ICMR BULLETIN VOL. 24-No.-8-AUGUST-1994
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- ICMR BULLETIN VOL. 24-No.-8-AUGUST-1994
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ISSN 0377-4910
STRATEGIES TO CONTROL MICRONUTRIENT MALNUTRITION
Hunger and malnutrition contribute to about 40-
have provided a new impetus to strengthen and expand
50 per cent of the child deaths in India. Apart from
control measures against micronutrient deficiencies at
protein energy malnutrition (PEM), which has long
the national level. The National Nutrition Policy of the
been recognised to contribute to high mortality and
Government of India (1993)3 aims to eliminate vitamin
growth retardation in children, micronutrient malnu
A deficiency and blindness, reduce iodine deficiency
trition poses a serious threat to the health of the
disorders (IDD) to below endemic levels (< 10% of
vulnerable groups of population. Though required in
population) and bring down anaemia in pregnant women
small quantities, these nutrients govern many vital
to 25 per cent by 2000 AD. An attempt is made here
functions connected with metabolism, reproduction,
to review the current policies and programmes, and
immune mechanism, and intelligence. These 'micro'
suggest alternative strategies to overcome micronutrient
nutrients, thus have 'inkro' health implications. The
malnutrition.
three important micronutrient deficiencies of public
MICRONUTRIENT MALNUTRITION IN INDIA
health significance in India are:
(i)
vitamin A deficiency leading to blindness in
children,
(ii)
iron deficiency anaemia contributing to re
duced work output and high maternal morta
lity
(iii)
Magnitude
Vitamin A Deficiency
Severe forms of vitamin A deficiency lead to ir
reversible blindness. Milder forms like Bitot spots in
iodine deficiency disorders causing intellec
tual and neurological impairment.
the eyes are observed in about 1-5 per cent of preschool
children in the country4,5. Longitudinal community
studies indicate that in some pockets of the country the
Although short-term measures to control these
incidence of corneal xerophthalmia is between 0.5 to 1
deficiencies have been in operation in India fbr the past
per thousand preschool children6,7. The repeat surveys
quarter of a century, the global movement set in motion
of the National Nutrition Monitoring Bureau8 in 10
by the World Summit fbr Children (1990)1 and the
states indicate a decline in the prevalence of Bitot spots
International Conference in Nutrition (ICN,
from about 2 per cent in 1975-79 to about 0.7 per cent
1992)2
Division of Publication^& Information, ICM・R, New. Delhi - I
in 1988-90; still of public health significance by WHO
criteria. Similarly, recent national surveys have indi
cated that vitamin A deficiency contributes to only
0.04 per cent of the total blindness as compared to about
2 per cent about two decades ago9.
mortality after vitamin A suppl ementation. Interest
Iron Deficiency Anaemia
reveal any impact of six monthly vitamin A supplemen
tation on child mortality17.
Anaemia, due to iron deficiency, is particularly
common in women of the reproductive age group and
young children. Surveys of haemoglobin levels of
populations in different areas reveal that 88 per cent
among pregnant women suffer from anaemia and about
26 per cent have severe anaemia (< 8 g/dl)10.
Iodine Deficiency Disorders
Goiter has been endemic in the Himalayan and sub-
Himalayan region. Recent surveys indicate presence of
goitre even in areas outside the sub-Himalayan belt.
An ICMR survey in 14 districts indicates that the
prevalence of endemic cretinism is very alarming11.
Among the 150 million people in the endemic regions
of the country, more than 54 million suffer from goitre
and about 9 million from different grades of mental
and motor handicaps12.
Consequences
.Vitamin A, in addition to preventing nutritional
blindness, has been considered to promote growth and
ingly mortality reduction either in Madurai or in Nepal
was not associated with any reduction in morbidity. It
is, therefore, not clear as to how vitamin A brought
about reduction in mortality. Another randomized double
blind and placebo controlled trial in Sudan did not
Severe anaemia in pregnancy is associated with
increased risk of maternal mortality causing an esti
mated 80,000 maternal deaths every year, high inci
dence of premature delivery, low birth weight, perinatal
mortality and foetal wastage. Anaemia in infancy and
childhood is associated with poor cognitive abilities,
impaired motor development and behavioural changes.
Anaemia can also lower resistance to infection, and
reduce work output and physical capacity. Iron supple
ments have been shown to improve the achievement
test scores of school children by 5-25 per cent18, and
children perform better on tests of mental and motor
skills.
Iodine deficiency in the mother interferes with the
development of the unborn child leading to abortions
and still births. The most compelling aspect of IDD
is neuromotor and intellectual retardation. The major
effect of iodine deficiency is endemic cretinism, which
is characterised by growth failure, mental deficiency'
and deaf mutism. Children born to iodine deficient
prevent certain morbidity and mortality in young children.
Vitamin A supplementation has been shown to restore
cell mediated immune response in the deficient chil
mothers have reduced IQ scores as compared to those
of non-deficient mothers19.
dren, and enhance antibody response and macrophage
function, suggesting immuno potentiating effect13. The
role of vitamin A supplementation in reducing child
Determinants
mortality has been controversial. A large community
based double blind trial conducted by the National
Institute of Nutrition (NIN), Hyderabad, revealed that
supplementation with six monthly massive dose of
vitamin A to children between 1-5 years of age, did
not, per. set have any impact either on child morbidity
or mortality14. The number of deaths were, however,
lower in children who had received two doses of either
vitamin A or placebo, than in those who had not
received the dose perhaps, due to Hawthorne effect or
contact effect15.
On the other hand, studies carried out in Madu
rai and Nepal7-16 reveal substantial decline in child
80
Dietary inadequacy is the main cause for the high
prevalence of vitamin A deficiency and iron deficiency
anaemia, while environmental
iodine deficiency,
characterised by poor iodine content in soil leading to
deficiency of iodine in food and water is responsible
fbr IDD. Maternal malnutrition, delayed and inadequate
supplementation, frequent childhood infections, avoid
ance of micronutrient-rich foods due to ignorance as a
result of high female illiteracy, poor bioavailability of
dietary iron and low purchasing power of the families
are the important causes for vitamin A and iron de
ficiencies. In the case of IDD, iodine in the soil is
depleted due to frequent flooding, heavy rains or glaciers
in mountainous regions.Consumption of unconventional
foods containing goitrogens has also been implicated.
Methods of Prevention
There are two basic approaches to prevent micro
nutrient deficiencies:
Iron deficiency anaemia
The National Anaemia Prophylaxis Programme,
started by the Government of India in 1970 in all the
states of the country, covers pregnant and lactating
(i) Short-term measures like supplementation of
women, women who* accept family planning and chil
specific nutrients either as medicinal doses or
dren of 1 to 12 years. While the adult beneficiaries
through food fortification, and
receive 60 mg of elemental iron (ferrous sulphate) and
(ii) Long-term sustainable programmes of promo
tion of production and consumption of micro
nutrient rich foods involving horticulture and
nutrition education.
Specific Nutrient Supplementation
500 fig of folic acid daily, the child beneficiaries are
provided daily 20 mg iron and 100 /ig fblic acid. The
tablets are to be distributed to each beneficiary for a
period of 100 days by the ANMs, MPHWs and the
health visitors.
An evaluation by the ICMR10 in 11 states during
1985-86, revealed very low coverage and poor perfor
Vitamin A deficiency
mance of the programme. There was no impact of the
programme on the haemoglobin levels in pregnant
Based on the successful field trials carried out by
women who had completed 20 weeks of gestation. It
the NIN20, a National Prophylaxis Programme against
is now proposed to concentrate on high risk groups of
blindness due to vitamin A deficiency is in operation
pregnant and lactating women, and preschool children
in the country since 1970, covering about 30 of the
and, to improve their compliance through a compre
estimated 85 million preschool children. Six monthly
hensive strategy of information, education and commu
administration of oral vitamin A concentrate (200,000 IU)
nication.
to preschoolers, particularly to those aged between 9
months and 3 years, is carried out by paramedical
Fortification
personnel (auxiliary nurse midwife/multipurpose health
workers-ANM/MPHW under the supervision of the
primary health care (PHC) Medical Officer. An evalu
ation of the national programme indicated significant
reduction in the prevalence of xerophthalmia in areas
where the vitamin A programme was implemented
satisfactorily, There was no impact in the other areas
due to poor coverage, the reasons for which included
inadequate and/or irregular supplies, lack of supervi
Iron fortified salt
Though the prevalence of anaemia is particularly
high in women, it is observed in all the segments of
the population. There is, therefore, a need to develop
a strategy to increase consumption of iron in all the
groups of population. The NIN has developed a method
of fortification of salt with iron as an alternative approach
to improve iron status of the general population. An
sion, poor coordination between the various health
additional 15 mg of iron will be available to the in
functionaries, non-involvement of village level workers,
dividual on the assumption that about 10-15 g of salt
and complete absence of nutrition education21.
is consumed by an adult in a day. Multieentric field
The outreach of the target population is being
improved in all the areas where Child Survival and Safe
Motherhood (CSSM) projects are in operation and by
linking vitamin A distribution with the Universal
Immunization Programme (UIP), and the Integrated
Child Development Services(ICDS) both of which have
trials have found the salt to be acceptable and the
incidence of anaemia was reduced. No untoward effects
were observed even among non-anaemic subjects22.
Currently, iron fortified salt is being distributed on a
limited scale in Tamil Nadu, Orissa and Rajasthan.
Iodised salt
infrastructure and an in-built system of monitoring and
supervision, and cover a higher proportion of children.
The oldest and the commonest control measure for
There is as yet no scientific evidence which indica'%
IDD has been fortification of common salt with po
that vitamin A supplementation be extended to infanta
tassium iodate. Injection of iodised oil has been em
below 6 months though this is now being suggested by
ployed as a specific measure for women and children
certain institutions.
in hyper-endemic areas. The National Goitre Control
81
Programme in India has gained momentum only re
cently, though in operation for the last three decades.
An independent assessment of the programme by the
Nutrition Foundation of India indicated23 inadequate
production of iodised salt, non-availability of rail wagons
fbr shifting the salt from production centres, entry and
free availability of non-iodised salt in endemic areas,
lack of quality control, poor supervision, lack of co
ordination between the various departments involved
in the programme and, lack of awareness about the IDD
in the population23.
The Government of India is now committed to
universal iodisation of the entire stock of edible salt
It has been argued that excess iodine in the case
of pregnant women can even induce neonatal chemical
hypothyroidism (NCH) by suppressing thyroxine syn
thesis27. Iodised oil is usually suggested as an interim
measure, till the salt iodisation programme picks up,
and that too for areas which are hyper-endemic and
inaccessible. Recently, studies28 have been conducted
to explore the possibility of using iodised oil orally,
which may be more acceptable to people than iodised
oil injection. However, oral iodised oil is even more
costly than the injection, since the amount of iodised
oil required is twice that needed by the intramuscular
route29.
to ensure availability of only iodised salt all over the
country. The Government will provide subsidies to
Dietary Modification
prevent cost escalation and start quality control labo
ratories to ensure presence of 30 ppm of iodine at the
production level and a minimum of 15 ppm at the
consumer level. Available evidence indicates that con
sumption of iodised salt, at the current levels of for
tification, is quite safe even in non-endemic areas.
Dietary modification to increase consumption of
micronutrient rich foods is the safest and most sustain
Double fortified salt
Since iron deficiency anaemia is also highly preva
lent in the areas where iodine deficiency disorders are
able long-term strategy. However, it needs an under
standing of the food preferences and taboos of the
community, and involves behavioural modifications,
changing attitudes and practices. Food and Nutrition
Board (Government of India), through its network of
67 centres, has been imparting education and training «
in nutrition and home-scale preservation of fruits and *
vegetables. These efforts are not adequate.
endemic, the most cost-effective approach to control
Attempts to increase production of micronutrient
both these problems of public health importance would
be fortification of salt simultaneously with both iron
rich foods through horticulture are being made by the
and iodine. The technology for double fortification of
Forestry. The Indian Council of Agricultural Research
salt has been successfully developed at the NIN24.
Laboratory and clinical studies have shown satisfactory
results with respect to stability and bioavailability of
iron and iodine25. Large scale community trials are
(ICAR) has established a number of Krishi Vigyan
Kendras (KVKs) or Farm Science Centres in various
needed to confirm its efficiency in controlling the twin
Department of Agriculture, Horticulture and Social
parts of the country to impart training to farmers in
the latest agriculture technologies to improve horticul
ture production. Women extension workers are being
problems of iron and iodine deficiencies. Preliminary
trained in agriculture technologies, home gardening and
field trials in tribal areas of Andhra Pradesh indicated
preparation of supplementary foods. Practical approaches
no deleterious clinical effects of consumption of the
attainable through increased production and consump
double fortified salt fbr about two years26.
tion of nutritious foods, though time consuming and
difficult to implement, can only be a permanent solution
Iodised oil
to all nutritional problems arising from dietary defi
Intramuscular injection of iodised oil has been used
for tackling goitre and cretinism in hyper-endemic areas
ciencies.
in many countries of the world. The advantage of the
approach is that a single dose of 1 ml will provide
protection for 3-5 years. The high cost and the difficulty
Constraints and Needs
Many nutrition programmes in India, though in
operation fbr over two decades have not had a significant
in reaching all the victims of IDD make this effective
impact on the prevalence of nutrient deficiencies be
approach less practicable.
cause of the followings constraints:① use of a 'vertical'
82
approach to control each deficiency; (ii) lack of coor
dination between the various^epartments; (iii) resource
Home Gardens
and man power constraints; (iv) inadequate and irregu
lar supplies; (v)) lack of proper orientation and training
cultural production has to be increased to provide
to the functionaries; (vi) poor monitoring and super
vision; and (vii) a weak education component. These
constraints can be overcome with determination and
vegetables, and yellow/orange fruits and vegetables are
rich sources of beta carotene (provitamin A). In India,
In terms of achieving national food security, horti
adequate quantities of micronutrients. Green leafy
perseverance.
availability of per capita beta carotene is low and its
distribution is unequal, favouring higher income groups.
Integrated Assessment
Green leafy vegetables contribute to only about 16 per
cent of the total vegetable production. A 50 per cent
An integrated assessment of the extent and distribu
tion of all the three micronutrient problems should be
adopted rather than the current approach of assessing
individual deficiencies separately and independently.
Assessment of vitamin A deficiency by using Bitot spots
in preschool children, and IDD by the presence of goitre
in various stages in 6-12 year old children is recom
mended. The extent of anaemia can also be assessed
during these surveys by the estimation of haemoglobin.
A well implemented micronutrient surveillance system
can be developed to continuously monitor the situation.
Integrated Delivery
increase in the productivity of vegetables and fruits can
boost the total production of horticultural crops to 100
million tonnes. Productivity can be increased by raising
awareness among the farmers about the importance of
these foods, supplying good quality seeds and encour
aging proper crop management procedures like appli
cation of chemical fertilizers and pesticides and reduc
ing post harvest losses.
Home gardens can substantially increase horticul
tural production at the household level. Use of less
familiar but hardy and nutritionally adequate foods like
Basella alba (a leafy vegetable) and papaya should be
encouraged to provide beta carotene. Similar foods can
be identified in different regions.
Since the health functionaries are involved in the
micronutrient supplementary programmes, an integrated
mechanism should be developed so as to enable the
workers to perform the tasks during their routine visits.
The NIN's home gardening project in 20 villages
in two drought prone and backward districts of Andhra
Pradesh for three years, yielded encouraging results.
They can also monitor the entry of non iodised salt
About a half of the households were growing one or
by spot checks of salt at the household level during
more beta carotene rich foods as against only 10 per
their routine visits, using the available kits.
cent at the beginning of the project. Trained manpower
were raising village level nurseries. The district ad
Information, Education and Communication
ministration has now volunteered to operate similar
programmes through the existing departments of Ag
Field programmes can succeed only when the
community is well informed and educated about the
riculture, Horticulture, Social Forestry, Women and
Child Development and Health.
problems of nutrient deficiencies and the measures of
their control, and motivated to utilise the available
Single nutrient deficiencies are rare. Diets deficient
resources. This involves use of the multi-media ap
in vitamin A and iron usually lack in other nutrients
proach, adoption of modem techniques of social marketing,
like vitamin B complex and C. Home gardening can,
on the job training of functionaries, development of
therefore, take care of multiple deficiencies. In the long
messages by formative research, and provision of simple
run, dietary modification, at the household level, will
audiovisual tools to the functionaries. Information,
be more cost effective, and perhaps, is the only strategy
education and communication (IEC) is an absolute
to completely eliminate nutrient deficiencies. The so
necessity for control and prevention of any deficiency.
called short-term nutrient supplementation programmes
Money and manpower should not be bottlenecks in this
cannot go on for ever, and will be more like filling
endeavour.
a bottomless pit.
83
National Plan of Action
Recognising the overwhelming importance of the
problem, a comprehensive plan of action is being
developed at the national level setting the goal of
eliminating micronutrient deficiencies by 2000 AD. It
is now realised that sporadic interventions in selected
sectors would not suffice to annihilate the problem.
Therefore, a multisectoral, concerted action at the
district and intermediary levels will be implemented.
Included in this armament of measures are nutrition
education to create community awareness and motiva
tion to ensure people's participation, nutrient supple
mentation, food fortification, horticulture production,
training of the functionaries etc. With such a compre
hensive, holistic approach, it can be hoped that the
challenge posed by micronutrient malnutrition will be
met with success.
11. ICMR Task Force. Epidemiological Survey ofEndemic Goitre
and Endemic Cretinism. Indian Council of Medical Research,
New Delhi, p.19, 1989.
12. Hetzel, B.S. The Story of Iodine Deficiency. An International
Challenge in Nutrition. Oxford University Press, New "Ybrk,
USA, (2nd Ed.) p.192, 1991.
13. Chandra, R.K. and Au, B. Single nutrient deficiency and cell
mediated immune responses - III Vitamin A. Nutr Res 1:181,
1981.
14. Vijayaraghavan, K., Radhaiah,, G., Prakasam, B.S., Sarma,
K.V.R. and Reddy, V. Effect of massive dose of vitamin A
on morbidity and mortality in Indian children. Lancet 336:
1342, 1990.
15. Gopalan, C. Vitamin A deficiency and child mortality. NF1
Bulletin 7(3): 6, 1986.
16. West, K.P. Jr., Pokhrel, R.R, Katz., J.» Leclerq.S., Shrestha,
S.R., Pradhar, E.K., Khatry, S.K., Helseh, J.M., Pandcy,
M.R. and Sommer, A. Efficacy of vitamin A in reducing
preschool child mortality in Nepal. Lancet 338: 67, 1991.
References:
1.. UNICEF. The State of the Vforld^ Children. Oxford Univer
sity Press, New Ybrk, 1990.
2.
International Conference on Nutrition. Major Issuesfor Nutri
tion Strategies. FAO/WHO, 1992.
3.
National Nutrition Policy. Department of Wjmen and Child
• Development, Government of India, 1993.
4.
National Nutrition Monitoring Bureau Annual Report. Na
tional Institute of Nutrition, Hyderabad, 1991.
5.
Tandon, B.N., Ramachandran, K. and Bhatnagar, S. Inte
grated Child Development Services in India: Objectives,
organisation and baseline survey of the project population.
Indian J Med Res 73: 374, 1981.
6.
7.
8.
9.
Vyayaraghavan, K., Sarma, K.V.R., Pralhad Rao, N. and
Reddy, V Impact of massive dose of vitamin A on incidence
of nutritional blindness. Lancet ii 149: 1984.
Rahmathullah,, L., Underwood, B.A.^Thulsiraj, R.D., Milton,
R.C., Ramaswamy, K. , Rahmathullah, R. and Babu, G. Reduced
mortality among children in India receiving a small weekly
dose of vitamin A. N Eng J Med 323: 929, 1990.
National Nutrition Monitoring Bureau. Report of Repeat
Surveys (1988-90). National Institute of Nutrition, Hyderabad,
1991.
National Programme for Control of Blindness, India. Report
of National Warks hop. Directorate General of Health Serv
ices, New Delhi, 1989.
10. ICMR Task Force. Evaluation of the National Nutritional
Anaemia Propohylaxis Programme - A Study. Indian Council
of Medical Research, New Delhi, 1989.
84
17. Herrera, M.G., Ncstel, P, El Amin, A., Fawzi, W.W.,
Mohammed, K.A. and Weld, L., Vitamin A supplementation
and child survival. Lancet 340: 267, 1992.
18. Levin, H.E., Pollitt, R., Galloway and Me Guire, J.M. Micro
nutrient Deficiency Disorders. Draft Monograph. World Bank
Health Sector Priority Review,腿shington, D.C., 1990.
19. Hetzel., B.S., Dunn, J.N. and Stanbury, J.B. The Prevention
and Control ofIodine Deficiency Disorders. Elsevier, Amster
dam, p.35 and 65, 1987.
20. Swaminathan, M.C.,Susheela, T.R andThimmayamma, B.V.S.
Field prophylactic trial with a single annual oral massive dose
of vitamin A. Am J Clin Nutr 23: 119, 1970.
21. Vijayaraghavan, K. and Pralhad Rao, N. An evaluation of the
National Prophylaxis Programme against blindness due to
vitamin A deficiency. Nutr Rep Int 25: 431, 1982.
22. Working Group on Fortification of Salt with Iron. Use of
common salt fortified with ijon in the control and prevention
of anaemia - A collaborative study. Am J Clin Nutr 35: 1442,
1982.
23. Gopalan, C. The National Goitre Control Programme - A blue
print for its intensification. NFI Sci Rep No.l: p.55t 1983.
24. Narasinga Rao, B.S. Double fortification of salt with iron and
iodine to control anaemia and goitre. Proc Nutr Soc India 37:
153, 1991.
25. Annual Report for 1985-86. National Institute of Nutrition,
Hyderabad, p.69, 1986.
26. Brahmam, G.N.V., Nair, K.M., Ranganathan, S., Gal Reddy,
Ch., Vishnuvardhan Rao, M., Naidu, A.N., Pralhad Rao, N.
and Reddy, V. Use of common salt fortified with iron and
iodine (Double fortified sak)) — A community study in Andhra
Pradesh, Tech Rep, National Institute of Nutrition, Hyderabad,
1994 (In Press).
27.
Kochupillai, N. Prevention and control of goitre — Demerits
of iodised oil injections. NFl Bulletin 12(4): 1, 1991.
28.
WHO-UNICEF, Nutrition Support Programme. Meeting the
challenge of iodine deGciency. LaPaz, UNICEF, p.200, 1989.
29.
Bautista, A., Barker, RA.» Duna, J.T., Sanchey, M. and
Kaiser, D.L. The effects of oral iodized oil on intelligence,
thyroid status and somatic growth in school-age children from
an area of endemic goitre. Am J Clin Nutr 35: 127, 1982.
This write-up has been contributed by Dr. K. Vijayaraghavan,
Deputy Director, National Institute of Nutrition,, Hyderabad.
ABSTRACTS
Some Research Projects Completed Recently
Pathophysiological implications of coarse cereals.
The study was carried out on healthy volunteers
and non-insulin dependent diabetics of either sex to
define the effects of a few cereals on serum lipoprotein
profile and glucose tolerance. The effect of a mixture of
wheat, barley and Bengal gram was also studied
In response to maize, none of the variables
examined were significantly different as compared to
white bread. Fhc glycaemic response to bajra was
significantly lower than that to white bread in healthy
subjects, but the two responses were indistinguishable in
patients of non-insulin dependent diabetes mellitus
(N1DDM). The insulinaemic response to bajra and
white bread were not significantly different in either
group of subjects. These characteristics do not make
maize and bajra very suitable for prevention or
Although barley had favourable physiological
effects, its acceptability is likely to be low because of its
poor organoleptic properties. Whereas the mixture of
wheat-barley-Bengal gram has much better organoleptic
properties than barley alone, and may be more
acceptable for the prevention and treatment of diabetes
mellitus.
R.L. Bijlani
Department of Physiology,
All India Institute of
Medical Sciences
New Delhi
Publications:
1.
Shukia, K., Narain, J. P.. Puri, P., Gupta. A.. Bijlani, R.L..
Mahapatra, S.C. and Karmarkar, M.G. Glycaemic response
to maize, bajra and barley. Indian J Physio! Pharmacol 35 :
249, 1991.
2.
Narain, J.P.. Shukla. K., Bijlani, R.L., Kochhar, K.P.,
Kafmarkar, M.G., Bala, S., Srivastava, L.M.and Reddy, K.S.
Metabolic responses to a four week barley supplement. Ini J
Food Sc Nutr 43:41,1992.
treatment of diabetes.
The glycaemic response to barley was significantly
lower than that to white bread in both groups of
subjects. However, the insulinaemic response to barley
was significantly lower than that to white bread only in
healthy subjects. In NIDDM patients, there was a
tendency for the response to barley to be higher than
that to white bread 0.5 h after ingestion. Barley, with a
low glycaemic index (68.7 in healthy subjects
53.4 in NIDDM patientsand) and a high insulinaemic
index (105.2) in NIDDM patients seems to mobilize
insulin in NIDDM. The glycaemic index of the wheatbarley-Bengal gram mixture was 68.6 and 64.9 and the
insulinaemic index 88.1 and
NIDDM subjects respectively.
66.0 in healthy and
The long-term effects of both barley and the wheat-
barley-Bengal gram mixture were an increase in HDL
cholesterol, a fall in LDL cholesterol, an increase in
Protection against ascending pyelonephritis by immu
nization with pili and K - antigen of Escherichia coli.
The study was carried out on female Wistar strain
albino rats (Wt. 180±20g) to produce ascending
pyelonephritis using uropathogenic strain of Escherichia
coli, to isolate and purify pili and K-antigens and to find
out whether immunization with pili and K-antigens
provides protection against ascending pyelonephritis；
Ascending pyelonephritis was produced successfully
in the rat model by inoculating uropathogenic E. coli 06
into the bladder with and without ligation of the left
ureter. Histopathology of tiic kidneys showed significant
increase in severity score on days 7 and 14 post-infection
in both obstructed and unobstructed kidneys.
85
Purified capsular polysaccharide K-antigen from
uropathogenic E. coli contained less than one per cent
contamination of nucleic acid and protein. Coupling of
K-antigen with bovine serum albumin (BSA) produced
a high molecular weight complex eluted into void
volume of sepharose 6B column. Immunization with
two doses of K-antigen-BSA conjugate at four weeks
interval protected 60 per cent rats from ascending
pyelonephritis. However, either K-antigen or BSA alone
failed to protect the animals against the disease.
compared to non-immunized infected animals sacrificed
on days 7 and 14 post-infection. Pyelonephritis
produced damage in the kidney and the transport of
glucose and amino acids through renal brush border
SDS-PAGE analysis of purified pili antigen
showed a single band at molecular weight of 17 kDa.
When tested pili antigen was found to be immunogenic.
Animals receiving either active or passive immunization
with pili antigen had comparatively low severity score
Department of
Experimental Medicine
membrane was also altered (reduced). The changes in
the uptake of glucose, L-alanine, L-lysine and L-proline
amino acids were partially restored after immunization
with pili antigen.
N.K. Ganguly
Postgraduate Institute of
Medical Education and Research
Chandigarh.
ICMR NEWS
The
following
meetings
of various
Member, in the 5th Biology of Diseases Vectors Course
technical
groups/committees of the Council were held at New
at Crete, Greace (July 17-24, 1994).
Delhi:
Dr. G.V. Satyavati, Director-General, ICMR,
participated in the Technical Advisory Board meeting of
Project Review Committee
for Research in NonCommunicable Diseases.
July 21, 1994
Meeting on Legal Policies
July 25 and
Dr. J.J. Rodrigues, Director-in-Charge, Dr. Nita
related to HIV/AIDS
and Prisons.
August 9, 1994
Task Force on Development
of an Instrument of
Psychological Stress
August 5, 1994
Mawar and Dr. R.R. Gangakhedkar, Sr. Research
Officers; National AIDS Research Institute, Pune and
Dr. Jayashree Nandi, Research Officer, National
Institute of Virology, Pune, participated in the X
the Council of Scientific and Industrial Research, New
Delhi held at Hyderabad (July 22-23, 1994).
International Conference
(August 7-12, 1994).
Participation of ICMR Scientists in Scientific Events:
Dr. S,K. Subba Rao, Deputy Director, Malaria
Research Centre, Delhi, participated, as a Faculty
on
AIDS
at
Yakohama
Dr. Leela Raman, Dy. Director (Senior Grade),
National Institute of Nutrition, Hyderabad,
participated in the symposium on Safe Motherhood at
Stockholm (August 15-16, 1994).
ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS/COURSES/CONFERENCES
Symposium/Seminar/Workshop/
Course/Conference
Date & Place
Contact Address
National Workshop on Laboratory Diag
nosis of Fungal Infections
August 1-7, 1994;
(at Madurai)
Dr. V.V. Pankajalakshmi, Organising Secretary of
the Workshop, Institute of Microbiology, Maduari
Medical College, Maduari.
X Indian Conference on Family Welfare and
Voluntary Sterilization.
August 19-21, 1994;
(at Pondicherry)
Dr. Asha Oumachigui, Organising Secretary of the
Conference, Department of Obstetrics and Gynaeco
logy, Jawaharlal Nehru Institute of Postgraduate
Medical Education and Research, Pondicherry.
86
Symposium/Seminar/ Workshop/
Course/C(inference
Date & Place
Contact Address
National Workshop on Neuroepidemiology.
September 1-4, 1994;
(at Bangalore)
Dr. M. Gourie-Devi, Organising Secretary of the
Workshop, Department of Neurology, National Insti
tute of Mental Health and Neurosciences, Bangalore.
Continuing Medical Education in Psychiatry.
September 10-11, 1994;
(at Manipal)
Dr.P.S.V.N. Shanna, Organising Secretary 4th Annual
Conference of the Indian Psychiatry Society,
Department of Psychiatry, Kasturba Medical
College, Manipal.
Symposium on Complex Carbohydrates.
September 15-16, 1994;
(at Roorkee)
Dr. Ritu Barthwal, Organising Secretary of the Sym
posium, Department of Biosciences and Biotechno*
logy. University of Roorkee, Roorkee.
VI National Symposium on Ultrasonics and
One Day Workshop on Ultrasound in Medicine.
September 15-17. 1994：
(At Tirupati)
Prof. L. Rama Murthy, Convenor, NSU-VI-94,
Department of Physics, S.V. University, Tirupati.
National Update on Nutrition in Children.
September 24-25, 1994;
(at New Delhi)
Dr. H.P.S. Sachdev. Secretary. Indian Academy of
Pediatrics, Department of Pediatrics. Maulana Azad
Medical College, New Delhi.
International Conference on Molecular and
Metabolic Endocrinology and Contraceptive
Technology.
September 26-27. 1994;
(at Madras)
Dr. M. Michael Aruldhas, Organising Secretary,
Silver Jubilee International Conference. Department
of Endocrinology. Dr. A.L. Mudaliar Postgraduate
Institute of Basic Medical Sciences, Madras.
M ICON-Internationr 94.
November 9-12, 1994;
(at Mysore)
Dr. R. Shankaran. Chairperson of the Organising
Committee. M ICON-1 nternational' 94, Defence Food
Research Laboratory. Siddhartha Nagar. Mysore.
Ill International Conference on DNA Finger
printing.
December 13-16, 1994：
(at Hyderabad)
Dr. Lalji Singh, Organising Secretary of the
Conference, Centre for Cellular and Molecular
Biology, Hyderabad
International Symposium on Atherosclerosis,
Thrombosis and Transfusion Medicine.
December 15-20. 1994：
(at Bombay)
Dr. D. Mohanty. Director, Institute of Immuno
haematology, Pare!, Bombay.
COUNCIL'S TRAINING PROGRAMMES
Reproductive Biology
Nutrition
At the Institute for Research in Reproduction, Bombay:
At the National Institute of Nutrition, Hyderabad:
...
...
Workshop on Gynaecologic Cytology and Immuno
cytochemistry (September 26-October 1, 1994).
Annual Training Course in Nutrition (December 1,
1994-February 28, 1995).
Occupational Health
Endocrinology
Al the National Institute of Occupational Health,
Ahmedahaci:
At the National Institute of Nutrition, Hyderabad:
...
Annual
Training
Techniques and
Course
on
Endocrinological
their Applications (August
September 16, 1994).
I-
...
Orientation Course on Occupational Health for
Industrial
Medical
Officers (September
19-24.
1994).
87
Training Course on Air Pollution Monitoring and
Risk Assessment (October 19-25, 1994).
...
Training Course in Pesticide Residue Analysis
(December 5-9, 1994).
Medical Entomology
...
Training Course for Laboratory Animal Super
visors (September 12- December 10, 1994).
Haematology
At the Institute of Immunohaematology, Bombay:
At the Vector Control Research Centre, Pondicherry:
...
M.Sc in Medical Entomology (from August 1994:
for 2 years).
Laboratory Animal Technology
...
Training Course in Blood Group Serology and
Blood Bank Methodology for Technicians (August
9-September 8, 1994).
...
Training Course in Blood Group Serology and
Blood Bank Methodology for Medical Officers
(August 9-October 7、1994).
At the Laboratory Animal Information Service Centre,
National Institute of Nutrition, Hyderabad:
INDIAN COUNCIL OF MEDICAL RESEARCH
Grant-in-aid for organising Seminars/Symposia/ Workshops
Council provides partial financial assistance for organising Seminars/Symposia/Workshops.
Applications for grant of financial assistance (complete in all respects in the prescribed proforma), will
be considered only if furnished atleast four months before the date of commencement of the
Seminar/ Symposium/ Workshop, etc.
Editorial Board
Chairperson
Members
Dr. G.V. Satyavati
Dr. Badri N. Saxena
Director-General
Dr. C.R. Ramachandran
Editor
Dr. N. Medappa
Printed and Published by Shri J.N. Mathur for the Indian Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi-110029
R.N. 21813/71
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