Department of Medicine, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India.
Department of Radiology, BKL Walawalkar Hospital and Rural Medical College, Sawarde, Maharashtra, India.
Front Public Health. 2023 Aug 3;11:1181401. doi: 10.3389/fpubh.2023.1181401. eCollection 2023.
India 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.
DERVAN 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 HbAC) 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.
The 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/m, 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 ( < 0.001). HOMA-S and compensatory β-cell response showed an inverse trend ( < 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) ( < 0.001) for all.
We 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.
印度正面临着 2 型糖尿病的流行。超重/肥胖、营养过剩、身体活动不足和家族史是糖尿病的已知危险因素。我们研究了营养不良在农村青春期少女糖尿病发展中的作用。
在印度西部马哈拉施特拉邦的 KONKAN 地区设立了 DERVAN 队列研究。共纳入 1520 名 16-18 岁的青春期少女。我们使用人体测量法测量血糖参数（葡萄糖、胰岛素和 HbAC）和身体大小，使用生物阻抗法测量身体成分。使用美国糖尿病协会（ADA）标准诊断前驱糖尿病。我们还使用稳态模型计算了各种胰岛素抵抗（HOMA-IR）、β细胞功能（HOMA-β）、胰岛素敏感性（HOMA-S）和补偿性β细胞反应的 HOMA 指数。体重指数（BMI）、体脂肪%和腰围被视为暴露因素，所有血糖参数和指数均被视为结局。
研究对象的中位年龄为 16.6 岁。体重、身高和 BMI 的中位数分别为 40.7kg、151.7cm 和 17.5kg/m2。体重不足的患病率为 28.8%，发育迟缓的患病率为 30.4%。根据 BMI，消瘦和肥胖的患病率分别为 58.4%和 4.2%。体脂肪%的中位数为 22.5%，体脂肪过多（>35%）的患病率为 5.7%。前驱糖尿病的患病率为 39.4%。空腹胰岛素浓度、HOMA-IR 和 HOMA-β在身体成分四分位组中呈正相关（<0.001）。HOMA-S 和补偿性β细胞反应呈负相关（<0.001）。与超重/肥胖组中的前驱糖尿病女孩相比，最营养不良组的女孩胰岛素浓度中位数较低（8.1μIU/ml 比 17.1μIU/ml），HOMA-IR 较低（1.1 比 2.3），HOMA-β 较低（75.6 比 129.2），但胰岛素敏感性较高（87.4 比 43.7）（<0.001）。
我们报告了农村青春期少女中前驱糖尿病的高患病率，肥胖的患病率非常低。肥胖中的前驱糖尿病是由高胰岛素血症和胰腺过度工作驱动的，而β细胞功能差和胰岛素分泌不足是营养不良组的主要驱动因素。非常需要针对营养不良人群的高危糖尿病筛查计划。在计划干预措施时应谨慎，因为过度喂养（或营养过剩）可能使人群面临肥胖和胰岛素抵抗的风险。
