Prediabetes in rural adolescent girls from DERVAN cohort: data from the KONKAN region of the state of Maharashtra, India (DERVAN-4)

Frontiers in Public Health

Public Health

Arvind Yadav¹  Anup Nilawar¹  Suvarna Patil²  Netaji Patil³  Rohit Bhat⁴  Omkar Dervankar⁴  Ajit Nandoskar⁴  Charudatta Joglekar⁴  Pallavi Hardikar-Bhat⁴ 

[1] Department of Biochemistry, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India;Department of Medicine, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India;Department of Radiology, BKL Walawalkar Hospital and Rural Medical College, Sawarde, Maharashtra, India;Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India;

关键词: prediabetes;    adolescents;    rural;    undernutrition;    India;   

DOI  :  10.3389/fpubh.2023.1181401

 received in 2023-03-07, accepted in 2023-07-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundIndia is witnessing an epidemic of type 2 diabetes. Overweight/obesity, overnutrition, physical inactivity, and family history are well-known risk factors for diabetes. We investigated the role of undernutrition in the development of diabetes among rural adolescent girls.MethodsDERVAN cohort study was set up in the KONKAN region of the western Indian state of Maharashtra. It enrolled 1,520 adolescent girls (16–18 years old at the time of enrollment). We measured glycemic parameters (glucose, insulin, and HbA1C) and body size using anthropometry and body composition using bioimpedance. Prediabetes was diagnosed using the American Diabetic Association (ADA) criteria. We also calculated various HOMA indices for insulin resistance (HOMA-IR), β-cell function (HOMA-β), insulin sensitivity (HOMA-S), and compensatory β-cell response using a homeostasis model. BMI, body fat%, and waist circumferences were treated as exposures and all the glycemic parameters and indices as outcomes.ResultsThe median age of the subjects was 16.6 years. The median weight, height, and BMI were 40.7 kg, 151.7 cm, and 17.5 kg/m2, respectively. Prevalence of underweight was 28.8%, and stunting was observed in 30.4%. Thinness and obesity using BMI were observed in 58.4% and 4.2%, respectively. The median body fat% was 22.5, and excess body fat (>35%) was observed in 5.7%. The prevalence of prediabetes was 39.4%. Fasting insulin concentrations, HOMA-IR, and HOMA-β showed a positive trend across body composition quartiles (p < 0.001). HOMA-S and compensatory β-cell response showed an inverse trend (p < 0.001). Compared with prediabetic girls in the overweight/obese group, girls most undernourished group had lower median insulin concentrations (8.1 μIU/ml vs. 17.1 μIU/ml), lower HOMA-IR (1.1 vs. 2.3), and lower HOMA-β (75.6 vs. 129.2) but higher sensitivity (87.4 vs. 43.7) (p < 0.001) for all.ConclusionWe have reported a high prevalence of prediabetes among rural adolescent girls with a very low prevalence of obesity. Prediabetes in obesity is driven by hyperinsulinemia and overworking of the pancreas while poor β-cell function and poor insulin secretion are major drivers in the undernourished group. The high-risk diabetes screening programs are much needed for the undernourished populations. Caution should be exercised for planning the interventions as overfeeding (or overnutrition) is likely to put the populations at risk of development of obesity and insulin resistance.

【 授权许可】

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Copyright © 2023 Patil, Patil, Hardikar-Bhat, Dervankar, Joglekar, Bhat, Nandoskar, Yadav and Nilawar.