Malnutrition in children with congenital heart disease (CHD) determinants and short term impact of corrective intervention.

OBJECTIVE: To identify determinants of malnutrition in children with congenital heart disease (CHD) and examine the short-term effects of corrective intervention. METHODS: Patients with CHD admitted for corrective intervention were evaluated for nutritional status before and 3 months after surgery. Detailed anthropometry was performed and z-scores calculated. Malnutrition was defined as weight, height and weight/height z-score <or= -2. Determinants of malnutrition were entered into a multivariate logistic regression analysis model. RESULTS: 476 consecutive patients undergoing corrective intervention were included. There were 16 deaths (3.4%; 13 in-hospital, 3 follow-up). The 3-month follow-up data of 358 (77.8%) of remaining 460 patients were analyzed. Predictors of malnutrition at presentation are as summarized: weight z-score <or= -2 (59%): congestive heart failure (CHF), age at correction, lower birth weight and fat intake, previous hospitalizations, >or= 2 children; height z-score <or= -2 (26.3%): small for gestation, lower maternal height and fat intake, genetic syndromes; and weight/height z-score <or= -2 (55.9%): CHF, age at correction, lower birthweight and maternal weight, previous hospitalizations, religion (Hindu) and level of education of father.Comparison of z-scores on 3-month follow-up showed a significant improvement from baseline, irrespective of the cardiac diagnosis. CONCLUSIONS: Malnutrition is common in children with CHD. Corrective intervention results in significant improvement in nutritional status on short-term follow-up.

Glycaemic status and prevalence of comorbid conditions among people with diabetes in Kerala.

BACKGROUND: We aimed to assess the glycaemic status and prevalence of comorbid conditions such as obesity, hypertension and dyslipidaemia in people with diabetes in a southern Indian community. METHODS: A cross-sectional community survey of adults > 18 years of age was done in central Kerala. Among the 3069 subjects surveyed, 276 were known to have diabetes. Of these, 169 who had type 2 diabetes underwent a detailed physical examination and anthropometric measurements, and determination of levels of fasting blood glucose, glycosylated haemoglobin, fasting lipid, serum creatinine and urine protein. Data of 164 subjects who had glycosylated haemoglobin levels were included for final analysis. RESULTS: The mean (SD) duration of diabetes was 5.5 (5.04) years and the mean age was 56.9 (11.4) years. Among the patients, 28 (17.2%) were receiving no treatment for diabetes, 24 (14.7%) were on diet control and 111 (68%) on pharmacotherapy. Only 6 patients were on insulin. The mean fasting blood glucose was 153 (63) mg/dl and the mean glycosylated haemoglobin level was 8.1 (2.34)%. In 60% of patients, the glycosylated haemoglobin level was above the recommended target of 7%. Obesity (31%), hypertension (51%), low-density lipoprotein cholesterol > 100 mg/dl (90%) and serum triglyceride levels > 150 mg/ dl (38%) were present in the study population. Only 29% of patients were on antihypertensive treatment and 5% on lipid-lowering agents. CONCLUSION: In this population, only 40% of people with diabetes had adequate glycaemic control. The use of insulin was infrequent. Comorbid conditions were common and inadequately treated. This indicates a lack of proper diabetic care in this community, which could lead to an increase in the burden of cardiovascular disease in the future.

Obesity in Indian children: time trends and relationship with hypertension.

BACKGROUND: Limited data are available from India regarding the distribution and profile of childhood obesity and hypertension. We examined the time trends in childhood obesity in a representative sample of schoolchildren from Ernakulam District, Kerala and determined the relationship of obesity with blood pressure. METHODS: We used a stratified random cluster sampling method to select the children. Anthropometric data were collected from 24 842 students, 5-16 years of age, during 2003-04. Blood pressure and anthropometric data were collected from 20 263 students during 2005-06. Overweight and obesity were defined by body mass index for gender and age. Gender, age and height were considered for determining hypertension. RESULTS: The proportion of overweight children increased from 4.94% of the total students in 2003 to 6.57% in 2005 (OR: 1.36; 95% CI: 1.25-1.47; p < 0.0001). The increase was significant in both boys and girls. The proportion of overweight children was significantly higher in urban regions and in private schools, and the rising trend was limited to private schools. Systolic or diastolic incident hypertension was found in 17.34% of overweight children versus 10.1% of the remaining students (OR: 1.87; 95% CI: 1.60-2.17; p < 0.0001). CONCLUSION: Childhood obesity showed an increasing trend in a short period of 2 years. Hypertension was common in overweight children. The results suggest the need for greater public awareness and prevention programmes on childhood obesity and hypertension.

Impact of socio-demographic variables, oral hygiene practices and oral habits on periodontal health status of Indian elderly: a community-based study.

Periodontal disease is the most common cause of tooth loss. It is has insidious onset, chronic course, and commonly result due to cumulative effect of dietary habits, oral hygiene methods and oral habits practiced over the years. This study was planned to evaluate the periodontal health status of elderly population (above 60 years) in the community, using CPITN index, gingival recession, mobility of teeth and halitosis, using modified WHO Oral Health Survey Proforma. In addition, impact of several socio-demographic variables, oral hygiene practices, oral habits, chronic systemic diseases, dietary preferences and body mass index (BMI) on periodontal health status was also studied. It was found that prevalence of periodontal diseases in the elderly was high. Step-wise multivariate logistic regression analysis showed that periodontal diseases were directly correlated with age, oral hygiene practices and presence of cardiac diseases.

National Family Health Survey and children.

This article aims to describe the National Family Health Survey (NFHS) being carried out in India with its first round during 1992-93 (NFHS-I) and second round during 1998-99 (NFHS-II), with special reference to information available in relation to children. The survey was on lines of the existing systems of Demographic Surveys (DHS) in various developed as well as developing countries. Another important objective of the survey was to provide quality data to the researchers to carry out analytical work on various aspects. Further, the survey has paved the way to carry out comparative studies not only between states in India but also between countries. An attempt has also been made here to present salient features of comparative results under NFHS-I and NFHS-II.

Nutritional risk factors in esophageal cancer.

OBJECTIVE: The present case-control study was undertaken with the objective to study the nutritional risk factors associated with esophageal cancer. METHODOLOGY: One hundred and fifty diagnosed esophageal cancer patients and an equal number of healthy individuals constituted the patient and control groups, respectively. Dietary consumption pattern during the preceding 20 years prior to the diagnosis of esophageal cancer was assessed utilising the standard food frequency questionnaire method. Information on alcohol consumption, smoking habits, chewing of betel leaf with tobacco was also collected. RESULTS: Multivariate analysis revealed that the risk of esophageal cancer was 7.81 times (p < 0.01) higher with daily consumption of alcohol. The risk increased to 3.16 times (p < 0.01) with the daily habit of chewing of betel leaf with tobacco. Nearly a two fold risk was observed when the consumption of "other vegetables" was less than four times per week. A 1.95 times (p < 0.01) increase in risk was observed with the daily habit of bidi smoking. CONCLUSION: Cancers in general are multifactorial in origin, and several environmental interactions are possible. It is not easy to quantify the contribution of diet to cancer risk. However, the results of the present study suggested that nutritional factors do play a role.

Factors predicting the non-utilisation of immunisation services using logistic regression technique.

A cross sectional study was conducted to determine the variables which have an individual predictive power on nonutilization of immunisation services using logistic regression model. Children between 12 and 23 months of age were assessed and enrolled using a pretested interview schedule. Statistical analysis was done using descriptive statistics, univariate analysis using Chi Square tests and multivariate logistic regression analysis. Of the 200 children studied 56% were fully immunised. Only illiterate mothers (p < 0.05) and poor access (> 3 km) to health facility (p < 0.001) were found to have an independent predictive power on the nonutilization of immunisation services. Sex of the child, parity levels, socioeconomic status did not independently influence the utilisation pattern. It is possible to identify these still existing small pockets of nonusers of immunisation services through the predictive variables and target them through special efforts.

ESR and iron status in pregnancy.

ESR (Westergen) correlated significantly with the iron status (as measured by Hb concentration, haematocrit, red cell count, MCH, P/H ratio, serum iron, TIBC and percent saturation of transferrin) in a group of pregnant women (PW) at term. Serum ferritin correlated negatively with the ESR but the correlation was not statistically significant. Serum ferritin levels of < 50 micrograms/L were present in 9 (34.6%) PW with ESR > or = 50 mm 1st hour and 5 (19.2%) PW with ESR < 50 mm 1st hour. The mean ESR in PW was 55.7 (+/- 22.9) and was > or = 50 mm 1st hour in 50% and < 75 mm 1st hour in 82.7%. The difference in the mean ESR in anaemic and nonanaemic PW was highly significant (p < 0.001), 87.5% anaemic PW with serum ferritin > 50 micrograms/L had ESR > or = 50 mm 1st hour, suggesting the possible effect of chronic infection in raising ferritin levels in these PW.

Risk factors for cerebral palsy.

Cerebral palsy is a major cause of crippling in children, but it's etiology is poorly understood. This case control study was done to assess some of the identified risk factors for cerebral palsy, 125 cerebral palsy cases selected from hospital clinic and 125 age and sex matched neighbourhood controls, all aged less than 5 years and residing in Delhi (India) were studied. Information regarding antenatal, natal and postnatal period was collected by mother's interview, and wherever available, from hospital records with the study subjects. Most common type of cerebral palsy was spastic (88%). Quadriplegia was the commonest topographical subtype (86.4%). Birth asphyxia was found to be present in only 25.6% of cases. The commonest risk factor amongst cases was low birth weight (28.8%). The multivariate odds ratios (confidence limits) for the risk factors found to be significantly associated with cerebral palsy were 36.1 (7.76-160) for birth asphyxia, 13.8 (4.95-38.3) for low birth weight, 37.4 (4.47-313) for neonatal convulsion, 23 (4.7-112) for neonatal jaundice, 14.4 (3.69-56.4) for neonatal infection, 24.9 (2.78-223) for instrument assisted delivery and 15.4 (1.57-152) for antepartum hemorrhage. Precipitate labour, caesarean section, twins, toxemia, breech delivery and head injury were not found to be significantly associated with cerebral palsy. Thus birth asphyxia, low birth weight, neonatal convulsions, neonatal jaundice, neonatal infection, instrument assisted delivery and antepartum hemorrhage are significant risk factors for cerebral palsy.

Correlates of mortality among hospital-born neonates with birth asphyxia.

BACKGROUND: Birth asphyxia is a major cause of neonatal mortality. An understanding of the determinants of mortality among asphyxiated neonates will help formulate effective management protocols. METHODS: One hundred and fifty consecutive neonates with birth asphyxia (apnoea or gasping respiration at 1-minute of age) were prospectively studied. The association of the outcome variable, namely, mortality before discharge, was documented in relation to a number of clinically important risk factors. RESULTS: The neonatal mortality of 24.7% (37/150) among asphyxiated neonates was 34.5-times compared to that of the non-asphyxiated population (p < 0.001). The mortality rates in preterm-and term-asphyxiated neonates were 47.8% and 6%, respectively (p < 0.0001). The relative risk of mortality increased progressively with increased birth-weight. On univariate analysis, prematurity, low birth-weight, respiratory distress, severity of asphyxia, hypoxic-ischaemic encephalopathy, apnoea, acidosis and seizures were found to be significant risk factors of death. However, on step wise regression analysis, prematurity emerged as the most significant determinant of mortality. The highest positive predictive value (58.3%) for mortality was documented for hypoxic-ischaemic encephalopathy. CONCLUSION: A significant reduction in mortality among asphyxiated neonates will require aggressive management of prematurity-related neonatal complications and hypoxic-ischaemic encephalopathy.

Sonographic signs in portal hypertension: a multivariate analysis.

A prospective case controlled study was conducted to evaluate the value of real time ultrasound in establishing the diagnosis and the etiology of portal hypertension. Patients attending the outpatient department of a tertiary care centre were included. There were 324 consecutive patients with portal hypertension due to cirrhosis (n = 229), non cirrhotic portal fibrosis (NCPF: n = 64) and extrahepatic portal venous obstruction (EHPVO: n = 31). During this period, 146 patients with dyspepsia, 35 with splenomegaly and 32 with ascites due to varied causes served as negative and positive controls. Real time ultrasonography using a 3.5 MHz linear array scanner was performed in a fasting state in all subjects. Portal and splenic vein diameter greater than 10 mm, splenomegaly, hepatic and splenic hilar collaterals were suggestive of portal hypertension. Non visualization of the portal vein which was replaced by a cavernoma had a diagnostic accuracy of 98% in EHPVO. Splenic infarcts and absence of ascites were features of non cirrhotic portal hypertension (NCPF and EHPVO). Sonography had an overall diagnostic accuracy of 80%. A stepwise logistic regression with multivariate analysis using discriminate function showed that collaterals at the hepatic and splenic hilum, hepatomegaly, ascites and splenic infarcts were independent markers to differentiate cirrhotic from noncirrhotic causes of portal hypertension. The discriminate equation generated had a mismatch of 9.8%. Correlations between the sonographic signs demonstrated that the variceal grade correlated positively with the presence of splenic hilar collaterals and the liver size inversely correlated with presence of ascites. It was concluded that real time ultrasonography is an accurate method to establish the presence and etiology of portal hypertension.

Non-linear law-like relationship between weight & height of infants & pre-school children.

A non-linear equation of the type log w - 0.008 h = a - be-kl for weight (w) and height (h) of 1177 infants and pre-school children from the Rural Health Centre area in Ballabhgarh was fitted by modified Guass-Newton Method using BMDP 03R program. On applying the non-linear model to the data of the present study it was found that the curve was a good fit in both sexes and also in all nutritional groups. The value of 'a' (the nutritional index) was almost the same in boys and girls but it was higher in case of children with normal nutrition (0.37) and lower in children with malnutrition (0.34 in Grade I, 0.32 in Grade II and 0.28 in Grades III & IV). The exponential term 'k' (index of maturation) was higher in boys compared to that of girls and higher in those with normal nutrition than with malnutrition. It was found that the rate of decay of the exponential term was slower in those with malnutrition compared to those with normal nutrition. While no difference was observed in the asymptotic value i.e., the rate at which infants reach the shape of older children, between boys and girls with normal nutrition (19 and 20 months respectively), it was delayed by 5 to 8 months in girls compared to boys with malnutrition. In the total sample, the Ehrenberg's index attained the asymptotic value at 20 months in boys and at 35 months in girls and at 27 months in the combined sample.

Law-like relationship between height and weight of school children.

Ehrenberg's Law-like relationship between height and weight [log (w) = ah + b] was applied to a group of public school and Govt. school children in New Delhi. It was found that the model log (w) = 0.8 h + 0.4 was comparatively a good fit for public school children and the model log (w) 0.8 h + 0.35 for Govt. school children. On fitting the model to the sample data it was found that the value of 'a' was 0.8, with some minor variation in the second decimal point and the value of 'b' was 0.39 & 0.36 respectively for public school boys and girls and 0.32 & 0.29 respectively for Govt. school boys & girls. These results corroborates with the findings of the earlier studies that the intercept constant 'b' in the Law-like relationship equation is influenced by the nutrition of children. This model is recommended because of its simplicity and practical usefulness using only already available information.

Age at which chest circumference overtakes head circumference in children.

Maximum likelihood method with probit transformation was applied to estimate median age at which chest circumference (CC) overtook head circumference (HC) in 1206 children from rural areas of Ballabhgarh in Haryana and in 1505 children from a slum population in Delhi. The results showed that, in case of rural area, this phenomenon occurred at an average age of 31.36 months and in children from urban slums, at an average age of 28 months. In both the areas, this phenomenon occurred at an average age of 20 to 21 months in normally nourished children. In children with grade I malnutrition, this was delayed by about 10 months as compared to those with normal nutrition and in children with grade II or worse malnutrition, this was further delayed by another 9 to 13 months on an average as compared to those with grade I malnutrition. These differences were found to be statistically significant (p < 0.001). These results indicate that the longer the delay in CC overtaking HC, the chance is higher for the children to be severely malnourished. Considering the relative ease of measuring head and chest circumferences, this parameter (age of CC crossing HC) could be useful in assessing the long term trend in the improvement of childhood nutrition in developing countries.

Humoral immune response to mutans streptococci associated with dental caries.

BACKGROUND. Mutans streptococci are important aetiological agents in dental caries and their prolonged contact with oral tissues evokes a variety of immune responses through local secretory and systemic antibodies. Patterns of such humoral responses in Indian children have not been reported and we undertook the present study to examine these. METHODS. One hundred and twenty-six children with dental caries and 55 matched controls were studied and saliva and sera collected from them. The tests on these specimens included total salivary and systemic immunoglobulins of different classes using radial immunodiffusion and Streptococcus mutans specific IgA, IgG and IgM using specifically standardized enzyme immunoassays. RESULTS. Children with caries had higher levels of IgG (1350 +/- 9.9 mg/dl; controls 1110 +/- 6.7 mg/dl) and IgA (260 +/- 1.8 mg/dl; controls 190 +/- 1 mg/dl) in the serum but their saliva had lower levels of total IgG (160 +/- 0.7 mg/dl; controls 340 +/- 2.9 mg/dl) and IgA (130 +/- 0.5 mg/dl; controls 410 +/- 3 mg/dl). IgM levels in caries children and controls were not significantly different. Higher levels of Streptococcus mutans specific IgA were detected in the saliva of 95 out of 126 (75%) children with caries compared to 13 out of 55 (22%) controls. Specific serum IgG and IgA levels were also increased in 105 and 114 children with caries, although the levels were not as high as those in saliva. Total and specific salivary and serum IgM antibodies were similar in children with caries and control subjects. CONCLUSION. The nature of the humoral immune response in Indian children with dental caries suggests that Streptococcus mutans specific salivary and serum antibodies may play a major role in pathogenesis. Our findings may have importance when devising methods for follow up and prognosis as well as for vaccination strategies.

Blood pressure profile, urinary sodium and body weight in the 'Oraon' rural and urban tribal community.

Blood pressure and nutritional profiles in the 'Oraon' tribal community of India living in rural and urban areas were studied between 1981-85 after a house to house survey of 4523 rural tribal people (RT) and 935 of their urban tribal counterparts (UT). Prevalence of hypertension was found to be 4.8/1000 males and 4.3/1000 females in rural tribal group giving an overall rate of 4.6/1000. In contrast the same were 27.1/1000 males and 21.4/1000 females in UT group, overall rate being 25.6/1000. Average calorie consumption were 1750 and 2280 and mean 24 hour-urinary sodium excretions 58 and 118 milliequivalents in RT and UT groups respectively. Of the total of 21 subjects in RT and 24 in UT detected to be hypertensive, 7 had common family inheritance. Increased mean arterial pressure correlated with increased sodium consumption and body weight. Hypertensives from both the groups showed higher urinary sodium excretion (P < 0.05). This epidemiologic study proves the role of a genetic factor/defect complicated by higher salt consumption in causation of increased blood pressure.

Are diarrheal incidence and malnutrition related in under five children? A longitudinal study in an area of poor sanitary conditions.

This study was conducted in Atali and Garkhera villages of Faridabad district of Haryana to assess the relationship between diarrheal incidence and malnutrition. Two hundred and fifty children in the age group of 6-47 months were followed up for one year from June 1988. History of diarrheal episodes was ascertained by fortnightly home visits. Nutritional status (weight for age) of the children was assessed at the beginning of the study and at every four monthly interval. The mean diarrheal incidence was 2.88 +/- 1.28 episodes per child year. The pre-valence of moderate to severe malnutrition in the children was 35% out of which 8.8% were severely malnourished. Although severely malnourished children had 0.56 more episodes of diarrhea in a year compared to normally nourished, the difference was not statistically significant. Similarly, number of episodes of diarrhea also did not affect the subsequent nutritional status of the children. The possible reason for this could be that in areas of poor sanitary conditions, nutritional status may not play an important role in increasing the susceptibility of children to diarrhea.

Studies on antibacterial properties of gentian violet impregnated silastic.

The antibacterial activity of gentian violet (GV) impregnated silastic discs was studied by measuring the zone of inhibition (ZOI), (in mm) produced by the discs planted on Staphylococcus epidermidis seeded agar plates. The effect of varying concentration of GV, the duration of antibacterial activity and effect of autoclaving were studied. The mean ZOI for 1 per cent GV was 19.28 +/- 0.89 mm and for 2 per cent GV it was 22.55 +/- 0.71 mm (P < 0.001). There was no significant difference between GV concentrations of 2-5 per cent. Over a period of 1-5 wk, no significant difference was found in the antibacterial activity of GV for any of the concentrations. In each of the concentrations there was a significant reduction in the ZOI after multiple autoclavings. The study thus indicates that it is possible to impart antibacterial properties to silastic implants so that their colonization with Staph. epidermidis can be prevented and this finding has obvious clinical implications.

Differential cell-mediated immune response to S. mutans in children with low and high dental caries.

Role of cell-mediated immune response (CMI) in dental caries was studied in 171 subjects, comprising of 86 children with low caries (LC), 31 with high caries (HC), and 54 age matched controls. [3H]thymidine mediated lymphoblast transformation test (LTT) using mutans streptococci antigen as stimulant was used to study the stimulation index (SI) of in vitro cultured lymphocytes from these children. The analysis revealed low stimulation index in high caries children whereas low caries children exhibited high stimulation index normally ranging between 2 to 6. The findings indicated that low caries children had strong CMI response as compared to high caries children. Although, the findings are based on limited number of samples, it certainly lays emphasis on protective or regulatory role of CMI in different phases of dental caries.