The cause of the epidemic of type 2 diabetes in children

The emerging epidemic of type 2 diabetes in youths during the last decade in North America, disproportionately among members of minority racial and ethnic groups, and in susceptible populations elsewhere in the world, reflects increasing rates of obesity and mirrors the increasing frequency of type 2 diabetes in adults. As in adults, type 2 diabetes in children is part of the insulin resistance syndrome, which includes hyperandrogenism seen as premature adrenarche and polycystic ovarian syndrome, hypertension, and dyslipidemia. Recent studies in children document risk factors for type 2 diabetes and associated cardiovascular risk factors, including obesity, family history, diabetic gestation, and underweight or overweight for gestational age. Genetically determined insulin resistance or limited β-cell reserve has been demonstrated in high-risk individuals, including first-degree relatives of girls with premature adrenarche. This genetic background, considered advantageous in a feast and famine existence (the thrifty genotype), is rendered detrimental with abundant food and physical inactivity, a lifestyle demonstrated to be typical of families of children with type 2 diabetes.