Krishnaveni G V, Yajnik C S
Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India.
Diabetes Unit, King Edward Memorial Hospital and Research Center, Pune, India.
Eur J Clin Nutr. 2017 Jul;71(7):865-869. doi: 10.1038/ejcn.2017.87. Epub 2017 May 24.
The developmental origins of health disease (DOHaD) hypothesis proposes that altered environmental influences (nutrition, metabolism, pollutants, stress and so on) during critical stages of fetal growth predisposes individuals to diabetes and other non-communicable disease in later life. This phenomenon is thought to reflect permanent effects ('programming') of unbalanced fetal development on physiological systems. Intrauterine programming may underlie the characteristic Indian 'thin-fat' phenotype and the current unprecedented epidemic of diabetes on the backdrop of multigenerational maternal undernutrition in the country. India has been at the forefront of the DOHaD research for over two decades. Both retrospective and prospective birth cohorts in India provide evidence for the role of impaired early-life nutrition on the later diabetes risk. These studies show that in a transitioning country such as India, maternal undernutrition (of micronutrients) and overnutrition (gestational diabetes) co-exist, and expose the offspring to disease risk through multiple pathways. Currently, the Indian scientists are embarking on complex mechanistic and intervention studies to find solutions for the diabetes susceptibility of this population. However, a few unresolved issues in this context warrant continued research and a cautious approach.
健康与疾病的发育起源（DOHaD）假说提出，胎儿生长关键阶段环境影响（营养、代谢、污染物、压力等）的改变会使个体在晚年易患糖尿病和其他非传染性疾病。这种现象被认为反映了胎儿发育失衡对生理系统的永久性影响（“编程”）。在该国多代孕产妇营养不良的背景下，宫内编程可能是印度特有的“瘦胖子”体型以及当前前所未有的糖尿病流行的潜在原因。二十多年来，印度一直处于DOHaD研究的前沿。印度的回顾性和前瞻性出生队列均为早期营养受损对后期糖尿病风险的作用提供了证据。这些研究表明，在像印度这样的转型国家，孕产妇营养不良（微量营养素缺乏）和营养过剩（妊娠期糖尿病）并存，并通过多种途径使后代面临疾病风险。目前，印度科学家正着手进行复杂的机制和干预研究，以寻找解决该人群糖尿病易感性问题的方法。然而，在这方面仍有一些未解决的问题需要持续研究并采取谨慎的方法。
