Diffuse idiopathic skeletal hyperostosis (DISH) in a middle Holocene forager from Lake Baikal, Russia: Potential causes and the effect on quality of life

Diffuse idiopathic skeletal hyperostosis (DISH) is often thought of as a disease of modern culture and lifestyle; however, cases have been reported in antiquity, although relatively sparsely. Using an osteobiographical approach, this study presents the oldest known case of DISH in Asia, a Kitoi individual, 76.1, from the middle Holocene cemetery of Shamanka II (Siberia, Russia). Rather than merely reporting a case of DISH, we explore the question: what would predispose a forager to develop a disease that is frequently associated with obesity and metabolic disorders? Evidence for physique, activity patterns, diet, and status are examined, comparing 76.1 to other individuals of his cultural group, in order to better understand why this individual may have developed DISH, as well as the potential effects of the disease on his quality of life. Results indicate that 76.1 was likely as active as other foragers belonging to his cultural group and, as can be discerned, his diet was similar; however, his physique differed, particularly his body mass estimate. Additionally, mortuary indicators suggest that 76.1 was of lower status than many of the other individuals buried at Shamanka II. Based on these multiple lines of enquiry, several scenarios are proposed as to what contributing factors resulted in 76.1's pathological state, including diet, physiological stress, the influence of status, dietary and genetic variation. Based on modern studies of quality of life in DISH individuals, as well as a lack of evidence for prolonged inactivity or disability, 76.1 did not appear to be significantly affected by the disease.