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.
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
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
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 *
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 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.
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%
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
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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