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1.  Infant feeding practice and childhood cognitive performance in South India 
Archives of disease in childhood  2009;95(5):347-354.
Aim
Several studies have suggested a beneficial effect of infant breast-feeding on childhood cognitive function. Our main objective was to examine whether duration of breast-feeding and age at introduction of complementary foods are related to cognitive performance in 9-10 year old school going children in South-India.
Methods
We examined 514 children from the Mysore Parthenon birth cohort for whom breast-feeding duration (6 categories from <3 to ≥18 months) and age at introduction of complementary foods (4 categories from <4 to ≥6 months) were collected at the 1st, 2nd and 3rd year annual follow-up visits. Their cognitive function was assessed at a mean age of 9.7 years using 3 core tests from the Kaufman Assessment Battery for children and additional tests measuring long-term retrieval/storage, attention and concentration, visuo-spatial and verbal abilities.
Results
All the children were initially breast-fed. The mode for duration of breast-feeding was 12-17 months (45.7%) and for age at introduction of complementary foods 4 months (37.1%). There were no associations between longer duration of breast-feeding, or age of introduction of complementary foods, and cognitive function at 9-10 years, either unadjusted or after adjustment for age, sex, gestation, birth size, maternal age, parity, socio-economic status, parents’ attained schooling, and rural/urban residence.
Conclusions
Within this cohort, in which prolonged breast-feeding was the norm (90% breast-fed ≥6 months and 65% breast-fed for ≥12 months), there was no evidence suggesting a beneficial effect of longer duration of breast-feeding on later cognitive ability.
doi:10.1136/adc.2009.165159
PMCID: PMC3428883  PMID: 19946010
Breast-feeding; Complementary foods; Children; Cognitive performance; India
2.  Maternal vitamin D status during pregnancy and body composition and cardiovascular risk markers in Indian children: the Mysore Parthenon study 
Background
Metabolic consequences of vitamin D deficiency have become a recent research focus. Maternal vitamin D status is thought to influence musculo-skeletal health in children, but its relationship with offspring metabolic risk is not known.
Objective
We aimed to examine the association between maternal vitamin D status and anthropometry, body composition and cardiovascular risk markers in Indian children.
Design
Serum 25-hydroxy D (25(OH)D ) concentrations were measured at 28-32 weeks gestation in 568 women who delivered at Holdsworth Memorial Hospital, Mysore. Anthropometry, glucose and insulin concentrations, blood pressure (BP) and fasting lipid concentrations were measured in the offspring at 5 and 9.5 years of age. Muscle-grip strength was measured using a hand held dynamometer at 9.5 years. Arm-muscle-area was calculated as a measure of muscle mass. Fasting insulin resistance was calculated using the HOMA equation.
Results
67% of women had vitamin D deficiency (serum 25(OH)D concentration <50 nmol/l). At 5 and 9.5 years, children born to vitamin D deficient mothers had smaller arm-muscle-area compared to children born to mothers without deficiency (P<0.05). There was no difference in grip strength between offspring of women with and without vitamin D deficiency. At 9.5 years, children of vitamin D deficient mothers had higher fasting insulin resistance than children of non-deficient women (P=0.04). There were no associations between maternal vitamin D status and other offspring risk factors at either age.
Conclusions
Intra-uterine exposure to low 25(OH)D concentrations is associated with lower muscle mass and higher insulin resistance in children.
doi:10.3945/ajcn.110.003921
PMCID: PMC3407368  PMID: 21228264
3.  MOTHER’S LIFETIME NUTRITION AND THE SIZE, SHAPE AND EFFICIENCY OF THE PLACENTA 
Placenta  2011;32(11):806-810.
Background
Studies have shown that the shape and size of the placenta at birth predict blood pressure in later life. The influences that determine placental morphology are largely unknown. We have examined the role of mother’s body size.
Methods
We studied 522 neonates who were born in a maternity hospital in Mysore, South India. The weight of the placenta and the length and breadth of its surface, were measured after delivery.
Results
Higher maternal fat mass predicted a larger placental surface (p=0.02), while larger maternal head circumference predicted a more oval placental surface (p=0.03). Higher maternal fat mass and larger maternal head circumference were associated with greater placental efficiency, indicated by lower ratios of the length (p=0.0003 and p=0.0001 respectively) and breadth (p=0.0002 and p<0.0001) of the surface to birthweight. In a sub-sample of 51 mothers whose own birthweight was available, higher maternal birthweight was related to lower ratios of the length and breadth of the surface to birthweight (p=0.01 and 0.002). Maternal height was unrelated to placental size or shape.
Conclusions
Higher maternal fat mass, reflecting the mother’s current nutritional state, and larger maternal head circumference, reflecting the mother’s fetal/infant growth, are associated with changes in the shape and size of the placental surface and greater placental efficiency. We suggest that these associations reflect effects of the mother’s nutrition at different stages of her lifecourse on the development of the placenta and on materno-placento-fetal transfer of nutrients.
doi:10.1016/j.placenta.2011.09.001
PMCID: PMC3223394  PMID: 21924491
Birthweight; maternal body composition; placenta; placental efficiency
4.  Cardiometabolic Risk Markers in Indian Children: Comparison with UK Indian and White European Children 
PLoS ONE  2012;7(4):e36236.
Objective
UK Indian adults have higher risks of coronary heart disease and type 2 diabetes than Indian and UK European adults. With growing evidence that these diseases originate in early life, we compared cardiometabolic risk markers in Indian, UK Indian and white European children.
Methods
Comparisons were based on the Mysore Parthenon Birth Cohort Study (MPBCS), India and the Child Heart Health Study in England (CHASE), which studied 9–10 year-old children (538 Indian, 483 UK Indian, 1375 white European) using similar methods. Analyses adjusted for study differences in age and sex.
Results
Compared with Mysore Indians, UK Indians had markedly higher BMI (% difference 21%, 95%CI 18 to 24%), skinfold thickness (% difference 34%, 95%CI 26 to 42%), LDL-cholesterol (mean difference 0.48, 95%CI 0.38 to 0.57 mmol/L), systolic BP (mean difference 10.3, 95% CI 8.9 to 11.8 mmHg) and fasting insulin (% difference 145%, 95%CI 124 to 168%). These differences (similar in both sexes and little affected by adiposity adjustment) were larger than those between UK Indians and white Europeans. Compared with white Europeans, UK Indians had higher skinfold thickness (% difference 6.0%, 95%CI 1.5 to 10.7%), fasting insulin (% difference 31%, 95%CI 22 to 40%), triglyceride (% difference 13%, 95%CI 8 to 18%) and LDL-cholesterol (mean difference 0.12 mmol/L, 95%CI 0.04 to 0.19 mmol/L).
Conclusions
UK Indian children have an adverse cardiometabolic risk profile, especially compared to Indian children. These differences, not simply reflecting greater adiposity, emphasize the need for prevention strategies starting in childhood or earlier.
doi:10.1371/journal.pone.0036236
PMCID: PMC3338673  PMID: 22558399
5.  Association of birthweight and head circumference at birth to cognitive performance in 9-10 year old children in South India: prospective birth cohort study 
Pediatric research  2010;67(4):424-429.
To examine whether birthweight and head circumference at birth are associated with childhood cognitive ability in South-India, cognitive function was assessed using 3 core tests from the Kaufman Assessment Battery for children and additional tests measuring long-term retrieval/storage, attention and concentration, visuo-spatial and verbal abilities among 505 full-term born children (mean age 9.7-y). In multiple linear regression adjusted for age, sex, gestation, socio-economic status, parent’s education, maternal age, parity, BMI, height, rural/urban residence, and time of testing, Atlantis score (learning ability/long-term storage and retrieval) rose by 0.1 SD per SD increase in newborn weight and head circumference respectively (p<0.05 for all) and Kohs’ block design score (visuo-spatial ability) increased by 0.1 SD per SD increase in birthweight (p<0.05). The associations were reduced after further adjustment for current head circumference. There were no associations of birthweight and/or head circumference with measures of short-term memory, fluid reasoning, verbal abilities and attention and concentration. In conclusion higher birthweight and larger head circumference at birth are associated with better childhood cognitive ability. The effect may be specific to learning, long-term storage and retrieval, and visuo-spatial abilities, but this requires confirmation by further research.
doi:10.1203/PDR.0b013e3181d00b45
PMCID: PMC3073480  PMID: 20032815
6.  Intrauterine Exposure to Maternal Diabetes Is Associated With Higher Adiposity and Insulin Resistance and Clustering of Cardiovascular Risk Markers in Indian Children 
Diabetes Care  2009;33(2):402-404.
OBJECTIVE
To test the hypothesis that maternal gestational diabetes increases cardiovascular risk markers in Indian children.
RESEARCH DESIGN AND METHODS
Anthropometry, blood pressure, and glucose/insulin concentrations were measured in 514 children at 5 and 9.5 years of age (35 offspring of diabetic mothers [ODMs], 39 offspring of diabetic fathers [ODFs]). Children of nondiabetic parents were control subjects.
RESULTS
At age 9.5 years, female ODMs had larger skinfolds (P < 0.001), higher glucose (30 min) and insulin concentrations, and higher homeostasis model assessment (HOMA) of insulin resistance and systolic blood pressure (P < 0.05) than control subjects. Male ODMs had higher HOMA (P < 0.01). Associations were stronger than at age 5 years. Female ODFs had larger skinfolds and male ODFs had higher HOMA (P < 0.05) than control subjects; associations were weaker than for ODMs. Associations between outcomes in control subjects and parental BMI, glucose, and insulin concentrations were similar for mothers and fathers.
CONCLUSIONS
The intrauterine environment experienced by ODMs increases diabetes and cardiovascular risk over genetic factors; the effects strengthen during childhood.
doi:10.2337/dc09-1393
PMCID: PMC2809291  PMID: 19918007
7.  Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size 
Background/objectives:
Vitamin D is required for bone growth and normal insulin secretion. Maternal hypovitaminosis D may impair fetal growth and increase the risk of gestational diabetes. We related maternal vitamin D status in pregnancy to maternal and newborn glucose and insulin concentrations, and newborn size, in a South Indian population.
Subjects/methods:
Serum 25 hydroxy vitamin D (25(OH)D) concentrations, glucose tolerance, and plasma insulin, proinsulin and 32-33 split proinsulin concentrations were measured at 30 weeks gestation in 559 women who delivered at the Holdsworth Memorial Hospital, Mysore. The babies' anthropometry and cord plasma glucose, insulin and insulin precursor concentrations were measured.
Results:
66% of women had hypovitaminosis D [25(OH)D concentrations <50 nmol/l] and 31% were below 28 nmol/l. There was seasonal variation in 25(OH)D concentrations (P<0.0001). There was no association between maternal 25(OH)D and gestational diabetes (incidence 7% in women with and without hypovitaminosis D). Maternal 25(OH)D concentrations were unrelated to newborn anthropometry or cord plasma variables. In mothers with hypovitaminosis D, higher 25(OH)D concentrations were associated with lower 30-minute glucose concentrations (p=0.03) and higher fasting proinsulin concentrations (p=0.04).
Conclusions:
Hypovitaminosis D at 30 weeks gestation is common in Mysore mothers. It is not associated with an increased risk of gestational diabetes, impaired fetal growth, or altered neonatal cord plasma insulin secretory profile.
doi:10.1038/ejcn.2008.14
PMCID: PMC2678985  PMID: 18285809
Vitamin D; Prenatal nutrition; Pregnancy outcome; Birth weight; India; Gestational diabetes; Glucose tolerance; Insulin secretion; Cord blood insulin
8.  A principal components approach to parent-to-newborn body composition associations in South India 
BMC Pediatrics  2009;9:16.
Background
Size at birth is influenced by environmental factors, like maternal nutrition and parity, and by genes. Birth weight is a composite measure, encompassing bone, fat and lean mass. These may have different determinants. The main purpose of this paper was to use anthropometry and principal components analysis (PCA) to describe maternal and newborn body composition, and associations between them, in an Indian population. We also compared maternal and paternal measurements (body mass index (BMI) and height) as predictors of newborn body composition.
Methods
Weight, height, head and mid-arm circumferences, skinfold thicknesses and external pelvic diameters were measured at 30 ± 2 weeks gestation in 571 pregnant women attending the antenatal clinic of the Holdsworth Memorial Hospital, Mysore, India. Paternal height and weight were also measured. At birth, detailed neonatal anthropometry was performed. Unrotated and varimax rotated PCA was applied to the maternal and neonatal measurements.
Results
Rotated PCA reduced maternal measurements to 4 independent components (fat, pelvis, height and muscle) and neonatal measurements to 3 components (trunk+head, fat, and leg length). An SD increase in maternal fat was associated with a 0.16 SD increase (β) in neonatal fat (p < 0.001, adjusted for gestation, maternal parity, newborn sex and socio-economic status). Maternal pelvis, height and (for male babies) muscle predicted neonatal trunk+head (β = 0. 09 SD; p = 0.017, β = 0.12 SD; p = 0.006 and β = 0.27 SD; p < 0.001). In the mother-baby and father-baby comparison, maternal BMI predicted neonatal fat (β = 0.20 SD; p < 0.001) and neonatal trunk+head (β = 0.15 SD; p = 0.001). Both maternal (β = 0.12 SD; p = 0.002) and paternal height (β = 0.09 SD; p = 0.030) predicted neonatal trunk+head but the associations became weak and statistically non-significant in multivariate analysis. Only paternal height predicted neonatal leg length (β = 0.15 SD; p = 0.003).
Conclusion
Principal components analysis is a useful method to describe neonatal body composition and its determinants. Newborn adiposity is related to maternal nutritional status and parity, while newborn length is genetically determined. Further research is needed to understand mechanisms linking maternal pelvic size to fetal growth and the determinants and implications of the components (trunk v leg length) of fetal skeletal growth.
doi:10.1186/1471-2431-9-16
PMCID: PMC2649926  PMID: 19236724
9.  Gestational Diabetes and the Incidence of Diabetes in the 5 Years following the Index Pregnancy in South Indian Women 
This study was carried out to examine the incidence of diabetes and the factors associated with this in a cohort of south Indian women five years after they were examined for gestational diabetes (GDM). Women (N=630) whose GDM status was determined (Carpenter-Coustan criteria; GDM: N=41) delivered live babies without major anomalies at the Holdsworth Memorial Hospital, Mysore. Of these, 526 women (GDM: N=35) available for follow-up after 5 years underwent a 2-hour oral glucose tolerance test and detailed anthropometry. Diabetes was determined using WHO criteria, and Metabolic Syndrome using IDF criteria recommended for south Asian women. The incidence of diabetes (37% vs. 2%) and Metabolic Syndrome (60% vs. 26%) was considerably higher in women with previous GDM compared to non-GDM women. GDM women who developed diabetes had lower gestational insulin area-under-the-curve (P=0.05). They had larger waist-to-hip ratio, skinfolds, body mass index, and lower 30-minute insulin increment at follow-up than other GDM women. In all, history of diabetes in first-degree relatives was independently associated with higher incidence of diabetes (P<0.001). Our findings suggest high diabetes and cardiovascular risks in women with previous GDM. Follow-up of these women after delivery would provide opportunities to modify adverse lifestyle factors.
doi:10.1016/j.diabres.2007.06.002
PMCID: PMC2358951  PMID: 17640759
Gestational diabetes; type 2 diabetes; follow-up; India; Metabolic Syndrome
10.  Gestational diabetes and the incidence of diabetes in the 5 years following the index pregnancy in South Indian women 
This study was carried out to examine the incidence of diabetes and the factors associated with this in a cohort of South Indian women 5 years after they were examined for gestational diabetes (GDM). Women (N = 630) whose GDM status was determined (Carpenter-Coustan criteria; GDM: N = 41) delivered live babies without major anomalies at the Holdsworth Memorial Hospital, Mysore. Of these, 526 women (GDM: N = 35) available for follow-up after 5 years underwent a 2-h oral glucose tolerance test and detailed anthropometry. Diabetes was determined using WHO criteria, and Metabolic Syndrome using IDF criteria recommended for south Asian women. The incidence of diabetes (37% versus 2%) and Metabolic Syndrome (60% versus 26%) was considerably higher in women with previous GDM compared to non-GDM women. GDM women who developed diabetes had lower gestational insulin area-under-the-curve (P = 0.05). They had larger waist-to-hip ratio, skinfolds, body mass index, and lower 30-min insulin increment at follow-up than other GDM women. In all, history of diabetes in first-degree relatives was independently associated with higher incidence of diabetes (P < 0.001). Our findings suggest high diabetes and cardiovascular risks in women with previous GDM. Follow-up of these women after delivery would provide opportunities to modify adverse lifestyle factors.
doi:10.1016/j.diabres.2007.06.002
PMCID: PMC2358951  PMID: 17640759
Gestational diabetes; Type 2 diabetes; Follow-up; India; Metabolic Syndrome
11.  Placental programming of blood pressure in Indian children 
Aim
To determine whether the size and shape of the placental surface predict blood pressure in childhood.
Methods
We studied blood pressure in 471 nine-year-old Indian children whose placental length, breadth and weight were measured in a prospective birth cohort study.
Results
In the daughters of short mothers (
Conclusions
The size and shape of the placental surface predict childhood blood pressure. Blood pressure may be programmed by variation in the normal processes of placentation: these include implantation, expansion of the chorionic surface in mid-gestation and compensatory expansion of the chorionic surface in late gestation.
doi:10.1111/j.1651-2227.2010.02102.x
PMCID: PMC3107945  PMID: 21166711
Birth size; Blood pressure; Indian children; Maternal height; Placental surface

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