Reliability and Validity of a Physical Activity Questionnaire for Indian Children and Adolescents.

BACKGROUND: In low- and middle-income countries, sedentary behavior is widely prevalent in the young. Reliable and valid instruments are essential for evaluating sedentary behavior and physical activity in children and adolescents. OBJECTIVE: To evaluate the reliability and validity of an easy to use physical activity questionnaire for children and adolescents from India. STUDY DESIGN: Evaluation of a questionnaire tool. PARTICIPANTS: 104 children and adolescents belonging to the age group of 10-17 years were selected using a purposive sampling technique. METHODS: The Madras Diabetes Research Foundation - Physical Activity Questionnaire for Children and Adolescents [MPAQ(c)] was used to assess the various dimensions of physical activity. Physical activity was also objectively assessed using accelerometer worn around the waist for five complete days. The baseline administration of MPAQ(c) was done between November and December, 2017. Reliability of MPAQ was assessed by repeat administration after 2 weeks for upto a month later. Validity of MPAQ(c) was measured against accelerometer using Spearman's correlation and Bland and Altman agreements. RESULTS: Test-retest reliability of the questionnaire revealed good agreement (ICC: 0.77 min/wk). Correlation coefficients (95% CI) for sedentary behavior and moderate to vigorous physical activity for MPAQ(c) against accelerometer were 0.52 (0.36, 0.64) and 0.41 (0.23, 0.55), respectively indicating moderate correlation. Good agreement was present between MPAQ(c) and accelerometer for sedentary behavior [mean bias = -4.9 (±2SD -197.1 to 187.3) min/d]. CONCLUSIONS: MPAQ(c) is a valid and reliable instrument for evaluating physical activity in Indian children aged 10-17 years.

Incidence and Predictors of Dysglycemia and Regression to Normoglycemia in Indian Adolescents and Young Adults: 10-Year Follow-Up of the ORANGE Study.

Background: The prevalence of diabetes in youth is increasing worldwide in parallel with the obesity epidemic. This study aimed to determine the incidence rates of dysglycemia (diabetes or prediabetes) and evaluate the predictors of its progression or regression to normal glucose tolerance (NGT) in a cohort of children and adolescents studied in Chennai, South India. Methods: A longitudinal follow-up of the Obesity Reduction and Awareness of Noncommunicable Diseases through Group Education (ORANGE) cohort was performed after a median of 7.1 years (n = 845; 5928 person-years of follow-up). To determine their diabetes status at follow-up, participants underwent an oral glucose tolerance test (n = 811 with NGT and 34 with prediabetes at baseline), excluding those with diabetes at baseline. Incidence rates for dysglycemia were reported per 1000 person-years of follow-up. Cox proportional hazards model was used to estimate the predictors of progression and regression. Results: Out of 811 individuals with NGT at baseline, 115 developed dysglycemia giving an incidence rate of 20.2 per 1000 person-years (95% confidence interval: 16.8-24.2). Among those with prediabetes at baseline, 70.6% of the individuals converted to NGT and the remaining 29.4% either got converted to diabetes or remained as prediabetes. Higher age, body mass index, fasting plasma glucose, 2-hour plasma glucose (2-h PG), positive family history of diabetes, and systolic blood pressure (BP) were independent predictors of incident dysglycemia, whereas lower age, waist circumference, 2-h PG, systolic BP, and triglycerides predicted regression to normoglycemia. Conclusions: This study highlights the growing burden of dysglycemia in Asian Indian youth and emphasizes the need for targeted preventive actions.

Influence of Socioeconomic Status on Knowledge of Obesity and Diabetes among Adolescents in Chennai, South India.

The Obesity Reduction and Awareness of Non-communicable disease through Group Education (ORANGE) Phase II program, is a school-based intervention aimed at healthy lifestyle practices for sixth and seventh grade adolescents (n = 2345) attending private (n = 1811) and government (n = 534) schools in Chennai. The objectives of this paper are (a) to describe the intervention activities and their outcomes qualitatively and (b) to report changes in body mass index (BMI) of the intervention group participants. This intervention strategy used a teacher-peer-training model in each school for long-term sustainability of the lessons learned from this program. During each intervention session, teachers led a classroom discussion on the health topic of interest, and peers facilitated small-group learning activities. Anthropometric measurements of participants were assessed pre- and post-intervention. We found government school students perceived hygienic actions (e.g., drinking clean water, taking baths daily) as healthy habits for preventing diabetes, whereas private school students associated an expensive lifestyle (e.g., eating at restaurants, riding a car) with diabetes prevention. Overall, the mean post-intervention BMI (18.3 kg/m2) was in the normal range compared to the pre-intervention BMI (17.7 kg/m2) (p < 0.0001). These results suggest that future interventions should be tailored for adolescents from different socio-economic groups while acknowledging their varied perceptions.

Epidemiology of childhood overweight & obesity in India: A systematic review.

BACKGROUND & OBJECTIVES: Childhood obesity is a known precursor to obesity and other non-communicable diseases (NCDs) in adulthood. However, the magnitude of the problem among children and adolescents in India is unclear due to paucity of well-conducted nationwide studies and lack of uniformity in the cut-points used to define childhood overweight and obesity. Hence an attempt was made to review the data on trends in childhood overweight and obesity reported from India during 1981 to 2013. METHODS: Literature search was done in various scientific public domains from the last three decades using key words such as childhood and adolescent obesity, overweight, prevalence, trends, etc. Additional studies were also identified through cross-references and websites of official agencies. RESULTS: Prevalence data from 52 studies conducted in 16 of the 28 States in India were included in analysis. The median value for the combined prevalence of childhood and adolescent obesity showed that it was higher in north, compared to south India. The pooled data after 2010 estimated a combined prevalence of 19.3 per cent of childhood overweight and obesity which was a significant increase from the earlier prevalence of 16.3 per cent reported in 2001-2005. INTERPRETATION & CONCLUSIONS: Our review shows that overweight and obesity rates in children and adolescents are increasing not just among the higher socio-economic groups but also in the lower income groups where underweight still remains a major concern.

Determinants, consequences and prevention of childhood overweight and obesity: An Indian context.

The prevalence of obesity in adolescents and children has risen to alarming levels globally, and this has serious public health consequences. Sedentary lifestyle and consumption of calorie-dense foods of low nutritional value are speculated to be two of the most important etiological factors responsible for escalating rate of childhood overweight in developing nations. To tackle the childhood obesity epidemic we require comprehensive multidisciplinary evidence-based interventions. Some suggested strategies for childhood obesity prevention and management include increasing physical activity, reducing sedentary time including television viewing, personalized nutrition plans for very obese kids, co-curriculum health education which should be implemented in schools and counseling for children and their parents. In developing countries like India we will need practical and cost-effective community-based strategies with appropriate policy changes in order to curb the escalating epidemic of childhood obesity.