Monitoring the Nutritional Status of Navajo Preschoolers

Year: 2000

Research Center: American Indian Studies Program, The University of Arizona

Investigator: Pareo, Shirley L., and Mark C. Bauer

Institution: University of New Mexico

Project Contact:
Shirley L. Pareo
Center for Health Promotion and Disease Prevention
University of New Mexico


The purposes of this project are to determine the nutritional status of Navajo preschoolers and to document the impact of recent food assistance changes on the nutritional and socioeconomic well-being of Navajo children and their families. Pareo and Bauer assert that the dietary patterns of preschool children are an important object of study because they directly reflect the food choices made by children’s caregivers, providing indicators of the use of nutrition knowledge and of the need for nutrition interventions. Also, preschool children are themselves emerging nutritional decisionmakers, becoming increasingly assertive about their food preferences and affecting the family’s shopping/food procurement approach.

The authors’ specific aims are to:

  • determine the proportion of children’s diets that are made up of USDA food assistance program products;
  • determine the patterns and strategies used by families to obtain food—use of food supplementation programs, shopping strategies, and decision-making about the use of these food sources;
  • investigate the effects of employment, residence, and other factors on the above; and
  • provide a dataset that can be used to inform discussion of policy and funding changes contemplated for food assistance programs, as well as to provide information on the effectiveness of nutritional intervention strategies among Navajo families.

The data are similar to those collected in the 1992 Navajo Health and Nutrition Survey (NHNS) through a collaborative effort by the Indian Health Service, the Navajo Nation Division of Health, and the U.S. Centers for Disease Control and Prevention. Results of that survey, published in 1997, applied to adults and children over the age of 12. Currently, there are no similar data available on Navajo preschoolers.

The authors began their research in this area in 1998 (through a small grant entitled “Monitoring Health and Nutrition on the Navajo Nation”) with a focus on the accessibility and affordability of healthy, nutritious foods for Navajo people living in various parts of the Navajo Nation. They sought first to determine to what extent and in what areas the healthy choices being promoted by nutrition education programs such as WIC are available and affordable. In the current project, they extend their study to examine dietary intakes.

Pareo and Bauer collected data on a random sample of 171 students who participated in the Head Start program in the Shiprock Agency of the Navajo Nation in 1999. Their sample includes children attending Head Start centers or participating in the Head Start home base program within the Northeast portion of the Navajo Nation, including parts of New Mexico and Arizona. Trained Navajo interviewers administered a 24-hour dietary recall and a nutrition behavior survey during a home visit. They interviewed the caregiver who had observed everything the child consumed the day before the interview. The nutrition behavior survey included questions about the child’s food preferences, the family’s food preferences, the family’s food choices and strategies for obtaining food, and demographics.

An interviewer coded and entered the diet recall data into the Food Intake Analysis System (FIAS, version 3.99). FIAS uses a subset of the USDA Nutrient Database for Food Consumption Surveys. The interviewer and data collection supervisor reviewed all food records for accuracy and coding consistency. The outcomes include:

  1. Mean daily intakes of macronutrients and micronutrients;
  2. Percent of nutrients contributed by food groups;
  3. Meal patterns;
  4. Foods consumed that were provided by food assistance programs; and
  5. Percent of mean daily intakes of macronutrients and micronutrients contributed from foods provided by food assistance programs.

The authors reported on completed analyses of 84 interviews, with a goal of completing approximately 150 interviews in total.

Their preliminary data show that most respondents reported not participating in food assistance programs. The authors note, however, that participation may be underestimated because many respondents were uncomfortable with the question. About 50 percent of the households reported the mother as the primary caregiver. Many others reported both parents as the primary caregiver. Over 25 percent of the households were more than 50 miles from a grocery store. Over 70 percent of the households included two adults; about one-quarter had more than two. Most adults other than parents were children over 18. About 30 percent of households had two children. Approximately 52 percent of the respondents were not employed.

The median energy intake for preschool children in the sample was 1,800 Kcal; about 10 percent reported intakes greater than 2,900 Kcal. Protein intakes were well above recommended levels. About 35 percent of calories were from fat. Three nutrients—vitamin A, calcium, and iron—stood out as of particular concern. Vitamin A intakes were very skewed—nearly 50 percent of children sampled did not meet the recommended intakes, and nearly 25 percent were well below this level. Twenty-five percent consumed less than the recommended intakes of calcium and iron. The foods most frequently consumed were flour tortillas; fried potatoes; fruit-flavored beverages such as Kool-Aid, Hi-C, and Gatorade; spaghetti; Hamburger Helper; and bananas.

The authors also plan to examine differences in nutrient intakes by age and to measure nutrient density. They note that high energy intakes found in the preliminary results do not indicate nutritional adequacy. They also plan to merge their dietary data with a Head Start database that includes anthropometric measures.

The authors caution that their data may not accurately represent the dietary intake of preschool children. Interviewers reported difficulty administering the dietary recall because respondents did not understand the language or concepts used. Interviewers also questioned whether respondents reported a child’s actual consumption or what was served.

Seasonal factors are also likely to have affected their results. Most of the interviews were conducted in the late summer when Head Start is not in session, and thus most of the foods reported were prepared at home. This is also the time of year when most fresh fruits and vegetables are available at lower cost; even so, few fruits and vegetables were reported.

Though the analysis is preliminary, Pareo and Bauer note several implications of their early results. First, they identify specific food behaviors that could be addressed in education programs targeting parents and Head Start staff. Increasing fruit and vegetable intake and increasing the variety of foods in the diet are possible areas for attention. High-energy intakes found for some children also indicate a need to address the risk of overweight at very young ages. The low reported use of food assistance in this sample also warrants further investigation. Finally, Head Start program administrators and parents are very interested in the findings and in using the results to improve food assistance and nutrition services in the Head Start program.