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kk@mrc.soton.ac.uk

Dr Kalyanaraman Kumaran MBBS, MSc, DM, FFPH

Clinical Scientist/Senior Lecturer, Senior Scientist Public Health, Diabetes Unit, KEM Hospital, Pune, India

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Dr Kalyanaraman Kumaran is Clinical Scientist/Senior Lecturer, MRC Lifecourse Epidemiology Unit, University of Southampton within Medicine at the University of Southampton.

After completing his undergraduate medical degree at Karnatak University, India, Dr Kumaran was involved in the collaborative studies on the fetal origins of adult disease between the MRC Unit, Southampton and Holdsworth Memorial Hospital, Mysore between 1994 and 1998. He obtained a DM from the University of Southampton based on the work in Mysore. His interest in translating research into practice led me to undergo formal training in public health in the UK between 1999 and 2004. During this period, he obtained an MSc in Public Health and the membership of the Faculty of Public Health.

Between October 2004 and March 2012, he worked as a consultant in communicable disease control for the Health Protection Agency, UK where he was involved in communicable disease control and environmental hazards. He also held a consultant in public health medicine post with NHS Somerset, UK where he was the lead for public health intelligence. He has a keen interest in teaching and was involved in the development and delivery of undergraduate and postgraduate public health teaching at the Peninsula Medical School after completing a postgraduate certificate in clinical education.

His interests include the application of evidence-based interventions at population level through a lifecourse approach, reduction of health inequalities and improved access to healthcare, and teaching and training initiatives. In April 2012, he started as clinical scientist/senior lecturer with the MRC Lifecourse Epidemiology Unit to be based mainly at the Diabetes Unit, Pune, India and work across the two teams on projects relating to the developmental origins of health and disease. He is currently involved in a community-based trial of pre-conceptional micronutrient supplementation and mechanistic studies of fetal programming in India.

Qualifications

FFPH 2009 Faculty of Public Health, London, UK
PG Cert 2004 Peninsula Medical School, Exeter and Plymouth, UK
MFPH 2003 Faculty of Public Health, London, UK
DM 2003 University of Southampton, Southampton, UK
DFPH 2001 Faculty of Public Health, London, UK
MSc 2000 London School of Hygiene and Tropical Medicine, London, UK
MBBS 1993 Jawaharlal Nehru Medical College, Belgaum, (Karnatak University), India

Appointments held

Consultant in Communicable Disease Control, South West (South) Health Protection Unit, Taunton, UK (part time); October 2004 - March 2012.

Consultant in Public Health, NHS Somerset, Yeovil, UK (part time); August 2010 - November 2011.

Honorary Senior Lecturer, Peninsula College of Medicine and Dentistry, Exeter, UK (part time); April 2005 - July 2010.

Specialist Registrar in Public Health, South West Public Health Training Scheme, South West Deanery, UK; August 1999 - September 2004.

Visiting Research Fellow, MRC Environmental Epidemiology Unit, Southampton, UK; November 1998 - July 1999.

Project Leader (MRC research project at Holdsworth Memorial Hospital, Mysore, India); March 1995 - October 1998.

Medical Officer (MRC Environmental Epidemiology Unit research project at Holdsworth Memorial Hospital, Mysore, India; February 1994 - February 1995.

Research interests

Dr Kumaran is involved in projects relating to the developmental origins of health and disease across Southampton-India sites mainly based in India (Pune, Mumbai and Mysore). The projects he is mainly involved with include:

1. The Pune Intervention Trial

The Pune Maternal Nutrition Study (PMNS) was established in 1993 to prospectively study the influence of maternal nutrition on foetal growth, and later cardio-metabolic risk of the offspring. High homocysteine and low vitamin B12 levels in pregnancy predicted lower birthweight and higher insulin resistance at 6 years in the offspring. B12 deficiency was widespread in this population and is due to low intake. We therefore commenced a community based B12 intervention study as the logical next step. The main hypothesis is that vitamin B12 supplementation of adolescent girls improves their offspring birth weight and B12 status, newborn and childhood body composition and reduce future diabesity.

After ethical approval and initial community sensitisation, the adolescent boys and girls in the PMNS (~17 years) were consented, screened, and recruited into the trial. They were individually randomised into 3 groups, to receive daily for at least 3 years or until their first delivery: 1) vitamin B12 2µg; or 2) vitamin B12 2µg plus multiple micronutrients (MMN) plus 5g of milk protein or 3) placebo.

Of the 690 who underwent screening, 557 were eligible for our study. Over 50% were B12 deficient according to international standards (<150 pmol/L) while folate deficiency was rare (~2%). These adolescents had higher levels of B12 deficiency compared to their mothers (34%). The supplementation commenced in September 2012.

A community based individually randomised controlled trial is complex to organise and involved detailed planning of logistics. About 20% of the cohort has migrated to other areas necessitating considerable travel. Our long standing rapport with the local community has been invaluable in securing high participation rates. The results will have significant implications for public health in India.

2. One-carbon metabolism and fetal growth

Chronic deficiency of vitamin B12, vitamin B6, folate and other B vitamins, may lead to anemia, birth defects, neural tube defects, intrauterine growth retardation (IUGR), low birth weight (LBW), and lower cognition in the children of the deficient mothers. Indians are largely vegetarian (consume no or only small amount of animal origin foods) and manifest multiple deficiencies, including vitamin B12 and proteins. Folate status is relatively normal. We have demonstrated that these nutritional deficiencies are associated with disturbance in 1-C metabolism, like hyperhomocystenemia and fetal growth and programming of diabetes. To obtain a comprehensive view of the net effects of these multiple deficiencies and variables, a single test i.e. methionine load test (MLT) will be performed. Methionine is an essential amino acid and its metabolism is directly affected during vitamin B12 deficiency.

This test is being performed on two broad groups of participants:

  • Those with severe B12 deficiency and being treated with vitamin B12 or multiple micronutrients (including vitamin B12) supplementation. The MLT is performed at baseline and after supplementation, to assess the effect of supplementation on one carbon metabolism. 

  • Non-pregnant and pregnant women (in first and third trimesters), to assess one-carbon metabolism in non-pregnant and pregnant states.

3. Intergenerational programming of diabesity in offspring of women with Gestational Diabetes Mellitus (InDiaGDM)

Fetal under-nutrition as well as over-nutrition (maternal obesity and diabetes) increase risk of diabetes in the offspring. Current thinking is that fetal programming is an ‘epigenetic’ phenomenon and the most prominent mechanism may be methylation of DNA and histones that regulate gene expression in key pathways. In the Diabetes Unit, Pune, we have previously highlighted a role for maternal micronutrients in fetal programming of adiposity, insulin resistance, and prediabetes (nutrient mediated teratogenesis). Now, we propose to investigate the impact of maternal hyperglycemia during pregnancy on the future risk of diabesity in the offspring (fuel mediated teratogenesis). This programme, first of its kind in India, will undertake ‘OMICs’ measurements (DNA methylation and targeted metabolomics) on cord blood samples of children born to women with gestation diabetes mellitus (GDM), in studies in Pune, Western India and Punjab, North India. Markers identified in the discovery phase will be investigated for validity and stability in blood, cord blood and placenta samples from children born to GDM mothers in the older cohorts in Pune and Punjab. The findings will add substantially to the evidence base of intergenerational transmission of diabetes in a diabetic pregnancy, and will inform policy-makers to help curb the escalating epidemic of diabetes in India. The study will commence in February 2014.

Department(s)

Human Development and Health

Dr Kumaran’s over-arching role is to link and work across the MRC Lifecourse Epidemiology Unit at Southampton University and the Diabetes Unit at Pune, India. He supports Profs Fall and Yajnik in taking forward the joint research programme and the setting up and management of teams for ongoing and future projects related to the developmental origins of health and disease. A major focus is translation into public health interventions. He is also involved in supporting and carrying forward the research across other Southampton-India sites at Pune, Mumbai and Mysore related to the developmental origins theme.

He is an accredited academic and service public health trainer. He is involved in the supervision of masters and doctoral students at Pune University and is also an external examiner (public health) there. He also serves as the infection control adviser to KEM Hospital, Pune.

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Articles

Book Chapters

  • Kumaran, K., Osmond, C., & Fall, C. (2017). Early origins of Cardiometabolic Disease. In D. Prabhakaran, S. Anand, T. A. Gaziano, J-C. Mbanya, Y. Wu, & R. Nugent (Eds.), Cardiovascular, Respiratory, and Related Disorders (3 ed., Vol. 5, pp. 37-56). World Bank Group.
  • Kumaran, K., & Lang, I. (2013). Understanding statistics. In C. Guest, W. Ricciardi, I. Kawachi, & I. Lang (Eds.), The Oxford Handbook of Public Health Practice. Third Edition Oxford, GB: Oxford University Press.

Review

  • Contributes to the Epidemiology for Clinicians course organised by the MRC Lifecourse Epidemiology Unit
  • Contributes to the development and delivery of postgraduate public health curriculum for Pune University, India
  • External examiner for the Masters in Health Sciences postgraduate degree offered by Pune University, India
  • Supervises and supports undergraduate medical students from Southampton on placements in Pune.
Dr Kalyanaraman Kumaran
Tel: +91-20-26111958 Email: kk@mrc.soton.ac.uk

Room Number: SGH/MRC/MP95

Telephone:(023) 8077 7624
Email:kk@mrc.soton.ac.uk

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