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

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.

Child undernutrition in affluent societies: what are we talking about?

“…Worldwide, undernutrition has been clearly linked to a substantial increased risk of mortality and morbidity (1) as well as long-term stunting (2) and probably also has metabolic effects stretching into adulthood (3,4) . Thus undernutrition in childhood is clearly an important risk factor.…”

“…Undernutrition is an intrinsic hazard in pre-school children in all cultures because infants have such high-nutrient requirements due to high rates of morbidity, requirements for growth, relatively inefficient metabolism and dependence on adults for all food. Worldwide, undernutrition has been clearly linked to a substantial increased risk of mortality and morbidity (1) as well as long-term stunting (2) and probably also has metabolic effects stretching into adulthood (3,4) . Thus undernutrition in childhood is clearly an important risk factor.…”

Early growth and markers of cardiovascular risk in Keralan children in the Integrated Child Development Scheme

“…The children in our cohort were of greater birth weight than contemporaries born in non-ICDS areas such as rural Maharashtra (2?66 kg), urban Andhra Pradesh (Hyderabad; 2?59 kg) and rural Andhra Pradesh (2?50 kg) (11)(12)(13) . However, during infancy and early childhood the children's weight remained consistently more than 1SD below the NCHS reference median with a nadir weight-for-age Z-score at 6 months of age.…”

Anthropometric Measures and Insulin Resistance in Rural Indian Adolescents

“…Details of design of the Hyderabad Nutrition trial and the follow up survey have been previously published [17]. All adolescents born to participants of the Hyderabad Nutrition trial during the years 1987-1990 were eligible to participate in the follow up study and were included in the current analysis.…”

“…Participation included completion of an interview administered via a questionnaire, clinical examinations and collection of fasting blood samples by a venous blood draw and a brief interview of the mothers. Height, weight, skinfold thickness at four sites, waist and hip circumference, blood pressure and temperature were measured [17]. Data collection was done from 2003 through 2005.…”