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High prevalence of Malnutrition exists amongst the geriatric population in India. Evidence on malnutrition is available from the plain regions of the country. However there is lack of scientific evidence on malnutrition status of geriatric population residing at high altitude regions of Uttarakhand, India.
Materials and methods
A community based cross-sectional study was conducted during 2015–2016 in District Nainital. Thirty clusters were identified using population proportionate to size sampling method; 30 geriatric subjects were selected from each cluster. Study population included 980 geriatric aged 60 years and above. Nutritional status of the geriatric population was assessed using Mini Nutritional Assessment (MNA) tool. Standard procedures were used to determine the height, weight, MCC and MUAC. The BMI was calculated from the measurements of weight (kg) and height (cm) (kg/m2). Data was entered in MS Excel 2007 and analyzed using SPSS version 20.0.
The MNA revealed that only 22.4% geriatric subjects had satisfactory nutritional status, 14.3% were malnourished and 63.3% were “at risk” of malnutrition. High prevalence of malnutrition was found among subjects belonging to age group of 60–70 years (58.9%), illiterate (74.5%) with family monthly income (1866–5546;43.3%), financially dependent (75.2%), with loss of appetite (71.6%), with chewing problem (63.1%) and who consumed < 2 full meals daily. (73.1%; all p < 0.0001;) in comparison to the subjects who had satisfactory nutritional status.
The present findings revealed that the high prevalence of malnutrition amongst the geriatric population in India. The risk factors identified were financial dependency, dietary intake, loss of appetite and chewing problem. Interventions to decrease these risk factors possibly may lead to reduction in malnutrition among geriatric population.
To assess the prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of India.
Community-based cross-sectional study. Data were collected on sociodemographic profile and anthropometric parameters. Weight and height measurements were utilized for calculation of BMI. Nutrient intake data were collected using 24 h dietary recall.
High-altitude region of Nainital District, Uttarakhand State, North India.
Community-dwelling geriatric subjects (n 981) aged 60 years or above.
We found that 26·6 % of the elderly subjects were underweight (BMI<18·5 kg/m2). Overweight (BMI 25·0–29·9 kg/m2) and obesity (BMI≥30·0 kg/m2) was seen among 18·0 % and 4·6 %, respectively. After controlling for potential cofounders, risk factors such as low level of education and income, chewing problems and lower number of daily meals were found to be associated with underweight. On the other hand, risk factors for overweight/obesity were lower age, high income and unskilled work.
There is a need to develop and implement intervention strategies to prevent underweight, overweight and obesity among the geriatric population of India.
To evaluate the predictive ability of mid-upper arm circumference (MUAC) for detecting severe wasting (weight-for-height Z-score (WHZ) <−3) among children aged 6–59 months.
Rural Uttar Pradesh, India.
Children (n 18 456) for whom both WHZ (n 18 463) and MUAC were available.
The diagnostic test accuracy of MUAC for severe wasting was excellent (area under receiver-operating characteristic curve = 0·933). Across the lower range of MUAC cut-offs (110–120 mm), specificity was excellent (99·1–99·9 %) but sensitivity was poor (13·4–37·2 %); with higher cut-offs (140–150 mm), sensitivity increased substantially (94·9–98·8 %) but at the expense of specificity (37·6–71·9 %). The optimal MUAC cut-off to detect severe wasting was 135 mm. Although the prevalence of severe wasting was constant at 2·2 %, the burden of severe acute malnutrition, defined as either severe wasting or low MUAC, increased from 2·46 to 17·26 % with cut-offs of <115 and <135 mm, respectively. An MUAC cut-off <115 mm preferentially selected children aged ≤12 months (OR=11·8; 95 % CI 8·4, 16·6) or ≤24 months (OR=23·4; 95 % CI 12·7, 43·4) and girls (OR=2·2; 95 % CI 1·6, 3·2).
Based on important considerations for screening and case detection in the community, modification of the current WHO definition of severe acute malnutrition may not be warranted, especially in the Indian context.
Iodine is an essential micronutrient needed for the production of thyroid hormones. Pregnant mothers who are deficient in iodine provide less iodine to the fetal thyroid. This results in low production of thyroid hormones by the fetal thyroid, thereby leading to compromised mental and physical development of the fetus. The current study aimed to assess the current status of iodine nutrition among pregnant mothers in Himachal Pradesh, India, a known endemic region for iodine deficiency.
Three districts, namely Kangra, Kullu and Solan, were selected.
In each district, thirty clusters (villages) were identified by utilizing the population-proportional-to-size cluster sampling methodology. In each cluster, seventeen pregnant mothers attending the antenatal clinics were included.
A total of 1711 pregnant mothers (647 from Kangra, 551 from Kullu and 513 from Solan) were studied. Clinical examination of the thyroid of each pregnant mother was conducted. Spot urine samples were collected from ten pregnant mothers in each cluster. Similarly, salt samples were collected from eleven pregnant mothers in each cluster.
Total goitre rate was 42·2 % (Kangra), 42·0 % (Kullu) and 19·9 % (Solan). The median urinary iodine concentration was 200 μg/l (Kangra), 149 μg/l (Kullu) and 130 μg/l (Solan). The percentage of pregnant mothers consuming adequately iodized salt (iodine content of 15 ppm and more) was found to be 68·3 % (Kangra), 60·3 % (Kullu) and 48·5 % (Solan).
Pregnant mothers in Kullu and Solan districts had iodine deficiency as indicated by a median urinary iodine concentration less than 150 μg/l.
The prevalence of Bitot's spots (BS) is often used to quantify vitamin A deficiency burden in India, both before and after mega-dose vitamin A supplementation (MVAS) programmes. However, the proportion of BS cured following this intervention is unclear in contemporary times. The current study evaluated the responsiveness of BS over 1 year to MVAS administered as per the national programme in rural India.
Prospective, community-based, 1-year follow-up of a cohort.
Rural Uttar Pradesh, India.
Two hundred and sixty-two children with BS, aged between 1 and 5 years, administered 60 mg (retinol equivalent) of vitamin A on diagnosis and after 1 month. Cure or resolution was defined if there was no discernible BS in either eye.
During 1 year, only three children were lost to follow-up. At 6 months of follow-up (MVAS at baseline and 1 month later), 51·1 (95% CI 45·3, 57·3) % were classified as cured. The corresponding figure at 1 year (additional MVAS at 6 months) was 59·9 (95% CI 54·1, 65·9) %. Among those cured at 6 months, about half and three-quarters had resolved at 2 and 3 months, respectively. Apart from male gender, there were no significant sociodemographic or clinical predictors of response.
Substantial non-response to MVAS at 6 months (49%) and 1 year (40%) of follow-up suggests that presently in the Indian subcontinent, BS is a relatively crude indicator of severe current vitamin A deficiency. For programmatic decisions and evaluation, the public health burden of vitamin A deficiency should not be assessed solely through BS.