1. Dietary Intake of American Indians and Alaska Native People Maureen A Murtaugh, PhD, RD Marty Slattery, PhD Lillian Tom-Orme, PhD, RN

2. We have no disclosures to make.

3. 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.

4. 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.

5. Data Participants Included –3110 Men –5462 Women Participants excluded –men 8000 calories/day (n= 1022, 25%) –women 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

6. 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

7. EARTH Study Questionnaires Health and lifestyle –Personal and family medical history –Physical activity –Dietary Intake

8. 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

9. Did you eat any of these foods?

10. What kind?

11. How often and how much?

12. 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.

13. 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

14. Diet Patterns Continued Tea and Coffee –Do use tea, coffee, and high sugar desserts Beer and Liquor –Do use beer and liquor

15. Nutrient Profile of Dietary Patterns HealthyWesternTraditional Tea and Coffee Beer and Liquor Mean ± SD Energy Intake (kcal)2917 ± 15263482 ± 17873431 ± 17243467 ± 17544277 ± 1970 Fat (g/1000 kcal)*33.8 ± 8.739.9 ± 7.036.5 ± 7.435.4 ± 8.530.3 ± 9.0 Carbohydrate (g/1000 kcal)*141.3 ± 24.9121.4 ± 20.2129.9 ± 21.8137.4 ± 23.2135.2 ± 28.1 Protein (g/1000 kcal)*37.2 ± 8.638.3 ± 8.440.3 ± 7.134.1 ± 7.729.4 ± 7.8 Animal protein (g/1000 kcal)*20.9 ± 8.925.0 ± 8.424.6 ± 8.219.5 ± 7.616.6 ± 6.9 Vegetable protein (g/1000 kcal)*15.9 ± 4.613.0 ± 3.415.4 ± 3.814.2 ± 4.011.9 ± 4.2 Saturated fat (g/1000 kcal)*10.2 ± 2.912.4 ± 2.611.6 ± 2.810.9 ± 2.99.3 ± 2.7 Dietary fiber (g/1000 kcal)*14.2 ± 5.09.6 ± 3.212.7 ± 3.811.1 ± 3.810.1 ± 3.8

16. Food Intake Across Dietary Patterns HealthyWesternTraditional Tea and Coffee Beer and Liquor Fruit (servings/1000 kcal)* 0.7 ± 0.90.2 ± 0.30.6 ± 0.70.4 ± 0.60.3 ± 0.5 Vegetable density* 2.0 ± 1.90.8 ± 1.01.1 ± 1.11.0 ± 1.20.8 ± 1.2 Whole grain (servings/1000 kcal)* 0.8 ± 0.90.4 ± 0.50.6 ± 0.70.5 ± 0.70.4 ± 0.5 Dairy (serv/1000 kcal)* 0.6 ± 0.60.4 ± 0.30.7 ± 0.60.6 ± 0.50.4 ± 0.3 Meat (serv/1000 kcal)* 0.5 ± 0.30.7 ± 0.40.5 ± 0.3 0.4 ± 0.2

17. Diet Pattern Associated with High Blood Pressure Diet Pattern Quintile Prevalence Ratio Excludes people with reported history of high blood pressure Adjusted for age, gender, smoking, energy intake, education, physical activity, and BMI

18. Western Diet Pattern and Elevated Lipids Prevalence Ratio HDL Cholesterol (mg/dL) Excludes people with reported history of high cholesterol Adjusted 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 *

19. 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

20. Healthy Eating Index Scoring Healthy Eating Index Components Criteria for Minimum Score Criteria for maximum score of 10 Food GroupMenWomen Meat0 servings2.5 servings2.2 servings Dairy0 servings2.0 servings Fruits0 servings3.2 servings2.5 servings Vegetables0 servings4.2 servings2.5 servings Grains0 servings9.1 servings7.4 servings Nutrients /Variety Total Fat45% of energy30% of energy Saturated Fat15% of energy<10% of energy Cholesterol450 mg300 mg Sodium4800 mg2400 mg Dietary Variety 3 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.

21. Frequency of Healthy Eating by Gender Poor HEI < 51 Needs Improvement HEI 51-80 Good HEI > 80 Men262 13% 1702 84.5% 41 2% Women212 5.6% 3357 87.3% 275 7.15%

22. Association of the Healthy Eating Index with Hypertension HEI Quartiles Prevalence Ratio

23. Association of Healthy Eating Index with Fasting Glucose P for trend =0.04 P for trend = 0.06 HEI Quartiles

24. 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.

25. 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

26. 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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