COVID-19 has affected all age groups of the population around the globe, and though not immediately evident, there is a silent side effect of the pandemic that seems to be impacting children. Dr. Aju Mathew details this long-term consequence that children and adolescents may face directly or indirectly due to the pandemic.

COVID-19 pandemic caused school closure across India. Several people inform me of the detrimental consequences of this unusual and unfortunate situation. Children are missing out on social interaction and learning skills. But, most importantly, children are becoming more sedentary, hooked on to their gadgets, and living a very indisciplined life. This week, I want to point to three studies that will highlight the long-term consequences of a bad lifestyle that eventually lead to metabolic syndrome.

Long-term consequences of young-onset diabetes (Type 2)

As a result of a clinical trial conducted among adolescents with type 2 diabetes, investigators in the United States had access to long-term follow-up data of 500 young persons. [1] There was an average of 13 years of follow-up in young persons living with diabetes. By a mean age of 26 years, 67% were hypertensive, 51% were dyslipidemic, 55% had kidney disease, and 51% had retinal diseases. When compared to individuals with type 1 diabetes or adults, these rates are astoundingly high. These individuals were markedly overweight or obese. One reason could be the poor socio-economic situation that mediated the metabolic syndrome that resulted in poor health outcomes. Regardless, it highlights the problem with young-onset type 2 diabetes and shows why it is important to prevent it in the first place.

How can that be done? I will discuss one important preventive strategy as I highlight the next study that caught my eye.

The danger of ultra-processed food

Childhood obesity is a major public health issue in most developed nations of the world. It is one problem that I anticipate we will see here in India as well. In an elegant cross-sectional study conducted over two decades (the famous NHANES study), investigators found that the consumption of ultra-processed food in the diet has increased in children age 2-19 years of age. [2] The proportion of energy intake from unprocessed food had dropped and the proportion of energy intake from ultra-processed food had increased.

We may think children in India are not at risk for this problem because of the lower socioeconomic conditions. Well, get ready to be alerted to the danger even for the poorer sections of our society (in fact, they may be more at risk; the NHANES study showed greater risk for less-affluent communities in the US). In a small study from Delhi, two investigators showed high rates of ultra-processed food consumption among adolescents from low-income and middle-income families. [3]

What is ultra-processed food in an Indian diet?

Answer: Anything ready-to-eat or packaged in a factory setting is likely to be such a food product. [4] Why is this important? Let me now take you to a fine thought experiment.

UK Biobank study on HbA1C levels and risk for cardiovascular events

Using data from more than 3,30,000 individuals, baseline HbA1C level was shown to be a risk factor for cardiovascular events, in a continuum, and not just at a threshold of >6.5. [5] As more young adolescents develop obesity and pre-diabetes state, we must be aware that the risk for incidence of diabetes and eventual cardiovascular complications will increase.

The answer lies in inculcating healthy habits, providing space and time for exercise and allowing for good public health policies, for instance, taxing unprocessed food at a higher rate (similar to the tobacco tax or the trans-fat tax).

Will it help? What do you think?

Email me your thoughts and comments at cancerkerala@gmail.com.

To read Dr. Aju Mathew's previous articles, click here: Dr Aju Mathew picks 3 clinical updates you should not miss, Dr. Aju Mathew lists 4 new updates in diabetes treatment & Dr. Aju Mathew presents top 3 updates on antibiotics

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

Dr Aju Mathew is a medical oncologist, haematologist, internist and epidemiologist practising in Kochi.