Skip to main content
×
Home

Obesity epidemic in India: intrauterine origins?

  • C. S. Yajnik (a1)
Abstract

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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Obesity epidemic in India: intrauterine origins?
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Obesity epidemic in India: intrauterine origins?
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Obesity epidemic in India: intrauterine origins?
      Available formats
      ×
Copyright
Corresponding author
Corresponding author: Dr C. S. Yajnik, fax +91 020 612 5603, email diabetes@vsnl.com
References
Hide All
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.
Barker DJP (1998) Mothers, Babies and Health in Later Life. Edinburgh: Churchill Livingstone.
Barsh GS, Farooqi IS & O'Rahilly S (2000) Genetics of body-weight regulation. Nature 404, 644651.
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.
Catalano PM, Thomas AJ, Huston LP & Fung CM (1998) Effect of maternal metabolism on fetal growth and body composition. Diabetes Care 21, B85B90.
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.
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.
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.
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.
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.
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.
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.
Fall CHD (2001) Non-industrialized countries and affluence. In type 2 diabetes: the thrifty phenotype. British Medical Bulletin 60, 3350.
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.
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.
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.
Freinkel N (1980) Of pregnancy and progeny. Diabetes 29, 10231035.
Garrow JS, Fletcher K & Halliday D (1965) Body composition in severe infantile malnutrition. Journal of Clinical Investigation 44, 417425.
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.
Gopalan C (1998) Obesity in the Indian urban 'middle class'. NFI Bulletin 19, 15.
Gupta AK & Ahmad AJ (1990) Childhood obesity and hypertension. Indian Pediatrics 27, 333337.
Hales CN & Barker DJP (1992) Type 2 (non-insulin dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35, 595601.
Harding JE (2001) The nutritional basis of the fetal origins of adult disease. International Journal of Epidemiology 30, 1523.
James WPT, Chunming C & Inoue S (2002) Appropriate Asian body mass indices? Obesity Reviews 3, 139.
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 http://www.idfparis2003.org/
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.
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.
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.
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.
Lucas A, Fewtrell MS & Cole TJ (1999) Fetal origins of adult disease – the hypothesis revisited. British Medical Journal 319, 245249.
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.
Martorell R, Stein AD & Schroeder DG (2001) Early nutrition and later adiposity. Journal of Nutrition 131, 874S880S.
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.
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.
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.
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.
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.
Oken E & Gillman MW (2003) Fetal origins of obesity. Obesity Research 11, 496506.
Pettitt DJ, Aleck KA, Baird HR, Carraher MJ, Bennett PH & Knowler WC (1988) Congenital susceptibility to NIDDM. Role of intrauterine environment. Diabetes 37, 622628.
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.
Phillips DIW, Barker DJP, Hales CN, Hirst S & Osmond C (1994) Thinness at birth and insulin resistance in adult life. Diabetologia 37, 150154.
Prentice A (2001) Obesity and its potential mechanistic basis. In type 2 diabetes: the thrifty phenotype. British Medical Bulletin 60, 5167.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Shelgikar KM, Hockaday TDR & Yajnik CS (1991) Central rather than generalised obesity is associated with hyperglycaemia in Indians. Diabetic Medicine 8, 712717.
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.
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.
Sims EAH (1990) Destiny rides again as twins overeat. New England Journal of Medicine 322, 15221523.
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.
Snehalatha C, Viswanathan V & Ramachandran A (2003) Cutoff values for normal anthropometric variables in Asian Indian adults. Diabetes Care 26, 13801384.
Widdowson EM & McCance RA (1960) Some effects of accelerating growth. I. General somatic development. Proceedings of the Royal Society of London 152B, 188206.
Winick M, Rosso P & Waterlow JC (1970) Cellular growth of cerebrum, cerebellum and brain stem in normal and marasmic children. Experimental Neurology 26, 393400.
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.
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.
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.
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.
Yajnik CS (2001a) The insulin resistance epidemic in India: fetal origins, later lifestyle, or both? Nutrition Reviews 59, 19.
Yajnik CS (2001b) Fetal origins of cardiovascular risk in developing countries. Pediatric Research 50, Suppl 2A.
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.
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.
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.
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.
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.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Proceedings of the Nutrition Society
  • ISSN: 0029-6651
  • EISSN: 1475-2719
  • URL: /core/journals/proceedings-of-the-nutrition-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 222 *
Loading metrics...

Abstract views

Total abstract views: 376 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd November 2017. This data will be updated every 24 hours.