Table 3.
Literature on Obesity Health Disparities Among Native Hawaiians and Other Pacific Islanders, January 1998–December 2008
| Study Author(s) and Year (Ref. No.) |
Sample and No. of Subjects |
% of Total Sample Who Were NHOPI |
Age, years |
Study Design | Main Goal and Outcomes/Findings |
Limitations |
|---|---|---|---|---|---|---|
| Maskarinec et al., 1998 (52) |
4,321 Native Hawaiians out of a total multiethnic sample of 27,678 |
16 | >30 | Observational, prospective cohort, population-based sample of 2% of the Hawai‘i State population |
To investigate effects of alcohol intake and body weight on mortality from all causes, cancer, cerebrovascular disease, and coronary heart disease. |
No information on preexisting cardiovascular disease, serum cholesterol level, hypertension, diabetes, or family history. |
| Native Hawaiians had the highest mortality rate and a higher prevalence of obesity. BMIa >29.3 was associated with 50% higher risk of death. Coronary heart disease mortality was higher in Native Hawaiians with BMIs >29.3. | ||||||
| Galanis et al., 1999 (53) |
946 Samoans in Western Samoa and American Samoa |
100 | 25–55 | Observational, cross- sectional, retrospective cohort, community and workplace sample |
To describe dietary intake as measured by 24-hour recall of American Samoans and Western Samoans. |
No biochemical measurement of cardiovascular disease risk or correlations with anthropometric measurements; potential sample bias; recall bias on dietary assessment. |
| American Samoans consumed a greater proportion of carbohydrates and protein but less fat or saturated fat than Western Samoans. The mean BMI of American Samoans was 35.2 as compared with 30.3 for Western Samoans. | ||||||
| Grandinetti et al., 1999 (32) |
567 Native Hawaiians in 2 rural communities in Hawai‘i; nonpregnant |
100 | ≥30 | Observational, retrospective cohort, population-based sample |
To assess the relation of degree of Native Hawaiian ancestry with BMI and waist- to-hip ratio. |
Cross-sectional; self-reported ancestry and dietary recall. |
| Combined prevalence of overweight and/ or obesity was 81.5% in Native Hawaiians as compared with the US prevalence of 52.6%. 49% of Native Hawaiians were obese as compared with the US prevalence of 21% Increased waist circumference was found in 51% of Native Hawaiians. More women (59%) than men (39%) had increased waist circumference. Age, percentage of Native Hawaiian ancestry, and total dietary energy intake were significantly associated with increased BMI and waist-to-hip ratio. Adiposity increased with percentage of Native Hawaiian ancestry. | ||||||
| McGarvey et al., 2002 (54) |
181 Samoans and American Samoans |
100 | 25–55 | Observational, nested study in a prospective cohort; population-based sample |
To test the association of 6 genetic microsatellite markers related to the human leptin (LEP) locus and the pro- opiomelanocortin gene region in adult Samoans and American Samoans. |
Functional significance of present finding remains unclear. |
| Significantly greater frequency of allele 226 at the LEP locus in the nonobese Samoans than in the obese subjects. | ||||||
| Mampilly et al., 2005 (36) |
585 Native Hawaiians out of a total multiethnic sample of 3,732 |
16 | ≥18 | Observational, cross- sectional telephone survey; Behavioral Risk Factor Surveillance System population sample |
To assess the physical activity levels of multiethnic groups in Hawai‘i. |
Telephone survey; self-report of physical activity. Self-reported weight and height. |
| Native Hawaiians were more active (39% moderate, 24% vigorous) than other Asians and Pacific Islanders but less active than whites. 48% of Native Hawaiians reported being overweight as compared with 58% of whites, 42% of Filipinos, and 41% of Japanese. | ||||||
| Henderson et al., 2006 (55) |
159 Native Hawaiians out of a random subsample of 811 persons from Hawai‘i and California |
20 | 45–74 | Observational, nested study in a prospective cohort; randomly selected sample |
To examine the relation between circulating levels of 2 primary proteins (IGF-1 and IGFBP-3) in the insulin-like growth factor pathway and obesity in 5 racial/ethnic groups using BMI as an indicator of adiposity. |
Unmeasured confounding factors; racial/ethnic differences in BMI cutpoints may have confounded study. Plasma IGF-I and IGFBP-3 were measured at a single time point. |
| No significant interaction was found between IGF-1 and BMI in Native Hawaiians as compared with Japanese and Latinos, in whom decreased IGF-1 was associated with increasing BMI. | ||||||
| Howarth et al., 2006 (56) |
433 Native Hawaiians out of a total multiethnic sample of 2,326 persons from Hawai‘i and California |
19 | 45–74 | Observational, prospective cohort; population-based sample |
To determine whether dietary energy density was related to current BMI and risk of overweight/obesity in a multiethnic population. |
Food frequency assessment of dietary energy density based on recall. Dietary recall may vary by body weight. |
| Native Hawaiian men had the highest BMI; weight and dietary energy density were significantly related to BMI. Native Hawaiian women were second-heaviest after African Americans. Higher energy density was significantly associated with greater likelihood of being overweight in all ethnic and sex groups. Native Hawaiians were unusual in that low energy density was associated with high BMI. | ||||||
| Maskarinec et al., 2006 (34) |
9,994 Native Hawaiians out of a total multiethnic sample of 76,163 |
13 | ≥18 | Observational, prospective cohort; pooled data from 18 population-based studies carried out over 25 years in Hawai‘i |
To describe trends in BMI and the relations of nutrient and food intake with excess weight. |
Limited in comparability of nutritional measures across studies over time, mainly because dietary assessment methods have improved over the years; recall bias. |
| Native Hawaiians had the highest prevalence of excess weight at all times. Carbohydrates were positively associated with excess weight among Native Hawaiians. Nutritional determinants of excess weight were similar among whites, Japanese, and Native Hawaiians, despite marked differences in BMI. | ||||||
| Albright et al., 2007 (33) |
12,306 Native Hawaiians out of a multiethnic total sample of 200,003 |
6 | 45–74 | Observational, prospective cohort; population-based sample |
To examine BMI in persons with ethnic admixture as compared with persons who were monoracial but shared a common ethnicity/race. |
Self-reported height, weight, and ethnicity; unable to quantify the genetic contribution of each ethnicity reported. |
| Native Hawaiians had the highest BMI compared with other ethnic groups. Ethnic admixtures that included Native Hawaiian heritage had higher BMIs than most other ethnic combinations. | ||||||
| Boyd, 2007 (37) | 32 Native Hawaiian community college students |
100 | 18–25 | Focus group, university convenience sample |
To assess perceptions of healthy lifestyles and supports for and barriers to healthy living. |
Small sample size; biased sample. |
| Demanding lifestyle and laziness were cited as barriers to being physically active. Preferences for group-oriented and college-course-based opportunities to learn about healthy living and how to become more physically active. | ||||||
| Dai et al., 2007 (57) | 583 American Samoans | 100 | ≥18 | Observational, nested study in a prospective cohort; random selection sample |
To detect trait loci influencing adiposity- related phenotypes using a whole genome linkage scan approach in families from American Samoa. |
No adjustment for other important genetic and environmental factors that contribute to adiposity, such as diet and physical activity. |
| Strong evidence for a major locus on chromosome 6q23.2 influencing serum leptin levels. Another genetic region, 16q21, appears to be a susceptibility locus that affects phenotypes for BMI, percentage of body fat, leptin levels, and waist circumference. | ||||||
| Maskarinec et al., 2007 (35) |
16,079 Native Hawaiians out of a multiethnic total sample of 117,065 |
14 | ≥40 | Observational, prospective cohort; population-based sample |
To investigate changes in risk factors in Hawai‘i over 20 years and compare health behaviors among ethnic groups. |
Differences in data collection across 2 studies; improvements in nutritional assessment over time; validity of ethnicity assignment (self- reported); little information on socioeconomic status. |
| Native Hawaiians had the highest chronic disease risk scores in comparison with other groups. BMI was highest for Native Hawaiians. | ||||||
| Novotny et al., 2007 (58) |
55 Samoan women | 100 | 18–28 | Observational, cross- sectional, convenience sample |
To examine anthropometric cutoff points as indicators of chronic disease risk. |
Cross-sectional, small sample of Samoan women; biased sample. |
| 80% of sample was overweight or obese. BMI and dual-energy X-ray absorptiometry lean mass were significantly and positively associated with glucose levels. | ||||||
| Maskarinec et al., 2008 (59) |
254 Native Hawaiian women out of a multiethnic total sample of 1,418 |
18 | ≥21 | Observational, cross- sectional, breast-cancer- related participant sample |
To examine relation of soy intake with body weight over the life span of women. |
Self-reported height, weight, and diet data; lifetime recall of soy intake was difficult. |
| Meat and vegetable intake and total energy intake (kcal/day) were higher for Native Hawaiians. Eating more soy foods in adulthood did not predict lower BMI or lower annual weight gain for Native Hawaiians. |
Abbreviations: BMI, body mass index; IGF-1, insulin-like growth factor 1; IGFBP-3, insulin-like growth factor binding protein 3; NHOPI, Native Hawaiians and other Pacific Islanders.
a
Weight (kg)/height (m)2.