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MUMBAI MATERNAL NUTRITION PROJECT (MMNP)

Cohort description

The Mumbai Maternal Nutrition Project (Figure below), also known as Project SARAS, is an (ongoing) randomised controlled trial of a food-based supplement for women living in slums in the city of Mumbai. Supplementation starts pre-conceptionally and continues throughout pregnancy, and comprises a daily snack (eg samosa or fritter) made from locally available micronutrient-rich foods: green leafy vegetables, dried fruit and milk. Control snacks are made of lower micronutrient content foods such as potato, sago and tapioca. The intervention is aimed at increasing the micronutrient quality of the women’s diets, in order to improve fetal development and thus to achieve long-term benefits for the child. The trial is powered to detect an intermediate outcome of a 100 g increase in birth weight. Recruitment to the trial stopped in February 2011, when a total of 6,771 women had joined. Data collection for birth outcomes will be complete in June 2012 (target 1500 newborn outcomes).

Trial setting: The supplements were developed, and the trial piloted, in slums in the Dadar-Prabhadevi area of Mumbai (2003-2005) and the main trial was launched in Bandra East, Khar and Andheri districts of the city in January 2006. It is being carried out in collaboration with the non-governmental organisation CSSC (Centre for the Study of Social Change), which co-ordinates a wide-ranging programme of activities in the slums, including primary medical care, micro-finance and women’s income generation and empowerment schemes.

Participants and baseline data: Non-pregnant married women aged 15-35 years, who planned to have children and give birth in Mumbai, were eligible to join the trial. Data collected at baseline included medical and pregnancy history, socio-economic status (Standard of Living Questionnaire), diet (using a specially developed food frequency questionnaire) and physical activity (questionnaire). Detailed anthropometry was performed by trained research workers.

The intervention: A food-based trial cannot be truly blind, but to prevent allocation being too obvious, we created 4 groups (2 intervention and 2 control). Women were randomised using a block design to ensure roughly equal numbers in three age and BMI strata. Four different snacks (2 intervention and 2 control) are cooked in the project kitchen every day and distributed to 56 supplementation centres in community centres and health clinics throughout the study area. The women eat the supplement in the centre, and the amount eaten is recorded. The timing of supplementation (3-6 pm) was chosen to prevent the snack interfering with the women’s normal mealtimes and they were asked to continue their normal diet. Compliance is defined as eating >3 snacks per week. The intervention was based on findings in the PMNS, showing that women who ate green leafy vegetables, fruit and milk more frequently had larger babies. Rather than aiming at a particular nutrient intake, we aimed to move women into the top quartile of the Pune intakes of these foods. New recipes have been developed during the course of the trial, to avoid monotony, with at least 5 different recipes in the intervention and control groups at any one time.

 

Pregnancy and delivery: Staff in the supplementation centres collect the women’s LMP dates. After two missed periods, a urine pregnancy test is carried out, and women enter the pregnancy phase of the study. Supplementation continues until delivery. An obstetric examination and ultrasound scans are carried out at 7-16 weeks, 17-23 weeks and 24-35 weeks gestation. Blood samples are taken at visit 1 to measure haemoglobin and micronutrient status (B12, folate, retinol), and at visit 3 to measure glucose tolerance, insulin resistance and lipids. Iron and folate tablets are prescribed as per Indian guidelines. The Edinburgh Post-natal Depression Score questionnaire is administered in the last trimester and repeated one month post delivery. Women continue their obstetric care under their chosen obstetrician, and deliver at any one of numerous public and private hospitals in Mumbai. We get news of delivery from the families themselves or via the health workers. The paediatric team visits the mother and baby in hospital or at home within 72 hours of birth to weigh the mother and record the baby’s anthropometry and any perinatal problems. The children are seen again at 1, 3, 6 and 12 post-natal months and annually thereafter, for anthropometry, a general paediatric check, and a developmental assessment using the Developmental Assessment Scales for Indian Infants (DASII).

Figure: Mumbai Maternal Nutrition Project

 

Publications from this study:-

  1. Shivashankaran D, Gurumurthy S, Kehoe S, Chheda PS, Margetts BM, Muley-Lotankar P, Agarwal A, Brown N, Sahariah SA, Taskar V, Fall CHDPotdar RD. (2011) Developing micronutrient-rich snacks for pre-conception and antenatal health: the Mumbai Maternal Nutrition Project (MMNP). In: Thompson B, Amoroso L (eds) Combating Micronutrient Deficiencies: Food-based Approaches. CAB International, Wallingford, UK/Food and Agriculture Organization of the United Nations, Rome, pp. 214–223. Chapter 12 (http://www.fao.org/docrep/013/am027e/am027e00.pdf).

 

The project is supported by:

  • Wellcome Trust
  • ICICI Ltd. Social Initiatives Group
  • Parthenon Trust
  • USAID
  • Medical Research Council, UK
  • University of Southampton

Organizations involved in the study:

Center for the Study of Social Change, Bandra, Mumbai

  • Dr. R.D. Potdar
  • Dr Sirazul Sahariah
  • Mrs. Meera Gandhi
  • Ms Harsha Chopra
  • Ms. Devi Shiva Shankaran
  • Ms Mayuri Patel
  • Mr Harshad Sane
  • Dr Monica Dayama
  • Dr Binal Master

Support:

  • Dept. of Clinical Pharmacology, Nair Hospital, Mumbai
  • Dr. Renuka Munshi
  • Ms. Falguni Panchal
  • Dr. Joshi’s Imaging Clinic, Dadar, Mumbai
  • Dr. Mukund Joshi
  • Dr. Ashwin Lavande Dr. Dharap’s Clinical Laboratory
  • Dr. Dharap Scientific

MRC Lifecourse Epidemiology Unit 

  • Dr. Caroline Fall
  • Dr. Nicholas Brown
  • Ms. Patsy Coakley
  • Ms. Vanessa Cox

Institute of Human Nutrition, University of Southampton

  • Prof. Alan Jackson
  • Dr. Barrie Margetts

 

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1.) PUNE PRE-ECLAMPSIA COHORT (PPEC)

2.) PUNE CHILDREN’S STUDY (PCS)

3.) PUNE MATERNAL NUTRITION STUDY (PMNS)

 

 

 

PUNE PRE-ECLAMPSIA COHORT (PPEC)

 

Cohort description:

The initial goal of this study (Figure below) was to investigate nutritional and biochemical parameters in women with pre-eclampsia. Women with pre-eclampsia were recruited on admission to the labour ward of the Bharati Hospital, Pune, during 2006-2010. Pre-eclampsia was defined as systolic and diastolic blood pressures >140 and >90 respectively, measured on two occasions > 6 hours apart, plus proteinuria of 3+ (>300 mg/day) on a dipstick test, with or without oedema. Normotensive women, with no medical or obstetric complications were recruited simultaneously as controls. Women were excluded if there were any pregnancy complications (multiple pregnancy, chronic hypertension, diabetes mellitus, seizure disorders, renal or liver disease, alcohol or drug misuse). None of the women smoked. Gestational age was based on LMP and ultrasound. Most of the women lived in the city of Pune and came from low-income families; their mean age and BMI were 23 years and 22 kg/m2 respectively.

Blood was collected from the mother before delivery and from the baby’s umbilical cord after delivery. The following measurements were made in maternal samples: plasma folic acid, vitamin B12, homocysteine, plasma and erythrocyte fatty acids, malondialdehyde as a marker of oxidative stress, angiogenic factors (VEGF, PLGF and sFlt-1) and neurotrophins (brain-derived growth factor, BDNF; nerve growth factor, NGF). Fatty acids and MDA were measured in cord blood.

Figure: Pune Pre-eclampsia Cohort

 

Publications from this cohort:

 

  1. Kilari A, Mehendale S, Dangat K, Pisal H, Joshi S. Associations of long Chain polyunsaturated fatty acid concentrations with birth outcome in term Indian mothers and their neonates. Am J Hum Biol 2011; 23: 319-24.
  2. Kulkarni A, Mehendale S, Yadav H, Joshi S. Reduced placental docosahexaenoic acid levels associated with increased levels of sFlt-1 in preeclampsia.  Prostaglandins,Leukot, Essent Fatty Acids 2011; 84: 51-5.
  3. Kilari A, Mehendale S, Pisal H, Panchanadikar T, Kale A, Joshi S. Nerve growth factor, birth outcome and pre-eclampsia. Int J Dev Neuroscience 2011; 29 :71-5.
  4. Kulkarni A, Chavan-Gautam P, Mehendale S, Yadav H, Joshi S. Global DNA methylation patterns in placenta and its association with maternal hypertension in pre-eclampsia. DNA Cell Biol 2011; 30: 79-84.
  5. Kulkarni A, Mehendale S, Pisal H, Kilari A, Dangat K, Salunkhe S, Taralekar V, Joshi S. Association of omega 3 fatty acids and homocysteine concentrations in pre-eclampsia Clin Nutr 2011; 30: 60-4.
  6. Kulkarni A, Mehendale S, Yadav H, Kilari A,Taralekar V, Joshi S. Circulating angiogenic factors and their association with birth outcomes in pre-eclampsia. Hyperten Res 2010; 33: 561-7
  7. Dangat K, Mehendale S, Yadav H, Kilari A, Kulkarni A,  Taralekar V, Joshi S. Long Chain Polyunsaturated Fatty Acid Composition of Breast Milk in Pre-eclamptic Mothers. Neonatol 2010; 97: 190-4.
  8. Kilari A, Mehendale S, Dangat K, Yadav H, Kulakarni A, Dhobale M, Taralekar V, Joshi S. Long Chain Polyunsaturated Fatty Acids In Mothers and Term Babies. J Perinat Med  2009; 37: 513–8
  9. Mehendale S, Kilari A, Dangat K, Taralekar V, Mahadik S, Joshi S. Fatty acids, antioxidants, and oxidative stress in pre-eclampsia. Int J Gyn Obstet 2008; 100: 234-8.

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PUNE CHILDREN’S STUDY (PCS)

Cohort description:

In 1991, we recruited 201 healthy four-year old children born at full-term in the KEM Hospital, Pune, whose routinely measured birth weights were recorded in labour ward registers (Figure below)1. We measured their anthropometry, IGF-I and cardio-metabolic risk markers1. At 8 years, the sample was enlarged to 477 by selecting additional children, from all categories of birth weight, from the hospital records. We measured the same cardio-metabolic risk markers3, urinary glucocorticoids and adrenal androgens, and ovarian morphology. During adolescence, the children were seen annually for anthropometry and Tanner pubertal staging and had a bone age X-ray at 13 years. At 21 years (study completed in 2011) we made repeat measurements of cardio-metabolic risk markers, measured carotid intima media thickness, nutritional status (vitamin B12, folate and homocysteine) and (in girls) features of polycystic ovary syndrome (PCOS). The children’s parents were studied at the 4-year, 8-year and 21-year follow-ups (anthropometry, body composition (DXA), OGTT, insulin resistance, lipids4 and nutrients: B12, folate and homocysteine). DNA was collected at 8 and 21 years from the children and parents.

Figure: Pune Children’s Study

Publications from this cohort:

  1. Yajnik CS, Fall CHD, Vaidya U, Pandit AN, Bavdekar A, Bhat DS, Osmond C, Hales CN, Barker DJP.  Fetal growth and glucose and insulin metabolism in four year old Indian children.  Diabetic Med 1995;12:330-6.
  2. Fall CHD, Pandit AN, Law CM, Yajnik CS, Clark PM, Breier B, Osmond C, Shiell AW, Gluckman PD, Barker DJP.  Size at birth and plasma insulin-like growth factor-1 concentrations in childhood.  Archives  Dis Childhood 1995;73:287-293.
  3. Bavdekar A, Yajnik CS, Fall CHD, Bapat S, Pandit AN, Deshpande V, Bhave S, Kellingray SD, Joglekar C.  The insulin resistance syndrome (IRS) in eight-year-old Indian children: small at birth, big at 8 years or both?  Diabetes 1999;48:2422-9.
  4. Yajnik CS, Joglekar CV, Pandit AN, Bavdekar AR, Bapat SA, Bhave SA, Leary SD, Fall CHD.  Higher offspring birthweight predicts the metabolic syndrome in mothers but not fathers 8 years after delivery. Diabetes2003;52:2090-6.
  5. Hardikar PS, Joshi SM, Bhat DS, Raut DA, Katre PA, Lubree HG, Jere A, Pandit AN, Fall CHD, Yajnik CS. Spuriously high prevalence of pre-diabetes diagnosed by HbA1c in young Indians partly explained by hematological factors and iron deficiency anemia. Diabetes 2012 (in press).

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PUNE MATERNAL NUTRITION STUDY (PMNS)

 

Cohort description:

 

The Pune Maternal Nutrition Study (Figure below) was set up in 1993 in six rural villages 40–50 km from Pune City. Women of reproductive age (N=2,675) were identified by a house-to-house survey and 2,466 agreed to participate in the study. The majority belonged to subsistence farming families. Trained health workers visited the women every month to record LMP dates and every 3 months to record anthropometry. Women who missed two periods had ultrasound scan at 15–18 weeks gestation to confirm pregnancy and record sonographic gestational age. Women entered the pregnancy phase of the study if a singleton pregnancy of <21 wk gestation was confirmed. Between 1994 and 1996, 1,102 women became pregnant; measurements during pregnancy (18 and 28 weeks gestation) included ultrasound scans for fetal growth and placental volume, and maternal anthropometry, blood pressure, glucose tolerance, insulin resistance, dietary intakes (FFQ and 24-hour recall), physical activity/workload (by questionnaire), socio-economic status, and blood nutrients (red cell folate, vitamin C, 25-OH-vitamin D, vitamin B12, homocysteine).

The children had detailed anthropometry at birth and annually. At 6 and 12 years, body composition (DXA), cardio-metabolic risk markers and cognitive function were measured. At 12 years, 90 children (13% of the original live births) had migrated out of the study area; but despite this 690 (95% of surviving children) attended the follow-up. The children are currently aged 15-17 years.

Figure: PMNS Maternal Nutrition Study

Publications from this cohort:

 

  1. Fall CHD, Yajnik CS, Rao S, Coyaji KJ, Shier RP.  The effects of maternal body composition before birth on fetal growth: the Pune Maternal nutrition and Fetal Growth Study.  In: eds. O’Brien PMS, Wheeler T, Barker DJP. Fetal Programming; Influences on development and disease in later life.  RCOG Press, London, 1999.
  2. Kinare AS, Natekar AS, Chinchwadkar MC, Yajnik CS, Coyaji KJ, Fall CHD, Howe DT.  Low mid-pregnancy placental volume in rural Indian women: a cause for low birthweight? (The Pune Maternal Nutrition and Fetal Growth Study).  Am J O G 2000;182:443-8.
  3. Rao S, Yajnik CS, Kanade A, Fall CHD, Margetts BM, Jackson AA, Shier R, Joshi S, Rege S, Lubree H, Desai B.  Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth; the Pune Maternal Nutrition Study. J Nutr 2001;131:1217-1224.
  4. Yajnik CS, Coyaji KJ, Joglekar CV, Kellingray S, Fall CHD.  Paternal insulin resistance and fetal growth: problem for the ‘fetal insulin’ and the ‘fetal origins’ hypotheses. Diabetologia 2001;44:1197-1201.
  5. Yajnik CS, Fall CHD, Coyaji KJ, Hirve SS, Rao S, Barker DJP, Joglekar C, Kellingray S.  Neonatal anthropometry: the thin-fat Indian baby; the Pune Maternal Nutrition Study. Int J Obesity 2003;27:173-180.
  6. Rao S, Kanade A, Margetts BM, Yajnik CS, Lubree H, Rege S, Desai B, Jackson AA, Fall CHD.  Maternal activity in relation to birth size in rural India; the Pune Maternal Nutrition Study. EJCN 2003 :57:531-542.
  7. Fall CHD, Yajnik CS, Rao S, Davies AA, Brown N, Farrant HJW. Micronutrients and fetal growth. J Nut 2003:133:1747S-1756S.
  8. Yajnik CS, Deshpande SS, Panchanadikar AV, Naik SS, Deshpande JA, Coyaji KJ, Fall CHD, Refsum H. Maternal total homocysteine concentration and neonatal size in India. Asia Pacific Journal of Clinical Nutrition 2005;14:179-181.
  9. Joshi NP, Kulkarni SR, Yajnik CS, Joglekar CV, Rao S, Coyaji KJ, Lubree HG, Rege SS, Fall CHD. Increasing maternal parity predicts neonatal adiposity: data from the Pune Maternal Nutrition Study. Am J Obstetrics and Gynecology 2005;193:783-789.
  10. Kanade AN, Rao S, Yajnik CS, Margetts BM, Fall CHD. Rapid assessment of maternal activity among rural Indian mothers; the Pune Maternal Nutrition Study. Public Health Nutrition 2005;8:588-95.
  11. Chorghade GP, Barker M, Kanade S, Yajnik CS, Fall CHD. Why are rural Indian women so thin? Findings from a village in Maharashtra. Public Health Nutrition 2006; 9: 9-18.
  12. Leary S, Fall CHD, Osmond C, Lovel H, Campbell D, Eriksson J, Forrester T, Godfrey K, Hill J, Jie M, Law C, Newby R, Robinson S, Yajnik CS. Geographical variation in neonatal phenotype. Acta Obstetrica Scandinavica 2006; 85: 1080-9.
  13. Leary S, Fall CHD, Osmond C, Lovel H, Campbell D, Eriksson J, Forrester T, Godfrey K, Hill J, Jie M, Law C, Newby R, Robinson S, Yajnik CS. Geographical variation in relationships between parental body size and offspring phenotype at birth. Acta Obstetrica Scandinavica 2006; 85: 1066-79.
  14. Ganpule A, Yajnik CS, Fall CHD, Rao S, Fisher DJ, Kanade A, Cooper C, Naik S, Joshi N, Lubree H, Deshpande V, Joglekar C. Bone mass in Indian children; relationships to maternal nutritional status and diet during pregnancy; the Pune Maternal Nutrition Study. J Clin Endocrinol Metab 2006; 91: 2994-3001.
  15. Barker MB, Chorghade G, Crozier S, Leary S, Fall CHD. Gender differences in body mass index in rural India are determined by socio-economic factors and lifestyle. J Nutr 2006; 136: 3062-8.
  16. Joglekar C, Fall CHD, Deshpande VU, Joshi N, Bhalerao A, Solat V, Deokar TM, Chougule SD, Leary SD, Osmond C, Yajnik CS. Newborn size, and childhood growth, and cardiovascular disease risk factors at the age of 6 years; The Pune Maternal Nutrition Study. Int J Obesity 2007; 31: 1534-44.
  17. Kulkarni S, Fall CHD, Joshi NV, Lubree HG, Deshpande VU, Pasarkar RV, Bhat DS, Naik SS, Yajnik CS.  Determinants of incident hyperglycemia 6 years after delivery in young rural Indian mothers: the Pune Maternal Nutrition Study (PMNS). Diabetes Care 2007;30:2542-7.
  18. Yajnik CS, Deshpande SS, Jackson AA, Refsum H, Rao S, Fisher DJ, Bhat DS, Naik SS, Coyaji KJ, Joglekar CV, Joshi N, Lubree HG, Deshpande VU, Rege SS, Fall CHD. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: The Pune Maternal Nutrition Study. Diabetologia 2008; 51: 29-38.
  19. Bhate V, Deshpande S, Bhat D, Joshi N, Ladkat R, Watve S, Fall C, de Jager C, Refsum H, Yajnik CS. Maternal vitamin B12 status in pregnancy and cognitive function in 9-year old Indian children. Food Nutrition Bulletin 2008; 29: 249-54.
  20. Rao S, Kanade AN, Yajnik CS, Fall CHD. Seasonality in maternal intake and activity influences pregnancy outcome among rural Indian mothers; Pune Maternal Nutrition Study. Int J Epidemio 2009; 38: 1094-103.
  21. Kinare, A, Chinchwadkar M, Natekar AS, Coyaji KJ, Wills AK, Joglekar CV, Yajnik CS, Fall CHD. Patterns of fetal growth in a rural Indian cohort and a comparison with a western European population, data from the Pune Maternal Nutrition Study. J Ultrasound Med 2010; 29: 215-23.
  22. Wills AK, Chinchwadkar MC, Joglekar CV, Natekar AS, Yajnik CS, Fall CHD, Kinare AS. Maternal and paternal height and BMI and patterns of fetal growth: The Pune Maternal Nutrition Study. Early Human Development  2010; 86: 535-540.
  23. Kehoe SH, Krishnaveni GV, Lubree H, Wills AK, Guntupalli AM, Veena SR, Bhat DS, Kishore R, Fall CHD, Yajnik CS, Kurpad A. Prediction of body fat percentage from skinfold and bio-impedance measurements in Indian school children. EJCN 2011; 65: 1263-70.
  24. Li H, Kilpeläinen TO, Liu C, Zhu J, Liu Y, Hu C, Yang Z, Zhang W, Bao W, Cha S, Wu Y, Yang T, Sekine A, Choi BY, Yajnik CS, Zhou D, Takeuchi F, Yamamoto K, Chan JC, Mani KR,  Been LF, Imamura M, Nakashima E, Lee N, Fujisawa T , Karasawa S, Wen W, Joglekar CV, Lu W, Chang Y, Xiang Y, Gao Y, Liu S, Song Y, Kwak SH, Shin HD, Park KS, Fall CHD, Kim JY, Sham PC, Lam KSL, Zheng W, Shu X, Deng H, Ikegami H, Krishnaveni GV, Sanghera DK, Chuang L, Liu L, Hu R, Kim Y, Daimon M, Hotta K, Jia W, Kooner JS, Chambers JC, Chandak GR, Ma RC, Maeda S, Dorajoo R, Yokota M, Takayanagi R, Kato N, Lin X, Loos RJF. Association of genetic variation in FTO with risk of obesity and type 2 diabetes with data from 96,551 East and South Asians. Diabetes 2011 (in press).

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NEW DELHI BIRTH COHORT (NDBC)

Cohort description:

The New Delhi Birth Cohort (Figure F) was set up in 1969-1972 to study pregnancy/perinatal outcomes and child growth. All families living in a 12 km2 area of South Delhi were surveyed (total population 119,799) and 20,755 married women of reproductive age were identified and recruited. They were followed up 2-monthly to record LMP dates, and women who became pregnant were visited regularly until delivery. There were 9,169 pregnancies and 8,030 singleton live births. Trained field workers recorded the weight and length of the babies within 72 hours of birth, at 3, 6, 9 and 12 months, and then 6-monthly until 21 years. The families were mainly ‘middle-class’ with above average income and literacy; however 43% lived in only one room, and there were high rates of child under-nutrition (46% stunted and 30% underweight at the age of 2 years). Hindus were the majority religious group (84%), followed by Sikhs (12%). 30% of the cohort was lost to follow-up in 1973 when unauthorized housing was demolished. A mean (SD) of 23 (5.5) sets of measurements were obtained for children remaining in the cohort between birth and 21 years.

Figure F: New Delhi Birth Cohort

In 1998-2002, we re-traced the cohort after a gap of ~5 years; 2,584 (32% of the original live births) were successfully re-contacted, still living in and around Delhi. We have carried out 2 studies of cardio-metabolic risk markers at ages 29 and 36 years. DNA was collected. In a series of papers, we have described relationships of size and growth in early life to cardiovascular risk factors in adulthood1-11. Members of the NDBC are now aged 40-43 years. We have details of surviving parents of the cohort (F0 generation, N=1,019) and  children of the cohort (F2 generation, N=3,173).

The NDBC participates in several international consortia. It contributed data to the Earlyread collaboration, linking lower birth weight to type 2 diabetes6. It is part of the COHORTS collaboration along 4 other birth cohorts in low- and middle-income countries4,8-10,14,17,18 and a member of the Global Burden of Metabolic Risk Factors of Chronic Disease Collaborating Group20-21.

Publications from the cohort – adult follow-up phases only

 

  1. Bhargava SK, Sachdev HPS, Fall CHD, Osmond C, Lakshmy R, Barker DJP, Dey Biswas SK, Ramji S, Prabharkaran D, Reddy KS. Relation of serial changes in childhood body mass index to impaired glucose tolerance in young adulthood. New England J Med  2004;350:865-75.
  2. Sachdev HS, Fall CHD, Osmond C. The changing face and implications of childhood obesity. N Engl J Med 2004; 350: 2416.
  3. Sachdev HPS, Fall CHD, Osmond C, Lakshmy R, Dey Biswas SK, Leary SD, Reddy KS, Barker DJP, Bhargava SK. Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood; the New Delhi birth cohort. Am J Clin Nutr 2005;82:456-66.
  4. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HPS and the Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008; 371: 340-357.
  5. Fall CHD, Sachdev HPS, Osmond C, Lakshmy R, Dey Biswas SK, Prabhakaran D, Tandon N, Ramji S, Reddy KS, Barker DJP, Bhargava SK. Adult metabolic syndrome and impaired glucose tolerance are associated with different patterns of body mass index gain during infancy; data from the New Delhi birth cohort. Diabetes Care 2008; 31: 2349-56.
  6. Whincup PH, Kaye SJ, Owen CG, Huxley R, Cook DG, Anazawa S, Barrett-Connor E, Bhargava SK, Birgisdottir B, Carlsson S, De Rooij S, Dyck R, Eriksson JG, Falkner B, Fall CHD, Forsen T, Grill V, Gudnason V, Hulman S, Hypponen E, Jeffreys E, Lawlor D, Leon D, Mi J, Minami J, Mishra G, Osmond C, Power C, Rich-Edwards J, Roseboom TJ, Sachdev HPS, Suzuki T, Syddall H, Thorsdottir I, Vanhala M, Wadsworth M, Yarbrough DE. Birthweight and risk of type 2 diabetes: a quantitative systematic review of published evidence. JAMA 2008; 300: 2885-97.
  7. Sachdev HPS, Osmond C, Fall CHD, Lakshmy R, Ramji S, Dey Biswas SK, Prabhakaran D, Tandon N, Reddy KS, Barker DJP, Bhargava SK. Predicting adult metabolic syndrome from childhood body mass index; follow-up of the New Delhi Birth Cohort. Archives of Disease in Childhood 2009; 94: 768-74.
  8. Adair LS, Martorell R, Stein AD, Hallal PC, Sachdev HPS, Prabhakaran D, Wills AK, Norris SA, Dahly DL, Lee NR, Victora CG, COHORTS group. Size at birth, weight gain in infancy and childhood, and adult blood pressure in five low and middle income country cohorts: When does weight gain matter? AJCN 2009; 89: 1383-92.
  9. Stein AD, Wang M, Martorell R, Norris SA, Adair LS, Bas I, Sachdev HPS, Bhargava SK, Fall CHD, Gigante DP, Victora CG and the COHORTS Group. Growth patterns in early childhood and final attained stature: data from five birth cohorts from low and middle-income countries. Am J Human Biol 2010; 22: 353-9.
  10. Martorell R, Horta BL, Adair LS,Stein AD, Richter L, Fall CHD, Bhargava SK,  Dey Biswas SK,  Perez L, Barros FC, Victora CGand COHORTS Group. Weight gain in the first two years of life is an important predictor of schooling outcomes in pooled analyses from five birth cohorts from low- and middle-income countries. J Nutrition 2010; 140: 348-54.
  11. Lakshmy R, Fall CHD, Sachdev HPS, Osmond C, Prabhakaran D, Dey Biswas S, Tandon N, Ramji S, Reddy KS, Barker DJP, Bhargava SK. Childhood body mass index and adult pro-inflammatory and pro-thrombotic risk factors; data from the new Delhi Birth Cohort. Int J Epidemiology 2011; 40: 102-111.
  12. Fall CHD, Borja JB, Osmond C, Richter L, Bhargava SK, Martorell R, Stein AD, Barros FC, Victora CG, and the COHORTS group. Infant feeding patterns and cardiovascular risk factors in young adulthood; data from five cohorts in low and middle income countries. Int J Epidemiol 2011; 40: 47-62.
  13. Huffman MD, Prabhakaran D, Osmond C, Fall CHD, Tandon N, Lakshmy R, Ramji S, Khalil A, Gera T, Prabhakaran P, Dey Biswas SK, Reddy KS, Bhargava SK, Sachdev HPS.  Incidence of Cardiovascular Risk Factors in an Indian Urban Cohort: Results from the New Delhi Birth Cohort. J Am Coll Cardiol 2011; 57: 1765-74.
  14. Richter L, Victora C, Hallal P, Adair L, Bhargava S, Fall C, Martorell R, Lee N, Norris S, Stein A and the COHORTS group (Consortium of Health Orientated Research in Transitioning Societies). Cohort profile. Int J Epidemiol 2011 (e-pub).
  15. Paul VK, Sachdev HS, Mavalankar D, Ramachandran P, Jeeva Sankar M, Bhandari N, Sreenivas V, Sundararaman T, Govil D, Osrin D, Kirkwood B. Reproductive health, and child health and nutrition in India: meeting the challenge. Lancet 2011; 377: 760-8.
  16. Ramakrishnan L, Sachdev HS, Sharma M, Abraham R, Prakash S, Gupta D, Singh Y, Bhaskar S, Sinha S, Chandak GR, Reddy KS, Bhargava S. Relationship of APOA5, PPAR gamma and HL gene variants with serial changes in childhood body mass index and coronary artery disease risk factors in young adulthood. Lipids Health Dis 2011; 10: 68.etc.
  17. Kuzawa C, Adair L, Fall CHD, Lee N, Norris S, Osmond C, Ramirez-Zea M, Sachdev HPS, Stein A, Victora C. Birth weight, postnatal weight gain and adult body composition in five low and middle income countries. Am J Hum Biol 2011 (e-pub).
  18. Norris SA, Osmond C, Gigante D, Kuzawa CW, Ramakrishnan L, Lee NR, Ramirez-Zea M, Richter LM, Stein AD, Tandon N, Fall CHD and the COHORTS group. Size at birth, weight gain in infancy and childhood, and adult diabetes risk in five low- or middle-income country birth cohorts. Diabetes Care 2011 (e-pub).
  19. Tandon  N, Fall CHD, Osmond C, Sachdev HPS, Prabhakaran D, Ramakrishnan L, Dey Biswas SK, Ramji S, Khalil A, Gera T, Reddy KS, Barker DJP, Cooper C, Bhargava SK. Growth from birth to adulthood and peak bone mass and density; data from the New Delhi Birth Cohort. Osteoporosis Int 2011 (in press).
  20. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M and Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index). National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet 2011; 377: 557-67.
  21. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang Y, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M and Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (blood glucose). Lancet 2011; 378: 31-40.

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MYSORE BIRTH RECORDS COHORT (MBRC)

Cohort description:

Obstetric records at the Holdsworth Memorial Hospital (HMH) in Mysore have been preserved from 1934 onwards (Figure below). They contain the weight, length and head circumference of babies at birth, measured routinely by midwives. In the early years (~1934-1954) the mothers were weighed and their pelvic diameters were measured on admission in labour. In 1993, we traced adults born in HMH between 1934 and 1954 by conducting a house-to-house survey of the area surrounding the hospital, and matched them to their birth records, using an algorithm based on their reported age, their parents’ names and address at delivery, and the ages of their siblings. It was possible to match approximately half the individuals traced in the survey to their birth data.

In an initial study of 536 men and women in 1993-1995, we measured anthropometry, cardio-metabolic risk markers and lung function, and in a sub-set, left ventricular dimensions and arterial compliance1-6. We subsequently extended the house-to-house survey and increased the cohort to 1,069. In addition, we identified 387 cohort members with adult children (N=711) who were also born in HMH. In an inter-generational study in 2001-2003, we measured their cardio-metabolic risk markers8,9 and collected DNA from the parents and offspring. The cohort was last studied in 2004.

We estimate that ~70% of the cohort are still alive and in Mysore, and that ~90% are willing to participate in a new follow-up study. We have applied to the Wellcome DBT fellowship scheme for Dr Murali Krishna, a psychiatrist at HMH, to study cognitive function, dementia and CVD risk markers in the surviving cohort. We are not asking for funds for this study here, but will use the opportunity to take DNA samples, which will contribute to this programme, from the cohort.

Figure: Mysore Birth Records Cohort

 

 

Publications from this cohort:

  1. Stein C, Fall CHD, Kumaran K, Osmond C, Cox V, Barker DJP.  Fetal growth and coronary heart disease in South India.  Lancet 1996;348:1269-73.
  2. Stein CE, Kumaran K, Fall CHD, Shaheen S, Osmond C, Barker DJP.  Relation of fetal growth to adult lung function in South India.  Thorax 1997;52:895-9.
  3. Fall CHD, Stein C, Kumaran K, Cox V, Osmond C, Barker DJP, Hales CN.  Size at birth, maternal weight, and non-insulin-dependent diabetes (NIDDM) in South Indian adults.  Diabetic Medicine 1998;15:220-7.
  4. Kumaran K, Fall CHD, Martyn CN, Vijayakumar M, Stein CE, Shier R.  Blood pressure, arterial compliance and left ventricular mass; no relation to small size at birth in South Indian adults.  Heart 2000;83:272-7.
  5. Kumaran K, Fall CHD.  Fetal origins of coronary heart disease and hypertension and its relevance to India; review of evidence from the Mysore studies. Int J Diab Dev Countries 2001;21:34-41.
  6. Kumaran K, Fall CHD, Martyn CN, Vijayakumar M, Stein CE, Shier R.  Left ventricular mass and arterial compliance: relation to coronary heart disease and its risk factors in South Indian adults.  IntJ Cardiol 2002;83:1-9.
  7. Ward AMV, Fall CHD, Stein CE, Kumaran K, Veena SR, Wood PJ, Syddall HE, Phillips DIW.  Cortisol and the metabolic syndrome in South Asians.  Clin Endocrinol 2003:58:500-505.
  8. Veena SR, Kumaran K, Swarnagowri MN, Jayakumar MN, Leary SD, Stein CE, Cox V, Fall CHD. Intergenerational effects on size at birth in South India. Paed Perinatal Epidemiol 2004;18:361-70.
  9. Veena SR, Geetha S, Leary SD, Saperia J, Fisher DJ, Kumaran K, Coakley P, Stein CE, Fall CHD. Relationships of maternal and paternal birthweight to features of the metabolic syndrome in the adult offspring: an intergenerational study in South India. Diabetologia 2007;50:43-54.
  10. Veena SR, Wills AK, Fisher DJ, Stein CE, Kumaran K, Krishnaveni GV, Nagarajaiah K, Coakley PJ, Fall CHD.Early life factors and Type 2 diabetes in South-India: Do the associations change with age? J Diabetes 2009; 1: 218-226.




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MYSORE PARTHENON COHORT (MPC)

 

Cohort description

The Mysore Parthenon study (Figure below) was set up in 1997-1998 to investigate the long-term effects of maternal and fetal characteristics on cardio-metabolic disease in a contemporary urban Indian cohort. It has a special focus on the long-term effects of maternal glucose tolerance in pregnancy and gestational diabetes (GDM). 830 women booking consecutively into the antenatal clinic of the Holdsworth Memorial Hospital (HMH) in Mysore had anthropometry and oral glucose tolerance tests (OGTT) at 28-30 weeks gestation; 6% developed GDM (WHO criteria)1. Maternal micronutrient status in pregnancy (vitamin B12, D, folate and homocysteine) was measured. A total of 663 women delivered live singleton babies at HMH; the babies had detailed anthropometry and placental dimensions were recorded (weight, length, breadth, thickness, cotyledon number). A sample of cord blood was stored.

The children have been followed up every year until the age of 5 years, and 6-monthly after that, for anthropometry and body composition (bio-impedance). CVD risk markers were measured in the children and both parents at 5 and 9.5 years of age2-25. Other measurements at 9.5 years included grip strength, cognitive function, diet and physical activity. From 7 years, sexual maturity (Tanner staging) has been assessed every 6 months. Follow-up has remained high in the cohort; 603 children are alive and still living in/near Mysore; 539 (84% of survivors) attended the last major follow-up at 9.5 years, and 556 (87%) attended the last completed 6-monthly follow-up at 12.5 years. The children are currently aged 13-14 years.

Figure E: Mysore Parthenon Cohort

Publications from this cohort:

  1. Hill JC, Krishnaveni GV, Annamma I, Leary S, Fall CHD. Glucose tolerance in pregnancy in South India; relationships to neonatal anthropometry. Acta Obstet Gynecol Scand 2005;84:159-65.
  2. Krishnaveni GV, Hill JC, Veena SR, Leary SD, Saperia J, Chachyamma KJ, Karat SC, Fall CHD. Truncal adiposity is present at birth and in early childhood in South Indian children. Indian Pediatrics 2005;42:527-538.
  3. Krishnaveni GV, Hill JC, Leary S, Veena SR, Saperia J, Saroja A, Karat SC, Fall CHD. Anthropometry, glucose tolerance and insulin concentrations in Indian children: relationships to maternal glucose and insulin concentrations during pregnancy. Diabetes Care 2005; 28: 2919-25.
  4. Krishnaveni GV, Hill JC, Veena SR, Geetha S, Jayakumar MN, Karat CLS, Fall CHD. Gestational Diabetes and the Incidence of Diabetes in the 5 Years following the Index Pregnancy in South Indian Women. Diabetes Research Clin Pract 2007; 78: 398-404.
  5. Farrant HJW, Krishnaveni GV, Hill JC, Boucher BJ, Fisher DJ, Noonan K, Osmond C, Veena SR, Fall CHD. Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J Clin Nutr 2009; 63: 646-52.
  6. Krishnaveni GV, Mills IC, Veena SR, Wootton SA, Wills AK, Coakley PJ, Fisher DJ, Shobha S, Karat SC, Fall CHD. Accelerometers for measuring free-living physical activity behaviour in Indian children. Indian Pediatrics 2009; 46: 1055-62.
  7. Veena SR, Krishnaveni GV, Wills AK, Hill JC, Fall CHD. A Principal Components Approach to Parent-to-Newborn Body Composition Associations in South India. BMC Pediatrics 2009; 9: 16.
  8. Krishnaveni GV, Veena SR, Kuriyan R, Kishore RP, Wills AK, Nalinakshi M, Kehoe S, Fall CH, Kurpad AV. Relationship between physical activity measured using accelerometers and energy expenditure measured using doubly labelled water in Indian children. Eur J Clin Nutr 2009; 63: 1313-9.
  9. Krishnaveni GV, Hill JC, Veena SR, Bhat DS, Wills AK, Karat CLS, Yajnik CS, Fall CHD. Low plasma vitamin B12 in pregnancy is associated with gestational ‘diabesity’ and later diabetes. Diabetologia 2009; 52: 2350-8.
  10. Krishnaveni GV, Veena SR, Kiran KN, Nalinakshi M, Kehoe S, Raju N, Karat SC, Fall CHD. After-school physical activity intervention for children in India: a pilot trial. Ind J Pediatrics 2009; 76: SS3: S30-S35.
  11. Veena SR, Krishnaveni GV, Srinivasan K, Wills AK, Hill JC, Kurpad AV, Muthayya S, Karat SC, Nalinakshi M, Fall CHD. Infant feeding practice and childhood cognitive performance in South India. Arch Dis Child 2010; 95: 347-354.
  12. Veena SR, Krishnaveni GV, Wills AK, Kurpad AV, Muthayya S, Hill JC, Karat SC, Nagarajaiah KK, Fall CHD, Srinivasan K. Association of birthweight and head circumference at birth to cognitive performance in 9-10 year old children in South India: prospective birth cohort study. Pediatric Research 2010; 67: 424-9.
  13. Krishnaveni GV, Veena SR, Hill JC, Kehoe S, Karat SC, Fall CHD. Intra-uterine exposure to maternal diabetes is associated with higher adiposity and insulin resistance and clustering of cardiovascular risk markers in Indian children. Diabetes Care 2010; 33: 402-4.
  14. Veena SR, Krishnaveni GV, Srinivasan K, Wills AK, Muthayya S, Kurpad AV, Yajnik CS, Fall CHD. Higher maternal plasma folate but not vitamin B-12 concentrations during pregnancy are associated with better cognitive function scores in 9-10 year old children in South-India. J Nutr 2010; 140: 1014-22.
  15. Barr JG, Veena SR, Kiran KN, Wills AK, Winder NR, Kehoe S, Fall CHD, Aihie Sayer A, Krishnaveni GV. The relationship of birthweight, muscle size at birth and postnatal growth to grip strength in 9 year-old Indian children: findings from the Mysore Parthenon Study. J DOHaD 2010; 1: 329-37.
  16. Krishnaveni GV, Veena SR, Wills AK, Hill JC, Karat SC, Fall CHD. Adiposity, insulin resistance and cardiovascular risk factors in 9-10 year old Indian children: Relationships with birth size and postnatal growth. J DOHaD 2010; 1: 403-411.
  17. Veena SR, Krishnaveni GV, Srinivasan K, Kurpad AV, Muthayya S, Hill JC, Kiran KN, Fall CHD. Childhood Cognitive Ability: Relationship to Gestational Diabetes Mellitus in India. Diabetologia 2010 53:2134-2138.
  18. Winder NR, Krishnaveni GV, Hill JC, Karat CL, Fall CHD, Veena SR, Barker DJP. Placental programming of blood pressure in Indian children. Acta Pediatrica 2011; 100: 653-60.
  19. Krishnaveni GV, Veena SR, Winder NR, Hill JC, Noonan K, Boucher BJ, SC Karat, Fall CHD. Maternal vitamin D status during pregnancy and body composition and cardiovascular risk markers in Indian children: the Mysore Parthenon study. Am J Clin Nutr 2011; 93: 628-35.
  20. Kehoe SH, Krishnaveni GV, Lubree H, Wills AK, Guntupalli AM, Veena SR, Bhat DS, Kishore R, Fall CHD, Yajnik CS, Kurpad A. Prediction of body fat percentage from skinfold and bio-impedance measurements in Indian school children. EJCN 2011; 65: 1263-70.
  21. Caleyachetty A, Krishnaveni GV, Veena SR, Hill J, Karat SC, Fall CHD, Wills AK. Breast feeding duration, age at starting solids and high BMI risk and adiposity in Indian children. Mat Child Nutr 2011 (in press).
  22. Veena SR, Krishnaveni GV, Wills AK, Hill JC, Karat SC, Fall CH. Glucose tolerance and insulin resistance in Indian children: relationship to infant feeding pattern. Diabetologia 2011; 54: 2533-7.
  23. Winder NR, Krishnaveni GV, Veena SR, Hill JC, Karat CLS, Thornburg KL, Fall CHD, Barker DJP. Mother’s lifetime nutrition and the size, shape and efficiency of the placenta. Placenta 2011; 32: 806-10.
  24. Li H, Kilpeläinen TO, Liu C, Zhu J, Liu Y, Hu C, Yang Z, Zhang W, Bao W, Cha S, Wu Y, Yang T, Sekine A, Choi BY, Yajnik CS, Zhou D, Takeuchi F, Yamamoto K, Chan JC, Mani KR,  Been LF, Imamura M, Nakashima E, Lee N, Fujisawa T , Karasawa S, Wen W, Joglekar CV, Lu W, Chang Y, Xiang Y, Gao Y, Liu S, Song Y, Kwak SH, Shin HD, Park KS, Fall CHD, Kim JY, Sham PC, Lam KSL, Zheng W, Shu X, Deng H, Ikegami H, Krishnaveni GV, Sanghera DK, Chuang L, Liu L, Hu R, Kim Y, Daimon M, Hotta K, Jia W, Kooner JS, Chambers JC, Chandak GR, Ma RC, Maeda S, Dorajoo R, Yokota M, Takayanagi R, Kato N, Lin X, Loos RJF. Association of genetic variation in FTO with risk of obesity and type 2 diabetes with data from 96,551 East and South Asians. Diabetes 2011 (in press).
  25. Kehoe SH,Krishnaveni GV, Veena SR, Hill JC, Osmond C, Kiran, Coakley P, Karat SC, Fall CHD. Birth Size and Physical Activity in a cohort of Indian children aged 6-10 years. J DOHaD 2011 (in press).


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VELLORE BIRTH COHORT (VBC)

Cohort description:

The Vellore birth Cohort (Figure below) was set up in 1969-73 to study pregnancy, perinatal and child outcomes. Twenty four wards in Vellore town, representing a broad range of socio-economic status, and 25 out of 41 contiguous villages from the Kizhvazhithunaiyankuppam rural community near Vellore were selected. All non-pregnant married women of reproductive age (total 20,626) were recruited. The weight and height of the women and their husbands were recorded, and women were visited by health workers to record LMP dates and follow up pregnancies. Of 14,147 pregnancies, there were 10,691 singleton live births. Of the latter, 47% were born outside the study area; all others were measured (birth weight, length, head and chest circumferences) at birth. These measurements were repeated in infancy (1-3 months), childhood (6-8 years) and adolescence (10-15 years).

In 1998-2000, we re-traced cohort members, targeting those who were singleton births and had complete parental and birth measurements (n=4,092); we found 2,572 who were still living in the study area or in nearby villages/towns/cities. Of these, 2,218 took part in a study to assess current lifestyle and measure cardio-metabolic risk markers. DNA was collected.

Figure G: Vellore Birth Cohort

 

 

Publications from this cohort – adult phases of follow-up only

 

  1. Raghupathy P, Antonisamy B, Fall CHD, Geethanjali FS, Leary SD, Saperia J, Priya G, Abel R, Richard J. High prevalence of glucose intolerance even among young adults in south India. Diabetes Research Clin Practice 2007;77: 269-79.
  2. Agnihotri B, Antonisamy B, Priya G, Fall CHD,Raghupathy P. Trends in human birth weight across two successive generations. Ind J Paed 2008; 75: 111-8.
  3. Antonisamy B, Raghupathy P, Christopher S, Richard J, Rao PSS, Barker DJP, Fall CHD. Cohort profile: the 1969-73 Vellore Birth Cohort Study in South India. Int J Epidemiol 2009; 38: 663-9.
  4. Raghupathy P, Antonisamy B, Geethanjali FS, Saperia J, Leary SD, Priya G, Richard J, Barker DJP, Fall CHD. Glucose tolerance, insulin resistance and insulin secretion in young south Indian adults; relationships to parental size, neonatal size and childhood body mass index. Diabetes Research Clin Pract 2010; 87: 283-92.
  5. Vasan SK, Neville MJ, Antonisamy B, Samuel P, Fall CHD, Geethanjali FS, Thomas N, Raghupathy P, Brismar K, Karpe F. Absence of birth weight lowering effect of ADCY5 and Near CCNL, but association of impaired glucose homeostasis with ADCY5 in Asian Indians. PLoS One 2011; 6: e21331.
  6. Samuel P, Antonisamy B, Raghupathy P, Richard J, Fall CHD. Socio-economic status and cardiovascular risk factors in rural and urban areas of Vellore, Tamilnadu, South India. Int J Epidemiol 2012 (in press).

 

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  4. what a timely blog post. Given that chidlren (particularly young girls )are being bombarded with inappropriate marketing encouraging them to grow up’ far too quickly, I think birth control is extremely important for teenagers now-a-days.