Diet & Type 2 Diabetes among Diet & Type 2 Diabetes among American Indians: American Indians:

The Strong Family Heart StudyThe Strong Family Heart Study

Mandy Fretts, PhD MPHMandy Fretts, PhD MPHNutritional Sciences Program Faculty Research ForumNutritional Sciences Program Faculty Research Forum

January 9, 2015January 9, 2015

BackgroundBackground

Type 2 diabetes is a chronic disease Type 2 diabetes is a chronic disease marked by high levels of sugar in the marked by high levels of sugar in the bloodblood

The burden of diabetes in the US is The burden of diabetes in the US is increasingincreasing

BackgroundBackground

Diabetes is a leading cause of morbidity & mortality Diabetes is a leading cause of morbidity & mortality among American Indians (AIs)among American Indians (AIs)

American Indians 2.5 times more likely to have American Indians 2.5 times more likely to have diagnosed diabetes than non-Hispanic whitesdiagnosed diabetes than non-Hispanic whites

High burden of diabetes in American Indian High burden of diabetes in American Indian communities may be attributable to lifestyle (e.g., communities may be attributable to lifestyle (e.g., diet, physical activity) diet, physical activity)

The Strong Heart Family Study

A study of cardiovascular disease among American Indians supported by the National Heart, Lung, and Blood Institute and the Indian Health Service

MethodsMethods13 communities in AZ, OK, ND, SD13 communities in AZ, OK, ND, SD

N=3665 (96 families)N=3665 (96 families)

Baseline exam (2001-2003)Baseline exam (2001-2003)

Follow-up exam (2007-2009)Follow-up exam (2007-2009)

Detailed data on socio-demographic factors, health Detailed data on socio-demographic factors, health behaviors, biomarkers, & geneticsbehaviors, biomarkers, & genetics

Available MeasuresAvailable MeasuresDemographicsDemographics

Social factors Social factors

DNADNA

BiomarkersBiomarkers

ECGECG

Cardiac/carotid ultrasound Cardiac/carotid ultrasound

Physical activity (pedometers)Physical activity (pedometers)

DietDiet

Dietary AssessmentDietary Assessment

Interview-administered past-year 119-item Block Interview-administered past-year 119-item Block FFQ, including American Indians food supplement FFQ, including American Indians food supplement (Indian taco, fry bread, spam, menudo, guysava, (Indian taco, fry bread, spam, menudo, guysava, tortillas)tortillas)

Ascertained frequency & portion size for each food Ascertained frequency & portion size for each food itemitem

Block database (Block Dietary Systems, Berkeley, Block database (Block Dietary Systems, Berkeley, CA) used to calculate average macronutrient CA) used to calculate average macronutrient intakesintakes

Baseline Characteristics of Study Participants

Female, % 5959

Age, yrs, median (IQR) 34 (23, 44)34 (23, 44)

BMI, kg/m2, median (IQR) 32 (26, 36)32 (26, 36)

Obesity, % 5757

Education, yrs, median (IQR) 12 (11, 13)12 (11, 13)

Steps/Day, median (IQR) 5410 (3500, 8000)5410 (3500, 8000)

Current smoking, % 3636

Achievement of Life’s Simple 7 Achievement of Life’s Simple 7 Dietary GuidelinesDietary Guidelines

*NHANES data from Roget VL et al. Heart Disease & Stroke Statistics—2011 Update. A Report From the American Heart Association. Circulation, 2011. 123: e 118-209.

Diabetes in the SHFSDiabetes in the SHFS

Diabetes=Treated with insulin or diabetic medication or fasting plasma glucose ≥ 126 mg/dl

Conclusions & Opportunities

The burden of diabetes among Americans is highThe burden of diabetes among Americans is high

Reported diets are high in fat & processed foods, and low in Reported diets are high in fat & processed foods, and low in whole grains, fruits & vegetableswhole grains, fruits & vegetables

Rich data setRich data set

Many opportunities for student projectsMany opportunities for student projects

http://strongheart.ouhsc.edu/http://strongheart.ouhsc.edu/

My email: amfretts@uw.eduMy email: amfretts@uw.edu