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Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: long term follow-up of Hyderabad nutrition trial.

Kinra S, Rameshwar Sarma KV - BMJ (2008)

Bottom Line: To determine whether integration of nutritional supplementation with other public health programmes in early life reduces the risk of cardiovascular disease in undernourished populations.No strong evidence existed for differences in blood pressures and serum lipids.In this undernourished population, integrated delivery of supplemental nutrition with other public health programmes in pregnancy and early childhood was associated with a more favourable profile of cardiovascular disease risk factors in adolescence.

View Article: PubMed Central - PubMed

Affiliation: Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT. sanjay.kinra@lshtm.ac.uk

ABSTRACT

Objective: To determine whether integration of nutritional supplementation with other public health programmes in early life reduces the risk of cardiovascular disease in undernourished populations.

Design: Approximately 15 years' follow-up of participants born within an earlier controlled, community trial of nutritional supplementation integrated with other public health programmes.

Setting: 29 villages (15 intervention, 14 control) near Hyderabad city, south India.

Participants: 1165 adolescents aged 13-18 years.

Intervention: Balanced protein-calorie supplementation (2.51 MJ, 20 g protein) offered daily to pregnant women and preschool children aged under 6 years, coupled with integrated delivery of vertical public health programmes.

Main outcome measures: Height, adiposity, blood pressures, lipids, insulin resistance (homoeostasis model assessment (HOMA) score), and arterial stiffness (augmentation index).

Results: The participants from the intervention villages were 14 mm (95% confidence interval 4 to 23; P=0.007) taller than controls but had similar body composition. The participants from the intervention villages had more favourable measures of insulin resistance and arterial stiffness: 20% (3% to 39%; P=0.02) lower HOMA score and 3.3% (1% to 5.7%; P=0.008) lower augmentation index. No strong evidence existed for differences in blood pressures and serum lipids.

Conclusions: In this undernourished population, integrated delivery of supplemental nutrition with other public health programmes in pregnancy and early childhood was associated with a more favourable profile of cardiovascular disease risk factors in adolescence. This pragmatic study provides the most robust evidence to date on this important hypothesis for which classic trials are unlikely. Improved maternal and child nutrition may have a role in reducing the burden of cardiovascular disease in low income and middle income countries.

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Related in: MedlinePlus

Flow chart of participant recruitment at follow-up in Hyderabad nutrition trial. *Higher figure in control area probably reflects greater influx of temporary migrant workers during harvest season. †Married daughters of villagers who were temporarily visiting their parents’ home for childbirth at time of baseline study. ‡Data are for all children (rather than study cohort), as date of birth of dead children was not collected (deemed insensitive). §These represent 49% (intervention) and 41% (control) of all eligible births
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fig1: Flow chart of participant recruitment at follow-up in Hyderabad nutrition trial. *Higher figure in control area probably reflects greater influx of temporary migrant workers during harvest season. †Married daughters of villagers who were temporarily visiting their parents’ home for childbirth at time of baseline study. ‡Data are for all children (rather than study cohort), as date of birth of dead children was not collected (deemed insensitive). §These represent 49% (intervention) and 41% (control) of all eligible births

Mentions: Of the 4338 pregnancies recorded in the trial, birth weights (recorded within 48 hours) were available for 2964 (68%) children. The mean birth weight of children born in the intervention area (2655 (SD 424) g) was higher than that of controls (2594 (SD 430) g); the mean difference was 61 g (95% confidence interval 18 to 104; P=0.007). Adjustment for sex of the child made no difference to the results; however, we deemed data on gestational age to be of insufficient quality (strong digit preference) to be included in the analyses. Personal information (necessary to trace families) was available for 2756 women, of which 1963 (71%) could be contacted successfully (figure). At the time of follow-up, the contacted women had delivered 8246 children, of which 2601 were eligible for follow-up (born between 1987 and 1990 and still alive in 2003). From these eligible children, we invited only those with existing information in the trial dataset (n=1492; 57%) to have a clinical examination. A total of 1165 children participated in the clinics: 654 (82%) in the intervention area and 511 (74%) in the control area, representing 45% of all eligible births from the area at the time. Children who took part in the clinics were slightly older and more likely to be males and students than those who were eligible but did not participate (table 1).


Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: long term follow-up of Hyderabad nutrition trial.

Kinra S, Rameshwar Sarma KV - BMJ (2008)

Flow chart of participant recruitment at follow-up in Hyderabad nutrition trial. *Higher figure in control area probably reflects greater influx of temporary migrant workers during harvest season. †Married daughters of villagers who were temporarily visiting their parents’ home for childbirth at time of baseline study. ‡Data are for all children (rather than study cohort), as date of birth of dead children was not collected (deemed insensitive). §These represent 49% (intervention) and 41% (control) of all eligible births
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2500199&req=5

fig1: Flow chart of participant recruitment at follow-up in Hyderabad nutrition trial. *Higher figure in control area probably reflects greater influx of temporary migrant workers during harvest season. †Married daughters of villagers who were temporarily visiting their parents’ home for childbirth at time of baseline study. ‡Data are for all children (rather than study cohort), as date of birth of dead children was not collected (deemed insensitive). §These represent 49% (intervention) and 41% (control) of all eligible births
Mentions: Of the 4338 pregnancies recorded in the trial, birth weights (recorded within 48 hours) were available for 2964 (68%) children. The mean birth weight of children born in the intervention area (2655 (SD 424) g) was higher than that of controls (2594 (SD 430) g); the mean difference was 61 g (95% confidence interval 18 to 104; P=0.007). Adjustment for sex of the child made no difference to the results; however, we deemed data on gestational age to be of insufficient quality (strong digit preference) to be included in the analyses. Personal information (necessary to trace families) was available for 2756 women, of which 1963 (71%) could be contacted successfully (figure). At the time of follow-up, the contacted women had delivered 8246 children, of which 2601 were eligible for follow-up (born between 1987 and 1990 and still alive in 2003). From these eligible children, we invited only those with existing information in the trial dataset (n=1492; 57%) to have a clinical examination. A total of 1165 children participated in the clinics: 654 (82%) in the intervention area and 511 (74%) in the control area, representing 45% of all eligible births from the area at the time. Children who took part in the clinics were slightly older and more likely to be males and students than those who were eligible but did not participate (table 1).

Bottom Line: To determine whether integration of nutritional supplementation with other public health programmes in early life reduces the risk of cardiovascular disease in undernourished populations.No strong evidence existed for differences in blood pressures and serum lipids.In this undernourished population, integrated delivery of supplemental nutrition with other public health programmes in pregnancy and early childhood was associated with a more favourable profile of cardiovascular disease risk factors in adolescence.

View Article: PubMed Central - PubMed

Affiliation: Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT. sanjay.kinra@lshtm.ac.uk

ABSTRACT

Objective: To determine whether integration of nutritional supplementation with other public health programmes in early life reduces the risk of cardiovascular disease in undernourished populations.

Design: Approximately 15 years' follow-up of participants born within an earlier controlled, community trial of nutritional supplementation integrated with other public health programmes.

Setting: 29 villages (15 intervention, 14 control) near Hyderabad city, south India.

Participants: 1165 adolescents aged 13-18 years.

Intervention: Balanced protein-calorie supplementation (2.51 MJ, 20 g protein) offered daily to pregnant women and preschool children aged under 6 years, coupled with integrated delivery of vertical public health programmes.

Main outcome measures: Height, adiposity, blood pressures, lipids, insulin resistance (homoeostasis model assessment (HOMA) score), and arterial stiffness (augmentation index).

Results: The participants from the intervention villages were 14 mm (95% confidence interval 4 to 23; P=0.007) taller than controls but had similar body composition. The participants from the intervention villages had more favourable measures of insulin resistance and arterial stiffness: 20% (3% to 39%; P=0.02) lower HOMA score and 3.3% (1% to 5.7%; P=0.008) lower augmentation index. No strong evidence existed for differences in blood pressures and serum lipids.

Conclusions: In this undernourished population, integrated delivery of supplemental nutrition with other public health programmes in pregnancy and early childhood was associated with a more favourable profile of cardiovascular disease risk factors in adolescence. This pragmatic study provides the most robust evidence to date on this important hypothesis for which classic trials are unlikely. Improved maternal and child nutrition may have a role in reducing the burden of cardiovascular disease in low income and middle income countries.

Show MeSH
Related in: MedlinePlus