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Objectives: To clarify the association between glucose intolerance and high altitudes (2900-4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability to diabetes mellitus (DM) accelerated by lifestyle change or ageing. Design: Cross-sectional epidemiological study on Tibetan highlanders. Participants: We enrolled 1258 participants aged 40-87 years. The rural population comprised farmers in Domkhar (altitude 2900-3800 m) and nomads in Haiyan (3000-3100 m), Ryuho (4400 m) and Changthang (4300-4800 m). Urban area participants were from Leh (3300 m) and Jiegu (3700 m). Main outcome measure: Participants were classified into six glucose tolerance-based groups: DM, intermediate hyperglycaemia (IHG), normoglycaemia (NG), fasting DM, fasting IHG and fasting NG. Prevalence of glucose intolerance was compared in farmers, nomads and urban dwellers. Effects of dwelling at high altitude or hypoxia on glucose intolerance were analysed with the confounding factors of age, sex, obesity, lipids, haemoglobin, hypertension and lifestyle, using multiple logistic regression. Results: The prevalence of DM (fasting DM)/IHG (fasting IHG) was 8.9% (6.5%)/25.1% (12.7%), respectively, in all participants. This prevalence was higher in urban dwellers (9.5% (7.1%)/28.5% (11.7%)) and in farmers (8.5% (6.1%)/28.5% (18.3%)) compared with nomads (8.2% (5.7%)/15.7% (9.7%)) (p=0.0140/0.0001). Dwelling at high altitude was significantly associated with fasting IHG+fasting DM/fasting DM (ORs for >4500 and 3500-4499 m were 3.59/4.36 and 2.07/1.76 vs <3500 m, respectively). After adjusting for lifestyle change, hypoxaemia and polycythaemia were closely associated with glucose intolerance. Conclusions: Socioeconomic factors, hypoxaemia and the effects of altitudes ≥3500 m play a major role in the high prevalence of glucose intolerance in highlanders. Tibetan highlanders may be vulnerable to glucose intolerance, with polycythaem

The transformation of land from swidden based to permanent agriculture is an important issue related to the sustainable livelihood and land use system of people in mountain environments. This paper reports the introduction of paddy rice cultivation and its consequences in four swiddener communities in Arunachal Pradesh, India, by focusing on cultivation techniques. The Indian government introduced paddy rice cultivation to Arunachal Pradesh in the 1950s by teaching the required techniques and supplying seed and agricultural tools. However, few swiddeners began rice cultivation because they disliked working in muddy paddies that could not produce non-rice crops. During the “green revolution” in the 1970s, many people decided to create paddy fields after observing the remarkably high yield of new rice varieties. Over 60 years of trial and error, many swiddener communities have developed a unique cultivation system suited to their local environment, while often learning from their neighboring communities of Ahom and Apatani that already practiced paddy rice cultivation. The paddy field has become a symbol of wealth and social status because of the high and stable yield of paddy rice and escalating land prices. However, the communities usually continue some aspects of swidden cultivation, because only a limited amount of land is suitable for paddy rice, people need non-rice crops, or because older people prefer swidden cultivation work and the taste of upland rice. This case study shows the importance of local needs and knowledge of skilled farmers in swidden transformation.

Objective: Prevalence of hypertension was examined in a widely dispersed (45 110 km2) representative group of Ladakhi in Northern India. The influence of hypoxic environment of wide-ranged altitude (2600–4900 m) and lifestyle change on hypertension was studied. Methods: 2800 participants (age 20–94 years) were enrolled. Systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure of ≥90 mm Hg and/or taking current anti-hypertensive medicine was defined as hypertension. Height and weight for body mass index and SpO2 were examined. The rural population comprised six subdivisions with a distinct altitude, dietary and occupational pattern. Participants in the urban area of Leh consist of two groups, that is, migrants settled in Leh from the Changthang nomadic area, and dwellers born in Leh. The prevalence of hypertension in the two groups was compared with that in the farmers and nomads in rural areas. The effects of ageing, hypoxia, dwelling at high altitude, obesity, modernised occupation, dwelling in an urban area, and rural-to-urban migration to hypertension were analysed by multiple logistic regression. Results: The prevalence of hypertension was 37.0% in all participants and highest in migrants settled in Leh (48.3%), followed by dwellers born in Leh town (41.1%) compared with those in rural areas (33.5). The prevalence of hypertension in nomads (all: 27.7%, Tibetan/Ladakhi: 19.7/31.9%)) living at higher altitude (4000–4900 m) was relatively low. The associated factors with hypertension were ageing, overweight, dwelling at higher altitude, engagement in modernised sedentary occupations, dwelling in urban areas, and rural-to-urban migration. The effects of lifestyle change and dwelling at high altitude were independently associated with hypertension by multivariate analysis adjusted with confounding factors. Conclusions: Socioeconomic and cultural factors play a big role with the effect of high altitude itself on high prevalence of hypertension in highlanders

Wild Edible Herbs in Paddy Fields and Their Sale in a Mixture in Houaphan Province, the Lao People’s Democratic Republic. Multiple wild edible herbs coexist in paddy fields under the agricultural practices used for growing rice. Paddy field vegetation was surveyed and the rural population’s perceptions and use of wild edible herbs were investigated in the northern Lao People’s Democratic Republic. A total of 115 wild herbaceous species were observed in the paddy fields of two villages; 52 species grew in fields, 95 on levees, and 63 on banks. Of these, 25 species were locally used, and 22 were sold as a mixture at the Xamneua market, with species composition varying by availability and season. The total number of edible greens increased during the summer season when available vegetables were scarce. Marsilea quadrifolia L. (Marsileaceae), the most abundant in the field and in the market, as well as Centella asiatica (L.) Urb. (Apiaceae), Eryngium foetidum L. (Apiaceae), Spilanthes oleracea L. (Asteraceae), and Monochoria hastata (L.) Solms (Pontederiaceae) were the most popular wild herbs sold. Wild edible herbs are called “phak”, which is also used to indicate cultivated vegetables, and clearly distinguishes them from the inedible herbs referred to as “nya.” Two methods are employed to gather wild edible herbs: some plants are uprooted as a way of thinning individuals, and other plants have only their young leaves picked so that they can be harvested repeatedly. Gathering and selling wild edible herbs was mainly conducted by women and children for whom it was a source of cash income. Thus, the relationships that exist between people and the wild plants they maintain as part of their farming activities can be considered an indicator of paddy field agrodiversity.

The Himalayan people have developed the ethnic foods to adapt to the harsh conditions and environment. The in-take of such foods has been in the systems for centuries and people have adapted such foods to protect and sustain them. People living in high altitude (>2500) are adapted to cereals and food grains grown in dry and cold climates, with less vegetables and more meat products. More diversity of food items ranging from rice, maize to vegetable, milk to meat is prevalent in the elevation less than 2500 to 1000 m. Ethnic foods possess protective properties, antioxidant, antimicrobial, probiotics, bio-nutrients, and some important health-benefits compounds. Due to rapid urbanisation, development, introduction of commercial ready-to-eat foods have adverse effects on production and consequently consumption of such age-old cultural ethnic foods is declining. The people should be ascertained about the worth indigenous knowledge they possess, and biological significance of their foods. Detailed health status in terms of consumption of both fermented and non-fermented foods and their cultural adaption need to be carried out urgently.

The Monpa is one of the major 26 tribes of Arunachal Pradesh State, India, inhabiting the land at the altitude from 2000 m to 4000m a.s.l. Monpa people at Dirang Circle are classified into two groups according to their lifestyle, "Unpa (field cultivators at lower altitude)" and "Brokpa (pastoralists at higher altitude)". One of the major characteristics of Brokpa's livelihood is seasonal moving around the grazing land at the altitude from 3000 m to 4500 m with Yak, cow and their cross-breeding, or sheep. Brokpa have close relationship with Unpa in terms of landholding, agricultural production and trading, and marriage. Brokpa owe the land and staple food to Unpa, and Unpa instead obtain the cheese and butter which are important protein source for them. The original culture of Brokpa community and their relationship with Unpa will be influenced by the recent increasing attention on the political, environmental, and socio-economic importance of the high altitude land in Arunachal Pradesh. Dunkarpa Welfare Association was established against such a background, aiming to support the Brokpa community by providing permanent settlement at roadside, school education facilities, and job for gaining regular cash income. However, sudden and compulsory change of the accustomed lifestyle will not be accompanied by mental satisfaction of Brokpa people. Thus, it is a challenge for the action plan of High Altitude Project to support the development of Brokpa's society with ensuring their welfare.

This paper presents the results of an investigation on water-borne infectious diseaseconducted among the people of Attapeu province from 2003 to 2008. Regardless of the lastcholera epidemic in Attapeu province, Lao PDR in the year 1999, the local peoples'awareness of cholera was remarkably low, as demonstrated by the knowledge survey ondiarrheal diseases performed in the province in 2006. In the case study material, derivedfrom continuous field observations on malaria among permanent residents in relocatedvillages in Sanxay district from 2004 to 2008, the infection rate among febrile cases was ashigh as 45% in the early resettlement period, while it was proved that the rate fell later to1.9-14%. Judging from the environmental condition of this settlement area, this papermakes clear the persistent threat of malaria. Furthermore, among the villagers, hookworminfection was highly prevalent. However, liver fluke infections were scarce and noascariasis was found from parasitic stool examination in 2007. Water quality analysis ofthe water sources resulted in remarkably safe water from tube wells from 2003 to 2008.