CHAPTER II CLINICAL STUDIES HEMATOLOGY AND BLOOD CHEMISTRY. Blood sustains life and is an important vector of infection and an epitome of

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1 CHAPTER II CLINICAL STUDIES HEMATOLOGY AND BLOOD CHEMISTRY 2.1 Introduction Blood sustains life and is an important vector of infection and an epitome of the universe. If the organs and the tissues lack proper supply of blood, bodily functions would break down, hampering mental functions, triggering emotional changes, and even causing debilitating diseases. Blood has to flow freely to keep the body performing at optimum levels and help to eliminate risks from diseases, infections, free radicals and the natural decay of body organs due to the ageing process. Circulatory problems are caused by poor diet, lack of exercise and high stress levels. The values of hematological parameters are affected by a number of factors even in apparently healthy populations. These factors include age, sex, ethnic background, body build and social, nutritional and environmental factors, especially altitude (Evans et al., 1999; Karazawa and Jamra, 1989; Serjeant et al., 1980; Frerichs et al., 1977). Several studies have been carried out in children at various ages and in adolescents, and significant differences have been reported in different populations, seasons, racial and ethnic groups and gender subgroups (Taylor et al., 1997; Akdag et al., 1996; Bain, 1996; Gonzalez Silva et al., 1994; Bao et al., 1993; Onwukeme and Olomu, 1991; Daac et al., 1991; Saxena and Wong, 1990). The blood volume in the body varies according to the size of the individual. Blood is a very good indicator of the healthy status of an individual. The body systems are always changing the balance of the blood. Its major function is to transport all the vital substances necessary to maintain bodily life processes. Several 39

2 diagnoses are made only by using the results of the blood hematology and biochemistry by the physicians. Blood glucose is one of the important blood parameter. Normal blood sugar level is vital for healthy life, increase or decrease cause a lot of troubles to human beings. Chronic diseases particularly atherosclerosis and hypertension with their complications, now emerge as the most serious health problem not only in developed countries but also in developing countries like India. These processes take a tremendous toll in premature sickness, disability and death and have a major economic impact on its victim and health care delivery system. Atherosclerotic process begins in childhood and is influenced by genetics, diet and lifestyle (Clarke et al., 1994). Most of the earlier studies of age-related lymphocyte changes have been restricted to newborns (Slade et al., 1988; Gerli et al., 1986; Prince et al., 1985; Pahwa et al., 1985; Griffiths-Chu et al., 1984; Jacoby and Oldstone, 1983; Campbell et al., 1974) or very young children (Denny et al., 1992) or have compared young adults to older adults (Schwab et al., 1983; Nagel et al., 1981). The reference values for neither lymphocyte subsets of neither adults nor children of mixed-age groups can be used for infants and children. There is a significant decline from infants to adults in absolute counts of WBC and total lymphocytes. These observations confirm the findings of other investigations (Hulstaert et al., 1994; Erkeller-Yuksel et al., 1992; Wiener et al.,1990; Yanase et al., 1986). Several studies have demonstrated the different influences of racial and environmental factors on the human lymphocyte immunophenotype (Senju et al., 1991; Tollerud, 1991; Tollerud, 1989; Thomas and Linch, 1983). Environmental factors and altitude also influence the value of hematological parameters (Taylor et al., 1997). Up to the age of 13 years, the male and female 40

3 values were similar, but were lower in female adolescents (14-15 years of age). Ai- Saleh et al., (2000) studied that MCV was significantly altered in blood in relation to environmental conditions. The monocyte count and neopterin level were significantly higher in the autistic children than in the comparison subjects (Thayne et al., 2003). There is a great need for cross-sectional population study to establish new reference range for monocytes in order to appropriately manage individuals with infection diseases and hematological disturbances (Elzbieta Gorska et al., 2006). Calcium is a vital micronutrient for human health but high calcium levels may be involved in processes that take a longer time to cause harm, such as the calcification of blood vessels or soft tissues, while low calcium levels may cause short-term deleterious effects such as heart rhythm abnormalities. Over intake of oily food such as fried food, pizza, burger and packed items among the school children resulted in accumulation of fat tissues in their body leading to hypercholesterolemia (Snow et al., 2004). Longstanding elevated hypercholesterolemia leads to accelerated atherosclerosis; this can express itself in a number of cardiovascular diseases: coronary artery disease, stroke and short strokelike episodes and peripheral vascular disease (Durrington, 2003; Grundy et al., 1998). Specifically, high levels of small LDL cholesterol particles are associated with increased risk of heart disease. Over intake of fluids especially soft drinks by the young generation leads to over accumulation of water and certain minerals. Sometimes this practice leads to insufficient entry of some vital minerals that leads to hyponatremia (Pestana, 2000). 41

4 The change in lifestyle, food habits and a change in the general and working environment of humans also alters several changes in their blood hematology and biochemistry (Indra and Bhuvaneshwari, 2008; Kristal-Boneh et al.,2008; Jinky Leilanie Del Prado-Lu, 2007; Eva Backe et al., 2004; Yokoyama et al., 2003; Qingshan Qu et al., 2002). In the present study an attempt was made to analyze the influence of westernized culture such as change in lifestyle and food habits on the blood hematology and biochemistry of school going children between the age of years of Tirunelveli. The impact was critically analyzed based on the sex, school, socio-economic status of parents and so on. 2.2 Materials and Methods Five ml. blood samples were collected by veinpuncture, from the subclavian vein found at anticubital region of the selected school students and preserved in EDTA coated test tubes. The tubes were carefully placed in a thermo cool box and were brought to the laboratory. The study group comprised of 860 school going children of both sexes of different age groups. The study is cross sectional and analytical. The two different types of schools were chosen for this study viz (1) unaided matriculation school (affluent group) and (2) Government aided schools (non-affluent group). About 2 ml. of blood was transferred into sodium heparinized vaccutainer tubes for biochemical analysis, while remaining 2 ml. was used for hematological analysis. The samples so obtained were processed within an hour for both hematologies as well as for biochemical analysis. To maintain stability, samples were thawed as needed. Total erythrocute count (RBC), Hemoglobin (Hb), Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), differential count of white blood cell (WBC), and the biochemical parameter such as 42

5 blood sugar, blood urea, creatinine, serum cholesterol, HDL, LDL, VLDL, TC/HDL. LDL/HDl ratio, serum triglycerides, serum sodium, serum potassium and serum chloride were analyzed and recorded using standard procedures reported by Ramnik Sood (1998). All data were statistically analyzed using Z test to determine if there were differences between exposed and the referent (normal population) groups using Microsoft excel equation version 2.1. The results of the students which fall within the normal BMI range ( ) was considered as the normal control group for comparative purpose. 2.3 Results and Discussion The student community in the present scenario is entirely different from the student of the past their change in their lifestyle, behavior and food habit, which is mostly influenced by the westernized culture creates lot of changes in their physical behavior, intelligent quotient (IQ) and so on. In relation to these changes there is every possibility for the alteration in their physiology, metabolism and health. The most visible change observed among the student community in the present study was the change in their eating behavior. Healthy eating practices definitely decrease young people s risk for a number of immediate health problems such as deficiency disorders, obesity, dental carries and so on. Unhealthy eating practice leads to series of health problem such as cardiovascular disorders, cancer, stroke, hypertension, osteoporosis and so on (Williams et al., 2002; Williams et al., 1995). In order to study the impact of the changed food behavior of the present day student community on their health status, the hematology and biochemistry of blood was assessed. The study showed several unnoticed information to the society and medical faculty. Hematology and blood chemistry is a precious diagnostic tool for the observation of various diseases and healthy status of an individual. The present 43

6 study revealed that the changed pattern of lifestyle created several changes in the hematology and blood chemistry of some section of students. The hemoglobin content and the RBC count among the student community showed a significant increase in the case of the overweight and obese students of both sexes. In case of obese and overobese boys the RBC count was increased to about 27.9 and 25.6% and 18.6% and 25.6% respectively in girls than the control. Correspondingly the hemoglobin content also showed a significant increase in obese boys and girls than the control (Table 2.1). The increased percentage of hemoglobin and RBC content was very prominent among matriculation school students than the aided school and municipal school students (Table 2.2 and 2.3). Another interesting observation made was, as the condition of the body size increased from normal to overweight, normal to obese and overobese, the percent increase of hemoglobin and RBC count also increased exponentially (Table 2.1,2.2 and 2.3). Apart from the hemoglobin content and RBC count, the other hematological indices such as PCV, MCV, MCH and MCHC also showed much variation in the studied obese student community than the control. Except the PCV values all other indices like MCV, MCH and MCHC decrease significantly from the control values in case of overweight, obese and overobese. More or less the same trend was observed in both the sexes (Table 2.1 and 2.2). The observation clearly exposed another pathetic group of students categorized as underweight. Their hematological position was very critical when compared to the normal and obese students. As far as the hemoglobin content was concerned there was a significant reduction (25% in boys and 19.4% in girls) was observed in both the sexes. In accordance with hemoglobin, the RBC count also significantly reduced to a greater extent in both the sexes (39.5% in boys and 44.2% in girls) of underweight students. The number of student s fall under this 44

7 category was very high in municipal school than the aided school (Table 2.2 and 2.4). The number of underweight students observed in matriculation school was very meager (Table 2.3). In case of the underweight category of students the PCV and MCH values are decreased than the control while the MCV and MCH values were increased to a greater extent (49%,21.8% in boys and 62.9%, 47.1% in girls) in both the sexes (Table 2.1 and 2.4). The variations observed in the blood indices showed no much difference in the students of aided school and matriculation school (Table 2.2 and 2.3). The WBC count among obeic students showed several numerical variations in the differential count. Except the eosinophil count and lymphocyte count, in case of obese and overobese students of both sexes, all other observed parameters showed similarity with the values of the control population. The significant increase of eosinophil count observed among the obese and overobese was 66.7% and 66.7% in boys and 40.7% and 55% in girls respectively (Table 2.1.1). When the observation was analyzed on the basis of their school of study, the highest percentage was observed among the students of matriculation school than the aided schools (Table and 2.3.1). Almost the same trend was observed in case of the percentage of lymphocyte also (Table 2.1.1, and 2.3.1). In case of the underweight, students there was a significant alteration observed in the differential count. The observation showed that there was a tremendous increase in WBC count and eosinophil count and marginal increase in the count of neutrophil, lymphocyte and monocyte (Table 2.1.1, 2.2.1, and 2.4.1). The trend observed was more or less same in both the sexes. In case of the municipal school students, all the observed phenomena showed a decreasing trend than the control. Among municipal school students only two 45

8 category of students alone were observed namely normal and underweight in both the sexes (Table 2.4 and 2.4.1). Among this group all the hematological parameters studied showed a significant marked difference in both the sexes when compared to control. The hemoglobin and RBC count showed a steep fall in the underweight personalities of both sexes (Table 2.4 and 2.4.1). The eosinophil and lymphocyte level, WBC count also showed a remarkable increase among the underweight students of both sexes when compared to the control. The biochemical analysis of the school children also showed many remarkable alterations in various parameters studied. There was no much variation observed in the biochemistry of the different sexes of the students. Random Glucose Blood glucose is an important blood parameter. Normal blood sugar level is vital for healthy life, increase or decrease cause a lot of troubles to human beings. The blood sugar level observed among the student community indicated a vast difference with regard to their body condition. As for as the underweight personalities were concerned, about 9.3% reduction in glucose level was observed in boys and 15% reduction in girls when compared to normal weight students (Table 2.5). In the case of overweight and obese students about 17.8% to 32.4% (P >0.05) increase was observed in boys and 14.6% to 27.3% (P >0.05) increase in girls (Table 2.5). The elevated glucose level observed among the overweight and obese students observed in the present study was very high (19.9% to 34.2% in boys and 13.5% to 26.8% in girls (P<0.05)) in aided school students than the matriculation school students. In matriculation school students the percent increase was 17.1% to 31.6% in boys and 14.2% to 27.2% (P >0.05) in girls (Table 2.6 and 2.7). The 46

9 elevated glucose level among the obeic students in the present study is highly influenced by their high BMI level. Creatinine A steep fall in the level of creatinine was observed in the underweight students than the normal weight students. The fall was about 28% in male underweight students but the level was more or less same in girls. But the level steadily increased in case of overweight, obese and overobese students of both sexes. The increase of creatinine in case of obese persons was highly significant (P >0.05) and the increased percentage range was between 28.6% to 128.6% in both the sexes (Table 2.5). The increases of creatinine observed among obese and overobese students are significantly high in case of aided school students in both sexes than the matriculation school (Table 2.7). Calcium The calcium level observed among the underweight students of both sexes correlates (P <0.05) with the values of the control population, whereas there was a significant raise (P >0.05) in calcium level was observed in the blood serum of overweight, obese and overobese students of both sexes compared to control. The increase percentage in calcium observed was 8.5%, 10.6% and 19.1% in overweight, obese and overobese boys respectively. In girls the percentage increase was 2.1%, 6.3% and 13.5% in overweight, obese and overbese respectively (Table 2.5). The increase of calcium level was significantly (P<0.05) very high among aided school students (11.7% to 24.5% in boys and 8.3% to 13.5% in girls) than the matriculation school students. Among the students of matriculation the increase observed was between 9.6% to 15.9% in boys and 5.2% to 13.5% in girls (Table 2.7). 47

10 Blood Urea As for as the blood urea was concerned except in the case of obese and overobese of both sexes (Table 2.5) in all other categories of students there was no significant raise (P >0.05) of urea level. The observed increase was about 3% to 5% in male obeic students and 4.1% to 9% in case of female obeic students. In all other cases the observed values almost correlate with the normal values of blood urea observed in the control (Table 2.5). The trend was almost similar in the students of aided, matriculation and municipal school students (Table 2.6, 2.7 and 2.8). Sodium and chloride Sodium and chloride plays a vital role in the physiology and well being of human beings. In the present study the level of sodium and chloride observed in the blood of school students showed no much variation (P<0.05) than the control population in both the sexes. A slight increase in the level of sodium and chloride (P <0.05) was observed in case of obese and overobese students of both sexes. The increase in sodium level was 0.5% to 1.7% in both the sexes. Whereas the chloride increase observed was between 0.3 to 0.8% in both the sexes (Table 2.5). The increased sodium and chloride level observed are comparatively high in aided school student of both sexes then the matriculation and municipal school students (Table 2.6, 2.7 and 2.8). Potassium The quantum of potassium level in the blood of studied students showed no much difference (P <0.05) with the normal values (Table 2.5). There was no significant difference observed in the potassium level of the students of aided school, matriculation school and municipal school (Table 2.6,2.7 and 2.8). 48

11 Cholesterol The level of cholesterol observed among the students during the present study showed a significant increase (P>0.05) in case of overweight, obese and overobese students when compared to control. The increase observed in boys was 19.5%, 35.4% and 39.4% in overweight, obese and overobese respectively. Where as in girls it was 22.2%, 15.8% and 50.7% in overweight, obese and overobese respectively (Table 2.5.1). The increased percentage of total cholesterol observed among the obese was very high in matriculation school students than the aided and municipal school students (Table 2.6.1, and 2.8.1). In correlation with the total cholesterol, the triglyceride level also showed remarkable alterations among the student community. There was a significant fall (P>0.05) in the level (11.7% in boys and 12% in girls) of triglycerides observed among the underweight students. But the level of triglycerides steadily increased (P>0.05) in case of overweight, obese and overobese students of both sexes when compared to the control. The percent increase observed in boys was 41.7%, 47.2% and 56.4% in overweight, obese and overobese respectively and in girls the percentage was 39.4%, 46.4% and 57.3% respectively (Table 2.5.1). The trend of increased level of triglycerides was very high among the matriculation school students than the aided and municipal school (Table and 2.7.1). A specific level of HDL is essential in the serum for normal physiological functioning of the individual. Fall in the level from the normal reference value is an indication for cardiac disorder. In the present study the HDL level showed a steep fall (P>0.05) among the students of overweight, obese and overobese irrespective of the sex and school of study. The fall in the HDL level ranges from 25.7% to 30.1% in boys and 24.6% to 29.9% in case of girl students (Table 2.5.1, and 2.7.1). 49

12 Another important risk factor for cardiovascular disorder are the excessive presence of LDL and VLDL in the blood serum. In the present study the LDL and VLDL level steadily increased (P>0.05) among the overweight, obese and overobese students of both sexes (Table 2.5.1). The elevated level observed was very high among matriculation school students than the aided school students and municipal school students (Table 2.6.1, and 2.8.1). The ratio between total Cholesterol and HDL and ratio between LDL and HDL is a vital parameter for indicating the healthy status of an individual. Elevation from the normal ratio level is one of the risk factor or an indication for cardiovascular disorders. In the present study the ratios observed among the students of overweight, obese and overobese are steadily and significantly increased from the normal values (P>0.05) in both the sexes (Table 2.5.1). The increase in values was much prevalent among the matriculation school students than the aided and municipal school students (Table 2.6.1, and 2.8.1). Cholesterol is required to build and maintain membranes; it regulates membrane fluidity over the range of physiological temperatures (Haines, 2001). Some research indicated that cholesterol may act as an antioxidant (Smith, 1991). Animal fats are complex mixtures of triglycerides, with lesser amounts of phospholipids and cholesterol. Eating more carbohydrates - especially simpler, more refined carbohydrates - increases levels of triglycerides in the blood, lowers HDL, and may shift the LDL particle distribution pattern into unhealthy atherogenic patterns (Starc et al., 1998). The lipid components of blood serum such as serum cholesterol, triglycerides, HDL, LDL and VLDL in the present study were significantly differ (P > 0.05) among the different categories of students such as underweight, overweight, 50

13 obese and overobese. The difference observed in the lipid profile was more or less same in both the sexes of the respondents. As for as the total cholesterol is concerned, there was a significant fall (10.9% in boys and 11.4% in girls) was observed in the underweight category of students. In correlation with the total cholesterol, there was a significant fall (P > 0.05) in the level (11.7% in boys and 12% in girls) of triglycerides also observed among the underweight students. 51

14 Table 2.1 Mean Hb, RBC count and other related blood indices of school children of Tirunelveli in relation to their sex. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Boys Hemoglobin (%) RBC (Million/Cu.mm) PCV (%) MCV (Cu.µ) MCH (pg) MCHC (%) Normal weight (278) 15.1 ± ± ± ± ± ± 3.9 (91) Overweight (27) Obese (24) Overobese (10) Girls 11.3 ± 0.5 (69.4)* 25.2% 15.0 ± 0.4 (0.3) 0.7% 15.9 ± 0.4 (9.2)* 5.3% 17.3 ± 1.5 (4.7)* 14.5% 2.6 ± 0.3 (45.1)* 39.5% 4.6 ± 0.4 (3.6)* 6.9% 5.5 ± 0.4 (12.7)* 27.9% 5.4 ± 0.2 (17.0)* 25.6% 36.9 ± 4.4 (2.7)* 8.7% 40.8 ± 3.8 (0.5) 0.9% 43.6 ± 2.5 (6.3)* 7.9% 45.5 ± 2.9 (5.4)* 12.6% ± 25.2 (53.8)* ± 9.5 (0.3) 7.2% 79.8 ± 7.8 (9.9)* 16.5% 84.1 ± 5.8 (6.1)* ± 6.4 (64.7)* 21.8% 32.8 ± 3.4 (4.4)* 8.1% 29.1 ± 2.9 (10.8)* 18.5% 31.9 ± 2.9 (4.9)* 10.6% 30.9 ± 4.1 (71.7)* 17.8% 37.2 ± 3.8 (4.5)* 1.1% 36.5 ± 2.0 (2.5) 2.9% 38.2 ± 4.9 (0.4) Normal weight (284) 14.4 ± ± ± ± ± ± 7.9 (91) Overweight (24) Obese (18) Overobese (13) 11.6 ± 0.7 (49.5)* 19.4% 14.6 ± 0.9 (3.3)* 1.4% 15.1 ± 0.6 (4.4)* 4.8% 15.3 ± 0.6 (5.3)* 6.2% * - Significant at 0.05% level 2.4 ± 0.5 (32.4)* 44.2% 4.6 ± 0.3 (15.1)* 6.9% 5.1 ± 0.2 (17.3)* 18.6% 5.4 ± 0.3 (12.3)* 25.6% 34.2 ± 3.7 (87.6)* 11.4% 39.1 ± 2.8 (17.1)* 1.3% 39.4 ± 3.4 (1.0) 2.1% 41.4 ± 3.4 (3.0)* 7.3% ± 33.7 (32.2)* 62.9% 86.0 ± 9.6 (25.4)* 5.2% 77.8 ± 7.6 (7.2)* 14.2% 77.0 ± 8.3 (5.9)* 15.1% 50.3 ± 10.5 (6.5)* 47.1% 32.2 ± 3.1 (10.4)* 5.8% 29.7 ± 1.6 (11.5)* 13.1% 28.5 ± 1.9 (10.3)* 16.7% 1.6% 34.4 ± 4.0 (81.2)* 10.9% 37.7 ± 3.8 (11.7)* 2.3% 38.5 ± 3.5 (0.1) 0.2% 37.2 ± 3.5 (1.4) 3.6% 52

15 Table Mean WBC count and other related blood parameters of school children of Tirunelveli in relation to their sex. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Boys WBC (Cu.mm) Neutrophil (%) Lymphocyte (%) Eosinophil (%) Monocyte (%) Normal weight (278) 8199 ± ± ± ± ± 1.4 (91) Overweight (27) Obese (24) Overobese (10) Girls 9836 ± 449 (34.7)* 19.9% 8185 ± 241 (0.3) 0.2% 8152 ± 882 (1.7) 0.6% 8600 ± 656 (1.9) 4.9% 57.0 ± 8.3 (1.9) 3.1% 53.8 ± 7.5 (7.5)* 2.7% 62.4 ± 5.2 (6.6)* 12.8% 62.1 ± 5.5 (3.8)* 12.3% 37 ± 5.0 (2.7) 7.2% 35.1 ± 4.5 (0.6) 1.7% 35.5 ± 4.9 (0.9) 2.8% 35.4 ± 2.2 (1.2) 2.6% 5.2 ± 1.3 (13.1)* 116.7% 4.0 ± 1.5 (2.1) 66.7% 4.0 ± 1.4 (2.1) 66.7% 4.0 ± 1.1 (1.5) 66.7% 3.9 ± 1.4 (0.8) 2.5% 4.3 ± 1.2 (1.4) 7.5% 4.2 ± 1.2 (0.8) ± 1.2 (1.0) 10. Normal weight (284) 8194 ± ± ± ± ± 1.4 (91) Overweight (24) Obese (18) Overobese (13) 9170 ± 487 (19.1)* 11.9% 8258 ± 998 (1.3) 0.8% 8377 ± 649 (1.2) 2.2% 8492 ± 837 (1.3) 3.6% * - Significant at 0.05% level 55.8 ± 7.5 (1.7) 2.4% 56.6 ± 5.8 (5.5)* 3.8% 57.3 ± 6.2 (1.9) 5.1% 56.9 ± 2.8 (3.1)* 4.4% 37.9 ± 5.9 (3.2)* 9.5% 35.0 ± 5.8 (4.3)* 1.1% 35.2 ± 5.4 (0.4) 1.7% 35.7 ± 5.1 (0.7) 3.2% 4.6 ± 1.3 (11.7)* 70.4% 3.6 ± 1.1 (2.7)* 33.3% 3.8 ± 0.9 (4.8)* 40.7% 4.2 ± 0.8 (6.4)* 55.5% 4.0 ± 1.4 (0.7) 2.5% 3.9 ± 1.5 (3.4)* 4.7 ± 0.9 (3.5)* 20.5% 4.9 ± 0.8 (4.6)* 25.6% 53

16 Table 2.2 Mean Hb, RBC count and other related blood indices of school children of Tirunelveli in relation to their aided school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Aided School Boys Hemoglobin (%) RBC (Million/Cu.mm) PCV (%) MCV (Cu.µ) MCH (pg) MCHC (%) Normal weight (127) 15.1 ± ± ± ± ± ± 3.3 (36) Overweight (5) Obese (6) Overobese (3) Aided School Girls 11.3 ± 0.5 (41.7) 25.2% 15.3 ± 0.2 (3.1) 1.3% 18.2 ± 0.3 (17.5) 20.5% 18.5 ± 0.1 (40.3) 22.5% 2.6 ± 0.3 (31.6) 39.5% 4.3 ± 0.3 (0.3)* 5.1 ± 0.6 (2.9) 18.6% 4.8 ± 0.1 (6.0) 11.6% 36.7 ± 4.5 (49.1) 11.3% 41.6 ± 1.1 (0.3)* 0.5% 43.2 ± 1.7 (2.4)* 4.3% 44.6 ± 1.5 (3.6) 7.7% ± 23.9 (35.8) 49.2% 96.3 ± 8.6 (0.2)* 0.6% 85.6 ± 10.4 (2.4)* 10.5% 90.5 ± 10.8 (0.8)* 5.4% 44.1 ± 6.0 (44.1) 27.1% 35.4 ± 2.9 (0.5)* ± 3.9 (2.3)* 10.9% 37.5 ± 3.1 (1.6)* 8.1% 31.3 ± 4.1 (45.6) 14.2% 36.7 ± 1.3 (0.5)* 0.5% 36.1 ± 1.7 (0.4)* 1.1% 41.6 ± 1.7 (5.0) 13.9% Normal weight (130) 14.4 ± ± ± ± ± ± 5.7 (30) Overweight (7) Obese (3) 11.7 ± 0.7 (26.5) 18.7% 14.9 ± 0.5 (0.1)* 3.5% 15.7 ± 0.3 (3.9) ± 0.3 (4.2) Overobese (3) 8.3% * - Non-significant at 0.05% level 2.7 ± 0.6 (16.6) 37.2% 4.4 ± 0.4 (0.3)* 2.3% 4.9 ± 0.4 (2.1)* 13.9% 5.1 ± 0.1 (11.2) 18.6% 35.3 ± 3.9 (54.2) 7.6% 38.8 ± 2.4 (0.6)* 1.6% 40.7 ± 0.6 (7.1) 6.5% 41.3 ± 1.5 (3.4) 8.1% ± 40.1 (20.7) 60.2% 89.1 ± 10.9 (0.6)* 2.9% 84.7 ± 2.8 (1.1)* 2.2% 81.0 ± 1.4 (6.7) 6.5% 45.9 ± 11.5 (23.9) 35.4% 34.3 ± 4.2 (0.2)* 1.2% 32.6 ± 1.1 (2.0)* 3.8% 35.7 ± 1.3 (2.4)* 5.3% 33.7 ± 4.4 (45.8) 15.3% 38.6 ± 2.9 (1.1)* ± 0.5 (4.5) 3.3% 44.2 ± 2.3 (3.3)

17 Table Mean WBC count and other related blood parameters of school children of Tirunelveli in relation to their aided school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Aided School Boys WBC (Cu.mm) Neutrophil (%) Lymphocyte (%) Eosinophil (%) Monocyte (%) Normal weight (127) 8199 ± ± ± ± ± 1.4 (36) Overweight (5) Obese (6) Overobese (3) Aided School Girls 9905 ± 387 (26.4)* 20.8% 8140 ± 207 (0.6) 0.7% 9533 ± 372 (8.8)* 16.3% 9666 ± 288 (8.8)* 17.8% 55.3 ± 8.7 (0.4) 55.9 ± 3.5 (0.7) 1.1% 61.0 ± 4.5 (3.4)* 10.3% 55.3 ± 8.3 (0.1) 38.7 ± 4.0 (4.1)* 12.2% 33.7 ± 4.0 (1.2) 2.3% 36.3 ± 5.9 (0.1) 5.2% 38.7 ± 0.6 (8.7)* 12.2% 5.0 ± 1.2 (10.3)* 108.3% 3.2 ± 1.3 (0.4) 33.3% 3.1 ± 1.8 (0.2) 29.2% 4.4 ± 0.5 (3.9)* 83.3% 4.0 ± 1.4 (0.2) 4.4 ± 1.1 (0.7) ± 0.8 (0) 4.4 ± 0.5 (1.3) 1 Normal weight (130) 8194 ± ± ± ± ± 1.4 (30) Overweight (7) Obese (3) ± 264 (13.8)* 25.7% 9100 ± 382 (6.3)* ± 251 (11.9)* 21.2% 9126 ± 495 (11.3)* Overobese (3) 11.4% * - Significant at 0.05% level 55.1 ± 7.3 (0.4) 1.1% 57 ± 8.4 (0.7) 4.6% 67 ± 1 (21.2)* 22.9% 56.2 ± 3.2 (0.8) 3.1% 39.3 ± 4.5 (1.3) 13.6% 38.3 ± 8.1 (0.8) 10.7% 35.8 ± 6.4 (0.1) 3.4% 38.2 ± 2.3 (1.8) 10.4% 5.0 ± 1.0 (3.5)* 85.2% 4.2 ± 0.9 (3.1)* 55.6% 4.3 ± 1.7 (3.8)* 59.3% 3.8 ± 1.6 (0.7) 40.7% 3.9 ± 1.5 (0.3) 3.3 ± 1.6 (1.2) 15.4% 3.7 ± 1.1 (0.5) 5.1% 4.5 ± 0.5 (1.4) 15.4% 55

18 Table 2.3 Mean Hb, RBC count and other related blood indices of school children of Tirunelveli in relation to their matriculation school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Matriculation School Boys Hemoglobin (%) RBC (Million/Cu.mm) PCV (%) MCV (Cu.µ) MCH (pg) MCHC (%) Normal weight (126) 15.1 ± ± ± ± ± ± 2.8 (5) Overweight (21) Obese (17) Overobese (7) Matriculation School Girls 11.1 ± 0.5 (18.4) 26.5% 15.3 ± 0.1 (3.6) 1.3% 16.1 ± 0.5 (7.0) 6.6% 18.3 ± 0.6 (16.5) 21.2% 2.5 ± 0.3 (13.3) 41.9% 4.4 ± 0.4 (2.8) 2.3% 4.8 ± 0.4 (6.1) 11.6% 5.0 ± 0.6 (3.8) 16.3% 34.6 ± 1.8 (3.9) 18.4% 43.1 ± 3.1 (0.7)* 1.6% 43.7 ± 2.7 (1.7)* 3.1% 44.7 ± 1.8 (2.9) 5.4% ± 23.1 (13.7) 33.7% 98.2 ± 9.4 (3.7) 7.2% 90.8 ± 11.3 (5.4) 14.2% 89.7 ± 11.1 (3.8) 15.2% 45.5 ± 6.7 (15.2) 20.4% 35.0 ± 2.8 (4.3) 7.4% 33.3 ± 3.1 (5.9) 11.9% 33.9 ± 5.6 (1.8)* 10.3% 32.2 ± 1.3 (54.9) 10.5% 35.8 ± 0.3 (2.7) 0.5% 36.9 ± 2.8 (1.3)* 2.5% 37.7 ± 3.6 (1.2)* Normal weight (113) 14.4 ± ± ± ± ± ± 6.1 (12) Overweight (15) Obese (14) 11.8 ± 0.7 (15.6) 18.1% 15.4 ± 0.3 (5.1) 6.9% 16.0 ± 0.4 (7.8) 11.1% 16.8 ± 1.6 (2.5)* Overobese (10) 16.7% * - Non-significant at 0.05% level 2.4 ± 0.5 (12.5) 44.2% 4.6 ± 0.3 (3.2) ± 0.3 (5.9) 11.6% 5.1 ± 0.2 (14.4) 18.6% 32.3 ± 2.1 (6.2) 16.3% 39.5 ± 3.6 (0.9)* 2.3% 40.4 ± 3.3 (2.0)* 4.7% 42.0 ± 2.3 (4.6) 8.8% ± 30.2 (15.8) 49.6% 86.2 ± 7.3 (3.3) 6.8% 84.1 ± 8.2 (3.8) 9.1% 82.2 ± 5.1 (6.4) 11.1% 50.7 ± 10.2 (17.3) 40.4% 33.8 ± 2.6 (3.3) 6.4% 33.4 ± 2.4 (4.0) 7.5% 35.8 ± 1.3 (0.8)* 0.8% 4.7% 36.8 ± 2.7 (46.8) 7.8% 39.5 ± 4.4 (0.4)* ± 3.4 (0.04)* 43.6 ± 2.8 (4.1) 9.3% 56

19 Table Mean WBC count and other related blood parameters of school children of Tirunelveli in relation to their matriculation school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Matriculation School Boys WBC (Cu.mm) Neutrophil (%) Lymphocyte (%) Eosinophil (%) Monocyte (%) Normal weight (126) 8199 ± ± ± ± ± 1.4 (5) Overweight (21) Obese (17) Overobese (7) Matriculation School Girls ± 269 (17.9)* 22.3% 9076 ± 328 (12.1)* 10.7% 9617 ± 281 (20.7)* 17.3% 9960 ± 288 (13.6)* 21.5% 56.2 ± 4.6 (0.1) 1.6% 56.9 ± 7.3 (0.3) 2.9% 64.2 ± 5.0 (6.3)* 16.1% 63.7 ± 5.2 (3.7)* 15.2% 40.8 ± 5.0 (2.5) 18.3% 36.4 ± 5.1 (1.1) 5.5% 36.8 ± 5.5 (1.3) 6.7% 36.7 ± 5.7 (0.7) 6.4% 5.2 ± 1.0 (3.6)* 116.7% 3.9 ± 1.6 (1.4) 62.5% 4.3 ± 1.4 (2.6) 79.2% 4.1 ± 1.1 (1.8) 70.8% 4.8 ± 1.3 (1.4) ± 1.0 (1.7) ± 0.9 (2.3) 12.5% 4.7 ± 1.2 (1.5) 17.5% Normal weight (113) 8194 ± ± ± ± ± 1.4 (12) Overweight (15) Obese (14) ± 336 (18.8)* 24.5% 9053 ± 413 (8.0)* 10.5% 9371 ± 423 (10.3)* 14.4% 9175 ± 307 (11.0)* Overobese (10) 12. * - Significant at 0.05% level 55.8 ± 6.2 (0.3) 2.4% 56.7 ± 6.3 (0.9) ± 5.2 (1.8) 6.1% 56.9 ± 3.1 (1.7) 4.4% 35.3 ± 7.9 (0.1) ± 4.4 (2.8)* 12.1% 40.0 ± 2.1 (7.5)* 15.6% 38.2 ± 1.8 (4.4)* 10.4% 4.7 ± 1.0 (5.4)* 74.1% 3.4 ± 1.2 (0.6) 25.9% 3.8 ± 1.8 (1.2) 40.7% 4.5 ± 1.1 (3.7)* 66.7% 3.4 ± 1.4 (1.6) 12.8% 4.1 ± 1.6 (0.2) 5.1% 4.7 ± 0.9 (2.6) 20.5% 4.7 ± 0.8 (3.0)* 20.5% 57

20 Table 2.4 Mean Hb, RBC count and other related blood indices of school children of Tirunelveli in relation to their municipal school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Municipal School Boys Hemoglobin (%) RBC (Million/Cu.mm) PCV (%) MCV (Cu.µ) MCH (pg) MCHC (%) Normal weight (25) 15.1 ± ± ± ± ± ± ± 0.5 (37.1) 20.5% 3.2 ± 0.3 (24.3) 25.6% 36.3 ± 4.3 (7.7) 11.9% ± 18.3 (44.9) ± 4.8 (56.9) 14.9% (50) Overweight (1) Obese (1) Overobese (0) Municipal School Girls 33.6 ± 4.2 (56.3) 7.2% Normal weight (31) 14.4 ± ± ± ± ± ± 6.0 (49) 12.2 ± 0.6 (29.1) 15.3% 15.7 ± 0.1 (21.4) ± 0.2 (26.7) 25.6% 4.8 ± 0.4 (1.8)* 32.4 ± 3.9 (15.4) 11.9% 42.5 ± 0.7 (19.3) ± 16.6 (42.8) 14.3% 88.8 ± 6.3 (2.0)* 0.2% 38.2 ± 3.6 (73.3) 7.6% 32.9 ± 3.0 (1.1)* 38.3 ± 4.7 (57.2) 6.1% 37.0 ± 0.8 (14.7) Overweight (2) 11.6% 15.5% 7.3% 9.3% Obese (1) Overobese (0) * - Non-significant at 0.05% level 58

21 Table Mean WBC count and other related blood parameters of school children of Tirunelveli in relation to their municipal school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Municipal School Boys WBC (Cu.mm) Neutrophil (%) Lymphocyte (%) Eosinophil (%) Monocyte (%) Normal weight (25) 8199 ± ± ± ± ± ± 282 (5.7) 13.4% 56.2 ± 8.8 (0.3)* 1.6% 33.9 ± 5.5 (3.1) 1.7% 4.2 ± 1.5 (5.1) 75. (50) Overweight (1) Obese (1) ± 1.6 (0.4)* 7.5% Overobese (0) Municipal School Girls Normal weight (31) 8194 ± ± ± ± ± 1.4 (49) 6418 ± 1176 (10.4) 21.7% 6668 ± 1064 (10.0) 56.2 ± 7.5 (2.5)* 3.1% 58.5 ± 6.4 (1.1)* 35.4 ± 5.9 (1.2)* 2.3% 40.0 ± 2.8 (2.7) 15.6% 4.3 ± 1.6 (5.8) 59.3% 2.5 ± 0.7 (0.9)* 7.4% Overweight (2) 18.6% 7.3% Obese (1) ± 1.6 (0.3)* 2.6% 4.5 ± 2.1 (0.3)* 15.4% Overobese (0) * - Non-significant at 0.05% level 59

22 Table 2.5 Mean blood and urine biochemistry of school children of Tirunelveli in relation to their sex. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Boys Random glucose (mg/dl) Creatinine (mg/dl) Calcium (mg/dl) Blood urea (mg/dl) Sodium (meq/l) Potassium (meq/l) Chloride (m.mol/l) Normal weight (278) 93.9 ± ± ± ± ± ± ± 3.5 (91) Overweight (27) Obese (24) Overobese (10) Girls 85.2 ± 5.0 (2.5) 9.3% ± 10.8 (11.3)* 17.8% ± 5.3 (31.0)* 28.9% ± 2.8 (42.1)* 32.4% 0.5 ± 0.2 (0.8) 28.6% 0.9 ± 0.4 (1.3) 28.6% 1.5 ± 0.6 (7.7)* 114.3% 1.6 ± 0.3 (0.4) 128.6% 9.4 ± 0.5 (1.2) 10.2 ± 0.6 (7.2)* 8.5% 10.4 ± 1.1 (4.5)* 10.6% 11.2 ± 0.9 (6.1)* 19.1% 11.7 ± 3.1 (1.2) 3.3% 11.7 ± 3.0 (0.6) 3.3% 11.5 ± 3.1 (0.9) ± 3.3 (0.5) 4.1% ± 2.5 (0.5) 0.07% ± 3.3 (1.2) 0.05% ± 4.3 (1.1) 0.6% ± 4.1 (1.6) 1.5% 4.1 ± 0.5 (2.5) 2.4% 4.2 ± 0.5 (0.7) 4.2 ± 0.3 (0.6) 4.1 ± 0.3 (1.2) 2.4% ± 11.2 (3.1)* 3.5% ± 3.5 (1.4) 0.9% ± 3.9 (0.4) 0.3% ± 3.7 (0.8) Normal weight (284) 99.9 ± ± ± ± ± ± ± 3.5 (91) Overweight (24) Obese (18) 84.9 ± 5.2 (2.1) ± 2.7 (48.3)* 14.6% ± 3.8 (43.5)* 22.7% ± 1.8 (87.5)* Overobese (13) 27.3% * - Significant at 0.05% level 0.8 ± 0.4 (2.1) 0.8 ± 0.4 (3.2)* 1.6 ± 0.2 (18.4)* ± 0.2 (18.2)* ± 0.5 (0.7) 2.1% 9.8 ± 0.6 (8.5)* 2.1% 10.2 ± 0.4 (7.7)* 6.3% 10.9 ± 0.3 (21.2)* 13.5% 11.8 ± 3.0 (0.6) 1.7% 10.9 ± 3.0 (0.4) 9.2% 11.5 ± 3.4 (0.6) 4.2% 12.8 ± 1.8 (1.6) 6.7% ± 2.9 (1.6) 0.4% ± 5.1 (2.1) 0.5% 142 ± 5.8 (0.7) 0.6% ± 4.7 (1.9) 1.7% 4.1 ± 0.5 (2.7)* 4.7% 4.3 ± 0.5 (1.1) 4.0 ± 0.3 (2.9)* ± 0.3 (2.9)* % ± 10.7 (4.6)* 4.7% ± 3.4 (3.7)* 1.1% ± 4.4 (0.5) 0.3% ± 4.4 (0.5) 0.3% 60

23 Table Mean lipid profide level of school children of Tirunelveli in relation to their sex. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Boys Total Cholesterol (mg/dl) Triglycerides (mg/dl) HDL(mg/dL) LDL (mg/dl) VLDL TC/HDL LDL/HDL ratio Normal weight (278) ± ± ± ± ± ± ± 0.5 (91) Overweight (27) Obese (24) Overobese (10) Girls ± 10.5 (16.8) 10.9% ± 10.7 (16.1) 19.5% 232 ± 11.9 (25.0) 35.4% ± 5.7 (37.1) 39.4% 97.6 ± 15.7 (7.7) 11.7% ± 15.3 (15.7) 41.7% ± 8.5 (30.1) 47.2% ± 6.9 (28.5) 56.4% 51.7 ± 8.9 (0.8)* 1.6% 37.8 ± 3.9 (17.2) 25.7% 36.0 ± 3.5 (20.9) 29.3% 35.6 ± 2.6 (18.7) 30.1% 98.4 ± 15.8 (1.4)* 2.4% ± 12.9 (6.2) ± 11.3 (9.7) 23.5% ± 8.4 (9.5) 26.5% 25.4 ± 7.7 (2.3)* ± 6.3 (0.8)* 3.7% 29.8 ± 6.9 (1.8)* 9.2% 32 ± 6.9 (2.2)* 17.2% 3.7 ± 0.6 (2.5)* 5.1% 4.9 ± 0.6 (8.6) 25.6% 5.7 ± 0.9 (9.3) 46.2% 6.4 ± 0.3 (29.9) 64.1% 2.5 ± 0.6 (1.3)* 4.2% 2.9 ± 0.3 (7.9) 20.8% 3.8 ± 0.5 (11.4) 58.3% 4.9 ± 0.3 (25.4) 104.2% Normal weight (284) ± ± ± ± ± ± ± 0.5 (91) Overweight (24) Obese (18) 152 ± 9.9 (18.8) 11.4% ± 6.5 (22.2) 20.3% ± 3.9 (69.8) 15.8% ± 7.2 (43.4) Overobese (13) 50.7% * - Non-significant at 0.05% level 98.8 ± 19.1 (6.7) ± 6.1 (11.2) 39.6% ± 6.9 (31.8) 46.4% ± 5.3 (43.5) 57.3% 52.7 ± 9.4 (2.4)* 4.6% 38 ± 6.3 (15.6) 24.6% 36.8 ± 2.6 (21.6) 26.9% 35.3 ± 2.3 (23.8) 29.9% 97.7 ± 16.8 (1.6)* 3.1% ± 5.4 (35.8) ± 6.4 (16.1) 25.8% ± 8.3 (12.9) 31.3% 24.8 ± 7.0 (3.9) 10.5% 25.5 ± 6.7 (9.1) 7.9% 28.4 ± 6.2 (0.5)* 2.5% 32.9 ± 5.0 (3.7) 18.8% 3.7 ± 0.5 (3.1) 5.1% 3.9 ± 0.5 (1.2)* 5.4 ± 0.3 (20.4) 38.5% 6.4 ± 0.3 (31.5) 64.1% 2.6 ± 0.6 (1.5)* 8.3% 2.7 ± 0.5 (1.7)* 12.5% 3.6 ± 1.1 (4.5) ± 0.6 (11.8) 87.5% 61

24 Table 2.6 Mean blood and urine biochemistry of school children of Tirunelveli in relation to their aided school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Aided School Boys Random glucose (mg/dl) Creatinine (mg/dl) Calcium (mg/dl) Blood urea (mg/dl) Sodium (meq/l) Potassium (meq/l) Chloride (m.mol/l) Normal weight (127) 93.9 ± ± ± ± ± ± ± 3.5 (36) Overweight (5) Obese (6) Overobese (3) Aided School Girls 93.1 ± 3.0 (18.5) 0.9% ± 2.8 (23.1) 19.9% ± 3.4 (28.8) 32.4% 126 ± 2.0 (36.6) 34.2% 0.6 ± 0.2 (4.2) 14.3% 0.9 ± 0.5 (0.7)* 28.5% 1.8 ± 0.5 (4.6) 157.1% 1.4 ± 0.1 (11.3) ± 0.4 (0.5)* 10.5 ± 0.3 (9.2) 11.7% 10.7 ± 0.3 (9.7) 13.8% 11.7 ± 0.2 (27.0) 24.5% 11.6 ± 3.0 (0.9)* 4.1% 12.2 ± 4.1 (0.03)* 0.8% 10.9 ± 3.1 (0.9)* 9.9% 11.1 ± 4.5 (0.4)* 8.3% ± 2.5 (0.4)* 0.1% ± 3.2 (1.6)* 1.5% ± 2.8 (1.8)* 1.4% 148 ± 1.0 (12.0) 4.8% 4.1 ± 0.4 (1.6)* 2.4% 4.1 ± 0.6 (0.7)* 2.4% 4.2 ± 0.4 (0.5)* 4.1 ± 0.2 (1.6)* 2.4% ± 3.2 (1.3)* 0.7% ± 3.4 (2.0)* 2.9% ± 5.4 (0.3)* 0.7% ± 0.6 (11.4) Normal weight (130) 99.9 ± ± ± ± ± ± ± 3.5 (30) 85 ± 5.3 (1.3) 14.9% ± 2.9 (26.2) Overweight (7) 13.5% 125 ± 4.3 (16.3) Obese (3) 25.1% ± 1.5 (48.6) Overobese (3) 26.8% * - Non-significant at 0.05% level 0.7 ± 0.4 (0.6)* 12.5% 0.8 ± 0.5 (0.3)* 1.7 ± 0.1 (10.4) 112.5% 1.6 ± 0.1 (10.0) ± 0.5 (0.5)* 2.1% 10.4 ± 0.3 (10.6) 8.3% 10.5 ± 0.4 (5.4) 9.4% 10.9 ± 0.1 (46.8) 13.5% 11.8 ± 3.0 (0.4)* 1.7% 12.1 ± 2.8 (0.1)* 0.8% 10.7 ± 5.3 (0.4)* 10.8% 14.3 ± 1.8 (2.1)* 19.2% ± 3.3 (3.5) 1.3% ± 6.3 (1.9)* 3.3% 147 ± 2.0 (5.1) 4.2% ± 3.5 (1.8)* 2.5% 4.1 ± 0.4 (1.7)* 4.6% 4.2 ± 0.6 (0.02)* 2.3% 3.9 ± 0.2 (2.5)* 9.3% 4.0 ± 0.5 (0.7)* 6.9% 3.6% ± 10.7 (9.4) 15.9% ± 3.6 (1.4)* 1.9% 105 ± 5.2 (0.1)* 0.3% ± 4.9 (0.4)* 0.9% 62

25 Table Mean lipid profide level of school children of Tirunelveli in relation to their aided school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Total Cholesterol (mg/dl) Triglycerides (mg/dl) HDL(mg/dL) LDL (mg/dl) VLDL TC/HDL LDL/HDL ratio Aided School Boys Normal weight (127) ± ± ± ± ± ± ± 0.5 (36) Overweight (5) Obese (6) ± 7.1 (11.9) 8.2% 205 ± 2.3 (32.2) 19.7% ± 8.5 (15.9) 32.4% 234 ± 3.0 (36.2) 36.6% 91.9 ± 4.9 (23.6) 16.8% ± 1.8 (59.0) 43.7% ± 4.9 (24.1) 45.2% 174 ± 1.7 (62.4) 53.7 ± 9.7 (1.9)* 5.5 % 35.6 ± 1.7 (20.0) ± 4.9 (7.7) 30.8% 36.2 ± 1.6 (15.7) 28.9% ± 16.7 (2.4)* 6.5% 116 ± 4.7 (9.5) 20.7% ± 5.0 (11.6) 24.3% 123 ± 2.6 (17.8) 27.9% 25.3 ± 7.9 (1.5)* 7.3% 25.4 ± 3.6 (1.2)* ± 2.5 (6.2) 23.4% 28.3 ± 7.5 (0.2)* 3.7% 3.7 ± 0.5 (1.7)* 5.1% 4.9 ± 0.5 (4.2) 25.6% 5.9 ± 0.3 (14.7) 51.3% 6.5 ± 0.3 (14.7) 2.5 ± 0.6 (1.2)* 4.2% 2.7 ± 0.4 (1.5)* 12.5% 3.4 ± 0.2 (9.6) Overobese (3) 57.5% 66.7% 95.8% Aided School Girls Normal weight (130) ± ± ± ± ± ± ± 0.5 (30) Overweight (7) Obese (3) ± 4 (31.2) 12.3% ± 5.3 (18.9) 21.9% ± 5.1 (23.0) 39.7% ± 3.0 (47.2) Overobese (3) 48.4% * - Non-significant at 0.05% level 92.1 ± 9.4 (27.8) 17.9% ± 3.5 (32.1) 38.6% 166 ± 1.0 (91.7) 47.8% ± 9.3 (12.2) 58.8% 53.7 ± 9.4 (2.0)* 6.5% 35.7 ± 3.8 (10.2) 29.2% 39 ± 3.6 (5.5) 22.6% 37 ± 2.6 (8.8) 26.5% 93.2 ± 14 (0.9)* 1.7% ± 3.2 (13.0) 17.5% 125 ± 5.2 (9.8) 31.8% 126 ± 2.6 (20.0) 32.9% 23.6 ± 6.2 (3.5) 14.8% 26.4 ± 6.7 (0.3)* 4.7% 28.3 ± 7.1 (0.2)* 2.2% 37.3 ± 0.5 (30.0) 34.6% 3.6 ± 0.5 (3.2) 7.7% 2.8 ± 0.5 (1.3)* 28.2% 5.5 ± 0.1 (19.0) ± 0.2 (21.7) 64.1% 41.7% 4.7 ± 0.5 (7.9) 2.6 ± 0.6 (1.1)* 8.3% 2.8 ± 0.5 (2.1)* 16.7% 3.8 ± 0.2 (15.5) 58.3% 4.7 ± 1.1 (3.3) 95.8% 63

26 Table 2.7 Mean blood and urine biochemistry of school children of Tirunelveli in relation to their matriculation school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Matriculation School Boys Random glucose (mg/dl) Creatinine (mg/dl) Calcium (mg/dl) Blood urea (mg/dl) Sodium (meq/l) Potassium (meq/l) Chloride (m.mol/l) Normal weight (126) 93.9 ± ± ± ± ± ± ± 3.5 (5) Overweight (21) Obese (17) Overobese (10) Matriculation School Girls 95.8 ± 4.3 (4.8) ± 12.2 (8.8) 17.1% ± 5.2 (26.1) 27.1% ± 2.8 (34.2) 31.6% 0.4 ± 0.1 (6.8) 42.8% 0.8 ± 0.4 (1.4)* 14.3% 1.3 ± 0.4 (4.9) 85.7% 1.7 ± 0.7 (3.5) 142.8% 9.5 ± 0.3 (1.5)* 1.1% 10.3 ± 0.5 (7.9) 9.6% 10.2 ± 1.3 (2.8) 8.5% 10.9 ± 1.0 (3.9) 15.9% 11.1 ± 3.5 (0.6)* 8.3% 11.9 ± 3.0 (0.2)* 1.6% 11.7 ± 3.2 (0.5)* 3.3% 13.3 ± 2.9 (1.1)* 9.9% ± 2.0 (1.3)* 0.99% ± 3.1 (1.6)* 0.92% ± 4.9 (0.3)* 0.4% ± 2.9 (0.1)* 0.1% 4.2 ± 0.5 (0.1)* 4.2 ± 0.5 (0.2)* 4.2 ± 0.3 (0.2)* 4.2 ± 0.4 (0.6)* ± 4.9 (14.6) 30.7% ± 3.6 (0.9)* 0.8% 105 ± 3.5 (0.7)* 0.5% ± 3.7 (0.2)* 0.4% Normal weight (113) 99.9 ± ± ± ± ± ± ± 3.5 (12) Overweight (15) Obese (14) 86.2 ± 5.5 (0.3)* 13.7% ± 2.7 (39.8) 14.2% ± 4.2 (32.4) 22.7% ± 1.6 (78.7) Overobese (7) 27.2% * - Non-significant at 0.05% level 0.3 ± 0.2 (6.8) 62.5% 0.8 ± 0.4 (1.2)* 1.6 ± 0.2 (18.3) ± 0.1 (17.9) ± 0.4 (0.2)* 2.1% 10.1 ± 0.4 (6.3) 5.2% 10.4 ± 0.3 (11.4) 8.3% 10.9 ± 0.3 (17.5) 13.5% 11.5 ± 2.9 (0.4)* 4.2% 11.4 ± 2.8 (0.6)* ± 3.5 (0.2)* 1.7% 13.1 ± 2.0 (1.7)* 9.2% ± 3.0 (4.8) ± 5.7 (1.6)* 1.7% ± 2.9 (4.8) 2.6% ± 4.6 (2.3)* 2.4% 4.1 ± 0.4 (1.1)* 4.6% 4.1 ± 0.5 (0.8)* 4.6% 4.0 ± 0.3 (1.8)* 6.9% 4.0 ± 0.3 (1.4)* 6.9% ± 7.5 (8.2) ± 3.2 (2.1)* 1.8% ± 3.7 (0.7)* 0.7% 106 ± 3.6 (1.2)* 1.2% 64

27 Table Mean lipid profide level of school children of Tirunelveli in relation to their matriculation school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Matriculation School Boys Total Cholesterol (mg/dl) Triglycerides (mg/dl) HDL(mg/dL) LDL (mg/dl) VLDL TC/HDL LDL/HDL ratio Normal weight (126) ± ± ± ± ± ± ± 0.5 (5) Overweight (21) Obese (17) Overobese (10) Matriculation School Girls ± 4.4 (18.6) 21.3% 205 ± 11.9 (12.7) 19.7% ± 12.8 (19.7) 36.2% 259 ± 8.2 (33.3) 51.2% 93.4 ± 3.2 (14.0) 15.5% ± 15.1 (13.3) 42.5% ± 9.6 (21.3) 47.8% ± 5.2 (37.4) 59.7% 46.4 ± 2.8 (4.3) 8.8% 37.2 ± 4.1 (16.2) 26.9% 36.1 ± 2.9 (22.0) 29.1% 35.4 ± 2.9 (14.5) 30.4% 95.8 ± 2.5 (0.3)* 0.3% ± 5.7 (17.0) 21.2% ± 13.3 (7.2) 23.4% 121 ± 10.2 (6.6) 25.9% 26.8 ± 7.9 (0.2)* 1.8% 27.2 ± 5.8 (0.3)* 0.3% 28.4 ± 7.6 (0.4)* ± 6.5 (2.5)* 23.4% 3.7 ± 0.8 (0.4)* 5.1% 5.1 ± 0.5 (10.3) 30.7% 5.7 ± 1.1 (6.5) 46.1% 6.4 ± 0.3 (23.9) 64.1% 2.4 ± 0.6 (0.1)* 2.8 ± 0.3 (7.1) 16.7% 3.9 ± 0.6 (0.6)* 62.5% 5.0 ± 0.2 (38.8) 108.3% Normal weight (113) ± ± ± ± ± ± ± 0.5 (12) Overweight (15) ± 2.1 (33.2) 11.3% ± 6.0 (22.6) 20.8% 237 ± 4.1 (58.5) Obese (14) 38.1% ± 5.5 (33.2) Overobese (7) 40.3% * - Non-significant at 0.05% level 92.1 ± 4.8 (15.6) 17.9% ± 3.5 (44.2) 37.7% ± 7.7 (24.1) 45.6% ± 8.3 (18.6) 53.4% 54.3 ± 10.5 (1.3)* 7.7% 37.2 ± 4.4 (11.4) 26.2% 37.6 ± 7.7 (24.1) 25.4% 35.7 ± 2.4 (18.8) 29.2% 88.3 ± 7.1 (2.4)* 6.8% ± 4.4 (15.8) 17.6% ± 7.1 (13.6) 25.9% ± 6.8 (14.5) 31.5% 21.8 ± 2.5 (8.5) 21.3% 24.5 ± 6.8 (1.9)* 11.5% 28.2 ± 6.5 (0.1)* 1.8% 34.3 ± 3.6 (5.4) 23.8% 3.5 ± 0.5 (2.9) 10.2% 3.7 ± 0.5 (0.9)* 5.1% 5.5 ± 0.3 (16.6) ± 0.2 (31.9) 64.1% 2.6 ± 0.6 (0.8)* 8.3% 2.8 ± 0.4 (2.8) 16.7% 4.1 ± 0.6 (9.5) 70.8% 4.5 ± 0.7 (9.8) 87.5% 65

28 Table 2.8 Mean blood and urine biochemistry of school children of Tirunelveli in relation to their municipal school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Municipal School Boys Random glucose (mg/dl) Creatinine (mg/dl) Calcium (mg/dl) Blood urea (mg/dl) Sodium (meq/l) Potassium (meq/l) Chloride (m.mol/l) Normal weight (25) 93.9 ± ± ± ± ± ± ± ± 3.0 (33.1)* 0.5% 0.6 ± 0.3 (4.1)* 14.3% 9.4 ± 0.4 (0.2) 11.5 ± 3.1 (0.1) ± 2.5 (0.9) 4.1 ± 0.5 (0.5) 2.4% (50) Overweight (1) Obese (1) Overobese (0) Municipal School Girls ± 3.2 (2.7)* 0.7% Normal weight (31) 99.9 ± ± ± ± ± ± ± 3.5 (49) 85.1 ± 5.2 (6.4)* 14.8% 115 ± 4.2 (11.5)* 15.1% 0.8 ± 0.4 (1.0) 0.3 ± 0.1 (8.7)* 62.5% 9.4 ± 0.4 (2.0) 2.1% 10.5 ± 0.1 (25.3)* 11.9 ± 3.0 (1.7) 0.8% 14.3 ± 2.7 (0.8) 19.2% ± 2.5 (1.0) 0.1% ± 3.5 (0.3) 4.1 ± 0.4 (1.6) 4.7% 4.7 ± 0.1 (4.4) Overweight (2) 9.4% % Obese (1) Overobese (0) * - Significant at 0.05% level ± 3.3 (1.4) ± 2.8 (1.0) 3.5% 66

29 Table Mean lipid profide level of school children of Tirunelveli in relation to their municipal school. The values given in the parenthesis are the Z value which is significant at 0.05% level. The percent increase/decrease of blood parameters compared to control also given. Municipal School Boys Total Cholesterol (mg/dl) Triglycerides (mg/dl) HDL(mg/dL) LDL (mg/dl) VLDL TC/HDL LDL/HDL ratio Normal weight (25) ± ± ± ± ± ± ± ± 7.2 (12.2)* 7.1% 91.6 ± 5.2 (29.1)* 17.1% 53.9 ± 9.4 (1.3) 5.9% ± 16.7 (1.3) 5.2% 24.8 ± 7.8 (1.7) 9.2% 3.7 ± 0.6 (2.1) 5.1% (50) Overweight (1) Obese (1) Overobese (0) Municipal School Girls 2.5 ± 0.6 (0.4) 4.2% Normal weight (31) ± ± ± ± ± ± ± 0.5 (49) ± 11.3 (12.0)* 12.8% ± 2.1 (24.2)* 97.4 ± 5.2 (20.9)* 13.3% ± 2.1 (34.0)* 39.4% 52.5 ± 9.6 (0.7) 4.2% 58 ± 1.4 (6.4)* 15.1% ± 17.6 (0.5) 7.4% ± 2.1 (7.9)* 18.7% 25.6 ± 7.5 (2.9)* 7.6% 27.0 ± 7.1 (0.3) 3.7 ± 0.5 (2.3) 5.1% 3.4 ± 0.1 (5.0)* 12.8% Overweight (2) 19.8% 2.5% Obese (1) Overobese (0) * - Significant at 0.05% level 2.5 ± 0.6 (0.2) 4.2% 2.8 ± 0.2 (2.1) 16.7% 67

30 The haematological parameters are the precious tools in assessing the well being of human beings and also animals. In the present investigation, the impact of westernized food on affluent group of students and poor economic back ground on the non-affluent students on their well being were studied using the haematological characteristics. In the present investigation a decrease in various parameters of blood was noticed among the socio-economically poor students irrespective of their age, sex, year of study and nature of their home environment and the mode of conveyance they are using for school going and vice versa. The total number of RBC, Hb content, haematocrit, MCH, MCHC values registered a significant decrease in the underweight students of all categories and sex (Sornaraj et al., 2008; Qingshan Qu et al.,2002). Such a decrease in blood cells and other blood parameters indicate the affected physiological status of the students. The fall in erythrocyte count and haemoglobin content is an indicative of anemic condition (Seivard, 1972). The fall in erythrocyte count with less in haemoglobin and fall in MCH is an indication of macrocytic hypochromic anemia (Rastogi et al.,2008; Sembulingam and Prema Sembulingam,2001). The higher MCV observed in this study group was due to the poor economic conditions prevailed in their home environment (Abdallah et al., 2009). The present investigation revealed a decrease in haemoglobin concentration and packed cell volume in the blood samples of all underweight students, which again a sign of anaemic condition. The increased packed cell volume among the underweight students in the present study might be induced by their study workload in which they are engaged for several hours. They also lost several quantum of energy during their visit to school by walk with heavy load of book and return back to their home. An increased MCV observed in the present study is indicative of anaemia of macrocytic type (Sembulingam and Prema 68