Director, Department of Paediatrics, KEM Hospital
Pune
Dr Sheila Bhave
Honorary Consultant in Paediatric Research,
Department of
Paediatrics, KEM Hospital, Pune
Dr CS Yajnik
Director, Diabetes Unit, KEM Hospital, Pune
Dr Ashish Bavdekar
Consultant Paediatrician, KEM Hospital, Pune
Dr Madhumati Otiv
Paediatric Research Fellow, KEM Hospital, Pune
Dr Caroline Fall
Reader, MRC Environmental Epidemiology
Unit,
University of Southampton, UK
This is a follow-up study of children born in the KEM Hospital, Pune
during October 1987 to April 1989. At the age of 4 years they included
201 children who had been looked after on the routine post-natal ward
and 178 children who needed special care in the newborn period. For
a second study at the age of 8 years, it was decided to concentrate
on the former group, and expand the numbers to get better representation
at the extremes of birthweight. 477 children took part.
4-year-old
study 8-year-old
study
The main findings were:
At four years, children of lower birthweight had higher glucose,
insulin and glucose/insulin ratios 30 minutes after an oral glucose
load1, and higher plasma IGF-I concentrations2.
At eight years, lower birthweight children had higher LDL-cholesterol
concentrations and subscapular/triceps skinfold thickness ratios3.
After adjustment for current body weight, they also had higher systolic
blood pressures, fasting insulin and 32-33 split proinsulin concentrations,
30-minute insulin concentrations, insulin resistance (HOMA) and prevalence
of the insulin resistance syndrome3.
The highest values for all these cardiovascular risk factors were
in children who were small at birth, but had caught up to be in the
highest quartile of weight, height or fat mass at eight years3.
Follow-up of the children continues.
Published references :
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. Arch Dis Child 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 2000; 48:2422-9.
The study is funded by Wellcome Trust
B) Pune Maternal Nutrition
Study (PMNS)
Dr CS Yajnik Director,
Diabetes Unit, KEM Hospital, Pune Dr K Coyaji Director,
KEM Hospital, Pune Dr Shobha Rao Agharkar Research
Institute, Pune Dr Arun Kinare Director,
Department of Ultrasonography, KEM Hospital, Pune Mrs Punam Gupta National Informatics Centre, Pune Dr Caroline Fall Reader,
MRC Environmental Epidemiology Unit, University
of Southampton,UK Prof Alan Jackson Director, Institute of Human Nutrition,
University of Southampton, UK
This study, which took place in 6 rural villages near
Pune, was designed to determine how the size and body composition, dietary
intakes and micronutrient status of a mother are related to the size
and body composition of her baby. Fieldworkers visited 2,675 women of
child-bearing age every month to record their LMP dates, and every three
months to record weight and height. Women entered the pregnancy phase
of the study if a singleton pregnancy of <21 weeks gestation
was confirmed. Enrolment began in June 1994 and ended in April 1996.
Maternal anthropometry and dietary intakes were measured at 18 and 28
weeks gestation, diet using a modified 24-hour recall method and food
frequency questionnaire. Erythrocyte folate, and plasma Vitamin C and
ferritin concentrations were also measured. The babies were weighed
and measured in detail at birth.
PMNS
study team PMNS
dietary assessment
The main findings were:
Mean birthweight was 2.665 kg
Placental volume, measured by ultrasound in mid-pregnancy was low
and correlated with birthweight1.
Higher maternal intakes of milk at 18 weeks gestation and of green
leafy vegetables and fruit at 28 weeks gestation were associated with
larger neonatal size2, even after adjustment for potential
confounding factors such as maternal education and socio-economic
status. Red cell folate and plasma Vitamin C concentrations were also
directly related to neonatal size.
Compared with babies born in the UK, the babies were small in all
dimensions, most notably mid-upper-arm circumference (muscle) and
abdominal circumference (visceral mass). However, subscapular triceps
skinfold thickness (fat) was relatively spared. Thus while small and
thin, the Indian babies were relatively adipose3.
The mother's fasting glucose concentrations and level of insulin
resistance were directly related to the baby's birthweight. The father's
two-hour glucose concentrations and insulin resistance were also related
to the birthweight of the baby, and to placental weight4
PMNS Maternal intakes of green leafy vegetables
(GLV) and folate status
The children are being followed up.
Published references
1.
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.
2.
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.
3.
Yajnik CS, Fall CHD, Rao S, Coyaji KJ, Hirve SS, Shier R, Rao VN. Fetal growth in rural India; a 'thrifty phenotype' defined? The Pune Maternal Nutrition Study. First World Congress on the Fetal Origins of Adult Disease, Mumbai, India, Feb 2001; Pediatric Research 2001;50:51A.
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.
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. Eur J Clin Nutr 2003 :57:531-542.
6.
Fall CHD , Yajnik CS, Rao S, Davies AA, Brown N, Farrant HJW. Micronutrients and fetal growth. J Nut 2003:133:1747S-1756S.
7.
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
C) Thinness in rural
Indian women, socio-cultural factors
Dr Ginny Chorghade MRC
Environmental Epidemiology Unit,
University of Southampton, UK Dr Mary Barker MRC Environmental Epidemiology Unit, University of Southampton, UK Dr Caroline Fall Reader MRC Environmental Epidemiology Unit, University of Southampton, UK Dr CS Yajnik Director, Diabetes Unit, KEM Hospital, Pune Dr Shobha Rao Agharkar Research Institute, Pune Dr VN Rao Director, KEMH Research Centre
The Pune Maternal Nutrition Study found that women in this rural community
had a lower mean body mass index that their menfolk. This study aimed
to examine, in the same population, the social and cultural factors
at household and community level, which lead to gender differences in
the nutritional status of adults and children. Focus group discussions
and household questionnaires were used to collect data.
The main findings were1:
Among children, sons and daughters are treated equally in provision
of food and health care.
Marriage brings several changes in the lifestyle of young women
which add together to reduce her nutritional status, for example increased
workload (both at home and on the farm), lack of rest and leisure,
starting the ritual of fasting, and the expectation of early child-bearing.
Men, though often engaged in heavy agricultural work, rest in the
evenings and do little domestic work.
Men control the family money, and regularly visit the village and
market, thus gaining access to extra food in the form of snacks.
Men are aware of the heavy workload for women, though less aware
of its possible implications for reproductive health.
The recent change from a bride-price system to a dowry system in
this community reflects parents' attempts to marry their daughters
out of the drudgery of agricultural work.
Published references
1. Chorghade GP, Barker ME, Kellingray SD, Yajnik
CS, Joglekar C, Fall CHD. Socio- cultural
factors which influence the nutritional status of women and young girls
in rural Maharashtra,India.
First World Congress on the Fetal Origins of Adult Disease,
Mumbai, India, Feb 2001; Pediatric
Research 2001;50:58A.
The studies in Pune have been funded by the Medical Research Council,
UK, the Wellcome Trust and the Wessex Medical Trust
