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Fetal growth and glucose and insulin metabolism in four-year-old Indian children
C S Yajnik1, C H Fall, U Vaidya
1King Edward Memorial Hospital Research Centre, Pune, India.
Insights
Low birthweight in Indian children is linked to impaired glucose tolerance, increasing their risk for Type 2 diabetes. This suggests fetal programming may influence diabetes development in India.
Area of Science:
- Pediatrics
- Endocrinology
- Public Health
Background:
- Low birthweight is associated with impaired glucose tolerance and Type 2 diabetes in British adults.
- Type 2 diabetes and low birthweight are prevalent in India.
Purpose of the Study:
- To investigate the association between low birthweight and reduced glucose tolerance in Indian children.
- To explore if intra-uterine growth restriction impacts glucose homeostasis in early childhood.
Main Methods:
- Oral glucose tolerance tests were conducted on 379 4-year-old children in Pune, India.
- Birthweights were recorded, and plasma glucose and insulin concentrations were measured 30 and 120 minutes post-glucose load.
- Data analysis considered children from routine postnatal wards and a Special Care Baby Unit.
Main Results:
- Lower birthweight was associated with higher plasma glucose and insulin concentrations 30 minutes after an oral glucose load in children from routine postnatal wards (p=0.01 and p=0.04).
- Children with birthweights ≤2.4 kg had higher mean glucose (8.1 mmol/l) and insulin (321 pmol/l) levels compared to those >3.0 kg.
- A similar trend of higher insulin levels was observed in lower birthweight children from the Special Care Baby Unit, though glucose trends were not significant.
Conclusions:
- Reduced intra-uterine growth, indicated by low birthweight, is associated with impaired glucose homeostasis in Indian children.
- Findings support the hypothesis that Type 2 diabetes mellitus in India may be programmed during fetal development.
- Early life factors like birthweight are critical determinants of metabolic health and diabetes risk later in life.
Abstract:
Studies in Britain have shown that adults who had a low birthweight have high plasma glucose concentrations 30 and 120 min after an oral glucose load, and an increased risk of Type 2 diabetes and impaired glucose tolerance. Both Type 2 diabetes and low birthweight are common in India. To determine whether low birthweight is associated with reduced glucose tolerance in Indian children, glucose tolerance tests were carried out on 379 4-year-old children, whose birthweights were recorded, in Pune, India. Among 201 children who had been looked after on the routine postnatal wards at birth, those with lower birthweights had higher plasma glucose and insulin concentrations 30 min after an oral glucose load, independently of their current size (p = 0.01 and 0.04, respectively). Mean glucose and insulin concentrations were 8.1 mmol l-1 and 321 pmol l-1 in children whose birthweight had been 2.4 kg or less, compared with 7.5 mmol l-1 and 289 pmol l-1 in those who weighted more than 3.0 kg. Among 178 children who had been looked after in the Special Care Baby Unit, those with lower birthweights also had higher plasma insulin concentrations at 30 min but there were no trends with plasma glucose. Our findings suggest that Indian children with reduced intra-uterine growth have reduced glucose homeostasis after a glucose challenge. This is consistent with the hypothesis that Type 2 diabetes mellitus in India may be programmed in fetal life.