Study objective: To describe height, weight, and body mass index (BMI) of the adult urban population in Mumbai, western India and to estimate the prevalence and severity of thinness and overweight in this population. To describe the association of BMI with education, age, and tobacco habits in an urban Indian population. Design: Cross sectional representative survey of 99 598 adults (40 071 men and 59 527 women). Setting: The survey was carried out in the city of Mumbai (formerly known as Bombay) in western India. Participants: Men and women aged >35 years who were residents of the main city of Mumbai. Main results: The mean height, weight, and BMI were 161.0 (SD 6.7) cm, 56.7 (SD 11.0) kg, and 21.8 (SD 3.8) kg/m 2 for men and 148.0 (SD 6.2) cm, 49.8 (SD 11.2) kg, and 22.7 (SD 4.7) kg/m 2 for women, respectively. Some 19% of men and women were thin (BMI<18.5 kg/m 2 ), while 19% of men and 30% of women were overweight (BMI>25kg/m 2 ). Multivariable logistic regression analyses showed that age, level of education, and tobacco use were independently associated with BMI. The odds ratio (OR) and 95% confidence intervals (CI) for thinness (BMI<18.5 kg/m 2 ) were OR 6.52, 95%CI 5.38 to 7.89 for men and OR 4.83, 95%CI 3.71 to 6.28 for women, respectively, (p<0.001) for the lowest level of education (illiterate group). The OR and 95%CI for overweight were 2.25, 2.20 to 2.58 for college educated men and 1.90, 1.64 to 2.20 for college educated women, respectively, p<0.001. Both smoking (2.33, 2.09 to 2.59; 2.89, 1.77 to 4.72 for men and women, respectively, p<0.001) and smokeless tobacco use (1.65, 1.52 to 1.80; 2.26, 2.14 to 2.38 for men and women, respectively p<0.0001) were significantly associated with low BMI. Conclusions: Sequelae of thinness and overweight represent major public health problems. The results of this study, indicating an equal prevalence of thinness and overweight in an urban area and their association with age, level of education, and tobacco use raise concerns of an emerging public health crisis in urban India.

Objective: To develop and test a quantitative, interviewer-administered food frequency questionnaire (FFQ) to ascertain nutrient intakes of individuals in northern India. Design: A 92-item FFQ was developed based on food use and market surveys of the study area. A validation study was conducted consisting of 24-h diet recalls (24HR) administered on 6 randomly selected days over 1 year. Two FFQs were administered, one each at the beginning and end of the 1-year period. FFQ and 24HR-derived nutrient scores were compared using correlation and regression analyses and by computing differences between nutrient intakes estimated by the two methods. Setting: Rural villages in Bhavnagar District, Gujarat, North India. Subjects: 60 individuals who agreed to provide all necessary data. Results: Pearson (parametric) correlation coefficients averaged 0.69 in comparing nutrient scores derived from the 24HR with those from the first FFQ and 0.72 in comparing the second FFQ (P < 0.0001). Spearman correlation coefficients were virtually identical to the Pearson correlations, averaging 0.68 and 0.72, respectively. In regression analyses, most coefficients were close to 1.0 (perfect linear association). Nutrient scores were significantly and consistently higher on both FFQs relative to the 24HR. Conclusions: This FFQ produces results broadly comparable, and superior in some respects, to those commonly used in the West. Higher than average measures of association indicate its suitability for comparing exposures within this study population in reference to health-related endpoints.

Objective: Limited inter-person variability in nutrient intake hampers epidemiologic studies of diet ± disease relationships. Despite conjecture about non-traditional study bases providing large inter-person differences, virtually nothing is known about variations in nutrient intake outside of Europe and North America. The current study was conducted in India to determine sources of variability in the intakes of nutrients thought to be of public health importance. Design: Adult subjects in Gujarat (North India; n 60) and in Kerala (South India, n 60) were administered 24 h diet recall interviews six and eight times, respectively, over a 1 y period. To assess subject (inter-person) and residual (intra-person) contributions to variance, regression models were ®t to the data. From this, the variance ratio (VR, total within or intra-person: total between or inter-person) was computed. Setting: Rural communities in North and South India. Results: In both regions, inter-person variability was larger than that observed in the West. This was most pronounced in Gujarat, for which the VR was`1.0 for seven of the 12 energy-adjusted nutrient intakes in both men and women. In analyses of the combined data, region accounted for b 20% of variance for fat, iron, copper, zinc, b-carotene and ribo¯avin in both men and women. With the region term removed from this model, virtually all of the variability ascribed to region contributed to inter-person variability. Conclusions:The relatively large inter-person variability observed here could contribute to improved`resolution' of diet ± outcome relationships in epidemiologic studies. While this applies to data from each region, it was especially evident in analyses of the combined data.

Objective:To develop and test a food frequency questionnaire (FFQ) for use in rural areas of Kerala, India.Design:Based on food use and market surveys of the study area, a quantitative 81-item interviewer-administered FFQ was developed. A validation study was conducted consisting of 24-h diet recalls (24HR) administered on 8 days randomly selected over an entire year and two administrations of the FFQ, one at the beginning of the l-year period and the other at the end. FFQ and 24HR-derived nutrient scores were compared using correlation and regression analyses and by examining differences in the nutrient scores.Setting:Rural villages in Ernakulum district, Kerala, South India.Subjects:In each of 30 households, the male head of household and female food preparer were enrolled.Results:Pearson (parametric) correlation coefficients (rp) averaged about 0.50 in comparing nutrient scores derived from the 24HR with those from the first FFQ and about 0.55 in comparing the second FFQ. On average, Spearman correlation coefficients (rs) were slightly lower than the rp in comparing the scores derived from the first FFQ, but virtually identical for the second FFQ. Regression analyses indicated better agreement in the comparison of the 24HR-derived scores with the first FFQ than the second FFQ. Difference scores, however, tended to be larger in comparing the first FFQ scores with the 24HR.Conclusions:This FFQ produces results broadly comparable to those used in Europe and North America, indicating its suitability for comparing exposures within a study population in reference to health-related endpoints.

OBJECTIVES: To investigate the relationship of specific nutrients and food items with oral precancerous lesions among tobacco users. DESIGN: A population‐based case‐control study. SETTING: Villages in Palitana taluk of Bhavnagar district, Gujarat, India. SUBJECTS AND METHODS: An interviewer‐administered food frequency questionnaire, developed and validated for this population, was used to estimate nutrient intake in blinded, house‐to‐house interviews. Among 5018 male tobacco users, 318 were diagnosed as cases. An equal number of controls matched on age (±5 years), sex, village, and use of tobacco were selected. MAIN OUTCOME MEASURES: Odds ratios (OR) from multiple logistic regression analysis controlling for relevant variables (type of tobacco use and economic status). RESULTS: A protective effect of fibre was observed for both oral submucous fibrosis (OSF) and leukoplakia, with 10% reduction in risk per g day‐1 (P < 0.05). Ascorbic acid appeared to be protective against leukoplakia with the halving of risk in the two highest quartiles of intake (versus the lowest quartile: OR = 0.46 and 0.44, respectively; P < 0.10). A protective effect of tomato consumption was observed in leukoplakia and a suggestion of a protective effect of wheat in OSF. CONCLUSION: In addition to tobacco use, intake of specific nutrients may have a role in the development of oral precancerous lesions.