Hostname: page-component-cd4964975-ppllx Total loading time: 0 Render date: 2023-04-01T17:48:13.023Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Obesity epidemic in India: intrauterine origins?

Published online by Cambridge University Press:  07 March 2007

C. S. Yajnik*
Diabetes Unit, King Edward Memorial Hospital & Research Center, Sardar Moodliar Road, Rasta Peth, Pune 411011, India
Corresponding author: Dr C. S. Yajnik, fax +91 020 612 5603, email
Rights & Permissions[Opens in a new window]


HTML view is not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The epidemic of ‘obesity’ in India is not appreciated because BMI underestimates the adiposity of Indians. Specific adiposity measurements are necessary for recognition of the adiposity of ‘thin’ Indians. The origin of this adiposity is only beginning to be understood. In addition to a possible genetic predisposition, intrauterine ‘programming’ might be responsible, although in the ‘thrifty phenotype’ hypothesis the adiposity of the ‘thin’ fetus has not been appreciated. Dutch men who faced ‘winter hunger’ during the first trimester of their in utero life have become more obese as adults. Low birth weight predicts central obesity in some studies, including studies in urban children. It has also been shown that small and thin Indian newborns (weight 2·7?kg and ponderal index 2·4?kg\m3) have poor muscle and visceral mass but higher adiposity for a given weight compared with white Caucasian babies. This body composition is influenced by maternal adiposity before pregnancy and by aspects of maternal nutritional intake and circulating nutrient concentrations during pregnancy. There are no strong paternal determinants of adiposity at birth. Adiposity may be an integral part of the orchestrated adjustments made to support ‘brain preservation’ during intrauterine growth, because brain tissue is predominantly fat. Increased nutrition in the face of a genetic predisposition or multigenerational undernutrition increases maternal insulin resistance in late pregnancy and promotes fetal adiposity even in absence of marked hyperglycaemia. Further research is necessary to define the role of specific nutrients and metabolites in the intrauterine processes promoting adiposity before maternal interventions to curtail the epidemic of obesity and diabetes are planned.

Symposium on ‘Adipose tissue development and the programming of adult obesity’
Copyright © The Nutrition Society 2004


Banerji, MA, Faridi, N, Atluri, R, Rochelle, L & Lebovitz, HE (1999) Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. Journal of Clinical Endocrinology and Metabolism 84, 137144.Google ScholarPubMed
Barker, DJP (1998) Mothers, Babies and Health in Later Life. Edinburgh: Churchill Livingstone.Google Scholar
Barsh, GS, Farooqi, IS & O'Rahilly, S (2000) Genetics of body-weight regulation. Nature 404, 644651.CrossRefGoogle ScholarPubMed
Bouchard, A, Tremblay, J, Deapres, A, Nadeau, P, Lupien, G, Theriault, J, Dussault, S, Moorjani, S, Pinault, A & Fournier, G (1990) The response to long-term overfeeding in identical twins. New England Journal of Medicine 322, 14771482.CrossRefGoogle ScholarPubMed
Catalano, PM, Thomas, AJ, Huston, LP & Fung, CM (1998) Effect of maternal metabolism on fetal growth and body composition. Diabetes Care 21, B85B90.Google ScholarPubMed
Chandalia, M, Abate, N, Garg, A, Stray-Gundersen, J & Grundy, SM (1999) Relationship between generalized and upper body obesity to insulin resistance in Asian Indian men. Journal of Clinical Endocrinology and Metabolism 84, 23292335.Google ScholarPubMed
Chowdhury, B, Lantz, H & Sjostrom, L (1996) Computed tomography determined body composition in relation to cardiovascular risk factors in Indian and matched Swedish males. Metabolism 45, 634644.CrossRefGoogle ScholarPubMed
Dabelea, D, Hanson, RL, Bennett, PH, Roumain, J, Knowler, WC & Pettitt, DJ (1998) Increasing prevalence of type 2 diabetes in American Indian children. Diabetologia 41, 904910.CrossRefGoogle ScholarPubMed
Desai, SA, Mani, UV, Deshmukh, SM, Iyer, UM, Sen, AK & Patel, RP (2000) Lifestyle risk factors for the development of chronic degenerative diseases in Baroda. International Journal of Diabetes in Developing Countries 20, 112121.Google Scholar
Deurenberg-Yap, M, Chew, SK & Deurenberg, P (2002) Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians. Obesity Reviews 3, 209215.CrossRefGoogle ScholarPubMed
Dudeja, V, Misra, A, Pandey, RM, Devina, G, Kumar, G & Vikram, NK (2001) BMI does not accurately predict overweight in Asian Indians in northern India. British Journal of Nutrition 86, 105112.CrossRefGoogle Scholar
Eriksson, J, Forsen, T, Tuomilehto, J, Osmond, C & Barker, D (2002) Size at birth, fat-free mass and resting metabolic rate in adult life. Hormonal Metabolism Research 34, 7276.CrossRefGoogle ScholarPubMed
Fall, CHD (2001) Non-industrialized countries and affluence. In type 2 diabetes: the thrifty phenotype. British Medical Bulletin 60, 3350.CrossRefGoogle Scholar
Fall, CHD, Stein, CE, Kumaran, K, Cox, V, Osmond, C, Barker, DJP & Hales, CN (1998) Size at birth, maternal weight, and type 2 diabetes in South India. Diabetic Medicine 15, 220227.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Fall, CHD, Yajnik, CS, Rao, S & Coyaji, KJ (1999) The effects of maternal body composition before pregnancy on fetal growth: The Pune Maternal Nutrition Study. In Fetal Programming Influences on Development and Disease in Later Life, pp. 231245 [O'Brien, PMS, Timothy, W, Barker, DJP, editors]. London: Royal College of Obstetricians and Gynaecologists.Google Scholar
Forouhi, NG, Jenkinson, G, Thomas, EL, Mullick, S, Mierisova, S, Bhonsle, U, McKeigue, PM & Bell, JD (1999) Relation of triglyceride stores in skeletal muscle cells to central obesity and insulin sensitivity in European and South Asian men. Diabetologia 42, 932935.CrossRefGoogle ScholarPubMed
Freinkel, N (1980) Of pregnancy and progeny. Diabetes 29, 10231035.CrossRefGoogle ScholarPubMed
Garrow, JS, Fletcher, K & Halliday, D (1965) Body composition in severe infantile malnutrition. Journal of Clinical Investigation 44, 417425.CrossRefGoogle ScholarPubMed
Gema, F, Javier, G, Francisco, J & María, A (2001) The adipocyte: a model for integration of endocrine and metabolic signaling in energy metabolism regulation. American Journal of Physiology 280, E827E847.Google Scholar
Gopalan, C (1998) Obesity in the Indian urban 'middle class'. NFI Bulletin 19, 15.Google Scholar
Gupta, AK & Ahmad, AJ (1990) Childhood obesity and hypertension. Indian Pediatrics 27, 333337.Google ScholarPubMed
Hales, CN & Barker, DJP (1992) Type 2 (non-insulin dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35, 595601.CrossRefGoogle ScholarPubMed
Harding, JE (2001) The nutritional basis of the fetal origins of adult disease. International Journal of Epidemiology 30, 1523.CrossRefGoogle ScholarPubMed
James, WPT, Chunming, C & Inoue, S (2002) Appropriate Asian body mass indices? Obesity Reviews 3, 139.CrossRefGoogle ScholarPubMed
Joglekar, AA, Yajnik, CS, Lubree, HG, Rege, SS, Bhat, DS, Raut, KN, Joglekar, CV, Shetty, P, Kurpad, AV & Yudkin, JS (2003) Body fat and metabolic syndrome in men from rural and urban India. In Proceedings of the 18th Congress of the International Diabetes Federation, Abstr. no. 1395; available at Google Scholar
Kapil, U, Singh, P, Pathak, P, Dwivedi, SN & Bhasin, S (2002) Prevalence of obesity amongst affluent adolescent school children in Delhi. Indian Pediatrics 39, 449452.Google ScholarPubMed
Knopp, RH, Warth, MR, Charles, D, Childs, M, Li, JR, Mabuchi, H & Van Allen, MI (1986) Lipoprotein metabolism in pregnancy, fat transport to the fetus, and the effects of diabetes. Biology of Neonate 50, 297317.CrossRefGoogle ScholarPubMed
Li, G, Chen, X, Jang, Y, Wang, J, Xing, X, Yang, W & Hu, Y (2002) Obesity, coronary heart disease risk factors and diabetes in Chinese: an approach to the criteria of obesity in the Chinese population. Obesity Reviews 3, 167172.CrossRefGoogle ScholarPubMed
Lubree, HG, Rege, SS, Bhat, DS, Raut, KN, Panchanadikar, AN, Joglekar, CV, Yajnik, CS, Shetty, P & Yudkin, J (2002) Body fat and cardiovascular risk factors in Indian men in three geographical locations. Food and Nutrition Bulletin 23, 146149.Google ScholarPubMed
Lucas, A, Fewtrell, MS & Cole, TJ (1999) Fetal origins of adult disease – the hypothesis revisited. British Medical Journal 319, 245249.CrossRefGoogle ScholarPubMed
McKeigue, PM, Shah, B & Marmot, MG (1991) Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 337, 971973.CrossRefGoogle ScholarPubMed
Martorell, R, Stein, AD & Schroeder, DG (2001) Early nutrition and later adiposity. Journal of Nutrition 131, 874S880S.CrossRefGoogle ScholarPubMed
Matthews, DR, Hosker, JP, Rudenski, AS, Naylor, BA, Treacher, DF & Turner, RC (1985) Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412419.CrossRefGoogle ScholarPubMed
Milner, RDG (1989) Mechanism of overgrowth. In Fetal Growth. Proceedings of the 20th Study Group of the Royal College of Obstetrics and Gynaecology, pp. 139148 [Sharp, F, Fraser, RB, Milner, RDG, editors]. London: Royal College of Obstetrics and Gynaecology Press.Google Scholar
Misra, A, Pandey, RM, Devi, R, Sharma, R, Vikram, NK & Khanna, N (2001) High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India. International Journal of Obesity 25, 17221729.CrossRefGoogle ScholarPubMed
Mohamed-Ali, V, Pinkney, JH & Coppack, SW (1998) Adipose tissue as an endocrine and paracrine organ. Journal of Obesity and Related Metabolic Disorders 22, 11451158.CrossRefGoogle ScholarPubMed
National Cholesterol Education Program (NCEP) Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Journal of American Medical Association 285, 24862497.CrossRefGoogle Scholar
Oken, E & Gillman, MW (2003) Fetal origins of obesity. Obesity Research 11, 496506.CrossRefGoogle ScholarPubMed
Pettitt, DJ, Aleck, KA, Baird, HR, Carraher, MJ, Bennett, PH & Knowler, WC (1988) Congenital susceptibility to NIDDM. Role of intrauterine environment. Diabetes 37, 622628.CrossRefGoogle ScholarPubMed
Pettitt, DJ, Baird, HR, Aleck, KA, Bennett, PH & Knowler, WC (1983) Excessive obesity in offspring of Pima Indian women with diabetes during pregnancy. New England Journal of Medicine 308, 242245.CrossRefGoogle ScholarPubMed
Phillips, DIW, Barker, DJP, Hales, CN, Hirst, S & Osmond, C (1994) Thinness at birth and insulin resistance in adult life. Diabetologia 37, 150154.CrossRefGoogle ScholarPubMed
Prentice, A (2001) Obesity and its potential mechanistic basis. In type 2 diabetes: the thrifty phenotype. British Medical Bulletin 60, 5167.CrossRefGoogle Scholar
Raji, A, Seely, EW, Arky, RA & Simonson, DC (2001) Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. Journal of Clinical Endocrinology and Metabolism 86, 53665371.CrossRefGoogle ScholarPubMed
Ramachandran, A, Snehalatha, C, Dharmaraj, D & Vishwanathan, M (1992) Prevalance of glucose intolerance in Asian Indians: urban-rural difference and significance of upper body adiposity. Diabetes Care 15, 13481355.CrossRefGoogle Scholar
Ramachandran, A, Snehalatha, C, Kapur, A, Vijay, V, Mohan, V, Das, AK, Rao, PV, Yajnik, CS Prasanna Kumar, KN & Nair, JD (2001) High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia 44, 10941101.CrossRefGoogle ScholarPubMed
Ramachandran, A, Snehalatha, C, Vinitha, R, Thayyil, M, Kumar, S, Sheeba, L, Joseph, S & Vijay, V (2002) Prevalence of overweight and obesity in urban Indian adolescent school children. Diabetes Research and Clinical Practice 57, 185190.CrossRefGoogle ScholarPubMed
Rao, S, Kanade, A, Margetts, BM, Yajnik, CS, Lubree, HG, Rege, S, Desai, B, Jackson, A & Fall, CHD (2003) Maternal activity in relation to birth size in rural India: The Pune Maternal Nutrition Study. European Journal of Clinical Nutrition 57, 531542.CrossRefGoogle ScholarPubMed
Rao, S, Yajnik, CS, Kanade, A, Fall, CHD, Margetts, BM, Jackson, AA, Shier, R, Joshi, S, Rege, S & Lubree, H (2001) Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune Maternal Nutrition Study. Journal of Nutrition 131, 12171224.CrossRefGoogle ScholarPubMed
Ravelli, GP, Stein, ZA & Susser, MW (1976) Obesity in young men after famine exposure in utero and early infancy. New England Journal of Medicine 295, 349353.CrossRefGoogle ScholarPubMed
Reddy, KS (1998) The emerging epidemiology of cardiovascular disease in India. In Diet, Nutrition and Chronic Diseases: An Asian Perspective, pp. 5054 [Shetty, PS, Gopalan, C, editors]. London: Smith Gordon.Google Scholar
Reddy, KS, Prabhakaran, D, Shah, P & Shah, B (2002) Differences in body mass index and waist:hip ratios in North Indian rural and urban populations. Obesity Reviews 3, 197202.CrossRefGoogle ScholarPubMed
Rogers, I (2003) The influence of birthweight and intrauterine environment on adiposity and fat distribution in later life. International Journal of Obesity and Related Metabolic Disorders 27, 755777.CrossRefGoogle ScholarPubMed
Shelgikar, KM, Hockaday, TDR & Yajnik, CS (1991) Central rather than generalised obesity is associated with hyperglycaemia in Indians. Diabetic Medicine 8, 712717.CrossRefGoogle Scholar
Shukla, HC, Gupta, PC, Mehta, HC & Hebert, JR (2002) Descriptive epidemiology of body mass index of an urban adult population in western India. Journal of Epidemiology and Community Health 56, 876880.CrossRefGoogle ScholarPubMed
Silverman, BL, Metzger, BE, Cho, NH & Loeb, CA (1995) Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes Care 18, 611617.CrossRefGoogle ScholarPubMed
Sims, EAH (1990) Destiny rides again as twins overeat. New England Journal of Medicine 322, 15221523.CrossRefGoogle ScholarPubMed
Snehalatha, C, Ramachandran, A, Vallabi, K, Satyavani, MY, Saudax, E & Viswanathan, V (1997) Computed axial tomographic scan measurement of abdominal fat distribution and its correlation with anthropometry and insulin secretion in healthy Asian Indians. Metabolism 46, 12201224.CrossRefGoogle ScholarPubMed
Snehalatha, C, Viswanathan, V & Ramachandran, A (2003) Cutoff values for normal anthropometric variables in Asian Indian adults. Diabetes Care 26, 13801384.CrossRefGoogle ScholarPubMed
Widdowson, EM & McCance, RA (1960) Some effects of accelerating growth. I. General somatic development. Proceedings of the Royal Society of London 152B, 188206.CrossRefGoogle Scholar
Winick, M, Rosso, P & Waterlow, JC (1970) Cellular growth of cerebrum, cerebellum and brain stem in normal and marasmic children. Experimental Neurology 26, 393400.CrossRefGoogle ScholarPubMed
World Health Organization (2000) The problem of overweight and obesity. InObesity: Preventing and Managing the Global Epidemic. WHO Technical Report Series no. 894, pp. 515. WHO: Geneva.Google Scholar
World Health Organization Expert Consultation (2004) Appropriate Body Mass Index (BMI) for Asian Populations and its Implication for Policy and Intervention Strategies. Lancet 363, 157163.CrossRefGoogle Scholar
Yajnik, CS (1998) Diabetes in Indians: small at birth or big as adults or both? In Diet, Nutrition and Chronic Diseases: An Asian perspective, pp. 4346 [Shetty, PS, Gopalan, C, editors]. London: Smith Gordon.Google Scholar
Yajnik, CS (2000) Interactions of perturbations in intrauterine growth and growth during childhood on the risk of adult-onset disease. Proceedings of the Nutrition Society 59, 257265.CrossRefGoogle ScholarPubMed
Yajnik, CS (2001a) The insulin resistance epidemic in India: fetal origins, later lifestyle, or both? Nutrition Reviews 59, 19.CrossRefGoogle ScholarPubMed
Yajnik, CS (2001b) Fetal origins of cardiovascular risk in developing countries. Pediatric Research 50, Suppl 2A.Google Scholar
Yajnik, CS, Fall, CHD, Coyaji, KJ, Hirve, SS, Rao, S, Barker, DJP, Joglekar, C & Kellingray, S (2003a) Neonatal anthropometry: The thin-fat Indian baby. The Pune Maternal Nutrition Study. International Journal of Obesity 26, 173180.CrossRefGoogle Scholar
Yajnik, CS, Fall, CHD, Vaidhya, U, Pandit, AN, Bavdekar, A, Bhat, DS, Osmond, C, Hales, CN & Barker, DJP (1995) Fetal growth and glucose and insulin metabolism in four-year-old Indian children. Diabetic Medicine 12, 330336.CrossRefGoogle ScholarPubMed
Yajnik, CS, Joglekar, CV, Pandit, AN, Bavdekar, AR, Bapat, SA, Bhave, SA, Leary, SD & Fall, CHD (2003b) Higher offspring birthweight predicts the metabolic syndrome in mothers but not fathers 8 years after delivery (The Pune Children's Study). Diabetes 52, 20902096.CrossRefGoogle Scholar
Yajnik, CS, Lubree, HG, Rege, SS, Naik, SS, Deshpande, JA, Deshpande, SS, Joglekar, CV & Yudkin, JS (2002) Adiposity and hyper-insulinemia in Indians are present at birth. Journal of Clinical Endocrinology & Metabolism 87, 55755580.CrossRefGoogle Scholar
Yajnik, CS, Shelgikar, KM, Naik, SS, Sayyad, MG, Raut, KN, Bhat, DS, Deshpande, JA, Kale, SD & Hockaday, TDR (2003c) Impairment of glucose tolerance over 10yr in normal glucose tolerant Indians. Diabetes Care 26, 22122213.CrossRefGoogle Scholar