BackgroundNational survey data show that age- and sex-standardized weight and length measurements decline early in Indian children. In population-level longitudinal data, early detection of growth trajectories is important for the implementation of interventions. We aimed to identify and characterize distinct growth trajectories of Indian children from birth to 12 months of age residing in urban and rural areas.MethodsPooled data from four interventional and non-interventional longitudinal studies across India were used for the analysis. Latent class mixed modeling (LCMM) was employed to identify groups of children with similar trajectories over age. The trajectories named Classes of Children were created for length-for-age Z scores (LAZ) and weight-for-age Z scores (WAZ) based on place of birth, residential area, and maternal education.ResultsWe identified two latent classes for LAZ in boys and three latent classes for LAZ in girls, and four classes for WAZ were identified in both boys and girls. The first class for LAZ, with the highest proportion of children (>80% of children), did not decline or increase with age; In boys, Class 1 was close to the WHO median, whereas in girls, Class 1 was lower than the WHO median from birth. The LAZ classes of remaining boys and girls declined with age (slope, μdg= − 1.04; 95% CI: −1.09, −0.99 for boys and μdg= − 0.69; 95% CI: −0.76, −0.63 for girls). The first trajectory of WAZ (approximately 50% of children) for boys (μdg=0.13; 95% CI: 0.11, 0.16) and the second trajectory of WAZ for girls (μdg=0.24; 95% CI: 0.18, 0.30) increased with age, while the remaining trajectories of WAZ declined with age.ConclusionThere is heterogeneity in the growth of Indian children in the first year of life, which was identified by distinct types of growth trajectories. The predominant trajectories of both LAZ and WAZ did not decline with age, while most other trajectories demonstrated an initial decline.

Two initiatives are reshaping how we can approach and address the persistent and widely prevalent challenge of malnutrition, the leading global risk factor for morbidity and mortality. First is the focus on precision nutrition to identify inter- and intra-individual variation in our responses to diet, and its determinants. Second is the Food is Medicine (FIM) approach, an umbrella term for programs and services that link nutrition and health through the provision of food (e.g., tailored meals, produce prescriptions) and access to healthcare services. This article outlines how interventions and programs using FIM can synergize with precision nutrition approaches to make individual- or population-level tailored nutrition accessible and affordable, help to reduce the risk of metabolic diseases, and improve quality of life.

Nutritional epidemiology aims to link dietary exposures to chronic disease, but the instruments for evaluating dietary intake are inaccurate. One way to identify unreliable data and the sources of errors is to compare estimated intakes with the total energy expenditure (TEE). In this study, we used the International Atomic Energy Agency Doubly Labeled Water Database to derive a predictive equation for TEE using 6,497 measures of TEE in individuals aged 4 to 96years. The resultant regression equation predicts expected TEE from easily acquired variables, such as body weight, age and sex, with 95% predictive limits that can be used to screen for misreporting by participants in dietary studies. We applied the equation to two large datasets (National Diet and Nutrition Survey and National Health and Nutrition Examination Survey) and found that the level of misreporting was >50%. The macronutrient composition from dietary reports in these studies was systematically biased as the level of misreporting increased, leading to potentially spurious associations between diet components and body mass index.

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.

Obesity is caused by a prolonged positive energy balance 1 , 2 . Whether reduced energy expenditure stemming from reduced activity levels contributes is debated 3 , 4 . Here we show that in both sexes, total energy expenditure (TEE) adjusted for body composition and age declined since the late 1980s, while adjusted activity energy expenditure increased over time. We use the International Atomic Energy Agency Doubly Labelled Water database on energy expenditure of adults in the United States and Europe ( n = 4,799) to explore patterns in total (TEE: n = 4,799), basal (BEE: n = 1,432) and physical activity energy expenditure ( n = 1,432) over time. In males, adjusted BEE decreased significantly, but in females this did not reach significance. A larger dataset of basal metabolic rate (equivalent to BEE) measurements of 9,912 adults across 163 studies spanning 100 years replicates the decline in BEE in both sexes. We conclude that increasing obesity in the United States/Europe has probably not been fuelled by reduced physical activity leading to lowered TEE. We identify here a decline in adjusted BEE as a previously unrecognized factor.

Background: National survey data show that growth faltering starts early in Indian children, and the early detection of growth trajectories is important for the prevention of later growth faltering. We aimed to identify and characterize distinct growth trajectories in the first year, in urban and rural Indian children. Methods: Pooled data from 5 interventional and non-interventional longitudinal studies across India were used for the analysis. Latent class mixed modeling (LCMM) was used to identify the groups of children with similar trajectories over age. Classes of children were created for length-for-age (LAZ) and weight-for-age (WAZ), based on place of birth, residential area, and maternal education. Results: We identified 2 and 3 latent trajectories for LAZ in boys and girls respectively, and 4 trajectories for WAZ in both boys and girls. The first trajectory for LAZ with the highest proportion of children (>80% of children), did not decline or increase with age; the boys trajectory was close to the WHO median while the girls trajectory was lower than the WHO median from birth. The LAZ trajectories of remaining boys and girls declined with age (slope, μdg=-1.04; 95% CI: -1.09, -0.99 for boys and μdg=-0.69; 95% CI: -0.76,-0.63 for girls). The first trajectory for WAZ (~50% of children) increased with age for boys (μdg=0.13; 95% CI: 0.11, 0.16) and girls (μdg=-0.64 (-1.14, -0.13), while in the remaining trajectories, WAZ declined with age. Conclusion: Distinct growth trajectories are present in Indian children in the first year. Identification of a faltering trajectory and associated modifiable factors can help with early preventive or corrective interventions.

There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decrease in the degree of GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

Nuclear techniques, including stable isotope techniques, provide great potential for understanding nutrition and human health with better accuracy and precision compared with other routine techniques. The International Atomic Energy Agency (IAEA) has been at the forefront for more than 25 y to offer guidance and support on the use of nuclear techniques. This article demonstrates how the IAEA has enabled its Member States to contribute to good health and well-being in their countries and to assess progress toward achieving global nutrition and health targets to combat malnutrition in all its forms. Support is provided in several ways including research, capacity building, education, and training as well as the provision of guidance materials. The nuclear techniques help to objectively measure nutritional and health-related outcomes such as body composition, energy expenditure, nutrient uptake, and body stores and assess breastfeeding practices as well as environmental interactions. These techniques are continuously improved to make nutritional assessments more affordable and less invasive with wide use in field settings. New research areas are emerging to assess diet quality with changing food systems and to explore stable isotope-assisted metabolomics to address key questions on nutrient metabolism. Through a deeper understanding of mechanisms, nuclear techniques can contribute to eradicating malnutrition worldwide.

Background: There exist several barriers to physical activity (PA) among adolescent girls. We therefore developed a culturally acceptable dance/fitness intervention called THANDAV (Taking High-Intensity Interval Training [HIIT] ANd Dance to Adolescents for Victory over noncommunicable diseases [NCDs]). The main aim of this study was to evaluate the THANDAV protocol among Asian Indian girls aged 10 to 17 years. Materials and Methods: THANDAV consisted of a 10-min routine with high- and low-intensity dance steps that was taught to 23 adolescent girls. Heart rate (HR), energy expenditure, body mass index (BMI), and blood pressure (BP) were recorded. Focused group discussions (FGDs) were conducted after the quantitative measurements were completed. Results: The average age of the girls was 13.9 +/- 2.1 years, and the mean BMI and BP were 19.8 +/- 3.3 kg/m(2) and 107/68 (+/- 8/7) mm/Hg, respectively. All participants achieved 80% of their maximum HR during the first dance and managed to sustain this HR throughout the 10-min routine. There was a significant increase in the HR (bpm) [88.7 +/- 8.4 to 195.6 +/- 11.8, P < 0.001] and VO2 (L/min) [0.025 +/- 0.0 to 0.395 +/- 0.1, P < 0.001] postintervention. The average energy cost of the activity (metabolic equivalent) was 6.3. The FGDs revealed that THANDAV was a socially acceptable, fun, and energetic form of PA. Conclusions: The THANDAV intervention meets HIIT norms and is a novel culturally appropriate form of PA that is enjoyable, takes little time, and can be done at home. It has the potential to be a sustainable intervention to improve cardiorespiratory fitness and prevent NCDs in Asian Indian adolescent girls. Clinical Trials Registry of India: CTRI/2020/02/023384.

Indian adults tend to inappropriately accumulate body fat even at low Body Mass Index (BMI). Usually, fat that is stored in the fed state is mobilized for energy during nocturnal fasting, thus achieving daily fat balance. This is called metabolic flexibility, which may be lost in some individuals leading to body fat accumulation. Measuring fat balance requires 24h measurement of fat oxidation, but nocturnal fat oxidation could be a reasonable surrogate. The variability of nocturnal fat oxidation is also unknown. A retrospective analysis on 24h fat oxidation in adult men (n=18) was carried out to test the former hypothesis, while the variability of nocturnal fat oxidation was measured prospectively in 5 adult men, who were fed the same diet for 2 days prior to the measurement. Whole-body indirect calorimetry was used for measuring Respiratory Quotient (RQ), energy expenditure and fat oxidation. In 24h analyses, nocturnal (0.44 ± 0.21 g/kg) was significantly higher than diurnal fat oxidation (0.24 ± 0.21 g/kg) and was 64.5% of the total 24h value. Nocturnal fat oxidation was positively correlated with 24h fat oxidation (r = 0.937; p<0.01) and inversely correlated with 24h fat balance (r = -0.850; p<0.01). Metabolic flexibility, measured as the Fed: Fasted RQ ratio, was negatively correlated with BMI (r = -0.226; p=0.366). The intra- and inter-individual variability of 12h nocturnal fat oxidation was low, at 4.7% and 7.2%, respectively. Nocturnal fat oxidation has a low variability when prior diets over 2 days are constant and the Fed: Fasted RQ ratio is an index of metabolic flexibility, which relates to BMI in young adults.

Background/Objectives Young Indian adults are at greater risk of overweight/obesity due to their high energy intake and sedentary lifestyle. Their energy requirement (ER) is based on their total energy expenditure (TEE) estimated from factorial method, which possibly overestimates their basal metabolic rate (BMR) and physical activity level (PAL). This study aimed to compare the accurately measured TEE with ER in young adults. Secondarily, to compare measured with predicted BMR and guideline PAL with that obtained from questionnaire and step counts. Subjects/Methods TEE was measured in 19 male adults (18–30 years), using the doubly labeled water technique, over 14 days. Indirect calorimetry was used to measure BMR, while the PAL was estimated by (a) the ratio of measured TEE and BMR, (b) step counts over 7 days measured using tri-axial accelerometers and (c) a physical activity questionnaire (PAQ). Results The measured TEE (9.11 ± 1.30 MJ/d) was significantly lower than the ER using either the Indian (15.2%) or the FAO/WHO/UNU (11.9%, both p < 0.01) recommendations. The measured BMR (6.90 ± 0.65 MJ/d) was significantly lower than that predicted using the FAO/WHO/UNU equation (6.5%, p < 0.01) but not for the Indian equation. The estimated PAL from measured TEE and BMR (1.35 ± 0.18), and from accelerometers (1.33 ± 0.11) was significantly lower than PAL obtained from PAQ (1.53 ± 0.17) or the guideline of 1.53 for Indians. Conclusions The predicted BMR and PAL guideline value was higher than that measured in young Indian adults, resulting in a ~13% lower measured TEE. This emphasizes the need to revisit the guidelines for predicting ER for this population.

This study aimed to define the estimated average requirement and the recommended dietary allowance of iron for Indian children and adolescents. The Estimated average requirement was derived for children aged 1–17y, from the mean bioavailability-adjusted daily physiological iron requirement, which in turn was estimated using a factorial method. This consisted of mean daily iron losses from the body and additional iron required for tissue growth and storage, while also defining the variance of each factor to derive the Recommended dietary allowance. The estimated average requirement of iron for children ranged from 5.6 to 11.0 mg/d in children aged 1–9y. For adolescents aged 10–17y, these ranged from 10.8 to 18.4 mg/d and 15.4 to 18.5 mg/d for adolescent boys and girls, respectively. New estimates of estimated average requirement for iron in Indian children are presented, and same may be used to inform iron supplementation and food fortification policies.

Anemia in Indian women continues to be highly prevalent, and is thought to be due to low dietary iron content. The high risk of dietary iron deficiency is based on the Indian Council of Medical Research recommendation of 21 mg/d, but there is a need for a secure and transparent determination of the Estimated Average Requirement (EAR) of iron in this population. In nonpregnant, nonlactating women of reproductive age (WRA), the EAR of iron was determined to be 15 mg/d. Applying this value to daily iron intakes among WRA in nationally representative Indian state-based data showed that the median risk of dietary iron deficiency was lower than previously thought (65%; IQR: 48-78%), with considerable heterogeneity between states (range: 25-93%). However, in a validation, this risk matched the risk of iron deficiency as defined by blood biomarkers in a recently completed survey. When the risk of dietary iron deficiency was modelled for an increase in iron intake through food fortification of a single dietary staple, that provided 10 mg/d, the median risk reduced substantially (from 65% to 20%), and it virtually disappeared when supplementary iron intakes through the national iron supplementation program were considered. The risk of exceeding the tolerable upper level (TUL) of intake of iron remains low in the population when receiving fortification of 10 mg/d, but is much higher if they consume greater amounts of iron through supplements (range: 0-54%). This newly and transparently defined Indian EAR of iron should be used to evaluate, with precision, the benefits and risks of iron fortification and supplementation policies.

The daily energy requirements are now based on replacing the measured daily energy expenditure (WHO/FAO/UNU 1985). When energy expenditure is equal to energy intake, energy balance is achieved, and is best indicated by weight stability. The specific energy requirement (expenditure) of a population is calculated using a factorial method that is based on the product of estimates of the basal metabolic rate (BMR), and the physical activity level (PAL). Some calculations also consider additional energy expenditure due to the thermic effect of food (TEF) which is typically about 10% of BMR. During pregnancy and in childhood, energy cost of deposition of tissues and optimal growth and during, lactation, energy cost of milk secretion is added. However, the factorial method is potentially problematic, as errors in any one factor propagate through to the final estimate of the requirement. For example, BMR is predicted from age and gender specific equations provided by the FAO/WHO/UNU, but these equations overestimate BMR of adult Indians by 5 to 12%. The PAL used for sedentary activities may also be wrong. In the latest recommendation of the Indian Council of Medical Research, the PAL is taken to be 1.53 for sedentary adults; this may need to be revised to a lower value as studies indicate that PAL of sedentary adult Indians is generally lower. In this context, the current energy recommendation may be overestimated in Indians, and should be reconsidered in the context of the dual burden of nutritional disease.

BACKGROUND AND OBJECTIVES Some cereals, consumed at breakfast, have shown lower glycemic responses. Limited data exist in the Indian context, where the effect could be modified due to genetic or racial differences. This study aimed to investigate the effect of cereal and milk, with or without fruits/nuts, on the glycemic response in healthy Indian men. METHODS AND STUDY DESIGN A randomized cross-over study was carried out on 16 men (18 - 45 years), with 3 interventions providing equal amounts of glycemic carbohydrate: a glucose drink (Reference), cereal and milk (CM), and cereal, milk, fruits and nuts (CMO), on separate days. Plasma glucose, serum insulin, C-peptide, ghrelin, energy expenditure (EE), substrate oxidation and appetite/satiety were measured repeatedly over 3 hours post meal. RESULTS A significant time effect and time x meal interaction between the meals, higher for the Reference meal, was observed for plasma glucose (p<0.001), insulin (p<0.001), C-peptide (p<0.001), and carbohydrate oxidation (p<0.001); while lower for satiety (p<0.001). The plasma glucose concentrations of CM and CMO meals returned to baseline 60 min postprandially, then remained there, unlike the Reference meal, where the plasma glucose values returned to baseline at 120 min and dipped significantly below baseline at 150 and 180 min. A significant effect of time (p<0.001) was observed for EE between meals. Ghrelin levels did not differ significantly between the test meals. CONCLUSIONS Cereal with milk, along with fruits and nuts at breakfast, has a lower and stable glycemic response, along with increased satiety among healthy male subjects.