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Rush E.C.,Auckland University of Technology | Katre P.,Persistent Systems | Yajnik C.S.,Kamalnayan Bajaj Diabetology Research Center
European Journal of Clinical Nutrition

This review brings together human and animal studies and reviews that examine the possible role of maternal vitamin B12 (B12) on fetal growth and its programming for susceptibility to chronic disease. A selective literature review was undertaken to identify studies and reviews that investigate these issues, particularly in the context of a vegetarian diet that may be low in B12 and protein and high in carbohydrate. Evidence is accumulating that maternal B12 status influences fetal growth and development. Low maternal vitamin B12 status and protein intake are associated with increased risk of neural tube defect, low lean mass and excess adiposity, increased insulin resistance, impaired neurodevelopment and altered risk of cancer in the offspring. Vitamin B12 is a key nutrient associated with one carbon metabolic pathways related to substrate metabolism, synthesis and stability of nucleic acids and methylation of DNA which regulates gene expression. Understanding of factors regulating maternal-fetal one carbon metabolism and its role in fetal programming of non communicable diseases could help design effective interventions, starting with maternal nutrition before conception. © 2014 Macmillan Publishers Limited. All rights reserved. Source

Hardikar P.S.,Kamalnayan Bajaj Diabetology Research Center | Joshi S.M.,Kamalnayan Bajaj Diabetology Research Center | Bhat D.S.,Kamalnayan Bajaj Diabetology Research Center | Raut D.A.,Kamalnayan Bajaj Diabetology Research Center | And 6 more authors.
Diabetes Care

OBJECTIVE - To examine the influence of glycemic and nonglycemic parameters on HbA 1c concentrations in young adults, the majority of whom had normal glucose tolerance. RESEARCH DESIGN AND METHODS - We compared the diagnosis of normal glucose tolerance, prediabetes, and diabetes between a standard oral glucose tolerance test (OGTT; World Health Organization 2006 criteria) and HbA 1c concentrations (American Diabetes Association [ADA] 2009 criteria) in 116 young adults (average age 21.6 years) from the Pune Children's Study. We also studied the contribution of glycemic and nonglycemic determinants to HbA 1c concentrations. RESULTS - The OGTT showed that 7.8% of participants were prediabetic and 2.6% were diabetic. By ADA HbA 1c criteria, 23.3% were prediabetic and 2.6% were diabetic. The negative predictive value of HbA 1c was 93% and the positive predictive value was 20% (only 20% had prediabetes or diabetes according to the OGTT; this figure was 7% in anemic participants). Of participants, 34% were anemic, 37% were iron deficient (ferritin < 15 ng/mL), 40% were vitamin B 12 deficient (<150 pmol/L), and 22% were folate deficient (<7 nmol/L). On multiple linear regression analysis, HbA 1c was predicted by higher 2-h glucose (R 2 = 25.6%) and lower hemoglobin (R 2 = 7.7%). When hematological parameters were replaced by ferritin, vitamin B 12, and folate, HbA 1c was predicted by higher glycemia (R 2 = 25.6%) and lower ferritin (R 2 = 4.3%). CONCLUSIONS - The use of HbA 1c to diagnose prediabetes and diabetes in iron-deficient populations may lead to a spuriously exaggerated prevalence. Further investigation is required before using HbA 1c as a screening tool in nutritionally compromised populations. © 2012 by the American Diabetes Association. Source

Katre P.,Kamalnayan Bajaj Diabetology Research Center | Bhat D.,Kamalnayan Bajaj Diabetology Research Center | Lubree H.,Kamalnayan Bajaj Diabetology Research Center | Otiv S.,Kamalnayan Bajaj Diabetology Research Center | And 4 more authors.
Asia Pacific Journal of Clinical Nutrition

Maternal vitamin B12 deficiency and hyperhomocysteinemia predict poor pregnancy outcome, foetal adiposity and insulin resistance. In India amongst practicing clinicians and policy makers there is little appreciation of widespread vitamin B12 deficiency. We investigated 163 (86 rural, 77 urban) pregnant women attending antenatal clinics in a rural health centre and a referral hospital in the city of Pune, at 17, 28, and 34 weeks gestation for vitamin supplements, and circulating concentrations of vitamin B12, folate, and total homocysteine. At enrolment 80% rural and 65% urban women had low vitamin B12 but only two rural women had low folate concentrations. During pregnancy 85% rural and 95% of urban women received folic acid; 12% rural and 84% urban women also received vitamin B12. In women receiving no supplementation (n=17) plasma vitamin B12 and folate did not change from 17 to 34 weeks gestation, but homocysteine increased (p<0.05). Homocysteine concentrations at 34 weeks gestation in women receiving only folic acid (n=71, mean 8.4 (95% CI 7.8, 9.1) μmol/L) were comparable to the unsupplemented group (9.7 (7.3, 12.7), p=0.15), but women who received a total dose of > 1000 μg of vitamin B12 up to 34 weeks (n=42, all with folic acid) had lower concentrations (6.7 (6.0, 7.4), p<0.001). Increasing dose of vitamin B12 (rs=-0.31, p=0.006) but not folic acid (rs=-0.19, p=0.11) was associated with lower plasma total homocysteine concentration. In vitamin B12 insufficient, folate replete pregnant women, vitamin B12 supplementation is associated with a reduction of plasma total homocysteine concentration in late pregnancy. Source

Bhate V.K.,Kamalnayan Bajaj Diabetology Research Center | Joshi S.M.,Kamalnayan Bajaj Diabetology Research Center | Ladkat R.S.,Kamalnayan Bajaj Diabetology Research Center | Deshmukh U.S.,Kamalnayan Bajaj Diabetology Research Center | And 5 more authors.
Journal of Developmental Origins of Health and Disease

Insufficiency of vitamin B12 (B12) and folate during pregnancy can result in low concentrations in the fetus and have adverse effects on brain development. We investigated the relationship between maternal B12 and folate nutrition during pregnancy and offspring motor, mental and social development at two years of age (2 y). Mothers (n = 123) and their offspring (62 girls, 61 boys) from rural and middle-class urban communities in and around Pune city were followed through pregnancy up to 2 y. Maternal B12 and folate concentrations were measured at 28 and 34 weeks of gestation. At 2 y, the Developmental Assessment Scale for Indian Infants was used to determine motor and mental developmental quotients and the Vineland Social Maturity Scale for the social developmental quotient. Overall, 62% of the mothers had low B12 levels (<150 pmol/l) and one mother was folate deficient during pregnancy. Maternal B12 at 28 and 34 weeks of gestation was associated with offspring B12 at 2 y (r = 0.29, r = 0.32, P < 0.001), but folate was not associated with offspring folate. At 2 y, motor development was associated with maternal folate at 28 and 34 weeks of gestation. Mental and social development quotients were associated positively with head circumference and negatively with birth weight. In addition, pregnancy B12 and folate were positively associated with mental and social development quotients. Maternal B12 and folate during intrauterine life may favorably influence brain development and function. Pregnancy provides a window of opportunity to enhance fetal psychomotor (motor and mental) development. © 2012 Cambridge University Press and the International Society for Developmental Origins of Health and Disease. Source

Lubree H.G.,Kamalnayan Bajaj Diabetology Research Center | Katre P.A.,Persistent Systems | Joshi S.M.,Kamalnayan Bajaj Diabetology Research Center | Bhat D.S.,Kamalnayan Bajaj Diabetology Research Center | And 5 more authors.
Journal of Developmental Origins of Health and Disease

Longitudinal studies investigating vitamin B12 and folate status of mothers and their offspring will provide a better understanding of intergenerational nutrition. During pregnancy and 2 years (2y) after delivery, we measured plasma vitamin B12 and folate concentrations in 118 women [aged (mean s.d.) 22.9 3.9y] who attended a rural (n = 68) or an urban (n = 50) antenatal clinic in Pune, India. Cord blood vitamin B12 and folate were measured, and when the child was 2y total homocysteine (tHcy) was also measured. Demographic and diet measurements were recorded using standard methods. Pregnancy plasma vitamin B12 concentration at 34 weeks was low [median (25th, 75th), 115 (95, 147) pm]; 75% had low status (<150 pm). Plasma folate was high (mean s.d., 33 21 nm); one had a folate concentration <7 pm. Cord plasma vitamin B12 and folate concentrations were higher than and positively associated with maternal concentrations. In stepwise regression, higher child vitamin B12 at 2y was predicted (total R 2 15.7%) by pregnancy vitamin B12 (std β 0.201, R 2 7.7%), current consumption of cow's milk (std β 0.194, R 2 3.3%) and whether breast feeding was stopped before 2y (std β 0.234 R 2 7.2%). Child's 2y tHcy concentration was high (11.4 3.6 m) and predicted by lower pregnancy vitamin B12 (std β 0.206, R 2 4.1%), lack of vitamin supplementation (std β 0.256, R 2 5.6%) in pregnancy and whether currently breastfed (std β 0.268, R 2 8.4%). Low maternal vitamin B12 status in pregnancy and prolonged breast-feeding results in disturbed one-carbon metabolism in offspring at 2y. Supplementation of women of child-bearing age, particularly during pregnancy and lactation, may improve the homocysteine status of these children. Copyright © Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2011. Source

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