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Abstract:
Non-communicable diseases (NCDs) including cardiovascular disease and type 2 diabetes (T2D) are rapidly increasing globally, but are disproportionately affecting low- and middle-income countries (LMICs). They are occurring at younger ages in LMICs with accompanying economic and societal costs. In India, an estimated 65 million people have T2D and a further 77 million are pre-diabetic. Unchecked, the population with T2D is expected to reach 109 million by 2035. The developmental origins of health and disease (DOHaD) hypothesis suggests that adversity during early life influences adult NCD risk. DOHaD research suggests that NCD risk is influenced not only by exposure to the well-known ‘load’ factors such as adult obesity and physical inactivity, but also by the ‘capacity’ of key metabolic tissues, which is acquired during early development. It is now well established that low birth weight (LBW), poor infant nutrition, and rapid childhood weight gain and obesity are risk factors for poor health trajectories and development of NCDs in later life.
Undernutrition (including widespread micronutrient deficiencies) remains a significant problem in India. In children under 5, the prevalence of stunting is ~35%; wasting ~17%; underweight ~33%, and anaemia ~41%. In women aged 15-49 years, 23% are underweight (body mass index, BMI<18.5 kg/m2) while ~53% are anaemic. These factors are reflected in a high prevalence of LBW (<2500g) in ~21% of the 26 million babies born in India each year. Rates of obesity are also increasing; it is estimated that ~12% of children and ~21% of women of reproductive age are overweight or obese (adult BMI>25 kg/m2).
Research in India has shown that maternal undernutrition (particularly maternal micronutrient deficiencies) and LBW have a detrimental impact on fetal development, leading to an increased vulnerability to diabetes and cardiovascular disease in adult life. Part of this increased risk results from changes in fetal body composition. The undernourished Indian newborn is typically light and thin (average birth weight 2.7kg) and has a low lean body mass, but is disproportionately adipose (the ‘thin-fat’ Indian. This phenotype persists through childhood and into adult life, and causes diabetes and cardiovascular disease at relatively low levels of obesity compared with western populations. The effects of early life under-nutrition are exacerbated by poor weight gain in infancy and rapid childhood weight gain even in the absence of obesity. Women who experienced fetal undernutrition have an increased risk of developing gestational diabetes when they become pregnant, another strong risk factor for diabetes in the next generation. Rates of gestational diabetes mellitus are rising in India; various data suggest a prevalence of 14-22% rural and urban populations. Thus, India’s ‘double burden’ of ill-health (high rates of chronic NCDs alongside maternal malnutrition, fetal and child undernutrition) are inextricably linked.
Current approaches to preventing cardiometabolic disease mainly target lifestyle factors in high-risk adults. While offering some benefit to the individual, such approaches do little to address the risk in future generations. Application of DOHaD principles offers a novel approach to tackling NCDs by delivering interventions in an integrated manner across the lifecourse: in adolescent or young women to ensure they approach pregnancy in optimum health; in pregnant women to ensure a healthy pregnancy and safe delivery; and in infancy and childhood to prevent excessive childhood adiposity and promote child development.
About Speaker:
Kalyanaraman Kumaran, MBBS MSc PG Cert DM FFPH
Professor of Public Health, University of Southampton, UK and
Senior Scientist, CSI Holdsworth Memorial Hospital & Vivekananda Memorial Hospital, India
Kumaran has over 30 years of experience in epidemiology and public health across the UK and India. His research focusses on understanding how factors operating in early life (such as maternal nutrition, fetal and infant growth) influence adult non-communicable diseases. He is also involved in the development and delivery of undergraduate and postgraduate public health teaching.
Kumaran has obtained research grants totalling over 14 million pounds, including ~7 million pounds as lead/principal investigator. He has over 100 publications including peer reviewed articles, book chapters, and policy and guideline documents.
His interests include travelling, reading, cycling and running. He is currently training to run his first full marathon!