The global diabetes epidemic as a consequence of lifestyle-induced low-grade inflammation.
The recent major increase in the global incidence of type 2 diabetes suggests that most cases of this disease are caused by changes in environment and lifestyle. All major risk factors for type 2 diabetes (overnutrition, low dietary fibre, sedentary lifestyle, sleep deprivation and depression) have been found to induce local or systemic low-grade inflammation that is usually transient or milder in individuals not at risk for type 2 diabetes. By contrast, inflammatory responses to lifestyle factors are more pronounced and prolonged in individuals at risk of type 2 diabetes and appear to occur also in the pancreatic islets. Chronic low-grade inflammation will eventually lead to overt diabetes if counter-regulatory circuits to inflammation and metabolic stress are compromised because of a genetic and/or epigenetic predisposition. Hence, it is not the lifestyle change per se but a deficient counter-regulatory response in predisposed individuals which is crucial to disease pathogenesis. Novel approaches of intervention may target these deficient defence mechanisms.
Kolb
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H
Hagedorn Research Institute, DK 2820 Gentofte, Denmark. hubert.kolb@gmx.com
Mandrup-Poulsen
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D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000235:genetics; D004040:Dietary Carbohydrates / Q000009:adverse effects; D004041:Dietary Fats / Q000009:adverse effects; D004196:Disease Outbreaks; D014943:Global Health; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D008019:Life Style; D018482:Muscle, Skeletal / Q000502:physiology / Q000503:physiopathology; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D013213:Starch / Q000378:metabolism; D014944:World Health Organization
D004040:Dietary Carbohydrates; D004041:Dietary Fats; D013213:Starch; D005947:Glucose