INCREASING PREVALENCE OF NIDDM IN THE PACIFIC ISLAND POPULATION OF WESTERN-SAMOA OVER A 13-YEAR PERIOD

OBJECTIVE - A survey of noncommunicable diseases (NCD) in the Pacific island population of Western Samoa in 1978 (n = 1,206) documented a re latively high prevalence of non-insulin-dependent diabetes mellitus (N IDDM) and obesity. A follow-up survey was performed in 1991 (n = 1,776 ) to assess changes in NCD prevalence and risk factor distribution ove r 13 years. RESEARCH DESIGN AND METHODS - In both surveys, the same re presentative villages from one urban and two rural areas were studied, and the survey procedure included an oral glucose tolerance test, ant hropometric and blood pressure measurements, and physical activity ass essment (1991 only). RESULTS - The age-standardized prevalence of NIDD M in 1991 was 9.5 and 13.4% in Apia (urban) for men and women, respect ively. In Poutasi (rural), 5.3% of men and 5.6% of women had NIDDM, an d in Tuasivi (rural) the prevalence was 7.0 and 7.5% for men and women , respectively. Age, body mass index (BMI), waist-to-hip circumference ratio, physical inactivity, and family history of diabetes all showed independent association with NIDDM and impaired glucose tolerance. Li ving in Apia (compared with Poutasi) was also associated with NIDDM. B etween 1978 and 1991, the age-standardized prevalence of NIDDM in Apia increased from 8.1 to 9.5% in men and 8.2 to 13.4% in women. In Pouta si, a dramatic increase occurred in prevalence from 0.1 to 5.3% in men , but little change in women was noted (5.4 to 5.6%). In Tuasivi, the increases were 2.3 to 7.0% in men and 4.4 to 7.5% in women. In combine d survey areas, increases were observed in the age-standardized preval ence of obesity and mean levels of total cholesterol, fasting triglyce rides, and uric acid between surveys as well as a reduction in the pre valence of smoking. CONCLUSIONS - This is the first study using standa rdized methods to show a dramatic increase in the prevalence of NIDDM in a developing Pacific island population, and it indicates the import ance of maintaining and expanding preventive programs for NIDDM and re lated lifestyle diseases in these populations.