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Aims: To determine whether current and postpartum maternal depression and low maternal intelligence are risk factors for malnutrition in children. Methods: In rural South India 72 children with malnutrition were identified from a central register; 72 controls were matched for age, gender, and residence. Results: Major depression in the postpartum period (OR 5.0, 95% CI 1.0 to 24.0), current major depression (OR 3.2, 95% CI 1.1 to 9.5), and low maternal intelligence (OR 3.8, 95% CI 1.3 to 11.1) were associated with malnutrition in the child. Low birth weight (OR 2.9, 95% CI 1.2 to 6.8) was also significantly associated with infant malnutrition. Conditional logistic regression adjusting for all other determinants yielded the following results: major depression during the postpartum period (OR 7.8; 95% CI 1.6 to 38.51), current major depression (OR 3.1; 95% CI 0.9 to 9.7), low maternal intelligence (OR 4.6; 95% CI 1.5 to 14.1), and low birth weight (OR 2.7; 95% CI 2.5 to 6.8). The interactions between current maternal depression and low birth weight and between postpartum depression and low maternal intelligence were statistically significant. The level of maternal intelligence was associated with nutritional status. The severity of malnutrition was also significantly associated with major depression during the postpartum period and low maternal intelligence. Conclusion: There is evidence for an association between postpartum maternal depression, low maternal intelligence, and low birth weight with malnutrition in children aged 6-12 months.

ObjectiveTo evaluate body fat patterning and phenotype including hepatic fat and pancreatic volume of non-obese (BMI: < 25 kg/m2) Asian Indians with type 2 diabetes residing in North India.MethodsNon-obese patients with type 2 diabetes (n = 93) and non-obese, normo-glycemic subjects (n = 40) were recruited. BMI, waist & hip circumferences, skinfold thickness at 8 sites, body fat, lean mass and detailed abdominal fat evaluation [total abdominal fat, total subcutaneous fat (superficial, deep, anterior, and posterior), total intra-abdominal fat (intra-peritoneal, retroperitoneal)], liver span, grades of fatty liver and pancreatic volume were compared.ResultsWaist circumference, subscapular skinfolds and total truncal fat (on DEXA) were higher whereas calf, total peripheral skinfolds and total leg fat (on DEXA) lower in patients. Specifically, the following volumes were higher in cases as compared to controls; total abdominal fat (19.4%), total intra-abdominal fat (49.7%), intra-peritoneal fat (47.7%), retroperitoneal fat (70.7%), pancreatic volume (26.6%), pancreatic volume index (21.3%) and liver span (10.8%). In cases, significant positive correlations were observed for pancreatic volume with BMI, waist and hip circumferences, W-HR, subscapular, abdominal and total truncal skinfolds, truncal, total subcutaneous, total intra-abdominal, intra-peritoneal, retroperitoneal fat depots, liver span and fatty liver.ConclusionsIn non-obese Asian Indians with type 2 diabetes, subcutaneous and intra-abdominal obesity, including fatty liver, and pancreatic volume were higher and peripheral subcutaneous adiposity was lower than BMI matched non-diabetic subjects. Importantly, increased pancreatic volume in patients was highly correlated with multiple measures of abdominal obesity and liver fat.

Purpose of Review Obesity has increased in South Asian countries that are still grappling with undernutrition. In this review, we highlight the characteristics of obesity, its relation to morbidities, and its management in South Asians. A literature search was conducted using relevant search engines and based on key words focusing on obesity in South Asians. Recent Findings The increasing trend in obesity prevalence is caused by imbalanced diets and physical inactivity. South Asians, in general, have higher body fat and lower skeletal muscle mass at the same or lower BMIs compared to white people ("high body fat-normal BMI-low muscle mass" phenotype). In addition, excess abdominal adiposity, typically seen in South Asians, and increased hepatic fat (non-alcoholic fatty liver disease) are associated with an increased risk for type 2 diabetes and cardiovascular disease. Challenges in treatment include lack of awareness regarding correct diets and non-compliance to diet and exercise regimens. Social and cultural issues limit physical activity in South Asian women. Finally, there is a lack of expert health professionals to deal with increased cases of obesity. Aggressive management of obesity is required in South Asians, with more intensive and earlier diet and exercise interventions (i.e., at lower BMI levels than internationally accepted). At a population level, there is no clear policy for tackling obesity in any South Asian country. Prevention strategies focusing on obesity in childhood and the creation of food and activity environments that encourage healthy lifestyles should be firmly applied. Summary Obesity in South Asians should be evaluated with ethnic-specific guidelines and prevention and management strategies should be applied early and aggressively.

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Accurate determination of energy expenditure (EE) is vitally important yet often neglected in clinical practice. Indirect calorimetry (IC) provides one of the most sensitive, accurate, and noninvasive measurements of EE in an individual. Over the last couple of decades, this technique has been applied to clinical circumstances such as acute illness and parenteral nutrition. Beyond assessing the nutritional needs, it has also shed light on various aspects of nutrient assimilation, thermogenesis, the energetics of physical exercise, and the pathogenesis of obesity and diabetes. However, because of little or no experience with IC provided during medical education, the benefits of IC are poorly appreciated. Newer technology, cost-effectiveness, and a better understanding of how to interpret measurements should lead to more frequent use of IC. This review focuses on the physicochemical background of IC, the various indications for use, techniques and instruments, potential pitfalls in measurement, and the recent advances in technology that has adapted the technique to long-term studies in humans.

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Background Post COVID-19 syndrome (PCS) has emerged as a major roadblock in the recovery of patients infected with SARS-CoV-2. Amongst many symptoms like myalgia, headache, cough, breathless; fatigue is one of the major symptoms which makes the patient severely debilitated. Research on PCS, in particular fatigue, in patients with diabetes has not been done. Methodology In this prospective study, we included patients with type 2 diabetes (T2D) who had COVID-19 infection (mild to moderate severity), and matched T2D patients who did not suffer from COVID-19 infection. Demography, anthropometry, glycemic measures, treatment, COVID-19 infection details were recorded. Symptoms were scored using Chalder Fatigue Scale (reported as fatigue score, FS) and handgrip strength (in kg) was recorded by Jamar Hydraulic Hand Dynamometer. Results A total of 108 patients were included (cases, 52, controls, 56). Both groups were matched for age, duration of diabetes, BMI, TSH and vitamin D levels. T2D patients with COVID-19 infection had significant more fatigue when compared with patients without COVID-19 infection but comparable handgrip strength. Furthermore, patients with T2D with previous COVID-19 infection and who had FS >4 have had significant higher inflammation markers during acute illness, and post COVID-19, had increased post prandial blood glucose levels, lost more weight, had reduced physical activity and significantly lower handgrip strength as compared to those with FS <4. Conclusion Patients with T2D who had COVID-19 infection as compared to those without had significantly more fatigue after the acute illness, and those with higher fatigue score had reduced handgrip strength indicating sarcopenia. Rehabilitation of those with FS >4 after acute infection would require careful attention to nutrition, glycemic control and graduated physical activity protocol.