Environment or gene: Why do Chinese people love diabetes?

Release date: 2014-05-09

The natural environment changes too fast, the human genome evolves too slowly

The rich life comes too hurried, and the memory of hunger remains in the body. The spread of a chronic disease is the result of the interaction between lifestyle and genetic quality, and it is also a great change in social life for decades, leaving a mark on our body.

In 1992, Jared Diamond, a professor at the University of California, Los Angeles School of Medicine, wrote in Nature that "the Chinese lifestyle is changing and diabetes will cause serious public health problems." This prediction by Diamond did not attract much attention - his most remarkable achievement was the Pulitzer Prize-winning science masterpiece "Guns, Germs and Steel."

Today, "Dimon's prophecy" has become a reality - China has become the largest country in diabetes. Nowadays, the Internet is full of information about the inability to distinguish between right and wrong diabetes. There are also various websites such as "friends of diabetes", "alliance" and "group". Diabetes has become a social epidemic.

"Coca-Cola" life ruined a healthy body

The middle-aged people who often went to high-end hotels for meetings and dinners, who were born in the 1950s and 1960s, experienced a bad life or even a lack of food when they were young. In the face of the table full of delicacies, some young people from poor families Young man, it is difficult to resist the temptation to eat three bowls of rice. Slowly, within a year, their waistline is increased by 10 cm or more.

When there are still many places in the country that have not yet solved the problem of food and clothing, the Daqing people in Heilongjiang have entered the well-off society in advance because of the local oil production. At that time, Daqing people had meat to eat, and they sat on the sofa and watch TV every day after dinner. This enviable life made many fat people appear in the area soon. Pan Xiaoren, then director of the Department of Endocrinology at the China-Japan Friendship Hospital, asserted that in five years, Daqing will enter a period of high incidence of diabetes, and the situation in Daqing will herald the picture of Chinese life in the next 20 years.

Pan Xiaoren’s foresight comes from a classic case in medical history.

At the beginning of the 20th century, Nauru, a South Pacific island nation, was isolated from the rest of the world. The ancestors of the island lived on agriculture and fisheries and lived a primitive but dynamic life. Later, the British came here and found that the island was full of precious minerals: a thick layer of petrified bird droppings. With the development of foreign colonists and the exploitation of phosphate, Nauru became rich overnight.

Westerners not only brought wealth to Nauru, but also brought junk food - cola, fried chicken, hamburger. Soon, the big fat man on the island can be seen everywhere, so that when the obese Nauru people travel by plane, one person has to occupy two seats. In the 1960s and 1970s, Nauru became the most popular country in the world for diabetes – half of them had diabetes. Diabetes has become the main cause of non-accidental deaths among locals, and Nauru has become the world's shortest-lived rich man – with an average life expectancy of only 50 years.

The Nauru people's high-calorie diet and lack of a sporty lifestyle are what medical scientists call "Coca-Cola's life." The rapid transformation of lifestyle is the same reason that Daqing people and Nauru people have diabetes. Zhou Ming’s situation is the same, except that his life is placed in a larger social environment and time span.

"China on the Tip of the Tongue": A Journey to the Country of Hunger

Diet is the most closely related factor to diabetes in all lifestyles. In 2012, a TV film called "China on the Tip of the Tongue" fired because it fits the rapid changes in social life in China in the past 20 or 30 years, and it has expanded from a country that needs food stamps to a meal. The process of the big country. The extravagant winds of eating and drinking are so prevalent that it is necessary to officially launch a "disc action."

However, a long-standing social trend, I am afraid it is difficult to control by a ban, and everyone who is encased in it is difficult to be independent. Li Guangwei, chief expert of endocrinology at the China-Japan Friendship Hospital, said that one of his patients was a business owner. After his own business success, he gave two children two companies. In order to do business, the family did not have the opportunity to sit down and have a meal. Everyone went out to eat and drink all day. In the end, the entrepreneur and his wife, son, daughter and family of all four are all pudgy, all have diabetes, and become a true "diabetes home." The doctor with high prestige in the domestic diabetes field said, "I have also received a secretary from the provincial party committee. I got diabetes in my 30s. He told me that sometimes I have to run 8 meals a day. Even if these people have the heart to control the disease, they are forced to I can’t help myself in the environment.”

“Eating a lot”, “Eating well” and “Eating fine” are the chief culprit in the diabetes epidemic.

The China Center for Disease Control and Prevention (CDC) Nutrition and Food Safety Institute conducted a study on the intake and trends of dietary nutrients in China from 1989 to 2009. It shows that in the past 20 years, the dietary structure of animals has been used for animal food and fat intake. The amount is increasing rapidly, while the consumption of cereals is declining.

After food and food production and supply entered the global trading system, not only a variety of sugary drinks, Western-style fast foods, and processed foods poured into China, but also edible oil, sugar, and meat became cheap, refined rice and white noodles. Widely replaced coarse grains. For example, in a study of the risk of eating white rice and diabetes in Shanghai women, the use of 50 grams of brown rice instead of polished rice per day reduced the risk of diabetes by 16%, because brown rice only passed the most basic Processing, triggering less insulin response.

In the process of globalization and urbanization, the rapid changes in the diet structure of Chinese people, accompanied by the continuous reduction of physical activity in life and work, the reduction of physical energy consumption, the rapid formation of weight gain and insulin resistance occur widely in people's bodies.

Just like New Zealand medical scientist Peter Gluckman wrote in the book Misplaced: Why Our Body Is No Longer Adapting to the World: In developing countries, “nutrition change” occurs almost instantaneously. Just 60 or 90 years ago, many people in such a society were still eating the minimum amount of agricultural food needed to sustain life before the Industrial Revolution. Now, these people are exposed to more and more Western food. Diabetes has spread in these countries, and rapid nutritional shifts have played a major role.

Sub-health group: epidemic of "sitting sedentary generation"

Due to busy work and staying up late, it is difficult for sub-health groups to be as strict as taboos, dieting, and exercise as doctors say, so there are some difficulties in maintaining blood sugar stability. Take Chinese doctors as an example. They are not only in the affluent class, but also know medical knowledge, but even such a group can hardly maintain a healthy lifestyle.

"In the United States, the poor have more diabetes; in China, the rich are more likely to get diabetes," Li Guangwei said, but the "rich" here must be quoted. The rich people in the United States pay attention to the health of the diet, take care of housework, go to the gym, train the body to be lean, and naturally have less diabetes. In order to save money, Americans with poor economic conditions eat cheap and high-calorie foods, and they don’t have the money to exercise. Therefore, there are many big fat people, and there are many high blood pressure, coronary heart disease and diabetes.

A survey of Chinese doctors' smoking behavior by the Tobacco Control Office of the Center for Chronic Non-communicable Diseases Prevention and Control of the China CDC showed that the smoking rate of Chinese male doctors was 47.3%, and that of doctors smoking an average of 10 cigarettes per day. China is currently the world's largest tobacco producer and consumer, and smoking is an independent risk factor for diabetes.

Wang Weiqing, director of the Department of Endocrinology at Shanghai Ruijin Hospital, also lamented, "We often meet with doctors in the United States. I have found that none of the famous experts in the United States are fat, and their size is very good."

But in China, Li Guangwei said that although the economic level has greatly improved, it has not really reached the level of affluence in Western countries. At the same time, the level of civilization in society is also different from that in developed countries. In the face of diabetes, the same vulnerable is the middle class that has just formed in Chinese society.

Zhao Yihang, who graduated from Tongji University, lives in Shanghai, the most developed city in China. The white-collar worker with a car and a car has a very tight working pace. The mobile phone is on standby 24 hours a day. Sometimes I get off work at 12 o'clock in the evening, and I have to go to the company at 5 o'clock the next morning. He used to be the main force of the college handball team, but now he has a busy schedule and no time to exercise. Because of staying up late, I often eat up late to replenish energy. A few years after graduation, Zhao Yihang was promoted from an ordinary employee to a department head. His life is on the rise and his weight has risen by 40 pounds.

Harvard University's "Nurse Health Research Project", which began in 1976, is known for its length of time and participation. The study found that watching TV for two hours a day can increase the risk of diabetes by 14%. According to the analysis, watching TV is one of the highest health risks in all sit-in activities. The reason may be that it is often easy to eat and drink while watching TV, and food advertisements on TV can stimulate the audience's consumption of processed food.

In recent years, Chinese people have generally enjoyed the comfort and convenience brought by family cars, but this has not only caused road congestion and air pollution throughout the country, but also caused undetectable damage to the human body. According to statistics, after a man owns a car, his weight will increase by an average of 1.8 kilograms, and the probability of reaching the obesity standard will double.

A survey of health and nutritional status in China showed that from 1991 to 2006, the level of physical activity per week for Chinese adults fell by 32%. Another similar survey said that in the past 15 years, the physical activity of Chinese people in professional places has dropped by 40%. The proportion of people who exercise, ride bicycles and walk for more than 30 minutes per day has been 46%-51% in 1997. It fell to 28%-33% in 2006.

The working environment and the changes in transportation have significantly reduced the physical activity of the Chinese middle class and white-collar workers. The formation of a large “squat group” is an important factor in the prevalence of diabetes and the age of onset.

In view of the complications of his father's diabetes due to delay in treatment, Zhao Yihang took active action after he had diabetes. He gave up driving and turned to take a shuttle bus to work. Considering that it is too expensive and difficult to stick to the gym, he also purchased an exercise gym game machine to facilitate home exercise. I wanted to live in Ruijin Hospital for a comprehensive examination. Just a few days after I came in, he asked the doctor with a bitter face. "My leader is going to take a vacation soon. I have to go back to work on Sunday!"

The deeper the memory of childhood “throttle gene”, the higher the risk of diabetes in the elderly.

Zhou Ming’s desire for food is largely due to the shadow of childhood. He remembered that when he was 6 years old, he came to the family for ten guests. He ate the whole family's ration for a meal. After a week, they can only rely on drinking porridge to maintain. Later, fortunately, the relatives passing by the countryside brought some tofu and miscellaneous grains. For the next two or three years, the cake made with bean curd became his daily food. "I have a rebounding mentality for eating. I always want to wait for me to have the conditions. I must enjoy it a lot."

This experience of Zhou Ming occurred in the famine era of China in 1959-1961. More "unlucky" than him is that some people have already experienced famine in their wombs when they are not yet born. Zhou Ming’s “rebound” may have some truth: Does the early hunger experience cause a person to become more susceptible to diabetes after entering adulthood? This assumption sounds bold, but it is indeed scientifically already explored. The problem.

In the 1960s, American geneticist Neil first proposed the theory of thrift gene. He believes that human ancestors have long lived in food shortages, and low productivity and excessive population reproduction have led to famine. Therefore, those who have the ability to adapt to thrift and can maximize the conversion of food into fat in the body can survive. Therefore, these people with thrift genes are originally the winners of natural evolution, but in a stable and affluent modern society, they are suffering from diabetes because they are more likely to accumulate fat.

The thrift gene can be used to explain Nauru's phenomenon: the poor and hard-working islanders' ancestors passed the thrifty genes to the Naurus from generation to generation, and when the foreign Western way of life was brought into the island, the Nauru people This kind of gene can not adapt to the sudden abundance of life, while Europeans have long been accustomed to modern lifestyles, and thrift genes have gradually disappeared in their bodies, so the same living environment did not bring them more diabetes.

In fact, although the hypothesis of thrift genes is very attractive, scientists have spent a lot of effort to find such genes, but they have not been very successful. In 1998, the Lancet published an article in which scientists conducted a study of a group of people born in the Dutch famine between 1944 and 1945 and found that compared with children born at a normal food supply in the following year. This group is more likely to gain weight in adulthood, accompanied by insulin resistance and elevated postprandial blood glucose. This is the famous "Dutch Famine Study".

This finding corrects Neil's theory that famine does affect human evolution, but not through the inheritance of one or several genes in the ancestors, but in the womb of a pregnant mother. That is to say, when the fetus encounters a famine in the mother, it will adjust its life strategy accordingly. In adulthood, these changes will make it more susceptible to diabetes. Specifically, malnutrition during the fetal period affects the development of fetal islet cells and functions, and also affects the development of the skeletal muscles of the fetus, resulting in islet resistance of peripheral tissues. In addition, the stress caused by famine can also affect the secretion of fetal neuroendocrine mediators, so that it is more prone to cardiovascular and metabolic diseases in adulthood. Famine in infancy has similar effects, but the effect is slightly weaker.

In 2010, Ma Guansheng and others from the Chinese Center for Disease Control and Prevention published a paper entitled "Increased Risk of Adult Diabetes in Infants and Young Children Famine in China" in Diabetes. Through the 2002 National Nutrition and Health Cross-sectional Survey of China, they found 7,874 rural subjects born in 1954-1964. They found that the fetuses and children who suffered from the Chinese famine in 1959-1961 were high in adulthood. The risk of blood sugar and diabetes increases, and it is even worse after the overnutrition.

Hu Bingchang, professor of nutrition and epidemiology at Harvard School of Public Health, hosted a study on the fetus in the three-year famine era in China. The results clearly showed that there was a significant correlation between the severe famine in the fetus and the risk of hyperglycemia in adulthood. Moreover, the more people who have Westernized eating habits and good economic conditions after adulthood, the stronger the connection.

The impact of early famine factors may also be the reason why Chinese people are not as fat as Americans, but have a higher prevalence of diabetes. When Zhou Ming, who is one meter tall and seven meters tall, has only 140 pounds, he has developed diabetes. In the past 10 years, the Chinese have indeed gained weight, and the weight of growth has almost equaled that of Westerners who have grown in the past 30 years. However, Chinese people's body mass index (BMI) often has diabetes before it has reached the WHO-defined obesity standard. In this regard, the medical community generally believes that Asians are more inclined to abdominal obesity or visceral obesity due to different races. When BMI is close to the obesity standard, the risk of obesity-related diseases has increased.

In this regard, Ning Guang said, "We originally thought that Chinese people would be more resistant to diabetes, but later found that there were fewer patients with diabetes at that time, just because the nutritional level had not been reached. It should be said that although there is no evidence that the Chinese are right. Diabetes is more susceptible, but at least we are no more resistant to diabetes than others."

"Daqing Spirit" for Diabetes Prevention: Intervention First

In 1986, when Pan Xiaoren expected Daqing's diabetes development trend, he made a bold experiment. The reason why it is bold is because the experiment lasts for 6 years, and if it fails, it will have nothing. He led Li Guangwei and others to find 576 residents in pre-diabetes in Daqing (compared with diabetes, there was no symptoms at all in the pre-diabetes, and they were less valued). Pan Xiaoren divided these people into two groups: the control group and the lifestyle intervention group. The control group only received general health education; the intervention group was divided into three groups, which allowed them to combine dieting, exercise, and dieting. . In the next 6 years, the diabetes status of these people was assessed every two years. By the end of the experiment in 1992, the incidence of diabetes in the three intervention groups was reduced by 51% compared with the control group. This shows that lifestyle interventions can effectively prevent diabetes.

The Daqing study, together with the Finnish Diabetes Prevention Study (DPS, 2001) and the American Diabetes Prevention Program (DPP, 2002), was hailed by the International Diabetes Federation as a “milestone in diabetes prevention”. The Daqing study is 8 to 10 years earlier than the latter two. It is the first randomized clinical trial of diabetes prevention in the world and the longest follow-up diabetes prevention trial.

After Pan Xiaoren died of illness, Li Guangwei inherited and developed the teacher's research. Since 1992, the above subjects have been followed until 2006. In May 2008, Li Guangwei and others published the article "A 20-year follow-up study on diabetes prevention in Daqing, China" in the "Lancet" magazine. Studies have shown that 92% of people in the pre-diabetes group have diabetes in 20 years without intervention. However, after accepting a lifestyle intervention of only 6 years, the incidence of diabetes can be reduced by 43% after 20 years. Li Guangwei said that for the pre-diabetes group, the previous industry view is that one-third may not develop diabetes, but Daqing research proves that if you do not intervene, almost everyone will develop diabetes, and lifestyle intervention is Effective prevention.

Why can diabetes be prevented without any intervention for the next 14 years? Li Guangwei explained that behavioral memory can last longer than metabolic memory. Unlike drug intervention, drug intervention may end after stopping the drug. However, after taking life interventions, these people have benefited from healthy living habits in the six-year expectation.

The subjects of the Daqing study were able to adhere to exercise and control diet after the intervention. An important reason was the mutual encouragement and supervision of the peers. Daqing is a city built on the oil field. The subjects are gathered together in units of exploration teams and oil refineries. "They are all going to exercise together, so the habit of exercise is easy to stick to." Li Guangwei pointed out that from the experience of Daqing, group education is an effective way to prevent diabetes.

However, although the Daqing study is well-known internationally, it has not received the attention it deserves at home. When the Daqing 6-year project was applied, the Ministry of Health allocated 100,000 yuan before and after, and Daqing City gave 270,000 yuan. The remaining funding gap was filled by the World Health Organization's $50,000 loan. In the 20-year follow-up study of Li Guangwei, the $450,000 in funding was provided by WHO.

Daqing research is difficult to replicate. Li Guangwei said that nowadays, doing research, the pursuit of SCI papers, evaluation of titles, academicians, are all looking at the "price-performance ratio" of research. If a topic is done for ten or twenty years, people should retire when the results are made. "But we were stupid at that time. I didn't think so much. I just wanted to solve the practical problem. This field was the first to be done by Pan Xiaoren in the world. It should be said that he is very far-sighted."

Nowadays, when humanity has already won a partial victory in the war against the "King of the Diseases" cancer, no one dares to claim that it can cure diabetes. The existing treatment methods can only control the development of the disease. The best way to deal with diabetes is to not be sick.

According to the results of the survey led by Ning Guang and others, half of Chinese adults are already in pre-diabetes. "You imagine that if these people all turn into diabetes patients in the future, how much impact will it have on China's health care system?" Li Weiguang said. For pre-diabetes, WHO's guidelines for medical treatment do not recommend drug intervention. The only way to stop them from continuing to evolve into diabetes is lifestyle intervention. And this requires diabetes education.

"Prevention is better than treatment, education is prevention." Li Guangwei said that the main purpose of diabetes education is to let people return to the simple life of the past, eat less, and have more physical activity.

As stated in the book Misplaced, "If humans do not try to match the environment, they will not survive today as a species. But now we have changed many aspects of the environment, and the speed of change is very fast. We The body is no longer adapted to the world we built ourselves. The genes we have evolved through the evolution of the environment have limited our ability to adapt to the lifestyles of modern cities. And we suffer from diabetes, heart disease and obesity. This misplaced is reflected."

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