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Nutritional Status of Underprivileged Indian Children and Youth with Type-1 Diabetes - A Multicentre Study
Anuradha V Khadilkar1,2, Chirantap Oza1, Shruti A Mondkar1
1Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, Odisha, India.
Insights
Type-1 diabetes (T1D) affects many Indian children. This study found that approximately one-fifth of youth with T1D were overweight or obese, and a fourth were stunted, highlighting the need for close monitoring of growth and nutrition.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Public Health Nutrition
Background:
- India has the highest global burden of type-1 diabetes (T1D) in children under 20.
- Limited data exists on the anthropometric status of underprivileged Indian children with T1D.
- The rising prevalence of obesity, alongside undernutrition, poses a double burden, potentially leading to insulin resistance in this population.
Purpose of the Study:
- To determine the prevalence of malnutrition, including undernutrition and overweight/obesity, in Indian children and adolescents with T1D.
- To identify key factors associated with short stature in this demographic.
- To analyze the relationship between T1D management (duration, insulin regimen, glycemic control) and anthropometric outcomes.
Main Methods:
- A registry-based, cross-sectional analysis was conducted using data from the Changing Diabetes in Children (CDiC) program across India.
- Anthropometric measurements and clinical data were collected from participants with T1D.
- Statistical analysis was performed to identify predictors of short stature and compare outcomes based on insulin regimens.
Main Results:
- 6.4% of participants were undernourished (3.4% severely), and 17.7% were overweight/obese (13.2% overweight).
- 21.2% exhibited short stature, with familial short stature accounting for 7.4%.
- Longer T1D duration and higher insulin requirements were significant predictors of short stature; glycemic control and insulin regimen were not significant predictors.
Conclusions:
- Approximately one-fifth of Indian children and youth with T1D are overweight/obese, and about a fourth are stunted.
- Short stature is particularly prevalent in those with longer diabetes duration and higher insulin needs.
- Continuous monitoring of anthropometric parameters is crucial for optimizing growth and nutritional status in pediatric T1D patients.
Background:
India has the highest number of prevalent type-1 diabetes (T1D) cases in the under-20-year age population. Data on the anthropometry of underprivileged Indian children with T1D are scarce. In economically disadvantaged countries like India, poor growth in patients with T1D is a major concern due to limited accessibility and affordability. Besides, due to the double burden of malnutrition, the prevalence of obesity is increasing mirroring the global trends, which may lead to the development of insulin resistance.
Objectives:
This study aims to assess the prevalence of malnutrition in Indian children and youth with T1D and to identify the determinants of short stature.
Methods:
A registry-based cross-sectional analysis of data collected from various centres across India enrolled in the Changing Diabetes in Children (CDiC) programme.
Results:
We observed that 6.4% were undernourished (3.4% severe undernutrition) and 17.7% (overweight 13.2%) had combined overweight/obesity. 21.2% of participants had short stature (adjusted for mid-parental height) with 7.4% cases of familial short stature. Longer duration of illness and insulin requirement were significant positive predictors of short stature while glycaemic control, insulin regimen and mid-parental height did not have a significant relationship with short stature. Participants on basal-bolus regimen had significantly higher insulin requirements and better glycaemic control than the ones on mixed-split regimen.
Conclusion:
We report that around one-fifth of children and youth with T1D were overweight/obese and around a fourth were stunted, especially those with longer duration of diabetes and higher insulin requirements. Close monitoring of anthropometric parameters is necessary for all children with T1D to optimize growth and nutrition.
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