Obesity and type diabetes

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Obesity is a powerful risk factor for the development of type 2 diabetes and more than two-thirds of patients with type 2 diabetes are obese. The risk of type 2 diabetes correlates positively with increasing obesity (Larsson et al., 1981; Harris, 1989). In the Nurses Health Study, the risk of developing diabetes increased five-fold in women with BMI of 25 kg/m2 compared with those with BMI of 22 kg/m2 The risk becomes higher reaching 28-fold with BMI of 30 kg/m2 and 93-fold with BMI > 35 kg/m2 (Colditz et al., 1996).

The risk of obesity and type 2 diabetes was better defined by a high WHR and waist circumference (Larsson et al., 1984). Additionally, the duration of obesity was directly related to the risk of diabetes (Everhart et al., 1992). The risk of type 2 diabetes from obesity is more prevalent across certain ethnic groups such as South Asians and Afro-Caribbeans (Bhopal, 2002).

The increasing prevalence of type 2 diabetes is paralleled by the rise in the level of obesity in the general population. This process occurred over too short a period to implicate genetic factors per se. It is most likely that environmental factors interact with genetic susceptibility in the pathogenesis of type 2 diabetes. The 'thrifty genotype hypothesis' has been proposed as an explanation for the increased prevalence of type 2 diabetes. This hypothesis suggests that during times of famine alternating with times of plenty, the ability to store fat efficiently leads to a survival advantage. In western society, when there is permanent 'plenty', this genetic 'advantage' has become a liability with increased risk of development of obesity and diabetes (Neel, 1962).

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