Genetics and diet in diabetes development
Development of diabetes and obesity has been associated with adaptation to a changing environment in addition to the genetic component. South Asians, for instance, may encounter too many calorie- and nutrient-rich foods after migration to Europe. During foetal and early developmental stages, these changes along with genetic risk could induce 'foetal programming' of adult metabolic disease. The EU-funded project GIFTS (Genomic and lifestyle predictors of foetal outcome relevant to diabetes and obesity and their relevance to prevention strategies in South Asian peoples) was established to develop diabetes prevention strategies through an enhanced understanding of early life programming (ELP). The aim of the multidisciplinary initiative was to combine studies on lifestyle, nutrition and genomics in order to inform public health policy through the development of guidelines. Project partners also designed a large-scale pragmatic intervention to prevent the metabolic syndrome, obesity and diabetes in South Asian populations aimed in early life. Investigations focused on three main areas, the first of which was baseline studies in pregnancy, randomised clinical trials in pregnancy and outcome studies in early life. Researchers also conducted genomic and biomarker studies. Post intervention involved understanding societal attitudes towards diabetes prevention and antenatal care, and the affordability of interventions and the dissemination of information. Studies were also conducted into nutritional and lifestyle factors in ELP and the role of genomics in the development of diabetes in cohorts of pregnant South Asian women in Bangladesh, Pakistan, Norway and the United Kingdom. Results showed that overweight pregnant mothers in Bangladesh (22 %) or Pakistan (36 %) are still common. At the same time, nutritional deficiency was high with vitamin D insufficiency being almost universal. Study participants were offered lifestyle advice and vitamin B12 and vitamin D supplements according to their nutritional status. Following qualitative research it was recommended that health services for preventing and managing diabetes in South Asian women before and during pregnancy need to be redesigned to be more culturally relevant. Current guidelines need to recognise that a large part of the South Asian population is deficient in vitamin B12, whether it resides in South Asia or Europe. GIFTS will improve understanding of the role of genetic and environmental factors in developing diabetes and obesity in people from South Asia, both in South Asia and in Europe. The results will inform public health policy and help to design effective interventions for diabetes prevention.
Keywords
South Asia, diabetes, GIFTS, early life programming, vitamin B12
