Maternal Nutrition, Body Composition and Gestational Weight Gain on Low Birth Weight and Small for Gestational Age-A Cohort Study in an Indian Urban Slum

Maternal nutritional status and care during pregnancy are essential for adequate birth weight. In this prospective cohort study (N = 1061) in an urban slum, we investigated the association of maternal anthropometry, body composition, gestational weight gain and dietary intakes with low birthweight (LBW, <2.5 kg). About one-third of the women were short (<150 cm), 35% were underweight (<45 kg), 23% suffered from chronic energy deficiency (CED, BMI < 18.5 kg/m2) and another 30% were overweight/obese. The mean age and BMI were 23 years and 21.7 kg/m2, respectively, and haemoglobin was 10.73 g/dL. The mean birthweight (N = 605) was 2.81 ± 0.5 kg, and the average gestational age was 38 ± 2 weeks. About 15% of infants had LBW, and 48% were small for gestational age (SGA). Maternal body composition was assessed by skinfold thickness (SFT) in all trimesters. In the first trimester (N = 762), we found that mean fat-free mass (FFM), fat mass (FM) and body fat percentage (% BF) were 38.86 kg, 11.43 kg and 21.55%, respectively. Low birthweight was significantly associated with preterm deliveries (p < 0.001) and less fat free mass (p = 0.02) in the third trimester. Among other factors were age (p = 0.017), maternal anthropometry (height: p = 0.031; weight: p = 0.059) and fewer antenatal check-ups (p = 0.037). Small size (SGA) was consistently associated with maternal bodyweight at all trimesters (term I, p = 0.013, term II, p = 0.003 and term III, p < 0.001), fat mass in the third trimester (p < 0.001) and maternal height (p = 0.003).

Socio-demographic factors, overweight/obesity and nutrients associated with hypertension among rural adults (≥18 years): Findings from National Nutrition Monitoring Bureau survey

BACKGROUND

Hypertension is the leading cause of death throughout the world. The study was conducted to assess the prevalence, determinants and knowledge & practices about hypertension among rural adults in India.

METHODS

A community-based cross-sectional study was carried out in 10 major states of India. Information on socio-economic & demographic particulars was collected and anthropometric measurements like height, weight, waist & hip circumference and blood pressure were measured. Foods and nutrient intakes were assessed by 24-h recall method. Analysis was done using SPSS window 22.

RESULTS

The prevalence of pre-hypertension was 45.3% (95% CI: 44.6-46.0) and hypertension was 22% (95% CI: 21.5-22.3) (age standardized prevalence; 20.2%) while, overweight/obesity was 22.6% (95% CI: 22.2-23.0) as per Asian cut offs (BMI≥23). The prevalence of hypertension was higher in West Bengal (29.5%) and Kerala (28.9%) and low in Madhya Pradesh and Uttar Pradesh (16-19%). The odds of hypertension was 1.2 times higher among forward communities, businessmen, tobacco users and those consuming alcohol, 2-3 times higher among overweight (CI: 1.87-2.25) and obese (2.65-3.27). The odds of hypertension was 1.2 times higher among those consuming lower tertile of carbohydrates (CI = 1.02-1.41) and zinc (CI = 1.11-1.42). About 76% were aware of hypertension, 21% were old hypertensive & 19% were on treatment.

CONCLUSIONS

Age standardized prevalence of hypertension was 20% among adults and was associated with age, occupation, overweight/obesity, tobacco and alcohol use, low intake of carbohydrates and zinc. Therefore, increasing awareness and consumption of healthy diet through behavior change communication will help to control hypertension among adults.

The burden of child and maternal malnutrition and trends in its indicators in the states of India: the Global Burden of Disease Study 1990-2017

BACKGROUND

Malnutrition is a major contributor to disease burden in India. To inform subnational action, we aimed to assess the disease burden due to malnutrition and the trends in its indicators in every state of India in relation to Indian and global nutrition targets.

METHODS

We analysed the disease burden attributable to child and maternal malnutrition, and the trends in the malnutrition indicators from 1990 to 2017 in every state of India using all accessible data from multiple sources, as part of Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three groups using their Socio-demographic Index (SDI) calculated by GBD on the basis of per capita income, mean education, and fertility rate in women younger than 25 years. We projected the prevalence of malnutrition indicators for the states of India up to 2030 on the basis of the 1990-2017 trends for comparison with India National Nutrition Mission (NNM) 2022 and WHO and UNICEF 2030 targets.

FINDINGS

Malnutrition was the predominant risk factor for death in children younger than 5 years of age in every state of India in 2017, accounting for 68·2% (95% UI 65·8-70·7) of the total under-5 deaths, and the leading risk factor for health loss for all ages, responsible for 17·3% (16·3-18·2) of the total disability-adjusted life years (DALYs). The malnutrition DALY rate was much higher in the low SDI than in the middle SDI and high SDI state groups. This rate varied 6·8 times between the states in 2017, and was highest in the states of Uttar Pradesh, Bihar, Assam, and Rajasthan. The prevalence of low birthweight in India in 2017 was 21·4% (20·8-21·9), child stunting 39·3% (38·7-40·1), child wasting 15·7% (15·6-15·9), child underweight 32·7% (32·3-33·1), anaemia in children 59·7% (56·2-63·8), anaemia in women 15-49 years of age 54·4% (53·7-55·2), exclusive breastfeeding 53·3% (51·5-54·9), and child overweight 11·5% (8·5-14·9). If the trends estimated up to 2017 for the indicators in the NNM 2022 continue in India, there would be 8·9% excess prevalence for low birthweight, 9·6% for stunting, 4·8% for underweight, 11·7% for anaemia in children, and 13·8% for anaemia in women relative to the 2022 targets. For the additional indicators in the WHO and UNICEF 2030 targets, the trends up to 2017 would lead to 10·4% excess prevalence for wasting, 14·5% excess prevalence for overweight, and 10·7% less exclusive breastfeeding in 2030. The prevalence of malnutrition indicators, their rates of improvement, and the gaps between projected prevalence and targets vary substantially between the states.

INTERPRETATION

Malnutrition continues to be the leading risk factor for disease burden in India. It is encouraging that India has set ambitious targets to reduce malnutrition through NNM. The trends up to 2017 indicate that substantially higher rates of improvement will be needed for all malnutrition indicators in most states to achieve the Indian 2022 and the global 2030 targets. The state-specific findings in this report indicate the effort needed in each state, which will be useful in tracking and motivating further progress. Similar subnational analyses might be useful for other low-income and middle-income countries.

FUNDING

Bill & Melinda Gates Foundation; Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Dose-dependent effect in the inhibition of oxidative stress and anticlastogenic potential of ginger in STZ induced diabetic rats

Ginger is an important medicinal herb has numerous bioactive components and is used in the management, control and/or treatment of diseases including diabetes mellitus. The present study was undertaken to see the dose-response effect of ginger and evaluate the possible protective effects of dietary ginger on oxidative stress and genotoxicity induced by streptozotocin (STZ) diabetic rats. Inbred male Wistar/NIN rats of 8-9 weeks old were treated with 30 mg/kg of STZ. Rats were divided into different groups of control, diabetic non-treated, and diabetic treated with ginger powder at 0.5%, 1% and 5% respectively. After feeding for a month, blood and tissues were collected to see the effect of ginger on antioxidant status, DNA damage and bone marrow genotoxicity. In this study ginger exerted a protective effect against STZ-induced diabetes by modulating antioxidant enzymes and glutathione and down regulating lipid and protein oxidation and inhibition in genotoxicity in a dose-response manner.