Kalaivani Mani, Hemraj Chitralok, Varhlunchhungi Varhlunchhungi, Ramakrishnan Lakshmy, Malhotra Sumit, Gupta Sanjeev Kumar, Marwaha Raman Kumar, Abraham Ransi Ann, Arora Monika, Rawal Tina, Khan Maroof Ahmad, Sinha Aditi, Tandon Nikhil
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Department of Cardiac-Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
PLoS One. 2025 May 6;20(5):e0321898. doi: 10.1371/journal.pone.0321898. eCollection 2025.
Cardio-metabolic risks emerge in early life and progress further in adult life. In recent times, COVID-19 pandemic aggravated risks owing to poor food security and diet quality. We aimed to assess the prevalence of cardiometabolic traits including the metabolically obese normal weight phenotype and its socioeconomic differentials in children and adolescents aged 6-19 years in India.
A baseline assessment was conducted between August and December, 2022, as part of a school-based cohort study that aimed at longitudinally evaluating the anthropometric and metabolic parameters among urban children and adolescents aged 6-19 years from three public (non-fee paying) and two private (fee paying) schools in India. Private and public schools were considered as a proxy for higher and lower socioeconomic status respectively. Blood pressure and blood samples in a fasting state were obtained only from adolescents aged 10-19 years. The prevalence and its 95% confidence interval using the Clopper exact method and adjusted prevalence ratios were calculated using random-effects logistic regression models.
Among 3888 recruited students, 1985 (51.05%) were from public schools, and 1903 (48.95%) were from private schools aged 6-19 years. The overall prevalence of underweight was 4.95% (95% CI 4.29-5.69), with a significantly higher prevalence in public schools (8.09%) than private schools (1.69%). The overall prevalences of general obesity and central obesity were 13.41% (95% CI 12.35-14.52) and 9.15% (95% CI 8.26-10.11), respectively, with significantly higher prevalence in private schools (p < 0.001). The prevalences of general and central obesity were four times (adjusted PR = 4.42, 95% CI 2.90-6.72) and eight times (adjusted PR = 8.31, 95% CI 4.82-14.35) higher, respectively, in private schools than public schools. The overall prevalence of hypertension was 7.37% (95% CI 6.33-8.51), and similar prevalences were found in public and private schools. Private school students had 2.37 times higher prevalence of impaired fasting plasma glucose (adjusted PR = 2.37, 95% CI 1.19-4.72) and 3.51 times higher prevalence of metabolic syndrome (adjusted PR = 3.51, 95% CI 1.54-8.01) than public school students. Among 2160 adolescents, 67.73% (1463) had normal body mass index. The prevalence of metabolically obese normal weight phenotype (MONW) was 42.86% (95% CI 40.30-45.44), which is higher in public [46.39% (95% CI 43.25-49.54)] than private [35.33% (95% CI 30.99-39.86)] schools (p < 0.001) with adjusted PR of 0.91 (95% CI 0.70-1.17). The most prevalent cardio-metabolic abnormality among metabolically obese normal weight phenotype was low high-density lipoprotein-c, significantly higher among adolescents from public schools (62.12% vs 52.73%, p = 0.039) than private schools. The prevalence of metabolically obese underweight (MOUW) (48/115) was 41.74% (95% CI 32.61-51.30), being higher among adolescents in public schools than private schools but not significant (p = 0.264).
Effective implementation of food security measures and targeted initiatives will be crucial to mitigate the socioeconomic disparities associated with the growing burden of cardiometabolic traits. Metabolic obesity among phenotypically normal or underweight adolescents should not be overlooked but should be intervened early through novel screening criteria to prevent future cardiovascular burdens. These findings also have implications for low- and -middle income countries like India, which are undergoing a nutritional transition where socioeconomic status strongly influences cardio-metabolic traits.
心血管代谢风险在生命早期出现，并在成年期进一步发展。近年来，由于粮食安全和饮食质量差，新冠疫情加剧了这些风险。我们旨在评估印度6至19岁儿童和青少年中心血管代谢特征的患病率，包括代谢性肥胖正常体重表型及其社会经济差异。
2022年8月至12月进行了基线评估，这是一项基于学校的队列研究的一部分，该研究旨在纵向评估印度三所公立（免费）和两所私立（收费）学校中6至19岁城市儿童和青少年的人体测量和代谢参数。私立和公立学校分别被视为较高和较低社会经济地位的代表。仅从10至19岁的青少年中获取空腹状态下的血压和血样。使用Clopper精确方法计算患病率及其95%置信区间，并使用随机效应逻辑回归模型计算调整后的患病率比值。
在3888名招募的学生中，1985名（51.05%）来自公立学校，1903名（48.95%）来自6至19岁的私立学校。体重不足的总体患病率为4.95%（95%CI 4.29 - 5.69），公立学校的患病率（8.09%）显著高于私立学校（1.69%）。一般肥胖和中心性肥胖的总体患病率分别为13.41%（95%CI 12.35 - 14.52）和9.15%（95%CI 8.26 - 10.11），私立学校的患病率显著更高（p < 0.001）。私立学校中一般肥胖和中心性肥胖的患病率分别是公立学校的四倍（调整后的PR = 4.42，95%CI 2.90 - 6.72）和八倍（调整后的PR = 8.31，95%CI 4.82 - 14.35）。高血压的总体患病率为7.37%（95%CI 6.33 - 8.51），公立和私立学校的患病率相似。私立学校学生空腹血糖受损的患病率比公立学校学生高2.37倍（调整后的PR = 2.37，95%CI 1.19 - 4.72），代谢综合征的患病率高3.51倍（调整后的PR = 3.51，95%CI 1.54 - 8.01）。在2160名青少年中，67.73%（1463名）体重指数正常。代谢性肥胖正常体重表型（MONW）的患病率为42.86%（95%CI 40.30 - 45.44），公立学校[46.39%（95%CI 43.25 - 49.54）]高于私立学校[35.33%（95%CI 30.99 - 39.86）]（p < 0.001），调整后的PR为0.91（95%CI 0.70 - 1.17）。代谢性肥胖正常体重表型中最常见的心血管代谢异常是高密度脂蛋白胆固醇水平低，公立学校青少年中的患病率（62.12%对52.73%，p = 0.039）显著高于私立学校。代谢性肥胖体重不足（MOUW）（48/115）的患病率为41.74%（95%CI 32.61 - 51.30），公立学校青少年中的患病率高于私立学校，但差异不显著（p = 0.264）。
有效实施粮食安全措施和有针对性的举措对于减轻与心血管代谢特征负担增加相关的社会经济差距至关重要。表型正常或体重不足的青少年中的代谢性肥胖不应被忽视，而应通过新的筛查标准尽早进行干预，以预防未来的心血管负担。这些发现也对像印度这样的低收入和中等收入国家具有启示意义，这些国家正在经历营养转型，社会经济地位强烈影响心血管代谢特征。
