Dietary Intake of American Indians and Alaska Native People

Maureen A Murtaugh, PhD, RDMarty Slattery, PhDLillian Tom-Orme, PhD, RN

We have no disclosures to make.

Background

• Navajo Health and Nutrition Survey Results (1990s)1

– High saturated fat– Low fiber, magnesium, calcium, and vitamins

A, E, B6 and folate

• Indian diet pattern more nutritious 2-5

– Indian diet pattern and traditional lifestyle associated with less risk of diabetes in studies of other American Indian people.

Purpose

• To describe dietary patterns and their cross-sectional association with measured risk factors for chronic disease in the Education and Research Towards Health (EARTH) study.

Data• Participants Included

– 3110 Men– 5462 Women

• Participants excluded – men < 800 and > 8000 calories/day (n= 1022, 25%)– women < 600 and > 6000 calories/day (n=1449, 21%)

• Nutrient intake was calculated using the Nutrition Data System for Research©, Regents of the University of Minnesota

• Food intake was quantified using frequency and portion size

EARTH Study Measured Risk Factors

• BMI– Height and weight

• Capillary blood glucose and lipids– Cholestech LDX® System (Cholestech,

Hayward, CA)

• Blood Pressure– Omron HEM 907 IntelliSense™

EARTH Study Questionnaires

• Health and lifestyle– Personal and family medical history– Physical activity– Dietary Intake

EARTH Dietary History Questionnaire

• Adapted from an existing questionnaire– Regional and

traditional foods added

• Computerized – Touch screen format

• Audio-CASI – A native voice read the

questions

Did you eat any of these foods?

What kind?

How often and how much?

Dietary Pattern Creation

• Using Factor Analysis to identify patterns of foods consumed together

• Following the 2005 US Dietary Guidelines to create a Healthy Eating Index Score

• Associations of Dietary patterns with risk factors for chronic disease assessed using Prevalence Ratios in SAS version 9.1.

Data Generated Diet Patterns• “Healthy Diet”

– Do eat salad greens, salad dressing, and vegetables– Do not eat eggs

• “Western Diet”– Do eat French fries and fried potatoes, fast food, red

and organ meats– Do not eat dairy products, fruit or vegetable juices

• “Traditional Diet”– Do eat soups, and organ meats– Do not drink diet soda

Diet Patterns Continued

• Tea and Coffee– Do use tea, coffee, and high sugar desserts

• Beer and Liquor– Do use beer and liquor

Nutrient Profile of Dietary PatternsHealthy Western Traditional

Tea and Coffee

Beer and Liquor

  Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SDEnergy Intake (kcal) 2917 ± 1526 3482 ± 1787 3431 ± 1724 3467 ± 1754 4277 ± 1970Fat (g/1000 kcal)* 33.8 ± 8.7 39.9 ± 7.0 36.5 ± 7.4 35.4 ± 8.5 30.3 ± 9.0Carbohydrate (g/1000 kcal)* 141.3 ± 24.9 121.4 ± 20.2 129.9 ± 21.8 137.4 ± 23.2 135.2 ± 28.1Protein (g/1000 kcal)* 37.2 ± 8.6 38.3 ± 8.4 40.3 ± 7.1 34.1 ± 7.7 29.4 ± 7.8Animal protein (g/1000 kcal)* 20.9 ± 8.9 25.0 ± 8.4 24.6 ± 8.2 19.5 ± 7.6 16.6 ± 6.9Vegetable protein (g/1000 kcal)* 15.9 ± 4.6 13.0 ± 3.4 15.4 ± 3.8 14.2 ± 4.0 11.9 ± 4.2Saturated fat (g/1000 kcal)* 10.2 ± 2.9 12.4 ± 2.6 11.6 ± 2.8 10.9 ± 2.9 9.3 ± 2.7

Dietary fiber (g/1000 kcal)* 14.2 ± 5.0 9.6 ± 3.2 12.7 ± 3.8 11.1 ± 3.8 10.1 ± 3.8

Food Intake Across Dietary Patterns

Healthy Western TraditionalTea and Coffee

Beer and Liquor

Fruit (servings/1000 kcal)* 0.7 ± 0.9 0.2 ± 0.3 0.6 ± 0.7 0.4 ± 0.6 0.3 ± 0.5

Vegetabledensity* 2.0 ± 1.9 0.8 ± 1.0 1.1 ± 1.1 1.0 ± 1.2 0.8 ± 1.2

Whole grain (servings/1000 kcal)* 0.8 ± 0.9 0.4 ± 0.5 0.6 ± 0.7 0.5 ± 0.7 0.4 ± 0.5

Dairy (serv/1000 kcal)* 0.6 ± 0.6 0.4 ± 0.3 0.7 ± 0.6 0.6 ± 0.5 0.4 ± 0.3

Meat (serv/1000 kcal)* 0.5 ± 0.3 0.7 ± 0.4 0.5 ± 0.3 0.5 ± 0.3 0.4 ± 0.2

Diet Pattern Associated with High Blood Pressure

00.20.40.60.8

11.21.41.61.8

2

Diet pattern

12345

Diet Pattern Quintile

Prevalence Ratio

Excludes people with reported history of high blood pressureAdjusted for age, gender, smoking, energy intake, education, physical activity, and BMI

Western Diet Pattern and Elevated Lipids

PrevalenceRatio

HDL Cholesterol (mg/dL)

Excludes people with reported history of high cholesterolAdjusted for age, gender, smoking, energy intake, education, physical activity, and BMI

*P for trend =0.03

Triglycerides mg/dL LDL Cholesterol (mg/dL)

150-199 vs <150 mg/dl

*

Association of Healthy Diet with Weight Status

Adjusted for age, gender, smoking, energy intake, education, physical activity, and BMI

P for trend = 0.01

BMI 25-30 BMI 30-35 BMI >35

Healthy Eating Index ScoringHealthy Eating Index Components

Criteria for Minimum Score

Criteria for maximum score of 10

Criteria for maximum score of 10

Food Group Men Women

Meat 0 servings 2.5 servings 2.2 servings

Dairy 0 servings 2.0 servings 2.0 servings

Fruits 0 servings 3.2 servings 2.5 servings

Vegetables 0 servings 4.2 servings 2.5 servings

Grains 0 servings 9.1 servings 7.4 servings

Nutrients /Variety

Total Fat ≥45% of energy ≤30% of energy ≤30% of energy

Saturated Fat ≥15% of energy <10% of energy <10% of energy

Cholesterol ≥450 mg ≥300 mg ≥300 mg

Sodium ≥4800 mg ≥2400 mg ≥2400 mg

Dietary Variety ≤3 different items/d ≥8 different items/d ≥8 different items/d

1The scoring range for each of the 10 components is 0 to 10. 2The number of servings per day for meat, dairy, fruits, vegetables, and grains depend on the recommended energy allowance specified in the Food Guide Pyramid (9,12). The recommended energy allowance for males, 51 years of age and over, is 2,300 Kcal and the recommended energy allowance for females is 1,900 Kcal. 3One serving of meat equals 2.5 ounces of lean meat.

Frequency of Healthy Eating by Gender

PoorHEI < 51

Needs ImprovementHEI 51-80

GoodHEI > 80

Men 26213%

170284.5%

412%

Women 2125.6%

335787.3%

2757.15%

Association of the Healthy Eating Index with Hypertension

HEI Quartiles

Prevalence Ratio

Association of Healthy Eating Index with Fasting Glucose

P for trend =0.04

P for trend = 0.06

HEI Quartiles

Discussion• Both Healthy Eating Index and data driven

dietary patterns were associated with indicators of health risk cross-sectionally.

• The association of the Healthy Eating pattern with Obesity may indicate reverse causality,

• The association of the Healthy Eating Index with glucose and hypertension suggests that Traditional foods and other foods should be used according to the US Dietary Guidelines.

Recommendations

• Reduce saturated and trans fats

• Eat less fast food, French fries and fried potatoes

• Choose unsweetened beverages

• Eat more steamed and raw vegetables

• Eat 2-4 servings of fruit per day

• Reduce portion sizes

Acknowledgments

• Navajo Nation Earth Advisory Board and IRB• Navajo Participants• EARTH staff• Co-authors

– Tom Greene– Khe-ni ma– Molly McFadden

• National Cancer Institution grants CA106218, CA88958, CA89139, and CA96095

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food sources of nutrients among the Navajo: findings from the Navajo Health and Nutrition Survey. J Nutr 1997, 127:2085S-2093S.

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• Kuhnlein HV, Soueida R, Receveur O: Dietary nutrient profiles of Canadian Baffin Island Inuit differ by food source, season, and age. Journal of the American Dietetic Association 1996, 96:155-162.

• Williams DE, Knowler WC, Smith CJ, Hanson RL, Roumain J, Saremi A, Kriska AM, Bennett PH, Nelson RG: The effect of Indian or Anglo dietary preference on the incidence of diabetes in Pima Indians. Diabetes Care 2001, 24:811-816.

• Ravussin E, Valencia ME, Esparza J, Bennett PH, Schulz LO: Effects of a traditional lifestyle on obesity in Pima Indians. Diabetes Care 1994, 17:1067-1074.