Background Malnutrition is a major contributor to disease burden in India. To inform subnational action, we aimed to assess the disease burden due to malnutrition and the trends in its indicators in every state of India in relation to Indian and global nutrition targets. Methods We analysed the disease burden attributable to child and maternal malnutrition, and the trends in the malnutrition indicators from 1990 to 2017 in every state of India using all accessible data from multiple sources, as part of Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three groups using their Socio-demographic Index (SDI) calculated by GBD on the basis of per capita income, mean education, and fertility rate in women younger than 25 years. We projected the prevalence of malnutrition indicators for the states of India up to 2030 on the basis of the 1990-2017 trends for comparison with India National Nutrition Mission (NNM) 2022 and WHO and UNICEF 2030 targets. Findings Malnutrition was the predominant risk factor for death in children younger than 5 years of age in every state of India in 2017, accounting for 68•2% (95% UI 65•8-70•7) of the total under-5 deaths, and the leading risk factor for health loss for all ages, responsible for 17•3% (16•3-18•2) of the total disability-adjusted life years (DALYs). The malnutrition DALY rate was much higher in the low SDI than in the middle SDI and high SDI state groups. This rate varied 6•8 times between the states in 2017, and was highest in the states of Uttar Pradesh, Bihar, Assam, and Rajasthan. The prevalence of low birthweight in India in 2017 was 21•4% (20•8-21•9), child stunting 39•3% (38•7-40•1), child wasting 15•7% (15•6-15•9), child underweight 32•7% (32•3-33•1), anaemia in children 59•7% (56•2-63•8), anaemia in women 15-49 years of age 54•4% (53•7-55•2), exclusive breastfeeding 53•3% (51•5-54•9), and child overweight 11•5% (8•5-14•9). If the trends estimated up to 2017 for the indicators in the NNM 2022 continue in India, there would be 8•9% excess prevalence for low birthweight, 9•6% for stunting, 4•8% for underweight, 11•7% for anaemia in children, and 13•8% for anaemia in women relative to the 2022 targets. For the additional indicators in the WHO and UNICEF 2030 targets, the trends up to 2017 would lead to 10•4% excess prevalence for wasting, 14•5% excess prevalence for overweight, and 10•7% less exclusive breastfeeding in 2030. The prevalence of malnutrition indicators, their rates of improvement, and the gaps between projected prevalence and targets vary substantially between the states. Interpretation Malnutrition continues to be the leading risk factor for disease burden in India. It is encouraging that India has set ambitious targets to reduce malnutrition through NNM. The trends up to 2017 indicate that substantially higher rates of improvement will be needed for all malnutrition indicators in most states to achieve the Indian 2022 and the global 2030 targets. The state-specific findings in this report indicate the...

BackgroundEffective task-shifting interventions targeted at reducing the global cardiovascular disease (CVD) epidemic in low and middle-income countries (LMICs) are urgently needed.MethodsDISHA is a cluster randomised controlled trial conducted across 10 sites (5 in phase 1 and 5 in phase 2) in India in 120 clusters. At each site, 12 clusters were randomly selected from a district. A cluster is defined as a small village with 250–300 households and well defined geographical boundaries. They were then randomly allocated to intervention and control clusters in a 1:1 allocation sequence. If any of the intervention and control clusters were <10 km apart, one was dropped and replaced with another randomly selected cluster from the same district. The study included a representative baseline cross-sectional survey, development of a structured intervention model, delivery of intervention for a minimum period of 18 months by trained frontline health workers (mainly Anganwadi workers and ASHA workers) and a post intervention survey in a representative sample. The study staff had no information on intervention allocation until the completion of the baseline survey. In order to ensure comparability of data across sites, the DISHA study follows a common protocol and manual of operation with standardized measurement techniques.DiscussionOur study is the largest community based cluster randomised trial in low and middle-income country settings designed to test the effectiveness of ‘task shifting’ interventions involving frontline health workers for cardiovascular risk reduction.Trial registrationCTRI/2013/10/004049. Registered 7 October 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2891-6) contains supplementary material, which is available to authorized users.

Background: To inform actions at the district level under the National Nutrition Mission (NNM), we assessed the prevalence trends of child growth failure (CGF) indicators for all districts in India and inequality between districts within the states. Methods: We assessed the trends of CGF indicators (stunting, wasting and underweight) from 2000 to 2017 across the districts of India, aggregated from 5 £ 5 km grid estimates, using all accessible data from various surveys with subnational geographical information. The states were categorised into three groups using their Sociodemographic Index (SDI) levels calculated as part of the Global Burden of Disease Study based on per capita income, mean education and fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using coefficient of variation (CV). We projected the prevalence of CGF indicators for the districts up to 2030 based on the trends from 2000 to 2017 to compare with the NNM 2022 targets for stunting and underweight, and the WHO/UNICEF 2030 targets for stunting and wasting. We assessed Pearson correlation coefficient between two major national surveys for district-level estimates of CGF indicators in the states. Findings: The prevalence of stunting ranged 3.8-fold from 16.4% (95% UI 15.2À17.8) to 62.8% (95% UI 61.5À64.0) among the 723 districts of India in 2017, wasting ranged 5.4-fold from 5.5% (95% UI 5.1À6.1) to 30.0% (95% UI 28.2À31.8), and underweight ranged 4.6-fold from 11.0% (95% UI 10.5À11.9) to 51.0% (95% UI 49.9À52.1). 36.1% of the districts in India had stunting prevalence 40% or more, with 67.0% districts in the low SDI states group and only 1.1% districts in the high SDI states with this level of stunting. The prevalence of stunting declined significantly from 2010 to 2017 in 98.5% of the districts with a maximum decline of 41.2% (95% UI 40.3À42.5), wasting in 61.3% with a maximum decline of 44.0% (95% UI 42.3À46.7), and underweight in 95.0% with a maximum decline of 53.9% (95% UI 52.8À55.4). The CV varied 7.4-fold for stunting, 12.2-fold for wasting, and 8.6-fold for underweight between the states in 2017; the CV increased for stunting in 28 out of 31 states, for wasting in 16 states, and for underweight in 20 states from 2000 to 2017. In order to reach the NNM 2022 targets for stunting and underweight individually, 82.6% and 98.5% of the districts in India would need a rate of improvement higher than they had up to 2017, respectively. To achieve the WHO/UNICEF 2030 target for wasting, all districts in India would need a rate of improvement higher than they had up to 2017. The correlation between the two national surveys for district-level estimates was poor, with Pearson correlation coefficient of 0.7 only in Odisha and four small north-eastern states out of the 27 states covered by these surveys. Interpretation: CGF indicators have improved in India, but there are substantial variations between the districts in their magnitude and rate of decline, and the inequality between districts has inc...

Deficiency of vitamin D or hypovitaminosis D is widespread irrespective of age, gender, race and geography and has emerged as an important area of research. Vitamin D deficiency may lead to osteoporosis (osteomalacia in adults and rickets in children) along with calcium deficiency. Its deficiency is linked with low bone mass, weakness of muscles and increased risk of fracture. However, further research is needed to link deficiency of vitamin D with extra-skeletal consequences such as cancer, cardiovascular disease, diabetes, infections and autoimmune disorders. The causes of vitamin D deficiency include length and timing of sun exposure, amount of skin exposed, latitude, season, level of pollution in atmosphere, clothing, skin pigmentation, application of sunscreen, dietary factors and genetic factors. The primary source is sunlight, and the dietary sources include animal products such as fatty fish, food items fortified with vitamin D and supplements. Different cut-offs have been used to define hypovitaminosis D and its severity in different studies. Based on the findings from some Indian studies, a high prevalence of hypovitaminosis D was observed among different age groups. Hypovitaminosis D ranged from 84.9 to 100 per cent among school-going children, 42 to 74 per cent among pregnant women, 44.3 to 66.7 per cent among infants, 70 to 81.1 per cent among lactating mothers and 30 to 91.2 per cent among adults. To tackle the problem of hypovitaminosis D in India, vitamin D fortification in staple foods, supplementation of vitamin D along with calcium, inclusion of local fortified food items in supplementary nutrition programmes launched by the government, cooperation from stakeholders from food industry and creating awareness among physicians and the general population may help in combating the problem to some extent.

Objective: The present study was conducted to assess the prevalence of hypertension in adult population residing in slums of West Delhi. Methods:A cross-sectional study was conducted among adult population of 18-59 years residing in urban slums of West Delhi. Blood pressure was measured using digital machine (OMRON). The data obtained were analyzed for percent prevalence, mean, standard deviation, and median. Joint National Committee (JNC)on prevention, detection, evaluation, and treatment of high blood pressure (JNC)VI and JNC VII criteria were used to classify hypertension. Results:The overall prevalence of hypertension was 25.3%. The prevalence was higher (27.9%)in males than females (22.8%)and also in the age group 46-59 years (43.0%)as compared to 18-45 years (19.8%). The overall prevalence of prehypertension, Stage I and Stage II hypertension, respectively, was 35.2%, 16.1% and 9.2%. Conclusion:A one-fourth of the adult population is hypertensive. Early diagnosis and treatment are advisable, besides awareness about dietary and lifestyle modification.

Background: Antioxidants (AO) supplementation in chronic pancreatitis (CP) has been evaluated for pain. But it is not clear whether AO in CP have an effect on pancreatic functions and other clinical outcomes. We evaluated effect of AO on endocrine function in CP. Materials and Methods: Double-blind placebo (PL)-controlled randomized pilot study on 107 patients with CP assigned to receive daily combined AO or PL for 6 months. Primary outcome was: improvement in endocrine function (Homeostasis Model Assessment-Insulin Resistance). Secondary outcome measures were: improvement in C-peptide, Qualitative Insulin Sensitivity Check Index, exocrine pancreatic function (fecal elastase), surrogate markers of fibrosis (platelet-derived growth factor BB, transforming growth factor-β1, α-smooth muscle actin), quality of life (QOL), pain, nutritional status, markers of oxidative stress (OS), AO status, and inflammation. Results: There was an increase in levels of serum selenium (107.2±26.9 to 109.7±26.9 vs. 104.1±28.6 to 124.0±33.6 μg/L, P=0.022) and serum vitamin E [0.58 (range, 0.27-3.22) to 0.66 (range, 0.34-1.98) vs. 0.63 (range, 0.28-1.73) to 1.09 (range, 0.25-2.91) mg/dL, P=0.001] in the AO than the PL group. However, no significant differences were observed between groups in any of the primary or secondary outcome measures. Conclusions: Supplementation with AO to patients with CP causes a sustained increase in blood levels of AO; however, it has no addition benefit over PL on endocrine and exocrine functions, markers of fibrosis, OS and inflammation, nutritional status, pain and QOL. Further larger studies with adequate sample size are required.

Objective: The objective of this study is to assess the risk factors of hypertension among adults residing in urban slums of West Delhi. Methods:A cross-sectional study was carried out among adult population of 18-59 years residing in urban slums of West Delhi. Blood pressure was measured twice using digital machine (OMRON). Height, waist circumference, and hip circumference were measured, weight was taken, and body mass index (BMI) was calculated. The Joint National Committee VII criteria were used to define hypertension, and the National Cholesterol Education Program and Adult Treatment Panel-III guidelines were used to define different categories of dyslipidemia. The World Health Organization (2014) criteria were used to classify the BMI. Results:The overall prevalence of hypertension among adults (n=423) was 25.3%. Among hypertensive adults, the prevalence of obesity was 22.7%, while among non-hypertensives, it was 10.9%. Similarly, overweight prevalence was higher (27.3%) in hypertensive adults compared to non-hypertensive adults (20.6%). The overall prevalence of hypercholesterolemia, hypertriglyceridemia, high-density lipoprotein-cholesterol <40/<50 mg/dl, and low-density lipoprotein-cholesterol (LDL-C) ≥130 was 19.7%, 33.7%, 75.7%, and 21.8%, respectively. The prevalence of hypercholesterolemia, hypertriglyceridemia, and serum LDL-C ≥130 mg/dl was 38%, 50%, and 32% among hypertensive adults, while among nonhypertensive adults, it was 15%, 29%, and 19%, respectively. Conclusion:Hypertensive adults had higher BMI, serum cholesterol, triglycerides, and LDL-C compared to non-hypertensives.

Objective: The present study was carried out to assess the prevalence of hypertension among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 202 elderly residing in urban slums of West Delhi. Hypertension was classified as per JNC VII criteria. Blood pressure was measured twice using digital machine (OMRON) after an interval of 5 min. The data obtained were analyzed for percent prevalence, mean, standard deviation, and median.Results: The overall prevalence of hypertension was 49.1%; higher among male (56.0%) than female (41.9%). The prevalence of Stage I, Stage II, and isolated systolic hypertension was 30.7%, 18.8%, and 47%, respectively.Conclusion: Almost half of the elderly population in slums was hypertensive. Periodical health checkup and management through treatment and dietary and lifestyle modification is needed.