Prevention and Detection of Childhood Obesity in Indian Children

Dr. Meghna Chawla

DNB (Paediatrics), Fellowship in Paediatric Endocrinology (UK)

Consultant Paediatric and Adolescent Endocrinologist, Ruby Hall Clinic, Pune

Assistant Professor and In-charge, Paediatric Endocrine Clinic, SKN Medical College, Maharashtra University of Health Sciences, Pune

 

Abstract

In today’s scenario, the potential public health issue that is emerging is the increasing incidence of childhood obesity in developing countries, and the resulting socioeconomic and public health burden that will be faced by these countries in the near future. Childhood obesity has various dreaded complications such as metabolic syndrome, Type 2 Diabetes Mellitus, and various psychosocial and behavior changes. Thus prevention of obesity in children is of utmost importance, which can be done by proper growth monitoring of children using reference growth charts. This article discusses in brief the difference among the reference growth charts and the difference in nutrition needs of Indian children.

Introduction

Childhood obesity is a global health concern which has reached an epidemic proportion in developed countries and has a growing prevalence in developing countries like India. It has been estimated that worldwide over 22 million children under the age of 5 are obese, and one in 10 children is overweight.1,2

A recent meta-analysis of 450 nationally representative cross sectional surveys from 144 countries showed that 43 million children are estimated to be overweight and obese [1]. Indian children too have shown an alarming rise in the trend of obesity, the incidence from various studies being 1% to 12.9%. The prevalence is higher in the urban than in the rural areas.3,4

Overweight and obesity are caused by numerous social and environmental factors that influence people’s food habit and physical activity.1 This rapidly changing dietary habits along with the adoption of sedentary lifestyle increases enormously the obesity-related non-communicable diseases. Children with obesity are at higher risk for having other chronic health conditions and diseases, such as asthma, sleep apnea, bone and joint problems, metabolic syndrome and type 2 diabetes. It is thus imperative to prevent it at the earliest, which can be done by ensuring proper growth monitoring of children using proper reference growth charts. By “proper” we mean contemporary, nationally representative growth charts which are the current Indian Academy of Pediatrics (IAP) 2015 growth charts for 5- to 18 year old children. For children < 5 years, IAP recommends the use of World Health Organization (WHO) growth charts.6 The BMI charts published by IAP have used the 23 and 27 adult equivalent cut offs for risk for overweight and obesity respectively, and have been considered to be appropriate for use as Asians are predisposed to more adiposity and its complications at a lower BMI.1,5 When we use the other comparative growth charts such as WHO and CDC, as shown in Figure 1, it is clear that we are detecting obesity at a much lower percentile than the others, thus preventing its frightening ramifications.7

Figure 1: BMI Growth Percentile Difference

Since one of the most important parameters contributing to growth is appropriate nutrition, the importance of using supplements which have the exact composition as required for Indian children for optimal growth cannot be over emphasized. As we can see in the Table 1, the RDA and protein requirements for Indian children are very different from international comparisons, hence we need to tailor our nutritional recommendations accordingly, to prevent any increase in childhood obesity.

Table 1: Recommended Dietary Allowance (RDA) for Different Countries

Nutrition Facts Unit Indian RDAa USRDAb UKRDAc EFSAd Singapore RDAe SEA RDAf
Energy Kcal 1350 ND 1378 1251 1248 1470
Linoleic Acid (Omega-6) g ϯ 10* ND 6 ND ND
Alpha- Linolenic Acid (Omega-3) g ϯ 0.9* ND 1 ND ND
Dietary Fiber g 18 25* 16.6 14 ND ND
Protein g 20.1 19 19.7 0.71g/ kg body weight 25 21
Vitamins
Vitamin D IU 200 600 400 600 400 200
Vitamin C mg 40 25 30 40 50 30
Folic acid mcg 50 200 100 110 200 200
Vitamin B1 (Thiamin) mg 0.7 0.6 0.7 0.072 0.74 0.6
Vitamin B2 (Riboflavin) mg 0.8 0.6 0.8 0.6 0.93 0.6
Vitamin B3 (Niacin) mg 11 8 11 1.3 10.2 8
Vitamin B6 mg 0.9 0.6 0.9 0.6 0.6 ND
Vitamin B12 mcg 1 1.2 0.8 ND 1.1 ND
Pantothenic Acid mg 3 3* ND ND ND ND
Biotin mcg 12 12* ND 25 ND ND
Choline mg 37.5 250* ND 170 ND ND
Minerals
Iron mg 13 10 6.1 5 7 8.4
Calcium mg 600 1,000 450 680 600 600
Zinc mg 7 5 6.5 4.6 ND 5.7
Chromium mcg 9.9 15* ND ND ND ND
ϯ: RDA not established in ICMR/WHO

*: Adequate Intake value

ND: Not defined

a)                   Indian Council of Medical Research 2010 RDA. For 4-6 years children.

b)                   Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005) and Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005). Accessed via www .nap.edu. Average value for 4-8 years children.

c)                    Nutrition Requirements, British Nutrition Foundation 2016. Average value for 4-6 years children.

d)                   Dietary Reference Values for nutrients: Summary report. European Food Safety Authority (EFSA) 2017. Average for 4-6 years children.

e)                   RDA Health Hub®. Ministry of Health, Singapore. For 3-5 years children.

f)                    Recommended Dietary Allowances: Harmonization in Southeast Asia 2005. For 4-6 years children.

Conclusion

Monitoring the nutritional status and growth of children at both the individual level and at population level has important implications for clinical practice and policy development. A timely action must be initiated to combat the rising epidemic of childhood obesity.

References

  1. Kar SS, Kar SS. Prevention of childhood obesity in India: Way forward. J Nat Sci Biol Med. 2015;6(1): 12–17.
  2. e Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92:1757-64.
  3. Kapil U, Singh b, Pathak P, et al. Prevalence of Obesity among affluent adolescent school children in Delhi. Indian Pediatr. 2002;39(5):449-52.
  4. Kotian MS, S GK, Kotian SS. Prevalence and Determinants of Overweight and Obesity Among Adolescent School Children of South Karnataka, India. Indian J Community Med. 2010 Jan; 35(1): 176–178.
  5. Tips for Parents – Ideas to Help Children Maintain a Healthy Weight. CDC 2018. Available at: https://www.cdc.gov/healthyweight/children/index.html
  6. Indian Academy of Pediatrics Growth Charts Committee, Khadilkar V, Yadav S, et al. Revised IAP Growth Charts for Height, Weight and Body Mass Index for 5-18 year old Indian Children. Indian Pediatr. 2015;52(1):47-55.
  7. Chawla M. Response to the WHO multicentre growth charts. Ind J Pract Pediatr 2014;16(3):112.

 

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