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In Reply: Dr Saad and colleagues draw attention to the possibility that genetic factors that influence insulin-mediated fetal growth, affecting birth weight and insulin resistance, could underlie the birth weight–type 2 diabetes association. We agree that genetic factors could be important but consider it unlikely that a single gene polymorphism would account for the observed complex, population-wide associations. Several genetic variants with moderate effects, interacting with environmental influences, would probably be necessary.

Drs Plagemann and Harder suggest that we concluded that the association between birth weight and type 2 diabetes was linearly inverse (possibly reflecting a flawed analytic approach), in contrast with their earlier finding of a U-shaped association.¹ Our findings were complex, involving distinct association patterns in different populations. First, in young adult populations (particularly including native North Americans), there were U-shaped associations dominated by positive relationships between type 2 diabetes and birth weights of about 3 kg and . . . [Full Text of this Article]

Peter H. Whincup, PhD
p.whincup@sgul.ac.uk

Christopher G. Owen, PhD; Derek G. Cook, PhD
Division of Community Health Sciences
St George’s, University of London
London, United Kingdom

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