Sir. The article by Thakappan and colleagues in the January 2010 issue of the Journal, defines the enormous threat of non communicable diseases which the State of Kerala faces (1). The results are aptly projected as the harbinger of what is going to happen in India and rest of the developing world. The study is all the more important for its finding that the anthropometric measures like body mass index (BMI) and waist circumference (WC) were only modest in predicting biochemical risk factors in this population. In this context, we would like to highlight the contribution of developmental origin of adult onset diseases and to project calf anthropometry as a marker to define the early life growth perturbation in this nutritionally stunted population. Though genetics and ethnic factors play role in the development of conventional risk factors. current literature is reassuring that lifestyle interventions can postpone the onset of adult onset diseases as a public health initiative (2).