Details of Earlier Research

[2009-2012, University of California Los Angeles]

Summary: Hypertension is a major contributor to the world-wide epidemic of cardiovascular disease (CVD).[1,2] It is estimated that hypertension causes 7.5 million deaths world-wide amounting to 12.8% of the total of all annual deaths.[3] Many risk factors leading to hypertension are modifiable and therefore provide an opportunity for preventive efforts.[4] There is an imperative need for population-based research to understand the modifiable factors such as job stress in leading to Hypertension.[4] I chose workplace settings for the research as they provide opportunities to explore determinants of these negative behaviors and are amenable to interventions.[1]

I led a moderately large study (N = 1071) in the software professionals in Bangalore, India employed at 27 different IT companies. The focus of our study was to study the association of Job stress and Hypertension as well as understanding the on the age gradient of hypertension prevalence. The research established higher prevalence of hypertension in the younger age cohort, affecting 31% professionals with 5% having malignant levels of hypertension. It was known earlier that south Asians are predisposed to be hypertensive a decade earlier compared the developed countries.[6] Our research suggested that hypertension in IT/ITES professionals occurs a decade earlier compared to the rest of India and two decades earlier compared to developed countries.[7] This suggests that if untreated, these professionals would go on to develop cardiovascular diseases (CVD) at an early age. The results also indicated that 46% of professionals were in pre-hypertension. In addition, I found that the dimensions of workplace autonomy and workplace environment are associated with hypertension.

Accomplishments

1. The earlier understanding was that the association between job strain and coronary heart disease (CHD) is weak, with job strain slightly increasing the risk of coronary diseases by 3.4% in the general population.[9] Our meta-analysis showed statistically significant associations with 30% higher risk of hypertension for those with job strain. This proves that job strain might be affecting the CHDs through hypertension. The paper on meta-analysis of job stress and hypertension therefore is a significant contribution of the body of literature and would influence future research delineating the effects of stress on CHDs. As a testimony to the impact of the paper, the original paper by us was republished by the BMJ group in their postgraduate medical journal.

2. It is important that individuals with higher stress have to change their lifestyle to prevent a progressive rise in BP using the recommended lifestyle modifications. [8] As a result of the findings from the study, the software companies have approached us and have requested to engage with them for improving health outcomes. I am in discussion with a major IT company to finalize on the details of engagement towards improving the health of the employees.

3. I have published extensively from this work. The Publications from this project are as follows.
   90. Babu, Giridhara R., et al. “Republished: Is hypertension associated with job strain? A meta-analysis of observational studies.” Postgraduate Medical Journal 90.1065 (2014): 402-409.
   91. Giridhara R Babu, T. Mahapatra, and R. Detels. “Job stress and hypertension in younger software professionals in India.” Indian Journal of Occupational and Environmental Medicine 17.3 (2013): 101.

• Babu GR, Jotheeswaran A, Mahapatra T, Mahapatra S, Kumar A SR, Detels R, Pearce N. Is hypertension associated with job strain? A meta-analysis of observational studies. Occup Environ Med. 2014 Mar; 71(3):220-7. doi: 10.1136/oemed-2013-101396. Epub 2013 Sep 24.

65. Babu GR, Mahapatra T, Mahapatra S, Detels R. Sexual behavior and job stress in software professionals, Bengaluru – India. Indian J Occup Environ Med. 2013 May; 17(2):58-65. doi: 10.4103/0019-5278.123165.
66. Babu GR, Mahapatra T, Detels R. Application of mixed methods for exploration of the association of job stress and hypertension among software professionals in Bengaluru, India. Indian J Occup Environ Med. 2013 May; 17(2):41-7. doi: 10.4103/0019-5278.123160.
67. Babu GR. Prevalence of Job Stress, General Health Profile and Hypertension Among Professionals in the Information Technology Sector in Bengaluru, India. Los Angeles: University of California, Los Angeles; 2012.

• Babu GR, Detels R. Prioritizing Social Actions And Involving Community For Prevention Of The Non-Communicable Diseases. The Internet Journal of Epidemiology. 2011;9(2).
• Babu GR. Obesity in Elderly and Life Expectancy in India. International Journal of Medicine and Public health. 2011;1(2):2-3.

1. Giridhara R Babu, Sathyanarayana T N, Snehendu B Kar, Roger Detels. Perceived occupational stressors and the health of Software Professionals in Bengaluru, India. The Qualitative Report.

4. Subsequent to the study in software professionals, we have now conducted the study in schoolteachers and employees of health department. These studies are helping us to collate evidence on worksite-based burden of NCDs and are helpful in designing the appropriate interventions. A series of papers are pending for publications on the burden of the diseases in different workgroups.
   1. Parimala, Giridhara R Babu, The Burden of Diabetes And Hypertension in the staff working in Directorate Of Health And Family Welfare Services, Bengaluru, Karnataka. [In press]
   2. Manjula, Sarin S, Giridhara R Babu. Prevalence of Diabetes Mellitus in School teachers of Bengaluru. [In press]
   3. Sudha BK, Sarin S, Giridhara R Babu Prevalence of Hypertension in School teachers of Bengaluru. [In press]

References for Details of Earlier Research:

1. Giridhara R Babu, Mahapatra, and R. Detels. “Job stress and hypertension in younger software professionals in India.” Indian Journal of Occupational and Environmental Medicine 17.3 (2013): 101.
2. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet. 2005;365:217–23.
3. World Health Organization. Global Health Risks: mortality and Burden of Disease Attributable to Selected Major Risks. Geneva: World Health Organization, 2010; 2009.
4. Srinath RK. Protecting the heart of global development. Heart Beat, The World Heart Federation Newsletter. 2005. Jun, [Last accessed on 2014 Jan 10].
5. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part II: Variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001;104:2855–64.
6. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997;349:1436–42.
7. Reddy KS. India wakes up to the threat of cardiovascular diseases. J Am Coll Cardiol. 2007;50:1370–2.
8. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.
9. Kivimäkii M, Nyberg ST, Batty GD, et al. Job strain as a risk factor for coronary 
heart disease: a collaborative meta-analysis of individual participant data. Lancet 
2012;380:1491–7.

Summary of the Current Research

Summary of the Current Research [2009-2012, Public Health Foundation of India]

The carbohydrate ‘fuel’ metabolism in a pregnant woman may have a long-term impact on the development of her offspring (‘fuel-mediated teratogenesis’ hypothesis) including in utero exposure to maternal hyperglycaemia leading to fetal hyperinsulinaemia, and the consequent increase in fetal fat cells. Therefore, a feed-forward loop can exist of rising adiposity and hyperinsulinaemia throughout childhood, perhaps leading to obesity and diabetes in later life. There is a need for prospective examination of body fat distribution in children born to mothers with different glycaemic levels to understand the plausible association between glucose metabolism and future risk of diabetes in offspring.

I am the principal investigator on the ongoing project, exploring whether maternal glucose levels in pregnant women are related to skinfold thickness in their infants. I wrote the proposal that won the wellcome trust grant for setting up a multicentre cohort study to evaluate the effects of glucose levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the risk of chronic diseases in infants. The study aimed to recruit 1045 participants over a period of 1 year, who will be followed up irrespective of their glycaemia status for a period of 15 months, beginning in the 24th week of gestation. We published a detailed protocol of the study in BMJ Open. [1] In order to extend the recruitment, complete the follow-up and create a repository of data/samples on all the participants, I have been awarded intermediate fellowship from Wellcome trust-DBT India alliance. With the funding support of WT-DBT India alliance, I am currently expanding the cohort study to aim to recruit more than 3000 pregnant women using the budget of US$ 573,796. Extending the study to multiple centres will provide the robust data for valid inferences.

Accomplishments

1. The knowledge from this study may be extremely important for developing an effective strategy for the control of the obesity-hyperglycaemia epidemic in low-income and middle-income countries. The results from our study can provide insights into the relation of adiposity during infancy and childhood into adult adiposity and Type 2 Diabetes Mellitus (T2DM).
2. Since 2012, I have worked towards finalizing the research instruments and we have ensured smooth conduct of the cohort study. A good coordination mechanism has been put in place between the research team and the hospital staff at the study centers. This has favorably enabled the arrangement of tracking down respondents for follow up by help from the hospital staff. As the principal investigator (PI), I have prepared the technical proposal in its entirety. I am convinced with the feasibility plan for the cohort study and am optimistic about the potential of expanding this cohort across multiple centres in Asia and thereby reap greater public health benefits.

Publications from the ongoing project are as follows:- (also visit, publications)

1. Babu, G. R., Garadi, L., Murthy, G. V. S., & Kinra, S. (2014). Effect of hyperglycaemia in pregnancy on adiposity in their infants in India: a protocol of a multicentre cohort study. BMJ open, 4(6), e005417.
2. Babu, G R., B. Tejaswi, M. Kalavathi, G. M. Vatsala, G. V. S. Murthy, Sanjay Kinra, and Sara E. Benjamin Neelon. “Assessment of screening practices for gestational hyperglycaemia in public health facilities: a descriptive study in Bangalore, India.” Journal of Public Health Research 4, no. 1 (2015).
3. Giridhara R Babu, GVS Murthy, R Deepa, A Yamuna, Prafulla Shriyan, Kiran Kumar H, Maithili Karthik, Keerthi Deshpande, Sara E Benjamin Neelon, Prabhakaran D, Anura Kurpad, Sanjay Kinra. Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI) Protocol of birth cohort at Bangalore, India. BMC Pregnancy and Childbirth (In Press)
4. Giridhara R Babu, GVS Murthy, R Deepa, A Yamuna, Nolita Saldanha, Prafulla Shriyan, Maithili Karthik, Keerthi Deshpande, Sara E Benjamin Neelon, Anura Kurpad, Sanjay Kinra. Screening for Gestational Hyperglycemia in Public Hospitals: Baseline Results from piloting MAASTHI, a Cohort Study. BMC Pregnancy and Childbirth (In Press)
5. Two more papers in review

Future Research Focus

In Asia, there is an imperative need to implement the practice of evidence based public health policy, planning and spending. My earlier and ongoing research provides the appropriate evidence, which can guide formulation of policy to bring in positive change that we can see in our lifetime. I am focused shaping my career towards independence and in building a long-term career in academic public health. Therefore, my future research plan is dedicated to explore the impact of tackling determinants in maternal and psychosocial environment and thereby promote positive health in populations through appropriate interventions.

The focus of my research is through realization of the following objectives.

1. Generating evidence regarding maternal and psychosocial environment of NCDs
2. Explore the appropriate interventions through pilot projects
3. Ensuring evidence based public health policy planning and implementation

Objectives (a) and (b) help in validated identification and prioritization of maternal determinants of childhood obesity (and subsequent risk of diabetes and hypertension) in Asia.  The evidence available in the next three years, will aid in generation of rigorous, feasible and contextually specific population based pilot interventions. The objective (c) will be achieved though implementation of pilot interventions based on objectives (a) & (b). The three objectives together will contribute to logical and empirically grounded choices of public health interventions.

In the next 2-3 years, I want to pilot the interventions based on the results from the research on the role of maternal and psychosocial environment of NCDs in different populations. The overall results from testing the interventions will result in implementation of evidence-based public health. In the next 5 years, I wish to inculcate the evidence into policy formulations at national and international level to influence policymakers to bring positive changes with respect to NCD prevention and control. Due to demographic transition and lifestyle changes, the aging Asian populations continually are affected by NCDs. My engagement of research and advocacy in NCDs will aid in improving the health of aging population and improve productivity. I am uniquely positioned to study the effects from intergenerational perspective and earnestly believe that the positive changes will see transformation of societies in the next two decades. Therefore, my long-term goal is to ensure healthy populations are sustained through integrated technical and advocacy efforts. My track record of working in public health over 15 years has provided a clear resolve for the achieving the objectives listed above.

Summary of the Research Portfolio

1. The research accomplishments in terms of grants are listed as follows:- Grants

2. The research publications are listed in this link: Publications
3. Advocacy is provided in this link: Links
4. Professional Memberships

**A Work in Progress***