5.4. La construcción del sentido
5.4.1. El ámbito mental de las representaciones ficticias
Research on the nutritional status of Native Americans is limited. Severe malnutrition was documented in the 1950s and 1960s, including numerous cases of kwashiorkor and marasmus. Today, low socioeconomic status and lack of such things as transportation, fuel, refrigeration, and running water contribute to an inadequate diet for some Native Americans. In general, however, recent changes in morbidity and mortality figures suggest that Native Americans have transitioned
from the conditions associated with under- consumption, such as infectious diseases, to conditions associated with overconsumption, including obesity, type 2 diabetes, and cardiovas- cular disease.24
Studies of current Alaska Native eating habits suggest that diets high in refined carbohydrates (starchy and sugary foods) and fat, and low in fruits and vegetables, are common. The protein and nutrient of Alaska Natives has declined during the past several decades, as many foods obtained through hunting and gathering were replaced by processed, canned, and packaged items.57The estimated carbohydrate content of
the Alaska Native diet before contact with Westerners was exceptionally low (3 to 5 percent of daily calories) due to a dependence on sea mammals and fish. Within only a few generations, that figure had increased to 50 percent of total calories, much of it from low-nutrient–density foods.82, 96Research on Alaska Natives has also
shown low intakes of calcium, iron, phosphorus, magnesium, zinc, vitamins A, C, D, and E, riboflavin, and folic acid, as well as fiber, omega-6, and omega-3 fatty acids. Traditional Alaska Native diets have been found lower in fat and carbohy- drates, and higher in protein, phosphorus, potas- sium, iron, zinc, copper, magnesium, manganese, selenium, and several vitamins, including A, D, E, riboflavin, and B6.72,73,84,88
A similar transition occurred in the diets of American Indians in other parts of the nation; and today, refined carbohydrates are prominent in the diet. Studies have identified white breads, tortillas, potato chips, french fries, and candy as the top contributors of energy for many Native Americans.23, 31, 80, 108, 112Of particular note is the
consumption of sweetened beverages, including soda and fruit-flavored drinks, estimated to be 15 to 27 percent of all carbohydrates consumed, and as much as 17 percent of daily calories.8, 23, 112, 114, 124
High-fat foods, including fried foods and processed meats and beef dishes, are another significant source of energy.
A low intake of fruits and vegetables is prevalent in the diets of both Native American adults and adolescents.23, 31Of Indians in California, 60 percent
said they had not eaten any fruit the previous day, and 28 percent reported they had not consumed any vegetables.56 Among the Lakota of South
Dakota, nearly 60 percent stated they ate fruit only two to eight times a month; nearly half reported 126 NATIVE AMERICANS
Many Dakota mark the anniversary of the Wounded Knee Massacre (December 29) with mourning prayers and a spirit plate of blessed food to nourish the dead.
High rates of lactose intol- erance have been reported for both Native Americans and Alaska Natives. The occurrence among individu- als, however, is related to percentage of Native American heritage.
eating vegetables (including potatoes) over five times weekly.46 A study of Catawba showed
47 percent ate less than one fruit daily, and 87 percent consumed only one vegetable or less.28
The vegetable most often consumed in a study of Native American women in Oklahoma was french fries; and only tomatoes, tossed salad, green beans, potato salad, and mashed potatoes were also mentioned in the list of the top fifty-three items most often eaten.114Barriers to increased con-
sumption of fruit and vegetables included cost, availability, and quality.
Native American nutrient intake has been compared to that of the general population in a few studies. It is notable that among both children and adults, few differences are found. One large study in three states reported that median intakes of vitamins A and C and folate were low for both American Indians and the total population.107A
comparison of dietary calcium intake among African American, Native American, and white women in North Carolina found that although whites ate significantly more high-calcium foods than did Native Americans, none of the respon- dents were consuming recommended levels of the mineral through their food.4Other researchers
who investigated rural Native American and white children in Oklahoma suggest that their diets are more influenced by factors such as poverty and living in a rural area than by cultural or structural issues related to race or ethnicity.112
Nutrient deficiencies in Native American adults and children may occur, but with the exception of Alaska Natives, most studies suggest dietary ade- quacy similar to that of the total U.S. population. Life expectancy has improved over recent years, yet disparities are still found. In Arizona the average age of death from all causes for American Indians is just under age fifty-five, compared to the national average of seventy-two years. Rates for the total population of Native Americans are better, but still 10 percent below average for men, and 8 percent below average for women.85, 119
Native American mothers are more likely to be younger than the general population and less likely to be married. Thirty percent of American Indian and Alaska Native women do not receive prenatal care during the first trimester of pregnancy. Yet the number of low–birth-weight infants and neonatal deaths is lower than that for the total U.S. popu- lation.85 Some researchers have suggested that
under-registration of very low–birth-weight infants
accounts for these figures.48Postnatal mortality
rates are nearly 60 percent higher for American Indians and Alaska Natives compared to the total population, and sudden infant death syndrome is particularly problematic.20Breastfeeding has tra-
ditionally been considered the proper way to feed infants among most Native Americans. Among the Navajo in one study, elders reported that breast- fed infants were better able to hear traditional teachings and were better disciplined. It also demonstrated that the children are loved. Eighty- one percent of subjects initiated breastfeeding. Most added infant formula within the first week and used this combined feeding practice for more than five months.132Other estimates of breast-
feeding show rates of 24 to 62 percent.53, 109Baby-
bottle tooth decay, due most often to extended use of a bottle with formula, milk, juice, or soda, affects more than one-half of all Native American and Alaska Native children.
Overweight and obesity are prevalent among Native Americans. National data suggest obesity rates of 37 to 40 percent among American Indian adults in 2002, approximately 20 percent above the average for the total population.21, 78In another
survey, the highest obesity rates were found in Native Americans living in Alaska, and the lowest in the Pacific Northwest.29Though definitions of
overweight and obesity vary in other research, the trends are consistent. Group-specific studies report 83 percent of Havasupai subjects and 60 percent of Seminoles were identified as obese; 63 percent of Navajo women and 33 to 50 percent of Navajo men were overweight; and 61 percent of Indians residing in Oklahoma were overweight or obese.17, 117 In some groups, such as the Inuits,
overweight was traditionally desirable as a visible demonstration of wealth during times of priva- tion.60Among the Navajo, elder men and women
prefer a heavier body shape.126 Comprehensive
studies of Native American school children and adolescents show consistently higher weight-for- height ratios than for white, black, or Hispanic populations, while body mass index (BMI) rates over the 85 percentile varied, up to 50 percent for girls, and nearly 50 percent for boys.7, 18, 58, 109, 134
Figures on obesity contradict some nutri- tional intake data, which show the caloric intake of many Native Americans to be normal or less than the recommended dietary allowances. Metabolic differences in obese Native Americans may be a factor, 24, 107, 133or lower rates of energy
Some Native Americans believe diabetes is caused by eating too much sugar. Others associate it with a high intake of salt.105
A diet high in simple carbo- hydrates has led to an increase in dental caries. This problem was virtually unknown among Native Americans before European contact.
Alaska Natives suffer the highest incidence of botu- lism in the world, due mostly to the way in which indigenous foods, such as seal, are butchered on the ground, then stored for long periods in plastic bags underground.100
expenditure through exercise may contribute: American Indians and Alaska Natives report lack of leisure-time physical activity at higher rates than any other U.S. ethnic group.29, 78However, a
study of Hualapai women of Arizona indicated that the daily caloric intake of obese women was significantly higher than for the non-obese women. Sweetened beverages and alcoholic bev- erages accounted for the differences. Researchers investigating Zuni adolescents suggest that underreporting of foods and/or alcohol may account for low reported energy intakes.23, 116, 127
Dieting behaviors among adult Native American women mostly involve healthy approaches such as eating more fruits and vegetables and exercis- ing more, according to one study, although skip- ping meals, fasting, and disordered eating such as self-induced vomiting were also mentioned; 10 percent engaged in binge eating. A national survey of Native American youth revealed that over 40 percent reported binge-eating behavior with vomiting rates of 4 to 6 percent. Frequent dieting was also common. All disordered eating occurred more frequently among overweight respondents.87, 103
The incidence of type 2 diabetes mellitus, especially among some Native Americans of the Plains and Southwest, is estimated to be between two and four times that of the general population. A study of American Indians over the age of forty-five in four states found rates of 33 percent in men and 40 percent in women living in North Dakota and South Dakota, 38 percent in men and 42 percent in women residing in Oklahoma, and 65 percent in men and 72 percent in women in Arizona.77The Pima Indians are believed to have
the highest rate of type 2 diabetes in the world, affecting 70 percent of all adults over the age of forty-five. Rates of the disease among children are also increasing substantially, and it has been noted that acanthosis nigricans (a patchy darken- ing of the skin) is an independent marker for insulin resistance in Native American young- sters.27, 34The death rate from type 2 diabetes is
more than three times as high for Native Americans as for the total population.119Notably,
diabetes was rare among Native Americans fifty years ago.91
One theory for the high rates of type 2 dia- betes among Native Americans is genetic predis- position.2 However, a comparison of type 2
diabetes among Pima Indians living in Arizona
and those living in Mexico found rates in Arizona to be more than five times those found in Mexico, suggesting that genetic predisposition alone does not account for high prevalence in the United States and that a Westernized environment may be a factor.99Higher rates of diabetes are found
among Alaska Natives who have significant increased intake of nonindigenous protein (i.e., beef, chicken), carbohydrates (i.e., white bread, potatoes or rice, soft drinks), and fat (i.e., butter, shortening), combined with a lower intake of native foods such as salmon, caribou, berries, and seal oil; and higher rates are found among Pima Indians who consume an Anglo diet when compared to Pima who consume a traditional diet.82, 128Some researchers suggest the difference
is due to the dietary change from indigenous starches to the refined flours and sugars of the adapted diet. Traditional starches are harder to digest and absorb, leading to lower blood sugar levels and insulin responses that may be protec- tive in the development of diabetes.14 Other
researchers suggest the increased intake of fat in the modern Native American diet may be respon- sible for the increase in type 2 diabetes.40, 113(See
Cultural Controversy feature.)
Associated with obesity and type 2 diabetes is a dramatic increase in the prevalence of heart disease among Native Americans during the last twenty-five years; heart disease is now the lead- ing cause of death. Rates of cardiovascular dis- ease for Native Americans have surpassed those of the total population in many locations, and are often more fatal.47, 54 Additional risk factors
include high rates of cigarette smoking, elevated cholesterol levels, and hypertension.38, 78 Elder
urban Native Americans are especially at risk.69
American Indians have the highest rates of gallbladder disease in the United States, accom- panied by an increased risk for gallbladder cancer.24, 102End-stage renal disease is also a con-
cern, particularly associated with type 2 diabetes, with incidence up to twenty times higher than in the general population.16, 79, 131 Gastrointestinal
infections, particularly gastroenteritis and bacil- lary dysentery, are also prevalent.
The incidence of alcoholism among Native Americans has decreased in recent years, but it still remains a significant medical and social problem. High unemployment rates and loss of tribal integrity, ethnic identity, and self-esteem are frequently cited as reasons for substance 128 NATIVE AMERICANS
Chapter 5: Native Americans 129