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1.  Association between maternal folate concentrations during pregnancy and insulin resistance in Indian children 
Diabetologia  2013;57:110-121.
Aims/hypothesis
In an Indian birth cohort, higher maternal homocysteine concentration in pregnancy was associated with lower birthweight of the offspring. Lower maternal vitamin B12 and higher folate concentrations were associated with higher offspring insulin resistance. Disordered one-carbon metabolism during early development may increase later metabolic risk. We explored these associations in another birth cohort in India at three age points.
Methods
We measured plasma vitamin B12, folate and homocysteine concentrations at 30 ± 2 weeks’ gestation in 654 women who delivered at one hospital. Neonatal anthropometry was recorded, and the children’s glucose and insulin concentrations were measured at 5, 9.5 and 13.5 years of age. Insulin resistance was estimated using HOMA of insulin resistance (HOMA-IR).
Results
Maternal homocysteine concentrations were inversely associated with all neonatal anthropometric measurements (p < 0.05), and positively associated with glucose concentrations in the children at 5 (30 min; p = 0.007) and 9.5 years of age (120 min; p = 0.02). Higher maternal folate concentrations were associated with higher HOMA-IR in the children at 9.5 (p = 0.03) and 13.5 years of age (p = 0.03). Maternal vitamin B12 concentrations were unrelated to offspring outcomes.
Conclusions/interpretation
Maternal vitamin B12 status did not predict insulin resistance in our cohort. However, associations of maternal homocysteine and folate concentrations with birth size, and with childhood insulin resistance and glycaemia in the offspring, suggest a role for nutritionally driven disturbances in one-carbon metabolism in fetal programming of diabetes.
Electronic supplementary material
The online version of this article (doi:10.1007/s00125-013-3086-7) contains peer-reviewed but unedited supplementary material, which is available to authorised users.
doi:10.1007/s00125-013-3086-7
PMCID: PMC3855580  PMID: 24162586
Child; Folate; Homocysteine; Insulin resistance; Pregnancy; Programming; Vitamin B12
2.  Testing the fetal overnutrition hypothesis; the relationship of maternal and paternal adiposity to adiposity, insulin resistance and cardiovascular risk factors in Indian children 
Public health nutrition  2012;16(9):1656-1666.
Objective
We aimed to test the fetal overnutrition hypothesis by comparing the associations of maternal and paternal adiposity (sum of skinfolds) with adiposity and cardiovascular risk factors in children.
Design
Children from a prospective birth cohort had anthropometry, fat percentage (bio-impedance), plasma glucose, insulin and lipid concentrations and blood pressure measured at 9·5 years of age. Detailed anthropometric measurements were recorded for mothers (at 30 ± 2 weeks’ gestation) and fathers (5 years following the index pregnancy).
Setting
Holdsworth Memorial Hospital, Mysore, India.
Subjects
Children (n 504), born to mothers with normal glucose tolerance during pregnancy.
Results
Twenty-eight per cent of mothers and 38 % of fathers were overweight/obese (BMI ≥ 25·0 kg/m2), but only 4 % of the children were overweight/obese (WHO age- and sex-specific BMI ≥ 18·2 kg/m2). The children’s adiposity (BMI, sum of skinfolds, fat percentage and waist circumference), fasting insulin concentration and insulin resistance increased with increasing maternal and paternal sum of skinfolds adjusted for the child’s sex, age and socio-economic status. Maternal and paternal effects were similar. The associations with fasting insulin and insulin resistance were attenuated after adjusting for the child’s current adiposity.
Conclusions
In this population, both maternal and paternal adiposity equally predict adiposity and insulin resistance in the children. This suggests that shared family environment and lifestyle, or genetic/epigenetic factors, influence child adiposity. Our findings do not support the hypothesis that there is an intrauterine overnutrition effect of maternal adiposity in non-diabetic pregnancies, although we cannot rule out such an effect in cases of extreme maternal obesity, which is rare in our population.
doi:10.1017/S1368980012003795
PMCID: PMC3622715  PMID: 22895107
Adiposity; Cardiovascular risk factors; Children; India; Insulin resistance; Intergeneration; Maternal and paternal effects
3.  Acceptability of male circumcision among mothers with male children in Mysore, India 
AIDS (London, England)  2008;22(8):983-988.
Objective
There is currently little information on the acceptability of male circumcision in India. This study investigated the acceptability of male circumcision among Indian mothers with male children.
Design
A cross-sectional survey was conducted among a convenience sample of 795 women attending a reproductive health clinic in Mysore, India, between January and April 2007.
Results
Of the 1012 invited eligible participants, 795 women agreed to participate (response rate = 78.5%). The majority of women were Hindus (78%), 18% were Muslims, and 4% were Christians. About 26% of respondents had no schooling, 29% had 7 years of schooling, 42% had 8–12 years, and 3% had more than 12 years. After women were informed about the risks and benefits of male circumcision, a majority of women with uncircumcised children (n = 564, 81%) said they would definitely circumcise their children if the procedure were offered in a safe hospital setting, free of charge, and a smaller number (n = 50, 7%) said they would probably consider the procedure. Only seven women (1%) said that they would definitely/probably not consider male circumcision, and 63 (9%) were unsure.
Conclusion
Since male circumcision has been found to decrease risk of HIV infection among men, it is important to determine its acceptability as a potential HIV prevention strategy in India. This study found male circumcision to be highly acceptable among a broad range of mothers with male children in Mysore, India. Further studies of acceptability among fathers and other populations are warranted.
doi:10.1097/QAD.0b013e3282ffde52
PMCID: PMC3612934  PMID: 18453858
acceptability; circumcision; India; men; women
4.  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
5.  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
6.  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
7.  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

Results 1-7 (7)