Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Clinical Care/Education/Nutrition

The Effect of Indian or Anglo Dietary Preference on the Incidence of Diabetes in Pima Indians

  1. Desmond E. Williams, MBChB, PhD1,
  2. William C. Knowler, MD, DrPH1,
  3. Cynthia J. Smith, MSc, RD2,
  4. Robert L. Hanson, MD, MPH1,
  5. Janine Roumain, MD, MPH1,
  6. Aramesh Saremi, MD1,
  7. Andrea M. Kriska, PhD3,
  8. Peter H. Bennett, MBChB, FRCP, FFCM1 and
  9. Robert G. Nelson, MD, PhD1
  1. 1Phoenix Epidemiology and Clinical Research Branch, National Institutes of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
  2. 2University of California, Irvine, CA
  3. 3Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
    Diabetes Care 2001 May; 24(5): 811-816. https://doi.org/10.2337/diacare.24.5.811
    PreviousNext
    • Article
    • Figures & Tables
    • Info & Metrics
    • PDF
    Loading

    Abstract

    OBJECTIVE—In short-term studies, adoption of a traditional diet is associated with reduction in metabolic abnormalities often found in populations experiencing rapid lifestyle changes. We examined the long-term effects of a self-assessed traditional or nontraditional dietary pattern on the development of type 2 diabetes in 165 nondiabetic Pima Indians.

    RESEARCH DESIGN AND METHODS—Dietary intake was assessed in 1988 by a quantitative food frequency method, and subjects were asked to classify their diet as “Indian,” “Anglo,” or “mixed.” The Indian diet reflects a preference for Sonoran-style and traditional desert foods. The Anglo diet reflects a preference for non-Sonoran–style foods typical of the remaining regions of the U.S.

    RESULTS—In women, the intake of complex carbohydrates, dietary fiber, insoluble fiber, vegetable proteins, and the proportion of total calories from complex carbohydrate and vegetable proteins were significantly higher (P < 0.05) in the Indian than in the Anglo diet. The mixed diet was intermediate in of all these constituents. In men, the intake for these nutrients was also higher in the Indian than in the Anglo group, but not significantly. Diabetes developed in 36 subjects (8 men and 28 women) during 6.2 years of follow-up (range 0.9–10.9). The crude incidence rates of diabetes were 23, 35, and 63 cases per 1,000 person-years in the Indian, mixed, and Anglo groups, respectively. After adjustment for age, sex, BMI, and total energy intake in a proportional hazards model, the risk of developing diabetes in the Anglo-diet group was 2.5 times as high (95% CI 0.9–7.2) and the rate in the mixed-diet group was 1.3 times as high (0.6–3.3) as in the Indian-diet group.

    CONCLUSIONS—This study suggests that the adoption of an Anglo diet may increase the risk of developing diabetes in Pima Indians, but it does not provide unequivocal evidence for or against this hypothesis.

    Diet is an environmental/behavioral factor that is believed to play a role in the development of diabetes, although the evidence for this is largely circumstantial. Obesity is strongly related to the development of type 2 diabetes, and in the last century the Pima Indians have experienced a dramatic increase in the degree of obesity (1). Over the same period, the traditional Pima diet of grains, squash, melons, and legumes, supplemented by gathered desert plants (2,3), has evolved to a diet more typical of the U.S. diet (4). Among Australian Aborigines, urban dwellers typically consume a diet higher in fat and lower in fiber than their rural, more active, counterparts. When a group of “urbanized” Aborigines with type 2 diabetes assumed a traditional lifestyle, including diet, for 7 weeks, they showed marked improvements in fasting glucose, insulin, and triglyceride concentrations (5). Likewise, a traditional Indian diet fed to Pima Indian and Caucasian volunteers for 2 weeks led to improvements in glucose tolerance and a reduction in plasma cholesterol concentration (6). On the other hand, a high-fat hypercaloric “affluent” diet fed to a small group of Tarahumara Indians for 5 weeks led to 7% weight gain and an increase in total and LDL cholesterol and plasma triglyceride concentrations (7). These studies suggest that a Western lifestyle is associated with an adverse health profile and that the adverse metabolic consequences of modernization might be reduced if a traditional lifestyle is maintained.

    The present study examined the long-term effects of a self-assessed preference for a more traditional or less traditional dietary pattern on the development of diabetes in Pima Indians from the Gila River Indian Community.

    RESEARCH DESIGN AND METHODS

    An age- and sex-stratified sample of 575 Pima Indians aged 18 to 74 years underwent a dietary survey in 1988 (4). The present study included the 165 subjects (77 men and 88 women) who did not have diabetes at the time of the survey, as ascertained from glucose tolerance tests during a research examination within 1 year of the dietary assessment. For the present analysis, this examination was considered as the baseline examination. Women who were pregnant or <6 weeks postpartum at the time of the dietary survey were excluded. The subjects were examined periodically between June 1988 and June 1999. Each subject included in this study had at least two examinations. Examinations included a glucose tolerance test with determination of the glucose concentration in venous plasma drawn after an overnight fast and 2 h after a 75-g oral carbohydrate load. Diabetes was defined according to the criteria of the World Health Organization (8). The date of diagnosis was determined from research examinations or from review of clinical records if diabetes was diagnosed in the course of routine medical care.

    Blood pressure was measured to the nearest 2 mmHg with a mercury sphygmomanometer while the subject rested in the supine position. Diastolic blood pressure was measured at the fourth Korotkoff sound. BMI was computed as the weight in kilograms divided by the square of height in meters.

    Plasma glucose concentrations were measured with an autoanalyzer by the potassium ferricyanide method until 1991 and by the hexokinase method thereafter (9). HbA1 was measured by electrophoresis (10) at baseline, and thereafter HbA1c was measured by high-performance liquid chromatography.

    Leisure-time physical activity was measured in a subsample (n = 139) of the study population with a modified activity questionnaire developed for use in this population (11,12,13). The questionnaire recorded the frequency and duration of activities that require energy expenditure greater than the activities of daily living, i.e., bathing, grooming, and feeding. The frequency and duration of these activities were weighted by their relative intensity (metabolic equivalent) (14) to produce an estimate of total leisure-time physical activity for the previous year (12).

    Parents of many subjects were examined as part of the longitudinal diabetes survey, and the presence of diabetes in the parent at the time of the dietary interview was determined from these examinations. For each subject, the number of siblings was computed as the number of offspring from the same mother.

    Dietary intake was assessed by a 24-h food recall and a quantitative food frequency assessment, as previously described (4). Results of the quantitative food frequency assessment were used in this study because they correlate most closely with the total energy expenditure measured with the doubly labeled water method (15). Interviews were conducted by trained Pima women and supervised by a research dietitian using standard methods recommended by the Nutrition Coordination Center of the University of Minnesota, Minneapolis, Minnesota (16). The quantitative assessment had an open format and inquired about the subject’s usual dietary intake. This method permits a more detailed estimate of the portion size than a self-administered food frequency questionnaire (17). Subjects were also asked to classify their diet as being mainly “Indian,” “Anglo,” or “mixed.” The Indian diet has been described in detail by Reid et al. (18), which reflects the influence of popular Sonoran-style foods common in the Southwest and includes dishes such as tortillas, tacos, tamales, chili stew, menudo, and chorizo sausage, as well as the traditional desert foods, and the melons and squash introduced by the Spanish in the late 17th century (19). Legumes are a staple in this diet, as pinto beans are combined with many food items (4). The Anglo diet, on the other hand, reflects a preference for a Western diet typical of the remaining regions of the U.S. Energy and nutrient intake was calculated using the University of Minnesota Nutrient Calculation System and database (version 1.3, released June 1989) developed by the University of Minnesota Nutrition Coordinating Center (16). The database was expanded to include specific American-Indian foods (19). Carbohydrates were subdivided into simple (sucrose, galactose, glucose, fructose, and lactose) and complex (starch and dietary fiber) carbohydrates.

    The studies were approved by the review boards of the National Institute of Diabetes and Digestive and Kidney Diseases and by the Tribal Council of the Gila River Indian Community. Each participant gave informed consent.

    Statistical analysis

    Data analysis was performed using Stata software (20). Student’s t and χ2 tests were used to test differences in means and proportions. Fisher’s exact test (21) was used to test differences in proportions when there were less than five expected observations in any cell. Analysis of variance was used to test differences between the three dietary groups. The effect of dietary pattern on the development of type 2 diabetes was examined using a Cox proportional hazards model to control for the effects of potentially confounding variables. A test for trend (P trend) across the different dietary preference categories was obtained by coding the Indian diet as 0, the mixed diet as 1, and the Anglo diet as 2 in the proportional hazards model. Follow-up time was computed from the date of the baseline examination to the date of the diagnosis of diabetes or the last examination before June 1999. Age at dietary interview was entered as a continuous variable and as a quadratic term. The quadratic term was not significant and was not included in the final model. BMI and total energy intake were included as standardized variables. Leisure-time physical activity was dichotomized at the median for each sex. Product terms among predictor variables were not examined because of the limited number of cases. The adequacy of the proportional hazards model was assessed using the method proposed by Grambsch and Therneau (22). In this method, a generalized linear regression of the scaled Schoenfeld residuals on functions of time is performed, and a nonzero slope (rejection of the null hypothesis) indicates that the log hazard ratio function was not constant over time. All variables satisfied the proportional hazards assumption.

    RESULTS

    Of the 165 subjects without diabetes at baseline, 49 classified their diet as Indian, 95 as mixed, and 21 as Anglo. The mean duration of follow-up was 6.2, 6.3, and 6.0 years in the Indian, mixed, and Anglo groups, respectively. The clinical and demographic characteristics of the population at baseline are shown in Table 1 according to self-reported dietary pattern. Blood pressure, BMI, waist circumference, and glucose tolerance were similar in all groups. Weight and height were also similar in all groups (data not shown). At baseline, there were no significant group differences in the proportion of subjects living on or off the reservation, the number of siblings in the family, or the parental family history of diabetes. Leisure-time physical activity was highest in the Indian-diet group and lowest in the Anglo-diet group, but the differences in physical activity levels were not statistically significant (Table 1).

    Among women, complex carbohydrates (P < 0.05), dietary fiber (P = 0.05), insoluble fiber (P = 0.04), and vegetable proteins (P = 0.04) were significantly higher in the Indian-diet group than in the Anglo-diet group, and the values for the mixed-diet group were intermediate (Table 2). Fat and protein contents of the three diets were similar. Differences in complex carbohydrate and vegetable proteins remained significant after expressing the nutrients as a percentage of total caloric intake (Table 2). However, the fiber content of the three diets did not differ significantly when expressed as a fraction of total energy intake. In men, there were no significant differences in nutrient intake by dietary preference, although there was a tendency for the Anglo diet to be lower in complex carbohydrates and higher in alcohol consumption when both were expressed as a fraction of total energy intake. At the end of the study, the mean fasting, 2-h glucose, and HbA1c concentrations were higher, but not significantly, in Anglo-diet subjects than in Indian-diet subjects, and concentrations were intermediate in mixed-diet subjects. Systolic and diastolic blood pressures were slightly higher, but not significantly, in Indian-diet subjects compared with those of the two other groups (Table 3).

    Diabetes developed in 36 (22%) of the subjects (8 men and 28 women) during a mean follow-up of 6.2 years (range 0.9–10.9). Subjects reporting an Anglo diet were more likely to develop diabetes over the study period (Table 4). The incidence of diabetes in the Indian, mixed, and Anglo dietary groups were 23, 35, and 63 cases per 1,000 person-years, respectively. The risk of developing diabetes in Anglo-diet subjects was 2.9 times (95% CI 1.1–8.1) as high as that of Indian-diet subjects (Table 4). Compared with the Indian diet, the unadjusted sex-specific hazard of diabetes in the Anglo diet was 3.3 (0.9–11.5) in women and 1.6 (0.2–16.1) in men. Additional adjustments for age, baseline BMI, total caloric intake, and sex did not substantially alter the point estimate (2.5; 0.9–7.2), but the CI included 1. After adjustment for age, BMI, and total energy intake, the risks were 3.0 (0.8–10.7) in women and 1.4 (0.1–16.6) in men.

    Further adjustment for physical activity in the subset of subjects with physical activity data was associated with a greater risk of diabetes in Anglo-diet subjects (5.0; CI 1.2–20.3) (Table 4), but the effect of the Anglo diet in this subset was greater than in the total sample, even without adjustment for physical activity (5.2; CI 1.3–21.3).

    No relationship was observed between any individual nutrient and the risk of diabetes after adjustment for total caloric intake (Table 5).

    CONCLUSIONS

    This study suggests that the adoption of an Anglo diet may increase the risk of developing diabetes in Pima Indians, but it does not provide definitive evidence for this hypothesis. Fewer men developed diabetes in our study, therefore these results pertain primarily to women. In the women, the nutrient pattern of a self-reported traditional Indian diet was distinct from that of an Anglo diet, and the Indian diet was associated with a lower risk of diabetes over 6 years. This finding is consistent with previous short-term studies that suggest that a traditional lifestyle protects some indigenous people from diabetes. Our results are strengthened by the intermediate values of both the nutrient intakes and the glucose and insulin concentrations in women who rated their diet as consisting of a mixture of the Indian and Western diets. Clearly, more investigation of this relationship is needed.

    The pattern of nutrient intake for the Indian diet in women was closer to that expected for the early Pima Indian diet (18), with the exception of fat intake. The increased fat intake may be an indication that the Pima diet has evolved over time toward the Western diet. Societal pressures and the commodity food distribution programs that serve this community undoubtedly influence the nutrient intake, even in subjects who wish to adhere to the early Indian diet (23). The food distribution programs provide staples such as canned meats, vegetables, and fruits, American cheese, dry cereals, fruit juices, canned or dried milk, and egg mix, which are frequently incorporated into the Pima diet (4).

    The main differences between the three diets in women were in total caloric intake and in the amount of complex carbohydrate, fiber, and vegetable protein they contained, with the Indian diet containing the highest levels of each of these nutrients. Although the fiber composition of the diet was not significantly different after adjusting for total energy intake, the influence of fiber on the dietary patterns may be a bulk effect, and if so, the absolute amounts would be more important. In the men, the difference in nutrient composition was probably not statistically significant because of the small sample size in the Anglo group. Presumably, the higher consumption of legumes in the Indian diet is responsible for the increased fiber intake, although this cannot be confirmed because quantitative food item data were not available for this analysis. Nevertheless, diets high in complex carbohydrate and fiber have a lower glycemia index (24–26) and are associated with lower postprandial glucose and insulin responses (25–27) than those containing lower levels of these nutrients. Each of these metabolic factors exerts a protective effect on glucose tolerance in prospective studies (28,29).

    The CI for the hazard of developing diabetes in the Anglo group included unity after adjusting for age, BMI, sex, and total energy intake. We believe that this may have been caused by the small sample size of the study, but we cannot rule out the possibility of chance or residual confounding in this relationship. However, the magnitude of the hazard ratio suggests that the Anglo group is at an increased risk of developing diabetes in this population. In this study, the dietary preference classification was made by the participants themselves and was subsequently shown to reflect differences in the nutrient contents of the three groups. The women who reported a mixed diet had values intermediate between the Anglo and Indian diet and may identify a group of subjects whose diets are in transition between these two groups. This method of classifying diet is subjective and may not be robust, but it does identify differences in dietary patterns in this population.

    The effect of dietary preference on the development of diabetes was more pronounced in women, as the number of incident cases was greater in women and the dietary patterns were more distinct than in men. Alternative explanations for the relationship between dietary pattern and diabetes were examined, with the main consideration being a lifestyle effect that was not only limited to diet. Physical activity levels did not affect the relationship between the different diets and development of diabetes. Our quantitative physical activity measurement only included leisure-time activities because the quantification of occupational activities is difficult, as the population has a high turnover of jobs (12). Therefore, we propose that dietary factors indeed influence the development of diabetes, but that the effects of individual nutrients are too small or too difficult to measure with the food frequency assessment used in this study. The effect may instead be captured by the global question of dietary preference.

    In summary, this study suggests that an adherence to an Indian diet may reduce the risk of diabetes among Pima Indians. Although the ascertainment of dietary pattern was subjective, distinct differences in the nutrient composition of the diet were found in women according to this classification. Increased acceptance of Western dietary habits and access to commodity food programs in this community may further increase the risk of diabetes by adversely affecting the nutrient composition of even the most traditional Indian foods and by increasing the total caloric intake well beyond the nutritional requirements of this population. This hypothesis should be tested in a larger sample of the population and in other populations undergoing similar transitions.

    View this table:
    • View inline
    • View popup
    Table 1 —

    General characteristics of the baseline population by self-described diet

    View this table:
    • View inline
    • View popup
    Table 2 —

    Baseline mean nutrient intake by self-described diet

    View this table:
    • View inline
    • View popup
    Table 3 —

    General characteristics at follow-up by self-described diet

    View this table:
    • View inline
    • View popup
    Table 4 —

    Cox production hazard ratio for the development of type 2 diabetes by type of diet in the study population

    View this table:
    • View inline
    • View popup
    Table 5 —

    Cox proportion hazard ratio for the development of type 2 diabetes by quartile of nutrient intake adjusted for total caloric intake

    Acknowledgments

    The collection of data used in this study was funded, in part, by National Institutes of Health Contract N01-DK-62285 from the National Institute of Diabetes and Digestive and Kidney Diseases. D.E.W. was supported by a postdoctoral fellowship from the American Diabetes Association.

    We are indebted to the members of the Gila River Indian Community for their continued participation in this prospective study, to the staff of the National Institutes of Health field clinic in Sacaton for their cooperation, and to the Nutritional Coordinating Center of the University of Minnesota for their assistance in data collection and processing.

    Footnotes

    • Address correspondence and reprint requests to Desmond E. Williams, NIDDK, 1550 E. Indian School Rd., Phoenix, AZ 85014. E-mail: demw{at}mail.nih.gov.

      Received for publication 8 May 2000 and accepted in revised form 29 January 2001.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    References

    1. ↵
      Knowler WC, Pettitt DJ, Saad MF, Charles MA, Nelson RG, Howard BV, Bogardus C, Bennett PH: Obesity in the Pima Indians: its magnitude and relationship with diabetes. Am J Clin Nutr 53: 1543S–1551S, 1991
      OpenUrlAbstract/FREE Full Text
    2. ↵
      Castetter EF, Bell WH: Pima and Papago Indian Agriculture. Albuquerque, New Mexico, University of New Mexico Press, 1942
    3. ↵
      Castetter EF, Underhill R. M: Ethnobiology of the Papago Indians (Biological series). Vol. 4, no. 3. Albuquerque, New Mexico, University of New Mexico Press, 1935
    4. ↵
      Smith CJ, Nelson RG, Hardy SA, Manahan EM, Bennett PH, Knowler WC: Survey of the diet of Pima Indians using quantitative food frequency assessment and 24-hour recall: the Diabetic Renal Disease Study. J Am Diet Assoc 96:778–784, 1996
      OpenUrlPubMedWeb of Science
    5. ↵
      O’Dea K: Marked improvement in carbohydrate and lipid metabolism in diabetic Australian Aborigines after temporary reversion to traditional lifestyle. Diabetes 33:596–603, 1984
      OpenUrlAbstract/FREE Full Text
    6. ↵
      Swinburn BA, Boyce VL, Bergman RN, Howard BV, Bogardus C: Deterioration in carbohydrate metabolism and lipoprotein changes induced by modern, high fat diet in Pima Indians and Caucasians. J Clin Endocrinol Metab 73:156–165, 1991
      OpenUrlCrossRefPubMedWeb of Science
    7. ↵
      McMurry MP, Cerqueira MT, Connor SL, Connor WE: Changes in lipid and lipoprotein levels and body weight in Tarahumara Indians after consumption of an affluent diet. N Engl J Med 325:1704–1708, 1991
      OpenUrlCrossRefPubMedWeb of Science
    8. ↵
      World Health Organization: Diabetes Mellitus: Report of a WHO Study Group. Geneva, World Health Org., 1985 (Tech. Rep. Ser., no. 727)
    9. ↵
      Stein MW: d-Glucose determination with hexokinase and glucose-6-phosphate dehydrogenase. In Methods of Enzymatic Analysis. Bergmeyer HU, Ed. New York, Academic Press, 1953, p. 117
    10. ↵
      Menard L, Dempsey ME, Blankstein LA, Aleyassine H, Wacks M, Soeldner JS: Quantitiative determination of HbA1 by agar gel electrophoresis. Clin Chem 26:1598–1602, 1980
      OpenUrlFREE Full Text
    11. ↵
      Kriska AM, Bennett PH: An epidemiological perspective of the relationship between physical activity and NIDDM: from activity assessment to intervention. Diabetes Metab Rev 8:355–372, 1992
      OpenUrlPubMedWeb of Science
    12. ↵
      Kriska AM, Knowler WC, LaPorte RE, Drash AL, Wing RR, Blair SN, Bennett PH, Kuller LH: Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care 13:401–411, 1990
      OpenUrlAbstract/FREE Full Text
    13. ↵
      Kriska AM, LaPorte RE, Pettitt DJ, Charles MA, Nelson RG, Kuller LH, Bennett PH, Knowler WC: The association of physical activity with obesity, fat distribution, and glucose intolerance in Pima Indians. Diabetologia 36:863–869, 1993
      OpenUrlCrossRefPubMedWeb of Science
    14. ↵
      Dill DB: The economy of muscular exercise. Physiol Rev 16:263–291, 1936
      OpenUrlFREE Full Text
    15. ↵
      Shulz LO, Harper IT, Smith CJ, Kriska AM, Ravussin E: Energy intake and physical activity in Pima Indians: comparison with energy expenditure measured by doubly labeled water. Obesity Res 2:541–548, 1994
      OpenUrlPubMed
    16. ↵
      Schakel SF, Sievert YA, Buzzard IM: Sources of data for developing and maintaining a nutrient database. J Am Diet Assoc 88:1268–1271, 1988
      OpenUrlPubMedWeb of Science
    17. ↵
      Subar AF, Thompson FE, Smith AF, Jobe JB, Ziegler RG, Potischman N, Schatzkin A, Hartman A, Swanson C, Kruse L: Improving food frequency questionnaires: a qualitative approach using cognitive interviewing. J Am Diet Assoc 95:781–788, 1995
      OpenUrlCrossRefPubMedWeb of Science
    18. ↵
      Reid JM, Fullmer SD, Pettigrew KD, Burch TA, Bennett PH, Miller M, Whedon GD: Nutrient intake of Pima Indian women: relationships to diabetes mellitus and gallbladder disease. Am J Clin Nutr 24:1281–1289, 1971
      OpenUrlAbstract
    19. ↵
      Smith CJ, Schakel SF, Nelson RG: Selected traditional and contemporary foods currently used by the Pima Indians. J Am Diet Assoc 91:338–341, 1991
      OpenUrlPubMed
    20. ↵
      Stata User’s Guide Release 6.0. College Station, TX. Stata Corporation, 1999
    21. ↵
      Fisher RA: The logic of inductive inference. Journal of the Royal Statistical Society Series A98:39–54, 1935
      OpenUrlCrossRefWeb of Science
    22. ↵
      Grambsch PM, Therneau TM: Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81:515–526, 1994
      OpenUrlAbstract/FREE Full Text
    23. ↵
      Smith CJ, Manahan EM, Pablo SG: Food habit and cultural changes among the Pima Indians. In Diabetes as a Disease of Civilization. Joe JR, Young RS, Eds. Berlin, New York, Mouton de Gruyter, 1993
    24. ↵
      Jenkins DJ, Jenkins AL, Wolever TM, Vuksan V, Rao AV, Thompson LU, Josse RG: Low glycemic index: lente carbohydrates and physiological effects of altered food frequency. Am J Clin Nutr 59:706S–709S, 1994
      OpenUrlAbstract/FREE Full Text
    25. ↵
      Liljeberg HG, Granfeldt YE, Bjorck IM: Products based on a high fiber barley genotype, but not on common barley or oats, lower postprandial glucose and insulin responses in healthy humans. J Nutr 126:458–466, 1996
    26. ↵
      Brand JC, Snow BJ, Nabhan GP, Truswell AS: Plasma glucose and insulin responses to traditional Pima Indian meals. Am J Clin Nutr 51:416–420, 1990
      OpenUrlAbstract/FREE Full Text
    27. ↵
      Jenkins DJ, Wolever TM, Jenkins AL, Thorne MJ, Lee R, Kalmusky J, Reichert R, Wong GS: The glycaemic index of foods tested in diabetic patients: a new basis for carbohydrate exchange favoring the use of legumes. Diabetologia 24:257–264, 1983
      OpenUrlPubMedWeb of Science
    28. ↵
      Salmeron J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC: Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women [see comments]. JAMA 277:472–477, 1997
      OpenUrlCrossRefPubMedWeb of Science
    29. ↵
      Salmeron J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, Stampfer MJ, Wing AL, Willett WC: Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 20:545–550, 1997
      OpenUrlAbstract/FREE Full Text
    PreviousNext
    Back to top
    Diabetes Care: 24 (5)

    In this Issue

    May 2001, 24(5)
    • Table of Contents
    • About the Cover
    • Index by Author
    Sign up to receive current issue alerts
    View Selected Citations (0)
    Print
    Download PDF
    Article Alerts
    Sign In to Email Alerts with your Email Address
    Email Article

    Thank you for your interest in spreading the word about Diabetes Care.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    The Effect of Indian or Anglo Dietary Preference on the Incidence of Diabetes in Pima Indians
    (Your Name) has forwarded a page to you from Diabetes Care
    (Your Name) thought you would like to see this page from the Diabetes Care web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Citation Tools
    The Effect of Indian or Anglo Dietary Preference on the Incidence of Diabetes in Pima Indians
    Desmond E. Williams, William C. Knowler, Cynthia J. Smith, Robert L. Hanson, Janine Roumain, Aramesh Saremi, Andrea M. Kriska, Peter H. Bennett, Robert G. Nelson
    Diabetes Care May 2001, 24 (5) 811-816; DOI: 10.2337/diacare.24.5.811

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Add to Selected Citations
    Share

    The Effect of Indian or Anglo Dietary Preference on the Incidence of Diabetes in Pima Indians
    Desmond E. Williams, William C. Knowler, Cynthia J. Smith, Robert L. Hanson, Janine Roumain, Aramesh Saremi, Andrea M. Kriska, Peter H. Bennett, Robert G. Nelson
    Diabetes Care May 2001, 24 (5) 811-816; DOI: 10.2337/diacare.24.5.811
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    Jump to section

    • Article
      • Abstract
      • RESEARCH DESIGN AND METHODS
      • RESULTS
      • CONCLUSIONS
      • Acknowledgments
      • Footnotes
      • References
    • Figures & Tables
    • Info & Metrics
    • PDF

    Related Articles

    Cited By...

    More in this TOC Section

    • Increased Second Trimester Maternal Glucose Levels Are Related to Extremely Large-for-Gestational-Age Infants in Women With Type 1 Diabetes
    • Effect of Renal Insufficiency on the Pharmacokinetics of Sitagliptin, a Dipeptidyl Peptidase-4 Inhibitor
    • A1C in Gestational Diabetes Mellitus in Asian Indian Women
    Show more Clinical Care/Education/Nutrition

    Similar Articles

    Navigate

    • Current Issue
    • Standards of Care Guidelines
    • Online Ahead of Print
    • Archives
    • Submit
    • Subscribe
    • Email Alerts
    • RSS Feeds

    More Information

    • About the Journal
    • Instructions for Authors
    • Journal Policies
    • Reprints and Permissions
    • Advertising
    • Privacy Policy: ADA Journals
    • Copyright Notice/Public Access Policy
    • Contact Us

    Other ADA Resources

    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • Scientific Sessions Abstracts
    • Standards of Medical Care in Diabetes
    • BMJ Open - Diabetes Research & Care
    • Professional Books
    • Diabetes Forecast

     

    • DiabetesJournals.org
    • Diabetes Core Update
    • ADA's DiabetesPro
    • ADA Member Directory
    • Diabetes.org

    © 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.