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Apr 2014
Indian Migration Study

Indian Migration Study, 2004
Principal Investigators            Shah Ebrahim, K. Srinath Reddy
Co-Principal Investigators: George Davey Smith(University of Bristol), Dorairaj Prabhakaran(CCDC), Yoav Ben-Shlomo (University of Bristol)

Cumulative socio-economic changes (both adverse and beneficial) associated with migration may be of particular relevance in explaining the high levels of obesity and diabetes among rural-urban migrants. Using the framework of a cardiovascular risk factor screening the Indian Migration Study examined migrants and their families for rural-urban differences in lifestyle patterns, socioeconomic status, anthropometrics and physiological measures with respect to the prevalence of cardio-metabolic outcomes. The study was designed to evaluate the health effects of migration from rural to urban places on chronic diseases such as obesity and diabetes, on risk factors such as tobacco use, physical activity, diet and on physiological measures, biomarkers, genetic and epigenetic variation. The study was conducted in factories of north, central and south India where investigators recruited migrant urban factory workers, their spouses and non-migrant rural siblings still living in their place of origin. Migration histories were classified into stages of recent, long-term, and intergenerational migration, and comparisons of rates were made between rural and urban participants of varying migration types. Data from the study is now being analysed and the investigators have published several important findings from the data including more recently, 1) the increase in obesity associated with migration among men (weaker associations for diabetes and more generally, in women); and 2) food consumption patterns that show significant increases in Western foods among migrants, yet show an increase of predominantly indigenous diets overall, irrespective of migration status. Using these and other data SANCD plans to construct a policy relevant model to predict India’s current and future burdens of diabetes under different risk factors and secular trend scenarios.
Projects related to the Indian Migration Study
Associations between milk/milk product consumption and anthropometric measures in Indian Population: Findings from the Indian Migration Study
Principal Investigators: Ambika Satija, Sutapa Agrawal, Shah Ebrahim et al                                      

The rise in overweight and obesity in India has been linked to the nutrition transition, characterized by increased animal food product consumption. The nutritional etiology of obesity remains unclear, especially with regard to the role of dairy products. In this paper we examined whether milk/milk product consumption is associated with obesity among adult Indians by exploring the data from a geographically representative cross-sectional sib-pair designed Indian Migration Study (IMS) conducted during 2005-07. Finding shows an independent, inverse association of milk consumption with the risk of being obese suggesting that high milk intake may lower the risk of obesity in adult Indians.

Poster presentation at the 42nd Annual Conference of the Nutrition Society of India (NSI), Mumbai, Maharashtra November 19-20, 2010
Associations between active transportation and obesity, hypertension and diabetes in Indian adults
Principal Investigators: Sutapa Agrawal, Chris Millett, Shah Ebrahim et al

Active transport has been widely promoted as a way of improving the environment, increasing physical active lifestyles and preventing overweight and obesity in developed countries. Little empirical evidence supporting this relationship in developing countries exists. This study aims to evaluate the associations between modes and duration of transport to work and obesity, hypertension and diabetes in Indian adults by exploring the data from a geographically representative cross-sectional sib-pair designed Indian Migration Study (IMS) conducted during 2005-07.  Findings of this study provides empirical evidence of an association between mode and duration of transport to work with obesity and diabetes in a developing country. Our findings suggest that efforts to increase active transport should be an integral component of strategies to maintain healthy weight and prevent diabetes in developing countries.

Oral presentation at the Geneva Health Forum 18-20 April 2012.
Associations between socio-demographic characteristics, migration experiences and psychological distress just after migration and after resettlement: Findings from the Indian Migration Study
Principal Investigators: Sutapa Agrawal, Fiona Taylor, Shah Ebrahim et al

Migration may increase risk of depressive and anxiety disorders. India has experienced a large scale rural to urban migration over the last three decades which may put excess stress on individuals and their families. Little empirical evidence on the impact of migration on mental health of migrants exists in India. In this study we aimed to investigate the associations between socio-demographic characteristics and, the migration experiences and mental health of migrants recalled just after migration and reported currently. Data from a geographically representative cross-sectional sib-pair designed Indian Migration Study (IMS) conducted during 2005-07 were used. The analysis is based on 2,112 migrants aged ≥18 years which has been extracted from the total IMS sample of 7,067 who reported their reasons for migration. The reason for migration and non adjustment in the urban environment emerged as the main cause of psychological distress among migrants just after migration and after settlement. Given the impact of migration-related stressors on psychological health, early intervention could prevent the development of chronic depression and other mental health illnesses among migrants.
Socio-demographic patterning of edible oils, 2010
Principal Investigators            Swati Khurana , Liza Bowen (LSHTM)

Edible fats and oils have different fatty acid compositions that affect the risk of coronary heart disease. To encourage healthy oil consumption, information on consumption across different socio-demographic groups within India is required. Using data from the Indian Migration Study this project evaluated education and socio-demographic factors related to edible oil consumption and on type and quantity of oils used by each household, in rural and urban adults, per month were used. Unhealthy oils included coconut, palm, vanaspati, ghee, butter. Healthy oils included sunflower, mustard and olive oil. The study found that consumption of unhealthy oils as primary oil is rare in India. Greater education, improved socio-economic position and urbanization are associated with consumption of unhealthy oils and Fiscal and educational policies to maintain the use of healthy oils may be required.

Khurana S. Sociodemographic patterning of edible oils. Proceedings of the 42nd Annual Conference of the Nutrition Society of India (NSI), Mumbai, Maharashtra; November 19-20, 2010
Salt intake in Indian diets, 2010
Principal Investigators            Swati Khurana, Shweta Khandelwal(CCDC)
Dietary habits of the Indian population indicate that the salt intake may be higher than some other populations. The aim of this study was to use the data derived from the Indian Migration Study to describe the levels of salt intake of individuals by age, sex, rural/urban residence, migration status, socio-economic position and geographic region and to identify which foods or food preparations contribute to the salt content in the diet of Indian adults. This study was taken on and submitted as dissertation by member of CCDC as a part of an MSc in Public Health at the London School of Hygiene and Tropical Medicine. 
Effects of migration on food consumption patterns in India, 2010
Principal Investigators       Dheeraj Bansal, Ambika Satija, Neha Khandpur, Liza Bowen(LSHTM), Dorairaj Prabhakaran (CCDC), Sanjay Kinra(LSHTM), K. Srinath Reddy, Shah Ebrahim

The increase in chronic disease burden in India is associated with marked changes in food consumption. The objective of this study is to assess the impact of migration on food consumption among Indian adults using data from the Indian Migration Study. The findings of this study indicated that thirteen food items were eaten by the greatest proportion of individuals on a daily basis. These were all indigenous foods. The proportion of people consuming tandoori roti, dal with vegetables, potato and ghee on a daily basis was highest in the urban sample, intermediate in the migrant group and lowest in the rural group. The proportion of individuals consuming Western food on a weekly basis followed a similar trend in which the prevalence of daily Western food consumption was found to be minimal.
Development and testing of a FFQ for use in urban and rural India, 2009-10
Principal Investigators            Shah Ebrahim , Liza Bowen
Using data from the Indian Migration Study, this project compiles nutritional data based on individual ingredients from hundreds of recipes to develop a food frequency questionnaire that adequately summarizes and captures the heterogeneity of Indian diets from 4 centres in India. This work was submitted for a successful PhD dissertation by an LSHTM research student in epidemiology.
The findings from this study are being written up for publication.
Differences in consumption of food items between obese and normal weight people in India, 2010
Principal Investigators        Ambika Satija, Fiona Taylor(LSHTM), Swati Khurana, Vikal Tripathy, Dorairaj Prabhakaran(CCDC), Sanjay Kinra(LSHTM), K. Srinath Reddy, Shah Ebrahim          

There is a rising prevalence of obesity in India, of which diet may be a major determinant and the relationship between consumption of food types and obesity is not well established in India. The objective of this study was to explore this by using data from the Indian Migration Study a cross-sectional study aimed to elucidate the effects of within-country migration on obesity, which collected detailed data on health, nutrition status and consumption of foods among 7068 factory workers and their families in 4 Indian cities. The study showed that compared to normal weight individuals, obese consume more Indian type foods which are high in fats and carbohydrates. Interventions aimed at limiting overall food consumption among the obese and promotion of exercise is needed. Public health interventions focused on controlling obesity need to target their message to the wealthy, the young and men.  

Satija A, Taylor FC, Prabhakaran D, Kinra S, Reddy KS, Ebrahim et al. Differences in consumption of food items between obese and normal weight people in India. Proceedings of the Annual conference of the Indian Association for the Study of Population, Population and Disease Burden 2009. Tirupathy, India: Conference Book of Abstracts; 2010. p 166.
Genetic and Environmental Determinants of Obesity and Diabetes, 2008
Principal Investigators            Shah Ebrahim, G.C.Chandak (CCMB)
Co-Principal Investigators   George Davey Smith (University of Bristol), K. Srinath Reddy(PHFI), Dorairaj Prabhakaran (CCDC), Yoav Ben-Shlomo (University of Bristol)

Indians are at high risk of diabetes, which is attributed to increased central adiposity.  In Europeans, nine common genes have recently been replicated for an increased risk of type 2 diabetes, including the FTO gene, which also increases the risk of obesity. This study proposes to examine the FTO and other susceptibility genes (total of 59 SNPs related to cardio-metabolic diseases) to evaluate whether these genes have similar effects in Indians and whether migration, as a major environmental exposure, results in differential phenotypic expression of obesity and diabetes in people with similar genetic risk genes.  Highly phenotyped data from the Indian Migration Study (>7000 samples in CCMB, Hyderabad) is being used for the following objectives: a) to study the prevalence of likely risk genes in the different regions of India, representing its ethnic diversity; b) to examine associations between these genes with obesity and diabetes phenotypes in migrant and non-migrant people; c) to examine biological and behavioural mechanisms by which genetic susceptibility operates to produce obesity and diabetes; and d) to establish a DNA and phenotypic database for collaborative use in the future. In addition to scientific outputs this research will produce a DNA databank with wide representation of India’s population which will be of value to scientists for discovery of genetic variation in a wide range of phenotypes relating to cardiovascular disease. This study is being carried out in collaboration with the Center for Cellular and Molecular Biology (CCMB), Hyderabad. 

Genotyping of 59 SNPs related to cardio-metabolic diseases has been completed in CCMB and investigators are now doing the statistical analysis and writing papers in collaboration with LSHTM and University of Bristol. Two research fellows are conducting their PhD studies at LSHTM and University of Bristol using this research study

1.        Taylor AE, Sandeep MN, Janipalli CS, et al. Associations of FTO and MC4R Variants with Obesity Traits in Indians and the Role of Rural/Urban Environment as a Possible Effect Modifier. J Obes 2011;July: 307542.[Epub 2011 May 17]. doi:  10.1155/2011/307542.PMID:21785715
2.        Gupta V et al. Sib-pair Analysis of 29 Common Polymorphisms with Quantitative Traits Related to Type 2 Diabetes in India. (submitted)

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