Yajnik C S, Deshpande S S, Jackson A A, Refsum H, Rao S, Fisher D J, Bhat D S, Naik S S, Coyaji K J, Joglekar C V, Joshi N, Lubree H G, Deshpande V U, Rege S S, Fall C H D
Diabetes Unit, KEM Hospital and Research Centre, Pune, Maharashtra, India.
Diabetologia. 2008 Jan;51(1):29-38. doi: 10.1007/s00125-007-0793-y. Epub 2007 Sep 13.
AIMS/HYPOTHESIS: Raised maternal plasma total homocysteine (tHcy) concentrations predict small size at birth, which is a risk factor for type 2 diabetes mellitus. We studied the association between maternal vitamin B12, folate and tHcy status during pregnancy, and offspring adiposity and insulin resistance at 6 years.
In the Pune Maternal Nutrition Study we studied 700 consecutive eligible pregnant women in six villages. We measured maternal nutritional intake and circulating concentrations of folate, vitamin B12, tHcy and methylmalonic acid (MMA) at 18 and 28 weeks of gestation. These were correlated with offspring anthropometry, body composition (dual-energy X-ray absorptiometry scan) and insulin resistance (homeostatic model assessment of insulin resistance [HOMA-R]) at 6 years.
Two-thirds of mothers had low vitamin B12 (<150 pmol/l), 90% had high MMA (>0.26 micromol/l) and 30% had raised tHcy concentrations (>10 micromol/l); only one had a low erythrocyte folate concentration. Although short and thin (BMI), the 6-year-old children were relatively adipose compared with the UK standards (skinfold thicknesses). Higher maternal erythrocyte folate concentrations at 28 weeks predicted higher offspring adiposity and higher HOMA-R (both p < 0.01). Low maternal vitamin B12 (18 weeks; p = 0.03) predicted higher HOMA-R in the children. The offspring of mothers with a combination of high folate and low vitamin B12 concentrations were the most insulin resistant.
CONCLUSIONS/INTERPRETATION: Low maternal vitamin B12 and high folate status may contribute to the epidemic of adiposity and type 2 diabetes in India.
目的/假设：孕妇血浆总同型半胱氨酸（tHcy）浓度升高预示着出生时体重低，而出生时体重低是2型糖尿病的一个风险因素。我们研究了孕期母亲维生素B12、叶酸和tHcy状态与后代6岁时肥胖及胰岛素抵抗之间的关联。
在浦那孕产妇营养研究中，我们对六个村庄的700名连续符合条件的孕妇进行了研究。在妊娠18周和28周时，我们测量了母亲的营养摄入量以及叶酸、维生素B12、tHcy和甲基丙二酸（MMA）的循环浓度。这些指标与后代6岁时的人体测量学指标、身体成分（双能X线吸收法扫描）和胰岛素抵抗（胰岛素抵抗稳态模型评估 [HOMA-R]）相关。
三分之二的母亲维生素B12水平低（<150 pmol/l），90%的母亲甲基丙二酸水平高（>0.26 μmol/l），30%的母亲tHcy浓度升高（>10 μmol/l）；只有一人红细胞叶酸浓度低。尽管6岁儿童身材矮小且体重指数（BMI）低，但与英国标准相比（皮褶厚度），他们相对肥胖。妊娠28周时母亲红细胞叶酸浓度较高预示着后代肥胖程度较高且HOMA-R较高（均p < 0.01）。母亲维生素B12水平低（妊娠18周时；p = 0.03）预示着儿童的HOMA-R较高。叶酸水平高且维生素B12水平低的母亲所生后代胰岛素抵抗最强。
结论/解读：母亲维生素B12水平低和叶酸水平高可能是印度肥胖症和2型糖尿病流行的原因之一。
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