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Kajale N, Khadilkar A, Shah N, Padidela R, Mughal Z, Chiplonkar S, Ekbote V, Khadilkar V. Impact of Adolescent Pregnancy on Bone Density in Underprivileged Pre-Menopausal Indian Women. J Clin Densitom 2022; 25:178-188. [PMID: 34911660 DOI: 10.1016/j.jocd.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/29/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
High prevalence (31.5%) of adolescent pregnancies (AP) have been reported in India. Reports suggest that pregnancy during adolescence may have deleterious effects on peak bone mass. Very few studies have described the long-term effects of a history of AP on bone mass. The objective of this study was to compare bone mineral density (BMD) and bone geometry of premenopausal women with first childbirth during adolescence (i.e., before age of 19 years) or after 20 years. A cross-sectional study was conducted in 242 women (age 28.0-54.5 years) from Pune, India (November, 2015 to November, 2017). Women were divided into 2-groups: Group-1: women-who had 1st-pregnancy and childbirth before 19 years of age (AP n = 131) and Group-2: women-who had 1st pregnancy after 20 years of age (non-AP n = 111). Demographic data, anthropometric measurements, and biochemical tests were performed using standard protocols. Physical activity and nutrient intakes were recorded using validated questionnaires. Areal BMD and bone geometry were measured using Dual-Energy-Absorptiometry-DXA (Lunar-iDXA, GE Healthcare) and peripheral-quantitative-computed-tomography-pQCT (XCT2000, Stratec Inc.). Mean age of the study group was 37 ± 4.6 years; in women from group-1 mean age at first delivery was 16.9 ± 1.6 years as against 22.6 ± 3.1 years in group-2. Both groups were similar in body mass index and socioeconomic status. pQCT measured radial diaphyseal cortical thickness (1.97 ± 0.3 mm vs 1.88 ± 0.3 mm resp., p = 0.016, periosteal circumference (38.0 ± 3.6 mm vs 36.7 ± 2.5 mm, resp. p = 0.016), total bone area (114.3 ± 24.8 mm2 vs 108.7 ± 14.7 mm2 resp. p = 0.026) and stress-strain index (SSI = 217 ± 75 vs 201 ± 40 mm3 resp. p = 0.042) were significantly higher in group-1 than group-2. After adjusting for anthropometric and lifestyle parameters, pQCT measured cortical thickness (1.98 ± 0.03 mm in group-1, 1.87 ± 0.03 mm group-2, p = 0.01, mean ± SE) and iDXA derived aBMD at forearm were still significantly higher (0.599 ± 0.006 g/cm3 vs 0.580 ± 0.006 g/cm3, p = 0.023) in Group-1. Our data suggest that women with a history of adolescent pregnancy had better bone geometry and higher aBMD at radius in later years. We speculate that early exposure to pregnancy resulted in higher aBMD at the radius and induced changes at radial diaphysis with bones becoming thicker and wider among these women.
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Affiliation(s)
- Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Nikhil Shah
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India; Department of Pediatrics, Cloudnine Hospital, Malad, Mumbai
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, Manchester
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, Manchester
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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Miller V, Reedy J, Cudhea F, Zhang J, Shi P, Erndt-Marino J, Coates J, Micha R, Webb P, Mozaffarian D, Abbott P, Abdollahi M, Abedi P, Abumweis S, Adair L, Al Nsour M, Al-Daghri N, Al-Hamad N, Al-Hooti S, Al-Zenki S, Alam I, Ali JH, Alissa E, Anderson S, Anzid K, Arambepola C, Arici M, Arsenault J, Asciak R, Barbieri HE, Barengo N, Barquera S, Bas M, Becker W, Beer-Borst S, Bergman P, Biró L, Boindala S, Bovet P, Bradshaw D, Bukhary NBI, Bundhamcharoen K, Caballero M, Calleja N, Cao X, Capanzana M, Carmikle J, Castetbon K, Castro M, Cerdena C, Chang HY, Charlton K, Chen Y, Chen MF, Chiplonkar S, Cho Y, Chuah KA, Costanzo S, Cowan M, Damasceno A, Dastgiri S, De Henauw S, DeRidder K, Ding E, Dommarco R, Don R, Duante C, Duleva V, Duran Aguero S, Ekbote V, El Ati J, El Hamdouchi A, El-kour T, Eldridge A, Elmadfa I, Esteghamati A, Etemad Z, Fadzil F, Farzadfar F, Fernandez A, Fernando D, Fisberg R, Forsyth S, Gamboa-Delgado E, Garriguet D, Gaspoz JM, Gauci D, Geleijnse M, Ginnela B, Grosso G, Guessous I, Gulliford M, Gunnarsdottir I, Hadden W, Hadziomeragic A, Haerpfer C, Hakeem R, Haque A, Hashemian M, Hemalatha R, Henjum S, Hinkov H, Hjdaud Z, Hoffman D, Hopping B, Houshiar-rad A, Hsieh YT, Hung SY, Huybrechts I, Hwalla NC, Ibrahim HM, Ikeda N, Illescas-Zarate D, Inoue M, Janakiram C, Jayawardena R, Jeewon R, Jitnarin N, Johansson L, Jonsdottir O, Jundishapur A, Kally O, Kandiah M, Karupaiah T, Keinan-Boker L, Kelishadi R, Khadilkar A, Kim CI, Koksal E, Konig J, Korkalo L, Koster J, Kovalskys I, Krishnan A, Kruger H, Kuriyan-Raj R, Kweon S, Lachat C, Lai Y, Lanerolle P, Laxmaiah A, Leclercq C, Lee MS, Lee HJ, Lemming EW, Li Y, Lindström J, Ling A, Liputo NIL, Lopez-Jaramillo P, Luke A, Lukito W, Lupotto E, Ma Y, Mahdy ZA, Malekzadeh R, Manan W, Marchioni D, Marques LL, Marques-Vidal P, Martin-Prevel, Y, Mathee A, Matsumura Y, Mazumdar P, Memon A, Mensink G, Meyer A, Mirmiran P, Mirzaei M, Misra P, Misra A, Mitchell C, Mohamed HJBJ, Mohammadi-Nasrabadi F, Mohammadifard N, Moy FM, Musaiger A, Mwaniki E, Myhre J, Nagalla B, Naska A, Ng SA, Ng SW, Ngoan LTN, Noshad S, Ochoa A, Ocke M, Odenkirk J, Oh K, Oleas M, Olivares S, Orfanos P, Ortiz-Ulloa J, Otero J, Ovaskainen ML, Pakseresht M, Palacios C, Palmer P, Pan WH, Panagiotakos D, Parajuli R, Park M, Pekcan G, Petrova S, Piaseu N, Pitsavos C, Polasa K, Posada L, Pourfarzi F, Preston AM, Rached I, Rahbar AR, Rehm C, Richter A, Riley L, Salanave B, Sánchez-Romero LM, Sarrafzadegan N, Sawada N, Sekiyama M, Selamat R, Shamsuddin K, Shariff ZM, Sharma S, Sibai AM, Sinkko H, Sioen I, Sisa I, Skeaff S, Steingrimsdottir L, Strand T, Suarez-Ortegon MF, Swaminathan S, Swan G, Sygnowska E, Szabo M, Szponar L, Tan-Khouw I, Tapanainen H, Tayyem R, Tedla B, Tedstone A, Templeton R, Termote C, Thanopoulou A, Thorgeirsdottir H, Thorsdottir I, Trichopoulos D, Trichopoulou A, Tsugane S, Turrini A, van Oosterhout C, Vartiainen E, Veerman JL, Virtanen S, Vollenweider P, Vossenaar M, Waidyatilaka I, Waskiewicz A, Waterham E, Wieler L, Wondwossen T, Wu S, Yaakub R, Yap M, Yusof S, Zaghloul S, Zajkás G, Zapata M, Zarina K, Zohoori FV. Global, regional, and national consumption of animal-source foods between 1990 and 2018: findings from the Global Dietary Database. The Lancet Planetary Health 2022; 6:e243-e256. [PMID: 35278390 PMCID: PMC8926870 DOI: 10.1016/s2542-5196(21)00352-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023]
Abstract
Background Methods Findings Interpretation Funding
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Khadilkar V, Lohiya N, Chiplonkar S, Khadilkar A. Body Mass Index Quick Screening Tool for Indian Academy of Pediatrics 2015 Growth Charts. Indian Pediatr 2020; 57:904-906. [PMID: 32533683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To develop gender-specific graphic tool in which BMI cut offs can be read from height and weight, without need for calculating BMI and to validate the tool against Indian Academy of Pediatrics (IAP) 2015 BMI charts. METHODS Validation of tool was performed using de-identified data on children from school health surveys. RESULTS For detection of overweight and obesity, the BMI tool had sensitivity of 95.7% and specificity of 85.7% for boys, and 95.7% and 89.7% for girls, respectively. For underweight, sensitivity of 100% for boys and girls, and specificity of 88.9% for boys and 82.4% for girls was observed. CONCLUSION We present a graphic BMI tool for screening for underweight, overweight and obesity, which complements the existing IAP charts.
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Affiliation(s)
- Vaman Khadilkar
- Department of Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Nikhil Lohiya
- Department of Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Shashi Chiplonkar
- Department of Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India. Correspondence to: Dr Anuradha Khadilkar, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharasthra, India.
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Chiplonkar S, Kajale N, Lohiya N, Parthasarhty L, Khadilkar V, Khadilkar A. Dietary Patterns in Underprivileged Indian Children and Adolescents with Type 1 Diabetes. CNF 2020. [DOI: 10.2174/1573401315666191126091201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Children with diabetes are likely to have different food and nutrient composition
due to dietary restrictions. Studies on dietary intakes in Indian underprivileged children with
Type1 diabetes are scarce.
Objective:
To study dietary patterns and nutrient intakes of underprivileged children and adolescents
with type1 diabetes in comparison with their healthy siblings.
Methods:
Cross-sectional study, diet assessed by 24-h recall on 3-non-consecutive days in 120 children
with type1 diabetes (11.2 ± 3.8 yrs) and 65-age-gender matched healthy siblings. Dietary patterns
determined by cluster analysis. Nutrient composition was compared by one-way ANOVA.
Results:
Children with diabetes belonged to middle/lower economic class. Mean HbA1C of children
with diabetes was 9.7 ± 2.0% with higher intakes of whole cereals, milk, fruits, vegetables and lower
intakes of refined cereals, pulses, animal products than healthy siblings (P <0.05). Four diet patterns
were characterized on the basis of major foods: i) wheat, ii) millets, iii) rice and pulse and iv) milk
and fruits. Though patterns were similar in both groups, significantly higher intakes of vitamin C
(35 ± 23 vs. 24.7 ± 16.3 mg/d), zinc (5.6 ± 2 vs. 4.5 ± 2.3 mg/d), thiamin (812 ± 383 vs. 570 ± 254 μg/d),
riboflavin (782 ± 341 vs. 352 ± 182 μg/d) and calcium (673 ± 272 vs. 461 ± 253 mg/d) noted in children
with diabetes. Total energy, protein and carbohydrate intakes were comparable; fat consumption
was significantly lower amongst children with diabetes, though above recommended daily allowance
(RDA) 41.6 ± 14.1 gm vs. 47.4 ± 18.9 gm, P=0.029.
Conclusion:
Underprivileged children with diabetes and siblings had similar dietary patterns;
children with diabetes consumed healthier diet than siblings, still glycemic control was not optimum.
Dietary interventions are needed to improve micronutrient intake and reduce fat intake in underprivileged
children with type1 diabetes to improve their glycemic control.
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Affiliation(s)
- Shashi Chiplonkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Neha Kajale
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Nikhil Lohiya
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Lavanya Parthasarhty
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
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Vispute S, Khadilkar V, Khadilkar A, Ekbote V, Singh N, Chiplonkar S. Inter-regional differences in body proportions in Indian children and adolescents-a cross-sectional multicentric study. Ann Hum Biol 2020; 47:1-9. [PMID: 32013592 DOI: 10.1080/03014460.2019.1698656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Sitting height (SH) and leg length (LL) help in assessing disproportionate growth. Anthropometric dissimilarity has been observed in different ethnicities.Aim: To (1) study sitting height and body proportions in children from different regions of India; and (2) compare sitting height and body proportions with data from other countries.Subjects and methods: This was a cross-sectional multicentric observational study, where 7961 (4328 boys) 3-18 year old children from five regions (north, south, east, west and central) were measured (height, weight and SH).Results: Boys from north India and girls from central India were taller and heavier (mean height 153.2 ± 18, 146.4 ± 11), while western boys and girls were the shortest (131.1 ± 20.7, 129.8 ± 19.5) (p < 0.05 for all). The highest SH was observed in the north (79.2 ± 8.5) and the lowest in the west (68.8 ± 9.1). Mean SH:LL ratio was highest in children from the northeast (1.13) followed by those from western, northern and central India (1.12, 1.10 and 1.07, respectively) and the ratio was the least in children from south India (1.05) (p < 0.0.5 for all except northeast and west). Children from the north and west were similar to the Dutch, children from the south were similar to South (black) Africans and the north-eastern children were similar to Chinese children.Conclusion: There were inter-regional differences in body proportions; similarities in body proportions with children from other ethnicities may throw light on the migration history of Indian people.
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Affiliation(s)
- Smruti Vispute
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Veena Ekbote
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Narendra Singh
- Department of Anthropology, Assam University, Diphu, India
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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Khadilkar A, Chiplonkar S, Sanwalka N, Khadilkar V, Mandlik R, Ekbote V. A Cross-Calibration Study of GE Lunar iDXA and GE Lunar DPX Pro for Body Composition Measurements in Children and Adults. J Clin Densitom 2020; 23:128-137. [PMID: 30981615 DOI: 10.1016/j.jocd.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To cross-calibrate dual energy X-ray absorptiometry machines when replacing GE Lunar DPX-Pro with GE Lunar iDXA. METHODS A cross-sectional study was conducted in 126 children (3-19 years) and 135 adults (20-66 years). Phantom cross calibration was carried out using aluminum phantom provided with each of the machines on both machines. Total body less head (TBLH), lumbar spine (L2-L4) and left femoral neck bone mineral density (BMD), bone mineral content (BMC), and bone area were assessed for each patient on both machines. TBLH lean and fat mass were also measured. Bland-Altman analysis, linear regressions, and independent sample t test were performed to evaluate consistency of measurements and to establish cross-calibration equations. RESULTS iDXA measured 0.33% lower BMD and 0.64% lower BMC with iDXA phantom as compared to DPX-Pro phantom (p < 0.001). In children, TBLH-BMC, femoral BMC and area were measured 10%-14% lesser, TBLH area was higher by 1%-2% and L2-L4 area by 10%-14% by iDXA as compared to DPX-Pro. iDXA measured higher TBLH fat [15% (girls), 31% (boys)] than DPX-Pro. In adults, TBLH-BMD (1.7%-3.4%), BMC (6.0%-10.9%) and area (4.2%-7.6%) were measured lesser by iDXA than DPX-Pro. L2-L4 BMD was higher [2.7% (men), 1.8% (women)] by iDXA than DPX-Pro. Femoral BMC was 2.11% higher in men and 4.1% lower in women by iDXA as compared to DPX-Pro. In children, R2 of cross-calibration equations, ranged from 0.91 to 0.96; in adults, it ranged from 0.93 to 0.99 (p < 0.01). After the regression equations were applied, differences in BMD values between both machines were negligible. CONCLUSION A strong agreement for bone mass and body composition was established between both machines. Cross-calibration equations need to be applied to transform DPX-Pro measurements into iDXA measurements to avoid errors in assessment. This study documents a need for use of cross-calibration equations to transform DPX-Pro body composition data into iDXA values for clinical diagnosis.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | | | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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Dongare-Bhor S, Lohiya N, Maheshwari A, Ekbote V, Chiplonkar S, Padidela R, Mughal Z, Khadilkar V, Khadilkar A. Muscle and bone parameters in underprivileged Indian children and adolescents with T1DM. Bone 2020; 130:115074. [PMID: 31626994 DOI: 10.1016/j.bone.2019.115074] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The incidence of Type 1 diabetes mellitus (T1DM) is increasing and sarcopenia and osteoporosis have been reported to be associated with long standing diabetes. There is scarcity of data on bone health status of children with T1DM. Our aim was to assess bone health parameters [by Dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT)] and muscle strength (by hand grip) in underprivileged Indian children with T1DM. MATERIAL AND METHODS A cross sectional, observational study was conducted in underprivileged children with diabetes attending the out patient clinic for T1DM at a tertiary care hospital. Children with T1DM with disease duration more than 1 year were included in the study. Age and gender matched controls were also enrolled. Data on age, gender, disease duration, anthropometric parameters and HbA1c were collected. Bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry (Lunar iDXA) and peripheral quantitative computed tomography (pQCT, Stratec XCT 2000) and muscle strength by handgrip. Data were analysed using SPSS 25.0. RESULTS 251 children with T1DM and 250 age gender matched controls were studied. Mean age of T1DM children was 10.8 ± 4.3yrs (controls 10.3 ± 3.6). Mean HbA1C was 9.7 ± 2.1%. The total body less head areal BMD (TBLH aBMD) and lumbar spine bone mineral apparent density (LSBMAD) Z-scores were significantly lower in children with T1DM (-1.5 ± 1.3, -1.3 ± 1.6 respectively) as compared to controls (-0.5 ± 1.3, -0.64 ± 1.5 respectively) (p < 0.05 for both). Z-scores for trabecular and total density (vBMD) were significantly lower in patients with T1DM (-0.7 ± 1.0, -0.7 ± 1.0 respectively) than controls (-0.15 ± 1.2, -0.31 ± 1.1), (p < 0.05) and trabecular density was lower at distal radius with increasing disease duration. Hand-grip strength Z-score was lower in children with T1DM (-3.0 ± 0.5) as compared to controls (-2.8 ± 0.5). Trabecular density and HbA1C concentrations were negatively correlated (R = -0.18, p < 0.05) as was muscle area and HbA1C concentrations (R = -0.17, p < 0.05,). CONCLUSION Bone and muscle health were affected in children with poorly controlled T1DM. With increasing disease duration, attention is required for optimising musculoskeletal health.
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Affiliation(s)
- Shital Dongare-Bhor
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Nikhil Lohiya
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Ankita Maheshwari
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Veena Ekbote
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Shashi Chiplonkar
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Vaman Khadilkar
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Anuradha Khadilkar
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
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Yang L, Kelishadi R, Hong YM, Khadilkar A, Nawarycz T, Krzywińska-Wiewiorowska M, Aounallah-Skhiri H, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Stawińska-Witoszyńska B, El Ati J, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Ekbote V, Zhao M, Heiland EG, Liang Y, Xi B. Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort. Hypertension 2019; 74:1343-1348. [PMID: 31630571 DOI: 10.1161/hypertensionaha.119.13807] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.
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Affiliation(s)
- Liu Yang
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (L.Y., B.X.)
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.)
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.)
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Tadeusz Nawarycz
- Department of Biophysics, Medical University of Lodz, Poland (T.N., L.O.-N.)
| | | | - Hajer Aounallah-Skhiri
- National Institute of Public Health, Nutrition Surveillance and Epidemiology in Tunisia Research Laboratory, Tunis, Tunisia (H.A.-S.)
| | | | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.)
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Alicja Krzyżaniak
- Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W., A.K., B.S.-W.)
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia (H.B.R.)
| | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.)
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Barbara Stawińska-Witoszyńska
- Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W., A.K., B.S.-W.)
| | - Jalila El Ati
- Nutrition Surveillance and Epidemiology Unit, National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.)
| | - Mostafa Qorbani
- Department of Epidemiology, Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran (M.Q.)
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Pierre Traissac
- Institut de Recherche pour le Développement, UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.)
| | | | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.)
| | - Veena Ekbote
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Emerald G Heiland
- Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden (E.G.H.)
| | - Yajun Liang
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (Y.L.)
| | - Bo Xi
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (L.Y., B.X.)
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Mandlik R, Mughal Z, Khadilkar A, Chiplonkar S, Ekbote V, Kajale N, Patwardhan V, Padidela R, Khadilkar V. Occurrence of infections in schoolchildren subsequent to supplementation with vitamin D-calcium or zinc: a randomized, double-blind, placebo-controlled trial. Nutr Res Pract 2019; 14:117-126. [PMID: 32256986 PMCID: PMC7075745 DOI: 10.4162/nrp.2020.14.2.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/13/2019] [Accepted: 08/13/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Vitamin D and zinc are recognized for their roles in immune-modulation, and their deficiencies are suggested to be important risk factors for childhood infections. This study, therefore, undertook to assess the occurrence of infections in rural Indian schoolchildren, subsequent to daily supplementation with vitamin D-calcium or zinc for 6 months. MATERIALS/METHODS This was a randomized, double-blind, placebo-controlled trial in apparently healthy 6–12 year-old rural Indian children, recruited to 3 study arms: vitamin D arm (1,000 IU D3 - 500 mg calcium, n = 135), zinc arm (10 mg, n = 150) and placebo arm (n = 150). The infection status was assessed using a validated questionnaire, and the biochemical parameters of serum 25(OH)D and serum zinc were measured by ELISA and colorimetry, respectively. The primary outcome variable was occurrence of infections (upper respiratory and total infections). RESULTS Serum 25(OH)D concentration in the vitamin D arm improved significantly by 34%, from 59.7 ± 10.9 nmol/L to 80 ± 23.3 nmol/L (P < 0.0001), but no improvement was observed for serum zinc concentration. While there was significant increase in the percentage of children reporting no or mild upper respiratory tract infections (URTI) and total infections (TI) in all three groups, improvements in the supplemented groups were similar to the placebo group. However, the vitamin D arm reported lower URTI and TI status in the vitamin D sufficient versus insufficient children. Also, URTI and TI status were found to be significantly (P < 0.0001) lower in children with improved 25(OH)D versus unchanged 25(OH)D. CONCLUSIONS Vitamin D-calcium supplementation helped to improve the vitamin D status but exerts no effect on the occurrence of infections when compared to the placebo group. Improvement in the serum 25(OH)D concentrations and attainment of vitamin D sufficiency may exert a beneficial effect on the infection status and needs to be investigated further. To evaluate the efficacy of zinc supplementation, higher dosages need to be administered in future studies.
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Affiliation(s)
- Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune - 411001, Maharashtra, India.,Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Ganeshkind Road, Pune - 411007, Maharashtra, India
| | - Zulf Mughal
- Department of Pediatric Endocrinology & Metabolic Bone Diseases, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune - 411001, Maharashtra, India.,Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Ganeshkind Road, Pune - 411007, Maharashtra, India
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune - 411001, Maharashtra, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune - 411001, Maharashtra, India
| | - Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune - 411001, Maharashtra, India
| | - Vivek Patwardhan
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune - 411001, Maharashtra, India
| | - Raja Padidela
- Department of Pediatric Endocrinology & Metabolic Bone Diseases, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune - 411001, Maharashtra, India
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10
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Khadilkar AV, Lohiya N, Mistry S, Chiplonkar S, Khadilkar V, Kajale N, Ekbote V, Vispute S, Mandlik R, Prasad H, Singh N, Agarwal S, Palande S, Ladkat D. Random Blood Glucose Concentrations and their Association with Body Mass Index in Indian School Children. Indian J Endocrinol Metab 2019; 23:529-535. [PMID: 31803592 PMCID: PMC6873251 DOI: 10.4103/ijem.ijem_536_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE AND AIMS Overweight/obese children are at risk of developing type 2 diabetes mellitus. Random glucose elevations provide early warning signs of glycemic dysregulation. To assess random blood glucose (RBG) concentrations and risk factors associated with prediabetes in children aged 3-18 years from six Indian regions. METHOD Multicenter, cross sectional, observational school-based study; multi-stage stratified random sampling was carried out. Height and weight measured; body mass index (BMI) was computed. RBG measured using a glucometer. National sample survey was used for dietary patterns. Data were analyzed using SPSS 25.0 for Windows. SETTING Study centers were from Maharashtra, Gujarat, Chhattisgarh, Assam, Tamil Nadu and Punjab from 40 selected schools. PARTICIPANT Children aged 3-18 years were measured. RESULTS Data on 14339 subjects (7413 boys) were analyzed. Prevalence of obesity was 5.8% and overweight-10.6%. Overall, 1% had low (<3 mmol/L), 93.7% in reference range (3.9-7.2 mmol/L) and 5.3% had elevated RBG (>7.2 mmol/L). With increasing mean BMI, there was increase in RBG concentrations. Children from Tamil Nadu were more likely to have RBG outside reference range compared to other regions (P < 0.05). Assam and Punjab had highest prevalence of RBG and BMI within reference range. Energy intake partly explained regional variations. Multivariate analysis showed male gender, urban residency, age >10 yrs (girls) and 13 yrs (boys), and overweight or obesity were predictive of prediabetes. CONCLUSION Increased prevalence of overweight, obesity and prediabetes in Indian children are a matter of concern. Regional differences suggest that strategies to prevent obesity and combat perturbations in blood sugar may have to be customized.
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Affiliation(s)
- Anuradha V. Khadilkar
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Nikhil Lohiya
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Sejal Mistry
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Shashi Chiplonkar
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Neha Kajale
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Veena Ekbote
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Smruti Vispute
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Rubina Mandlik
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Hemchand Prasad
- Department of Paediatric Endocrinology, Dr Mehta's Hospital Pvt Ltd, Chennai, Tamil Nadu, India
| | - Narendra Singh
- Department of Anthropology, Assam University, Diphu, Assam, India
| | - Sanwar Agarwal
- Department of Paediatric Endocrinology, Ekta Institute of Child Health, Raipur, India
| | - Sonal Palande
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Dipali Ladkat
- Department of Paediatric and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
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Mandlik R, Chiplonkar S, Kajale N, Khadilkar V, Khadilkar A. Infection Status of Rural Schoolchildren and its Relationship with Vitamin D Concentrations. Indian J Pediatr 2019; 86:675-680. [PMID: 30915647 DOI: 10.1007/s12098-019-02933-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/14/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess the nutritional and infection status of rural schoolchildren and to study the relationship of infection status with serum 25(OH)D concentrations. METHODS This study was carried out in a primary school, in a rural setting, near Pune (18°N), Maharashtra. Data collected from 387 children included anthropometric, clinical, infection-related data (using a validated questionnaire) and dietary data (by 24-h recall method over 3 non-consecutive days, including a holiday) and serum 25(OH)D estimations (by ELISA). RESULTS Prevalence of underweight and stunting were 18% and 11% respectively. Upper respiratory tract infection (URTI) related symptoms were commonly reported. Episodes of URTI were found to be significantly and negatively correlated with serum 25(OH)D concentrations (rs = -0.14, p < 0.05) and lesser URTI episodes and duration were reported by children who were vitamin D sufficient as compared to those who were insufficient. No association of total infections was found with vitamin D status. CONCLUSIONS Moderate prevalence of underweight and stunting and frequent URTIs were observed in this population. Higher serum 25(OH)D concentrations and vitamin D sufficiency may be important for prevention of upper respiratory tract infections in rural children.
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Affiliation(s)
- Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India.,Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Ganeshkind, Pune, Maharashtra, India
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India
| | - Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India. .,Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Ganeshkind, Pune, Maharashtra, India.
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12
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Khadilkar A, Ekbote V, Kajale N, Chiplonkar S, Prasad H, Agarwal S, Singh N, Patwardhan V, Lubree H, Ladkat D, Mandlik R, Vispute S, Palande S, Patel P, Lohiya N, Khadilkar V. Sitting height percentiles in 3-17-year-old Indian children: a multicentre study. Ann Hum Biol 2019; 46:267-271. [PMID: 31257924 DOI: 10.1080/03014460.2019.1637936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Sitting height (StH) percentiles are not described for the Indian paediatric population.Aim: To generate multicentre StH percentile values for Indian children.Subjects and methods: A total of 7961 apparently healthy children (3-17 years old, Boys: 4328) randomly selected from 10 schools from six states of India were measured for height (ht), StH and weight during July 2016-October 2017.Results: The StH:Ht ratio was 0.52 (0.02) and was similar between boys and girls (p > 0.1). The ratio decreased in boys until the age of 14 years and then slightly increased; the lowest ratio was observed during 13-15 years. In girls, however, the StH:Ht ratio decreased until the age of 9 years and then plateaued until 15 years of age with a slight increase at 16 years; the lowest ratio was observed at the age of 12-13 years. Sitting height percentiles (3rd, 10th, 25th, 50th, 75th, 90th and 97th) were computed using LMS chartmaker.Conclusions: The results indicate that, during the pubertal years, the lower limb growth is more predominant than trunk growth. Further, this study provides smoothened percentile curves for sitting height in Indian children for the first time.
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Affiliation(s)
- Anuradha Khadilkar
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Veena Ekbote
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Neha Kajale
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Shashi Chiplonkar
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Hemchand Prasad
- Department of Pediatric Endocrinology, Dr Mehta's Hospital Pvt Ltd, Chennai, India
| | - Sanwar Agarwal
- Department of Pediatric Endocrinology, Ekta Institute of Child Health, Raipur, India
| | - Narendra Singh
- Department of Anthropology, Assam University, Diphu, India
| | - Vivek Patwardhan
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Himangi Lubree
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Dipali Ladkat
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Rubina Mandlik
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Smruti Vispute
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Sonal Palande
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Prerna Patel
- Department of Biotechnology and Biochemistry, Khyati Institute of Science, Khyati Foundation, Ahmedabad, India
| | - Nikhil Lohiya
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
| | - Vaman Khadilkar
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, India
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13
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Patwardhan V, Khadilkar A, Chiplonkar S, Khadilkar V. Dyslipidemia and Fat Distribution in Normal Weight Insulin Resistant Men. J Assoc Physicians India 2019; 67:26-29. [PMID: 31559764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although less common, insulin resistance and deranged lipids are also observed in normal weight individuals. Few studies have assessed body composition and lipid profiles in normal weight insulin resistant individuals. OBJECTIVE To assess differences in body composition and lipid profile in normal weight and overweight 40-60 years apparently healthy men with special reference to insulin resistance. DESIGN Cross-sectional observational study in apparently healthy men (40-60 yrs) was performed. Anthropometry, body composition (Dual Energy X-ray Absorptiometry scan), biochemical parameters (lipids, sugar and Insulin) were assessed. HOMA_IR was calculated. Subjects were grouped based on BMI and HOMA-IR for comparison. RESULTS Of the 286 subjects 152 (53%) had BMI < 25 (group A) and 134 (47%) had BMI > 25 (group B). Homa-IR was more than 3 in 18% in and in 36% in B. Group B had significantly higher fat, waist circumference, systolic blood pressure, insulin and HOMA-IR. In subgroup analysis in group A, subjects with HOMA IR>3 (group A2) had significantly higher BMI, waist, TG, TG: HDL ratio, android and total fat and lower HDL as compared sub-group A1(HOMA IR<3) (p< 0.05). Mean BMI, waist circumference and systolic blood pressure were significantly higher in B2 than A2 group (p< 0.05). Although total, android and gynoid fat percentage were significantly higher in group B2, android to gynoid ratio was significantly higher in A2 (p< 0.05). CONCLUSION No significant difference in lipids and fat distribution between insulin resistant and non-resistant subjects in overweight groups suggests that insulin resistance in overweight may be an extension of the pathological state related to obesity. In contrast, significant differences in lipid and fat distribution in normal weight insulin resistant individuals may likely be due to a different mechanism.
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Affiliation(s)
- Vivek Patwardhan
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra , Correspondence Author
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra
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Mandlik R, Ekbote V, Chiplonkar S, Khadilkar V, Khadilkar A. Parental Education, Children's Nutritional Status and Non-verbal Intelligence in Rural School-children. Indian Pediatr 2019; 56:205-208. [PMID: 30954992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess non-verbal intelligence and its relationship with nutritional status, nutrient intakes and parents' education in school-children. METHODS A cross-sectional, observational study was conducted in children between 6-11 years, without any known chronic disorder or intellectual disability. Data were collected regarding parents' education, anthropometry and dietary intakes. Non-verbal intelligence was assessed by Raven's Coloured Progressive Matrices (RCPM). RESULTS In 323 enrolled children (52.9% boys), a significant positive association was observed between RCPM scores and parents' education (father's rs=0.14, mother's rs=0.22), height Z-scores (rs=0.14) and dietary intakes of zinc (rs=0.14), iron (rs=0.12) and folate (rs=0.14). CONCLUSIONS Height in normal range, higher zinc, iron and folate intakes, and parental higher educational levels were associated with higher non-verbal intelligence scores.
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Affiliation(s)
- Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India. Correspondence to: Dr Anuradha Khadilkar, Department of Pediatrics, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune 411 001, India.
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15
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Mandlik R, Ekbote V, Chiplonkar S, Khadilkar V, Khadilkar A. Parental Education, Children’s Nutritional Status and Non-verbal Intelligence in Rural School-children. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Khadilkar V, Khadilkar A, Arya A, Ekbote V, Kajale N, Parthasarathy L, Patwardhan V, Phanse S, Chiplonkar S. Height Velocity Percentiles in Indian Children Aged 5-17 Years. Indian Pediatr 2019; 56:23-28. [PMID: 30806356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess height velocity and develop height velocity percentiles in 5-17-year-old Indian children; and to study the magnitude and age at peak height velocity. DESIGN Mixed longitudinal study. SETTING Private schools at Pune and Delhi. PARTICIPANTS/PATIENTS 2949 children (1681 boys) belonging to affluent class aged 5-17 years (1473-Pune, 1476-Delhi). METHODS Annual height and weight measurements from 2007 to 2013. Total 13214 height velocity measurements (7724 on boys). OUTCOME MEASURES Height velocity percentiles (3rd, 10th, 25th, 50th, 75th, 90th and 97th) constructed using LMS chart maker. RESULTS Age- and gender-specific height velocity percentiles were generated. Median height velocity in girls decreased from 5 to 8 years, increased to a peak of 6.6 cm at 10.5 years and then declined to 0.3 cm at 17.5 years. In boys, median height velocity reduced till 10.5, increased to a peak of 6.8 cms at 13.5 years and then declined to 1cm by 18 years. CONCLUSIONS Height velocity percentiles in 5-17-year-old urban Indian children were constructed.
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Affiliation(s)
- Vaman Khadilkar
- Department of Pediatrics, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Department of Pediatrics, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India. Correspondence to: Dr Anuradha Khadilkar, Deputy Director, Hirabai Cowasji Jehangir Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra 411 001, India. A
| | - Archana Arya
- Department of Pediatrics, Sir Gangaram Hospital, New Delhi, India
| | - Veena Ekbote
- Department of Pediatrics, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Neha Kajale
- Department of Pediatrics, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Lavanya Parthasarathy
- Department of Pediatrics, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Vivek Patwardhan
- Department of Pediatrics, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Supriya Phanse
- Department of Pediatrics, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
| | - Shashi Chiplonkar
- Department of Pediatrics, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospitals, Pune, Maharashtra, India
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Hou Y, Bovet P, Kelishadi R, Litwin M, Khadilkar A, Hong YM, Nawarycz T, Stawińska-Witoszyńska B, Aounallah-Skhiri H, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Krzywińska-Wiewiorowska M, Ati JE, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Parthasarathy L, Yang L, Zhao M, Chiolero A, Xi B. Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study. Hypertens Res 2018; 42:845-851. [PMID: 30587855 DOI: 10.1038/s41440-018-0178-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/11/2018] [Accepted: 11/05/2018] [Indexed: 11/09/2022]
Abstract
Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.
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Affiliation(s)
- Yaping Hou
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mieczysław Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Tadeusz Nawarycz
- Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland
| | | | - Hajer Aounallah-Skhiri
- National Institute of Public Health (INSP), Nutrition Surveillance and Epidemiology in Tunisia (SURVEN) Research Laboratory, 1002, Tunis, Tunisia
| | | | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Alicja Krzyżaniak
- Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | | | - Jalila El Ati
- Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia
| | - Mostafa Qorbani
- Department of Epidemiology, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Pierre Traissac
- Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France
| | - Lidia Ostrowska-Nawarycz
- Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland
| | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Lavanya Parthasarathy
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Liu Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, McGill University, Montreal, Canada
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.
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Vartak V, Khadilkar A, Khadilkar V, Chiplonkar S, Yajnik C, Garda L, Sethna Y, Nene U. Maternal anxiety and competency of mothers of children with type 1 diabetes. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
OBJECTIVES To field test the IAP2015 (Indian Academy of Pediatrics) charts in different socioeconomic classes; to compare standard deviation scores (Z-scores) of children's height, weight and body mass index (BMI) for age as computed based on IAP2007 or WHO charts against the IAP2015 references. METHODS A cross-sectional observational study was conducted in the district of Pune on apparently healthy 5-18 y old children from urban affluent, urban underprivileged and rural areas. Anthropometric measurements were performed and parameters were converted into Z-scores. RESULTS Urban affluent children were tallest and heaviest whereas urban underprivileged children were shortest. Z-score comparison showed that all children were shortest on WHO references and taller as per IAP2007 references. BMI Z-score was higher on IAP2007 charts and lower on WHO references. Highest number of children were within the reference range on IAP2015 charts among urban affluent. More children were classified stunted on WHO references and least on IAP2007 references. WHO references overestimated wasting and as per IAP2007 charts, less number were wasted. Less number of children were classified as being obese/overweight by WHO and IAP2007 references. CONCLUSIONS IAP2015 charts are better representative of healthy children of current generation and may be used to prevent inappropriate classification in present scenario.
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Affiliation(s)
- Nikhil Lohiya
- Department of Pediatric Endocrinology, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India
| | - Shubhadarshini Pawar
- Department of Pediatric Endocrinology, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India.
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India
| | - Rahul Jahagirdar
- Department of Pediatric Endocrinology, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India
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Parthasarathy L, Khadilkar V, Chiplonkar S, Khadilkar A. Effect of Antioxidant Supplementation on Total Antioxidant Status in Indian Children with Type 1 Diabetes. J Diet Suppl 2018; 16:390-400. [PMID: 29958027 DOI: 10.1080/19390211.2018.1470123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hyperglycemia results in the overproduction of free oxygen radicals that impair the endogenous antioxidant defenses. A randomized controlled trial was conducted to compare the effect of 3 months of antioxidant supplementation in the form of foods rich in micronutrients with pharmacological supplement on total antioxidant status of Indian children with type 1 diabetes. Ninety children with diabetes (mean age 11.5 ± 3.6 yrs, 37 boys) were randomly allocated to three groups: Group 1 (n = 31) = DM controls; Group 2 (n = 30) = multimicronutrient syrup; and Group 3 (n = 29) = dietary supplements (nine snack recipes rich in micronutrients). They received intervention for 3 months. Healthy controls were enrolled from local schools. Fasting blood was tested for total antioxidant status (TAS) and glycosylated hemoglobin (HbA1C). Children with diabetes had lower TAS (0.70 ± 0.2 vs. 1 ± 0.24 mmol/l, p = .0001) compared to healthy controls. Anthropometric and biochemical parameters were similar at baseline for all groups of diabetic children. Group 1 showed significant deterioration in TAS at endline (0.72 ± 0.16 vs. 0.60 ± 0.17 mmol/l, p = .008). Increase in TAS recorded in Group 2 was from 0.66 ± 0.21 to 0.70 ± 0.16 mmol/l and in Group 3 was from 0.68 to 0.73 mmol/l. There was a significant difference between Group 1 and Group 3 for percentage change in TAS (-13% vs. 16%, p = .035). Postsupplementation there was an increase in TAS values in children with diabetes, but they were still lower than in healthy controls. Indian diabetic children have compromised antioxidant status, which may be improved by incorporation of multimicronutrient-rich recipes in their diets.
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Affiliation(s)
- Lavanya Parthasarathy
- a Growth and Endocrine Unit , Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital , Pune , India
| | - Vaman Khadilkar
- a Growth and Endocrine Unit , Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital , Pune , India
| | - Shashi Chiplonkar
- a Growth and Endocrine Unit , Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital , Pune , India
| | - Anuradha Khadilkar
- a Growth and Endocrine Unit , Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital , Pune , India
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Mandlik R, Khadilkar A, Kajale N, Ekbote V, Patwardhan V, Mistry S, Khadilkar V, Chiplonkar S. Response of serum 25(OH)D to Vitamin D and calcium supplementation in school-children from a semi-rural setting in India. J Steroid Biochem Mol Biol 2018; 180:35-40. [PMID: 29247782 DOI: 10.1016/j.jsbmb.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/30/2017] [Accepted: 12/12/2017] [Indexed: 01/19/2023]
Abstract
The objectives of this study were to: 1) Determine the impact of varying baseline serum 25OHD on increase in vitamin D concentrations after daily supplementation with vitamin D and calcium (1000 IU + 500 mg respectively) for six months in school-children from a semi-rural setting 2) Test the efficacy of daily vitamin D-calcium supplementation on improvement in serum vitamin D concentrations to ≥75 nmol/L. Data collected from 106 subjects (58 boys, 48 girls), aged 6-12 years, included anthropometric measures like height and weight, body composition analysis, three one-day dietary recalls and sunlight exposure (by questionnaire). Blood was collected at baseline and endline and estimated for serum vitamin D by ELISA technique using standard kits. Classification of Vitamin D status was performed according to the 2011 Endocrine Society Practice Guidelines: vitamin D deficiency - <50 nmol/L; insufficiency - 50.0-74.9 nmol/L; sufficiency - ≥75 nmol/L. Statistical analysis was performed using SPSS software. Mean baseline serum vitamin D concentration was 59.7 ± 11.2 nmol/L; this rose to 79.8 ± 23.3 nmol/L with no significant differences between genders at the two time-points. Inverse relationship was obtained between baseline serum 25(OH)D concentrations and change in serum concentrations after supplementation, implying that with increasing baseline serum concentrations of 25(OH)D, increase in vitamin D levels post supplementation were significantly lower (r = - 0.96, p < 0.0001). Greatest benefit of change in serum vitamin D concentrations after supplementation was experienced by children with basal concentrations of <45 nmol/L. Daily vitamin D supplementation was effective in improving serum 25(OH)D to ≥75 nmol/L in 44% of children. Significantly higher percentage of children who were deficient at baseline (64%) were able to attain serum concentrations of ≥75 nmol/L as compared to children who were vitamin D insufficient (43%) (p < 0.001). Thus, daily supplementation with 1000 IU of vitamin D along with 500 mg of calcium helped in improving serum vitamin D concentrations to ≥75 nmol/L. Children who were vitamin D deficient particularly experienced these benefits.
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Affiliation(s)
- Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune 411001, Maharashtra, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune 411001, Maharashtra, India.
| | - Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune 411001, Maharashtra, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune 411001, Maharashtra, India
| | - Vivek Patwardhan
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune 411001, Maharashtra, India
| | - Sejal Mistry
- Rutgers University, Piscataway, NJ, United States
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune 411001, Maharashtra, India
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune 411001, Maharashtra, India
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Khadilkar AV, Sanwalka N, Mughal MZ, Chiplonkar S, Khadilkar V. Indian girls have higher bone mineral content per unit of lean body than boys through puberty. J Bone Miner Metab 2018; 36:364-371. [PMID: 28580516 DOI: 10.1007/s00774-017-0843-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
Our aim is to describe changes in the muscle-bone unit assessed as a ratio of bone mineral content (BMC) to lean body mass (LBM) through puberty at total body and various skeletal sites in Indian boys and girls. A cross-sectional study was conducted (888 children, 480 boys, aged 5-17 years) in Pune, India. Pubertal staging was assessed. BMC, LBM and fat percentage at the arms, legs, android, gynoid and total body (less the head) were assessed by dual energy X-ray absorptiometry. The amount of BMC per unit LBM (BMC/LBM) was computed. Changes in mean BMC/LBM at 5 Tanner (pubertal) stages after adjustment for age and fat percentage were calculated. In boys, adjusted BMC/LBM was significantly higher with successive Tanner stages [legs (TS-II vs TS-I), android (TS-III vs TS-II, TS-IV vs TS-III) and gynoid region (TS-III vs TS-II and TS-II vs TS-I) (p < 0.05)]. In girls, adjusted BMC/LBM was significantly higher with successive Tanner stages at total body, legs and gynoid (TS-III vs TS-II; TS-II vs TS-I; TS-V vs TS-IV), arms (TS-I to TS-V) and android regions (TS-V vs TS-IV) (p < 0.05). Boys had significantly higher adjusted BMC/LBM than girls at earlier Tanner stages (TS-I to TS-III), whereas girls had significantly higher adjusted BMC/LBM than boys at later Tanner stages (TS-IV, TS-V) (p < 0.05). Indian boys and girls showed higher total and regional body, and age- and fat percentage-adjusted BMC/LBM with successive pubertal stages. Girls had higher BMC/LBM than boys which may possibly act as a reservoir for later demands of pregnancy and lactation.
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Affiliation(s)
- Anuradha V Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Block 5, Lower Ground Floor, 32, Sassoon Road, Pune, 411001, Maharashtra, India.
| | | | - M Zulf Mughal
- Royal Manchester Children's Hospital, Manchester, UK
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Block 5, Lower Ground Floor, 32, Sassoon Road, Pune, 411001, Maharashtra, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Block 5, Lower Ground Floor, 32, Sassoon Road, Pune, 411001, Maharashtra, India
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Abstract
INTRODUCTION Due to the high prevalence of Vitamin D deficiency in spite of abundant sunshine and scarcity of studies investigating Vitamin D status in Indian children from rural and semirural areas, the objectives of this cross-sectional study were to: (1) assess the Vitamin D status of school-children in a semi-rural setting and (2) identify the determinants of Vitamin D status in these children. MATERIALS AND METHODS Data collected included anthropometric measurements (height and weight), body composition, three-one-day dietary recall method, demographic data, and sunlight exposure. Serum 25-hydroxyVitamin D (25(OH)D) was estimated by enzyme-linked immunosorbent assay (ELISA) technique. SPSS software was used for statistical analysis. RESULTS Anthropometric characteristics of the children were similar and mean serum 25(OH)D concentration was 58.5 ± 10.3 nmol/L with no significant differences between genders. Around 80% children reported sunlight exposure of 2 h or more. A majority (71%) of children were Vitamin D insufficient with serum 25(OH)D concentrations between 50 and 74.9 nmol/L. Determinants of Vitamin D identified were duration of sunlight exposure and body fat percent. Significant (P < 0.05) positive association of duration of sunlight exposure was observed with serum 25(OH)D concentrations, while BF% showed a negative association with serum 25(OH)D (β = -0.307; standard error = 0.1388; P < 0.05). DISCUSSION We have reported a high prevalence of Vitamin D insufficiency in school-children aged 6-12 years, from a semirural setting, in spite of a majority (80%) reporting >2 h of sunlight exposure. We have also demonstrated that duration of sunlight exposure and body fat percentage are the two important determinants of serum 25(OH)D concentrations in these children.
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Affiliation(s)
- Rubina Mandlik
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Veena Ekbote
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vivek Patwardhan
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
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Khadilkar V, Chiplonkar S, Ekbote V, Kajale N, Mandlik R, Khadilkar A. Reference centile curves for wrist circumference for Indian children aged 3-18 years. J Pediatr Endocrinol Metab 2018; 31:185-190. [PMID: 29306926 DOI: 10.1515/jpem-2017-0161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 12/04/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Childhood obesity and its consequences have reached alarming proportions worldwide and in India. Wrist circumference is emerging as an easily measurable reproducible parameter for screening children at risk of obesity-related morbidities such as hypertension and insulin resistance. The objectives of this study were: (1) to compute age and gender-specific wrist circumference percentiles for 3-18-year-old apparently healthy Indian children and adolescents; (2) to assess the relationship of wrist circumference with measures of obesity and adiposity such as body mass index (BMI), fat percentage and blood pressure (BP) and (3) to suggest age and gender-specific cut-offs for wrist circumference percentile for the risk of hypertension in Indian children and adolescents. METHODS This was a cross-sectional study on samples of 10,199 3-18-year-old children (5703 boys) from randomly selected schools from five major cities in India. Height, weight, waist and wrist circumference and BP were recorded. Body composition was measured using bioelectrical impedance analysis (BIA). Wrist circumference percentiles were computed using the LMS method. RESULTS The average wrist circumference of boys and girls was 10.4 cm and 10.0 cm at 3 years and increased to 15.1 cm and 13.9 cm, respectively, at 18 years. Compared to their Caucasian counterparts, Indian children's wrists were smaller. Receiver operating characteristic (ROC) curve analysis derived the 70th percentile of wrist circumference as the cut-off for identifying the risk of hypertension. CONCLUSIONS Contemporary cross-sectional reference percentile curves for wrist circumference for 3-18-year-old Indian children are presented. The 70th percentile of the current study is proposed as the cut-off to screen children for cardiometabolic risk factors such as hypertension.
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Affiliation(s)
- Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Veena Ekbote
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Rubina Mandlik
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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Chiplonkar S, Kajale N, Ekbote V, Mandlik R, Parthasarathy L, Khadilkar V, Khadilkar A. Validation of Bioelectric Impedance Analysis against Dual-energy X-Ray Absorptiometry for Assessment of Body Composition in Indian Children Aged 5 to 18 Years. Indian Pediatr 2017; 54:919-924. [PMID: 28849765 DOI: 10.1007/s13312-017-1182-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To validate body composition measurements by Bioelectric Impedance Analysis (BIA) against Dual-Energy X-ray Absorptiometry (DXA) as the reference method in healthy children and adolescents. DESIGN Cross-sectional. SETTING Schools in and around Pune city, India. PARTICIPANTS A random sample of 210 (114 boys, 96 girls) apparently healthy Indian children and adolescents (5-18 y). METHODS Weight, height, Tanner stage (TS) were recorded. Body composition measures: fat-free mass (FFM), fat mass (FM), lean mass (LM), bone mineral content (BMC) and body fat percentage (%BF) were assessed by BIA and DXA on a single day. Agreement between the methods was estimated by Pearson's correlation, and Bland and Altman analysis. MAIN OUTCOME MEASURES %BF, FM, FFM, LM, BMC. RESULTS BIA underestimated %BF by 6.7 (3.7)% as compared to DXA. Mean FFM, BMC and LM by BIA were significantly higher than by DXA (P<0.001). These differences remained similar after adjusting for age, BMI and TS. Mean differences between FFM (-2.32 (1.39) kg), BMC (-0.18 (0.15) kg), and LM (-2.15 (1.34) kg) by DXA and BIA were significant (P<0.01). Correlations between BIA and DXA were 0.92 for %BF, 0.96 for LM and 0.98 for FFM and BMC. Both the methods were similar in identifying normal and overfat children as per their respective cut-offs. CONCLUSION BIA and DXA techniques are not interchangeable for assessment of body composition. However, BIA may be used in the field/clinical setting preferably with ethnicity specific references.
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Affiliation(s)
- Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India. Correspondence to: Dr Anuradha Khadilkar, Deputy Director, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra 411 001, India.
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Pandit-Agrawal D, Khadilkar A, Chiplonkar S, Khadilkar V, Patwardhan V. Screening score for early detection of cardio-metabolic risk in Indian adults. Int J Public Health 2017. [PMID: 28638978 DOI: 10.1007/s00038-017-0994-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To develop and to evaluate efficacy of screening score for early detection of cardio-metabolic risk (CMR) in adults. METHODS Cross-sectional data on anthropometry, lipids, sugar levels, diet, and physical activity were collected on 720 adults (361 men, 35-50 year) using standardized techniques. Screening score was developed using regression analysis-cluster of risk conditions (blood pressure, lipids, and sugar levels) was dependent variable against age, sex, waist, diet, and physical activity as independent variables. Odd ratios were added to obtain final score and receiver-operating characteristic (ROC) curves were constructed to identify cut-off value of CMR score. RESULTS Mean age and BMI were 42.7 ± 9.4 years and 25.7 ± 5.0 kg/m2. Analysis showed age, male sex, waist, lack of fruits, green leafy vegetables, and lack of physical activity were independent predictors for increased CMR (p < 0.05). Total score ranged from 0 to 20. Area under the curve for ROC was 0.728 [95% (CI) 0.67-0.78]. Criterion value >8 had sensitivity (76%) and specificity (56%) for screening cases with CMR. CONCLUSIONS Screening score is a pragmatic way of identifying individuals with CMR without performing biochemical tests. Cost-effective community screening programs may be planned.
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Affiliation(s)
- Deepa Pandit-Agrawal
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, 411 001, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, 411 001, India.
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, 411 001, India
| | | | - Vivek Patwardhan
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, 411 001, India
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Parthasarthy LS, Phadke N, Chiplonkar S, Khadilkar A, Khatod K, Ekbote V, Shah S, Khadilkar V. Association of Fat Mass and Obesity-associated Gene Variant with Lifestyle Factors and Body Fat in Indian Children. Indian J Endocrinol Metab 2017; 21:297-301. [PMID: 28459029 PMCID: PMC5367234 DOI: 10.4103/ijem.ijem_372_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
CONTEXT Common intronic variants of the fat mass and obesity-associated (FTO) gene have been associated with obesity-related traits in humans. AIMS (1) The aim of this study is to study the distribution of FTO gene variants across different body mass index (BMI) categories and (2) to explore the association between FTO gene variants and lifestyle factors in obese and normal weight Indian children. SUBJECTS AND METHODS Fifty-six children (26 boys, mean age 10.3 ± 2.2 years) were studied. Height, weight, and waist and hip circumference were measured. Physical activity (questionnaire) and food intake (food frequency questionnaire) were assessed. Body fat percentage (%BF) was measured by dual-energy X-ray absorptiometry. FTO allelic variants at rs9939609 site were detected by SYBR Green Amplification Refractory Mutation System real-time polymerase chain reaction using allele-specific primers. Generalized linear model was used to investigate the simultaneous influence of genetic and lifestyle factors on %BF. RESULTS Mean height, weight, and BMI of normal and obese children were 130.6 ± 7.1 versus 143.2 ± 15.6, 24.0 ± 5.2 versus 53.1 ± 15.8, and 13.9 ± 2.1 versus 25.3 ± 3.2, respectively. The frequency of AA allele was 57% among obese children and 35% in normal weight children. Children with the AA allele who were obese had least physical activity, whereas children with AT allele and obesity had the highest intake of calories when compared to children who had AT allele and were normal. %BF was positively associated with AA alleles and junk food intake and negatively with healthy food intake and moderate physical activity. CONCLUSIONS Healthy lifestyle with high physical activity and diet low in calories and fat may help in modifying the risk imposed by FTO variants in children.
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Affiliation(s)
- Lavanya S. Parthasarthy
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Jangli Maharaj Road, Pune, Maharashra, India
| | - Nikhil Phadke
- Genepath Dx, Phadke Hospital, 1260, Jangli Maharaj Road, Pune, Maharashra, India
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Jangli Maharaj Road, Pune, Maharashra, India
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Jangli Maharaj Road, Pune, Maharashra, India
| | - Kavita Khatod
- Genepath Dx, Phadke Hospital, 1260, Jangli Maharaj Road, Shivajinagar, Pune, Maharashra, India
| | - Veena Ekbote
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Jangli Maharaj Road, Pune, Maharashra, India
| | - Surabhi Shah
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Jangli Maharaj Road, Pune, Maharashra, India
| | - Vaman Khadilkar
- Genepath Dx, Phadke Hospital, 1260, Jangli Maharaj Road, Pune, Maharashra, India
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Khadilkar A, Chiplonkar S, Agrawal DP, Sanwalka N, Khadilkar V. Bone Health Status in Indian Overweight/Obese Children. Indian J Pediatr 2016; 83:1473-1475. [PMID: 27287776 DOI: 10.1007/s12098-016-2179-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Abstract
This cross-sectional study, to assess bone health in Indian overweight, obese children in comparison with healthy controls was conducted in 245 (126 girls) children and adolescents aged 6-17 y in Pune, India. It was found that total body bone mineral content, bone area and bone mineral density adjusted for Tanner stage and weight were significantly lower in obese children as compared to overweight children, which in turn, was significantly lower than normal weight children (p < 0.05). Thus, overweight and obesity is negatively related to bone health in children and adolescents. Interventions need to be planned to increase peak bone mass accrual in overweight and obese children to reduce future risk of fracture and osteoporosis.
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Affiliation(s)
- Anuradha Khadilkar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Old Building Basement, 32, Sassoon Road, Pune, Maharashtra, 411001, India.
| | - Shashi Chiplonkar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Old Building Basement, 32, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Deepa Pandit Agrawal
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Old Building Basement, 32, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Neha Sanwalka
- Department of Nutrition and Biostatistics, NutriCanvas, Mumbai, India
| | - Vaman Khadilkar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Old Building Basement, 32, Sassoon Road, Pune, Maharashtra, 411001, India
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Ma C, Kelishadi R, Hong YM, Bovet P, Khadilkar A, Nawarycz T, Krzywińska-Wiewiorowska M, Aounallah-Skhiri H, Zong X, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Stawińska-Witoszyńska B, El Ati J, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Parthasarathy L, Zhao M, Xi B. Performance of Eleven Simplified Methods for the Identification of Elevated Blood Pressure in Children and Adolescents. Hypertension 2016; 68:614-20. [PMID: 27432869 DOI: 10.1161/hypertensionaha.116.07659] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/26/2016] [Indexed: 02/06/2023]
Abstract
The identification of elevated blood pressure (BP) in children and adolescents relies on complex percentile tables. The present study compares the performance of 11 simplified methods for assessing elevated or high BP in children and adolescents using individual-level data from 7 countries. Data on BP were available for a total of 58 899 children and adolescents aged 6 to 17 years from 7 national surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. Performance of the simplified methods for screening elevated or high BP was assessed with receiver operating characteristic curve (area under the curve), sensitivity, specificity, positive predictive value, and negative predictive value. When pooling individual data from the 7 countries, all 11 simplified methods performed well in screening high BP, with high area under the curve values (0.84-0.98), high sensitivity (0.69-1.00), high specificity (0.87-1.00), and high negative predictive values (≥0.98). However, positive predictive value was low for most simplified methods, but reached ≈0.90 for each of the 3 methods, including sex- and age-specific BP references (at the 95th percentile of height), the formula for BP references (at the 95th percentile of height), and the simplified method relying on a child's absolute height. These findings were found independently of sex, age, and geographical location. Similar results were found for simplified methods for screening elevated BP. In conclusion, all 11 simplified methods performed well for identifying high or elevated BP in children and adolescents, but 3 methods performed best and may be most useful for screening purposes.
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Affiliation(s)
- Chuanwei Ma
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Roya Kelishadi
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Young Mi Hong
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Pascal Bovet
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Anuradha Khadilkar
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Tadeusz Nawarycz
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Małgorzata Krzywińska-Wiewiorowska
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Hajer Aounallah-Skhiri
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Xin'nan Zong
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Mohammad Esmaeil Motlagh
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Hae Soon Kim
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Vaman Khadilkar
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Alicja Krzyżaniak
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Habiba Ben Romdhane
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Ramin Heshmat
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Shashi Chiplonkar
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Barbara Stawińska-Witoszyńska
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Jalila El Ati
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Mostafa Qorbani
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Neha Kajale
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Pierre Traissac
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Lidia Ostrowska-Nawarycz
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Gelayol Ardalan
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Lavanya Parthasarathy
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Min Zhao
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Bo Xi
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.).
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Xi B, Zong X, Kelishadi R, Hong YM, Khadilkar A, Steffen LM, Nawarycz T, Krzywińska-Wiewiorowska M, Aounallah-Skhiri H, Bovet P, Chiolero A, Pan H, Litwin M, Poh BK, Sung RYT, So HK, Schwandt P, Haas GM, Neuhauser HK, Marinov L, Galcheva SV, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Romdhane HB, Heshmat R, Chiplonkar S, Stawińska-Witoszyńska B, El Ati J, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Parthasarathy L, Zhao M, Zhang T. Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years. Circulation 2015; 133:398-408. [PMID: 26671979 DOI: 10.1161/circulationaha.115.017936] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). METHODS AND RESULTS Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. CONCLUSIONS These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.
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Affiliation(s)
- Bo Xi
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Xin'nan Zong
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Roya Kelishadi
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Young Mi Hong
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Anuradha Khadilkar
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Lyn M Steffen
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Tadeusz Nawarycz
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Małgorzata Krzywińska-Wiewiorowska
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Hajer Aounallah-Skhiri
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Pascal Bovet
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Arnaud Chiolero
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Haiyan Pan
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Mieczysław Litwin
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Bee Koon Poh
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Rita Y T Sung
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Hung-Kwan So
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Peter Schwandt
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Gerda-Maria Haas
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Hannelore K Neuhauser
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Lachezar Marinov
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Sonya V Galcheva
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Mohammad Esmaeil Motlagh
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Hae Soon Kim
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Vaman Khadilkar
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Alicja Krzyżaniak
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Habiba Ben Romdhane
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Ramin Heshmat
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Shashi Chiplonkar
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Barbara Stawińska-Witoszyńska
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Jalila El Ati
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Mostafa Qorbani
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Neha Kajale
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Pierre Traissac
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Lidia Ostrowska-Nawarycz
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Gelayol Ardalan
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Lavanya Parthasarathy
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Min Zhao
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Tao Zhang
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
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Khadilkar V, Mandlik R, Palande S, Chawla M, Nadar R, Chiplonkar S, Khadilkar A. Growth status of small for gestational age (SGA) Indian children from two socioeconomic strata. Int J Pediatr Endocrinol 2015. [PMCID: PMC4429082 DOI: 10.1186/1687-9856-2015-s1-p33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Khadilkar V, Parthasarathy L, Khadilkar A, Chiplonkar S. Body composition in Indian children and adolescents with type 1 diabetes. Int J Pediatr Endocrinol 2015. [PMCID: PMC4428742 DOI: 10.1186/1687-9856-2015-s1-p18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sanwalka N, Khadilkar A, Chiplonkar S, Khatod K, Phadke N, Khadilkar V. Influence of Vitamin D Receptor Gene Fok1 Polymorphism on Bone Mass Accrual Post Calcium and Vitamin D Supplementation. Indian J Pediatr 2015; 82:985-90. [PMID: 25972288 DOI: 10.1007/s12098-015-1783-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/27/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the association of vitamin D receptor (VDR) gene polymorphisms of the Fok1 locus on bone mass accrual in Indian girls used to a low calcium intake. METHODS An intervention trial was undertaken in 102 girls aged 8-16 y, attending a state run school in Pune city, India. All girls received 500 mg calcium daily and 30,000 IU of vitamin D3 quarterly for one year. Dietary calcium intake was evaluated. Bone mineral content (BMC), bone area (BA) and bone mineral density (BMD) were measured at total body using Dual Energy X-ray Absorptiometry (Lunar DPX-PRO). Polymorphisms of the Fok1 locus of the vitamin D Receptor (VDR) gene were detected using SYBR Green quantitative polymerase chain reaction. RESULTS The prevalence of Fok1 polymorphism was 43.1% (Ff), 9.8% (ff) and 47.1% (FF). At baseline, FF genotype had significantly lower BMD as compared to ff and Ff genotype (p < 0.05). At baseline, majority of girls (82.4%) were hypocalcemic with low calcium intake. Post-supplementation, FF genotype had significantly lower bone mass as compared to ff and Ff genotype. Significant increase in BMC [Ff (17.9%); ff (18.1%); FF (17.4%)], and BMD [Ff (5.4 %); ff (6.3%); FF (4.8%)] was observed post supplementation (p value < 0.05), though percentage increase in BMC and BMD was similar for three Fok1 polymorphisms (p > 0.1). CONCLUSIONS VDR gene polymorphism, as defined by Fok1 genotype had no positive influence on bone mass accrual in response to calcium supplementation.
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Affiliation(s)
- Neha Sanwalka
- Department of Nutrition and Biostatistics, NutriCanvas, Mumbai, India
| | - Anuradha Khadilkar
- Department of Growth and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Old Building Basement, 32, Sassoon Road, Pune, Maharashtra, 411001, India.
| | - Shashi Chiplonkar
- Department of Growth and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Old Building Basement, 32, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Kavita Khatod
- Department of Molecular Diagnostics, GenePath Diagnostics, Pune, India
| | - Nikhil Phadke
- Department of Molecular Diagnostics, GenePath Diagnostics, Pune, India
| | - Vaman Khadilkar
- Department of Growth and Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Old Building Basement, 32, Sassoon Road, Pune, Maharashtra, 411001, India
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Khadilkar A, Mandlik R, Chiplonkar S, Khadilkar V, Ekbote V, Patwardhan V. Reference centile curves for triceps skinfold thickness for Indian children aged 5–17 years and cut-offs for predicting risk of childhood hypertension: A multi-centric study. Indian Pediatr 2015; 52:675-80. [DOI: 10.1007/s13312-015-0695-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khadilkar A, Ekbote V, Chiplonkar S, Khadilkar V, Kajale N, Kulkarni S, Parthasarathy L, Arya A, Bhattacharya A, Agarwal S. Waist circumference percentiles in 2-18 year old Indian children. J Pediatr 2014; 164:1358-62.e2. [PMID: 24655536 DOI: 10.1016/j.jpeds.2014.02.018] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 01/13/2014] [Accepted: 02/05/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop reference percentile curves in Indian children for waist circumference (WC), and to provide a cutoff of WC percentile to identify children at risk for metabolic syndrome (MS). STUDY DESIGN A multicenter, cross-sectional study was performed in 5 major Indian cities. Height, weight, and blood pressure (BP) were measured in 10,842 children (6065 boys). Elevated BP was defined as either systolic BP or diastolic BP >95th percentile. WC was measured with the child standing using a stretch-resistant tape. Sex-specific reference percentiles were computed using the LMS method which constructs reference percentiles adjusted for skewness. To determine optimal cutoffs for WC percentiles, a validation sample of 208 children was assessed for MS risk factors (ie, anthropometry, BP, blood lipids), and receiver operating characteristic (ROC) curve analysis was performed. RESULTS Age- and sex-specific WC percentiles (5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, and 95th) are presented. WC values increased with age in both the boys and the girls. The median WC at age >15 years was greater in boys compared with girls. ROC analysis suggested the 70th percentile as a cutoff for MS risk (sensitivity, 0.84 in boys and 0.82 in girls; specificity, 0.85 in both boys and girls; area under the ROC curve, 0.88 in boys and 0.92 in girls). CONCLUSION Age- and sex-specific reference curves for WC for Indian children and cutoff values of 70th WC percentile for screening for MS risk are provided.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Surabhi Kulkarni
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | | | - Archana Arya
- Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
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Khadilkar V, Ekbote V, Kajale N, Khadilkar A, Chiplonkar S, Kinare A. Effect of one-year growth hormone therapy on body composition and cardio-metabolic risk in Indian children with growth hormone deficiency. Endocr Res 2014; 39:73-8. [PMID: 24066645 DOI: 10.3109/07435800.2013.828742] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Growth hormone (GH) deficiency in children manifests as short stature but is also associated with metabolic disturbances. Paucity of GH is also likely to be associated with increased intima media thickness. Data on body composition (BC) and carotid intima media thickness (cIMT) in children with growth hormone deficiency (GHD) from developing countries are very scarce. Therefore, objectives of present study were to assess effect of 1 year of rhGH therapy on (i) BC and lipid profile (LP) in a cohort of Indian GHD children and (ii) effect on atherosclerotic markers - cIMT in subsample. Anthropometry, BC [% body fat (BF), % lean body mass (LBM), bone mineral content (BMC)] (DXA) and LP were measured in 49 pre-pubertal GHD-children (9.3 ± 3.1 years) at baseline and after 1 year of rhGH therapy. On subset of 20 children, cIMT of right common carotid artery was also measured. Baseline BC parameters were compared with age-gender matched healthy controls (n = 49). At baseline % BF was 23 ± 9 %, LBM was 9 ± 3 kg and BMC was 0.306 ± 0.15 kg in GHD- children; BF was comparable, while lean and bone were less than controls (p < 0.05). Post therapy, significant reduction in fat (15%), and cIMT (7%) and increase in LBM and BMC by 40% and 44%, respectively (p < 0.05) was seen. Our cohort of untreated GHD children had abnormal BC and cIMT as compared to controls. rhGH therapy for 1 year had beneficial effect on BC and cardiovascular risk factors.
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Affiliation(s)
- Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Growth and Paediatric Endocrine Unit , Pune, Maharashtra , India and
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Ekbote V, Khadilkar A, Chiplonkar S, Mughal Z, Khadilkar V. Enhanced effect of zinc and calcium supplementation on bone status in growth hormone-deficient children treated with growth hormone: a pilot randomized controlled trial. Endocrine 2013; 43:686-95. [PMID: 23224626 DOI: 10.1007/s12020-012-9847-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022]
Abstract
Reduced bone mineral content in growth hormone-deficient children (GHD) has been reported. Calcium, zinc, and vitamin D play an important role in bone formation. Hence, the aim of this pilot randomized controlled study was to evaluate the effect of calcium, vitamin D, and zinc supplementation in prepubertal GHD children treated with GH on bone health parameters. After 1 year of treatment with GH (20 mg/m(2)/week), 31 GHD (mean age 8.7 ± 2.8 years, 18 boys) prepubertal children were randomised to receive calcium (500 mg/day) and vitamin D (60,000 IU/3 months) [Group A] or a similar supplement of calcium, vitamin D, and zinc (as per Indian Recommended Allowance) [Group B] along with GH therapy for the next 12 months. The two groups were similar in anthropometric and body composition parameters at baseline (p > 0.1). After 1 year of GH therapy, height-adjusted % gain was similar in both groups, 48 % in bone mineral content (BMC) and 45 % in bone area (BA). Height-adjusted % increase in BMC was significantly (p < 0.05) higher in the second year than in the first in both the groups. This % increase in BMC and BA was greater in Group B (51 and 36 % respectively) than in Group A (49 and 34 %), although marginally (p < 0.05). Supplementation of calcium and vitamin D along with GH therapy in GHD Indian children has the potential for enhancing bone mass accrual; this effect was further enhanced through the addition of zinc supplement.
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Affiliation(s)
- Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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Pandit D, Chiplonkar S, Khadilkar A, Kinare A, Khadilkar V, Divate U. Evaluation of risk of atherosclerosis in Indian adults. J Assoc Physicians India 2013; 61:312-316. [PMID: 24482943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate interrelationship of arterial measurements with metabolic syndrome (MS) components and zinc status in apparently healthy Indian adults. METHODS Anthropometry and biochemical data were recorded in 110 men and 139 women (25-50 yr). Carotid Intima media thickness (CIMT), stiffness (beta), pulse wave velocity (PWV), elasticity modulus (Ep), and arterial compliance (AC) of the right carotid artery were evaluated ultrasonically. According to definition of MS, subjects were categorized as MS-1, MS-2, MS-3. Further, normal and MS subjects were divided as zinc sufficient and deficient. RESULTS In all, 12.1% subjects had 3 risk factors for MS. Mean CIMT, beta, Ep and PWV were significantly higher by 6%, 11.6%, 29.5% and 12.4% in subjects with MS than normal (p < 0.05). AC showed significant decline in MS subjects by only 3% than normal (p < 0.05). Serum zinc was inversely correlated with beta, Ep and PWV in both the genders in subjects with MS (p < 0.05). A synergistic effect of serum zinc deficiency with MS further envisages the elevated risk of arterial stiffness. CONCLUSION Risk of atherosclerosis is marked by increase in stiffness parameters even in presence of a single MS risk and zinc deficiency may further aggravate the risk indicating need for early diagnosis.
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Affiliation(s)
- Deepa Pandit
- Agharkar Research Institute, Agarakar Road, Pune 411 004, India
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, 32, Sassoon Road, Pune 411 001, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, 32, Sassoon Road, Pune 411 001, India
| | - Arun Kinare
- Hirabai Cowasji Jehangir Medical Research Institute, 32, Sassoon Road, Pune 411 001, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, 32, Sassoon Road, Pune 411 001, India
| | - Uma Divate
- Hirabai Cowasji Jehangir Medical Research Institute, 32, Sassoon Road, Pune 411 001, India
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Sanwalka N, Khadilkar A, Chiplonkar S, Khatod K, Phadke N, Khadilkar V. Vitamin D receptor gene polymorphisms and bone mass indices in post-menarchal Indian adolescent girls. J Bone Miner Metab 2013; 31:108-15. [PMID: 23081732 DOI: 10.1007/s00774-012-0390-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 09/10/2012] [Indexed: 01/23/2023]
Abstract
To study the association between vitamin D receptor (VDR) gene polymorphisms and bone mass indices in adolescent girls, a cross-sectional study was conducted in 120 post-menarchal girls aged 15-18 years in Pune city, India. Serum levels of ionised calcium, inorganic phosphorous, parathyroid hormone and 25-hydroxy vitamin-D were measured. Bone mineral content (BMC), bone area (BA) and bone mineral density (BMD) were measured at total body (TB), lumbar spine (LS) and left femoral neck (FN) using dual energy X-ray absorptiometry. Polymorphisms of the VDR gene at the Fok1 and Bsm1 loci were detected using SYBR Green quantitative polymerase chain reaction. The overall distribution of genotypes at the Bsm1 locus in this study was 33.3 % Bb, 29.2 % bb and 37.5 % BB while that for the Fok1 locus was 44.2 % Ff, 7.5 % ff and 48.3 % FF. There were no significant differences in the blood parameters when classified according to Bsm1 or Fok1 genotypes. Subjects with BB genotype have significantly higher mean TBBMC, TBBA, TBBMD and LSBMD than Bb and bb (p < 0.05) and showed a tendency for association with LSBMC and LSBA (p < 0.1). Subjects with Ff genotype showed a tendency for association with left FNBMC and FNBA (p < 0.1). Bsm1 genotype did not show an association with FN bone indices whereas Fok1 genotype did not show association with TB or LS bone indices. In conclusion, the present study demonstrates VDR gene polymorphism, defined by Bsm1 genotype, has an influence on total body and lumbar spine bone mass indices in post-menarchal Indian girls.
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Affiliation(s)
- Neha Sanwalka
- Interdisciplinary School of Health Sciences, University of Pune, Pune, India
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Chiplonkar S, Khadilkar A, Pandit-Agrawal D, Kawade R, Kadam N, Ekbote V, Sanwalka N, Khadilkar V. Influence of micronutrient status and socioeconomic gradient on growth indices of 2-18-year-old Indian girls. J Pediatr Endocrinol Metab 2013; 26:825-32. [PMID: 23729550 DOI: 10.1515/jpem-2013-0106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/15/2013] [Indexed: 11/15/2022]
Abstract
Micronutrient deficiencies are common consequences of the plant-based diet in children from developing countries which may affect their linear and ponderal growth. The aim of the study was to investigate the association between micronutrient status and growth indices in Indian girls. In cross-sectional studies (2006-2010), data on weight, height and diet were collected on 1302 girls (2-18 years) from Pune city, India. Fasting hemoglobin was measured on 1118 girls and serum zinc was measured on 695 girls. Height-for-age Z-scores (HAZ) and body mass index for age Z-score (BMIZ) were computed using contemporary Indian references. HAZ >-1 was observed in 54% girls, and 18.1% were short (HAZ <-2). BMIZ was within the reference range (-2<BMIZ<2) in majority (82.4%) of the girls. Average HAZ and BMIZ were significantly higher in higher socioeconomic (HSE) than in middle (MSE) and lower (LSE) socioeconomic groups (p<0.05). Girls in all age groups had calcium, zinc, iron and vitamin intakes of <50% of Indian recommended dietary intakes. Mean nutrient intakes were significantly higher in HSE than in MSE and LSE girls (p<0.05). Girls with short stature (HAZ <-2) had significantly lower intakes of calcium, zinc, iron, β-carotene, riboflavin, niacin, folate and ascorbic acid (p<0.05). Higher levels of serum zinc and hemoglobin were observed in girls with HAZ >-1 than in short girls even after adjusting for socioeconomic status (SES). The mean serum zinc level of thin girls (BMIZ <-2) was significantly lower than those of both normal and overweight girls after adjusting for SES. Micronutrient sufficiency is of paramount importance for adequate growth in Indian girls.
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Prasad HK, Ekbote V, Rustagi V, Borade A, Chiplonkar S, Khadilkar V, Khadilkar AV. Performance of WHO growth standards on Indian children with growth related disorders. Indian J Pediatr 2012; 79:884-90. [PMID: 22361910 DOI: 10.1007/s12098-012-0687-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 01/11/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess performance of WHO 2006 standards on anthropometric measurements of children referred for growth related disorders to a speciality pediatric clinic in Pune, India, from June 2006 through June 2010. METHODS Data presented in this study were collected retrospectively from case records of all children from birth to 60 mo (n=1840, mean age 2.7±1.3 y) who presented with growth related disorders; healthy age and sex matched children were recruited as controls (n=824, mean age 2.8±1.2 y). Children were divided as per their clinical diagnosis into eight different groups: growth hormone deficiency, bone disorders, syndromic short stature, familial short stature, hypothyroidism, nutritional and systemic disorder, other endocrinopathies and overgrowth disorders. Anthropometric parameters for all study subjects were converted to standard deviation scores (SD scores) using the WHO Anthro 2005. RESULTS Mean height SD scores of children with growth related disorders were significantly lower than that of the controls, while that of the tall children were significantly higher (p<0.05). All children who were clinically very short were below the 1st percentile, while none of the children with overgrowth or normal children were classified as stunted. Weight for height SD scores of children with nutritional and systemic disorders were the lowest, while those for the obese children were the highest. CONCLUSIONS The present results suggest that the WHO 2006 growth standards classify children with growth disorders appropriately and the classification is in concordance with the clinical assessment. They provide health practitioners in a clinical setting with an effective tool to assess growth of children.
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Affiliation(s)
- Hemchand Krishna Prasad
- Department of Pediatric Endocrinology, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
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Khadilkar A, Kadam N, Chiplonkar S, Fischer PR, Khadilkar V. School-based calcium-vitamin D with micronutrient supplementation enhances bone mass in underprivileged Indian premenarchal girls. Bone 2012; 51:1-7. [PMID: 22503722 DOI: 10.1016/j.bone.2012.03.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 03/10/2012] [Accepted: 03/27/2012] [Indexed: 01/14/2023]
Abstract
Low adult bone mass is linked to osteoporosis and fractures and is dependent on the extent of childhood and adolescent bone mineralization. The aim of the study was to investigate the effect of 1-year supplementation of calcium, multivitamin with zinc along with vitamin-D on bone mass accrual of school-going premenarchal girls from low income groups in Pune, India. Double-blind, matched-pair, cluster, randomization study was carried out in 214 premenarchal girls (8-12 years) from 2 schools in Pune, India. The two schools together formed 3 classes with 3 clusters each of age-matched girls of which one cluster was allocated to either one of the intervention groups (Ca-group:500 mg/d calcium, Ca+MZ-group:500 mg/d calcium+multivitamin tablet containing 15 mg/d zinc) or control group (C-group: multivitamin tablet without any minerals); all subjects received vitamin-D supplementation. Anthropometry, biochemical parameters, total body bone mineral content (TBBMC) and bone mineral density (TBBMD) (Dual energy X-ray absorptiometry) were assessed at baseline and endline. Post supplementation, mean percent increase in TBBMC was significantly higher in Ca-group (22.3%) and Ca+MZ-group (20.8%) compared to C-group (17.6%) (p<0.05) with no significant differences observed between Ca+MZ and Ca groups (p>0.1). Improvement in TBBMC-for-age Z-scores was higher in the two calcium supplemented groups (13.6%-22%) compared to the C-group (no improvement). Calcium supplementation, with or without multivitamins and zinc, showed a promising improvement in bone health especially with regards to improvement in bone related Z-scores in our population of underprivileged premenarchal girls.
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Abstract
OBJECTIVE The aim of the study was to evaluate carotid arterial stiffness and intima media thickness (IMT) in obese children in comparison with healthy children, and to examine associations of lipid profile and blood pressure with carotid artery morphology. METHODS Anthropometric and blood parameters were assessed in 44 overweight, 95 obese (6-17 years) and 69 healthy age-matched normal children. Percent body fat was measured by dual-energy X-ray absorptiometry and stiffness and IMT of the common carotid artery were evaluated using Aloka alpha 10 equipment. RESULTS Anthropometric and lipid parameters were significantly higher in overweight and obese than in normal children (p < 0.05). Stiffness (beta), pulse wave velocity (PWV), elastic modulus (Ep) and blood pressure were significantly higher in obese and overweight children than in normal children (p < 0.05). However, overweight and obese children did not show any significant difference in IMT compared with normal children (p > 0.1). Significant positive correlation of PWV, beta and Ep and negative correlation of arterial compliance with body fat and triglyceride was noted (p < 0.05). Different multinomial regression models for each e-Tracking parameter indicated that the relative risk of hypertension was highest with high PWV, followed by LDL cholesterol, Ep and body fat. CONCLUSION PWV may be considered an important marker for evaluation of early functional changes of the carotid artery in children and adolescents.
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Affiliation(s)
- Deepa Pandit
- Agharkar Research Institute, Agarakar Road, Pune, India
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Abstract
OBJECTIVE To assess the prevalence and the relative importance of risk factors for low bone mass in Indian pre- and post-menopausal women. METHODS Data were collected on anthropometry and lifestyle factors in apparently healthy 80 pre- and 92 post-menopausal (40-75 years) women. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. Fasting blood samples were analysed for Parathyroid hormone, vitamin D, calcium and zinc. RESULTS BMD at all three sites was significantly lower in post-menopausal than the pre-menopausal women (p < 0.001). Prevalence of osteoporosis was highest at the lumbar spine (25.8%) in post-menopausal women, while prevalence of osteopenia was high in pre-menopausal women (44.3%). Vitamin D deficiency was seen in 54.5% pre and 41.8% post-menopausal women and significant correlation of serum 25(OH)D levels (r = 0.16) was obtained only for total hip Z-score (p < 0.05). Correlation between sun index and lumbar spine BMD was marginally significant (r = 0.14, p = 0.07). Generalised linear models revealed that after adjusting for age, weight and height, percent decrease of 2.1-4.5% in BMD may be attributed to menopause. CONCLUSION Age, weight, height, menopause, low intakes of calcium and low 25(OH)D along with poor sunlight exposure are the major factors contributing to bone loss in Indian women above 40 years of age.
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Pandit D, Chiplonkar S, Khadilkar A, Khadilkar V, Ekbote V. Body Fat Percentages by Dual-energy X-ray Absorptiometry Corresponding to Body Mass Index Cutoffs for Overweight and Obesity in Indian Children. Clin Med Pediatr 2009; 3:55-61. [PMID: 23818795 PMCID: PMC3676297 DOI: 10.4137/cmped.s3446] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Indians are suspected to have higher body fat percent at a given body mass index (BMI) than their western counterparts. OBJECTIVE To estimate percent body fat in apparently healthy Indian children and adolescents by dual-energy X-ray absorptiometry (DXA) and explore linkages of BMI with body fat percent for better health risk assessment. METHODS Age, weight, height of 316 boys and 250 girls (6-17 years) were recorded. Body composition was measured by dual-energy X-ray absorptiometry (DXA). High adiposity was defined as body fat percent (BF%) > McCarthy's 85th percentile of body fat reference data. Receiver operating characteristic analysis (ROC) was carried out for CDC BMI Z score for it's ability to judge excess fatness. RESULTS High BF% was seen in 38.5% boys and 54.0% girls (p < 0.05). Percentage of obese children as defined by the BMI cutoffs of International Obesity Task Force (IOTF) (2.1% for boys and 6.9% for girls) was lower than that using Indian (13.7% for boys and 20.9% for girls) and CDC (14.1% for boys and 20.9% for girls) cutoffs. The point closest to one on the ROC curves of CDC BMI Z-scores indicated high adiposity at BMI cutoff of 22 at the age of 17 yr in both the genders. CONCLUSIONS Higher body fat percentage is associated with lower BMI values in Indian children.
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Affiliation(s)
- Deepa Pandit
- Agharkar Research Institute, Agarakar Road, Pune, India
| | | | | | - Vaman Khadilkar
- HC Jehangir Medical Research Institute, Sasson Road, Pune, India.
| | - Veena Ekbote
- HC Jehangir Medical Research Institute, Sasson Road, Pune, India.
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Kadam N, Khadilkar A, Chiplonkar S, Khadilkar V, Mughal Z. Variation in lumbar spine bone mineral content by age and gender in apparently healthy Indians. J Bone Miner Metab 2009; 27:705-12. [PMID: 19444378 DOI: 10.1007/s00774-009-0091-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 03/25/2009] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess variation in bone mass from childhood through later age and to examine bone health status of Indian males and females. Lumbar spine (LS) bone mineral content (BMC) was measured by dual energy X-ray absorptiometry of lumbar vertebrae (L1-L4) in 683 males and 858 females (5-70 years) from Pune, India and apparent bone mineral density (BMAD) was calculated. A cubic regression model was fitted to describe the change in bone mineral content (BMC) with age in males and females separately. Regression analysis revealed that peak LS BMC was achieved around 26 years (63.6 +/- 11.0 g) for males and 30 years (54.1 +/- 11.6 g) for females. After 50 years of age, BMC showed an average annual decrease of 2.7% in males and 4.1% in females. Males had 11-15% higher mean BMAD than females after 50 years of age. T scores of 19% males and 28% females above 50 years, were less than -2.5 and T scores of 36% males and 43% females were between -1.0 and -2.5 when compared with the Lunar reference database. Low peak bone mass at a young age and higher bone loss in adults are alarming features of apparently healthy Indians.
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Affiliation(s)
- Nidhi Kadam
- Agharkar Research Institute, Pune 411 004, India
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Ghaskadbi SS, Shetye L, Chiplonkar S, Ghaskadbi S. Ultraviolet irradiation initiates ectopic foot formation in regenerating hydra and promotes budding. J Biosci 2005; 30:177-82. [PMID: 15886453 DOI: 10.1007/bf02703697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We have studied the effects of ultraviolet-C (UVC) and Ultraviolet-B (UVB) on growth and pattern formation in Pelmatohydra oligactis. UVC brings about a significant increase in budding in intact hydra while UVB does not exhibit such an effect. Excessive budding could be a response for survival at wavelengths that damage biological tissues. If the head or base piece of a bisected hydra is irradiated and recombined with the unirradiated missing part, regeneration proceeds normally indicating that exposure of a body part with either an intact head or foot to UVC does not influence pattern formation. Most significantly, in the middle piece, but not in the head or the base piece of a trisected hydra, UVC leads to initiation of ectopic feet formation in almost one third of the cases. Thus, UV irradiation interferes with pattern formation in regenerating hydra, possibly by changing positional values, and promotes budding in intact hydra. This is the first report on induction of ectopic feet formation by UV in regenerating hydra and opens up the possibility of using UV irradiation as a tool to understand pattern formation in the enigmatic hydra.
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Agte V, Jahagirdar M, Chiplonkar S. Apparent absorption of eight micronutrients and phytic acid from vegetarian meals in ileostomized human volunteers. Nutrition 2005; 21:678-85. [PMID: 15925291 DOI: 10.1016/j.nut.2004.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Accepted: 11/09/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Apparent absorption of eight micronutrients and degradation of phytic acid were studied in human subjects who underwent ileostomy. The prominent factors affecting micronutrient absorption from vegetarian Indian meals (n = 11) were identified. METHODS Levels of beta-carotene, ascorbic acid, riboflavin, and thiamine in food and ileostomy contents were estimated by spectrophotometry and spectrofluorometry. Contents of zinc, iron, copper, and manganese were estimated by atomic absorption spectrometry and that of phytic acid by gradient elution ion exchange chromatography. Statistical analyses were done with SPSS 10.0. RESULTS Absorption of beta-carotene, ascorbic acid, riboflavin, and thiamine was 63% to 75.6%. There was a negative non-significant trend in values of beta-carotene absorption with increased intake of beta-carotene (r = - 0.51, P > 0.1) and iron (r = -0.67, P = 0.1) but a positive significant trend with riboflavin intakes (r = 0.84, P = 0.018). Percentage of absorption of ascorbic acid showed weak positive associations with intakes of riboflavin (r = 0.71) and ascorbic acid (r = 0.5). Percentage of absorption of ascorbic acid was positively correlated with percentage of absorption of beta-carotene (r = 0.80, P < 0.05), iron, and riboflavin (r = 0.64, P = 0.086), indicating some common influencing factors. Percentages of absorption for zinc (20.2), iron (9.9), and copper (17.6) was comparable with those reported for soy protein-based, high phytate diets. Pattern of phytic acid in the meals and output indicated partial degradation and absorption (34%). CONCLUSIONS For vegetarian Indian meals, apparent absorptions of beta-carotene and ascorbic acid were 76% and 73.5% and of riboflavin and thiamine was 63%. Zinc, copper, and iron showed a lower absorption (10% to 20%).
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Affiliation(s)
- Vaishali Agte
- Biometry & Nutrition Group, Agharkar Research Institute, Pune, India.
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Abstract
During recent years importance of B complex vitamins, beta-carotene and vitamin C has been realised in terms of their antioxidative and anticarcinogenic properties. Fruits and vegetables are the rich sources of these vitamins. However, there are considerable cooking losses of vitamins, and information on vitamin contents of cooked foods is essential for assessing the adequacy of vitamin intakes. Secondly, there is a growing trend to consume ready-to-eat foods such as stuffed pancakes (samosa, patties), pastries, French fries; replacing traditional foods for lunch or dinner like roti, vegetable curry, bread, non-vegetarian items. Ready-to-eat foods are considered to give empty calories rather than a balanced diet. A study was undertaken to estimate ascorbic acid, folic acid, riboflavin, thiamine and beta-carotene of 263 cooked food samples and 260 meals representing dietary patterns of Asia, Africa, Europe, USA and Latin America by spectrophotometry and photoflurometry. A broad range of beta-carotene (84-2038 mcg%), riboflavin (0.01-0.48 mg%), thiamine (0.04-0.36 mg%), vitamin C (1-28 mg%) and folate (26-111 mcg%) was observed in individual foods. Bakery products and sweets were found to be poor sources and green leafy vegetables and fruits were good sources of these five vitamins. The differences between ready-to-eat foods and meals consumed during lunch or dinner were prominent for beta-carotene, ascorbic acid, riboflavin and folic acid (P < 0.05). The cooking losses were 34.6, 30, 52.2, 45.9 and 32.2% in case of ascorbic acid, thiamine, riboflavin, beta-carotene and folic acid respectively. Irrespective of whether it is ready-to-eat or a lunch/dinner food item, the contribution of vegetables in the preparations was found to make a marked impact on the vitamin profile. While results justify the concept of a food pyramid, emphasis needs to be given to types of fruits and vegetables rich in vitamins; preferably in their uncooked form, rather than considering their total consumption.
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Affiliation(s)
- Vaishali Agte
- Biometry and Nutrition Group, Agharkar Research Institute, G. G. Agarkar Road, Pune 411004, India
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Agte V, Chiplonkar S, Joshi N, Paknikar K. Apparent absorption of copper and zinc from composite vegetarian diets in young Indian men. Ann Nutr Metab 1994; 38:13-9. [PMID: 8185283 DOI: 10.1159/000177789] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In order to identify the factors affecting apparent absorption of copper and zinc in vegetarian subjects, percent absorption of copper and zinc was estimated during 6 metabolic experiments, each of 2 weeks duration, carried out on 6 healthy young men. They were observed at 3 levels of energy, i.e. 9.2, 10.5 and 12.1 MJ/day. Intakes of zinc were in the range of 20.6-27.1 mg/day and the observed values of apparent absorption (intake-fecal output) were 11.2-20.3%. In case of copper, intakes were 2.7-5.2 mg/day while the apparent absorption was to the tune of 10.6-21.7%. These values of absorption were lower than those of the non-vegetarian diets. Multiple regression analysis of 17 dietary factors suggested that hemicellulose, milk protein, niacin and cereal protein act as significant enhancers in zinc absorption while thiamine, phytate, oxalates, ascorbic acid and phosphorus acted as inhibitors. Copper absorption was enhanced by the dietary levels of riboflavine, cellulose, milk proteins, oxalates and zinc, while phosphorus, niacin, calcium and pulse protein inhibited the absorption of copper.
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Affiliation(s)
- V Agte
- Agarkar Research Institute, Pune, India
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