Mumbai Maternal Nutrition Project (SARAS)

Overview

The Mumbai Maternal Nutrition Project (MMNP, also known as Project “SARAS”, meaning “excellent”) is led by Dr Ramesh Potdar (insert image J), Centre for the Study of Social Change (CSSC), Mumbai, India. Other key investigators are Dr Sirazul Ameen Sahariah (insert image K), Mrs Meera Gandhi (insert image L) and Dr Harsha Chopra (insert image M), CSSC, Mumbai. Key collaborators are: Dr Giriraj R Chandak, Centre for Cellular and Molecular Biology, Hyderabad, and Prof Andrew Prentice and Dr Matt Silver, MRC The Gambia and London School of Hygiene and Tropical Medicine. The Mumbai Maternal Nutrition Project (2006-2012) was a randomised controlled trial of a food-based supplement for women living in slums in the city of Mumbai. Supplementation was started pre-conceptionally and continued until delivery. The children born to these women have been followed up since birth (SARAS KIDS study) and during 2013-2018, body composition (DXA), a range of cardiometabolic risk markers and cognitive function were measured at the age of 5-8 years. Blood samples and buccal swabs were collected for DNA and have been used in the EMPHASIS study to assess effects of maternal supplementation on the child’s DNA methylation. The SARAS KIDS study has, along with other Indian birth cohorts, contributed data to ongoing GWAS studies looking for SNPs associated with newborn size and later cardiometabolic risk markers.

Objective

To evaluate the effect of a maternal pre-conceptional food-based supplement on growth, body composition, cardiometabolic risk factors and cognitive function in the children, and to investigate DNA methylation as a potential mechanism linking maternal supplementation to these outcomes in the children.

Methods

The intervention in mothers was a daily snack made from locally available micronutrient-rich foods: green leafy vegetables, dried fruit and milk powder, eaten in addition to the women’s habitual diet. Women in the control group received snacks made from foods of lower micronutrient content. 6,513 women were recruited between 2006 and 2011, and births were completed in 2012. From June 2013 to August 2018, body composition (DXA), cardiometabolic risk factors (glucose tolerance, insulin resistance and plasma lipids) and cognitive function (multiple domains, using a battery adapted for Indian children), were measured as the children reached the 5-8 year age window. The results are currently being analysed and will be available in late 2019.

Findings from the Mumbai Maternal Nutrition Project (SARAS)

  • The intervention increased birthweight in newborns of women in the middle and upper thirds of pre-pregnant body mass index (>18.5 kg/m2), but not in newborns of underweight mothers. There were similar effects on other ‘soft tissue’ measurements (chest, abdominal and mid-upper-arm circumferences, and skinfolds) but no effects on newborn length or head circumference
  • The intervention halved the prevalence of maternal gestational diabetes (Treatment group: 7.1% vs Control group: 13.3%)
  • Potdar RD, Sahariah SA, Gandhi M, Kehoe SH, Brown N, Sane H, Dayama M, Jha S, Lawande A, Coakley PJ, Marley-Zagar E, Chopra H, Shivshankaran D, Chheda-Gala P, Muley-Lotankar P, Subbulakshmi G, Wills AK, Cox VA, Taskar V, Barker DJP, Jackson AA, Margetts BM, Fall CHD. Improving women’s diet quality pre-conceptionally and during gestation: effects on birth weight and prevalence of LBW; a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project). Am J Clin Nutr 2014; 100: 1257-68. PMID: 25332324
  • Kehoe S, Chopra H, Sahariah SA, Bhat DS, Munshi R, Young S, Brown N, Tarwande D, Gandhi M, Margetts BM, Potdar R, Fall CHD. Effects of a food-based intervention on markers of micronutrient status in low-income Indian women. Br J Nutr 2015; 113: 813-21. PMID: 25677713
  • Sahariah SA, Potdar RD, Gandhi M, Kehoe SH, Brown N, Sane H, Coakley PJ, Marley-Zagar E, Chopra H, Shivshankaran D, Cox VA, Jackson AA, Margetts BM, Fall CHD. A daily snack containing green leafy vegetables, fruit and milk before and during pregnancy prevented gestational diabetes in a randomized controlled trial in Mumbai, India. J Nutr 2016; 146:1453S-60S. PMID: 27281802
  • Chandak GR, Silver MJ, Saffari A, Lillycrop KA, Shrestha S, Sahariah SA, Di Gravio C, Goldberg G, Tomar AS, Betts M, Sajjadi S, Acolatse L, James P, Issarapu P, Kumaran K, Potdar RD, Prentice AM, Chopra J, Cooper C, Darboe MK, Gandhi M, Janha R, Jarjou L, Kaur L, Kehoe SH, Ngum M, Nongmaithem SS, Owens S, Prentice A, Priyanka TDS, Sane H, Ward KA, Yadav DK, Yajnik CS, Fall CHD and the EMPHASIS Study Group. Protocol for the EMPHASIS study; epigenetic mechanisms linking maternal pre-conceptional nutrition and children’s health in India and Sub-Saharan Africa. BMC Nutrition 2017; 3:81; DOI 10.1186/s40795-017-0200-0. Not Pubmed listed
  • Lawande A, Di Gravio C, Potdar RD, Sahariah SA, Gandhi M, Chopra H, Sane H, Kehoe SH, Marley-Zagar E, Margetts BM, Jackson AA, Fall CHD. Effect of a micronutrient-rich snack taken pre-conceptionally and throughout pregnancy on ultrasound measures of fetal growth: the Mumbai Maternal Nutrition Project (MMNP). Maternal and Child Nutrition 2018. doi: 10.1111/mcn.12441. PMID: 28251804
  • Di Gravio C, Lawande A, Potdar RD, Sahariah SA, Gandhi M, Brown N, Chopra H, Sane H, Kehoe SH, Marley-Zagar E, Margetts BM, Jackson AA, Fall CHD. The association of maternal age with fetal growth and newborn measures: the Mumbai Maternal Nutrition Project (MMNP). Reproductive Sciences 2018; doi: 10.1177/1933719118799202 (e-pub). PMID: 30419799
  • Chopra HV, Kehoe SH, Sahariah SA, Sane HN, Cox VA, Tarwade DV, Margetts BM, Potdar RD, Fall CHD, Joshi SR. Effect of a daily snack containing green leafy vegetables on women’s fatty acid status – a randomized controlled trial in Mumbai, India. Asia Pacific J Clin Nutr 2018;27:804-817. PMID: 30045425
Cohorts
India Cohorts