Dietary patterns and their association with cardiovascular risk factors in a population undergoing lifestyle changes: The Strong Heart Study

Nutr Metab Cardiovasc Dis. 2013 Jun;23(6):528-35. doi: 10.1016/j.numecd.2011.12.005. Epub 2012 Apr 24.


Background and aims: Rates of cardiovascular disease (CVD) are disproportionately high in American Indians (AI), and changes in lifestyle may be responsible. It is not known whether diverse dietary patterns exist in this population and whether the patterns are associated with CVD risk factors. This article describes the relationships between dietary patterns and CVD risk factors in this high-risk population.

Methods and results: Nutrition data were collected via food frequency questionnaire from 3438 Strong Heart Study (SHS) participants, ≥ age 15 y. All participants were members of 94 extended families. The final sample consisted of 3172 men and women. Diet patterns were ascertained using factor analysis with the principal component factoring method. We derived four predominant dietary patterns: Western, traditional AI/Mexican, healthy, and unhealthy. Participants following the Western pattern had higher LDL cholesterol (LDL-C) (p < 0.001), slightly higher systolic blood pressure (BP) (p < 0.001), lower HDL cholesterol (HDL-C) (p < 0.001), and slightly lower homeostasis model assessment estimates of insulin resistance (HOMA-IR) in the lowest vs. highest deciles of adherence to this pattern (p < 0.001). The traditional diet was associated with higher HDL-C (p < 0.001), but higher body mass index (BMI) (p < 0.001) and HOMA-IR (p < 0.001). Followers of the healthy pattern had lower systolic BP, LDL-C, BMI, and HOMA-IR in increasing deciles (p < 0.001). The unhealthy pattern was associated with higher LDL-C.

Conclusions: Dietary patterns reflect the changing lifestyle of AI and several of the patterns are associated with CVD risk factors. Evolving methods of food preparation have made the traditional pattern less healthy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Biomarkers / blood
  • Blood Pressure
  • Body Mass Index
  • Cardiovascular Diseases / ethnology*
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Diet
  • Feeding Behavior*
  • Female
  • Humans
  • Indians, North American / ethnology*
  • Insulin / blood
  • Insulin Resistance
  • Life Style*
  • Linear Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Risk Factors
  • Triglycerides / blood
  • United States / epidemiology
  • Young Adult


  • Biomarkers
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Insulin
  • Triglycerides