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The Moche of north coastal Perú were among the earliest New World societies to develop state socio-political organization. The Moche State (AD 200-800) was a centralized hierarchical society that controlled the Moche Valley as well as valleys to the north and south. Prior to the establishment of the state, a series of less hierarchical organizations were present in the valley. Irrigation agriculture has often been cited as central to development of the Moche State. To test this assertion I examined 750 individuals recovered from the largest cemetery at the site of Cerro Oreja. Although the most important occupation of Cerro Oreja was during the Gallinazo phase (AD 1-200), many individuals were interred here during the earlier Salinar period (400 -1 BC). Consequently, the Cerro Oreja collection holds a key to understanding the development of one of the earliest and most extensive states in the Americas. The teeth and/or alveoli of each individual were examined for the presence of dental caries, periodontal disease, abscesses, and antemortem tooth loss. My analysis suggests women and children did increasingly focus their diet on agricultural products. These findings seem to support the hypothesis that increased irrigation and reliance on agricultural production was fundamental to the development of the Moche state. However, men’s diets remained consistent through time. Status seems to have been of little import in determining diet before and during early periods of state development, in dramatic contrast to what we know of its importance during the zenith of the state’s power. I suggest that increasing differentiation of gender roles was important to the development of the state, and that gender differences may have been the most salient force in the transition to political hierarchy and social stratification in the Moche valley.