The Effect of Ethnicity on Nutrition throughout the Lifecycle

1
The Effect of Ethnicity on Nutrition throughout
the Lifecycle
2
Nutrition during Pregnancy

• Pregnant women receive nutrition-related messages
  from multiple sources, including family members,
  friends and health care providers, all of which
  may vary based on ethnicity

• Women of various ethnic backgrounds may have
  different food availabilities, food preferences,
  dietary patterns, and culturally influenced
  beliefs of foods during pregnancy

3
Maternal Health Indicators by Ethnicity
Statistics from CDC. (2003). Pediatric Nutrition
Surveillance. Retrieved 10/05/05 from
http//www.cdc.gov/nccdphp/dnpa/pdf/2001_ped_nutri
tion_report.pdf.
4
Distribution of Gestational Weight Gain by
Ethnicity in a Sample of WIC Women

n173,006
Less than recommended
More than recommended
Recommended
Schieve et al. Obstet Gynecol 199891878-84.
5
Percentage of women retaining 9kg (19.8 lb) by
race

Actual gestational weight gain
Key point At every level of weight gained
during pregnancy (less than recommended,
recommended and more than recommended) black
women retained more weight post-partum than white
women
6
African Americans during Pregnancy

• Compared to white counterparts
• Greater prevalence of overweight before
  pregnancy 49.6 have an overweight pre-pregnancy
  BMI
• More likely to suffer from anemia in the 3rd
  trimester and post-partum period -- 43.9 for
  both time periods
• Have the lowest rate of pre-pregnancy underweight
  compared to all other ethnic populations
• More likely to retain weight after pregnancy

7
What are African-American pregnant women eating?
Top 5 food sources contributing most to

• Intake of energy
• Biscuits, muffins
• French fries/fried potatoes
• Whole milk
• White bread, bagels, crackers
• Soft drinks

• Protein intake
• Hamburger, beef, meatloaf
• Whole milk
• Fried chicken
• Eggs
• Cheese and cheese spread

• Fat intake
• mayonnaise, salad dressings
• French fries/fried potatoes
• Whole milk
• Biscuits, muffins
• Cheese and cheese spreads

Siega-Riz AM, et al. (2002) What are pregnant
women eating? Nutrient and food group differences
by race. Am J Obstet Gynecol. 186(3)480-6.
8
What are pregnant African-American women eating?
Top food sources contributing most to

• Folate and Iron Intake
• Dry cereal
• White bread, bagels and crackers
• Biscuits, muffins
• Rice
• Oranges and tangerines
• Collards, kale, and greens

• Vitamin C Intake
• Orange juice, grapefruit juice
• Oranges, tangerines
• Other fruit juices
• Fortified fruit drinks
• broccoli

• Carbohydrate Intake
• Soft drinks
• Other fruit drinks
• Biscuits, muffins
• White bread, bagels, crackers
• French fries, fried potatoes

Siega-Riz AM, et al. (2002) What are pregnant
women eating? Nutrient and food group differences
by race. Am J Obstet Gynecol. 186(3)480-6.
9
Asian-American/Pacific Islanders during Pregnancy

• Highest rate of underweight women during the
  pre-pregnancy period 24.6
• Lowest rate of overweight women during the
  pre-pregnancy period 20.9
• More likely than white counterparts to suffer
  from anemia during the 3rd trimester and
  post-partum period 28.7 35.3, respectively

10
What are pregnant Asian-American women
eating?Some may follow Yin-Yang theory

• Yin-Yang (hot-cold) theory of pregnancy exists
  for some Asian cultures
• Many Asian-American groups consider pregnancy a
  hot condition
• Chinese consider pregnancy a cold condition
• To maintain health, pregnant women are
  recommended to restrict diet to cold foods
  (hot foods for Chinese)
• These classifications are not defined by literal
  meanings, but rather by culture, tradition, and
  personal experiences over time
• Yang (hot) foods include beef, chicken, eggs,
  fried foods, hot and spicy foods, liquor
• Yin (cold) foods include vegetables, fresh
  fruits, whole grains, soybean products

11
Hispanic-Americans during Pregnancy

• Equivalent overweight rates during the
  pre-pregnancy period to white counterparts 41.4
• However, they have lower underweight rates 7.9
• More likely than white counterparts to suffer
  from post-partum anemia 32.1
• Despite many disadvantages in terms of poverty,
  education and prenatal care, immigrant women born
  in Mexico have consistently shown better
  pregnancy outcomes compared to US-born
  Mexican-Americans1 -- possible dietary changes
  that accompany acculturation?

Harley K, Eskenazi B, et al. (2005). The
association of time in the US and diet during
pregnancy in low-income women of Mexican
descent. Paediatric and Perinatal Epidemiology.
19(125-34).
12
What are pregnant Mexican-American women
eating?Differences found between
Mexican-Americans born in the US v. Mexico
Mexico-born pregnant women

• are more likely to meet current health
  recommendations

• have significantly higher intakes of
• Vitamins A, C E
• folate, calcium zinc
• total calories

• have lower intakes of folate, iron zinc with
  more years lived in the US

Harley K, Eskenazi B, et al. (2005). The
association of time in the US and diet during
pregnancy in low-income women of Mexican
descent. Paediatric and Perinatal Epidemiology.
19(125-34).
13
Differences found between Mexico-born and US-born
Mexican-Americans

• Pregnant Mexico-born immigrants had significantly
  higher caloric intake than US born MAs but still
  had lower pre-pregnancy weights and pregnancy
  weight gains
• May have to do with physical activity, which was
  not measured in the study
• Lower prevalence of low birthweight and preterm
  delivery among Mexico-born women compared to
  US-born counterparts, despite risk factors of
  poverty, low education and less access to
  prenatal care

Harley K, Eskenazi B, et al. (2005). The
association of time in the US and diet during
pregnancy in low-income women of Mexican
descent. Paediatric and Perinatal Epidemiology.
19(125-34).
14
Native Americans/Alaska Natives during Pregnancy

• Compared to all other ethnic populations, Native
  Americans/Alaska Natives
• have the highest rate of pre-pregnancy
  overweight 52.6
• have a lower rate of pre-pregnancy underweight
  (other than African-Americans)
• have intermediate levels of 3rd trimester and
  post-partum anemia 30.3 30.2, respectively

15
Nutrition during Lactation

• There are many nutritional, immunological,
  allergenic, economic, and psychological
  advantages associated with breastfeeding
• A womans dietary practices affect breast milk
  during lactation
• Many cultural beliefs exist concerning the direct
  connection between a womans diet and the milk
  produced
• Some of these ideas do indeed have a basis, while
  others are the result of cultural attitudes,
  notions, and superstitions
• Addtionally, women with previously poor-quality
  diets low in vitamins and minerals may produce
  milk with less-than-optimal amounts of certain
  vitamins, especially vitamins A, D, B6, and B12

16
Percentage of infants ever breastfed, and
breastfed at 6 and 12 months by ethnicity
1. CDC. (2005, April 11). Breastfeeding Case
Which infants are most likely to be breastfed?
Retrieved 10/05/05 from http//www.cdc.gov/pednss/
how_to/interpret_data/case_studies/breastfeeding/w
ho.htm.
17
Trends in the percentage of infants ever
breastfed, by ethnicity
CDC. (2005, April 11). Breastfeeding prevalence
increasing or decreasing among racial and ethnic
groups over time? Retrieved 10/05/05
from http//www.cdc.gov/pednss/how_to/interpret_da
ta/case_studies/breastfeeding/who_and_when.htm.
18
African Americans Lactation

• Prevalence of black infants ever breastfed
  increased from 13.8 in 1992 to 30.8 in 2001,
  the largest relative increase of any other group
• Still, black infants currently have the lowest
  prevalence of ever breastfed
• Percentage of black infants breastfed at least 6
  and 12 months is 10 and 8.3, the lowest of any
  group

19
Hispanic Americans Lactation

• Hispanic infants have the highest prevalence of
  ever breastfed at 62.7, with a relative
  increase from 1992 of 73
• Percentage of Hispanic infants breastfed at least
  6 and 12 months is 29.0 and 22.8, the highest
  of any group

20
Asian American/Pacific Islanders Lactation

• Prevalence of AA/PI infants ever breastfed is
  53.8, breastfed at 6 months is 25.6 and
  breastfed at 12 months is 16.9 (2nd in all 3
  measures only to Hispanic-Americans)
• In a study by Wu, et al., the duration of
  breastfeeding was similar in US-born Asians and
  US whites, but was longer in Asia-born
  immigrants1
• Yin-Yang theory may be followed yang (hot)
  foods would be recommended since heat is believed
  to be lost after childbirth
• Classifications of food are not defined by
  literal meanings, but rather by culture,
  tradition, and personal experiences over time
• Yang (hot) foods include beef, chicken, eggs,
  fried foods, hot and spicy foods, liquor

1. Wu AH, et al. (1996) Menstrual and
reproductive factors and risk of breast cancer in
Asian-Americans. Br J Cancer. 73(5)680-6.
21
American Indian/Alaska Natives Lactation

• Breastfeeding is often identified as a
  traditional and culturally appropriate food for
  their infants, though certain barriers such as
  misinformation exist
• In the early postpartum period, 51 of AI/ANs
  were breastfeeding (Healthy People 2000)
• Rate from 1990 to 1997 increased from 47 to 56
• However, the percentage of infants still
  breastfed at age six months decreased from 27 in
  1990 to 25 in 1997

22
Successful Breastfeeding Promotion Interventions
among AI/ANs

• Breastfeeding initiation rates increased from 38
  in 1995 to 60 in 1997 for those subjects in the
  Sagkeeng First Nation Community breast-feeding
  promotion intervention1
• After a breast-feeding promotion intervention
  among Navajo Indians2
• the proportion of women breastfeeding exclusively
  for any period of time increased from 16.4 to
  54.6
• Proportion of infants fed formula from birth
  declined by almost half (83.6 ? 45.4)

• Martens PJ. (2002). Increasing breastfeeding
  initiation and duration at a community level an
  evaluation of Sagkeeng First Nation's community
  health nurse and peer counselor programs. J Jum
  Lact. 18(3)236-46.
• Wright AL, et al. (1998). Increasing
  Breastfeeding Rates to Reduce Infant Illness at
  the Community Level. Pediatrics. 101837-44.

23
American Indian/Alaska Natives Lactation
Protective benefit of breastfeeding
Pettitt D, et al. (1997). Breastfeeding and
incidence of non-insulin-dependent diabetes
mellitus in Pima Indians. Lancet 250166-8.
24
Infant Nutrition(less than 12 months of age)

• Infant feeding practices are integral parts of
  individuals' ethnic and cultural beliefs
• Culturally-based feeding beliefs influence how
  individual mothers in various ethnic groups make
  decisions

25
Health Advances and Concerns for All US Infants
and Children
CDC. (2003). Pediatric Nutrition Surveillance.
Retrieved 10/05/05 from http//www.cdc.gov/nccdphp
/dnpa/pdf/2001_ped_nutrition_report.pdf.
26
Key Issues Concerning Nutrition during Infancy

• Infants fed breast milk have a lower risk of
  being overweight during older childhood and
  adolescence
• Short stature (low length/height-for-age) may
  reflect the nutritional status of a child
• Could possibly result from growth retardation due
  to chronic malnutrition caused by inadequate food
  intake
• The highest prevalence of iron-deficiency anemia
  is in infants
• More likely to occur in infants of low birth
  weight and lower socioeconomic status
• Several studies of infants in various urban areas
  of the US reveal an iron deficiency prevalence of
  17 to 441

1. Brotanek, et al. (2005). Iron Deficiency,
Prolonged Bottle-Feeding, and Racial/Ethnic
Disparities in Young Children. Arch Pediatr
Adolesc Med, 159 1038-42.
27
Importance of Infant Nutrition

• The foundation for dietary habits and nutritional
  adequacy over ones lifetime is established
  during infancy
• Infancy is the stage when initial contact with
  and orientation to foods typical of ones culture
  are established

28
Prevalence of Low Birth Weight Varies by Ethnicity

• Low-birth weight infants are at an increased risk
  for developing health problems such as
  respiratory disorders and neurodevelopment
  disabilities
• Prevalence of low birth weight in the US
• White infants 8.4
• Black infants 12.6
• AAPI infants 8.2
• American Indian/Alaska Native infants 7.3
• Hispanic-American infants 7.0

CDC. (2003). Pediatric Nutrition Surveillance.
Retrieved 10/05/05 from http//www.cdc.gov/nccdphp
/dnpa/pdf/2001_ped_nutrition_report.pdf.
29

• From 1992-2001, low
• birthweight rates
• improved for Hispanic infants
• remained the same for black and AAPI infants
• worsened for white and American Indian/Alaska
  Native infants

CDC. (2003). Pediatric Nutrition Surveillance.
Retrieved 10/05/05 from http//www.cdc.gov/nccdphp
/dnpa/pdf/2001_ped_nutrition_report.pdf.
30
Prevalence of High Birth Weight Varies by
Ethnicity

• High birth weight ( 4,000 grams) puts infants at
• increased risk for death and birth injuries
• The prevalence of high birth weight
• American Indian/Alaska Native infants 11.0
• White infants 9.2
• Hispanic-Americans 8.4
• AAPI infants 6.2
• Black infants 5.0

31
Childhood Nutrition

• Ethnicity influences the types of foods children
  eat

32
Key Issues Concerning Nutrition during Childhood

• Short stature (low length/height-for-age) may
  reflect the long-term health and nutritional
  status of a child or a population
• The prevalence of overweight in children has
  doubled since 1980
• The most common nutritional deficiency in
  children is iron-deficiency, which is associated
  with developmental delays and behavioral
  disturbances

33
Duration of Bottle-Feeding varies by
Race/Ethnicity (1-3y)
Prevalence of Iron-Deficiency Anemia Varies by
Race/Ethnicity (1-3y)
Brotanek JM, et al. (2005). Iron Deficiency,
Prolonged Bottle-Feeding and Racial/Ethnic
Disparities in Young Children. Arch Pedia Adolesc
Med. 159103842.
34
Female dietary intake of cholesterol, fat,
saturated fat and sodium varies by ethnicity
MA Mexican-American
Source McDowell MA, et al. (1994). Energy and
macronutrient intakes of person ages 2 months and
over in the United States NHANES III, Phase 1,
1988-91. National Center for Health Statistics.
35
Male dietary intake of fiber, fat, saturated fat
and sodium varies by ethnicity
MA Mexican-American
Source McDowell MA, et al. (1994). Energy and
macronutrient intakes of person ages 2 months and
over in the United States NHANES III, Phase 1,
1988-91. National Center for Health Statistics.
36
Female dietary intake of micronutrients varies by
ethnicity
MA Mexican-American
Source Alaimo K, et al. (1994). Dietary intake
of vitamins, minerals, and fiber of persons ages
2 months and over in the United States  NHANES
III, Phase I. 1988-1991. National Center for
Health Statistics
37
Male dietary intake of micronutrients varies by
ethnicity
MA Mexican-American
Source Alaimo K, et al. (1994). Dietary intake
of vitamins, minerals, and fiber of persons ages
2 months and over in the United States  NHANES
III, Phase I. 1988-1991. National Center for
Health Statistics
38
Prevalence of overweight and risk of
overweightamong children (2-5y), by race and
ethnicity
Percentage Overweight
Graph from the CDC report titled Overweight Case
Study Who Is Affected?
39
Prevalence of overweight and obesity, children
ages 6-11, by ethnicity

• Of importance
• Mexican American and African American children in
  the US are considerably more overweight and obese
  than their white counterparts

40
Iron Deficiency most common nutritional
deficiency in childhood1

• Prevalence found to be 9 among children ages
  12-30 months
• Recent research has found an association between
  prolonged bottle-feeding and iron deficiency
• Prevalence of iron deficiency
• Bottle-fed 12 months or less 3.8
• Bottle-fed 13-23 months 11.5
• Bottle-fed 24-48 months 12.4

1. Brotanek, et al. (2005). Iron Deficiency,
Prolonged Bottle-Feeding, and Racial/Ethnic
Disparities in Young Children. Arch Pediatr
Adolesc Med, 159 1038-42.

41
Dietary factors contributing to iron deficiency
anemia in young children

• Use of cow's milk during the first year of life
• Excessive intake of milk (24 oz. per day
• meets the calcium needs of 1- 5 year olds)
• Excessive intake of fruit juice or drinks
• Prolonged bottle-feeding (past 15 months of age)

42
African-American children suffer from the
highest rates of anemia
43
African-Americans during Childhood

• Female African-Americans children (ages 6-11)
  experience the highest overweight and obesity
  prevalence among female youth 37.6 and 22.2
  respectively1
• According to the CDCs Pediatric Nutrition
  Surveillance, black children have the highest
  prevalence of anemia 19.6

1. Statistics from the American Obesity
Association
44
Asian-Americans during Childhood

• Low-income AAPI children in California are
  becoming overweight at an increasing rate -- and
  will soon catch up to low-income white, black and
  Latino children in the proportion who are
  overweight or obese
• The percentage of low-income AAPI children in CA
  who are overweight more than doubled between 1994
  and 2003, from 7 to 15
• AAPIs have the fastest growing rate of overweight
  and obese children
• The lure of fast food, children's adoption of
  American eating habits, and long work hours were
  identified as barriers to a healthy, more
  traditional lifestyle1

1. Harrison GG, et al. (2005). Seizing the
Moment. Cancer.
45
Hispanic-Americans during Childhood

• Latino ethnicity is associated with an increased
• prevalence of continued bottle use (bottle-fed
• between 2 and 5 years of age) 1
• 36.8 of MA children were bottle-fed between the
  ages of 24 to 48 months compared to 16.9 and
  13.8 for white and black children, respectively
• MA children may be at an increased risk for iron
  deficiency since they are more likely to be
  bottle-fed past 15 months
• MA males (ages 6-11) experience the highest
  overweight and obesity prevalence among male
  youth 43 and 27.3 respectively2

• Brotanek, et al. (2005). Iron Deficiency,
  Prolonged Bottle-Feeding, and Racial/Ethnic
  Disparities in Young Children. Arch Pediatr
  Adolesc Med, 159 1038-42.
• Statistics from the American Obesity Association

46
American Indian/Alaska Natives during Childhood

• Fruit and vegetable consumption among a
  population-based sample of AI/AN youth
• Less than 1/4 of youths consumed recommended
  daily servings of fruit
• Less than 1/3 consumed recommended daily servings
  of vegetables

Source Di Noia J, et al. (2005) Dietary Patterns
of Reservation and Non-Reservation Native
American Youths. Ethnicity Disease.
15(4)705-12.
47
Adolescent Nutrition

• Ethnicity influences the types of foods
  adolescents eat

48
Adolescent Nutrition

• Prevalence of overweight and obesity among
  adolescents is rising
• Overweight and obese status can negatively affect
  an adolescents physical, social and
  psychological development
• Overweight and obese status are associated with
  emotional difficulties, such as
• Low self-esteem
• Depression
• Anxiety

49
Adolescence
Overweight children and adolescents are more
likely to become overweight adults

• Consequences of obesity in adolescence include an
  increased risk for developing many diseases and
  conditions, such as
• Heart disease
• Hypertension
• High cholesterol levels
• Type II diabetes
• Sleep apnea

50
Ethnicity affects nutritional status during
adolescence

• Various ethnic groups have different food
  availabilities, food preferences, dietary
  patterns, and cultural definitions of foods

• Frequency of family meals varies by ethnicity
• Frequent family meals are associated with
  improved nutritional intake and a decreased risk
  for unhealthy weight control practices1
• Adolescents undergo dramatic physical, cognitive,
  social, and emotional changes in a relatively
  short period of time these changes affect eating
  practices and health

1. Neumark-Sztainer D, et al. (2003). Family
meal patterns associations with sociodemographic
characteristics and improved dietary intake among
adolescents. JADA, 103(3)317-22.
51
Percentage of adolescents reporting inadequate
fruit and vegetable consumption, by ethnicity
Neumark-Sztainer D, et. al. (1996). Correlates of
fruit and vegetable consumption among
adolescents. Preventive Medicine, 25 497-505.
52
Food Intake Patterns for Adolescents, by ethnicity
Weicha JM, et al. (2001). Differences in dietary
patterns of Vietnamese, White, African-American,
and Hispanic adolescents in Worcester, Mass.
JADA, 101248-251.
53
Ethnic differences family meals/week

• Frequency of family meals is positively
  associated with intakes of fruits, vegetables,
  grains, and calcium-rich foods, and negatively
  associated with soft drink intake
• Strong positive associations are found between
  family meal frequency and intakes of energy
  percentage of calories from protein calcium
  iron vitamins A, C, E, B-6, folate and fiber
• Family meals are most frequent among Asian
  American adolescents and least frequent among
  African American adolescents

Neumark-Sztainer D, et al. (2003). Family meal
patterns associations with sociodemographic
characteristics and improved dietary intake among
adolescents. JADA, 103(3)317-22.
54
Fruit, vegetable and milk intake of high school
students

• Of importance Low percentages across the board
  indicate that
• recommendations are not being met by all groups

1. CDC Surveillance Summaries, MMWR 2000 49(no.
SS-5)
55
Ethnicity affects nutritional status, which can
affect timing of puberty

• Obesity may contribute to earlier onset of
  puberty in girls
• Strong evidence supports the claim that body fat
  is associated with the initiation of the hormonal
  events of puberty
• Association between obesity and early puberty
  varies in degree by ethnicity

56
Overweight Prevalence by Ethnicity for
Adolescent Boys and Girls
.
Ogden CL, et al. (2002). Prevalence and Trends in
Overweight Among US Children and Adolescents,
1999-2000. JAMA 2881728-1732.
57
Overweight in this study was defined as a BMI
for age that was 95th percentile
Hedley A, et al. (2002) Prevalence of Overweight
and Obesity Among US Children, Adolescents and
Adults. JAMA, 291(23) 2847-50.
58
Proportion of adolescents with early, late, or
average age at menarche
Percent of sample
11-13
13
59
Prevalence of menses by ethnicity and age
Herman-Giddens ME, et al. (1997). Secondary
Sexual Characteristics and Menses in Young Girls
Seen in Office Practice A Study from the
Pediatric Research in Office Settings Network.
Pediatrics, 99505-512.
60
Dieting Practices in Both Male and Female HS
Students, by Ethnicity
Statistics from Calderon L, et al. (2004).
Dieting Practices in High School Students. ADA,
104 1369-74.
61
Body weight dissatisfaction, dieting and
disordered eating behaviors vary by ethnicity
CDC Surveillance Summaries. MMWR 200049(No.
SS-5).
62
Vietnamese-American Food Intake Patterns during
Adolescence

• Fruit intake of Vietnamese youth was 35.5 and
  vegetable intake 15.3 greater than white youth
• Dairy product intake of Vietnamese youth was 44
  less than white youth (high levels of lactose
  intolerance in Asian-American population)
• Although their diet was higher in fruit and
  vegetables than any other ethnic group, 72 of
  Vietnamese adolescents still did not meet the
  recommended 5 servings/day1

1. Weisha JM, et al. (2001). Differences in
dietary patterns of Vietnamese, White,
African-American, and Hispanic adolescents in
Worcester, Mass. JADA, 101248-251.
63
Asian-Americans and Adolescence

• Ages 13 to 18 overweight prevalence of 20.6
• US-born AA adolescents born are more than twice
  as likely to be overweight than foreign born
  adolescents who move to the US1
• Foreign-born Asian students in the US report
  significant increases in the consumption of fats
  and sweets2

• Novotny R, et al. (2003). Calcium Intake of
  Asian, Hispanic and White Youth. J Am Coll Nutr,
  22(1)64-70.
• Lv N, et al. (2004). Dietary Pattern Change and
  Acculturation of Chinese Americans in
  Pennsylvania. JADA, 104(5) 771-8.

64
Hispanic-American Adolescents

• US-born Hispanic-American adolescents are more
  than twice as likely to be overweight than
  foreign-born adolescents who move to the US
• Hispanic-Americans males (12-19y) experience the
  highest obesity and overweight prevalence rates
  for adolescent males 44.2 and 27.5
  respectively

1Novotny R, et al. (2003). Calcium Intake of
Asian, Hispanic and White Youth. J Am Coll Nutr,
22(1)64-70.
65
Mean intake of fat, saturated fat, cholesterol
and fiber by participants (12-19y) in the Navajo
Health and Nutrition Survey, 1991-1992, and Zuni
11th and 12th graders
66
Native Americans during Adolescence

• Intake of dietary fat and cholesterol current
  dietary recommendations
• One exception Zuni females' intake of
  cholesterol met recommendations
• Fiber
• 70 of Zuni males and 80 of Zuni females did not
  consume the minimum recommended amount of fiber
• Navajo adolescents consumed 15 of total calories
  from foods with low nutritional value, such as
  soft drinks, candy, desserts, snacks, and added
  fat

1. Cole SM, et al. (2001). Dietary intake of
Zuni adolescents. JADA, 101802-806 2. Navajo
Health and Nutrition Survey, 1991-1992
67
Zuni Adolescent Dietary Intake

• Of total calories for Zuni males
• sugared drinks accounted for 13
• salty snacks 8
• sweets 3.7
• Of total calories for Zuni females
• sugared drinks accounted for 20.7
• salty snacks 4.1
• sweets 4.9

1. Cole SM, et al. (2001). Dietary intake of
Zuni adolescents. JADA, 101802-806
68
Native Americans and Obesity during Adolescence

• Overweight and obesity prevalence varies greatly
  by tribal group and region
• For Native Americans (5-19y), the Aberdeen area
  Indian Health Service reported an overweight
  prevalence of 39 for males and 38 for females

69
Bodyweight Concerns for the Elderly

• Though obesity is still a major health concern
  for the elderly, many struggle with losing too
  much weight due to aging or possible illness
• CDC researchers found that although both obese
  and underweight people are at an increased risk
  of premature death, extreme thinness is more
  strongly associated with death in people over age
  70

70
Importance of Nutrition during the Aging Process

• Distinct nutrition-related factors that may
  protect against diseae in people who live to be
  100y
• elevated HDL levels
• decreased platelet activation, which can exert a
  protective effect against CVD
• high levels of vitamins A and E (potent
  antioxidants)

Position of the American Dietetic Association
Nutrition Across the Spectrum of Aging. JADA.
2005 105 616-633.
71
Dietary changes associated with aging

• As people age, dietary patterns change
• Quantity of food and energy intake decreases
  substantially
• Mean energy declines by 1,000 - 1,200 kcal in men
  and by 600 - 800 kcal in women between 20y and
  80y
• Micronutrient intakes decline, especially
  calcium, zinc, iron, and B vitamins
• In those people 65 years of age and older
  assessed in NHANES III indicated that 11 of men
  and 10.2 of women were anemic

American Dietetic Association. (2005). Nutrition
Across the Spectrum of Aging. JADA.. 105
616-633.
72
Elderly Navajo Population

• Report diets of limited variety
• Diets low in
• Vitamin A
• Vitamin C
• Folate
• Calcium
• Compared with Whites (65y), Native
  Americans/Alaskan Natives are 2.6 times more
  likely to develop diabetes

Findings from the Navajo Health and Nutrition
Survey, 1991-1992
73
For more information on the effect of ethnicity
on adult and elderly nutrition, please refer to
the lecture titled The Effect of Ethnicity on
Nutrition and Risk for Chronic Disease in the
United States