Dietary Quality Varies Among Adults on the Flathead Nation of the Confederated Salish and Kootenai Tribes in Montana

  • Carmen Byker Shanks
  • Selena AhmedEmail author
  • Virgil Dupuis
  • Mike Tryon
  • MaryAnn Running Crane
  • Bailey Houghtaling
  • Teresa Garvin
Original Paper


Diet-related chronic disease is among the most pressing public health issues and represents a health disparity among Native American communities. A community-based participatory approach was taken to evaluate dietary quality of adult residents of the Flathead Reservation of the Confederated Salish & Kootenai Tribes in Montana (the Flathead Nation). A survey was administered to collect basic demographic information and food security status (N = 80). Dietary quality was assessed using the 24-h dietary recall method with subsequent calculation of Healthy Eating Index 2010 (HEI-2010) scores, modified HEI without a dairy category, and the Dietary Diversity Scores (DDS). Participants included 80 adults from different households across eight communities (n = 10 per community) at the Flathead Nation. Approximately 50% of participants reported low or very low food security status while the remainder scored high or marginal food security. The mean total HEI-2010 score of study participants was 45.5 out of 100 points with a range between 20.0 and 78.1. The mean DDS of study participants was 4.6 (± 1.365) out of a total of 9 points. Participants with higher DDS had significantly higher intake of dietary fiber (p < 0.0003), potassium (0.0024), and cholesterol (p < 0.0048) compared to the lower DDS group. No significant correlations were found between HEI-2010 scores with DDS, demographic information, or food security status while significant differences were found between food security status and income (p < 0.01) and enrollment in nutrition assistance programs (p < 0.03). This study highlights the need to evaluate multiple parameters of dietary quality coupled with a community-based participatory approach in order for findings to be culturally relevant and support food and nutrition interventions.


Food security Dietary guidelines Healthy Eating Index Dietary diversity Native American 



The authors are grateful to the study participants for sharing their time. In addition, the authors are grateful to the community members of the Flathead Nation who collaborated on this study by providing their knowledge, perspectives, and time including their Community Advisory Board and the Tribal Council. The authors would like to extend gratitude to the research assistants and collaborators at Salish and Kootenai College and the Montana State University Food and Health Lab that supported with this work. This work was supported by National Institute of General Medical Sciences of the National Institutes of Health under Award Number P20GM103474 and Award Number 5P20GM104417. The content presented here is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Authors Contributions

Designed research: CBS, SA, MT. Data collection: CBS, MR, BH. Analyzed data: CBS, SA, TG. Wrote the manuscript: CBS and SA with contributions from all authors. Created graphs and tables: CBS, SA, TG. Interpreted data: CBS, SA, VD, MT, MRC, BH, TG. All authors have read and approved the final manuscript.


CBS, SA, and MT received funding support for this work from National Institute of General Medical Sciences of the National Institutes of Health under Award Number P20GM103474 and Award Number 5P20GM104417. The content presented here is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

Carmen Byker Shanks, Selena Ahmed, Virgil Dupuis, Mike Tryon, MaryAnn Running Crane, Bailey Houghtaling, Teresa Garvin have no conflict of interest.


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Authors and Affiliations

  1. 1.Food and Health Lab, Food and Nutrition and Sustainable Food Systems Programs, Department of Health and Human DevelopmentMontana State UniversityBozemanUSA
  2. 2.Salish Kootenai CollegePabloUSA
  3. 3.Gretchen Swanson Center for NutritionOmahaUSA

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