Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: long term follow-up of Hyderabad nutrition trial.
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.


METHODS
Approximately 15 years' follow-up of participants born within an earlier controlled, community trial of nutritional supplementation integrated with other public health programmes.


METHODS
29 villages (15 intervention, 14 control) near Hyderabad city, south India.


METHODS
1165 adolescents aged 13-18 years.


METHODS
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.


METHODS
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.
Kinra
Sanjay
S
Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT. sanjay.kinra@lshtm.ac.uk
Rameshwar Sarma
K V
KV
Ghafoorunissa
Mendu
Vishnu Vardhana Rao
VV
Ravikumar
Radhakrishnan
R
Mohan
Viswanthan
V
Wilkinson
Ian B
IB
Cockcroft
John R
JR
Davey Smith
George
G
Ben-Shlomo
Yoav
Y
D000293:Adolescent; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D011247:Pregnancy; D011248:Pregnancy Complications / Q000178:diet therapy*; D011634:Public Health; D012307:Risk Factors; D012423:Rural Health
D002784:Cholesterol