A Triple Burden In Native Hawaiian And Pacific Islander Patients With Epilepsy: The Cardiometabolic Risks Of Obesity, Diabetes, Smoking, And Their Association With Seizure Control

Epilepsy Research  ·  Hawaii Pacific Neuroscience  ·  Published 2026

Epilepsy Research, Volume 225, 2026  ·  Hawaii Pacific Neuroscience

A new study published in Epilepsy Research by researchers at Hawaii Pacific Neuroscience reveals that Native Hawaiian and Pacific Islander (NHPI) patients with epilepsy face a disproportionate “triple burden” of obesity, diabetes, and tobacco use — and that smoking is the single strongest predictor of poor seizure control across all groups studied.

Background: A Community Facing Compounding Risks

People with epilepsy (PWE) already navigate a complex and demanding condition. For Native Hawaiians and Pacific Islanders in Hawaii, that challenge is compounded by well-documented cardiometabolic health disparities — elevated rates of obesity, type 2 diabetes, and tobacco use that intersect with neurological vulnerability in ways that have been underexplored in medical literature.

This study set out to quantify those disparities systematically, comparing cardiometabolic risk profiles across White, Asian, and NHPI patients with epilepsy treated at a Hawaii-based clinic, and to determine whether these conditions are independently linked to seizure outcomes.

Study Design & Methods

Researchers conducted a retrospective chart review of 403 adult patients with epilepsy, drawing from the clinic’s patient population with the following racial composition:

Multivariable logistic regression was used to compare comorbidity profiles across groups and to identify factors independently associated with poor seizure control — defined as breakthrough seizures or drug-resistant epilepsy.

Key Findings: The Triple Burden

After adjustment, NHPI patients demonstrated significantly higher odds of all three cardiometabolic conditions compared to White patients:

Why This Research Matters

This study is among the first to characterize the intersection of cardiometabolic risk and epilepsy outcomes specifically within Hawaii’s Native Hawaiian and Pacific Islander population. The findings carry direct clinical implications: while addressing obesity and diabetes is essential for overall health, the data suggest that smoking cessation may be the highest-yield behavioral intervention for improving seizure control in this community.

The authors emphasize the need for culturally tailored smoking cessation programs — approaches that are specifically designed to resonate with NHPI patients and address tobacco use not only as a cardiometabolic risk factor but as a direct neurological concern.

Hawaii Pacific Neuroscience — Comprehensive Epilepsy Center & BRAIN Research Team

Research Team

This study was a collaborative effort across the Comprehensive Epilepsy Center, Video-EEG Epilepsy Monitoring Unit, and BRAIN (Bridging Research and Innovation in Neuroscience) at Hawaii Pacific Neuroscience, in partnership with the John A. Burns School of Medicine, University of Hawaii.

Hawaii Pacific Neuroscience remains committed to research that reflects and serves the unique populations of Hawaii — ensuring that the islands’ diverse communities are represented in the science that shapes their care.

Hawaii Pacific Neuroscience  ·  Comprehensive Epilepsy Center  ·  hawaiineuroscience.com