Lecturer Department of Physiology, Vidyasagar College for Women, University of Calcutta, Kolkata, West Bengal, India.

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1 Sou East Asia Journal of Publi Heal ISSN: Publi Heal Original Researh Effets of high altitude and nutritional status over e physial fitness of young Nepalese residing in Pokhara, Kaski distrit of western Nepal Pallav Sengupta, Koushik Bhattaharya 1 1, Leturer Department of Physiology, Vidyasagar College for Women, University of Calutta, Kolkata, West Bengal, India. Leturer, Department of Physiology, Lumbini Medial College, Nepal. Abstrat Pokhara is situated over 5,577ft above sea level in The Kingdom of Nepal. Suh high-hilly regions of Nepal ontain only one-ird as muh oxygen as sea level air and in order to alimatize to suh environmental hypoxia, a series of metaboli and musuloardio-respiratory adaptations initiate at influene oxygen transport and utilization, whih is neessary to ahieve optimal physial performane at altitude. The heal of people residing at suh high altitude is determined not only by e environment but also by means of nutritional determinants. The present study was onduted to expliate e effet of high altitude environment wi nutritional fators over physial fitness of young Nepalese of Pokhara. Twenty-five male young Nepalese were randomly seleted from Pokhara, Nepal (mean age 1.6) and twenty-five sedentary ollege students of Kolkata, India (mean age 1.9) were taken as ontrols. Results showed a signifiant differene in BMI, body fat perentage, pre- and post-exerise BP, PFI, VO max, energy expenditure and anaerobi power (P<0.05). Young adults of Nepal are also found to be defiient in protein, alium and iron in eir diet, desribing eir poor nutritional status. Togeer ese data entail at e physial fitness of young adults of Nepal is under e influene of environmental fators as well as eir nutritional status. Keywords: Anaerobi power, Body fat, Harvard Step Test, High altitude, Physial fitness, Nepal. Introdution The Kingdom of Nepal is a landloked ountry bordered by e Tibet, an Autonomous Region of e People's Republi of China in e nor and of e Republi of India in all oer diretions. It o o o is situated between e 6 'N and 30 7'N latitudes and 80 4'E o and 88 1'E longitudes. Its altitude varies from 80 meters above mean sea level in e souern Terai to 8,848 meters above mean 1 sea level in e nor at 8.5 N, E. Physiographially, Nepal is divided into five zones: high Himal zone, high mountain zone, middle mountains, Siwaliks and Terai. The peoples residing in e high-hilly regions of Nepal experiene e limate s effet on eir physial fitness and at refers e full range of physial qualities whih an be understood as an integrated measurement of all funtions and 3 strutures involved in e performane. In adults, low ardiorespiratory fitness seems to be a stronger preditor of bo ardiovasular and all-ause mortality an any oer well 4 established risk fators. Extremely high-hilly regions of Nepal ontain only one ird as muh oxygen as sea-level air whih 5 should have an impat over e heal of people. But reports about e overall physial fitness pattern wi speial referene Pratie points Heal of people residing at high altitude is shaped not only by e low-oxygen environment, but also by population anestry, soio-ultural determinants as well as nutritional fators. Present study revealed at young Nepalese residing in mid-mountain regions are positively influened by environmental and nutritional fators on eir morphometri parameters and physiologial fitness. A signifiant differene was found in BMI, body fat perentage, pre- and post-exerise BP, PFI, VO max, energy expenditure and anaerobi power (p<0.05). However, young adults of Nepal are found to be defiient in protein, alium and iron in eir diet, desribing eir poor nutritional status. Large-sale studies are required to examine e relationship of high altitude and nutritional status and eir impat over e physial fitness of young Nepalese residing oer distrits of Nepal. Correspondene: Pallav Sengupta, Leturer, Department of Physiology, Vidyasagar College for Women, University of Calutta, 39, Sankar Ghosh Lane, Kolkata , West Bengal, India. sunny_pallav_1984@yahoo.o.in. Sou East Asia Journal of Publi Heal 01;(1): Sengupta & Bhattaharya, publisher and liensee Publi Heal Foundation Bangladesh. This is an Open Aess artile whih permits unrestrited non-ommerial use, provided e original work is properly ited. 34

2 Sengupta & Bhattaharya Heal status of young Nepalese to eir respiratory and ardia parameters are almost Data are expressed as mean±sd; omparison of parameters santy. Thus, e aim of is investigation was to determine between ontrol subjets and Nepalese was done by two e influene of limate as well as nutritional status over e tailed unpaired t-test, using Mirosoft Exel- 007 and e ertain fitness parameters of young Nepalese and to hek result was onsidered as signifiant when e two-tailed P e hypoesis at geographial loation and nutrition have 18 value <0.05. an influene on e physial fitness of residents. Meods and Materials Results Among physial parameters shown in Table, body fat Twenty-five male young Nepalese (age of 1.6±4.8) of perentage is found to be signifiant between e two groups Pokhara, Nepal (8º 10' N - 8º 16' N) between 18-5 years of (P<0.05). Also in physial fitness variables, PFI sores age are seleted randomly followed by purposive sampling to reveal at e young Nepalese have an exellent physial partiipate in e present study. Pokhara is situated in middle fitness level. Resting heart rate and pre-exerise diastoli mountain regions of Kaski distrit of western Nepal, at an pressure also showed better endurane of young Nepalese altitude of over 5,577ft above sea level (Table 1). Twentyomparative an ontrol subjets. Table also represents e five sedentary ollege students of Kolkata, India, belonging aspet of anaerobi power, energy expenditure to e same age group were reruited as ontrol for e study and predited aerobi apaity (VO max). Nepalese showed a (age of 1.9±.5). Subjets were instruted to take eir last greater anaerobi power and VO max but less expenditure of meal at least two hours before onduting e test in order to energy for a speifi work an ontrol subjets. avoid e speifi dynami ation (SDA) of food. All tests on young Nepalese were arried out in e respetive olonies of Table : Physial variables, anaerobi power, aerobi Pokhara and e experiments wi ontrol subjets were apaity and energy expenditure of e Nepalese and ontrol arried out and measurements were taken in temperature of group C and relative humidity of about 45-50% in winter season in India. To minimize e experimenter bias eah measurement was taken for ree times and e mean was represented as e final result. Subjets had no history of any major disease and were not under any physial onditioning program and or mediation. Eah subjet was given suffiient rest before eah experiment to get an aurate result. Table 1: Geographial loation of Pokhara, Nepal Loation Highest elevation Lowest elevation Average elevation Total population (As per 001ensus) An average family size Latitude 8º 10' N - 8º 16' N Longitude 83º 58'30" E-80º0'30" E 1,700 m (5,577 ft) 87 m (,713 ft) 941 m (above 3,087 ft.) Body mass index (BMI), body fat perentage (BF%), body surfae area (BSA), resting heart rate and blood pressure, 11-1 physial fitness index (PFI), Anaerobi Power by Variables Height (m) Body weight (kg) BMI (Kg/m ) Body Fat % BSA (m ) Resting Heart Rate (Beats/min) Pre-exerise SBP (mm Hg ) Pre-exerise DBP (mm Hg) Post-exerise SBP (mm Hg) Post-exerise DBP (mm Hg) Energy expenditure 5.67± ± Margaria Double Step Test, Aerobi Capaity (VO max), (K.Cal. min ) 15 Energy Expenditure are measured along wi nutritional 16 Keys: SBP - Systoli Blood Pressure, DBP - Diastoli Blood anropometri measurements of e respondents. Pressure. Values are mean± SD, sample size (n 1=n =5). Supersripts (*,,, ) indiate signifiant differene by Nutritional status of Nepalese was arried out by dietary two tail unpaired t-test (for equal varianes) at P<0.05. survey following an interative 4-Hour Reall meod to indiates signifiant differenes wiin ontrol group and gauge a typial day s atual intake. By questionnaire subjets were asked for e volume of food, preparation of wiin Nepalese group, represents signifiant differene food and time of onsumption. From is data ooked and between ontrol versus Nepalese. raw foods were separated and different nutrients aording 17 to eir alorifi value and oer fators were determined. PFI -1-1 Anaerobi power (kg.m.se ) -1 VO max (liters.min ) Control ± ± ± ± ± ± ± ± ± ± ± ± ±0.33 Nepalese ± 8.31* 54.3 ± ± ± 1.9* * 1.53± ± ± ± ± ± ± ± ±0.4 Sou East Asia Journal of Publi Heal 01;(1):

3 Sengupta & Bhattaharya Heal status of young Nepalese Figure 1: Nutritional anropometry of Nepalese and ontrol group m MUAC TC CC WC BC Figure 1 represents e anropometri measures at reflet e nutritional status of bo groups whih may affet e fitness pattern. Among ese WC and BC are found to be signifiant between two groups (P<0.05). Table 3 represents ommon food items onsumed by Nepalese as noted during e interative questionnaire. Based on e data e nutritional assessment of Nepalese was done. It has been found at Nepalese diet is defiient in protein, but ey onsume more fat an eir RDA reommends (Table 4). They also are defiient in iron and alium in eir diet. An interative dietary survey also showed at e average monly inome of e families of subjets was about 4000 rupees whih indiates e poor soio-eonomi ondition of e subjets. The average family size was found to be 6.1, whih also orrelates to lower inome. Control Nepalese Disussion MUAC: Mid-upper arm, HC: head, TC: mid-igh, CC: alf musle of e leg, WC: waist, BC: buttok; sample size The present study reveals young adults of Nepal was found Ø to have less body fat perentage an e sedentary (n 1=n = 5). Supersript ( ) indiates signifiant differene population. This may be due to study populations whih are by two tail unpaired t-test (for equal varianes) at P<0.05 young adults and ey may have a propensity for being Table 3: Categories of food items onsumed by e Nepalese 19 leaner raer an obese. It may also be due to eir adaptive physiologial hanges for residing in suh high Group Cereals Legumes Food Items Rie, Chura (beaten rie), Bread Beans, Melon, Dal (Masur) altitude. Though BSA of e subjets of bo groups is wiin normal range, but BSA of young Nepalese is found to be signifiantly less an ontrol subjets whih may be beause of eir etomorphi stature, whih is again attributable to e environmental onditions ey live in. Vegetable Fats and Oils Fruits Beverages Meat Fish Oer Animal Produt Milk, Eggs Nutritional status and dietary Allowane Nepalese b Reommended Dietary b Allowane a Energy (±.0) Vegetables (leafy and fruit), tomato, Aloo Tama (Potato Bamboo Shoots) Butter, Ghee, vegetable oil Orange, Banana Tea, Coffee, Alohol, Tongba (homemade wine), Rakshi (millet based distilled aloholi drink), lassi Beef, Pork, Chiken Fish of all kinds b Protein (±8.94) b Fat (±9.75) Iron 1.0 (±4.80) Calium 04.1 (±1.30) Among reliable and valid measures of ardio- respiratory 0 1- fitness and endurane, resting heart rate and aerobi apaity (VO max), a lower resting heart rate and more VO max was observed in Nepalese an e ontrol subjets at signify e better endurane. Suh physial differenes may be due to eir lifestyle in hilly areas whih require extra energy expenditure for eir daily ativities resulting in 3 some adaptive hanges. VO max in high altitude is determined by many fators like barometri pressure, ardia output of e subjet, hemoglobin saturation wi 4 oxygen. Table 4: Assessment of nutritional status of e Nepalese d Vitamin A (±144.3) Thiamin 1. (±0.0) Dietary Vitamins Riboflavin 1.4 (±0.4) Niain (±.41) Vitamin C 40 (±10.) e Foli aid (±13.6) a b d e Keys: Data are represented in mean (±SD); Kal/day; g/day; mg/day; International Unit (IU); µg/day; as niain equivalents; 1 mg of niain=60 mg of tryptophan. 400 Sou East Asia Journal of Publi Heal 01;(1):

4 Sengupta & Bhattaharya Heal status of young Nepalese Streng demanding ativities inrease ventriular musle onsumption was found to be suffiient in Nepalese, in e 3,5,6 mass resulting in inreased fore of ontration and present study, ough, it was reported at nutritional hene ardia output whih may be e ause signifiant anemia is very prevalent publi heal problem in Nepal. A 19 inrease of resting or pre-exerise blood pressure. But, large perentage of preshool hildren, pregnant and non- during exerise streing of musle auses pregnant women were found to be anemi. The prevalene vasoonstrition whih resulted in restrition of blood flow of anemia among e ommunity adolesents was 46%: e 7 and in turn inreased systoli pressure and pooling of prevalene of mild anemia was 38%, moderate 8% and 3 blood in many parts of e body auses vasoonstrition in severe 0.4%. This study also indiates less Vitamin A musles and us inreased e diastoli pressure. But, in e intake of young Nepalese, whih may be due to a relatively present study, systoli pressure showed an inrease after high fat intake and very low onsumption of fruits and exerise, but e diastoli pressure showed a derease in vitamin A rih vegetables. It has been reported at 5% of bo ases. Control subjets showed more inrease in women and 1% of preshool hildren of Nepal suffers from systoli blood pressure after exerises whih an Nepalese. night blindness. The National Vitamin A Program (NVAP) This may be an indiator of better ardio-respiratory overs urrently 4 distrits. The reommendation is at 11 ondition of Nepalese. Brouha et al. suggested at for a e bi-annual Vitamin A apsule supplementation should be speifi workload, better e physial ondition of e ontinued and expanded to over all e 75 distrits of e 33 individual, more rapid will be e return of heart rate to its ountry. Vitamin C, whih is benefiial for endurane and pre-exerise level and onsequently lower reovery ardia better physial performane, was also found to be ost. Similar results were found in Nepalese where e inadequate in diet of young Nepalese. Conversely, dietary return of e heart rate to its resting level was more rapid intake of Vitamin B 1 (iamin), Vitamin B (riboflavin) and an at of ontrol subjets. Moreover, e peak heart rate is niain in Nepalese were found to be suffiient whih may be lesser in omparison to Control subjets indiating eir orrelated to eir exellent physial fitness level, beause better physial ondition. Their pulse rate reovered quikly ese vitamins play a major role in maintaining musular whih an indiator of better fitness whih is refleted in 34,35 streng and endurane. signifiantly higher PFI and lower energy expenditure and ey also have better anaerobi power an sedentary Conlusion workers. These data suggest Nepalese have a better Cardio- The heal of young people residing at suh high altitude of respiratory fitness. Nepal is determined not only by e environment but also by means of nutritional determinants. Present study reveals Aording to eir life-style in high altitude young Nepalese young Nepalese residing in mid-mountain regions of perform work related to streng more an ontrol Pokhara are positively influened by environmental and sedentary subjets, so ey should have more upper arm nutritional fators on eir morphometri parameters and irumferene whih are an estimate of energy storage and physiologial fitness. However, large-sale studies are protein mass of e body whih is an indiret estimate of required to examine e relationship of high altitude and 8-31 streng, but no signifiant differene was observed in nutritional status and eir impat over e physial fitness upper arm irumferene between e two groups. of young Nepalese residing oer distrits of Nepal. The present paper also reports nutritional status of twentyfive sex-maed young adults of Nepal as found in dietary Conflit of interest There is no onflit of interest about e publiation of is survey. It has been found at young Nepalese are lak in artile. energy intake, and, in e physiologial parameters ey are found to expend less energy for a partiular work an ontrol subjets. These data supports eir BMI values Referenes whih are found to be insignifiant while omparing wi 1. Government of Nepal. Offiial Website: http: eir ontrol ounterparts. They also lak suffiient protein (aessed June 01) in eir diet, but, more fat onsumption was observed in. ICIMOD. Energy for Mountain Distrits, Workshop interative 4-hour reall meod. They also defiient in Report. Kamandu: International Centre for iron and alium in diet Though, it has been reported Integrated Mountain Development, previously at people of Nepal are aware of e neessity of mironutrients, as shown by e fat at even in 004 it is 3. Castillo Garzon MJ, Ortega Porel FB, Ruiz J. ustomary in many distrits of Nepal for people to drink Improvement of physial fitness as anti-aging fresh yak blood about twie a year. The vein of e animal is intervention. Med Clin 005;14: laned and people ollet e fresh blood in eir mugs and 4. Sengupta P. The Laboratory Rat: relating its age wi drink e fluid immediately. The belief is at as e yak humans. Int J Prev Med. (in press). grazes on Himalayan herbs, it has a lot of essential nutrients, whih are benefiial also to humans. They also believe at 5. Peplow M. High winds suk oxygen from Everest drinking of rakshi or alohol immediately, helps to get Prediting pressure lows ould protet limbers. BioEd benefit from is intake of fresh blood. Dietary iron Online. Retrieved 004. Sou East Asia Journal of Publi Heal 01;(1):

5 Sengupta & Bhattaharya Heal status of young Nepalese 6. Eknoyan G. Adolphe Quetelet ( ) - e 1. Sengupta P, Chaudhuri P, Bhattaharya K. Male average man and indies of obesity. Nephrol Dial Reprodutive Heal and Yoga. Int J Yoga (in press). Transplant 008;3: Sengupta P. Heal Impats of Yoga and Pranayama: an 7. Deurenberg P, Yap M, van Staveren WA. Body mass art-of e-state review. Int J Prev Med 01; 3: index and perent body fat. A metaboli analysis 3. Sengupta P. Environmental and oupational exposure among different eni groups. Int J Obes Relat Metab of metals and eir role in male reprodutive funtions. Disord 1998; : Drug Chem Toxiol 013; 36: DuBois & DuBois. A formula to estimate e 4. Chandra AK, Sengupta P, Goswami H, Sarkar M. approximate surfae area if height and weight be Exessive Dietary Calium in e Disruption of known.arh Intern Med 1916; 17:863. Strutural and Funtional Status of Adult Male 9. st Khurana I. Medial physiology. 1 ed. New Delhi: Reprodutive System in Rat wi Possible Mehanism. Elsevier, 006. Mol Cell Biohem 01;364: Boo J. A short history of blood pressure 5. Sengupta P. Assessment of Physial Fitness Status of measurement. Pro Royal So Med 1977;70: Young Sikkimese Residing In High-Hill Temperate Regions of Eastern Sikkim. Asian J Med Si 011;: 11. Brouha I, Heal CW, Gray B. A step test simple meod of measuring physial fitness for hard musular work in adult men. Rev Canadian Biol 6. Sengupta P. A Sientifi Review of Age Determination 1943;:86. for a Laboratory Rat: How Old is it in Comparison wi 1. Ryhming I. A modified Harvard Step Test for Human Age? Biomed Int 011; : Evaluation of Physial Fitness. Arbeitsphysiologie 7. Guyton AC and Hall JE. Textbook of Medial 1953; 15: Physiology, Philadelphia,10 ed, 000, p Margaria R, Aghemo P and Rovelli E. Measurement of 8. Sengupta P, Sahoo S. A Cross-Setional Study to musular power (anaerobi) in man. J Appl Physiol Evaluate e Fitness Pattern among e Young 1966;1: Fishermen of Coastal Orissa. Ind J Pub Heal Res Dev. 14. Astrand PO, Rodahl K, Dahl H, Stromme S. Test book (in press). of work Physiology. 4 ed. Philadelphia: MGraw-Hill, 9. Chaudhuri P, Sengupta P. Emerging Trend of Gym Pratie and Its Consequene over Physial and 15. Datta SR, Ramanaan, NL. Energy Expenditure in Physiologial Fitness. Biol Exerise 01;8: work predited from Heart rate and pulmonary 30. Sengupta P, Sahoo S. A Fitness Assessment Study ventilation. J App Physio 1969; 6: among Young Fishermen of Coastal Areas of West Bengal, India. Sou East Asia J Publi Heal 16. Roy JS. Body omposition in biologial anropology. 011;1:8-34. Cambridge Studies in Biologial and Evolutionary Anropology. No 6. Cambridge: Cambridge 31. Sengupta P, Chaudhuri P, Biswas S, Haldar, R. An University Press, Evaluation of e Effet of Emerging Trend of Gym- Going over Physial and Physiologial Fitness. 17. NAS. Dietary Referene Intakes for Energy, International Conferene on Moleules to Systems Carbohydrate, Fiber, Fat, Fatty Aids, Cholesterol, Physiology (ICMSP). Kolkata, 011: Protein, and Amino Aids (Maronutrients). Washington D.C.: Food and Nutrition Board, Institute 3. Rikimaru T, Joshi N, Pandey S. Anaemia in Adolesent of Mediine, National Aademy of Sienes, 005. Girls. Kamandu: Nutrition Setion, Child Heal Division, Das D, Das A. Statistis in Biology and Psyhology. 4 ed. Calutta: Aademi publishers, Martineau T, The Child Heal Support Programme: takling some of e auses of hild malnutrition and 19. Sengupta P, Sahoo S. Evaluation of Heal Status of e ill-heal. Nep Paed So 198;1: Fishers: Predition of Cardiovasular Fitness and Anaerobi Power. World J Life Si Med Res 011;1:5-34. Lukaski HC. Vitamin and mineral status: effets on 30. physial performane. Nutrition 004;0: Sengupta P, Chaudhuri P, Bhattaharya K. A small- 35. Chandra AK, Sengupta P, Goswami H, Sarkar M. sale ross-setional study for e assessment of Effets of Dietary Magnesium on Testiular Histology, ardiorespiratory fitness in relation to body Steroidogenesis, Spermatogenesis and Oxidative omposition and morphometri haraters in Stress Markers in adult rats. Ind J Exp Biol 013;51:37- fishermen of Araku valley, Andhra Pradesh, India. Int J 47. Prev Med. (in press). Sou East Asia Journal of Publi Heal 01;(1):

Original Article INTRODUCTION. Pallav Sengupta

Original Article INTRODUCTION. Pallav Sengupta www.ijpm.in www.ijpm.ir A Small scale Cross sectional Study for the Assessment of Cardiorespiratory Fitness in Relation to Body Composition and Morphometric Characters in Fishermen of Araku Valley, Andhra