Early life origins of insulin resistance and type 2 diabetes in India and other Asian countries
Early life origins of insulin resistance and type 2 diabetes in India and other Asian countries
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DOI：
10.1093/jn/134.1.205
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发表时间：
2004-01-01
影响因子：
4.2
通讯作者：
Yajnik, CS
中科院分区：
文献类型：
--
作者：
Yajnik, CS
在印度和其他亚洲国家，2型糖尿病的流行正在迅速增加。节俭的基因型和节俭的表型是两个非排他性的解释。印度次大陆的人们世世代代都面临着营养不良的问题，印度婴儿是世界上最小的婴儿之一。然而，糖尿病的流行是最近才开始的，尽管城市婴儿出生体重较高，但糖尿病在城市人中比在农村人中更常见。这表明，出生后的因素也一定起到了作用。因此，包含胎儿、出生后和成人的胰岛素抵抗和2型糖尿病演变的生命过程模型似乎是最合适的。对于给定的BMI，印度人的体脂比例和内脏脂肪都比其他人群高。这种瘦脂肪的表型在出生时就存在。新生儿的大小和身体组成受到父母大小、母亲食物摄入量、体力活动和营养物质和代谢物(叶酸、葡萄糖、甘油三酯、胆固醇等)循环浓度的影响。母亲的胰岛素抵抗促进了营养物质向胎儿的转移。童年发育加速是肥胖和胰岛素抵抗的另一个危险因素，特别是在出生时很小的儿童。儿童期发育似乎更多地受到父亲遗传因素的影响，而胎儿宫内发育更多地受到母体因素(宫内环境)的影响。城市生活方式，包括不良的饮食和久坐习惯，会进一步促进肥胖、胰岛素抵抗和2型糖尿病。这些因素可能是可以修正的。预防2型糖尿病必须从子宫开始，并持续到整个生命过程。
There is a rapidly increasing epidemic of type 2 diabetes in India and other Asian countries. The thrifty genotype and the thrifty phenotype are two nonexclusive explanations. People in the Indian subcontinent have faced undernutrition for many generations, and Indian babies are among the smallest in the world. However, the diabetes epidemic is of recent origin, and diabetes is more common among urban than rural Indians despite the higher birth weight of urban babies. This suggests that postnatal factors must also contribute. Thus, a life-course model of evolution of insulin resistance and type 2 diabetes, incorporating fetal, postnatal and adult components, seems most appropriate. For a given BMI, Indians have a higher percentage of body fat and more visceral fat than members of other populations. This thin-fat phenotype is present at birth. Neonatal size and body composition are influenced by parental size, maternal food intake, physical activity and circulating concentrations of nutrients and metabolites (folate, glucose, triglycerides, cholesterol etc.). Maternal insulin resistance promotes transfer of nutrients to the fetus. Accelerated childhood growth is another risk factor for adiposity and insulin resistance, especially in children born small. Childhood growth seems to be more influenced by paternal genetic factors, whereas intrauterine growth is more influenced by maternal factors (intrauterine environment). Urban lifestyles, including poor diet and sedentary habits, promote further obesity, insulin resistance and type 2 diabetes. These factors may be amenable to correction. Prevention of type 2 diabetes must begin in utero and continue throughout the life course.