Pune-based scientists who embarked on an maternal nutrition study 12 years ago to figure out how to prevent future generations from getting diabetes, found that the answer lay in maternal nutrition. Looking after the health of adolescent girls and reproductive mothers is the key. The deficiency of Vitamin B12 in the mother’s nutrition is an important determinant of the risk of diabetes in children. Vitamin B12 is a member of the B complex group, necessary for synthesis of red blood cells, maintenance of nervous system and growth in children. The Pune Maternal Nutrition Study began in 1993 and is being followed up since. The paper, discussing the link between growth and nutrition in early life and the risk of Type 2 diabetes, has been accepted for publication in the International Diabetes Monitor. Lead author Dr C S Yajnik, Director of the diabetes unit of King Edward Memorial Hospital and Research Centre, Pune, said: “The concept of developmental origins of health and disease makes much sense.” Although the medical profession has been slow to embrace the theory, the World Health Organisation, he said, has endorsed the idea in its life-course model of non-communicable disease. “We need to understand the specific aspects of maternal nutrition that influence adiposity in the offspring as well as the factors that influence a child’s age at adiposity rebound (rising of body mass).” A child’s body mass starts rising between the age of 4 to 8 years. But if it happens at an earlier age, it is a particularly strong risk factor for Type 2 diabetes. So is both fetal undernutrition and overnutrition. Children who grow rapidly are at an increased risk as well, especially if they were born small. In this context, special efforts are needed to change the current practice of overfeeding low birth-weight babies, said Yajnik. The researchers found that low maternal Vitamin B12 levels but high folate status predispose the baby to adiposity and insulin resistance, risk factors for Type 2 diabetes. Children of mothers who had a low count of Vitamin B12 also did not perform well in neuro-cognitive tests, said Dr Urmila Deshmukh, paediatrician with the study. THE AIM: Investigate the effects of maternal nutrition (from before conception) on their baby's risk of developing diabetes and cardiovascular disease. BY WHOM AND WHERE: The Pune Maternal Nutrition Study began in 1993 in six villages and is still on. THE PROCESS: The mothers were small (average weight 42 kg), average age 21 years. Initially, 3000 women were screened every month. When 800 of them became pregnant, they became the main participants of the study. Six women had diabetes when pregnant. The researchers kept tab on the women's nutrition, blood levels and metabolism. Intake of macronutrients (calories, protein) was found to have little effect on the size of the baby, but intake of micronutrient-rich foods (leafy vegetables, fruit and milk) and concentrations of vitamin B12, folate and vitamin C were strong determinants of offspring size. The women gave birth to small thin babies (average weight 2.7 kg). But despite their small size, they had comparable central subcutaneous fat. They had higher concentrations of insulin and leptin in the cord blood, which suggest that the body composition at birth may be a more important risk factor for future Type 2 diabetes than size itself. The babies were followed up every six months to evaluate diabetes and heart disease risk. When they were six years old, the low levels of maternal B12 vitamin and high folate helped the researchers predict a risk of higher adiposity and insulin resistance. While none of the children have yet got diabetes, Yajnik says that those two factors are clear-cut indicators of contracting the disease.
