Public Health Nutrition

Monitoring and surveillance

Early growth and markers of cardiovascular risk in Keralan children in the Integrated Child Development Scheme

Nick Browna1 c1, Chaniyil Krishnan Sasidharana2 and David Fishera3

a1 Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ, UK

a2 Baby Memorial Hospital, Khozikode, Kerala, India

a3 Medical Research Council, Clinical Trials Unit, London, UK


Objective Low birth weight is associated with increased lifelong morbidity. Kerala has a renowned, low-cost, maternal–child health system in which is couched universal access to the Integrated Child Development Scheme (ICDS), central to which is community-based maternal–infant nutritional supplementation. We assessed whether children in this environment showed enhanced birth weight and postnatal growth and whether the evolution of early markers of CVD was attenuated in comparison to contemporaries from other states.

Design A part retrospective, part prospective cohort study in which children (n 286) born in 1998–2000 in Calicut were identified from Anganwadi records. They were traced at 6 years and underwent full anthropometry and blood pressure measurements at 6 and 8 years.

Results Mean birth weight (2·86 (sd 0·40) kg) was greater than in Indian contemporaries but consistently <−1sd below the National Center for Health Statistics reference median throughout childhood. Birth weight significantly predicted body mass (BMI) at 8 years. Lower birth weight was strongly predictive of a higher waist:hip ratio (WHR) indicative of adverse central (coelomic) fat distribution (P < 0·01). Faster weight gain in infancy was weakly predictive of a lower WHR (P = 0·59), but faster late childhood growth at 6–8 years was non-significantly predictive of adverse WHR.

Conclusions At 8 years of age, children in Calicut participating in the ICDS have greater birth weight and relative attenuation of the evolution of early CVD markers compared with children in apparently comparable states. The relative contributions of the ICDS and other factors inherent to Kerala cannot be inferred from the present study.

(Received November 04 2008)

(Accepted August 07 2009)

(Online publication September 22 2009)


c1 Corresponding author: Email