Search tips
Search criteria 


Logo of bmjLink to Publisher's site
BMJ. 1994 April 9; 308(6934): 942–945.
PMCID: PMC2539758

Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype?


OBJECTIVE--To determine the prevalence of diabetes in relation to birth weight in Pima Indians. DESIGN--Follow up study of infants born during 1940-72 who had undergone a glucose tolerance test at ages 20-39 years. SETTING--Gila River Indian community, Arizona. SUBJECTS--1179 American Indians. MAIN OUTCOME MEASURE--Prevalence of non-insulin dependent diabetes mellitus (plasma glucose concentration > or = 11.1 mmol/l two hours after ingestion of carbohydrate). RESULTS--The prevalence was greatest in those with the lowest and highest birth weights. The age adjusted prevalences for birth weights < 2500 g, 2500-4499 g, and > or = 4500 g were 30%, 17%, and 32%, respectively. When age, sex, body mass index, maternal diabetes during pregnancy, and birth year were controlled for, subjects with birth weights < 2500 g had a higher rate than those with weights 2500-4499 g (odds ratio 3.81; 95% confidence interval 1.70 to 8.52). The risk for subsequent diabetes among higher birthweight infants (> or = 4500 g) was associated with maternal diabetes during pregnancy. Most diabetes, however, occurred in subjects with intermediate birth weights (2500-4500 g). CONCLUSIONS--The relation of the prevalence of diabetes to birth weight in the Pima Indians is U shaped and is related to parental diabetes. Low birth weight is associated with non-insulin dependent diabetes. Given the high mortality of low birthweight infants selective survival in infancy of those genetically predisposed to insulin resistance and diabetes provides an explanation for the observed relation between low birth weight and diabetes and the high prevalence of diabetes in many populations.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (966K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Hales CN, Barker DJ, Clark PM, Cox LJ, Fall C, Osmond C, Winter PD. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ. 1991 Oct 26;303(6809):1019–1022. [PMC free article] [PubMed]
  • Robinson S, Walton RJ, Clark PM, Barker DJ, Hales CN, Osmond C. The relation of fetal growth to plasma glucose in young men. Diabetologia. 1992 May;35(5):444–446. [PubMed]
  • Phipps K, Barker DJ, Hales CN, Fall CH, Osmond C, Clark PM. Fetal growth and impaired glucose tolerance in men and women. Diabetologia. 1993 Mar;36(3):225–228. [PubMed]
  • Hales CN, Barker DJ. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia. 1992 Jul;35(7):595–601. [PubMed]
  • Knowler WC, Bennett PH, Hamman RF, Miller M. Diabetes incidence and prevalence in Pima Indians: a 19-fold greater incidence than in Rochester, Minnesota. Am J Epidemiol. 1978 Dec;108(6):497–505. [PubMed]
  • Knowler WC, Pettitt DJ, Saad MF, Bennett PH. Diabetes mellitus in the Pima Indians: incidence, risk factors and pathogenesis. Diabetes Metab Rev. 1990 Feb;6(1):1–27. [PubMed]
  • Pettitt DJ, Aleck KA, Baird HR, Carraher MJ, Bennett PH, Knowler WC. Congenital susceptibility to NIDDM. Role of intrauterine environment. Diabetes. 1988 May;37(5):622–628. [PubMed]
  • Pettitt DJ, Bennett PH, Saad MF, Charles MA, Nelson RG, Knowler WC. Abnormal glucose tolerance during pregnancy in Pima Indian women. Long-term effects on offspring. Diabetes. 1991 Dec;40 (Suppl 2):126–130. [PubMed]
  • Pettitt DJ, Baird HR, Aleck KA, Bennett PH, Knowler WC. Excessive obesity in offspring of Pima Indian women with diabetes during pregnancy. N Engl J Med. 1983 Feb 3;308(5):242–245. [PubMed]
  • Bennett PH, Burch TA, Miller M. Diabetes mellitus in American (Pima) Indians. Lancet. 1971 Jul 17;2(7716):125–128. [PubMed]
  • Comess LJ, Bennett PH, Burch TA, Miller M. Congenital anomalies and diabetes in the Prima Indians of Arizona. Diabetes. 1969 Jul;18(7):471–477. [PubMed]
  • Pettitt DJ, Knowler WC, Baird HR, Bennett PH. Gestational diabetes: infant and maternal complications of pregnancy in relation to third-trimester glucose tolerance in the Pima Indians. Diabetes Care. 1980 May-Jun;3(3):458–464. [PubMed]
  • Freinkel N. Banting Lecture 1980. Of pregnancy and progeny. Diabetes. 1980 Dec;29(12):1023–1035. [PubMed]
  • McCance RA, Widdowson EM. The determinants of growth and form. Proc R Soc Lond B Biol Sci. 1974 Jan 22;185(1078):1–17. [PubMed]
  • Swenne I, Bone AJ, Howell SL, Hellerström C. Effects of glucose and amino acids on the biosynthesis of DNA and insulin in fetal rat islets maintained in tissue culture. Diabetes. 1980 Sep;29(9):686–692. [PubMed]
  • Swenne I, Crace CJ, Milner RD. Persistent impairment of insulin secretory response to glucose in adult rats after limited period of protein-calorie malnutrition early in life. Diabetes. 1987 Apr;36(4):454–458. [PubMed]
  • van Assche FA, Aerts L. The fetal endocrine pancreas. Contrib Gynecol Obstet. 1979;5:44–57. [PubMed]
  • Wilkin TJ. Early nutrition and diabetes mellitus. BMJ. 1993 Jan 30;306(6873):283–284. [PMC free article] [PubMed]
  • Lillioja S, Mott DM, Howard BV, Bennett PH, Yki-Järvinen H, Freymond D, Nyomba BL, Zurlo F, Swinburn B, Bogardus C. Impaired glucose tolerance as a disorder of insulin action. Longitudinal and cross-sectional studies in Pima Indians. N Engl J Med. 1988 May 12;318(19):1217–1225. [PubMed]
  • Lillioja S, Mott DM, Spraul M, Ferraro R, Foley JE, Ravussin E, Knowler WC, Bennett PH, Bogardus C. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians. N Engl J Med. 1993 Dec 30;329(27):1988–1992. [PubMed]
  • Martin BC, Warram JH, Krolewski AS, Bergman RN, Soeldner JS, Kahn CR. Role of glucose and insulin resistance in development of type 2 diabetes mellitus: results of a 25-year follow-up study. Lancet. 1992 Oct 17;340(8825):925–929. [PubMed]
  • Barker DJ, Hales CN, Fall CH, Osmond C, Phipps K, Clark PM. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia. 1993 Jan;36(1):62–67. [PubMed]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Group