Recent epidemiologic studies show that diabetes mellitus is almost as prevalent in undernourished populations as it is in well-nourished ones, despite the virtual absence of obesity as an etiologic determinant in the former. Undernutrition itself may be the risk factor that replaces obesity in predisposing such populations to diabetes. The glucose intolerance of protein-energy malnutrition is known to be associated with structural changes in the beta cell, and in a significant proportion of undernourished subjects it is irreversible despite prolonged and vigorous nutritional rehabilitation. Chronic undernutrition over a lifetime may, therefore, be an important determinant of diabetes in an individual, either by progressively impairing beta cell function or by increasing the susceptibility of the individual to other genetic and environmental diabetogenic influences.

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