One third of the Indian babies are of low birth weight (<2.5 kg), and this is attributed to maternal undernutrition. We therefore examined the relationship between maternal nutrition and birth size in a prospective study of 797 rural Indian women, focusing on macronutrient intakes, dietary quality and micronutrient status. Maternal intakes (24-h recall and food frequency questionnaire) and erythrocyte folate, serum ferritin and vitamin C concentrations were measured at 18 +/- 2 and 28 +/- 2 wk gestation. Mothers were short (151.9 +/- 5.1 cm) and underweight (41.7 +/- 5.1 kg) and had low energy and protein intakes at 18 wk (7.4 +/- 2.1 MJ and 45.4 +/- 14.1 g) and 28 wk (7.0 +/- 2.0 MJ and 43.5 +/- 13.5 g) of gestation. Mean birth weight and length of term babies were also low (2665 +/- 358 g and 47.8 +/- 2.0 cm, respectively). Energy and protein intakes were not associated with birth size, but higher fat intake at wk 18 was associated with neonatal length (P < 0.001), birth weight (P < 0.05) and triceps skinfold thickness (P < 0.05) when adjusted for sex, parity and gestation. However, birth size was strongly associated with the consumption of milk at wk 18 (P < 0.05) and of green leafy vegetables (P < 0.001) and fruits (P < 0.01) at wk 28 of gestation even after adjustment for potentially confounding variables. Erythrocyte folate at 28 wk gestation was positively associated with birth weight (P < 0.001). The lack of association between size at birth and maternal energy and protein intake but strong associations with folate status and with intakes of foods rich in micronutrients suggest that micronutrients may be important limiting factors for fetal growth in this undernourished community.

Modifiable maternal nutritional factors may influence bone health in the offspring. Fathers play a role in determining their child's bone mass, possibly through genetic mechanisms or through shared environment.

Objective: To describe the relationship of the mother's physical activity to the birth size of her baby in a rural Indian population. Design: Prospective observational study. Setting: Six villages near Pune, Maharashtra, India. Subjects: A total of 797 women were studied after excluding abortions and termination of pregnancies (112), foetal anomalies (8), multiple pregnancies (3), incomplete pre-pregnancy anthropometry (14) and pregnancies detected later than 21 weeks of gestation (168). Method: An activity questionnaire was developed after focus group discussions and incorporated community-specific activities. It was validated against an observer-maintained diary. Activity scores were derived using published data on energy costs to weight the contributions of various activities. It was then administered to assess physical activity at 18 ( AE 2) and 28 ( AE 2) weeks of gestation. Outcome measures: Birth outcome, maternal weight gain and neonatal anthropometry. Results: The activity questionnaire was used to classify women into light, moderate and heavy activity categories. Maternal activity did not influence the incidence of prematurity or stillbirth, or the duration of gestation. It was inversely related to maternal weight gain up to 28 weeks of gestation (P ¼ 0.002). Higher maternal activity in early, as well as mid gestation, was associated with lower mean birth weight (P ¼ 0.05 and 0.02, respectively ), and smaller neonatal head circumference (P ¼ 0.005 and 0.009) and mid-arm circumference (P ¼ 0.03 and 0.01) after adjusting for the effect of major confounding factors. Conclusions: The Findings suggest that excessive maternal activity during pregnancy is associated with smaller foetal size in rural India, The approach described for developing an activity questionnaire has potential for adoption in other settings.

If causal, these observations indicate that complete exposure (16 weeks) to the winter season (harvest-time) in late gestation could increase birth weight by 90 g in poor farming communities in rural India, and the benefit would increase further by lowering maternal activity. Our results underscore the importance of considering seasonality in planning targeted intervention strategies in such settings.

Objectives: To examine the magnitude of overweight and its association with blood pressure (BP) among adolescents. Design: Cross-sectional study with all children in age range 9-16 years (n ¼ 1146 boys and 1077 girls) from two schools catering to urban affluent high socio-economic class (HSE), for anthropometric measurements by trained investigators and BP measurement by a pediatrician using sphygmomanometer. Results: The prevalence of overweight based on conventional body mass index (BMI) cutoff was 27.5% for boys and 20.9% for girls but varied for different indicators. Prevalence of high systolic blood pressure (HSBP) was 12.0% in boys and 9.7% in girls and increased with increasing levels of BMI, weight, triceps skin fold thickness (TSFT) and percent body fat. Mean level of SBP among overweight children was significantly (Po0.001) higher by about 12 mm Hg, whereas that for diastolic blood pressure was higher by 8 mm Hg (Po0.001) as compared to their non-overweight (age, sex-matched) counterparts. This was true in both sexes and for all indicators used for assessing overweight. Prevalence of HSBP increased suddenly beyond BMI value of 20 kg/m 2 in boys and 21.5 kg/m 2 in girls, beyond TSFT value of 12 mm for boys and 14 mm for girls whereas such cutoffs for body fat were above 25% in both sexes. These cutoffs appear much lower than the conventional ones and therefore indicate the need for validation of conventional cutoffs in different populations. Conclusions: Our findings highlight that BP measurement needs to be a routine part of physical examination in school children, and the use of cutoffs anchored to metabolic risks may be essential for assessment of obesity.