Dietary nutrients and anthropometry of Dene/Métis and Yukon children

Measurement of diet quality among First Nations peoples in Canada and associations with health: a scoping review

BACKGROUND

Given the increasing number and the diversity of dietary quality indices used for research, and the differences between settings, there is a need to identify valid indices of dietary quality in different contexts and populations and to identify their associations with health-related outcomes.

OBJECTIVES

The primary objective of this scoping review is to identify the tools used in determining dietary quality among First Nations and to describe the changes in diet. The second objective is to describe the associations identified in studies that have measured the relationship between health and dietary quality among First Nations; and the third objective is to identify factors associated with diet quality.

METHODS

PubMed, Embase, CINAHL, Global Health, and Web of Science were searched from inception to June 2021 and updated in February 2022. Articles were included if the research subjects were First Nations, or if articles reported disaggregated subset data for First Nations. Eligible studies focused on nutrition and diet and were published in English or French.

RESULTS

A total of 151 articles were included in the analysis. Studies used several indicators to measure if individuals adhered to dietary guidelines. Traditional food consumption was frequently used as an indicator of diet quality (n = 96). The consumption of store-bought foods was used as an indicator in 28 studies. Some studies used other diet quality indicators such as the Healthy Eating Index (n = 5) and ultra-processed food "NOVA" classification (n = 6). A trend for decreasing traditional food intake over time was apparent, alongside an increase in store-bought food intake. This trend was accompanied with declining health status, including the increased prevalence of overweight and obesity, diabetes, metabolic diseases, and dental caries.

CONCLUSION

This scoping review showed that diet quality among First Nations is improved when traditional foods are consumed. Reduced diet quality was associated with increased risk of noncommunicable diseases.

Inuit Country Food and Health during Pregnancy and Early Childhood in the Circumpolar North: A Scoping Review

Inuit communities in the Circumpolar North have experienced a nutrition transition characterized by the decreased intake of culturally important, nutrient-rich traditional food (country food), and an increased intake of market food, resulting in concerns over reduced diet quality and emerging chronic diseases. Nutrition in early life is critical for development, may influence health risks in later life, and is an important concern for Inuit community health. The goal of this scoping review was to characterize the nature, extent, and range of the published literature on Inuit country food and health in pregnancy and childhood. A search string was developed and applied to three databases, followed by title and abstract screening and full text review. Articles published between 1995 and 2019 were included, and data were extracted and summarized descriptively. The number of articles generally increased over time, despite the unequal geographic distribution of articles. The majority of the articles focused on environmental contaminants, and one-quarter described nutrient adequacy. Few articles described food security or food safety in pregnancy, and the most utilized quantitative methods. Gaps in understanding of country food use in pregnancy and early childhood highlight areas of future research to support public health policy for this population. Given the critical role of good nutrition in early life and the important contribution country food makes to diet quality for Inuit, further understanding of this interface is warranted.

Game bird consumption in Dene communities of the Northwest Territories, Canada

OBJECTIVE

Game bird consumption is an important part of the diet of Indigenous populations in Canada and, as part of country food consumption, is associated with improved nutritional status. The objective of this project was to document the consumption of game birds for Dene First Nations in the Northwest Territories (NWT), Canada.

DESIGN

Participants were invited to complete a FFQ using an iPad to document the types of country foods consumed, as well as consumption frequency and preparation methods, including thirteen types of game birds.

SETTING

The project was implemented in nine communities in the Dehcho and Sahtú regions of the NWT, Canada.

PARTICIPANTS

A total of 237 children and adult participants from Dene First Nations in the Mackenzie Valley region of the NWT took part in the current study.

RESULTS

FFQ findings indicated that game birds were frequently consumed in both Dehcho and Sahtú communities. Canada goose and mallard were found to be consumed by the largest number of participants. Five different species (including Canada goose and mallard) were found to be consumed by at least 25 % of participants over the last year. When consuming game birds, most participants reported consuming the meat as well as most, if not all, other parts of the bird.

CONCLUSIONS

Differences were observed since the last country food assessment in the 1990s in the same regions. These findings increase knowledge of the current Dene diet patterns and support the understanding of diet transition.

Implications of the nutrition transition for vitamin D intake and status in Aboriginal groups in the Canadian Arctic

Aboriginal Canadians have low intakes of vitamin D and are shifting away from consumption of traditional foods. Higher body mass index, skin pigmentation, and geographic latitude of residence further predispose Canadian Aboriginal populations to low vitamin D status. Low vitamin D status could compromise bone health and other health outcomes. Studies assessing vitamin D status of different Aboriginal groups are limited. The aim of this review is to examine the literature on vitamin D status and intakes of Canadian Aboriginal populations living in the Arctic. PubMed was searched for relevant articles published from 1983 to 2013. The prevalence of 25-hydroxy vitamin D deficiency ranged from 13.9% to 76.0% among children and adults in the summer. Furthermore, mean vitamin D intakes among all age groups were below the estimated average requirement. As vitamin D deficiency has been recently associated with chronic diseases, and Aboriginal populations living in the Arctic are at high risk for low vitamin D status, their vitamin D status should be assessed regularly across seasons.

Food use of Dene/Métis and Yukon children

OBJECTIVE

To describe food use of Dene/Métis and Yukon children with focus on food sources--traditional food (TF) and market food (MF), season, gender and location.

STUDY DESIGN

Children of 10-12 years of age were interviewed for 24-h recalls (n = 222 interviews) in five communities during two seasons in 2000-2001.

METHODS

Differences in children's food and nutrient intakes when consuming or not consuming at least one item of TF and across three regions were tested using ANCOVA after rank transformation of raw values. Food use was described and compared by food groups.

RESULTS

MF was the major portion of the diet, with TF contributing only an average 4.3%-4.7% of energy in the two seasons. Most TF was in the form of land animal meats. More than half of the energy intake from MF came from less nutrient dense food items. In spite of low TF intake, children who consumed TF had significantly (P < or = 0.05) more protein, iron, zinc, copper, magnesium, phosphorus, potassium, vitamin E, riboflavin and vitamin B6 than those who did not. Children in the more northern communities consumed significantly (P < or = 0.05) more TF, protein, iron, copper, vitamin B6 and manganese, and less energy, fat, saturated fat and sodium.

CONCLUSIONS

Extensive use of less nutrient-dense food by children is a concern, suggesting a need for dietary improvement. Use of more TF should be encouraged, especially for children living in more southern Arctic communities near commercial centers.

Cadmium and other elements in tissues from four ungulate species from the Mackenzie Mountain region of the Northwest Territories, Canada

Tissue samples from four ungulate species from the south Mackenzie Mountain region of the Northwest Territories (NT), Canada, were analysed for stable and radioactive elements and (15)N and (13)C stable isotopes. Elevated Cd concentrations in moose (Alces americanus) kidney have been observed in the region and are a health care concern for consumers of traditional foods. This study examined the factors associated with, and potential renal effects from, the accumulation of cadmium, and interactions with other elements in four sympatric ungulate species. Mean renal Cd concentration was highest in moose (48.3mg/kg ww), followed by mountain caribou (Rangifer tarandus caribou) (13.9mg/kg ww) and mountain goat (Oreamnos americanus) (5.78mg/kg ww). No local sources of Cd were evident and the elevated levels in moose are considered to be natural in origin. Conversely, total Hg concentration was significantly higher in mountain caribou kidney (0.21mg/kg ww) than in moose (0.011mg/kg ww). (134)Cs (t½=2.1 y) in mountain goat and Dall's sheep (Ovis dalli) muscle is evidence of deposition from the Fukushima reactor accident in 2011. (137)Cs (t½=30.2 y) in all four ungulates is primarily a remnant of the nuclear weapons tests of the 1960s. The levels of both nuclides are low and the risk to the animals and people consuming them is negligible. Stable isotope δ(15)N and δ(13)C signatures in muscle showed a separation between the mountain caribou, with a lichen-dominated diet, and moose, which browse shrubs and forbs. Isotope signatures for mountain goat and Dall's sheep showed generalist feeding patterns. Differences in elemental and radionuclide levels between species were attributed to relative levels of metal accumulation in the different food items in the diets of the respective species. Kidneys from each species showed minor histological changes in the proximal tubule and glomerulus, although glomerular changes were rare and all changes were rare in mountain goat kidney. Kidney function was not expected to be affected in any species. Provisional Monthly Intake recommendations from the WHO indicate that Cd in moose organs will continue to be a public health care concern. However, traditional foods continue to be an important nutritional component of northern diets, particularly in consideration of the shift towards store-bought food.

Facilitators and Barriers to Traditional Food Consumption in the Cree Community of Mistissini, Northern Quebec

To identify barriers to traditional food consumption and factors that facilitate it among the Cree community of Mistissini, a series of four focus groups was conducted with a total of twenty-three people. Two ecological models were created, one for facilitating factors and a second for obstacles, illustrating the role of numerous interconnected influences of traditional food consumption. Environmental impact project, laws and regulation, local businesses, traditional knowledge, youth influence, employment status, and nonconvenience of traditional food were named among numerous factors influencing traditional food consumption. The findings of this study can be used by political and public health organizations to promote traditional food where more emphasis should be invested in community and environmental strategies.

Omega-3 polyunsaturated fatty acid profiles and relationship with cardiometabolic risk factors in Cree (Eeyouch) of Northern Québec

Background

n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) from fish are known modulators of cardiometabolic risk factors.

Objective

To examine fatty acids (FAs) status and the relationship between n-3 LC-PUFA and cardiometabolic risk factors in Cree participants.

Design

We analyzed data from a cross-sectional study (n=829) conducted in Cree adults (aged 18–74 years) from 7 communities of the James Bay territory of Quebec (Canada) in 2005–2009. Sociodemographic, lifestyle, clinical and anthropometric data were collected. FAs were quantified in red blood cells (RBCs) under fasting conditions.

Results

A total of 89% of the participants were overweight (with 69% obesity), 33% had hypertriglyceridemia, 44% had low plasma HDL-c and 77% had fasting plasma insulin ≥90 pmol/l. Total n-3 PUFAs accounted for 6% of total FAs and were higher among older participants, while n-6 PUFAs accounted for 31% of total FAs and were higher among younger participants. According to the adjusted multiple linear regression models, n-3 LC-PUFA was associated (p<0.05) with higher total cholesterol, LDL-c and apo B-100, and was also associated (p<0.05) with lower blood glucose.

Conclusion

Overall, this study showed that n-3 LC-PUFA levels measured in the RBCs of the Cree adults are relatively low and tend towards lower levels among youth. These levels might be insufficient to offset the prevalence of cardiometabolic risk factors.

Caribou consumption in northern Canadian communities

Chronic wasting disease (CWD) is a transmissible spongiform encephalopathy (TSE) found in both farmed and wild deer, elk, and moose in the United States and Canada. Surveillance efforts in North America identified the geographical distribution of the disease and mechanisms underlying distribution, although the possibility of transmission to other cervids, including caribou, and noncervids, including humans, is not well understood. Because of the documented importance of caribou (Rangifer tarandus) to human populations in the northern regions of Canada, a risk-management strategy for CWD requires an understanding of the extent of potential dietary exposure to CWD. Secondary 24-h dietary recalls conducted among Inuvialuit and Inuit in 4 communities in the Northwest Territories and Nunavut were employed in this study. Econometric demand systems were estimated to model the impacts of individual- and community-level socioeconomic characteristics on expenditures on caribou and other foods, in order to examine the households' ability to consume other foods in response to changing levels of caribou consumption. Thirty-five percent of respondents reported consuming caribou in the survey period, and caribou comprised, on average, 26% of daily dietary intake by weight, or approximately 65 g/d, across individuals in the 4 communities. Consuming caribou was also shown to exert positive impacts on dietary quality, as measured by calorie intake and dietary diversity. Communities with less access to employment, income and food stores are predicted to be constrained in their ability to obtain an adequate diet in the event of scarcity of caribou meat.

Socioeconomic and Cultural Correlates of Diet Quality in the Canadian Arctic: Results from the 2007–2008 Inuit Health Survey

Purpose: We examined the impact of socioeconomic and cultural factors on dietary quality in adult Inuit living in the Canadian Arctic.

Methods: Interviews and a 24-h dietary recall were administered to 805 men and 1292 women from Inuit regions in the Canadian Arctic. We examined the effect of age, sex, education, income, employment, and cultural variables on respondents' energy, macronutrient intake, sodium/potassium ratio, and healthy eating index. Logistic regression was used to assess the impact of socioeconomic status (SES) on diet quality indicators.

Results: Age was positively associated with traditional food (TF) consumption and greater energy from protein but negatively associated with total energy and fibre intake. Associations between SES and diet quality differed considerably between men and women and there was considerable regional variability in diet quality measures. Age and cultural variables were significant predictors of diet quality in logistic regression. Increased age and use of the Inuit language in the home were the most significant predictors of TF consumption.

Conclusions: Our findings are consistent with studies reporting a nutrition transition in circumpolar Inuit. We found considerable variability in diet quality and complex interaction between SES and cultural variables producing mixed effects that differ by age and gender.

Is hunting still healthy? Understanding the interrelationships between indigenous participation in land-based practices and human-environmental health

Indigenous participation in land-based practices such as hunting, fishing, ceremony, and land care has a long history. In recent years, researchers and policy makers have advocated the benefits of these practices for both Indigenous people and the places they live. However, there have also been documented risks associated with participation in these activities. Environmental change brought about by shifts in land use, climate changes, and the accumulation of contaminants in the food chain sit alongside equally rapid shifts in social, economic and cultural circumstances, preferences and practices. To date, the literature has not offered a wide-ranging review of the available cross-disciplinary or cross-ecozone evidence for these intersecting benefits and risks, for both human and environmental health and wellbeing. By utilising hunting as a case study, this paper seeks to fill part of that gap through a transdisciplinary meta-analysis of the international literature exploring the ways in which Indigenous participation in land-based practices and human-environmental health have been studied, where the current gaps are, and how these findings could be used to inform research and policy. The result is an intriguing summary of disparate research that highlights the patchwork of contradictory understandings, and uneven regional emphasis, that have been documented. A new model was subsequently developed that facilitates a more in-depth consideration of these complex issues within local-global scale considerations. These findings challenge the bounded disciplinary and geographic spaces in which much of this work has occurred to date, and opens a dialogue to consider the importance of approaching these issues holistically.

Fatty acid profiles among the Inuit of Nunavik: current status and temporal change

The Inuit undergo substantial changes in their lifestyle, but few data exist on how these changes occur in biomarkers, such as polyunsaturated fatty acids (PUFAs). Here, we report data from a cross-sectional survey conducted in 2004 among 861 representative Nunavik Inuit adults, in whom FAs were measured in red blood cells (RBCs). FAs were also measured in plasma phospholipids (n=452) to assess temporal trend by comparing plasma PUFAs measured in 1992. Food intakes were estimated using a validated food frequency questionnaire. In 2004, marine food intake was 84±4g/d (±SEM). Adjusted-mean of RBC omega-3 was significantly higher, and omega-6 lower, in older age groups (Ptrend<0.001). In 2004, plasma omega-3 was 25% lower, while omega-6 was 9% higher, compared to 1992. Our study revealed that Nunavik Inuit adults still have high RBC omega-3, but show signs of nutritional transition - as indicated by lower omega-3 and higher trans-fats in RBCs of young compared to older.

Anthropometric measurements in Canadian children: a scoping review

OBJECTIVE

The objective of the current study was to identify what forms of anthropometric measurement are currently being utilized with Canadian children and youth and what are the gaps in the literature on this topic.

METHODS

The current study utilized a scoping review methodology in order to achieve the study objectives. Online databases Medline and PubMed and CINAHL were used to search articles from the last decade (2002-2012) that addressed Canadian children aged 2-18 years.

SYNTHESIS

50 studies were included in this review. A variety of anthropometric measurements were identified, including body mass index, waist circumference, hip-to-waist ratio, among others. Six of the included studies (12%) utilized nationally representative data from large-scale studies. BMI was the most reported form of measurement with 88% of studies collecting it. Waist circumference was a distant second with 20% of studies reporting it. Several gaps in the literature exist with regards to First Nations (FN) research; many of the measurement methods were not used. Additionally, FN accounted for only 2.5% of the study's sample. The majority of studies took place in Quebec (29%) and Ontario (27%).

CONCLUSION

Body mass index is the most reported method of anthropometric measurement used for children. Efforts should be taken by health care practitioners and researchers to collect other forms of measurement in order to assist in understanding the validity of other measures and their value when used with children. Furthermore, attention needs to be focused on utilizing and studying various forms of anthropometric measurement across all Canadian regions and populations.

Dietary correlates of an at-risk BMI among Inuit adults in the Canadian high arctic: cross-sectional international polar year Inuit health survey, 2007-2008

BACKGROUND

The study's objective was to investigate the dietary correlates of an at-risk body mass index (BMI) among Inuit adults from thirty-six communities across the Canadian Arctic using data from the cross-sectional International Polar Year Inuit Health Survey, conducted in 2007-2008.

METHODS

The survey included assessments of 24-hr dietary recall, sociodemographics, physical activity, and anthropometry. Dietary characteristics of overweight and obesity were similar and therefore combined into one at- risk BMI category (≥25 kg/m2) for analyses. The relationship between an at-risk BMI and energy intake from macronutrients, high sugar drinks, high-fat foods, saturated fatty acids, and traditional foods were examined entering each dietary variable separately into a logistic regression model as an independent variable. Analyses were adjusted for age, sex, region, kcalories, walking, smoking and alcohol consumption. Further multivariable models considered selected dietary variables together in one model.

RESULTS

An at-risk BMI was present for 64% with a prevalence of overweight and obesity of 28% and 36%, respectively. Consumption of high-sugar drinks (>15.5% E) was significantly related with having an at-risk BMI (OR = 1.6; 95% CI 1.2; 2.2), whereas the % E from total carbohydrate evaluated as a continuous variable and as quartiles was inversely related to an at-risk BMI (P -trend < 0.05) in multivariable analyses. While % E from high-fat foods was positively related to an at-risk BMI, the findings were not significant in a model controlling for high-sugar drinks and % E from carbohydrates.

CONCLUSIONS

The prevalence of overweight and obesity is of public health concern among Inuit. The current findings highlight the obesogenic potential of high-sugar drink consumption in an ethnically distinct population undergoing rapid cultural changes and raises concerns regarding carbohydrate restricted diets. Health promotion programs aimed at preventing the development of an unhealthy body weight should focus on physical activity and the promotion of healthy diets with reduced intake of sugar drinks.

Obesity and type 2 diabetes in Northern Canada's remote First Nations communities: the dietary dilemma

First Nations populations in Northwestern Ontario have undergone profound dietary and lifestyle transformations in less than 50 years, which have contributed to the alarming rise in obesity and obesity-related diseases, in particular type 2 diabetes mellitus. Even though the genetic background of First Nations peoples differs from that of the Caucasians, genetics alone cannot explain such a high prevalence in obesity and type 2 diabetes. Modifications in lifestyle and diet are major contributors for the high prevalence of chronic diseases. What remains constant in the literature is the persistent view that locally harvested and prepared foods are of tremendous value to First Nations peoples providing important health and cultural benefits that are increasingly being undermined by western-based food habits. However, the complexities of maintaining a traditional diet require a multifaceted approach, which acknowledges the relationship between benefits, risks and viability that cannot be achieved using purely conventional medical and biological approaches. This brief review explores the biological predispositions and potential environmental factors that contribute to the development of the high incidence of obesity and obesity-related diseases in First Nations communities in Northern Canada. It also highlights some of the complexities of establishing exact physiological causes and providing effective solutions.

Environmental contaminants and human health in the Canadian Arctic

The third Canadian Arctic Human Health Assessment conducted under the Canadian Northern Contaminants Program (NCP), in association with the circumpolar Arctic Monitoring and Assessment Programme (AMAP), addresses concerns about possible adverse health effects in individuals exposed to environmental contaminants through a diet containing country foods. The objectives here are to: 1) provide data on changes in human contaminant concentrations and exposure among Canadian Arctic peoples; 2) identify new contaminants of concern; 3) discuss possible health effects; 4) outline risk communication about contaminants in country food; and 5) identify knowledge gaps for future contaminant research and monitoring. The nutritional and cultural benefits of country foods are substantial; however, some dietary studies suggest declines in the amount of country foods being consumed. Significant declines were found for most contaminants in maternal blood over the last 10 years within all three Arctic regions studied. Inuit continue to have the highest levels of almost all persistent organic pollutants (POPs) and metals among the ethnic groups studied. A greater proportion of people in the East exceed Health Canada's guidelines for PCBs and mercury, although the proportion of mothers exceeding these guidelines has decreased since the previous assessment. Further monitoring and research are required to assess trends and health effects of emerging contaminants. Infant development studies have shown possible subtle effects of prenatal exposure to heavy metals and some POPs on immune system function and neurodevelopment. New data suggest important beneficial effects on brain development for Inuit infants from some country food nutrients. The most successful risk communication processes balance the risks and benefits of a diet of country food through input from a variety of regional experts and the community, to incorporate the many socio-cultural and economic factors to arrive at a risk management decision that will be the most beneficial in Arctic communities.

Associations of television viewing, physical activity and dietary behaviours with obesity in aboriginal and non-aboriginal Canadian youth

OBJECTIVE

To determine associations of diet, physical activity and television (TV) viewing time with obesity among aboriginal and non-aboriginal youth in conjunction with socio-economic variables.

DESIGN

Cross-sectional study of differences between aboriginal and non-aboriginal groups and associations between lifestyle and socio-economic factors with obesity were examined.

SETTING

Population data from the Canadian Community Health Survey Cycle 2.2 conducted in 2004 in the ten provinces of Canada.

SUBJECTS

A total of 198 aboriginal and 4448 non-aboriginal Canadian youth aged 12-17 years.

RESULTS

Compared to non-aboriginal youth, physical activity participation among aboriginal youth was higher, but consumption of vegetables and dairy products was lower, and more aboriginal youth were 'high' TV watchers. Low income adequacy was associated with decreased odds for obesity among aboriginal youth in contrast to higher odds among non-aboriginal youth. Non-aboriginal 'high' TV watchers consumed more soft drinks and non-whole-grain products than did 'low' TV watchers. Physical activity participation did not differ between 'high' and 'low' TV watchers for both groups, and was associated with lowered odds for obesity only among aboriginal youth.

CONCLUSIONS

Sociodemographic and lifestyle risk factors associated with obesity differ between aboriginal and non-aboriginal youth. These findings may be useful for guiding intervention efforts.

Emerging obesity and dietary habits among James Bay Cree youth

OBJECTIVE

To describe dietary habits and extent of overweight and obesity among Cree youth.

DESIGN

Dietary intake and habits were assessed by a 24 h recall and FFQ as part of a cross-sectional survey.

SETTING

Three Cree communities in northern Québec, Canada.

SUBJECTS

A total of 125 youth aged 9-18 years.

RESULTS

Overall 67·6 % of the study population was either at risk of overweight or overweight. Over 98 % had a usual saturated fat intake over 10 % of energy while 65 % had a lower consumption of fruit/vegetables and 95 % had a lower consumption of milk and milk products than recommended by Canada's Food Guide. The majority (96·8 %) consumed high-fat foods (>40 % of total energy as fat), which accounted for 39 % of total energy intake (EI). Similarly, 92·8 % consumed high-sugar food and beverages (>25 % of total energy as sugar), which accounted for 12·8 % of total EI. Furthermore, 95 % of the youth had a Healthy Eating Index (HEI) below the recommended score of 80 or above. Certain measures of diet quality (traditional food (TF) consumption, HEI and vegetables and fruit consumption) were significantly correlated with adiposity measures.

CONCLUSIONS

A high prevalence of low-diet quality was found with a high degree of sugar and fat intake and a low consumption of vegetables/fruit and milk/milk alternates and any weekly TF. Dietary interventions are sorely needed.

Environmental toxins, a potential risk factor for diabetes among Canadian Aboriginals

OBJECTIVES

To review the current literature to determine if there is a case for examining the presence of toxins in traditional foods and the environment as a possible risk factor for type 2 diabetes in Canadian Aboriginal populations.

STUDY DESIGN

Literature review. METHODS. The scientific literature on possible causes of type 2 diabetes in Aboriginal populations in Canada was reviewed. Potential exposure through food and water to environmental toxins such as methylmercury, arsenic, persistent organic pollutants (POPs), including bisphenol A and phthalates, as well as Aboriginal lifestyle and composition of the traditional diet is discussed. RESULTS. There is growing evidence to suggest that environmental toxins may be associated with noninsulin-dependent diabetes mellitus (type 2 diabetes), which many consider to be endemic worldwide. In Canada, diabetes has reached epidemic proportions, especially among Aboriginal populations. Based on both molecular and pathological findings, some toxins found in the environment interfere with the functioning of the pancreas' islets of Langerhans cells, and consequently they affect insulin production. In addition, there is new evidence suggesting that obesity may be linked to endocrine disruptors, thus increasing the likelihood that obesity in itself may not be a chief risk factor for diabetes.

CONCLUSIONS

Diabetes prevalence rates among First Nations, Inuit and Métis populations are 3-5 times higher than the general population. Accepted risk factors such as diet, lifestyle and genetics do not fully explain this phenomenon. However, as many environmental toxins bioaccumulate in the food chain and are found in wild game and fish traditionally harvested and consumed by Aboriginal peoples, these chemicals could present health risks not yet fully explored. As there is not enough evidence to rule out this possibility, further studies are suggested. If correct, such environmental risk factors, especially if they are encountered early in life, would have implications on Aboriginal public health.

Age-based differences in hair zinc of Vancouver preschoolers

Marginal zinc deficiency (MZD), the subclinical stage of zinc deficiency, is common in industrialized societies. Serum zinc, the most common biomarker of zinc status, lacks sensitivity and specificity to diagnose this deficiency. Hair zinc, however, is sensitive and specific enough to detect MZD in children. Differences in hair zinc associated with age and sex have been reported. These differences have not been investigated thoroughly; therefore, interpretation of the results of hair analyses is difficult. This cross-sectional study was designed to examine the hair zinc status of a group of Vancouver preschoolers (24-71 months) and assess the age- and sex-based differences in their hair zinc. Hair samples were obtained (n = 719) and analyzed for zinc using inductively coupled plasma mass spectrometry. Our results indicated a mean hair zinc of 115 +/- 43 microg/g with 17% below the low hair zinc cutoff (70 microg/g). Boys and girls had comparable mean hair zinc, while girls had a significantly higher occurrence of low hair zinc than boys (21% vs. 12%). Children <4 years of age had significantly lower mean hair zinc and higher rate of low hair zinc compared to children > or =4. Our study provides important reference values for the hair zinc of healthy North American preschoolers.

Dietary intake and development of a quantitative food-frequency questionnaire for a lifestyle intervention to reduce the risk of chronic diseases in Canadian First Nations in north-western Ontario

Objectives

To characterise the diet of First Nations in north-western Ontario, highlight foods for a lifestyle intervention and develop a quantitative food-frequency questionnaire (QFFQ).

Design

Cross-sectional survey using single 24 h dietary recalls.

Setting

Eight remote and semi-remote First Nations reserves in north-western Ontario.

Subjects

129 First Nations (Oji-Cree and Ojibway) men and women aged between 18 and 80 years.

Results

The greatest contributors to energy were breads, pasta dishes and chips (contributing over 20 % to total energy intake). ‘Added fats’ such as butter and margarine added to breads and vegetables made up the single largest source of total fat intake (8·4 %). The largest contributors to sugar were sugar itself, soda and other sweetened beverages (contributing over 45 % combined). The mean number of servings consumed of fruits, vegetables and dairy products were much lower than recommended. The mean daily meat intake was more than twice that recommended. A 119-item QFFQ was developed including seven bread items, five soups or stews, 24 meat- or fish-based dishes, eight rice or pasta dishes, nine fruits and 14 vegetables. Frequency of consumption was assessed by eight categories ranging from ‘Never or less than one time in one month’ to ‘two or more times a day’.

Conclusion

We were able to highlight foods for intervention to improve dietary intake based on the major sources of energy, fat and sugar and the low consumption of fruit and vegetable items. The QFFQ is being used to evaluate a diet and lifestyle intervention in First Nations in north-western Ontario.

The paradox of anemia with high meat intake: a review of the multifactorial etiology of anemia in the Inuit of North America

Anemia is a serious concern among indigenous populations in North America, and it appears to be widespread among the Inuit despite abundant intakes of heme iron. It is therefore hypothesized that anemia for the Inuit involves other dietary factors not usually associated with animal foods, such as low intakes of vitamin A and/or folate, riboflavin, and vitamin C. Also, Helicobacter pylori infection and/or parasitosis may result in gastrointestinal blood loss and/or functional iron deficiency. This review aims to describe factors that may cause anemia in Inuit populations despite high meat intakes, abundant bioavailable iron, and other important hematological nutrients.

Unique patterns of dietary adequacy in three cultures of Canadian Arctic indigenous peoples

Background

Information is needed on dietary adequacy of Arctic indigenous populations in Canada. Extensive work has been completed on composition of Arctic food and food use, and dietary reference intakes are available.

Objective

To complete the first comprehensive dietary adequacy assessment of three populations of adult Arctic indigenous people.

Setting and subjects

Dietary assessment interviews were conducted with randomly selected indigenous adults during two seasons in 44 representative communities of Yukon First Nations (n= 797), Dene/Métis, (n= 1007) and Inuit (n= 1525).

Methods

Twenty-four-hour recalls were used to derive adjusted distributions of usual nutrient intakes in four age/gender groups for assessment of dietary adequacy for carbohydrate, dietary fibre, protein,n–3 fatty acids,n–6 fatty acids, calcium, copper, iron, magnesium, manganese, phosphorus, selenium, zinc, vitamin A, riboflavin, folate, vitamin B6, vitamin C, vitamin D and vitamin E.

Results

Nutrients with high prevalence of adequacy for most age/gender groups in all three cultures were protein, carbohydrate,n–3 fatty acids, iron, copper, zinc, manganese, selenium, riboflavin and vitamin B6; some individuals exceeded the upper intake level for iron, zinc, selenium, vitamin A and vitamin D. Estimated average requirement nutrients of concern for adequacy were magnesium, folate, vitamin A, vitamin C and vitamin E; however, a few age/gender groups were exceptions. Prevalence of inadequacy for AI nutrients which may be undesirably high were fibre,n–6 fatty acids and calcium. Vitamin D was more adequate in Inuit women and men than for Yukon First Nations or Dene/Métis.

Conclusions

Unique patterns of dietary adequacy exist among Arctic indigenous peoples. Local wildlife food sources and market food sources should be maximised for their nutrient contributions to Arctic diets.

Local cultural animal food contributes high levels of nutrients for Arctic Canadian Indigenous adults and children

Food systems of Canadian Arctic Indigenous Peoples contain many species of traditional animal and plant food, but the extent of use today is limited because purchased food displaces much of the traditional species from the diet. Frequency and 24-h dietary interviews of Arctic adults and children were used to investigate these trends. The most frequently consumed Arctic foods were derived from animals and fish. In adults these foods contributed 6-40% of daily energy of adults. Children ate much less, 0.4-15% of energy, and >40% of their total energy was contributed by "sweet" and "fat" food sources. Nevertheless, for adults and children, even a single portion of local animal or fish food resulted in increased (P < 0.05) levels of energy, protein, vitamin D, vitamin E, riboflavin, vitamin B-6, iron, zinc, copper, magnesium, manganese, phosphorus, and potassium; although children had similar results for these nutrients, they did not reach significance for energy, vitamin D, or manganese. Because market foods are the major source of energy in the Arctic, traditional animal-source foods are extremely important to ensure high dietary quality of both adults and children.