South Asian Children Research Articles

Common Variants of FTO Are Associated with Childhood Obesity in a Cross-Sectional Study of 3,126 Urban Indian Children

Background FTO variants are robustly associated with obesity and related traits in many population and shown to have variable impact during life course. Although studies have shown association of FTO variants with adiposity in adult Indian, its association in Indian children is yet to be confirmed.MethodsHere we examined association of FTO variants (rs9939609 and rs8050136) with obesity and related anthropometric and biochemical traits in 3,126 Indian children (aged 11–17 years) including 2,230 normal-weight and 896 over-weight/obese children. We also compared effects observed in the present study with that observed in previous studies on South Asian adults and children of other ethnic groups.ResultsThe variant rs9939609 showed significant association with risk of obesity [OR = 1.21, P = 2.5×10−3] and its measures BMI, weight, waist circumference and hip circumference [β range = 0.11 to 0.14 Z-score units; P range = 1.3×10−4 to 1.6×10−7] in children. The observed effect sizes in Indian children were similar to those reported for European children. Variant rs9939609 explained 0.88% of BMI variance in Indian children. The effect sizes of rs9939609 on BMI and WC were ∼2 fold higher in children than adults. Interestingly rs9939609 was also associated with serum levels of thyroid stimulating hormone (TSH) [β = 0.10 Z-score, P = 5.8×10−3]. The other variant rs8050136 was in strong linkage disequilibrium with rs9939609 (r2 = 0.97) and provided similar association results.ConclusionThe study provides first report of association of FTO variants with obesity and related anthropometric traits in Indian children with higher impact in children compared to adults. We also demonstrated association of FTO variant with serum levels of TSH, indicating putative influence of FTO in hypothalamic-pituitary-thyroid axis.

506 Do South Asian Babies have more Congenital Heart Defects, does Consanguinity Influence it? findings from Born in Bradford Study

Background and AimsBorn in Bradford is a birth cohort study established in March 2007 to look at health and outcomes in a multi ethnic population in Bradford (UK). We aimed...

Differences in body composition between infants of South Asian and European ancestry: the London Mother and Baby Study

Background South Asian children and adults have a more adipose body composition compared with those of European ancestry. This is thought to be related to their increased risk of metabolic disorders. However, little is known about how early in life such differences are manifest.Objective To determine whether there are differences in fat mass (FM) and fat-free mass (FFM) between UK-born South Asians and White Europeans in infancy.Design A cross-sectional study of 30 South Asian and 30 White European infants aged 6–12 weeks. Mothers were recruited from clinics in London, and infants’ FM and FFM were determined using air-displacement plethysmography (PeaPod®).Results In early infancy South Asians had less FFM than White Europeans [0.34 kg less, 95% confidence interval (CI): 0.15, 0.52], with a considerably weaker indication of them also having more FM (0.02 kg more, 95% CI: −0.14, 0.18). These differences persisted when the overall smaller body size of South Asian infants was taken into account. For a given total infant weight, the balance of body composition of South Asians was shifted by 0.16 kg (95% CI: 0.06, 0.25) from FFM to FM. The ethnic differences in the amount of FFM were almost completely accounted for by ethnic differences in the rate of growth in utero and length of gestation.Conclusions The characteristic differences in body composition observed between adult South Asians and White Europeans are apparent in early infancy. Of particular note is that this is the first study to demonstrate that South Asians compared with White Europeans have reduced FFM in infancy. The early manifestation of this phenotype suggests that it is either genetic and/or determined through exposure to maternal physiology, rather than a consequence of behaviours or diet in childhood or at older ages.

OP29 Ethnic and Socioeconomic Influences on Childhood Blood Pressure: The Child Heart and Health Study in England (Chase)

BackgroundCompared to UK white European adults, UK black African-Caribbean adults have higher mean systolic (SBP) and diastolic (DBP) blood pressure; UK South Asian adults have higher mean DBP but lower...

Differences in body composition and metabolic status between white UK and Asian Indian children (EarlyBird 24 and the Pune Maternal Nutrition Study)

What is already known about this subjectSouth Asian children at birth are thinner, but more adipose and more resistant to insulin than White Caucasian children.South Asian adults are more adipose and more insulin resistant, but their greater adiposity does not fully explain the difference in insulin resistance.South Asian children at 8 y are more insulin resistant than White Caucasian children.What this study addsThe BMI of South Asian children at 6 y is distributed normally, while that of White Caucasian children is heavily skewed.South Asian children at 6 y are slimmer, and the boys, but not the girls, are more adipose.South Asian boys, but not girls are more insulin resistant. Both genders metabolically less healthy, but their adiposity explains only part of the difference.Background/AimsThe concept of the ‘thin–fat’ Indian baby is well established, but there is little comparative data in older children, and none that examines the metabolic correlates. Accordingly, we investigated the impact of body composition on the metabolic profiles of Asian Indian and white UK children.MethodsBody mass index (BMI), waist circumference, sum of four skin-folds, % body fat (by dual-energy X-ray absorptiometry), glucose, insulin, insulin resistance (Homeostasis Model Assessment), trigylcerides, cholesterol [total, low-density lipoprotein, high-density lipoprotein {HDL}, total/HDL ratio] and blood pressure (systolic, diastolic and mean arterial) were measured in 262 white Caucasian children from Plymouth, UK (aged 6.9 ± 0.2 years, 57% male), and 626 Indian children from rural villages around Pune, India (aged 6.2 ± 0.1 years, 53% male).ResultsIndian children had a significantly lower BMI (boys: −2.1 kg m−2, girls: −3.2 kg m−2, both P < 0.001), waist circumference (P < 0.001) and skin-fold thickness (P < 0.001) than white UK children, yet their % body fat was higher (boys +4.5%, P < 0.001, girls: +0.5%, P = 0.61). Independently of the differences in age and % body fat, the Indian children had higher fasting glucose (boys +0.52 mmol L−1, girls +0.39 mmol L−1, both P < 0.001), higher insulin (boys +1.69, girls +1.87 mU L−1, both P < 0.01) and were more insulin resistant (boys +0.25, girls +0.28 HOMA-IR units, both P < 0.001).ConclusionsThe ‘thin–fat’ phenotype observed in Indian babies is also apparent in pre-pubertal Indian children who have greater adiposity than white UK children despite significantly lower BMIs. Indian children are more insulin resistant than white UK children, even after adjustment for adiposity.

Does genotype predict response to treatment in children infected with hepatitis B perinatally?

HBV genotype may correlate with outcome and treatment response. Genotype has been compared with treatment response in children infected perinatally with hepatitis B following treatment with oral antiviral drugs (lamivudine or adefovir) or interferon (IFN) alone and with prednisolone priming (Pred/IFN). All children who took part in clinical trials in this unit since 1990 were included. Hepatitis B genotypes were determined by direct sequencing or using a commercial line probe assay (InnoLipa). Sixty-five children were included; 20 were treated with IFN; 19 with Pred/IFN; 22 with lamivudine and 7 with adefovir, some took part in more than one treatment study. 63 out of 65 children were clearly typed into single genotypes; 16, 7, 3, and 37 typing as A, B, C, and D respectively. The majority of South-Asian children had genotype D and European and Afro-Caribbean children were more likely to have genotype A. Treatment response (seroconversion from HBeAg to Anti-HBe) was better in children with genotypes A [n = 16] and D [n = 37] (55.5% and 48.7%), compared to those with B [n = 7] and C [n = 3] (12.5% and 0%) for all treatments. The response to interferon alone was better in children with genotype A compared to D (50% and 36%), but prednisolone priming improved the response so that there was no difference between genotypes A and D (66.7% and 70%). Assessment of genotype in children pre-treatment may provide a guide to potential response. The response to treatment by genotype should be evaluated in future clinical trials in children.

37 – South Asian children spend more time in light activities and less time in moderate and vigorous PA on weekdays

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Travel to School and Physical Activity Levels in 9–10 Year-Old UK Children of Different Ethnic Origin; Child Heart and Health Study in England (CHASE)

BackgroundTravel to school may offer a convenient way to increase physical activity levels in childhood. We examined the association between method of travel to school and physical activity levels in urban multi-ethnic children.Methods and Findings2035 children (aged 9–10 years in 2006–7) provided data on their usual method of travel to school and wore an Actigraph-GT1M activity monitor during waking hours. Associations between method of travel and mean level of physical activity (counts per minute [CPM], steps, time spent in light, moderate or vigorous activity per day) were examined in models adjusted for confounding variables. 1393 children (69%) walked or cycled to school; 161 (8%) used public transport and 481 (24%) travelled by car. White European children were more likely to walk/cycle, black African Caribbeans to travel by public transport and South Asian children to travel by car. Children travelling by car spent less time in moderate to vigorous physical activity (−7 mins, 95%CI-9,-5), and had lower CPM (−32 CPM, 95%CI-44,-19) and steps per day (−813 steps, 95%CI,-1043,-582) than walkers/cyclists. Pupils travelling by public transport had similar activity levels to walkers/cyclists. Lower physical activity levels amongst car travellers' were especially marked at travelling times (school days between 8–9 am, 3–5 pm), but were also evident on weekdays at other times and at weekends; they did not differ by gender or ethnic group.ConclusionActive travel to school is associated with higher levels of objectively measured physical activity, particularly during periods of travel but also at other times. If children travelling by car were to achieve physical activity levels (steps) similar to children using active travel, they would increase their physical activity levels by 9%. However, the population increase would be a modest 2%, because of the low proportion of car travellers in this urban population.

Ambulatory physical activity levels of white and South Asian children in Central England

To assess ambulatory physical activity in white and south Asian children from Central England and to examine variation in activity between weekdays and weekends. 536 primary school children [255 boys and 281 girls, mean age (SD) = 9.6 (1.0) years] wore a sealed pedometer for 4 days (2 weekend and 2 weekdays). Repeated measures analysis of covariance was used to examine weekend versus weekday, gender, ethnic and socio-economic status differences in steps/day controlling for age, hours of daylight and body mass index (BMI). Children attained significantly higher mean steps/day during weekdays than weekends (p = 0.001) with age being more strongly associated with weekend than weekday steps/day (p = 0.014). The decline in steps/day from weekdays to weekends was greater in high compared to low socio-economic status children (p = 0.002). White children attained higher mean steps/day than south Asian children (p = 0.015). BMI was negatively associated with steps/day (p = 0.004). 39.2 and 29.9% of white and south Asian children met the BMI-referenced cut-offs for health. Physical activity was greater during weekdays compared to weekends, was associated with BMI, age and socio-economic status and white children were more active than south Asian children.

South Asian children: contribution of meals and snacks towards nutrient intake

An abstract is not available for this content. As you have access to this content, full HTML content is provided on this page. A PDF of this content is also available in through the ‘Save PDF’ action button.

Nutrient intake of South Asian children compared with UK recommendation

Nutrient intake of South Asian children compared with UK recommendation

Ethnic differences in macular thickness

To determine ethnic differences in time-domain (Stratus) optical coherence tomography-measured macular thickness in 12-year-old children. Population-based cross-sectional study. A total of 2367 children from grade 7 (mean age 12.7 ± 0.45 years) examined during the Sydney Myopia Study during 2004-2005. Examination included determination of best corrected visual acuity. Autorefraction was performed after cycloplegia. Axial length was measured using non-contact interferometry and OCT was performed using Stratus OCT. Ethnicity was self reported by participants' parents. Macular thickness. The four largest ethnic groups were Caucasian (n = 1224), East Asian (n = 291), South Asian (n = 107) and Middle Eastern (n = 146). The greatest ethnic differences were found at the central macula, which was significantly thicker in Caucasian compared with East Asian, South Asian and Middle Eastern children (mean differences 9.0 µm, 12.1 µm and 6.5 µm, respectively; all P < 0.0001). The average inner macula was significantly thicker in Caucasian than East Asian and South Asian children (P = 0.005 and P < 0.0001, respectively). The average outer macula was significantly thicker in Caucasian than Middle Eastern and South Asian children (P = 0.03 and P < 0.0001, respectively). Macular parameters were found to vary by ethnicity in 12-year-old children. Caucasian children had the thickest macular parameters and South Asian children had the thinnest. The greatest differences were found in the central macula.

Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years

BackgroundCentral obesity has been associated with the risk of cardiovascular and metabolic disease in children and anthropometric indices predictive of central obesity include waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). South Asian children have higher body fat distribution in the trunk region but the literature regarding WC and related indices is scarce in this region. The study was aimed to provide age- and gender-specific WC, WHR and WHtR smoothed percentiles, and to explore prevalence and correlates of central obesity, among Pakistani children aged five to twelve years.MethodsA population-based cross-sectional study was conducted with a representative multistage random cluster sample of 1860 primary school children aged five to twelve years in Lahore, Pakistan. Smoothed percentile curves were constructed for WC, WHR and WHtR by the LMS method. Central obesity was defined as having both age- and gender-specific WC percentile ≥90th and WHtR ≥0.5. Chi-square test was used as the test of trend. Multivariate logistic regression was used to quantify the independent predictors of central obesity and adjusted odds ratios (aOR) with 95% CI were obtained. Linear regression was used to explore the independent determinants of WC and WHtR. Statistical significance was considered at P < 0.05.ResultsFirst ever age- and gender-specific smoothed WC, WHR and WHtR reference curves for Pakistani children aged five to twelve years are presented. WC increased with age among both boys and girls. Fiftieth WC percentile curves for Pakistani children were higher as compared to those for Hong Kong and British children, and were lower as compared to those for Iranian, German and Swiss children. WHR showed a plateau pattern among boys while plateau among girls until nine years of age and decreased afterwards. WHtR was age-independent among both boys and girls, and WHtR cut-off of ≥0.5 for defining central obesity corresponded to 85th WHtR percentile irrespective of age and gender. Twelve percent children (95% CI 10.1-13.0) had a WC ≥90th percentile and 16.5% children (95% CI 14.7-18.1) had a WHtR ≥0.5 while 11% children (95% CI 8.9-11.6) had both WC ≥90th percentile and WHtR ≥0.5. Significant predictors of central obesity included higher grade, urban area with high socioeconomic status (SES), high-income neighborhood and higher parental education. Children studying in higher grade (aOR 5.11, 95% CI 1.76-14.85) and those living in urban area with high SES (aOR 82.34, 95% CI 15.76-430.31) showed a significant independent association. Urban area with high SES and higher parental education showed a significant independent association with higher WC and higher WHtR while higher grade showed a significant independent association with higher WC.ConclusionsComprehensive worldwide reference values are needed to define central obesity and the present study is the first one to report anthropometric indices predictive of central obesity for Pakistani school-aged children. Eleven percent children were centrally obese and strong predictors included higher grade, urban area with high SES and higher parental education. These findings support the need for developing a National strategy for childhood obesity and implementing targeted interventions, prioritizing the higher social class and involving communities.

Ethnic Differences in Fraction of Exhaled Nitric Oxide and Lung Function in Healthy Young Children

Ethnic differences in lung function in school-aged children and adults are well recognized, but little is known about such differences in preschool children. We investigated whether differences exist in fraction of exhaled nitric oxide (Feno), multiple-breath washout (MBW) indices, specific airways resistance (sRaw), and spirometry indices between healthy preschool children of South Asian and white European origin. Feno, MBW indices (lung clearance index, functional residual capacity, conductive airways inhomogeneity, and acinar airways inhomogeneity), sRaw, and spirometry were measured in healthy South Asian and white children aged 4 to 6 years, and comparisons were made between the two groups. Statistical analyses were by multiple linear regression and t tests. Thirty-seven white (mean age 5.8 ± 0.7 years, 49% boys) and 31 South Asian children (mean age 5.4 ± 0.8 years, 52% boys) were recruited. Feno was, on average, 36% higher (P < .05) in South Asian children compared with white children. FVC and FEV(1) and fractions thereof (FEV(0.75) and FEV(0.5)) z-scores were significantly lower in South Asian compared with white children by 0.69 (P = .01), 0.76 (P = .004), 0.76 (P = .009), and 0.85 (P = .002) z-scores, respectively, but there were no significant differences in FEV(1)/FVC, FEF(25-75), sRaw, or MBW indices. Differences in Feno and forced expiratory lung volumes between South Asian and white children exist from a very young age. Ethnic differences should be taken into account when interpreting lung function results in preschool children for effective management of respiratory conditions.

Survival trends of cancer amongst the south Asian and non-south Asian population under 30 years of age in Yorkshire, UK

Introduction: Several studies have shown differences in survival trends between ethnic groups across adults with cancer in the UK. It is unclear whether these differences exist exclusively in the older adult population or whether they begin to emerge in children and young adults. Methods: Subjects ( n = 3534) diagnosed with cancer under 30 years of age in Yorkshire between 1990 and 2005 were analysed. Differences in survival rates for diagnostic subgroups were estimated by ethnic group (south Asian or not) using Kaplan–Meier estimation and Cox regression. Results: When compared to non-south Asians (all other ethnic groups excluding south Asians) a significant increased risk of death was seen for south Asians with leukaemia (hazard ratio (HR) = 1.75; 95% confidence interval (CI) = 1.11–2.76) and lymphoma (HR = 2.05; 95% CI = 1.09–3.87), whereas south Asians with solid tumours other than central nervous system tumours had a significantly reduced risk of death(HR = 0.50; 95% CI = 0.28–0.89). This was independent of socioeconomic deprivation. Conclusion: We found evidence of poorer survival outcomes for south Asians compared to non-south Asian children and young adults with leukaemia and lymphoma, but better outcomes for south Asian children and young adults with other solid tumours. This needs to be explained, and carefully addressed in the on-going development of cancer services.

Ethnic differences in carotid intima media thickness and carotid-femoral pulse wave velocity are present in UK children

BackgroundThere are marked ethnic differences in cardiovascular risk in UK adults; South Asians have high coronary heart disease (CHD) and stroke risks while black African-Caribbeans have high stroke risks and...

Ethnic factors in mental health service utilisation among people with intellectual disability in high‐income countries: systematic review

An emerging literature suggests that ethnic and cultural factors influence service utilisation among people with intellectual disability (ID), but this has not previously been reviewed. To investigate possible ethnic variation in uptake of mental health services in children, adolescents and adults with ID in high-income countries. A systematic review using main databases of studies that consider ethnic influences on mental health utilisation of people with ID. Methodological quality of studies was assessed. Nine studies that reached selection criteria were identified. Six studies that compared two or more ethnic groups found a variation in levels of mental health service utilisation. The most consistent finding was that South Asian children, adolescents and adults with ID in the UK had lower use of mental health services than White British comparison groups. Ethnic influences on mental health service utilisation were identified. Understanding their significance and potential negative consequences requires further investigation.

P2-324 Ethnic differences in cardiovascular risk in childhood: comparison of UK south Asian, African-Caribbean and European children

IntroductionUK South Asian adults have high risks of coronary heart disease, stroke and type 2 diabetes (T2D) when compared with Europeans; UK African-Caribbeans have high risks of stroke and T2D...

Childhood ethnic differences in ametropia and ocular biometry: the Aston Eye Study

To describe the methodology, sampling strategy and preliminary results for the Aston Eye Study (AES), a cross-sectional study to determine the prevalence of refractive error and its associated ocular biometry in a large multi-racial sample of school children from the metropolitan area of Birmingham, England. A target sample of 1700 children aged 6-7 years and 1200 aged 12-13 years is being selected from Birmingham schools selected randomly with stratification by area deprivation index (a measure of socio-economic status). Schools with pupils predominantly (>70%) from a single race are excluded. Sample size calculations account for the likely participation rate and the clustering of individuals within schools. Procedures involve standardised protocols to allow for comparison with international population-based data. Visual acuity, non-contact ocular biometry (axial length, corneal radius of curvature and anterior chamber depth) and cycloplegic autorefraction are measured in both eyes. Distance and near oculomotor balance, height and weight are also assessed. Questionnaires for parents and older children will allow the influence of environmental factors on refractive error to be examined. Recruitment and data collection are ongoing (currently N=655). Preliminary cross-sectional data on 213 South Asian, 44 black African Caribbean and 70 white European children aged 6-7 years and 114 South Asian, 40 black African Caribbean and 115 white European children aged 12-13 years found myopia prevalence of 9.4% and 29.4% for the two age groups respectively. A more negative mean spherical equivalent refraction (SER) was observed in older children (-0.21 D vs +0.87 D). Ethnic differences in myopia prevalence are emerging with South Asian children having higher levels than white European children 36.8% vs 18.6% (for the older children). Axial length, corneal radius of curvature and anterior chamber depth were normally distributed, while SER was leptokurtic (p<0.001) with a slight negative skew. The AES will allow ethnic differences in the ocular characteristics of children from a large metropolitan area of the UK to be examined. The findings to date indicate the emergence of higher levels of myopia by early adolescence in second and third generation British South Asians, compared to white European children. The continuation of the AES will allow the early determinants of these ethnic differences to be studied.

Prediction of body-fat percentage from skinfold and bio-impedance measurements in Indian school children.

Few equations for calculating body-fat percentage (BF%) from field methods have been developed in South-Asian children. The objective of this study was to assess agreement between BF% derived from primary reference methods and that from skinfold equations and bio-impedance analysis (BIA) in Indian children. We measured BF% in two groups of Indian children. In Pune, 570 rural children aged 6-8 years underwent dual-energy X-ray absorptiometry (DXA) scans. In Mysore (18)O in doubly labeled water was administered to 59 urban children aged 7-9 years. We conducted BIA at 50 kHz and anthropometry, including sub-scapular and triceps skinfold thicknesses. We used the published equations of Wickramasinghe, Shaikh, Slaughter and Dezenburg to calculate BF% from anthropometric data and the manufacturer's equation for BIA measurements. We assessed agreement with values derived from DXA and doubly labeled water using Bland-Altman analysis. Children were light and thin on average compared with international standards. There was poor agreement between the reference BF% values and those from all equations. Assumptions for Bland-Altman analysis were not met for Wickramasinghe, Shaikh and Slaughter equations. The Dezenberg equations under-predicted BF% for most children (mean difference in Pune -13.4, LOA -22.7, -4.0 and in Mysore -7.9, LOA (-13.7 and -2.2). The mean bias for the BIA equation in Pune was +5.0% and in Mysore +1.95%, and the limits of agreement were wide; -5.0, 15.0 and -7.8, 11.7 respectively. Currently available skinfold equations do not accurately predict BF% in Indian children. We recommend development of BIA equations in this population using a four-compartment model.