Nutritional concerns in American Indian and Alaska Native children: transitions and future directions.

The nutritional health of American Indian and Alaska Native children has changed dramatically over the past 30 years. The prevention and treatment of malnutrition (primarily undernutrition) was a major health issue until the mid to late 1970s. Now, a generation later, obesity in American Indian and Alaska Native children is a major health threat. In 1969, the National Institutes of Health sponsored a conference to review the nutritional status of North American Indian children and to set a national agenda to improve the nutritional health of Indian children. Subsequently, increased food availability; food assistance programs; and improved sanitation, transportation, and health care have eliminated undernutrition as a major health issue. However, the substantial reduction in undernutrition has been accompanied by a rapid increase in childhood obesity. The current epidemic of child and adult obesity and associated obesity-related morbidities, such as type 2 diabetes mellitus and other chronic diseases, has implications for the immediate and long-term health of young American Indians. This article reviews the current nutritional health of American Indian and Alaska Native children, the changes that have occurred the past 30 years, and the nutrition transition to increasing obesity and subsequent diabetes that is being seen in American Indians. Future directions to improve the health of American Indian and Alaska Native children are discussed, as is the urgent need for obesity prevention programs that are culturally oriented, family centered, and community- and school-based and that target healthful eating and physical activity beginning in childhood.

Intake of nutrients and food sources of nutrients among the Navajo: findings from the Navajo Health and Nutrition Survey.

Diet has been implicated in the etiology of chronic diseases in many populations, including the Navajo and other American Indian tribes. This report describes the current nutrient intake of the Navajo and identifies the primary food sources of key nutrients. In the Navajo Health and Nutrition Survey, interviewers obtained single 24-h diet recalls from 946 nonpregnant participants age 12-91 between October 1991 and December 1992. Among various sex and age groups, total fat contributed 33-35% of energy and saturated fat contributed 10-11% of energy in the diets. Median fiber intake was 11-14 g/d. Median intakes of vitamin A, vitamin E, vitamin B-6, folate, calcium and magnesium were below sex- and age-specific recommended dietary allowances (RDA) for men and women of all age groups. Intake of vitamin C was below the RDA for men and women age 20 and older. Median iron intake was below the RDA for women under age 60. Fruits and vegetables were each consumed less than once per day per person, as were dairy products. Fry bread and Navajo tortillas, home-fried potatoes, mutton, bacon and sausage, soft drinks, coffee and tea provided 41% of the energy and 15-46% of the macronutrients consumed. Recommendations to increase the intake of essential micronutrients in the Navajo diet are presented.

Weight, body image, and weight control practices of Navajo Indians: findings from the Navajo Health and Nutrition Survey.

Historically, the Navajo exhibited a low prevalence of overweight, but a number of small studies over the past few decades indicate that the prevalence is increasing. In the population-based Navajo Health and Nutrition Survey conducted in 1991-92, overweight was defined as a body mass index (BMI, kg/m2) at or above the 85th percentile (BMI > 27.8 for men, > 27.3 for women) of the Second National Health and Nutrition Examination Survey. One third of men age 20 and 39 and one half of men age 40 and 59, but fewer than 10% of men age 60 and older were overweight. Two thirds or more of women in all age groups were overweight. Nineteen percent of the participants underestimated their weight status (underweight, appropriate, overweight) relative to their BMI category and 17% overestimated their weight status. Women overestimated their weight status more often than men (P < 0.05), and participants age 20-39 overestimated their weight status more often than older participants (P < 0.001). Men and women age 60 and older preferred heavier body shape models as ideals of health more often than younger participants (P < 0.001). Nearly half of the participants, regardless of their weight status, reported that they were trying to lose weight; most reported using diet and exercise. Because overweight is an important risk factor for many chronic diseases, including diabetes mellitus, cardiovascular disease and cancer, primary prevention of overweight and weight management for adults are recommended to prevent an increase in the burden of chronic disease among the Navajo.

Diabetes mellitus among Navajo Indians: findings from the Navajo Health and Nutrition Survey.

Noninsulin-dependent diabetes mellitus is a major health problem among most American Indian tribes. This is the first population-based reservation-wide study of the Navajo that has used oral glucose tolerance testing to determine diabetes status. Employing WHO criteria, we found an age-standardized prevalence of diabetes mellitus (DM) of 22.9% among persons aged 20 y and older. This prevalence is 40% higher than any previous age-standardized estimate for the Navajo and four times higher than the age-standardized U.S. estimate. More than 40% of Navajo aged 45 y and older had DM. About one third of those with DM were unaware of it, with men more likely to be unaware than women. Among persons with a medical history of DM, almost 40% had fasting plasma glucose values > or = 200 mg/dL. Persons with DM were heavier, more sedentary and more likely to have a family history of DM than were persons without DM. Persons with DM had more hypertension, lower HDL levels and higher triglyceride levels than their counterparts without DM. Insulin usage was infrequent among persons with a history of DM, and about one third of women with such a history used no medical therapy to control their diabetes. Although important measures to combat diabetes have already been undertaken by the Navajo, additional efforts are required to slow the progression of this disease and prevent its sequelae.

The health of Navajo women: findings from the Navajo Health and Nutrition Survey, 1991-1992.

Cancer-screening behaviors, reproductive history, risk behaviors during pregnancy and chronic disease risk factors were examined in a representative sample of 566 Navajo women residing on the Navajo Reservation in 1991-1992. Among all women 15 y and older, 59% were overweight, 4% were current smokers, 10% currently used smokeless tobacco and 12% were anemic. Seventy-one percent of Navajo women aged 18 and older reported ever having had a Pap smear, but only 35% of women aged 50 and over reported ever having had a mammogram. Among parous women, the prevalence of having received no prenatal care for any pregnancy declined from 60% among women 60 and older to 13% among women 20-29 y of age, and the prevalence of ever having had a child born at home declined from 82 to 2%. These data suggest marked secular improvement in these pregnancy-related risk behaviors. However, data on cancer-screening behaviors indicate opportunities to improve health of Navajo women by increasing their use of mammography and Pap smear screening services.