3 Whincup PH, Kaye SJ, Owen CG et al. Birth weight and risk of type 2 diabetes: a systematic review. JAMA 2008; 300:2886–97. 4 Lucas A. Long-term programming effects of early nutri- tion—implications for the preterm infant. J Perinatol 2005;25(Suppl 2):S2–S6. 5 Fall CH, Stein CE, Kumaran K et al. Size at birth, mater- nal weight, and type 2 diabetes in South India. Diabet Med 1998;15:220–27. 6 Modi N, Thomas EL, Uthaya SN, Umranikar S, Bell JD, Yajnik C. Whole body magnetic resonance imaging of healthy newborn infants demonstrates increased central adiposity in Asian Indians. Pediatr Res 2009;65:584–87. 7 Yajnik CS, Fall CH, Coyaji KJ et al. Neonatal anthropom- etry: the thin-fat Indian baby. The Pune Maternal Nutrition Study. Int J Obes Relat Metab Disord 2003;27: 173–80. 8 Yajnik CS, Lubree HG, Rege SS et al. Adiposity and hyper- insulinemia in Indians are present at birth. J Clin Endocrinol Metab 2002;87:5575–80. 9 Catalano PM, Presley L, Minium J, Hauguel-de MS. Fetuses of obese mothers develop insulin resistance in utero. Diabetes Care 2009;32:1076–80. 10 Han TS, Hooper JP, Morrison CE, Lean ME. Skeletal pro- portions and metabolic disorders in adults. Eur J Clin Nutr 1997;51:804–09. 11 Kahn HS, Graff M, Stein AD, Lumey LH. A fingerprint marker from early gestation associated with diabetes in middle age: the Dutch Hunger Winter Families Study. Int J Epidemiol 2009;38:101–09. 12 Newsome CA, Shiell AW, Fall CH, Phillips DI, Shier R, Law CM. Is birth weight related to later glucose and in- sulin metabolism? A systematic review. Diabet Med 2003; 20:339–48. 13 Hales CN, Barker DJ. The thrifty phenotype hypothesis. Br Med Bull 2001;60:5–20. 14 Corkey BE. Diabetes: have we got it all wrong? Insulin hypersecretion and food additives: cause of obesity and diabetes? Diabetes Care 2012;35:2432–37. 15 Martin-Gronert MS, Ozanne SE. Metabolic programming of insulin action and secretion. Diabetes Obes Metab 2012; 14(Suppl 3):29–39. 16 Waterland RA, Jirtle RL. Transposable elements: targets for early nutritional effects on epigenetic gene regulation. Mol Cell Biol 2003;23:5293–300. 17 Yajnik CS. Nutrient-mediated teratogenesis and fuel- mediated teratogenesis: two pathways of intrauterine programming of diabetes. Int J Gynaecol Obstet 2009; 104(Suppl 1):S27–S31. Published by Oxford University Press on behalf of the International Epidemiological Association ß The Author 2013; all rights reserved. International Journal of Epidemiology 2013;42:1229–1230 doi:10.1093/ije/dyt131 Commentary: The meaning of thrift David JP Barker 1,2 * and Michelle Lampl 2 1 MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK and 2 Center for the Study of Human Health, Emory University, Atlanta, GA, USA *Corresponding author. E-mail: djpbarker@gmail.com Accepted 22 April 2013 According to the Oxford dictionary, ‘thrifty’ means many things: ‘wisely economical, industrious, thriv- ing, prosperous’. The term ‘thrifty phenotype’ 1 was used as a contrast to the ‘thrifty genotype’. 2 The thrifty genotype hypothesis for type 2 diabetes pro- posed that diabetogenic genes persist at high levels in populations because they somehow confer a sur- vival advantage in times of nutritional deprivation. There is little evidence to support such a speculation and the genes have not been found. The speculation rested on the stereotypic model of type 2 diabetes as a disease of high intakes of energy-dense food, physical inactivity and obesity. Across India, however, recently described as ‘the world capital of diabetes’, the dis- ease occurs in vegetarians who are physically active and not obese. 3 A deeper scientific inquiry is now needed to stem the rising epidemic of a disorder which affects 366 million people around the world and will soon affect 552 million people. 4 The thrifty phenotype hypothesis built on the work of the late Nick Hales who advocated that type 2 dia- betes originates in deficient insulin secretion. 1 He pi- oneered the study of insulin precursors, importantly 32–33 split proinsulin. He pointed out that people with type 2 diabetes have a reduced early insulin re- sponse to oral glucose, indicating insulin deficiency. THE MEANING OF THRIFT 1229 Downloaded from https://academic.oup.com/ije/article-abstract/42/5/1229/620512 by guest on 01 March 2019