Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-12T20:30:59.517Z Has data issue: false hasContentIssue false
  • English
  • Français

Preventing diabetes — applying pathophysiological and epidemiological evidence

Published online by Cambridge University Press:  09 March 2007

Wilfred Y. Fujimoto ,
Richard W. Bergstrom ,
Edward J. Boyko ,
Kwang-Wen Chen ,
Steven E. Kahn ,
Donna L. Leonetti ,
Marguerite J. McNeely ,
Laura L. Newell ,
Jane B. Shofer  and
Christine H. Tsunehara
...Show all authors
Wilfred Y. Fujimoto*
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Richard W. Bergstrom
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Edward J. Boyko
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Kwang-Wen Chen
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Steven E. Kahn
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Donna L. Leonetti
Affiliation:
Departments of Anthropology, University of Washington, Seattle, Washington, USA
Marguerite J. McNeely
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Laura L. Newell
Affiliation:
Departments of Anthropology, University of Washington, Seattle, Washington, USA
Jane B. Shofer
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Christine H. Tsunehara
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Patricia W. Wahl
Affiliation:
Biostatistics, University of Washington, Seattle, Washington, USA
*
*Corresponding author: Wilfred Y. Fujimoto, University of Washington, Department of Medicine, Box 356426, Seattle, Washington 98195-6426, USA. tel (206) 5430-3470, fax (206) 616-4341, email wilfuji@u.washington.edu
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This is a review of research carried out in Japanese Americans that points towards possible approaches to prevention of type 2 diabetes mellitus. The natural history of type 2 diabetes usually includes both insulin resistance and β-cell dysfunction. Insulin secretion may compensate for insulin resistance. Alternatively, enhanced insulin sensitivity may mask an insulin secretory defect. Epidemiological data support the view that in the vast majority of cases of type 2 diabetes, insulin resistance is essential to the pathogenesis of hyperglycemia. Increased diabetes prevalence as ethnic groups migrate to more urban or westernized regions has been attributed to increased occurrence of insulin resistance. Research among Japanese Americans in Seattle, Washington, showed a higher prevalence of type 2 diabetes than in Japan, which suggested that factors associated with ‘westernization’ might be playing a role in bringing out underlying susceptibility to diabetes. Our research has shown that these impressions were correct and that the abnormalities that characterize the metabolic syndrome play a significant role. Due to increased intra-abdominal fat deposition, Japanese Americans were likely to be ‘metabolically obese’ despite relatively normal BMI. A diet higher in animal fat and lower levels of physical activity were risk factors leading to increased intra-abdominal fat deposition, insulin resistance, and diabetes. Information from epidemiological studies such as these may be used to determine whether diabetes may be prevented through changes in lifestyle or application of specific therapies targeted towards identified metabolic abnormalities.

Keywords

βb-Cell dysfunctionInsulin resistanceMetabolic obesityWesternization
Type
Research Article
Information
British Journal of Nutrition , Volume 84 , Issue S2 , December 2000 , pp. S173 - S176
Copyright
Copyright © The Nutrition Society 2000

References

Bergman, RN (1989) Lilly lecture 1989. Toward physiological understanding of glucose tolerance. Minimal model approach. Diabetes 38, 1512–1527.Google Scholar
Bergstrom, RW, Newell-Morris, LL, Leonetti, DL, Shuman, WP, Wahl, PW & Fujimoto, WY (1990 a) Association of elevated fasting C-peptide and increased intra-abdominal fat distribution with development of NIDDM in Japanese-American men. Diabetes 39, 104–111.CrossRefGoogle ScholarPubMed
Bergstrom, RW, Wahl, PW, Leonetti, DL & Fujimoto, WY (1990 b) Association of fasting glucose levels with a delayed secretion of insulin following oral glucose in subjects with glucose intolerance. Journal of Clinical Endocrinology and Metabolism 71 , 1447–1453.Google Scholar
Chen, KW, Boyko, EJ, Bergstrom, RW, Leonetti, DL, Newell-Morris, L, Wahl, PW & Fujimoto, WY (1995) Earlier appearance of impaired insulin secretion than visceral adiposity in the pathogenesis of NIDDM:5-year follow-up of initially nondiabetic Japanese-American men. Diabetes Care 18, 747–753.CrossRefGoogle ScholarPubMed
Fujimoto, WY, Abbate, SL, Kahn, SE, Hokanson, JE & Brunzell, JD (1994 a) The visceral adiposity syndrome in Japanese-American men. Obesity Research 2, 364–371.CrossRefGoogle ScholarPubMed
Fujimoto, WY, Akanuma, Y, Kanazawa, Y, Mashiko, S, Leonetti, D & Wahl, P (1989) Plasma insulin levels in Japanese and Japanese-American men with type 2 diabetes may be related to the occurrence of cardiovascular disease. Diabetes Research and Clinical Practice 6, 121–127.CrossRefGoogle Scholar
Fujimoto, WY, Bergstrom, RW, Boyko, EJ, Kinyoun, JL, Leonetti, DL, Newell-Morris, LL, Robinson, LR, Shuman, WP, Stolov, WC, Tsunehara, CH & Wahl, PW (1994 b) Diabetes and diabetes risk factors in second- and third-generation Japanese Americans in Seattle, Washington. Diabetes Research & Clinical Practice 24, (Suppl.), S43–S52.CrossRefGoogle ScholarPubMed
Kahn, SE & Porte, D Jr (1997) The pathophysiology of type II (non-insulin dependent) diabetes mellitus: implications for treatment. In Ellenberg & Rifkin's Diabetes Mellitus, pp. 487–512 [Porte, D Jr and Sherwin, RS, editors]. 5th edn, Stamford, CT: Appleton & Lange.Google Scholar
Kahn, SE, Leonetti, DL, Prigeon, RL, Boyko, EJ, Bergstrom, RW & Fujimoto, WY (1995) Proinsulin as a marker for the development of non-insulin dependent diabetes mellitus in Japanese-American men. Diabetes 44 , 173–179.CrossRefGoogle ScholarPubMed
King, H, Aubert, RE & Herman, WH (1998) Global burden of diabetes 1995–2025. Diabetes Care 21, 1414–1431.CrossRefGoogle ScholarPubMed
King, H & Rewers MWHO Ad Hoc Diabetes Reporting Group (1993) Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Care 16, 157–177.CrossRefGoogle ScholarPubMed
Kitagawa, T, Owada, M, Urakami, T & Yamauchi, K (1998) Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of animal protein and fat. Clinical Pediatrics 37, 111–115.CrossRefGoogle ScholarPubMed
Leonetti, DL, Tsunehara, CH, Wahl, PW & Fujimoto, WY (1996) Baseline dietary intake and physical activity of Japanese-American men in relation to glucose tolerance at 5-year follow-up. American Journal of Human Biology 8, 55–67.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Matsuzawa, Y, Fujioka, S, Tokunaga, K & Tarui, S (1992) Classification of obesity with respect to morbidity. Proceedings of the Society of Experimental Biology and Medicine 200, 197–201.CrossRefGoogle ScholarPubMed
Shuman, WP, Newell-Morris, LL, Leonetti, DL, Wahl, PW, Moceri, VM, Moss, AA & Fujimoto, WY (1986) Abnormal body fat distribution detected by computed tomography in diabetic men. Investigative Radiology 21, 483–487.CrossRefGoogle ScholarPubMed
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20, 1183–1197.CrossRefGoogle Scholar
Vague, J (1956) The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. American Journal of Clinical Nutrition 4, 20–34.CrossRefGoogle ScholarPubMed