India is experiencing an escalating epidemic of diabetes for which the most cost-effective solution is prevention. Awareness is the first step towards prevention. We undertook a questionnaire-based study to evaluate gaps in awareness of different implications of diabetes among various sections of the urban population of Pune. Individuals aged ≥13 years (378 diabetic, 1122 non-diabetic) from different socio-economic backgrounds were interviewed using a structured questionnaire. Awareness regarding causes, symptoms, complications, treatment and preventive measures, curability of diabetes and long-term implications of diabetes in pregnancy was evaluated. An awareness score was calculated based on the percent of total questions correctly answered. Of those surveyed, 78 % scored less than 50 %, 44 % did not know the meaning of diabetes, 30 % could not name any of the risk factors, symptoms, complications and preventive measures for diabetes, and 70 % were unaware of the long-term risks of diabetes in pregnancy. As a group, diabetic participants scored marginally better than non-diabetic participants (mean score 39 vs. 31 %; P<0.001). Participants at high risk of diabetes (sedentary workers, non-diabetic participants with first-degree family history of diabetes and non-diabetic hypertensive participants) had poor knowledge about the condition (mean scores <40 %). Lower age, lower education and male gender were independently associated with poor awareness; education was the strongest predictor. Awareness regarding different implications of diabetes is poor in the population of Pune. There is a need for widespread and extensive public education campaigns to raise awareness and contribute to the national diabetes prevention initiatives.
Background: Maternal nutrition during pregnancy is a strong determinant of fetal size, body composition and future health. A few studies have measured detailed neonatal anthropometry and body composition. We studied the association between maternal pregnancy measurements and neonatal size and body composition in GDM and NGT pregnancies. Methods: Mothers from antenatal clinics were tested with 75gm OGTT (IADPSG criteria). Maternal demographic, anthropometric, and nutritional (vit B12, folate, homocysteine) and metabolic (glucose, insulin, lipids) measurements were obtained. Detailed neonatal anthropometry and body composition (DXA) were measured. We studied maternal predictors of neonatal size and composition by adjusting for socio economic status (SES), gestation at delivery and sex of baby. Results: We studied 398 pregnancies (234 NGT, 164 GDM). GDM mothers were older, more affluent, obese, and had higher triglycerides but lower HDL and total cholesterol concentrations compared to NGT mothers. Neonates of GDM mothers were heavier and more adipose (skinfolds, DXA body fat%) but 25% were SGA (INTERGROWTH). In addition to the conventional predictors (maternal size, adiposity and weight gain), we found novel associations of neonatal size (birthweight and length) with maternal folate (direct) and homocysteine (inverse) and of neonatal adiposity with maternal glucose and insulin resistance (direct), and HDL cholesterol and disposition index (inverse). Conclusion: Our results highlight a role for maternal micronutrient nutrition, fuels and insulin resistance in influencing neonatal size and body composition. These findings expand the concept of ‘fuel mediated teratogenesis’ (Freinkel, 1980) to ‘dual teratogenesis’ (Yajnik, 2009) and offer additional opportunities to improve fetal growth and body composition. Increasing dietary methyl donors may be useful in addition to controlling maternal insulin resistance may reduce fetal adiposity. Disclosure M.K. Deshmukh: None. A.A. Bhalerao: None. D.A. Raut: None. N.S. Memane: None. R. Kamat: None. D. Bhat: None. H. Damle: None. S.S. Wagle: None. C.S. Yajnik: None.
Background: Based on studies in overweight-obese populations, it is tacitly assumed that maternal hyperglycemia is responsible for obesity-adiposity at birth and in later life. Study design: Two hospital based case control studies: 1) Neonatal outcomes, 2) Later life outcomes. Methods: We studied associations of neonatal and later life obesity-adiposity [age and sex-adjusted BMI, waist circumference, skinfolds, and body fat percent by Dual energy X-ray Absorptiometry (DXA)] in offspring of mothers with diabetes (ODM) and those of mothers without diabetes (ONDM). Exposures were parental hyperglycemia and overweight-obesity. Results: Neonatal study included 372 non-diabetic and 816 diabetic pregnancies [74 type 1 diabetes, 102 type 2 diabetes, 640 gestational diabetes (GDM)]. Mothers with type 1 diabetes were the youngest, thinnest, and with highest HbA1c. Maternal glycemia but not BMI was associated with neonatal obesity-adiposity. Thus, neonates of mothers with type 1 diabetes had highest ponderal index, abdominal circumference, and skinfolds. Later life study included 200 ODM (25 type 1 diabetes, 22 type 2 diabetes, 153 GDM) and 177 age, sex and socio-economic matched ONDM (2 to 26 y). Their obesity-adiposity was associated with bi-parental overweight-obesity in an additive manner, but not with parental diabetes. Offspring birth weight was also positively associated. Offspring of mothers with type 1 diabetes had the lowest and offspring of mothers with type 2 diabetes the highest obesity-adiposity. Conclusion: Neonatal obesity-adiposity is driven by maternal glycemia while later life obesity-adiposity by bi-parental obesity. Our results provide a clear insight into pathogenesis of obesity-adiposity in the offspring.
Background: It’s well known that maternal diabetes increases risk of obesity-adiposity and hyperglycemia in children. Few studies have explored the modifying influence of child’s lifestyle (nutrition and physical activity, PA). Intensive treatment of GDM have not shown any protection against adiposity in the child. We assessed the current lifestyle in offspring of diabetic mothers (ODM) 2-26 years after birth and investigated its association with obesity-adiposity and hyperglycemia. Methods: We studied 200 ODM and 177 offspring of nondiabetic mothers (ONDM, age and gender matched). Anthropometry, body composition (DXA) and blood glucose (capillary in <10y, 1.75g/kg OGTT in >10y) were measured. Overweight + obesity was classified by international standards [IOTF (≤18y), WHO (>18y)], glucose intolerance (ADA 2014). Dietary intake was assessed using food frequency questionnaire (preceding 6 months) and PA by recording time and frequency of vigorous, moderate, and sedentary activities. We studied the influence of diet and activity on risks of obesity-adiposity and hyperglycemia. Results: ODM consumed sweets, milk and milk products, vegetables and salads more frequently and cereals less frequently than ONDM. Frequent consumption of ‘healthy foods’ and infrequent consumption of ‘unhealthy foods’ were associated with decreased risk for obesity-adiposity. Higher level of moderate PA (>60min/day) and lower sedentary PA (<480 min/day) were associated with lower obesity-adiposity in both the groups. Hyperglycemia was not affected. These effects worked across both groups, there was no interaction with maternal diabetes. Conclusions: Healthy lifestyle (food and activity) is protective against obesity-adiposity but not against hyperglycemia in young Indian children (both ODM and ONDM). Our results suggest a need for a formal lifestyle intervention in children born in diabetic pregnancies for reduction in obesity-adiposity and hyperglycemia. Disclosure S.S. Wagle: None. K. Kumaran: None. R. Ladkat: None. D. Bhat: None. R. Kamat: None. S. Wadke: None. M.K. Deshmukh: None. P.C. Yajnik: None. C.S. Yajnik: None.
Background: Maternal diabetes is a risk factor for obesity and glucose intolerance in the child, and contributes to the escalating epidemic of diabesity. This could have both a genetic and fetal programming basis. Only sparse data is available in India. We followed children born to diabetic and nondiabetic mothers 2-26 years after delivery to assess their cardio-metabolic risk factors. Methods: Of 861 women diagnosed and treated for diabetes in pregnancy (1986-2014), we traced 346 and studied 200 children (ODM). We also studied 177 children of nondiabetic mothers (ONDM), matched for age, gender and socioeconomic status. We measured anthropometry, body composition (DXA) and a capillary blood glucose (<10y, 119 ODM, 93 ONDM) or a 1.75g/kg OGTT with venous blood (>10y, 81 ODM, 84 ONDM). Overweight+obesity was diagnosed by IOTF (≤18y) or WHO criteria (>18y). Glucose tolerance was classified by the ADA 2014 criteria. We compared cardio-metabolic risk factors in ODM and ONDM by calculating age and gender specific SD scores (reference ONDM). Results: Three (4%) ODM were known diabetic (diagnosed at 16, 14 and 23y, 2 receiving OHA and 1 insulin), one was diagnosed on testing. ODM had higher BMI, skinfolds, body fat percent, and circulating glucose, insulin, total and LDL cholesterol, and triglyceride concentrations. ODM had higher HOMA-IR and pulse rate but lower disposition index (HOMA-β/HOMA-IR) and diastolic blood pressure. Prediabetes (IFG+IGT) (37 vs. 20%, p=0.005) and overweight+obesity (24 vs. 15%, p=0.014) were more common in ODM compared to ONDM. Conclusions: We confirm elevated risk of obesity, adiposity, diabetes and other cardio-metabolic risk factors in children of Indian diabetic mothers. Despite following the current standards of practice for GDM management, the offspring continue to have high risk of diabesity. This suggests a need for reevaluation of current standards of care which overlook the peri-conceptional window of fetal programming. Disclosure S.S. Wagle: None. K. Kumaran: None. R. Ladkat: None. D. Bhat: None. P.C. Yajnik: None. C.S. Yajnik: None.
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