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

doi:10.1136/bmj.a605

Published 25 July 2008, doi:10.1136/bmj.a605
Cite this as: BMJ 2008;337:a605

Research

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

Sanjay Kinra, lecturer¹, K V Rameshwar Sarma, senior deputy director (retired)², Ghafoorunissa, senior deputy director (retired)², Vishnu Vardhana Rao Mendu, assistant director², Radhakrishnan Ravikumar, cardiac radiologist³, Viswanthan Mohan, chairman³, Ian B Wilkinson, BHF senior clinical fellow⁴, John R Cockcroft, professor⁵, George Davey Smith, professor⁶, Yoav Ben-Shlomo, professor of clinical epidemiology⁷

¹ Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, ² National Institute of Nutrition, Hyderabad 500 007, India, ³ Madras Diabetes Research Foundation, Chennai 600 086, India, ⁴ Department of Pharmacology, University of Cambridge, Cambridge CB2 2QQ, ⁵ Welsh Heart Centre, Cardiff CF14 4XN, ⁶ MRC Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ⁷ Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: S Kinra sanjay.kinra{at}lshtm.ac.uk

Objective To determine whether integration of nutritional supplementationwith other public health programmes in early life reduces therisk of cardiovascular disease in undernourished populations.

Design Approximately 15 years’ follow-up of participantsborn within an earlier controlled, community trial of nutritionalsupplementation integrated with other public health programmes.

Setting 29 villages (15 intervention, 14 control) near Hyderabadcity, south India.

Participants 1165 adolescents aged 13-18 years.

Intervention Balanced protein-calorie supplementation (2.51MJ, 20 g protein) offered daily to pregnant women and preschoolchildren aged under 6 years, coupled with integrated deliveryof 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 were14 mm (95% confidence interval 4 to 23; P=0.007) taller thancontrols but had similar body composition. The participantsfrom the intervention villages had more favourable measuresof 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) loweraugmentation index. No strong evidence existed for differencesin blood pressures and serum lipids.

Conclusions In this undernourished population, integrated deliveryof supplemental nutrition with other public health programmesin pregnancy and early childhood was associated with a morefavourable profile of cardiovascular disease risk factors inadolescence. This pragmatic study provides the most robust evidenceto date on this important hypothesis for which classic trialsare unlikely. Improved maternal and child nutrition may havea role in reducing the burden of cardiovascular disease in lowincome and middle income countries.

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