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Shobha Rao ¹, Jayashree Sarode ¹, Priti Apte ¹, Asawari Kanade ¹

Affiliations
1 Biometry and Nutrition Group, Agharkar Research Institute, Pune - 411 004, IN

Abstract

The objective of the study was to examine the risks for high blood pressure associated with under nutrition and over nutrition among adolescents, as both forms of malnutrition coexist in India owing to nutritional transition. Adolescents (9-16 yrs) from schools catering to Lower Socio Economic class (LSE; 943 boys, 1000 girls) and High Socio Economic class (HSE; 867 boys, 1042 girls) were measured for weight, height, sitting height, body fat, skin folds and blood pressure. Results revealed that high prevalence of overweight in adolescents from HSE class compared to that in LSE (24.1% vs 2.2% in boys and 20.8% vs 3.9% in girls; p<0.01 for both) indicated risk for High Systolic Blood Pressure (HSBP) while high prevalence of stunting in LSE class (20.8% in boys and 11.8% in girls) indicated risk for High Diastolic Blood Pressure (HDBP). Leg height to height ratio showed significant inverse association with blood pressure levels. In LSE class, prevalence of HDBP was significantly higher than prevalence of HSBP in each quartile of BMI, body fat and skin folds. Increase in systolic blood pressure per unit increase of BMI, was higher in adolescents from LSE class (1.99 mmHg in boys and 1.03 mmHg in girls) compared to those in HSE class (0.91 mmHg in boys and 0.52 mmHg in girls) and this was also true for diastolic blood pressure. Implications of increase in BMI are serious for undernourished children than better nourished children. The observation therefore, underscores the need for planning strategies for preventing adiposity in adolescents from urban as well as rural and poor sections of Indian population.

Keywords

Blood Pressure, Adolescents, Social Class.

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Prajakta Parab-Waingankar ¹, Shobha Rao ¹

Affiliations
1 Biometry & Nutrition Unit, Agharkar Research Institute, Pune- 411 004, IN

Abstract

Although hypertension is highly prevalent among urban Indian population, there exists insufficient investigation on its relation with obesity and abdominal obesity indicators for early risk prediction. Data on Body Mass Index (BMI), Body Fat (BF%), Waist Circumference (WC), Abdominal Circumference (AC), Waist to Hip Ratio (WHR), Waist to Height ratio (WHT), Sub-scapular (SSF) and Supra-iliac Skin Folds (SUF) and Blood Pressure were recorded through a cross-sectional study on 302 urban affluent men (aged 30-60 years) in Pune, India. Younger adults had the highest prevalence of both overweight (25.2%) and obesity (52.0%) and age related trend was significant (p<0.05) for prevalence of abdominal obesity. Obesity prevalence based on BF (%) was alarmingly high compared to that based on BMI. Indicators of abdominal obesity (WC, AC, SSF and SUF) increased with increase in BMI. Mean values of SBP and DBP and prevalence of hypertension increased significantly (p<0.05) with increase in BMI, AC, WC and its ratios but not with increase in either BF (%) or skinfolds indicating that it is the distribution of fat and not the total body fat that matters. The risk of hypertension was 2 to 3 times higher for BMI > 27.6 kg/m², for WC > 91.3 cm, for AC > 97.0 cm and for WHT > 0.55. Optimal cut-off for risk of hypertension obtained by ROC was much lower than conventional cut-off in case of WC (86.3 vs 90 cm) than that for BMI (25.3 vs 25 kg/m²) indicating the need for further studies to validate the potential of simple measurements such as WC and its ratios for risk assessment of hypertension among Indian population.

Keywords

Obesity, Abdominal Obesity, BMI, Waist Circumference, Hypertension.

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Swati Raje ¹, Shobha Rao ²

Affiliations
1 Dept. of Community Medicine, MIMER Medical College, Talegaon Dabhade, Maharashtra, IN
2 Biometry & Nutrition Group, Agharkar Research Institute, Pune - 411 004, IN

Abstract

Inadequate nutritional intakes, both in quality and quantity, during gestation have strong impact on birth outcome. Therefore, maternal consumption of specific food(s), besides total nutrient intake may influence birth weight. But the experimental evidence is scarce. The study was conducted on 354 full term mothers from rural Maharashtra for socioeconomic, demographic and anthropometric (maternal and neonatal) measures. Dietary consumption pattern was assessed using semi quantitative food frequency questionnaire (FFQ). Mothers were thin (weight 46±17.2 kg), short (height 151±15.8 cm) and 25.2 % were undernourished (BMI <18 kg/m²). Mean birth weight was 2548±309 g while the prevalence of low birth weight (LBW) was 44.8 % and was inversely associated with maternal weight (p=0.021) and BMI (p=0.013). Maternal diets were predominantly cereal based, lacked variety and 75% of the mothers were having calorie intake below 80% of RDA while 50 and 20% were below this cut off for protein and fat intake respectively. Significantly high risk for LBW was seen for young (<20 yrs) mothers (OR=2.25; CI: 1.14-4.48), those with low family income < Rs. 2000) (OR=2.77; CI: 1.43-5.35) and with low BMI (<18.5 kg/m²) (OR=2.26; CI: 1.32-3.87). Additionally, significant risk for LBW was seen for lower consumption (<1/day) of roti (OR=2.4; CI: 0.80-7.24) and no consumption of milk (OR=2. 3; CI: 1.16-4.75). Observations underscored the importance of maternal diet as dietary modification offers the only modifiable avenue for improving birth weight inpoor populations.

Keywords

Low Birth Weight, Maternal BMI, Maternal Dietary Consumption.

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Prajakta Parab-Waingankar ¹, Shobha Rao ¹

Affiliations
1 Biometry and Nutrition Group, Agharkar Research Institute, Pune - 411 004, IN

Abstract

Indian diets have not been thoroughly investigated despite the fact that 'Nutrition Transition' parallels a rapidly escalating epidemic of obesity and Non-Communicable Diseases. Data on socio-economic background, dietary intake, BMI, Body Fat, Waist Circumference (WC), Abdominal Circumference (AC) and fasting blood estimations were recorded on 302 affluent men (30-60 years) in a cross-sectional study in Pune, India. Average daily calorie intake was lower (1714.7 ± 442 kcal) than the Recommended Dietary Allowance (ICMR, 2010) while mean fat (45.8 ± 19.1 g), carbohydrate (279.2 ± 68.3 g) and protein intakes (46.5 ± 15.1 g) were comparable. Increase in mean WC and AC (3.9 cm), in prevalence of overall obesity (49.4% to 65.4%) and in prevalence of abdominal obesity (24.7% to 40.7%) was significant (p<0.05 for all) across tertiles of total calories. But with increase in fat intake, it was only the prevalence of abdominal obesity that increased significantly (23.2% to 39.5%; p<0.05). Subjects having higher calorie intake (>1816 kcal/d) had two times higher risk for overall and abdominal adiposity while subjects having higher fat intake (>50g/d) had two times higher risk for abdominal obesity alone. Fat density but not carbohydrate, was sensitive as the prevalence of high Fasting Blood Glucose (FBG), significantly (p<0.05) increased (20.2% to 42.9%) with its increase. Additionally, the risk of high FBG was about 3 times higher (p<0.01) for high fat density (>30%). Thus, high fat density but not carbohydrate density may be an important causative factor for high rates of abdominal obesity and disturbed glucose metabolism in India.

Keywords

Overall Obesity, Abdominal Obesity, Fat Density, Fasting Blood Glucose.

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Shobha Rao ¹, Pooja Gaigaware ², Amol P. Mankar ²

Affiliations
1 Society for Initiatives in Nutrition and Development, Pune, IN
2 International Institute for Population Sciences, Mumbai, IN

Abstract

High prevalence rates of Non Communicable Diseases (NCDs), particularly hypertension and the precedence in its age at onset in developing countries including India, demands identification of risk factors especially among urban young populations. Working young males from Pune, India (n=254) were measured for weight, height, Body Mass Index (BMI), Waist Circumference (WC) Waist Hip Ratio (WHR), Body Fat (BF), Visceral Fat (VF) and blood pressure; 72.5% were overweight, 48.4 % were obese (BMI≥25) while 68.9% were obese using body fat criterion. Central obesity (WC≥90) was 38.2% and was almost half of overall obesity. BMI was significantly (p<0.001) associated with WC and central obesity increased significantly (p<0.01) as BMI increased from lowest to highest (6% to 76.5%) tertile. Mean SBP was 121.9±10.4 mmHg and mean DBP was 79.9±8.6 mmHg while prevalence of hypertension (HTN) was high (25.6%) especially due to High Diastolic (22.4%) Blood Pressure (HDBP). Overweight and obese subjects had significantly (p<0.001) higher systolic and diastolic blood pressure levels but prevalence of HTN showed significant association only with BMI and VF but not with WC,WHR or BF indicating the importance of body fat distribution. In particular, subjects in the highest tertile of BMI had significantly (p<0.01) higher risk for HTN (OR 3.1, CI:1.5-6.2) and HDBP (OR 3.2, CI:1.5-7.0). This was also true for subjects in highest tertile of VF. Preventing obesity among young adults through modifiable factors associated with BMI and VF is necessary for reducing substantial amount of cardiovascular disease mortality.

Keywords

Overweight, Obesity, Hypertension, Young Adults.

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Shobha Rao ¹, Asawari Kanade ¹, Smita Joshi ¹, Avanti Joshi ¹

Affiliations
1 Department of Biometry and Nutrition, Maharashtra Association for the Cultivation of Science, Law College Road, Pune-411 004, IN

Abstract

It is well known that marked individual differences are encountered in the onset and magnitude of adolescent growth spurt, in either sex. Often these individual differences are attributed to socio-economic factors or to the nutritional factors, or to the malnutrition in the early chilhood. It is rarely recognized that considerable differences exist in respect of individual's capacity to respond to the rapid physical and physiological changes, that take place during adolescence.

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Shobha Rao ¹

Affiliations
1 Biometry and Nutrition Group, Agharkar Research Institute, Pune - 411 004, IN

Abstract

Rural population, where widespread under nutrition with obesity meagre is prevalent, is relatively less studied for prevalence of NCDs and the associated risk factors. Young rural adults (<30 yrs) (males 449 and females 267) were examined for anthropometry and blood pressure. Subjects were underweight (45.3±7.9 kg females; 56.4±9.1 kg males), short (153.0±5.5 cm females; 166.3±6.2 cm males) and thin (BMI 19.4±2.8 kg/m² females; 20.3±2.9 kg/m² males) as adults. The prevalence of overweight (BMI±25Kg/m²) was low (4.1% females; 6.5% males) while obesity was negligible but under nutrition (BMI<18.5 kg/m²) was evident (43.4% females; 29% males). Prevalence of hypertension (HTN) was significantly higher in males than in females (16.3% vs 6.4%; p<0.000) but was not true for dyslipidemia or high sugar. The prevalence of HTN and dyslipidemia increased significantly from lower tertile to higher tertile for all the indicators (BMI, waist-WC, waist-hip ratio-WHR, body fat-BF, abdominal circumference-AC), only among males. Moreover, the significant risk was observed at much lower level of BMI (>18.9 kg/m²) compared to conventional cut off (>23 kg/m²). Within the narrow range of BMI, central obesity increased with BMI, but was not responsible for high prevalence of HTN while short adult height (<166.1 cm) was, indicating early origins of HTN. These observations underscore the need for improving hypertension screening and treatment in primary health centres of rural areas as undernourished individuals exposed to nutritional transition are believed to experience much higher risk of hypertension compared to urban populations.

Keywords

Under Nutrition, Hypertension, Young Rural Adults.

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Prajakta Parab-Waingankar ¹, Shobha Rao ¹

Affiliations
1 Biometry and Nutrition Group, Agharkar Research Institute, Pune-411004, IN

Abstract

The pertinent role of diet in the development of obesity and metabolic syndrome (MS) is evident among studies from developed countries, however scarce data is available from India that has a culturally unique diet pattern. Data on socio-economic background, dietary patterns, BMI, body fat, circumferences, skin folds and blood pressure were recorded on 302 affluent men (30-60 years) in a cross-sectional study in Pune, India. Fasting blood estimations were performed for glucose, insulin and lipids. The subjects were predominantly (70%) vegetarians with daily butter consumption at 50%, high consumption (>4 times/week) of milk at 60.5% and >2 times/week for milk products (36%), home-made fried snacks (35%), outside snacks (25.5%) and outside meals (32.2%). High consumption of home-made fried and sweet snacks, outside snacks and milk products showed significantly higher (p<0.05) means, prevalence and odds ratio for overall and abdominal obesity. High consumption of fried foods increased abdominal obesity by 2-4 times. Significant associations were also observed between consumption patterns, dyslipidemia and MS. Prevalence of dyslipidemia significantly (p<0.05) increased from 42% to 48% to 55% across tertiles of outside snack consumption, with a significant risk observed in the middle tertile (OR: 1.94, p<0.05). Food groups that had displayed risk for abdominal obesity continued to demonstrate a positive association with MS viz. milk products (OR:2.23, p<0.05), home-made fried snacks (OR: 4.45, p<0.01) and outside snacks (OR:3.45, p<0.05). Odds ratio for fried and outside snacks continued to be significant even after adjusting for BMI. In contrast, the risk for MS was lowest (OR: 0.15, p=0.068) among subjects consuming fish (>once/week) as compared to consumption of once or less per month, even after adjusting for BMI. It was thus evident that consuming foods high in unhealthy fats and sugar (>2 times/week) increased the risk for both abdominal obesity and metabolic syndrome.

Keywords

Obesity, Abdominal Obesity, BMI, Waist Circumference, Metabolic Syndrome, Dyslipidemia, Diet, Fried Foods, Outside Snacks.

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Sayali Deshpande Joshi ¹, Shobha Rao ²

Affiliations
1 School of Health Sciences, Savitribai Phule Pune University, Pune, IN
2 Research and Training, Society for Initiatives in Nutrition and Development (SIND), Aundh, Pune, IN

Abstract

The study examined longitudinal changes in food consumption associated with changes in adiposity among rural men in India. Young rural men (n=142) in Pune were followed-up decade apart (2005 and 2015) for anthropometry including Body Mass Index (BMI), Body Fat (BF), Waist Circumference (WC) and Waist to Hip Ratio (WHR) and for Food Consumption (using FFQ). It was observed that decadal gain in mean BMI (3.77±2.60 kg/m2 ), BF (7.45±4.98 %) and WC (10.29±6.98cm) was significant (p<0.000) amounting to 19%, 49% and 15% of baseline values respectively. Consequently, prevalence increased for overweight (45%), obesity (33%), adiposity (36%) and central obesity (23%). Consumption of rice increased among (17%) participants while that of roti decreased among 9%, but increased for non-vegetarian foods, fried snacks and marketed sweets among 25, 53 and 22% participants respectively. Significant associations were observed not only for mean gains in BMI and WC, but also for higher prevalence and ORs for overweight among those who increased consumption of non-vegetarian foods (OR-4.34; 95%CI: 1.7- 11.1), fried snacks (OR-4.32; 95%CI: 1.5-12.8) and marketed sweets (OR-3.21; 95%CI: 1.1-9.1). Further, increased consumption of non-vegetarian foods also indicated two times and five times higher ORs for overall and central obesity respectively. These observations underscore role of specific foods in nutritional transition that increase obesity and demands targeted approach for its prevention by emphasizing nutritional awareness, promoting healthy dietary habits and physical activity among rural men. Moreover, the findings have implications for similar settings in other developing countries.

Keywords

Nutritional Transition, Longitudinal Changes In Food Consumption, Adiposity, Prospeactive Cohort, Rural Men

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