Ranjan Yajnik

Director Diabetes Unit

Diabetes Unit, King Edward Memorial Hospital and Research Centre, India

Prof Yajnik (born 31st January, 1952) MD FRCP, is a Consultant Physician, and Director of the Diabetes Unit at King Edward Memorial Hospital, Pune since 1985. He heads the Pankunwar Firodia Daycare Centre and the Kamalnayan Bajaj Diabetology Research Centre, and is an Associate Professor at the BJ Medical College, Pune. He is a visiting Fellow at the MRC Life course Epidemiology Unit at Southampton, UK and a Visiting University Professor at the Peninsula Medical School, Department of Molecular Medicine and Genetics at Exeter, UK. He was an advisor on the Population and Public Health Council of the Wellcome Trust (2009- 2011) and also sits on H3Africa Panel. Prof Yajnik was the first to demonstrate the association of central obesity with type 2 diabetes in Indians, and its association with ‘insulin-resistance syndrome’. He described the “thin fat Indian” (low BMI, low muscle mass but excess adiposity) which partly explains the risk of type 2 diabetes at a lower BMI compared to Europeans. He is the thin fat Indian in the Y-Y paradox picture in the Lancet (2004), one of the most frequently shown medical pictures. Prof Yajnik established the first Indian study (Pune Children’s Study) in collaboration with Prof David Barker and Caroline Fall which demonstrated the association of low birth weight with childhood insulin resistance. This was a paradigm shift for the aetiology of NCD’s in India which is the world’s capital for both low birth weight and NCD’s. Recently, a 21-year follow up has been completed. Subsequently, he set up the landmark Pune Maternal Nutrition Study (PMNS) in 6 villages near Pune to relate fetal growth and development with maternal size, her nutrition and metabolism in pregnancy. PMNS described the thin-fat Indian baby which is 800 g lighter but more adipose than an English baby, and had all the predictors of future risk of diabetes (hyperinsulinemia, hyperleptinemia and hypoadiponectinemia) at birth. Maternal micronutrient rather than macronutrient nutrition was important for fetal growth, and low vitamin B12 and high folate had undesirable effects, challenging the standard practice of prescribing large doses of folic acid to B12 deficient Indian mothers. This has paved a way for novel interventions to influence fetal growth and future risk of diabetes and cardiovascular disease. Mendelian randomization technique (MTHFR, FUT2 and TCN gene polymorphisms) has supported a causality for these observations. He demonstrated normal vitamin B12 absorption in the majority of this population, and efficacy of physiological doses of vitamin B12 (2 and 10 mcg/d) in improving 1-C metabolism. ICMR and MRC UK have now funded an intervention with vitamin B12 and multi-micronutrients in adolescents to reduce the risk of adiposity and insulin resistance in the offspring. This will be one of the first ‘primordial interventions’. In addition to describing ‘Nutrient-mediated teratogenesis’, Prof Yajnik has also investigated the role of maternal ‘fuels’ in fetal programming (Norbert Frienkel’s ‘fuel-mediated teratogenesis’) and proposed a ‘dual teratogenesis’ model to explain rapidly escalating diabetes and CVD epidemic. Prof. Yajnik has put India on the international map in the field of diabetology and DOHAD (Developmental Origins of Health and Disease). He has published over 100 scientific papers, reviews and chapters in prestigious international journals, has extensively lectured in various international fora (DOHaD, ADA, EASD, ICO, ESPE, ICE etc.), has been an advisor to multiple national and international bodies (Indian Council of Medical Research, Indian Department of Biotechnology, WHO, NIH and NICHD) and referred and edited for prestigious Journals. He has guided many MD and PhD students in India and abroad. He has received many awards and honours in recognition of his outstanding contribution, including SGP Moses Oration of Research Society for Study of Diabetes in India, Association of Physicians of India and South Asian Society for study of Atherosclerosis, the most prestigious being the Hellmut Mehnert Award of the International Diabetes Federation in 2009 and the David Barker Medal 2011. Prof Yajnik’s research is continuously funded by the Wellcome Trust, London. His work is also funded by MRC UK, International Atomic Energy Agency, Nestle Nutrition Foundation, Department of Biotechnology (India), Indian Council of Medical Research.