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Background and Aim: Achalasia cardia, a primary motility disorder of the esophagus, poses significant malnutrition risks. This study aims at comprehensively assessing the nutritional status in untreated achalasia patients, contrasting it with functional gastrointestinal disorders (FGIDs) cases and impact of per-oral endoscopic myotomy (POEM) on nutrition at one-year., Methods: We conducted a prospective study, including consecutive achalasia cases, from December 2021 to April 2022 at a tertiary care centre. Biochemical parameters, anthropometry, subjective global assessment (SGA) and malnutrition universal screening tool were used for nutritional assessment. Cases diagnosed with FGIDs served as controls., Results: As many as 118 cases (41.2 ± 13.9 years, 61% males) with achalasia and 200 controls (43.4 ± 11.9 years, 69% males) were included in the study. Sub-types of achalasia included type I (16.9%), II (76.3%) and III (6.8%). Overall, 38.1% and 6.8% cases were moderately and severely malnourished, respectively. As compared to controls, cases with achalasia had lower pre-albumin (19.4 vs. 25.2; p = 0.001), serum calcium (p = 0.012), vitamin D (p = 0.001), serum iron (p = 0.001), triceps fold thickness (p = 0.002) and hand-grip strength (p = 0.001). On univariate analysis, type-I achalasia, body mass index, % weight loss, lower esophageal sphincter pressures and Eckardt scores were predictors of malnourishment (SGA). On multivariate analysis, type of achalasia, mid arm circumference and low body mass index were significant predictors of malnourishment in cases with achalasia. There was significant improvement in the nutritional status after POEM at one-year follow-up., Conclusion: Achalasia patients demonstrate a notably higher risk of malnutrition compared to individuals with FGIDs. Nutritional status significantly improves after POEM. (NCT05161923)., Competing Interests: Declarations. Competing interest: ZN, JB, PI, RG, VV, SPT, NC, MA, MR, SD and DNR declare that they have no conflict of interest. Ethical approval and consent to participate: Written informed consent was obtained from all participants and the study was approved by institutional review board committee (AIG/IEC post BH and R 11/01.2021–02). Human ethics: The study was conducted in accordance with the ethical standards of the Helsinki Declaration of 2013. Ethics statement: The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com. Consent for publication: Consent for publication was obtained. Disclaimer: The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article., (© 2024. Indian Society of Gastroenterology.)

Background: Technological advancements and globalization have shifted dietary behaviours, contributing to increased chronic disease prevalence in Low- and Middle-Income Countries (LMICs) like India. Adolescents are particularly vulnerable due to these changes, which can impact their lifelong health. This study aimed to assess the nutritional status of adolescents in public schools in Chandigarh, India., Methodology: Conducted as part of a cluster randomized control trial, the study used two-stage random sampling to select 12 schools and eighth-grade classes, recruiting 453 adolescents aged 10-16 years. Nutritional status was evaluated through dietary behaviour assessments, anthropometric measurements, and 24-hour urinary salt-level analysis. Dietary patterns were recorded using two 24-hour recalls, and analyzed with PURE study software based on 2010 Indian dietary data from ICMR-NIN. Anthropometric measures followed standardized protocols, and salt levels were assessed in laboratories., Results: The mean age of the adolescents was 13.06 years, with 55% being boys. Among them, 32% had high salt intake, and 55% had high sugar intake. Additionally, 90% had low fruit intake, and 83% had low vegetable intake. The adolescents were deficient in several macro and micronutrients, including energy, fats, fibre, iron, zinc, iodine, riboflavin, and vitamins B-6 and B-12. A higher proportion of boys (10%) were classified as thin compared to girls (2%), while a greater proportion of girls (36%) had abdominal obesity. In contrast, a larger proportion of boys (23%) were severely acutely malnourished. Nearly all adolescents exhibited high urinary excretory salt levels., Conclusion: Most adolescents exhibited dietary risk factors, including high salt and sugar intake, along with low consumption of fruits and vegetables. Many were deficient in various macro and micronutrients, with the coexistence of both thinness and obesity. Regular nutritional assessments in schools are essential to address the dual burden of undernutrition and overnutrition. Furthermore, health-promoting interventions should be developed within school settings to encourage healthy dietary practices., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Kaur et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: The demographic transition toward aging heralds an increase in the number of geriatric patients with cancer in India. Comprehensive geriatric assessment (CGA) is a sine qua non for treatment planning and shared decision making in these patients. We aimed to study the prevalence of malnutrition and the associated risk factors in geriatric patients with solid organ cancer., Methods: In this observational study, treatment-naïve geriatric patients with cancer underwent CGA. We performed a Mini Nutritional Assessment (MNA) to diagnose malnutrition. Data analysis was done using descriptive statistics, Pearson's chi-square, Spearman correlation, and multivariable regression analysis to assess the factors associated with malnutrition., Results: One hundred forty-two patients were included in the analysis. The median age was 67 (range, 60-88) years, with a male preponderance of 73.2% (n = 104) and a stage IV disease of 75.4% (n = 107). Most patients, 91.6% (n = 130), had abnormal MNA scores. Nearly one third of the patients, 35.2% (n = 50), were underweight (BMI <18.5 kg/m 2 ). Poor performance status (PS) was seen in 66.2% (n = 94) of the patients. Poor appetite 79.6% (n = 113) was the most common risk factor, followed by addictions (74.6%, n = 106), chronic constipation (35.9%, n = 51), and polypharmacy (21.8%, n = 31). Cognitive impairment and depression were seen in 35.2% (n = 50) and 57.1% (n = 81) of the patients, respectively. The study found a significant correlation of MNA with age ( P = .048), depression ( P < .001), PS ( P < .001), functional decline ( P < .001), and cognition ( P < .001)., Conclusion: There exists a widespread prevalence of malnutrition and amenable risk factors in geriatric patients with cancer. Nutritional assessment is essential, and interventions should be implemented to improve clinical outcomes.

Aim: Undernurition stands as a significant contributor to childhood mortality, particularly in developing nations such as India. At the grass root level, anthropometric monitoring indicators such as stunting, underweight and wasting take place within Anganwadi centres (village courtyard). The scrutiny of growth records, utilising these markers, not only quantifies the burden but also informs corrective measures. This study aimed to assess the prevailing growth monitoring records within the rural vicinity of Puducherry., Methods: A community-based cross-sectional study design was implemented to examine the health condition of children below 3 years of age, who were enrolled and utilising services in Anganwadi centres. The anthropometric data, such as weight and height, were collected from growth monitoring records maintained in Anganwadi. The proportions of undernutrition indicators such as stunting, underweight and wasting were presented with a 95% confidence interval (CI)., Results: Within our rural service area encompassing 13 Anganwadis, a total of 572 children aged 3 or less were registered. Notably, approximately 14.2% (95% CI: 11.5-17.3) of these children experienced underweight, 16.4% (95% CI: 13.6-19.7) were stunted and 13.3% (95% CI: 10.8-16.3) were wasted. In terms of gender disparities, the prevalence of undernurition was notably higher among boy children, with 15.4% being underweight, 16.9% stunted and 14.7% wasted., Conclusions: The prevalence of childhood undernurition is a public health concern, demanding the enhancement of existing nutritional initiatives to ameliorate the healthy well-being of these children. The timely identification of malnourished children holds paramount importance, as intensified interventions can be promptly employed to uplift the health status of these vulnerable individuals., (© 2024 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: Street children are poverty-stricken and have insufficient money to meet their daily nutritional requirements. They do not have a proper place to sleep and defecate. They sleep at traffic signals, in religious places, and on footpaths. This exposes them to pollution, dirt, and other pathogens., Objectives: This study aimed to measure the nutritional status of street children in Delhi using Z-scores and Composite Index of Anthropometric Failure (CIAF)., Methods: Anthropometric measurements are direct methods of measuring the nutritional status of humans. Anthropometric indicators such as underweight (weight-for-age), stunting (height-for-age) and BMI/wasting (weight-for-height) are used to measure the nutritional status of street children. Z-scores and CIAF are calculated for street children based on the WHO 2009 reference., Results: According to Z-scores, stunting (56%) is the most common anthropometric failure among street children followed by underweight (31%) and wasting (19%). According to the CIAF, 63% of street children are malnourished, where stunting (37%) is the highest single burden of anthropometric failure, followed by wasting (3%) and underweight (1%); children suffering from the double burden of anthropometric failure are 9%, and children suffering from the triple burden of anthropometric failure (i.e., wasting, stunting, and underweight) are 13%., Conclusion: A high incidence of stunting points to poor quality of food and suggests prolonged nutrition deficiency among street children. The Z-score or conventional measures of anthropometry underestimate the total burden of malnutrition among street children, while CIAF provides an estimation of children with single-burden, double-burden, and triple-burden malnutrition or total burden of malnutrition., Competing Interests: Declaration of competing interest The author declares the following financial interests/personal relationships which may be considered as potential competing interests: I certify that the submission is original work and is not under review at any other publication., (Copyright © 2024 Elsevier Inc. All rights reserved.)

There are no high-quality data on dietary behaviour of adolescents in India. This study aimed to assess the intake of energy (E), macronutrients and selected micronutrients in a sample of 11-13-year-old schoolchildren in Delhi, India. Participants from private schools ( n =10) recorded dietary intake using a 3-d food diary. Information was entered into the dietary assessment tool, Intake24, to ascertain portion size and convert data into nutrient intake through integrated food tables. Of the 514 consenting participants, 393 (76·4 %) (169 girls, 224 boys) aged 11·4 (±1·8) years completed the study. The median (interquartile range (IQR) daily E intake was 2580 (2139·3-2989·8) kcal (10·8 (9·0 - 12·5) MJ) for girls and 2941·5 (2466·7-3599·3) kcal (12·3 (10·3-15·2) MJ) for boys. The median (IQR) daily nutrient intakes for girls and boys respectively were protein 64·6 (54·8-79·3) g, 74·4 (61·4; 89·4) g; carbohydrate 336·5 (285·3-393·6) g, 379·6 (317·8-461·8) g; and saturated fat 45·6 (34·8-58·3) g, 54·6 (41·9-69·5) g. There were no significant between-gender differences in percentage E from protein (10·2 (9·2-11·4)), or carbohydrate (52·4 (48·7-56·7)). Girls obtained less percentage E from saturated fat (16·1 (11·0-18·2) compared with boys 16·3 (14·2-19·1) ( P < 0·05). E from saturated fat was above FAO recommendations in >74 % of participants. The estimated average requirement for iron was achieved by < 40 % of girls. In conclusion, strategies to optimise the dietary intake of adolescents in India should focus on preventing excess intakes of E and saturated fat and improving iron intake in girls.

Background: Nutrition of the elderly affects immunity and functional ability and leads to increased morbidity and mortality. Validation of a short-form (SF) scale will make the assessment easier for primary care physicians. Hence, the study was done to assess the validity and reliability of Mini-Nutritional Assessment-SF (MNA-SF) Questionnaire among elderly in Puducherry. Methods: A cross-sectional study among 279 elderly was conducted in four villages of rural Puducherry. We have used three forms of MNA questionnaire. Diagnostic accuracy of the MNA-SF was assessed and internal consistency was interpreted using Cronbach's alpha. Results: The prevalence of malnutrition by the MNA full-form scale was 17.9%. Similar prevalence was reported by the body mass index (BMI) MNA-SF (16.5%), but calf-circumference (CC) MNA-SF overestimated the prevalence (38%). Sensitivity was higher in CC-MNA-SF (92%) when compared to BMI-MNA-SF (72%), while specificity was higher in BMI-MNA-SF (95.6%) when compared to CC-MNA-SF (73.8%). The positive predictive value was higher in BMI-MNA-SF (78.3%) when compared to CC-MNA-SF (43.4%), while the negative predictive value almost similar in both the scales. Reliability of the questionnaire showed the highest value for MNA full form (alpha = 0.71). Conclusion: This shows that both the forms of MNA-SF (BMI-based, CC-based) were valid and can be recommended as a screening tool for the assessment of nutritional status of the elderly. [ABSTRACT FROM AUTHOR]

Background: Nutritional status of a Tuberculosis (TB) patient plays a role in disease manifestation. Aims & Objective: To assess the nutritional status of adult tuberculosis patients under intensive phase of treatment. Settings and Design: A descriptive study with cross-sectional design was conducted at Burdwan Municipality of West Bengal. Methods and Material: In this study, TB patients aged 18 years and above receiving intensive phase of treatment, registered in the Tuberculosis units in the months of October-December, 2018 and residing in the municipality were approached. Nutritional status was evaluated through two approaches - dietary intake by twenty-four hours recall method and anthropometric status by measuring weight, height, BMI and MUAC. Data were analysed using SPSS v20. Results: Out of 113 study subjects, under-nutrition was present in 61.9% and inappropriate MUAC was observed in 68.1%. Interestingly, intake of Cereals and Millets among food groups was found to be deficient. The adjusted odds ratio for having under-nutrition among new cases compared to previously treated was 0.16 (0.33-0.82). Conclusions: For combating protein energy malnutrition in TB patients, emphasis should be given on balanced diet intake. [ABSTRACT FROM AUTHOR]

We conducted the study to assess the effect of patient-tailored diet counseling on the nutritional status of chronic respiratory disease (CRD) patients under the pulmonary rehabilitation program from June 2021-May 2022. These patients completed 2 months of patient-tailored diet counseling sessions under the pulmonary rehabilitation program, which consisted of 4-5 interactive diet counseling sessions fortnightly. The pre- and postassessment was done using standardized outcomes: Malnutrition Universal Screening Tool (MUST), body mass index (BMI), and ideal body weight. The study enrolled 110 CRD patients. There was a statistically significant improvement in pre- and postassessment in MUST score, appetite, and unintentional weight loss (P < 0.001). Most of the patient's BMI normalized. In prenutritional assessment, most of the patients were malnourished and in postassessment, the number of malnourished and anemic patients was reduced. This study concludes that nutritional counseling effectively improves nutritional status and anemia., (Copyright © 2024 Copyright: © 2024 Indian Journal of Public Health.)

Background: A prospective study of 50 patients of trauma was carried out at a tertiary level trauma center in Mumbai. The aim was to study the hypermetabolic response to trauma and the effect of early enteral feeding and nutritional supplementation in blunting this response in these patients. Methods: Early enteral feeding was started within 72 h in most patients. The caloric requirement was calculated as per the body weight and a 150 : 1 ratio of nonprotein calories to protein was maintained. A 24-h urinary nitrogen loss was estimated and nitrogen balance was calculated on days 1, 3 and 7. Results: The correlation between the injury severity and the severity of catabolism was also analysed. Urinary nitrogen loss and nitrogen balance were used as parameters to evaluate the hypermetabolic response. Conclusions: Early (within 72 h) enteral nutritional support blunts this hypermetabolic response to some extent in these trauma patients. [ABSTRACT FROM AUTHOR]

Competing Interests: We declare no competing interests. We are grateful for the excellent research assistance provided by Akhil Kumar in creating the appendices.

Background: In India, there is a need to monitor population-level trends in changes in diet quality in relation to both undernutrition and noncommunicable diseases., Objectives: We conducted a study to validate a novel diet quality score in southern India., Methods: We included data from 3041 nonpregnant women of reproductive age (15-49 years) from 2 studies in India. Diet was assessed using a validated food frequency questionnaire (FFQ). The Global Diet Quality Score (GDQS) was calculated from 25 food groups (16 healthy; 9 unhealthy), with points for each group based on the frequency and quantity of items consumed in each group. We used Spearman correlations to examine correlations between the GDQS and several nutrient intakes of concern. We examined associations between the GDQS [overall, healthy (GDQS+), and unhealthy (GDQS-) submetrics] and overall nutrient adequacy, micro- and macronutrients, body mass index (BMI), midupper arm circumference, hemoglobin, blood pressure, high density lipoprotein (HDL), and total cholesterol (TC)., Results: The mean GDQS was 23 points (SD, 3.6; maximum, 46.5). In energy-adjusted models, positive associations were found between the overall GDQS and GDQS+ and intakes of calcium, fiber, folate, iron, monounsaturated fatty acid (MUFA), protein, polyunsaturated fatty acid (PUFA), saturated fatty acid (SFA), total fat, and zinc (ρ = 0.12-0.39; P < 0.001). Quintile analyses showed that the GDQS was associated with better nutrient adequacy. At the same time, the GDQS was associated with higher TC, lower HDL, and higher BMI. We found no associations between the GDQS and hypertension., Conclusions: The GDQS was a useful tool for reflecting overall nutrient adequacy and some lipid measures. Future studies are needed to refine the GDQS for populations who consume large amounts of unhealthy foods, like refined grains, along with healthy foods included in the GDQS., (Copyright © The Author(s) on behalf of the American Society for Nutrition 2021.)

Objective: To estimate the burden of undernutrition and its association with rotavirus positivity among under-five children admitted with diarrhea., Methods: This prospective observational study was carried out in hospital-setting from February 2016 to January 2020. For all cases who met the eligibility criteria, an informed written consent was obtained from parents/caregivers. A case report form was used to collect sociodemographic, anthropometric and clinical data. The anthropometric measurements of children were performed according to World Health Organization (WHO) guidelines., Results: Nutritional assessment revealed that 74.1% study subjects were underweight [Weight-for-Age (WAZ) < -2], 59% were stunted [Height-for-Age (HAZ), < -2] and 52.3% were wasted Body Mass Index (BMIZ) < -2]. Stunting was found to be significantly higher among boys as compared to girls and rotavirus positive diarrhea was significantly less prevalent among stunted children., Conclusion: There exists a very high prevalence of underweight, stunting, and wasting among hospitalized children with diarrhea. As the better nutrition has not been shown to guard against rotavirus diarrhea, coverage scale-up of rotavirus vaccination, improved hygiene and sanitation, and focussed nutrition programmes are the need of the hour in India.

Objective: Low birth weight (LBW) is a serious public health problem in low- and middle-income countries and a leading cause of death in the first month of life. In India, about 18% of children are born with LBW (<2500 grams) in 2015-16. In this study, we aim to examine the influence of maternal factors and socio-demographic covariates on LBW in Indian children., Methods: Data were drawn from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015-16. A cross-sectional study was designed using a stratified two-stage sampling technique. Cross-tabulation, Pearson's chi-squared test, and multivariate logistic regression analyses were employed to assess the impact of maternal factors and other covariates on children's LBW., Results: Of total participants (n = 147,762), 17.5% of children were found to be born with LBW. The study revealed that women who had prior experience of stillbirth (Adjusted odds ratio [AOR]: 1.20, 95% CI: 1.04-1.38) and any sign of pregnancy complications (AOR: 1.08, 95% CI: 1.05-1.11) were more likely to have LBW children, even after adjusting for a range of covariates. Maternal food diversity was found to a protective factor against children's LBW. Women with underweight and anemic condition were associated with an increased likelihood of LBW children. Regarding maternity care, women who attended ≥4 ANC visits (AOR: 0.84, 95% CI: 0.80-0.88), took iron tablets/syrup during pregnancy (AOR: 0.94, 95% CI: 0.90-0.98), and delivered in a public health facility (AOR: 0.84, 95% CI: 0.79-0.88) were less likely to have LBW babies. Besides, various socio-demographic factors such as place of residence, caste, religion, education, wealth quintile, and geographical region were significantly associated with LBW of children., Conclusion: Interventions are needed for adequate ANC utilization, improvement in public facility-based delivery, providing iron supplementation, and uptake of balanced energy-protein diet among pregnant mothers. Besides, special attention should be given to the socio-economically disadvantaged women to address adverse pregnancy and birth outcomes including LBW., Competing Interests: The authors have declared that no competing interests exist.

Pre-school age (3-5 years) children are vulnerable to malnutrition due to poor dietary intake, dietary habits, and socio-economic conditions. Children from marginalized families are more vulnerable than non-marginalized families due to limited access to health- and nutrition-related services, besides other socio-economic factors. This study was done to assess the dietary intakes, patterns, and determinants of pre-school age (3-5 years) children from marginalized populations in two districts of Odisha. We used three different questionnaires, namely general demographic information, single 24-h recall dietary survey, and food frequency questionnaire, to collect data. Dietary patterns were obtained using principal component analysis, and the recommended dietary allowance (RDA) method was applied to estimate the prevalence of inadequate intake. A general linear model of regression was used to investigate the relationship of dietary patterns scores with independent variables. A total of 86 boys (57.3%) and 64 girls (42.7%) were recruited for the study. The majority (more than two-third) of the children had <70% of RDA of iron, vitamin C, and zinc. The three dietary components that best described the dietary patterns among children in the study were vegetarian, non-vegetarian, and mixed patterns. They explained 54.9% of the variability. The 'vegetarian' dietary pattern was inversely associated with children whose mothers were illiterate ( p = 0.005), who lived in families having per capita family monthly income less than INR 786 (10.3 US$) ( p = 0.007), and who were first born ( p = 0.04). The dietary patterns may help interventionists in designing programs aimed at preventing malnutrition and chronic diseases among children in marginalized communities., Competing Interests: The authors declare they have no conflicts of interest., (© 2020 The Authors. Published by Atlantis Press International B.V.)

Background: Death is inevitable, but healthy ageing is possible with proper nutrition and health care. This systematic review and meta-analysis conducted to estimate the nation-wide prevalence and malnutrition and risk of malnutrition among the elderly in India., Methods: PubMed, EMBASE, Web of Science, Cochrane`s library, Google Scholar were searched for the articles reporting the prevalence of malnutrition among the elderly using MNA or MNA-SF tools. The study published between the year 2010-2019 were included. Sensitivity analysis, quality assessment was done using standard methods. The publication biasness was also determined using Doi plot and LFK index. The pooled prevalence was reported with effect size and considering the random effect model and quality effect model. The subgroup analysis was also conducted for gender, study setting, study area and study regions., Results: The prevalence of malnutrition and risk of malnutrition among the elderly was 18.29% and 48.17% respectively. The prevalence of malnutrition was higher among female (16.67%), clinic setting (28.87%), urban areas (19.29%) and northern region (27.37%) of India. This trend differs with the prevalence of risk of malnutrition. Meta-regression analysis shows a region-based prediction of malnutrition and setting based prediction of risk of malnutrition., Conclusion: The prevalence of malnutrition was not considerably higher among the elderly population but about half of the elderly population were at risk of malnutrition. This trend differs with the gender, study setting, study area and study region. Additional study using other nutritional assessment tools were needed. Intervention studies among the elderly were recommended., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This work studied the use of crude glycerol obtained from biodiesel industry as substrate to generate yeast lipid from Rhodotorula mucilagenosa IIPL32 MTCC 25056. Crude glycerol is a low value by product obtained from biodiesel industry. Rhodotorula mucilagenosa IIPL32 MTCC 25056 was evaluated for its potential to produce lipid using crude glycerol as sole source of carbon. Under nitrogen limiting condition a lipid and biomass content of 5.6 g/L and19.7 g/L were obtained from crude glycerol. The fatty acid profile was found to be interestingly rich in oleic acid (61.88%), linoleic acid (16.17%) and linolenic acid (1.03%) comprising ~80% of MUFA and PUFA of total lipid. Further, evaluations were attempted to compare MUFA rich yeast lipid against different plant-borne edible oils commonly used in India. In this study, nutritional indices were calculated to check feasibility of using yeast oil as a plausible blend to edible oil., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Poor dietary intake during pregnancy remains a significant public health concern, affecting the health of the mother and fetus. This study examines the adequacy of energy, macronutrient, and micronutrient intakes among self-declared lacto-vegetarian and non-vegetarian pregnant women. We analyzed dietary data from 627 pregnant women in Uttar Pradesh, India, using a multiple-pass 24 h diet recall. Compared to non-vegetarians, lacto-vegetarians (~46%) were less likely to report excessive carbohydrate (78% vs. 63%) and inadequate fat intakes (70% vs. 52%). In unadjusted analyses, lacto-vegetarians had a slightly higher mean PA for micronutrients (20% vs. 17%), but these differences were no longer significant after controlling for caste, education, and other demographic characteristics. In both groups, the median intake of 9 out of 11 micronutrients was below the Estimated Average Requirement. In conclusion, the energy and micronutrient intakes were inadequate, and the macronutrient intakes were imbalanced, regardless of stated dietary preferences. Since diets are poor across the board, a range of policies and interventions that address the household food environment, nutrition counseling, behavior change, and supplementation are needed in order to achieve adequate nutrient intake for pregnant women in this population.

Objectives: Our study goal was to evaluate a set of nutritional indicators among adults with confirmed or suspected active tuberculosis disease in southern India, given the limited literature on this topic. Study objectives were to assess the: I) double burden of malnutrition at individual and population levels; II) relative performance of anthropometric indicators (body mass index, waist circumference) in diabetes screening; and III) associations between vitamin D and metabolic abnormalities., Design: Cross-sectional study., Setting: Hospital in rural southern India., Participants: Among adult patients (n = 834), we measured anthropometry, body composition, and biomarkers (vitamin D, glycated hemoglobin, hemoglobin) of nutritional status. Subsets of participants provided blood and sputum samples., Results: Among participants, 91.7% had ≥ 1 malnutrition indicator; 34.6% had both undernutrition and overnutrition indicators. Despite the fact that >80% of participants would be considered low-risk in diabetes screening based on low body mass index and waist circumference, approximately one-third had elevated glycated hemoglobin (≥ 5.7%). The lowest quintile of serum 25-hydroxyvitamin D was associated with an increased risk of glycated hemoglobin ≥ 5.7% (adjusted risk ratio 1.61 [95% CI 1.02, 2.56]) compared to the other quintiles, adjusting for age and trunk fat., Conclusions: Malnutrition and diabetes were prevalent in this patient population; since both can predict poor prognosis of active tuberculosis disease, including treatment outcomes and drug resistance, this emphasizes the importance of dual screening and management of under- and overnutrition-related indicators among patients with suspected or active tuberculosis disease. Further studies are needed to determine clinical implications of vitamin D as a potential modifiable risk factor in metabolic abnormalities, and whether population-specific body mass index and waist circumference cut-offs improve diabetes screening., Competing Interests: E.A.Y., J.L.F., P.M.B., W.B., and D.G.R. have no conflicts of interest. S.M. is an unpaid board member of and holds equity stake in a diagnostic start-up focused on developing assays for low-cost and point-of-care measurement of certain nutrients from a drop of blood using results from his research as a faculty member at Cornell University. M.J.G. receives funding to his institution from Gilead Sciences for an investigatorinitiated study unrelated to the current work. There are no further patents, products in development or marketed products to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Dietary record tools such as food frequency questionnaire (FFQ) and food diaries (FD) are the most commonly used choices for assessing dietary intakes in most large-scale epidemiological studies. The authors developed a self-administered 360-item food frequency questionnaire (FFQ) to assess dietary intakes amongst a population-based cohort in South Kerala. In the validation study ( n = 460), the data were collected using FFQs that were administered on three different occasions which were then compared to 7-day food records. The intake of foods and nutrients was higher as determined by the FFQ than that assessed using food records. Spearman correlations for macro-nutrients ranged from 0.72 for protein to 0.61 for carbohydrates and for micronutrients, from 0.71 for vitamin B6 to 0.34 for magnesium. The correlation was improved with energy-adjusted nutrient intakes. On average, the exact agreement for the macronutrients ranged from 48.2% to 57.1%, and that for micronutrients ranged from 66.7% to 41.9%, with the median percentage of 49.58%. The authors conclude that the FFQ has an acceptable reproducibility, however, there was a systematic trend towards higher estimates with the FFQ for most nutrients compared to the FD records., Competing Interests: The authors declare no conflict of interest.

Background and Objectives: To evaluate the reproducibility and construct validity of the Madras Diabetes Research Foundation FFQ (MDRF-FFQ) with biomarkers for its use in epidemiological settings in India., Methods and Study Design: The MDRF-FFQ was administered to 500 participants representing rural and urban areas of 10 Indian states, twice at an interval of 12 months. Reproducibility was assessed using intra cluster correlation coefficients (ICC). Construct validity of carbohydrate and fat intake was assessed using baseline serum lipids by regression analysis., Results: Reproducibility as measured by ICC was 0.50-0.77 for saturated fatty acids (SFA) and energy in urban and 0.61-0.72 for protein and SFA in rural areas. The ICC for food groups was 0.53-0.77 for whole grains, fruits and vegetables in urban and 0.50-0.89 for animal foods and whole grains in rural areas. After adjusting for potential confounders, carbohydrate intake was positively associated with serum triglycerides (TG) (β [SE]: +2.3 [0.72] mg/dL; p=0.002) and inversely with high density lipoprotein cholesterol (HDL) (β [SE]:-0.48 [0.12], p<0.001), while dietary fat and SFA (% Energy) were positively associated with HDL, low density lipoprotein (LDL) and total cholesterol and inversely with TG., Conclusions: The MDRF-FFQ can be considered as a reliable and valid tool to measure the long-term dietary exposure in respect of macronutrient intakes in Indian populations despite diverse dietary practices.

Background: Undernutrition is a serious health problem and highly prevalent in developing countries. There is no as such confirmatory test to measure undernutrition. The objective of the present study is to determine a new Composite Score using anthropometric measurements. Composite Score was then compared with other methods like body mass index (BMI) and mid-upper arm circumference (MUAC) classification, to test the significance of the method., Methods: Anthropometric data were collected from 780 adult Oraon (Male = 387, Female = 393) labourers of Alipurduar district of West Bengal, India, following standard instruments, and protocols. Nutritional status of the study participants were assessed by conventional methods, BMI and MUAC. Confirmatory factor analysis was carried out to reduce 12 anthropometric variables into a single Composite Score (C) and classification of nutritional status was done on the basis of the score. Furthermore, all the methods (BMI, MUAC and C) were compared and discriminant function analysis was adopted to find out the percentage of correctly classified individuals by each of the three methods., Result: The frequency of undernutrition was 45.9% according to BMI category, 56.7% according to MUAC category and 51.8% according to newly computed Composite Score. Further analysis showed that Composite Score has a higher strength of correct classification (98.7%), compared to BMI (95.9%) and MUAC (96.2%)., Conclusion: Therefore, anthropometric measurements can be used to identify nutritional status in the population more correctly by calculating Composite Score of the measurements and it is a non-invasive and relatively correct way of identification.

Background: Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression., Setting: WLH were recruited from primary health centers in rural India., Method: A quasi-experimental trial of a comprehensive Accredited Social Health Activist (Asha)-supported intervention compared 4 distinct Asha-based programs [(1) standard education (SE) alone; (2) nutrition education (+NE); (3) nutrition supplements (+NS); or (4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin, and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately after intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time., Findings: Among 600 WLH enrolled (n = 150 per arm), mean age, CD4 count, and BMI (kg/m) were 34.31, 447.42, and 20.09, respectively, at baseline. At 18-month follow-up, program 4 (+NENS) experienced greatest improvements in CD4 counts compared with program 1 (+SE) [adjusted difference = 223.81, 95% confidence interval (CI): 170.29 to 277.32]. For BMI, programs 3 (+NS; adjusted difference = 2.33, 95% CI: 1.39 to 3.26) and 4 (+NENS; adjusted difference = 2.14, 95% CI: 1.17 to 3.12) exhibited greater gains compared with program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference = -0.18, 95% CI: -1.12 to 0.76). Hemoglobin and serum albumin also improved over time; program 4 (+NENS) exhibited the greatest gains., Conclusions: A low-cost Asha-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations.

Objective: This study aimed to define the estimated average requirement and the recommended dietary allowance of iron for Indian children and adolescents., Methods: The Estimated average requirement was derived for children aged 1-17y, from the mean bioavailability-adjusted daily physiological iron requirement, which in turn was estimated using a factorial method. This consisted of mean daily iron losses from the body and additional iron required for tissue growth and storage, while also defining the variance of each factor to derive the Recommended dietary allowance., Results: Results: The estimated average requirement of iron for children ranged from 5.6 to 11.0 mg/d in children aged 1-9y. For adolescents aged 10-17y, these ranged from 10.8 to 18.4 mg/d and 15.4 to 18.5 mg/d for adolescent boys and girls, respectively., Conclusions: New estimates of estimated average requirement for iron in Indian children are presented, and same may be used to inform iron supplementation and food fortification policies.

Background & Aim: Malnutrition is serious but under-diagnosed problem among hospitalized patients as approximately one-third patients may become malnourished during their stay. We audited our clinical nutrition practice (CNP) to understand the gaps and planned quality improvement initiatives to strengthen CNP through early delivery of oral nutrition supplement (ONS) prescribed., Method: A prospective study was conducted in a tertiary care hospital in three phases between Dec'15 and Feb'17. Phase-1(P1): To assess the prevalence of malnutrition on admission and CNP; Phase-2(P2): Sensitization of Clinical Dietitians' to improve the nutrition care process; Phase-3(P3): Coalition of Multidisciplinary Team (MDT) to improve the timely delivery of ONS. Patients' demographics, baseline nutritional status (Subjective Global Assessment (SGA)), details of nutrition intervention and outcomes were recorded. Data were analyzed using SPSS version 20.0., Results: Out of 1443 patients (P1-500; P2-428; P3-515) enrolled, 63% were men and 37% women with mean age of 53.6 ± 15.49y. A significant improvement in the nutritional diagnosis as per SGA (0.031) and increasing trend in ONS prescription (P1:10(2%); P2:56(13%); P3:83(16%) (p = 0.000) was evident, which was attributed to the sensitization of Dietitians. Early delivery of ONS within 6 h from the time of prescription (EDONS) was progressively higher in P3 (P1:10%; P2:16.1%; P3:44.6%) and notable reversal of delayed delivery (>24 h) (P1:40%, P2:16%, P3:8.4%) (p = 0.000). Remarkable decline in the Length of Stay (LOS) was shown between the phases (P1:6.82 ± 10.3d; P2:5.68 ± 4.07d; P3:5.60 ± 4.74d) (p = 0.010). Vegetarians (6.54d) had a longer stay compared with non-vegetarians (5.88d) (p = 0.036). Lower BMI correlated negatively with LOS (p = 0.026). Univariant analysis showed a significant increase in LOS with admission history on weight loss (No weight loss = 5.52d, <10% loss = 7.74d, 10-15% = 7.51d, >15% = 8.32 d) (p = 0.001), severe malnutrition (12.67d) and EDONS in shortening the LOS (<6 h = 6.11, 6-12 h = 7.97, 12-24 h = 6.83, >24 h = 17.3 days) (p = 0.000). Multiple Linear regression analysis using ANOVA indicated that EDONS was the only major contributing factor in lowering the LOS (p = 0.002). Re-admission was higher in non ONS group (72%: non ONS; 26%: ONS group) (p = 0.000)., Conclusion: Dietitian-Led multi-professional inter-disciplinary Coalition, bridging the knowledge gap among MDT with regular sensitization about the importance of hospital malnutrition and EDONS, has led to the early identification and intervention of nutrition risk which enhanced progressive decrease in LOS and healthcare cost., (Copyright © 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Introduction: With rise in incidence and prevalence of cancers in the ageing population, the need for an age sensitive comprehensive assessment measure has been felt. Comprehensive Geriatric Assessment (CGA) is often difficult to implement due to time and logistic constraints. A brief assessment tool encompassing the specific domains of the CGA would be a better way to assess older adults with cancer. These tools exist but have not necessarily been culturally adapted. The main aim of the study was to develop a culturally relevant short geriatric assessment tool and explore its psychometric properties., Methodology: An initial item pool was formed after review of the literature and study of the existing scales. This draft tool was then pre and pilot tested to finalize the items and check the feasibility of application. The final tool was validated by exploratory factor analysis on a sample of 100 older patients with cancer., Results: After pre and pilot study on fifteen and thirty older patients with cancer respectively, this tool consisting of a total of 38 items spread over eight domains was developed and validated on a sample of 100 subjects. Due to co-linearity, three items were deleted after exploratory factor analysis, bringing the final item number to35. The Cronbach's alpha was 0.93 and the intra-class correlation co-efficient (ICC) was 0.94. Thus, the final tool had 13 questions with sub-parts (35 items in total). The time taken to administer the tool was around 25 min., Conclusion: The tool developed is valid and reliable and can be used for the initial assessment and further care planning of older Indian patients with cancer., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Anemia has been identified as a severe public health concern among young children in India, however, information on the prevalence of anemia attributed to micronutrient deficiencies is lacking. We aimed to assess multiple micronutrient status (iron, zinc, selenium, vitamin A, vitamin D, folate and vitamin B12) in young Indian children and to investigate the role of these seven micronutrients and other non-nutritional factors on hemoglobin concentrations and anemia. One-hundred and twenty children aged 12 to 23 months were included in a cross-sectional nutritional assessment survey, of which 77 children provided a blood sample. Hemoglobin (Hb), serum ferritin, soluble transferrin receptor (sTfR), total body iron, zinc, selenium, retinol binding protein (RBP), folate, vitamin B12 and 25-hydroxyvitamin D (25(OH)D) were measured, and adjusted for inflammation using C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), where appropriate. Predictors for hemoglobin and anemia were identified in multiple regression models. Most of the children were classified as anemic, of which 86 to 93% was associated with iron deficiency depending on the indicator applied. Deficiencies of folate (37%), and notably vitamin D (74%) were also common; fewer children were classified with deficiencies of vitamin B12 (29%), zinc (25%), and vitamin A (17%) and selenium deficiency was nearly absent. Multiple micronutrient deficiencies were common with over half (57%) deficient in three or more micronutrients, and less than 10% of children were classified with adequate status for all the micronutrients measured. Iron status was found to be the only nutritional factor statistically significantly inversely associated with anemia (P = 0.003) in multivariate analysis after controlling for sex. A coordinated multi-micronutrient program is urgently needed to combat the co-existing micronutrient deficiencies in these young children to improve micronutrient status and reduce the high burden of childhood anemia., Competing Interests: The authors have declared that no competing interests exist.

Background and Aims: HIV infection and insufficient nutritional intake form a malicious cycle which leads to immunodeficiency and malnutrition. Thus, this research was done to see the effect of nutritional counseling on knowledge, attitude and practice (KAP) of HIV patients of Udupi district. Also, the rational evidence of association of nutritional status with CD4 counts and opportunistic infections combined are limited which led to design of this study., Methods: This interventional study was done in ART Centre, Udupi, India with a sample size of 66 with 33 each in experimental and control group (EG and CG). At first, the biochemical parameters, KAP, 3 day dietary intake and food group intake over Food Frequency Questionnaire (FFQ) were recorded. PG-SGA (Scored Patient-Generated Subjective Global Assessment) scoring was used to categorize patients' nutritional status. Individual nutritional counseling was provided to EG and change in KAP of EG and CG were recorded after 1 month., Results: Pre-KAP mean of EG was 151.56 which increased to 169.13 after intervention. The mean KAP score of EG was statistically different from CG after counseling, P < 0.001. Of the total, 15 (22.7%) patients were found to be malnourished. The dietary intake of nutrients and food group was significantly lower than RDA. Tukey HSD post hoc analysis showed significant statistical difference for the CD4 count between moderate and severe malnourished category with P = 0.017. Statistically significant nutrient intake differences were also observed between PGSGA groups while odds ratio showed no significant association., Conclusions: Improvement in KAP and poor nutritional status indicates that individual Nutrition and Health Education Counseling be made an integral part in the management of HIV in Udupi. Also, the difference in CD4 count across two PG-SGA stages depicts an association between nutritional status and immune status of HIV patients., (Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Setting: Dakshina Kannada District, coastal South India, under the Revised National Tuberculosis Control Programme (RNTCP)., Objective: To identify the potential and practices at primary health centres (PHCs) for the assessment of nutritional status of patients with tuberculosis (TB), the basic tools used to measure height and weight and the type of nutritional counselling provided., Design: A cross-sectional study was conducted with physical verification of availability of height and weight measuring equipment. Information was collected on the method used by medical officers for assessing nutritional status in PHCs, action taken in case the patient is undernourished and any formal training in nutritional assessment and counselling., Results: Of 37 PHCs assessed, weighing machines were available in all and stadiometers in 38%. Medical officers were not calculating body mass index for nutritional assessment even when height and weight were being uniformly measured. Nutritional classification was mostly based on the appearance and physique of the patient. Counselling included advice to take milk, eggs and protein powders with efforts to arrange funds from village health, sanitation and nutrition committees., Conclusion: There is a need to equip the PHCs and their medical officers with necessary tools and training for nutritional assessment and counselling of patients with tuberculosis.

Undernutrition is the most prevalent comorbidity in patients with tuberculosis (TB) in India. Undernutrition is often severe and results in higher risk of death, drug toxicity during treatment, poor functional status at end of treatment and a higher risk of relapse after successful treatment. A World Health Organization guideline has recommended nutritional assessment, counseling, and care as integral parts of TB care. The Revised National Tuberculosis Control Programme has recognized undernutrition as a significant comorbidity, released a guidance document for improving nutritional care and support, and launched a scheme for direct bank transfer of monthly cash benefit to TB patients. However, there are gaps at the provider level on nutritional assessment, due to challenges in calculation and interpretation of body mass index (BMI). A mobile based application has been developed for use in the programme, which makes estimation of BMI possible, classifies the severity of undernutrition, suggests triage and clinical actions based on the BMI, indicates desirable body weight corresponding to a BMI of 21 kg/m 2 , and the daily caloric and protein intake for underweight patients with active TB. The app also provides tips for dietary counseling for TB patients, information on the major food groups, emphasizes an adequate and balanced diet from locally available foods for nutritional recovery of TB patients., (Copyright © 2018 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Objective: To study infant and young child feeding (IYCF) practices and their association with nutritional status among young children., Design: A community-based, cross-sectional study was carried out in ten states of India, using a multistage random sampling method. Anthropometric measurements such as length/height and weight were conducted and nutritional assessment was done using the WHO child growth standards., Setting: National Nutrition Monitoring Bureau survey, 2011-2012.ParticipantsChildren aged &lt;3 years and their mothers., Results: Only 36 % of infants received breast-feeding within an hour of birth and 50 % were exclusively breast-fed up to 6 months. Prevalence of underweight, stunting and wasting was 38, 41 and 22 %, respectively. The chance of undernutrition among &lt;3-year-old children was significantly higher among those from scheduled caste/scheduled tribe communities, the lowest-income group, with illiterate mothers and lack of sanitary latrine. Among infants, the chance of undernutrition was significantly higher among low-birth-weight babies, and among children whose mother had not consumed iron-folic acid tablets during pregnancy. Immunization practices and minimum dietary diversity were observed to be associated with undernutrition among 12-23-month-old children., Conclusions: Undernutrition is still an important public health problem in India and observed to be associated with low socio-economic status, illiteracy of mother, low birth weight and dietary diversity. Improving socio-economic and literacy status of mothers can help in improving maternal nutrition during pregnancy and thus low birth weight. Also, improving knowledge of mothers about IYCF practices will help in improving children's nutritional status.

Assessment of the status of health and nutrition of a population is imperative to design and implement sound public health policies and programmes. The various extensive national health and nutrition surveys provide national-level information on different domains of health. These provide vital information and statistics for the country, and the data generated are used to identify the prevalence and risk factors for the diseases and health challenges faced by a country. This review describes the various national health and nutrition surveys conducted in India and also compares the information generated by each of these surveys. These include the National Family Health Survey, District Level Household Survey, Annual Health Survey, National Nutrition Monitoring Bureau Survey, Rapid Survey on Children and Comprehensive National Nutrition Survey., Competing Interests: None

The relevance of protein and its constituent amino acids (AAs) in the structure and function of the human body is well known. Accumulating evidence has conferred specific functional and regulatory roles for individual AAs, adding relevance to their requirements across different age groups. The methods for measuring AA requirements have progressed from the classical nitrogen balance to the current stable isotope-based AA balance methods. Requirements of most of the indispensable AA (IAA) have been estimated in healthy Indian population by the best available balance method and has shown to be higher than earlier 1985 WHO/FAO/UNU (World Health Organization/Food and Agriculture Organization/United Nations University) recommendations. In addition, potential changes in the requirement, through adaptation to chronic undernutrition or to infection, have also been evaluated. In 2007, the WHO/FAO/UNU released a recommendation that increased the daily IAA requirement, based on primary evidence from Indian balance studies. This meant that to ensure that the new IAA requirements were met, individual foods or mixed diets needed to be assessed for their protein quality, or their ability to deliver the required amount of IAA. The recent FAO report on protein quality evaluation recommends the use of a new chemical AA score, the digestible IAA score (DIAAS), to replace the earlier protein digestibility corrected AA score. The DIAAS requires the determination of individual AA digestibility at the ileal level. A minimally invasive dual stable isotope tracer-based approach has been developed in India and has been used to determine digestibility of various foods in Indian adults and children. The increase in IAA requirements and subsequent protein quality requirements have implications for national regulatory frameworks, growth and development, and in turn, for economic and agricultural policy., Competing Interests: None

Introduction: The prevalence of malnutrition increases with old age, especially in developing countries like India, and it is the most common cause of morbidity and mortality, because of many factors out of which dentate status is one., Aim and Objective: The aim of this study is to evaluate and determine the effect of nutritional status and dietary intake on the oral health-related quality of life (OHRQOL) of elderly edentulous complete denture-wearing patients and to know whether elderly complete denture wearers have a higher risk of malnutrition. The objective was to assess the need to include dietary and nutritional counseling during prosthodontic rehabilitation of elderly edentulous patients., Materials and Methods: A cross-sectional study was conducted among 200 elderly denture-wearing patients above 60 years of age from Nagpur, Maharashtra. Mini-Nutritional Assessment (MNA) questionnaire was used to assess nutritional status, and Geriatric Oral Health Assessment Index (GOHAI) questionnaire was used to determine the OHRQOL of these patients. Descriptive statistics were used to analyze data using SPSS version 21 (SPSS Inc., Chicago, IL, USA)., Results: Among the assessed participants, nearly 95% of them had total scores of GOHAI between 12 and 57 which require "needed dental care." As per MNA, 10.5% had adequate nutrition, 70% were at risk of malnutrition, and remaining 19.5% of participants were malnourished. There was a significant correlation between GOHAI and MNA scores., Conclusion: Low nutritional status was associated with the poor OHRQOL among the elderly. A strong association was found between mean GOHAI and MNA scores and thereby nutritional status and OHRQOL. The use of conventional dentures increases the risk of malnutrition in the elderly due to inability to eat and chew food properly. Dietary analysis and counseling should be strictly incorporated into geriatric treatment planning during prosthetic rehabilitation., Competing Interests: There are no conflicts of interest

Childhood stunting is often conceptualised as a singular concept (i.e., stunted or not), and such an approach implies similarity in the experiences of children who are stunted. Furthermore, risk factors for stunting are often treated in isolation, and limited research has examined how multiple risk factors interact together. Our aim was to examine whether there are subgroups among stunted children, and if parental characteristics influence the likelihood of these subgroups among children. Children who were stunted were identified from the 2005-2006 Indian National Family Health Survey (n = 12,417). Latent class analysis was used to explore the existence of subgroups among stunted children by their social, demographic, and health characteristics. We examined whether parental characteristics predicted the likelihood of a child belonging to each latent class using a multinomial logit regression model. We found there to be 5 distinct groups of stunted children; "poor, older, and poor health-related outcomes," "poor, young, and poorest health-related outcomes," "poor with mixed health-related outcomes," "wealthy and good health-related outcomes," and "typical traits." Both mother and father's educational attainment, body mass index, and height were important predictors of class membership. Our findings demonstrate evidence that there is heterogeneity of the risk factors and behaviours among children who are stunted. It suggests that stunting is not a singular concept; rather, there are multiple experiences represented by our "types" of stunting. Adopting a multidimensional approach to conceptualising stunting may be important for improving the design and targeting of interventions for managing stunting., (© 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.)

Background and Aim: Nutritional therapy is an integral part of care in all phases of liver transplantation (LTx). However, there are several factors that make it a challenge to manage malnutrition in these patients including, but not limited to, loss of appetite, dietary restrictions and dietary habits. Dietary habits are guided by personal choice, social, cultural and regional background with diversity ranging from veganism to vegetarianism with the latter predominant in Indian population. Therefore, it is difficult to improve nutritional intake of patients with standard dietary recommendations. We evaluated the effects of implementing personalized dietary counseling and a customized nutrition plan on its ability to enhance oral intake and, thereby improve nutritional status of patients with end stage liver disease (ESLD) being evaluated for LTx. We compared the outcomes with a matched group of patients who were prescribed standard dietary recommendations from a historic database. Primary outcome was measured by number of patients achieving ≥75% of recommended energy and protein requirements during hospitalization for LTx. Secondary outcomes included mean energy and protein intake, hours of ventilation, length of stay in Intensive Care Unit (ICU) and hospital, mortality and readmission rate in the acute phase (3months) after LTx., Methods: This was a prospective observational study, performed at a single LTx centre. All patients >18years who enrolled for LTx and consented for the study were included. The study was conducted after obtaining institutional ethics committee approval. A protocol based nutrition planning was implemented from April'14. According to this protocol, all patients being evaluated for LTx underwent a detailed nutritional assessment by a qualified Clinical Dietitian (CD) and regularly followed up with until LTx. Nutritional intervention, including a customized nutrition care plan and personalized dietary counseling, was provided based on the severity of malnutrition. To evaluate the efficacy of this protocol, we compared the nutritional adequacy (calorie and protein intake) of 65 consecutive patients who underwent LTx between August'14-October'15 (group 1) with a historic database of 65 patients who underwent LTx between January'13 and April'14 (group 2). Patients' demographics, disease severity score, baseline markers of nutritional status (subjective global assessment (SGA), and body mass index (BMI)), were recorded. First, assessment of individual patient's oral energy and protein intake was determined by the daily calorie count during hospitalization. Then the nutritional intervention (oral nutrition supplement (ONS)/enteral nutrition (EN)/parenteral nutrition (PN)) plan was customized according to their spontaneous oral intake. As part of the protocol, health related quality of life was also assessed using short form 8 (SF-8) in group 1. Statistical analyses using Pearson's correlation, Chi-Square test were applied with SPSS version 20.0., Results: The mean age of group 1 and 2 were 52.6 ± 9.8, 51.9 ± 10.5 (range 25-70years) with BMI of 26.8 ± 6.0, 26.5 ± 5.4 respectively. According to SGA, there was significant improvement in the nutritional status of group 1 patients compared to group 2 on admission for LTx. It was indicated that 88% of group 1 individuals in comparison to 98% in group 2 were malnourished. The calorie intake of group 1 (1740.2 ± 254.8) was significantly higher than group 2 (1568.5 ± 321.6) (p = 0.005). The marked improvement in protein intake in group 1 (63.1 ± 12.1) when compared with group 2 (53.1 ± 13.4) was statistically significant (p = 0.008). A subset analysis showed that non-vegetarians (consuming meat and dairy products) between the groups showed that group 1 had a significantly higher calorie (p = 0.004) and protein (p = 0.0001) intake compared to individuals in group 2. Following implementation of study's protocol, the goal of achieving ≥75% of the prescribed calories (p = 0.013) and protein (p = 0.0001) was significantly higher in group 1., Conclusion: When compared to the standard prescription, an individualized protocol to diagnose, stratify the severity of malnutrition early, and follow up by customized nutrition planning for patients helped to achieve nutritional targets more effectively. Inspite of patients' diversity in nutritional habits and reluctance to accept change, it is clear that a qualified and dedicated transplant nutrition team can successfully implement perioperative nutrition protocol to achieve better nutritional targets., (Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background and Objectives: Dietary diversity plays a critical role in infants as they need energy and nutrient dense foods for both physical and mental development. This study examines whether three dietary diversity indices validate against Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) and studies the relationship of dietary diversity with nutritional status of preschool children, in two districts of India: Wardha district in Maharashtra state and Koraput district in Odisha state., Methods and Study Design: Dietary diversity was calculated using: individual food scores calculated using 24 hour diet recall (FS24hr) data; household dietary diversity using Berry's index (DDI) and food scores calculated using food frequency data (FSFFQ). Nutritional status was assessed by anthropometric indices., Results: It was observed that 42.7% of 1 to 5 years children were underweight, 38% stunted and 27.6% wasted across both locations. The dietary diversity was found to be relatively better in Wardha when compared with Koraput with mean diversity of FS24hr 7, DDI 90 and FSFFQ 63 in both locations. Preschool children in both locations consumed a cereal based diet. Apart from protein in both locations and energy in Koraput, the NAR of all nutrients consumed was <70% of requirement. MAR showed lower consumption of nutrients than the recommended levels (50% adequacy). NAR and MAR correlate with FS24hr indicating that dietary diversity calculated using 24 hour diet recall ensures nutrient adequacy but showed association only with Height-for-Age scores., Conclusion: Dietary diversity calculated using three methods did not show any correlation with nutritional status of 1 to 5 years children.

Traditional knowledge and practice of Indigenous Peoples related to their food use and well-being is a wealth of information for academic study and for public health nutrition. Despite unique long-evolved heritages of knowledge of ecosystem resources, Indigenous Peoples comprise 15% of the global poor, but only 5% of the world's population, and they experience poverty, discrimination, and poor nutritional health at far greater rates than mainstream populations in their nations of residence. These disparities are unacceptable in all human rights frameworks, and the call to alleviate them resonates through all human development programmes and the United Nations organizations. The scholars contributing to this special issue of Maternal and Child Nutrition describe how gender roles and the right to food for several cultures of Indigenous Peoples can be fostered to protect their unique foods and traditions, providing food sovereignty and food and nutrition security benefits, especially for women and children. Aspects of societal maternal or paternal lineality and locality, division of labour, spirituality and decision-making are described. These factors structure the impact of gender roles with Indigenous worldviews on the dynamics of family food access, its availability and use, and the use of local food biodiversity. Cultures of Indigenous Peoples in Ecuador, Nigeria, Thailand, India, Canada, Japan, and Morocco are discussed. This publication is a work of the Task Force on Traditional, Indigenous and Cultural Food and Nutrition of the International Union of Nutritional Sciences., (© 2018 John Wiley & Sons Ltd.)

A community-based cross-sectional study was carried out with 603 children ages 5 and under and 500 of their mothers from 510 households to examine the prevalence of undernutrition and chronic diseases among the Khasis of North-East India. Anthropometric measurements including Mid-Upper Arm Circumference, height, and weight were taken. Dry blood spots to estimate haemoglobin and vitamin A were collected from children and women separately by finger prick. Mothers provided data about household socio-demographic particulars and infant and young child feeding practices. The prevalence in children of underweight was 31%, stunting was 57%, and wasting was 10%. Undernutrition was higher among boys as compared to girls. Nutrient intakes were below recommended levels. The prevalence of anaemia among children ages 1 to 5 years old was 68%, and vitamin A deficiency was 59%, and they were 83% and 48%, respectively, among women. Hypertension was observed in 15% of women, whereas diabetes was less than 1%. Only about 20% of households were food secure, and this was associated with parental literacy, per capita income, and family size. Undernutrition was unacceptably high among the Khasis despite rich food biodiversity. Proper implementation of nutritional intervention programs such as Integrated Child Development Services, Mid Day Meal, and the Public Distribution System will improve the nutrient intake and nutritional status of the population. Additionally, preservation of forest lands and products paired with judicious use of the rich food biodiversity available will promote dietary diversity and ultimately better nutrition and health., (© 2018 John Wiley & Sons Ltd.)

The assessment of diets in multi-ethnic cosmopolitan settings is challenging. A semi-quantitative 163-item food frequency questionnaire (FFQ) was developed for the adult Singapore population, and this study aimed to assess its reproducibility and relative validity against 24-h dietary recalls (24 h DR) and biomarkers. The FFQ was administered twice within a six-month interval in 161 adults (59 Chinese, 46 Malay, and 56 Indian). Fasting plasma, overnight urine, and 24 h DR were collected after one month and five months. Intra-class correlation coefficients between the two FFQ were above 0.70 for most foods and nutrients. The median correlation coefficient between energy-adjusted deattenuated FFQ and 24 h DR nutrient intakes was 0.40 for FFQ1 and 0.39 for FFQ2, highest for calcium and iron, and lowest for energy and carbohydrates. Significant associations were observed between urinary isoflavones and soy protein intake ( r = 0.46), serum carotenoids and fruit and vegetable intake ( r = 0.34), plasma eicosapentaenoic acid and docosahexaenoic acid (EPA + DHA) and fish/seafood intake ( r = 0.36), and plasma odd chain saturated fatty acids (SFA) and dairy fat intake ( r = 0.25). Associations between plasma EPA + DHA and fish/seafood intake were consistent across ethnic groups ( r = 0.28-0.49), while differences were observed for other associations. FFQ assessment of dietary intakes in modern cosmopolitan populations remains feasible for the purpose of ranking individuals' dietary exposures in epidemiological studies., Competing Interests: The authors declare no conflict of interest.

Background: Breakfast is considered the first and most important meal of the day. Missing the first meal may result in significant nutritional deficits, if not compensated in subsequent meals., Aim: To describe the nutrient intake through breakfast and to study its association with nutritional indicators among adolescent girls., Methods: A cross-sectional study among adolescent girls ( n = 565) 16-18 years was carried out in urban slums of Pune, Maharashtra, India. Haemoglobin was assessed by cyanmethemoglobin method. Nutritional status was assessed through anthropometry and three 24-hours diet recall. Z scores, independent sample test, and linear logistic regression were used to assess undernutrition, to compare means of nutrient intake and to associate nutrient intake with nutritional status, respectively., Results: Almost 50% did not consume solid food for breakfast and 99% of the participants consumed inadequate breakfast (<610 kcal). Two types of breakfast emerged: I (bakery products + beverage) and II (traditional breakfast + beverage). Although the mean energy intake of type II breakfast (235±100.55 kcal) and the mean micronutrient intake was significantly higher than type I (micronutrients: vitamin C and folate ( p = 0.001), iron ( p = 0.01)) it did not meet the adequacy norms for breakfast. Among nutritional indicators breakfast intake was not directly associated with body mass index. However, mean intake of nutrients such as energy, protein and iron through the day were significantly lesser ( p = 0.001, p = 0.01 and p = 0.01 respectively) among anaemic adolescents. Linear regression showed significant association between energy, fat intake and BAZ scores., Conclusions: Compensating dietary deficits that arise in the first meal would directly address the day's nutrient deficit. The results highlight the need for a food-based approach to address undernutrition among adolescent girls in resource-poor settings.

This population-based cross-sectional study examined the prevalence and risk factors of suboptimal vitamin D levels (assessed using circulating 25-hydroxycholecalciferol (25(OH)D)) in a multi-ethnic sample of Asian adults. Plasma 25(OH)D concentration of 1139 Chinese, Malay and Indians (40-80 years) were stratified into normal (≥30 ng/mL), and suboptimal (including insufficiency and deficiency, <30 ng/mL) based on the 2011 Endocrine Society Clinical Practice Guidelines. Logistic regression models were used to assess the associations of demographic, lifestyle and clinical risk factors with the outcome. Of the 1139 participants, 25(OH)D concentration was suboptimal in 76.1%. In multivariable models, age ≤65 years (compared to age >65 years), Malay and Indian ethnicities (compared to Chinese ethnicity), and higher body mass index, HbA1c, education and income levels were associated with suboptimal 25(OH)D concentration ( p < 0.05). In a population-based sample of Asian adults, approximately 75% had suboptimal 25(OH)D concentration. Targeted interventions and stricter reinforcements of existing guidelines for vitamin D supplementation are needed for groups at risk of vitamin D insufficiency/deficiency.

Background: Different studies in India have shown that more than 50% of elderly population of India are suffering from malnutrition and more than 90% have less than recommended intake., Objectives: The aim of this study is to estimate the prevalence and correlates of malnutrition among elderly aged 60 years and above in an urban area in Coimbatore using Mini Nutritional Assessment (MNA)., Methods: A cross-sectional study was conducted on 154 households and 190 elderly were interviewed. Nutritional status was assessed using the MNA questionnaire., Results: Mean (standard deviation) age of the total population (n = 190) was 71.09 (7.93) years and 30% was male. In this population, 37 (19.47%) was malnourished (MNA <17.0) and 47 (24.73%) were at risk for malnutrition (MNA 17.0-23.5). No significant association was observed between smoking, current alcohol consumption, higher medication use, higher comorbidity, and use of walk aid with malnutrition. Among the social factors studied, lower socioeconomic status compared to higher socioeconomic status (adjusted odds ratio [OR] =5.031, P < 0.001), single/widowed/divorced compared to married (adjusted OR = 3.323, P < 0.05), and no pension compared to those having pension (adjusted OR = 3.239, P < 0.05) were significantly associated with malnutrition., Conclusion: The prevalence of malnutrition observed in the aged people is unacceptably high. The increasing total number of lifestyle, somatic, functional, and social factors was associated with lower MNA scores. The findings of the present study clearly indicate that malnutrition is a multifactorial condition associated with sociodemographic, somatic, and functional status. Hence, we recommend that the treatment of malnutrition should be multifactorial, and the treatment team should be multidisciplinary. Further research is needed to develop appropriate guidelines for nutritional screening and interventional programs among geriatric population.

Objective: In India, national databases indicate anaemia prevalence of 80 % among 6-35-month-old children and 58 % among 36-59-month-old children. The present study aimed to characterise anaemia and the associated factors among infants and pre-schoolers living in rural India., Design: Multivariate logistic regression analysis of data collected prior to an intervention trial. Fe-deficiency with anaemia (IDA), Fe deficiency with no anaemia (IDNA) and anaemia without Fe deficiency were defined. Serum ferritin, soluble transferrin receptor (sTfR) and sTfR/log ferritin index were used to indicate Fe status., Setting: Twenty-six villages of Nalgonda district, Telangana, India. Data were collected in community sites. Participants Four hundred and seventy-six infants (aged 6-12 months), 316 pre-schoolers (aged 29-56 months) and their mothers., Results: Prevalence of anaemia among infants and pre-schoolers was 66·4 and 47·8 %, prevalence of IDA was 52·2 and 42·1 %, prevalence of IDNA was 22·2 and 29·8 %, prevalence of anaemia without Fe deficiency was 14·2 and 5·7 %. Among infants, anaemia was positively associated with maternal anaemia (OR=3·31; 95 % CI 2·10, 5·23; P<0·001), and sTfR/log ferritin index (OR=2·21; 95 % CI 1·39, 3·54; P=0·001). Among pre-schoolers, anaemia was positively associated with maternal anaemia (OR=3·77; 95 % CI 1·94, 7·30; P<0·001), sTfR/log ferritin index (OR=5·29; 95 % CI 2·67, 10·50; P<0·001), high C-reactive protein (OR=4·39; 95 % CI 1·91, 10·06, P<0·001) and young age (29-35 months: OR=1·92; 05 % CI 1·18, 3·13, P=0·009)., Conclusions: Anaemia prevalence continues to be high among infants and pre-schoolers in rural India. Based on sTfR/ferritin index, Fe deficiency is a major factor associated with anaemia. Anaemia is also associated with inflammation among pre-schoolers and with maternal anaemia among infants and pre-schoolers, illustrating the importance of understanding the aetiology of anaemia in designing effective control strategies.

Bioelectrical impedance analysis (BIA) is a method for the assessment of nutritional status. We studied the effect of graft function on nutritional status in postrenal 45 transplant patients with borderline to good allograft function using BIA. The patients had a mean serum creatinine of 1.42 ± 0.42 mg% and mean glomerular filtration rate (GFR) of 45.1 ± 14.1 mL/min. Based on BIA-derived GFR, the patients were divided into two groups; group 1: borderline graft function GFR <40 mL/min and a mean of 27.34 ± 9.1 mL/min and group 2: good graft function GFR ≥40 mL/min and a mean of 51.60 ± 9.16 mL/min. The patient data were compared with 30 healthy individuals. There was a significant difference between healthy controls and the posttransplant patients. There were significant differences between the study groups in body weight (P <0.01), serum creatinine (P <0.005), body mass index (BMI) (P <0.000), fat free mass (FFM) (P <0.003), fat mass (FM) (P <0.003), body cell mass (P <0.000), and dry weight (P <0.001). Group 1 had significantly lower body weight, BMI, FFM, FM, and dry weight, indicating poorer nutritional status compared with those in group 2. Based on phase angle, there were significant differences between group A (phase angle <4.0) and group B (phase angle >4.0) in extracellular water (P <0.015), intracellular water (P <0.002), plasma fluid (P <0.016), interstitial fluid (P <0.016), and body cell mass (P <0.024). Subjective global assessment (SGA) scores showed that transplant patients had normal nutritional status, but when compared with healthy individuals as assessed by BIA, there were significant differences in FM, FFM, and body cell mass. In conclusion, BIA was more sensitive to evaluate nutritional depletion than SGA in transplant patients with borderline.

Background and Objectives: Cultural and/or environmental barriers make the assessment of dietary intake in rural populations challenging. We aimed to assess the accuracy of a meal recall questionnaire, adapted for use with impoverished South Indian populations living in rural areas., Methods and Study Design: Dietary data collected by recall versus weighed meals were compared. Data were obtained from 45 adults aged 19-85 years, living in rural Andhra Pradesh, who were recruited by convenience sampling. Weighed meal records (WMRs) were conducted in the household by a researcher aided by a trained field worker. The following day, field workers conducted a recall interview with the same participant. Eight life size photographs of portions of South Indian foods were created to aid each participant's recall and a database of nutrients was developed to calculate nutrient intake. Pearson correlations were used to assess the strength of associations between intake of energy and nutrients calculated from meal recalls versus WMRs. Least products regression was conducted to examine fixed and proportional bias. Bland-Altman plots were constructed to measure systematic or differential bias., Results: Significant correlations were observed between estimates for energy and nutrients obtained by the two methods (r2=0.19-0.67, p<0.001). No systematic bias was detected by Bland-Altman plots. Recall method underestimated the intake of protein and fat in a manner proportional to the level of intake., Conclusions: Our culturally adapted meal recall questionnaire provides an accurate measure for assessment of the intake of energy, macronutrients and some micronutrients in rural Indian populations.

Objective: Globally more than 1/3rd of the child deaths are attributed to under nutrition and it continues to be a major public health problem in developing countries. This research paper is an attempt towards intervention and management of severely malnourished children with the use of locally prepared therapeutic diets to bring down the case fatality rate., Methods: A cross-sectional longitudinal study was undertaken at a tertiary care hospital in North India. Children under 5 y of age fulfilling the WHO case definition of severe acute malnutrition and suffering from medical complications were enrolled and managed on standard WHO protocols using locally prepared therapeutic diet (Starter F-75 diet and Catch-up F-100 diet)., Results: During the period of 11 mo, a total of 315 children (192 boys and 123 girls) under 5 y with severe acute malnutrition requiring in-patient care were enrolled and evaluated. The overall case fatality rate was 3.5% while average weight gain seen was 9.33 ± 8.28 g/kg body weight/day and average length of stay was 11.71 ± 7.59. The Nutrition Rehabilitation Centre (NRC) observed a cure rate of 47% and secondary failure rate of 19%., Conclusions: The present study highlights the integral role of locally prepared therapeutic diet (starter F-75 and F-100) besides standardized care provided at Nutrition Rehabilitation Centre (NRC) to combat malnutrition which is a major scourge in the developing world. To sustain the benefits and prevent relapse, there is a need to integrate the services at NRC with the community-based therapeutic care to deliver continuum of care from facility to door step and vice versa.

Objective: To assess the appropriateness of current mid upper-arm circumference (MUAC) cut-offs to identify children with severe acute malnutrition in India., Design: The analysis concerned 6307 children admitted to nutrition rehabilitation centres (2009-2011) where they received therapeutic care as per guidelines by WHO and the Indian Academy of Pediatrics., Setting: States of Jharkhand, Madhya Pradesh and Uttar Pradesh, India., Subjects: Children aged 6-59 months with bilateral pitting oedema or weight-for-height Z-score (WHZ)<-3 or MUAC<115 mm at admission., Results: Children aged 6-23 months represented ~80 % of the admissions. Among them, the proportion with WHZ<-3 was similar to that with MUAC<115 mm (85·7 % v. 81·8 %); the proportion with MUAC<115 mm whose WHZ was <-3 was 82·6 %; and the proportion with WHZ<-3 whose MUAC<115 mm was 78·8 %. MUAC<115 mm was as effective as WHZ<-3 in identifying 6-59-month-old children with medical complications (32·2 % v. 31·6 %, respectively), the most important risk factor of death among oedema-free children. Furthermore, death rates in children with MUAC<115 mm were higher than in children with WHZ<-3 (0·61 % v. 0·58 %, respectively) and 91 % of the deaths among oedema-free children were deaths of children with MUAC<115 mm., Conclusions: In populations similar to those included in our analysis, MUAC<115 mm appears to be an appropriate criterion to identify children with severe acute malnutrition who are at a greater risk of medical complications and death, particularly among children 6-23 months old.