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

Sanjay Kinra*, K. V. Rameshwar Sarma, Ghafoorunissa, Vishnu Vardhana Rao Mendu, Radhakrishnan Ravikumar, Viswanthan Mohan, Ian B. Wilkinson, John R. Cockcroft, George Davey Smith, Yoav Ben-Shlomo

*Corresponding author for this work

Research output: Contribution to journalArticle

75 Citations (Scopus)

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 simitar 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 cardiovasculardisease 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 rote in reducing the burden of cardiovascular disease in tow income and middle income countries.

Original languageEnglish
Pages (from-to)445-449
Number of pages5
JournalBMJ
Volume337
Issue number7667
DOIs
Publication statusPublished - 23 Aug 2008
Externally publishedYes

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