Prevalence of unexplained anaemia in Inuit men and Inuit post-menopausal women in Northern Labrador: International Polar Year Inuit Health Survey

Increasing our knowledge about the epidemiology of Helicobacter pylori in Nunavik's Inuit population (Québec, Canada) using Qanuilirpitaa? 2017 cross-sectional survey

Helicobacter pylori is a bacterium that may colonise and proliferate in human stomachs, leading invariably to chronic inflammation and, to a lesser extent, to peptic ulcers and cancer. The main objective of this study is to describe the epidemiology surrounding H. pylori in Nunavik's Inuit population using the 2004 and 2017 Health Surveys. Estimated prevalences were 70.9% for bacterial colonisation using a stool antigens test (SAT), 72.5% for anti-H. pylori antibodies, 12.7% for faecal occult blood in participants aged ≥ 50 and respectively of 28.4%, 11.2% and 2.4% for a prior diagnosis of colonisation, gastritis and peptic ulcer in the medical charts, with under five cases of gastric cancer reported. Variables associated with higher SAT+ prevalence were the number of household members (prevalence ratio [PR] = 1.03) and age (quadratic relationship), whereas mainly drinking municipal (PR = 0.84) and natural water (PR = 0.72) compared to bottled water, and increasing alcohol consumption (PR = 0.96) were associated with reduced prevalence. Despite current regional guidelines targeting high risk individuals in the context of high prevalence, Nunavik's health authorities must remain vigilant by following gastric cancer incidence and the rapid evolution of guidelines, while considering local realities.

Determinants of iron deficiency and anemia among Nunavimmiut: results from the Qanuilirpitaa? 2017 Nunavik Health Survey

OBJECTIVE

To estimate the prevalence of iron deficiency (ID) and anemia and study their main distal and proximal protective and risk factors among Nunavimmiut 16 years and older in 2017.

METHODS

In a cross-sectional participatory survey of 831 women and 436 men from the Qanuilirpitaa? 2017 Nunavik Inuit Health Survey, venous blood samples were collected to measure various indicators of iron status and anemia as well as biomarkers of nutritional and inflammatory status and contaminant exposures. Sociodemographic, food security status, anthropometric, lifestyle, dietary, and health data were collected using questionnaires, clinical sessions, and a medical chart review. ID and anemia diagnoses were based on serum ferritin (SF) and hemoglobin (Hb), respectively. Multiple regressions were used to assess correlates of anemia and iron status.

RESULTS

Prevalence of ID was highest among women of childbearing age (16-49 years old, 33%) and anemia among adults aged 50 years and older (31%). These estimates are prone to biases due to the relatively low participation rate (37%). Serum vitamin D, omega-3 polyunsaturated fatty acid content of erythrocyte membranes, blood selenium, inflammation, higher socioeconomic status (SES), obesity, and alcohol consumption were all positively associated with SF, while Helicobacter pylori infection and a recent pregnancy were negatively associated with Hb among women of childbearing age. Among older adults, food insecurity was associated with lower SF.

CONCLUSION

While data reported here provide some indication of an improvement since the previous survey conducted in 2004, additional efforts should be devoted to further increasing the SES and access to country foods and nutritious market foods in this population, the two main protective factors against ID and anemia identified in the present study.

Sources of exposure to lead in Arctic and subarctic regions: a scoping review

Understanding lead exposure pathways is a priority because of its ubiquitous presence in the environment as well as the potential health risks. We aimed to identify potential lead sources and pathways of lead exposure, including long-range transport, and the magnitude of exposure in Arctic and subarctic communities. A scoping review strategy and screening approach was used to search literature from January 2000 to December 2020. A total of 228 academic and grey literature references were synthesised. The majority of these studies (54%) were from Canada. Indigenous people in Arctic and subarctic communities in Canada had higher levels of lead than the rest of Canada. The majority of studies in all Arctic countries reported at least some individuals above the level of concern. Lead levels were influenced by a number of factors including using lead ammunition to harvest traditional food and living in close proximity to mines. Lead levels in water, soil, and sediment were generally low. Literature showed the possibility of long-range transport via migratory birds. Household lead sources included lead-based paint, dust, or tap water. This literature review will help to inform management strategies for communities, researchers, and governments, with the aim of decreasing lead exposure in northern regions.

Benefits and Risks Associated with Meat Consumption during Key Life Processes and in Relation to the Risk of Chronic Diseases

Red meat has been an important part of the diet throughout human evolution. Overall, when included as part of a healthy and varied diet, red meat can provide a rich source of bioavailable essential nutrients and high biological value protein. The present paper discusses the dietary role/impact of red and processed meat, with some reference to the relative effect of white meat, in a range of chronic conditions including iron-deficiency anaemia, cardiovascular diseases (CVD), cancer and dementia. The role of red meat in relation to key physiological conditions such as maintaining skeletal muscle and bone health and during pregnancy is also discussed. The inclusion of lean red meat in a healthy, varied diet may be beneficial during these critical conditions. There is however increasing evidence that red meat and especially processed meat are associated with increased risks of CVD, cancer and dementia whereas white meat is neutral or associated with a lower risk. There now seems little doubt that processed and unprocessed meat should have separate public dietary guidance.

Drivers and health implications of the dietary transition among Inuit in the Canadian Arctic: a scoping review

OBJECTIVE

The current study undertook a systematic scoping review on the drivers and implications of dietary changes among Inuit in the Canadian Arctic.

DESIGN

A keyword search of peer-reviewed articles was performed using PubMed, Web of Science, CINAHL, Academic Search Premier, Circumpolar Health Bibliographic Database and High North Research Documents. Eligibility criteria included all full-text articles of any design reporting on research on food consumption, nutrient intake, dietary adequacy, dietary change, food security, nutrition-related chronic diseases or traditional food harvesting and consumption among Inuit populations residing in Canada. Articles reporting on in vivo and in vitro experiments or on health impacts of environmental contaminants were excluded.

RESULTS

A total of 162 studies were included. Studies indicated declining country food (CF) consumption in favour of market food (MF). Drivers of this transition include colonial processes, poverty and socio-economic factors, changing food preferences and knowledge, and climate change. Health implications of the dietary transition are complex. Micro-nutrient deficiencies and dietary inadequacy are serious concerns and likely exacerbated by increased consumption of non-nutrient dense MF. Food insecurity, overweight, obesity and related cardiometabolic health outcomes are growing public health concerns. Meanwhile, declining CF consumption is entangled with shifting culture and traditional knowledge, with potential implications for psychological, spiritual, social and cultural health and well-being.

CONCLUSIONS

By exploring and synthesising published literature, this review provides insight into the complex factors influencing Inuit diet and health. Findings may be informative for future research, decision-making and intersectoral actions around risk assessment, food policy and innovative community programmes.

Anemia, iron status, and associated protective and risk factors among children and adolescents aged 3 to 19 years old from four First Nations communities in Quebec

OBJECTIVES

Anemia and iron deficiency (ID) are frequent among Indigenous children of Canada, but few data are available in Quebec. The present study aimed to characterize anemia and ID prevalence and associated protective and risk factors among First Nations youth in Quebec.

METHODS

The 2015 First Nations (JES!-YEH!) pilot study was conducted among children and adolescents (3 to 19 years; n = 198) from four First Nations communities in Quebec. Blood and urine samples and anthropometric measurements were collected. Hemoglobin (Hb), serum ferritin (SF), plasma hs-CRP, and urinary cotinine levels were measured. Factors associated with anemia and ID (including traditional and market food consumption) were assessed using an interview-administered food frequency questionnaire, based on which nutritional intakes were calculated. Structural equation models were used to test associations.

RESULTS

The prevalence of anemia and ID was elevated (16.8% and 20.5% respectively). Traditional meat, fruit, and fruit juice (natural and powdered)-via their positive association with vitamin C intake-were the only food variables positively associated with SF (coefficient [95% CI] 0.017 [0.000, 0.114]; 0.090 [0.027, 0.161]; and 0.237 [0.060, 0.411]). Male sex was also associated with higher SF (0.295 [0.093, 0.502]). Inflammation status (hs-CRP > 5 mg/L) was inversely associated with Hb (- 0.015 [- 0.025, - 0.005]), whereas SF was positively associated with Hb (0.066 [0.040, 0.096]). Fruit and juice consumption was also positively associated with Hb, via vitamin C intake and SF (0.004 [0.001, 0.010]; 0.008 [0.003, 0.017]).

CONCLUSIONS

Interventions fostering healthier food environments as well as higher consumption of traditional meats and foods naturally rich in vitamin C, which is known to enhance iron absorption, and fighting inflammation could contribute to decrease the high prevalence of anemia and ID in this young Indigenous population.

Potential impact of restricted caribou (Rangifer tarandus) consumption on anemia prevalence among Inuit adults in northern Canada

Background

Caribou (Rangifer tarandus) is the top dietary source of iron and several micronutrients necessary for red blood cell production (erythropoiesis) in the contemporary diet of Inuit adults across Canada. Many caribou populations across the circumpolar north, however, have experienced dramatic declines in recent decades. Restricted access to caribou may negatively impact the nutrition and health of Inuit communities.

Methods

We used data from the Inuit Health Survey, a cross-sectional survey of 2550 Inuit adults in thirty-six communities across northern Canada (conducted in 2007-2008) to examine the relationship between caribou consumption, hemoglobin (Hb), and blood biomarkers of nutrient intake and contaminant exposure. Multivariable linear regression was used to investigate the potential public health impact of a theoretical restriction in caribou consumption, by estimating the response of Hb concentrations (and the attendant change in anemia prevalence), to theoretical changes in caribou consumption (with and without substitution of caribou with other country food meat).

Results

Mean (95% CI) daily caribou meat consumption differed by an order of magnitude 4.3 (3.9-4.7), 51.1 (48.5-53.8), and 236.7 (224.7-248.7) grams/day between tertiles of caribou consumption. Mean (95% CI) hemoglobin levels increased from 129.1 (128.1-130.2) g/L to 132.5 (131.3-133.7) g/L between the highest and lowest tertiles of caribou consumption. In multivariable regression analyses, average daily caribou meat consumption was positively associated (P< 0.001) with hemoglobin levels. This relationship translated into approximately 4 g/L hemoglobin increase in participants in the third tertile of caribou consumption. The overall prevalence of anemia observed in the study population was 26.5% (24.5 - 28.3%) and a modelled restriction in caribou consumption (i.e. caribou = 0) increased the overall prevalence of anemia by approximately 6%. The maximum negative effect of caribou restrictions was related to a complete restriction on caribou consumption, coupled with the substitution of caribou with other country food meat (35.4% prevalence).

Conclusions

Given the importance of caribou to Inuit culture, health and wellbeing, and the high price of healthful market foods in remote northern communities, strategies to promote the sustainable harvest of country foods are urgently required to ensure the health and nutrition security of the Inuit, in the context of rapidly changing Arctic environments and ecosystems.