ABSTRACT
Background: Overnourished under-five children are anthropometrically classified as either being at possible risk of overweight, overweight or obese and defined so, when either weight for height or body mass index for age (BMI-for-age) are >1SD to 2SD, >2SD to 3SD and >3SD, respectively of the analogous World Health Organization standards. Aim: To compare weight for height and BMI for age definitions for quantifying overnutrition burden. Methods: Theoretical consequences of ignoring age were evaluated by comparing, at varying height for age z-scores, the age- and sex-specific cutoffs of BMI that would define overnutrition with these two metrics. Overnutrition prevalence was then compared in simulated populations (short, intermediate and tall) and real-life datasets from India. Results: In short (-2SD) children, the BMI cutoffs with weight for height criteria were lower in comparison to BMI for age till 7-8 months, but higher at later ages. In National Family Health Survey-4, India dataset (short population), overnutrition (>1SD) prevalence with weight for height was higher from 0-0.5 years (exclusive breastfeeding age), but lower at subsequent ages. The prevalence difference (weight for height - BMI for age) in 0.5-5 years was -2.26% (6.57% vs 8.83%); this attenuated in 0-5 years (-1.55%; 7.23% vs 8.78%). The discrepancy was maximal for stunted children and was lower in girls. A similar pattern, of lower magnitude, was observed for overweight (>2SD) comparison. In intermediate and tall populations, there were no meaningful differences. Conclusion: The two definitions produce cutoffs, and hence estimates of overnutrition, that differ with the age, sex, and height of under-five children. The relative invariance, with age and height, of BMI for age, favors its use.
ABSTRACT
Objective: To evaluate the relationship between maternal age at child birth, and perinatal and under-five mortality. Design: Prospective birth cohort. Setting: Urban community. Participants: 9169 pregnancies in the New Delhi Birth Cohort resulted in 8181 live births. These children were followed for survival status and anthropometric measurements at birth (+3 days), 3,6,9 and 12 months (7 days), and every 6 months thereafter until 21 years age. Information on maternal age at child birth and socio-demographic profile was also obtained. Outcome measures: Offspring mortality from 28 weeks gestation till 5 years age. Results: Offspring mortality (stillbirths – 5 years; n=328) had a U-shaped association with maternal age (P<0.001). Compared to the reference group (20-24 years), younger (£19 years) and older (³ 35 years) maternal ages were associated with a higher risk of offspring mortality (HR: 1.68; 95% CI 1.16, 2.43 and HR 1.48; 95% CI 1.01, 2.16, respectively). In young mothers, the increased risk persisted after adjustment for socio-economic confounders (maternal education, household income and wealth; HR 1.51; 95% CI 1.03, 2.20) and further for additional behavioral (place of delivery) and biological mediators (gestation and birthweight) (HR 2.14; 95% CI 1.25,3.64). Similar associations were documented for post-perinatal deaths but for perinatal mortality the higher risk was not statistically significant (P >0.05). In older mothers, the increased mortality risk was not statistically significant (P >0.05) after adjustment for socio-economic confounders. Conclusion: Young motherhood is associated with an increased risk of post-perinatal mortality and measures to prevent early childbearing should be strengthened.
ABSTRACT
Background & objectives: Abnormal endothelial function represents a preclinical marker of atherosclerosis. This study was conducted to evaluate associations between anthropometry, cardiometabolic risk factors, and early life factors and adult measures of endothelial function in a young urban Indian cohort free of clinical cardiovascular disease. Methods: Absolute changes in brachial artery diameter following cuff inflation and sublingual nitroglycerin (400 μg) were recorded to evaluate endothelium-dependent and -independent measures of endothelial function in 600 participants (362 men; 238 women) from the New Delhi Birth Cohort (2006-2009). Data on anthropometry, cardiometabolic risk factors, medical history, socio-economic position, and lifestyle habits were collected. Height and weight were recorded at birth, two and 11 yr of age. Age- and sex-adjusted linear regression models were developed to evaluate these associations. Results: The mean age of participants was 36±1 yr. Twenty two per cent men and 29 per cent women were obese (BMI > 30 kg/m2). Mean systolic blood pressure (SBP) was 131±14 and 119±13 mmHg, and diabetes prevalence was 12 and 8 per cent for men and women, respectively. Brachial artery diameter was higher for men compared with women both before (3.48±0.37 and 2.95±0.35 cm) and after hyperaemia (3.87±0.37 vs. 3.37±0.35 cm). A similar difference was seen before and after nitroglycerin. Markers of increased adiposity, smoking, SBP, and metabolic syndrome, but not early life anthropometry, were inversely associated with endothelial function after adjustment for age and sex. Interpretation & conclusions: The analysis of the current prospective data from a young urban Indian cohort showed that cardiometabolic risk factors, but not early life anthropometry, were associated with worse endothelial function.
ABSTRACT
Objectives: To compare: (i) prevalences of thinness in schoolchildren by four body mass index references in common use viz., Centre for Disease Control (CDC); Cole; Indian Academy of Pediatrics (IAP); World Health Organization (WHO); and (ii) relationship of thinness with absence of cardio-metabolic risk factors in these BMI references. Design: Cross-sectional. Setting: Schools in Delhi. Participants: Anthropometry and blood pressure were measured in 16,245 school children aged 5 to 18 years. Fasting lipids and blood sugar were estimated in 2796 subjects. Outcome measures: Age and sex-specific prevalences of thinness and predictive ability of reference cut-off for detecting any cardio-metabolic risk factor were compared. Results: Prevalence of thinness varied with the reference employed; more so for boys. Overall prevalence of thinness was least with IAP reference and highest with CDC cut-offs (6.6% to 16.9% in boys, 6.5% to 10.3% in girls). Children identified as thin by any reference had comparable, significantly lower risks (OR 0.59 to 0.73) of associated cardio-metabolic aberrations. In subjects with any cardio-metabolic or blood pressure aberration, the prevalence of thinness was highest with CDC and least with IAP definition. Conclusion: Prevalence of thinness varies considerably with the reference employed. Thin children, identified by any reference, have a lower risk of associated cardio-metabolic aberrations; however, thinness is a poor diagnostic test for this purpose. In populations undergoing nutrition transition, there is a need to link cardio-metabolic risk factors with recommended anthropometric criteria to define undernutrition.