ABNORMAL CARBOHYDRATE METABOLISM AND PREGNANCY. A STUDY AMONG PREGNANT GUAMANIAN WOMEN

Guam ALS/parkinsonism-dementia: a long-latency neurotoxic disorder caused by "slow toxin(s)" in food?

Parkinsonism (P) with progressive dementia (D) of the Alzheimer type is recognized as a clinical variant of a form of amyotrophic lateral sclerosis (ALS) that has occurred in high incidence among the Chamorro people of the islands of Guam and Rota in the Marianas chain of Micronesia. The declining annual incidence, upward shifting of the age of onset, narrowing of the sex ratio, and occurrence of the disease among non-Chamorros, point to a disappearing environmental causation peculiar to the traditional culture of these islands. Evidence is presented in support of the proposal that heavy use of certain toxic plants, notably cycads, a traditional source of food and medicine for the Chamorro people, plays an important etiological role. Clinical and epidemiological approaches are offered to test for a relationship between ALS/P-D and long-latency plant toxicity.

The effect of westernization on native populations. Studies on a Micronesian community with a high diabetes prevalence

A diabetes prevalence study in 1975 on an isolated urbanized Central Pacific island (Nauru) showed rates comparable to the American Pima Indians--the highest yet recorded in the world literature. This paper reports the results of a follow-up study and the high prevalence has been confirmed. In this survey of 417 people aged ten years and over, 9.8% were known diabetics. With a plasma glucose of 160 mg/100 ml or over at two hours after a 75 gram oral glucose load as the criterion of diagnosis, , diabetes was detected in a further 19.2%, making a total diabetic population of 29% in the population studied. The prevalence of diabetes was 44% in people aged 20 years and over. A further 7% had borderline diabetes on the basis of a two-hour plasma glucose of 140--159 mg/100 ml. Parity did not appear to be a causative factor in relation to the high diabetes prevalence. However, obesity is common in this community and is more marked than that seen in other Pacific or Caucasian communities. The high prevalence of diabetes in this population appears to be related to the inter-action of environmental factors, such as obesity, with a diabetic genotype. The results confirm the possible detrimental effects of westernization on native populations.

The high prevalence of diabetes mellitus on a Central Pacific Island

A diabetes prevalence study on an isolated urbanized Central Pacific Island has established a prevalence rate of 34.4% in individuals aged 15 years and over. Of these, 10.4% had previously known diabetes; in the others the diagnosis was made on the basis of a plasma glucose level of at least 160 mg/100 ml 2h after a 75 gm oral glucose load. A further 11.3% of the subjects had borderline diabetes as judged by a 2-h plasma glucose of between 140 and 159 mg/100 ml. Of the diabetics, 72% had a positive family history of diabetes. The high prevalence rate appears to be related to a number of factors including a diabetic genotype, urbanization, and obesity.