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      Traditional lifestyles, transition, and implications for healthy aging: An Example from the remote island of Pohnpei, Micronesia

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          Abstract

          Lifestyle-related, non-communicable diseases, such as diabetes, hypertension, and obesity have become critical concerns in the Pacific islands of Micronesia. We investigated the relationship between the diminution of traditional lifestyle practices and the decline in the health of the population in the State of Pohnpei, Federated States of Micronesia. To assess this, our interdisciplinary team developed two scales, one to rank individuals on how traditional their lifestyles were and one to rank individuals on the healthiness of their lifestyles. Participants’ locations were categorized as living on a remote atoll, living on the main island, or as a transitional population. Pohnpeians living in transitional communities (e.g. recently moved from a remote atoll to the main island, or the reverse) ranked lowest on both the tradition and health scales, rather than ranking intermediate between the remote and main island groups as we had hypothesized. As predicted, individuals residing on the remote atolls were living the most traditional lifestyles and also had the healthiest lifestyles, based on our rating system. The higher an individual scored on the tradition scale, e.g. the more traditional life they lived, the higher they scored on the health scale, suggesting the importance of traditional lifestyle practices for maintaining health. These findings have significant implications for promoting health and longevity of Micronesians and other Pacific Island peoples. We suggest the process of transition be recognized as a significant lifestyle and health risk and be given the attention we give to other risk factors that negatively influence our health. Based on our findings, we discuss and recommend the revitalization of particular traditional lifestyle practices, which may advance healthy aging among Pohnpeians.

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          Most cited references17

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          Deaths: final data for 2005.

          This report presents final 2005 data on U.S. deaths, death rates, life expectancy, infant and maternal mortality, and trends by selected characteristics such as age, sex, Hispanic origin, race, marital status, educational attainment, injury at work, state of residence, and cause of death. This report presents descriptive tabulations of information reported on death certificates, which are completed by funeral directors, attending physicians, medical examiners, and coroners. The original records are filed in the state registration offices. Statistical information is compiled into a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision (ICD-10). In 2005, a total of 2,448,017 deaths were reported in the United States. The age-adjusted death rate was 798.8 deaths per 100,000 standard population, representing a decrease of 0.2 percent from the 2004 rate and a record low historical figure. Life expectancy at birth remained the same as that in 2004-77.8 years. Age-specific death rates decreased for the age group 65-74 years but increased for the age groups 15-24 years, 25-34 years, and 45-54 years. The 15 leading causes of death in 2005 remained the same as in 2004. Heart disease and cancer continued to be the leading and second leading causes of death, together accounting for almost one-half of all deaths. The infant mortality rate in 2005 was 6.87 deaths per 1,000 live births. Generally, mortality patterns in 2005, such as the age-adjusted death rate declining to a record historical low, were consistent with long-term trends. Life expectancy in 2005 remained the same as that in 2004.
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            Marked improvement in carbohydrate and lipid metabolism in diabetic Australian aborigines after temporary reversion to traditional lifestyle.

            K O'Dea (1984)
            The rationale for the present study was that temporarily reversing the urbanization process in diabetic Aborigines should improve all aspects of their carbohydrate and lipid metabolism that are linked to insulin resistance. Ten full-blood, diabetic Aborigines from the Mowanjum Community (Derby, Western Australia) agreed to be tested before and after living for 7 wk as hunter-gatherers in their traditional country in north-western Australia. They were middle aged (53.9 +/- 1.8 yr) and overweight (81.9 +/- 3.4 kg), and all lost weight steadily over the 7-wk period (average, 8 kg). A detailed analysis of food intake over 2 wk revealed a low-energy intake (1200 kcal/person/day). Despite the high contribution of animal food to the total energy intake (64%), the diet was low in total fat (13%) due to the very low fat content of wild animals. Oral glucose tolerance tests (75 g glucose) were conducted in the urban setting and repeated at the end of 7 wk of traditional lifestyle. The marked improvement in glucose was due to both a fall in fasting glucose (11.6 +/- 1.2 mM before, 6.6 +/- 0.8 mM after) and an improvement in postprandial glucose clearance (incremental area under the glucose curve: 15.0 +/- 1.2 mmol/L/h before, 11.7 +/- 1.2 mmol/L/h after). Fasting plasma insulin concentration fell (23 +/- 2 mU/L before, 12 +/- 1 mU/L after) and the insulin response to glucose improved (incremental area under the insulin curve: 61 +/- 18 mU/L/h before, 104 +/- 21 mU/L/h after). The marked fall in fasting plasma triglycerides (4.0 +/- 0.5 mM before, 1.2 +/- 0.1 mM after) was due largely to the fall in VLDL triglyceride concentration (2.31 +/- 0.31 mM before, 0.20 +/- 0.03 mM after.(ABSTRACT TRUNCATED AT 250 WORDS)
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              Physical limitations contribute to food insecurity and the food insecurity-obesity paradox in older adults at senior centers in Georgia.

              The purpose of this study was to explore the relationship of obesity and physical limitations with food insecurity among Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 621, median age = 76 years, 83% female, 36% Black, and 64% White, convenience sample). Food insecurity was assessed using the modified 6-item US Household Food Security Survey Module; obesity was defined as Body Mass Index (BMI) or waist circumference (WC) class I or II obesity; and physical limitations (arthritis, joint pain, poor physical function, weight-related disability) were based on the Disablement Process. A series of multivariate logistic regression models found weight-related disability and obesity (WC class II) may be potential risk factors for food insecurity. Thus, obesity and weight-related disability may be risk factors to consider when assessing the risk of food insecurity and the need for food assistance in this vulnerable subgroup of older adults.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 March 2019
                2019
                : 14
                : 3
                : e0213567
                Affiliations
                [1 ] Institute of Economic Botany, The New York Botanical Garden, Bronx, New York, United States of America
                [2 ] Southern Arizona VA Health Care System, Tucson, Arizona, United States of America
                [3 ] Department of Plant and Microbial Biology, North Carolina State University, Raleigh, North Carolina, United States of America
                [4 ] American Academy of Family Physicians, Leawood, Kansas, United States of America
                [5 ] Department of Statistics, Columbia University, New York, New York, United States of America
                [6 ] Conservation Society of Pohnpei, Kolonia, Pohnpei, Federated States of Micronesia
                [7 ] Formerly, Indo-Pacific Division of The Nature Conservancy, Kolonia, Pohnpei, Federated States of Micronesia
                [8 ] Department of Natural Resources and Environmental Management, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
                Scripps Florida, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-2796-2408
                Article
                PONE-D-16-47335
                10.1371/journal.pone.0213567
                6413935
                30861022
                222291f6-56a2-4015-aca8-b26bb1f98439

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                : 20 January 2017
                : 25 February 2019
                Page count
                Figures: 2, Tables: 4, Pages: 20
                Funding
                Support for this research was provided by MetLife Foundation https://www.metlife.com/about/corporate-responsibility/metlife-foundation/index.html (MB), V. Kann Rasmussen Foundation http://www.vkrf.org/ (MB), Gildea Foundation (MB), Germeshausen Foundation http://www.germeshausen.org/ (MB), and the Marisla Foundation (MB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Earth Sciences
                Geomorphology
                Topography
                Landforms
                Islands
                Earth Sciences
                Geomorphology
                Topography
                Landforms
                Atolls
                Biology and Life Sciences
                Nutrition
                Diet
                Medicine and Health Sciences
                Nutrition
                Diet
                Biology and Life Sciences
                Nutrition
                Diet
                Food
                Medicine and Health Sciences
                Nutrition
                Diet
                Food
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Biology and Life Sciences
                Ecology
                Biodiversity
                Ecology and Environmental Sciences
                Ecology
                Biodiversity
                Biology and Life Sciences
                Organisms
                Eukaryota
                Plants
                Medicinal Plants
                Custom metadata
                The data cannot be made publically available for ethical reasons due to the agreements made with the Pohnpei Council of Traditional Leaders and governmental officials in Pohnpei who granted permission and monitored the research. They requested that names and data from the questionnaires not be released to respect the privacy of the research participants. On a case by case basis the research team can consider making portions of the data available to individuals who make a formal request. The data is maintained at the Institute of Economic Botany (IEB) at The New York Botanical Garden. The IEB Director, Dr. Michael Balick can be contacted with specific requests at mbalick@ 123456nybg.org .

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