A four‐stage model explaining the higher risk of Type 2 diabetes mellitus in South Asians compared with European populations

Bhopal, R. S.

doi:10.1111/dme.12016

Cited by 77Diabetes, Cardiovascular Risks, and LipoproteinsBirth, Development, and HealthAdipokines, Inflammation, and Metabolic Diseases

A four‐stage model explaining the higher risk of Type 2 diabetes mellitus in South Asians compared with European populations

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Bhopal, R. S.·2013·Diabetic Medicine

DOI 10.1111/dme.12016

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Abstract

With approximately 1.5 billion people at risk, the staggeringly high risk of Type 2 diabetes in South Asians comprises a global problem. The causes of this high risk are complex, with 23 major risk factors identified in a Lancet seminar. This paper proposes a four‐stage explanatory model: (1) the birth of a small, adipose, lowlean mass South Asian baby—the phenotype tracking through life; (2) in childhood and early adulthood, the deposition of any excess energy intake preferentially in upper body and ectopic fat stores rather than in the lower body or superficial subcutaneous fat stores; (3) as a consequence of points 1 and 2, and exacerbated by an environment of low physical activity and excess calories, the accelerated appearance of high levels of plasma insulin, triglycerides and glucose, and the fatty‐liver vicious cycle; (4) β‐cell failure as a result of fewer β‐cells at birth, exposure to apoptotic triggers such as fat in the pancreas, and high demand from insulin resistance, which causes diabetes. Other risk factors—especially energy‐dense hyperglycaemic diet and low physical activity—play into this pathway. The recommended behavioural changes fit with this model, which brings clarity to guide future research, policy, practice and health promotion.

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South Asians develop type 2 diabetes at younger ages, more rapidly and with lower BMI than Europeans.
“South Asians develop type 2 diabetes at younger ages, more rapidly and with lower BMI”
From Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission (2022) · cites this paper as [98]
South Asians may be more sensitive to weight loss, with physiological differences in insulin resistance, body composition and fat oxidation.
“may be more sensitive to weight loss, with physiological differences in insulin resistance, body composition and fat oxidation [98, 99].”
From Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission (2022) · cites this paper as [98]

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Authors: Bhopal, R. S.
Affiliations: University of Edinburgh (GB)
Corresponding author: Bhopal, R. S.
ORCID: Bhopal, R. S.
Venue: Diabetic Medicine
Publisher: Wiley
Published: 2012-12-13
Volume: 30
Issue: 1
Pages: 35-42
ISSN: 0742-3071 (ISSN-L)
1464-5491
DOI: 10.1111/dme.12016
OpenAlex: W2019105043
Cited by: 77
References: 77
Citations by year: 2024: 1 · 2023: 3 · 2022: 5 · 2021: 11 · 2020: 10 · 2019: 5 · 2018: 5 · 2017: 6 · 2016: 10 · 2015: 6 · 2014: 8 · 2013: 7
FWCI: 5.39
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Diabetic Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Engineering and Physical Sciences Research Council (EP/K50340X/1)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords: type 2 diabetes, South Asians, ethnic differences in diabetes risk, adiposity, ectopic fat deposition, insulin resistance, beta-cell failure, hepatic steatosis, hypertriglyceridemia, physical inactivity, childhood obesity, diabetes prevention
MeSH terms: Asia, Western, Body Weight, Diabetes Mellitus, Type 2, Europe, Humans, Human Development, Life Style, Phenotype, Risk Factors, Urban Health, Prevalence

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A four‐stage model explaining the higher risk of Type 2 diabetes mellitus in South Asians compared with European populations

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