Intraindividual double-burden of anthropometric undernutrition and “metabolic obesity” in Indian children: a paradox that needs action

Abstract

Background Intraindividual coexistence of anthropometrically defined undernutrition and “metabolic obesity”, characterised by presence of at least one abnormal cardiometabolic risk factor, is rarely investigated in young children and adolescents, particularly in Low-and-Middle-Income-Countries undergoing rapid nutrition transition. Methods Prevalence of biomarkers of metabolic obesity was related to anthropometric and socio-demographic characteristics in 5-19 years old participants from the population-based Comprehensive National Nutrition Survey in India (2016-2018). The biomarkers, serum lipid-profile (total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides), fasting glucose, and glycosylated hemoglobin (HbA1C), and all jointly were analysed in 22567, 23192, 25962 and 19143 participants, respectively. Results Overall (entire dataset), the prevalence of abnormalities was low (4.3-4.5%) for LDL and TC, intermediate for dysglycemia (10.9-16.1%), and high for HDL and triglycerides (21.725.8%). Proportions with ≥1 abnormal metabolic obesity biomarker(s) were 56.2% overall, 54.2% in thin (BMI-for-age <-2SD) and 59.3% in stunted (height-for-age <-2SD) participants. Comparable prevalence was evident in mild undernutrition (-1 to -2 SD). Clustering of two borderline abnormalities occurred in one-third, warranting active life-style interventions. Metabolic obesity prevalence increased with BMI-for-age. Among those with metabolic obesity, only 9% were overweight/obese (>1SD BMI-for-age). Among poor participants, triglyceride, glucose and HDL abnormalities were higher. Conclusions A paradoxical, counter-intuitive prevalence of metabolic obesity biomarker(s) exists in over half of anthropometrically undernourished and normal-weight Indian children and adolescents. There is a crucial need for commensurate investments to address overnutrition along with undernutrition. Nutritional status should be characterized through additional reliable biomarkers, instead of anthropometry alone.

Prevalence of and Factors Associated With High Blood Pressure Among Adolescents in India

“…This occurrence is part of the extended double burden of malnutrition with a paradoxical co-occurrence of metabolic obesity in anthropometrically undernourished children, which was described in a 15-year-old data set from urban schools in Delhi, India, 9 and recently confirmed in a nationally representative survey. 10 Thus, whether high BP also occurs in anthropometrically undernourished Indian adolescents is important to know.…”

“…JAMA Network Open. 2022;5(10):e2239282. doi:10.1001/jamanetworkopen.2022.39282 (Reprinted) October 31, 2022 9/13 Downloaded From: https://jamanetwork.com/ on 11/06/2022 nomograms of BP in healthy, normal-weight Indian children, the 2017 guideline of the American Academy of Pediatrics was used, the effect of which on estimates of high BP prevalence is unknown.…”

Global Hunger Index does not really measure hunger - An Indian perspective

“…These findings indicate a substantial discordance between anthropometric measures of thinness and biomarkers, including the extreme scenario of overnutrition. This paradoxical finding was recently confirmed at a national scale from the recent quality-controlled Comprehensive National Nutrition Survey in a sample of 19143 participants 29 . This study showed that the intra-individual coexistence of ‘metabolic obesity’ in anthropometrically undernourished Indian children had worsened.…”

Changes in Child Undernutrition and Overweight in India From 2006 to 2021: An Ecological Analysis of 36 States

“…Our findings highlight a potentially worrisome disconnect between the apparent expansion of human development and improvements in child nutrition outcomes. 26 Specifically, the bivariate decomposition analysis predicted moderate to large declines in populationlevel stunting and wasting based on the rise in favorable development indicators such as women's literacy, improved sanitation, and households with electricity. Our analyses showed that these Mean sex ratio at birth for children born in the last five years (females per 1,000 males)…”

“…34 Even in children aged 5 to 19 years, metabolic abnormalities such as high triglycerides are present at all levels of weight status, with progressively higher levels of metabolic morbidities with increasing body mass index-for-age. 26 Rising overweight in childhood combined with the elevated risk of metabolic diseases in ethnic South Asians creates a perfect storm for higher morbidity, mortality, and medical costs due to cardiometabolic disease over the life course.…”