TAILIEUCHUNG - International Textbook of Obesity - part 8

Một đánh giá gần đây của nghiên cứu về mối liên quan giữa thai và / hoặc sự phát triển của trẻ sơ sinh và bệnh mãn tính trưởng thành kết luận rằng các hiệp hội báo cáo có thể được thiên vị hơn là quan hệ nhân quả với sai lệch chọn lựa | OBESITY AND TYPE 2 DIABETES MELLITUS 359 103 and Native Americans 104 although at least two studies in Europeans have failed to show the expected associations 105 106 . A recent review of studies into associations between fetal and or infant growth and adult chronic disease concludes that the reported associations may be biased rather than causal with possible selection bias due to loss to follow-up and confounding by socioeconomic factors 107 . New evidence for a genetic explanation of the link between fetal growth and adult diabetes comes from Dunger et al. 108 with the observation that variation in the expression of the insulin gene is associated with size at birth. Whatever the mechanism for the association of low birthweight with adult disease and McCance et al. have suggested that the observations can be explained by more conventional genetic hypotheses 104 the association is strong in a number of ethnically varied populations and hence its effects may contribute to differences in risk of type 2 diabetes seen in people with similar levels of adult obesity. Leptin Obesity and Type 2 Diabetes While it is now accepted that human obesity is generally associated with elevated circulating leptin levels 109 and in many studies leptin is correlated with insulin levels 110-114 or insulin resistance 115 116 it is not clear whether leptin has a role in glucose intolerance in humans. In the leptin deficient ob ob mouse treatment with leptin lowered glucose and insulin concentrations in the blood independently of weight loss 117 118 . The leptin treated animals also increased physical activity and metabolic rate to normal levels 117 and this may have enhanced insulin sensitivity and glucose uptake via increased glycogen mobilization as discussed above or increased glucose uptake by some insulin-independent mechanism which would result in reduced insulin levels 118 . Leptin may also influence insulin secretion in ob ob mice via neuropeptide Y NPY 119 or by direct action on

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