TITLE HERE - Navajo Nation

TITLE HERE - Navajo Nation

Dietary Intake of American Indians and Alaska Native People Maureen A Murtaugh, PhD, RD Marty Slattery, PhD Lillian 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 Patterns Energy Intake (kcal) Fat (g/1000 kcal)* Carbohydrate (g/1000 kcal)* Protein

(g/1000 kcal)* Animal protein (g/1000 kcal)* Vegetable protein (g/1000 kcal)* Saturated fat (g/1000 kcal)* Dietary fiber (g/1000 kcal)* Healthy Western Traditional Tea and Coffee Beer and Liquor Mean SD

Mean SD Mean SD Mean SD Mean SD 2917 1526 3482 1787 3431 1724 3467 1754 4277 1970 33.8 8.7 39.9 7.0 36.5 7.4

35.4 8.5 30.3 9.0 141.3 24.9 121.4 20.2 129.9 21.8 137.4 23.2 135.2 28.1 37.2 8.6 38.3 8.4 40.3 7.1 34.1 7.7 29.4 7.8

20.9 8.9 25.0 8.4 24.6 8.2 19.5 7.6 16.6 6.9 15.9 4.6 13.0 3.4 15.4 3.8 14.2 4.0 11.9 4.2 10.2 2.9 12.4 2.6

11.6 2.8 10.9 2.9 9.3 2.7 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 Fruit (servings/ 1000 kcal)* Vegetable density*

Healthy Western Traditional Tea and Coffee Beer and Liquor 0.7 0.9 0.2 0.3 0.6 0.7 0.4 0.6 0.3 0.5 2.0 1.9

0.8 1.0 1.1 1.1 1.0 1.2 0.8 1.2 0.8 0.9 0.4 0.5 0.6 0.7 0.5 0.7 0.4 0.5 0.6 0.6 0.4 0.3 0.7 0.6

0.6 0.5 0.4 0.3 0.5 0.3 0.7 0.4 0.5 0.3 0.5 0.3 0.4 0.2 Whole grain (servings/1000 kcal)* Dairy (serv/1000 kcal)* Meat

(serv/1000 kcal)* Diet Pattern Associated with High Blood Pressure Prevalence Ratio 1 1 1 1 0 0 0 0 2 8 . 6 .

4 . 2 . 1 8 . 6 . 4 . 2 . 0 1 2 3 4 5 D i e

p a t e t n r Diet Pattern Quintile Excludes people with reported history of high blood pressure Adjusted for age, gender, smoking, energy intake, education, physical activity, and BMI Western Diet Pattern and Elevated Lipids *P for trend =0.03 Prevalence Ratio * 150-199 vs

<150 mg/dl Triglycerides mg/dL HDL Cholesterol (mg/dL) Excludes people with reported history of high cholesterol Adjusted for age, gender, smoking, energy intake, education, physical activity, and BMI LDL Cholesterol (mg/dL) Association of Healthy Diet with Weight Status P for trend = 0.01 BMI 30-35 BMI 25-30 Adjusted for age, gender, smoking, energy intake, education, physical activity, and BMI

BMI >35 Healthy Eating Index Scoring Healthy Eating Index Components Criteria for Minimum Score Food Group Criteria for maximum score of 10 Criteria for maximum score of 10 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 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 Nutrients /Variety 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 Poor HEI < 51 Needs Improvement HEI 51-80 Good HEI > 80

Men 262 13% 1702 84.5% 41 2% Women 212 5.6% 3357 87.3% 275 7.15% Association of the Healthy

Eating Index with Hypertension Prevalence Ratio HEI Quartiles Association of Healthy Eating Index with Fasting Glucose P for trend = 0.06 P for trend =0.04 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

References Ballew C, White LL, Strauss KF, Benson LJ, Mendlein JM, Mokdad AH: Intake of nutrients and food sources of nutrients among the Navajo: findings from the Navajo Health and Nutrition Survey. J Nutr 1997, 127:2085S-2093S. Receveur O, Boulay M, Kuhnlein HV: Decreasing traditional food use affects diet quality for adult Dene/Metis in 16 communities of the Canadian Northwest Territories. The Journal of nutrition 1997, 127:2179-2186. 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.

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