Abstract

The worldwide increase in the incidence of type 2 diabetes (T2D) is falling disproportionately on transitioning societies, where historically nutrition has been poor, but recent changes have led to increased food availability and reduced exercise levels. As well as the obesity related T2D risk associated with these demographic changes there is also evidence of transgenerational risk for T2D . Low birth weight and early stunting may be followed by adolescent obesity and increased risk for gestational diabetes. Increased glucose exposures during fetal development may increase risk of obesity, insulin resistance and T2D in the next generation. This vicious cycle may accelerate T2D prevalence across generations.

Our collaborations with University of Witswatersrand involves detailed evaluation of growth and metabolism and exploration of epigenetic mechanisms which may underpin transgenerational risk for T2D , across the three generations recruited to the Birth to Twenty (Bt20) cohort in Soweto. Through extensive field work in the more rural Mpumalanga province of South Africa we have developed a complex intervention around pre-pregnancy and pregnancy weight gain with the aim of reducing transgenerational risk for T2D (Ntshembo). This clustered randomised controlled trial will explore whether local health worker based interventions can be effective in reducing risk for metabolic disease in transitioning societies.