Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis

著者: C. N. Hales, David J.P. Barker - Diabetologia 1992 被引用: 3,309

In this contribution we put forward a novel hypothesis concerning the aetiology of Type 2 (non-insulin dependent) diabetes mellitus. The concept underlying our hypothesis is that poor foetal and early post-natal nutrition imposes mechanisms of nutritional thrift upon the growing individual. We propose that one of the major long-term consequences of inadequate early nutrition is impaired development of the endocrine pancreas and a greatly increased susceptibility to the development of Type 2 diabetes. In the first section we outline our research which has led to this hypothesis. We will then review the relevant literature. Finally we show that the hypothesis suggests a reinterpretation of some findings and an explanation of others which are at present not easy to understand. The controversy concerning the relative roles of insulin deficiency and insulin resistance in Type 2 diabetes continues unresolved. Despite the early demonstration that obese people have elevated plasma insulin concentrations1 many studies over the years have failed to control adequately for the influence of obesity. Another difficulty with the interpretation of plasma insulin concentrations is that sustained hyperglycaemia could have detrimental effects on insulin secretion.