OBJECTIVE -Type 2 diabetes and obesity have genetic and environmental determinants. We studied the effects of different environments on these diseases in Pima Indians in Mexico and the U.S.
RESEARCH DESIGN AND METHODS -AdultPima-Indian and non-Pima populations in the Sierra Madre mountains of Mexico were examined using oral glucose tolerance tests and assessments for obesity, physical activity, and other risk factors. Results were compared with those from Pima Indians in Arizona. Both Pima populations were typed for DNA polymorphisms to establish their genetic similarity.RESULTS -The age-and sex-adjusted prevalence of type 2 diabetes in the Mexican Pima Indians (6.9%) was less than one-fifth that in the U.S. Pima Indians (38%) and similar to that of non-Pima Mexicans (2.6%). The prevalence of obesity was similar in the Mexican Pima Indians (7% in men and 20% in women) and non-Pima Mexicans (9% in men and 27% in women) but was much lower than in the U.S. Pima Indians. Levels of physical activity were much higher in both Mexican groups than in the U.S. Pima Indians. The two Pima groups share considerable genetic similarity relative to other Native Americans.CONCLUSIONS -The much lower prevalence of type 2 diabetes and obesity in the Pima Indians in Mexico than in the U.S. indicates that even in populations genetically prone to these conditions, their development is determined mostly by environmental circumstances, thereby suggesting that type 2 diabetes is largely preventable. This study provides compelling evidence that changes in lifestyle associated with Westernization play a major role in the global epidemic of type 2 diabetes.
Diabetes Care 29:1866 -1871, 2006T he global prevalence of diabetes in the 20-to 79-year age range in 2003 was estimated to be 5.1%, but the prevalence varied dramatically by region and race (1). Rural areas of developing countries have a low prevalence of type 2 diabetes, but in many countries, prevalence is increasing rapidly due to increasing urbanization and aging of the population (2). Certain populations experience a disproportionately elevated prevalence of diabetes. For example, type 2 diabetes reaches epidemic proportions in Nauru (3), in the Aborigines of Australia (4), and many in American-Indian groups in the U.S. (5-7), and the prevalence is much higher in these ethnic groups than in others in the same countries. These observations, together with strong evidence of the importance of genetic susceptibility in type 2 diabetes (8), indicate that type 2 diabetes results from an interaction between genetic predisposition and lifestyles associated with unfavorable environments.To elucidate the nature and contribution of environmental influences on type 2 diabetes, we studied two groups of Pima Indians in Mexico and in the U.S. The high prevalence of type 2 diabetes in the Pima Indians in the U.S. is well established (5,6), but the prevalence among their counterparts living in Mexico was previously unknown. The Pima Indians in the U.S. reside mainly in the desert regions of Arizon...