Cited by 423Indigenous Health and EducationDiabetes, Cardiovascular Risks, and LipoproteinsObesity, Physical Activity, Diet

The DOI matches its Crossref record; 28 of the 28 references it cites were found in a registry or an index; none of the 13 sources its claims cite is checked for support yet.

Effects of Traditional and Western Environments on Prevalence of Type 2 Diabetes in Pima Indians in Mexico and the U.S.

Open access
Schulz, Leslie O., Bennett, Peter H., Ravussin, Eric, Kidd, Judith R., Kidd, Kenneth K., Esparza, Julian, Valencia, Mauro E.·2006·Diabetes Care

Abstract

OBJECTIVE—Type 2 diabetes and obesity have genetic and environmental determinants. We studied the effects of different environments on these diseases in Pima Indians in Mexico and the U.S. RESEARCH DESIGN AND METHODS—Adult Pima-Indian and non-Pima populations in the Sierra Madre mountains of Mexico were examined using oral glucose tolerance tests and assessments for obesity, physical activity, and other risk factors. Results were compared with those from Pima Indians in Arizona. Both Pima populations were typed for DNA polymorphisms to establish their genetic similarity. RESULTS—The age- and sex-adjusted prevalence of type 2 diabetes in the Mexican Pima Indians (6.9%) was less than one-fifth that in the U.S. Pima Indians (38%) and similar to that of non-Pima Mexicans (2.6%). The prevalence of obesity was similar in the Mexican Pima Indians (7% in men and 20% in women) and non-Pima Mexicans (9% in men and 27% in women) but was much lower than in the U.S. Pima Indians. Levels of physical activity were much higher in both Mexican groups than in the U.S. Pima Indians. The two Pima groups share considerable genetic similarity relative to other Native Americans. CONCLUSIONS—The much lower prevalence of type 2 diabetes and obesity in the Pima Indians in Mexico than in the U.S. indicates that even in populations genetically prone to these conditions, their development is determined mostly by environmental circumstances, thereby suggesting that type 2 diabetes is largely preventable. This study provides compelling evidence that changes in lifestyle associated with Westernization play a major role in the global epidemic of type 2 diabetes.

Overview

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Written from the paper’s full text.

TL;DR

Pima Indians in a traditional Mexican environment had much lower type 2 diabetes and obesity prevalence than genetically similar Pima Indians in the U.S., despite sharing a similar gene pool. The findings suggest that environmental/lifestyle factors associated with Westernization largely determine whether genetically susceptible populations develop type 2 diabetes.

Key findings

  • Age- and sex-adjusted type 2 diabetes prevalence was 6.9% in Mexican Pima Indians, 38% in U.S. Pima Indians, and 2.6% in non-Pima Mexicans; the U.S. Pima prevalence was 5.5 times higher than Mexican Pima and 16 times higher than non-Pima Mexicans (P < 0.01).
  • Obesity was similar in Mexican Pima Indians (7% men, 20% women) and non-Pima Mexicans (9% men, 27% women) but much higher in U.S. Pima Indians (63.8% men, 74.8% women).
  • Physical activity was much higher in both Mexican groups than in U.S. Pima Indians: moderate-to-heavy activity was ~2.5-fold higher in Mexican men and 7-fold higher in Mexican women than in their U.S. Pima counterparts.
  • The two Pima groups clustered together genetically relative to other Native Americans, with a bootstrap support value of 95% (947 of 1,000), indicating a very similar gene pool.

Methods

  • Cross-sectional study of adult Pima and non-Pima Mexicans in the Sierra Madre mountains of Mexico, examined with oral glucose tolerance tests, anthropometry, physical activity questionnaires, and 24-h dietary recalls; results were compared with U.S. Pima Indians from the Gila River Indian Community in Arizona examined during June 1995–June 1996.
  • Diabetes and impaired glucose tolerance were defined by 1999 WHO criteria; obesity was defined as BMI ≥30 kg/m², with body fat estimated by bioelectrical impedance.
  • Genetic similarity was assessed by typing 309 independent DNA markers in 52 unrelated full Pima Indians from Mexico and 52 full Pima Indians from the U.S.; prevalence rates were directly standardized for age and sex.

Limitations

  • The paper states that cause and effect cannot be proven from this cross-sectional study, although it proposes that low diabetes prevalence in the Mexican populations is largely due to lesser obesity.
  • The paper states that a difference between the Pima populations in frequencies of unidentified diabetes susceptibility genes due to genetic drift or founder effects cannot be excluded.
  • The paper notes that dietary intake was not evaluated in the U.S. Pima sample used for comparison; an earlier U.S. Pima dietary study was cited instead. Evident from the text: participation was 77% of eligible Mexican Pima Indians and 71% of non-Pima Mexicans, and the diabetes difference between Mexican Pima and non-Pima Mexicans was not statistically significant.

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Integrity signals

Registry

Crossref · 10.2337/dc06-0138

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

Show all 18 claims

  • It may state two separate claims as one. 9
  • Probably not a substantial claim. 6
14 of 14
  • The paper relies on this without support.

    The U.S. Pima-Indian sample used for comparison is typical of the larger Pima population examined in the ongoing longitudinal study.

    “The data in the U.S. Pima-Indian sample used for comparison are typical of those seen in the larger Pima population examined in the ongoing longitudinal study.”
  • The paper relies on this without support.

    The 24-h dietary recall accurately represents the usual diet of the Mexican populations.

    “A 24-h dietary recall was conducted in the Mexican populations.”
  • The paper relies on this without support.

    The non-Pima Mexicans have no parental Amerindian heritage.

    “The non-Pima Mexicans reported no parental Amerindian heritage.”
  • The paper relies on this without support.

    The Pima heritage classification accurately identifies full and part Pima individuals.

    “Subjects were considered full Pima if they reported that both their parents were full Pima and part Pima if one parent was Pima.”
  • The paper relies on this without support.

    The cross-sectional prevalence differences reflect lifetime risk of diabetes.

    “The much lower prevalence of diabetes in the Mexican Pima Indians aged Ն55 years (9%) compared with that in the U.S. Pima Indians (77%) suggests that the lifestyle of the Mexican Pima Indians may result in life-long protection from type 2 diabetes, even among the majority of those who are genetically susceptible.”
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Metadata

Authors
Schulz, L. O., Bennett, P. H., Ravussin, E., Kidd, J. R., Kidd, K. K., Esparza, J., & Valencia, M. E.
Affiliations
  • University of Wisconsin–Milwaukee (US)
  • National Institutes of Health (US)
  • Pennington Biomedical Research Center, Baton Rouge, Louisiana
  • Yale University (US)
  • Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
  • Centro de Investigacion en Alimentación y Desarrollo A.C., Hermosillo, Mexico
  • Centro de Investigación en Alimentación y Desarrollo (MX)
Venue
Diabetes Care
Published
2006-08-01
Volume
29
Issue
8
Pages
1866-1871
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
OpenAlex
W2098164111
Cited by
420
References
28
Citations by year
2026: 9 · 2025: 16 · 2024: 22 · 2023: 21 · 2022: 20 · 2021: 15 · 2020: 29 · 2019: 17 · 2018: 11 · 2017: 19 · 2016: 16 · 2015: 16 · 2014: 24 · 2013: 31 · 2012: 21
FWCI
41.63
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute of General Medical Sciences (GM 57672, P01GM057672)
  • National Institute of Diabetes and Digestive and Kidney Diseases (76-DK-0256, DK-49957)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Indigenous Health and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
type 2 diabetes, Pima Indians, diabetes prevalence, obesity, physical activity, Westernization, lifestyle modification, genetic susceptibility, Sierra Madre, diabetes prevention, Native Americans, DNA polymorphism
MeSH terms
Adult, Culture, Diabetes Mellitus, Type 2, Diet, Female, Humans, Indians, North American, Male, Mexico, Middle Aged, Motor Activity, Obesity, Sex Characteristics, United States, Age Distribution

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