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Nutritional Epidemiology

Adherence to Dietary Recommendations for Saturated Fat, Fiber, and Sodium Is Low in American Indians and Other U.S. Adults with Diabetes^1,2

³ Zinman College for Physical Education and Sports, Wingate Institute, 42902 Netanya, Israel; Department of Epidemiology and Preventive Medicine, Sackler Medical Faculty, Tel Aviv University, Tel Aviv, Israel; ⁴ Center for Biostatistics, Methodist Hospital Research Institute, Houston, TX; ⁵ Aberdeen Area Indian Health Service, Aberdeen, SD 57401; ⁶ Wagner Indian Health Service, Diabetes Prevention Project, Wagner, SD 57380; ⁷ Medstar Research Institute, Hyattsville, MD 20783; ⁸ American Association of Homes and Services for the Aging, Washington, DC; and ⁹ Georgetown University, Washington, DC 20057

The objective of this article was to evaluate how well American Indians with diabetes met dietary recommendations and to compare adherence to dietary recommendations with those of U.S. adults with diabetes in the NHANES. Dietary intake in both studies was assessed using a 24-h recall questionnaire. Dietary intakes were evaluated against American Diabetes Association (ADA) dietary recommendations. The analysis sample consisted of 1008 participants from the Strong Heart Study (SHS) examined from 1997 to 1999 and 373 participants from NHANES examined from 1999 to 2000, all with diabetes. In both samples, intake of protein, PUFA, monounsaturated fatty acids, and carbohydrates met the 1997 ADA dietary recommendations. However, intakes of SFA as well as sodium were higher and dietary fiber intake was lower than recommended. In the SHS and NHANES, only 4.6 and 8.5% of persons with diabetes met recommendations for both SFA and fiber (P = 0.02), respectively. However, only 8.3% of the NHANES sample met the 2006 recommendations for SFA and fiber and none of the SHS sample met those recommendations. This cross-sectional study shows low adherence to ADA dietary recommendations for saturated fat, fiber, and sodium by American Indians with diabetes and by the broader U.S. population of adults with diabetes and shows that for American Indians with diabetes, programs to decrease SFA and increase fiber intakes are warranted.

^* To whom correspondence should be addressed. E-mail: eilatsi{at}017.net.il.

Manuscript received 5 February 2008. Initial review completed 4 March 2008. Revision accepted 20 June 2008.