1. Diet & Type 2 Diabetes among American Indians: The Strong Family Heart Study Mandy Fretts, PhD MPH Nutritional Sciences Program Faculty Research Forum January 9, 2015

2. Background Type 2 diabetes is a chronic disease marked by high levels of sugar in the blood The burden of diabetes in the US is increasing

3. Background Diabetes is a leading cause of morbidity & mortality among American Indians (AIs) American Indians 2.5 times more likely to have diagnosed diabetes than non-Hispanic whites High burden of diabetes in American Indian communities may be attributable to lifestyle (e.g., diet, physical activity)

4. 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

5. Methods 13 communities in AZ, OK, ND, SD N=3665 (96 families) Baseline exam (2001-2003) Follow-up exam (2007-2009) Detailed data on socio-demographic factors, health behaviors, biomarkers, & genetics

6. Available Measures Demographics Social factors DNABiomarkersECG Cardiac/carotid ultrasound Physical activity (pedometers) Diet

7. Dietary Assessment Interview-administered past-year 119-item Block FFQ, including American Indians food supplement (Indian taco, fry bread, spam, menudo, guysava, tortillas) Ascertained frequency & portion size for each food item Block database (Block Dietary Systems, Berkeley, CA) used to calculate average macronutrient intakes

8. Baseline Characteristics of Study Participants Female, %59 Age, yrs, median (IQR) 34 (23, 44) BMI, kg/m 2, median (IQR) 32 (26, 36) Obesity, %57 Education, yrs, median (IQR) 12 (11, 13) Steps/Day, median (IQR) 5410 (3500, 8000) Current smoking, %36

9. Achievement of Life’s Simple 7 Dietary 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.

10. Diabetes in the SHFS Diabetes=Treated with insulin or diabetic medication or fasting plasma glucose ≥ 126 mg/dl

11. Conclusions & Opportunities The burden of diabetes among Americans is high Reported diets are high in fat & processed foods, and low in whole grains, fruits & vegetables Rich data set Many opportunities for student projects http://strongheart.ouhsc.edu/ My email: amfretts@uw.edu