Improved Overall Quality of Diets Reported by Expanded Food and Nutrition Education Program Participants in the Mountain Region.

OBJECTIVE: To evaluate the Expanded Food and Nutrition Education Program, a large US Department of Agriculture nutrition education program for low-income people, by comparing the overall quality and cost of diets when entering and exiting the program. METHODS: Secondary analysis of data collected in 2011 from female participants in the Mountain region. Dietary recalls were collected by paraprofessionals. Outcome measures were the differences between Healthy Eating Index-2005 scores and costs of diets at entry and exit. Significance was determined using the Wilcoxon signed-rank test. RESULTS: At entry the mean total Healthy Eating Index-2005 score was 49.1 (out of a possible 100) and at exit, 55.2 (P < .001) (n = 3,338). Eight of 12 component scores also improved significantly whereas the sodium score worsened. The estimated median cost of diets was 13% higher at exit compared with entry. CONCLUSIONS: Participants' overall diet quality improved and was accompanied by an increase in food cost.

A stable isotope biomarker of marine food intake captures associations between n-3 fatty acid intake and chronic disease risk in a Yup'ik study population, and detects new associations with blood pressure and adiponectin.

The nitrogen isotope ratio (δ(15)N) of RBCs has been proposed as a biomarker of marine food intake in Yup'ik people based on strong associations with RBC eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, EPA and DHA derive from marine fats, whereas elevated δ(15)N derives from marine protein, and these dietary components may have different biologic effects. Whether δ(15)N is similarly associated with chronic disease risk factors compared with RBC EPA and DHA is not known. We used covariate-adjusted linear models to describe biomarker associations with chronic disease risk factors in Yup'ik people, first in a smaller (n = 363) cross-sectional study population using RBC EPA, DHA, and δ(15)N, and then in a larger (n = 772) cross-sectional study population using δ(15)N only. In the smaller sample, associations of RBC EPA, DHA, and δ(15)N with obesity and chronic disease risk factors were similar in direction and significance: δ(15)N was positively associated with total, HDL, and LDL cholesterol, apolipoprotein A-I, and insulin-like growth factor binding protein-3 (IGFBP-3), and inversely associated with triglycerides. Based on comparisons between covariate-adjusted ß-coefficients, EPA was more strongly associated with circulating lipids and lipoproteins, whereas δ(15)N was more strongly associated with adipokines, the inflammatory marker interleukin-6, and IGFBP-3. In the larger sample there were new findings for this population: δ(15)N was inversely associated with blood pressure and there was a significant association (with inverse linear and positive quadratic terms) with adiponectin. In conclusion, δ(15)N is a valid measure for evaluating associations between EPA and DHA intake and chronic disease risk in Yup'ik people and may be used in larger studies. By measuring δ(15)N, we report beneficial associations of marine food intake with blood pressure and adiponectin, which may contribute to a lower incidence of some chronic diseases in Yup'ik people.

Enculturation, perceived stress, and physical activity: implications for metabolic risk among the Yup'ik--the Center for Alaska Native Health Research Study.

OBJECTIVES: American Indians and Alaska Natives (ANs) report among the lowest levels of physical activity in the USA, but there is very little systematic research examining the determinants of physical activity patterns in these populations. This study investigated the relationships between enculturation (or cultural traditionality), psychosocial stress, and physical activity in a community-based sample of Yup'ik women and men living in rural AN communities. Associations between these variables and several metabolic risk factors were also examined. DESIGN: A sample of 488 Yup'ik participants (284 women and 204 men) from six villages in the Yukon-Kuskokwim Delta region completed a wellness survey and an array of physiological assessments [e.g., body mass index (BMI), blood pressure]. A subset of 179 participants also completed a 3-day pedometer assessment of physical activity. RESULTS: Multivariate linear regression models indicated that participants who were more enculturated (i.e., living more of a traditional lifestyle) and who experienced lower levels of psychosocial stress were significantly more physically active. In turn, both lower levels of psychosocial stress and higher levels of physical activity were associated with lower BMI, lower percent body fat, and lower waist circumference. CONCLUSIONS: Findings underscore the importance of gaining a culturally specific understanding of physical activity patterns in indigenous groups in order to inform effective health promotion strategies.

Stable nitrogen and carbon isotope ratios indicate traditional and market food intake in an indigenous circumpolar population.

The transition of a society from traditional to market-based diets (termed the nutrition transition) has been associated with profound changes in culture and health. We are developing biomarkers to track the nutrition transition in the Yup'ik Eskimo population of Southwest Alaska based on naturally occurring variations in the relative abundances of carbon and nitrogen stable isotopes (δ(15)N and δ(13)C values). Here, we provide three pieces of evidence toward the validation of these biomarkers. First, we analyzed the δ(15)N and δ(13)C values of a comprehensive sample of Yup'ik foods. We found that δ(15)N values were elevated in fish and marine mammals and that δ(13)C values were elevated in market foods containing corn or sugar cane carbon. Second, we evaluated the associations between RBC δ(15)N and δ(13)C values and self-reported measures of traditional and market food intake (n = 230). RBC δ(15)N values were correlated with intake of fish and marine mammals (r = 0.52; P < 0.0001). RBC δ(13)C values were correlated with intake of market foods made from corn and sugar cane (r = 0.46; P < 0.0001) and total market food intake (r = 0.46; P < 0.0001). Finally, we assessed whether stable isotope ratios captured population-level patterns of traditional and market intake (n = 1003). Isotopic biomarkers of traditional and market intake were associated with age, community location, sex, and cultural identity. Self-report methods showed variations by age and cultural identity only. Thus, stable isotopes show potential as biomarkers for monitoring dietary change in indigenous circumpolar populations.

Westernizing diets influence fat intake, red blood cell fatty acid composition, and health in remote Alaskan Native communities in the center for Alaska Native health study.

OBJECTIVE: To investigate the impact of a Westernizing diet on fat intake, red blood cell fatty acid composition, and health risks among Yup'ik Eskimos living in rural Alaskan Native communities. DESIGN: Diet data and blood specimens were collected from 530 Yup'ik Eskimos aged 14 to 94 years old. Height, weight, and waist circumference were measured. STATISTICAL ANALYSES: Comparisons of select fatty acid intake between participants in quintiles of traditional food intake (percent energy) were made using analyses of variance and post hoc Bonferroni tests. General linear models were used to determine the association between traditional food intake and health outcomes. RESULTS: Fatty acid composition of the diet differed according to the level of traditional food intake. Traditional food intake was positively associated with higher total fat, eicosapentaenoic acid, and docosahexaenoic acid intake. No association was observed between traditional food intake and saturated fatty acid intake; indeed, participants consuming more traditional foods derived a substantially smaller proportion of their dietary fatty acids from saturated fatty acids (P<0.001). Analyses of red blood cell fatty acid composition supported these findings. After multivariable adjustment, traditional food intake was significantly positively associated with high-density lipoprotein cholesterol concentration and significantly negatively associated with triglyceride concentration (P<0.001). CONCLUSIONS: Diets emphasizing traditional Alaskan Native foods were associated with a fatty acid profile promoting greater cardiovascular health than diets emphasizing Western foods. Further research needs to evaluate the effects of a Westernizing diet on the overall diet of Alaskan Natives.

Nutrient intakes are associated with adherence to a traditional diet among Yup'ik Eskimos living in remote Alaska Native communities: the CANHR Study.

OBJECTIVES: To determine whether dietary westernization is associated with intake of select nutrients among Alaska Natives living in remote communities. To investigate participant characteristics associated with adherence to the traditional Alaska Native diet. STUDY DESIGN: Cross-sectional survey. METHODS: A 24-hour recall was collected from 241 men and 307 women aged 14-94 years living in seven remote communities of Western Alaska. Bivariate analyses and ANOVA were used to examine the relationship between energy from traditional foods (the primary variable of interest), participant characteristics and intake of select nutrients. RESULTS: Traditional foods accounted for 22% of energy intake.overall. This estimate varied by age, educational attainment, and geographic location. Participants in the highest quintile of traditional food intake consumed significantly more vitamin A, vitamin D, Vitamin E, Iron, and n-3 fatty acids than participants in the lowest quintile (p < 0.001). Intake of vitamin C, calcium, and total dietary fiber decreased with increased consumption of traditional foods (p < 0.001). CONCLUSIONS: The degree of dietary westernization contributes to nutrient intake, both positively and negatively, in a dose response manner. Participant characteristics, particularly age, must be addressed in the development of a nutrition education program since they are associated with distinct dietary intakes.

Diet quality among Yup'ik Eskimos living in rural communities is low: the Center for Alaska Native Health Research Pilot Study.

OBJECTIVE: The objectives of this pilot study were to describe the nutrient intake of Yup'ik Eskimos in comparison with national intake, identify dietary sources of key nutrients, and assess the utility of the Healthy Eating Index (HEI) to measure diet quality of Yup'ik Eskimos living in rural Alaskan Native communities. PARTICIPANTS AND DESIGN: A single 24-hour recall was collected from 48 male and 44 female Yup'ik Eskimos (aged 14 to 81 years), who resided in three villages in the Yukon Kuskokwim River Delta, AK, during September 2003. MAIN OUTCOME MEASURES: HEI scores, nutrient intake, and traditional food intake. STATISTICAL ANALYSES PERFORMED: Spearman correlations for associations between variables. RESULTS: Youth scored higher than elders despite similar nutrient intakes. Overall diet quality was generally low; 63% of all participants' diets were classified as poor. Although the HEI serves to identify areas of concern with respect to diet quality, it is limited in its ability to detect the positive value of traditional foods. CONCLUSIONS: Traditional foods and healthful market foods, including rich sources of fiber and calcium, should be encouraged. Although traditional foods were important sources of energy and nutrients, market foods composed the preponderance of the diet, emphasizing the importance of appropriately modifying a diet quality index based on a Western framework, such as the HEI.

Building a community-based participatory research center to investigate obesity and diabetes in Alaska Natives.

The Center for Alaska Native Health Research (CANHR) is a community-based participatory research project aimed at understanding current risk factors for obesity, diabetes, and cardiovascular disease in Alaska Natives living in Southwest Alaska. We utilize a multidisciplinary approach that includes assessment of genetic, nutritional and behavioral risk factors and their interrelationships with one another in the overall development of disease. The design of the CANHR project involved community participation in the development, implementation and interpretation of research results. We have developed a participatory research program that is designed to be culturally appropriate, relevant to community needs and interests, and respectful to our participants. This manuscript describes the organizational development of our CANHR study and the procedures employed in its progression to date.