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The double burden of 'malnutrition': Under-Nutrition & Obesity

Is iron status associated with markers of non-communicable disease in adolescent Indian children?

Abstract

Background

High body iron status has been associated with non-communicable diseases (NCD) like diabetes (high fasting blood glucose, FBG), hypertension (HTN) or dyslipidaemia (high total cholesterol, TC) in adults, but this has not been examined in adolescent children. This is relevant to iron supplementation and food iron fortification programs that are directed at Indian children.

Methods

The association of NCD with Serum Ferritin (SF) was examined using logistic additive models, adjusted for confounders such as age, body mass index, C-Reactive Protein, haemoglobin and sex, in adolescent (10–19 years old) participants of the Indian Comprehensive National Nutrition Survey. The interaction of these associations with wealth and co-existing prediabetes was also examined. A scenario analysis was also done to understand the impact of iron fortification of cereals on the prevalence NCD among adolescents.

Results

The odds ratio (OR) of high FBG, HTN and TC were 1.05 (95% CI: 1.01–1.08), 1.02 (95% CI: 1.001–1.03) and 1.04 (95% CI: 1.01–1.06) respectively for every 10 µg/L increase in SF. The odds for high TC increased with co-existing prediabetes. The scenario analysis showed that providing 10 mg of iron/day by fortification could increase the prevalence of high FBG by 2–14% across states of India. Similar increments in HTN and TC can also be expected.

Conclusions

High SF is significantly associated with NCD in adolescents, dependent on wealth and co-existing prediabetes. This should be considered when enhancing iron intake in anaemia prevention programs, and the NCD relationship with body iron stores should be studied.

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Fig. 1: Relation between Fasting Blood Sugar and Serum Ferritin.
Fig. 2: Relation between Blood Pressure and Serum Ferritin.
Fig. 3: Relation between Total Cholesterol and Serum Ferritin.

Data availability

This was a secondary analysis on the CNNS data, which are the property of the Ministry of Health and Family Welfare, Government of India.

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Acknowledgements

HSS and AVK are recipients of the Wellcome Trust/Department of Biotechnology India Alliance Clinical/Public Health Research Centre Grant # IA/CRC/19/1/610006.

Funding

These secondary analyses and manuscript were not supported by any specific funding. The CNNS was conducted by the Ministry of Health and Family Welfare, Government of India, and the UNICEF, with financial support from the Mittal Foundation.

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Authors and Affiliations

Authors

Contributions

HSS and AVK conceived the idea, guided the analysis and drafted the manuscript. SG and TT conducted all statistical analyses. All authors were involved during drafting and approved the final manuscript. All authors had access to raw data.

Corresponding authors

Correspondence to A. Kurpad or H. S. Sachdev.

Ethics declarations

Competing interests

HSS designed the draft protocol of the CNNS with consultancy support from the UNICEF, India. HSS and AVK were members of the Technical Advisory Committee of the CNNS, constituted by the Ministry of Health and Family Welfare of the Government of India, to oversee its conduct and analysis. HSS is a member of the World Health Organization Nutrition Guidance Expert Advisory Subgroup on Diet and Health. HSS and AVK are members of Expert Groups of the Ministry of Health and Family Welfare on Nutrition and Child Health, and the National Technical Board on Nutrition of the Niti Ayog, Government of India.

Ethical approval

No separate ethical approval was required for this secondary analysis. The CNNS was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the Population Council’s International Review Board (New York, USA) and ethics committee of Post Graduate Institute of Medical Education and Research (Chandigarh, India).

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Ghosh, S., Thomas, T., Kurpad, A. et al. Is iron status associated with markers of non-communicable disease in adolescent Indian children?. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01222-2

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