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Anuradha V Khadilkar

Anuradha V Khadilkar
Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune · Growth and Pediatric Endocrine Unit

MD , Pediatrics

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286
Publications
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Publications

Publications (286)
Article
Background and aims Implementation of COVID restrictions following lockdown led to changes in routines of subjects with type 1 diabetes due to closure of schools and outdoor activities. The aim of this study was to assess the impact of decreased physical activity due to COVID restrictions on cardio-metabolic risk parameters (waist circumference, la...
Article
Objectives: To evaluate the strength of association of two measures of BFS: frame-size one (FS1; height ÷ wrist circumference) and frame-size two (FS2; elbow breadth), with body-fat indices, body composition, and hypertension in Indian children and adolescents, and to determine age and sex-specific cutoffs of BFS to predict hypertension. Methods:...
Article
Objectives: To assess grip strength and gender differences in grip strength in 9-18-y-old urban and rural Indian children, to study association of grip strength with body composition, and assess determinants of grip strength. Methods: This was part of a multicenter, cross-sectional, school-based study (n = 1978, mean age 13.3 ± 2.2 y) from three...
Article
Objectives Owing to increase in referrals for precocity observed during COVID-19 lockdown, this study was conducted to estimate the proportion of patients referred for precocity and within these, those with idiopathic central precocious puberty (iCPP) before vs. during the COVID lockdown, and to assess the differences in anthropometric and clinical...
Article
We present a case of a young girl who presented with hypertensive crisis and recent onset weight gain with hirsutism. On evaluation for Cushing syndrome (CS), her cortisol concentration was high, showed a paradoxical cortisol rise on dexamethasone suppression and the adrenocorticotropic hormone (ACTH) was low. Adrenal imaging showed normal adrenal...
Article
Objective: Among urban and rural Indian children aged 9-18 years, we aimed 1) to assess the prevalence and determinants of primary hypertension(PH) 2) To explore the relationship of fat indices and body composition(BC) with hypertension. Methods: Data from a multicentre study(2016-2017), representative of children(9-18yrs) from 6 states, were analy...
Article
Objectives The role of insulin sensitivity (IS) in the development and progression of metabolic syndrome (MS) in subjects with type-1 diabetes (T1D) is being increasingly recognized. As patients with T1D lack endogenous insulin secretion, measurement of insulin concentration by immunoassay or by indices such as homeostasis model of assessment for i...
Article
Introduction: Bone age (BA) is a quantitative determination of skeletal maturation. The role of puberty in variations in BA is poorly understood as hypothalamic-pituitary-gonadal (HPG) axis maturation and skeletal maturation are regulated in parallel but independently by multiple different factors. In countries like India where there is rapid nutr...
Article
Objectives Children with type 1 diabetes (T1D) having diabetic nephropathy (DN) are at increased risk of developing end stage renal disease. The present study aimed to determine the prevalence of DN and its predictors in Indian children and youth with T1D. Methods This cross-sectional study included 319 children and youth (2.6–21 years) with T1D h...
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Full-text available
IntroductionChildren with type 1 diabetes (T1D) are at the same risk of developing metabolic syndrome (MS) as the general population. Several environmental factors such as lifestyle, exogenous insulin therapy (over-insulinization) and genetic/familial factors are thought to underlie the phenotype of 'double diabetes' (co-existence of MS components...
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Dietary calcium deficiency is considered to be widespread globally, with published estimates suggesting that approximately half of the world's population has inadequate access to dietary calcium. Calcium is essential for bone health, but inadequate intakes have also been linked to other health outcomes, including pregnancy complications, cancers, a...
Article
Introduction: Obesity is a disorder of energy balance with increasing prevalence in Indian children. Objectives were to: 1) study resting metabolic rate (RMR), anthropometry, body-composition (BC), and their relationships in Indian children and adolescents affected with overweight/obesity (OW/OB) and non-overweight (NOW) children 2) factors influen...
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Background and aims Prevalence of metabolic syndrome (MS) is increasing in children with type-1 diabetes (T1D). Genetic and environmental factors shared among family members are considered significant risk factors. We conducted this study to assess the association of parental MS with development of metabolic risk (MR) in patients with T1D. Method...
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Aims Mid upper arm circumference (MUAC) measurement is an easy and low-cost method to determine nutritional status. MUAC cut-offs for screening for overnutrition in Indian children from 5 to 17 years age are recently published. We conducted this study to validate MUAC cut-offs against BMI to screen overnutrition in children with T1D in comparison w...
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Background: Malnutrition among under-five children (U5C) in India is a major public health problem due to double burden caused by nutritional transition. WHO cut-offs are adopted as global growth standards which define how children should grow in condition of optimal nutrition and health. Growth references which are representative of population-sp...
Article
We present a 12-year-old girl with recent onset weight gain and purple striae over the abdomen. Examination revealed her to be hypertensive. On evaluation for Cushing syndrome (CS), her cortisol and adrenocorticotropic hormone (ACTH) were found to be high. MRI brain showed a suspicious lesion (thought to be pituitary microadenoma). Inferior petrosa...
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We describe siblings born from non-consanguineous parents, with older sibling having asymptomatic hyperglycaemia while younger sibling presented with low birth weight and persistent hyperglycaemia from first month of life. Our case, the older sibling was heterozygous for paternally inherited GCK pathogenic variant resulting in diabetes of maturity-...
Article
Autoimmune polyglandular syndrome-1 (APS-1)also known as autoimmune polyendocrinopathy candidiasis ectodermal dystrophy is a rare autosomal recessive disorder caused by mutation of AIRE gene on chromosome 21q22.3 with an overall prevalence of <1:100,000. Here, we present a 16-year-old male having clinical history of evolution of symptoms for oral c...
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Diabetes is the third most prevalent severe chronic disease of youth. Management of any chronic condition like type-1 diabetes (T1D) during adolescence, a time of rapid growth and physiological changes accompanied by important individuation and socialization processes, constitutes a major challenge for the youth, their family and the health-care te...
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Most low- and middle-income countries present suboptimal intakes of calcium during pregnancy and high rates of mortality due to maternal hypertensive disorders. Calcium supplementation during pregnancy is known to reduce the risk of these disorders and associated complications, including preeclampsia, maternal morbidity, and preterm birth, and is,...
Article
Context: Studies on prepregnancy body mass index (BMI), gestational weight gain (GWG), and pregnancy outcomes among urban Indian slums are sparse. Aims: To study BMI during early pregnancy, GWG, and maternal and neonatal outcomes among slum-dwelling women in Pune, India. Design: A retrospective study among pregnant women attending antenatal care (A...
Article
Background: Effect of tobacco, areca nut, and alcohol consumption (vices) on orthopantomogram (OPG) indices. Aims: To assess the relationship between vices on OPG indices in Indian adult males aged 20–60 years. Subjects and Methods: This study was conducted on 172 males with a mean age of 34.2 ± 1 years. OPG was used for measuring mandibular indice...
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Objectives: To: 1. Assess muscle function (MF) of rural Indian children (6-11y, n=232), using Jumping Mechanography (JM) and hand dynamometer, 2. Investigate gender differences, 3. Identify determinants of MF. Methods: Data on anthropometry, muscle mass%, diet, physical activity, sunlight exposure, MF (maximum relative power Pmax/mass, maximum rela...
Article
High prevalence (31.5%) of adolescent pregnancies (AP) have been reported in India. Reports suggest that pregnancy during adolescence may have deleterious effects on peak bone mass. Very few studies have described the long-term effects of a history of AP on bone mass. The objective of this study was to compare bone mineral density (BMD) and bone ge...
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The problem of poor nutrition with impaired growth persists in young children worldwide, including in India, where wasting occurs in 20% of urban children (<5 years). Exacerbating this problem, some children are described by their parent as a picky eater with behaviors such as eating limited food and unwillingness to try new foods. Timely intervent...
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Background: both ethnicity and age are important determinants of musculoskeletal health. We aimed to determine the prevalence of sarcopenia, assess the suitability of current diagnostic guidelines, and explore muscle-bone relationships in adults from India. Methods: 1009 young (20-35years) and 1755 older (>40years) men and women from existing studi...
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Objectives: Owing to increase in prevalence of obesity and metabolic syndrome in Indian children and adolescents, this study is conducted to assess the predictive value of IAP 2015 and WHO 2007 BMI for age cut-offs in identifying metabolic risk in Indian children. Methods: Cross-sectional multicentric school-based study on 9-18-year-old healthy...
Article
We present a 7-year-old girl with Rubinstein-Taybi syndrome (RTS) and slipped capital femoral epiphysis (SCFE). She underwent bilateral arthroscopy with implant fixation for the SCFE and the symptoms resolved. This was followed by fracture of the femur after minor trauma. Dual energy X-ray absorptiometry (DXA) scan done to evaluate her bone health...
Article
Objectives Among urban (U) and rural (R) Indian children ages 9–18 years, we aimed to (1) assess prevalence and determinants of primary hypertension (PH) (2) evaluate differences in fat indices (BMI, waist circumference, tricep skinfold thickness), body composition (BC, fat and muscle mass (MM)), weight-adjusted resting metabolic rate (RMR/Wt), die...
Article
Objectives To compare the nutrition transition among adolescents ages 13–18 years across six states in India. Methods A validated 10-item apriori index-based Nutrition Transition Diet Score (NTDS; range 0–10) including seven food groups: packaged foods (score 1 ≥ 30 g/d), fried foods (score 1 ≥ 30 g/d), sugar-sweetened beverages (SSB) (score 1 > 0...
Article
Background Malnutrition is common in developing countries and is not restricted to young children. For early identification of malnutrition, mid upper arm circumference (MUAC) measurements has been suggested as an easy, accurate and low-cost method. Our objectives were to construct age and gender specific MUAC reference centiles, and define and val...
Article
Wolcott-Rallison syndrome (WRS), the most common cause of permanent neonatal diabetes mellitus (DM) in consanguineous families, has a poor prognosis, with a mean survival of 5.8 years. Majority of children with WRS succumb to the disease in the first decade of life. We present the long-term follow-up of an 8-year-2-month-old girl with genetically p...
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Full-text available
Background: There are several methods of bone age (BA) assessment, which include Gruelich-Pyle (GP), Gilsanz-Ratib (GR), and Tanner Whitehouse-3 (TW-3) methods. Although GP atlas is the most widely used, there are concerns about its accuracy in children of different ethnicities, making the use of the TW-3 method an attractive option in Indian child...
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An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Objectives While growth charts depicting 7 percentile lines for height and weight are useful for healthcare workers and pediatricians, endocrinologists need indication-specific z score cutoffs to plan investigations and treatment. The current Indian charts do not offer lower percentile/z scores (−2.25, −2.5, and −3 z score) lines. Also, increasing...
Article
Background A 2017 meta-analysis of data from 25 randomised controlled trials (RCTs) of vitamin D supplementation for the prevention of acute respiratory infections (ARIs) revealed a protective effect of this intervention. We aimed to examine the link between vitamin D supplementation and prevention of ARIs in an updated meta-analysis. Methods For...
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Introduction: There is a growing body of evidence against using World Health Organization (WHO) charts for developing nations. Our objectives were: 1) To compare nutritional status of <5-year-old Indian children using WHO charts and synthetic Indian charts (SC) 2019. 2) To study nutritional status across wealth index categories. 3) To study nutrit...
Preprint
Full-text available
Grip strength (GS) is used as an index of overall health in children. The objectives of our study were to assess GS, gender differences in GS in 9 -18 year old urban (U) and rural (R) Indian children, study association of GS with body composition (BC) and assess determinants. This was part of a multicentre, cross sectional, school-based study (n=19...
Article
Objective To assess test anxiety (TA) and factors affecting TA in school-going children. To observe the impact of TA on quality of life (QOL).MethodA multi-centric cross-sectional observational study was conducted in Indian schools from 6 different states in both rural and urban settings. Indian school children 9 to 18-y-old were the subjects. Demo...
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Background Children and their mothers, who are usually the primary caregivers, are likely to be distressed due to type 1 diabetes (T1DM). Objectives (1) To assess diabetes-specific distress (DD) perceived by children and adolescents with T1DM and their mothers and association of distress between children and mothers. (2) To study the association o...
Article
Children with beta thalassemia major (BTM) are known to have reduced bone mass which increases incidence of non-traumatic fractures. Few studies have assessed prevalence of fractures and bone health in underprivileged children with BTM. Our objectives were to 1) determine prevalence of fractures in underprivileged Indian children with BTM, 2) asses...
Article
Objectives In March 2020, lockdown was imposed in India to combat spread of Coronavirus, which was extended till 31st May. Implementation of lockdown and limited outdoor activities resulted in changes in routines of children with diabetes. The aim of this study was to assess the impact of lockdown on glycemic control, weight and body mass index (BM...
Preprint
Full-text available
Resting metabolic rate (RMR) quantifies the minimal energy required to sustain vital body functions and is a crucial component of childhood development. While inter-individual variations in RMR have been studied for over a century they are poorly understood. Wang (Am. J. Hum., 2012) has modelled mean RMR per unit body mass (RMR/BM) in children grou...
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We present a 58-day-old male infant with neonatal diabetes and septic arthritis of hip. He was born of a consanguineous marriage at 35 weeks of gestation and was asymptomatic till presentation. Family history revealed his older sibling had suffered from meningitis and a second sibling had neonatal diabetes (died due to an unknown infection). Our pa...
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Purpose: Accurate diagnosis is required for management of Congenital adrenal hyperplasia (CAH). The conventional method for detection of mutations in the CYP21A2 gene is targeted capillary sequencing which is labor intensive and has limited multiplexing capability. Next generation sequencing (NGS) provides data with high sequence coverage and dept...
Article
Background: Dyslipidemias are on the rise and are increasingly being treated with statins. As the metabolism of cholecalciferol and cholesterol are interrelated, reduction in cholesterol synthesis by statins is likely to affect Vitamin D status. Objectives: (1) The aim is to study the effect of treatment with statins (Atorvastatin/Rosuvastatin)...
Article
Intussusception in children is mainly idiopathic or due to a viral aetiology. Occasionally, pathological lead points like Meckel diverticulum or rarely metabolic causes like hyperglycaemia can result in formation of an intussusception. We describe the case of a boy with diabetic ketoacidosis presenting with abdominal pain. Despite correction of aci...
Article
Background In children with type 1 diabetes mellitus (T1DM), low trabecular volumetric bone mineral density (Trab vBMD) has been reported. However, studies using the trabecular bone score (TBS) are scarce. The objective of our study was to assess areal bone mineral density at the lumbar spine (LS aBMD), the TBS and Trab vBMD in children with type 1...
Article
We present a 9-year-old male child having history of fractures on trivial trauma with a family history of the same. He was treated for osteogenesis imperfecta (OI; zolendronate, calcium and vitamin D) and showed clinical improvement. On evaluating his bone health using dual energy X-ray absorptiometry and peripheral quantitative CT, we found that t...
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Abstract Vitamin D, a secosteroid, plays an important role in several physiological processes, and its deficiency can lead to numerous pathophysiological conditions in humans. The primary objective of this study was to develop and validate the robustness of a mass spectrometry-based method capable of quantifying 25(OH)D3 for an upcoming epidemiolog...
Article
Objective To develop gender-specific graphic tool in which BMI cut offs can be read from height and weight, without need for calculating BMI and to validate the tool against Indian Academy of Pediatrics (IAP) 2015 BMI charts.Methods Validation of tool was performed using de-identified data on children from school health surveys.ResultsFor detection...
Article
Introduction: In patients with beta thalassemia major, inadequate transfusion and chelation may compromise bone health and increase risk of fractures. The objective of this study was to describe the prevalence of fractures in Indian inadequately transfused and chelated children, adolescents and young adults with beta thalassemia major. Methods:...
Article
Introduction Beta thalassemia major (BTM) is characterized by anemia and iron overload, especially with inadequate chelation therapy. Dual energy x-ray absorptiometry software (DXA) may misanalyse bone measurements due to iron deposition in organs such as the liver. Our objective was to study difference between the posterior-anterior spine measurem...
Preprint
Full-text available
Objectives: To assess the overall effect of vitamin D supplementation on risk of acute respiratory infection (ARI), and to identify factors modifying this effect. Design: We conducted a systematic review and meta-analysis of data from randomised controlled trials (RCTs) of vitamin D for ARI prevention using a random effects model. Pre-specified sub...
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Full-text available
Background and objectives: Disease specific growth charts are useful to monitor growth and disease progress in specific disorders such as Turner syndrome. As there is a paucity of data on spontaneous growth of Indian girls with Turner syndrome, the objectives were to construct reference curves for height and assess height velocity in Indian girls...
Article
Objectives: To develop gender-specific graphic tool in which BMI cut offs can be read from height and weight, without need for calculating BMI and to validate tool against Indian Academy of Pediatrics (IAP) 2015 BMI charts. Methods: Validation of tool was performed using de-identified data on children from school health surveys. Results: For d...
Article
Background Children with type 1 diabetes having dyslipidemia are at increased risk of developing premature atherosclerosis and cardiovascular disease. The present study aims to determine the prevalence of dyslipidemia and its predictors in poorly controlled Indian children with type 1 diabetes. Methods The cross sectional study included 235 childr...
Article
Dual energy X-ray absorptiometry (DXA) scanning is the most common investigating modality used to assess bone mineral density (BMD). Conditions causing tissue calcification and artefacts such as metallic objects may mislead the results of the DXA scan. We present here a case of a child with diabetes where the DXA images were distorted by faecal lum...
Article
CNS tumours and their treatment commonly lead to endocrinopathies in children. Advances in surgical techniques, chemotherapy and radiotherapy have improved the survival in children with CNS tumours however they have also added to the late effect burden. Since the pituitary and hypothalamus regulate many important bodily functions, loss in their fun...
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It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted norm...
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Background/objectives: Vitamin D and zinc are recognized for their roles in immune-modulation, and their deficiencies are suggested to be important risk factors for childhood infections. This study, therefore, undertook to assess the occurrence of infections in rural Indian schoolchildren, subsequent to daily supplementation with vitamin D-calcium...
Article
Hypoglycaemic due to congenital hyperinsulinism in Beckwith-Wiedemann syndrome is commonly seen. It is usually transient and is managed by enteral feeds, high glucose-containing intravenous fluids and medications like diazoxide. We describe a case of an infant with genetically proven Beckwith-Wiedemann syndrome with prolonged hyperinsulinemic hypog...
Article
Background: Sitting height (SH) and leg length (LL) help in assessing disproportionate growth. Anthropometric dissimilarity has been observed in different ethnicities. Aim: To (1) study sitting height and body proportions in children from different regions of India; and (2) compare sitting height and body proportions with data from other countries....
Article
Objectives: To screen for variants in the MC4R and LEP genes in 46 patients with clinical suspicion of non-syndromic early onset severe obesity (NEOSO). Methods: Children with early onset obesity satisfying WHO criteria of obesity were studied. The MC4R and LEP genes were sequenced using a PCR amplicon based NGS on Illumina MiSeq next generation...
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Full-text available
Background: Reduced levels of estrogen have been associated with metabolic alterations and increased insulin resistance (IR) in postmenopausal women, thus predisposing them to cardiometabolic risks. The aim of this study was to assess alterations in parameters of cardiometabolic risk in apparently healthy pre- and post-menopausal women and to stud...
Article
Background Children with diabetes are likely to have different food and nutrient composition due to dietary restrictions. Studies on dietary intakes in Indian underprivileged children with Type1 diabetes are scarce. Objective To study dietary patterns and nutrient intakes of underprivileged children and adolescents with type1 diabetes in compariso...