India is gaining weight. Traditionally known for malnutrition, Indians now report more and more frequently with overweight, obesity, and their consequences. Indians exhibit unique features of obesity: Excess body fat, abdominal adiposity, increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (such as liver, muscle, and others). Obesity is a major driver for the widely prevalent metabolic syndrome and type-2 diabetes mellitus (T2DM). Although this phenomenon is a global one, India is unique in that it has to grapple with both over- and undernutrition at the same time. This article reviews the weight of the problem of obesity in India.

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Context: Many people around the world strive to achieve younger-looking skin. This is often promised by topical treatments. Oral treatments for skin ageing have been unsuccessful due to their constituents being broken down by acid and enzymes in the gut; however several studies have shown that hydrolyzed collagen is absorbed in the gut and then delivered to skin and joints through the blood stream. Aims: The aim of this study was to determine whether an oral nutritional supplement drink containing hydrolyzed collagen and other specific ingredients reported to have antiageing properties, would have a positive effect on skin wrinkling, elasticity and hydration. Materials and Methods: A double-blind, randomized, placebo controlled clinical trial was conducted on healthy subjects to assess whether this oral supplement could improve certain specific skin properties of post-menopausal women, namely depth of facial wrinkles, skin elasticity and hydration. Results: The evidence provided here proves that the combination of specific ingredients present in this nutritional drink acts to significantly reduce the depth of facial wrinkles and increase skin elasticity and hydration. Conclusions: This study shows that the oral nutritional supplement consisting of hydrolyzed collagen, hyaluronic acid, and essential vitamins and minerals, leads to a significant improvement in wrinkle depth. It is also able to induce noticeable improvement in elasticity and hydration of the skin.

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Murraya koenigii is a culinary important plant of Indian origin, and also been a component of many formulations used in the Ayurvedic system of medicine since many centuries. A scrutiny of literature reveals some notable pharmacological activities of the plant. Carbazole alkaloids which are abundantly present in the leaves, fruits, roots and bark of this plant, have been reported for their antidiabetic, anticancer, antibacterial, anti-nociceptive and antioxidant activities. Besides these activities, the plant is described to have a wide array of therapeutic activities. Phytochemistry and pharmacology of this plant necessitates a comprehensive review of its prospects as an important therapeutic agent for the management of numerous diseases commonly affecting humans. The current review provides a detailed report of the phytochemical, pharmacological, clinical and pre-clinical works carried out on this culinary plant and also throws light on its therapeutic prospects.

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Obesity leads to chronic, excessive adipose tissue expansion resulting in an increase in the risk for cardiovascular disease, type 2 diabetes mellitus, and other metabolic abnormalities. This is primarily thought to stem from the low-grade, systemic inflammatory response syndrome that characterizes adipose tissue in obesity. With a global increase in the prevalence of obesity, nutrition and exercise play a key role in its prevention and treatment. Natural product (nutraceutical) interventions are currently being investigated on a large-scale basis as potential treatments for obesity and weight management. Apart from taking care of the imbalance between energy intake and energy output, nutraceuticals should have the potential to ameliorate the development of oxidative stress and inflammation in obesity, thereby limiting the onset of obesity complications. The current article aims to examine current research on nutraceuticals and their role in the management of obesity and body composition.

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Nutritional needs in patients with chronic kidney disease are different from those of the normal population. As such, estimation of these nutritional requirements mandates a thorough understanding of the various physiologic and pathologic processes related to renal system. Many of these patients get admitted in intensive care and dialysis units at some stage of life for one indication or the other. Intensivists also have to update their knowledge when it comes to providing nutrition to these patients during their intensive care unit (ICU) stay. Majority of these patients are on chronic dialysis and this aspect has to be taken care of while they are treated in ICU. The assessment of nutritional needs and the various dietary modifications requires the services of a nephrologist on patient-to-patient basis depending upon the underlying co-morbid diseases. Majority of the studies involving patients with renal disease have been carried out in normal population, and as such, data is lacking from ICU and dialysis units. The present article is an attempt to discuss various aspects of patients with chronic kidney disease and their nutritional needs and the relevant dietary modifications and is an extrapolation of the present evidence of normal population to the patients admitted in ICU and dialysis units.

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Malnutrition is a serious issue in Pakistani society. During the past few years, many nutritional programmes have been initiated by the governmental and nongovernmental organizations. Some of these programmes focus on raising awareness among the masses while others focus on either directly supplying nutrients to the people or fortification of dietary components. However, the root of the problem-illiteracy, poverty, and socioeconomic deprivation-is still being neglected. These programmes have not yet been able to take control of the situation and Pakistan is still far behind other countries when it comes to nutrition. This article reviews the nutritional programmes in place in Pakistan, analyses their limitations and suggests a way forward.

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Male sexual dysfunction (MSD) is a common and distressful condition which is often amenable to counseling and other non pharmacological therapy. These ALLIANCE guidelines are an exhaustive coverage of the counseling and related non-pharmacological methods used for management of MSD. The guidelines discuss various concepts of medical care, including the bio-psychosocial model, patient centered care, couple centered care, therapeutic patient education, shared decision making, minimizing the discomfort of change, and coping skills training, as related to MSD. They go on to describe the ideal environment and prerequisites in which a proper history should be elicited, and physical examination performed. Counseling related to investigations, physical activity and yoga is described. Specific examples of psychotherapy for various sexual disorders are presented to illustrate the usage of counseling. The guidelines discuss cognitive behavioral therapy, couple centered therapy, family therapy, and use of religion in detail. Counseling regarding pharmacological, device and invasive therapy is also covered. The guidelines conclude with a call to enhance community awareness of MSD

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Background: In India, human immunodeficiency virus (HIV) epidemic occurs in the population in which malnutrition is already endemic. The relationship between HIV and nutrition is multi-faceted and multi-directional. HIV can cause or worsen malnutrition due to decreased food intake, increased energy requirements, and poor nutrient absorption. Malnutrition in turn further weakens the immune system, increasing susceptibility to infections and worsening the disease impact. Materials and Methods: This interventional study was carried out in the antiretroviral therapy (ART) Centre of Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai during the period of July 2011 to February 2012. A total of 123 patients during the study period were included and a pre-designed and pre-tested questionnaire was used to collect data. Data were analyzed using Statistical Package of Social Sciences (SPSS) 16.0. Results: In the present study, out of 123 study participants taken into consideration, 47.15% were males and 52.85% were females. After nutritional counseling, the percentage of participants practice of using boiled or clean water for drinking purpose increased significantly from 30.90% to 82.12% ( P < 0.0001) and to not eat leftover food increased from 26.83% to 81.30% ( P < 0.0001). The change in mean BMI was observed to be statistically significant from baseline Visit I (20.859) to Visit III (21.916) ( P < 0.0001). Conclusion: Effects of nutritional counselling in our study groups were favourable. There were improvements in dietary practices about nutrition in people living with HIV/AIDS.

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Background: Infant feeding and complementary feeding practices are the determinants of growth and development. Inadequate nutrition contributes substantially to childhood death and disease. Restriction of diet during common childhood illnesses further compromises the nutritional status of the child. Objectives: The present study aims to determine the beliefs and practices among rural caregivers regarding diet during common childhood illnesses. Materials and Methods: A cross-sectional study was conducted at pediatrics department of Pravara Rural Hospital, Loni from April to June 2012 by interviewing 200 caregivers of ill children. A pre-designed and pre-tested questionnaire, which based on the beliefs and practices regarding dietary pattern in common childhood illnesses, was used to collect the data. Results were analyzed in the form of percentage and proportions whenever appropriate. Results: In this study, caregivers believed that a child must be fed less during illness. Majority (89%) believed that curd should be restricted during measles, and 69% and 72% believed that oily foods should be restricted during jaundice and fever, respectively. Feeding the child with khichadi (81.5%) was most preferred during measles, while banana (95%) was preferred food during diarrhea. About 32% preferred thinner consistency of food, and 21% believed that the breastfeeding should be decreased during illness. Conclusion: There is scope of improving feeding practices and to remove misbelieves among few caregivers. Health workers should educate elderly caregivers and mothers about the same.

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Context: Gmelina arborea Roxb (Family: Verbenaceae) is widely used in Sri Lankan traditional Ayurvedic medicine for long -term treatment of diabetes mellitus. Aims: To investigate the in vitro and in vivo antioxidant activities of the aqueous bark extract of G. arborea. Materials and Methods: The in vitro total antioxidant activities of the hot water bark extract of G. arborea were evaluated by 2,2'-diphenyl-2-picrylhydrazyl hydrate (DPPH), ferric reducing antioxidant potential (FRAP), and NO inhibition assays. The in vivo antioxidant activity was evaluated by the activities of liver enzymes, antioxidant enzymes, and extent of lipid peroxidation (LPO) in the liver of streptozotocin (STZ)-diabetic rats. Results: In vitro antioxidant assays (DPPH, FRAP, and NO) clearly demonstrated the antioxidant potential of G. arborea extract. The G. arborea extract decreased LPO by 27%; activities of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase decreased by 29%, 23% and 29%, respectively (P < 0.05). The liver reduced glutathione, activities of glutathione reductase, glutathione peroxidase, and glutathione S-transferase of plant extract treated diabetic rats increased to 606.47 ± 8.04 μg/g liver tissue, 7.92 ± 0.75, 8.56 ± 1.00, and 7.44 ± 1.42 nmol/min/mg protein, respectively (P < 0.05). The extract was more effective than glibenclamide in restoring the hepatic antioxidant enzymes in STZ diabetic rats. Conclusions: The present investigation revealed that the bark extract of G. arborea exerts significant in vivo and in vitro antioxidant activities.

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Background: Even after more than three decades of implementation, the success of Integrated Child Development Services program in tackling maternal and childhood problems still remains a matter of concern. The present study was conducted to evaluate nutritional and other activities at Anganwadi centers (AWCs) in different districts of Gujarat state, India. Materials and Methods: A total of 60 AWCs were selected including 46 AWCs from the rural area and 14 AWCs from the urban area during April 2012 to March 2013 from 12 districts of Gujarat. Five AWCs were selected from one district randomly. Detailed information about various nutritional activities including growth monitoring, information related to preschool education (PSE), and nutrition and health education (NHED) were collected. Results: Growth chart was present in 96.7% AWCs and accurately plotted by Anganwadi workers (AWWs) in 95.0% AWCs. Weight monitoring of children was done by using Salter scale/spring balance in 75.0% AWCs, followed by weighing pan (18.3%). Overall 18.5% moderately malnourished and 1.5% severely malnourished children were reported. PSE material was available only in 35.0% AWCs. Only in one-third AWCs, NHED training material was available in adequate quantity. Conclusion: There were gaps in the status of PSE activities in AWCs, which needs to be promptly addressed. The need for PSE should be emphasized to all AWWs. There was also a shortage of supply of PSE and NHED material at the AWCs suggesting need of regular supply of material.

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Malnutrition is common in patients with chronic kidney disease (CKD) and is an important cause of morbidity and mortality. Assessment of nutritional status is mandatory for all CKD patients. Many tools are available for assessing the nutritional status. Patients with CKD need to follow a healthy diet plan to maintain normal protein stores and to avoid metabolic complications. This article deals with the practical aspects of nutrition in patients with CKD.

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Age-related macular degeneration (ARMD) is the most common cause of severe, irreversible, vision loss in elderly people. It is estimated that 20 to 25 million people suffer from ARMD worldwide, of which 8 million people experience blindness. The treatment options are few and usually not successful in restoring the vision back. The anti-oxidants prevent the damage to the macula by free radicals and are beneficial in retarding the progress of ARMD. They also prevent the onset of ARMD. Anti-oxidant supplements are indicated to prevent the onset and retard the progression of ARMD. The Age-Related Eye Disease Study found that the daily supplementation of vitamin C 500 mg, vitamin E 400 IU and beta carotene 15 mg, zinc 80 mg and copper 2 mg for five years significantly retarded the progression of ARMD. Based on the results of this high quality, double blinded study, the American Academy of Ophthalmology recommends that patients with intermediate and severe ARMD consider taking antioxidants plus zinc on a daily basis.

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With the ever increasing epidemic of obesity, diabetes and hypertension among young adults, the risk of mortality and morbidity due to atherosclerotic heart disease is gradually increasing. Dyslipidemia is an additional risk factor for cardiovascular disease. Nutraceutical supplements can provide valid alternate to patients who are intolerant to statins or patients preferring alternative treatments. The combination of a lipid lowering diet and scientifically proven nutraceutical supplements can significantly reduce low density lipoprotein (LDL) cholesterol, increase LDL particle size, decreased LDL particle number decreased triglycerides and increased high density lipoprotein (HDL) particles. In addition, they address lipid induced vascular damage by suppressing inflammation, oxidative stress and immune response leading to additional antihypertension, antidiabetic properties. The current article reviews the evidence in support of different dietary supplements and their lipid lowering beneficial effects.

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There is a growing concern of vitamin D deficiency and its relationship with several extra-skeletal pathological states, ranging from immune disorders (systemic lupus erythematosus, type 1 diabetes mellitus, multiple sclerosis, inflammatory bowel diseases, and rheumatoid arthritis), cardiovascular disorders (coronary artery disease, atherosclerosis, and hypertension), infections (viral and bacterial), endocrine disorders (growth failure, infertility in males, metabolic syndrome, and type 2 diabetes mellitus), neuro-psychiatric, and neuro-degenerative disorders, renal disorders, chronic lung disorders to cancer. Besides its positive effects on the musculo-skeletal system, vitamin D has shown to take an active part in the regulation of cellular proliferation, differentiation, apoptosis, and angiogenesis. It has been shown to control approximately 3% of the human genes directly or indirectly. Although there is a strong body of evidence toward implication of vitamin& D deficiency with several extra-skeletal disorders, it remains unclear if vitamin D supplementation may slow down, halt or even reverse the disease processes. This review aims to discuss the potential associations of vitamin D with various extra-skeletal disorders.

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Vitamin D deficiency often presents with musculoskeletal symptoms, such as pain and weakness. These symptoms are common, presenting complaints in patients across the country, across medical specialties. This work highlights the high incidence of low vitamin D levels among 234 female patients presenting with musculoskeletal symptoms in Haryana, North India. A single center cross-sectional study was performed in patients presenting with various musculoskeletal complaints, during winter months. Analysis of 25-hydroxy vitamin D levels revealed a prevalence of vitamin D deficiency of 55.55% and insufficiency of 38.46% (combined: 94.01%).

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Introduction: Fish oils, containing mainly poly-unsaturated fatty acids (PUFA), are reported to be nutri-medically beneficial. There is however little or no data on the lipid contents of, and fatty acids present in, culinary fish species consumed in Umuahia, Nigeria, hence this study. Methods: The fatty acid saturation profiles and lipid contents of Scomberomorus maculatus (Mitchill, 1815), Micropogonias undulatus (Linnaeus 1766), Chrysichthys nigrodigitatus (Lacépède: 1803), Trichiurus japonicus (Temminck and Schlegel, 1844), Sardinella pilchardus (Walbaum, 1792), and Prochilodus lineatus (Valenciennes, 1836), all culinary fishes consumed in Umuahia were studied using standard procedures. Results: C. nigrodigitatus had the highest crude lipid content (21.1 ± 1.1%) followed by S. pilchardus (20.4 ± 0.6%) and P. lineatus (20.1 ± 1.0%). S. maculatus and T. japonicus had the lowest crude lipid content (~13.3% each). PUFA were most abundant in S. maculatus (40.5 ± 0.4%) and T. japonicus (39.9 ± 0.5%), but least abundant in S. pilchardus and C. nigrodigitatus (~6.0% each). Linolenic and palmitic acids were the most abundant PUFA and saturated fatty acid, respectively, in the studied fish species. Conclusion: S. maculatus and T. japonicus are the most nutri-medically desirable fishes of the six studied species.

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Under nutrition is still a major problem in India and at the same time overweight and obesity are also beginning to affect a substantial proportion of the population. Macro and micronutrient deficiencies affect a significant proportion of the population. Children, pregnant, and lactating women are the most affected with the retardation of cognitive and physical growth, increased susceptibility to infections which ultimately affects productivity of the country. Hence, the Government has devised several national programs like Integrated Child development services (ICDS), National Iron + initiative, National Iodine deficiency disorder control program (NIDDCP) etc., The activities under each program have been listed and its impact as assessed by various evaluation programs has also been mentioned. The determinants of under nutrition are a result of a complex interaction between various factors articulated by UNICEF as immediate, underlying, and fundamental determinants. The fact remains that inspite of all the programs, household food security is determined by a more complex array of factors. Concerted effort and a convergence by all the programs are required with particular emphasis on gender equity. More attention is required in rural areas, scheduled caste and tribe people, very young children between 0-2 years, and the girl child.

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Nutrition in the critically ill patients has always been a difficult task for the intensivist. Unlike normal subjects, various physiological and pathological aspects have to be taken into consideration before initiating the nutrition in this subset of patients. The associated morbidities in critically sick patient not only pose clinical difficulties to maintain a normal nutritional status but also create various limitations in selection of a particular nutrient. Various diseases commonly found in intensive care patients produces stress on the body and bring about changes in substrate metabolism thus leading to the deficiency of various nutrients. Numerous tools and methodologies are available nowadays to predict the assessment, screening, and monitoring of the nutritional status in critically ill patients. However, the nutritional status is a big decisive factor in predicting the outcome and malnutrition has been strongly associated with increased mortality and morbidity in these patients. The nutritional requirement also varies with regards to age, body mass index, co-morbid disease, duration in ICU, and many other factors and as such the calculation for nutritional supplementation has to be done strictly on an individual basis. In all these patients, it is also vital to achieve a strict glycemic control by using insulin so as to prevent any increase in morbidity and mortality. Enteral and parenteral nutritional controversies are as old as the concept of nutrition in Intensive Care Unit (ICU). Besides therapeutic merits, both enteral and parenteral nutrition are also associated with complications which can be prevented by set protocols as well as by education of nursing personnel involved in the care of critically ill. This article reviews all these aspects concerned with nutrition in critically ill patients so as to make an effort to build a comprehensive approach and strategies for designing the nutritional supplementation.

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Vitamin A deficiency is a major cause of childhood mortality and morbidity in India and other developing countries. The ocular manifestations of vitamin A are collectively called xerophthalmia and range from conjunctival xerosis to severe blinding complications such as keratomalacia. Vitamin A deficiency exists as a major public health nutrition problem among preschool-aged children, especially in the South East Asian region, as well as among the pregnant and lactating women. Deficiency can be diagnosed by the ocular manifestations such as Bitot's spots, serum retinol levels, and conjunctival impression cytology (CIC). Improving vitamin A status in the diet or by periodic administration of vitamin A to children can reduce both mortality and blindness. This review is an attempt to highlight the ocular manifestations of vitamin A deficiency, its prevalence, treatment, and preventive strategies.

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Background: Pregnancy is characterized by generation of reactive species and reduction in immune functions of the woman, exposing her to oxidative stress and infections/infestations. In developing countries, pregnant women seldomly seek antenatal care early in their pregnancies, exposing them to pregnancy complications. Aim: The aim of this study is to measure the levels of anti-infective antioxidant minerals – selenium and zinc, in rural pregnant women who are on their first antenatal visits, to know their status before routine antenatal supplements are commenced. Materials and Methods: Serum selenium and zinc concentrations were determined using atomic absorption spectrophotometer, in 181 apparently normal pregnant rural women aged between 18 and 40 years, who were on first antenatal visits. They were first grouped according to trimesters and later according to parity. Controls were 50 age-matched, non-pregnant women who were not in their menstrual periods at the time of the study. Results: Results showed that serum selenium and zinc in pregnant women were significantly lower (P < 0.001) than values obtained from non-pregnant women (controls). However, there was no significant difference between the values from the controls and first trimester in both elements (P = 0.964 and 0.974, respectively), but thereafter, the elements became significantly lower (P < 0.001) and remained so throughout gestation. Though both elements showed significantly lower value in each parity group when compared with the control (P < 0.001), selenium did not show significant difference (P = 0.066) between one parity group and another, while zinc showed significantly higher value (P < 0.001) in high multiparas over preceding parity group. Conclusion: Our results suggest that pregnant women in the rural areas are prone to oxidative stress and infections ever before they seek for antenatal care. Public health education should be organized regularly in these rural areas to highlight the dangers of late antenatal registration, while the need for consumption of local foods that contain these trace elements by pregnant women should be emphasized on antenatal days.

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Background: The diabetes pandemic puts an unmanageable load on exisiting health care services, especially in resource challenged settings. It is necessary to create simple, easy-to-administer, and easy-to-understand dietary prescriptions which can be explained in a short period of time, by diabetes care providers without formal training in nutrition, to patients . Aim: This study assesses the accuracy and utility of an easy-to-administer diet, termed as the Bharti Hospital, weight ÷ 10, two minute diet. Materials and Methods: This prospective, unicentric, observational study was performed at an endocrine center in Haryana, north India. Two hundred consecutive persons with diabetes were explained a simple diet, with a single page visual aid, by a multipurpose diabetes worker, supervised by the consultant dietician and endocrinologist. Accuracy of the dietary prescription was assessed by calorie and nutrient content, measured by the dietician. Efficiency was measured by the time taken to administer the dietary prescription. Acceptability of the diet therapy was judged as a patient-reported outcome, using a pre-tested structured questionnaire, self-administered by the subject after undergoing nutritional counseling. Efficacy was assessed in all patients who returned at one month for follow-up, using a 24-hour dietary recall questionnaire. Results: Without counting calories from cooking fat/oil, the calorie content of the diet was 17.5 calories/kg/day, with a balanced mix of carbohydrates, proteins, and fat. The times taken to administer this diet ranged from 1.0 to 7.5 minutes (mean average, 3.15 ± 2.46 minutes). Patients rated acceptability of this prescription at 4.1 ± 0.7 on a 5-point Likert scale. Forty patients, followed up at 1 month, reported caloric intake of 24.3 ± 4.51 cals/kg/day. Conclusion: The Bharti Hospital 2 minute weight ÷ 10 diet provides a simple framework upon which a dietary prescription can be based. It provides a fast, yet effective method of explaining dietary management by staff who do not have formal qualification in nutrition, and is acceptable to patients. This diet should be customized and studied in different culinary regions across the world.

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Background: In Pakistan, poor infant and young child feeding practices are contributing to the burden of infectious diseases and malnutrition. Objective: This study aimed to estimate the determinants of selected feeding practices and key indicators of breastfeeding in Pakistan. Materials and Methods: Total 5718 children aged 0 to 23 months from the Pakistan Demographic and Health Survey of 2006-2007 were included. WHO recommended infant and young child feeding indicators were estimated, and selected feeding indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Results: Only 26.3% of mothers initiated breastfeeding within the first hour after birth, 97.6% had ever breastfed, 92.5% were currently breastfeeding, and 62.7% were currently bottle feeding. Bottle feeding rates were higher among infants whose mothers partner had worked (OR = 1.66), had ever been employed (OR = 1.17), birth order > 5 (OR = 1.25) and in the Richest wealth quintiles (OR for the richest = 2.34). The likelihood of not initiating breastfeeding within first hour after birth was higher for mothers those who were not visited to the antenatal clinic (OR = 1.54), no post natal visits (OR = 1.45), working mother (OR = 1.76), delivery at facility based centre (OR = 1.95), richer households (OR = 1.77), birth order > 5 (OR = 1.67), and formally married women (OR = 2.31). Conclusions: Breastfeeding practice indicators suggest that there is need for promotion of correct/recommended breastfeeding practices in the community. Breast feeding promotion should targeted those women who have younger age and working in the urban areas.

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Nutritional management in critically ill-patients is always a challenging task as malnutrition can have a direct impact on the prognosis. Besides assessing for nutritional requirement, the underlying severe illness and co-morbidities have to be given due consideration. Nutritional assessment has to be individualized, and nutritional plan should be formulated by involving a dedicated nutritionist. Early initiation of nutrition definitely improves the outcome in critically ill patients. Facts and principles of enteral and parenteral nutrition must be disseminated among all physicians and nursing staff working in intensive care units. Majority of old controversies related to parenteral and enteral nutrition have been settled with the intervention of various national and international committees such as Alliance and Espen. Nutritional disorders such as malnutrition, overfeeding and negative energy balance are highly associated with increased morbidity and mortality. Enteral nutrition though always preferred can always be supplemented with parenteral nutrition so as to optimize nutrition and energy status in critically ill patients.

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