AcomparativestudyofSouthIndianchildrenwithTamilchildrenborninFrance

ChantalMalenfant

National Center for Scientific Research, (CNRS), Nutrition, Paris, France

ReceivedApril24,2009

A comparative database with Tamil children [( 0 to 6 yr old, south Indian (n=13) and Sri Lanka (n=69)] born in France (Paris and its suburbs, first generation) and those living in south India [(Tamil Nadu (n=43) and Kerala (n=66)] was created with the ultimate purpose of preventing deficiencies in children’s health. Two main methods were used for collection of socio-demographic data as parents and body mass index of children. In France, Tamil boys (n=42) and girls (n=40) had almost the same percentage for obesity (about 5%), adiposity rebound was more for girls (7%) than for boys (2%). But thinness (between the 3rd and 10th percentile) was more in boys (22%) and girls (24%). In India (boys n=48, girls n=61), obesity was more in girls than those born in France; as also adiposity rebound, and underweight was noticed in a third of both girls and boys. In France, cultural impact of immigration is very important and can explain the stress of immigrant families. This may account for the thinness of the children.

Key wordsBodymassindex-culture-immigration-obesity-Tamilchildren-thinness-underweight

IndianJMedRes130,November2009,pp590-592

This study was designed to investigate thegrowth of children (between 0-6 yr old) born inFrance from immigrant parents (Tamils comingfrom South India or Sri Lanka) first generationlivinginthesuburbsofParis,accordingtovariousforms of socialization with those born in SouthIndia living in Tamil Nadu (Puducherry) and inruralKerala(Varkala).Theultimateobjectivewastopreventdeficienciesinchildren’shealth(obesity,adiposityreboundandinsufficiencyweight-belowthe3rdpercentile-).

Thereareabout65millionsTamilpeopleinIndiaand2millionsinSriLanka.Eightmillionsarescatteredintherestoftheworld.About300000thousandliveinFrance (more specifically in the area of Paris)1.

The study population of children (Tamils fromIndia and from Sri Lanka) are first generation in France. IndiansfromTamilNaduandfromKeralabothlivinginSouthIndiahavesamefoodandotherlivinghabits.

Material & Methods

The samemethodologywas used both in Franceand in India to collect data. Data were collectedin France (2007-08) through questionnaires withTamil mother or (and) father concerning breast-feeding, eating habits, leisure activities (includingsport), any contracteddiseasesof their children.Theparents’ socio-demographic data were also collected.Questionnaire survey was conducted in centers forpreventingchildren’shealthwhereinformedbyalargecongregationofTamilfamilies.

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MALENFANT:A COMPARATIvE STUDy OF SOUTH INDIAN CHILDREN WITH TAMIL CHILDREN BORN IN FRANCE 591

Heightandtheweightofchildrenbetweentheagesof0to6:atbirth,1month,6months,12months(1yr),24months(2yr),36months(3yr),48months(4yr),60months(5yr)and72months(6yr)wascollectedfrommedicalreports.Parents’weightandheightwerealsonoted.

In India (2005-2006) data were collected fromTamilNadu(2005)and inKerala(2006) through thesame questionnaire used in France. Questionnairesurveywasconductedbytheprimaryschoolteachersin schools and by people in charge of children increches. Parents were explained of the goals of theresearch. Parents’ weight and height were recordedonlyinKerala.

Statistical analysis:Forbothcountries,measurementofBody Mass Index (Height/Weight²) was used as threshold asgivenbytheInternationalobesityTaskForce2.

Underweightwasunderthe3rdpercentile;Thinnessbetweenthe3rdand10thpercentile;Normalrangebetween10thand90thpercentile;Adiposityreboundbetween90thand97th;andobesityabovethe97thpercentile.

There were some missing data for the 6 yr oldchildreninIndia.Forthisarticle,thereforedatafromchildrenbetween1and5yroldonlywereused.Foodconsumption’sanalysiswasnotdone.

Results

Thedatawereobtainedfrom191children:109insouth India (43 fromTamilNadu:Puducherryand66fromKerala)and82inFrance(13fromTamilNaduand69fromSriLanka).ofthese109children,44percentareboysand56percentaregirls.ofthese82childreninFrance,51percentareboysand49percentaregirls.

Socio demographic data:MostTamilparentswhoarelivinginFrance(>50%)werenotliterate,aboutathirdhavegotdiplomaathighschoolandveryfewwenttotheuniversity.ofthoselivinginIndia,about30percentwereilliterate(women:35%,men:25%),somewenttoathighschool(women:13%and32%formen)andattheuniversitywomen:24%,men:30%).InIndia43percentamongfatherswereholdinggoodjobsascomparedto6per cent in France. Women were mainly home makers in France(91.1%)and76percentinIndia.

Children’s body mass index France–Tamilboysandgirlshadalmostthesamepercentageforobesity(about5%);adiposityreboundwasmoreimportantforgirls(7%)thanforboys(2%).

An important range of children were in the thincategory (between the 3rd and 10th percentile) whichwassamebothforboys(22%)andgirls(24%).

The percentage of underweight children wasnotnegligible (16%forboys,and9%forgirls).Theproblem of underweight among Tamil children hasbeenpointoutinapreviousstudy3.Morethan50percent of children were in the normal range (55% forboysandgirls)(Figs1and2).

India–IndianchildrenborninIndiapresentahigherpercentageforobesityandadiposityreboundthanthoseborn in France, specifically for girls (11% for obesity and11%foradiposityrebound)andinFranceforgirls(obesity:5%andadiposityrebound:7%).

But, those in the very underweight was higher,onethirdamonggirlsandboys.Thinnesswaslessthanthose in France, but still was important specially for(boys17%).About40percent(boysandgirls)wereinnormalrange(Figs3and4).

InFrance,thinnesswasfoundin6percentmothersandin3percentfatherswhile55percentmothers42percentfatherswerenormal,36and49percenthadadiposityreboundinmothersandfathersrespectively.

InIndia,Tamilparentsweremainlyinthenormalrange(70%),withmorefathershavingsevereobesity(3%) with obesity (3%) with 14 per cent (mothersandfathers)intheadiposityreboundcategory.AdultsIndianshavemorebodyfatandlowermusclevolumesthanotherethnicgroups4.

Fig. 1 & 2.Children’s[boys(Fig.1)andgils(Fig.2)]bodymassindex–SouthIndiaandSriLankaborninFrance.

592 INDIANJMEDRES,NoVEMBER2009

Discussion MostofTamilparents living inFrancehad jobsoftheworkercategory.TheTamilsfromTamilNaduwereeitherintheupperclassorinthemiddleclasslikehavingarestaurantorshop;someweretranslators.TamilparentsfromSriLanka,wereworseoffastheywereaffectedbythewars.Theyhadpoorpayingjobsasworkerswithhighleveloffrustration,whichaffectedchildrens’education. A few Tamils in France did speak proper French.But language was a major barrier for women duringpregnancy and delivery. They had their first child without usingthetraditionalritualsthatwasstressful.Theyalsofeltunconfortableduetolivinginatotallyalienculture. It was not the same case in South India. Tamilpeople (from Puducherry and Varkala) had highereducation(thanthosewhohavemigrated)andgotbetterjobs,evenforwomen.Butthereisstilllargecategory(46%)workers in India,even if it is less (64%) thanthosewhoareinFrance.Underweightwas16percentamongboysatallages(from1to5yrold)inFrance.Themostimportantagegroupwas5yrold-9percentgirlsbeingunderweight(mainlyat1and2years). AmongallethnicgroupslivinginFrance,Indianchildrenwerethealonegrouppresentingunderweightamong children. Thinness was significantly more important forgirls than forboys.Thereare regional,

ethnicandculturalvariationinthetemporaltrendsforobesityandoverweight5.

More Physical activity was recorded amongIndian children. Boys were playing more than girls(specifically outdoors).

obesityisemergingeverywhere,moreintheurbanmiddle/higher socio economic groups, primarily dueto fast food consumption which may partly explainchildren’adiposity rebound.Also,manypersonsbornin poverty and acquiring affluence in aduldhood suffer fromobesity6.

InIndia,thinnessandunderweightweremorethanthose born in France. Even, though the prevalenceof childhood undernutrition has decreased in Asiancountriesingeneral,underweightisstillanimportantproblem in India, more specifically in some rural areas. In our study, the percentage underweight of childrenwerehigherinKeralathaninTamilNadu.

In the year 2000, we pointed out5 obesity asan emerging public health problem in Asia (andspecifically in India). It is also an important problem as well as for those who emigrate. Culture plays animportantrole,culturalimpactofimmigrationleadstorejecteverythingwhichdoesnotbelongtoyouandinthesametimeimmigrantswerehavingthesamehabitsthanthosewhoarenativefromtheadoptedcountry.

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3. Malenfant C. Food behavior and evolution of growth withchildren born in France from immigrant parents: the tamilcase.J Med Thérape Pédiatr2003;4:225-30.

4. Sachdev HPS. Growth and development ofAsian children.In: Nutrition Goals for Asia- vision 2020- Proceedings IX Asian Congress of Nutrition.NewDelhi:NutritionFoundationofIndia,2003.p.173-9.

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Fig. 3 & 4.Children’s [boys (Fig.3) andgirls (Fig.4)]bodymassindex-SouthIndia(TamilNaduandKerala)-borninIndia.

Reprint requests:DrChantalMalenfant,2,rueFlorenceBlumenthal75016,Paris,France e-mail: chantal.malenfant@orange.fr