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Complicated though it sounds, this is the conclusion of the Pune Maternal Nutrition Study, conducted at the diabetes center of KEM hospital in Pune, India. This study has been accepted for publication in the journal Diabetologia in the upcoming months.
This study is unusual in that it investigates the relationship between maternal nutrition and the risk to offspring of Type 2 diabetes and heart disease.
The Diabetes Unit at the KEM hospital, headed by Dr. C. S. Yajnik, has been actively investigating peculiarities of diabetes in Indians for the past two decades. The unit's researchers believe that the nutrition and metabolism of the mother determine the health of the offspring. In fact, they have described these factors as being responsible for the birth of a baby who is at high risk of developing diabetes and heart disease later in life.
It is a common practice in India to prescribe iron and folic acid to pregnant women. But studies conducted in Pune by the Diabetes Unit have shown that folate deficiency is rarely encountered, whereas vitamin B12 deficiency is very common.
In a situation where there is an excess of folic acid and a deficiency of Vitamin B12, it is speculated that certain events occur in the metabolic pathways that lead to increased fat tissue production and deposition and decreased protein synthesis and lean tissue deposition. This could be the cause of the birth of a 'thin-fat' child, or a child who has less lean tissue but comparatively high fat tissue.
Indian diabetics generally appear thin compared to patients in Britain, but have big waists, more fat around the internal body organs and around the hips. They belong to the 'thin-fat' group of patients.
The 'thin-fat' people are said to be insulin resistant. That means their bodies require high quantities of insulin, the enzyme responsible for the utilization of sugar, to produce its normal effects. Such insulin-resistant people are at a high risk of developing diabetes.
Dr. Yajnik and his team recruited 700 pregnant women from six villages for the Pune Maternal Nutrition Study. The study began in 1993. They measured maternal nutritional intake and circulating levels of folic acid and vitamin B12 at 18 and 28 weeks of pregnancy. More than 60 percent of the women had low levels of vitamin B12, while only one woman had a low concentration of folic acid. The women were supplemented with oral iron and folic acid, as per the routine norm in India.
The children of these mothers were measured in detail at birth and every six months thereafter for six years. At 6 years of age, the offspring were investigated for body size, body composition and evidence of insulin resistance.
The children were found to be short and thin but with relatively more fat compared to white Caucasian children. They were thin-fat, similar to Indian babies and adults. Insulin resistance was not excessive, but on the higher side. The offspring of mothers with a combination of high folate and low vitamin B12 concentrations were the most insulin resistant.
The Pune Maternal Nutrition Study is the first in humans to suggest that a defect in the metabolism of Vitamin B12 and folic acid could be at the heart of programming of adult diabetes in India. Further studies are needed to test these findings.
India has the largest number of diabetics in the world. It could be due to the intra-uterine programming, as suggested by the study. Indian mothers have been shown to be deficient in vitamin B12. This vitamin is required in very small amounts, about 2-4 micrograms per day. Non-vegetarian foods and dairy products are rich sources of this vitamin.
Most Indians are vegetarian for religious reasons or because of socio-economic reasons. Supplementation of the diet with Vitamin B12 might be an easy answer to reduce the increasing incidence of this metabolic disease. Further studies should be done to corroborate the findings of this study and the line of management should be determined. After all, the health of the newborn children determines the health of a nation.
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(Dr. Pradnya Kulkarni is a former clinical pathologist for a private laboratory in Pune, India. She now devotes her time to writing medical articles.)
