The Elevated Susceptibility to Diabetes in India: An Evolutionary Perspective

Area of Science:

• Endocrinology
• Nutritional Science
• Anthropology

Background:

• India is the global
• diabetes capital
• with high rates of under-nutrition and early-onset diabetes at lower body weights.
• Indian populations exhibit unique diabetes characteristics compared to global trends.

Purpose of the Study:

• To interpret the high prevalence of diabetes in India using a
• capacity-load
• model of glucose homeostasis.
• To investigate the role of metabolic capacity and metabolic load in elevated diabetic risk among Indians.

Main Methods:

• Utilizing data from modern cohorts to support the capacity-load model.
• Analyzing the interplay between metabolic capacity (e.g., insulin production, glucose clearance) and metabolic load (body fat, dietary glycemic load, sedentary behavior).
• Reviewing archeological and historical evidence using stature as a marker for metabolic capacity.

Main Results:

• Elevated diabetic risk in Indians stems from high metabolic load from westernized lifestyles acting on low baseline metabolic capacity.
• Low birth weight, associated with short stature and low lean mass, contributes to reduced metabolic capacity in Indian populations.
• Long-term declines in Indian stature, linked to ecological stresses, suggest a historical basis for reduced metabolic capacity.

Conclusions:

• The high diabetes burden in India is explained by a mismatch between high metabolic load and low metabolic capacity, rooted in historical factors.
• Reduced growth and thin physique increase susceptibility to obesity and metabolic penalties from diet and inactivity.
• While improving metabolic capacity is a long-term goal, reducing metabolic load is crucial for immediate amelioration.