglected.
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Gupta A, Sachdev HS, Kapil U, Prakash S, Pandey RM, Sati HC, Sharma LK, Lal PR. Characterisation of anaemia amongst school going adolescent girls in rural Haryana, India. Public Health Nutr 2022; 25:1-10. [PMID: 35067260 PMCID: PMC9991616 DOI: 10.1017/s1368980022000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High burden of anaemia exists amongst rural adolescent girls in India. The objective of this study was to characterise anaemia in school going adolescent girls in rural Haryana, India. DESIGN Linear and multiple logistic regression analysis of data collected prior to an intervention trial was conducted. Participants were classified into anaemic (haemoglobin <12 g/dl) and non-anaemic group and were further classified into deficiencies of Fe, folate or vitamin B12, mixed, anaemia of other causes and inflammation. SETTING Three schools in Ballabgarh block of Faridabad District, Haryana, India. PARTICIPANTS One hundered and ninety-eight non-anaemic and 202 anaemic adolescent girls (12-19 years). RESULTS Anaemic girls had 29·6 % Fe deficiency, 28·1 % folate or vitamin B12 deficiency, 15·8 % mixed deficiency and 9·7 % acute inflammation. Anaemia of other causes was found in 16·8 % of the anaemic participants. Girls with Fe and isolated folate deficiency had 2·5 times and four times higher odds of developing anaemia, respectively, as compared with non-anaemic girls. Fe deficiency with no anaemia was found amongst 11 % non-anaemic girls. Non-anaemic girls had a high prevalence of combined deficiency of folate or vitamin B12 (29·5 %) and acute inflammation (14·4 %). CONCLUSIONS The current strategy of Fe and folic acid supplementation alone will not suffice for achieving the desired reduction in the prevalence of anaemia as unknown causes and anaemia of inflammation contribute to a substantial proportion of anaemia. Integrating other nutrition-specific components like improving water, sanitation and hygiene practices with the ongoing micronutrient supplementation program will comprehensively tackle anaemia. Unknown causes of anaemia warrant further research.
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Affiliation(s)
- Aakriti Gupta
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi110001, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Umesh Kapil
- Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Prakash
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Lokesh Kumar Sharma
- Department of Biochemistry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Priti Rishi Lal
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi110001, India
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Kurpad AV, Sachdev HS. Childhood and Adolescent Anemia Burden in India: The Way Forward. Indian Pediatr 2022. [PMID: 36036186 PMCID: PMC9748895 DOI: 10.1007/s13312-022-2639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The burden of anemia in Indian children, based on capillary blood sampling, is believed to be profound and worsening (67.1%) according to the successive National Family Health Surveys (NFHS). This might be an overestimate. The recent Comprehensive National Nutrition Survey of Indian children, that used venous blood sampling, found only less than half (30.7%) the NFHS prevalence, of which only one third was due to iron deficiency (ID). Unfortunately, the apparently worsening NFHS anemia burden estimate has been interpreted as an inadequacy of the present iron supplementation policy. This has led to additional iron supply through mandatory rice fortification. However, the lack of efficacy of iron supplementation appears inevitable, if the true prevalence of iron deficiency anemia is only about 10%. Thus, etiology is a critical consideration when devising appropriate and effective prevention policies. Future policies must focus on precision, thoughtfulness, restraint, and community engagement.
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Affiliation(s)
- Anura Viswanath Kurpad
- grid.416432.60000 0004 1770 8558Department of Physiology, St John’s Medical College, Bengaluru, Karnataka India
| | - Harshpal Singh Sachdev
- grid.419277.e0000 0001 0740 0996Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110 016 India
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Varghese JS, Adair LS, Patel SA, Bechayda SA, Bhargava SK, Carba DB, Horta BL, Lima NP, Martorell R, Menezes AMB, Norris SA, Richter LM, Ramirez-Zea M, Sachdev HS, Wehrmeister FC, Stein AD. Changes in asset-based wealth across the life course in birth cohorts from five low- and middle-income countries. SSM Popul Health 2021; 16:100976. [PMID: 34901377 PMCID: PMC8637637 DOI: 10.1016/j.ssmph.2021.100976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 01/08/2023] Open
Abstract
Background Temporally-harmonized asset-based measures of wealth can be used to study the association of life-course wealth exposures in the same scale with health outcomes in low- and middle-income countries (LMICs). The within-individual longitudinal stability of asset-based indices of wealth in LMICs is poorly understood. Methods Using data from five birth cohorts from three continents, we developed temporally-harmonized asset indices over the life course through polychoric principal component analysis of a common set of assets collected consistently over time (18 years in Brazil to 50 years in Guatemala). For each cohort, we compared the harmonized index to cross-sectional indices created using more comprehensive asset measures using rank correlations. We evaluated the rank correlation of the harmonized index in early life and adulthood with maternal schooling and own attained schooling, respectively. Results Temporally-harmonized asset indices developed from a consistently-collected set of assets (range: 10 in South Africa to 30 in Philippines) suggested that mean wealth improved over time for all birth cohorts. Cross-sectional indices created separately for each study wave were correlated with the harmonized index for all cohorts (Brazil: r = 0.78 to 0.96; Guatemala: r = 0.81 to 0.95; India: 0.75 to 0.93; Philippines: r = 0.92 to 0.99; South Africa: r = 0.84 to 0.96). Maternal schooling (r = 0.15 to 0.56) and attained schooling (r = 0.23 to 0.53) were positively correlated with the harmonized asset index in childhood and adulthood respectively. Conclusions Temporally-harmonized asset indices displayed coherence with cross-sectional indices as well as construct validity with schooling. Temporally-harmonized asset indices are useful to assess relative importance of wealth at different life stages with health on the same scale. Harmonized indices using a subset of assets were correlated with cross-sectional asset indices using all available assets in five LMIC birth cohorts. Harmonized indices displayed construct validity, as demonstrated by its correlation with schooling. Harmonized indices were robust to alternate specifications such as shorter lists of assets, study years, and factor extraction procedures.
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Key Words
- CLHNS, Cebu Longitudinal Health and Nutrition Survey
- COHORTS, Consortium On Health Orientated Research in Transitioning Societies
- EFA, Exploratory Factor Analysis
- INCAP, Institute of Nutrition for Central America and Panama
- LMIC, Low- and middle-income countries
- Life course epidemiology
- MCA, Multiple Correspondence Analysis
- NDBC, New Delhi Birth Cohort
- PCA, Principal Component Analysis
- SD, standard deviation
- SEP, Socio-economic position
- Social mobility
- Wealth index
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Affiliation(s)
- Jithin Sam Varghese
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sonny Agustin Bechayda
- USC-Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines.,Department of Anthropology, Sociology, and History, University of San Carlos, Cebu City, Philippines
| | | | - Delia B Carba
- USC-Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Natalia P Lima
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | | | - Aryeh D Stein
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Naga Rajeev L, Saini M, Kumar A, Sinha S, Osmond C, Sachdev HS. Weight-for-height is associated with an overestimation of thinness burden in comparison to BMI-for-age in under-5 populations with high stunting prevalence. Int J Epidemiol 2021; 51:1012-1021. [PMID: 35020895 DOI: 10.1093/ije/dyab238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Thinness at <5 years of age, also known as wasting, is used to assess the nutritional status of populations for programmatic purposes. Thinness may be defined when either weight-for-height or body-mass-index-for-age (BMI-for-age) are below -2 SD of the respective World Health Organization standards. These definitions were compared for quantifying the burden of thinness. METHODS Theoretical consequences of ignoring age were evaluated by comparing, at varying height-for-age z-scores, the age- and sex-specific cut-offs of BMI that would define thinness with these two metrics. Thinness prevalence was then compared in simulated populations (short, intermediate and tall) and real-life data sets from research and the National Family Health Survey-4 (NFHS-4) in India. RESULTS In short (-2 SD) children, the BMI cut-offs with weight-for-height criteria were higher in comparison to BMI-for-age after 1 year of age but lower at earlier ages. In Indian research and NFHS-4 data sets (short populations), thinness prevalence with weight-for-height was lower from 0.5 to 1 years but higher at subsequent ages. The absolute difference (weight-for-height - BMI-for-age) for 0.5-5 years was 4.6% (15.9-11.3%) and 2.2% (19.2-17.0%), respectively; this attenuated in the 0-5 years age group. The discrepancy was higher in boys and maximal for stunted children, reducing with increasing stature. In simulated data sets from intermediate and tall populations, there were no meaningful differences. CONCLUSIONS The two definitions produce cut-offs, and hence estimates of thinness, that differ with the age, sex and height of children. The relative invariance, with age and stature, of the BMI-for-age thinness definition favours its use as the preferred index for programmatic purposes.
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Affiliation(s)
- L Naga Rajeev
- Department of Mathematics and Statistics, Manipal University Jaipur, Jaipur, Rajasthan, India.,Division of Clinical Epidemiology and Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Monika Saini
- Department of Mathematics and Statistics, Manipal University Jaipur, Jaipur, Rajasthan, India
| | - Ashish Kumar
- Department of Mathematics and Statistics, Manipal University Jaipur, Jaipur, Rajasthan, India
| | - Sikha Sinha
- Division of Clinical Epidemiology and Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Harshpal Singh Sachdev
- Division of Clinical Epidemiology and Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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Zengin A, Kulkarni B, Khadilkar AV, Kajale N, Ekbote V, Tandon N, Bhargava SK, Sachdev HS, Sinha S, Scott D, Kinra S, Fall CHD, Ebeling PR. Prevalence of Sarcopenia and Relationships Between Muscle and Bone in Indian Men and Women. Calcif Tissue Int 2021; 109:423-433. [PMID: 33966094 DOI: 10.1007/s00223-021-00860-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022]
Abstract
Both ethnicity and age are important determinants of musculoskeletal health. We aimed to determine the prevalence of sarcopenia, assess the suitability of current diagnostic guidelines, and explore muscle-bone relationships in adults from India. A total of 1009 young (20-35 years) and 1755 older (> 40 years) men and women from existing studies were collated and pooled for the analysis. Dual-energy x-ray absorptiometry measured areal bone mineral density (aBMD) at the hip and spine, and fat and lean mass; hand dynamometer measured hand grip strength (HGS). Indian-specific cut-points for appendicular lean mass (ALM), ALM index (ALMI) and HGS were calculated from young Indian (-2SD mean) populations. Sarcopenia was defined using cut-points from The Foundations for the National Institutes of Health (FNIH), revised European Working Group on Sarcopenia in Older People (EWGSOP2), Asian Working Group for Sarcopenia (AWGS), and Indian-specific cut-points. Low lean mass cut-points were then compared for their predictive ability in identifying low HGS. The relationship between muscle variables (ALM, ALMI, HGS) and aBMD was explored, and sex differences were tested. Indian-specific cut-points (men-HGS:22.93 kg, ALM:15.41 kg, ALMI:6.03 kg/m2; women-HGS:10.76 kg, ALM:9.95 kg, ALMI:4.64 kg/m2) were lower than existing definitions. The Indian-specific definition had the lowest, while EWGSOP2 ALMI had the highest predictive ability in detecting low HGS (men:AUC = 0.686, women:AUC = 0.641). There were sex differences in associations between aBMD and all muscle variables, with greater positive associations in women than in men. The use of appropriate cut-points for diagnosing low lean mass and physical function is necessary in ethnic populations for accurate sarcopenia assessment. Muscle-bone relationships are more tightly coupled during ageing in Indian women than men.
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Affiliation(s)
- Ayse Zengin
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Monash University, Clayton, VIC, Australia.
| | - Bharati Kulkarni
- Clinical Division, National Institute of Nutrition, Jamai Osmania PO, Hyderabad, India
| | | | - Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | | | - Harshpal Singh Sachdev
- Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Shikha Sinha
- Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - David Scott
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Monash University, Clayton, VIC, Australia
- Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School - Western Campus, The University of Melbourne, St Albans, VIC, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Monash University, Clayton, VIC, Australia
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Balachandar R, Pullakhandam R, Kulkarni B, Sachdev HS. Relative Efficacy of Vitamin D 2 and Vitamin D 3 in Improving Vitamin D Status: Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13103328. [PMID: 34684328 PMCID: PMC8538717 DOI: 10.3390/nu13103328] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Widespread prevalence of vitamin D deficiency has been documented globally. Commonly used interventions to address this deficiency include supplementation and/or fortification with either ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3), but the relative efficacy of these two vitamers is unclear. The current study aimed to evaluate the relative efficacy of ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3) for raising the serum levels of vitamin D metabolites and functional indicators including serum parathyroid (PTH) levels, isometric muscle strength, hand grip strength and bone mineral density. METHODS Randomized and non-randomized controlled studies evaluating relative efficacy of ergocalciferol and cholecalciferol were systematically reviewed to synthesize quantitative and qualitative evidence as per the recommendations of according to "Preferred Reporting Items for Systematic reviews and Meta-analysis" guidelines. Search terms were constructed on the basis of the "participants", "intervention", "control", "outcome" and "study type" (PICOS) strategy to systematically search the popular electronic databases. Relevant data from studies meeting inclusion and exclusion criteria were extracted and analyzed. Meta-regression, subgroup and sensitivity analyses were performed to investigate the influence of study-level characteristics including intervention dosage, frequency of dosing, interval between the last dose and test for outcome assessment, participant characteristics and analytical methods. RESULTS Apparently healthy human participants (n = 1277) from 24 studies were included for meta-analysis. The quantitative analysis suggested higher efficacy of cholecalciferol than ergocalciferol in improving total 25(OH)D (mean difference: 15.69, 95%CI: 9.46 to 21.93 nmol/L) and reducing PTH levels, consistently across variable participant demographics, dosage and vehicle of supplementation. Meta-regression suggested smaller differences in the efficacy of cholecalciferol and ergocalciferol at lower doses. Average daily dose was the single significant predictor of effect size, as revealed by multivariate meta-regression analysis. CONCLUSIONS Compared to ergocalciferol, cholecalciferol intervention was more efficacious in improving vitamin D status (serum levels of total 25(OH)D and 25(OH)D3) and regulating PTH levels, irrespective of the participant demographics, dosage and vehicle of supplementation.
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Affiliation(s)
- Rakesh Balachandar
- ICMR-National Institute of Occupational Health, Ahmedabad 380016, India;
| | | | - Bharati Kulkarni
- ICMR-National Institute of Nutrition, Hyderabad 500007, India;
- Correspondence:
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Kulkarni B, Peter R, Ghosh S, Pullakhandam R, Thomas T, Reddy GB, Rajkumar H, Kapil U, Deb S, Johnston R, Agrawal PK, De Wagt A, Kurpad AV, Sachdev HS. Prevalence of Iron Deficiency and its Sociodemographic Patterning in Indian Children and Adolescents: Findings from the Comprehensive National Nutrition Survey 2016-18. J Nutr 2021; 151:2422-2434. [PMID: 34049401 DOI: 10.1093/jn/nxab145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Anemia control programs in India focus mainly on the measurement of hemoglobin in response to iron-folic acid supplementation. However, representative national estimates of iron deficiency (ID) are not available. OBJECTIVES The objective of the present study was to evaluate ID prevalence among children and adolescents (1-19 y) using nationally representative data and to examine the sociodemographic patterning of ID. METHODS Cross-sectional data from the Comprehensive National Nutrition Survey in children (1-4 y: n = 9635; 5-9 y: n = 11,938) and adolescents (10-19 y; n = 11,507) on serum ferritin (SF) and other biomarkers were analyzed to determine inflammation-adjusted ID prevalence [SF (μg/L): <12 in 1-4 y and <15 in 5-19 y] and its relation to sociodemographic indicators. Multiple-regression analyses were conducted to identify the exposure associations of iron status. In addition, the relation between SF and hemoglobin was assessed as an indicator of iron utilization in different wealth quintiles. RESULTS ID prevalence was higher in 1- to 4-y-old children (31.9%; 95% CI: 31.0%, 32.8%) and adolescent girls (30.4%; 95% CI: 29.3%, 31.5%) but lower in adolescent boys and 5- to 9-y-old children (11%-15%). In all age groups, ID prevalence was higher in urban than in rural participants (1-4 y: 41% compared with 29%) and in those from richer quintiles (1-4 y: 44% in richest compared with 22% in poorest), despite adjustment for relevant confounders. SF significantly interacted with the wealth index, with declining trends in the strength of association between hemoglobin and SF from the richest to the poorest groups suggesting impaired iron utilization for hemoglobin synthesis in poorer wealth quintiles. CONCLUSIONS ID prevalence was indicative of moderate (in preschool children and adolescent girls) or mild (in 5- to 9-y-old children and adolescent boys) public health problem with significant variation by state and age. Focusing on increasing iron intake alone, without addressing the multiple environmental constraints related to poverty, may not result in intended benefits.
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Affiliation(s)
- Bharati Kulkarni
- ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Rajini Peter
- ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Santu Ghosh
- St. John's Medical College, Bangalore, India
| | - Raghu Pullakhandam
- ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | | | - G Bhanuprakash Reddy
- ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Hemalatha Rajkumar
- ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Umesh Kapil
- Department of Human Nutrition, All India Institute of Medical Sciences, Delhi, India
| | - Sila Deb
- Ministry of Health and Family Welfare, Delhi, India
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Sarna A, Porwal A, Acharya R, Ashraf S, Ramesh S, Khan N, Sinha S, Sachdev HS. Waist circumference, waist-to-height ratio and BMI percentiles in children aged 5 to 19 years in India: A population-based study. Obes Sci Pract 2021; 7:392-404. [PMID: 34401198 PMCID: PMC8346379 DOI: 10.1002/osp4.493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Nationally representative percentiles for waist circumference (WC), waist-to-height-ratio (WHtR), and body mass index (BMI) are not available for children and adolescents in India. METHODS Using LMS method, age- and gender-specific reference growth charts were constructed for WC (n = 68,261), WHtR (n = 68,261), and BMI (n = 67,741) from children/adolescents aged 5-19 years who participated in a nationally representative survey. General obesity, indicating overall obesity, was defined as age-sex-specific BMI z-scores ≥ 95th percentile. Central obesity was defined in three ways: WC ≥ 90th percentile, WHtR ≥ 0.5, and both WC ≥ 90th percentile and WHtR ≥ 0.5. FINDINGS WC and BMI percentiles for boys and girls are lower than those previously reported from India and several other countries. The BMI percentiles are lower than the WHO 2007 reference population. The prevalence of general obesity using India specific BMI centiles was 2.9% (95% CI: 2.6-3.2). The prevalence of central obesity was 6.1% (95% CI: 5.7-6.6) using WC ≥ 90th percentile, 5.3% (95% CI: 5.0-5.7) using WHtR ≥ 0.5, and 3.6% using both criteria. Three-fourth of children with general obesity also had central obesity based on WC ≥ 90th. CONCLUSIONS Indian children are thinner than Caucasian and other Asian children, and the global WHO reference population. Using India specific reference, the prevalence of central obesity is higher than general obesity with a significant overlap between the two.
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Affiliation(s)
- Avina Sarna
- Population CouncilZone 5AGround Floor India Habitat CentreNew DelhiIndia
| | - Akash Porwal
- Population CouncilZone 5AGround Floor India Habitat CentreNew DelhiIndia
| | - Rajib Acharya
- Population CouncilZone 5AGround Floor India Habitat CentreNew DelhiIndia
| | - Sana Ashraf
- Population CouncilZone 5AGround Floor India Habitat CentreNew DelhiIndia
| | - Sowmya Ramesh
- Population CouncilZone 5AGround Floor India Habitat CentreNew DelhiIndia
| | - Nizamuddin Khan
- Population CouncilZone 5AGround Floor India Habitat CentreNew DelhiIndia
| | | | - Harshpal Singh Sachdev
- Pediatrics and Clinical EpidemiologySitaram Bhartia Institute of Science and ResearchNew DelhiIndia
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Sinha S, Shah D, Osmond C, Fall CHD, Bhargava SK, Sachdev HS. Intergenerational change in anthropometry of children and adolescents in the New Delhi Birth Cohort. Int J Epidemiol 2021; 51:291-302. [PMID: 34279626 DOI: 10.1093/ije/dyab142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A comparison of the anthropometry of children and adolescents with that of their parents at the same age may provide a more precise measure of intergenerational changes in linear growth and body mass index (BMI). METHODS New Delhi Birth Cohort participants (F1), born between 1969 and 1972, were followed up for anthropometry at birth and at 6-monthly intervals until 21 years of age. At variable intervals 1447 children, aged 0-19 years (F2) and born to 818 F1 participants, were measured (weight and height), providing 2236 sets of anthropometries. Intergenerational changes (F2-F1) in height and BMI [absolute and standard deviation (SD) units] were computed by comparing children with their parents at corresponding ages. RESULTS F2 children were taller (P < 0.001) than their parents at corresponding ages; the increase {mean [95% confidence interval)CI)] World Health Organization SD units} was 0.97 (0.83, 1.11), 1.21 (1.10, 1.32), 1.09 (0.98, 1.19), 1.10 (1.00, 1.21) and 0.75 (0.65, 0.85) for age categories of 0-5, 5-7.5, 7.5-10, 10-12.5 and >12.5 years, respectively. In absolute terms, this increase ranged from 3.5 cm (0-5-year-olds) to 7.5 cm (10-12.5-year-olds). The corresponding increases in BMI SD scores were 0.32 (0.18, 0.47), 0.60 (0.45, 0.75), 1.13 (0.99, 1.27), 1.30 (1.15, 1.45) and 1.00 (0.85, 1.15), respectively. The absolute BMI increase ranged from 1-3 kg/m2 at >5 years age to ∼3 kg/m2 at >10-years of age. The intergenerational increases were comparable in both sexes, but were greater in children born and measured later. A positive change in socioeconomic status was associated with an increase in height across the generations. CONCLUSIONS Children and adolescents, throughout the ages 0-19 years, have become considerably taller and have a higher BMI than their parents at corresponding ages in an urban middle-class Indian population undergoing socioeconomic improvements.
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Affiliation(s)
- Sikha Sinha
- Division of Clinical Epidemiology and Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Dheeraj Shah
- Department of Pediatrics, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Harshpal Singh Sachdev
- Division of Clinical Epidemiology and Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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Rasaily R, Saxena NC, Pandey S, Garg BS, Swain S, Iyengar SD, Das V, Sinha S, Gupta S, Sinha A, Kumar S, Pandey A, Pandey RM, Sachdev HS, Sankar MJ, Ramji S, Paul VK, Bang AT. Effect of home-based newborn care on neonatal and infant mortality: a cluster randomised trial in India. BMJ Glob Health 2021; 5:bmjgh-2017-000680. [PMID: 32972965 PMCID: PMC7517550 DOI: 10.1136/bmjgh-2017-000680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/14/2018] [Accepted: 07/13/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Home-based newborn care has been found to reduce neonatal mortality in rural areas. Study evaluated effectiveness of home-based care delivered by specially recruited newborn care workers- Shishu Rakshak (SR) and existing workers- anganwadi workers (AWW) in reducing neonatal and infant mortality rates. METHODS This three-arm, community-based, cluster randomised trial was conducted in five districts in India. Intervention package consisted of pregnancy surveillance, health education, care at birth, care of normal/low birthweight neonates, identification and treatment of sick neonates and young infants using oral and injectable antibiotics and community mobilisation. The package was similar in both intervention arms-SR and AWW; difference being healthcare provider. The control arm received routine health services from the existing health system. Primary outcomes were neonatal and young infant mortality rates at 'endline' period (2008-2009) assessed by an independent team from January to April 2010 in the study clusters. FINDINGS A total of 6623, 6852 and 5898 births occurred in the SR, AWW and control arms, respectively, during the endline period; the proportion of facility births were 69.0%, 64.4% and 70.6% in the three arms. Baseline mortality rates were comparable in three arms. During the endline period, the risk of neonatal mortality was 25% lower in the SR arm (adjusted OR 0.75, 95% CI 0.57 to 0.99); the risks of early neonatal mortality, young infant mortality and infant mortality were also lower by 32%, 27%, and 33%, respectively. The risks of neonatal, early neonatal, young infant, infant mortality in the AWW arm were not different from that of the control arm. INTERPRETATION Home-based care is effective in reducing neonatal and infant mortality rates, when delivered by a dedicated worker, even in settings with high rates of facility births. TRIAL REGISTRATION NUMBER The study was registered with Clinical Trial Registry of India (CTRI/2011/12/002181).
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Affiliation(s)
- Reeta Rasaily
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - N C Saxena
- Indian Council of Medical Research (ICMR), New Delhi, India
| | | | - Bishan S Garg
- Mahatma Gandhi Institute of Medical Sciences (MGIMS), Wardha, India
| | - Saraswati Swain
- National Institute of Applied Human Research & Development (NIAHRD), Cuttack, India
| | | | - Vinita Das
- King George Medical University (KGMU), Lucknow, India
| | - Sheela Sinha
- Patna Medical College Hospital (PMCH), Patna, India
| | - Subodh Gupta
- Mahatma Gandhi Institute of Medical Sciences (MGIMS), Wardha, India
| | - Anju Sinha
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - Shiv Kumar
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - Arvind Pandey
- National Institute of Medical Statistics, New Delhi, India
| | | | | | | | | | - Vinod K Paul
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Abhay T Bang
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, India
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Sachdev HS, Porwal A, Acharya R, Ashraf S, Ramesh S, Khan N, Kapil U, Kurpad AV, Sarna A. Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1-19 years in India: a population-based study. Lancet Glob Health 2021; 9:e822-e831. [PMID: 33872581 PMCID: PMC7612991 DOI: 10.1016/s2214-109x(21)00077-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND WHO's haemoglobin cutoffs to define anemia were based on five studies of predominantly White adult populations, done over 50 years ago. Therefore, a general re-examination of the existing haemoglobin cutoffs is warranted for global application, in representative healthy populations of children and adults. Such data are scarce in low-income and middle-income countries; however, a 2019, large-scale, nationally representative survey of children and adolescents aged 0-19 years in India (Comprehensive National Nutrition Survey [CNNS]) offered an opportunity for this re-examination. Using this survey, we aimed to assess the age-specific and sex-specific percentiles of haemoglobin and cutoffs to define anaemia in the CNNS population. METHODS For this population-based study, we constructed age-specific and sex-specific haemoglobin percentiles from values reported for a defined healthy population in the CNNS, which used rigorous quality control measures during sample collection and in the laboratory analyses. To obtain a healthy population, we excluded participants with iron, folate, vitamin B12, and retinol deficiencies; inflammation; variant haemoglobins (haemoglobin A2 and haemoglobin S); and history of smoking. We considered age-specific and sex-specific 5th percentiles of haemoglobin derived for this healthy population as the study cutoff to define anaemia. We compared these with existing WHO cutoffs to assess significant differences between them at each year of age and sex for quantifying the prevalence of anaemia in the entire CNNS sample. FINDINGS Between Feb 24, 2016, and Oct 26, 2018, the CNNS survey collected blood samples from 49 486 individuals. 41 210 participants had a haemoglobin value, 8087 of whom were included in our study and comprised the primary analytical sample. Compared with existing WHO cutoffs, the study cutoffs for haemoglobin were lower at all ages, usually by 1-2 g/dL, but more so in children of both sexes aged 1-2 years and in girls aged 10 years or older. Aanemia prevalence with the study cutoffs was 19·2 percentage points lower than with WHO cutoffs in the entire CNNS sample with valid haemoglobin values across all ages and sexes (10·8% with study cutoffs vs 30·0% with WHO cutoffs). INTERPRETATION These findings support the re-examination of WHO haemoglobin cutoffs to define anaemia. Our haemoglobin reference percentiles, derived from healthy participants in a large representative Indian survey, are suitable for national use in India. Substantial variations in the 5th percentile of haemoglobin values across the 1-19 years age range and between sexes argue against constructing common cutoffs in stratified age groups for convenience. FUNDING None. TRANSLATIONS For the Hindi, Punjabi, Tamil and Kannada translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Harshpal Singh Sachdev
- Paediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India.
| | - Akash Porwal
- Population Council, India Habitat Centre, New Delhi, India
| | - Rajib Acharya
- Population Council, India Habitat Centre, New Delhi, India
| | - Sana Ashraf
- Population Council, India Habitat Centre, New Delhi, India
| | - Sowmya Ramesh
- Population Council, India Habitat Centre, New Delhi, India
| | | | - Umesh Kapil
- Department of Epidemiology, Biostatistics and Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, India
| | - Avina Sarna
- Population Council, India Habitat Centre, New Delhi, India
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Poveda NE, Hartwig FP, Victora CG, Adair LS, Barros FC, Bhargava SK, Horta BL, Lee NR, Martorell R, Mazariegos M, Menezes AMB, Norris SA, Richter LM, Sachdev HS, Stein A, Wehrmeister FC, Stein AD. Patterns of Growth in Childhood in Relation to Adult Schooling Attainment and Intelligence Quotient in 6 Birth Cohorts in Low- and Middle-Income Countries: Evidence from the Consortium of Health-Oriented Research in Transitioning Societies (COHORTS). J Nutr 2021; 151:2342-2352. [PMID: 33982126 PMCID: PMC8436131 DOI: 10.1093/jn/nxab096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Growth faltering has been associated with poor intellectual performance. The relative strengths of associations between growth in early and in later childhood remain underexplored. OBJECTIVES We examined the association between growth in childhood and adult human capital in 5 low- and middle-income countries (LMICs). METHODS We analyzed data from 9503 participants in 6 prospective birth cohorts from 5 LMICs (Brazil, Guatemala, India, the Philippines, and South Africa). We used linear and quasi-Poisson regression models to assess the associations between measures of height and relative weight at 4 age intervals [birth, age ∼2 y, midchildhood (MC), adulthood] and 2 dimensions of adult human capital [schooling attainment and Intelligence Quotient (IQ)]. RESULTS Meta-analysis of site- and sex-specific estimates showed statistically significant associations between size at birth and height at ∼2 y and the 2 outcomes (P < 0.001). Weight and length at birth and linear growth from birth to ∼2 y of age (1 z-score difference) were positively associated with schooling attainment (β: 0.13; 95% CI: 0.08, 0.19, β: 0.17; 95% CI: 0.07, 0.32, and β: 0.25, 95% CI: 0.10, 0.40, respectively) and adult IQ (β: 0.74, 95% CI: 0.35, 1.14, β: 0.73, 95% CI: 0.35, 1.10, and β: 1.52, 95% CI: 0.96, 2.08, respectively). Linear growth from age 2 y to MC and from MC to adulthood was not associated with higher school attainment or IQ. Change in relative weight in early childhood, MC, and adulthood was not associated with either outcome. CONCLUSIONS Linear growth in the first 1000 d is a predictor of schooling attainment and IQ in adulthood in LMICs. Linear growth in later periods was not associated with either of these outcomes. Changes in relative weight across the life course were not associated with schooling and IQ in adulthood.
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Affiliation(s)
- Natalia E Poveda
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Fernando P Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fernando C Barros
- Postgraduate Program in Health and Behaviour, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Santosh K Bhargava
- Consultant Pediatrician and Founder New Delhi Birth Cohort, New Delhi, India
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Nanette R Lee
- USC-Office of Population Studies Foundation, Inc, University of San Carlos – TC, Talamban, Cebu City, Cebu, Philippines
| | - Reynaldo Martorell
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa,Global Health Research Institute, School of Human Development and Health & NIHR Southampton Biomedical Research Centre, University of Southampton, United Kingdom
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Harshpal Singh Sachdev
- Senior Consultant Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Alan Stein
- Department of Psychiatr, University of Oxford, Oxford, United Kingdom,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gupta A, Kant S, Ramakrishnan L, Pandey RM, Khandelwal R, Kapil U, Sachdev HS. Impact of daily-supervised administration of a package of iron and folic acid and vitamin B 12 on hemoglobin levels among adolescent girls (12-19 years): a cluster randomized control trial. Eur J Clin Nutr 2021; 75:1588-1597. [PMID: 33828241 DOI: 10.1038/s41430-021-00878-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The prevalence of anemia has remained high among Indian adolescent girls over the past decade, despite the ongoing iron and folic acid (IFA) supplementation program. This study was conducted to assess the impact of daily supplementation of a package of IFA with vitamin B12 on hemoglobin levels among adolescent girls. METHODS A community-based cluster-randomized trial was conducted in the rural block of Faridabad District, Haryana, India in the year 2017. A total of 760 adolescent girls in the age group of 12-19 years with mild and moderate anemia were selected from government schools. Daily-supervised administration of iron and folic acid was conducted for 90 days: experimental group-IFA (iron (60 mg), folic acid (500) mcg), and cyanocobalamin (1000 mcg), control group-IFA and placebo. Hemoglobin, serum ferritin, and vitamin B12 levels were assessed at baseline and endline. RESULTS Two-hundred adolescent girls completed 90 doses of daily supplementation. The mean hemoglobin (experimental group: 1.3 ± 1.0 g/dL, control group: 1.6 ± 1.2 g/dL, P = 0.004) and ferritin levels (experimental group: 18.6 ± 31.5 ng/mL, control group: 18.8 ± 35.0 ng/mL, P = 0.188) increased in both the control and experiment groups. Serum vitamin B12 deficiency significantly reduced to 2.5% in the experimental group and ferritin deficiency alleviated in more than 96% of the girls post intervention. CONCLUSIONS Daily supplementation of IFA with/without vitamin B12 for 90 days eliminated iron, vitamin B12 deficiency and reduced the overall proportion of anemia by 53.5%. However, addition of vitamin B12 to IFA supplementation had no impact on improving the hemoglobin levels among adolescent girls. The present study does not recommend provision of vitamin B12 for prevention and treatment of anemia in this population group.
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Affiliation(s)
- Aakriti Gupta
- Departments of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ritika Khandelwal
- Departments of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Umesh Kapil
- Departments of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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Kumaran K, Krishnaveni GV, Suryanarayana KG, Prasad MP, Belavendra A, Atkinson S, Balasubramaniam R, Bandsma RHJ, Bhutta ZA, Chandak GR, Comelli EM, Davidge ST, Dennis CL, Hammond GL, Jha P, Joseph KS, Joshi SR, Krishna M, Lee K, Lye S, McGowan P, Nepomnaschy P, Padvetnaya V, Pyne S, Sachdev HS, Sahariah SA, Singhal N, Trasler J, Yajnik CS, Baird J, Barker M, Martin MC, Husain N, Sellen D, Fall CHD, Shah PS, Matthews SG. Protocol for a cluster randomised trial evaluating a multifaceted intervention starting preconceptionally-Early Interventions to Support Trajectories for Healthy Life in India (EINSTEIN): a Healthy Life Trajectories Initiative (HeLTI) Study. BMJ Open 2021; 11:e045862. [PMID: 33593789 PMCID: PMC7888364 DOI: 10.1136/bmjopen-2020-045862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Healthy Life Trajectories Initiative is an international consortium comprising four harmonised but independently powered trials to evaluate whether an integrated intervention starting preconceptionally will reduce non-communicable disease risk in their children. This paper describes the protocol of the India study. METHODS AND ANALYSIS The study set in rural Mysore will recruit ~6000 married women over the age of 18 years. The village-based cluster randomised design has three arms (preconception, pregnancy and control; 35 villages per arm). The longitudinal multifaceted intervention package will be delivered by community health workers and comprise: (1) measures to optimise nutrition; (2) a group parenting programme integrated with cognitive-behavioral therapy; (3) a lifestyle behaviour change intervention to support women to achieve a diverse diet, exclusive breast feeding for the first 6 months, timely introduction of diverse and nutritious infant weaning foods, and adopt appropriate hygiene measures; and (4) the reduction of environmental pollution focusing on indoor air pollution and toxin avoidance.The primary outcome is adiposity in children at age 5 years, measured by fat mass index. We will report on a host of intermediate and process outcomes. We will collect a range of biospecimens including blood, urine, stool and saliva from the mothers, as well as umbilical cord blood, placenta and specimens from the offspring.An intention-to-treat analysis will be adopted to assess the effect of interventions on outcomes. We will also undertake process and economic evaluations to determine scalability and public health translation. ETHICS AND DISSEMINATION The study has been approved by the institutional ethics committee of the lead institute. Findings will be published in peer-reviewed journals. We will interact with policy makers at local, national and international agencies to enable translation. We will also share the findings with the participants and local community through community meetings, newsletters and local radio. TRIAL REGISTRATION NUMBER ISRCTN20161479, CTRI/2020/12/030134; Pre-results.
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Affiliation(s)
- Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Kumar Gavali Suryanarayana
- Department of Academics and Research, Vivekananda Memorial Hospital, Saragur, Karnataka, India
- Development Support, Swami Vivekananda Youth Movement, Mysore, India
| | - Manohar Prabhu Prasad
- Department of Academics and Research, Vivekananda Memorial Hospital, Saragur, Karnataka, India
| | | | - Stephanie Atkinson
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Robert H J Bandsma
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences and Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Giriraj Ratan Chandak
- Genomic Research on Complex Diseases, CSIR - Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Elena M Comelli
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Toronto, Ontario, Canada
| | - Sandra T Davidge
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Geoffrey L Hammond
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Prabhat Jha
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - K S Joseph
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sadhana R Joshi
- Nutritional Medicine Division, Interactive Research School for Health Affairs, Bharati Vidyapeeth, Pune, India
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
| | - Kang Lee
- Department of Applied Psychology and Human Development, OISE/University of Toronto, Toronto, Ontario, Canada
| | - Stephen Lye
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Departments of Obstetrics & Gynecology, Physiology, and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patrick McGowan
- Department of Biological Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Pablo Nepomnaschy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Vivek Padvetnaya
- Jindal School of Government and Public Policy, O.P. Jindal Global University, Sonipat, Haryana, India
| | - Saumyadipta Pyne
- Public Health Dynamics Lab and Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Health Analytics Network, Pennsylvania, Harrisburg, USA
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Sirazul Ameen Sahariah
- Reproductive Maternal Newborn Child and Adolescent Health and Nutrition, MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
| | - Nalini Singhal
- Department of Paediatrics, University of Calgary, Calgary, Mull, Canada
| | - Jacquetta Trasler
- Departments of Pediatrics, Human Genetics, and Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Janis Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
| | - Marie-Claude Martin
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Daniel Sellen
- Joannah and Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Anthropology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Paediatrics and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephen G Matthews
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Departments of Obstetrics & Gynecology, Physiology, and Medicine, University of Toronto, Toronto, Ontario, Canada
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Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, Balabanova D, Bhutta ZA, Borrazzo J, Claeson M, Doherty T, El-Jardali F, George AS, Gichaga A, Gram L, Hipgrave DB, Kwamie A, Meng Q, Mercer R, Narain S, Nsungwa-Sabiiti J, Olumide AO, Osrin D, Powell-Jackson T, Rasanathan K, Rasul I, Reid P, Requejo J, Rohde SS, Rollins N, Romedenne M, Singh Sachdev H, Saleh R, Shawar YR, Shiffman J, Simon J, Sly PD, Stenberg K, Tomlinson M, Ved RR, Costello A. After COVID-19, a future for the world's children? Lancet 2020; 396:298-300. [PMID: 32622373 PMCID: PMC7332261 DOI: 10.1016/s0140-6736(20)31481-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/21/2022]
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Abraham RA, Agrawal PK, Johnston R, Ramesh S, Porwal A, Sarna A, Acharya R, Khan N, Sachdev HS, Kapil U, Saxena R, Janmohamed A, Wagt A, Deb S, Khera A, Ramakrishnan L. Comparison of hemoglobin concentrations measured by HemoCue and a hematology analyzer in Indian children and adolescents 1‐19 years of age. Int J Lab Hematol 2020; 42:e155-e159. [DOI: 10.1111/ijlh.13209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/26/2020] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ransi Ann Abraham
- Department of Cardiac Biochemistry All India Institute of Medical Sciences New Delhi India
| | | | | | | | | | | | | | | | - Harshpal Singh Sachdev
- Paediatrics and Clinical Epidemiology Sitaram Bhartia Institute of Science and Research New Delhi India
| | - Umesh Kapil
- Department of Human Nutrition All India Institute of Medical Sciences New Delhi India
| | - Renu Saxena
- Department of Hematology All India Institute of Medical Sciences New Delhi India
| | | | | | - Sila Deb
- Ministry of Health and Family Welfare New Delhi India
| | - Ajay Khera
- Ministry of Health and Family Welfare New Delhi India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry All India Institute of Medical Sciences New Delhi India
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49
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Kuriyan R, Naqvi S, Bhat KG, Ghosh S, Rao S, Preston T, Sachdev HS, Kurpad AV. The Thin But Fat Phenotype is Uncommon at Birth in Indian Babies. J Nutr 2020; 150:826-832. [PMID: 31858112 DOI: 10.1093/jn/nxz305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/15/2019] [Accepted: 11/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Indian babies are hypothesized to be born thin but fat. This has not been confirmed with precise measurements at birth. If it is true, it could track into later life and confer risk of noncommunicable diseases (NCDs). OBJECTIVES Primarily, to accurately measure percentage of body fat (%BF) and body cell mass (BCM) in Indian babies with normal birth weight, compare them across different gestational ages and sex, and test the hypothesis of the thin but fat phenotype in Indian babies. Secondarily, to examine the relation between body weight and body fat in Indian babies. METHODS Term newborns (n = 156) weighing ≥2500 g, from middle socioeconomic status mothers were recruited in Bengaluru, India, and their anthropometry, %BF (air displacement plethysmography), and BCM (whole-body potassium counter) were measured. Maternal demography and anthropometry were recorded. The mean %BF and its dispersion were compared with earlier studies. The relation between newborn %BF and body weight was explored by regression analysis. RESULTS Mean birth weight was 3.0 ± 0.3 kg, with mean %BF 9.8 ± 3.5%, which was comparable to pooled estimates of %BF from published studies (9.8%; 95% CI: 9.7, 10.0; P > 0.05). Appropriate-for-gestational age (AGA) babies had higher %BF (1.8%) compared to small-for-gestational age (SGA) babies (P < 0.01). Mean %BCM of all babies at birth was 35.4 ± 10.5%; AGA babies had higher %BCM compared to SGA babies (7.0%, P < 0.05). Girls in comparison to boys had significantly higher %BF and lower %BCM. Body weight was positively associated with %BF. CONCLUSION Indian babies with normal birth weight did not demonstrate the thin but fat phenotype. Body weight and fat had positive correlation, such that SGA babies did not show a preservation of their %BF. These findings will have relevance in planning optimal interventions during early childhood to prevent NCDs risk in adult life.
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Affiliation(s)
- Rebecca Kuriyan
- Division of Nutrition, St. John's Research Institute, Bengaluru, India
| | - Saba Naqvi
- Division of Nutrition, St. John's Research Institute, Bengaluru, India
| | - Kishor G Bhat
- Division of Nutrition, St. John's Research Institute, Bengaluru, India
| | - Santu Ghosh
- Division of Epidemiology and Biostatistics, St. John's Medical College, Bengaluru, India
| | - Suman Rao
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Thomas Preston
- Stable Isotope Biochemistry Laboratory, Scottish Universities Environmental Research Centre, Glasgow, UK
| | | | - Anura V Kurpad
- Department of Physiology, St. John's Medical College, Bengaluru, India
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50
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Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, Balabanova D, Bhan MK, Bhutta ZA, Borrazzo J, Claeson M, Doherty T, El-Jardali F, George AS, Gichaga A, Gram L, Hipgrave DB, Kwamie A, Meng Q, Mercer R, Narain S, Nsungwa-Sabiiti J, Olumide AO, Osrin D, Powell-Jackson T, Rasanathan K, Rasul I, Reid P, Requejo J, Rohde SS, Rollins N, Romedenne M, Singh Sachdev H, Saleh R, Shawar YR, Shiffman J, Simon J, Sly PD, Stenberg K, Tomlinson M, Ved RR, Costello A. A future for the world's children? A WHO-UNICEF-Lancet Commission. Lancet 2020; 395:605-658. [PMID: 32085821 DOI: 10.1016/s0140-6736(19)32540-1] [Citation(s) in RCA: 377] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Helen Clark
- The Helen Clark Foundation, Auckland, New Zealand; Partnership for Maternal Newborn & Child Health, Geneva, Switzerland
| | | | - Anshu Banerjee
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Stefan Peterson
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Sarah L Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, OT, Canada; Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - John Borrazzo
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Mariam Claeson
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Fadi El-Jardali
- Department of Health Management and Policy, Beirut, Lebanon; Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Asha S George
- School of Public Health, University of Western Cape, Bellville, South Africa
| | | | - Lu Gram
- Institute for Global Health, London, UK
| | - David B Hipgrave
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Aku Kwamie
- Health Policy and Systems Research Consultant, Accra, Ghana
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Raúl Mercer
- Program of Social Sciences and Health, Latin American School of Social Sciences, Buenos Aires, Argentina
| | - Sunita Narain
- Centre for Science and Environment, New Delhi, India
| | | | | | | | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Papaarangi Reid
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, Data and Analytics Section, New York, USA
| | - Sarah S Rohde
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Nigel Rollins
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | | | - Harshpal Singh Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Rana Saleh
- Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Yusra R Shawar
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy Shiffman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jonathon Simon
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, QLD, Australia
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rajani R Ved
- National Health Systems Resource Centre, New Delhi, India
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