Obesity, diabetes, and insulin resistance: implications from molecular biology, epidemiology, and experimental studies in humans and animals. Synopsis of the American Diabetes Association's 29th Research Symposium and Satellite Conference of the 7th International Congress on Obesity, Boston, Massachusetts.
The number of genetic features potentially contributing to the development of obesity and of NIDDM continues to expand, even while evidence from epidemiological studies and prospective longitudinal evaluations of risk factors continue to argue strongly for nongenetic factors in the expression of these disorders. Even as the intensive search goes on for the diabesity gene(s), it is imminently clear that treatment initiatives can and must be oriented to reducing the well-established risk factors, most likely through multiple simultaneous interventions and alterations. Clearly restriction of calories is the most immediately effective of the various tools currently available. The recent results of long-term minimal restriction suggest extraordinary benefits to health can result for those predisposed to the diabesity or insulin resistance syndrome. Changes in diet composition may facilitate maintenance of a lower calorie intake, but in themselves they are not likely to significantly alter the risks of the syndrome, with the exception of lower cholesterol diets for reducing elevated cholesterol levels. Exercise and increased general physical activity must be seen as potentially beneficial; however, because of the magnitude of the physical training activities likely to be effective in lowering insulin resistance on a chronic basis, the expected outcomes from the usual types of relatively limited exercise regimen are less likely to have powerful preventive effects. Nevertheless, the combination of exercise and moderate alterations in caloric intake is likely to have a synergistic beneficial effect. Pharmacological interventions in the insulin resistance syndrome are in their early developmental phases, and we look forward to new developments in this area. Effective anti-obesity agents are greatly needed, and new understanding of the excess risk carried by obesity for many features of the diabesity or insulin resistance syndrome suggest the urgency of greater investment in research toward new modes of therapy. We look forward with great anticipation to the next Obesity, Diabetes, and Insulin Resistance Conference, where new progress in prediction, new understanding of pathogenesis, new genetic markers and modifiers, and new treatment candidates are sure to be forthcoming.
Hansen
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D000818:Animals; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000235:genetics / Q000503:physiopathology*; D003921:Diabetes Mellitus, Experimental / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000235:genetics; D006006:Glycogen Synthase / Q000235:genetics; D006801:Humans; D007333:Insulin Resistance; D051379:Mice; D008820:Mice, Obese; D009154:Mutation; D009765:Obesity / Q000453:epidemiology / Q000235:genetics / Q000503:physiopathology; D011110:Polymorphism, Genetic; D012307:Risk Factors
D006006:Glycogen Synthase