South Asian Children Research Articles

The impact of domestic violence exposure on South Asian children in the United States: Perspectives of domestic violence agency staff

The South Asian community is the fastest growing ethnic group in the United States, and past research suggests that South Asian domestic violence (DV) survivors may require culturally-specific resources. Similarly, South Asian children in the US exposed to DV may have unique responses and needs, but this has not been explored to date. The objective of this study was to examine the specific needs of South Asian children exposed to DV from the vantage point of staff from South Asian DV agencies across the United States. Thirty interviews were conducted, with data coded and consolidated into larger themes using thematic analysis. Participants described several factors important to understanding the impact of DV on South Asian children including the role of the extended family, identifying with two cultures, fear about what the South Asian community will think, gender differences, and the importance of projecting an image of perfection. Participants also discussed development of culturally-tailored resources. This study suggests the importance of framing South Asian children’s experiences within the context of interweaving South Asian and American cultural values, with careful attention paid to how potential culture clashes between parents and children may impact the way children process trauma. Further work should triangulate these themes with children, parents, and extended family, as well as collaborate with South Asian DV agencies to design child-focused programs.

Systematic review of infant and young child complementary feeding practices in South Asian families: the Pakistan perspective.

Suboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged <2 years in Pakistan. Searches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0-2 years and/or their families. Search terms: 'children', 'feeding' and 'Asians' with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence). From 45 712 results, seventeen studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF was found in all studies. Nine of fifteen studies assessing timing recorded CF introduced between 6 and 9 months. Five of nine observed dietary diversity across four of seven food groups; and two of four, minimum meal frequency in over 50 % of participants. Influencing factors included lack of CF knowledge, low maternal education, socio-economic status and cultural beliefs. This is the first systematic review to evaluate CF practices in Pakistan. Campaigns to change health and nutrition behaviour are needed to meet the substantial unmet needs of these children.

Patterns of childhood body mass index (BMI), overweight and obesity in South Asian and black participants in the English National child measurement programme: effect of applying BMI adjustments standardising for ethnic differences in BMI-body fatness associations

Background:The National Child Measurement Programme (NCMP) records weight and height and assesses overweight-obesity patterns in English children using body mass index (BMI), which tends to underestimate body fatness in South Asian children and overestimate body fatness in Black children of presumed African ethnicity. Using BMI adjustments to ensure that adjusted BMI was similarly related to body fatness in South Asian, Black and White children, we reassessed population overweight and obesity patterns in these ethnic groups in NCMP.Methods:Analyses were based on 2012–2013 NCMP data in 582 899 children aged 4–5 years and 485 362 children aged 10–11 years. Standard centile-based approaches defined weight status in each age group before and after applying BMI adjustments for English South Asian and Black children derived from previous studies using the deuterium dilution method.Findings:Among White children, overweight-obesity prevalences (boys, girls) were 23% and 21%, respectively, in 4–5 year olds and 33% and 30%, respectively, in 10–11 year olds. Before adjustment, South Asian children had lower overweight-obesity prevalences at 4–5 years (19%, 19%) and slightly higher prevalences at 10–11 years (42%, 34%), whereas Black children had higher overweight-obesity prevalences both at 4–5 years (31%, 29%) and 10–11 years (42%, 45%). Following adjustment, overweight-obesity prevalences were markedly higher in South Asian children both at 4–5 years (39%, 35%) and at 10–11 years (52%, 44%), whereas Black children had lower prevalences at 4–5 years (11%, 12%); at 10–11 years, prevalences were slightly lower in boys (32%) but higher in girls (35%).Interpretation:BMI adjustments revealed extremely high overweight-obesity prevalences among South Asian children in England, which were not apparent in unadjusted data. In contrast, after adjustment, Black children had lower overweight-obesity prevalences except among older girls.Funding:British Heart Foundation, NIHR CLAHRC (South London), NIHR CLAHRC (North Thames).

Reassessing patterns of childhood body-mass index, overweight, and obesity in South Asian and black participants in the English National Child Measurement Programme: use of ethnicity-specific body-mass index adjustments

BackgroundThe National Child Measurement Programme (NCMP) assesses patterns of overweight–obesity in English children. It uses body mass index (BMI), which overestimates body fatness in South Asian children and underestimates body fatness in black children of presumed African ethnicity. Using previously derived BMI adjustments, ensuring that adjusted BMI was similarly related to body fatness in South Asian, black, and white children, we reassessed population body fatness, overweight, and obesity patterns in these ethnic groups in the NCMP. MethodsAnalyses were based on 2012–13 NCMP data in 582 899 children aged 4–5 years and 485 362 children aged 10–11 years. Standard centile-based approaches defined weight status in each age-group before and after applying BMI adjustments, derived previously with the deuterium dilution method, for South Asian and black children. FindingsAmong white children, overweight–obesity prevalences were 23% (45 508/197 691) for boys and 21% (39 411/188 663) for girls in 4–5 year olds and 33% (52 635/160 278) and 30% (45 978/151 146), respectively, in 10–11 year olds. Before adjustment, South Asian children had lower overweight–obesity prevalences at 4–5 years (19% of boys [4485/23 191], 19% of girls [4176/22 109]; both p<0·0001) and higher prevalences at 10–11 years (42% of boys [8105/19 406], 34% of girls [6379/18 636]; both p<0·0001), whereas black children had higher overweight–obesity prevalences both at 4–5 years (31% of boys [4459/14 468], 29% of girls [4041/13 970]; both p<0·0001) and at 10–11 years (42% of boys [4788/11 347], 45% of girls [5048/11 319]; both p<0·0001). After adjustment, overweight–obesity prevalences were markedly higher in South Asian than in white children both at 4–5 years (39% of boys [9125/23 191], 35% of girls [7711/22 109]; both p<0·0001) and at 10–11 years (52% of boys [10 120/19 406], 44% of girls [8125/18 636]; both p<0·0001), whereas black children had a lower prevalence at 4–5 years (11% of boys [1526/14 468], 12% of girls [1700/13 970]; both p<0·0001); at 10–11 years, black boys had a slightly lower prevalence (32% [3619/11 347]; p=0·04) but girls a higher prevalence (35% [3937/11 319]; p<0·0001) than white children. InterpretationAdjusted BMI data reveal a substantial excess of overweight–obesity among English South Asian children (at 4–5 years and especially at 10–11 years) and among black girls (aged 10–11 years), with important implications for prevention. These patterns are not apparent with the use of unadjusted BMI data, which systematically underestimated overweight–obesity prevalences in South Asian children and overestimated them in black children. FundingBritish Heart Foundation, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (South London & North Thames).

Increasing admissions to paediatric intensive care units in England and Wales: more than just rising a birth rate

ObjectiveTo determine the number of individual children admitted to Paediatric Intensive Care Units (PICUs) in England and Wales between 2004 and 2013 and to investigate potential factors for any change...

Complementary feeding practices for infants and young children in South Asia. A review of evidence for action post-2015.

Some 37% (~64million) South Asian children under 5 years are stunted. Most stunting occurs during the complementary feeding period (6-23months). Our objective was to (a) characterize complementary feeding practices in South Asia and (b) review the effectiveness of information, education, and counselling (IEC) interventions aiming to improve complementary feeding in South Asia. We conducted a comprehensive review of (a) the latest nationally representative survey data and (b) peer-reviewed interventions (January 1990 to December 2015) that used IEC as the main strategy to improve complementary feeding. The analytical sample included 30,966 children aged 6-23months. Foods made from grains are the main complementary food (76.8% of children). Only 33.2% of children are fed fruits and vegetables rich in vitamin A and a mere 17.1% are fed complementary foods containing meat, fish, poultry and/or eggs. Timely introduction, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet were estimated at 57.4%, 47.7%, 33.0%, and 20.5%, respectively. The evidence on the effectiveness of IEC interventions is limited in quantity, quality, and scale. The 12 intervention studies that met the inclusion criteria indicate that IEC interventions delivered by many types of primary care workers/community resource persons using multiple contact opportunities improved the timeliness, frequency, diversity, and/or adequacy of complementary feeding. However, acceptability, availability, and affordability seem to constrain improvements in diet diversity, particularly foods of animal origin. The small size of most intervention studies and the training and/or supervision intensity of counsellors raise concerns about the potential for scale and/or sustainability of some of the interventions reviewed.

A qualitative study to identify parents\u2019 perceptions of and barriers to asthma management in children from South Asian and White British families

BackgroundOver one million children receive treatment for asthma in the UK. South Asian children experience excess morbidity and higher rates of hospitalization than the White population. This study aimed to explore perceptions and experiences of asthma and asthma management in British South Asian and White British families, to identify barriers to optimal management and to inform culturally appropriate interventions to improve management.MethodsA qualitative methodology, using semi-structured interviews was adopted. Members of 30 families from six major South Asian ethnic-religious groups were purposively sampled (n = 49). For comparison, 17 White British parents were interviewed. Topics included understandings of asthma; day-to-day management; interactions with health care providers and the perceived quality of healthcare services. Data were analyzed using interpretive thematic analysis, facilitated by NVivo. Similarities and differences between South Asian and White families were analysed across key themes.ResultsMany of the problems facing families of a child with asthma were common to South Asian and White British families. Both had limited understanding of asthma causes and triggers and expressed confusion about the use of medications. Both groups reported delays in receiving a clear diagnosis and many experienced what was perceived as uncoordinated care and inconsistent advice from health professionals. No family had received an asthma plan. South Asian families had more difficulty in recognising severity of symptoms and those with limited English faced additional barriers to receiving adequate information and advice about management due to poor communication support systems. South Asian parents reported higher levels of involvement of wider family and higher levels of stigma. Attendance at the emergency department was related to previous experience, difficulties in accessing primary care, lack of knowledge of alternatives and difficulties in assessing severity.ConclusionsBarriers to optimal asthma management exist at the individual family, community and healthcare systems levels. Culturally sensitive, holistic and collaboratively designed interventions are needed. Improved communication support for families with lower proficiency in English is required. Healthcare professionals need to ensure that families receive an asthma plan and make greater efforts to check families’ understandings of asthma triggers, use of medications, assessment of asthma severity and accessing help.

Childhood cancer incidence by ethnic group in England, 2001\u20132007: a descriptive epidemiological study

BackgroundAfter the first year of life, cancers are the commonest cause of death in children. Incidence rates vary between ethnic groups, and recent advances in data linkage allow for a more accurate estimation of these variations. Identifying such differences may help identify potential risk or protective factors for certain childhood cancers. This study thus aims to ascertain whether such differences do indeed exist using nationwide data across seven years, as have previously been described in adult cancers.MethodsWe obtained data for all cancer registrations for children (aged 0–14) in England from January 2001 to December 2007. Ethnicity (self-assigned) was established through record linkage to the Hospital Episodes Statistics database or cancer registry data. Cancers were classified morphologically according to the International Classification of Childhood Cancer into four groups – leukaemias; lymphomas; central nervous system; and other solid tumours. Age standardised incidence rates were estimated for each ethnic group, as well as incidence rate ratios comparing each individual ethnic group (Indian, Pakistani, Bangladeshi, Black African, Black Carribean, Chinese) to Whites, adjusting for sex, age and deprivation.ResultsThe majority of children in the study are UK born. Black children (RR = 1.18, 99% CI: 1.01–1.39), and amongst South Asians, Pakistani children (RR = 1.19, 99% CI: 1.02–1.39) appear to have an increased risk of all cancers. There is an increased risk of leukaemia in South Asians (RR = 1.31, 99% CI: 1.08–1.58), and of lymphoma in Black (RR = 1.72, 99% CI: 1.13–2.63) and South Asian children (RR = 1.51, 99% CI: 1.10–2.06). South Asians appear to have a decreased risk of CNS cancers (RR = 0.71, 99% CI: 0.54–0.95).ConclusionsIn the tradition of past migrant studies, such descriptive studies within ethnic minority groups permit a better understanding of disease incidence within the population, but also allow for the generation of hypotheses to begin to understand why such differences might exist. Though a major cause of mortality in this age group, childhood cancer remains a relatively rare disease; however, the methods used here have permitted the first nationwide estimation of childhood cancer by individual ethnic group.

A systematic review of complementary feeding practices in South Asian infants and young children: the Bangladesh perspective

BackgroundSub-optimal nutrition among children remains a problem across South Asia (SA). Appropriate complementary feeding practices (CFP) can greatly reduce this risk. The primary objective of this systematic review (SR) of CF studies was to assess timing, dietary diversity, meal frequency and influencing factors in children under two in Bangladesh.MethodsSearches included English-language research published between January 2000 and June 2016 within MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, BanglaJOL, Cochrane Library, CINAHL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research concerning the adequacy of complementary feeding practices in South Asian children aged 0–2 years and/or their families. We excluded interventional papers and those focusing exclusively on breast-feeding. In total 45,712 titles and abstracts were screened against inclusion criteria, 860 of which received independent full text review by two reviewers. 36 papers relevant to Bangladesh were identified. The ‘EPPI-Centre Weight of Evidence Framework’ was used to objectively assess each study’s value in answering the review question. As per WHO Infant and Young Children Feeding Guidelines (IYCF), introduction of CF was assessed as the proportion of infants aged 6–8 months who received solid, semi-solid or soft foods. Search terms were: “children”, “feeding” and “Asians” with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal.ResultsThree cohort, 30 cross-sectional and 3 mixed methods studies were included. Despite adopting the WHO IYCF Guidelines, sub-optimal CF practices were found in many studies. Timely initiation of CF practices ranged from 24 to 83%. Achieved minimum dietary diversity ranged from 25% to 44% and minimum meal frequency from 33% to 81%. Influencing factors included maternal education, poor knowledge of CF practices and socioeconomic variables.ConclusionsThis is the first systematic review to evaluate CF practices in Bangladesh. Despite adoption of the WHO IYCF guidelines, inadequate CFP remain in communities across Bangladesh.Trial registrationPROSPERO Registration No: CRD42014014025.

How sustainable household environment and knowledge of healthy practices relate to childhood morbidity in South Asia: analysis of survey data from Bangladesh, Nepal and Pakistan

ObjectivesPrevalence of diarrhoea and acute respiratory infection (ARI) is considerably high among South Asian children. The objective of this study is to compare the associations of sustainable household environment and...

Longitudinal patterns in objective physical activity and sedentary time in a multi-ethnic sample of children from the UK.

SummaryBackgroundChildren of South Asian decent born in the UK display lower levels of physical activity than British Caucasians although no longitudinal data are available.ObjectivesWe aimed to investigate change in activity levels over 1 year in a diverse ethnic sample of children residing in London, UK.MethodsChildren were categorized into ethnic groups (Caucasian/mixed, Black, South Asian). At baseline and 1‐year follow‐up, children's objective physical activity was monitored (Actigraph accelerometer) for at least 1 day. Mixed models were employed to investigate differences in change in activity levels between ethnic groups.ResultsA total of 281 children were included in the analyses. South Asians had a significantly greater increase in time spent sedentary at follow‐up than those of a Caucasian/mixed ethnicity (B [ratio sedentary/wear time] = 0.024; 95% confidence interval 0.003, 0.046). South Asian children recorded lower moderate to vigorous physical activity at baseline (B = −6.5, 95% confidence interval, −11.1, −1.9 min d−1, p = 0.006) although levels remained relatively stable over follow‐up and changes did not differ across ethnic group.ConclusionsIn a diverse ethnic sample of children from inner city London, those of a South Asian ethnicity exhibited a significantly greater increase in sedentary time over a period of 12 months in comparison with Caucasian/mixed and Black children.

Physical Activity, Sedentary Time, and Fatness in a Biethnic Sample of Young Children.

This study aimed to investigate associations of objectively measured physical activity (PA) and sedentary time with adiposity in a predominantly biethnic (South Asian and White British) sample of young children. The sample included 333 children age 11 months to 5 yr who provided 526 cross-sectional observations for PA and body composition. Total PA volume (vector magnitude counts per minute), daily time at multiple intensity levels (the cumulative time in activity >500, >1000, >1500, …, >6000 counts per minute), and time spent sedentary (<820 counts per minute), in light PA (820-3907 counts per minute) and in moderate-to-vigorous PA (≥3908 counts per minute) were estimated with triaxial accelerometry. Indicators of adiposity included body mass index, waist circumference, and the sum of subscapular and triceps skinfold thicknesses. Statistical analyses were performed using multilevel regression and isotemporal substitution models adjusted for confounders. Effect modification by ethnicity was examined. There was no evidence for effect modification by ethnicity (P interaction ≥ 0.13). In the whole sample, the accumulated time spent above 3500 counts per minute (i.e., high light-intensity PA) was inversely associated with the sum of skinfolds (β = -0.60 mm, 95% confidence interval [CI] = -1.19 to -0.021, per 20 min·d), and the magnitude of association increased dose dependently with PA intensity (peaking for time spent >6000 counts per minute = -1.57 mm, 95% CI = -3.01 to -0.12, per 20 min·d). The substitution of 20 min·d of sedentary time with moderate-to-vigorous PA was associated with a lower sum of skinfolds (-0.77 mm, 95% CI = -1.46 to -0.084). High light-intensity PA appears to be beneficial for body composition in young South Asian and White British children, but higher-intensity PA is more advantageous.

Breaking Down Barriers: Recommendations for Improving Sexual Abuse Reporting Rates in British South Asian Communities

Sexual abuse reporting rates, which are low in general, are thought to be even worse for those living within British South Asian communities. After brief consideration of why British South Asian women and children do not report sexual abuse, this article focuses on the working practices of the non-governmental agencies that support such women. It reflects on existing legislation and policy and makes several key recommendations with reference to how this, along with practice, should change. The findings indicate an urgent need for a national training programme; the implementation of mandatory healthy relationship programmes; enhanced community involvement; outreach work; and the creation of victim groups and mentor schemes.

A pilot interventional study to evaluate the impact of cholecalciferol treatment on HbA1c in type 1 diabetes (T1D)

BackgroundHigher 25(OH)D3 levels are associated with lower HbA1c, but there are limited UK interventional trials assessing the effect of cholecalciferol on HbA1c.Aims(1) To assess the baseline 25(OH)D3 status in a Manchester cohort of children with type 1 diabetes (T1D). (2) To determine the effect of cholecalciferol administration on HbA1c.MethodsChildren with T1D attending routine clinic appointments over three months in late winter/early spring had blood samples taken with consent. Participants with a 25(OH)D3 level <50 nmol/L were treated with a one-off cholecalciferol dose of 100,000 (2–10 years) or 160,000 (>10 years) units. HbA1c levels before and after treatment were recorded.ResultsVitamin D levels were obtained from 51 children. 35 were Caucasian, 11 South Asian and 5 from other ethnic groups. 42 were vitamin D deficient, but 2 were excluded from the analysis. All South Asian children were vitamin D deficient, with mean 25(OH)D3 of 28 nmol/L. In Caucasians, there was a negative relationship between baseline 25(OH)D3 level and HbA1c (r = −0.484, P < 0.01). In treated participants, there was no significant difference in mean HbA1c at 3 months (t = 1.010, P = 0.328) or at 1 year (t = −1.173, P = 0.248) before and after treatment. One-way ANCOVA, controlling for age, gender, ethnicity, BMI and diabetes duration showed no difference in Δ HbA1c level.ConclusionWe report important findings at baseline, but in children treated with a stat dose of cholecalciferol, there was no effect on HbA1c. Further studies with larger sample sizes and using maintenance therapy are required.

Body mass index adjustments to increase the validity of body fatness assessment in UK Black African and South Asian children

Background/Objectives:Body mass index (BMI) (weight per height2) is the most widely used marker of childhood obesity and total body fatness (BF). However, its validity is limited, especially in children of South Asian and Black African origins. We aimed to quantify BMI adjustments needed for UK children of Black African and South Asian origins so that adjusted BMI related to BF in the same way as for White European children.Methods:We used data from four recent UK studies that made deuterium dilution BF measurements in UK children of White European, South Asian and Black African origins. A height-standardized fat mass index (FMI) was derived to represent BF. Linear regression models were then fitted, separately for boys and girls, to quantify ethnic differences in BMI–FMI relationships and to provide ethnic-specific BMI adjustments.Results:We restricted analyses to 4–12 year olds, to whom a single consistent FMI (fat mass per height5) could be applied. BMI consistently underestimated BF in South Asians, requiring positive BMI adjustments of +1.12 kg m−2 (95% confidence interval (CI): 0.83, 1.41 kg m−2; P<0.0001) for boys and +1.07 kg m−2 (95% CI: 0.74, 1.39 kg m−2; P<0.0001) for girls of all age groups and FMI levels. BMI overestimated BF in Black Africans, requiring negative BMI adjustments for Black African children. However, these were complex because there were statistically significant interactions between Black African ethnicity and FMI (P=0.004 boys; P=0.003 girls) and also between FMI and age group (P<0.0001 for boys and girls). BMI adjustments therefore varied by age group and FMI level (and indirectly BMI); the largest adjustments were in younger children with higher unadjusted BMI and the smallest in older children with lower unadjusted BMI.Conclusions:BMI underestimated BF in South Asians and overestimated BF in Black Africans. Ethnic-specific adjustments, increasing BMI in South Asians and reducing BMI in Black Africans, can improve the accuracy of BF assessment in these children.

Early life stress of infants in the SPRING home visits intervention promoting child growth and development in rural India (SPRING-ELS): development of stress measures for administration at scale

BackgroundSPRING-ELS (Early Life Stress) is a substudy of the SPRING cluster randomised controlled trial that is assessing a home visits programme in rural India promoting early child development and growth. Early life stress interferes with healthy child development so our aim was to evaluate its role in the SPRING causal pathway. We report findings from the preparatory phase of SPRING-ELS. MethodsTo develop an explanatory model of early life stress in the community, 45 mothers of children under 2 years old took part in eight focus group discussions. To determine potential barriers to sampling, in-depth interviews were done with five mothers and two barbers (to understand cultural beliefs about young children's hair). In addition, five focus group discussions were done with mothers, grandmothers, and barbers. Salivary and hair cortisol (to assess diurnal rhythm and chronic stress) were measured in 13 children aged 11–13 months. The SPRING trial is registered with ClinicalTrials.gov, number NCT02059863. FindingsCauses of stress included violence, poverty, poor hygiene, neglect and poor care, maternal stress, and carer alcoholism. Consequences included a range of physical and mental adversity. Improved caregiving was seen as the most important prevention method. However, in contrast to previous research, stress was seen to affect older children, who have a better understanding of their environment, than younger infants. Taking saliva samples was straightforward. Mothers preferred to be helped by assessors to take these samples rather than doing it themselves. However, hair sampling was challenging. There are many cultural beliefs surrounding young children's hair and a child's first haircut is a ceremonial occasion: rates of refusal were high (four of 13 families refused). Sample size was adjusted accordingly. InterpretationMeasuring early life stress in the community is feasible and acceptable. Careful introduction in the community has achieved a 14% refusal rate to take hair samples despite major cultural barriers. These stress measures have been integrated into SPRING outcome assessments, which are being performed with a total of 1200 children. Each assessment is done over 2 days when a child reaches 1 year of age. 60 children are being assessed at home each week using salivary and hair cortisol measurments and questionnaires of environmental stressors developed using findings from our explanatory model. To our knowledge, SPRING is the first large child health intervention trial to include measures of early life stress and the first time that hair cortisol will be assessed in South Asian children. FundingWellcome Trust research training fellowship to SB (grant number 107818/Z/15/Z).

Sleep Duration and Adiposity in Early Childhood: Evidence for Bidirectional Associations from the Born in Bradford Study.

Study Objectives:To examine independent associations of sleep duration with total and abdominal adiposity, and the bidirectionality of these associations, in a young biethnic sample of children from a disadvantaged location.Methods:Child sleep duration (h/day) was parent-reported by questionnaire and indices of total (body weight, body mass index, percent body fat (%BF), sum of skinfolds) and abdominal adiposity (waist circumference) were measured using standard anthropometric procedures at approximately 12, 18, 24, and 36 months of age in 1,338 children (58% South Asian; 42% White). Mixed effects models were used to quantify independent associations (expressed as standardised β-coefficients (95% confidence interval (CI)) of sleep duration with adiposity indices using data from all four time-points. Factors considered for adjustment in models included basic demographics, pregnancy and birth characteristics, and lifestyle behaviours.Results:With the exception of the sum of skinfolds, sleep duration was inversely and independently associated with indices of total and abdominal adiposity in South Asian children. For example, one standard deviation (SD) higher sleep duration was associated with reduced %BF by -0.029 (95% CI: −0.053, −0.0043) SDs. Higher adiposity was also independently associated with shorter sleep duration in South Asian children (for example, %BF: β = -0.10 (-0.16, -0.028) SDs). There were no significant associations in White children.Conclusions:Associations between sleep duration and adiposity are bidirectional and independent among South Asian children from a disadvantaged location. The results highlight the importance of considering adiposity as both a determinant of decreased sleep and a potential consequence.

Reaction time norms as measured by ruler drop method in school-going South Asian children: A cross-sectional study

This study aimed to estimate normative range for reaction time using ruler drop method for school-going South Asian children between 6 and 12 years of age. A cross-sectional study was used to evaluate the reaction time for 204 children. Normal values for each age group were obtained. The results of multiple linear regressions showed a decrease in the reaction time values with age, and a significant change occurring between six and eight years of age. No difference in reaction time was obtained between boys and girls. Ruler drop method is an easy to use test and the results of this study provide a normative data for age groups 6–12 years ranging from 214.2ms to 248.8ms. These values can serve as a reference to screen children with delayed reaction time.

Using a co-production prioritization exercise involving South Asian children, young people and their families to identify health priorities requiring further research and public awareness.

ObjectivesTo facilitate South Asian (SA) families and health‐care professionals (HCPs) participation in a prioritization exercise to co‐produce child health research and public awareness agendas.DesignA three‐stage process was adopted involving the following: (i) systematic literature review, (ii) HCP scoping survey and (iii) focus groups of SA adolescents and families. A Punjabi‐ and Urdu‐speaking community facilitator moderated focus groups. A British Sign Language interpreter assisted in the hard of hearing group. Concordant and discordant themes between HCPs and SAs were identified.SettingNational survey of HCPs. Leicestershire for SA families.ParticipantsA total of 27 HCPs and 35 SAs. SAs varied by descent, age (16‐74), UK stay length (3‐57 years) religion and disability.ResultsRanked by submission frequency in the survey, HCPs prioritized (i) public awareness on obesity, mental health, health‐care access, vitamin D and routine health checks and (ii) research on nutrition, diabetes, health education and parenting methods.DiscussionSouth Asians prioritized research into the effectiveness of alternative medicines, a theme not identified by HCPs. Both HCPs and SAs prioritized increased research or public awareness on mental health illness, blood and organ donation, obesity and diet. Whilst HCPs identified diabetes, vitamin D and rickets together with parenting methods were important priorities requiring increased public awareness, and these views were not shared by SAs.ConclusionsMinority groups are not always included in priority setting exercises due to concerns about language and perceived difficulty with accessing communities. Through this co‐production exercise, we showed that it is possible and essential.

Body-mass index adjustments to increase the validity of body fatness assessment in UK black African and South Asian children: a cross-sectional calibration study

BackgroundExcess childhood body fatness, overweightness, and obesity are a major public health challenge in the UK. Accurate assessments, usually based on body-mass index (BMI), are crucial. However, recent studies have demonstrated that BMI underestimates body fatness in South Asian children and overestimates it in black African children. These errors are a concern in these ethnic minority populations, particularly UK South Asians, who are at high risk of obesity, type 2 diabetes, and cardiovascular disease. We aimed to develop BMI adjustments for these children to ensure that BMI relates to body fatness in the same way as for white European children. MethodsFour recent UK population-based studies, which used deuterium dilution assessments of fat mass as a reference method, were pooled to include 1725 children (52% girls) aged 4–12 years (mean 9·3, SD 1·6) of white European, South Asian, and black African origins. A height-standardised fat-mass index (FMI) was derived to represent body fatness. Linear regression models were fitted, separately by sex, to quantify ethnic differences in BMI–FMI associations and to provide ethnic-specific BMI adjustments. FindingsThe FMI derived for this study population and used in analyses was fat mass/height5, which was independent of height for the 4–12-year age-group. BMI consistently underestimated body fatness in South Asians, requiring a BMI adjustment of +1·12 kg/m2 (95% CI 0·83–1·41) for boys and +1·07 (0·74–1·39) for girls, irrespective of age and FMI. BMI overestimated body fatness in black Africans. However, adjustments for black African children were more complex, with statistically significant interactions between black African ethnicity and FMI (p=0·004 boys, p=0·003 girls) and between FMI and age-group (p<0·0001 boys and girls). BMI adjustments therefore varied by age-group and FMI level, between −0·24 and −2·84 kg/m2 for boys and between −0·22 and −2·86 kg/m2 for girls for unadjusted BMI values of 13 kg/m2 in 10–12 year-olds and 25 kg/m2 in 4–6 year-olds, respectively. InterpretationBMI underestimated body fatness in South Asians and overestimated it in black Africans. Ethnic-specific adjustments—increasing BMI in South Asians and reducing BMI in black Africans—can improve the accuracy of body fatness assessment in these children. FundingThis work was supported by the British Heart Foundation (grant ref PG/15/19/31336) and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (South London) (grant ref CLAHRC-2013-10022). Primary data collection was funded by the British Heart Foundation (PG/11/42/28895), BUPA Foundation (TBF-S09-019), Child Growth Foundation (GR 10/03), and Wellcome Trust (WT094129MA). MF is supported by Great Ormond Street Hospital Childrens' Charity.