A limitation of our study was its reliance on a relatively small sample, leading to an increased likelihood of type two statistical errors. However, we were still able to observe statistically significant associations that had biological relevance. Furthermore, it is important to note that the 100 participants in this study represented a substantial proportion of these two small island communities. Our study also employed a cross-sectional design, which meant that it was not possible to rule out the possibility of reverse causation and or establish causality. Given the contribution of genetic, developmental factors, and other unmeasured confounders to risk factor response, refinement of our models based on longitudinal analysis with a more complete set of exposure and outcome data would provide a valuable extension to this work.