Triple burden of malnutrition and role of anaemia in the development of complications associated with type 1 diabetes in Indian children and youth

Misha Antani; Yash Pargaonkar; Chirantap Oza; Shruti A. Mondkar; Vaman Khadilkar; Ketan Gondhalekar; Anuradha Khadilkar

doi:10.1515/jpem-2022-0327

Article

Triple burden of malnutrition and role of anaemia in the development of complications associated with type 1 diabetes in Indian children and youth

Misha Antani , Yash Pargaonkar , Chirantap Oza , Shruti A. Mondkar , Vaman Khadilkar , Ketan Gondhalekar and Anuradha Khadilkar

Published/Copyright: October 27, 2022

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 35 Issue 12

Abstract

Objectives

The double burden of malnutrition accompanied by micronutrient deficiency is referred to as the triple burden of malnutrition (TBM). Very few studies have highlighted the TBM in children with type-1 diabetes. We conducted this study with the objective of estimating the TBM in Indian children and youth with type-1 diabetes (T1D) and to study role of anaemia in the development of complications associated with T1D.

Methods

This cross-sectional observational study included 394 subjects with T1D. Demographic data, anthropometry, blood pressure, biochemical measurements, dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography were performed using standard protocols. Estimated glucose disposal rate (eGDR) and estimated glomerular filtration rate (eGFR) were calculated for all subjects.

Results

We report a 16, 5.8, and 16.2% prevalence of anaemia, underweight and overweight/obese suggesting TBM with microcytic hypochromic anaemia as the most common morphological form. Haemoglobin concentrations showed positive correlation with systolic and diastolic blood pressure. The presence of anaemia was a significant predictor of eGDR and macrovascular complications in T1D which could not be attributed to glycemic control. Bone health of anaemic T1D subjects was poor than subjects without anaemia on DXA scan after adjusting for confounders. No systematic pattern between Hb concentrations and eGFR or ACR was found.

Conclusions

TBM in Indian children and youth with T1D is a significant health problem and anaemia is an important predictor in the development of macrovascular complications and poor bone health associated with T1D. However, its role in development of microvascular complications remains to be explored.

Keywords: anaemia; DXA; eGDR; EGFR; pQCT; triple burden of malnutrition; type-1 diabetes

Corresponding author: Dr. Anuradha Khadilkar, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune 411001, India; and Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India, Phone: +91 0206057004, E-mail: anuradhavkhadilkar@gmail.com

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The local Institutional Review Board have approved the study.

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Received: 2022-06-27

Accepted: 2022-10-10

Published Online: 2022-10-27

Published in Print: 2022-12-16

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https://doi.org/10.1515/jpem-2022-0327

Keywords for this article

anaemia; DXA; eGDR; EGFR; pQCT; triple burden of malnutrition; type-1 diabetes