title: Dietary intakes of nutrients thought to modify cardiovascular risk from three groups of American Indians: The Strong Heart Dietary Study, Phase II.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is the leading cause of mortality among American Indians. Rates of CVD appear to be increasing among American Indians while they are decreasing among other racial and ethnic groups in the United States. Rates of comorbid conditions associated with CVD, such as obesity, impaired glucose tolerance, and hypertension, are also higher among American Indians than among other racial and ethnic groups in the United States. Dietary factors play a role in the development of CVD and associated comorbid conditions, yet surprisingly few data exist to describe the dietary intakes and nutritional adequacy of American Indian adults at risk for CVD.
  
  
  OBJECTIVE
  To describe intakes of nutrients that may affect CVD risk consumed by members of 13 nations of American Indian adults, aged 45 to 70 years, who reside in tribal communities in Arizona, North Dakota, South Dakota, and Oklahoma. A secondary objective was to compare dietary intake estimates to nationally representative data from adults of similar age to determine potential dietary differences that may account for the disparities seen in rates of CVD and related conditions. Finally, dietary intake estimates were compared with national dietary guidance to determine areas for improvement.
  
  
  METHODS
  Data from a 24-hour dietary recall provided by 3,482 adults who participated in the Strong Heart Dietary Study, Phase II, were analyzed to describe dietary intakes of nutrients that may alter CVD risk. Nonparametric analyses of variance were used to compare data by center, age, and sex. Dietary intake data for each sex/center group were compared with data from the Third National Health and Nutrition Examination Survey (NHANES III), Phase I, dietary estimates, and to national dietary guidelines.
  
  
  RESULTS
  Nutrient intakes varied little between centers. Sex differences were noted in energy and nutrient intakes across all centers. Age-related decreases in energy and total and saturated fat intakes were noted among all sex/center groups. Median intakes of vitamins A and C and folate were low among all sex/center groups. Remarkably few differences in dietary intake were noted between NHANES III and Strong Heart Dietary Study, Phase II, participants. Carbohydrate and sodium intakes were higher among participants compared with NHANES III estimates, whereas intakes of several vitamins were lower.
  
  
  CONCLUSIONS
  Dietary intakes of American Indians vary by age, sex, and geographic location, but do not differ substantially from national estimates of dietary intake. The dietary differences noted between NHANES III and Strong Heart Dietary Study, Phase II, participants are not consistent with the remarkably different rates of CVD and associated comorbidities that currently exist.
authors.affiliation: Leadership Education and Training Program in Maternal and Child Health Nutrition, University of Minnesota, Minneapolis, USA. stang@epi.umn.edu
authors.forename: Jamie
authors.initials: J
authors.lastname: Stang
authors.forename: Ellie M
authors.initials: EM
authors.lastname: Zephier
authors.forename: Mary
authors.initials: M
authors.lastname: Story
authors.forename: John H
authors.initials: JH
authors.lastname: Himes
authors.forename: J L
authors.initials: JL
authors.lastname: Yeh
authors.forename: Thomas
authors.initials: T
authors.lastname: Welty
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001130:Arizona / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology*; D005247:Feeding Behavior / Q000208:ethnology*; D005260:Female; D006293:Health Promotion; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009658:North Dakota / Q000453:epidemiology; D018673:Nutrition Policy; D009749:Nutrition Surveys; D052756:Nutritional Sciences / Q000193:education / Q000208:ethnology; D009825:Oklahoma / Q000453:epidemiology; D012737:Sex Factors; D013023:South Dakota / Q000453:epidemiology