DOHaD research with populations in transition: a case study of prenatal diet remote recall with Yup'ik Alaskan women.

Maternal prenatal diet can exert a powerful influence on the health of children when they reach adulthood--an orienting phenomenon in the Developmental Origins of Health and Disease research paradigm. Similar to other subsistence-based communities experiencing a rapid nutrition transition, obesity is increasing among Yup'ik Alaskans. Diabetes prevalence, however, remains relatively low and may reflect developmental nutritional processes that have yet to be thoroughly considered. Here we investigate recall of Yup'ik women's diets during a past pregnancy using a mixed-methods approach as a critical first step in exploring such alternative developmental hypotheses. For certain populations, retrospective dietary reports might be the only source of information on factors relevant to understanding developmental pathways to health and disease. Our analysis identified community-specific factors that will likely improve the accuracy of future retrospective dietary analyses investigating the role of prenatal nutrition in the developmental origins of metabolic disease, especially among Alaska Natives.

A reconsideration of the origins of the type 2 diabetes epidemic among Native Americans and the implications for intervention policy.

Type 2 diabetes has reached epidemic proportions in many Native American communities in North America. The overwhelming majority of physicians, biomedical researchers, and medical ecologists continue to explain the astoundingly high prevalence rates of diabetes among Native Americans and other high prevalence populations in terms of yet-to-be-identified genetic factors. Recent experimental and epidemiological research, however, has brought to light an etiological alternative to the genetic-predisposition model. This body of research suggests that type 2 diabetes may result initially from fetal malnutrition and, in subsequent generations, be propagated via perturbations in the intrauterine environment. Native American populations at greatest risk for diabetes today are the ones most likely to have endured severe nutritional stress in their recent histories, thus experiencing the conditions that are most conducive to the diabetic developmental sequence. If further substantiated, the implications of the fetal-origin model of diabetes for diabetes intervention programs are profound.

Nutritional origins of insulin resistance: a rat model for diabetes-prone human populations.

While there has been little success identifying the genetic bases of noninsulin-dependent (type-2) diabetes, current epidemiological data and animal models implicate fetal undernutrition in the development of type-2 diabetes. We examined the effects of fetal undernutrition on insulin responses and glucose tolerance in adulthood in genetically normal rats. Control rats were adequately nourished in utero and consumed nutritionally adequate (N) diets throughout life. Experimental rats (F1 generation) were undernourished in utero and consumed either N or high-energy, high-fat (HF) diets postweaning. The offspring of the experimental rats (F2 generation) received the respective diets of their parent. Body weights of experimental F1 rats at d 4 were 40% less than that of control pups, and they remained significantly smaller than controls throughout adulthood. The experimental F1 rats consuming N diets postweaning had a reduced insulin response (-30%) at 30-min postglucose challenge in adulthood (P > 0.05). However, their offspring (F2 generation) displayed a markedly elevated insulin response [+80% at 30 min (P < 0.05) and + 230% at 120 min (P < 0.001) postglucose challenge]. The insulin response of the F2 generation rats fed the high-energy, HF diet was even more pronounced [+130% at 30 min (P < 0.003) and + 250% at 120 min (P < 0.001) postglucose challenge]. Thus, undernourishment in utero produces striking insulin resistance in genetically normal, well-nourished second-generation rats.

Food acquisition habits, nutrient intakes, and anthropometric data of Havasupai adults.

OBJECTIVE: To describe the dietary patterns, anthropometric data, and food sources of Havasupai adults (> or = 18 years old) and determine the effect of age and gender. DESIGN: Dietary intakes (one 24-hour recall), anthropometric measures (body mass index [BMI], waist-to-hip ratio [WHR]) and demographic data, including sites of food purchases, were obtained. Food sources of selected nutrients were calculated from diet recalls. SETTING/SUBJECTS: 92 adults (60 women, 32 men) from the Havasupai Reservation, Supai, Ariz. STATISTICAL ANALYSES: Descriptive statistics were generated for demographic data. Nutrient intakes, BMI, and WHR were compared across gender and age groups ("Younger" [18 to 59 years old] vs "older" [> or = 60 years old]) by one-way analysis of variance. Two-tailed t tests identified significant differences in selected food practices by age group. RESULTS: Diets were moderately high in fat (35% of energy), saturated fat (12%), and sugar (14%); intakes of zinc, calcium, vitamin A, vitamin B-6, and folate were frequently inadequate (less than two thirds of the Recommended Dietary Allowance). Of the 92 subjects, 76 (83%) were obese (BMI > or = 27). Fifty-four of the 60 women (90%) and 24 of the 32 men (75%) exhibited abdominal obesity (no age effect). Thirty-nine of the subjects (42%) consumed at least one food item purchased off the reservation on the day of the recall; the remaining 53 subjects (58%) consumed only food purchased or acquired on the reservation. Older Havasupai were significantly more dependent on the tribal store and other village food sources than were younger adults. Food sources of key nutrients did not differ by age or gender. APPLICATIONS: The dietary patterns of isolated populations may be shaped by the unique limitations of their food sources as well as by factors such as age and gender. Individual and community-wide efforts to improve nutrient intakes and food patterns must recognize these geographic limitations. For populations such as the Havasupai, cooperative marketing and health promotion efforts between tribal officials, health care providers, and managers of the cafe and tribal store could improve the availability and consumption of a wider range of health-promoting foods.