Recent research underscores how a mother’s nutrition can shape her child’s long-term health. How strong is the scientific evidence linking maternal diet during pregnancy to the risk of developing non-communicable diseases like diabetes and cardiovascular conditions later in life?
The link between early-life undernutrition and later risk of obesity and Non-Communicable Disease (NCD) is well-established. We know that undernourishment particularly in the first 1000 days (from conception to the first 2 years) can have a profound impact on child growth and development. A recent national health survey suggests that 18%of Indian children are born underweight (low birth weight), one of the highest incidences globally. These children often grow into adults with central fat, and higher vulnerability to diabetes and hypertension, even at relatively low BMIs.
The likely scientific explanation is that our body adapts to an undernourished environment in the womb through altering several physiological processes to optimize for survival. After birth, when exposed to calorie-dense diets and sedentary lifestyles, this mismatch increases the likelihood of type 2 diabetes and hypertension at younger ages. Prevention, therefore, must begin before birth – through improved maternal nutrition, adequate weight gain during pregnancy, breastfeeding in the first six months, and timely introduction of solid food after six months. Good nutrition and physical activity during school years then help sustain this advantage. Without these interventions, India will continue to see a generation where early deprivation translates into lifelong metabolic disease.
The “thin-fat baby” hypothesis has been widely discussed in the Indian context. Could you explain what it means and how it reflects India’s unique nutritional and developmental challenges?
The “thin-fat baby” hypothesis describes a specific body composition observed in many South Asian infants, particularly in India. It suggests that these babies are born with a disproportionate body composition: they generally appear lean (low birth weight and reduced muscle mass/abdominal viscera) but relatively higher body fat percentage and high metabolic risk. Known as “Thrifty- phenotype”, the baby adapts to undernutrition in the womb but when later exposed to unhealthy diets and sedentary lifestyles, they become prone to obesity and metabolic disorders. The phenomenon highlights India’s nutritional paradox – a population that can be both undernourished and metabolically at risk. Thus traditional risk factors (such as high BMI) may not be an accurate predictor of cardiometabolic health in India.
India faces a dual burden of maternal undernutrition and obesity. How do these contrasting conditions influence offspring health and the risk of metabolic disorders?
In India today, the coexistence of undernutrition and obesity is becoming increasingly visible. The National Family Health Survey-5 shows that nearly 36 per cent of children under five are stunted, while over 24 per cent of adults are overweight or obese. What is striking is that both forms of malnutrition often exist within the same household; for instance, a child who is anaemic or stunted may have parents who are overweight.
Among adults, abdominal obesity is rising across both urban and rural populations, often masked by relatively low BMIs. For treatment, the challenge lies in balancing two very different needs. Restrictive diets for weight loss can worsen micronutrient deficiencies. Anaemia is common even among overweight adults, which complicates care. Food environments make this worse – affordable calories come from ultra-processed foods, while nutrient-dense staples like pulses, eggs, and vegetables are less accessible.
This is why clinical care now requires shifting from “treatment” framework to “prevention” framework which involves comprehensive screening with blood markers and anthropometric measurement. Empowering patients and populations must focus not just on calories but on dietary quality, with an emphasis on a diverse diet with adequate protein, micronutrients like iron, and adequate fibre. The reality is that India and other low- and middle-income countries cannot treat undernutrition and obesity in silos any longer; they demand an integrated approach at every level of the health system. Notably, our locally-available, seasonal foods offer dietary diversity and can be encouraged along with physical activity guidance throughout the life course to provide simple yet effective preventive strategies.
Beyond nutrition, how do socio-economic, cultural, and environmental factors such as poverty or air pollution—interact to affect maternal and fetal health outcomes?
Addressing maternal anemia requires a holistic approach that transcends supplementation. Some key components include promoting access to nutritious foods through public distribution systems, national and state-level programs, and nutrition education. Improving access to potable water, sanitation facilities, and menstrual hygiene practices are also equally critical to reduce infections that exacerbate anemia. Social factors such as shifting gender norms that limit women’s access to good nutrition and healthcare; and empowering women through education and economic opportunities can have a cascading effect on reducing anemia..
Despite years of effort and multiple large-scale programs, the persistence of anemia among pregnant women points to deeper structural issues. One gap is the tendency to treat maternal nutrition as a siloed medical problem rather than addressing the larger social, environmental, and systemic determinants. Women, especially in underserved areas, may face logistical hurdles, social restrictions, or simply lack the agency to seek nutritional support. Having said that, screening and prevention strategies such as supplementation during pregnancy can protect the mother and child, especially the most vulnerable. Overall, a holistic multi-pronged approach will be required to reduce anemia at the population level.
What preventive nutrition and healthcare interventions can help break the intergenerational cycle of malnutrition and NCDs in India?
Protecting the first 1,000 days of a child’s life through iron and folic acid supplementation, balanced diets for mothers, exclusive breastfeeding, and timely introduction of solid food (complementary feeding) is important. This reduces the risk of undernutrition while also lowering future obesity risk.
Improving the quality of food provided through government safety nets like the Integrated Child Development Scheme (ICDS) and school meal programs is equally crucial. India has made progress in introducing millets, pulses, and fortified staples, but there is still scope to set stronger nutrition standards that limit access to and consumption of foods with high fat, sugar, and salt (HFFS) while enhancing protein and micronutrient content.
Routine micronutrient supplementation, dietary diversification, food fortification, and strengthening healthcare services ensure better maternal and child health. Community engagement, through health workers and self-help groups, facilitates behavior change and awareness about nutrition. Complementing fortification with nutrition education and healthcare services enhances the overall effectiveness of these interventions.
From a policy standpoint, what are the most urgent steps India should take to ensure healthier pregnancies and “hopeful futures” for the next generation?
India has implemented various policies and programs targeting maternal nutrition, like the Integrated Child Development Services (ICDS) and the Anemia Mukt Bharat initiative. Challenges, however, persist in effective implementation, including inadequate funding, limited human resources, irregular supply of supplements, and lack of robust monitoring and evaluation systems.
Rather than introducing new policies, the focus should be on strengthening existing frameworks through improved coordination, capacity building, and accountability mechanisms. Using digital tools such as POSHAN tracker can help if adequate training, support, and resources are allocated. However, data privacy and transparency in data sharing should be sorted out to allow for researchers, administrators, program managers and other stakeholders for data-driven decision making. Enhancing inter-sectoral collaboration and ensuring community participation are also important for translating policy into action.
We must start rethinking our approach, grounding it in empathy, scientific evidence, local context, and a recognition that nutrition is not just a health issue but a reflection of structural inequities. Maternal nutrition is not a short-term health issue; its impact stretches across generations. We should therefore take a life course view towards nutrition. When we frame maternal nutrition as a cornerstone of human capital development, it becomes clear that it’s not just a health department’s responsibility – it’s a national imperative. Every rupee spent on maternal nutrition is an investment in India’s demographic dividend.