PERSPECTIVE
Diabetes
The great weight gain experiment, accelerators, and their implications for autoantibodies in diabetes
Correspondence to:
Correspondence to:
Prof. T J Wilkin
University Medicine, Level 7, Derriford Hospital, Plymouth PL6 8DH, UK; T.Wilkin@pms.ac.uk
Perspective on the paper by Reinehr et al (see page 473)
Keywords: diabetes; autoantobies; insulin resistance; diabetes; accelerator hypothesis; diagnosis
| The first 150 words of the full text of this article appear below. |
Cause and effect can generally be established only by an intervention in which all extraneous variables are controlled. Usually, this means creating the artificial conditions of a randomised trial. Occasionally, the intervention comes about naturally.
For more than 50 years, mankind has been the subject of one such natural experiment—an intervention of unprecedented scale which has proved both a serious threat to health and an unexpected source of fundamental new understanding. The intervention has been that of extreme weight gain, amounting in adults to some 9 kg over the past generation.1 The corresponding increase in children has been even greater.2 The gains have not been in bone, muscle, or water, but in fat. Body fat—most particularly visceral fat—leads to insulin resistance, and insulin resistance to increasing demands on ß-cell reserve.3
Diabetes is a disorder of ß-cell failure in which insulin reserves are no longer sufficient to meet demand.4 The
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