Everyone has a “personal fat threshold” that if exceeded could allow type 2 diabetes to develop, even if the individual has a lower body weight, a conference has heard.
Delegates attending the annual meeting of the European Association for the Study of Diabetes (EASD) in Stockholm, Sweden, heard about the landmark ReTUNE Study (Reversal of Type 2 Diabetes upon Normalisation of Energy Intake in the Non-obese) by a team at Newcastle University, UK.
The researchers looked to see if weight loss can also reverse the condition in people with a BMI at or only just above the normal range of BMI below 27kg/m2, which would support the idea of a “personal fat threshold”.
The study, funded by Diabetes UK, involved 20 men and women with type 2 diabetes, with an average BMI 24.8kg/m2 and average age of 59.0 years.
Each participant followed a weight loss programme in which they consumed 800 calories a day, from low calorie soups and shakes and non-starchy vegetables, for two weeks, which was followed by four to six weeks in which they kept their new weight steady.
They completed up to three rounds of this diet and weight maintenance cycle until they had lost 10-15% of their body weight, and their results were compared to those of a group of 20 people without diabetes who were matched for age, sex and BMI.
In total, 14 of the 20 participants (70%) with type 2 diabetes went into remission, a similar proportion to previous studies involving participants living with type 2 diabetes and overweight and obesity.
The average BMI fell from 24.8 to 22.4 and total body fat fell from 32.1% to 27.7%, while special MRI scans showed that levels of fat inside the liver and pancreas fell substantially.
Even though the average amount of fat in the liver of the study participants was regarded as “unremarkable” at 4.1%, it was about three times higher than in healthy controls of the same weight and it fell to 1.4%, close to the healthy control level.
Fat in the pancreas fell from an average of 5.8% to 4.3% and the activity of the insulin-producing cells returned towards normal.
The researchers say their results demonstrate that type 2 diabetes is caused by the same factors in normal weight people as it is in those living with overweight or obesity – and this is important because doctors tend to assume that it has a different cause in those with lower body weights.
Professor Roy Taylor, the principal trial investigator at Newcastle University, said if those individuals lost about 10% of their weight, they would have a good chance of their type 2 diabetes going into remission.
“The results also support the personal fat threshold concept that anyone with type 2 diabetes has a little more fat on board than they individually can cope with. This is determined by your genes. Each of us has a threshold level under which they can store fat safely and that this has little to do with BMI,” he said.
“If you develop type 2 diabetes, you simply have more fat inside your body than you can cope with, even if apparently slim.
“This excess fat spills into your liver and pancreas stopping normal function and causing type 2 diabetes. You only need an extra half gram of fat in the pancreas to prevent normal insulin production.”
He said their findings should also help to dispel some of the stigma that is attached to type 2 diabetes.
“It is clearly a condition which is not ‘caused’ by being over any level of BMI but by storing a little too much fat inside the liver and pancreas, whatever your weight,” added Prof Taylor.
The researchers say anyone with a family member who has type 2 should have their blood sugar checked each year, whatever their weight. They also advise regular checks for anyone who has had diabetes in pregnancy or is not of white, European ethnicity.
Leave a Reply