Country-specific nutrient requirements & recommended dietary allowances for Indians: Current status & future directions

Management of undernutrition during preconception and pregnancy in an urban setting in North India

Introduction

The prevalence of underweight in women of reproductive age (WRA) in South Asia remains unacceptably high. Underweight women suffer from lowered immunity, infertility, and a risk of developing non-communicable diseases. In pregnancy, undernutrition results in poor neonatal and maternal outcomes. We present the findings and the management strategy of undernutrition in the preconception and pregnancy phase intervention group in the WING study in low- to lower-middle-income neighborhoods of North India.

Methods

We analyzed data from the Women and Infants Integrated Interventions for Growth Study (WINGS) intervention group. In this individually randomized factorial design trial, 13,500 women were enrolled from low to middle-income neighborhoods of Delhi: 6,722 women in the preconception group and 2,640 from the pregnancy group. Food supplements in the form of locally prepared snacks were given to provide necessary calories and protein requirements as per the Body mass index (BMI) during the preconception period and each trimester of pregnancy. The snacks (sweet or savory) and milk or egg as a source of high-quality protein were delivered at home, and intakes were observed. Individual tracking and close monthly monitoring were done for compliance, besides screening and treatment of infections.

Results

The enrolled women's mean (SD) age was 24.2 (3.1) years. Approximately 35% of women had a height of < 150 cm, and 50% had schooling >12 years. 17% of women in preconception and 14 % in pregnancy intervention groups were Underweight. Approximately two-thirds of underweight women improved 9-12 months after management in the preconception group, and the same proportion improved 4 weeks after management during pregnancy. The proportion of women with inadequate weight gain (IWG) during pregnancy was higher in women who were underweight during preconception.

Discussion

A comprehensive approach to managing undernutrition with high-quality energy-dense food supplementation substantially improved weight gain in women during preconception and pregnancy.

Clinical trial registration

http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339%26EncHid=%26userName=societyforappliedstudies, identifier: Clinical Trial Registry India #CTRI/2017/06/008908.

Atmospheric polycyclic aromatic hydrocarbons in India: geographical distribution, sources and associated health risk-a review

Atmospheric distribution of polycyclic aromatic hydrocarbons and associated human health risks have been studied in India. However, a comprehensive overview is not available in India, this review highlights the possible sources, and associated cancer risks in people living in different zones of India. Different databases were searched for the scientific literature on polycyclic aromatic hydrocarbons in ambient air in India. Database searches have revealed a total of 55 studies conducted at 139 locations in India in the last 14 years between 1996 and 2018. Based on varying climatic conditions in India, the available data was analysed and distributed with four zone including north, east, west/central and south zones. Comparatively higher concentrations were reported for locations in north zone, than east, west/central and south zones. The average concentrations of ∑PAHs is lower in east zone, and concentrations in north, west/central and south zones are higher by 1.67, 1.47, and 1.12 folds respectively than those in east zone. Certain molecular diagnostic ratios and correlation receptor models were used for identification of possible sources, which aided to the conclusion that both pyrogenic and petrogenic activities are the mixed sources of PAH emissions to the Indian environment. Benzo(a)pyrene toxicity equivalency for different zones is estimated and presented. Estimated Chronic daily intake (CDI) due to inhalation of PAHs and subsequently, cancer risk (CR) is found to be ranging from extremely low to low in various geographical zones of India.

Food insecurity in the Eastern Indo-Gangetic plain: Taking a closer look

OBJECTIVE

Food security is an important policy issue in India. As India recently ranked 107th out of 121 countries in the 2022 Global Hunger Index, there is an urgent need to dissect, and gain insights into, such a major decline at the national level. However, the existing surveys, due to small sample sizes, cannot be used directly to produce reliable estimates at local administrative levels such as districts.

DESIGN

The latest round of available data from the Household Consumer Expenditure Survey (HCES 2011-12) done by the National Sample Survey Office of India used stratified multi-stage random sampling with districts as strata, villages as first stage and households as second stage units.

SETTING

Our Small Area Estimation approach estimated food insecurity prevalence, gap, and severity of each rural district of the Eastern Indo-Gangetic Plain (EIGP) region by modeling the HCES data, guided by local covariates from the 2011 Indian Population Census.

PARTICIPANTS

In HCES, 5915 (34429), 3310 (17534) and 3566 (15223) households (persons) were surveyed from the 71, 38 and 18 districts of the EIGP states of Uttar Pradesh, Bihar and West Bengal respectively.

RESULTS

We estimated the district-specific food insecurity indicators, and mapped their local disparities over the EIGP region. By comparing food insecurity with indicators of climate vulnerability, poverty and crop diversity, we shortlisted the vulnerable districts in EIGP.

CONCLUSIONS

Our district-level estimates and maps can be effective for informed policy-making to build local resiliency and address systemic vulnerabilities where they matter most in the post-pandemic era.

ADVANCES

Our study computed, for the Indian states in the EIGP region, the first area-level small area estimates of food insecurity as well as poverty over the past decade, and generated a ranked list of districts upon combining these data with measures of crop diversity and climatic vulnerability.

Effect of Multimodal Intervention (computer based cognitive training, diet and exercise) in comparison to health awareness among older adults with Subjective Cognitive Impairment (MISCI-Trial)-A Pilot Randomized Control Trial

INTRODUCTION

This study was aimed to investigate the effect of multimodal intervention on the cognitive functions of older adults with subjective cognitive impairment (SCI).

MATERIALS AND METHODS

Sixty subjects were randomized 1:1:1:1 to receive either computer based cognitive therapy (CBCT) or CBCT+Mediterranean equivalent diet (MED) or CBCT+MED+ Exercise regime and the control group. The intervention group received supervised CBCT twice a week to have 40 sessions, each of 40 minutes duration, and/ or supervised aerobic and resistive exercise twice a week for 24 weeks and or MED at home under the supervision of a dietician. The control group was provided with health awareness instructions for brain stimulating activities such as sudoku, mental maths, and learning music and new skills.

RESULTS

Cognitive functions which was the primary outcome measure were assessed using the Post Graduate Institute Memory Scale (PGI-MS), and Stroop Colour and Word Test at baseline and after 6 months intervention period. As assessed by the PGI-MS, there was significant improvement in domains such as mental balance, attention and concentration, delayed recall, immediate recall, verbal retention of dissimilar pairs, Visual retention, and total score both in the unimodal and multimodal intervention groups. However, the improvement was observed to be the highest in the multimodal intervention group as compared to unimodal group. All the participants completed the trial.

CONCLUSION

This pilot randomized control trial indicated that multimodal intervention could be an effective non-pharmacological intervention in individuals with SCI for improving their cognitive functions.

Dietary diversity as a sustainable approach towards micronutrient deficiencies in India

The silent epidemic of micronutrient deficiencies (MNDs) continues to be a major public health challenge in the developing world, including India. The prevalence of iron, iodine, zinc, vitamin A and folate deficiencies is alarmingly high worldwide. India is additionally facing a high prevalence of vitamin D and B12 deficiencies. To combat the hidden epidemic of MNDs, various governments around the world have mostly relied on supplementation or fortification-based interventions. India launched salt iodization programme in 1962 and vitamin A and iron-folate supplementation programmes in 1970. Yet, even after decades of these programmes, MNDs are still widespread in the country. Due to slow progress in alleviating the burden of most MNDs, the Government of India aims to scale up fortification-based intervention programmes. However, there are safety and effectiveness concerns with such approaches. Hence, overdependence on supplementation and fortification alone may be counterproductive. Instead, food based dietary diversification approach can be the way forward. In this article, we list the common MNDs in India, evaluate major policy interventions, discuss concerns pertaining to fortification and suggest the need for a concurrent food-based approach, in particular dietary diversification, as a long-term and sustainable strategy to address population-based MNDs.

Dietary Diversity and Its Associations with Anemia among Women of Reproductive Age in Rural Odisha, India

The aim of this study is to examine diet diversity, predictors associated with it, and its associations with anemia among non-pregnant women of reproductive age in rural India. Baseline data from the Reductions in Anemia through Normative Innovations (RANI) project were used and included 980 non-pregnant women aged 15-49 years from Odisha, India. The Food and Agriculture Organization's Minimum Dietary Diversity for Women (MDD-W) was used to assess diet diversity. Anemia was determined by hemoglobin level and categorized as normal (hemoglobin ≥ 12 g/dL), mild (11 ≤ hemoglobin <12 g/dL) and moderate/severe (hemoglobin < 11 g/dL). Multivariable logistic regression was used to examine factors associated with diet diversity, and multinomial logistic regression for associations between diet diversity and anemia. Forty-four percent of women were classified as having a diverse diet (MDD-W ≥5). Women with higher education level, belonging to a scheduled caste (vs. tribe), and higher body mass index had higher odds of a diversified diet (p < .05 for all). A more diverse diet was associated with 30% of lower odds of mild anemia (odds ratio = 0.7, 95% confidence interval: 0.5-0.98, p = .035), however, no statistically significant associations were found for moderate/severe anemia. Diet diversity was inversely associated with prevalence of mild anemia among non-pregnant women of reproductive age in rural India.

Plant-Based Dietary Practices and Socioeconomic Factors That Influence Anemia in India

While rates of malnutrition have declined over the last decade in India due to successful government interventions, the prevalence of anemia remains high. Staple foods provide almost 70% of the daily iron intake. As staple foods are a rich source of phytate, this ingested iron is poorly absorbed. Currently, 59% of children below 3 years of age, 50% of expectant mothers and 53% of women aged 15-19 years are anemic. The most common intervention strategy has been through the use of iron supplements. While the compliance has been low and supplies irregular, such high rates of anemia cannot be explained by iron deficiency alone. This review attempts to fit dietary and cooking practices, field-level diagnostics, cultural beliefs and constraints in implementation of management strategies into a larger picture scenario to offer insights as to why anemia continues to plague India. Since the rural Indian diet is predominantly vegetarian, we also review dietary factors that influence non-heme iron absorption. As a reference point, we also contrast anemia-related trends in India to the U.S.A. Thus, this review is an effort to convey a holistic evaluation while providing approaches to address this public health crisis.

Fluoride and nitrate in groundwater of rural habitations of semiarid region of northern Rajasthan, India: a hydrogeochemical, multivariate statistical, and human health risk assessment perspective

In arid and semiarid regions, groundwater is required for the drinking, agriculture, and industrial activities due to scarcity of surface water. Groundwater contaminated with high concentrations of fluoride and nitrate can severely affect human health in these regions. Twenty-eight groundwater samples from rural habitations of Jhunjhunu district, Rajasthan, India, were collected in March 2018 and subjected to analysis for water quality parameters. Fluoride and nitrate concentrations in groundwater varied from 0 to 5.74 mg/L and 10.22-519.64 mg/L, respectively. Nitrate content of about 86% samples and fluoride content of about 54% exceeded the permissible limit of Bureau of Indian Standards (IS:10,500) as well as World Health Organization standards. All groundwater samples belonged to poor to unfit drinking water quality index. Principle component analysis elucidates the anthropogenic contribution to high nitrate concentrations observed in this area. Noncarcinogenic human health risk evaluated from high nitrate and fluoride in drinking water for children, men, and women points to the fact that noncarcinogenic risk is exceeding the allowable limit to human health. The predominating hydrochemical facies in the area is Na⁺-HCO₃^--Cl^- followed by Na⁺-Mg²⁺-HCO₃^--Cl^-. The Gibbs plot and bivariate ionic cross-plots suggest the noncarbonate weathering (rock dominance), evaporation dominance, and ion exchange process to be the predominating geochemical mechanisms governing the evolution of groundwater hydrogeochemistry. Giggenbach diagram shows the immature character, i.e., incomplete equilibration of the groundwater.

Groundwater hydro-geochemistry, quality, microbiology and human health risk assessment in semi-arid area of Rajasthan, India: a chemometric approach

The present investigation focused on groundwater hydro-geochemistry of Alsisar block of Jhunjhunu district, India, aims on evaluating the quality of groundwater for drinking and irrigation purposes and assessing the human health risk from ingestion of groundwater. The groundwater of Alsisar block is neutral to alkaline, brackish and very hard in nature. Total dissolved solids, total hardness, Na⁺, Mg²⁺, HCO₃^-, F^- and NO₃^- in majority of the groundwater samples were exceeding the World Health Organization and Bureau of Indian Standards recommended limits. The drinking water quality index ranged from 111.53 to 492.84. None of the sample belonged to excellent and good categories of drinking water quality. Fluoride varied from 0.018 to 4.176 mg L^-1, and nitrate varied from 0.34 to 520.66 mg L^-1 in groundwater. The non-carcinogenic risk assessment for children, men and women owing to ingestion of fluoride and nitrate-enriched groundwater indicates human health risks in the entire study area. Irrigation with groundwater of Alsisar block is liable to cause salinity and magnesium hazard to agricultural crops grown in the area. Source apportionment using principal component analysis suggests the geogenic origin of fluoride and anthropogenic origin of nitrate. Na⁺-Mg²⁺-Cl^- followed by Na⁺-Mg²⁺-HCO₃^- are the predominant hydrochemical facies in the groundwater of Alsisar block. Silicate rock weathering, ion exchange and evaporation are the predominating processes governing ionic concentrations in the groundwater. Biochemical and molecular tests demonstrated the presence of Brevibacillus borstelensis strain DSM 6347 16s rRNA and Bacillus paramycoides strain MCCC 1A04098 16s rRNA in the groundwater of the area.

Causal effects of dietary calcium, zinc and iron intakes on coronary artery disease in men: G-estimation and inverse probability of treatment weighting (IPTW) analyses

BACKGROUND & AIMS

Dietary minerals have significant effects on the risk of cardiovascular disease. However, the results of previous studies were not uniform across different countries. The current study aims to determine the causal effects of dietary calcium, zinc, and iron intakes on coronary artery disease (CAD) among Nepalese men.

METHODS

A matched case-control study was carried out at Shahid Gangalal National Heart Center. Dietary intakes of 466 male participants over the past 12 months were evaluated using a semi-quantitative customized food frequency questionnaire. G-estimation and inverse probability treatment weighting (IPTW) analyses were performed to determine the causal odds of CAD due to dietary calcium, zinc, and iron intakes.

RESULTS

Daily dietary calcium, zinc, and iron intakes were categorized into two groups: less than versus more than the median value and less than versus equal or more than recommended daily allowance (RDA). In G-estimation, dietary calcium intake was inversely associated with CAD in both medians (OR: 91; 91%CI: 0.86, 95) and RDA categories (OR: 0.88: 95%CI: 0.84, 0.97). However, in IPTW analysis, only median calcium intake was significantly associated with CAD (OR: 7; 91%CI: 0.5, 98). We observed a significant inverse association of equal or more than RDA of dietary zinc intake with CAD (OR: 0.91: 95%CI: 0.87, 0.96 in G-estimation, OR: 0.73: 95%CI: 0.66, 0.82 in IPTW); however, more than median dietary zinc intake showed inverse but not significant association with CAD in both analyses. Dietary iron intake was inversely but not significantly associated with CAD in G-estimation in both groups. Nevertheless, in IPTW analysis, equal or more than RDA iron intake was significantly positively (OR: 1.4; 95%CI: 1.14, 1.73) related to CAD.

CONCLUSIONS

A significant inverse association of dietary zinc intake above RDA indicates the potential protective effect of higher dietary zinc against CAD. However, causal odds of CAD are inconsistent across the median or RDA of calcium and iron intakes. Therefore, cohort and randomized clinical trial studies with a large sample size are recommended to substantiate these nutrients' causal link with CAD development in the Nepalese population.

Bone mass of overweight affluent Indian youth and its sex-specific association with body composition

SUMMARY: The study assessed whether overweight is associated with better bone densities in healthy youth. It was observed that overweight individuals had better BMDs at the hip but not at other sites after controlling for the bone area. Lean body mass was an important determinant of BMDs in men, but both lean and fat mass were important for BMDs in women. INTRODUCTION: The study assessed the relationship of overweight and obesity to the bone mass in young men and women consuming adequate calcium. METHODS: Bone and body composition parameters were measured using dual energy X-ray absorptiometry in overweight men (n = 74) and women (n = 77) in the age group of 20-35 years and compared with controls having normal body mass index (BMI). Biochemical parameters of bone metabolism were also assessed. RESULTS: After adjustment for whole body bone area, bone mineral densities (BMDs) at femoral neck and hip were significantly higher in overweight individuals when compared with controls. However, BMD at lumbar spine, forearm, and whole body were not significantly different in the two BMI groups. Overweight women had lower vitamin D and higher parathormone levels than controls. Regression analyses indicated that height was an important determinant of BMD at most of the skeletal sites in both men and women. Lean body mass was an important determinant of BMDs in men, but both lean and fat mass were important for BMDs in women. CONCLUSION: Overweight may be associated with better BMDs at the hip but not at other sites after controlling for the bone area. Body composition parameters may have sex-specific associations with BMD.