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Why was the cohort set up?

Modern lifestyles and nutritional transition have given rise to an emerging epidemic of obesity and type 2 diabetes in developed and developing countries.1,2 In general, metabolic compromise is seen in South Asians at relatively lower levels of obesity compared with Europeans, with Chinese having an intermediate relationship, suggesting that the patterns of development of obesity and metabolic function in different Asian populations merits focused investigation.3

The prevalence of type 2 diabetes in Singapore has increased from 1.9% in 1975 to 11.2% in 2010, and is now one of the highest in the developed world.4 The three major Singaporean ethnic groups, Chinese, Malays and Indians, appear to have distinct susceptibilities leading to differing metabolic risk.5 Such differences may be genetic, developmental or cultural in origin. The pathways leading to insulin resistance, obesity and related traits are complex and derive from an interplay of genomic and environmental factors operating over the lifespan, including during early development.6 Environmental cues such as maternal nutrition can have important effects on foetal gene expression and have been shown to influence developmental plasticity7 via epigenetic processes.8 In recent years, major epigenetic pathways involving histone and DNA modifications have been unravelled and more technological tools developed to study their function.9,10 It has recently been reported that it may be of value to measure epigenetic changes in DNA derived from foetal tissues at birth, such as umbilical cord.11 Hence, we wished to examine whether specific epigenetic marks have utility as biomarkers for identifying babies that are ‘programmed’ in utero to develop obesity or non-communicable diseases later in life.11,12 A set of epigenetic biomarkers would allow clinical intervention at early stages in individuals at risk, thereby enabling prevention of obesity and metabolic diseases.13

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