I (Prof Gundu Rao) was invited by the Government of India, in 1990 as a senior adviser for developing Cardiovascular Disease (CVD) prevention projects. My application for the United Nations TOKTEN (Transfer of Knowledge Through Expatriate Nationals) program was sponsored by Dr Khalilullah, Professor and Head, Cardiology, (the then Director), G.B. Pant Hospital, New Delhi, India. I visited major medical institutions for three years in a row from 1990 to 1993. During these visits, I recognized that the incidence and prevalence of CVD in Indians was very high.

We also discovered that this is not just a disease of the adults but has its origin even at the conception. To create awareness and develop educational and prevention programmes, I established a professional society, South Asian Society on Atherosclerosis and Thrombosis (SASAT) at the University of Minnesota in 1993. One of the local branches of this society was located in Mission Hospital, Mysore.

At this hospital, studies are in progress for over seven decades on a very important aspect of the Origin of Adult Diseases. According to the data generated in this hospital, 30% of children born in India, are of low birth weight (LBW). These LBW children develop cardiometabolic diseases at a later stage in life. Based on these studies, as well as studies at other centres, David Barker a British Epidemiologist developed Barker Hypothesis to explain Fetal Origin of Adult Diseases (FOAD). A hypothesis proposed in 1990 suggested that intrauterine growth retardation, low birth weight, and premature birth have a causal relationship to the origins of hypertension, coronary artery disease, and non-insulin dependent diabetes. Read more about it here.

In the early 1990s, I led a delegation (including Dr Devi Shetty from Narayana Hrudayalaya, Bengaluru) to the World Health Organization (WHO) to convince the Non-Communicable Disease (NCD) section, that cardiometabolic diseases have their origin as early as at the fetal development stage. Therefore, the intervention should start as early as at the conception or even at an earlier stage. We met Dr Margaret Chan, the Director and the NCD chief, Dr Shanthi Mendis and presented our novel approach for CVD prevention. Unfortunately, nothing came out of this adventure. The reason I mention this is, even after seven decades, we have not developed any interventions for a pre-disposing condition which is preventable.

Recently, we have been able to put together an Indo-US bilateral project to explore other alternative explanation to this phenomenon (FOAD). In this project, we are exploring the basic mechanism that is responsible for fetal DNA reprogramming to alter the fetal lipid metabolism. Preliminary studies suggest that exosomes shed from pregnant mothers (micro RNAs) may play a critical role in dictating the fetal lipid metabolism at a later stage in life. These studies are funded by the National Institute of Health, USA. A collaboration between the staff of KEM Hospital Pune (Pune Maternal Nutrition Study Group) and the staff of Children’s Hospital, Washington DC. We are hopeful to see this bare some fruits.

The following experience has been shared and approved by Prof Gundu Rao, Emeritus Professor, University of Minnesota, for publication.