Łuczyński Włodzimierz, Głowińska-Olszewska Barbara, Bossowski Artur
Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Bialystok, Poland.
Diabetes Metab Res Rev. 2016 Oct;32(7):666-671. doi: 10.1002/dmrr.2797. Epub 2016 Apr 21.
The exact cause of the obesity epidemic remains unknown; however, both environmental and genetic factors are involved. People at risk of developing obesity include children with type 1 diabetes mellitus (T1DM), which in turn increases their cardiovascular disease risk. Here, we discuss the clinical and genetic factors influencing weight in patients with T1DM. In children with T1DM, the presence of obesity depends mainly on sex, metabolic control, and disease duration. However, genetic factors, including the fat mass and obesity-associated (FTO) gene, are also associated with body weight. Indeed, children with the FTO gene rs9939609 obesity-risk allele (homozygous = AA or heterozygous = AT) are predisposed to a higher body mass index and have a greater risk of being overweight or obese. However, in this review, we show that FTO gene polymorphisms only have a small effect on body weight in children, much weaker than the effect of clinical factors. The association between FTO gene polymorphisms and body weight is only statistically significant in children without severe obesity. Moreover, other genetic factors had no effect on weight in patients with T1DM, and further research involving larger populations is required to confirm the genetic basis of diabetes and obesity. Therefore, identifying the clinical features of children with T1DM, such as their initial body mass index, sex, metabolic control, and disease duration, will still have the strongest effect on reducing risk factors for cardiovascular diseases. Physicians should pay close attention to modifiable elements of these relationships, for example, metabolic control and energy and insulin intake, when caring for patients with T1DM. Copyright © 2016 John Wiley & Sons, Ltd.
肥胖流行的确切原因尚不清楚；然而，环境和遗传因素都与之相关。有患肥胖症风险的人群包括1型糖尿病（T1DM）患儿，而这反过来又会增加他们患心血管疾病的风险。在此，我们讨论影响T1DM患者体重的临床和遗传因素。在T1DM患儿中，肥胖的存在主要取决于性别、代谢控制和病程。然而，包括脂肪量和肥胖相关（FTO）基因在内的遗传因素也与体重有关。事实上，携带FTO基因rs9939609肥胖风险等位基因（纯合子=AA或杂合子=AT）的儿童更容易有较高的体重指数，且超重或肥胖的风险更大。然而，在本综述中，我们表明FTO基因多态性对儿童体重的影响很小，远弱于临床因素的影响。FTO基因多态性与体重之间的关联仅在无严重肥胖的儿童中具有统计学意义。此外，其他遗传因素对T1DM患者的体重没有影响，需要开展涉及更多人群的进一步研究来证实糖尿病和肥胖的遗传基础。因此，识别T1DM患儿的临床特征，如他们最初的体重指数、性别、代谢控制和病程，对降低心血管疾病风险因素仍将产生最强有力的影响。医生在护理T1DM患者时应密切关注这些关系中可改变的因素，例如代谢控制以及能量和胰岛素摄入量。版权所有© 2016约翰威立父子有限公司。
