Ans. is 'a' i.e.. Intraabdominal fat {Ref: Harrison 18th/e p. 2968-2975; IT^/e p. 2279]Risk factors for type 2 Diabetes mellitusObesityo The risk of impaired glucose tolerance (IGT) or type 2 diabetes rises with increasing body weight.o The NHS demonstrated an approximately 100-fold increased risk of incident diabetes over 14 years in nurses whose baseline BMI was >35 kg/m2 compared with those with BMI < 22.o Obesity acts at least in part by inducing resistance to imidin-mediated peripheral glucose uptake, which is an important component of type 2 diabetes.o Reversal of obesity decreases the risk of developing type 2 diabetes and, in patients with established disease, improves glycemic control.Fat distributiono The distribution of excess adipose tissue is another important determinant ofthe risk of insulin resistance and type 2 diabetes.o The degree of insulin resistance and the incidence of type 2 diabetes are highest in those subjects with centra/ or abdominal obesity, as measured bv waist circumference or waist-to-hio circumference ratio.o Intra-abdominal {visceral) fat rather than subcutaneous or retroperitoneal fat appears to be of primary- importance in this regard.o This 'male'type obesity is different from the typical female' type, which primarily affects the gluteal and femoral regions and is not as likely to be associated with glucose intolerance or cardiovascular disease,o Why the pattern of fat distribution is important and the relative roles of genetic and environmental factors in its development are not known.Other important risk factorsBirth weiehtThere is an apparent U-shaped relationship between birth weight and risk of type 2 diabetes.Lifestyle factors# Although insulin resistance and impaired insulin secretion in type 2 diabetes have a substantial genetic component, they> can also be influencedr both positively and negatively, by behavioral factors, such as physical activity, diet, smoking, alcohol consumption, body weight, and sleep duration. Improving these lifestyle factors can reduce the risk of diabetes mellitus.ExerciseA sedentary' lifestyle lowers energy- expenditure and promotes weight gain and increases the risk of ty!pe 2 diabetes.Among sedentary' behaviors, prolonged television watching is consistently associated with the development of obesity and diabetes.Physical activity ofmoderate intensity reduces the incidence of new cases of type 2 diabetes, regardless of thepresence or absence of IGT.SmokingSeveral large prospective studies have raised the possibility' that cigarette smoking increases the risk of type 2 diabetes.While a definitive causal association has not been established, a relationship between cigarette smoking and diabetes mellitus is biologically possible based upon a number of observations:Smoking increases the blood glucose concentration after an oral glucose challenge.Smoking may impair insulin sensitivity.Cigarette smoking has been linked to increased abdominal fat distribution and greater waist-to-hip ratiothat, as mentioned above, may have an impact upon glucose tolerance.Sleep durationo Quantity and quality-# of sleep may predict the risk of development of type 2 diabetes mellitus.o Difficulty initiating and maintaining sleep were also associated with an increased incidence.Dietary Patternso Dietary patterns affect the risk of type 2 diabetes mellitus.o Consumption of red meat, processed meat and sugar sweetened beverages is associated with an increased risk of diabetes, whereas consumption of a diet high in fruits, vegetables, nuts, whole grains, and olive oil is associated with a reduced risk.Increased risko Western versus prudent diet,A western diet (characterized by high consumption of red meat, processed meat, high fat dairy! products, sweets, and desserts) was associated with an increased risk of diabetes independent of BMI, physical activity, age, or family history.o Sugar-sweetened beveragesSugar-sweetened beverages, in particular soft drinks, have been associated with obesity in children. Most, but not all, studies report an increased risk of diabetes with consumption of sugar-sweetened beverages.o Vitamin D deficiencySeveral prospective observational studies have shown an inverse relationship between circulating 25-hydroxyvitamin D levels and risk of type 2 diabetes.o SeleniumAlthough animal models suggest that low doses of the antioxidant selenium may improve glucose metabolism, these findings have not been demonstrated in humans.o Iron intake An association between serum ferritin lex-els, high iron intake,, and type 2 diabetes has been reported, but the association is not well understood. Low iron diets are not recommended.o Chromium deficiency Chromium deficiency is generally limited to hospitalized patients with increased catabolism and metabolic demands in the setting of malnutrition.Other patients at risk for chromium deficiency include patients with short bowel syndrome, burns, traumatic injuries, or those on parenteral nutrition without appropriate trace mineral supplementation.Reduced risk for diabetes mellituso Mediterranean dieto Dairy productso Nutso Whole grains and cereal fibero Fruito Coffee and caffeinated beverages