Children and adolescents receiving insulin therapy for type 1 diabetes mellitus frequently exhibited central adiposity despite not being classified as overweight or obese by body mass index criteria, according to an observational study conducted at a tertiary care teaching hospital in South India. Researchers observed that central adiposity was considerably more prevalent than general obesity among the participants, with nearly half of the individuals showing central fat accumulation falling outside the conventional body mass index thresholds for overweight or obesity.
The investigation evaluated the nutritional status of children with type 1 diabetes, comparing their anthropometric parameters at discharge after diagnosis with those at study enrolment. The study cohort comprised 66 consecutive children and adolescents aged 1 to 18 years who had been receiving insulin treatment for longer than one year. Across the sample, the male-to-female ratio was 0.65 to 1, the median participant age was 11.9 years with an interquartile range of 9.0 to 14.1 years, and the median diabetes duration was 3.2 years with an interquartile range of 1.7 to 4.8 years.
Conducted in the Department of Paediatrics between August 2024 and February 2026, the study followed an ambispective observational design. Investigators assessed participants’ height, weight, weight-for-height for children under five years of age, and body mass index for those aged five years and older at the time of enrolment. These current measures were directly compared against historical anthropometric parameters recorded at hospital discharge following the initial diagnosis of type 1 diabetes, obtained directly from medical records.
To interpret growth and nutritional metrics, the researchers utilized World Health Organization growth references for children under five years of age and Indian Academy of Paediatrics references for participants aged five years and older. In addition to conventional stature and mass indices, clinicians measured waist circumference and calculated waist-to-height ratios at enrolment for the 60 participants aged five years and older to capture abdominal fat distribution patterns.
Over the observation period from post-diagnosis discharge to study enrolment, participants exhibited distinct anthropometric trajectories. The body mass index standard deviation score increased significantly from baseline to enrolment (p < 0.001), while height standard deviation scores demonstrated a statistically significant decline (p = 0.002). Weight standard deviation scores also increased across the cohort, although this change did not achieve statistical significance (p = 0.055).
Indicators of undernutrition showed general reductions between discharge and follow-up. The prevalence of wasting or thinness declined from 15.2 percent (10 of 66 children) at discharge to 7.6 percent (5 of 66 children) at enrolment. Underweight prevalence decreased from 13.6 percent (9 of 66 children) to 10.6 percent (7 of 66 children). Meanwhile, the prevalence of stunting remained largely unaltered between the two assessment points, recorded at 7.6 percent (5 of 66 children) at discharge compared to 9.1 percent (6 of 66 children) at enrolment.
Concurrently, the clinicians documented an upward trend in excess body weight among the patients. The number of participants classified as overweight rose from 10 of 66 children (15.2 percent) at discharge to 13 of 66 children (19.7 percent) at enrolment. While zero children met the criteria for obesity at discharge, 3 of 66 children (4.5 percent) were classified as obese at enrolment, yielding a combined overweight and obesity prevalence of 24.2 percent (16 of 66 children). However, these proportional shifts in categorical nutritional status across the two time points did not reach statistical significance.
Analyses focused on abdominal fat distribution identified substantial rates of central adiposity among the 60 children aged five years and older. When evaluating any diagnostic threshold, central obesity was present in 19 of the 60 children (31.7 percent). Specifically, an increased waist circumference was identified in 17 of 60 children (28.3 percent), and an elevated waist-to-height ratio was observed in 10 of 60 children (16.7 percent). Notably, 9 of the 19 children presenting with central obesity (47.4 percent) were not categorized as overweight or obese based on standard body mass index criteria.
In their concluding assessment, the authors emphasized that central obesity was more common than general obesity among children with type 1 diabetes mellitus receiving treatment. The investigators reported that central adiposity may be present in children whose body mass index is not suggestive of overweight or obesity, indicating that relying on body mass index alone can leave abdominal fat accumulation unrecognized in this pediatric population.
Subject of Research: Nutritional status and central adiposity in pediatric type 1 diabetes
Article Title: Nutritional status and central adiposity in children and adolescents with type 1 diabetes at a South Indian tertiary centre: an observational study
Article References: Thiyyagura, D. R., Aroor, S., Handattu, K., Kini, P., Mundkur, S. C., & Bhat. Y, R. (2026). Nutritional status and central adiposity in children and adolescents with type 1 diabetes at a South Indian tertiary centre: an observational study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-08015-7
Image Credits: AI Generated
DOI: 10.1186/s12887-026-08015-7
Keywords: type 1 diabetes mellitus, central adiposity, pediatric nutrition, body mass index, waist circumference, waist-to-height ratio, insulin therapy, ambispective observational study, pediatric endocrinology, malnutrition, overweight, obesity, anthropometric parameters, standard deviation score, growth references, South India
