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Kashyap R, Holla B, Bhattacharjee S, Sharma E, Mehta UM, Vaidya N, Bharath RD, Murthy P, Basu D, Nanjayya SB, Singh RL, Lourembam R, Chakrabarti A, Kartik K, Kalyanram K, Kumaran K, Krishnaveni G, Krishna M, Kuriyan R, Kurpad SS, Desrivieres S, Purushottam M, Barker G, Orfanos DP, Hickman M, Heron J, Toledano M, Schumann G, Benegal V. Childhood adversities characterize the heterogeneity in the brain pattern of individuals during neurodevelopment. Psychol Med 2024:1-13. [PMID: 38509831 DOI: 10.1017/s0033291724000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Several factors shape the neurodevelopmental trajectory. A key area of focus in neurodevelopmental research is to estimate the factors that have maximal influence on the brain and can tip the balance from typical to atypical development. METHODS Utilizing a dissimilarity maximization algorithm on the dynamic mode decomposition (DMD) of the resting state functional MRI data, we classified subjects from the cVEDA neurodevelopmental cohort (n = 987, aged 6-23 years) into homogeneously patterned DMD (representing typical development in 809 subjects) and heterogeneously patterned DMD (indicative of atypical development in 178 subjects). RESULTS Significant DMD differences were primarily identified in the default mode network (DMN) regions across these groups (p < 0.05, Bonferroni corrected). While the groups were comparable in cognitive performance, the atypical group had more frequent exposure to adversities and faced higher abuses (p < 0.05, Bonferroni corrected). Upon evaluating brain-behavior correlations, we found that correlation patterns between adversity and DMN dynamic modes exhibited age-dependent variations for atypical subjects, hinting at differential utilization of the DMN due to chronic adversities. CONCLUSION Adversities (particularly abuse) maximally influence the DMN during neurodevelopment and lead to the failure in the development of a coherent DMN system. While DMN's integrity is preserved in typical development, the age-dependent variability in atypically developing individuals is contrasting. The flexibility of DMN might be a compensatory mechanism to protect an individual in an abusive environment. However, such adaptability might deprive the neural system of the faculties of normal functioning and may incur long-term effects on the psyche.
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Affiliation(s)
- Rajan Kashyap
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bharath Holla
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sagarika Bhattacharjee
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nilakshi Vaidya
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, PONS Centre, Charité Mental Health, Germany
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Debashish Basu
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Lourembam
- Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, India
| | - Amit Chakrabarti
- Division of Mental Health, ICMR-Centre for Ageing and Mental Health, Kolkata, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor, India
| | | | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
| | - Ghattu Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Murali Krishna
- Health Equity Cluster, Institute of Public Health, Bangalore, India
| | - Rebecca Kuriyan
- Division of Nutrition, St John's Research Institute, Bengaluru, India
| | - Sunita Simon Kurpad
- Department of Psychiatry & Department of Medical Ethics, St John's Research Institute, Bengaluru, India
| | - Sylvane Desrivieres
- SGDP Centre, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Meera Purushottam
- Molecular Genetics Laboratory, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gareth Barker
- Department of Neuroimaging, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | | | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jon Heron
- Center for Public Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mireille Toledano
- MRC Centre for Environment and Health, School of Public Health, Imperial College, London, UK
| | - Gunter Schumann
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, PONS Centre, Charité Mental Health, Germany
- PONS Centre, Institute for Science and Technology of Brain-inspired Intelligence (ISTBI), Fudan University, Shanghai, China
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Bevan JH, Kumaran K, Walker IV, Wilkinson J. Every medical school should have a planetary health teaching fellow. BMJ 2023; 382:2026. [PMID: 37684037 DOI: 10.1136/bmj.p2026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Affiliation(s)
- James Hj Bevan
- Faculty of Medicine, School of Primary Care, Population Science and Medical Education, University of Southampton, UK
| | - Kalyanaraman Kumaran
- Faculty of Medicine, School of Primary Care, Population Science and Medical Education, University of Southampton, UK
| | - Inna V Walker
- Faculty of Medicine, School of Primary Care, Population Science and Medical Education, University of Southampton, UK
- Health Institute for Health and Care Research Coordinating Centre (NIHRCC), University of Southampton, Southampton, UK
- Health Education England Wessex, NHS England, South East Region, Winchester, UK
| | - Jane Wilkinson
- Faculty of Medicine, School of Primary Care, Population Science and Medical Education, University of Southampton, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Khare SP, Madhok A, Patta I, Sukla KK, Wagh VV, Kunte PS, Raut D, Bhat D, Kumaran K, Fall C, Tatu U, Chandak GR, Yajnik CS, Galande S. Differential expression of genes influencing mitotic processes in cord blood mononuclear cells after a pre-conceptional micronutrient-based randomised controlled trial: Pune Rural Intervention in Young Adolescents (PRIYA). J Dev Orig Health Dis 2023; 14:437-448. [PMID: 36632790 DOI: 10.1017/s204017442200068x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In The Pune Maternal Nutrition Study, vitamin B12 deficiency was seen in 65% of pregnant women, folate deficiency was rare. Maternal total homocysteine concentrations were inversely associated with offspring birthweight, and low vitamin B12 and high folate concentrations predicted higher offspring adiposity and insulin resistance. These findings guided a nested pre-conceptional randomised controlled trial 'Pune Rural Intervention in Young Adolescents'. The interventions included: (1) vitamin B12+multi-micronutrients as per the United Nations International Multiple Micronutrient Antenatal Preparation, and proteins (B12+MMN), (2) vitamin B12 (B12 alone), and (3) placebo. Intervention improved maternal pre-conceptional and in-pregnancy micronutrient nutrition. Gene expression analysis in cord blood mononuclear cells in 88 pregnancies revealed 75 differentially expressed genes between the B12+MMN and placebo groups. The enriched biological processes included G2/M phase transition, chromosome segregation, and nuclear division. Enriched pathways included, mitotic spindle checkpoint and DNA damage response while enriched human phenotypes were sloping forehead and decreased head circumference. Fructose-bisphosphatase 2 (FBP2) and Cell Division Cycle Associated 2 (CDCA2) genes were under-expressed in the B12 alone group. The latter, involved in chromosome segregation was under-expressed in both intervention groups. Based on the role of B-complex vitamins in the synthesis of nucleotides and S-adenosyl methionine, and the roles of vitamins A and D on gene expression, we propose that the multi-micronutrient intervention epigenetically affected cell cycle dynamics. Neonates in the B12+MMN group had the highest ponderal index. Follow-up studies will reveal if the intervention and the altered biological processes influence offspring diabesity.
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Affiliation(s)
- Satyajeet P Khare
- Centre of Excellence in Epigenetics, Department of Biology, Indian Institute of Science Education and Research (IISER), Pune, India
- Symbiosis School of Biological Sciences (SSBS), Symbiosis International (Deemed University), Lavale, Pune, India
| | - Ayush Madhok
- Centre of Excellence in Epigenetics, Department of Biology, Indian Institute of Science Education and Research (IISER), Pune, India
| | - Indumathi Patta
- Centre of Excellence in Epigenetics, Department of Biology, Indian Institute of Science Education and Research (IISER), Pune, India
| | - Krishna K Sukla
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Vipul V Wagh
- Symbiosis School of Biological Sciences (SSBS), Symbiosis International (Deemed University), Lavale, Pune, India
| | - Pooja S Kunte
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Deepa Raut
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Dattatray Bhat
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, India
| | | | - Caroline Fall
- Medical Research Council Lifecourse Epidemiology Centre, Southampton, UK
| | - Utpal Tatu
- Indian Institute of Science (IISc), Bangalore, India
| | - Giriraj R Chandak
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, India
| | | | - Sanjeev Galande
- Centre of Excellence in Epigenetics, Department of Biology, Indian Institute of Science Education and Research (IISER), Pune, India
- Department of Life Sciences, Shiv Nadar University, Gautam Buddha Nagar, Uttar Pradesh, India
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5
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Basu D, Ghosh A, Naskar C, Balachander S, Fernandes G, Vaidya N, Kumaran K, Krishna M, Barker GJ, Sharma E, Murthy P, Holla B, Jain S, Orfanos DP, Kalyanram K, Purushottam M, Bharath RD, Varghese M, Thennarasu K, Chakrabarti A, Singh RL, Singh RL, Nanjayya SB, Ahuja CK, Kartik K, Krishnaveni G, Kuriyan R, Kurpad SS, Desrivieres S, Iyengar U, Zhang Y, Hickman M, Spiers A, Toledano M, Schumann G, Benegal V. Risk clustering and psychopathology from a multi-center cohort of Indian children, adolescents, and young adults. Dev Psychopathol 2023; 35:800-808. [PMID: 35393927 DOI: 10.1017/s0954579422000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Developmental adversities early in life are associated with later psychopathology. Clustering may be a useful approach to group multiple diverse risks together and study their relation with psychopathology. To generate risk clusters of children, adolescents, and young adults, based on adverse environmental exposure and developmental characteristics, and to examine the association of risk clusters with manifest psychopathology. Participants (n = 8300) between 6 and 23 years were recruited from seven sites in India. We administered questionnaires to elicit history of previous exposure to adverse childhood environments, family history of psychiatric disorders in first-degree relatives, and a range of antenatal and postnatal adversities. We used these variables to generate risk clusters. Mini-International Neuropsychiatric Interview-5 was administered to evaluate manifest psychopathology. Two-step cluster analysis revealed two clusters designated as high-risk cluster (HRC) and low-risk cluster (LRC), comprising 4197 (50.5%) and 4103 (49.5%) participants, respectively. HRC had higher frequencies of family history of mental illness, antenatal and neonatal risk factors, developmental delays, history of migration, and exposure to adverse childhood experiences than LRC. There were significantly higher risks of any psychiatric disorder [Relative Risk (RR) = 2.0, 95% CI 1.8-2.3], externalizing (RR = 4.8, 95% CI 3.6-6.4) and internalizing disorders (RR = 2.6, 95% CI 2.2-2.9), and suicidality (2.3, 95% CI 1.8-2.8) in HRC. Social-environmental and developmental factors could classify Indian children, adolescents and young adults into homogeneous clusters at high or low risk of psychopathology. These biopsychosocial determinants of mental health may have practice, policy and research implications for people in low- and middle-income countries.
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Affiliation(s)
- Debasish Basu
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Abhishek Ghosh
- Drug Deaddiction and Treatment Center, Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Chandrima Naskar
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gwen Fernandes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nilakshi Vaidya
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
- Centre for Population Neuroscience and Precision Medicine, Charité Mental Health, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
| | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health, Mysore, India
| | - Gareth J Barker
- Department of Neuroimaging, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Eesha Sharma
- Department of Child & Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Kartik Kalyanram
- Rishi Valley, Rural Health Centre, Madanapalle, Andhra Pradesh, India
| | - Meera Purushottam
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Amit Chakrabarti
- Centre on Non-Communicable Diseases Division of Non-Communicable Diseases (NCD) Indian Council of Medical Research (ICMR), Kolkata, India
| | - Rajkumar Lenin Singh
- Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Roshan Lourembam Singh
- Department of Psychology, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | | | - Chirag Kamal Ahuja
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kamakshi Kartik
- Rishi Valley, Rural Health Centre, Madanapalle, Andhra Pradesh, India
| | - Ghattu Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Rebecca Kuriyan
- Division of Nutrition, St John's Research Institute, Bangalore, India
| | - Sunita Simon Kurpad
- Department of Psychiatry & Department of Medical Ethics, St. John's Medical College & Hospital, Bangalore, India
| | - Sylvane Desrivieres
- Centre for Population Neuroscience and Precision Medicine, MRC Social, Genetic, Developmental Psychiatry Centre, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Udita Iyengar
- Centre for Population Neuroscience and Precision Medicine, MRC Social, Genetic, Developmental Psychiatry Centre, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Yuning Zhang
- Centre for Population Neuroscience and Precision Medicine, MRC Social, Genetic, Developmental Psychiatry Centre, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | | | - Alex Spiers
- Department for Epidemiology and Biostatistics, School of Public Health, Imperial College of Science, London, UK
| | - Mireille Toledano
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine, Charité Mental Health, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry and Psychotherapy and PONS Centre, Institute for Science and Technology of Brain-inspired Intelligence (ISTBI), Fudan University, Shanghai, China
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
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Vaidya N, Holla B, Heron J, Sharma E, Zhang Y, Fernandes G, Iyengar U, Spiers A, Yadav A, Das S, Roy S, Ahuja CK, Barker GJ, Basu D, Bharath RD, Hickman M, Jain S, Kalyanram K, Kartik K, Krishna M, Krishnaveni G, Kumaran K, Kuriyan R, Murthy P, Papadopoulos Orfanos D, Purushottam M, Kurpad SS, Singh L, Singh R, Subodh BN, Toledano M, Walter H, Desrivières S, Chakrabarti A, Benegal V, Schumann G. Neurocognitive Analysis of Low-level Arsenic Exposure and Executive Function Mediated by Brain Anomalies Among Children, Adolescents, and Young Adults in India. JAMA Netw Open 2023; 6:e2312810. [PMID: 37171822 PMCID: PMC10182429 DOI: 10.1001/jamanetworkopen.2023.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/20/2023] [Indexed: 05/13/2023] Open
Abstract
Importance Arsenic, a contaminant of groundwater and irrigated crops, is a global public health hazard. Exposure to low levels of arsenic through food extends well beyond the areas with high arsenic content in water. Objective To identify cognitive impairments following commonly prevalent low-level arsenic exposure and characterize their underlying brain mechanisms. Design, Setting, and Participants This multicenter population-based cohort study analyzed cross-sectional data of the Indian Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA) cohort, recruited between November 4, 2016, and May 4, 2019. Participants aged 6 to 23 years were characterized using deep phenotyping measures of behavior, neuropsychology, psychopathology, brain neuroimaging, and exposure to developmental adversities and environmental neurotoxins. All analyses were performed between June 1, 2020, and December 31, 2021. Exposure Arsenic levels were measured in urine as an index of exposure. Main Outcomes and Measures Executive function measured using the cVEDA neuropsychological battery, gray matter volume (GMV) from T1-weighted magnetic resonance imaging, and functional network connectivity measures from resting state functional magnetic resonance imaging. Results A total of 1014 participants aged 6 to 23 years (589 male [58.1%]; mean [SD] age, 14.86 [4.79] years) were included from 5 geographic locations. Sparse-partial least squares analysis was used to describe a negative association of arsenic exposure with executive function (r = -0.12 [P = 5.4 × 10-4]), brain structure (r = -0.20 [P = 1.8 × 10-8]), and functional connectivity (within network, r = -0.12 [P = 7.5 × 10-4]; between network, r = -0.23 [P = 1.8 × 10-10]). Alterations in executive function were partially mediated by GMV (b = -0.004 [95% CI, -0.007 to -0.002]) and within-network functional connectivity (b = -0.004 [95% CI, -0.008 to -0.002]). Socioeconomic status and body mass index moderated the association between arsenic and GMV, such that the association was strongest in participants with lower socioeconomic status and body mass index. Conclusions and Relevance The findings of this cross-sectional study suggest that low-level arsenic exposure was associated with alterations in executive functioning and underlying brain correlates. These results indicate potential detrimental consequences of arsenic exposure that are below the currently recommended guidelines and may extend beyond endemic risk areas. Precision medicine approaches to study global mental health vulnerabilities highlight widespread but potentially modifiable risk factors and a mechanistic understanding of the impact of low-level arsenic exposure on brain development.
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Affiliation(s)
- Nilakshi Vaidya
- Centre for Population Neuroscience and Precision Medicine, Department of Psychiatry and Neuroscience, Charité Universitätsmedizin Berlin, Berlin, Germany
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bharath Holla
- Department of Psychiatry and Integrative Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jon Heron
- Centre for Public Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Eesha Sharma
- Department of Child & Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Yuning Zhang
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Gwen Fernandes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Udita Iyengar
- Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, United Kingdom
| | - Alex Spiers
- MRC (Medical Research Council) Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Anupa Yadav
- Indian Council of Medical Research–Centre on Noncommunicable Diseases, Kolkata, India
| | - Surajit Das
- Indian Council of Medical Research–Centre on Noncommunicable Diseases, Kolkata, India
| | - Sanjit Roy
- Indian Council of Medical Research–Centre on Noncommunicable Diseases, Kolkata, India
| | - Chirag K. Ahuja
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gareth J. Barker
- Department of Neuroimaging, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, United Kingdom
| | - Debasish Basu
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health, Mysore, India
| | - Ghattu Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | | | - Rebecca Kuriyan
- Division of Nutrition, St John’s Research Institute, Bangalore, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dimitri Papadopoulos Orfanos
- NeuroSpin, Commissariat à l’Énergie Atomique et aux Énergies Alternatives, Université Paris-Saclay, Paris, France
| | - Meera Purushottam
- Molecular Genetics Laboratory, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sunita Simon Kurpad
- Department of Psychiatry, St John’s Medical College and Hospital, Bangalore, India
- Department of Medical Ethics, St John’s Medical College and Hospital, Bangalore, India
| | - Lenin Singh
- Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Roshan Singh
- Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - B. N. Subodh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mireille Toledano
- MRC (Medical Research Council) Centre for Environment and Health, Imperial College London, London, United Kingdom
- Mohn Centre for Children’s Health and Wellbeing, School of Public Health, Imperial College London, London, United Kingdom
| | - Henrik Walter
- Psychiatry, Psychiatric Neuroscience and Neurophilosophy, Research Division of Mind and Brain, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvane Desrivières
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Amit Chakrabarti
- Indian Council of Medical Research–Centre on Noncommunicable Diseases, Kolkata, India
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine, Department of Psychiatry and Neuroscience, Charité Universitätsmedizin Berlin, Berlin, Germany
- Centre for Population Neuroscience and Precision Medicine, Institute for Science and Technology of Brain-Inspired Intelligence, Fudan University, Shanghai, China
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Sharma E, Ravi GS, Kumar K, Thennarasu K, Heron J, Hickman M, Vaidya N, Holla B, Rangaswamy M, Mehta UM, Krishna M, Chakrabarti A, Basu D, Nanjayya SB, Singh RL, Lourembam R, Kumaran K, Kuriyan R, Kurpad SS, Kartik K, Kalyanram K, Desrivieres S, Barker G, Orfanos DP, Toledano M, Purushottam M, Bharath RD, Murthy P, Jain S, Schumann G, Benegal V. Growth trajectories for executive and social cognitive abilities in an Indian population sample: Impact of demographic and psychosocial determinants. Asian J Psychiatr 2023; 82:103475. [PMID: 36736106 DOI: 10.1016/j.ajp.2023.103475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
Cognitive abilities are markers of brain development and psychopathology. Abilities, across executive, and social domains need better characterization over development, including factors that influence developmental change. This study is based on the cVEDA [Consortium on Vulnerability to Externalizing Disorders and Addictions] study, an Indian population based developmental cohort. Verbal working memory, visuo-spatial working memory, response inhibition, set-shifting, and social cognition (faux pas recognition and emotion recognition) were cross-sectionally assessed in > 8000 individuals over the ages 6-23 years. There was adequate representation across sex, urban-rural background, psychosocial risk (psychopathology, childhood adversity and wealth index, i.e. socio-economic status). Quantile regression was used to model developmental change. Age-based trajectories were generated, along with examination of the impact of determinants (sex, childhood adversity, and wealth index). Development in both executive and social cognitive abilities continued into adulthood. Maturation and stabilization occurred in increasing order of complexity, from working memory to inhibitory control to cognitive flexibility. Age related change was more pronounced for low quantiles in response inhibition (β∼4 versus =2 for higher quantiles), but for higher quantiles in set-shifting (β > -1 versus -0.25 for lower quantiles). Wealth index had the largest influence on developmental change across cognitive abilities. Sex differences were prominent in response inhibition, set-shifting and emotion recognition. Childhood adversity had a negative influence on cognitive development. These findings add to the limited literature on patterns and determinants of cognitive development. They have implications for understanding developmental vulnerabilities in young persons, and the need for providing conducive socio-economic environments.
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Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | - G S Ravi
- Department of Health Data Science, University of Liverpool, United Kingdom
| | - Keshav Kumar
- Department of Mental Health and Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Nilakshi Vaidya
- PONS Centre, Charité Mental Health, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Germany
| | - Bharath Holla
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Madhavi Rangaswamy
- Department of Psychology, CHRIST (Deemed to be University), Bengaluru, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health, Mysuru, India
| | | | - Debashish Basu
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Lourembam
- Department of Psychology, Regional Institute of Medical Sciences, Imphal, India
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Unit, University of Southampton, United Kingdom & Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysuru, India
| | - Rebecca Kuriyan
- Division of Nutrition, St John's Research Institute, Bengaluru, India
| | - Sunita Simon Kurpad
- Department of Psychiatry & Department of Medical Ethics, St. John's Medical College & Hospital, Bengaluru, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor, India
| | | | - Sylvane Desrivieres
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychology, Psychiatry & Neuroscience, MRC SGDP Centre, King's College London, United Kingdom
| | - Gareth Barker
- Department of Neuroimaging, Institute of Psychology, Psychiatry & Neuroscience, King's College London, United Kingdom
| | | | - Mireille Toledano
- MRC Centre for Environment and Health, School of Public Health, Imperial College, London, United Kingdom
| | - Meera Purushottam
- Molecular Genetics Laboratory, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gunter Schumann
- PONS Centre, Charité Mental Health, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Germany; Centre for Population Neuroscience and Precision Medicine (PONS), Institute for Science and Technology of Brain-inspired Intelligence (ISTBI), Fudan University, Shanghai, China
| | - Vivek Benegal
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Kumaran K, Birken C, Baillargeon JP, Dennis CL, Fraser WD, Huang H, Fan J, Lye S, Matthews SG, Norris SA. An intergenerational life-course approach to address early childhood obesity and adiposity: the Healthy Life Trajectories Initiative (HeLTI). Lancet Glob Health 2023; 11 Suppl 1:S15. [PMID: 36866472 DOI: 10.1016/s2214-109x(23)00098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Interactions between genes and early-life exposures during conception, fetal life, infancy, and early childhood have been shown to affect an individual's health later in life. Maternal undernutrition and obesity, gestational diabetes, and impaired growth in utero and in early life are associated with adiposity and overweight and obesity in childhood, which are risk factors for poor health trajectories and non-communicable diseases. In Canada, China, India, and South Africa, 10-30% of children aged 5-16 years are overweight or obese. METHODS The application of developmental origins of health and disease principles offers a novel approach to prevention of overweight and obesity and reduction of adiposity by delivering integrated interventions across the life course, starting before conception and continuing through early childhood. The Healthy Life Trajectories Initiative (HeLTI) was established in 2017 through a unique collaboration between national funding agencies in Canada, China, India, South Africa, and WHO. The aim of HeLTI is to evaluate the effect of an integrated four-phase intervention starting preconceptionally and continuing through pregnancy, infancy, and early childhood on reducing childhood adiposity (fat mass index) and overweight and obesity, and optimising early child development, nutrition, and other healthy behaviours. FINDINGS Approximately 22 000 women are being recruited in Shanghai (China), Mysore (India), Soweto (South Africa), and across various provinces of Canada. Women who conceive (an expected 10 000) and their children will be followed up until the child reaches the age of 5 years. INTERPRETATION HeLTI has harmonised the intervention, measures, tools, biospecimen collection, and analysis plans for the trial to be run across four countries. HeLTI will help establish whether an intervention aimed at addressing maternal health behaviours, nutrition, and weight; providing psychosocial support to reduce maternal stress and prevent mental illness; optimising infant nutrition, physical activity, and sleep; and promoting parenting skills can reduce the intergenerational risk of excess childhood adiposity and overweight and obesity across diverse settings. FUNDING Canadian Institutes of Health Research; National Science Foundation of China; Department of Biotechnology, India; and South African Medical Research Council.
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Affiliation(s)
- Kalyanaraman Kumaran
- CSI Holdsworth Memorial Hospital, Mysore, India; MRC Lifecourse Epidemiology Centre, Southampton General Hospital, University of Southampton, Southampton, UK.
| | - Catherine Birken
- SickKids Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | | | - Cindy-Lee Dennis
- University of Toronto, Toronto, ON, Canada; St Michael's Hospital, Toronto, ON, Canada
| | - William D Fraser
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Hefeng Huang
- Fudan University, Shanghai, China; Shanghai Jiao Tong University, Shanghai, China
| | - Jianxia Fan
- Shanghai Jiao Tong University, Shanghai, China
| | - Stephen Lye
- University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Stephen G Matthews
- University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Shane A Norris
- University of the Witwatersrand, Johannesburg, South Africa
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Mahendra A, Kehoe SH, Kumaran K, Krishnaveni GV, Arun N, Pidaparthy P, Kini P, Taskeen U, Fall CHD. Periconceptional diet and the risk of gestational diabetes in south Indian women: findings from the BAngalore Nutrition Gestational diabetes LiFEstyle Study (BANGLES). Lancet Glob Health 2023; 11 Suppl 1:S4. [PMID: 36866481 DOI: 10.1016/s2214-109x(23)00089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Gestational diabetes can predispose two generations-a mother and her child-to a higher risk of obesity and type 2 diabetes. Culture-specific strategies to prevent gestational diabetes are required. BANGLES investigated the associations between women's periconceptional diet and gestational diabetes risk. METHODS BANGLES was a prospective observational study (n=785), in which women of various socioeconomic status were recruited at 5-16 weeks' gestation in Bangalore, India. Periconceptional diet was recalled at recruitment, using a validated 224-item food frequency questionnaire, that was reduced to 21 food groups for the food group-gestational diabetes analysis, and 68 food groups for the principal component analysis for a diet pattern-gestational diabetes analysis. Diet-gestational diabetes associations were examined using multivariate logistic regression, adjusting for a priori confounders determined from the literature. Gestational diabetes was assessed by a 75 g oral glucose tolerance test at 24-28 weeks' gestation, applying 2013 WHO criteria. FINDINGS Women who consumed whole-grain cereals (adjusted odds ratio [OR] 0·58, 95% CI 0·34-0·97, p=0·03); had moderate egg consumption (>1-3 times per week) compared with less than once per week (adjusted OR 0·54, 95% CI 0·34-0·86, p=0·01); and a higher weekly intake of pulses and legumes (adjusted OR 0·81, 95% CI 0·66-0·98, p=0·03), nuts and seeds (adjusted OR 0·77, 95% CI 0·63-0·94, p=0·01), and fried and fast food (adjusted OR 0·72, 95% CI 0·59-0·89, p=0·002) had a lower gestational diabetes. None of these associations was significant after correction for multiple testing. A high-diversity, urban diet pattern characterised by diverse home-cooked and processed foods and associated with older, affluent, educated, urban women was associated with a lower risk (adjusted OR 0·80, 95% CI 0·64-0·99, p=0·04). BMI was the strongest risk factor for gestational diabetes and possibly mediated the diet pattern-gestational diabetes associations. INTERPRETATION The same food groups that were associated with a lower gestational diabetes risk were components of the high-diversity, urban diet pattern. One healthy diet pattern might not be relevant to India. Findings support global recommendations to encourage women to attain a healthy pre-pregnancy BMI, increase diet diversity to prevent gestational diabetes, and have policies to increase food affordability. FUNDING Schlumberger Foundation.
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Affiliation(s)
- Anvesha Mahendra
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; School of Food Science & Nutrition, University of Leeds, Leeds, UK; Epidemiology Research Unit, CSI Holdworth Memorial Hospital, Mysore, India.
| | - Sarah H Kehoe
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; Epidemiology Research Unit, CSI Holdworth Memorial Hospital, Mysore, India
| | - G V Krishnaveni
- Epidemiology Research Unit, CSI Holdworth Memorial Hospital, Mysore, India
| | - Nalini Arun
- Bangalore Baptist Hospital, Bangalore, India
| | | | | | - Unaiza Taskeen
- Epidemiology Research Unit, CSI Holdworth Memorial Hospital, Mysore, India
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
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Bhawra J, Khadilkar A, Krishnaveni GV, Kumaran K, Katapally TR. The 2022 India Report Card on physical activity for children and adolescents. J Exerc Sci Fit 2023; 21:74-82. [PMID: 36408207 PMCID: PMC9663889 DOI: 10.1016/j.jesf.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background With strong evidence of physical inactivity's link to chronic disease and economic burden - particularly with childhood active living behaviors tracking into adulthood - it is imperative to promote physical activity among children and adolescents in India. Objectives To evaluate active living patterns among Indian children and adolescents. Methods The India Report Card (IRC) team, which consists of experts in India and Canada, systematically collected and appraised evidence on 11 indicators of active living, including 5 behavioral (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior), 2 individual-level (Physical Fitness, Yoga) and 4 sources of influence (Family and Peers, School, Community and Built Environment, Government). Peer-reviewed articles were appraised based on national representativeness, sample size, and data quality. Grey literature was appraised based on comprehensiveness, validity of the sources, and representativeness. All indicators were assessed against parameters provided by the Active Healthy Kids Global Alliance. Results Active Transportation and Government Strategies were ranked highest with a B- and C+ grade, respectively. Overall Physical Activity and Schools were assigned a C grade, while Sedentary Behavior and Community and Built Environment were given D grades. Yoga was the lowest ranking indicator with a D- grade. Organized Sport Participation, Active Play, Family and Peers, and Physical Fitness were all graded incomplete. Conclusions Active Transportation, Government Strategies, and Overall Physical Activity have improved since the 2018 IRC, a positive trend that needs to be translated to other indicators. However, Sedentary Behavior has consistently worsened, with grades C, C-, and D-, in 2016, 2018, and 2022, respectively. Evidence generated by the 2022 IRC suggests opportunities for improvement not only in India, but also the 56 other countries taking part in Global Matrix 4.0.
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Affiliation(s)
- Jasmin Bhawra
- School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Ghattu V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysuru, Karnataka, India
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Tarun R Katapally
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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ArulJothi KN, Kumaran K, Senthil S, Nidhu AB, Munaff N, Janitri VB, Kirubakaran R, Singh SK, Gupt G, Dua K, Krishnan A. Implications of reactive oxygen species in lung cancer and exploiting it for therapeutic interventions. Med Oncol 2023; 40:43. [PMID: 36472716 PMCID: PMC9734980 DOI: 10.1007/s12032-022-01900-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
Lung cancer is the second (11.4%) most commonly diagnosed cancer and the first (18%) to cause cancer-related deaths worldwide. The incidence of lung cancer varies significantly among men, women, and high and low-middle-income countries. Air pollution, inhalable agents, and tobacco smoking are a few of the critical factors that determine lung cancer incidence and mortality worldwide. Reactive oxygen species are known factors of lung carcinogenesis resulting from the xenobiotics and their mechanistic paths are under critical investigation. Reactive oxygen species exhibit dual roles in cells, as a tumorigenic and anti-proliferative factor, depending on spatiotemporal context. During the precancerous state, ROS promotes cancer origination through oxidative stress and base-pair substitution mutations in pro-oncogenes and tumor suppressor genes. At later stages of tumor progression, they help the cancer cells in invasion, and metastases by activating the NF-kB and MAPK pathways. However, at advanced stages, when ROS exceeds the threshold, it promotes cell cycle arrest and induces apoptosis in cancer cells. ROS activates extrinsic apoptosis through death receptors and intrinsic apoptosis through mitochondrial pathways. Moreover, ROS upregulates the expression of beclin-1 which is a critical component to initiate autophagy, another form of programmed cell death. ROS is additionally involved in an intermediatory step in necroptosis, which catalyzes and accelerates this form of cell death. Various therapeutic interventions have been attempted to exploit this cytotoxic potential of ROS to treat different cancers. Growing body of evidence suggests that ROS is also associated with chemoresistance and cancer cell immunity. Considering the multiple roles of ROS, this review highlights the exploitation of ROS for various therapeutic interventions. However, there are still gaps in the literature on the dual roles of ROS and the involvement of ROS in cancer cell immunity and therapy resistance.
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Affiliation(s)
- K. N. ArulJothi
- grid.412742.60000 0004 0635 5080Department of Genetic Engineering, Faculty of Engineering and Technology, SRM Institute of Science and Technology, SRM Nagar, Chennai, 603203 India
| | - K. Kumaran
- grid.412742.60000 0004 0635 5080Department of Genetic Engineering, Faculty of Engineering and Technology, SRM Institute of Science and Technology, SRM Nagar, Chennai, 603203 India
| | - Sowmya Senthil
- grid.412742.60000 0004 0635 5080Department of Genetic Engineering, Faculty of Engineering and Technology, SRM Institute of Science and Technology, SRM Nagar, Chennai, 603203 India
| | - A. B. Nidhu
- grid.412742.60000 0004 0635 5080Department of Genetic Engineering, Faculty of Engineering and Technology, SRM Institute of Science and Technology, SRM Nagar, Chennai, 603203 India
| | - Nashita Munaff
- grid.412742.60000 0004 0635 5080Department of Biotechnology, Faculty of Engineering and Technology, SRM Institute of Science and Technology, SRM Nagar, Chennai, 603203 India
| | - V. B. Janitri
- grid.262613.20000 0001 2323 3518Rochester Institute of Technology, Rochester, NY USA
| | - Rangasamy Kirubakaran
- grid.444708.b0000 0004 1799 6895Department of Biotechnology, Vinayaka Mission’s Kirupananda Variyar Engineering College, Vinayaka Missions Research Foundation, Salem, Tamil Nadu India
| | - Sachin Kumar Singh
- grid.449005.cSchool of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi G.T Road, Phagwara, Punjab India ,grid.117476.20000 0004 1936 7611Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - Gaurav Gupt
- grid.448952.60000 0004 1767 7579School of Pharmacy, Suresh Gyan Vihar University, Jagatpura, Mahal Road, Jaipur, 302017 India ,grid.412431.10000 0004 0444 045XDepartment of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India ,grid.449906.60000 0004 4659 5193Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, India
| | - Kamal Dua
- grid.117476.20000 0004 1936 7611Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007 Australia ,grid.117476.20000 0004 1936 7611Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Anand Krishnan
- grid.412219.d0000 0001 2284 638XDepartment of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Free State, Bloemfontein, 9300 South Africa
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Lalitha R, Surak A, Bitar E, Hyderi A, Kumaran K. Fluid and electrolyte management in preterm infants with patent ductus arteriosus. J Neonatal Perinatal Med 2022; 15:689-697. [PMID: 35599502 DOI: 10.3233/npm-210943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Optimal fluid management of preterm babies with suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is frequently challenging for neonatal care physician because of paucity of clinical trials. There is wide variation in practice across neonatal units, resulting in significant impact on outcomes in Extremely Low Birth Weight (ELBW) babies with hemodynamically significant PDA. A delicate balance is required in fluid management to reduce mortality and morbidity in this population. The purpose of this review is to lay out the current understanding about fluid and electrolyte management in ELBW babies with hemodynamically significant PDA and highlight areas for future research.
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Affiliation(s)
- R Lalitha
- Department of Pediatrics, University of Western Ontario, Division of Neonatal-Perinatal Medicine, London, ON, Canada
| | - A Surak
- University of Alberta, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Edmonton, Alberta, Canada
| | - E Bitar
- University of Alberta, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Edmonton, Alberta, Canada
| | - A Hyderi
- University of Alberta, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Edmonton, Alberta, Canada
| | - K Kumaran
- University of Alberta, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Edmonton, Alberta, Canada
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ArulJothi K, Kumaran K, Abirami S, Rangasamy K, Devi A. Exploring the LDL-cholesterol raising SNPs gene scores for improved screening of polygenic familial hypercholesterolemia in Indian population: Pilot study. Gene Reports 2022. [DOI: 10.1016/j.genrep.2022.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Mahendra A, Kehoe SH, Crozier SR, Kumaran K, Krishnaveni GV, Arun N, Padmaja, Kini P, Taskeen U, Kombanda KT, Johnson M, Osmond C, Fall CHD. Peri-conceptional diet patterns and the risk of Gestational diabetes mellitus in South Indian women. Public Health Nutr 2022; 26:1-34. [PMID: 35620916 PMCID: PMC10131144 DOI: 10.1017/s1368980022001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/22/2022] [Accepted: 05/12/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify peri-conceptional diet patterns among women in Bangalore, and examine their associations with risk of gestational diabetes mellitus. DESIGN BANGLES, started in June 2016, was a prospective observational study, in which women were recruited at 5-16 weeks' gestation. Peri-conceptional diet was recalled at recruitment, using a validated 224-item food frequency questionnaire. GDM was assessed by a 75-gram oral glucose tolerance test at 24-28 weeks' gestation, applying WHO 2013 criteria. Diet patterns were identified using principal component analysis and diet pattern-GDM associations were examined using multivariate logistic regression, adjusting for 'a priori' confounders. SETTING Antenatal clinics of two hospitals, Bangalore, South India. PARTICIPANTS 785 pregnant women of varied socio-economic status. RESULTS GDM prevalence was 22%. Three diet patterns were identified: a) High-diversity, urban (HDU) characterised by diverse, home-cooked and processed foods was associated with older, more affluent, better-educated and urban women; b) Rice-fried snacks-chicken-sweets (RFCS), characterised by low diet-diversity, was associated with younger, less-educated, and lower income, rural and joint families; c) Healthy, traditional vegetarian (HTV), characterised by home-cooked-vegetarian and non-processed foods was associated with less-educated, more affluent, and rural and joint families. The HDU pattern was associated with a lower GDM risk (aOR: 0.80 per SD, 95% CI: 0.64, 0.99, p=0.04) after adjusting for confounders. BMI was strongly related to GDM risk and possibly mediated diet-GDM associations. CONCLUSIONS The findings support global recommendations to encourage women to attain a healthy pre-pregnancy BMI and increase diet-diversity. Both healthy and unhealthy foods in the patterns indicate low-awareness about healthy foods and a need for public-education.
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Affiliation(s)
- Anvesha Mahendra
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Sarah H Kehoe
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - GV Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Nalini Arun
- Department of Obstetrics and Gynaecology, Bangalore Baptist Hospital, Bangalore, India
| | - Padmaja
- Department of Obstetrics and Gynaecology, Bangalore Baptist Hospital, Bangalore, India
| | - Prakash Kini
- Department of Obstetrics and Gynaecology, Cloudnine Hospital, Bangalore, India
| | - Unaiza Taskeen
- Previously Affiliated to Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Krupa T Kombanda
- School of Exercise and Nutrition, Deakin University, Geelong, Australia
| | - Matthew Johnson
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
| | - Caroline HD Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Krishna M, Majgi S, DU B, Krishnaveni GV, Veena SR, Prince M, Kumaran K, Christaprasad Karat S, Kumar M, Padukundru M, Nagaraj S, Fall CH. A lifecourse approach to the relationship between lung function and cognition function in late life: findings from the Mysore studies of Natal effect on Ageing and Health (MYNAH) in South India. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.16981.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Emerging evidence from high income settings indicates that lung function may be an independent determinant of cognitive abilities in late life. Despite a high burden of chronic lung disorders and neurocognitive disorders, there are limited data exploring the relationship between lung and cognitive function in later life in low- and middle-income (LMIC) settings. Methods: Between 2013 and 2016, 721 men and women from the Mysore Birth Records Cohort in South India, aged 55-80 years, were retraced and underwent standardised assessments for sociodemographic characteristics, cardiometabolic risk factors, lung function, cognitive function and mental health. Approximately 20 years earlier, a subset of them had assessments for cardiometabolic risk factors (n=522) and lung function (n=143). Results: Forced Expiratory Volume at one second (FEV1) and six seconds (FEV6) were higher among men than women. Women had higher immediate and delayed recall scores compared to men. Multivariate models indicated that those with lower FEV1 (lts) and FEV1/FEV6 ratio in late life had lower composite cognitive score (SD, standard deviation), independent of growth and environment in early life and childhood, attained education, socioeconomic position, cardiometabolic disorders in mid-and late life and lifestyle factors (0.29 SD per litre 95% confidence interval [CI] (0.10, 0.50) p=0.006 for FEV1 and 1.32 SD (0.20, 2.50) p=0.02 for FEV1/FEV6 ratio). Lung function in midlife was unrelated to cognitive outcomes in late life. Conclusions: Causality cannot be inferred from cross sectional associations. Therefore, causality is best explored in longitudinal studies with serial, but contemporaneous measurements of both lung and cognitive function. Mechanistic studies that examine the role of shared risk factors like environmental pollutants and biomass exposure on this relationship are urgently required in LMICs.
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D'souza N, Behere RV, Patni B, Deshpande M, Bhat D, Bhalerao A, Sonawane S, Shah R, Ladkat R, Yajnik P, Bandyopadhyay SK, Kumaran K, Fall C, Yajnik CS. Corrigendum: Pre-conceptional Maternal Vitamin B12 Supplementation Improves Offspring Neurodevelopment at 2 Years of Age: PRIYA Trial. Front Pediatr 2022; 10:860732. [PMID: 35265568 PMCID: PMC8899710 DOI: 10.3389/fped.2022.860732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2021.755977.].
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Affiliation(s)
- Naomi D'souza
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Rishikesh V Behere
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Bindu Patni
- Terre des Hommes Rehabilitation and Morris Child Development Centre at KEM Hospital, Pune, India
| | - Madhavi Deshpande
- Terre des Hommes Rehabilitation and Morris Child Development Centre at KEM Hospital, Pune, India
| | - Dattatray Bhat
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Aboli Bhalerao
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Swapnali Sonawane
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Rohan Shah
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Rasika Ladkat
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Pallavi Yajnik
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | | | - Kalyanaraman Kumaran
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Caroline Fall
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
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18
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V P, Arun V, Mc R, Nagaraj S, Krishnaveni GV, Kumaran K, Fall CH, Krishna M. Validation of EURO-D, a geriatric depression scale in South India: Findings from the Mysore study of Natal effects on Ageing and Health (MYNAH). J Affect Disord 2021; 295:939-945. [PMID: 34706466 DOI: 10.1016/j.jad.2021.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/21/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Many of the assessment tools used to study depression amongst older people in low- and middle- income countries (LMICs) are adaptations of instruments developed in other cultural settings. There is a need to validate those instruments in LMICs. METHODS 721 men and women aged 55-80 years from the Mysore Birth Records Cohort underwent standardised assessments for sociodemographic characteristics, cardiometabolic risk factors, cognitive function and mental health. Sensitivity, specificity and level of agreement of EURO-D diagnosis of depression with diagnosis of depression derived by the Geriatric Mental State (GMS) examination were calculated. To validate the EURO-D score against GMS depressive episode, we used maximum Youden's index as the criterion for each cut-off point. Concurrent validity was assessed by measuring correlations with the WHO Disability Assessment Schedule (WHO DAS II). RESULTS Of the 721 (408 men and 313 women) who participated in this study, 138 (54 men and 84 women) were diagnosed with depression. Women had higher depression scores on the EURO-D scale and disability on the WHO DAS II scale. A maximum Youden's Index of 0.60 was observed at a EURO-D cut-off of 6, which corresponded to 95% sensitivity, 64% specificity, kappa value of 0.6 and area under the curve (AUC) of 80%. There was significant and positive correlation between EURO-D and WHO DAS II scores. LIMITATIONS Future independent validation studies in other settings are required. DISCUSSION This study supports the use of the EURO-D scale for diagnosing depression amongst older adults in South India.
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Affiliation(s)
- Prajwal V
- SJCE JSS Science and Technology University Mysore India
| | - Vanishri Arun
- SJCE JSS Science and Technology University Mysore India
| | - Ramya Mc
- CSI Holdsworth Memorial Hospital, Mysore, India
| | | | | | - Kalyanaraman Kumaran
- CSI Holdsworth Memorial Hospital, Mysore, India; MRC Lifecourse Epidemiology Unit, University of Southampton, United Kingdom
| | - Caroline Hd Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, United Kingdom
| | - Murali Krishna
- CSI Holdsworth Memorial Hospital, Mysore, India; Foundation for Research and Advocacy in Mental Health, Mysore, India.
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19
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Yajnik CS, Bandopadhyay S, Bhalerao A, Bhat DS, Phatak SB, Wagh RH, Yajnik PC, Pandit A, Bhave S, Coyaji K, Kumaran K, Osmond C, Fall CHD. Poor In Utero Growth, and Reduced β-Cell Compensation and High Fasting Glucose From Childhood, Are Harbingers of Glucose Intolerance in Young Indians. Diabetes Care 2021; 44:2747-2757. [PMID: 34610922 DOI: 10.2337/dc20-3026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE India is a double world capital of early-life undernutrition and type 2 diabetes. We aimed to characterize life course growth and metabolic trajectories in those developing glucose intolerance as young adults in the Pune Maternal Nutrition Study (PMNS). RESEARCH DESIGN AND METHODS PMNS is a community-based intergenerational birth cohort established in 1993, with serial information on parents and children through pregnancy, childhood, and adolescence. We compared normal glucose-tolerant and glucose-intolerant participants for serial growth, estimates of insulin sensitivity and secretion (HOMA and dynamic indices), and β-cell compensation accounting for prevailing insulin sensitivity. RESULTS At 18 years (N = 619), 37% of men and 20% of women were glucose intolerant (prediabetes n = 184; diabetes n = 1) despite 48% being underweight (BMI <18.5 kg/m2). Glucose-intolerant participants had higher fasting glucose from childhood. Mothers of glucose-intolerant participants had higher glycemia in pregnancy. Glucose-intolerant participants were shorter at birth. Insulin sensitivity decreased with age in all participants, and those with glucose intolerance had consistently lower compensatory insulin secretion from childhood. Participants in the highest quintile of fasting glucose at 6 and 12 years had 2.5- and 4.0-fold higher risks, respectively, of 18-year glucose intolerance; this finding was replicated in two other cohorts. CONCLUSIONS Inadequate compensatory insulin secretory response to decreasing insulin sensitivity in early life is the major pathophysiology underlying glucose intolerance in thin rural Indians. Smaller birth size, maternal pregnancy hyperglycemia, and higher glycemia from childhood herald future glucose intolerance, mandating a strategy for diabetes prevention from early life, preferably intergenerationally.
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Affiliation(s)
| | | | - Aboli Bhalerao
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Dattatray S Bhat
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Sanat B Phatak
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Rucha H Wagh
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Pallavi C Yajnik
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Anand Pandit
- Department of Paediatrics, KEM Hospital Research Centre, Pune, India
| | - Sheila Bhave
- Department of Paediatrics, KEM Hospital Research Centre, Pune, India
| | - Kurus Coyaji
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Kalyanaraman Kumaran
- Holdsworth Memorial Hospital, Mysore, India.,Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, U.K
| | - Clive Osmond
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, U.K
| | - Caroline H D Fall
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, U.K
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20
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Fernandes GS, Spiers A, Vaidya N, Zhang Y, Sharma E, Holla B, Heron J, Hickman M, Murthy P, Chakrabarti A, Basu D, Subodh BN, Singh L, Singh R, Kalyanram K, Kartik K, Kumaran K, Krishnaveni G, Kuriyan R, Kurpad S, Barker GJ, Bharath RD, Desrivieres S, Purushottam M, Orfanos DP, Toledano MB, Schumann G, Benegal V. Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort. BMC Public Health 2021; 21:1920. [PMID: 34686158 PMCID: PMC8539836 DOI: 10.1186/s12889-021-11892-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/07/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse. METHODS Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and family structure. RESULTS 1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males report more of every individual childhood adversity and are more likely to report misusing substances compared with females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5-11.7) and collective level ACEs (adj OR 6.6, 95% CI 1.4-31.1) show associations with substance misuse whilst in young adults, child level ACEs such as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1-3.5). CONCLUSION ACEs such as abuse and domestic violence are strongly associated with substance misuse, most commonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACE resilience programmes and 'trauma-informed' approaches to tackling longer-term impact of ACEs in India. FUNDING Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and the Indian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).
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Affiliation(s)
- G S Fernandes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.
| | - A Spiers
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - N Vaidya
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India.,Centre for Population Neuroscience and Precision Medicine, Kings College London, London, UK
| | - Y Zhang
- Centre for Innovation in Mental Health, Department of Psychology, University of Southampton, Southampton, UK
| | - E Sharma
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - B Holla
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - J Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - P Murthy
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - A Chakrabarti
- ICMR-Centre on Non-Communicable Diseases, Kolkata, India
| | - D Basu
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B N Subodh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - L Singh
- Department of Psychiatry, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India
| | - R Singh
- Department of Psychiatry, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India
| | - K Kalyanram
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor, Andhra Pradesh, India
| | - K Kartik
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor, Andhra Pradesh, India
| | - K Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - G Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - R Kuriyan
- Department of Psychiatry and Medical Ethics, St John's Medical College & Hospital, Bangalore, India
| | - S Kurpad
- Department of Psychiatry & Department of Medical Ethics, St. John's Medical College & Hospital, Bangalore, India
| | - G J Barker
- Centre for Population Neuroscience and Precision Medicine, Kings College London, London, UK.,Department of Neuroimaging, King's College London, London, UK
| | - R D Bharath
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - S Desrivieres
- Centre for Population Neuroscience and Precision Medicine, Kings College London, London, UK
| | - M Purushottam
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - D P Orfanos
- NeuroSpin, CEA, Université Paris-Saclay, Paris, France
| | - M B Toledano
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - G Schumann
- Centre for Population Neuroscience and Precision Medicine, Kings College London, London, UK
| | - V Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
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21
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Krishna M, Krishnaveni GV, Sargur V, Kumaran K, Kumar M, Nagaraj K, Coakley P, Karat SC, Chandak GR, Varghese M, Prince M, Osmond C, Fall CHD. Size at birth, lifecourse factors, and cognitive function in late life: findings from the MYsore study of Natal effects on Ageing and Health (MYNAH) cohort in South India. Int Psychogeriatr 2021; 34:1-14. [PMID: 34666849 DOI: 10.1017/s1041610221001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine if smaller size at birth, an indicator of growth restriction in utero, is associated with lower cognition in late life, and whether this may be mediated by impaired early life brain development and/or adverse cardiometabolic programming. DESIGN Longitudinal follow-up of a birth cohort. SETTING CSI Holdsworth Memorial Hospital (HMH), Mysore South India. PARTICIPANTS 721 men and women (55-80 years) whose size at birth was recorded at HMH. Approximately 20 years earlier, a subset (n = 522) of them had assessments for cardiometabolic disorders in mid-life. MEASUREMENTS Standardized measurement of cognitive function, depression, sociodemographic, and lifestyle factors; blood tests and assessments for cardiometabolic disorders. RESULTS Participants who were heavier at birth had higher composite cognitive scores (0.12 SD per SD birth weight [95% CI 0.05, 0.19] p = 0.001) in late life. Other lifecourse factors independently positively related to cognition were maternal educational level and participants' own educational level, adult leg length, body mass index, and socioeconomic position, and negatively were diabetes in mid-life and current depression and stroke. The association of birth weight with cognition was independent cardiometabolic risk factors and was attenuated after adjustment for all lifecourse factors (0.08 SD per SD birth weight [95% CI -0.01, 0.18] p = 0.07). CONCLUSIONS The findings are consistent with positive effects of early life environmental factors (better fetal growth, education, and childhood socioeconomic status) on brain development resulting in greater long-term cognitive function. The results do not support a pathway linking poorer fetal development with reduced late life cognitive function through cardiometabolic programming.
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Affiliation(s)
- Murali Krishna
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
- Foundation for Research and Advocacy in Mental Health Mysore, Mysore, India
| | | | - Veena Sargur
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
| | - Kalyanaraman Kumaran
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mohan Kumar
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
| | - Kiran Nagaraj
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
| | - Patsy Coakley
- Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | | | - Mathew Varghese
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Martin Prince
- Institute of Psychiatry, Kings College London, London, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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22
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Koparkar S, Srivastava L, Randhir K, Dangat K, Pisal H, Kadam V, Malshe N, Wadhwani N, Lalwani S, Srinivasan K, Kumaran K, Fall C, Joshi S. Cognitive function and behavioral problems in children born to mothers with preeclampsia: an Indian study. Child Neuropsychol 2021; 28:337-354. [PMID: 34592908 DOI: 10.1080/09297049.2021.1978418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Studies from high-income countries report associations of preeclampsia (PE) with reduced cognitive function and adverse behavioural outcomes in children. We examined these associations in Indian children aged 5-7 years. Children of mothers with PE (n=74) and without PE (non-PE; n=234) were recruited at delivery at Bharati Hospital, Pune, India. The cognitive performance was assessed using 3 core tests from the Kaufman Assessment Battery and additional tests including Verbal fluency, Kohs block design, and Coding A (from Wechsler Intelligence Scale for Children). The parent-reported Strengths and Difficulties Questionnaire (SDQ) was used to assess children's behavioral characteristics. Scores were compared between children from PE and non-PE groups, and associations analyzed further using regression models, adjusted for potential confounders. After adjusting for age, sex, socio-economic status and maternal education, children of PE mothers had lower Kohs block design scores (adjusted odds ratio per score category 0.57, [95% CI 0.34-0.96] p=0.034; 0.62 [95%CI (0.36, 1.07), p=0.09 on further adjustment for birth weight and gestation) compared to children of mothers without PE. In the SDQ, there was a lower prevalence of abnormal 'conduct problem' scores in PE group than non-PE group (OR=0.33, 95% CI 0.13-0.83, p=0.018, in the fully adjusted model); there were no differences for other behavioral domains. This preliminary study in Indian children suggests that fetal exposure to maternal PE may have an adverse impact on visuo-spatial performance but does not adversely affect behavior. Further studies with larger sample sizes are essential to understand effects of maternal PE on cognitive/behavioral outcomes in children.
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Affiliation(s)
- Shruti Koparkar
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Leena Srivastava
- Department of Paediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth Deemed University, Pune, India
| | - Karuna Randhir
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Kamini Dangat
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Hemlata Pisal
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Vrushali Kadam
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Nandini Malshe
- Department of Paediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth Deemed University, Pune, India
| | - Nisha Wadhwani
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
| | - Sanjay Lalwani
- Department of Paediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth Deemed University, Pune, India
| | - K Srinivasan
- Department of Psychiatry, St. John's Medical College Hospital, Bangalore, India.,Division of Mental Health and Neurosciences, St. John's Research Institute, Bangalore, India
| | - K Kumaran
- Epidemiology Research Unit, CSI, Holdsworth Memorial Hospital, Mysore, India
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to Be) University, Pune, India
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Chai CA, Yeoh WS, Rajandram R, Aung KP, Ong TA, Kuppusamy S, Nazran A, Kumaran K, Razack AHA, Teoh JY. Comparing CxBladder to Urine Cytology as Adjunct to Cystoscopy in Surveillance of Non-muscle Invasive Bladder Cancer-A Pilot Study. Front Surg 2021; 8:659292. [PMID: 34055868 PMCID: PMC8155709 DOI: 10.3389/fsurg.2021.659292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Guidelines advocate cystoscopy surveillance (CS) for non-muscle invasive bladder cancer (NMIBC) post-resection. However, cystoscopy is operator dependent and may miss upper tract lesions or carcinoma in-situ (CIS). Urine cytology is a common adjunct but lacks sensitivity and specificity in detecting recurrence. A new mRNA biomarker (CxBladder) was compared with urine cytology as an adjunct to cystoscopy in detecting a positive cystoscopy findings during surveillance cystoscopy in our center. Materials and Methods: Consented patients older than 18, undergoing CS for NMIBC, provide paired urine samples for cytology and CxBladder test. Patients with positive cystoscopy findings would undergo re-Trans Urethral Resection of Bladder Tumor (TURBT). Results: Thirty-five patients were enrolled from April to June 2019. Seven contaminated urine samples were excluded. The remaining cohort of 23 (82%) and 5 (18%) females had a mean age of 66.69 (36–89). Eight (29%) patients with positive cystoscopy finding underwent TURBT. All 8 patients also had positive CxBladder result. This shows that CxBladder has a sensitivity and negative predictive value (NPV) of 100%, specificity of 75% and positive predictive value (PPV) of 62% in predicting a positive cystoscopy finding. TURBT Histo-pathological findings showed Low-grade Ta NMIBC in one patient (4%), and 7 (25%) patients had inflammatory changes. Urine cytology was only positive in one patient with a positive cystoscopy finding. This led to a sensitivity of merely 13% and NPV of 74%, while specificity and PPV was 100% in predicting a positive cystoscopy finding. Conclusion: CxBladder had high NPV and sensitivity which accurately predicted suspicious cystoscopy findings leading to further investigation. It has great potential for use as adjunct to cystoscopy for surveillance of NMIBC.
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Affiliation(s)
- C A Chai
- Urology Division, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - W S Yeoh
- Urology Division, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - R Rajandram
- Urology Division, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - K P Aung
- Urology Division, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - T A Ong
- Urology Division, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - S Kuppusamy
- Urology Division, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A Nazran
- Urology Division, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - K Kumaran
- Urology Division, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A H A Razack
- Urology Division, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - J Y Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Kumaran K, Krishnaveni GV, Suryanarayana KG, Prasad MP, Belavendra A, Atkinson S, Balasubramaniam R, Bandsma RHJ, Bhutta ZA, Chandak GR, Comelli EM, Davidge ST, Dennis CL, Hammond GL, Jha P, Joseph KS, Joshi SR, Krishna M, Lee K, Lye S, McGowan P, Nepomnaschy P, Padvetnaya V, Pyne S, Sachdev HS, Sahariah SA, Singhal N, Trasler J, Yajnik CS, Baird J, Barker M, Martin MC, Husain N, Sellen D, Fall CHD, Shah PS, Matthews SG. Protocol for a cluster randomised trial evaluating a multifaceted intervention starting preconceptionally-Early Interventions to Support Trajectories for Healthy Life in India (EINSTEIN): a Healthy Life Trajectories Initiative (HeLTI) Study. BMJ Open 2021; 11:e045862. [PMID: 33593789 PMCID: PMC7888364 DOI: 10.1136/bmjopen-2020-045862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Healthy Life Trajectories Initiative is an international consortium comprising four harmonised but independently powered trials to evaluate whether an integrated intervention starting preconceptionally will reduce non-communicable disease risk in their children. This paper describes the protocol of the India study. METHODS AND ANALYSIS The study set in rural Mysore will recruit ~6000 married women over the age of 18 years. The village-based cluster randomised design has three arms (preconception, pregnancy and control; 35 villages per arm). The longitudinal multifaceted intervention package will be delivered by community health workers and comprise: (1) measures to optimise nutrition; (2) a group parenting programme integrated with cognitive-behavioral therapy; (3) a lifestyle behaviour change intervention to support women to achieve a diverse diet, exclusive breast feeding for the first 6 months, timely introduction of diverse and nutritious infant weaning foods, and adopt appropriate hygiene measures; and (4) the reduction of environmental pollution focusing on indoor air pollution and toxin avoidance.The primary outcome is adiposity in children at age 5 years, measured by fat mass index. We will report on a host of intermediate and process outcomes. We will collect a range of biospecimens including blood, urine, stool and saliva from the mothers, as well as umbilical cord blood, placenta and specimens from the offspring.An intention-to-treat analysis will be adopted to assess the effect of interventions on outcomes. We will also undertake process and economic evaluations to determine scalability and public health translation. ETHICS AND DISSEMINATION The study has been approved by the institutional ethics committee of the lead institute. Findings will be published in peer-reviewed journals. We will interact with policy makers at local, national and international agencies to enable translation. We will also share the findings with the participants and local community through community meetings, newsletters and local radio. TRIAL REGISTRATION NUMBER ISRCTN20161479, CTRI/2020/12/030134; Pre-results.
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Affiliation(s)
- Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Kumar Gavali Suryanarayana
- Department of Academics and Research, Vivekananda Memorial Hospital, Saragur, Karnataka, India
- Development Support, Swami Vivekananda Youth Movement, Mysore, India
| | - Manohar Prabhu Prasad
- Department of Academics and Research, Vivekananda Memorial Hospital, Saragur, Karnataka, India
| | | | - Stephanie Atkinson
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Robert H J Bandsma
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences and Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Giriraj Ratan Chandak
- Genomic Research on Complex Diseases, CSIR - Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Elena M Comelli
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Toronto, Ontario, Canada
| | - Sandra T Davidge
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Geoffrey L Hammond
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Prabhat Jha
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - K S Joseph
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sadhana R Joshi
- Nutritional Medicine Division, Interactive Research School for Health Affairs, Bharati Vidyapeeth, Pune, India
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
| | - Kang Lee
- Department of Applied Psychology and Human Development, OISE/University of Toronto, Toronto, Ontario, Canada
| | - Stephen Lye
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Departments of Obstetrics & Gynecology, Physiology, and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patrick McGowan
- Department of Biological Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Pablo Nepomnaschy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Vivek Padvetnaya
- Jindal School of Government and Public Policy, O.P. Jindal Global University, Sonipat, Haryana, India
| | - Saumyadipta Pyne
- Public Health Dynamics Lab and Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Health Analytics Network, Pennsylvania, Harrisburg, USA
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Sirazul Ameen Sahariah
- Reproductive Maternal Newborn Child and Adolescent Health and Nutrition, MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
| | - Nalini Singhal
- Department of Paediatrics, University of Calgary, Calgary, Mull, Canada
| | - Jacquetta Trasler
- Departments of Pediatrics, Human Genetics, and Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Janis Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
| | - Marie-Claude Martin
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Daniel Sellen
- Joannah and Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Anthropology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Paediatrics and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephen G Matthews
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Departments of Obstetrics & Gynecology, Physiology, and Medicine, University of Toronto, Toronto, Ontario, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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D'souza N, Behere RV, Patni B, Deshpande M, Bhat D, Bhalerao A, Sonawane S, Shah R, Ladkat R, Yajnik P, Bandyopadhyay SK, Kumaran K, Fall C, Yajnik CS. Pre-conceptional Maternal Vitamin B12 Supplementation Improves Offspring Neurodevelopment at 2 Years of Age: PRIYA Trial. Front Pediatr 2021; 9:755977. [PMID: 34956975 PMCID: PMC8697851 DOI: 10.3389/fped.2021.755977] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The first thousand days window does not include the pre-conceptional period. Maternal pre-conceptional health has a profound influence on early embryonic development (implantation, gastrulation, placentation etc). Nutrition provided by B-complex vitamins is important for fetal growth, especially neural development. We report effects of a maternal pre-conceptional vitamin B12 and multi micronutrient (MMN) supplementation on offspring neurodevelopmental performance. Methods: In the Pune Rural Intervention in Young Adolescents trial (PRIYA), adolescents (N = 557, 226 females) were provided with vitamin B12 (2 μg/day) with or without multiple micronutrients, or a placebo, from preconception until delivery. All groups received mandatory iron and folic acid. We used the Bayley's Scale of Infant Development (BSID-III) at 24-42 months of age to investigate effects on offspring neurodevelopment. Results: Participants had similar baseline B12 levels. The levels improved in the B12 supplemented groups during pre-conception and pregnancy (28 weeks gestation), and were reflected in higher cord blood holotranscobalamin (holo-TC) levels compared to the placebo group. Neurodevelopmental outcomes in the B12 alone group (n = 21) were better than the placebo (n = 27) in cognition (p = 0.044) and language (p = 0.020) domains (adjusted for maternal baseline B12 levels). There was no difference in neurodevelopmental outcomes between the B12 + MMN (n = 26) and placebo group. Cord blood Brain Derived Neurotrophic Factor (BDNF) levels were highest in the B12 alone group, though not significant. Conclusion: Pre-conceptional vitamin B12 supplementation improved maternal B12 status and offspring neurodevelopment at 2 years of age. The usefulness of cord BDNF as a marker of brain development needs further investigation. Our results highlight the importance of intervening during pre-conception.
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Affiliation(s)
- Naomi D'souza
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Rishikesh V Behere
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Bindu Patni
- Terre des Hommes Rehabilitation and Morris Child Development Centre at KEM Hospital, Pune, India
| | - Madhavi Deshpande
- Terre des Hommes Rehabilitation and Morris Child Development Centre at KEM Hospital, Pune, India
| | - Dattatray Bhat
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Aboli Bhalerao
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Swapnali Sonawane
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Rohan Shah
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Rasika Ladkat
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Pallavi Yajnik
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | | | - Kalyanaraman Kumaran
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Caroline Fall
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
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Kumaran K, Joshi SM, Di Gravio C, Lubree H, Joglekar C, Bhat D, Kinare A, Bavdekar A, Bhave S, Pandit A, Osmond C, Yajnik C, Fall C. Do components of adult height predict body composition and cardiometabolic risk in a young adult South Asian Indian population? Findings from a hospital-based cohort study in Pune, India: Pune Children's Study. BMJ Open 2020; 10:e036897. [PMID: 33033015 PMCID: PMC7542941 DOI: 10.1136/bmjopen-2020-036897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We investigated whether the relationship between components of height and cardiovascular disease (CVD) risk may be explained by body composition. We also examined relationships between parental heights and offspring CVD risk. DESIGN A cohort study using cross-sectional data. SETTING A secondary care hospital setting in Pune, India. PARTICIPANTS We studied 357 young adults and their parents in the Pune Children's Study. Primary and secondary outcomes: we measured weight, total height, leg length, sitting height, plasma glucose, insulin and lipids, and blood pressure (BP). Total and regional lean and fat mass were measured by dual X-ray absorptiometry. RESULTS Leg length was inversely related, and sitting height was directly related to BMI. Total height and leg length were directly related to lean mass, while sitting height was directly related to both lean and fat mass. Leg length was inversely related to systolic BP and 120 min glucose, independent of lean and fat mass. Sitting height was directly related to systolic BP and triglycerides; these relationships were attenuated on adjustment for lean and fat mass. When examined simultaneously, greater leg length was protective and greater sitting height was associated with a more detrimental CVD risk profile. CONCLUSIONS Shorter adult leg length and greater sitting height are associated with a more adverse CVD risk factor profile. The mechanisms need further study, but our findings suggest a role for lean and fat mass.
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Affiliation(s)
- Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, UK
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Suyog M Joshi
- Diabetes Unit, KEM Hospital Research Centre, Pune, Maharashtra, India
| | - Chiara Di Gravio
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Himangi Lubree
- Vadu Rural Health Centre, KEM Hospital Research Centre, Pune, Maharashtra, India
| | - Charudatta Joglekar
- Department of Statistics, BKL Walawalkar Hospital and Diagnostic Centre, Ratnagiri, Maharashtra, India
| | - Dattatray Bhat
- Diabetes Unit, KEM Hospital Research Centre, Pune, Maharashtra, India
| | - Arun Kinare
- Department of Radiodiagnosis, Bharati Medical College and Hospital, Bharati Vidyapeeth, Pune, Maharashtra, India
| | - Ashish Bavdekar
- Department of Paediatrics, KEM Hospital, Pune, Maharashtra, India
| | - Sheila Bhave
- Department of Paediatrics, KEM Hospital, Pune, Maharashtra, India
| | - Anand Pandit
- Department of Paediatrics, KEM Hospital, Pune, Maharashtra, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, UK
| | | | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, UK
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Saffari A, Shrestha S, Issarapu P, Sajjadi S, Betts M, Sahariah SA, Tomar AS, James P, Dedaniya A, Yadav DK, Kumaran K, Prentice AM, Lillycrop KA, Fall CHD, Chandak GR, Silver MJ. Effect of maternal preconceptional and pregnancy micronutrient interventions on children's DNA methylation: Findings from the EMPHASIS study. Am J Clin Nutr 2020; 112:1099-1113. [PMID: 32889533 PMCID: PMC7528567 DOI: 10.1093/ajcn/nqaa193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Maternal nutrition in pregnancy has been linked to offspring health in early and later life, with changes to DNA methylation (DNAm) proposed as a mediating mechanism. OBJECTIVE We investigated intervention-associated DNAm changes in children whose mothers participated in 2 randomized controlled trials of micronutrient supplementation before and during pregnancy, as part of the EMPHASIS (Epigenetic Mechanisms linking Preconceptional nutrition and Health Assessed in India and sub-Saharan Africa) study (ISRCTN14266771). DESIGN We conducted epigenome-wide association studies with blood samples from Indian (n = 698) and Gambian (n = 293) children using the Illumina EPIC array and a targeted study of selected loci not on the array. The Indian micronutrient intervention was food based, whereas the Gambian intervention was a micronutrient tablet. RESULTS We identified 6 differentially methylated CpGs in Gambians [2.5-5.0% reduction in intervention group, all false discovery rate (FDR) <5%], the majority mapping to ESM1, which also represented a strong signal in regional analysis. One CpG passed FDR <5% in the Indian cohort, but overall effect sizes were small (<1%) and did not have the characteristics of a robust signature. We also found strong evidence for enrichment of metastable epialleles among subthreshold signals in the Gambian analysis. This supports the notion that multiple methylation loci are influenced by micronutrient supplementation in the early embryo. CONCLUSIONS Maternal preconceptional and pregnancy micronutrient supplementation may alter DNAm in children measured at 7-9 y. Multiple factors, including differences between the nature of the intervention, participants, and settings, are likely to have contributed to the lack of replication in the Indian cohort. Potential links to phenotypic outcomes will be explored in the next stage of the EMPHASIS study.
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Affiliation(s)
- Ayden Saffari
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Smeeta Shrestha
- Genomic Research on Complex Diseases (GRC Group), CSIR–Centre for Cellular and Molecular Biology, Hyderabad, India
- School of Basic and Applied Sciences, Dayananda Sagar University, Bangalore, India
| | - Prachand Issarapu
- Genomic Research on Complex Diseases (GRC Group), CSIR–Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Sara Sajjadi
- Genomic Research on Complex Diseases (GRC Group), CSIR–Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Modupeh Betts
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Ashutosh Singh Tomar
- Genomic Research on Complex Diseases (GRC Group), CSIR–Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Philip James
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Akshay Dedaniya
- Genomic Research on Complex Diseases (GRC Group), CSIR–Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Dilip K Yadav
- Genomic Research on Complex Diseases (GRC Group), CSIR–Centre for Cellular and Molecular Biology, Hyderabad, India
- Department of Physiology, Boston University, School of Medicine, Boston, MA, USA
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- CSI Holdsworth Memorial Hospital, Mysore, India
| | - Andrew M Prentice
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Giriraj R Chandak
- Genomic Research on Complex Diseases (GRC Group), CSIR–Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Matt J Silver
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, United Kingdom
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Zhang Y, Vaidya N, Iyengar U, Sharma E, Holla B, Ahuja CK, Barker GJ, Basu D, Bharath RD, Chakrabarti A, Desrivieres S, Elliott P, Fernandes G, Gourisankar A, Heron J, Hickman M, Jacob P, Jain S, Jayarajan D, Kalyanram K, Kartik K, Krishna M, Krishnaveni G, Kumar K, Kumaran K, Kuriyan R, Murthy P, Orfanos DP, Purushottam M, Rangaswamy M, Kupard SS, Singh L, Singh R, Subodh BN, Thennarasu K, Toledano M, Varghese M, Benegal V, Schumann G. The Consortium on Vulnerability to Externalizing Disorders and Addictions (c-VEDA): an accelerated longitudinal cohort of children and adolescents in India. Mol Psychiatry 2020; 25:1618-1630. [PMID: 32203154 DOI: 10.1038/s41380-020-0656-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/06/2020] [Accepted: 01/17/2020] [Indexed: 01/29/2023]
Abstract
The global burden of disease attributable to externalizing disorders such as alcohol misuse calls urgently for effective prevention and intervention. As our current knowledge is mainly derived from high-income countries such in Europe and North-America, it is difficult to address the wider socio-cultural, psychosocial context, and genetic factors in which risk and resilience are embedded in low- and medium-income countries. c-VEDA was established as the first and largest India-based multi-site cohort investigating the vulnerabilities for the development of externalizing disorders, addictions, and other mental health problems. Using a harmonised data collection plan coordinated with multiple cohorts in China, USA, and Europe, baseline data were collected from seven study sites between November 2016 and May 2019. Nine thousand and ten participants between the ages of 6 and 23 were assessed during this time, amongst which 1278 participants underwent more intensive assessments including MRI scans. Both waves of follow-ups have started according to the accelerated cohort structure with planned missingness design. Here, we present descriptive statistics on several key domains of assessments, and the full baseline dataset will be made accessible for researchers outside the consortium in September 2019. More details can be found on our website [cveda.org].
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Affiliation(s)
- Yuning Zhang
- Centre for Population Neuroscience and Precision Medicine (PONS), MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Nilakshi Vaidya
- Centre for Population Neuroscience and Precision Medicine (PONS), MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Udita Iyengar
- Centre for Population Neuroscience and Precision Medicine (PONS), MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eesha Sharma
- Department of Child & Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Chirag K Ahuja
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Gareth J Barker
- Department of Neuroimaging, Institute of Psychology, Psychiatry & Neuroscience, London, King's College, London, UK
| | - Debasish Basu
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Sylvane Desrivieres
- Centre for Population Neuroscience and Precision Medicine (PONS), MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Elliott
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Gwen Fernandes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jon Heron
- Centre for Public Health, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Preeti Jacob
- Department of Child & Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Deepak Jayarajan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health, Mysuru, India
| | - Ghattu Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysuru, India
| | - Keshav Kumar
- Department of Mental Health and Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysuru, India.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Rebecca Kuriyan
- Division of Nutrition, St John's Research Institute, Bengaluru, India
| | - Pratima Murthy
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, India.,Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Meera Purushottam
- Molecular Genetics Laboratory, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Madhavi Rangaswamy
- Department of Psychology, CHRIST (deemed to be university), Bengaluru, India
| | - Sunita Simon Kupard
- Department of Psychiatry & Department of Medical Ethics, St. John's Medical College & Hospital, Bengaluru, India
| | - Lenin Singh
- Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Roshan Singh
- Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - B N Subodh
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Mireille Toledano
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine (PONS), MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. .,Population Neuroscience and Precision Medicine (PONS), LIN-Charite Research Group Department of Psychiatry and Psychotherapy, Charite, CCM, Humboldt University, Berlin, Germany. .,Institute for Science and Technology of Brain-inspired Intelligence (ISTBI), Fudan University, Shanghai, PR China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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31
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Randhir K, Pisal H, Kadam V, Khaire-Ghadge A, Malshe N, Deshpande R, Palkar S, Lalwani S, Kumaran K, Yajnik C, Osmond C, Fall C, Joshi S. Association of preeclampsia with anthropometric measures and blood pressure in Indian children. PLoS One 2020; 15:e0231989. [PMID: 32369488 PMCID: PMC7199948 DOI: 10.1371/journal.pone.0231989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Birth weight and post-natal growth are important predictors of adult health. Preeclampsia (PE) is associated with low birth weight and may have long term effects on the health of the children. The current study aims to compare anthropometry and blood pressure between children of mothers with and without PE in an Indian cohort. METHODS We studied children born to women with (PE; n = 211) and without preeclampsia (non-PE; n = 470) at Bharati Hospital, Pune, India. Anthropometry and blood pressure were measured in children at 3-7 years of age. Weight and height Z-scores were calculated using the WHO 2006 growth reference. Independent t-tests were used to compare means between the two groups, and associations between preeclampsia and child outcomes were analyzed using multiple linear regression, adjusting for potential confounders. RESULTS Weight and height Z-scores (p = 0.04 and 0.008), and subscapular skinfold thickness (p = 0.03) were higher among children of PE compared with children of non-PE mothers. Systolic blood pressure was also higher in children of PE mothers (1.70 mmHg [95% CI 0.05, 2.90] p = 0.006). BMI and diastolic blood pressure did not differ between groups. In regression models adjusted for newborn weight and gestational age, current age and sex, and maternal height, BMI and socio-economic status, children of PE mothers had higher weight Z-score (0.27 SD [95%CI 0.06, 0.48] p = 0.01), height Z-score (0.28 SD [95%CI 0.09, 0.47] p = 0.005), and subscapular skinfold thickness (0.38 mm [95%CI 0.00, 0.76] p = 0.049). A trend for higher systolic blood pressure (1.59 mmHg [95%CI -0.02, 3.20] p = 0.053) in the children was also observed in the adjusted model. The difference in systolic blood pressure was attenuated after adjusting further for the child's weight and height (1.09 mmHg [95%CI -0.48, 2.67] p = 0.17). There was no evidence of differences in effects between boys and girls. CONCLUSION Children of PE mothers were taller and heavier, and had higher systolic blood pressure, partly explained by their increased body size, than children of non-PE mothers. In utero exposure to preeclampsia may increase the risk of future cardiovascular disease.
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Affiliation(s)
- Karuna Randhir
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
| | - Hemlata Pisal
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
| | - Vrushali Kadam
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
| | - Amrita Khaire-Ghadge
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
| | - Nandini Malshe
- Dept. of Pediatrics, Bharati Hospital and Research Centre, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
| | - Ruma Deshpande
- Dept. of Pediatrics, Bharati Hospital and Research Centre, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
| | - Sonali Palkar
- Dept. of Pediatrics, Bharati Hospital and Research Centre, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
| | - Sanjay Lalwani
- Dept. of Pediatrics, Bharati Hospital and Research Centre, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | | | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be) University, Katraj, Pune, India
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32
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Sharma E, Jacob P, Murthy P, Jain S, Varghese M, Jayarajan D, Kumar K, Benegal V, Vaidya N, Zhang Y, Desrivieres S, Schumann G, Iyengar U, Holla B, Purushottam M, Chakrabarti A, Fernandes GS, Heron J, Hickman M, Kartik K, Kalyanram K, Rangaswamy M, Bharath RD, Barker G, Orfanos DP, Ahuja C, Thennarasu K, Basu D, Subodh BN, Kuriyan R, Kurpad SS, Kumaran K, Krishnaveni G, Krishna M, Singh RL, Singh LR, Toledano M. Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA): A developmental cohort study protocol. BMC Psychiatry 2020; 20:2. [PMID: 31898525 PMCID: PMC6941284 DOI: 10.1186/s12888-019-2373-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low and middle-income countries like India with a large youth population experience a different environment from that of high-income countries. The Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA), based in India, aims to examine environmental influences on genomic variations, neurodevelopmental trajectories and vulnerability to psychopathology, with a focus on externalizing disorders. METHODS cVEDA is a longitudinal cohort study, with planned missingness design for yearly follow-up. Participants have been recruited from multi-site tertiary care mental health settings, local communities, schools and colleges. 10,000 individuals between 6 and 23 years of age, of all genders, representing five geographically, ethnically, and socio-culturally distinct regions in India, and exposures to variations in early life adversity (psychosocial, nutritional, toxic exposures, slum-habitats, socio-political conflicts, urban/rural living, mental illness in the family) have been assessed using age-appropriate instruments to capture socio-demographic information, temperament, environmental exposures, parenting, psychiatric morbidity, and neuropsychological functioning. Blood/saliva and urine samples have been collected for genetic, epigenetic and toxicological (heavy metals, volatile organic compounds) studies. Structural (T1, T2, DTI) and functional (resting state fMRI) MRI brain scans have been performed on approximately 15% of the individuals. All data and biological samples are maintained in a databank and biobank, respectively. DISCUSSION The cVEDA has established the largest neurodevelopmental database in India, comparable to global datasets, with detailed environmental characterization. This should permit identification of environmental and genetic vulnerabilities to psychopathology within a developmental framework. Neuroimaging and neuropsychological data from this study are already yielding insights on brain growth and maturation patterns.
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Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Preeti Jacob
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Deepak Jayarajan
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Keshav Kumar
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Nilakshi Vaidya
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychology, Psychiatry & Neuroscience, MRC SGDP Centre, King’s College London, London, UK
| | - Yuning Zhang
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychology, Psychiatry & Neuroscience, MRC SGDP Centre, King’s College London, London, UK
| | - Sylvane Desrivieres
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychology, Psychiatry & Neuroscience, MRC SGDP Centre, King’s College London, London, UK
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychology, Psychiatry & Neuroscience, MRC SGDP Centre, King’s College London, London, UK
| | - Udita Iyengar
- Department of Child & Adolescent Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Meera Purushottam
- Molecular Genetics Laboratory, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Amit Chakrabarti
- Regional Occupational Health Centre (ROHC), Eastern, ICMR-National Institute of Occupational Health (NIOH), Kolkata, West Bengal India
| | - Gwen Sascha Fernandes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor, Andhra Pradesh India
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor, Andhra Pradesh India
| | | | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Gareth Barker
- Department of Neuroimaging, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | | | - Chirag Ahuja
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, Karnataka India
| | - Debashish Basu
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - B. N. Subodh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rebecca Kuriyan
- Division of Nutrition, St John’s Research Institute, Bengaluru, India
| | - Sunita Simon Kurpad
- Department of Psychiatry and Department of Medical Ethics, St. John’s Medical College and Hospital, Bengaluru, India
| | | | - Ghattu Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health, Mysore, India
| | - Rajkumar Lenin Singh
- Department of Psychiatry, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur India
| | - L. Roshan Singh
- Department of Clinical Psychology, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur India
| | - Mireille Toledano
- Faculty of Medicine, School of Public Health, Imperial College, London, UK
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Kehoe SH, Dhurde V, Bhaise S, Kale R, Kumaran K, Gelli A, Rengalakshmi R, Lawrence W, Bloom I, Sahariah SA, Potdar RD, Fall CHD. Barriers and Facilitators to Fruit and Vegetable Consumption Among Rural Indian Women of Reproductive Age. Food Nutr Bull 2019; 40:87-98. [PMID: 30974984 DOI: 10.1177/0379572118816459] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Micronutrient deficiencies have been a serious public health problem among women of reproductive age in low- and middle-income countries including India, adversely affecting maternal and child health and human capital outcomes. Fruit and vegetables are important sources of micronutrients, and consumption of these foods is less than recommendations. OBJECTIVE The objective of this study was to identify perceived barriers and facilitators to fruit and vegetable consumption among women of reproductive age living in rural communities in the State of Maharashtra, India. METHODS Women aged 18 to 40 years were recruited from 8 villages surrounding the city of Wardha, Maharashtra, India. We used qualitative methods and held 9 focus group discussions and 12 one-to-one interviews. The data collection was stopped when no new information emerged. We used inductive thematic coding to analyze the data. RESULTS Women knew that fruit and vegetables were beneficial to health and expressed that they wanted to increase the intake of these foods for themselves and their children. Seven main themes were identified as being barriers or facilitators to fruit and vegetable consumption: (1) personal factors, (2) household dynamics, (3) social and cultural norms, (4) workload, (5) time pressures, (6) environmental factors, and (7) cost. CONCLUSIONS Rural Indian women consumed fruit and vegetables infrequently and said they would like to consume more. Several potentially modifiable factors affecting the intake of fruit and vegetables were identified. Value chain analyses of fruit and vegetables in these communities will be important to identify opportunities to intervene and increase consumption.
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Affiliation(s)
| | - Varsha Dhurde
- 2 Centre for Study of Social Change, Mumbai, Maharashtra, India
| | - Shilpa Bhaise
- 2 Centre for Study of Social Change, Mumbai, Maharashtra, India
| | - Rashmi Kale
- 2 Centre for Study of Social Change, Mumbai, Maharashtra, India
| | | | - Aulo Gelli
- 3 International Food Policy Research Institute, Washington DC, USA
| | - R Rengalakshmi
- 4 MS Swaminathan Research Foundation, Chennai, Tamil Nadu, India
| | | | - Ilse Bloom
- 1 University of Southampton, Southampton, UK.,5 NIHR Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, UK
| | | | - Ramesh D Potdar
- 2 Centre for Study of Social Change, Mumbai, Maharashtra, India
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Yajnik CS, Behere RV, Bhat DS, Memane N, Raut D, Ladkat R, Yajnik PC, Kumaran K, Fall CHD. A physiological dose of oral vitamin B-12 improves hematological, biochemical-metabolic indices and peripheral nerve function in B-12 deficient Indian adolescent women. PLoS One 2019; 14:e0223000. [PMID: 31600243 PMCID: PMC6786546 DOI: 10.1371/journal.pone.0223000] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/11/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Vitamin B-12 deficiency is often considered synonymous with pernicious anemia, a rare condition in which severe malabsorption of the vitamin requires high-dose parenteral treatment. In developing countries such as India, inadequate dietary intake of B-12 due to socio-cultural factors leads to widely prevalent asymptomatic low B-12 status. In this scenario, lower doses of oral B-12 may be effective, safer and more affordable. OBJECTIVE To examine the effects of oral B-12 treatment at physiological doses on hematological and biochemical indices and peripheral nerve function in B-12 deficient rural Indian adolescent women. METHODS Thirty-nine women with B-12 deficiency who were excluded from a community based B-12 supplementation trial (Pune Rural Intervention in Young Adolescents (PRIYA)) received oral B-12 2μg/day, either alone (n = 19) or with multiple micronutrients (UNIMAPP formula + 20gm milk powder, n = 20) for 11 months. Hematological indices, nutrients (B-12, folate), metabolites (homocysteine) and peripheral nerve function (SUDOSCAN, Impetomedical, Paris and sensory nerve conduction velocity (NCV) of median and sural nerves) were assessed at baseline and after 11 months of B-12 treatment. RESULTS Results were similar in the two treatment allocation groups, which were therefore combined. At baseline, all women had B-12 concentration <100pmol/L, 79% were anemic and 33% had macrocytosis, but none had neuropathy. After 11 months of treatment, B-12 levels increased, while folate did not change. The prevalence of anemia fell to 59% and mean corpuscular volume (MCV) and plasma homocysteine concentrations decreased. Sudomotor nerve function in the feet improved by an average of 14.7%, and sensory conduction velocity in median and sural nerves increased by 16.2% and 29.4% respectively. CONCLUSION We document clinically beneficial effects of supplementation with a physiological dose of oral B-12 in asymptomatic rural Indian adolescent women with very low B-12 status. These findings support a public health approach to tackle the widely prevalent low B-12 status in young Indians.
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Affiliation(s)
| | | | - Dattatray S. Bhat
- Diabetes Unit, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Nilam Memane
- Diabetes Unit, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Deepa Raut
- Diabetes Unit, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Rasika Ladkat
- Diabetes Unit, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Pallavi C. Yajnik
- Diabetes Unit, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI, Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Caroline H. D. Fall
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
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Krishna M, Jones S, Maden M, DU B, MC R, Kumaran K, Karat SC, Fall CH. Size at birth and cognitive ability in late life: A systematic review. Int J Geriatr Psychiatry 2019; 34:1139-1169. [PMID: 31056774 PMCID: PMC6771720 DOI: 10.1002/gps.5138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 04/19/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Recent evidence suggests that growth restriction in utero may lead to neurocognitive disorders in late life, either through impaired brain development or adverse metabolic programming. METHODS Systematic review of literature investigating the relationship between size at birth and cognitive abilities in late life. The search, data extraction, and rating for the quality of reporting were conducted independently by two researchers. RESULTS Of 533 selected studies, 11 were included in this systematic review and 10 of these were from high-income setting. Of these 11 studies, eight indicated that lower birth weight is a risk factor for lower cognitive function in late life, at least in high-income countries. The reported effect sizes were small and it was not possible to conduct meta-analyses because of clinical heterogeneity DISCUSSION: A modest association of lower birth weight with lower cognitive abilities in late life is consistent with persisting effects of the prenatal environment on brain function. As with all observational studies, confounding is an alternative explanation. Further studies are required to elucidate the mechanisms.
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Affiliation(s)
- Murali Krishna
- Department of ResearchFoundation for Research and Advocacy in Mental Health (FRAMe)MysoreIndia
- Epidemiology Research UnitCSI Holdsworth Memorial HospitalMysoreIndia
| | - Steven Jones
- Medical Institute, Riverside CampusUniversity of ChesterChesterUK
| | - Michelle Maden
- Post Graduate Medical Institute, Faculty of Health and Social CareEdge Hill UniversityOrmskirkUK
| | - Bharath DU
- Department of ResearchFoundation for Research and Advocacy in Mental Health (FRAMe)MysoreIndia
| | - Ramya MC
- Epidemiology Research UnitCSI Holdsworth Memorial HospitalMysoreIndia
| | - Kalyanaraman Kumaran
- Epidemiology Research UnitCSI Holdsworth Memorial HospitalMysoreIndia
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Samuel Christraprasad Karat
- Epidemiology Research UnitCSI Holdsworth Memorial HospitalMysoreIndia
- Jerudong Park Medical CentreJerudongBrunei
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Kehoe SH, Dhurde V, Bhaise S, Kale R, Kumaran K, Gelli A, Rengalakshmi R, Sahariah SA, Potdar RD, Fall CHD. How Do Fruit and Vegetable Markets Operate in Rural India? A Qualitative Study of the Impact of Supply and Demand on Nutrition Security. Food Nutr Bull 2019; 40:369-382. [PMID: 31167553 DOI: 10.1177/0379572119846809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diets in rural India are cereal based with low intakes of micronutrient-rich foods. The value chains for nutrition approach aims to study supply and demand of such foods. This may aid in development of interventions to improve diets and livelihoods. OBJECTIVES (1) To identify how fruit and vegetables are accessed, (2) to describe and map the structure of value chains for exemplar foods, (3) to understand how foods are priced, and (4) to explore factors that affect decisions about which crops are grown, marketed, and sold. METHODS After stakeholder consultation, we identified 2 fruits (mango and guava) and 2 vegetables (shepu and spinach) as exemplar foods. Criteria for these exemplar foods were that they should be known to participants and there should be variability in intakes. We held 24 interviews with value chain actors including farmers, wholesalers, and vendors of the exemplar foods. Data collection was stopped when no new information emerged. We used inductive thematic coding for our analysis. RESULTS The value chains for each of the exemplar foods were relatively simple and involved farmers, middlemen, and vendors at either city or village level. The main themes identified as being factors considered when making decisions about which foods to grow and sell were (1) farming resources and assets, (2) quality of produce, (3) environmental conditions, (4) financial factors, (5) transport availability, and (6) consumer demand. CONCLUSIONS There are opportunities to intervene within fruit and vegetable value chains to increase availability, affordability, and access to produce in rural India. Future research is required to determine which interventions will be feasible, effective, and acceptable to the community and other stakeholders.
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Affiliation(s)
- Sarah H Kehoe
- University of Southampton, Southampton, United Kingdom
| | - Varsha Dhurde
- Centre for Study of Social Change, Mumbai, Maharashtra, India
| | - Shilpa Bhaise
- Centre for Study of Social Change, Mumbai, Maharashtra, India
| | - Rashmi Kale
- Centre for Study of Social Change, Mumbai, Maharashtra, India
| | | | - Aulo Gelli
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - R Rengalakshmi
- Gender and Grassroots Institution, MS Swaminathan Research Foundation, Chennai, Tamil Nadu, India
| | | | - Ramesh D Potdar
- Centre for Study of Social Change, Mumbai, Maharashtra, India
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Abstract
An association of low birth weight with an increased risk of adult cardiovascular disease and diabetes led to the developmental origins of health and disease (DOHaD) hypothesis, which proposes that undernutrition during early development permanently 'programmes' organ structure and metabolism, leading to vulnerability to later cardio-metabolic disease. High birth weight caused by maternal gestational diabetes is also associated with later diabetes, suggesting that fetal over-nutrition also has programming effects. Post-natal factors (excess weight gain/obesity, smoking, poor diets and physical inactivity) interact with fetal exposures to increase disease risk. Animal studies have shown permanent metabolic effects in offspring after alterations to maternal or early post-natal diets but evidence in humans is largely limited to observational and quasi-experimental situations such as maternal famine exposure. Randomized trials of maternal nutritional interventions during pregnancy have so far had limited follow-up of the offspring. Moreover, interventions usually started after the first trimester and therefore missed key peri-conceptional or early pregnancy events such as epigenetic changes, placentation and fetal organogenesis. Recent and ongoing trials intervening pre-conceptionally and powered for long-term offspring follow-up will address these issues. While current preventive strategies for cardio-metabolic disease focus on high-risk individuals in mid-life, DOHaD concepts offer a 'primordial' preventive strategy to reduce disease in future generations by improving fetal and infant development. This article is part of the theme issue 'Developing differences: early-life effects and evolutionary medicine'.
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Affiliation(s)
- Caroline H. D. Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, South India
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Chapko D, Butler J, Black C, Johnston M, Fall C, Kumaran K, Krishnaveni GV, Murali M. Public engagement with cohort participants in Scotland and India: How do participants want to shape mental health research? Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionWe now have the opportunity to disentangle the complexities of lifespan brain health through linking rich birth cohorts data to novel information utilizing health informatics techniques. Wellcome Trust evidenced that efforts to manage and link digital health data require exploring the attitudes of public and data guardians towards this initiative.
Objectives and ApproachOur teams in Aberdeen, Mysore and Mumbai have established general population cohorts that have provided evidence on the early-life origins of later-life diseases. In 2016, we engaged with the participants of the Aberdeen Children of the 1950s (62-68,N~8,400) in an event attended by 350 study members. We are also engaging with members and data guardians of Mysore Parthenon Cohort (20-21y,N~500), Mysore Birth Records Cohort (51-83y,N~750), and Mumbai Maternal Nutrition Cohort (5-11y,N~1,600). This qualitative project utilises focus groups and individual interviews. The goal is to understand their attitudes and perceived public benefits towards future novel data collection, data platforms and biorepositories.
ResultsThe ACONF event attendees were very willing to volunteer for further studies. The highest support was for ‘provide a blood sample’ (92%) and the lowest for ‘take an online survey’ (83%). They were satisfied with data governance but had incomplete understanding of linkage possibilities with their data. Through the ongoing activities in Mysore and in Mumbai, we aim to achieve the following: 1) Develop awareness of health informatics through public engagement with participants and researchers; 2) Explore attitudes and potential barriers to creation of secure data linkage between imaging, laboratory, health data and outcomes to facilitate future linkage studies; 3) Understand what is required for interoperable, secure data storage and plan future biorepository as a resource for researchers that will build over time in India.
Conclusion/ImplicationsThe proposed activities will inform preparation of a large scale grant to investigate the hypothesis that early life environment affects future risk of mental illness and cognitive ability globally. They will also begin to create a platform of enduring value for future cross-cultural population research.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet 2018; 391:1830-1841. [PMID: 29673873 PMCID: PMC6075697 DOI: 10.1016/s0140-6736(18)30311-8] [Citation(s) in RCA: 592] [Impact Index Per Article: 98.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/03/2017] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
Abstract
A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.
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Affiliation(s)
- Judith Stephenson
- Institute for Women's Health, University College London, London, UK.
| | - Nicola Heslehurst
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Hall
- Institute for Women's Health, University College London, London, UK
| | | | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, UK
| | | | - Sarah R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Kalyanaraman Kumaran
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Chittaranjan S Yajnik
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, Maharashtra, India
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Gita D Mishra
- School of Public Health, University of Queensland, Herston, QLD, Australia
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Chandak GR, Silver MJ, Saffari A, Lillycrop KA, Shrestha S, Sahariah SA, Di Gravio C, Goldberg G, Tomar AS, Betts M, Sajjadi S, Acolatse L, James P, Issarapu P, Kumaran K, Potdar RD, Prentice AM, Fall CH. Protocol for the EMPHASIS study; epigenetic mechanisms linking maternal pre-conceptional nutrition and children's health in India and Sub-Saharan Africa. BMC Nutr 2017; 3. [PMID: 30820326 PMCID: PMC6390934 DOI: 10.1186/s40795-017-0200-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Animal studies have shown that nutritional exposures during pregnancy can modify epigenetic marks regulating fetal development and susceptibility to later disease, providing a plausible mechanism to explain the developmental origins of health and disease. Human observational studies have shown that maternal peri-conceptional diet predicts DNA methylation in offspring. However, a causal pathway from maternal diet, through changes in DNA methylation, to later health outcomes has yet to be established. The EMPHASIS study (Epigenetic Mechanisms linking Pre-conceptional nutrition and Health Assessed in India and Sub-Saharan Africa, ISRCTN14266771) will investigate epigenetically mediated links between peri-conceptional nutrition and health-related outcomes in children whose mothers participated in two randomized controlled trials of micronutrient supplementation before and during pregnancy. Methods The original trials were the Mumbai Maternal Nutrition Project (MMNP, ISRCTN62811278) in which Indian women were offered a daily snack made from micronutrient-rich foods or low-micronutrient foods (controls), and the Peri-conceptional Multiple Micronutrient Supplementation Trial (PMMST, ISRCTN13687662) in rural Gambia, in which women were offered a daily multiple micronutrient (UNIMMAP) tablet or placebo. In the EMPHASIS study, DNA methylation will be analysed in the children of these women (~1100 children aged 5–7 y in MMNP and 298 children aged 7–9 y in PMMST). Cohort-specific and cross-cohort effects will be explored. Differences in DNA methylation between allocation groups will be identified using the Illumina Infinium MethylationEPIC array, and by pyrosequencing top hits and selected candidate loci. Associations will be analysed between DNA methylation and health-related phenotypic outcomes, including size at birth, and children’s post-natal growth, body composition, skeletal development, cardio-metabolic risk markers (blood pressure, serum lipids, plasma glucose and insulin) and cognitive function. Pathways analysis will be used to test for enrichment of nutrition-sensitive loci in biological pathways. Causal mechanisms for nutrition-methylation-phenotype associations will be explored using Mendelian Randomization. Associations between methylation unrelated to supplementation and phenotypes will also be analysed. Conclusion The study will increase understanding of the epigenetic mechanisms underpinning the long-term impact of maternal nutrition on offspring health. It will potentially lead to better nutritional interventions for mothers preparing for pregnancy, and to identification of early life biomarkers of later disease risk.
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Affiliation(s)
| | - Matt J Silver
- MRC Unit The Gambia and MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, UK
| | - Ayden Saffari
- MRC Unit, The Gambia and MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, UK
| | | | - Smeeta Shrestha
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | | | | | | | | | | | - Sara Sajjadi
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | | | - Philip James
- MRC Unit, The Gambia and MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, UK
| | | | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK and CSI Holdsworth memorial Hospital, Mysore, India
| | | | - Andrew M Prentice
- MRC Unit, The Gambia and MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, UK
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Kumaran K, Yajnik P, Lubree H, Joglekar C, Bhat D, Katre P, Joshi S, Ladkat R, Fall C, Yajnik C. The Pune Rural Intervention in Young Adolescents (PRIYA) study: design and methods of a randomised controlled trial. BMC Nutr 2017; 3:41. [PMID: 32153821 PMCID: PMC7050839 DOI: 10.1186/s40795-017-0143-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/04/2017] [Indexed: 02/06/2023] Open
Abstract
Background The Pune Maternal Nutrition Study (PMNS) was established to prospectively study the relationship of maternal nutrition to fetal growth and later cardiometabolic risk in the offspring. High homocysteine and low vitamin B12 levels in pregnancy predicted lower birthweight and higher insulin resistance at 6 years in the offspring. B12 deficiency was widespread in this population, due to low dietary intake. We therefore commenced a community-based intervention study with the underlying hypothesis that vitamin B12 supplementation of adolescent members of the PMNS cohort will improve birth weight, B12 status, and reduce future diabetes risk, in their offspring. Methods The individually randomised controlled trial commenced in September 2012, with boys and girls randomized into 3 groups, to receive daily for at least 3 years or until the birth of their first child: 1) vitamin B12 2 μg; or 2) vitamin B12 2 μg plus multiple micronutrients (MMN) plus 20 g of milk powder or 3) placebo. Iron and folic acid is given to all participants. Compliance is assessed by monthly supplement counts. Adverse events are recorded using a standardised questionnaire. The primary outcome is cord blood B12 concentration; based on 180–200 pregnancies in the girls, the study has ~80% power to detect a 0.5 SD change in newborn B12, in the B12 supplementation groups compared with controls, at the 5% significance level. Primary analysis will be by intention to treat. Discussion Our study tests a primordial prevention strategy through an intergenerational intervention started pre-conceptionally in both boys and girls using physiological doses of micronutrients to improve immediate pregnancy-related and long-term cardio metabolic outcomes. The results will have significant public health implications in a setting with widespread B12 deficiency but relative folate sufficiency. The randomised controlled trial design allows us to be confident that our findings will be causally relevant. Trial registration ISRCTN 32921044, applied on 14/09/2012. CTRI 2012/12/003212, registered on 02/12/2012. Retrospectively registered.
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Affiliation(s)
- Kalyanaraman Kumaran
- 1Diabetes Unit, KEM Hospital Research Centre, Rasta Peth, Pune 411011 India.,2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD UK
| | - Pallavi Yajnik
- 1Diabetes Unit, KEM Hospital Research Centre, Rasta Peth, Pune 411011 India
| | - Himangi Lubree
- 1Diabetes Unit, KEM Hospital Research Centre, Rasta Peth, Pune 411011 India
| | | | - Dattatray Bhat
- 1Diabetes Unit, KEM Hospital Research Centre, Rasta Peth, Pune 411011 India
| | - Prachi Katre
- 1Diabetes Unit, KEM Hospital Research Centre, Rasta Peth, Pune 411011 India
| | - Suyog Joshi
- 1Diabetes Unit, KEM Hospital Research Centre, Rasta Peth, Pune 411011 India
| | - Rasika Ladkat
- 1Diabetes Unit, KEM Hospital Research Centre, Rasta Peth, Pune 411011 India
| | - Caroline Fall
- 2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD UK
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Limaye T, Kumaran K, Joglekar C, Bhat D, Kulkarni R, Nanivadekar A, Yajnik C. Efficacy of a virtual assistance-based lifestyle intervention in reducing risk factors for Type 2 diabetes in young employees in the information technology industry in India: LIMIT, a randomized controlled trial. Diabet Med 2017; 34:563-568. [PMID: 27589695 DOI: 10.1111/dme.13258] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 12/26/2022]
Abstract
AIMS To investigate a virtual assistance-based lifestyle intervention to reduce risk factors for Type 2 diabetes in young employees in the information technology industry in India. METHODS LIMIT (Lifestyle Modification in Information Technology) was a parallel-group, partially blinded, randomized controlled trial. Employees in the information technology industry with ≥3 risk factors (family history of cardiometabolic disease, overweight/obesity, high blood pressure, impaired fasting glucose, hypertriglyceridaemia, high LDL cholesterol and low HDL cholesterol) from two industries were randomized to a control or an intervention (1:1) group. After initial lifestyle advice, the intervention group additionally received reinforcement through mobile phone messages (three per week) and e-mails (two per week) for 1 year. The primary outcome was change in prevalence of overweight/obesity, analysed by intention to treat. RESULTS Of 437 employees screened (mean age 36.2 ± 9.3 years; 74.8% men), 265 (61.0%) were eligible and randomized into control (n=132) or intervention (n=133) group. After 1 year, the prevalence of overweight/obesity reduced by 6.0% in the intervention group and increased by 6.8% in the control group (risk difference 11.2%; 95% CI 1.2-21.1; P=0.042). There were also significant improvements in lifestyle measurements, waist circumference, and total and LDL cholesterol in the intervention group. The number-needed-to-treat to prevent one case of overweight/obesity in 1 year was 9 (95% CI 5-82), with an incremental cost of INR10665 (£112.30) per case treated/prevented. A total of 98% of participants found the intervention acceptable. CONCLUSIONS A virtual assistance-based lifestyle intervention was effective, cost-effective and acceptable in reducing risk factors for diabetes in young employees in the information technology industry, and is potentially scalable.
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Affiliation(s)
- T Limaye
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, India
| | - K Kumaran
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Joglekar
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, India
| | - D Bhat
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, India
| | - R Kulkarni
- Just for Hearts Healthcare Pvt. Ltd., Pune, India
| | | | - C Yajnik
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, India
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Baird J, Jacob C, Barker M, Fall CHD, Hanson M, Harvey NC, Inskip HM, Kumaran K, Cooper C. Developmental Origins of Health and Disease: A Lifecourse Approach to the Prevention of Non-Communicable Diseases. Healthcare (Basel) 2017; 5:E14. [PMID: 28282852 PMCID: PMC5371920 DOI: 10.3390/healthcare5010014] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/17/2017] [Accepted: 02/24/2017] [Indexed: 12/22/2022] Open
Abstract
Non-communicable diseases (NCDs), such as cardiovascular disease and osteoporosis, affect individuals in all countries worldwide. Given the very high worldwide prevalence of NCDs across a range of human pathology, it is clear that traditional approaches targeting those at most risk in older adulthood will not efficiently ameliorate this growing burden. It will thus be essential to robustly identify determinants of NCDs across the entire lifecourse and, subsequently, appropriate interventions at every stage to reduce an individual's risk of developing these conditions. A lifecourse approach has the potential to prevent NCDs, from before conception through fetal life, infancy, childhood, adolescence, adulthood and into older age. In this paper, we describe the origins of the lifecourse concept, the importance of early life influences, for example during pregnancy, examine potential underlying mechanisms in both cell biology and behavior change, and finally describe current efforts to develop interventions that take a lifecourse approach to NCD prevention. Two principal approaches to improving women's nutritional status are outlined: nutritional supplementation and behavior change.
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Affiliation(s)
- Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
| | - Chandni Jacob
- Institute of Developmental Sciences, University of Southampton, Southampton S016 5YA, UK.
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Caroline H D Fall
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
| | - Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton S016 5YA, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Hazel M Inskip
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
| | - Kalyanaraman Kumaran
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton SO16 6YD, UK.
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Krishna M, Kumar GM, Veena SR, Krishnaveni GV, Kumaran K, Karat SC, Coakley P, Osmond C, Copeland JRM, Chandak G, Bhat D, Varghese M, Prince M, Fall C. Birth size, risk factors across life and cognition in late life: protocol of prospective longitudinal follow-up of the MYNAH (MYsore studies of Natal effects on Ageing and Health) cohort. BMJ Open 2017; 7:e012552. [PMID: 28209604 PMCID: PMC5318644 DOI: 10.1136/bmjopen-2016-012552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/12/2016] [Accepted: 09/30/2016] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION For late-life neurocognitive disorders, as for other late-life chronic diseases, much recent interest has focused on the possible relevance of Developmental Origins of Health and Disease (DOHaD). Programming by undernutrition in utero, followed by overnutrition in adult life may lead to an increased risk, possibly mediated through cardiovascular and metabolic pathways. This study will specifically examine, if lower birth weight is associated with poorer cognitive functioning in late life in a south Indian population. METHODS AND ANALYSIS From 1934 onwards, the birth weight, length and head circumference of all babies born in the CSI Holdsworth Memorial Hospital, Mysore, India, were recorded in obstetric notes. Approximately 800 men and women from the Mysore Birth Records Cohort aged above 55 years, and a reliable informant for each, will be asked to participate in a single cross-sectional baseline assessment for cognitive function, mental health and cardiometabolic disorders. Participants will be assessed for hypertension, type-2 diabetes and coronary heart disease, nutritional status, health behaviours and lifestyles, family living arrangements, economic status, social support and social networks. Additional investigations include blood tests (for diabetes, insulin resistance, dyslipidaemia, anaemia, vitamin B12 and folate deficiency, hyperhomocysteinemia, renal impairment, thyroid disease and Apolipoprotein E genotype), anthropometry, ECG, blood pressure, spirometry and body composition (bioimpedance). We will develop an analysis plan, first using traditional univariate and multivariable analytical paradigms with independent, dependent and mediating/confounding/interacting variables to test the main hypotheses. ETHICS AND DISSEMINATION This study has been approved by the research ethics committee of CSI Holdsworth Memorial Hospital. The findings will be disseminated locally and at international meetings, and will be published in open access peer reviewed journals.
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Affiliation(s)
- Murali Krishna
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - G Mohan Kumar
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - S R Veena
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - G V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | | | - Patsy Coakley
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | | | - Giriraj Chandak
- Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | | | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Martin Prince
- Institute of Psychiatry, De Crespigny Park, Kings College, London, UK
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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Carmeliet J, Hens H, Roels S, Adan O, Brocken H, Cerny R, Pavlik Z, Hall C, Kumaran K, Pel L. Determination of the Liquid Water Diffusivity from Transient Moisture Transfer Experiments. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1097196304042324] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Boltzmann transformation method is used to determine the liquid water diffusivity from moisture content profiles as measured in a capillary water absorption experiment. An inter-laboratory comparison for analyzing the reliability of the determination method showed that the inaccuracy in the liquid water diffusivity is caused by scatter in the transformed data and by uncertainty in the boundary conditions at the intake surface and ahead of the steep moisture front. A methodology is proposed based on (1) the evaluation of the validity of the diffusion approach, (2) a simplified handling of the boundary conditions, (3) smoothing of the scattered data and (4) the evaluation of the quality of the determined liquid water diffusivity. For HAM (Heat-Air-Moisture transport) calculations values of the liquid water diffusivity for moisture contents higher than the capillary moisture content are disregarded. The liquid water diffusivity can be described by an exponential function limited at a lower moisture content bound. To describe the moisture diffusivity including liquid water and water vapour transports, a new parametric description of the moisture diffusivity is presented, which shows sufficient flexibility both in the hygroscopic and overhygroscopic ranges. When permeability is calculated from diffusivity, the permeability should monotonically increase with decreasing capillary pressure. In the hygroscopic region it should coincide with the measured water vapour permeabilities.
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Affiliation(s)
- J. Carmeliet
- Department of Civil Engineering, K.U. Leuven, Kasteelpark Arenberg 51, B-3001 Leuven, Belgium
| | | | - S. Roels
- Department of Civil Engineering, K.U. Leuven, Kasteelpark Arenberg 51, B-3001 Leuven, Belgium
| | | | - H. Brocken
- TNO Building and Construction Research, P.O. Box 49, 2600 AA Delft, The Netherlands
| | | | - Z. Pavlik
- Faculty of Civil Engineering, Department of Structural Mechanics, Czech Technical University, Thakurova 7, CZ-16629 Prague 6, Czech Republic
| | - C. Hall
- Centre for Materials Science and Engineering, University of Edinburgh, The King’s Buildings, Edinburgh EH9 3JL, UK
| | - K. Kumaran
- Institute for Research in Construction, National Research Council Canada, 1200 Montreal Road, Ottawa ON K1A 0R6, Canada
| | - L. Pel
- Department of Applied Physics, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
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Krishna M, Beulah E, Jones S, Sundarachari R, A S, Kumaran K, Karat SC, Copeland JRM, Prince M, Fall C. Cognitive function and disability in late life: an ecological validation of the 10/66 battery of cognitive tests among community-dwelling older adults in South India. Int J Geriatr Psychiatry 2016; 31:879-91. [PMID: 26680150 PMCID: PMC6100091 DOI: 10.1002/gps.4404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/11/2015] [Accepted: 10/15/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The 10/66 Dementia Research Group developed and validated a culture and education fair battery of cognitive tests for diagnosis of dementia in population-based studies in low-income and middle-income countries including India. AIMS This study examined the association between individual domains of the 10/66 battery of cognitive tests and 'disability' and 'functional impairment' in community-dwelling older adults in South India. METHODS One hundred twenty-nine adults aged 60-90 years residing in Karunapura, in the city of Mysore, were interviewed in their own homes. Cognitive functioning was measured by administering the 10/66 battery of cognitive tests that composes of Community Screening Instrument for Dementia (CSI'D' COGSCORE), verbal fluency (VF) and word list memory recall (WLMR). A reliable informant was interviewed to ascertain if the subject's cognitive problems have resulted in functional impairment. Disability was measured by WHO Disability Schedule-II (DAS). RESULTS The women had significantly lower CSI'D' COGSCORE score when compared with men (p = 0.002). The presence of 'functional impairment' resulting from cognitive decline was significantly associated with lower scores on VF (p = 0.03), WLMR (p = 0.03) and CSI'D' COGSCOREs (p < 0.01). There was a significant inverse association between WHO DAS II score and WLMR (p = 0.004), VF (0.006) and CSI'D' COGSCORE scores (p ≤ 0.001) even after adjusting for self-reported ischaemic heart disease, stroke, chronic obstructive airway disease, hypertension and diabetes. CONCLUSIONS Lower scores on individual domains of the 10/66 battery of cognitive tests are associated with higher levels of disability and functional impairment in community-dwelling older adults. These culture and education fair tests are suitable for use in population-based research in India. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Murali Krishna
- Wellcome DBT Early Career Fellow, CSI Holdsworth Memorial HospitalMysoreIndia
| | | | - Steven Jones
- Faculty of Health and Social CareEdge Hill UniversityLancashireUK
| | | | - Saroja A
- CSI Holdsworth Memorial HospitalMysoreIndia
| | | | | | | | | | - Caroline Fall
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
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Limaye TY, Kulkarni RL, Deokar MR, Kumaran K. High prevalence of cardiometabolic risk factors in young employees of Information Technology industry. Indian J Occup Environ Med 2016; 20:64-7. [PMID: 27390483 PMCID: PMC4922281 DOI: 10.4103/0019-5278.183848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: We assessed the burden of cardiometabolic risk factors in Information Technology (IT) employees as they are exposed to adverse lifestyle. Materials and Methods: In this cross-sectional study, health records were obtained from two IT industries in Pune. Prevalence of cardiometabolic risk factors [hyperglycemia, high blood pressure (BP), hypertriglyceridemia, high low-density lipoprotein (LDL)-cholesterol, low high-density lipoprotein (HDL)-cholesterol, and overweight/obesity] was determined using standard cutoffs. We also examined clustering of risk factors (≥two risk factors). Results: Data were available on 1,350 of 5,800 employees (mean age: 33 ± 6 years, 78% men). Prevalence of diabetes and hypertension was 2.5% and 13.5%, respectively. Prevalence of prediabetes, borderline high BP, hypertriglyceridemia, high LDL-cholesterol, low HDL-cholesterol, and overweight/obesity was 6.5%, 20.3%, 21%, 22.1%, 70.1%, and 51.4%, respectively. Risk factor clustering was observed in 63.5% that increased with age (P < 0.001). Conclusion: Given the high burden of risk factors at relatively young age, spreading awareness and promoting healthy lifestyle through workplace interventions are warranted.
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Affiliation(s)
- Tejas Y Limaye
- King Edward Memorial Hospital and Research Center, Pune, Maharashtra, India
| | - Ravindra L Kulkarni
- Moraya Multispecialty Hospital and Research Center, Pune, Maharashtra, India
| | - Manisha R Deokar
- Moraya Multispecialty Hospital and Research Center, Pune, Maharashtra, India
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Ward C, Chinnery H, Landry MA, OBlenes S, Kumaran K. Restructuring Care Teams Within a Neonatal Intensive Care Unit. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e85b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Organizing care teams in a large neonatal intensive care unit (NICU) is a challenge. In our pod-based model, babies were assigned a care team based on acuity and bed location. They were frequently moved between teams to accommodate nursing assignments, causing an imbalance in patient census and acuity across teams. As part of a larger process improvement project, we implemented and studied an alternate model for assigning patients to a care team.
OBJECTIVES: The objective of this project was to improve consistency of patient care and to balance the workload across the three care teams in the NICU.
DESIGN/METHODS: The setting is a 69 bed tertiary teaching NICU with approximately 1300 admissions a year. Three clinical teams share day to day assignment of a combination of these level III and level II pods. A multidisciplinary subgroup conducted a two hour Kaizen (brain storming) event with a larger group of stake-holders during which the decision was made to assign babies to a care team based on current workload of each team. The care teams follow each patient from admission to discharge, regardless of the baby’s location within the unit instead of moving babies between teams. Education communication, feedback strategies regarding the process change were formulated and executed by the sub-group. The new method was piloted for a period of three months. Objective data was collected regarding patient movement, patient acuity, census balance, and rounds time. Qualitative data was collected through staff and family surveys. ignments, causing an imbalance in patient census and acuity across teams. As part of a larger process improvement project, we implemented and studied an alternate model for assigning patients to a care team.
RESULTS: Forty percent of babies admitted to the NICU crossed care teams during their stay prior to the process change while 0.3% changed teams after the change. The number of moves per patient decreased from 1.4 to 1.27. The variability in both census and acuity was diminished following implementation of the changes. The daily average number of man-hours to complete daily rounds decreased from 47.5 before the change to 40.5 after the change. There was a 35% response rate to the staff survey with an overall positive response to the changes with regards to improving the patient and family experience. The family satisfaction survey showed a trend toward increased satisfaction following the change.
CONCLUSION: Process improvement methods can be used to successfully change how care teams are structured in a tertiary NICU.
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