Sitaram Bhartia Institute of Science and Research, New Delhi, India.
Population Council, New Delhi, India.
Eur J Clin Nutr. 2021 Aug;75(8):1205-1217. doi: 10.1038/s41430-021-00916-3. Epub 2021 Apr 23.
Intra-individual 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.
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.
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 (21.7-25.8%). Proportions with ≥1 abnormal metabolic obesity biomarker(s) were 56.2% overall, 54.2% in thin (BMI-for-age < -2 SD) and 59.3% in stunted (height-for-age < -2 SD) 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 (>1 SD BMI-for-age). Among poor participants, triglyceride, glucose and HDL abnormalities were higher.
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.
个体内共存的营养不足和“代谢性肥胖”，其特征是至少存在一种异常的心血管代谢风险因素，这种情况在幼儿和青少年中很少被研究，特别是在经历快速营养转型的中低收入国家。
在印度基于人群的综合国家营养调查（2016-2018 年）中，对 5-19 岁的参与者进行了代谢性肥胖生物标志物的流行情况与人体测量学和社会人口统计学特征的相关性研究。对血清脂质谱（总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）和甘油三酯）、空腹血糖和糖化血红蛋白（HbA1C）进行了分析，分别在 22567、23192、25962 和 19143 名参与者中进行了分析。
总体而言（整个数据集），LDL 和 TC 的异常发生率较低（4.3-4.5%），血糖异常发生率中等（10.9-16.1%），HDL 和甘油三酯异常发生率较高（21.7-25.8%）。整体上有≥1 种异常代谢性肥胖生物标志物的比例为 56.2%，消瘦（BMI-年龄<-2SD）和生长迟缓（身高-年龄<-2SD）参与者中分别为 54.2%和 59.3%。在轻度营养不良（-1 至-2SD）中也存在类似的流行率。三分之一的参与者存在两种边缘异常，这需要积极的生活方式干预。代谢性肥胖的患病率随着 BMI-年龄的增加而增加。在有代谢性肥胖的人群中，只有 9%为超重/肥胖（>1SD BMI-年龄）。在贫困参与者中，甘油三酯、血糖和 HDL 异常的发生率更高。
在印度超过一半的人体测量学上营养不良和体重正常的儿童和青少年中，存在一种矛盾的、违背直觉的代谢性肥胖生物标志物（多个）的流行率。迫切需要投资解决营养过剩和营养不足的问题。营养状况应通过额外的可靠生物标志物来描述，而不仅仅是通过人体测量学。
