He Iti Noa, Na Te Aroha. Unconditional love - the greatest gift of all Maori health and wellbeing. Studies relevant to Maori Health conducted within an indigenous framework: Appropriate cut-offs for body mass index and macronutrient composition intended to reduce risk of type 2 diabetes

Abstract

Type 2 diabetes (T2DM) has reached epidemic proportions within Māori communities, yet there are major gaps in knowledge. This impacts on prevention strategies. The purpose of this research was two-fold: to explore the prevention of type 2 diabetes among Māori and to raise critical questions about Māori health research and practice. It was in part a ‘cultural audit’ to illustrate how health research and practice ‘masks’ whiteness, or the majority culture, being a consequence of the dominance of Western science-based theoretical ideas and policy models. Te Tiriti o Waitangi is introduced focussing on the three principles of participation, partnership and protection, and the implications of applying Te Tiriti to nutrition research and practice is discussed. The first aim of the research was to conceptualise a framework to provide a structural understanding of Māori wellbeing for Māori health research and health-related indices and the thesis begins with a description of the researcher’s own story, her conceptualisation of kaupapa Māori models of knowledge sharing and a discussion on Māori health models and the significance of kai (food) and physical activity. The thesis then reports on research which embodies a kaupapa Māori paradigm to address two further aims: • to compare different dietary approaches in insulin resistant individuals to determine the macronutrient composition most likely to reduce risk of T2DM among Māori; • to relate body mass index (BMI) to body composition and measures of diabetes and cardiovascular risk in Māori and non-Māori to determine the appropriateness of applying BMI cut offs based on European populations to Māori. Two related issues were considered: the most appropriate macronutrient composition for Māori at high risk of T2DM; and whether different BMI or waist circumference cut-offs should be used to define overweight and obesity among Māori. A ‘Kai Study” was undertaken because dietary advice for people with T2DM is largely based on research in European populations. It is a comparison of the standard diabetes dietary prescription that emphasises the benefits of fiber rich carbohydrate and fat reduction (HCHF), with a diet compatible with the preferences of indigenous people, including more protein rich food and less carbohydrate (HP). Eighty-four Māori participants were randomised to HCHF, HP or a control group for 24 weeks. It was found that dietary advice compatible with the food preferences of Māori is associated with changes in body composition which might be expected to reduce risk of type 2 diabetes, whereas standard advice to increase fiber rich carbohydrate containing foods produces little improvement. This confirms the importance of basing nutritional recommendations on research with relevant populations. Two approaches were used to examine whether BMI cut offs for the definition of overweight and obesity in Māori should differ from those used for Europeans. Findings demonstrated that anthropometric measures perform similarly in Māori and European men and women and correctly discriminate between those with and without insulin resistance, or the metabolic syndrome, 79-87% of the time, providing a strong argument against having different BMI or waist circumference cut offs for people of Māori descent.