Nutrition education in the undergraduate medical curriculum at the Aga Khan University, Karachi, Pakistan.
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Curriculum↗
Biomedical subjects
S H Badruddin
Publications and source records attributed to S H Badruddin.
Urbanisation and activity pattern of south Asian children.
OBJECTIVE: To compare the physical activity level and total energy expenditure of 10-12 year old school children living at different levels of urbanization. METHOD: All the participating children kept a three-day record of their activities, for every fifteen-minutes, in specially designed diaries. Activities were grouped according to intensity that was determined on the basis of Physical Activity Ratio (PAR). After calculating the average time spent in a day, in activities of varying intensity, overall Physical Activity Level (PAL) of each subject was calculated by factorization method. After measuring bodyweight using a standard equation Basal Metabolic Rate (BMR) of the subjects was calculated. Total Energy Expenditure (TEE) was assessed on the basis of PAL and BMR of each child. SUBJECTS: Physical activity level of six groups of 10-12 year old children, representing various urbanization categories, was studied. Three groups of children were recruited from Punjab, Pakistan: rural, middle income urban and high income urban, and they were assigned urbanization rank (UR) 1, 2 and 3. Another three groups of children were recruited from Slough, UK: British Pakistani, British Indian, and British Caucasian and they were assigned urbanization rank 4, 5 and 6 respectively. RESULTS: Physical activity level decreased significantly with the urbanization rank only among girls of Pakistani origin (UR 1-4). Pattern of gender differences in activity level was different in rural and urban children. Rural girls were slightly more active than rural boys, whereas in urban areas boys were significantly more active than girls. Because of lower bodyweight the less urbanized children in spite of having higher PAL had a lower mean TEE as compared to the more urbanized groups. CONCLUSION: The activity level of rural children having access to formal education and television could not be expected to be very different from their urban counterparts. Inactivity of urban girls needs particular attention. Because of lower caloric requirements, on similar diets, less urbanized groups may succumb to overweight more easily than the urbanized groups. Participation in active games may present a substitute to decreased involvement in moderately active work and play activities.
Child↗
Urbanisation and coronary heart disease risk factors in South Asian children.
BACKGROUND: Coronary Heart Disease (CHD) and other Non Communicable Diseases (NCDs) are increasing globally. Comparison of various sections of the South Asian populations living at different levels of urbanization can help in understanding the role of demographic transition in the increased prevalence of these diseases in urbanized populations. OBJECTIVE: To compare the prevalence of certain CHD risk factors in 10-12 year old school children living at different levels of urbanization. METHOD: Differences in height, Body Mass Index (BMI), Waist Hip Ratio (WHR), Fasting Blood Glucose (FBG) and Total Blood Cholesterol (TBC) were studied. SUBJECTS: Anthropometric and biochemical measurements of six groups of 10-12 year old children, representing various urbanization categories, were studied. Three groups of children were recruited from Punjab, Pakistan: rural, middle income urban and high income urban and they were assigned urbanization rank (UR) 1, 2 and 3. Another three groups of children were recruited from Slough, UK: British Pakistani, British Indian, and British Caucasian and they were assigned urbanization rank 4, 5 and 6 respectively. RESULTS: Proportion of children having high CHD risk increased with urbanization rank. Increase in BMI and TBC with urbanization status was steadier than the increase in FBG and WHR. Stunting which have been found to have a positive association with obesity and increased risk of CHD was higher among the less urbanized groups. BMI and TBC of the urbanized South Asian groups were lower, but FBG was higher than the British Caucasian, who served as controls. CONCLUSION: These findings support the hypothesis that high CHD death rate among South Asians in UK may have its origin in the genetic predisposition to diabetes but are not likely to be solely due to this factor. The environmental factors like under nourishment in early life, adoption of urbanized life style or a combination of both could be the major determinants of CHD morbidity and mortality.
Anthropometry↗
Urbanisation and health related knowledge and attitudes of South Asian children.
OBJECTIVE: To study the differences in health related knowledge and attitudes of less and more urbanised 10-12 year old South Asian school children. METHOD: A total of 589 Asian children living in UK and in Pakistan were studied. Three groups of children were recruited from Punjab, Pakistan: rural (RrP, n = 100), middle income urban (MUP, n = 148) and high income urban (HUP, n = 159) and they were assigned urbanization rank (UR) 1, 2 and 3. Another two groups of children were recruited from Slough, UK: British Pakistani (BrP, n = 110) and British Indian (Brl, n = 71) and they were assigned urbanization rank 4 and 5 respectively. Information about Cardiovascular Health (CVH) related knowledge, Health Locus of Control (HLC), smoking behaviour, self-perception of bodyweight and self-perception of activity level was collected through questionnaire. Actual weight status was judged by measuring body height and weight. Actual Physical Activity Level (PAL) was calculated from three day activity records kept by children. RESULTS: In general health related knowledge improved with urbanisation status. In all groups girls scored better on knowledge test than boys from the same group. HLC scores increased (indicate higher level of internal locus of control) steadily with urbanisation from UR 1-3. In most groups girls had slightly lower HLC scores. Smoking intentions were not related to UR. Validity of perceptions slightly improved with urbanisation rank only for activity level. CONCLUSION: Due to lack of knowledge and belief in external health locus of control, behaviour modification is likely to harder in less urbanized Pakistani groups. For the prevention of disease, efforts are required not only to increase the children's knowledge about health but also to increase awareness and understanding of healthy body weight, physical activity, hazards of smoking and to inculate belief in internal control over own health.
Analysis of Variance↗
Dietary practices and beliefs of patients with chronic liver disease.
OBJECTIVE: To study of the dietary practices and beliefs of patients suffering from chronic liver disease. SETTING: Two private tertcary care hospitals. METHOD: Fifty patients presenting to the Gastroenterology Clinics at the Aga Khan University Hospital and Baqai Hospital, with compensated liver disease and no other co-morbid condition which required dietary modifications, were enrolled in the study. Patients were interviewed regarding their current dietary practices using an open-ended questionnaire. RESULTS: The mean age of the patients was 48 years and the majority were in relatively poor nutritional status. Four had BMI's < 18; 58% had Hb < 12 g/dl and 36% had albumin levels < 3 gm/dl. The percentage of patients avoiding various foods is as follows: meats 72%, fats and oils 64%, salt 42%, spices 34%, milk and milk products 28%, rice 20%. CONCLUSION: The most commonly cited reason for avoiding a given food was the advice of the family doctor, followed by advice by gastroenterologists, family and friends. Concepts from alternative medicine and continuation of dietary restrictions imposed during a decompensated phase also influenced intake. Compromised nutritional status is a poor predictor of clinical outcome in liver disease therefore it is important that gastroenterologists be proactive regarding nutritional counseling and both patients and their primary care physicians understand the importance of not imposing unnecessary restrictions on dietary intake.
Adolescent↗
Rural-urban differences in food and nutrient intake of Pakistani children.
BACKGROUND: Global increase in urbanisation accompanied by increase in complexity of nutritional problems is a cause of concern for most nations. OBJECTIVE: The aim of this study was to assess the differences in frequency of food consumption and nutrient intake of urban and rural Pakistani children. SETTING: Forty rural, 59 middle income urban and 81 affluent urban children belonging to the province of Punjab. Children were recruited through schools in Lahore and Rayonpura, Kala-Shah-Kaku (Sheikhupura district). METHOD: Three-day estimated diet records were kept by a total of 180, 10-12 year old school-children. The nutrient intake was calculated by the nutritional analysis package COMP-EAT and analysed on SPSS. The results of the three groups were compared. RESULTS: Consumption of chapati, eggs, yoghurt and some of the traditional vegetarian snacks was very similar in all the three groups. Consumption of lentils, cooked vegetables, paratha (fried Asian bread) and tea decreased and that of milk, meat curry, chicken curry, chocolates, cakes, ice-cream, fruit and raw vegetables increased with urbanization. As compared with the rural children, the urban children had a higher mean daily intake of calories, sugar, protein, total fats, cholesterol, calcium, sodium, potassium, niacin, vitamin B12, folic acid, antioxidant vitamins A, C and E and lower intake of total carbohydrates, fibre and starch. CONCLUSION: It is concluded that although the macro-nutrient consumption pattern of rural children appears to be heart healthy lower consumption of protective micro-nutrients by them may put them at risk. In view of rapid urbanisation and its multidimensional impacts on the health of the populations living in the urban areas of the developing world, these dietary trends provide baseline information for health professionals.
Child↗
Evaluation of dowdo (wheat-milk gruel) in children with acute diarrhoea.
Appropriate feeding practices have an important impact on diarrhoeal disease management in developing countries. We evaluated the efficacy of feeding dowdo, a wheat-milk gruel, traditionally used as a weaning food in the Northern Areas of Pakistan. Dowdo was compared with khitchri, a rice-lentil mixture, in acute diarrhoea through a randomized trial. Seventy- six children between 6 and 36 months of age, with acute watery diarrhoea of less than seven days were recruited. After rehydration with standard World Health Organization (WHO) glucose-based oral rehydration solution or intravenous Ringers lactate, patients were randomly assigned to either diet group. Dowdo and Khitchri were found to be equally effective in terms of stool frequency and output, duration of diarrhoea, weight gain and duration of hospitalization. The results indicate that feeding dowdo was as effective as khitchri in children with acute diarrhoea. Additionally, acceptability of dowdo was better than Khitchri. It is recommended that dowdo be used for nutritional management of diarrhoeal disease in children in the Northern Areas of Pakistan.
Acute Disease↗
Constraints to adoption of appropriate breast feeding practices in a squatter settlement in Karachi, Pakistan.
Appropriate breast feeding practices (ABFP) are important for successful lactation. Constraints to adoption of ABFP by mothers in a squatter settlement in Karachi, Pakistan are reported. One hundred and two mother-infant pairs were followed from birth to 16 weeks of age. Eighty-seven infants received prelacteal feeds of honey as a quasi-religious ritual, 16 received ghutti for "cleansing of stomach", other prelacteal feeds were given as substitutes for breast feeding. Twenty nine mothers initiated breast feeding within 4 hours of birth. Supplemental water was given to 53 infants; major reasons being mothers' perception of thirst and diarrhoea in the infant. Supplemental milk was given to 24 infants. Insufficient milk and work load of mothers were main reasons for supplementation. Home remedies were given in 36 instances for prevention/treatment of indigestion or colds. Quasi-religious ritual of giving honey, perception that child birth was a major stress and early initiation of breast feeding adds to that stress, fear of dehydration and perception of insufficient breast milk were the major constraints to adoption of appropriate breast feeding practices.
Adult↗
Cardiovascular risk factors in school children from low middle income families in Karachi, Pakistan.
Serum levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were determined on 239 school children aged 5-19 years belonging to lower middle class families. The mean TC, LDL-C, HDL-C and TG ranged from 3.70-4.37 mmol/L, 2.17-2.70 mmol/L, 0.94-1.14 mmol/L, 1.07-1.26 mmol/L respectively. In general, girls had higher TC, LDL-C and HDL-C levels. There was no significant difference in the TG levels between boys and girls. Thirty-three percent of the girls and 22% of the boys had TC level > or = 4.4 mmol/L, the level at which dietary intervention is recommended for children. Fifty-three percent of the girls and 37% of the boys had TG levels > or = than the 90th percentile of the levels for children of similar age and sex in North America. The HDL-C levels were low with 37% of the girls and 44% of boys having values < or = the 10th percentile of levels for North American children. The mean daily intake of cholesterol ranged from 241 mg to 364 mg/day. Except for the 5-9 year olds, boys had a higher cholesterol intake than girls (P < 0.005). Twenty-two percent of the boys and 32% of the girls were overweight but weight status was significantly associated with elevated TC levels only in the boys (P < 0.05). Activity level was not significantly related to TC levels but girls who were active had significantly higher HDL-C levels than girls who were sedentary (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Weaning and diarrhoeal disease.
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Diarrhea↗
Vitamin A status of children in the urban slums of Karachi, Pakistan, assessed by clinical, dietary, and biochemical methods.
We assessed the vitamin A status of 532 children with an age range of 6-60 months who were living in slum areas of Karachi, Pakistan, using three methodologies: clinical eye examination, dietary vitamin A intake, and serum retinol level. No definite clinical signs of xerophthalmia were observed in any of these children. The mean +/- SD vitamin A intake estimated from a food frequency questionnaire for the group with inadequate (low and deficient) serum retinol levels (< 20 micrograms/dl) was 362 +/- 332 retinol equivalents (RE) compared with 431 +/- 332) RE in the group with adequate serum levels (P < 0.005). Deficient serum retinol levels (< 10 micrograms/dl) were present in 12 children (2%); two of these had a healed corneal scar. Low serum retinol levels (10-19 micrograms/dl) were present in 46%, while 51% children had adequate levels (> or = 20 micrograms/dl). The mean +/- SD serum retinol level for the inadequate (< 20 micrograms/dl) and adequate groups were 15.3 +/- 2.8 and 26.6 +/- 6.7 micrograms/dl, respectively. These results suggest that a significant number of children in these communities have low vitamin A levels and thus may constitute an at risk group. These results also suggest that the dietary intake method may be a simple and inexpensive screening tool for assessment of vitamin A status in communities.
Anthropometry↗
Is anemia an accurate predictor of vitamin A status in Pakistani children?
Serum retinol and hemoglobin levels were determined in 532 children aged 6-60 months living in urban slums of Karachi, Pakistan. Overall 67% (358 of 532) of children had hemoglobin levels of less than 11 g/dl, the World Health Organization definition of anemia for this age group. Estimations for red blood cell indices (hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red blood cell count) were done on a sample of 391 children to classify anemia morphologically. A similar percentage (69.8% [273 of 391 children]) of anemia was found in this group. The anemia was predominantly microcytic and hypochromic. Normocytic normochromic anemia was present in only 16.5%. Serum retinol levels were significantly correlated with hemoglobin (P < 0.002), hematocrit (P < 0.01), and red blood cell (P < 0.001) levels. However, anemia was found to be a poor predictor (positive predictive value [PPV] = 2.5%) for the presence of vitamin A deficiency (retinol < 10 micrograms/dl). The PPV increased to 54% if 20 micrograms/dl, which is an indicator of marginal vitamin A status, was used as the cutoff point. The sensitivity of the hemoglobin test was found to be 75% in correctly identifying vitamin A deficiency when retinol levels of 10 micrograms/dl and 20 micrograms/dl were both used as the cutoff points for deficiency. The specificity for the hemoglobin test varied from 33% to 40% when levels of 10 micrograms/dl and 20 micrograms/dl were used as the cutoff points for vitamin A deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
The impact of nutritional counselling on serum lipids, dietary and physical activity patterns of school children.
Eighty-eight school children and their parents who had been counselled regarding appropriate dietary and activity patterns aimed at reducing serum cholesterol were followed-up 21 months later to determine changes in dietary and activity patterns and in serum lipid levels. The decline in serum total cholesterol ranged from 8 to 14% in the different age and sex groups (P < 0.05 to P < 0.001). Serum triglycerides did not change significantly. Cholesterol intake decreased 36% and 54% in 10-14 year old boys and girls respectively (P > 0.001). The activity level increased significantly in both the 5-9 year and 10-14 year olds (P < 0.05 to P < 0.005). These results show that nutrition education can bring about a change in dietary and activity patterns, resulting in a decline in serum cholesterol levels.
Adolescent↗
Nutritional aspects of mammary carcinogenesis: a case-control study.
Dietary factors are believed to play an important role in mammary carcinogenesis. International correlations, case-control and cohort studies have associated the incidence and mortality from breast cancer with high fat consumption in the form of meat, gravy and dairy products. Most of these studies have been conducted in the developed countries. Due to paucity of data from developing countries, we conducted a case-control study to evaluate the role of nutritional factors in mammary carcinogenesis. This prospective study was conducted in the oncology clinic at a university hospital. On a detailed questionnaire, information was collected from 80 patients with histologically proven breast cancer (cases) and 80 normal healthy subjects (controls). Information was collected on several patients characteristics as well as intake of 44 different food items. Special care was taken to exclude any recent changes in diet, induced in cases since learning the diagnosis of breast cancer. Interviews were conducted by the same interviewer and lasted approximately 20 minutes. Analysis of data reveal no significant difference in patients characteristics between cases and controls. Similarly, no significant difference was found in the intake of most dietary items including meat and dairy products. However, a significant difference was observed in the consumption of fish, vegetable and fruits (P = 0.05). We conclude that our study fails to support the fat-breast cancer hypothesis. It also suggests a potential role of other dietary items such as fish, vegetables and fruits in mammary carcinogenesis.
Adult↗
Weaning recommendations: the scientific basis.
Current weaning recommendations are based on nutritional need, physiologic maturation, and the behavioral and developmental aspects of infant feeding. Inadequate energy and protein intake and deficiencies of iron, zinc, vitamin A, and vitamin D are the most commonly observed nutrient deficiencies during infancy and weaning recommendations have focused on their prevention. This article reviews the data and summarizes implications for infant weaning in both developed and developing countries. Current published recommendations for infant feeding are outlined and major concerns are highlighted.
Child Development↗
Dietary risk factors associated with acute and persistent diarrhea in children in Karachi, Pakistan.
Feeding practices may have an important impact on diarrheal diseases in developing countries. This study evaluated feeding practices in three groups of male children aged 6-36 mo: 100 with persistent diarrhea (PD), 79 with acute diarrhea (AD), and 86 in a comparison group (CG). The children came from comparably poor socioeconomic settings in Karachi, Pakistan, except that the literacy rates were higher in mothers of the CG (P = 0.0001). Although greater than 95% of all infants were breast-fed, delayed initiation of breast-feeding was more common in the diarrhea groups. Children with diarrhea were also more likely to receive supplemental milk (PD = 92%, AD = 87%) than were children in the CG (69%, P less than 0.05). Feedings were not withheld during diarrhea but changes were made in the nature of foods given. These results indicate that several feeding practices may be important risk factors for diarrhea in Pakistan.
Acute Disease↗
Factors associated with elevated serum cholesterol levels in well-to-do Pakistani schoolchildren.
Cholesterol (CH) and triglyceride (TG) levels were determined in blood drawn after an overnight fast from 388 school children aged 5-19 years from private schools in Karachi. The mean CH levels ranged from 4.4 to 4.6 mmol l-1 (170.1 to 177.9 mg dl-1) for boys and 4.4 to 4.8 mmol l-1 (170.1 to 185.6 mg dl-1) for girls. The range of TG levels was 1.0 to 1.2 mmol l-1 (88.6 to 106.3 mg dl-1) and 0.9 to 1.1 mmol l-1 (79.7 to 97.4 mg dl-1) for boys and girls respectively. Sixty-two per cent of the girls and 54% of the boys had cholesterol values greater than or equal to 4.4 mmol l-1 (170 mg dl-1), a level at which dietary intervention is recommended for children. Thirty-two per cent of all the children had triglyceride levels above the 90th percentile of the levels for similar age groups in North America. The mean cholesterol intake was 469 mg/day for girls and 518 mg/day for boys. Overweight and inactivity were associated with raised serum cholesterol levels. Forty per cent of the girls and 25% of the boys reported a strong family history of hypercholesterolaemia and/or heart disease. The results show that the prevalence of hypercholesterolaemia is high in well-to-do Pakistani school children and factors which can be modified to lower serum cholesterol levels are identified.
Adolescent↗
Serum cholesterol in neonates and their mothers. A pilot study.
Reports from the Aga Khan University indicate that 58% of 400 school children studied had undesirably high serum cholesterol levels. The present study was undertaken to determine whether the high cholesterol levels are present at birth and to determine the relationship between cord blood, maternal blood cholesterol and maternal diet. Cord blood from 58 neonates and fasting venous blood from 45 mothers were analyzed from total serum cholesterol. Mothers were interviewed regarding their usual diet during pregnancy. Mean cord blood cholesterol was 56.90 mg/dl (range 26 to 123 mg/dl). Mean maternal blood cholesterol was 232.4 mg/dl (range 141-382 mg/dl). Mean maternal intake of cholesterol was 457 mg (recommended level less than or equal to 300 mg/day). There was no significant co-relation between cord blood cholesterol and maternal blood cholesterol or maternal intake of cholesterol. Eighteen percent of the mothers reported a strong family history of hypercholesterolemia and/or heart disease, but this genetic tendency was not observed in the blood cholesterol level at birth indicating that environmental factors namely diet may have a prime role in determining serum cholesterol levels in childhood.
Cholesterol↗