Why are South Asians prone to type 2 diabetes? A hypothesis based on underexplored pathways.
Why are South Asians prone to type 2 diabetes? A hypothesis based on underexplored pathways.
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DOI：
10.1007/s00125-020-05132-5
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发表时间：
2020-06
期刊：
影响因子：
8.2
通讯作者：
Kanaya AM
中科院分区：
文献类型：
--
作者：
Narayan KMV;Kanaya AM
南亚人患2型糖尿病的患病率很高，即使BMI较低。这篇评论阐述了我们的观点和假设的原因。来自流行病学研究的新数据表明，南亚人分泌胰岛素的能力可能较低，因此在受到不健康生活方式的挑战时，代偿储备可能较少。因此，胰岛素抵抗可能不是该人群中2型糖尿病的主要驱动因素。此外，数据还表明，南亚人的平均肌肉质量较低，并且可能具有异位肝脏脂肪积聚和肌细胞内脂肪沉积的特定倾向，这会导致胰岛素作用的进一步破坏。我们假设南亚人的高糖尿病易感性是通过双重平行和/或相互作用的机制在进化上设定的：由于瘦体重低，β细胞功能降低和胰岛素作用受损，这进一步加剧了肝脏和肌肉中的异位脂肪沉积。这些领域值得进一步研究。
South Asians have a high prevalence of type 2 diabetes, even at a lower BMI. This review sets out our perspective and hypothesis on the reasons for this. Emerging data from epidemiological studies indicate that South Asians may have a lower ability to secrete insulin, and thus may have less compensatory reserves when challenged with unhealthy lifestyles. Thus, insulin resistance may not be the primary driver of type 2 diabetes in this population. Furthermore, data also suggest that South Asians, on average, have lower muscle mass, and may have a specific propensity to ectopic hepatic fat accumulation and for intramyocellular fat deposition, which cause further disruption in insulin action. We hypothesise that the high diabetes susceptibility in South Asians is evolutionarily set through dual parallel and/or interacting mechanisms: reduced beta cell function and impaired insulin action owing to low lean mass, which is further accentuated by ectopic fat deposition in the liver and muscle. These areas warrant further research.
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