MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK.
Indian J Med Res. 2009 Nov;130(5):593-9.
Nearly 20 years ago, it was discovered that low birthweight was associated with an increased risk of adult diabetes and cardiovascular disease (CVD). This led to the hypothesis that exposure to undernutrition in early life increases an individual's vulnerability to these disorders, by 'programming' permanent metabolic changes. Implicit in the programming hypothesis is that improving the nutrition of girls and women could prevent common chronic diseases in future generations. Research in India has shown that low birthweight children have increased CVD risk factors, and a unique birth cohort in Delhi has shown that low infant weight, and rapid childhood weight gain, increase the risk of type 2 diabetes. Progress has been made in understanding the role of specific nutrients in the maternal diet. In the Pune Maternal Nutrition Study, low maternal vitamin B12 status predicted increased adiposity and insulin resistance in the children, especially if the mother was folate replete. It is not only maternal undernutrition that causes problems; gestational diabetes, a form of foetal overnutrition (glucose excess), is associated with increased adiposity and insulin resistance in the children, highlighting the adverse effects of the 'double burden' of malnutrition in developing countries, where undernutrition and overnutrition co-exist. Recent intervention studies in several developing countries have shown that CVD risk factors in the offspring can be improved by supplementing undernourished mothers during pregnancy. Results differ according to the population, the intervention and the post-natal environment. Ongoing studies in India and elsewhere seek to understand the long-term effects of nutrition in early life, and how best to translate this knowledge into policies to improve health in future generations.
近 20 年前，人们发现低出生体重与成年期糖尿病和心血管疾病（CVD）风险增加有关。这导致了一种假设，即生命早期的营养不良暴露会通过“编程”永久性代谢变化增加个体对这些疾病的易感性。编程假说隐含的意思是，改善女孩和妇女的营养状况可以预防后代常见的慢性疾病。印度的研究表明，低出生体重儿童的心血管疾病危险因素增加，而德里的一个独特出生队列研究表明，低婴儿体重和快速儿童期体重增加会增加 2 型糖尿病的风险。在理解母体饮食中特定营养素的作用方面已经取得了进展。在浦那母婴营养研究中，母亲维生素 B12 水平低预测儿童肥胖和胰岛素抵抗增加，尤其是母亲叶酸充足的情况下。导致问题的不仅是母体营养不良；妊娠糖尿病是一种胎儿营养过剩（葡萄糖过多）的形式，与儿童肥胖和胰岛素抵抗增加有关，突出了发展中国家营养不良和营养过剩并存的“双重负担”的不利影响。几个发展中国家最近的干预研究表明，在怀孕期间补充营养不良的母亲可以改善后代的心血管疾病风险因素。结果因人群、干预措施和产后环境而异。印度和其他地方正在进行的研究旨在了解生命早期营养的长期影响，以及如何将这方面的知识转化为改善后代健康的政策。
