Background and objectives Weight-for-height (WHZ) and body mass index (BMI)-for-age (BAZ) are commonly used to assess child overnutrition but have limitations: they conflate skeletal growth with body weight, correlate with height, and inadequately distinguish fat from lean mass, particularly during puberty. This study proposes an India-specific generalised body mass index (gBMI), an age- and sex-specific power-type index adapted from Benn's concept, to better capture adiposity. Methods Exponent parameters for gBMI were estimated using healthy-child data, selected by WHO selection criteria, from the National Family Health Survey (NFHS-3,4,5) and the Comprehensive National Nutrition Survey (CNNS), comprising 12,466 children under 5 years and 6,487 aged 5-19 years. Polynomial regression to model age- and sex-specific variation in the weight-height relationship was used to estimate the exponents of height, and growth curves were generated using generalised additive models for location, scale, and shape (GAMLSS) with location scale and shape (LMS) methods. Validation employed independent data from 457 urban schoolchildren aged 5-16 years in Bengaluru, including fat and lean mass measured by dual-energy X-ray absorptiometry (DXA). Results The exponent varied with age (1.3 in infancy, ∼2.9 in pubertal boys, 2.7 in girls, stabilising at ∼2 in late adolescence). Unlike BMI, gBMI residuals showed near-zero correlation with height. gBMI-for-age Z-scores (gBAZ) showed lower wasting in children under 5 years (10.7% vs. 19.2% using WHZ) and higher adolescent overnutrition (8.7% vs. <1% using BAZ). Validation showed stronger association of gBAZ with body fat (r=0.70) than BAZ (r=0.65). Interpretation and conclusions The gBMI provides an adaptable, height-independent, and adiposity-sensitive index for assessing malnutrition and obesity in children and adolescents. Its use could refine nutritional surveillance and interventions, with potential wider applicability with longitudinal evaluations.

BACKGROUND:Despite the rising prevalence of dyslipidemia in adolescents from socioeconomic and lifestyle transitions, nationally representative data on dyslipidemia and its risk factors among Indian adolescents remain limited. OBJECTIVE:This study aimed to estimate the prevalence and risk factors of dyslipidemia among Indian adolescents using nationally representative survey data. METHODS:Using the Comprehensive National Nutrition Survey (CNNS) data (2016-2018), we estimated the prevalence and risk factors of dyslipidemia among adolescents aged 10 to 19 years (n = 11,960). Overall dyslipidemia (≥1 lipid abnormality) prevalence was estimated at the national and state levels, accounting for sampling design. Prevalence of each lipid abnormality was stratified by age, gender, and residence. Binomial logistic regression examined associated risk factors and interactions between lifestyle factors and comorbidities. RESULTS:In CNNS, overall dyslipidemia prevalence was 39.9% (95% CI: 37.4-42.4), higher in boys (41.9%), late-adolescents (42.5%), and rural residents (41.1%). Prevalence varied widely across states. Low high-density lipoprotein cholesterol (HDL-C) (28.0%) was the most prevalent lipid abnormality, followed by high triglycerides (TGs) (15.8%). Low HDL-C was more prevalent in boys, and high TG was more prevalent in girls, whereas both abnormalities were more prevalent in late adolescents and rural areas. Besides male gender and late adolescence, lower wealth index, Muslims or Christians, overweight/obesity, alcohol use, and low physical activity had higher odds of dyslipidemia. Belonging to other socio-educationally disadvantaged communities or being ovovegetarian was protective. Alcohol use, diet, and obesity showed significant interactions. CONCLUSION:In India, nearly two-fifths of the adolescents have dyslipidemia, posing a substantial future cardiovascular disease burden and premature mortality. These findings emphasize the need for school-based early screening and lifestyle interventions.

India's Supplementary Nutrition Programme (SNP), under the Integrated Child Development Services, provides a Morning Snack and a Hot Cooked Meal to children aged 36-72 months through Anganwadis (day-care centres). This study assessed these meals against SNP standards (2012) and age-specific ICMR recommendations, when standards were unavailable, and explored the use of linear programming (LP) to improve nutrient quality of SNP meals. A cross-sectional survey documented the SNP-meals, ingredients, serving portions and other details, using questionnaires administered to Anganwadi workers and programme officials from purposively selected Anganwadis across 27 States and Union Territories. Nutrient composition was estimated using standard food composition tables, and State-specific food lists and retail prices were incorporated into the LP framework to identify foods that could improve nutrient content of SNP meals. Energy standards were met in 56% of States, while 22% fell more than 20% below recommendations. Protein standards were achieved in 74% of States; however, declined to 52% after adjusting for digestibility. Only 22% of States met the ICMR-based fat requirement. Zinc, iron and folate were largely met, whereas calcium and vitamins A, B6 and B12 were below recommendations in more than half the States. Meals were predominantly cereal-based with limited inclusion of nutrient-dense foods. LP identified foods that reduced nutrient gaps, although many improvements exceeded the per-child cost allocation. Overall, meals showed wide variability, with persistent gaps in fat and key micronutrients. LP provides a structured approach to enhance nutrient provision within the programme setting, although meeting all nutrient targets may require adjustments to cost and procurement strategies.

Background and objectives While some studies suggest that lower birth weight is associated with poorer adult lung function, findings regarding early childhood, adolescent, and adult growth variables remain inconsistent. We conducted this study to determine whether low lung function in Indians is related to lower birthweight and early growth. Methods The New Delhi Birth Cohort (NDBC) was used as the study population to examine patterns and periods of growth in infancy, childhood, and adolescence using a conditional growth model. Lung function data were collected using spirometry and the forced oscillation technique at approximately 50 yr of age. We further examined associations of conditional size measures with adult lung function outcomes using multiple linear regression models. Results Lung function was positively associated with weight till 5 yr of age. Further, an increase of 1 standard deviation (SD) in conditional weight between 5-10 yr resulted in a decrease in forced vital capacity (FVC) of 50 mL [95% confidence interval (CI) -0.10 to 0.00 ( P = 0.08)]. Between 10-50 yr of age, a negative association was observed between weight and lung function. Positive associations of some of the measures of lung function were observed with length at birth, 2 yr, adolescent height, and final adult height. An increase of 1 SD in conditional height between birth and two years resulted in an increase in forced expiratory volume in 1 second (FEV1) of 130 mL (95% CI, 0.09 to 0.17). Interpretation and conclusion Birth weight and birth length, and greater than predicted linear growth throughout childhood, are independently associated with better adult lung function, in terms of spirometry and oscillometry. It is plausible that greater than predicted weight gain after 5 yr of age or during adolescence, or adulthood has an inverse association with lung function.

BackgroundSurveys based on capillary blood show that anaemia is rampant in India, but capillary blood haemoglobin (Hb) may not accurately reflect venous blood Hb concentrations. Further, iron deficiency (ID) is thought to be the main cause of anaemia, there are no venous blood-based surveys to confirm this.MethodsA community-based (urban, slum and rural) cross-sectional, venous blood survey was conducted in eight Indian states to estimate anaemia and ID prevalences from Hb and inflammation-corrected plasma ferritin concentrations in adolescents, adults, and elderly.ResultsThe prevalence of anaemia was 44%, 41% and 45% in adolescent girls, adult and elderly women respectively, compared to 24%, 21% and 37% in adolescent boys, adult, and elderly men. The overall prevalence varied widely, ranging from 12% in Meghalaya to 70% in Assam. Mild anaemia prevalence was predominant at about half of overall anaemia prevalence. ID-associated anaemia (IDA) prevalence was less than a third of the overall anaemia prevalence, and varied among age and sex groups, approaching 45% only in adolescent girls. IDA prevalence was even lower in the mild anaemia group. Thus, the major proportion of anaemia in all groups was associated with 'other' causes.ConclusionsAnaemia prevalence, when measured by venous blood Hb, was substantially lower than earlier capillary blood-based estimates and was predominantly of the mild variety. The prevalence of IDA was also much lower than anticipated; therefore, the aetiological role of ID appears not to be predominant. These results have policy implications for anaemia prevention and correction at the population level.

BACKGROUND:In low- and middle-income countries, legumes are commonly used as a high-quality protein source in complementary foods. However, the digestibility of legume protein in infants might be low because of the immaturity of the digestive system at that age. OBJECTIVES:The aim of this study was to measure the true indispensable amino acid (IAA) digestibility of mung bean protein in infants aged 10-12 mo. METHODS:This was a cross-sectional study in which the IAA digestibility of intrinsically 2H-labeled mung bean protein was measured against U-[13C]-spirulina protein as a reference in 6 apparently healthy infants using the dual stable isotope technique. The IAA digestibility of the reference protein, U-[13C]-spirulina, was also measured in an additional 3 infants against a 2H-free amino acid mixture. RESULTS:The mean true IAA digestibility of mung bean protein and that of spirulina protein was 83.6% ± 23.0% and 103.5% ± 33.0%, respectively. These values in infants were higher than those determined earlier in adults (83.6% compared with 63.2% and 103.5% compared with 85.2% for mung bean and spirulina protein, respectively). In mung bean, digestibility ranged from 59.4% ± 11.6% (valine) to 126.5% ± 20.8% (isoleucine) and in spirulina from 46.9% ± 3.3% (valine) to 148.0% ± 17.7% (isoleucine). The digestible indispensable amino acid score (DIAAS) for mung bean protein at this age was 50%. CONCLUSIONS:Infants have a high mean IAA digestibility for mung bean protein, although the generalizability of this finding needs to be confirmed. The estimated DIAAS remains low at 50%. In plant-based complementary foods, a ratio of 1:2 of a legume-cereal mix is required to meet protein requirement in infants at this age. This trial was registered at the Clinical Trials Registry of India as CTRI/2020/09/027639.

IntroductionPollution (PM2.5) exposure can result in acute respiratory illness (ARI) and anaemia in children. We aimed to investigate if antioxidant nutrient intakes could mitigate the impact of PM2.5 on child health outcomes on a national scale in India.MethodsWe triangulated satellite-derived PM2.5 exposure data at the primary sampling unit level, with ARI and anaemia prevalence data from national district-level survey, and antioxidant nutrient intakes from household food expenditure survey. Logistic mixed effects regression model was used to estimate the effect of PM2.5 at different levels of nutrient intake.ResultsThis study included 208,782 children with valid ARI and 197,289 children with valid hemoglobin measurements. The prevalence of ARI and anaemia were 2.8% (95% CI: 2.3, 3.2) and 57.6% (95% CI: 57.2, 57.9) respectively. The intake of selected antioxidant nutrients such as vitamin C, D, and selenium, when higher than their estimated average requirement (EAR), lowered the risk of ARI associated with high PM2.5 exposure, while intakes higher than the EAR of vitamins A, C, D, zinc, and selenium similarly lowered the risk of anaemia. In terms of foods, similar benefits were observed with daily consumption of small amounts of fruits and vegetables.ConclusionThe result of this study highlights the importance of antioxidant rich balance diet for neutralizing adverse health effects of air pollution exposure to some extent till the environmental policy of the country could reduce emission of hazardous pollutants below safe level for human health.

ABSTRACT:The World Health Organization has recently lowered the hemoglobin (Hb) diagnostic cutoff for anemia in 6-23-month-old children by 0.5 g/dL and specifies the use of venous blood. The national prevalence of anemia defined from venous blood in children 6-23 months reduced by ~10% points when using the new Hb cutoff.

Diagnosis of vitamin B12 (B12) deficiency is hampered by the low specificity cut-offs of blood-based biomarkers, like serum B12 and holo-transcobalamin (HoloTc), or B12-associated metabolites like methylmalonic acid (MMA) and homocysteine (Hcy) concentrations, or their combinations computed as combined B12 (cB12). We assessed B12 deficiency through non-invasive [13C]-propionate oxidation breath test to derive functional cut-off and tested its sensitivity in response to acute change in B12 status in low B12 adult male participants by parenterally administering 3 mg hydroxocobalamin and profiling through untargeted and targeted B12 related metabolites. The functional deficiency cut-off, based on a breakpoint analysis of [13C]-propionate oxidation with B12 concentrations, was 144 pmol/L [95% CI 106.4-182.4, p = 0.02] for B12 deficiency. Untargeted metabolomic analyses revealed potential functional B12 metabolites that are known to be associated with mitochondrial function, oxidative stress, lipids, bile acids and 1-carbon metabolism. Parenteral B12 treatment increased [13C]-propionate oxidation (14.9%, range 1.1 to 66.9) significantly and was also associated with significant alterations (p < 0.05) in B12, HoloTc, MMA, Hcy concentrations, cB12, and associated functional metabolites like propionylcarnitine (C3), its ratio to acetylcarnitine (C3/C2) and palmitoylcarnitine (C3/C16). This study explores the clinical utility of propionate breath test to define functional B12 deficiency and associated metabolites through omics-based approach.This study was registered in Clinical Trials Registry of India (CTRI) with the registration number CTRI/2018/04/012957 (registered on 03/04/2018), available from https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MjQwNDc=&Enc=&userName .

BACKGROUND:Vitamin B12 deficiency is a prevalent health concern that can lead to hematological and neurological disorders. Despite adequate intake, vitamin B12 deficiency/insufficiency can arise due to interindividual differences in absorption and metabolism influenced by genetic factors, gastrointestinal health, and medications. Although previous studies have explored the genetic basis of circulating vitamin B12 concentration, they have not been validated using precise, stable, isotope-based measurements of vitamin B12 bioavailability. OBJECTIVES:To measure the plasma bioavailability of an oral dose of [13C]-labeled vitamin B12 (cyanocobalamin) using 2-compartment pharmacokinetic modeling and examine its associations with genetic variants in key genes involved in vitamin B12-related pathways. METHODS:In a cohort of 104 young healthy Indian adults, functional vitamin B12 markers including total vitamin B12 and holotranscobalamin were measured using chemiluminescence immunoassays. Bioavailability was estimated by nonlinear mixed effects modeling of plasma vitamin B12 time-concentration profiles using a modified 2-compartment model. Genetic associations were analyzed, and polygenic risk scores (PRSs) were computed. RESULTS:The mean measured vitamin B12 bioavailability was 52% ± 16%, demonstrating significant 4.4-fold variability. A total of 85 single nucleotide polymorphism (SNPs) in/near 14 genes were significantly associated with vitamin B12 bioavailability, including 5 previously reported SNPs associated with vitamin B12-related traits and 80 novel variants from known vitamin B12 pathway genes. Bioavailability-PRS explained 72% (95% CI: 60%, 81%) of the variance in vitamin B12 bioavailability in the same cohort and 55% in a 3-fold cross-validation test. At the first quartile threshold, the PRS identified individuals requiring supplementation with a positive predictive value of 0.32. CONCLUSIONS:These findings provide insights into the genetic determinants of vitamin B12 absorption and homeostasis, emphasizing the potential of using genetic markers to personalize nutritional strategies. This is critical for identifying subgroups susceptible to vitamin B12 deficiency despite adequate intake, highlighting the need for precision nutrition led by functional measurements in specific populations. This trial was registered in Clinical Trials Registry of India (CTRI) as CTRI/2020/11/029108.

OBJECTIVE:To examine fetal growth patterns in preeclampsia (PE) and compare them with a control, low-risk Indian population. STUDY DESIGN:Prospective longitudinal observational study. MAIN OUTCOME MEASURES:Fetal biometry measurements were undertaken at various time points across pregnancy. Ultrasound scans measured, crown-rump length (CRL) at 11-14 weeks and biparietal diameter (BPD), femur length (FL), head and abdominal circumference (HC and AC), and estimated fetal weight (FWT) during the mid (18-22 weeks) and late (32-35 weeks) gestation. Z-scores with 95 % CIs were calculated using the low-risk group as a reference. Fetal growth centile curves were developed using GAMLSS and evaluated against low-risk group centiles. RESULTS:The study included 106 low-risk population and 92 PE women. 'Low-risk' pregnancies defined using Intergrowth-21st criteria. At 11-14 weeks, CRL Z-scores were similar between low-risk and PE groups. At 18-22 weeks, PE fetuses had lower Z-scores for BPD [-0.36 SD (95 % CI: (-0.61, -0.11)], AC [-0.41 SD (95 % CI: (-0.66, -0.19)], HC [-0.62 SD (95 % CI: -0.90, -0.35)], FL [-0.49 SD (95 % CI: -0.74, -0.25)], and FWT [-0.54 SD (95 % CI: -0.78, -0.32)] compared to low-risk group. At 32-35 weeks, differences in mean Z-scores were no longer statistically significant, but PE fetuses consistently showed lower centile values throughout gestation. CONCLUSION:Fetuses in PE group exhibited lower biometric Z-scores for BPD, AC, HC, and FL at 18-22 weeks, indicating early growth restriction. PE fetuses remained at lower percentiles even at 32-35 weeks suggesting a sustained impact on fetal growth pattern.

OBJECTIVE:To generate longitudinal fetal growth data in an Indian population and compare it with Intergrowth-21st. MATERIAL AND METHODS:Fetal biometry data was collected in a prospective longitudinal observational study (REVAMP: Research Exploring Various Aspects and Mechanisms in Preeclampsia) from 2017 to 2022. Fetal crown-rump length (CRL) was measured at 11-14 weeks gestation, and biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) at 18-22 and 32-35 weeks, and converted into Z-scores using the Intergrowth standard. Generalized Additive Models for Location, Scale and Shape (GAMLSS) models were used to construct fetal growth centile curves compared against Intergrowth centiles. RESULTS:Out of 1096 singleton pregnancies in REVAMP, this analysis included 655 'healthy' pregnancies (uncomplicated by pre-eclampsia, diabetes, pre-term delivery or low birth weight) and a sub-set of 106 'low-risk' pregnancies defined using Intergrowth criteria. The 'healthy' study subjects showed lower mean CRL Z-score [-0.45 SD (95% CI:-0.54,-0.37)] at 11-14 weeks, and BPD Z-score [-1.2 SD (-1.28,-1.11) and -1.17 SD (-1.23,-1.1)] at 18-22 and 32-35 weeks respectively. Mean HC Z-score was comparable to the Intergrowth standard at 18-22 weeks [-0.08 SD (-0.16, 0.02)] but smaller at 32-35 weeks [-0.25 SD (-0.32,-0.19)]. Mean AC Z-score was lower at 18-22 weeks [-0.32 SD (-0.41,-0.23)] but comparable at 32-35 weeks [0.004 SD (-0.07, 0.07)]. FL was comparable to or larger than the Intergrowth standard at both time points [0.05 SD (-0.05, 0.14); 0.82 SD (0.75, 0.89), respectively]. These findings were similar, though measurements were slightly larger, in the 'low-risk' sample. CONCLUSIONS:This data from healthy and low-risk pregnant women in urban western India indicates that some fetal dimensions and growth trajectories differ significantly from the Intergrowth-21st. Our data suggest the need for a larger representative study to define a population-specific fetal growth reference for India, for identification of fetal growth restriction.

The World Health Organization has recently updated the guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years. Apart from differences with regard to the nutritional framework that defines fi nes the quantity of energy required as Ready-to-Use Therapeutic Food (RUTF) for the outpatient treatment of severe wasting and/or nutritional oedema, there are also important gaps in the practical guidance. Instead of the recommended energy intake of 150-185 - 185 kcal/kg/day, our alternative calculations indicate the requirement to be only 105-120 - 120 kcal/kg/day. If true, the implementation of such caloric overfeeding can have adverse consequences. Gaps in practical guidance also need to be addressed, including the timing of transition to home-based diets, maximal duration of therapeutic feeding, especially in non-responders (similar to 50% similar to 50% in South Asia), and the role of augmented home foods as the primary therapeutic food option. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

BackgroundLow birth weight (LBW) is a public health problem in India with consequences in the short and long term. It increases the risk of obesity and its related comorbidities including type 2 diabetes and cardiovascular disease (CVD) in later life. This study aimed to assess the risk markers of chronic disease in term born low birthweight Indian children aged 8–14 years.MethodsThis was a cross-sectional follow-up of LBW children from DIViDS (Delhi Infant Vitamin D Supplementation) cohort and involved assessment of their anthropometric measurements, body composition, levels of adipokines and biomarkers of chronic diseases. Neighbourhood children born normal birth weight (NBW) (>2.5 kg) were enrolled for comparison.ResultsThe study included 667 LBW and 87 NBW children. Height-for-age, body mass index for-age (BMIZ), fat-free mass index, and waist circumference of LBW children were lower than those of NBW children. LBW children could jump farther. LBW children who were now overweight had higher leptin, triglyceride and VLDL and lower HDL, compared to NBW children in the same BMIZ category. Currently underweight LBW children had higher adiponectin and lower leptin levels than the reference group. There were no differences between LBW and NBW children in visfatin, fasting glucose and insulin, hemoglobin A1c, triglyceride, low density lipoprotein or C-reactive protein.ConclusionAt 8–14 years few children were overweight and there were few differences in some risk markers of chronic disease between LBW and NBW children. Overweight, which was associated with some increased risk markers, may increase with age, thus timely counselling and monitoring of these LBW children will be important to mitigate these risks.

Introduction Prevalence of undernutrition continues to be high in India and low household wealth is consistently associated with undernutrition. This association could be modified through improved dietary intake, including dairy consumption in young children. The beneficial effect of dairy on child growth has not been explored at a national level in India. The present analyses aimed to evaluate the direct and indirect (modifying association of household level per adult female equivalent milk and milk product consumption) associations between household wealth index on height for age (HAZ) and weight for age (WAZ) in 6-59 months old Indian children using data from of nationally representative surveys. Methods Two triangulated datasets of two rounds of National Family Health Survey, (NFHS-3 and 4) and food expenditure (National Sample Survey, NSS61 and 68) surveys, were produced by statistical matching of households using Non-Iterative Bayesian Approach to Statistical Matching technique. A Directed Acyclic Graph was constructed to map the pathways in the relationship of household wealth with HAZ and WAZ based on literature. The direct association of wealth index and its indirect association through per adult female equivalent dairy consumption on HAZ and WAZ were estimated using separate path models for each round of the surveys. Results Wealth index was directly associated with HAZ and WAZ in both the rounds, but the association decreased from NFHS-3 (β HAZ : 0.145; 95% CI: 0.129, 0.16) to NFHS-4 (β HAZ : 0.102; 95%CI: 0.093, 0.11). Adult female equivalent milk intake (increase of 10gm/day) was associated with higher HAZ (β_NFHS-3=0.001;95% CI: 0, 0.002; β_NFHS-4=0.002;95% CI: 0.002, 0.003) but had no association with WAZ. The indirect association of wealth with HAZ through dairy consumption was 2-fold higher in NFHS-4 compared to NFHS-3. Conclusions The analysis of triangulated survey data shows that household level per- adult female equivalent dairy consumption positively modified the association between wealth index and HAZ, suggesting that regular inclusion of milk and milk products in the diets of children from households across all wealth quintiles could improve linear growth in this population.

BACKGROUND:Promoting and supporting breastfeeding is an important public health intervention with multiple benefits for both infants and mothers. Even modest increases in the prevalence and duration of breastfeeding could significantly reduce healthcare costs and improve maternal and child health outcomes. However, widespread adoption of breastfeeding recommendations remains poor in most settings, which contributes to widening health and social inequalities. Pediatricians have a duty to advocate for improving child health, including promoting and supporting breastfeeding. SUMMARY:This paper, from the International Pediatric Association Special Advisory Group on Nutrition, considers common barriers to breastfeeding and addresses how pediatricians can better promote and support breastfeeding, both at an individual level and by influencing practice and policy. All pediatricians need to understand the basics of breastfeeding, including lactation physiology, recognize common breastfeeding problems, and advise mothers or refer them for appropriate support; training curricula for general pediatricians and all pediatric subspecialties should reflect this. Even in the situation where their day-to-day work does not involve direct contact with mothers and infants, pediatricians can have an important influence on policy and practice. They should support colleagues who work directly with mothers and infants, ensuring that systems and environments are conducive to breastfeeding and, where appropriate, milk expression. Pediatricians and pediatric organizations should also promote policies aimed at promoting and supporting breastfeeding at local, regional, national, and international levels. KEY MESSAGES:Pediatricians have a duty to promote and support breastfeeding, regardless of their day-to-day role and responsibilities. Pediatric training curricula should ensure that all trainees acquire a good understanding of breastfeeding so they are able to effectively support mothers in their personal practice but also influence breastfeeding practice and policy at a local, regional, national, and international level.

Study ObjectivesRapid growth in childhood predisposes to obesity and cardiometabolic diseases in adulthood. While obstructive sleep apnea (OSA) is bidirectionally linked to obesity, its developmental origins are sparsely studied. We examined associations between postnatal growth and the risk of OSA in adulthood.MethodsWe included adults whose childhood anthropometric data was collected in the New Delhi Birth Cohort study. The risk of OSA was defined by the Berlin Questionnaire (BQ) with and without the obesity criterion. Using logistic regression, we studied associations of OSA risk with conditional growth parameters, which are statistically independent measures of gain in height, weight, and body mass index (BMI), during infancy (0-2 years), early childhood (2-5 years), and late childhood (5-11 years).ResultsAmong 521 subjects (58.9% males) with a mean (SD) age of 40.9 (1.7) years, 30.9% had a high risk of OSA. On multivariate analysis, a high risk of OSA was associated with a higher conditional BMI in infancy (odds ratio: 1.25; 95% confidence interval: 1.00-1.57; p = 0.048) and early childhood (1.35; 1.07-1.69; p = 0.011). Higher risk of OSA was associated with greater conditional weight in early childhood (1.34; 1.06-1.68; p = 0.013). Using the modified BQ definition without obesity, adult risk of OSA was significantly associated with a higher adult BMI instead of childhood conditional BMIs.ConclusionsGreater gain in conditional BMI or weight in early childhood is associated with a high risk of OSA in middle age, which is mediated by a higher attained adult BMI.