Decline in Incidence of Epidemic Glucose Intolerance in Nauruans: Implications for the “Thrifty Genotype” (original) (raw)

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From the WHO Collaborating Centre for the Epidemiology of Diabetes Mellitus and Health Promotion for Noncommunicable Disease Control, International Diabetes Institute

260 Kooyong Road, Caulfield South, Victoria 3162, Australia

Reprint requests to Dr. Gary Dowse at this address.

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From the WHO Collaborating Centre for the Epidemiology of Diabetes Mellitus and Health Promotion for Noncommunicable Disease Control, International Diabetes Institute

260 Kooyong Road, Caulfield South, Victoria 3162, Australia

Search for other works by this author on:

,

From the WHO Collaborating Centre for the Epidemiology of Diabetes Mellitus and Health Promotion for Noncommunicable Disease Control, International Diabetes Institute

260 Kooyong Road, Caulfield South, Victoria 3162, Australia

Search for other works by this author on:

From the WHO Collaborating Centre for the Epidemiology of Diabetes Mellitus and Health Promotion for Noncommunicable Disease Control, International Diabetes Institute

260 Kooyong Road, Caulfield South, Victoria 3162, Australia

Search for other works by this author on:

Revision received:

15 January 1991

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Gary K. Dowse, Paul Z. Zimmet, Caroline F. Finch, Veronica R. Collins, Decline in Incidence of Epidemic Glucose Intolerance in Nauruans: Implications for the “Thrifty Genotype”, American Journal of Epidemiology, Volume 133, Issue 11, 1 June 1991, Pages 1093–1104, https://doi.org/10.1093/oxfordjournals.aje.a115822
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Abstract

Trends in the prevalence and incidence of non-insulin-dependent diabetes mellitus and impaired glucose tolerance were studied in Micronesian Nauruans aged 20 years and above, by linking glucose tolerance data collected during population surveys performed in 1975/1976, 1982, and 1987. Based on World Health Organization criteria, the age-standardized prevalence of non-insulin-dependent diabetes mellitus has remained relatively constant (24.0% in 1987), but the prevalence of impaired glucose tolerance has decreased significantly from 21.1% (95% confidence interval (Cl) 17.0-25.3) in 1975/1976 to 8.7% (95% Cl 7.1-10.3) in 1987. Between the periods 1975/1976–1982 and 1982–1987, the incidence of progression from normal glucose tolerance to either impaired glucose tolerance (incidence rate ratio (IRR) = 0.55, p <0.01) or non-insulin-dependent diabetes (IRR = 0.46, p < 0.05) has decreased dramatically, while progression from impaired glucose tolerance to non-insulin-dependent diabetes has increased (IRR = 1.23). The overall age-standardized incidence of non-insulin-dependent diabetes has declined from 26.2 cases/1,000 person-years in 1975/1976–1982 to 22.5 cases/1,000 person-years in 1982–1987. As there were no changes in the frequency of recognized risk factors, the decline in incidence of glucose intolerance is probably due to the intensity of the epidemic in Nauru, which has already removed a high proportion of the genetically susceptible individuals from the pool with normal glucose tolerance. Coupled with the observations that mortality is higher and fertility lower in diabetic Nauwans across the age range, the observed decline in the incidence and prevalence of non-insulin-dependent diabetes mellitus and impaired glucose tolerance may presage a fail in the population frequency of the diabetic genotype, at least in its more severe form, as might be predicted on the basis of Neel's “thrifty genotype” hypothesis.

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© 1991 by The Johns Hopkins University School of Hygiene and Public Health

Topic:

• diabetes mellitus
• diabetes mellitus, type 2
• glucose intolerance
• fertility
• gene frequency
• genotype
• world health organization
• insulin
• mortality
• epidemics
• glucose tolerance

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