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Issarapu P, Arumalla M, Elliott HR, Nongmaithem SS, Sankareswaran A, Betts M, Sajjadi S, Kessler NJ, Bayyana S, Mansuri SR, Derakhshan M, Krishnaveni GV, Shrestha S, Kumaran K, Di Gravio C, Sahariah SA, Sanderson E, Relton CL, Ward KA, Moore SE, Prentice AM, Lillycrop KA, Fall CHD, Silver MJ, Chandak GR. DNA methylation at the suppressor of cytokine signaling 3 (SOCS3) gene influences height in childhood. Nat Commun 2023; 14:5200. [PMID: 37626025 PMCID: PMC10457295 DOI: 10.1038/s41467-023-40607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Human height is strongly influenced by genetics but the contribution of modifiable epigenetic factors is under-explored, particularly in low and middle-income countries (LMIC). We investigate links between blood DNA methylation and child height in four LMIC cohorts (n = 1927) and identify a robust association at three CpGs in the suppressor of cytokine signaling 3 (SOCS3) gene which replicates in a high-income country cohort (n = 879). SOCS3 methylation (SOCS3m)-height associations are independent of genetic effects. Mendelian randomization analysis confirms a causal effect of SOCS3m on height. In longitudinal analysis, SOCS3m explains a maximum 9.5% of height variance in mid-childhood while the variance explained by height polygenic risk score increases from birth to 21 years. Children's SOCS3m is associated with prenatal maternal folate and socio-economic status. In-vitro characterization confirms a regulatory effect of SOCS3m on gene expression. Our findings suggest epigenetic modifications may play an important role in driving child height in LMIC.
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Affiliation(s)
- Prachand Issarapu
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Manisha Arumalla
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Hannah R Elliott
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suraj S Nongmaithem
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Alagu Sankareswaran
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India
| | - Modupeh Betts
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Sara Sajjadi
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India
| | - Noah J Kessler
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - Swati Bayyana
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India
| | - Sohail R Mansuri
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India
| | - Maria Derakhshan
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - G V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Smeeta Shrestha
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Chiara Di Gravio
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Eleanor Sanderson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate A Ward
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Department of Women & Children's Health, King's College London, London, UK
| | - Sophie E Moore
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Department of Women & Children's Health, King's College London, London, UK
| | - Andrew M Prentice
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Karen A Lillycrop
- School of Medicine, University of Southampton, Southampton, UK
- Biological Sciences, University of Southampton, Southampton, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Matt J Silver
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
| | - Giriraj R Chandak
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India.
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India.
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2
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Sandu AL, Waiter GD, Staff RT, Nazlee N, Habota T, McNeil CJ, Chapko D, Williams JH, Fall CHD, Chandak GR, Pene S, Krishna M, McIntosh AM, Whalley HC, Kumaran K, Krishnaveni GV, Murray AD. Sexual dimorphism in the relationship between brain complexity, volume and general intelligence (g): a cross-cohort study. Sci Rep 2022; 12:11025. [PMID: 35773463 PMCID: PMC9247090 DOI: 10.1038/s41598-022-15208-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/20/2022] [Indexed: 01/20/2023] Open
Abstract
Changes in brain morphology have been reported during development, ageing and in relation to different pathologies. Brain morphology described by the shape complexity of gyri and sulci can be captured and quantified using fractal dimension (FD). This measure of brain structural complexity, as well as brain volume, are associated with intelligence, but less is known about the sexual dimorphism of these relationships. In this paper, sex differences in the relationship between brain structural complexity and general intelligence (g) in two diverse geographic and cultural populations (UK and Indian) are investigated. 3D T1-weighted magnetic resonance imaging (MRI) data and a battery of cognitive tests were acquired from participants belonging to three different cohorts: Mysore Parthenon Cohort (MPC); Aberdeen Children of the 1950s (ACONF) and UK Biobank. We computed MRI derived structural brain complexity and g estimated from a battery of cognitive tests for each group. Brain complexity and volume were both positively corelated with intelligence, with the correlations being significant in women but not always in men. This relationship is seen across populations of differing ages and geographical locations and improves understanding of neurobiological sex-differences.
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Affiliation(s)
- Anca-Larisa Sandu
- Aberdeen Biomedical Imaging Centre, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Lilian Sutton Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Gordon D Waiter
- Aberdeen Biomedical Imaging Centre, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Lilian Sutton Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Roger T Staff
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Nafeesa Nazlee
- Aberdeen Biomedical Imaging Centre, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Lilian Sutton Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Tina Habota
- Aberdeen Biomedical Imaging Centre, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Lilian Sutton Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Chris J McNeil
- Aberdeen Biomedical Imaging Centre, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Lilian Sutton Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Dorota Chapko
- School of Public Health, Imperial College London, London, UK
| | | | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Giriraj R Chandak
- Genomic Research on Complex Diseases, CSIR - Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Shailesh Pene
- Department of Imaging and Interventional Radiology, Narayana Multispecialty Hospital, Mysore, India
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health, Mysore, India
| | - Andrew M McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Heather C Whalley
- Division of Psychiatry, Centre for Clinical Brain Sciences, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | | | - Alison D Murray
- Aberdeen Biomedical Imaging Centre, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Lilian Sutton Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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Nongmaithem SS, Beaumont RN, Dedaniya A, Wood AR, Ogunkolade BW, Hassan Z, Krishnaveni GV, Kumaran K, Potdar RD, Sahariah SA, Krishna M, Di Gravio C, Mali ID, Sankareswaran A, Hussain A, Bhowmik BW, Khan AKA, Knight BA, Frayling TM, Finer S, Fall CHD, Yajnik CS, Freathy RM, Hitman GA, Chandak GR. Babies of South Asian and European Ancestry Show Similar Associations With Genetic Risk Score for Birth Weight Despite the Smaller Size of South Asian Newborns. Diabetes 2022; 71:821-836. [PMID: 35061033 PMCID: PMC7612532 DOI: 10.2337/db21-0479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022]
Abstract
Size at birth is known to be influenced by various fetal and maternal factors, including genetic effects. South Asians have a high burden of low birth weight and cardiometabolic diseases, yet studies of common genetic variations underpinning these phenotypes are lacking. We generated independent, weighted fetal genetic scores (fGSs) and maternal genetic scores (mGSs) from 196 birth weight-associated variants identified in Europeans and conducted an association analysis with various fetal birth parameters and anthropometric and cardiometabolic traits measured at different follow-up stages (5-6-year intervals) from seven Indian and Bangladeshi cohorts of South Asian ancestry. The results from these cohorts were compared with South Asians in UK Biobank and the Exeter Family Study of Childhood Health, a European ancestry cohort. Birth weight increased by 50.7 g and 33.6 g per SD of fGS (P = 9.1 × 10-11) and mGS (P = 0.003), respectively, in South Asians. A relatively weaker mGS effect compared with Europeans indicates possible different intrauterine exposures between Europeans and South Asians. Birth weight was strongly associated with body size in both childhood and adolescence (P = 3 × 10-5 to 1.9 × 10-51); however, fGS was associated with body size in childhood only (P < 0.01) and with head circumference, fasting glucose, and triglycerides in adults (P < 0.01). The substantially smaller newborn size in South Asians with comparable fetal genetic effect to Europeans on birth weight suggests a significant role of factors related to fetal growth that were not captured by the present genetic scores. These factors may include different environmental exposures, maternal body size, health and nutritional status, etc. Persistent influence of genetic loci on size at birth and adult metabolic syndrome in our study supports a common genetic mechanism that partly explains associations between early development and later cardiometabolic health in various populations, despite marked differences in phenotypic and environmental factors in South Asians.
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Affiliation(s)
- Suraj S Nongmaithem
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
- Human Genetics, Wellcome Sanger Institute, Hinxton, CB10 1SA, UK
| | - Robin N Beaumont
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Akshay Dedaniya
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Andrew R Wood
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Babatunji-William Ogunkolade
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Zahid Hassan
- Dept of Physiology and Molecular Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | | | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | | | - Murali Krishna
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
- Foundation for Research and Advocacy in Mental Health (FRAMe) Mysore. India
| | - Chiara Di Gravio
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Inder D Mali
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Alagu Sankareswaran
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Akhtar Hussain
- Centre of Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
- Faculty of Health Sciences, Nord University, Norway
| | - Biswajit W Bhowmik
- Centre of Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kalam A Khan
- Centre of Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Bridget A Knight
- NIHR Exeter Clinical Research Facility, University of Exeter, Exeter, UK
- RD&E NHS Foundation Trust, Royal Devon & Exeter Hospital, Exeter, UK
| | - Timothy M Frayling
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah Finer
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Caroline HD Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Rachel M Freathy
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Graham A Hitman
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Giriraj R Chandak
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
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Nagabharana TK, Joseph S, Rizwana A, Krishna M, Barker M, Fall C, Kumaran K, Krishnaveni GV. What stresses adolescents? A qualitative study on perceptions of stress, stressors and coping mechanisms among urban adolescents in India. Wellcome Open Res 2021; 6:106. [PMID: 34095512 PMCID: PMC8170530 DOI: 10.12688/wellcomeopenres.16818.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background: In India, stress levels are increasing steadily among youth. We aimed to explore the factors that contribute to psychological stress and coping strategies among adolescents in Mysore, India to inform the development of an intervention. Methods: We recruited 16 volunteers in Mysore, India including 6 younger (12-15 years; 3 girls) and 10 older adolescents/ young adults (17-25 years; 5 girls) using a purposive sampling technique. Older adolescents were recruited from ongoing birth cohort study, and the younger adolescents by word-of-mouth from the community. Individual in-depth interviews were carried out based on a semi-structured interview guide comprising open-ended questions. The interviews were analysed to derive themes and emerging constructs related to stress and coping strategies. Results: Adolescents generally perceived stress in their daily lives. Family conflicts and academic pressures were the main triggers for increased stress. Issues around peer relationships, and social position were also important contributors. Adolescents reported that they had robust coping strategies. These included stress release through rationalising and acceptance of the situation, distraction activities, spirituality, and self-comforting methods. However, they felt the need for further support from their family, and the society in general. In particular they expressed the need for a space to share their concerns and obtain guidance through healthy discussions with adults. Conclusions: Our study indicates that adolescents in India are exposed to a wide range of stressors in their daily lives. The conflict between 'traditional' society's opinions of what adolescents should do and the new age adolescents' aspirations for autonomy to find 'informed' solutions for their issues may hinder the stress management efforts. Moving forward, we propose to develop a culturally acceptable intervention tool that accommodates adolescents' perspectives and psychosocial context.
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Affiliation(s)
- T K Nagabharana
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India
| | - Shama Joseph
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India
| | - Azeez Rizwana
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health (FRAMe), MYSORE, Karnataka, 570022, India
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - G V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India
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Patil S, Patil N, Joglekar C, Yadav A, Nilawar A, Banavali U, Bhat R, Dombale V, Warpe B, Mohite R, Joshi K. a Dolescent and pr Econception health pe Rspecti Ve of Adult Non-communicable diseases ( DERVAN): protocol for rural prospective adolescent girls cohort study in Ratnagiri district of Konkan region of India (DERVAN-1). BMJ Open 2020; 10:e035926. [PMID: 32895267 PMCID: PMC7476477 DOI: 10.1136/bmjopen-2019-035926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Precise impact of nutritional insufficiencies in adolescence as a risk factor for non-communicable diseases (NCD) in later life as adults remains largely unknown.We are conducting research into the effects of nutrition on adolescent girls of Ratnagiri district by a prospective cohort study (aDolescent and prEconception health peRspectiVe of Adult Non-communicable diseases cohort). Our study focuses on the physical health, nutritional parameters and cognitive profiles of adolescent girls, during the prenatal and postnatal period and we aim to follow this cohort and their offspring for 20 years. METHODS AND ANALYSIS Cohort recruitment began in June 2019. Our aim is to recruit more than 1500 adolescent girls, age 16-18 years, over a period of 3 years. The recruit's cognition, diet and physical activity will be recorded. The following investigations will be performed: body composition by anthropometry and bioimpedence, and blood pressure, fasting blood sample to measure glucose, insulin, lipids, micronutrients and hormones, abdominal ultrasonography to measure liver, pancreas and kidneys.A biorepository has been created for long-term storage of blood, urine and saliva samples for future analysis. By this longitudinal study, we aim to identify the effects of malnutrition on the behavioural and biological measures in adolescent subjects and evaluate if these are associated with the onset of NCDs in adulthood. ETHICS AND DISSEMINATION Institutional Ethic Committee (IEC) of BKL Walawalkar Rural Medical College and Hospital has granted the permission to carry out the study. IEC is registered with Government of India. Its registration code is EC/755/INST/MH/2015/RR-18. It is not a clinical trial but as required we have also registered the study on Clinical Trial Registry of India (CTRI). The registration code is CTRI/2019/04/018453.Appropriate written informed consent and assent are obtained from the parents and the adolescent girls, respectively. We plan to publish our results in peer-reviewed journals.
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Affiliation(s)
- Suvarna Patil
- Department of Medicine, BKL Walawalkar Hospital & Rural Medical College, Sawarde, Maharashtra, India
| | - Netaji Patil
- Department of Radiology, BKL Walawalkar Hospital & Rural Medical College, Sawarde, Maharashtra, India
| | - Charudatta Joglekar
- Centre for Adolescent Health and Nutrition, BKL Walawalkar Hospital & Rural Medical College, Sawarde, India
| | - Arvind Yadav
- Department of Biochemistry, BKL Walawalkar Hospital & Rural Medical College, Sawarde, Maharashtra, India
| | - Anup Nilawar
- Department of Biochemistry, BKL Walawalkar Hospital & Rural Medical College, Sawarde, Maharashtra, India
| | - Ulka Banavali
- Centre for Adolescent Health and Nutrition, BKL Walawalkar Hospital & Rural Medical College, Sawarde, India
| | - Rohit Bhat
- Centre for Adolescent Health and Nutrition, BKL Walawalkar Hospital & Rural Medical College, Sawarde, India
| | - Vijay Dombale
- Department of Pathology, BKL walawalkar Hospital & Rural Medical College, Sawarde, Maharashtra, India
| | - Bhushan Warpe
- Department of Pathology, BKL walawalkar Hospital & Rural Medical College, Sawarde, Maharashtra, India
| | - Rachana Mohite
- Centre for Adolescent Health and Nutrition, BKL Walawalkar Hospital & Rural Medical College, Sawarde, India
| | - Kiran Joshi
- Department of Obstetrics and Gynaecology, BKL walawalkar Hospital & Rural medical College, Sawarde, Maharashtra, India
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Waqas A, Zafar S, Lawlor DA, Wright J, Hafeez A, Ahmad I, Sikander S, Rahman A. A scientometric analysis of birth cohorts in South Asia: Way forward for Pakistan. PLoS One 2020; 15:e0235385. [PMID: 32645067 PMCID: PMC7347181 DOI: 10.1371/journal.pone.0235385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
The present study aims to: a) systematically map the of birth cohort studies from the South Asian region b) examine the major research foci and landmark contributions from these cohorts using reproducible scientometric techniques and c) offer recommendations on establishing new birth cohorts in Pakistan, building upon the strengths, weaknesses and gaps of previous cohorts. Bibliographic records for a total of 260 articles, published during through December 2018, were retrieved from the Web of Science (core database). All data were analysed using Microsoft Excel (2013), Web of Science platform and CiteSpace. A series of network analysis were then run for each time-period using the link reduction method and pathfinder network scaling. The co-cited articles were clustered into their homogeneous research clusters. The clusters were named using the Latent Semantic Indexing (LSI) method that utilized author keywords as source of names for these clusters. The scientometric analyses of original research output from these birth cohorts also paint a pessimistic landscape in Pakistan- where Pakistani sites for birth cohorts contributed only 31 publications; a majority of these utilized the MAL-ED birth cohort data. A majority of original studies were published from birth cohorts in India (156), Bangladesh (63), and Nepal (15). Out of these contributions, 31 studies reported data from multiple countries. The three major birth cohorts include prospective and multi-country MAL-ED birth cohort and The Pakistan Early Childhood Development Scale Up Trial, and a retrospective Maternal and infant nutrition intervention cohort. In addition to these, a few small-scale birth cohorts reported findings pertaining to neonatal sepsis, intrauterine growth retardation and its effects on linear growth of children and environmental enteropathy.
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Affiliation(s)
- Ahmed Waqas
- Human Development Research Foundation, Markaz, Islamabad, Pakistan
| | - Shamsa Zafar
- Department of Gynaecology and Obstetrics, Fazaia Medical College, Islamabad, Pakistan
| | - Deborah A. Lawlor
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, United Kingdom
- Population Health Science, Bristol Medical School, Bristol University, Bristol, United Kingdom
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Assad Hafeez
- Health Services Academy, Chak Shahzad, Islamabad, Pakistan
| | - Ikhlaq Ahmad
- Human Development Research Foundation, Markaz, Islamabad, Pakistan
- Health Services Academy, Chak Shahzad, Islamabad, Pakistan
| | - Siham Sikander
- Human Development Research Foundation, Markaz, Islamabad, Pakistan
- Health Services Academy, Chak Shahzad, Islamabad, Pakistan
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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7
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Krishnaveni GV, Veena SR, Johnson M, Kumaran K, Jones A, Bhat DS, Yajnik CS, Fall CHD. Maternal B12, Folate and Homocysteine Concentrations and Offspring Cortisol and Cardiovascular Responses to Stress. J Clin Endocrinol Metab 2020; 105:5811162. [PMID: 32206806 PMCID: PMC7216924 DOI: 10.1210/clinem/dgz114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/11/2019] [Indexed: 01/12/2023]
Abstract
CONTEXT Imbalances in maternal 1-carbon nutrients (vitamin B12, folate) have been shown to be associated with higher offspring cardiometabolic risk markers in India. OBJECTIVE We examined the hypothesis that low plasma vitamin B12 (B12) and high folate and homocysteine concentrations in the mother are associated with higher hypothalamic-pituitary-adrenal axis (cortisol) and cardiovascular responses during the Trier Social Stress Test for Children (TSST-C) in an Indian birth cohort. METHODS Adolescents (n = 264; mean age: 13.6 years), whose mothers' plasma B12, folate and total homocysteine concentrations had been measured during pregnancy, completed 5-minutes each of public speaking and mental arithmetic tasks in front of 2 unfamiliar "judges" (TSST-C). Baseline and poststress salivary cortisol concentrations were measured. Heart rate, blood pressure, stroke volume, cardiac output, and total peripheral resistance were measured continuously at baseline, during the TSST-C, and for 10 minutes after the TSST-C using a finger cuff; beat-to-beat values were averaged for these periods, respectively. RESULTS Maternal low B12 status (plasma B12 < 150 pmol/L) was associated with greater cortisol responses to stress in the offspring (P < .001). Higher homocysteine concentrations were associated with greater offspring heart rate response (P < .001). After adjustment for multiple comparisons, there were nonsignificant associations between higher maternal folate concentrations and offspring total peripheral resistance response (P = .01). CONCLUSION Our findings suggest that maternal 1-carbon nutritional status may have long-term programming implications for offspring neuroendocrine stress responses.
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Affiliation(s)
- Ghattu V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
- Correspondence and Reprint Requests: GV Krishnaveni, Post Box 38, CSI Holdsworth Memorial Hospital, Mandi Mohalla, Mysore 570001, India. E-mail:
| | - Sargoor R Veena
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Matt Johnson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
| | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
| | | | - Dattatray S Bhat
- Diabetes Unit, King Edward Memorial Hospital and Research Center, Pune, India
| | | | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
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Kehoe SH, Krishnaveni GV, Veena S, Kiran KN, Karat SC, Dhubey A, Coakley P, Fall CHD. Active children are less adipose and insulin resistant in early adolescence; evidence from the Mysore Parthenon Cohort. BMC Pediatr 2019; 19:503. [PMID: 31849318 PMCID: PMC6918651 DOI: 10.1186/s12887-019-1855-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to determine whether physical activity volume and intensity in mid-childhood and early adolescence were associated with cardiometabolic risk factors at 13.5 years. Methods Participants were recruited from the Mysore Parthenon observational birth cohort. At ages 6–10 and 11–13 years, volume and intensity of physical activity were assessed using AM7164 or GT1M actigraph accelerometers worn for ≥4 days, and expressed as mean counts per day and percentage time spent in light, moderate and vigorous physical activity according to criteria defined by Evenson et al. At 13.5 years, fasting blood samples were collected; lipids, glucose and insulin concentrations were measured and insulin resistance (HOMA) was calculated. Systolic and diastolic blood pressure were measured at the left arm using a Dinamap (Criticon). Anthropometry and bio-impedance analysis were used to assess body size and composition. Metabolic and anthropometric measures were combined to produce a metabolic syndrome risk score. Results At 6–10 years, boys and girls respectively spent a median (IQR) of 1.1 (0.5, 2.0) % and 0.8 (0.4, 1.3) % of recorded time vigorously active. At 11–13 years, boys and girls respectively spent a median (IQR) of 0.8 (0.4, 1.7) % and 0.3 (0.1, 0.6) % of time vigorously active. All of the physical activity parameters were positively correlated between the 6–10 year and the 11–13 year measurements indicating that physical activity tracked from childhood to early adolescence. There were no associations between physical activity at 6–10 years and individual 13.5 year risk factors but % time vigorously active was inversely associated with metabolic syndrome score (B = −0.40, 95% CI −0.75, 0.05). Volume of physical activity at 11–13 years was inversely associated with 13.5 year HOMA and fat percentage and vigorous physical activity was associated with HOMA, fat percentage, sum of skinfolds, waist circumference and total: HDL cholesterol ratio. Vigorous physical activity was inversely associated with metabolic syndrome score (B = −0.51, 95% CI −0.94, −0.08). Conclusions Volume and intensity of physical activity in early adolescence were negatively associated with metabolic and anthropometric risk factors. Interventions that aim to increase adolescent physical activity, especially vigorous, may prevent cardiometabolic disease in later life.
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Affiliation(s)
- Sarah H Kehoe
- Medical Research Council Lifecourse Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Ghattu V Krishnaveni
- Epidemiology Research Unit, Holdsworth Memorial Hospital, Mandi Mohalla, Mysuru, Karnataka, 570021, India
| | - Sargoor Veena
- Epidemiology Research Unit, Holdsworth Memorial Hospital, Mandi Mohalla, Mysuru, Karnataka, 570021, India
| | - Krishnarajasagara N Kiran
- Epidemiology Research Unit, Holdsworth Memorial Hospital, Mandi Mohalla, Mysuru, Karnataka, 570021, India
| | - Samuel C Karat
- Epidemiology Research Unit, Holdsworth Memorial Hospital, Mandi Mohalla, Mysuru, Karnataka, 570021, India
| | - Asha Dhubey
- Epidemiology Research Unit, Holdsworth Memorial Hospital, Mandi Mohalla, Mysuru, Karnataka, 570021, India
| | - Patsy Coakley
- Medical Research Council Lifecourse Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Caroline H D Fall
- Medical Research Council Lifecourse Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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Krishnaveni GV, Srinivasan K. Maternal Nutrition and Offspring Stress Response-Implications for Future Development of Non-Communicable Disease: A Perspective From India. Front Psychiatry 2019; 10:795. [PMID: 31736810 PMCID: PMC6829676 DOI: 10.3389/fpsyt.2019.00795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/04/2019] [Indexed: 01/08/2023] Open
Abstract
Psychological stress is recognized as a major modifiable risk factor for adult non-communicable disease (NCD) that includes depression, type 2 diabetes mellitus, and cardiovascular disease. Dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity resulting in either exaggerated or blunted cortisol responses, and altered autonomic cardiovascular control have been thought to underlie this association. The developmental origins hypothesis proposes that impaired nutrition during fetal and early postnatal growth is associated with a higher NCD risk later in life. Maternal nutrients are vital for fetal growth and development, and both maternal undernutrition and over nutrition as in the case of gestational diabetes are associated with higher NCD risk markers in the offspring. Recent studies suggest that fetal exposure to maternal nutritional imbalances may permanently alter cortisol and cardio-sympathetic stress-responsiveness, which may link early life nutrition with adult disease risk. A few recent studies that examined the association between low birth weight as a marker of fetal undernutrition and stress response in humans showed that lower birth weight was associated with an altered HPA axis and cardiovascular sympathetic nervous system responses to stress in adults as well as in children. In addition, altered stress responses in relation to gestational diabetes have been noted. In this paper, we present available evidence from India for the association between maternal nutrition and offspring stress responsiveness against the backdrop of global evidence, and discuss its role in the escalating NCD rates in this population. We also discuss the scope for future studies in India and other transitioning countries.
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Babu GR, Karthik M, Ravi D, Ana Y, Shriyan P, Hasige KK, Deshpande K, Siddlingaiah LB, Kinra S, Murthy GVS. What makes the pregnant women revisit public hospitals for research? Participant engagement and retention trial in a public hospital (PERTH): an RCT protocol. BMC Pregnancy Childbirth 2018; 18:369. [PMID: 30208868 PMCID: PMC6134518 DOI: 10.1186/s12884-018-2000-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cohort studies have public health importance as they effectively provide evidence on determinants of health from a life course perspective. Researchers often confront the poor follow-up rates as a major challenge in the successful conduct of cohort studies. We are currently recruiting in a birth cohort study, titled as "Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin" (MAASTHI) in a public hospital; with the aim of assessing maternal glycemic levels on the risk of adverse fetal outcomes. Nested within the ongoing cohort, the proposed trial aims to evaluate the effectiveness of two interventions in improving the follow-up in the cohort study in a public hospital. METHODS A randomized trial of 795 pregnant women, with 265 women each in three arms observed through pregnancy, until their baby is 14 weeks old. The comparator group receives a standard leaflet, with details on the importance of glucose testing and regular follow up in pregnancy. Intervention arm-1 will receive the standard leaflet plus individualized messages, through an Interactive Voice Response (IVR) system; a type of computer-linked telephone intervention system to remind the participants about the lab test and follow-up dates. Intervention arm- 2 will have the opportunity to attend Mother and Baby Affairs (MBA) workshops, which will provide information on Gestational Diabetes Mellitus (GDM) screening and management to pregnant women and personalized counselling services. The outcome of interest is the difference in the proportion of participants completing follow-up at different points in time, among three arms. DISCUSSION Between the two interventions (IVR and MBA), the study results would uncover the contextually specific, timely intervention, which can increase the proportion of pregnant women followed up in public hospitals. If effective, this study will provide information on an effective intervention, useful in ensuring the success of longitudinal follow-up in the public hospitals. TRIAL REGISTRATION NCT03088501 , Date Registered: 16/03/2017.
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Affiliation(s)
- Giridhara R Babu
- Public Health Foundation of India (PHFI), IIPH-H, Bengaluru campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bengaluru, 560023 India
| | - Maithili Karthik
- Public Health Foundation of India (PHFI), IIPH-H, Bengaluru campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bengaluru, 560023 India
| | - Deepa Ravi
- Public Health Foundation of India (PHFI), IIPH-H, Bengaluru campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bengaluru, 560023 India
| | - Yamuna Ana
- Public Health Foundation of India (PHFI), IIPH-H, Bengaluru campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bengaluru, 560023 India
| | - Prafulla Shriyan
- Public Health Foundation of India (PHFI), IIPH-H, Bengaluru campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bengaluru, 560023 India
| | - Kiran Kumar Hasige
- Public Health Foundation of India (PHFI), IIPH-H, Bengaluru campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bengaluru, 560023 India
| | - Keerti Deshpande
- Public Health Foundation of India (PHFI), IIPH-H, Bengaluru campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bengaluru, 560023 India
| | | | - Sanjay Kinra
- London School of Hygiene & Tropical Medicine & University College London Hospital, London, UK
| | - Gudlavalleti Venkata Satyanarayana Murthy
- Indian Institute of Public Health-Hyderabad, Plot # 1, A.N.V.Arcade, Amar Co-op Society, Kavuri Hills, Madhapur, Hyderabad, 500033 India
- London School of Hygiene & Tropical Medicine, ICEH, 3rd Floor, South Courtyard, Keppel Street, London, WC1E 7HT UK
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Di Gravio C, Krishnaveni GV, Somashekara R, Veena SR, Kumaran K, Krishna M, Karat SC, Fall CHD. Comparing BMI with skinfolds to estimate age at adiposity rebound and its associations with cardio-metabolic risk markers in adolescence. Int J Obes (Lond) 2018; 43:683-690. [PMID: 30006579 PMCID: PMC6230257 DOI: 10.1038/s41366-018-0144-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/26/2018] [Accepted: 05/18/2018] [Indexed: 12/03/2022]
Abstract
Background Body mass index (BMI) reaches a nadir in mid-childhood, known as the adiposity rebound (AR). Earlier AR is associated with a higher risk of cardio-vascular diseases in later life. Skinfolds, which are a more direct measure of adiposity, may give better insight into the relationship between childhood adiposity and later obesity and cardio-metabolic risk. Objective We aimed to assess whether AR corresponds to a rebound in skinfolds, and compare associations of BMI-derived AR and skinfold-derived AR with cardio-metabolic risk markers in adolescence. Methods We used penalised splines with random coefficients to estimate BMI and skinfold trajectories of 604 children from the Mysore Parthenon Birth Cohort. Age at AR was identified using differentiation of the BMI and skinfold growth curves between 2 and 10 years of age. At 13.5 years, we measured blood pressure, and glucose, insulin and lipid concentrations. Results BMI and skinfolds had different growth patterns. Boys reached BMI-derived AR earlier than skinfold-derived AR (estimated difference: 0.41 years; 95% CI:[0.23, 0.56]), whereas the opposite was observed in girls (estimated difference: −0.71 years; 95% CI:[−0.90, −0.54]). At 13.5 years, children with earlier BMI-derived AR had higher BMI (−0.58 SD per SD increase of AR; 95%CI:[−0.65, −0.52]), fat mass (−0.44; 95%CI:[−0.50, −0.37]), insulin resistance (HOMA-IR: −0.20; 95%CI:[−0.28, −0.12]) and systolic blood pressure (−0.20; 95%CI:[−0.28, −0.11]), and lower HDL-cholesterol (0.12; 95%CI:[0.04, 0.21]). The associations were independent of BMI at time of rebound, but were fully explained by fat mass at 13.5 years. Similar associations were found for skinfold-derived AR. Conclusion BMI-derived adiposity rebound predicts later cardio-metabolic risk markers similarly to that derived from skinfolds, a direct measure of adiposity.
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Affiliation(s)
- Chiara Di Gravio
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
| | | | | | - S R Veena
- CSI Holdsworth Memorial Hospital, Mysore, India
| | - K Kumaran
- CSI Holdsworth Memorial Hospital, Mysore, India
| | | | - S C Karat
- CSI Holdsworth Memorial Hospital, Mysore, India
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Krishnaveni GV, Kumaran K, Krishna M, Sahariah S, Chandak G, Kehoe S, Jones A, Bhat D, Danivas V, Srinivasan K, Suguna Shanthi J, Karat SC, Barker M, Osmond C, Yajnik C, Fall C. Life course programming of stress responses in adolescents and young adults in India: Protocol of the Stress Responses in Adolescence and Vulnerability to Adult Non-communicable disease (SRAVANA) Study. Wellcome Open Res 2018; 3:56. [PMID: 30027123 PMCID: PMC6039920 DOI: 10.12688/wellcomeopenres.14583.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 01/04/2023] Open
Abstract
Background: Early life nutrition may affect individuals' susceptibility to adult non-communicable diseases (NCD). Psychological stress is a well-recognised NCD risk factor. Recent evidence suggests that impaired foetal nutrition alters neuro-endocrine pathways, and hypothalamic-pituitary-adrenal axis feedback systems, resulting in abnormal stress responses, and NCD risk. This study aims to examine adolescent cortisol and cardiovascular stress responses in relation to maternal nutrition and contemporaneous NCD risk markers. Methods: The study sample will be drawn from three well-established birth cohorts in India; the Parthenon cohort, Mysore (N=550, age~20y), the SARAS KIDS prenatal intervention cohort, Mumbai (N=300, age~10-12y) and the Pune Rural Intervention in Young Adults/ PRIYA cohort, Pune (N=100, age~22y). We will perform the 'Trier Social Stress Test (TSST)', a well-accepted stress-test module which involves participants performing 5-minutes each of public speaking and mental arithmetic tasks in front of unfamiliar 'judges' (stressor). Repeated measures of salivary cortisol and autonomic cardiovascular outcomes relative to the stressor will be assessed. Measures of psychological stress, cognitive function, blood pressure, glucose-insulin metabolism and depression will be carried out. Mechanistic studies including DNA methylation in gluco-corticoid receptor ( NR3C1) and 11β-HSD2 gene loci and neuroimaging will be carried out in a subsample. Qualitative interviews and focus group discussions in a subsample of the Parthenon cohort will explore the perception of stress and stressors among the youth. We will convert repeated measures into time-weighted averages before analysis. We will carry out multivariable regression analysis to test the associations. We will further refine the analyses using the mixed-model regression and conditional analyses for the association with repeated measures. Ethics and dissemination: This study has been approved by the research ethics committee of CSI Holdsworth Memorial Hospital, Mysore. The findings will be disseminated locally and at international meetings, and reports will be submitted to open access peer reviewed journals.
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Affiliation(s)
- GV Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospitol, Mysore, India
| | | | - Murali Krishna
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospitol, Mysore, India
| | | | | | - Sarah Kehoe
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Dattatray Bhat
- Diabetes Unit, KEM Hospital Research Centre, Pune, India
| | - Vijay Danivas
- Mysore Medical College and Research Institute, Mysore, India
| | | | - J Suguna Shanthi
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospitol, Mysore, India
| | - SC Karat
- Department of Pediatrics, Jerudong Park Medical Centre, Jerudong Park, Brunei
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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13
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Krishnaveni GV, Jones A, Veena SR, Somashekara R, Karat SC, D Fall CH. Adiposity and Cortisol Response to Stress in Indian Adolescents. Indian Pediatr 2018; 55:125-130. [PMID: 29242410 PMCID: PMC6051515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We examined associations of different adiposity measures with cortisol responses during the Trier Social Stress Test for children (TSST-C). DESIGN Descriptive study. SETTING Holdsworth Memorial Hospital, Mysore, India. PARTICIPANTS Adolescents aged 13.5y from a birth cohort were recruited (N=269, 133 boys). METHODS The stressor (TSST-C) was 5-minutes each of public speaking and mental arithmetic tasks in front of two unfamiliar 'judges'. Salivary cortisol concentrations were measured at baseline and at regular intervals after TSST-C. Weight, height, sub scapular and triceps skinfold thickness, and waist and hip circumference were measured, and percentage body fat was estimated (fat%; bioimpedance). Body mass index (BMI) and Waist-to-hip ratio (WHR) were calculated. All variables were converted into within-cohort SD scores before analysis. Stress-induced change in cortisol concentrations from baseline (cortisol response) was examined in relation to adiposity. RESULTS Stress increased cortisol concentrations significantly from baseline (mean (SD): 5.5 (6.4) ng/mL; P<0.001). Higher WHR was associated with lower cortisol response at 20 and 30-minutes after stress (~0.13 SD decrease in cortisol response per SD higher WHR, P<0.05). Higher fat% was also associated with lower cortisol response only in girls 20-minutes post-stress (0.23 SD lower response per SD higher fat%, P=0.004). Sum of skinfold thickness and BMI were not associated with cortisol responses. CONCLUSION Abdominal adiposity is associated with reduced hypothalamic-pituitary-adrenal axis reactivity to stress in this adolescent population.
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Affiliation(s)
- G V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India. Correspondence to: Dr Krishnaveni GV, CSI Holdsworth Memorial Hospital, Mandi Mohalla, Mysore 570021, India.
| | - A Jones
- Department of Pediatrics, University of Oxford, Oxford, UK
| | - S R Veena
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - R Somashekara
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - S C Karat
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - C H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Ward JL, Harrison K, Viner RM, Costello A, Heys M. Adolescent cohorts assessing growth, cardiovascular and cognitive outcomes in low and middle-income countries. PLoS One 2018; 13:e0190443. [PMID: 29338025 PMCID: PMC5770018 DOI: 10.1371/journal.pone.0190443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/14/2017] [Indexed: 01/06/2023] Open
Abstract
Introduction Life-course studies are needed to explore how exposures during adolescence, particularly puberty, contribute to later cardiovascular risk and cognitive health in low and middle-income countries (LMIC), where 90% of the world’s young people live. The extent of any existing cohorts investigating these outcomes in LMIC has not previously been described. Methods We performed a systematic literature review to identify population cohort studies of adolescents in LMIC that assessed anthropometry and any of cardiovascular risk (blood pressure, physical activity, plasma glucose/lipid profile and substance misuse), puberty (age at menarche, Tanner staging, or other form of pubertal staging) or cognitive outcomes. Studies that recruited participants on the basis of a pre-existing condition or involved less than 500 young people were excluded. Findings 1829 studies were identified, and 24 cohorts fulfilled inclusion criteria based in Asia (10), Africa (6) and South / Central America (8). 14 (58%) of cohorts identified were based in one of four countries; India, Brazil, Vietnam or Ethiopia. Only 2 cohorts included a comprehensive cardiovascular assessment, tanner pubertal staging, and cognitive outcomes. Conclusion Improved utilisation of existing datasets and additional cohort studies of adolescents in LMIC that collect contemporaneous measures of growth, cognition, cardiovascular risk and pubertal development are needed to better understand how this period of the life course influences future non-communicable disease morbidity and cognitive outcomes.
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Affiliation(s)
- Joseph L. Ward
- UCL Institute of Child Health, University College London, London, United Kingdom
- * E-mail:
| | - Katherine Harrison
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Russell M. Viner
- UCL Institute of Child Health, University College London, London, United Kingdom
| | - Anthony Costello
- UCL Institute for Global Health, University College London, London, United Kingdom
- Department of Maternal, Newborn, Child and Adolescent Health (MCA) World Health Organization, Geneva, Switzerland
| | - Michelle Heys
- UCL Institute for Global Health, University College London, London, United Kingdom
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15
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Abstract
Abstract
Objective
We examined associations of different adiposity measures with cortisol responses during the Trier Social Stress Test for children (TSST-C).
Design
Descriptive study.
Setting
Holdsworth Memorial Hospital, Mysore, India.
Participants
Adolescents aged 13.5y from a birth cohort were recruited (N=269, 133 boys).
Methods
The stressor (TSST-C) was 5-minutes each of public speaking and mental arithmetic tasks in front of two unfamiliar ‘judges’. Salivary cortisol concentrations were measured at baseline and at regular intervals after TSST-C. Weight, height, sub scapular and triceps skinfold thickness, and waist and hip circumference were measured, and percentage body fat was estimated (fat%; bioimpedance). Body mass index (BMI) and Waist-to-hip ratio (WHR) were calculated. All variables were converted into within-cohort SD scores before analysis. Stressinduced change in cortisol concentrations from baseline (cortisol response) was examined in relation to adiposity.
Results
Stress increased cortisol concentrations significantly from baseline (mean (SD): 5.5 (6.4) ng/mL; P<0.001). Higher WHR was associated with lower cortisol response at 20 and 30-minutes after stress (~0.13 SD decrease in cortisol response per SD higher WHR, P<0.05). Higher fat% was also associated with lower cortisol response only in girls 20-minutes post-stress (0.23 SD lower response per SD higher fat%, P=0.004). Sum of skinfold thickness and BMI were not associated with cortisol responses.
Conclusions
Abdominal adiposity is associated with reduced hypothalamic-pituitary-adrenal axis reactivity to stress in this adolescent population.
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Nongmaithem SS, Joglekar CV, Krishnaveni GV, Sahariah SA, Ahmad M, Ramachandran S, Gandhi M, Chopra H, Pandit A, Potdar RD, H D Fall C, Yajnik CS, Chandak GR. GWAS identifies population-specific new regulatory variants in FUT6 associated with plasma B12 concentrations in Indians. Hum Mol Genet 2017; 26:2551-2564. [PMID: 28334792 PMCID: PMC5886186 DOI: 10.1093/hmg/ddx071] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 02/20/2017] [Indexed: 01/26/2023] Open
Abstract
Vitamin B12 is an important cofactor in one-carbon metabolism whose dysregulation is associated with various clinical conditions. Indians have a high prevalence of B12 deficiency but little is known about the genetic determinants of circulating B12 concentrations in Indians. We performed a genome-wide association study in 1001 healthy participants in the Pune Maternal Nutrition Study (PMNS), replication studies in 3418 individuals from other Indian cohorts and by meta-analysis identified new variants, rs3760775 (P = 1.2 × 10−23) and rs78060698 (P = 8.3 × 10−17) in FUT6 to be associated with circulating B12 concentrations. Although in-silico analysis replicated both variants in Europeans, differences in the effect allele frequency, effect size and the linkage disequilibrium structure of credible set variants with the reported variants suggest population-specific characteristics in this region. We replicated previously reported variants rs602662, rs601338 in FUT2, rs3760776, rs708686 in FUT6, rs34324219 in TCN1 (all P < 5 × 10−8), rs1131603 in TCN2 (P = 3.4 × 10−5), rs12780845 in CUBN (P = 3.0 × 10−3) and rs2270655 in MMAA (P = 2.0 × 10−3). Circulating B12 concentrations in the PMNS and Parthenon study showed a significant decline with increasing age (P < 0.001), however, the genetic contribution to B12 concentrations remained constant. Luciferase reporter and electrophoretic-mobility shift assay for the FUT6 variant rs78060698 using HepG2 cell line demonstrated strong allele-specific promoter and enhancer activity and differential binding of HNF4α, a key regulator of expression of various fucosyltransferases. Hence, the rs78060698 variant, through regulation of fucosylation may control intestinal host-microbial interaction which could influence B12 concentrations. Our results suggest that in addition to established genetic variants, population-specific variants are important in determining plasma B12 concentrations.
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Affiliation(s)
- Suraj S Nongmaithem
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana 500 007, India
| | - Charudatta V Joglekar
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Rasta Peth, Pune, Maharashtra 411 011, India
| | - Ghattu V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka 570 021, India
| | - Sirazul A Sahariah
- Research Department, Centre for the Study of Social Change, Mumbai, Maharashtra 400 051, India
| | - Meraj Ahmad
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana 500 007, India
| | - Swetha Ramachandran
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana 500 007, India
| | - Meera Gandhi
- Research Department, Centre for the Study of Social Change, Mumbai, Maharashtra 400 051, India
| | - Harsha Chopra
- Research Department, Centre for the Study of Social Change, Mumbai, Maharashtra 400 051, India
| | - Anand Pandit
- Department of Pediatrics, King Edward Memorial Hospital and Research Centre, Rasta Peth, Pune, Maharashtra 411 011, India
| | - Ramesh D Potdar
- Research Department, Centre for the Study of Social Change, Mumbai, Maharashtra 400 051, India
| | - Caroline H D Fall
- Research Department, Centre for the Study of Social Change, Mumbai, Maharashtra 400 051, India.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Chittaranjan S Yajnik
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Rasta Peth, Pune, Maharashtra 411 011, India
| | - Giriraj R Chandak
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana 500 007, India.,Human Genetics Unit, Genome Institute of Singapore, Biopolis, 138 672, Singapore
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17
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Babu GR, Murthy GVS, Deepa R, Yamuna, Prafulla, Kumar HK, Karthik M, Deshpande K, Benjamin Neelon SE, Prabhakaran D, Kurpad A, Kinra S. Maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI): a prospective cohort study : Protocol of birth cohort at Bangalore, India. BMC Pregnancy Childbirth 2016; 16:311. [PMID: 27741952 PMCID: PMC5065083 DOI: 10.1186/s12884-016-1088-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/22/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND India is experiencing an epidemic of obesity-hyperglycaemia, which coincides with child bearing age for women. The epidemic can be sustained and augmented through transgenerational transmission of adiposity and glucose intolerance in women. This presents an opportunity for exploring a clear strategy for the control of this epidemic in India. We conducted a study between November 2013 and May 2015 to inform the design of a large pregnancy cohort study. Based on the findings of this pilot, we developed the protocol for the proposed birth cohort of 5000 women, the recruitment for which will start in April 2016. The protocol of the study documents the processes which aim at advancing the available knowledge, linking several steps in the evolution of obesity led hyperglycemia. METHODS Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI) is a cohort study in the public health facilities in Bangalore, India. The objective of MAASTHI is to prospectively assess the effects of glucose levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the possible risk markers of later chronic diseases. The primary objective of the proposed study is to investigate the effect of glucose levels in pregnancy on skinfold thickness (adiposity) in infancy as a marker of future obesity and diabetes in offspring. The secondary objective is to assess the association between psychosocial environment of mothers and adverse neonatal outcomes including adiposity. The study aims to recruit 5000 pregnant women and follow them and their offspring for a period of 4 years. The institutional review board at The Indian Institute of Public Health (IIPH)-H, Bangalore, Public Health Foundation of India has approved the protocol. All participants are required to provide written informed consent. DISCUSSION The findings from this study may help to address important questions on screening and management of high blood sugar in pregnancy. It may provide critical information on the specific determinants driving the underweight-obesity-T2DM epidemic in India. The study can inform the policy regarding the potential impact of screening and management protocols in public healthcare facilities. The public health implications include prioritising issues of maternal glycemic control and weight management and better understanding of the lifecourse determinants in the development of T2DM.
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Affiliation(s)
- Giridhara R. Babu
- Wellcome Trust-DBT India alliance Intermediate Research Fellow in Public Health, Additional Professor, Public Health Foundation of India (PHFI), IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - GVS Murthy
- Indian Institute of Public Health-Hyderabad, Plot # 1, A.N.V. Arcade, Amar Co-op Society, Kavuri Hills, Madhapur, Hyderabad, 500033 India
- ICEH, London School of Hygiene & Tropical Medicine, 3rd Floor, South Courtyard, Keppel Street, London, WC1E 7HT UK
| | - R. Deepa
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Yamuna
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Prafulla
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - H. Kiran Kumar
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Maithili Karthik
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Keerti Deshpande
- Research team of MAASTHI, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Beside leprosy hospital, 1st cross, Magadi road, Bangalore, 560023 India
| | - Sara E. Benjamin Neelon
- Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House 755, Baltimore, MD 21205 USA
- Centre for Diet and Activity Research, MRC Epidemiology, University of Cambridge, Cambridge, UK
| | - D. Prabhakaran
- Centre for Control of Chronic Conditions (CCCC, Public Health Foundation of India (PHFI), New Delhi, India
- Centre for Chronic Disease Control (CCDC), New Delhi, India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
- Emory Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Anura Kurpad
- Nutrition Division, St John’s Research Institute, Bangalore, India
- Nutrition Society of India, National Institute of Nutrition Campus, Hyderabad, 500 007 India
- IAEA Collaborating Centre for Stable Isotope Technologies in Nutrition, St John’s Research Institute, Bangalore, India
- International Nutrition Foundation Protein Advisory Group and Chair, Expert Committee on Obesity, ICMR, New Delhi, India
| | - Sanjay Kinra
- Reader in Clinical Epidemiology & Honorary Consultant in Paediatric Obesity - London School of Hygiene & Tropical Medicine & University College London Hospital, London, UK
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Nizamuddin S, Govindaraj P, Saxena S, Kashyap M, Mishra A, Singh S, Rotti H, Raval R, Nayak J, Bhat BK, Prasanna BV, Dhumal VR, Bhale S, Joshi KS, Dedge AP, Bharadwaj R, Gangadharan GG, Nair S, Gopinath PM, Patwardhan B, Kondaiah P, Satyamoorthy K, Valiathan MS, Thangaraj K. Reply to 'Lack of replication of association of THSD7A with obesity'. Int J Obes (Lond) 2016; 40:727-8. [PMID: 26902698 DOI: 10.1038/ijo.2016.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S Nizamuddin
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - P Govindaraj
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - S Saxena
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - M Kashyap
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - A Mishra
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - S Singh
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - H Rotti
- School of Life Sciences, Manipal University, Manipal, India
| | - R Raval
- School of Life Sciences, Manipal University, Manipal, India
| | - J Nayak
- Shri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, India
| | - B K Bhat
- Shri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, India
| | - B V Prasanna
- Shri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, India
| | - V R Dhumal
- Sinhgad College of Engineering, Pune, India
| | - S Bhale
- Sinhgad College of Engineering, Pune, India
| | - K S Joshi
- Sinhgad College of Engineering, Pune, India
| | - A P Dedge
- Sinhgad College of Engineering, Pune, India
| | - R Bharadwaj
- Foundation for Revitalization of Local Health Traditions, Bengaluru, India
| | - G G Gangadharan
- Foundation for Revitalization of Local Health Traditions, Bengaluru, India
| | - S Nair
- Department of Statistics, Manipal University, Manipal, India
| | - P M Gopinath
- School of Life Sciences, Manipal University, Manipal, India
| | - B Patwardhan
- Interdisciplinary School of Health Sciences, University of Pune, Pune, India
| | - P Kondaiah
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bengaluru, India
| | - K Satyamoorthy
- School of Life Sciences, Manipal University, Manipal, India
| | - M S Valiathan
- School of Life Sciences, Manipal University, Manipal, India
| | - K Thangaraj
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
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Krishnaveni GV, Veena SR, Srinivasan K, Osmond C, Fall CHD. Linear Growth and Fat and Lean Tissue Gain during Childhood: Associations with Cardiometabolic and Cognitive Outcomes in Adolescent Indian Children. PLoS One 2015; 10:e0143231. [PMID: 26575994 PMCID: PMC4648488 DOI: 10.1371/journal.pone.0143231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/02/2015] [Indexed: 12/19/2022] Open
Abstract
Background We aimed to determine how linear growth and fat and lean tissue gain during discrete age periods from birth to adolescence are related to adolescent cardiometabolic risk factors and cognitive ability. Methods Adolescents born to mothers with normal glucose tolerance during pregnancy from an Indian birth cohort (N = 486, age 13.5 years) had detailed anthropometry and measurements of body fat (fat%), fasting plasma glucose, insulin and lipid concentrations, blood pressure and cognitive function. Insulin resistance (HOMA-IR) was calculated. These outcomes were examined in relation to birth measurements and statistically independent measures (conditional SD scores) representing linear growth, and fat and lean tissue gain during birth-1, 1–2, 2–5, 5–9.5 and 9.5–13.5 years in 414 of the children with measurements at all these ages. Results Birth length and linear growth at all ages were positively associated with current height. Fat gain, particularly during 5–9.5 years was positively associated with fat% at 13.5 years (0.44 SD per SD [99.9% confidence interval: 0.29,0.58]). Greater fat gain during mid-late childhood was associated with higher systolic blood pressure (5–9.5 years: 0.23 SD per SD [0.07,0.40]) and HOMA-IR (5–9.5 years: 0.24 [0.08,0.40], 9.5–13.5 years: 0.22 [0.06,0.38]). Greater infant growth (up to age 2 years) in linear, fat or lean components was unrelated to cardiometabolic risk factors or cognitive function. Conclusion This study suggests that factors that increase linear, fat and lean growth in infancy have no adverse cardiometabolic effects in this population. Factors that increase fat gain in mid-late childhood may increase cardiometabolic risk, without any benefit to cognitive abilities.
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Affiliation(s)
| | - Sargoor R Veena
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | | | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
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21
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Krishna M, Kalyanaraman K, Veena SR, Krishanveni GV, Karat SC, Cox V, Coakley P, Nagaraj K, Stein C, Paul B, Prince M, Osmond C, Fall CH. Cohort Profile: The 1934-66 Mysore Birth Records Cohort in South India. Int J Epidemiol 2015; 44:1833-41. [PMID: 26445965 PMCID: PMC4690000 DOI: 10.1093/ije/dyv176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Murali Krishna
- Early Career Research Fellow, Wellcome DBT India Alliance, India, Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India,
| | | | - S R Veena
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - G V Krishanveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - S C Karat
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Vanessa Cox
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Patsy Coakley
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Kiran Nagaraj
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Claudia Stein
- Division of Information, Evidence, Research and Innovation at WHO/Europe, Copenhagen, Denmark and
| | - Bdr Paul
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | | | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Caroline Hd Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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