Hidden hunger is widespread in India. Individual dietary diversity score (IDDS) is a measure of the nutrient adequacy of the diet. The Food and Agricultural Organisation (FAO) has set guidelines for measurement of dietary diversity: the IDDS and the minimum dietary diversity score for women (MDD-W) to assess nutritional deficiency but validation against nutritional biomarkers is required. Using available data among rural youth (17 years) from the Pune Maternal Nutrition Study (PMNS) the validity of DDS was assessed to measure deficiencies of vitamin B12, folate and haemoglobin. Of the 355 boys and 305 girls 19% were classified as underweight, 57% as B12 deficient (<150pmol/L) and 22% as anaemic (<12/13g/dL). Cereals, legumes and ‘other-vegetables’ were the most frequently consumed foods. More boys than girls consumed milk, flesh, eggs, and micronutrient-dense foods. Median IDDS 4(3,4 IQR) and MDD-W 6(5,7) were low. Youth with B12 deficiency had a higher likelihood of an IDDS≤4 (1.89 95%CI 1.24,2.87) or a MDD-W≤5 (1.40 95%CI 1.02, 1.94). Youth with anaemia were more likely to have an IDDS ≤4 (1.76 95%CI 1.01,3.14) adjusted for socio-economic scores, body mass index, calorie intake and sex. Folate deficiency was low (3%) and was not associated with either score. Youth with lowest plasma-B12 and haemoglobin infrequently or never consumed dairy/non-vegetarian foods. These rural Indian youth were underweight, had low DDS and consumed foods low in good quality proteins and micronutrients. Associations of DDS with circulating micronutrients indicate that DDS is a valid measure to predict B12 deficiency and anaemia.

There is a growing epidemic of obesity and type 2 diabetes in the world, more than 75% of the patients are in the developing countries. India is facing a twin burden of under-nutrition and over-nutrition: it figures prominently both in the hunger map of the world as well as being the world's capital of diabetes. Indians are susceptible to diabetes at a younger age and at a relatively lower BMI compared to the white Caucasians. This is partly explained by the fact that the thin-looking Indians are quite adipose (higher body fat percent). Intrauterine epigenetic regulation could explain the thin-fat Indian body composition. A combination of maternal one carbon metabolism derangement (influenced by vitamin B12 and Folate nutrition) and hyperglycemia appear to be major drivers. Persistent micronutrient abnormalities and rapid economic development seem to contribute to the intergenerational amplification of the diabetes-adiposity epidemic in Indians. Effective curtailment of the growing epidemic may lie in the realm of maternal and child health and nutrition.

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ObjectiveCentral (truncal) adiposity is associated strongly with insulin resistance and diabetes. There are very few reports comparing methods of trunk fat measurement in their ability to predict glycaemia and insulin resistance. We report a comparative analysis of different trunk fat measurements in predicting glycaemia and insulin resistance in middle aged Indian men.Materials and MethodsTrunk fat measurements were performed using anthropometry, magnetic resonance imaging (MRI), dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) on 128 men. Additional measurements were taken to characterise insulin resistance (Matsuda index) and beta cell function (Insulinogenic Index), glycaemia (fasting and 120 min glucose concentrations). Using residual approach we compared the ability of different trunk fat measurement techniques to predict insulin resistance, beta cell function and glycaemia.ResultsThere was a strong association between trunk fat measures from each technique with glycaemia and insulin resistance indices but not with the Insulinogenic Index. Insulin resistance and glycaemia, were best predicted using anthropometric measurements, notably by waist circumference and subscapular skinfold thickness. Neither MRI measures of trunk or visceral fat nor DXA trunk fat added significantly. CT liver density contributed to some extent to predict insulin resistance and 120 min glucose after anthropometric measurements.ConclusionsOur results suggest that, in Indian men, anthropometric measurements are good predictors of glycaemia and insulin resistance. Other complex measurements such as MRI, DXA and CT make only a small addition to the prediction. This finding supports the application of anthropometry for determining trunk fat in clinical and epidemiological settings.