After enduring a trip that spanned three days, my colleague traveling with me and I were happy to finally walk out of an airport. I traded one reality for another seemingly unreal one: the city was more like a video game. The sun beat down on my tired body, which was clad with the armor of my sweatshirt, and the moist air seeped into every open crevice. Thankful to have finally arrived,
I couldn’t help but smile as we made our way to our ride home—a car whose only air-conditioning came from dense summer air tumbling in through the rolled-down windows. My eyes were stuck wide open in awe as they soaked up the images of the world outside of the car driving from the “controlled” airport grounds and into the pool of people, rickshaws, motorcycles, animals, and general chaos moving in every possible direction. Just when I thought there was no more space to move, a motorcyclist would vroom by, nearly hitting another car, into some tiny crack of space. The continuous honking of horns composed a symphony as we drove. Women in saris of every shade, vibrant fruit stands, cows, dogs, bold ads for Bollywood movies, and yellow-and-green rickshaws mixed up a smoothie of colors like a live blending machine. And then they started. Even within the walls of our vehicle, the close proximity of cyclists and faces poking out of buses gave them a chance to notice that we were different. With our fair faces and brown hair, cameras in hand, I felt like an alien simply dropped onto another planet as people turned heads to examine our features. Being able to find the humor in such situations that are different and perhaps uncomfortable has really helped adjust to such a new place. But on the other hand, Indian hospitality is so warm and welcoming that after starting work on Monday, some of my homesickness began to be replaced by excitement and motivation to start some data analysis. We were welcomed with open arms, and it wasn’t long before we even had lunch buddies who always kept us entertained and shared their wisdom about the city over some hot biryani and chilled, sweet mango lassi. And now, the research question at hand. India has a striking number of low birthweight (LBW)—less than 2.5 kg—babies born every year: 28% from 2005-6, while other studies have cited even more.[1] The Million Death Study,[2] being conducted in India, has found that LBW and pre-term (<37 weeks) babies accounted for 14% of all neonatal deaths in 2005.[3] Keep in mind that in 2004, neonatal deaths were responsible for an astonishing 45% of deaths under five years of age.[4] A baby born pre-term or with intrauterine growth retardation (IUGR) is at risk of being LBW.[5] LBW babies, in turn, may suffer long-term consequences, such as increased risk of chronic diseases.[6] Furthermore, a mother who is not properly nourished during pregnancy has a higher risk of delivering a LBW baby.[7] Thus, any possible solution should begin with the mother. Studies have shown that protein intake (but not too much) has beneficial effects on birthweight.[8] In India, most people get their protein from cereal, legumes, and milk,[9] but may not consume what is necessary to keep the baby healthy during pregnancy. Milk is an excellent source of protein.[10] Thus, ensuring that women and adolescent girls get sufficient milk could be the answer to resolving low birthweight issues. The complications? Indian babies have been shown to have the same amount of body fat as Western babies albeit a lower overall body weight, giving them the nickname “thin-fat;”[11] this means that increasing birthweight by too much could also be detrimental. Furthermore, both B12 and protein can be found in milk, so it can be hard to differentiate between the effects of each. My job is to analyze a dataset from a cohort of 2,000 pregnant women to see how protein affects birth outcomes by looking at intake of foods such as milk and also to untangle the rivalry between protein and B12. The data analysis is one part; telling the story of protein, milk, and pregnancy outcomes in a way that makes the gravity of the problem understandable not only from a scientific vantage point, but also from an economics and health policy perspective, which forms the second part of the puzzle. In other words, all of the numbers are a complicated way of saying that LBW is a problem not only in the short term, but also for the baby’s adult life; this problem is especially apparent in India. It is a problem that needs to be addressed and can be prevented with sustainable policy interventions. These are the reasons I find myself miles from home, typing this post after enjoying a hot cup of masala chai. With its lush greenery, blooming flowers, cobblestones, and Spanish-villa-like architecture, St. John’s has become our family and safe-haven from the sometimes-overwhelming bustle of the extraordinary city that lies outside the campus walls. Let the number crunching begin! *Play on New World Symphony Orchestral Academy (http://www.nws.edu/default.aspx) References [1] Tracking Progress on Child and Maternal Nutrition: A Survival and Development Priority, Rep. United Nations Children’s Fund (UNICEF), Nov. 200, Web, 23 June 2012. [2] "Million Death Study (MDS)," Centre for Global Health Research (CGHR), Centre for Global Health Research, St. Michael's Hospital and University of Toronto, n.d., Web, 22 June 2012. [3] The Million Death Study Collaborators, "Causes of Neonatal and Child Mortality in India: A Nationally Representative Mortality Survey," The Lancet 376.9755 (2010): 1853-860, Elsevier Limited, 15 Nov. 2010, Web, 22 June 2012. [4] Tracking Progress on Child and Maternal Nutrition: A Survival and Development Priority, Rep. United Nations Children’s Fund (UNICEF), Nov. 200, Web, 23 June 2012. [5] "Maternal Nutrition and Adverse Pregnancy Outcomes: Lessons from Epidemiology," Nestlé Nutrition Workshop Series Pediatric Program 55 (2005): 1-15, PubMed, National Center for Biotechnology Information, U.S. National Library of Medicine, Web, 22 June 2012. [6] Barker, D., "In Utero Programming of Chronic Disease," Clinical Science 95 (1998): 115-28, The Biochemical Society and the Medical Research Society, Web, 22 June 2012. [7] Pratibha Dwarkanath, et al., "Glucose Kinetics and Pregnancy Outcome in Indian Women with Low and Normal Body Mass Indices," European Journal of Clinical Nutrition 63.11 (2009): 1327-334, Macmillan Publishers Limited, 27 May 2009, Web, 22 June 2012. [8] Kramer MS, Kakuma R., Energy and protein intake in pregnancy, Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD000032. DOI: 10.1002/14651858.CD000032. [9] "The Effect of Fish and Omega-3 LCPUFA Intake on Low Birth Weight in Indian Pregnant Women," European Journal of Clinical Nutrition (2009) 63, 340–34663 (2009): 340-46, Macmillan Publishers Limited, 24 Oct. 2007, Web, 22 June 2012. [10] Kramer MS, Kakuma R., Energy and protein intake in pregnancy, Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD000032. DOI: 10.1002/14651858.CD000032. [11] S. Muthayya, et al., "Anthropometry and Body Composition of South Indian Babies at Birth," Public Health Nutrition 9.07 (2006): 896-903, The Nutrition Society, 10 Jan. 2006, Web, 22 June 2012.
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The Lab JournalWelcome to the summer internship series of 2012! Follow 9 Scientista bloggers through their summer internships to catch a glimpse of what it is like to be a scientista^TM. By Title- India Presents: A "New World Symphony"
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