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.
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