Fetal origins of type 2 diabetes in Surinam Hindustani in The Hague

Diabetes prevalence is extremely high among Hindustani (South Asians) all over
the world. In the Netherlands, too, very high figures have been found. The
causes of this high prevalence are unknown. Current hypotheses concern among
others genetic factors, fetal development resulting in a low birth weight and
lifestyle. Many experts think that the high diabetes risk among Hindustani is
related to fetal developmental issues. A striking finding in Indian babies is
the combination of a low birth weight and a high body fat percentage (the *thin-
fat Indian baby*). Indian children are characterized by adiposity and
hyperinsulinemia already at birth. In India, in the Pune Maternal Nutrition
Study (PMNS) associations have been found between the nutritional status of the
mother and the fat percentage and distribution of their babies. However, these
findings may not be applicable to Hindustan babies in western countries. In
Hindustan populations living in western countries, up to now no research has
been performed comparable to the PMNS. This is remarkable, as diabetes
prevalence among Hindustan immigrants in western countries is even higher than
in India. At 28 weeks gestation, we will ask the women (N= 500) to fill in a
questionnaire (among others diet, physical exercise, background variables,
(family) history of diabetes and other diseases). In addition, blood will be
taken (glucose, HbA1c, (HDL ) cholesterol, triglycerides, omega-3 and omega-6
fatty acids, vitamin C, D and B12, folate, homocysteine, calcium, magnesium,
zinc, ferritin, C-reactive protein). We will study the associations between
these parameters and neonatal parameters (insulin, glucose and triglycerides in
cord blood; and birth weight and thickness of skinfolds). These results can be
used to design new preventive measurements.

In the present study we will assess the associations between the nutritional
status of Hindustan pregnant women on the one hand and anthropometric and
metabolic parameters of their neonates on the other hand.

a longitudinal observational study

- At 28 weeks of pregnancy women will be asked to fill in a questionnaire and
several measurements will be performed (length, weight, head circumference,
mid-upperarm circumference and the four skinfolds). The questionnaire contains
the following parts: a general part, a part on physical exercise and a food
frequency questionnaire. We estimate that filling in the questionnaire will
take about 60 minutes and performing the physical measurements about 15
minutes. Also blood will be taken from the pregnant women.
- After delivery cord blood will be taken of women who deliver in the hospital.
This isn't painful for neither the mother nor the baby. It's proven to be safe
and is used frequently for for example bloodcell-donation.
- Within 72 hours after birth several measurements will be performed on the
neonate. Weight and length will be measured, as well as head, abdominal and
mid-upperarm circumference and the thickness of the subscapular and
triceps-skinfold. These measurements aren't painful and have no risks for the
baby. We expect that it will take about 15 minutes to perform these
measurements.