Intake of nutrients related to cardiovascular disease risk among three groups of American Indians: the Strong Heart Dietary Study.
ABSTRACT Although diet is implicated in the elevated rate of cardiovascular disease among some American Indian tribes, the dietary intakes of these individuals have not been described. The Strong Heart Dietary Study compared diets of 10 tribes in Arizona, Oklahoma, and the Dakotas to examine the possible contribution of diet to cardiovascular and other chronic diseases.
During 1988-1991, 892 people responded to a 24 hr diet recall questionnaire. Nutrient intake by study area, sex, and age group were compared by analysis of variance, and intakes were compared with nutrient intakes reported by participants in Phase 1 of the Third National Health and Nutrition Examination Survey and with dietary recommendations of the National Research Council, the American Heart Association, and the Healthy People 2000 objectives.
The intake of energy and nutrients varied significantly by sex and age. Men consumed more energy, macronutrients, and sodium than did women (P < or = 0.001). Women's diets were denser in carbohydrate, beta-carotene, vitamin C, and vitamin E than were men's diets (P < or = 0.001). Younger participants consumed more energy, macronutrients, vitamin E, and sodium than did older participants (P < or = 0.001). Older participants had diets denser in protein and beta-carotene than did younger participants (P < or = 0.001). Energy intake did not differ significantly by study area, but men in Arizona consumed more energy from carbohydrate and less energy from total fat than did men elsewhere (P < or = 0.01). Men and women in Arizona consumed more cholesterol and fiber than did other participants (P < or = 0.01) and less of the antioxidant vitamins (P < or = 0.01). Participants in the Strong Heart Diet Study reported diets higher in fats and cholesterol than did participants in Phase 1 of the Third National Health and Nutrition Examination Survey. Few Strong Heart participants achieved dietary recommendations for the reduction of risk of chronic disease.
Area differences in nutrient intake were observed, but most participants consumed diets associated with increased risk of heart disease and other chronic diseases. Women and older participants in general reported healthier nutrient intakes. Dietary intervention programs should educate American Indians about dietary modifications to reduce the risk of cardiovascular and other nutrition-related disorders.
Article: Interrelationships of added sugars intake, socioeconomic status, and race/ethnicity in adults in the United States: National Health Interview Survey, 2005.[show abstract] [hide abstract]
ABSTRACT: The consumption of added sugars (eg, white sugar, brown sugar, and high-fructose corn syrup) displaces nutrient-dense foods in the diet. The intake of added sugars in the United States is excessive. Little is known about the predictors of added sugar intake. To examine the independent relationships of socioeconomic status and race/ethnicity with added sugar intake, and to evaluate the consistency of relationships using a short instrument to those from a different survey using more precise dietary assessment. Cross-sectional, nationally representative, interviewer-administered survey. Adults (aged > or = 18 years) participating in the 2005 US National Health Interview Survey Cancer Control Supplement responding to four added sugars questions (n=28,948). The intake of added sugars was estimated using validated scoring algorithms. Multivariate analysis incorporating sample weights and design effects was conducted. Least squares means and confidence intervals, and significance tests using Wald F statistics are presented. Analyses were stratified by sex and controlled for potential confounders. The intake of added sugars was higher among men than women and inversely related to age, educational status, and family income. Asian Americans had the lowest intake and Hispanics the next lowest intake. Among men, African Americans had the highest intake, although whites and American Indians/Alaskan Natives also had high intakes. Among women, African Americans and American Indians/Alaskan Natives had the highest intakes. Intake of added sugars was inversely related to educational attainment in whites, African Americans, Hispanic men, and American Indians/Alaskan Native men, but was unrelated in Asian Americans. These findings were generally consistent with relationships in National Health and Nutrition Examination Survey 2003-2004 (using one or two 24-hour dietary recalls). Race/ethnicity, family income, and educational status are independently associated with intake of added sugars. Groups with low income and education are particularly vulnerable to diets with high added sugars. Differences among race/ethnicity groups suggest that interventions to reduce intake of added sugars should be tailored. The National Health Interview Survey added sugars questions with accompanying scoring algorithms appear to provide an affordable and useful means of assessing relationships between various factors and added sugars intake.Journal of the American Dietetic Association 08/2009; 109(8):1376-83. · 3.59 Impact Factor
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ABSTRACT: The results of previous studies on the association between dietary fat intake and coronary heart disease (CHD) incidence are inconsistent. The aim of this study was to examine the association between dietary fat intake and CHD incidence in American Indians in the Strong Heart Study. A total of 2938 participants aged 47-79 y and free of CHD at the second examination (1993-1995) were examined and followed for CHD, nonfatal CHD, and fatal CHD events to 31 December 2002. Dietary intake was assessed by using a 24-h diet recall and was calculated as percentages of energy. Participants were followed for a mean (+/-SD) of 7.2 +/- 2.3 y. During follow-up, 436 incident CHD cases (298 nonfatal CHD and 138 fatal CHD events) were ascertained. Participants aged 47-59 y in the highest quartile of intake of total fat, saturated fatty acids, or monounsaturated fatty acids had higher CHD mortality than did those in the lowest quartile [hazard ratio (95% CI): 3.57 (1.21, 10.49), 5.17 (1.64, 16.36), and 3.43 (1.17, 10.04), respectively] after confounders were controlled for. These associations were not observed for those aged 60-79 y. Total fat, saturated fatty acid, and monounsaturated fatty acid intake were strong predictors of CHD mortality in American Indians aged 47-59 y, independent of other established CHD risk factors. It may be prudent for American Indians to reduce their fat intake early in life to reduce the risk of dying from CHD.American Journal of Clinical Nutrition 11/2006; 84(4):894-902. · 6.67 Impact Factor
Article: Cardiovascular disease risk factor awareness in American Indian communities: the strong heart study.[show abstract] [hide abstract]
ABSTRACT: To use data from the longitudinal Strong Heart Study (SHS) to determine the level of awareness about risk factors for heart disease among 13 populations of American Indians in Arizona, Oklahoma, and South/ North Dakota. The aim of this study is to assess awareness of nine major risk factors for heart disease among participants in SHS. During July 1993 to December 1995 (phase II of SHS), 3638 participants ages 46 to 80 years (mean age 60) were asked if nine known risk factors for cardiovascular disease affect a person's chances of getting heart disease; 3226 (89%) participants completed the study and met the method reliability criteria for inclusion. Among each of the nine risk factors, the percentage of correct answers provided by study participants ranged from 70% (family history of heart disease) to 90% (being very overweight). Participants with hypertension (90% vs 86%, P<.05) and diabetes mellitus (81% vs 71%, P<.05) were more likely than those without these disorders to know they were heart disease risk factors. For all nine risk factors, the percentage of correct answers was lower (P<.05) among smokers than among nonsmokers. In multivariate logistic regression analyses, female sex, advanced education, and being from Oklahoma were significantly associated with heart disease awareness. Although overall risk factor awareness for heart disease was high, subgroups were identified who could benefit from culturally appropriate health education and other interventions to motivate health prevention actions, especially for smoking.Ethnicity & disease 02/2006; 16(3):647-52. · 0.90 Impact Factor