Papers by Anuradha Khadilkar
Indian Journal of Endocrinology and Metabolism, 2015
Growth chart committee of Indian Academy of Pediatrics (IAP) has revised growth charts for 5-18-y... more Growth chart committee of Indian Academy of Pediatrics (IAP) has revised growth charts for 5-18-year-old Indian children in Jan 2015. The last IAP growth charts (2007) were based on data collected in 1989-92 which is now >2 decades old. India is in an economic and nutrition transition and hence growth pattern of Indian children has changed over last few years. Thus, it was necessary to produce contemporary, updated growth references for Indian children. The new IAP charts were prepared by collating data from nine groups who had published studies in indexed journals on growth from India in the last decade. Growth charts were constructed from a total of 87022 middle and upper socioeconomic class children (m 54086, f 32936) from all five zones of India. Data from middle and upper socioeconomic class children are likely to have higher prevalence of overweight and obesity and hence growth charts produced on such populations are likely to "normalize" obesity. To remove such unhealthy weights form the data, method suggested by World Health Organization was used to produce weight charts. Thus, the new IAP weight charts are much lower than the recently published studies on affluent Indian children. Since Indian's are at a higher risk of obesity-related cardiometabolic complications at lower body mass index (BMI), BMI charts adjusted for 23, and 27 adult equivalent cutoffs as per International obesity task force guidelines were constructed. IAP now recommends use of these new charts to replace the 2007 IAP charts.
Indian Pediatrics, 2016
To compare lipid parameters between diabetics and controls and to study association between metab... more To compare lipid parameters between diabetics and controls and to study association between metabolic control and lipid profile. Lipid profile and HbA1c were measured (n=80, 39 boys) in diabetic children [age 10.7(3.4) y] and 54 controls, tests repeated after 1 year (in 45 diabetics). Diabetic children had higher mean (SD) LDL-C [95.3(27.7) vs 84.5(26.4) mg/dL], lower HDL-C [48.2 (13.1) vs 53.1(11.9) mg/dl]. Moderate physical activity (P=0.014) protected against high LDL-C levels. HbA1c (P=0.00) predicted total and LDL-C levels. At 1year, 63% showed reduced LDL-C with improving HbA1c; 72% showed increased LDL-C with deteriorated HbA1c. Improving metabolic control is cardinal to reduce cardiometabolic risk; physical activity is beneficial.
Circulation, Jan 15, 2015
Background-Several distributions of country-specific blood pressure (BP) percentiles by sex, age ... more Background-Several distributions of country-specific blood pressure (BP) percentiles by sex, age and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limit international comparisons of prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents using seven nationally representative data (
Indian Journal of Endocrinology and Metabolism, 2015
Growth hormone (GH) and its physiological mediator, insulin-like growth factor-1(IGF-1), have a m... more Growth hormone (GH) and its physiological mediator, insulin-like growth factor-1(IGF-1), have a major role in linear bone growth and accrual of bone mass during childhood and adolescence. In general, linear growth-promoting effects of GH appear to depend upon the production of IGF-1 and perhaps other IGF peptides. [1] IGF-1 acts on the
International Journal of Pediatric Endocrinology, 2015
Studies suggest that children and adolescents with type 1 diabetes (T1DM) have suboptimal body co... more Studies suggest that children and adolescents with type 1 diabetes (T1DM) have suboptimal body composition with higher fat mass and lower bone mass. Aim of our study was to compare body composition of Indian children with type 1 diabetes with age gender matched healthy controls.
The Indian Journal of Pediatrics, 2015
Asia Pacific journal of clinical nutrition, 2015
Diet plays a crucial role for maintaining normal growth and development while optimizing glycemic... more Diet plays a crucial role for maintaining normal growth and development while optimizing glycemic control in children with diabetes. Dietary restrictions, in a diabetic child's diet may lead to micronutrient deficiencies. To examine dietary nutritional deficiencies of Asian Indian children with Type 1 diabetes mellitus and develop micronutrient-rich recipes suitable for them. Anthropometry, diet (3-day recall) of 70 children with diabetes (24 boys) was recorded. Daily nutrient intakes and nutrient content of recipes were estimated using CDIET version 2.0. Mean intake amongst children for energy was 79% of Indian Recommended Dietary Allowance (RDA), protein was 105% RDA, but fat intakes were high (143% RDA). Mean intakes of riboflavin, β carotene, zinc, iron were less than 50%, and thiamin and calcium were around 60% RDA suggesting a possible multiple micronutrient deficiency. Based on popularly consumed snacks, 20 healthy recipes were devised that can be incorporated in children...
Indian pediatrics, Jan 8, 2015
Indian Journal of Endocrinology and Metabolism, 2014
Bone Abstracts, 2013
Objective: Low bone mineral density has been reported in children and adolescents with type 1 dia... more Objective: Low bone mineral density has been reported in children and adolescents with type 1 diabetes (T1DM). The aims of this cross-sectional study were to study growth, serum IGF1 concentrations and bone health parameters assessed by Dual Energy X-ray Absorptiometry (DXA). Methods: Height was measured and converted to Z scores (HAZ). Serum IGF1 concentrations were measured (ELISA) in a subset. Bone mineral content for total body (less head) (TBBMC) and lumbar spine was measured (n = 170, 77 boys, 6-16 years old) and converted to Z scores using local normative data. Result: Mean age was 11.1 ± 3.8 years, disease duration was 2.2 ± 2.5 years and HbA1C was 10.1 ± 1.8%. Diabetic children were shorter than reference population (HAZ −0.6 ± 1.1); Z scores for height and total body bone area (TBBA) for height were b−2SD in 12% & 6% respectively. Serum IGF1 Z scores were lower amongst group with longer disease duration (−1.58 ± 1.3 vs −2.63 ± 0.7; P = 0.037). Disease duration (β = −0.180, P = 0.000) and metabolic control (HbA1C; β = −0.096, P = 0.042) were negative predictors of HAZ and TBBA for height Z in younger children. Using the Molgaard approach, children with longer disease duration had lower HAZ (− 0.31 ± 0.92 vs − 1.28 ± 1.11; P = 0.000; "short bones") and TBBA for height Z scores (0.12 ± 1.62 vs −0.53 ± 0.94; P = 0.044; "slender bones"). Older children (tanner stages 4 and 5) had lower BMC and BA as compared to reference population possibly due to delayed growth spurt. Conclusion: Longer duration of diabetes was associated with shorter and slender but appropriately mineralized bones. Small and slender bones in diabetic children may increase risk of fragility fractures in the future. This article is part of a Special Issue entitled "Bone and diabetes".
The Journal of Pediatrics, 2014
Objectives To develop reference percentile curves in Indian children for waist circumference (WC)... more Objectives To develop reference percentile curves in Indian children for waist circumference (WC), and to provide a cutoff of WC percentile to identify children at risk for metabolic syndrome (MS). Study design A multicenter, cross-sectional study was performed in 5 major Indian cities. Height, weight, and blood pressure (BP) were measured in 10 842 children (6065 boys). Elevated BP was defined as either systolic BP or diastolic BP >95th percentile. WC was measured with the child standing using a stretch-resistant tape. Sex-specific reference percentiles were computed using the LMS method which constructs reference percentiles adjusted for skewness. To determine optimal cutoffs for WC percentiles, a validation sample of 208 children was assessed for MS risk factors (ie, anthropometry, BP, blood lipids), and receiver operating characteristic (ROC) curve analysis was performed. Results Age-and sex-specific WC percentiles (5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, and 95th) are presented. WC values increased with age in both the boys and the girls. The median WC at age >15 years was greater in boys compared with girls. ROC analysis suggested the 70th percentile as a cutoff for MS risk (sensitivity, 0.84 in boys and 0.82 in girls; specificity, 0.85 in both boys and girls; area under the ROC curve, 0.88 in boys and 0.92 in girls). Conclusion Age-and sex-specific reference curves for WC for Indian children and cutoff values of 70th WC percentile for screening for MS risk are provided.
Indian Journal of Endocrinology and Metabolism, 2013
Background and Objectives: Growth parameters are important indicators of a child's overall health... more Background and Objectives: Growth parameters are important indicators of a child's overall health, and they are infl uenced by factors like blood glucose control in diabetic children. Data on growth parameters of Indian diabetic children is scarce. This retrospective, cross-sectional, case control study was conducted at diabetes clinic for children at a tertiary care center at Pune, to study growth parameters of diabetic children in comparison with age-gender matched healthy controls and evaluate effect of different insulin regimes and age at diagnosis of diabetes on growth. Materials and Methods: One twenty fi ve diabetic children (boys: 50) and age gender matched healthy controls were enrolled. All subjects underwent anthropometric measurements (standing height and weight). Mean height (HAZ), weight (WAZ) and body mass index (BAZ) for age Z scores were calculated. Diabetes control was evaluated by measuring glycosylated hemoglobin (HbA1C). Statistical analysis was done by SPSS version 12. Results: Mean age of diabetic children and age gender matched controls was 9.7 ± 4.4 years. Diabetic children were shorter (128.3 ± 24.3 cm vs. 133.6 ± 24.7 cm) and lighter (29.2 kg ± 15.3 vs. 31.3 ± 15.4 kg). HAZ (−1.1 ± 1.2 vs. −0.2 ± 0.8) and WAZ (−1.2 ± 1.3 vs. −0.7 ± 1.3) were signifi cantly lower in diabetic children (P < 0.05). Children on both insulin regimes (intensive and conventional) were shorter than controls (HAZ-intensive −1.0 ± 1.0, conventional −1.3 ± 1.3, control −0.2 ± 0.8, P < 0.05). HAZ of children who were diagnosed at <3 years of age was the least (−1.6 ± 1) amongst all diabetic children while those diagnosed after puberty (>14 years) were comparable to healthy controls. Conclusions: Growth was compromised in diabetic children in comparison to controls. Children diagnosed at younger age need more attention to optimize growth.
Circulation, Jan 15, 2015
-Several distributions of country-specific blood pressure (BP) percentiles by sex, age and height... more -Several distributions of country-specific blood pressure (BP) percentiles by sex, age and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limit international comparisons of prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents using seven nationally representative data (China, India, Iran, Korea, Poland, Tunisia and USA). -Data on BP for 52,636 non-overweight children and adolescents aged 6-19 years were obtained from seven large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and USA. BP values were obtained with certified mercury sphygmomanometers in all seven countries, using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th and 99th) by age and height were estimated using the Generalized Additive Model for Location Scale and Shape (GAMLSS) model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. Compared to BP level of the 90th and 95th percentiles of the U.S. Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower while diastolic BP was similar. -These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help identify hypertensive youths in diverse populations.
Indian Journal of Endocrinology and Metabolism, 2015
Growth hormone through insulin-like growth factor 1 (IGF-1) plays an important role in both bone ... more Growth hormone through insulin-like growth factor 1 (IGF-1) plays an important role in both bone growth and mineralization. This cross-sectional study was carried out to evaluate the relationship between serum IGF-1 concentrations and dual energy X-ray (DXA) measured whole body less head bone area (BA), lean body mass (LBM), and bone mineral content (BMC). One hundred and nineteen children (boys = 70, age = 7.3-15.6 years) were studied for their anthropometric parameters by standard methods and bone and body composition by DXA. Their fasting serum IGF-1 concentrations were assessed by enzyme-linked immunosorbent assay and Z-scores were calculated using available reference data. Bone and body composition parameter Z-scores were calculated using ethnic reference data. Mean age of the boys and girls was similar (11.5 ± 1.8 years). The mean serum IGF-1concentrations and IGF-1 Z-scores were similar (P &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.1) between boys and girls and were of the order of (302.3 ± 140.0 and - 1.4 ± 1.1, respectively). The LBM for age and BA for age Z-score was greater in children with IGF-1 Z-score &amp;amp;amp;amp;amp;amp;amp;amp;gt; median than children with IGF-1 Z-score &amp;amp;amp;amp;amp;amp;amp;amp;lt; median. The mean BMC for age Z-scores were 0.4 ± 0.9 and - 0.2 ± 0.8 in children with above and below the median of IGF-1 Z-score (P &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.1). Serum IGF-1 levels were more strongly associated with BA and LBM, suggesting that its effect on bone is greater with respect to periosteal bone acquisition and through its effect on muscle mass.
Indian Journal of Endocrinology and Metabolism, 2015
Introduction: Dietary and life style practices differ in postpartum (PP) and nonpregnant Indian w... more Introduction: Dietary and life style practices differ in postpartum (PP) and nonpregnant Indian women. Effect of these practices on postpartum weight retention (PPWR) and development of cardio-metabolic risk (CMR) has been scarcely studied in urban women. Aims of this study were to (i) compare anthropometry, biochemical parameters and body composition up to 3 years PP (ii) effect of PPWR, dietary fat intake and physical activity on CMR factors. Methods: Design: Cross-sectional, 300-fullterm, apparently healthy primi-parous women (28.6 ± 3.4 years) randomly selected. 128 women within 7-day of delivery (Group-A), 88 with 1-2 years (Group-B) and 84 with 3-4-year-old-children (Group-C) were studied. Anthropometry, sociodemographic status, physical activity, diet, clinical examination, biochemical tests, body composition, at total body (TB), by dual energy X-ray absorptiometry (GE-Lunar DPX) were collected. Results: Women at 3-year PP showed higher weight retention (6.5[10] kg) than at 1-year (3.0[7] kg) (median [IQR]). Android fat % (central obesity) increased (P < 0.05) at 1-year PP (47 ± 10.0%) when compared to 1-week PP (44.3 ± 6.7%) and remained elevated at 3-year PP (45.6 ± 10.2%). Regression analysis revealed that at 1-year PP, increase in PPWR (Odd Ratio [OR] 1.8, 95% confidence interval [CI] = [1.2, 2.5], P < 0.001) and inactivity (OR 1.4, 95% CI= (0.97, 2.0), P < 0.1) were predictors for CMR. At 3-year PP, only PPWR was responsible for increase in CMR parameters (OR 1.6, 95% CI = (1.3, 2.3), P < 0.001) and not inactivity (P > 0.1). Conclusion: Postdelivery, low physical activity and higher PPWR may increase CMR in Indian women.
Indian Journal of Endocrinology and Metabolism, 2014
Nine children (7 boys, 2 girls; age range: 2.5-11.5 years) diagnosed with Laron syndrome based on... more Nine children (7 boys, 2 girls; age range: 2.5-11.5 years) diagnosed with Laron syndrome based on clinical features and investigations were studied over a period of 5 years from January 2008 to January 2013. Clinical history including consanguinity, birth weight, history of neonatal hypoglycemia, onset of short stature, family history, and evidence of chronic illness or secondary causes were noted. A thorough examination was performed for clinical features of GH deficiency, pubertal status,
Bone Abstracts, 2013
ABSTRACT Abstract OBJECTIVE: Low bone mineral density has been reported in children and adolescen... more ABSTRACT Abstract OBJECTIVE: Low bone mineral density has been reported in children and adolescents with type 1 diabetes (T1DM). The aims of this cross-sectional study were to study growth, serum IGF1 concentrations and bone health parameters assessed by Dual Energy X-ray Absorptiometry (DXA). METHODS: Height was measured and converted to Z scores (HAZ). Serum IGF1 concentrations were measured (ELISA) in a subset. Bone mineral content for total body (less head) (TBBMC) and lumbar spine was measured (n=170, 77 boys, 6-16years old) and converted to Z scores using local normative data. RESULT: Mean age was 11.1±3.8years, disease duration was 2.2±2.5years and HbA1C was 10.1±1.8%. Diabetic children were shorter than reference population (HAZ -0.6±1.1); Z scores for height and total body bone area (TBBA) for height were &lt;-2SD in 12% &amp; 6% respectively. Serum IGF1 Z scores were lower amongst group with longer disease duration (-1.58±1.3 vs -2.63±0.7; P=0.037). Disease duration (β=-0.180, P=0.000) and metabolic control (HbA1C; β=-0.096, P=0.042) were negative predictors of HAZ and TBBA for height Z in younger children. Using the Molgaard approach, children with longer disease duration had lower HAZ (-0.31±0.92 vs -1.28±1.11; P=0.000; &quot;short bones&quot;) and TBBA for height Z scores (0.12±1.62 vs -0.53±0.94; P=0.044; &quot;slender bones&quot;). Older children (tanner stages 4 and 5) had lower BMC and BA as compared to reference population possibly due to delayed growth spurt. CONCLUSION: Longer duration of diabetes was associated with shorter and slender but appropriately mineralized bones. Small and slender bones in diabetic children may increase risk of fragility fractures in the future. This article is part of a Special Issue entitled &quot;Bone and diabetes&quot;.
The Journal of Pediatrics, 2014
To develop reference percentile curves in Indian children for waist circumference (WC), and to pr... more To develop reference percentile curves in Indian children for waist circumference (WC), and to provide a cutoff of WC percentile to identify children at risk for metabolic syndrome (MS). A multicenter, cross-sectional study was performed in 5 major Indian cities. Height, weight, and blood pressure (BP) were measured in 10,842 children (6065 boys). Elevated BP was defined as either systolic BP or diastolic BP &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;95th percentile. WC was measured with the child standing using a stretch-resistant tape. Sex-specific reference percentiles were computed using the LMS method which constructs reference percentiles adjusted for skewness. To determine optimal cutoffs for WC percentiles, a validation sample of 208 children was assessed for MS risk factors (ie, anthropometry, BP, blood lipids), and receiver operating characteristic (ROC) curve analysis was performed. Age- and sex-specific WC percentiles (5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, and 95th) are presented. WC values increased with age in both the boys and the girls. The median WC at age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;15 years was greater in boys compared with girls. ROC analysis suggested the 70th percentile as a cutoff for MS risk (sensitivity, 0.84 in boys and 0.82 in girls; specificity, 0.85 in both boys and girls; area under the ROC curve, 0.88 in boys and 0.92 in girls). Age- and sex-specific reference curves for WC for Indian children and cutoff values of 70th WC percentile for screening for MS risk are provided.
Indian Journal of Endocrinology and Metabolism, 2012
Indian Journal of Endocrinology and Metabolism, 2014
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Papers by Anuradha Khadilkar