NHR Apr-Sept 2019: Original Research: A cross-sectional study to find out the prevalence of obesity in children taking excessive dietary sodium and the effect of Natrium muriaticum on presenting complaints in such cases

A cross-sectional study to find out the prevalence of obesity in children taking excessive dietary sodium and the effect of Natrium muriaticum on presenting complaints in such cases


Doris Lalrinawmi*1, Gautam Ash2

  1. Former Postgraduate Trainee, Dept. of Paediatrics, National Institute of Homoeopathy, Govt. of India
  2. Professor and In-charge, Dept. of Paediatrics, National Institute of Homoeopathy, Govt. of India

*Correspondence: dorislalrinawmi610@gmail.com


ABSTRACT

Background: The mean population sodium consumption and childhood obesity is on the rise in an alarming rate in India. It has already been recognized that, a diet high in sodium and obesity increases risk of cardiovascular diseases via the effects on high blood pressure. Recently many studies have emerged which suggest that high dietary sodium intake may be implicated in weight gain. So, the aim of the study was to know the prevalence of obesity among children taking excessive dietary sodium along with the effects of Natrium muriaticum (NM) for the presenting complaints in those patients.

Methods: A cross-sectional study for finding the prevalence of obesity among children taking excessive dietary sodium as well as a prospective clinical study to assess the effects of Natrium muriaticum for their presenting complaint was carried out at the paeditric outpatient department of National Institute of Homoeopathy. Multiple 24-hr dietary recall interviews were done for screening patients. The BMI chart developed by the National Center for Health Statistics in collaboration with National Centre for Chronic Disease Prevention and Health Promotion (2000) for boys and girls separately from 2-20 years was used. In managing the cases, Natrium muriaticum was given. A careful detailed history was taken in each case.

Results: The prevalence of obesity among children taking excessive dietary sodium was 29.93%.Chi-square value was found to be statistically significant (P<0.05) which revealed the importance and role of Natrium muriaticum in the management of complaints of children taking high dietary sodium.

Conclusion: The prevalence of obesity among children taking high dietary sodium is high. The Homoeopathic treatment with Natrium muriaticum for the different complaints offers a quality treatment in the best of manner for these cases.

Keywords: Prevalence; Body Mass Index (BMI); Paediatrics; Homoeopathy; Clinical Study.


INTRODUCTION

Childhood is an age of risks that can be impactful to lifelong functioning. Serious illnesses or disorders can be avoided or managed better if they are screened for early signs or with early wellness practices. Therefore, keeping children healthy as much as possible can support a better healthy pathway to adulthood.

The problem of childhood obesity is global and is one of the most serious public health challenges of this century. Globally, the prevalence of childhood overweight and obesity has risen in recent years. The International Association for the Study of Obesity (IASO) and international Obesity Task Force (IOTF) estimated that 200 million school children are either overweight or obese.(1) The National Health and Nutrition examination survey, 2009-2010, found 32% of children, 2-9 years old to be overweight or obese and 17% in the obese range. In 1998, World Health Organization recognized obesity as a major public health problem.(2)

Limited evidences are available regarding the burden of obesity among Indian children. Review of the studies published in the last three decades between 1983 to 2013 reporting on the prevalence of childhood overweight and obesity (age 1-18 yr) in India was conducted by Harish Ranjani, T.S. Mehreen et al., where the overweight and combined overweight/obesity prevalence showed an increasing trend. The prevalence of overweight increased from 9.7 per cent prior to 2001 to 13.9 per cent in studies reported after 2010. The combined trend followed a similar pattern increasing from 15.9 per cent prior to 2001 to 16.3 per cent from 2001-2005. The value then increased to 17.4 per cent in the 2006-2010 periods, finally reaching 19.3 per cent in studies reported after 2010.(1)

Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardio-vascular diseases at a younger age.(3)

The causes of excess weight gain in young people include factors like person’s behavior and genetics. Behavior that influence excess weight gain includes eating high calorie, low nutrient foods and beverages, not getting enough physical activity, sedentary activities and medication use.(4)

A vast number of facts are still undiscovered in the field of medical science. Among these is in regards to the intake of Sodium, which have a wide range of unfavorable effects on its excessive use. Many effects have well been established and known for ages. It’s possible related to being an important contributory factor for childhood obesity has now emerged in recent years. Many works have come up to find out this possible relationship. Studies done by Libuda et el (5), Yoon et al (6), Zhu et al (7) and Lee et al(8) have reported positive associations between sodium intake and a range of adiposity outcomes including BMI.

Homoeopathy is a system of medicine which treat a patient as a whole, that is, it’s treatment is not merely based on a specific nosological name that a patient is presented with. Rather it takes into consideration of the whole person – both physically and mentally. The selection of medicine for each case differs according to individualization and the totality of symptoms formed thereafter. Many factors are taken into account for this purpose which makes each case peculiar.

India is one of the developing countries where childhood overweight and obesity is increasing day by day. This scenario is well observed in Out-Patient Department (OPD) of National Institute of Homoeopathy (NIH). A large number of patients attend OPD of NIH. Among them, a good number of patients are from paediatric age group having Obesity. Also the key findings in the study done by George Institute For Global Health shows that Salt consumption is higher in the southern and eastern parts of India(9), therefore, West Bengal being one of them.

METHODS

Trial design: This cross-sectional study followed by a prospective clinical study was conducted at Paediatric OPD of NIH. Institutional Ethical Committee (IEC) approved the protocol [Ref. No. 5-023/NIH/ PG/Ethical Comm. 2009/Vol. III/1977 (A/S); dated March 27, 2017]. The trial protocol (unpublished) and full dissertation was submitted as the postgraduate thesis of the corresponding author to The West Bengal University of Health Sciences.

Participants: Inclusion criteria were patients taking Sodium more than WHO recommended value, BMI > 95th percentile for age, age between 5 to 15 years, both sexes, of all religions and different socio-economic status and patient’s guardian willing to give consent for participation. Exclusion criteria were patients taking Sodium less than WHO recommended value, BMI < 95th percentile for age, patients suffering from uncontrolled systemic illness or life threatening infections, patient’s guardian not willing to give consent for participating in the study, patients not willing to undergo any investigations, if advised and patients who do not undergo regular follow-up.

Interventions: Intervention was planned as administration of Natrium muriaticum in centesimal or 50 millesimal potencies and in individualized dosage, as decided appropriate to the case or condition. In centesimal potencies, each dose consisted of

4 cane sugar globules medicated with a single drop of the indicated medicine, preserved in 90% v/v ethanol. In 50 millesimal potencies, a single medicated cane sugar globule of poppy seed size (no.10) was dissolved in 50 ml distilled water with addition of 2 drops of 90% v/v ethanol, 10 doses were marked on the vial, each dose of 5 ml was instructed to be taken after 10 uniformly forceful downward strokes to the vial in 45 ml normal water in a clean cup, to stir well, to take 5 ml of this liquid orally, and to discard rest of the liquid in the cup. Each dose was directed to be taken orally on clean tongue with empty stomach. Duration of such therapy was 6 months. Medicines were obtained from SBL Pvt. Ltd. and Homoeopathy International®, both are Good Manufacturing Practice (GMP) certified firms. Single individualized medicine was prescribed on each occasion taking into account presenting symptom totality, clinical history details, constitutional features, miasmatic expressions, repertorization using RADAR® software when required with due consultation with Materia Medica. Subsequent prescriptions were generated as per Kent’s observations and Hering’s law. Participants were assessed by two homoeopaths at a time. Medicine was selected on each occasion by two homoeopaths, and in case of any differences in opinion, it was resolved by involvement of another homoeopath. All the homoeopaths involved were affiliated with respective state councils.

General management: All the participants were given general guidelines to reduce daily dietary sodium intake and for regular exercise. They were advised to be present for monthly follow-ups.

Outcomes: The response of the patients to Natrium muriaticum was observed and improvement was assessed in terms of their presenting symptoms, physical and mental symptoms and clinical findings.

Sample size: No relevant data was available on prevalence study of obesity in children with high Sodium intake and effectiveness of NM in presenting complaints of such cases.

Statistical methods: The analysis was carried out with per protocol approach; i.e. only the protocol-compliant sample entered into the final analysis. The baseline descriptive data (categorical and continuous) were presented in terms of absolute values and percentages. Outcome data obtained at baseline and after 6 months were compared by Chi–square test ‘χ2’. P values less than 0.05 were considered as statistically significant. No interim and subgroup analyses were planned. Reporting adhered to the CONSORT(10) and RedHot(11) guidelines for reporting trials, Mathie’s criteria for model validity of homoeopathic treatment (12,13) (MVHT) and Saha’s criteria for reporting quality of homoeopathic individualization in clinical trials(14).

RESULTS

Study flow:

A total of 1134 children were screened for prevalence study, 558 patients were found to be taking sodium > 2g/day, among which 167 patients were obese. As per the pre-specified inclusion and exclusion criteria, 33 children were selected for prospective clinical study. After 6 months of intervention, outcome data were recorded again. During course of treatment, 3 were dropped out; 30 completed the trial and entered into the final analysis. (Fig. 1)

Fig. 1: Study flow diagram

Recruitment: The study continued for 12 months; started in March 2017 and continued up to March 2018.

Baseline data: Six variables were studied for

the baseline socio-demographic features of the subjects – body mass index (BMI), age, gender, residence, religion and socio-economic status. (Table 1)

Table 1: Baseline socio-demographic data (N=558)

Features N(%)
Body mass Index
·        Less than 85th percentile 352 (63.08)
·        Between 85th and 95th percentile 39 (6.99)
·        Above 95th percentile 167 (29.93)
Age group
·        05 – 09 337 (60.39)
·        10 – 15 221 (39.61)
Gender
·        Male 264 (47.31)
·        Female 294 (52.69)
Residence
·        Urban 81 (14.52)
·        Rural 477 (85.48)
Religion
·        Hindu 352 (63.08)
·        Islam 206 (36.92)
Socio economic status
·        Upper class 73 (13.08)
·        Lower class 485 (86.92)

Numbers analyzed: Outcomes from 30 out of 33 subjects were complete and only those entered into the final analyses.

Outcomes and estimations: Prevalence of obesity was assessed from patients taking high Sodium after screening. The response of the patients to Natrium muriaticum was observed and improvement was assessed in terms of their presenting symptoms, physical and mental symptoms and clinical findings. The prevalence of obesity among children taking excessive dietary sodium was 29.93%. Odds ratio (OR) is calculated to measure the strength of the association between dietary consumption and obesity from the obtained data. The calculated OR is 1.84, which is less than 2.10, which shows a weak positive association between dietary sodium consumption and obesity. Chi-square value was found to be statistically significant (P<0.05) which revealed the importance and role of Natrium muriaticum in the management of complaints of children taking high dietary sodium.

DISCUSSION:

Principal findings: A cross-sectional study followed by prospective clinical study was carried out at National Institute of Homoeopathy, India. 1134 patients were screened for daily sodium intake and obesity within a period of 1 year. The prevalence of obesity among patients taking excessive dietary sodium was found to be 29.93%. Over 6 months of intervention, symptom severity and health status improved significantly in the study group suggesting NM as an effective treatment option for the presenting complaints of obese children taking excessive dietary sodium.

Strengths of the study: The prevalence study of obesity among children taking excessive dietary sodium was done for the first time in India. Also study of the possible effects of NM in the treatment of complaints in such patients was done for the first time. Changes in the outcomes over time correlated significantly, thus validating the study findings further. Homoeopathic treatment was based on the principles of individualization. Another important strength was the participation of qualified and experienced homoeopaths schooled in and practicing “classical” homoeopathy. Our study was representative of individualized (“classical”) homoeopathy only. In a broader interpretation of the law of similar, medicines were selected for symptoms both typical of the diagnoses and outside the predominating pathologies (“constitutional”).

Weaknesses of the study: The study was conducted in a hospital setup thus a community or precise area of study was lacking, which could have covered a widespread area and more number of children. Also the screening for sodium consumption was done only with multiple 24hr dietary recall interview, which is time consuming and less reliable in estimation of sodium intake, as wrong information from the patient part is a possibility. In prospective clinical study in the homoeopathic management, sample size was small involving only 30 patients and the period of treatment was limited. This was due to the work been taken up for a dissertation related to postgraduate academic activities.

Unanswered questions and future research: The exact depth of the prevalence in a particular area or community is lacking. Therefore, the prevalence study of this kind should be done on a much larger sample and if possible in a precise locality. Screening for daily sodium consumption could be done with 24-hr urinary sodium test along with 24-hr dietary recall. The statistical analysis becomes more reasonable and the inferences become dependable in large samples and sufficiently prolonged periods of study.

Conclusion: This cross-sectional study followed by prospective clinical study was carried out at National Institute of Homoeopathy, India. Over 6 months of intervention, symptom severity and health status improved significantly in the study group suggesting NM as an effective treatment option for the presenting complaints of obese children taking excessive dietary sodium. However, being an underpowered trial, results should be interpreted cautiously and further independent research in multi-centric design is required on larger sample size before making any firm recommendations.

Conflict of interest statement:  The authors declare that they have no competing interests. The trial was carried out as the postgraduate thesis of the corresponding author under guidance of GA, who was a permanent teaching faculty of the institute.

Funding: We received no funding for the study. Funding required for the project was borne by the authors themselves.

Authors’ contributions: DL conceived and designed the study. DL and GA collected data. GA ran the statistical analyses and interpreted the data. DL prepared the manuscript. All the authors reviewed and approved the final manuscript.

REFERENCES

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Cite this article as: Lalrinawmi D, Ash G. A cross- sectional study to find out the prevalence of obesity in children taking excessive dietary sodium and the effect of Natrium muriaticum on presenting complaints in such cases. National Homoeo Recorder 2019;15(2,3):

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