Table 2.

Detailed characteristics of included studies.

Author	Study Year	Country	Indigenous Group	Study Population	Sample Size and Description	Study Design	Study Aim	Results/Findings Related to Nutrition Behavior
Indigenous populations potentially at risk of CMDs
(Akande et al., 2021) [41]	2021	Canada	Inuit (Nunavut Inuit)	General population, possibly at risk	16 adults (10 women, six men)	Qualitative study involving semi-structured photo-elicitation interviews	To explore the perspectives of Nunavut Inuit on the barriers and enablers of healthy diets and physical activity participation in the community of Iqaluit	-Work-related changes, from hunting to a wage economy, influence food availability, impacting dietary choices. -Affordability is the main perceived barrier to healthy food choices, affecting traditional and non-traditional healthy foods. -Unhealthy junk foods are cheaper, while traditional foods have become more expensive due to the rising cost of hunting equipment and skilled hunters. -The availability of funds for purchasing healthy food is limited by spending choices such as smoking, drug use, and alcohol consumption. -The availability of healthy food options (including traditional foods) is a major barrier to eating healthily. -Political restriction on the number of specific wild animals allowed to be hunted reduces the consumption of healthy hunted meat. -Colonization and sociocultural assimilation have influenced food consumption practices, making former ‘food sharing’ practices less common.
(Bell et al., 2017) [14]	2017	Australia	Māori	General population, possibly at risk	15 Indigenous (Māori) people	Qualitative study involving narrative interviews	To identify the intrinsic mechanisms that specifically relate to Indigenous people’s interpretation of obesity	-Western models of calorie counting, diet and exercises were perceived as not sensitive to the needs and unrelatable concepts in the context of obesity. -The perceived association of biomedical health care with colonization causes feelings of alienation and reduces the acceptance of the health professional’s advice regarding a healthy diet.
(Berg et al., 2012) [28]	2012	United States of America	American Indians	General population, possibly at risk	998 American Indians	Quantitative study	To examine factors related to engaging in at least four days of physical activity per week and factors related to consuming at least five fruits and vegetables per day among a sample of American Indians in the Midwest	Education, knowledge, and perceptions are critical factors in improving nutrition behaviors.
(Bjerregaard and Larsen, 2021) [50]	2021	Greenland	Greenland Inuit	General population, possibly at risk	2436 Inuit aged 15+ years	Quantitative study	To explore the role of social position in dietary patterns and expenditures on food and other commodities	-Low social position associated with the selection of unhealthy food patterns.
(Bruner and Chad, 2014) [43]	2014	Canada	Woodland Cree	General population, possibly at risk	279 (females 15 years and older), 19 for interviews	Mixed-methods study	To explore the social, cultural, behavioral, and environmental factors influencing diet intake from a trans-generational perspective and to characterize the dietary practices among Woodland Cree women	-Shifts in the consumption of food associated with their Indian culture and an increase in ‘store-bought’ fast foods and overeating contributed to unhealthy bodies. -Younger community members prefer store-bought foods which are less healthy than hunting. -High costs to travel a long distance (145 km) to purchase food in the closest marketplaces influence food choices (e.g., fresh food would be spoiled). -Availability of healthy food options is limited locally, leading to the high frequency of purchasing packaged processed foods. -Environmental changes (e.g., deforestation) negatively influence hunting and thus make obtaining traditional foods more difficult. -A health center routinely supplies fruits and vegetables to individuals/programs, which is well received, yet this is not often possible due to long-distance traveling (300 km) to acquire these items. -Shifts in the consumption of food associated with their Indian culture and an increase in ‘store-bought’ fast foods and overeating contributed to unhealthy bodies. -Younger community members prefer store-bought foods which are less healthy than hunting.
(Buksh et al., 2022) [46]	2022	Pacific Island countries, Fiji	iTaukei mothers	General population, possibly at risk	15 Indigenous women	Qualitative study involving in-depth interviews	To explore sociocultural factors that contribute to overeating and unhealthy eating behaviors in an urban Indigenous community in Fiji	-Families with lower SES cannot afford meat and opt for cheaper processed meat options (canned meat, fish, sausages), thus eating less healthily. -Cultural norms, beliefs, expectations, and pressures contribute to overeating, unhealthy eating, and nutrition transitions among Indigenous populations in urban areas.
(Buksh et al., 2023) [47]	2023	Pacific Island countries, Fiji	iTaukei mothers (urban Indigenous Fijian mothers)	General population, possibly at risk	15 Indigenous women	Qualitative study involving in-depth interviews	To explore how urban indigenous Fijian mothers perceive healthy eating and how these perceptions impact the food decisions they make for their families	Multifaceted perceptions on healthy eating positively and negatively impacted the family food choices.
(Byker Shanks et al., 2020) [36]	2020	United States of America	Flathead Indian	General population, possibly at risk	Surveyed 79 residents and conducted 76 semi-structured interviews	Quantitative and qualitative multi- methods study	To document food environment experiences among residents of the Flathead Reservation in rural Montana	Perceptions of the food environment were linked to strategies that could be targeted to improve dietary quality.
(Domingo et al., 2021) [37]	2021	Canada	First Nations communities	General population, possibly at risk	3681 (2370 women/1311 men) First Nations people aged >= 19 years	Quantitative study	To examine the pattern of household food insecurity in First Nations communities and its association with obesity	Low income is linked to changes in unhealthy dietary practices. Receiving income support linked to healthy dietary practices.
(Estradé et al., 2021) [35]	2021	United States of America	Native American	General population, possibly at risk	580 tribal members, self-identified as the main household food purchaser (74% female)	Quantitative study	To identify psychosocial and household environmental factors related to diet quality among Native Americans (NA)	-Healthier household-level food patterns associated with higher diet quality. -High educational level associated with higher diet quality.
(Ho et al., 2008) [39]	2008	Canada	First Nations (Anishinaabe (Ojibwe and Oji-Cree)	General population, possibly at risk	129 First Nations adults	Descriptive quantitative study	To describe determinants of diet-related behavior and physical activity in First Nations for the development of culturally appropriate diabetes prevention programs	Larger households in remote communities tend to have higher scores for acquiring healthy food.
(Jock et al., 2020) [34]	2020	USA (Midwest, Southwest)	Native American	General population, possibly at risk	300 adults, three NA communities	Quantitative study	To describe the subgroups and demographic characteristics related to NA household food environments	There was low fruit and vegetable access among both the higher and lower access household food environments. Wild or brown rice and game meats were frequently obtained from higher access groups.
(Keith et al., 2018) [29]	2018	United States of America	American Indians	General population, possibly at risk	20 participants who were newly enrolled, academically underprepared tribal college students enrolled in life skills course	A nonexperimental cohort design used for qualitative descriptive analysis	To build an understanding of factors that influence healthy food choices among tribal college students at increased risk for college attrition	-Lack of income as students limit the acquisition of healthy foods. -Transportation challenges and high food costs are linked to difficulties in making healthy food choices. -Lack of nutrition knowledge linked with unhealthy food choices. -Difficulty accessing the store influences the likeliness to buy healthy foods. -Lack of exposure and positive role models for food choices. -A busy schedule is a barrier to preparing healthy meals at home. -Cultural traditions and practices are linked with healthy eating choices.
(Keshavarz et al., 2023) [42]	2023	Canada	Self-identified Indigenous people	General population, possibly at risk	1528 individuals in 2004 and 950 individuals in 2015	Quantitative study	To identify the dietary patterns of off-reserve Indigenous Peoples in Canada and their association with chronic conditions	High income positively correlated with higher adherence to healthy dietary patterns.
(Love et al., 2019) [30]	2019	United States, Oklahoma	American Indian Communities, Chickasaw Nation and the Choctaw Nation	General population, possibly at risk	513 American Indians	Quantitative study	To examine the relations between the perceived food environment, utilization of food retailers, fruit and vegetable intake, and chronic diseases, including obesity, hypertension, and type 2 diabetes among AI adults	57% of participants reported that it was easy to purchase fruits and vegetables in their town, and fewer (35%) reported that the available fruits and vegetables were of high quality. Additionally, over half (56%) reported traveling ≥20 miles round trip to shop for food.
(Philip et al., 2017) [33]	2017	United States, Alaska	Native population (Alaska) (Yup’ik)	General population, possibly at risk	486 Yup’ik adults	Quantitative study	To assess the relationships between socioeconomic, behavioral, and cardiometabolic risk factors among Yup’ik people of southwestern Alaska, with a focus on the role of the socioeconomic and cultural components	-Access to enough and appropriate foods is linked with better dietary practices. -Western culture is associated with higher consumption of processed foods and lower consumption of subsistence foods. -Western culture was associated with higher consumption of processed foods and lower consumption of subsistence foods.
(Rapinski et al., 2023) [49]	2023	French Guiana	Palikur/Parikwene People	General population, possibly at risk	75 community members, elders, healthcare professionals, administrators	Qualitative study, including ethnographic research and interviews	To identify the dietary patterns of off-reserve Indigenous men, women, and children in Canada and their association with chronic conditions in 2004 and 2015 while considering related sociodemographic and socioeconomic conditions	The income level among adults was recognized as an important factor that may be associated with the dietary intake of the off-reserve Indigenous population.
(Rosella et al., 2020) [38]	2020	Canada, Ontario	First Nations communities	General population, possibly at risk	993 adults	Cohort study	To predict 10-year diabetes risk and describe the factors that contribute to diabetes risk in First Nations adults living in Ontario First Nations communities	Factors included food insecurity, low income, and eating traditional vegetative foods.
(Setiono et al., 2019) [27]	2019	United States of America	American Indian Communities	General population, possibly at risk	580 adults from each of the six communities	Descriptive quantitative study	To characterize common dietary patterns among adults from 6 AI communities (N = 580) and assess their relationship with BMI, percentage body fat, waist-to-hip ratio, hypertension, and self-reported T2DM and cardiovascular disease	Five main dietary patterns: meat and fried foods, processed foods, fruits and vegetables, sugary snacks, and meat alternatives and high-protein foods. Those consuming more meat and fried foods had higher waist-to-hip ratios (0.03; 95% CI: 0.01, 0.04), BMI (2.45 kg/m2; 95% CI: 0.83, 4.07), and odds of being overweight or obese (OR: 2.63; 95% CI: 1.10, 6.31). Higher intake of processed foods was associated with increased odds of self-reported T2DM (OR: 3.41; 95% CI: 1.31, 8.90).
(Sorensen et al., 2005) [53]	2005	Russia, Northeastern Siberia	Yakutia	General population, possibly at risk	201 people in three urbanized towns and three rural communities	Descriptive quantitative study	To investigate diet and lifestyle determinants of plasma lipids in the Yakut, an Indigenous Siberian herding population	Modern lifestyles (often associated with higher incomes) correlated positively with market and mixed diets, while subsistence lifestyles (often associated with lower incomes) negatively correlated with market diets but positively correlated with mixed and subsistence diets.
(Stotz et al., 2021a) [25]	2021	United States of America	American Indian, Alaska Natives	General population, possibly at risk, possibly at risk	29 AI/AN with T2DM, 22 family members, 10 community-based key informants	Qualitative study involving focus groups and key informants’ interviews	To examine stakeholder perspectives on food insecurity and associated challenges to healthy eating among American Indian and Alaska Native Adults with T2DM	-Food insecurity was reported as a barrier to healthy eating practices. -High cost of healthy food and limited income linked with unhealthy food choices. -Living in rural areas is linked to a lack of access to healthful foods such as fruits and vegetables, supermarkets, and full-scale grocery stores, and to the higher availability of fast and processed foods. -Lack of fresh fruits and vegetables at grocery stores and non-availability of traditional foods and food-acquisition habits are barriers to healthy eating. -Strong community and family support systems, traditional foods, and food acquisition and preparation practices facilitate healthy eating.
(Stotz et al., 2021b) [26]	2021	United States of America	American Indian, Alaska Native Adults	General population, possibly at risk, possibly at risk	Nine experts in diabetes education, 20 community-based key informants, 29 AI/AN and 22 family members	Qualitative study involving key-informant interviews and focus groups	To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D to inform the cultural adaptation of an existing diabetes nutrition education curriculum	-Low cost associated with barriers to consuming fresh healthy food Urban dwellers experience barriers to healthy eating compared to rural dwellers. -Challenges with gardening are associated with barriers to consuming fresh healthy food. -Both individual factors (e.g., comorbidities and chronic diseases) and societal factors (e.g., trauma related to colonization) influence the ability to eat healthfully.
(Valeggia et al., 2010) [48]	2010	Argentina	Two Indigenous populations of the Argentine Gran Chaco: the Toba and Wichı	General population, possibly at risk	541 adults	Quantitative study	To evaluate the association between socioeconomic and nutritional statuses in adults of two Indigenous populations of the Argentine Gran Chaco: the Toba and Wichı’ of the province of Formosa	-Higher socioeconomic status linked to high consumption of marketed foods.
(Wycherley et al., 2019) [44]	2019	Australia	Indigenous Australians living in remote areas	General population, possibly at risk	13 remote Indigenous Australian communities, with populations ranging from 139–1079 persons	Quantitative study	To explore the modifiable environmental-level factors associated with the features of dietary intake that underpin cardiometabolic disease risk in this population group	-Unemployment linked to lower dietary intake quality. -Lower household income is associated with poorer dietary intake quality. -Lesser household crowding and shorter distances to neighboring stores are associated with lower dietary intake quality.
Indigenous populations living with CMDs
(Bird et al., 2008) [40]	2008	Canada	Inuit	Adults with T2DM	Four ethnographic and informal interviews	Qualitative multi-case study, including ethnographic research, as well as informal interviews and field observations	To explore the experience of adult members of a small Arctic community who are living with diabetes as well as factors that influence their food choices and perceptions of diabetes and health management	-Lack of education and uncertainty about the proper carbohydrate choices and meal spacing. -Adaptability of T2DM patients to respond to their health condition is increased by learning about coping strategies, including healthy eating, and sharing knowledge to improve healthy eating. -Mixed sentiments about experiences with the ‘Southern’ style of healthcare, e.g., distrust, skepticism, trust, and respect, which influence the following of the healthcare providers’ instruction on a healthy diet.
(Dussart, 2009) [45]	2009	Australia	Aboriginal	Adults with T2DM	84 Aboriginal diabetic sufferers, kin and medical staff	Qualitative semi-structured interviews	To better understand how diabetes sufferers cope with their illness in everyday life for creating more culturally sensitive health promotion initiatives	-Biomedical imperatives (about an appropriate diet for the management of diabetes) are clashing with Indigenous forms of sociality. -Due to social expectations of generosity and sharing food, store-bought prepared food relieves the stress. -Initiatives to introduce dietary changes must find a balance between personal autonomy and social obligations.
(Goins et al., 2020) [31]	2020	United States of America	American Indians	Adults with T2DM	28 participants, 57% women	Qualitative study using a low-inference descriptive design with semi-structured in-depth interviews	To examine the beliefs, attitudes, and practices of older American Indians regarding their T2DM management	-Higher costs of foods linked with unhealthy food choices. -Difficulty of grocery shopping in terms of reading labels linked to determining the best food choices. -T2DM management influenced by sociocultural factors, Native culture, southern Appalachian culture, spirituality, traditional Native foods, southern Appalachian foods and foodways; social aspects of food, historical trauma, and financial circumstances related to food.
(Juárez-Ramírez et al., 2019) [52]	2019	Mexico	Mayan people	Adults with T2DM	195 adults with T2DM	Mixed-methods study	To understand non-adherence to medically recommended diets among Mayans with diabetes	- Cultural beliefs and not nutrition explain the origin of diabetes; therefore the relevance of food is overlooked. -High-calorie foods (corn, pork, sugar-based foods) are part of traditional ceremonies and make it difficult to follow dietary regimens.
(Schure et al., 2019) [32]	2019	United States of America	American Indians	Adults with T2DM	28 noninstitutionalized older tribal members aged >60 years	Qualitative study involving semi-structured in-person interviews	To examine dietary-related beliefs and self-management among older American Indians with T2DM	-Cultural upbringing of not wasting food hinders diabetic patients from eating healthily. -Social support, motivation, community dinners, healthcare professional and family influence, and personal beliefs (e.g., distaste for wasting food) facilitate adherence to a healthy diet.
(Teufel-Shone et al., 2018) [24]	2018	United States of America	Several American Indian, Alaska Natives	Adults with T2DM	2484 AI/AN with T2DM	Quantitative study	To examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives with T2DM	Both males (34.9%) and females (65.1%) had higher healthy food scores than unhealthy scores. Unhealthy food scores showed significant positive relationships with distress for both genders (females: β = 0.078, p = 0.0007; males: β = 0.139, p < 0.0001).
(Wilson et al., 2021) [51]	2021	Guatemala	Indigenous Guatemalan community	Adults with T2DM	32 adults with T2DM	Qualitative structured interviews	To assess barriers to making dietary modifications for people living with T2DM in a rural Indigenous Guatemalan population	-A healthful diet is too costly. -Fluctuation of income level in ‘off-season’ times affects money available for healthy food. -Travel time and travel costs to the next market (5 to 30 km away) limit a healthy diet. -Lack of refrigerators limits the amount of perishable, fresh food that can be bought at a distance. -Challenges exist in the necessity to prepare food differently for diabetic patients than family members (incompatibility with family and traditional diet).