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search was conducted using Medline literature database search, followed by review of full length journal papers and unpublished materials such as research reports.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

Toxicity assessment of wild bean seed protein--arcelin on Asian armyworm, Spodoptera litura (Fabricius).

Arcelin, an anti-metabolic protein was purified from the seeds of wild bean, Lablab purpureus. The feeding assay containing arcelin at 5, 10 and 15 microg concentrations revealed no antifeedant effect against fifth instar larvae of S. litura. However, the enhanced activity of alpha- and beta-naphthyl esterases in the mid-gut samples of S. litura treated with arcelin suggests countermeasure against the toxic effect of arcelin.

Histological changes in intestine in semichronic diarrhoea induced by lactose enriched diet in rats: effect of Diarex-Vet.

Efficacy of Diarex-Vet (The Himalaya Drug Company, Makali, Bangalore, India) was evaluated histologically in semichronic diarrhoea induced by lactose enriched diet in rats. The rats in different groups were given lactose enriched diet alone for 2 days before starting the treatment with Diarex-Vet at a dose of 250, 500 and 750 mg/kg body weight along with lactose enriched diet for 5 days. Animals were euthanised at the end of 5 days of treatment and histological changes were observed in the ileum, caecum and colon. Semiquantitative analysis of goblet cells in intestines showed dose dependent response among the treated groups. The morphological changes were comparable to normal in the group given 750 mg/kg body wt Diarex-Vet. The effects observed were attributed to the lactase like analogous activity of Diarex-Vet or the inhibition of the osmotic processes in the intestinal lumen thereby reducing the morphological changes in the intestines.

Use of RAPD in assessing the genetic variability in Spodoptera litura.

A polymerase chain reaction based assay to distinguish six different ecotypes of the Spodoptera litura, a sporadic insect pest and a predominant defoliator of various crops was carried out. A total of 40 random primers were screened to reveal the existence of polymorphism between the populations. Among them eight showed scorable banding patterns and three primers (OPA-01, OPA-05, OPM-01) exhibited distinguishable banding patterns. However, Chengalpattu and Chennai populations revealed their closed relatedness and Coimbatore population stood distantly from others.

Hazard analysis and critical control points of weaning foods.

Hazards and critical control points were identified during the preparation, feeding and storage of weaning foods fed to the children (6-24 months) belonging to low income group (LIG) families using survey methods, spot and indepth observations and microbial analysis. High microbial counts were obtained for the weaning food samples procured from the families that were rated as poor for both personal hygiene and environmental sanitation. Food samples that were held at ambient temperature (25-35 degrees C) showed high counts of coliforms, AMCC, yeast and mold, Staphylococcus aureus and Bacillus cereus. Spice mixtures and mop samples also revealed high counts for all these organisms. Coliforms were not isolated from the water samples of all the 10 households. However, a high count of Bacillus cereus (10(3-5)/ml) was observed in water samples of two selected households. The hazards and critical control points identified were high initial contamination of raw foods, poor environmental sanitation and personal hygiene, feeding of overnight moist foods stored at ambient temperature and insufficient steaming of these foods.

Impact of the integrated package of nutrition and health services.

Preschool children in 0-36 months of age are nutritionally the most vulnerable group. Nutrition and health services delivery through an ICDS programme aims at ameliorating the problems of malnutrition and infection. The extent of utilization of nutrition and health services in relation to nutritional status can provide valuable information on operational efficacy of the programme. In the present study, 610 preschool children (0-36 months) under an urban ICDS block were placed in three categories of service utilization viz. full, partial and none. The impact of the extent of service utilisation on nutritional status and morbidity was assessed over a one year period. The findings showed that complete utilization of all services resulted in significant improvement in nutritional status as assessed through anthropometric indices viz. height/age, weight/age and weight/height as percent NCHS median standard. Data on morbidity in children showed that the number of episodes and the duration of illness(es) were significantly lower when the services were utilized fully than when utilized partially or not utilized at all. Thus major efforts should go into the convergence of services and full utilization by the community.

Effect of HD-03--a herbal formulation in galactosamine-induced hepatopathy in rats.

The effect of HD-03 a herbal preparation was studied on galactosamine (400 mg/kg b.wt., i.p.) induced hepatotoxicity in rats. Animals were pre-treated for 14 days with HD-03 and compared against untreated group for SGPT, SGOT, serum bilirubin and liver glycogen. Histopathology of liver lobes was considered to evaluate the extent of hepatic injury induced by galactosamine. These were reversed by HD-03 pre-treatment. HD-03 provided convincing evidence of hepatoprotection against galactosamine induced hapatotoxicity.

Subacute sclerosing panencephalitis presenting as optic neuritis.

Subacute sclerosing panencephalitis (SSPE) is a rare progressive neurologic disease affecting both grey and white matter of the brain in children and young adults. One such case which involved the visual system is described here.

Child and adolescent psychiatry in-patient facility.

The short-term in-patent facility of the Child and Adolescent Psychiatry Unit in the National Institute of Mental Health and Neurosciences, Bangalore is described. Its clientele over one year is reviewed. Totally 152 admissions were made. Hysterical neurosis (30.8%), Psychoses (25.2%), Conduct disorder (10.5%) and Hyperkinetic syndrome (9.8%) were the most common diagnoses observed in this population who needed short-term intervention. Average duration of stay was 4-12 weeks. All children were admitted with a parent. In 95.8% of the cases the treatment expenses were borne partially/fully by the hospital. The policy and functioning of the facility is discussed.

Effect of D-400, a herbomineral formulation on liver glycogen content and microscopic structure of pancreas and liver in streptozotocin induced diabetes in rats.

Streptozotocin induces severe and irreversible hyperglycaemia in experimental animals. The effect of oral administration of D-400 (1 gm/kg/day), a herbomineral formulation on streptozotocin induced-diabetes was studied in rats. Liver glycogen content was assayed biochemically on 2,4 and 8 weeks after D-400 treatment. Superoxide dismutase(SOD) activity of pancreatic islet cells was assessed on 8th week of D-400 treatment. The microscopic structure of pancreas and liver were examined in both control and treated animals. D-400 treatment showed progressive and significant increase in liver glycogen at 2,4 and 8 weeks respectively. Streptozotocin induced a decrease in pancreatic islet cell superoxide dismutase which was reversed by D-400 treatment for a period of 8 weeks. The free radical scavenging activity of D-400 may be attributed to shilajeet, one of its important ingredient. Streptozotocin induced histopathological changes in pancreas and liver was also partially reversed by D-400. The findings indicate that D-400 helps in improving the glycogen stores in the liver and prevents the streptozotocin induced damage through free radicals by increasing the islet cell superoxide dismutase activity.

A clinical study of infants presenting to a mental retardation clinic.

Early detection has a central role in the prevention and management of mental retardation. The purpose of this present study is to delinerate the characteristics of developmentally delayed infants and their families attending Mental Retardation Clinic. The sample consisted of 101 infants who were registered in Mental Retardation Clinic of NIMHANS, Bangalore in 1988 constituting 12.5% of total registrations. Data was collected from case records. Majority of subjects were males, first or second born, 7 months or older, from a consanguineous lower or middle class family. Along with developmental delay, 60% had other complaints. Medical problems were reported in about half of the subjects and most had abnormalities on physical examination. Aetiology was discernible in 77.1%. Majority had associated physical disorder such as cerebral palsy, seizures and hearing and/or visual impairment. Around 17% came for follow-up thrice or more, 43% dropped out after work-up. The main conclusions are that; (i) certain socio-demographic, personal and clinical variables influence treatment seeking, and (ii) developmental delay recognised in infancy tends to be associated with clear aetiologic factors and significant medical/neurologic problems.

Botulinum toxin A in blepharospasm and hemifacial spasm.

We report the first Indian experience of botulinum toxin A in the treatment of blepharospasm and hemifacial spasm. Sixteen patients, 7 with essential blepharospasm, 5 with Meige syndrome and 4 with hemifacial spasm received botulinum toxin A injection. One patient received 3 courses of injections, 2 received 2 courses and the rest received only one course. The effect was observed after a latent period of less than 48 hours in all patients and lasted for a mean of 16.65 weeks. More than 70% improvement occurred after 17/20 injections (85%). Poor response was more often seen when blepharospasm was associated with oromandibular dystonia (2/5 injections). Though the duration of response and subjective score of improvement was best in patients with hemifacial spasm, the numbers were very small for any statistical evaluation. The side effects were local, transient, mild and well tolerated. The commonest side effect was blepharoptosis.

Growth performance in anemia and following iron supplementation.

The growth status of anemic (n = 117, Hb 7-10 g/dl) and normal (n = 53, H > or = 11 g/dl) children 3-5 years of age living under similar environmental and socio-economic conditions was evaluated. The dietary intake was assessed on a random subsample of the anemic and normal children. The anemic children had a poorer growth status than normal children as indicated by their significantly (p < 0.001) lower body weight, height and weight for age and significantly (p < 0.001) larger number in Grades II and III malnutrition. Iron supplementation (40 mg elemental iron/day) for six months produced a significant (p < 0.001) increase in Hb levels of both groups (1.6 g/dl in the anemic and 0.8 g/dl in the non-anemic) compared to their respective controls who received sugar placebos. The growth performance of the anemic children supplemented with iron was superior to that of anemic placebo treated children as indicated by a better weight gain and a significantly higher weight for height (p < 0.05). Weight for age was a good differentiator of the anemic from normal while weight for height was a good indicator of the impact of iron supplements on growth.