We evaluated the adverse effect of asymptomatic Helicobacterp ylori infection in children on the response to Fe supplementation. One hundred and sixtynine children aged 1-10y ears from the urban poor community underwenta[ 13 C]urea breath test for H. pylori and haematologicalt ests at admission and after 8weeks. Both H. pylori-positive and -negative children were randomly assigned to receive ferrous fumarate syrup (20 mg elemental Fe twice daily) or placebo for 8w eeks and as ingle dose of vitamin A( 33,000 m g). Admission findings were compared between H. pylori-positive and -negative children. Response to Fe was comparedb etween Fe-supplemented H. pylori-positive and -negative children. Seventy-nine per cent of the children were aged 1-5 years and half of them were boys. In eighty-five H. pylori-positive and eighty-four H. pylori-negative children, the differences in mean Hb (112 ( SD 12·6) v .1 13 ( SD 12·0) g/l), haematocrit( 34 ( SD 3·5) v .3 5( SD 3·2) %) and ferritin (23·8 v .2 1·0 m g/l) were similar. After 8w eeks of Fe supplementation, mean Hb was 5·3g/l more (95 %C I1 ·59, 9·0) and haematocrit was 1·4% more (95 %C I0 ·2, 2·6) in H. pylori-negative ( n 44) compared with H. pyloripositive ( n 42) children. Mean ferritin was similar at admission and improved in both H. pylori-positive and -negative children. Asymptomatic H. pylori infection was not associated with higher rates of anaemia or Fe deficiency in children, but had asignificant adverse effect on response to Fe therapy. However, this result is based on exploratory analysis and needs confirmation.

Rapid postnatal growth in low-birth weight infants increases the risk of hypertension, CHD and type 2 diabetes in adult life. To provide validated tools to study the growth in South Asian infants, we evaluated two published equations to measure total body water (TBW) and fat-free mass (FFM) based on anthropometry in 6-to 24-month-old infants, using 2 H 2 O dilution. In a method-comparison study in seventy-eight infants aged 6-24 months (forty-two girls and thirty-six boys) from the urban poor attending an immunisation clinic of a hospital in Kolkata, we measured their length to the nearest 0·1 cm, weight to the nearest 10 g and TBW using 2 H 2 O dilution. The calculated TBW in kg (TBWkg) and FFM in kg (FFMkg) using two equations based on the length and weight were each compared with TBWkg and FFMkg calculated from 2 H 2 O dilution. The mean FFMkg were 7·31 (SD 1·11), 7·13 (SD 1·08) and 7·26 (SD 1·13) by the 2 H 2 O dilution method, and the anthropometry equations of Mellits and Cheek (AN-1) and Morgenstern et al. (AN-2), respectively. The mean of the paired difference in FFMkg was 0·18 (SEM 0·06) and 0·04 (SEM 0·07) between 2 H 2 O, and AN-1 and AN-2, respectively. There is a good agreement for FFM derived by AN-2 with 2 H 2 O dilution. The former is 1 % lower than that obtained from the reference method (P¼ 0·28). The AN-2 equation is useful for evaluating FFM in infants in India. Total body water: Fat-free mass: 2 H 2 O dilution technique: InfantsMeasuring fat-free mass (FFM) in infants and young children is of scientific and public health interest. Recent findings on the relationship between intra-uterine growth retardation and diseases in adults such as hypertension, type 2 diabetes and CHD generated renewed interest in studying the developmental indicators of infants and young children (1 -4) . Furthermore, it has been shown that more rapid postnatal growth (catch-up growth) in infants born with intra-uterine growth retardation is also a risk factor for these adult diseases (5 -8) . In South Asian countries, the rate of low birth weight is very high largely due to intra-uterine growth retardation (9) . Furthermore, the incidence of hypertension, type 2 diabetes and CHD is higher among South Asians compared with the Caucasians (10) . We therefore need population-based studies on growth and its components like FFM in infancy and early childhood. The absence of validated equations for measuring FFM in infants in South Asia based on simple measurements such as height/ length and weight is a known constraint. Are the existing equations suitable for use in infants and young children in South Asia?In the light of that mentioned earlier, measurement of body composition such as FFM assumes importance. The practical methods for use in clinics and in the field to measure FFM in infants and children are largely based on anthropometry (such as height/length and weight) and equations for children have been developed mainly in developed countries. We found two such validated equations in literature based on anthropometr...

The objective of the study was to develop prediction equations for fat-mass percentage in infants in India based on skinfold thickness, mid-arm circumference, and age. Skinfold thicknesses and mid-arm circumference of 46 apparently-healthy infants (27 girls and 19 boys), aged 6–24 months, from among the urban poor attending a well baby clinic of a hospital in Kolkata were measured. Their body-fat percentage was measured using the D2O dilution technique as the reference method. Equations for body-fat percentage were developed using a stepwise forward regression model using skinfold thicknesses, mid-arm circumference, and age as independent variables, and the body-fat percentage was derived by D2O dilution as the dependent variable. The new prediction equations are: body-fat percentage=-69.26+5.76×B-0.33×T2+5.40×M+0.01×A2 for girls and body-fat percentage=-8.75+3.73×B+2.57×S for boys, where B=biceps skinfold thickness, T=triceps skinfold thickness, and S=suprailiac skinfold thickness all in mm, M=mid-arm circumference in cm, and A=age in month. Using the D2O dilution technique, the means (SD) of the calculated body-fat percentage were 17.11 (7.25) for girls and 16.93 (6.62) for boys and, using the new prediction equations, these were 17.11 (6.25) for girls and 16.93 (6.02) for boys. The mean of the differences of paired values in body-fat percentage was zero. The mean (SD) of the differences of paired values for body-fat percentage derived by the D2O technique and the new equations, applied on an independent sample of 23 infants (11 girls and 12 boys) were -0.93 (6.56) for girls and 1.14 (2.43) for boys; the 95% confidence limits of the differences of paired values for body-fat percentage were -2.03 to +3.89 for girls and -0.26 to +2.54 for boys. Given that the trajectories of growth during infancy and childhood are a major risk factor for a group of diseases in adulthood, including coronary heart disease and diabetes, these predictive equations should be useful in field studies.

The association of early postnatal growth with diseases in adults such as hypertension, type 2 diabetes and CHD has generated interest in studying postnatal growth. Bioelectrical impedance analysis (BIA) is a useful measure to estimate total body water (TBW) and fat-free mass (FFM). We evaluated three published equations (Fjeld et al. (Pediatr Res (1990) 27, 98 -102), Bocage (MSc Thesis (1988) University of West Indies) and Kushner et al. (Am J Clin Nutr (1992) 56, 835 -839) to measure TBW and derived FFM based on BIA, using 2 H 2 O dilution as a reference method for suitability in infants in India. In a cross-sectional study in seventy-eight apparently healthy infants aged 6 -24 months from the urban poor attending an immunisation clinic at a hospital in Kolkata, we measured their length to the nearest 0·1 cm, weight to the nearest 10 g, resistance at 50 kHz using BIA and TBW using 2 H 2 O dilution. TBW was derived using three published BIA-based equations and compared with TBW using 2 H 2 O dilution. Based on the BIA equations of Fjeld et al., Bocage and Kushner et al., the mean TBW values were 2·46 % (P, 0·001), 4·62 % (P,0·001) and 9·50 % (P,0·001) lower than the reference 2 H 2 O method, respectively. All three published BIA-based equations consistently underestimated the TBW and FFM and appeared inadequate for studying infants in India. The equation described by Fjeld et al. gave the smallest deviation from the reference method and may be used for field studies. New equations based on population-specific data are desirable for a more precise measure of TBW. Practical methods for use in clinics and in the field to measure fat-free mass (FFM) or lean body mass in infants and children are largely based on anthropometry (such as height or length and weight) and recently introduced bioelectrical impedance analysis (BIA) techniques. Based on these methods, equations have been developed for children in both developed and developing countries. We could identify two equations (1,2) based on length or height and weight and three based on the BIA technique (Fjeld et al. , Bocage (4) and Kushner et al.( 5) ) for infants and children. Before we can use any of these equations with confidence on a population different from those on whom these equations were developed, it is important to validate them.We have earlier reported our evaluation of the two equations above based on length or height and weight using stable-isotope ( 2 H 2 O) dilution as the reference method (6) . However, equations based on conventional anthropometry, i.e. length and weight, have the inherent limitation in that they do not critically distinguish between FFM and fat mass. On the other hand, the theoretical basis of bioelectrical impedance analysis indicates that it is well suited to assess total body water (TBW) (7) . The method is based on the phenomenon that only water (containing electrolytes) in the human body can conduct electricity. Fat is relatively devoid of water and restricts the flow of current through it. At any given current freque...

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