KEM Hospital Research Centre, Pune
C S Yajnik is the Director of the Diabetes Unit at the King Edward Memorial Hospital and Research Centre in Pune, India. He investigates the high susceptibility of Indians to diabetes and related disorders. He is known for his description of the ‘thin-fat’ Indian (high body fat percent at low BMI) and its intrauterine programming by maternal nutritional and metabolic factors. He is an Honorary Visiting Fellow, MRC Lifecourse Epidemiology Unit, Southampton, UK, visiting Professor at University of Exeter UK, and of the Danish Diabetes Academy, and adjunct Professor IISER, Pune. He received Helmut Mehnert Award of International Diabetes Federation (2009), David Barker Medal of International DOHaD Society (2011), and Outstanding Investigator Award of World-India Diabetes Foundation. Yajnik is an advisor to numerous organizations including DBT, ICMR, National Institute of Nutrition (NIN), India, WHO (Geneva), and the Wellcome Trust, London, UK.
SESSION 2C: Symposium: Community Health– A Genomic Perspective
Rajiva Raman, BHU, Varanasi
Early life origins of diabetes in Indians
The dogma of diabetes describes a genetic susceptibility and precipitation by obesogenic factors (diet, inactivity, stress etc). The genetic factors are non-modifiable, therefore, the diabetes prevention trials of today concentrate on treatment of precipitating factors (diet, exercise and stress). The interventions are usually done in post-reproductive adults, and therefore, do not help the next generation. Both fetal under- and over-nutrition has been found to increase susceptibility of the fetus to future disease; this process is now called ‘fetal programming’. A wide range of environmental factors operating in pregnancy have the potential for fetal programming. India has a unique position, in that it is the world’s capital of early life undernutrition, as well as being one of the world capitals of diabetes. Research has demonstrated a substantial role for fetal programming by maternal undernutrition, as well as diabetes, in the aetiology of diabetes. A part of this susceptibility operates through influences on body composition and both micronutrient deficiencies and macronutrient excess increase the risk. Postnatal factors that promote a catch-up growth in small babies seem to exaggerate the risk. Epigenetic factors also seem to be playing an important role, which suggests that the susceptibility to non-communicable disease could be modified. Trials are in progress to influence fetal programming by improving the health of the adolescents.