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Native Americans and Alaska Natives (NA/AN) display a disproportionate burden for chronic diseases such as cardiovascular disease (CVD). The National Health Interview Survey in 2005 1 showed that the rate of self- reported circulatory diseases (13.0%), including hypertension, stroke, and coronary heart disease, was much higher among NA/AN than non- Hispanic Whites (12.0%), Blacks (10.2%) and Asians (6.7%). Similar findings were reported from the Strong Heart Study (SHS) cohort of Native Americans from Arizona, Oklahoma, and the Dakotas 2. The SHS found that rates for CVD and its associated risk factors were higher among the SHS cohort compared to data from the National Health and Nutrition Examination Survey (NHANES) III. The SHS investigators reported that intakes for total fat, saturated fats and monounsaturated fats were significant predictors of CVD mortality independent of other CVD risk factors 3. Studies in other NA/AN communities have showed that average intakes for total fat, saturated fats and cholesterol do not meet the U.S. Dietary Guidelines 4-5. The objective of this cross-sectional study was to determine if current dietary intakes of total fat, saturated fats, cholesterol, and omega-3 fatty acids among a cohort of Pacific Northwest Tribal Nations (PNwT) places them at risk for CVD. Results from this study suggest that average intakes of total fat, saturated fat and cholesterol in PNwT likely places them at risk for CVD. The data would suggest that many individuals may not meet dietary recommendations to reduce heart disease. These intakes combined with the high prevalence for overweight and obesity may further increase CVD risk. However, mean omega-3 fatty acid intakes for this population exceed Adequate Intake recommendations, which may reduce their risk for CVD 9. The coastal location of the PNwT provides ready access to seafood which is one of the richest food sources for omega-3 fatty acids. This analysis addressed the issue of plausible reporters. This differs from previous studies in other NA/AN communities which did not account for plausibility 3-5. We found that by limiting the analysis to plausible reporters, the mean intakes for cholesterol and omega-3 fatty acids were higher than the mean intakes of the total sample, however the energy contributions from fat and saturated fat remained the same. Failure to account for implausible reporters may underestimate dietary risk factors of NA/AN communities. This is the first study among PNwT describing the dietary profile related to CVD risk. Findings from the PNwT cohort highlight the diversity among NA/AN communities. Nutrient intake was assessed by a Food Frequency Questionnaire (FFQ) and food records (FR). Participants completed the Block FFQ at entry into the cohort. Period of recall was the year prior to entry. FR were completed every 4 months as two 1 day FR and one set of 2 days of FR for a total of 4 FR over 1 year. All participants were trained in record keeping techniques, provided a tool kit of measuring devices and recording materials, and had their records reviewed upon completion. FR data were entered into the Nutrition Data System for Research (NDS-R) Database Version 4.07 (© Regents of the University of Minnesota) and averages were calculated. Age was calculated from date of birth and date of first visit. Height was measured to the nearest inch using a portable stadiometer. Weight was measured on a calibrated electronic scale and recorded to the nearest pound. Body mass index (BMI) was calculated from weight (kg) and height (m) using the formula wt(kg)/ht(m) 2. Estimated intakes for total fat (g), saturated fat (g), cholesterol (mg), and omega-3 fatty acids (g) were determined from the FFQ and the FR. Implausible reporters (over & under reporters) for both methods were determined using the 1 SD method developed by McCrory et al 6. Quantitative variables were compared between men and women using one-way Analysis of Variance (ANOVA) and categorical variables were compared using chi-square. We would like to thank the people of the Quinault, Quileute and Makah Nations for their participation. We would also like to thank the National Institute of Environmental Health Sciences and the investigators at the University of Maryland (Dr. Lynn Grattan) for their support. 1 Pleis JR et al. Summary Health Statistics for U.S. adults: National Health Interview Survey, 2005. Centers for Diseases Control (CDC). 2 Welty TK, et al. Cardiovascular disease risk factors among American Indians. The Strong Heart Study. Ann Epidemiol, 1999; 142(3): 269-287. 3 Stang J, et al. Dietary Intakes of nutrients thought to modify cardiovascular risk from three groups of American Indians: The Strong Heart Study, phase II. J Am Diet Assoc, 2005; 105: 1895-1903. 4 Ballew C, et al. Intake of nutrients and food sources among the Navajo: Findings from the Navajo Health and Nutrition Examination Survey. J Nutr, 1997; 127: 2085S-2093S. 5 Nobmann ED, et al. Dietary intakes vary with age among Eskimo adults of Northwest Alaska in the GOCADON Study, 2000-2003. J Nutr, 2005; 135(4): 856-862. 6 McCrory MA, et al. Procedures for screening out inaccurate reports of dietary energy intake. Public Health Nutr, 2002; 5(6A): 873-882 and Huang, et al. Effect of screening out implausible energy intake reports on relationships between diet and BMI. Obes Res, 2005; 13(7): 1205-1217. 7 Dietary Guidelines for Americans 2005 (2005). USDA [On-line]. Available: http://www.healthierus.gov/dietaryguidelines/ 8 Institute of Medicine, F. a. N. B. (2006). Dietary Reference Intakes: The essential guide to nutrient requirements. (1 ed.) Washington, DC: National Academy Press. 9 Hu FB, et al. Dietary fat intake and the risk of coronary heart disease in women. N Eng J Med, 1997; 337: 1491-1499. The PNwT cohort is composed of members from three Tribal Nations (Makah, Quinault, and Quileute) along the Pacific Northwest Coast of Washington. Individuals aged 6 – 10 yr and 18 yr or older were randomly selected from tribal registries. Enrollment began in the summer of 2006. The Institutional Review Boards from the University of Maryland and Purdue University approved the study protocol and formal written agreements were made with each Tribal Nation. This analysis was limited to non-pregnant adults (18+ yr) with diet, weight and height information at the completion of their first year of the study. Figure 1 outlines the flow chart for inclusion. Purpose Sample population MethodsDiscussion References Acknowledgements Dietary intakes related to cardiovascular disease risk among a sample of adults from Pacific Northwest Tribal Nations Fialkowski MK 1, Boushey CJ 2, McCrory MA 2, Roberts S 3, Grattan L 3 1 Department of Health & Kinesiology, Purdue University. 2 Department of Foods & Nutrition, Purdue University. 3 School of Medicine, University of Maryland. Total enrolled n=648 Complete FFQ n=630 Pregnant adults n=13 Non- pregnant adults n=519 Men n=226 Complete height & weight n=217 Women n=293 Complete height & weight n=272 Children n=98 Complete > 1 FR n=545 Pregnant adults n=10 Non- pregnant adults n=445 Men n=186 Complete height & weight n=177 Women n=259 Complete height & weight n=242 Children n=90 Results Results from both dietary methods were similar so findings from the FR only are shown. Characteristics of this sample are in Table 1. Dietary intakes are depicted in Tables 2 and 3. Results are shown for those who met and did not meet the criteria for being a plausible reporter. There were significant differences (p<0.01) in cholesterol and omega-3 fatty acid intakes between men and women. However, average intakes for both men and women were contrary to dietary recommendations for total fat, saturated fat, and cholesterol. Intakes for omega-3 fatty acids exceeded Adequate Intake recommendations. Table 1. Descriptive information for PNwT adults in comparison to the SHS PNwT Men (n=177) PNwT Women (n=242) SHS Men (n=1846) SHS Women (n=2703) Mean (SD) Mean Age (years)41.3 (14.4)43.2 (14.4)(45 – 75 years) FR days completed3 (1) NA BMI31.4 (6.3)33.1 (8.1)29.931.8 Percent (%) overweight/obese (BMI ≥ 25)86878387 Table 2. Mean dietary intakes of PNwT adult women in comparison to recommendations and the SHS All (n=256)Plausible (n=120)2005 Dietary guidelines 7 SHS (n=2096) Mean (SD)Mean Energy (kcal)1901 (658)2085 (343)N/A1651 % energy from fat36 (7)37 (6)20-35%34 % energy from saturated fat12 (3) 10% or less12 Cholesterol (mg)293 (180)313 (140)< 300 mg281 Omega-3 fatty acids (g)1.6 (1)1.8 (0.9)1.75 8 NR Table 3. Mean dietary intakes of PNwT adult men in comparison to recommendations and the SHS All (n=185)Plausible (n=78)2005 Dietary guidelines 7 SHS (n=1309) Mean (SD)Mean Energy (kcal)2211 (876)2667 (503)N/A1972 % energy from fat36 (7)37 (6)20-35%35 % energy from saturated fat12 (3) 10% or less12 Cholesterol (mg)353 (252)449 (278)< 300 mg379 Omega-3 fatty acids (g)1.8 (1)2.2 (1.1)2.25 8 NR Conclusion In conclusion, similar to other Native communities, the dietary intakes of PNwT place them at risk for CVD. Further study needs to occur in PNwT to determine how these dietary profiles moderate risk for CVD. These studies need to address whether the high intakes of omega-3 fatty acids may play a beneficial role in this unique population. Figure 1. PNwT cohort sample flow chart
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