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 similar 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 cardiovascular disease 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 role in reducing the burden of cardiovascular disease in low income and middle income countries.

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I . A study amongst schoolboys in villages around Hyderabad, India, showed that almost all the boys had riboflavin deficiency, 61 % had pyridoxine deficiency, and 9'4% had thiamin deficiency as judged by enzymic tests.2. The prevalence of angular stomatitis was 41.3 yo and that of glossitis was 18.2 %. Biochemical deficiency of riboflavin and pyridoxine was marginally higher in children with angular stomatitis with or without associated glossitis, than in children without oral lesions.3. Treatment with B-complex vitamins (containing 4 mg riboflavin and 10 mg pyridoxine) daily for I month produced significant reduction in the prevalence of glossitis but had no effect on angular stomatitis. The latter responded to topical application of gentian violet. 4.Small but significant changes in erythrocyte enzymes occurred over the period of I month even without vitamin supplements.5 . Results suggest that while glossitis is a relatively early manifestation of riboflavin or pyridoxine deficiency or both, angular stomatitis has a more complex aetiology perhaps associated with infection.Lesions of the mouth such as angular stomatitis and glossitis have been shown in experimentally-induced riboflavin deficiency as well as pyridoxine deficiency. Recent reports from the National Institute of Nutrition, Hyderabad, show that in adults this condition responds to treatment with either riboflavin or pyridoxine (Krishnaswamy, 1971 ; Iyengar, 1973). While glossitis seems to be more common amongst the adults of our community, angular stomatitis is more common amongst the children.A recent survey of rural schoolchildren living near Hyderabad, revealed a higher incidence of angular stomatitis amongst boys than amongst girls. The condition failed to respond to treatment with either riboflavin alone or with B-complex vitamins over a period of 3 weeks and 4 weeks respectively (K. V. R. Sarma, M. Damodaran and A. Tiar, unpublished results).The present study was carried out to investigate this observation further, by applying biochemical tests for assessing vitamin status, and examining the response to topical application of gentian violet. EXPERIMENTALThe subjects, 407 boys aged 5-1 3 years old and attending four rural schools near Hyderabad, were examined for clinical signs of vitamin deficiency such as angular stomatitis, glossitis, cheilosis, Bitot's spots, phrynoderma and angular scars. Of these, 168 boys had active angular stomatitis with or without glossitis (group A) whereas 134 boys were completely free of all lesions of the mouth including healed scars (group B). Boys in group A were further divided randomly into three subgroups (groups AI, A2 and A3) and those in group B into two subgroups (groups BI and B2).These boys were treated daily with either two tablets of B-complex vitamins (containing (mg/tablet): thiamin 2, riboflavin 2, pyridoxine 5, calcium pantothenate 2, niacin 20) (groups Ar and BI) or with placebo tablet containing IOO mg lactose (groups A2 and B2) or by topical application of a solution of gentian violet (10 g/l...

Education on ill effects of aerated drinks, fast foods and the importance of nutrition during the adolescent phase should be emphasized in future programmes.

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ObjectivesThis study examined association between socio-economic position and cardiovascular risk factors in adolescents to investigate whether childhood socio-economic position is a risk factor for future cardiovascular disease, independently of adult behaviours.Study design and methodsParticipants (n = 1128, 46% girls, aged 13–18 years) were members of a birth cohort (Andhra Pradesh Children and Parents Study or APCAPS) established to investigate long-term effects of a pregnancy and childhood nutritional supplementation trial conducted in 29 villages near Hyderabad in South India. Cross-sectional associations between socio-economic position and cardiovascular risk factors were examined using linear regression models.ResultsThe mean BMI was 16.7 kg/m2 for boys and 17.8 kg/m2 for girls. Socio-economic position was positively associated with fat mass index (0.15 kg/m2; 95% CI: 0.05–0.25) and inversely associated with central-peripheral skinfold ratio (−0.04; 95% CI: −0.06 to −0.01) and, in boys, fasting triglycerides (−0.05; 95% CI: −0.09 to −0.01). Association of socio-economic position with other risk factors (blood pressure, arterial stiffness, fasting glucose, insulin and cholesterol) was weak and inconsistent, and did not persist after adjustment for potential confounders, including age, sex, pubertal stage, height, adiposity and nutrition supplementation.ConclusionsThe study thus showed that lower socio-economic position may be associated with greater central adiposity and higher triglyceride levels in these settings. Socio-economic gradient in cardiovascular risk may strengthen in future with later economic and lifestyle changes. Cardiovascular disease prevention strategies should therefore focus on the youth from the low income group.