Objective The Life in BALANCE (LIB) study is a pilot translational study modeling the Diabetes Prevention Program (DPP) intensive lifestyle coaching intervention among an underserved, high-risk population: American Indians/Alaska Natives (AI/ANs) living in a large urban setting (Las Vegas, Nevada). Research Design and Methods A total of 22 overweight/obese AI/ANs (age, 39.6 ± 10.4 years; BMI, 34.1 ± 6.3 kg/m2) at increased risk for developing type 2 diabetes (HbA1c > 5.4 (36 mmol/mol) < 6.4 percent (46 mmol/mol) participated in the program between April and December, 2011. Study participants completed a 16 week intensive lifestyle coaching intervention. In addition to obtaining qualitative data regarding opportunities and challenges of applying the lifestyle intervention for AI/AN participants in an urban setting, clinical data, including BMI, waist circumference, blood pressure, fasting blood glucose, and blood lipids (HDL, LDL and Triglycerides), were collected. Results Only 12 of the 22 participants remained in the LIB program at the final post-program follow-up. Participants demonstrated significant decreased waist circumference and elevated HDL cholesterol. Triglycerides manifested the highest percentage change without statistical significance. No significant change was observed in blood pressure or fasting blood glucose. Conclusions LIB participants’ improvements in BMI, waist circumference, HDL cholesterol and triglycerides suggests type 2 diabetes prevention programs aimed at urban AI/ANs show significant potential for reducing the risk of developing type 2 diabetes among this underserved and high risk community. Qualitative data suggest the main challenge for type 2 diabetes prevention specific to this population is a need for improved community outreach strategies.

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Maternal prenatal diet can exert a powerful influence on the health of children when they reach adulthood--an orienting phenomenon in the Developmental Origins of Health and Disease research paradigm. Similar to other subsistence-based communities experiencing a rapid nutrition transition, obesity is increasing among Yup'ik Alaskans. Diabetes prevalence, however, remains relatively low and may reflect developmental nutritional processes that have yet to be thoroughly considered. Here we investigate recall of Yup'ik women's diets during a past pregnancy using a mixed-methods approach as a critical first step in exploring such alternative developmental hypotheses. For certain populations, retrospective dietary reports might be the only source of information on factors relevant to understanding developmental pathways to health and disease. Our analysis identified community-specific factors that will likely improve the accuracy of future retrospective dietary analyses investigating the role of prenatal nutrition in the developmental origins of metabolic disease, especially among Alaska Natives.