Rukman Manapurath: Early-life determinants of cardiometabolic disease

Tell us about your research

Growing up in Kerala and training as a physician in India, I observed a striking paradox: communities facing undernutrition early in life while also experiencing rising rates of diabetes and heart disease later. This contrast drew me toward preventive medicine and eventually into research. My work focuses on cardiometabolic risk across the life course, starting as early as pregnancy and the first years of life. I study how factors like foetal growth, early nutrition, and metabolic programming shape cardiovascular outcomes later, with a particular focus on women and children in low- and middle-income settings.

Why is this research important?

Cardiovascular disease is the leading cause of death globally, and the numbers keep rising. What most people do not realise is that risk accumulates long before a person ever has a heart attack or develops diabetes. Pregnancy, infancy, and early childhood are windows where the biological foundations of cardiometabolic health are laid. We currently have very limited tools to identify who is at risk during these early windows, especially in settings like South Asia where the burden is growing fast. Our current work aims to change that by developing and validating biomarkers that can flag risk early enough to act on it.

What excites you about your work and your research?

I am a clinician turned researcher, and I always ask: will this change what a doctor does, or what a policy says? My PhD work showed how carefully designed growth-promoting interventions in early childhood can avert childhood obesity. Preventing undernutrition and avoiding metabolic harm is exactly the kind of problem that keeps me engaged. Earlier work on B12 supplementation in toddlers showing measurable reductions in homocysteine at school age told me that what we do in the first two years of life leaves a biological signature that persists for years. That is the thread running through everything I do.

When meta-analyses I led informed a WHO guideline on preterm or low birth weight care, I could see research moving from a spreadsheet into a child's life. At the University of Copenhagen, what energises me is how complementary Denmark and India are. Denmark brings structural advantages: well-funded research programs, registry infrastructure, and career pathways that are hard to access from a low-income setting. India brings something equally powerful: a large, trained research workforce, deeply established community networks, and a disease burden that, if we study it well, generates evidence relevant across South Asia and beyond. Putting those two things together is not just convenient, it is scientifically necessary if we want global health research to reflect the populations carrying the highest risk.

Where do you see yourself in 10 years?

In ten years, I see myself leading an independent research program in maternal and early-life cardiometabolic health, anchored in long-term mother–child cohort platforms in South Asia and linked to strong collaborations across Europe.

Scientifically, I would like our field to move from documenting risk to predicting and preventing it early.

Beyond research, I see myself contributing to global health agendas through roles in international agencies and guideline groups, helping translate evidence into policy and practice. I also want to support and mentor physician-scientists from low- and middle-income countries to lead research programs and build sustainable cohort platforms within their own settings.

What advice do you have for junior researchers in global health?

Read primary literature closely, especially the methods. In an era where AI can summarise papers in seconds, what will set you apart is understanding why a study was designed a certain way, what assumptions it makes, and where the evidence breaks down. That depth only comes from careful reading.

At the same time, spend time in the field. Working in real community settings will shape how you think about research questions, feasibility, and impact in ways that no classroom or dataset can. The best global health research is grounded equally in strong methods and real-world context.

What is your favourite source of global health inspiration and/or knowledge?

Two things keep me grounded and motivated. The first is fieldwork in India. Spending time with the communities we study reminds me that every data point represents a real family navigating real constraints, and it keeps my research questions honest.

The second is following people who have been able to bridge research and policy well. Dr. Rajiv Bahl is one example. He moved from clinical research in India to global child health leadership at WHO and now at the Indian Council of Medical Research, while staying focused on what evidence needs to do in the real world. That kind of balance between science and impact is something I find very motivating.

I also find myself going back often to large cohort studies, systematic reviews, and global reports. They help me see the bigger picture, but it is the combination of that with field experience.