The obesity-diabetes association: what is different in indians?

There is a growing epidemic of obesity and type 2 diabetes in the world, more than 75% of the patients are in the developing countries. India is facing a twin burden of under-nutrition and over-nutrition: it figures prominently both in the hunger map of the world as well as being the world's capital of diabetes. Indians are susceptible to diabetes at a younger age and at a relatively lower BMI compared to the white Caucasians. This is partly explained by the fact that the thin-looking Indians are quite adipose (higher body fat percent). Intrauterine epigenetic regulation could explain the thin-fat Indian body composition. A combination of maternal one carbon metabolism derangement (influenced by vitamin B12 and Folate nutrition) and hyperglycemia appear to be major drivers. Persistent micronutrient abnormalities and rapid economic development seem to contribute to the intergenerational amplification of the diabetes-adiposity epidemic in Indians. Effective curtailment of the growing epidemic may lie in the realm of maternal and child health and nutrition.