最近精读的文献题目为：Global aetiology and epidemiology of type 2 diabetes mellitus and its complications

1. Summary

• Who: Yan Zheng, Sylvia H. Ley, and Frank B. Hu
• How: An updated view of the global epidemiology of T2DM, as well as dietary, lifestyle and other risk factors for T2DM and its complications.
• What: The major driving factors of the global T2DM epidemic including overweight and obesity, sedentary lifestyle, and so on. Breaking the vicious cycle of diabetes mellitus begetting diabetes mellitus over generations. Cardiovascular complications are the leading cause of morbidity and mortality among patients with T2DM. Clinical trials have demonstrated that diet and lifestyle modifications are effective.
• Why: an updated review

2. Elegant and concise descriptions

• Asia is a major area of the rapidly emerging T2DM global epidemic, with China and India the top two epicentres.
• Given its global influence, it is essential to break the vicious cycle of diabetes mellitus begetting diabetes mellitus over generations by implementing effective strategies to prevent gestational diabetes mellitus.
• The onset of diabetes mellitus frequently occurs years before the actual diagnosis.
• Canada and Australia, the disproportionately higher incidence of T2DM with a trend of earlier age at onset was evident among indigenous populations compared with non-indigenous populations.
• The determinants of T2DM consist of a matrix of genetic, epigenetic and lifestyle factors that interact with one another and operate within the larger physical–sociocultural environment.
• some individuals with prediabetes mellitus are more susceptible to T2DM than others, which suggests that individual differences in response to lifestyle interventions exist.
• and thus, substantially larger association studies are needed to identify most T2DM loci, which typically have small to modest effect sizes.
• The thrifty genotype hypothesis postulates that thrifty genotypes favouring efficient metabolism and storage of energy were positively selected for as a result of evolutionary selection by repeated feast and famine cycles; these genotypes are maladaptive in many modern environments.
• Epigenetic processes could be a central underlying mechanism of this thrifty phenotype hypothesis, leading to altered feeding behaviour, insulin secretion and action and even transgenerational
  risk transmission.

3. Pros and cons
Pros: Omitting
Cons: Authors have demonstrated almost every aspect of diabetes, but not explored in depth within one aspect.

4. New knowledge

• The relationship between alcohol intake and T2DM: U shaped (meta-analysis of 20 cohort studies)
• Moderate alcohol consumption for 6 weeks improved insulin sensitivity (a randomized clinical trial involving postmenopausal women)
• The thrifty genotype hypothesis: thrifty genotypes are maladaptive in many modern environments
• Thrifty phenotype hypothesis: a mismatch between early developmental environments and adulthood environments

5. Questions

• Moderate alcohol consumption is associated with a reduced risk of T2DM, but may be associated with higher risk of cvd mortaltiy among T2DM patients. So, how to judge such factor?