Dietary Flavonoids, Copper Intake, and Risk of Metabolic Syndrome in Chinese Adults

Associations between multiple urinary metals and metabolic syndrome: Exploring the mediating role of liver function in Chinese community-dwelling elderly

BACKGROUND

Multiple metals exposure has been revealed to be related to metabolic syndrome (MetS). However, the associations and interactions between multiple metals exposure and MetS are remains controversial, and the potential mechanism of the above-mentioned is still unclear.

METHODS

The associations between urinary metals and the MetS were analyzed by multivariable logistic regression model and restricted cubic spline (RCS). Bayesian kernel machine regression (BKMR) model and quantile-based g-computation (qgcomp) were applied to explore the mixed exposure and interaction effect of metals. Mediation analysis was used to explore the role of liver function.

RESULTS

In the single metal model, multiple metals were significantly associated with MetS. RCS analysis further verified the associations between 8 metals and MetS. BKMR model and qgcomp showed that zinc (Zn), iron (Fe), and tellurium (Te) were the main factors affecting the overall effect. In addition, mediation analysis indicated that serum alanine aminotransferase (ALT) mediated 21.54% and 13.29% in the associations of vanadium (V) and Zn with the risk of MetS, respectively.

CONCLUSIONS

Elevated urinary concentration of Zn, V, Te, copper (Cu), molybdenum (Mo), and thallium (Tl) were related to the increased risk of MetS. Conversely, Fe and selenium (Se) may be protective factors for MetS in mixed exposure. Liver function may play a key role in the association of V and Zn exposure with MetS.

Dietary polyphenols and the risk of metabolic syndrome: a systematic review and meta-analysis

BACKGROUND

Accumulating evidence has suggested that dietary polyphenols may be protective against metabolic syndrome (MetS); however, the available evidence is contradictory. The aim of this meta-analysis was to assess the association between dietary intake of polyphenols and the odds of MetS.

METHODS

The PubMed and Scopus databases were systematically searched to obtain eligible studies. The risk of MetS for the highest versus the lowest intakes of total, subclasses and individual polyphenols were examined by pooling odds ratios (OR) and 95% confidence intervals (95%CI) using the random effects model.

RESULTS

A total of 14 studies (6 cohort and 8 cross-sectional studies) involving a total of 50,366 participants with 10,879 cases of MetS were included. When various polyphenol compounds were pooled, they were significantly related to a 22% decreased odds of MetS (([5 studies]; OR: 0.78; 95%CI: 0.72-0.85). Higher intakes of total flavonoids (([9 studies]; OR: 0.78; 95%CI: 0.72-0.85), flavan-3-ols (([2 studies]; OR: 0.64; 95%CI: 0.43-0.94), isoflavones (([3 studies]; OR: 0.84; 95%CI: 0.75-0.93), stilbenes (([4 studies]; OR: 0.86; 95%CI: 0.76-0.97), flavones (([2 studies]; OR: 0.79; 95%CI: 0.71-0.89), and quercetin (([2 studies]; OR: 0.63; 95%CI: 0.43-0.93) were also significantly associated with a decreased risk of MetS. The associations were not modified by the age of the participants. No association was found for total polyphenols, phenolic acids, lignans, anthocyanins, and flavonols.

CONCLUSION

The results of this meta-analysis supported that higher polyphenol intake can lower the risk of MetS.

Essential metals modified the effects of polycyclic aromatic hydrocarbons on the metabolic syndrome: Mediation effects of miRNA

Metabolic syndrome (MetS) prevalence has increased dramatically worldwide and has become a public health issue. Polycyclic aromatic hydrocarbons (PAHs) were identified as risk factors of MetS, while essential metals are integral parts of metalloenzymes catalyzing metabolic processes. However, effects of co-exposure to PAHs and essential metals have not been investigated yet. We aimed to assess whether essential metals could modify the hazard effects of PAHs on MetS, and underlying mediation effects of microRNA (miRNAs) were further explored. A cross-sectional study of 1451 males including 278 MetS cases was conducted. Internal exposure levels of 5 classes of PAH metabolites, 7 essential metals, as well as expressions of PAHs-associated 8 plasma miRNAs were assessed. Multiple exposure models, Bayesian kernel machine regression (BKMR), and quantile g-computation (QGcomp) were used simultaneously to identify MetS-related critical chemicals. Mutual effect modification between chemicals and mediation effects of miRNAs on chemical-MetS association was testified. In this study, hydroxyphenanthrene (OHPhe) and selenium (Se) were consistently identified as MetS-related key chemicals in three statistical methods. OHPhe was positively associated with MetS [OR (95 % CI) = 1.79 (1.21, 2.65), P = 0.004], while Se had a negative relationship with MetS [OR (95 % CI) = 0.61 (0.43, 0.87), P = 0.007]. Effect modification analysis observed the association between OHPhe and MetS was weakened with increased Se exposure. Only the expression of miR-24-3p was negatively associated with MetS [OR (95 % CI) = 0.81 (0.66, 0.95), P = 0.048] and could mediate 16.1 % of OHPhe-MetS association in subjects with low Se exposure (≤0.87 μg/mmol creatinine) (P = 0.019). We found a mutual effect modification between OHPhe and Se on MetS, and the positive OHPhe-MetS association was attenuated with increased Se exposure. Mediation effects of miR-24-3p on OHPhe-MetS association were dependent on Se dose. Our findings may provide new insight into the prevention and intervention of MetS.

A national cross-sectional analysis of dietary copper intake and abdominal aortic calcification in the US adults: NHANES 2013-2014

BACKGROUND AND AIMS

Copper is an essential dietary element with a crucial role in physiological regulation. However, the relationship between dietary copper intake and abdominal aortic calcification (AAC) remains uncertain.

METHODS AND RESULTS

This study encompassed a cohort of 2535 adults aged over 40 years, derived from the National Health and Nutrition Examination Survey 2013-2014. Dietary copper intake from both food sources and supplements was assessed through two 24-h dietary recall interviews. AAC was measured by dual-energy X-ray absorptiometry and classified into 3 groups using the Kauppila score system. Multivariable logistic regression models were constructed to evaluate the association between dietary copper intake and AAC. Among the participants, a total of 771 individuals (30.4%) were diagnosed with AAC, of which 239 (9.4%) exhibited severe AAC. Higher dietary copper intake was significantly associated with a lower incidence of severe AAC. Specifically, for each 1 mg/day increase in dietary copper intake, the incidence of severe AAC decreased by 38% (odds ratios [OR] 0.62, 95% confidence intervals [CI] 0.39-0.98) after adjustment for relevant covariates. Moreover, individuals in the third tertile of copper intake had a 37% lower incidence of AAC compared to those in the first tertile [OR 0.63, 95% CI (0.43-0.95)]. However, no significant associations were found between supplemental copper intake or serum copper levels and AAC.

CONCLUSIONS

This study demonstrates that lower dietary copper intake, rather than serum copper levels or supplement copper intake, is significantly associated with a higher prevalence of AAC in adults ≥40 years old in the United States.

The association between dietary intake of flavonoids and its subclasses and the risk of metabolic syndrome

Background

The healthiest way to prevent metabolic syndrome (MetS) is through behavioral and nutritional adjustments. We examined the relationship between total flavonoids intake, flavonoid subclasses, and clinically manifest MetS.

Methods

A cross-sectional analysis was conducted among 28,719 individuals from the National Health and Nutrition Examination Survey (NHANES) and Food and Nutrient Database for Dietary Studies (FNDDS) 2007-2011 and 2017-2018. Two 24-h reviews were conducted to determine flavonoids intake and subclasses. The link between flavonoids intake and MetS was investigated using a multivariate logistic regression model.

Results

Q2 and Q3 of total flavonoids intake were associated with 20 and 19% lower risk of incident MetS after adjusting age and sex. Anthocyanidins and flavanones intake in Q2 and Q3 substantially reduced the MetS risk compared to Q1. MetS risk decreased steadily as the total intake of flavonoids increased to 237.67 mg/d. Flavanones and anthocyanidins also displayed V-shaped relationship curves (34.37 and 23.13 mg/d).

Conclusion

MetS was adversely linked with total flavonoids intake, flavanones, and anthocyanidins. Moreover, the most effective doses of total flavonoids, flavanones, and anthocyanidins were 237.67, 34.37, and 23.13 mg/d, respectively, potentially preventing MetS.

Usual Intake of Flavonoids Is Inversely Associated with Metabolic Syndrome in African American and White Males but Not Females in Baltimore City, Maryland, USA

Despite research that suggests flavonoids protect against metabolic syndrome (MetS) and evidence that intake of these compounds differs by race, knowledge about whether flavonoid-MetS associations vary among racial groups is limited. This study sought to estimate usual total flavonoid intake in African American and White adults and assess its sex- and sex/race-specific associations with MetS and its risk factors. Analysis of cross-sectional data from 1837 adults participating in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were analyzed. Usual total flavonoid intake was estimated using the NCI Method, and logistic regression measured its linkages with health outcomes. Among males overall and when stratified by race, odds of MetS and its risk factors low high-density lipoprotein cholesterol (HDL-C) and elevated glucose were lower at the 75th percentile of usual total flavonoid intake than at the 25th percentile (OR for MetS = 0.62; 95% CI = 0.53, 0.71). However, low HDL-C and elevated glucose were positively associated with usual flavonoid intake among females. The comparable associations by race within sex imply that the relationships between flavonoid and health outcomes may be evident across an array of intakes.

Associations of the Dietary Iron, Copper, and Selenium Level With Metabolic Syndrome: A Meta-Analysis of Observational Studies

Background

Epidemiological studies have investigated the associations of dietary iron, copper, and selenium level with metabolic syndrome (MetS). However, their results are conflicting. This meta-analysis of observational study was, therefore, employed to investigate the associations above.

Methods

A comprehensive literature search was employed using PubMed, Web of Science, Embase, and Scopus database up to October 2021 (no restriction was set for the initiate time). The pooled relative risk (RR) of MetS for the highest vs. lowest dietary iron, copper, and selenium level was estimated, respectively.

Results

A total of 14 observational studies (55,131 participants) were identified as meeting the inclusion criteria. Specifically, 7 studies were related to the dietary iron level. The overall multivariable adjusted RR demonstrated that the dietary iron level was positively associated with MetS (RR = 1.27, 95% CI: 1.12–1.44; p < 0.001). With regard to the dietary copper level, 7 studies were included for meta-analysis. The overall multivariable adjusted RR showed that the dietary copper level was inversely associated with MetS (RR = 0.85, 95% CI: 0.78–0.93; p < 0.001). In addition, 4 studies were specified for the dietary selenium level. The overall multivariable adjusted RR indicated that the dietary selenium level was inversely associated with MetS (RR = 0.77, 95% CI: 0.63–0.95; p = 0.01) as well.

Conclusion

Our results suggest that the dietary iron level is positively associated with MetS, whereas a negative association between the dietary copper and selenium level and MetS is obtained. Further large well-designed prospective cohort studies are warranted to elaborate on the issues examined in this study.

Relationships Between Indicators of Metabolic Disorders and Selected Concentrations of Bioelements and Lead in Serum and Bone Tissue in Aging Men

BACKGROUND

The aim of this study was to investigate the relationships between serum and bone concentrations of selected bioelements, ie, zinc (Zn), copper (Cu), iron (Fe), chrome (Cr), magnesium (Mg), and selenium (Se), and a heavy metal, ie, lead (Pb), and the selected indicators of metabolic disorders - Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP) and Body Mass Index (BMI).

MATERIAL AND METHODS

The study comprised 151 men aged 60 to 75 years who were scheduled for hip replacement surgery due to osteoarthritis. The concentrations of elements in the serum and bone tissue were measured using inductively coupled plasma optical emission spectrometry (Mg, Zn, Cu, Cr, Fe, and Pb) and the spectrofluorometric method (Se). Fasting plasma glucose (FPG), high-density cholesterol (HDL-Ch), and triacylglycerols (TAG) were determined. Lipid accumulation product (LAP) and visceral adiposity index (VAI) were calculated.

RESULTS

There was no relationship between serum and bone concentrations of bioelements and lead and the BMI index. Bone Mg was significantly higher in men with higher VAI, but no such relation was observed in the serum. Similarly, bone Mg and Zn were higher in patients with higher LAP, which was not observed in the serum. Multivariate logistic regression analysis with adjustment for age was performed. There was a correlation between serum Zn concentration and the cut-off point for VAI. The cut-off point for LAP was related to the bone tissue concentrations of Mg, Zn, and Cu.

CONCLUSION

We found some relationships between the concentrations of selected bioelements and Pb and VAI, LAP, and BMI in bone but not in the serum. VAI positively correlated with bone Mg, while LAP positively correlated with bone Cu, Zn, and Mg.

Association of whole blood copper, magnesium and zinc levels with metabolic syndrome components in 6-12-year-old rural Chinese children: 2010-2012 China National Nutrition and Health Survey

BACKGROUND

Metabolic syndrome (MetS) is significantly associated with the risk of cardiovascular disease and its prevalence is showing a trend of getting younger. Previous studies on the relationship between elements and MetS were mostly reported in adults with single element analysis, while reports in children with combined effects of multiple elements were very limited. The aim of this study is to investigate the association between whole blood Cu, Mg and Zn in both single and combined effects and MetS components in rural Chinese children aged 6-12 years based on the data from 2010-2012 China National Nutrition and Health Survey.

METHODS

A total of 911 children (51.2% male, 48.7% female) aged 6-12 years were included. Basic characteristics and MetS component parameters were collected and determined by trained stuffs. Elements were detected by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Multivariate logistic regression analysis was performed to examine the independent relationship between elements and MetS components.

RESULTS

In single metal analysis, copper was positively associated with elevated waist (OR = 2.00, 1.18-3.28) and all of the metals were associated with elevated TG. And the comprehensive analysis of multiple elements were mostly consistent with the results of single element analysis (low Cu + high Zn with elevated TG (OR = 2.21, 1.18-4.13), high Cu + low Mg with elevated TG (OR = 0.40, 0.16-0.95), high Cu + high Mg with elevated waist (OR = 2.03, 1.26-3.27)), except the combination of Zn and Mg (high Zn + low Mg with reduced HDL-C (OR = 0.47, 0.28-0.77)).

CONCLUSIONS

Our study suggested Cu, Zn and Mg in children are indeed associated with metabolic syndrome components, whether in single element or multi-element combined analysis. The results will be confirmed through additional cohort research.

The protective effects of dietary intake of flavonoids and its subclasses on metabolic syndrome incidence

This study aimed to evaluate the association between the intake of total flavonoids and flavonoid subclasses and metabolic syndrome (MetS) risk and to assess the modulating effects of lifestyle factors on these associations. A total of 1915 participants from the Tehran Lipid and Glucose Study were followed-up during 2006-2008 and 2016-2018. Their dietary intake was assessed by a food frequency questionnaire at baseline and within three-year intervals afterward. Moreover, the modifying effect of weight gain on the association between total flavonoids and MetS was assessed by Cox regression analysis. Participants in the highest tertile of flavonoid, flavonol, and flavone had a significantly lower MetS risk as compared to those in the lowest tertile. Also, in participants with weight gain <7%, all flavonoid subclasses had a more pronounced risk-reducing effect. Overall, the total flavonoid, flavonol, and flavone reduced the risk of MetS; this association could be modified by weight gain.

Dietary Assessment Methods to Estimate (Poly)phenol Intake in Epidemiological Studies: A Systematic Review

Nutritional epidemiological studies have frequently reported associations between higher (poly)phenol intake and a decrease in the risk or incidence of noncommunicable diseases. However, the assessment methods that have been used to quantify the intakes of these compounds in large-population samples are highly variable. This systematic review aims to characterize the methods used to assess dietary (poly)phenol intake in observational studies, report the validation status of the methods, and give recommendations on method selection and data reporting. Three databases were searched for publications that have used dietary assessment methods to measure (poly)phenol intake and 549 eligible full texts were identified. Food-frequency questionnaires were found to be the most commonly used tool to assess dietary (poly)phenol intake (73%). Published data from peer-reviewed journals were the major source of (poly)phenol content data (25%). An increasing number of studies used open-access databases such as Phenol-Explorer and USDA databases on flavonoid content since their inception, which accounted for 11% and 23% of the data sources, respectively. Only 16% of the studies reported a method that had been validated for measuring the target (poly)phenols. For future research we recommend: 1) selecting a validated dietary assessment tool according to the target compounds and target period of measurement; 2) applying and combining comprehensive (poly)phenol content databases such as USDA and Phenol-Explorer; 3) detailing the methods used to assess (poly)phenol intake, including dietary assessment method, (poly)phenol content data source; 4) follow the Strengthening the Reporting of Observational Studies in Epidemiology-Nutritional Epidemiology (STROBE-nut) framework; and 5) complementing dietary intake assessment based on questionnaires with measurement of (poly)phenols in biofluids using appropriate and validated analytical methods.

Environment-Based Impairment in Mineral Nutrient Status and Heavy Metal Contents of Commonly Consumed Leafy Vegetables Marketed in Kyrgyzstan: a Case Study for Health Risk Assessment

Leafy vegetables are important components of the human diet for providing mineral nutrients. However, due to the tendency of metal accumulation, metal contents of leafy vegetables need not only to be determined but also estimated health risk for revealing possible health effects on humans. The aims of this study are (I) to examine comprehensive concentrations of trace/heavy metals along with some macroelements including Ca, Cd, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, and Zn in selected leafy vegetables from Kyrgyzstan; (II) to assess recommended dietary allowances (RDA); and (III) to evaluate hazard quotient (HQ) and carcinogenic risk estimation with associated vegetable consumption. For this purpose, B, Ca, Cd, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, and Zn elements were quantified, utilizing an ICP-OES instrument, in 18 samples belonging to 12 different groups of leafy vegetables including celery, Chinese parsley, dill, garden sorrel, lettuce, parsley, purple basil, spinach, and white-red-napa cabbage collected from different bazaars of Kyrgyzstan. Average elemental contents of the analyzed vegetables were determined (in mg kg^-1) as follows: B (3.21-64.79), Ca (852.51-17,183.20), Cd (0.015-0.09), Cu (6.08-63.47), Fe (116.52-768.66), K (2347.04-17,305.42), Mg (136.34-1261.11), Na (54.75-526.42), Ni (0.09-1.3), Pb (1.91-9.54), and Zn (29.49-314.93). Estimated daily intake, recommended daily allowance, hazard quotients, and carcinogenic risk values of the vegetables were calculated with the help of these results. In considering HQ values, Chinese cabbage was determined to be safe for the consumption of both genders whereas parsley to be safe for only males. Based on the carcinogenic risk calculation, most of the vegetables examined in this study were categorized as moderately risky. It was inferred from the given results that airborne pollution has impaired/increased the mineral contents of vegetables for both genders. The findings obtained from this study were compared with international standards and will contribute to the data available on a global scale.

Association of Serum Levels of Zinc, Copper, and Iron with Risk of Metabolic Syndrome

The association between serum concentrations of zinc, copper, or iron and the risk of metabolic syndrome are inconclusive. Therefore, we conduct a case-control study to explore the relationship between serum levels of zinc, copper, or iron and metabolic syndrome as well as each metabolic factor and insulin resistance. We enrolled 1165 adults, aged ≥ 40 (65.8 ± 10) years in a hospital-based population to compare the serum levels of zinc, copper, and iron between subjects with and without metabolic syndrome by using multivariate logistic regression analyses. The least square means were computed by general linear models to compare serum concentrations of zinc, copper, and iron in relation to the number of metabolic factors. The mean serum concentrations of zinc, copper, and iron were 941.91 ± 333.63 μg/L, 1043.45 ± 306.36 μg/L, and 1246.83 ± 538.13 μg/L, respectively. The odds ratios (ORs) of metabolic syndrome for the highest versus the lowest quartile were 5.83 (95% CI: 3.35-10.12; p for trend < 0.001) for zinc, 2.02 (95% CI: 1.25-3.25; p for trend: 0.013) for copper, and 2.11 (95% CI: 1.24-3.62; p for trend: 0.021) for iron after adjusting for age, sex, personal habits, body mass index, and homeostatic model assessment insulin resistance. Additionally, the serum zinc, copper, and iron concentrations increased as the number of metabolic factors rose (p for trend < 0.001). This was the first study to clearly demonstrate that higher serum levels of zinc, copper, and iron were associated with the risk of metabolic syndrome and the number of metabolic factors independent of BMI and insulin resistance.

Higher flavonoid intake is associated with a lower progression risk of non-alcoholic fatty liver disease in adults: a prospective study

Flavonoid-rich foods have shown a beneficial effect against non-alcoholic fatty liver disease (NAFLD) in short-term randomised trials. It is uncertain whether the usual dietary intake of flavonoids may benefit patients with NAFLD. The present study evaluated the association between the usual intake of flavonoids and the risk of progression in NAFLD. The prospective study included 2694 adults from the Guangzhou Nutrition and Health Study. Face-to-face interviews using a seventy-nine-item FFQ were administered to assess habitual dietary flavonoid intake, while abdominal ultrasonography was conducted to evaluate the presence and degree of NAFLD, with measurements conducted 3 years apart. After adjustment for potential confounders, higher flavonoid intakes were gradely associated with reduced risks of worsen NAFLD status. The relative risks of worsening (v. non-worsening) NAFLD in the highest (v. lowest) quintile were 0·71 (95 % CI 0·54, 0·93) for total flavonoids, 0·74 (95 % CI 0·57, 0·95) for flavanones, 0·74 (95 % CI 0·56, 0·96) for flavan-3-ols, 0·90 (95 % CI 0·68, 1·18) for flavonols, 0·73 (95 % CI 0·56, 0·93) for flavones, 0·79 (95 % CI 0·61, 1·02) for isoflavones and 0·74 (95 % CI 0·57, 0·96) for anthocyanins. An L-shaped relationship was observed between total flavonoid intake and the risk of NAFLD progression. Path analyses showed that the association between flavonoids and NAFLD progression was mediated by decreases in serum cholesterol and homeostasis model assessment of insulin resistance. This prospective study showed that higher flavonoid intake was associated with a lower risk of NAFLD progression in the elderly overweight/obese Chinese population.

Association between dietary mineral nutrient intake, body mass index, and waist circumference in U.S. adults using quantile regression analysis NHANES 2007-2014

OBJECTIVE

Mineral nutrients play an important role in maintaining material and energy metabolism. Reports on mineral nutrient intakes and body mass index (BMI) and waist circumference (WC) are rare in the United States. This study examined the relationship between BMI, WC and dietary mineral intakes.

METHOD

We used the data from National Health and Nutrition Examination Survey 2007-2014. Nutrient intakes were adjusted for energy according to the residual adjustment method. We used the quantile regression model to analyze the relationship between BMI, WC under different distributions and the average daily mineral intakes.

RESULT

A total of 19,952 people were included in the study, including 9,879 men and 10,073 women (≥20 years old). The median BMI was 27.935 kg/m2 and the median WC was 97.700 cm. The results of quantile regression showed that calcium, magnesium, potassium, copper, zinc and iron intakes were negatively correlated with BMI and WC, after adjusting for age and gender. Sodium and phosphorus intakes were positively correlated with BMI, sodium intakes were positively correlated with WC. This correlation was enhanced with increasing quantiles of risk levels. In high BMI or high WC populations, mineral intakes had a greater impact on BMI and WC. The quantile regression coefficients of selenium intakes were not statistically significant at each quantile.

CONCLUSION

Our results suggested that the mineral nutrient intakes were associated with BMI and WC in American adults. However, we also need to further study the longitudinal effects of mineral intakes and obesity.

Dietary Minerals Measurement in Normal Versus Obese Native American Adolescents

Obesity remains one of the five leading global risks for mortality in both developed and developing countries. Changes in dietary approaches have recently emerged as an approach to combat and prevent the high prevalence of obesity, specifically for minority groups having higher obesity rates. However, little research has been conducted on specific obesity rates in the Native American adolescent population and its' correlation to micronutrient intake. Our study chose a specific minority population of adolescents in order to contribute more academic research on obesity rates and micronutrient intake on Native American adolescents. Data was compiled using the Harvard School of Public Health Youth/Adolescent Questionnaire, which allowed significant results to be found among normal weight, overweight, and obese, male and female adolescents. This study used anthropometric measurements and dietary assessments to obtain baseline measurements and further determine the cause of the prevalence of obesity within Native American adolescent population. The majority of minerals featured significant results among various populations, more specifically among normal weight and obese males. Our finding indicates a relationship between a higher mineral intake and lower body weight in the male adolescent population. The data revealed an innovative correlation between micronutrient intake and obesity prevalence in Native American adolescents, which may provide a potential intervention to further prevent or combat obesity rates.