Placental expression of miR-21-5p, miR-210-3p and miR-141-3p: relation to human fetoplacental growth

BACKGROUND/OBJECTIVES

Dysregulation of microRNAs (miRNAs) and their target genes in placental tissue is associated with foetal growth restriction. We aimed to evaluate associations of placental miR-21-5p, miR-141-3p and miR-210-3p expression with maternal, placental and newborn parameters and with placental expression of their potential target genes PTEN, VEGF, FLT and ENG in a set of well-characterized small- (SGA) and appropriate- (AGA) for gestational age full-term singleton pregnancies.

SUBJECTS/METHODS

Placental samples (n = 80) from 26 SGA and 54 AGA were collected from full-term singleton pregnancies. Placental transcript abundances of miR-21-5p, miR-141-3p and miR-210-3p were assessed after normalization to a reference miRNA, mir-16-5p by real-time quantitative PCR. Placental transcript abundances of PTEN, VEGF, FLT and ENG were assessed after normalizing to a panel of reference genes.

RESULTS

Placental miR-21-5p transcript abundance was negatively associated with placental weight (n = 80, r = -0.222, P = 0.047) and this association was specific to the AGA births (n = 54, r = -0.292, P = 0.032). Placental transcript abundances of miR-210-3p and miR-141-3p were not associated with placental weight or birth weight in all 80 births. However, placental miR-210-3p transcript abundance was positively associated with birth weight specifically in the SGA births (n = 26, r = 0.449, P = 0.021). Placental transcript abundance of miR-21-5p was negatively associated with PTEN transcript abundance (Spearman's ρ = -0.245, P = 0.028) while that of miR-141-3p was positively associated with FLT (Spearman's ρ = 0.261, P = 0.019) and ENG (Spearman's ρ = 0.259, P = 0.020) transcript abundances in all 80 births.

CONCLUSION

We conclude that placental miR-21-5p and miR-210-3p may be involved in fetoplacental growth. However, this regulation is unlikely to be mediated through placental expression of PTEN, VEGF, FLT or ENG.

Placental expression of RNU44, RNU48 and miR-16-5p: stability and relations with fetoplacental growth

BACKGROUND/OBJECTIVES

The current study aimed to identify suitable reference miRNA for placental miRNA expression analysis in a set of well-characterized and fetal-sex balanced small- (SGA) and appropriate- (AGA) for gestational age full-term singleton pregnancies.

SUBJECTS/METHODS

In this retrospective study, placental samples (n = 106) from 35 SGA (19 male and 16 female) and 71 AGA (30 male and 41 female) full-term singleton pregnancies were utilized. Placental transcript abundance of three widely used reference miRNAs [miR-16-5p and Small nucleolar RNAs (snoRNAs) RNU44 and RNU48] were assessed by real-time quantitative PCR. Raw cycle threshold (C_t) analysis and RefFinder tool analysis were conducted for evaluating stability of expression of these miRNAs.

RESULTS

Raw C_t values of miR-16-5p were similar between SGA and AGA births (P = 0.140) and between male and female births within SGA (P = 0.159) and AGA (P = 0.060) births while that of RNU44 and RNU48 were higher in SGA births (P = 0.008 and 0.006 respectively) and in male births within the SGA group (P = 0.005) for RNU44 and in female births within the AGA group (P = 0.048) for RNU48. Across all 106 samples tested using the RefFinder tool, miR-16-5p and RNU44 were equally stable reference miRNAs.

CONCLUSION

We recommend miR-16-5p and RNU44 as suitable reference miRNAs for placental samples from settings similar to our study.

Placental expression of leptin: fetal sex-independent relation with human placental growth

OBJECTIVES

Leptin (LEP) is a vital placental hormone that is known to affect different aspects of placental function and fetal development. The present study aimed to determine the association of placental LEP transcript abundance with maternal, placental, and newborn parameters.

SUBJECTS/METHODS

In this retrospective case-control study, placental samples (n = 105) were collected from small (SGA) and appropriate (AGA) for gestational age full-term singleton pregnancies (n = 44 SGA and n = 61 AGA). Placental transcript abundance of LEP was assessed by real-time quantitative PCR after normalization to a reference gene panel. LEP methylation was measured using a quantitative MethyLight assay in a subset of samples (n = 54).

RESULTS

Placental LEP transcript abundance was negatively and significantly associated with placental weight (β = -3.883, P = 0.015). This association continued to be significant in the SGA group (β = -10.332, P = 0.001), both in female (β = -15.423, P = 0.021) and male births (β = -10.029, P = 0.007). LEP transcript abundance was not associated with LEP methylation levels (Spearman's ρ = 0.148, P = 0.287).

CONCLUSION

We conclude that placental upregulation of LEP is an integral and fetal sex-independent component of placental growth restriction, which can be potentially targeted through maternal dietary modifications to improve fetoplacental growth.

Placental expression of ENG, VEGF, and FLT: Gender-specific associations with maternal vitamin B12 status

OBJECTIVES

Adequate vitamin B₁₂ is a requisite during pregnancy and its deficiency is linked with increased risk for adverse outcomes, likely mediated by impaired placental angiogenesis. Thus, we aimed to test associations of maternal vitamin B₁₂ status with the placental expression of angiogenesis-associated genes ENG, VEGF, and FLT.

SUBJECTS/METHODS

In this retrospective case-control study, placental and maternal trimester 1 blood samples (n = 104) were collected from small for gestational age (SGA) and appropriate for gestational age (AGA) full-term singleton pregnancies. Maternal trimester 1 vitamin B₁₂ status was measured. Placentae and neonates were weighed at birth. Realtime quantitative PCR was performed to assess placental transcript abundance of ENG, VEGF, and FLT normalized to a panel of reference genes. Associations of placental transcript abundance of the genes with maternal trimester 1 vitamin B₁₂ status were evaluated.

RESULTS

Placental ENG transcript abundance associated negatively with maternal trimester 1 vitamin B₁₂ status (β = -0.461, P = 0.017, n = 104). This association was specific to the female births (β = -0.590, P = 0.014, n = 60). Placental VEGF transcript levels were negatively associated with maternal trimester 1 vitamin B₁₂ status only in the female births (β = -1.995, P = 0.029). Placental FLT transcript levels were not associated with maternal trimester 1 vitamin B₁₂ status.

CONCLUSION

Maternal trimester 1 vitamin B₁₂ status was associated negatively with placental ENG and VEGF expression predominantly in the female births. Therefore, we hypothesize that the placenta adapts to low maternal vitamin B₁₂ status by up-regulating angiogenic pathways in a gender-specific manner.

Evidence of higher intramyocellular fat among normal and overweight Indians with prediabetes

BACKGROUND

The rise in prevalence rates of Type 2 Diabetes among Indians is well recognized. The research focus has been primarily to understand the changes in insulin sensitivity and beta cell dysfunction among Indians with Type 2 Diabetes. However, no data are available on the role of peripheral tissue, in particular intramyocellular lipid (IMCL) content and its impact on glucose homeostasis among Indians with prediabetes.

METHODS

28 male subjects (20-40 year) were studied. 13 with prediabetes (BMI ranging from 25.4 ± 2.9 kg/m²) and 15 controls (BMI ranging from 24.6 ± 2.8 kg/m²) were recruited. Body composition by dual energy X-ray absorptiometry (DXA), insulin sensitivity, insulin secretion rates were derived using the minimal model of C-peptide secretion and kinetics rates and skeletal muscle strength of the lower limb (quadriceps) was assessed using Isokinetic dynamometry. From muscle biopsy samples of the vastus lateralis, IMCL fat content (Oil red O staining) was determined.

RESULTS

The prediabetes group were older compared to controls (P < 0.01), but had similar BMI. The muscle to fat ratio, plasma Insulin, C peptide, HOMA-IR and HOMA % B were also comparable between the groups. IMCL fat content (%) was significantly higher in the prediabetes group compared to controls (7.0 ± 0.7% vs. 2.0 ± 0.3%, P < 0.01). This difference persisted even after controlling for age. Overall the IMCL fat content (%) was positively and significantly associated with HbA1c (r = 0.76, P < 0.01). HOMA-IR was significantly correlated with central (android, trunk) adiposity (kg) (r = 0.71, P < 0.01) but not with IMCL (%).

CONCLUSIONS

This is the first direct evidence of existence of significantly higher lipid levels within skeletal muscle cells among normal and overweight young Indians with prediabetes. However, there was no association between IMCL and HOMA-IR among the prediabetes group.

Fetal sex modifies the effect of maternal macronutrient intake on the incidence of small-for-gestational-age births: a prospective observational cohort study

Background

Maternal macronutrient intake is likely to play a pivotal role in fetoplacental growth. Male fetuses grow faster and their growth is more responsive to maternal size.

Objective

We assessed the role of fetal sex in modifying the effect of maternal macronutrient intake on the risk of small-for-gestational-age (SGA) birth.

Design

This was a prospective, observational cohort study of 2035 births from an urban South Asian Indian population. Maternal intakes of total energy and macronutrients were recorded by validated food-frequency questionnaires. The interaction of trimester 1 macronutrient intake with fetal sex was tested on the outcome of SGA births.

Results

The prevalence of SGA was 28%. Trimester 1 macronutrient composition was high in carbohydrate and low in fat (means ± SDs-carbohydrate: 64.6% ± 5.1%; protein: 11.5% ± 1.1%; and fat: 23.9% ± 4.4% of energy). Higher carbohydrate and lower fat consumption were each associated with an increased risk of SGA [adjusted OR (AOR) per 5% of energy (95% CI): carbohydrate: 1.15 (1.01, 1.32); fat: 0.83 (0.71, 0.97)] specifically among male births (males: n = 1047; females: n = 988). Dietary intake of >70% of energy from carbohydrate was also associated with increased risk (AOR: 1.67; 95% CI: 1.00, 2.78), whereas >25% of energy from fat intake was associated with decreased risk (AOR: 0.61; 95% CI: 0.41, 0.90) of SGA in male births.

Conclusions

Higher carbohydrate and lower fat intakes early in pregnancy were associated with increased risk of male SGA births. Therefore, we speculate that fetal sex acts as a modifier of the role of maternal periconceptional nutrition in optimal fetoplacental growth.

Maternal intake of milk and milk proteins is positively associated with birth weight: A prospective observational cohort study

BACKGROUND

A striking number of low birth weight (LBW) Indian babies are born annually. Previous studies have confirmed the positive association between milk intake and birth weight. However, the relations between protein and vitamin B₁₂ from milk and birth weight have not been systematically explored.

AIMS

We examined the relations between birth weight and maternal intake of milk, protein from milk and vitamin B₁₂ from milk.

METHODS

This prospective, observational cohort study was conducted in an urban South Indian hospital. The dietary intakes of milk and milk products were assessed using validated food frequency questionnaire and at delivery birth outcomes were measured. The relations between milk products, milk protein, and vitamin B₁₂ from milk with birth weight and gestational weight gain were assessed in 2036 births with first trimester dietary and delivery data.

RESULTS

Median consumption of milk products in the first trimester was 310 g·day^-1 and average birth weight was 2876 g. Birth weight was positively associated with intake of milk products and of % protein from milk products (%milk protein) in the first trimester [β = 86.8, 95% confidence interval (CI): 29.1, 144.6; β = 63.1, 95% CI: 10.8, 115.5; P < 0.001 for both]. Intake of milk products and of %milk protein in the third trimester was positively associated with gestational weight gain (GWG) between the second and third trimester (One-way ANOVA, P < 0.001 and = 0.001, respectively). Neither birth weight nor GWG were associated with %vitamin B₁₂ from milk products.

CONCLUSIONS

These findings indicate that intake of milk products in the first trimester and especially, protein from milk products is positively associated with birth weight in this South Asian Indian population.

Vitamin B12 status in pregnant women and their infants in South India

BACKGROUND/OBJECTIVES

Vitamin B₁₂ deficiency during pregnancy has been associated with increased risk of adverse perinatal outcomes. However, few studies have investigated the burden and determinants of vitamin B₁₂ status in young infants. This study was conducted to determine the associations between maternal and infant vitamin B₁₂ status.

SUBJECTS/METHODS

Pregnant women participating in a vitamin B₁₂ supplementation trial in Bangalore, India, were randomized to receive vitamin B₁₂ (50 μg) or placebo supplementation daily during pregnancy through 6 weeks postpartum. All women received 60 mg of iron and 500 μg of folic acid daily during pregnancy, as per standard of care. This prospective analysis was conducted to determine the associations between maternal vitamin B₁₂ biomarkers (that is, plasma vitamin B₁₂, methylmalonic acid (MMA) and tHcy) during each trimester with infant vitamin B₁₂ status (n=77) at 6 weeks of age.

RESULTS

At baseline (⩽14 weeks of gestation), 51% of mothers were vitamin B₁₂ deficient (vitamin B₁₂<150 pmol/l) and 43% had impaired vitamin B₁₂ status (vitamin B₁₂<150 pmol/l and MMA>0.26 μmol/l); 44% of infants were vitamin B₁₂ deficient at 6 weeks of age. After adjusting for vitamin B₁₂ supplementation, higher vitamin B₁₂ concentrations in each trimester were associated with increased infant vitamin B₁₂ concentrations and lower risk of vitamin B₁₂ deficiency in infants (P<0.05). After adjusting for vitamin B₁₂ supplementation, infants born to women with vitamin B₁₂ deficiency had a twofold greater risk of vitamin B₁₂ deficiency (P<0.01). Higher maternal folate concentrations also predicted lower risk of vitamin B₁₂ deficiency in infants (P<0.05). Impaired maternal vitamin B₁₂ status, which combined both circulating and functional biomarkers, was the single best predictor of infant vitamin B₁₂ status.

CONCLUSIONS

Impaired maternal vitamin B₁₂ status throughout pregnancy predicted higher risk of vitamin B₁₂ deficiency in infants, after adjusting for vitamin B₁₂ supplementation. Future interventions are needed to improve vitamin B₁₂ status periconceptionally, and to ensure optimal vitamin B₁₂ status and health outcomes in pregnant women and their children.

Waist-to-Height Ratio as an Indicator of High Blood Pressure in Urban Indian School Children

OBJECTIVE

To examine the utility of waist-to-height ratio to identify risk of high blood pressure when compared to body mass index and waist circumference in South Indian urban school children.

DESIGN

Secondary data analysis from a cross-sectional study.

SETTING

Urban schools around Bangalore, India.

PARTICIPANTS

1913 children (58.1% males) aged 6-16 years with no prior history of chronic illness (PEACH study).

METHODS

Height, weight, waist circumference and of blood pressure were measured. Children with blood pressure ?90th percentile of age-, sex-, and height-adjusted standards were labelled as having high blood pressure.

RESULTS

13.9% had a high waist-to-height ratio, 15.1% were overweight /obese and 21.7% had high waist circumference. High obesity indicators were associated with an increased risk of high blood pressure. The adjusted risk ratios (95% CI) of high systolic blood pressure with waist-to-height ratio, body mass index and waist circumference were 2.48 (1.76, 3.47), 2.59 (1.66, 4.04) and 2.38 (1.74, 3.26), respectively. Similar results were seen with high diastolic blood pressure.

CONCLUSION

Obesity indicators, especially waist-to-height ratio due to its ease of measurement, can be useful initial screening tools for risk of high blood pressure in urban Indian school children.

Body composition of term healthy Indian newborns

BACKGROUND/OBJECTIVES

Previous anthropometry-based studies have suggested that in Indian newborns fat mass is conserved at the expense of lean tissue. This study was undertaken to assess the body composition of Indian newborns and to evaluate its relation with parents' anthropometry, birth weight and early postnatal weight gain.

SUBJECTS/METHODS

Body composition of healthy term singleton newborns was assessed by the deuterium dilution method in the second week of life. Anthropometry was carried out at birth and on the day of study.

RESULTS

Data from 127 babies were analyzed. Birth weight was 2969±383 g. Body composition was assessed at a mean age of 12.7±3.1 days. Fat and fat-free mass were 354±246 and 2764±402 g, respectively, and fat mass percentage (FM%) was 11.3±7.3%. Birth weight and fat-free mass were higher among boys, but no gender difference was noted in FM%. Birth weight was positively correlated with fat as well as fat-free mass but not FM%. FM% showed positive correlation with gain in weight from birth to the day of assessment.

CONCLUSIONS

This is the first study from India to report body composition in newborns using deuterium dilution. FM% was comparable to that reported for Western populations for babies of similar age. Our results suggest that the percentage of fat and fat-free mass is relatively constant over the range of birth weights included in this study, and greater weight gain during early postnatal period results in greater increase in FM%.

Trier social stress test in Indian adolescents

OBJECTIVE

To test the Trier Social Stress Test for children (TSST-C) in a cohort of Indian adolescents.

DESIGN

Cohort study.

SETTING

Holdsworth Memorial Hospital, Mysore, India.

PARTICIPANTS

Adolescent children (N=273, 134 males; mean age 13.6 yrs) selected from an ongoing birth cohort; 269 completed the test.

INTERVENTION

Performance of 5-minutes each of public- speaking and mental arithmetic tasks in front of two unfamiliar 'evaluators'.

OUTCOME MEASURES

Salivary cortisol concentrations were measured at baseline and at regular intervals after the TSST-C. Continuous measurements of heart rate, finger blood pressure, stroke volume, cardiac output and systemic vascular resistance were carried out before, during and for 10 minutes after the TSST-C using a finger cuff.

RESULTS

Cortisol concentrations [mean increment (SD): 6.1 (6.9) ng/mL], heart rate [4.6 (10.1) bpm], systolic [24.2 (11.6) mmHg] and diastolic blood pressure [16.5 (7.3) mmHg], cardiac output [0.6 (0.7) L/min], stroke volume [4.0 (5.6) mL] and systemic vascular resistance [225 (282) dyn.s/cm5] increased significantly (P<0.001) from baseline after inducing stress.

CONCLUSIONS

The TSST-C produces stress responses in Indian adolescents of a sufficient magnitude to be a useful tool for examining stress physiology and its relationships to disease outcomes in this population.

Sleep and birthweight predict visceral adiposity in overweight/obese children

BACKGROUND

Visceral adiposity poses significant consequences for long-term health and it is important to identify methods that can be used to prevent fat deposition in visceral adipose tissue.

OBJECTIVE

To identify the factors contributing to differential fat distribution in overweight/obese children.

METHODS

Demographic, dietary and lifestyle factors potentially associated with increased visceral adipose tissue in overweight and obese South-Indian children aged 3 to 16 years. The diagnosis of visceral obesity was based on the waist-to-height ratio (WHtR) cut-off value of 0.5.

RESULTS

Exposure variables with statistically different distributions in the two WHtR categories, when examined by Mann-Whitney and chi-square tests, were used to develop a binary logistic regression model of visceral adiposity. Increased birthweight and higher sleep duration were significant predictors of having a healthy WHtR, with odds ratios of 1.30 and 1.26 respectively.

CONCLUSIONS

Early programming effects associated with low birthweight and current sleep deprivation could promote the storage of excess fat as visceral adipose tissue in overweight and obese children.

Complementary feeding patterns in India

There are far too many children in the world who suffer from under-nutrition and growth faltering, with life time consequences such as reduced work capacity, increased infections, impaired intellectual performance and an increased risk of non communicable diseases later in life. These changes occur early in life, and consequently, complementary feeding has been receiving increased attention in the international nutrition community. In India, common problems relate not only to insufficient breastfeeding, but also to detrimental feeding practices. Only about 20% of children aged 6-23 months were fed according to the three recommended Infant and Child Feeding practices. The most common types of solid or semi-solid foods fed to both breastfeeding and non-breastfeeding children under 3 years of age were foods made from grains and roots. These complementary feeding practices were found to be significantly associated with poor socioeconomic status, undesirable socio-cultural beliefs, maternal illiteracy, and ignorance. Although many initiatives have been carried out in India to promote Infant and Young Child Feeding, the progress in reducing the number of undernourished children in India over the last decade has been slow and modest. Equally, with the growing evidence and interest in the role of infant nutrition in the development of over nutrition and non-communicable disease, it is important to plan appropriate complementary feeding interventions that result in optimal growth. Contact opportunities with parents, specifically mothers, must be used for counseling through multiple communication channels such as local media, in order to constantly educate the population with consistent and simple messages on child feeding.

Mechanistic roles for calcium and vitamin D in the regulation of body weight

Low intakes of calcium and inadequate vitamin D status often cluster with higher prevalence rates of obesity. Consequently, there has been much interest in the mechanisms by which calcium and vitamin D could regulate body weight and adiposity. This review has focused on randomized controlled trials (RCTs) that have manipulated these nutrients and studied pathways of energy balance. Overall, there is consistent evidence that calcium and vitamin D increase whole body fat oxidation after single and multiple meals, and that calcium promotes a modest energy loss through increased faecal fat excretion. The evidence is equivocal for a greater diet-induced thermogenesis, increased lipolysis, suppression of key lipogenic enzymes, decreased hunger ratings or reduced energy/macronutrient intake. Emerging evidence suggests a potential improvement in insulin sensitivity following vitamin D that would impinge on food intake and substrate oxidation. However, the very few RCTs on supplemental vitamin D and energy balance have not explored postprandial avenues of the hormone's actions. Future efforts in this area need to define the threshold intake of these nutrients that would maximize metabolic and gastrointestinal outcomes. Such studies would provide a platform for endorsing the non-skeletal role of calcium and vitamin D in human pathophysiology.

The effect of a 1-year multiple micronutrient or n-3 fatty acid fortified food intervention on morbidity in Indian school children

BACKGROUND/OBJECTIVES

Few studies have shown that supplementation with micronutrients (MNs) or n-3 fatty acids may have health benefits such as reduced morbidity in schoolchildren. The effect of a combination of these nutrients has never been investigated. This study aimed to determine the effect of a combination of two different doses of MN and n-3 fatty acids on morbidity in schoolchildren in Bangalore, India.

SUBJECTS/METHODS

In all 598 children (6-10 years) received foods fortified with either high (100% recommended dietary allowance) or low (15% recommended dietary allowance) MN, combined with either high (900 mg α-linolenic acid (ALA) plus 100 mg docosahexaenoic acid) or low (140 mg ALA) n-3 fatty acids for 1 year. Morbidity was measured by weekly self-reports using a structured questionnaire. Poisson regression analyses of episodes/child/year and duration/episode adjusted for age and sex were performed on clusters of symptoms, including upper and lower respiratory tract infections (URTI and LRTI), gastrointestinal complaints (GI) and general symptoms of illness to observe MN and n-3 fatty acid treatment effects.

RESULTS

Children consuming high n-3 fatty acids had significantly fewer episodes of URTI/child/year (relative risk (RR)=0.88, 95% confidence interval (CI): 0.79, 0.97) and significantly shorter duration/episode of URTI (RR=0.81, 95% CI: 0.78, 0.85), LRTI (RR=0.91, 95% CI: 0.85, 0.97), GI complaints (RR=0.79, 95% CI: 0.74, 0.85) and general symptoms (RR=0.90, 95% CI: 0.82, 0.98) compared with children who received low n-3 fatty acid intervention. The high MN intervention reduced the duration of general symptoms (RR=0.89, 95% CI: 0.82, 0.98).

CONCLUSION

Although n-3 fatty acids may be beneficial for reducing illness in Indian schoolchildren, more research is needed to confirm presence of combined effect with MN.

Comparison of isotope dilution with bioelectrical impedance analysis among HIV-infected and HIV-uninfected pregnant women in Tanzania

BACKGROUND

Bioelectrical impedance analysis (BIA) is a simple tool to assess total body water (TBW), from which body composition can be estimated using statistical equations. However, standard BIA equations have not been sufficiently validated during pregnancy, in HIV infection, or in sub-Saharan Africa. We therefore compared TBW estimates from multifrequency BIA with those from the reference method deuterium isotope dilution (Deut) in a cohort of 30 HIV-uninfected and 30 HIV-infected pregnant women from Tanzania.

METHODS

We enrolled pregnant women presenting for routine antenatal care and collected data on pregnancy outcomes. At each trimester of gestation and once at 10-wk post-partum, we measured maternal anthropometry, TBW_BIA, and TBW_Deut.

RESULTS

TBW_BIA was highly correlated at each time point with TBW_Deut among HIV-infected (all P ≤0.001) and HIV-uninfected women (all P <0.0001). During pregnancy, mean TBW_BIA progressively underestimated TBW_Deut in the overall cohort; trimester-specific differences (mean ±SD) were -1.02 ±2.36 kg, -1.47 ±2.43 kg, and -2.42 ±2.63 kg, respectively. The difference at 10-wk postpartum was small (-0.24 ±2.07 kg). In Bland-Altman and regression models, TBW_BIA was subject to a systematic predictive bias at each antenatal and postnatal time point (all P ≤0.038). Among HIV-positive women, TBW_Deut measured during the first (P =0.02) and second trimester (P =0.03) was positively related to birthweight.

CONCLUSIONS

The validity of current BIA equations to assess TBW during pregnancy and in the postpartum period among women from sub-Saharan Africa remains uncertain. Deuterium dilution may assess aspects of maternal body composition relevant for pregnancy outcomes among HIV-infected women.

Cardiovascular autonomic responses to hyperinsulinemia in young adult males of normal and low body mass index

Acute hyperinsulinemia increases sympathetic nervous system activity, it is unclear if individuals of low body mass index (BMI) have different responses from those of normal BMI. Approximately 30% of adults in India have a low BMI and are likely to become hyperinsulinemic as they transition to better nutritional planes. We evaluated whether individuals of low BMI had different autonomic nervous responses to acute hyperinsulinemia as compared with individuals of normal BMI. 51 young men were divided into 2 groups based on their BMI. All subjects underwent anthropometry, physical activity levels and a hyperinsulinemic euglycemic clamp (HEC). Lead II ECG and beat to beat blood pressure were recorded during the HEC. Basal insulin level and steady state plasma insulin values during HEC were significantly higher in the normal BMI. Insulin sensitivity and glucose disposal rates during the HEC were significantly higher in the low BMI group. LF-RR power (nu) increased and HF-RR power (nu) decreased with hyperinsulinemia, resulting in a significant increase in LF/HF ratio but with no between-group differences. There was a significant increase in low frequency systolic blood pressure variability and a significant reduction in baroreflex sensitivity in both the groups with hyperinsulinemia. However, there were no between-group differences in the magnitude of these responses. The present study indicates that insulin mediated activation of the autonomic nervous system was comparable between low and normal BMI groups in spite of differences in insulin sensitivity and body composition and suggests that insulin mediated autonomic nervous activation is affected by other factors.

Childhood cognitive ability: relationship to gestational diabetes mellitus in India

AIMS/HYPOTHESIS

Our aim was to test the hypothesis that gestational diabetes mellitus (GDM) in mothers is associated with poorer cognitive ability in their offspring in India.

METHODS

During 1997 to 1998 maternal GDM status was assessed by OGTT at 30 +/- 2 weeks of gestation. Between 2007 and 2008, at a mean age of 9.7 years, 515 children (32 offspring of GDM mothers [ODM]; 483 offspring of non-GDM mothers [controls]) from the Mysore Parthenon birth cohort underwent cognitive function assessment using tests from the Kaufman Assessment Battery for Children--Second Edition and additional tests measuring learning, long-term storage/retrieval, short-term memory, reasoning, attention and concentration, and visuo-spatial and verbal abilities.

RESULTS

Compared with controls, ODM scored higher in tests for learning, long-term retrieval/storage (p = 0.008), reasoning (p = 0.02), verbal ability (p = 0.01), and attention and concentration (p = 0.003). In multiple regression, adjusted for the child's age, sex, gestation, neonatal weight and head circumference, maternal age, parity and BMI, and the parent's socioeconomic status, education and rural/urban residence, this difference remained significant only for learning, long-term retrieval/storage (beta = 0.4 SD (95% CI 0.01-0.75); p = 0.04) and verbal ability (beta = 0.5 SD (95% CI 0.09-0.83); p = 0.02), and not with other test scores.

CONCLUSIONS/INTERPRETATION

In this population of healthy Indian children, there was no evidence of lower cognitive ability in ODM. In fact some cognitive scores were higher in ODM.

Helicobacter pylori infection does not influence the efficacy of iron and vitamin B(12) fortification in marginally nourished Indian children

BACKGROUND/OBJECTIVES

Helicobacter pylori infection and iron and vitamin B(12) deficiencies are widespread in economically disadvantaged populations. There is emerging evidence that H. pylori infection has a negative effect on the absorption of these micronutrients. The aim of this study was to evaluate the effect of H. pylori infection on the efficacy of micronutrient (including iron and vitamin B(12))-fortified foods supplied for 1 year in marginally nourished children.

SUBJECTS/METHODS

In all, 543 Indian children, aged 6-10 years, participated in a double-blind, randomized controlled intervention trial, receiving foods fortified with either high (100% Recommended Dietary Allowances (RDA)) or low (15% RDA) amounts of iron, vitamin B(12) and other micronutrients. The presence of H. pylori infection was diagnosed by the (13)C-labeled urea breath test at 11 months after the start of the intervention. Blood hemoglobin, serum ferritin (SF), total body iron and plasma vitamin B(12) were estimated at baseline and 12 months, and differences between these time points were assessed using an independent t-test.

RESULTS

Overall, the prevalence of H. pylori infection in this group of children was 79%. Baseline hemoglobin, SF, body iron and vitamin B(12) concentrations were not associated with H. pylori infection. The response to the intervention (either high or low amounts of iron and vitamin B(12) fortification) in terms of change in iron markers and vitamin B(12) status did not differ between children with and without H. pylori infection.

CONCLUSIONS

This study shows that the presence of H. pylori infection did not affect the efficacy of long-term iron and vitamin B(12) fortification in these marginally nourished children.

Glucose kinetics and pregnancy outcome in Indian women with low and normal body mass indices

BACKGROUND/OBJECTIVES

Fetal energy demands are met from the oxidation of maternally supplied glucose and amino acids. During the fasted state, the glucose supply is thought to be met by gluconeogenesis. Underweight women with low body mass index (BMI) might be unable to adequately supply amino acids to satisfy the demands of gluconeogenesis.

SUBJECTS/METHODS

Glucose kinetics were measured during the first and second trimesters of pregnancy in 10 low-BMI and 10 normal-BMI pregnant women at the 12th hour of an overnight fast using a primed 6 h U-(13)C glucose infusion and was correlated to maternal dietary and anthropometric variables and birth weight.

RESULTS

Low-BMI mothers consumed more energy, carbohydrates and protein, had faster glucose production (R (a)) and oxidation rates in the first trimester. In the same trimester, dietary energy and carbohydrate correlated with glucose production, glycogenolysis and glucose oxidation in all women. Both groups had similar rates of gluconeogenesis in the first and second trimesters. Glucose R (a) in the second trimester was weakly correlated with the birth weight (r=0.4, P=0.07).

CONCLUSIONS

Maternal energy and carbohydrate intakes, not BMI, appear to influence glucose R (a) and oxidation in early and mid pregnancy.

In vivo arginine production and nitric oxide synthesis in pregnant Indian women with normal and low body mass indices

BACKGROUND/OBJECTIVES

Nitric oxide (NO) has been proposed as a mediator of vascular expansion during pregnancy. Inability to increase NO synthesis and/or production of its precursor, arginine, may be a contributor to pregnancy-induced hypertension or preeclampsia. Because maternal weight is associated with blood pressure and risk of preeclampsia during pregnancy, it may also influence arginine and/or NO production. The purpose of this study was to determine the in vivo arginine production and NO synthesis rate in pregnant women with normal (n=10) and low (n=10) body mass indices (BMIs).

SUBJECTS/METHODS

Arginine flux and NO synthesis rate were measured in the postabsorptive state with constant infusions of 15N2-arginine and 13C,2H4-citrulline. Plasma concentrations of arginine and NO metabolites were also measured. Kinetic parameters were correlated to maternal variables, gestational age, birth weight and blood pressure.

RESULTS

Endogenous arginine flux was significantly faster in the low-BMI compared with normal-BMI women in the first trimester (63.1+/-3.4 vs 50.2+/-2.0 micromol/kg per h, P<0.01), but not in the second. Plasma NO concentration was higher (44.7+/-5.3 vs 30.4+/-1.9 micromol/l, P=0.03) and its rate of synthesis trended faster in the low-BMI compared with normal-BMI group in the second trimester. Maternal weight and BMI were negatively correlated with arginine flux in both trimesters and NO synthesis in the second trimester.

CONCLUSIONS

These findings suggest, but do not prove, that maternal BMI may be a factor in the ability to produce NO during pregnancy and may be one way by which BMI influences blood pressure during pregnancy.

Insulin sensitivity and cardiac autonomic function in young male practitioners of yoga

BACKGROUND

While yoga is thought to reduce the risk of chronic non-communicable diseases such as diabetes, there are no studies on insulin sensitivity in long term practitioners of yoga. We assessed insulin sensitivity and cardiac autonomic function in long term practitioners of yoga.

METHODS

Fifteen healthy, young, male practitioners of yoga were compared with 15 young, healthy males who did not practice yoga matched for body-mass index. Fasting insulin sensitivity was measured in the fasting state by the hyperinsulinaemic-euglycaemic clamp.

RESULTS

There were no significant differences between the groups in their anthropometry or body composition. However, the fasting plasma insulin was significantly lower in the yoga group. The yoga group was also more insulin sensitive (yoga 7.82 [2.29] v. control 4.86 [11.97] (mg/[kg.min])/(microU/ml), p < 0.001). While the body weight and waist circumference were negatively correlated with glucose disposal rate in the controls, there were no similar correlations in the yoga group. The yoga group had significantly higher low-frequency power and lower normalized high-frequency power.

CONCLUSION

Long term yoga practice (for 1 year or more) is associated with increased insulin sensitivity and attenuates the negative relationship between body weight or waist circumference and insulin sensitivity.

Total body muscle mass estimation from bioelectrical impedance analysis & simple anthropometric measurements in Indian men

BACKGROUND & OBJECTIVE

Skeletal muscle mass represents about 30-40 per cent of the total body weight, and has important roles in function and metabolism. Although newer methods of measuring muscle mass are accurate and sophisticated, there is a need for methods that can be used in low resource settings. Existing methods of predicting muscle mass are based on mid upper arm circumference (MUAC) measurements, sometimes corrected for triceps skinfold fat. The present study was undertaken to develop predictive equations for estimating muscle mass from simple and non-invasive methods such as bioelectrical impedance (BIA) and anthropometric measurements (circumferences and skinfold thickness) in Indian men.

METHODS

BIA measurements and anthropometric measurements were carried out on 67 normal, healthy men between the ages of 18 and 45 yr. True muscle mass was measured from 24 h creatinine excretion. Multiple linear regression with step-wise forward selection was used to predict total muscle mass using measurements like height(2)/impedence, height and weight and using arm muscle area (AMA), thigh muscle area (TMA) and calf muscle area (CMA).

RESULTS

The prediction equation for muscle mass (kg) using height(2)/impedance and height was - 12.347+ (0.363 x height(2)/impedance) + (0.122 x height) [R(2) = 0.55; Standard error of estimate (SEE) = 2.58 kg], while the equation using appendicular muscle area was 10.122 + (0.23 x AMA)+ (0.049 x TMA) [R(2) 0.36; SEE 3.07 kg].

INTERPRETATION & CONCLUSION

This study provides prediction equations for estimating muscle mass in healthy Indian males from simple non invasive methods such as BIA and anthropometric measurements such as circumferences and skinfold thickness. Further studies need to be done on a larger sample size and using an external group to validate the equations.

The effect of fish and omega-3 LCPUFA intake on low birth weight in Indian pregnant women

BACKGROUND

Inadequate consumption of fish could be a risk factor for low birth weight (LBW). This study assessed fish intake and omega-3 LCPUFA intake and status for their association with LBW in a cohort of urban, south Indian pregnant women.

SUBJECTS/METHODS

In a prospective cohort study, data on maternal fish intake and omega-3 LCPUFA intake and status of 676 women were obtained at baseline (first trimester), the second and third trimesters of pregnancy. Infant birth weight was measured immediately following hospital delivery. The dropout rate was 7.6%.

RESULTS

Fifty-six percent of the study women consumed fish with low daily median intakes (3.4, 4.1 and 3.8 g day(-1) at the three trimesters, respectively). Consequently, the median intakes of EPA and DHA during pregnancy were also low at 2.1 and 10.1 mg day(-1), respectively. EPA and DHA intakes were associated with their status in erythrocyte membrane phospholipids during pregnancy (r=0.40 and 0.36, r=0.34 and 0.32 and r=0.37 and 0.41, at the three trimesters, respectively, all P<0.001). Women who did not eat fish during the third trimester had a significantly higher risk of LBW (OR: 2.49, P=0.019). Similarly, low EPA intake during the third trimester had an association with a higher risk of LBW (OR: 2.75, P=0.011).

CONCLUSIONS

Among low fish-eating pregnant women, fish intake in the third trimester was closely associated with birth weight. Supplementation with omega-3 LCPUFA during pregnancy may have important implications for fetal development in India.

Nutritional status of affluent Indian school children: what and how much do we know?

OBJECTIVE

This paper reviews available literature on nutritional status of Indian school children 6-18 years from middle and high socio economic status (MHSES).

METHODS

Literature search was conducted using Medline literature database search, followed by review of full length journal papers and unpublished materials such as research reports.

RESULTS

Studies showed that anemia prevalence (hemoglobin concentration <120 g/L) ranged from 19 to 88% across five different cities in India. Other micronutrient deficiencies including, folate, riboflavin, niacin, vitamin C, vitamin A, and vitamin B12 were also present based on biochemical parameters in one study and clinical signs of deficiency in three other studies. Overweight and obesity were prevalent among 8.5-29.0% and 1.5-7.4% respectively among school children, as indicated by 11 studies. Predominant components in children's diet were cereals and pulses, followed by milk and milk products; the fruits and vegetables component was comparatively lower.

CONCLUSION

Nutritional status of MHSES children in India needs attention especially with respect to the high prevalence of anemia, overweight and obesity. There are indications that micronutrient deficiencies exist, but sufficient data are lacking, in particular biochemical data. A current estimate, using well designed methodologies, of prevalence of micronutrient deficiencies and information on the etiology of anemia among children of MHSES groups would be valuable to help understand the nutritional status and extent of micronutrient malnutrition.

Low anemia prevalence in school-aged children in Bangalore, South India: possible effect of school health initiatives

OBJECTIVE

Anemia is a serious public health problem in Indian school children. Since 2003, simple health intervention programs such as antihelminthic treatment and vitamin A supplementation have been implemented in primary schools in the Bangalore region, Karnataka, India. This study examines the prevalence of anemia in school children who are beneficiaries of this program.

DESIGN

Cross-sectional survey.

SETTING

Bangalore district, South India.

SUBJECTS

A total of 2,030 boys and girls, aged 5-15 years, attending schools in the Bangalore district.

INTERVENTIONS

School-based, twice yearly intervention: deworming (albendazole 400 mg, single oral dose) and vitamin A supplementation (200,000 IU, single oral dose).

MAIN OUTCOME MEASURES

Anemia prevalence based on measure of blood hemoglobin (Hb).

RESULTS

Mean age and blood Hb concentration of all children were 9.5+/-2.6 years and 12.6+/-1.1 g/dl (range 5.6-16.7), respectively. The overall anemia prevalence in this group was 13.6%. Anemia prevalence was lower in boys than girls (12.0%; n=1037 vs 15.3%; n=993 respectively, P<0.05). There was no significant difference in anemia prevalence between children in urban and rural locations (14.6 and 12.3%, respectively).

CONCLUSIONS

The current low anemia prevalence in Bangalore could be due to the impact of school-based intervention programs that have been in place since 2003. The beneficial interactions of deworming and vitamin A supplementation could have widespread implications for current preventive public health initiatives. There is now need for the development of clear policy guidelines based on these simple and integrated interventions.

Measurement of 24 h energy expenditure in male tuberculosis patients

BACKGROUND & OBJECTIVES

The total daily energy expenditure in patients with infectious disease is presumed to be high because of an increase in the basal metabolic rate (BMR), a reason for the weight loss observed in these patients. A reduction in daily physical activity, which may reduce the total daily energy expenditure. The aim of this study was to measure the free living total daily energy expenditure and physical activity of newly diagnosed hospitalized patients with tuberculosis using the labelled bicarbonate method.

METHODS

In 6 healthy volunteers and 6 patients with newly diagnosed tuberculosis, 13C labelled bicarbonate method was used to measure free living total daily energy expenditure and physical activity. The 13C sodium bicarbonate (NaH13CO3) tracer was infused intravenously over a 48 h period and breath samples collected at regular intervals to estimate expired 13CO2.

RESULTS

The patients had a 14 per cent increase in their BMR although they were not febrile at the time of measurement. However, their total daily energy expenditure was lower than that of the controls (mean value of 8.3 and 10.3 mJ/day respectively) and their physical activity level was also lower (mean 1.4 and 1.6 units respectively).

INTERPRETATION & CONCLUSION

The total daily energy expenditure of afebrile patients with newly diagnosed tuberculosis is not higher than that of sedentary controls, despite an increased basal metabolic rate. It is possible that the observed weight loss in patients with tuberculosis is due to a reduced energy intake linked to anorexia associated with the disease. These findings may have relevance in nutritional treatment of chronic infections.

The effect of long term combined yoga practice on the basal metabolic rate of healthy adults

Background

Different procedures practiced in yoga have stimulatory or inhibitory effects on the basal metabolic rate when studied acutely. In daily life however, these procedures are usually practiced in combination. The purpose of the present study was to investigate the net change in the basal metabolic rate (BMR) of individuals actively engaging in a combination of yoga practices (asana or yogic postures, meditation and pranayama or breathing exercises) for a minimum period of six months, at a residential yoga education and research center at Bangalore.

Methods

The measured BMR of individuals practicing yoga through a combination of practices was compared with that of control subjects who did not practice yoga but led similar lifestyles.

Results

The BMR of the yoga practitioners was significantly lower than that of the non-yoga group, and was lower by about 13 % when adjusted for body weight (P < 0.001). This difference persisted when the groups were stratified by gender; however, the difference in BMR adjusted for body weight was greater in women than men (about 8 and 18% respectively). In addition, the mean BMR of the yoga group was significantly lower than their predicted values, while the mean BMR of non-yoga group was comparable with their predicted values derived from 1985 WHO/FAO/UNU predictive equations.

Conclusion

This study shows that there is a significantly reduced BMR, probably linked to reduced arousal, with the long term practice of yoga using a combination of stimulatory and inhibitory yogic practices.

Bicarbonate kinetics in Indian males

Measurement of rates of in vivo substrate oxidation such as that of glucose, fatty acids and amino acids, are based on tracer (14C or 13C) data, and often depend on the isotopic content of expired CO2. The recovery of tracer-labelled CO 2 generated from the oxidation of 13C labelled substrates may not be 100% over short term. This can lead to underestimation of oxidation rate of substrates, and consequently a correction for the incomplete recovery of tracer has to be applied by the determination of the recovery of 13CO2 in the breath during tracer bicarbonate infusions. We have studied the recovery of tracer-labelled bicarbonate using a bolus administration model, and further characterized kinetics of bicarbonate using a three-compartment model, to assess which compartmental fluxes changed during the change from a fasted state to fed state. Recovery of bicarbonate was lower at 69% and 67% (fasted and fed state) than the value of 71% and 74% found during earlier longer term of continuous infusions. During feeding, there was a 20-fold increase in the flux of bicarbonate between the central compartment and the compartment that was equivalent to the viscera. This study shows that the difference between the fasted and fed state recovery of tracer bicarbonate similar to that obtained with continuous infusions, and that bicarbonate fluxes show large changes between different compartments in the body depending on metabolic state.

Consequences of inadequate food energy and negative energy balance in humans

Energy deficiency is probably best measured in adults by the body mass index (BMI). Acute energy deficiency (AED) is associated with body weight loss, along with changes in body composition, as well as a reduced BMR and physical activity. Chronic energy deficiency (CED) is an inadequacy in food to which individuals adapt, at some cost. Individuals with this have never 'lost' weight: they have simply grown less. They adapt to the decreased food energy by reductions in their total energy expenditure (TEE), linked mainly to a lower body size, and to their physical activity. It seems unlikely that enhanced metabolic efficiency contributes substantially to energy saving in CED. Supplementation of energy deficient individuals is accompanied by significant fat deposition; this may have deleterious consequences. Women in many developing countries achieve a successful outcome to pregnancy in spite of being chronically undernourished. Reductions in basal metabolism and behavioural changes in the form of diminished physical activity could meet most of the extra energy needed for pregnancy. Milk energy output is maintained within the expected range in undernourished lactating mothers. Energy deficiency in children is best measured by height-for-age for stunting, and weight-for-height for wasting. Deficits in behavioural and functional parameters in children exist with undernutrition, and can be reduced by early nutritional supplementation along with the appropriate environment.

A simple method of measuring total daily energy expenditure and physical activity level from the heart rate in adult men

OBJECTIVE

To evaluate a simple method that uses only a heart rate monitor to predict total energy expenditure (TEE) and physical activity level (PAL) from 24 h heart rate (HR) measurements.

DESIGN

The simple method involved the determination of the physical activity ratio (PAR) from corresponding heart rate ratios (HRR) (ratio of observed to resting HR), from an individualized calibration curve relating activities with known PAR to the HRR. Several curve fits were evaluated for this curve. The PAL was calculated from minute to minute PAR. The TEE was computed as the product of the PAL and the predicted basal metabolic rate (BMR). The accuracy of the simple method was assessed by within-subject comparisons of the simple method versus the oxygen consumption - HR method and a time and motion study.

SETTING

Bangalore City, India.

SUBJECTS

In all, 17 healthy male subjects between 18 and 44 years were recruited for the study.

INTERVENTIONS

None.

RESULTS

The simple method correlated well with both the reference methods when using a calibration curve that involved the fitting of two straight lines at low and high PAR activities, respectively, to the PAR and HRR data. The mean error in TEE, as a product of BMR and PAL, was about 1%, but with limits of agreement between the methods that were about 20% of the TEE. However, the low mean error could have been due to a canceling of errors in the determination of BMR and PAL.

CONCLUSIONS

The simple method is a relatively cheap, useful technique for evaluating TEE and PAL in resource-poor situations. It may particularly be of use in epidemiological investigations where population estimates of TEE and PAL are required.

Low maternal vitamin B12 status is associated with intrauterine growth retardation in urban South Indians

OBJECTIVE

To assess the maternal sociodemographic, anthropometric, dietary and micronutrient status in apparently healthy pregnant women in order to determine their associations with intrauterine growth retardation (IUGR).

DESIGN

Prospective observational study.

SETTING

Bangalore City, India.

SUBJECTS

A total of 478 women were recruited at 12.9+/-3.3 weeks of gestation and followed up at the first, second and third trimesters of pregnancy and at delivery. The dropout rate was 8.5%.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Birth weight was measured at hospital delivery.

RESULTS

The mean birth weight was 2.85+/-0.45 kg. In all, 28.6% of newborns were IUGR. There was a strong inverse relationship between maternal educational level and risk of IUGR. A low body weight at baseline was also associated with a high risk of IUGR. Compared with women in the highest quartile for second trimester weight gain, those in the lowest quartile had a significantly higher adjusted odds ratio (AOR: 3.98; 95% CI: 1.83, 8.65) for IUGR. Women in the lowest tertile for serum vitamin B(12) concentration during each of the three trimesters of pregnancy had significantly higher risk of IUGR (AOR: 5.98, 9.28 and 2.81 for trimesters 1-3, respectively).

CONCLUSIONS

The present study demonstrates associations between educational status, maternal weight and gestational weight gain with IUGR. Importantly, in a subsample, there were strong associations of vitamin B(12) status with IUGR, suggesting that better socioeconomic conditions, improved nutritional status and early detection of vitamin B(12) deficiency in pregnancy combined with appropriate interventions are likely to play an important role in reducing IUGR.

Estimation of deep-abdominal-adipose-tissue (DAAT) accumulation from simple anthropometric measurements in Indian men and women

OBJECTIVE

To develop gender-specific predictive equations to measure the amount of deep-abdominal-adipose-tissue (DAAT) accumulation from simple anthropometric measurements.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 120 healthy men and women (40-79 years).

MEASUREMENTS

Body weights, circumferences, skinfolds, computed-Tomography (CT)-derived sagittal-diameters and the DAAT areas.

RESULTS

High significant correlations are seen between the indices of waist-circumferences, sagittal diameters and body weights to DAAT areas in both the sexes. Stepwise multiple regression analysis with all anthropometric measures gave 84% (SEE 38.7 cm(2)) of the variance in men and 72% (SEE 29 cm(2)) in women. Body weights, waist-circumferences and sagittal-diameters had more predictive power in men, and in women, the arm-circumferences replaced the sagittal diameters. Five models with categorical measures of circumferences, skinfolds, and sagittal diameters explained 74.8-82% of the variance in men and 62-70% in women. The simplest equation with least measurement indices, that is, body-weight, waist-circumference and body mass index explained 74% (SEE 27.7 cm(2)) of the variance in men: DAAT (cm(2))= -382.9+(1.09 x weight-(kg))+(6.04 x waist-(cm))+(-2.29 x BMI). For women, body-weight and waist-circumference explained 63% (SEE 31.79 cm(2)) of the variance: DAAT (cm(2))= -278+(-0.86 x weight-(kg))+(5.19 x waist-(cm)).

CONCLUSION

Body weight emerged as the outstanding index to measure the DAAT areas. Following anthropometric measures are the waist circumferences, sagittal diameters and BMI. Although the ability to estimate the amount of DAAT from anthropometry is limited, practical predictive models have been developed.

Evaluation of stool antigen test for Helicobacter pylori infection in asymptomatic children from a developing country using 13C-urea breath test as a standard

OBJECTIVE

Prevalence of asymptomatic Helicobacter pylori infection is very high in infants and children in developing countries. C urea breath test (UBT) is a reliable non-invasive diagnostic test for H. pylori infection in children that avoids invasive endoscopy. We compared a newly introduced H. pylori stool antigen test (with a high sensitivity and specificity in symptomatic children) with UBT in asymptomatic children mostly 1-5 years old, from a population with a high prevalence of infection.

METHOD

Eighty six asymptomatic children (42 boys and 44 girls) were tested for H. pylori infection using the UBT and a stool antigen test (HpSA) based on a sandwich enzyme immunoassay for antigen detection.

RESULTS

Forty five of the eighty-six (52.3%) children tested positive for H. pylori using the breath test. In 34 of these forty-five children, H. pylori antigen was detected in stool (sensitivity = 75.6%, 95% CI = 63 to 88%). Of the 50 of 86 (58%) children positive by HpSA test, 34 were positive for breath test. Of the 41 children with negative UBT test 25 were negative for stool antigen test (specificity = 61%, 95% CI = 46 to 76%).

CONCLUSION

The sensitivity and specificity of the new stool antigen test are lower in asymptomatic children with high H. pylori prevalence rate compared to those reported for children with gastrointestinal symptoms. Its usefulness is limited for diagnosis in an asymptomatic child with H. pylori infection.

Body fat measurement in Indian men: comparison of three methods based on a two-compartment model

Obesity is a major risk factor for diabetes and related disorders. The current classification of obesity is based on body mass index (BMI, kg/m(2)), which is a surrogate for the total body fat. Since the relationship between BMI and body fat varies in different populations, an independent validation of the BMI-body fat relationship in the population of interest is desirable.

OBJECTIVES

(1) To study the validity of field methods of measuring body fat (multiple skinfolds and bioimpedance) against a criterion method (deuterium dilution) and (2) To compare the prevalence of obesity (WHO 2000 criteria for BMI) with adiposity (body fat >25%) in middle-aged Indian men in rural and urban Pune.

DESIGN

Community-based multistage stratified random sampling of middle-aged men from rural and urban Pune for study of body composition and cardiovascular risk. A third of these men, selected to represent wide BMI distribution, were studied for body fat measurements by specific methods.

SUBJECTS

A total of 141 healthy men, approximately similar number from rural, urban slums and middle class from Pune. They were 39.3 (+/-6.2) y old and had a BMI of 21.9 (+/-3.7) kg/m(2).

MEASUREMENTS

Anthropometry (height, weight and multiple skinfold thicknesses) by trained observers using standardised technique to calculate body fat by Durnin and Womersley's equation. Total body water and body fat by bioelectrical impedance analysis (BIA) and deuterium oxide dilution (D(2)O).

RESULTS

Mean total body fat was 14.3 kg (23.0%) by anthropometry, 16.5 kg (26.0%) by BIA and 15.3 kg (24.6%) by D(2)O method. Although there was a good correlation between fat estimation by three methods (r= approximately 0.9, P<0.001 all), compared to D(2)O method anthropometry underestimated body fat by 1.0 kg and BIA overestimated fat by 1.2 kg (P<0.001 both). Using the standard cut-point of 25% body fat for 'adiposity' 29.5% rural, 46.0% slum and 75.0% middle class men were adipose. These proportions were considerably higher than the number of men who were 'preobese' (BMI> or =25-29.9 kg/m(2), 9.0% rural, 22.0% urban slums and 27.0% urban middle class) and 'obese' (BMI >30 kg/m(2), 4.0% urban slums, none in rural and urban middle class).

CONCLUSION

We recommend that future studies assessing risk for chronic diseases in Indians should measure adiposity by anthropometry (multiple skinfolds) or BIA (calibrated for Indians) rather than relying only on BMI cut-points.

Automated derivatization with o-phthalaldehyde for estimation of amino acids in plasma using reversed-phase high performance liquid chromatography

A fully automated method for quantitative estimation of plasma amino acids using fluorescence detection of ophthaladehyde/2-mercaptoethanol derivatives of the analytes and their separation by gradient elution reversed-phase HPLC has been described. The method is simple and the three-step gradient elution is suitable for routine analysis of a large number of biological samples due to clear resolution, high degree of precision, accuracy, cost-effectiveness and lack of interference from chemical contaminations. Using this method, 19 amino acids were completely resolved and the within-run coefficients of variation ranged from 2.53 to 10.7% with a mean variation of 5.68%.

Intestinal parasitic infection and total serum IgG in asymptomatic adult males in an urban slum and efficacy of antiparasitic therapy

Malnutrition is thought to potentiate the polyclonal stimulation of IgE by parasites. This diminishes immunity due to the decrease in specific anti-parasitic IgE. Prevalence of intestinal parasitic infections in chronically undernourished, asymptomatic adult males from a slum and efficacy of anti-parasitic therapy and its effect on total serum IgE were evaluated. Stool specimens from 51 subjects were examined. Anti-helminth and anti-protozoan therapy consisted of oral, single dose albendazole (400mg) and tinidazole (2g) respectively. Total serum IgE was measured. 23 (45.1%) subjects were positive. Albendazole and tinidazole cleared intestinal parasites but had no significant effect on total serum IgE levels.

Lean body mass in preschool aged urban children in India: gender difference

OBJECTIVE

To estimate lean body mass (LBM) in preschool aged boys and girls in India and explore gender difference.

DESIGN

Crossectional.

SETTING

Immunization clinic of a charitable Government General Hospital in Kolkata, India.

SUBJECTS

Two-hundred and forty-five children (147 boys and 98 girls) aged 1-5 y from among the urban poor were admitted in the study between July 1999 and December 2000. Children with acute or chronic illness or congenital malformation were excluded.

METHOD

Length/height to the nearest 0.1 cm, weight to the nearest 10 g and total body resistance using multifrequency bioelectrical (Xitron 4000B) impedance analyzer (BIA) at 50 kHz were measured. Their nutritional status was compared with National Center for Health Statistics (NCHS) median data and lean body mass (LBM) was calculated using anthropometry and BIA equations. The groups were compared using analysis of variance and multiple linear regression.

RESULTS

Girls were more stunted (P<0.001) and underweight (P<0.047), while the degree of wasting was similar. Mean LBM percentage was higher in boys compared with girls by anthropometry (P<0.001) and BIA (P<0.005), which persisted after adjusting for age. With increasing age, LBM percentage declined in girls (P<0.02) in contrast to reference girls, in whom it increased. In boys LBM percentage increased with age as is in reference boys.

CONCLUSIONS

In addition to the girls being more stunted and underweight, LBM% decreased in girls with increasing age but steadily increased in boys, suggesting hidden deprivation of female children.

Areca nut, energy metabolism and hunger in Asian men

BACKGROUND

The nut of the Areca catechu palm has long been attributed effects on hunger and the digestive process.

OBJECTIVES

The objectives were to assess experimentally effects of areca nut on fasting and postprandial energy metabolism, substrate utilization and hunger.

SUBJECTS AND METHODS

Two randomized, placebo-controlled, double-blind studies were undertaken. In study 1, eight Indian men received bioadhesive gels delivering 0, 5, 10 or 20 mg arecoline to the buccal sulcus after an overnight fast. Resting energy expenditure and substrate utilization were determined by ventilated hood calorimetry over 6 h during which hunger was rated on five occasions. In study 2, 15 Indian men received gels delivering 0 or 10 mg arecoline after consuming a 2.5 MJ meal, and the same protocol was then applied as in study 1.

RESULTS

Fasting resting energy expenditures exceeded basal metabolic rate (BMR) by 5.4+/-0.8% (Mean+/-SE) after placebo, and 5.1+/-0.7% after 20 mg arecoline, but by 0.9+/-0.8% and 0.7+/-0.5% following 5 mg and 10 mg arecoline, respectively. Carbohydrate (CHO) utilization rates rose after areca nut compared to placebo (F(3,252)= 7.3, p< 0.001). Hunger varied across doses (chi(2) = 10.5, p < 0.02), being lowest after 10 mg and highest after 20 mg, and was influenced by interaction of dose with delta resting energy expenditure. In study 2, areca dose interacted with fat-free mass (FFM) to lower by 5.4+/-11.2% the thermic effect of a meal (F(1,28) = 4.9, p = 0.05), and retarded peak 'digestive-phase' thermogenesis by 60 min (F(1,58) = 5.7, p = 0.02). Postprandial delta CHO utilization was greater (F(1,28) = 4.5, p = 0.05), and hunger was lower (chi:(2) = 3.8, p = 0.05), after areca nut. The areca nut altered relationships of hunger to thermic effects of the meal, and to delta substrate utilization, in ways consistent with appetite suppression.

CONCLUSION

Areca nut constituents modulate metabolic signals regulating appetite in man. This concurs with customary belief.

Daily requirement for and splanchnic uptake of leucine in healthy adult Indians

BACKGROUND

The 1985 FAO/WHO/UNU requirement for leucine is too low according to tracer-derived estimates of leucine oxidation and balance in adults from developed regions.

OBJECTIVE

The leucine requirement in populations in developing countries was assessed with use of the 24-h tracer balance method and on the basis of nitrogen balances.

DESIGN

Twenty healthy Indian men were studied during their consumption for 6 d of 2 L-amino acid diets that supplied either 14 and 30 (n = 10) or 22 and 40 (n = 10) mg leucine x kg(-1) x d(-1) in random order. At 1800 on day 7, a 24-h constant intravenous [13C]leucine tracer-infusion protocol was conducted to determine leucine oxidation and daily leucine balance. During the intake of 40 mg leucine/d, [2H3]leucine was given orally to assess the splanchnic uptake of leucine.

RESULTS

Mean 24-h leucine oxidation rates were 29.8, 30.6, 33.6, and 39.3 mg x kg(-1) x d(-1) at leucine intakes of 14, 22, 30, and 40 mg x kg(-1) x d(-1), respectively; daily leucine balances were -16.5, -9.0, -3.3, and 0.5 mg x kg(-1) x d(-1), respectively. Mixed-models linear regression of balance against leucine intake resulted in a zero balance at a leucine intake of 37.3 mg x kg(-1) x d(-1). Nitrogen balances were -12.7, -17.9, -3.9, and 1.0 mg x kg(-1) x d(-1) at leucine intakes of 14, 22, 30, and 40 mg x kg(-1) x d(-1). Regression of nitrogen balance against intake resulted in a zero balance at a leucine intake of 37.6 mg x kg(-1) x d(-1). The first-pass splanchnic uptake of leucine was 45.7% and 33.9% in the fasted and fed periods, respectively.

CONCLUSION

A tentative mean leucine requirement of 40 mg x kg(-1) x d(-1) is proposed for healthy Indian adults, as it is for Western subjects.