Insulin Resistance Syndrome

Insulin Resistance Syndrome

            The  various  studies  done  world  wide  show  that  diabetes  is  a  multifactorial disease. The Neele’s thrifty genotype or fasting or feasting hypothesis shows that an individual harbors the genes for diabetes at birth which becomes expressive when the apt environment arrives. The probable cause for Indian epidemic of diabetes is at the intrauterine level.

            Most of the Indian new born babies are small compared to the western new born babies. However the major deficit was in the non fat issue that is the abdominal viscera and skeletal muscle. But the fat at subscapuler skin fold was well preserved; this suggests that besides the obligatory preservation of brain, the mal-nourished fetus favors adipose tissue deposition at the expense of muscle and the abdominal viscera which include liver, pancreas and kidney. In the metabolic terms, net lipogenesis rather then structural protein synthesis was favored in the small babies of small mother. The thin but centrally obese phenotype of an adult with type-2-diabetic Indians seem to be let down in utero. Poorly developed lever, pancreas and kidney could have relevance to the occurrence of number of disorders of the future.

A study conducted at the Southampton has shown that poor intrauterine growth and adult diabetes and the coronary artery disease are inter related, the major cause of fetal mal nutrition is maternal malnutrition.

            A study conducted at the KEM hospital at Pune showed that at the age of four years, circulating glucose and the insulin concentrations 30 minutes after an oral glucose load where related inversely to the birth weight and directly to the current weight and the skin fold thickness.

            Thus poor intrauterine growth coupled with subsequent obesity was  associated with disturbance in glucose insulin metabolism suggestive of insulin resistance. This is the earliest age at which a relationship of poor intrauterine growth with disturbed glucose and insulin metabolism are demonstrated. These children where again studied at the age of 8 years.

        The combination of being small at birth but big at the age of 8 years was associated not only with higher glucose and the insulin concentration but also with insulin resistance syndrome features. There where higher blood insulin levels and also triglycerides. Not only the weight and fat mass at 8 years where related but also the height so that the taller children who were born small where also insulin resistant. It appears that catch up growth in low birth weight babies is associated with development in insulin resistance syndrome.

            The post natal obesity seems to be more detrimental in small babies adapted to the life of scarcity inutero. This is the bases of adaptation and dysadaptation hypothesis of the insulin resistance and diabetes this explains high risk of diabetes in India and other developing population at a relatively low BMI (body mass index). Thus being small at birth predisposes and subsequent over weight precipitates diabetes.