Cardiovascular disease and risk factors in three Alaskan Eskimo populations: the Alaska-Siberia project

Traditional Heart-Healthy Diet and Medication Adherence in the Norton Sound Region: An 18-Month Telehealth Intervention

INTRODUCTION

Innovations are needed for preventing cardiovascular disease (CVD) and for reaching diverse communities in remote regions. The current study reports on a telemedicine-delivered intervention promoting a traditional heart-healthy diet and medication adherence with Alaska Native men and women residing in the Norton Sound region of Alaska.

METHODS

Participants were 299 men and women with high blood pressure or high cholesterol smoking daily who were randomized to receive telemedicine-delivered counseling and printed materials on diet and medication adherence or on smoking and physical activity. Intervention contacts were at baseline and 3-, 6-, and 12-months follow-up, with a final assessment at 18 months. Nutrition outcomes were the ratio of heart-healthy foods and traditional heart-healthy foods relative to all foods reported on a 34-item food frequency questionnaire. Recent and typical adherence for heart medications were self-reported.

RESULTS

Intervention effects were significant for the heart-healthy foods ratio at 6 months only (p = 0.014) and significant for the traditional heart-healthy foods ratio at 6 months only for those aged 47+ (p = 0.031). For recent and typical medication adherence, there were no significant group differences by time.

DISCUSSION

In a remote region of Alaska, telemedicine proved feasible and acceptable for engaging Alaska Native men and women in counseling on CVD risk behaviors. The findings indicate that more touchpoints may be necessary to impart comprehensive lasting change in heart-healthy eating patterns. Medication adherence group differences were not significant; however, medication adherence was high overall.

Mercury diminishes the cardiovascular protective effect of omega-3 polyunsaturated fatty acids in the modern diet of Inuit in Canada

BACKGROUND

Inuit in Canada have low reported incidence of myocardial infarction (MI) because of their traditional rich n-3 fatty acids marine diet. They are experiencing rapid nutrition transition and ischemic heart disease is now becoming a health concern.

OBJECTIVES

Our goal was to describe the modern Inuit diet, the eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and methyl mercury (MeHg) intake and estimate their contributions to the risk of MI. We also estimated the effect of promoting the consumption of more traditional food on Inuit's MI risk.

METHODS

We estimated the effect of Inuit diet on MI risk with modelling. Model formulas and assumptions were extracted from various epidemiology studies and literatures. International Polar Year Inuit Health Survey (IHS) was a comprehensive health and nutrition survey conducted in 2007-8 with 2072 participants (aged 18-79) in Canada. Traditional food intake, blood biomarkers values from the IHS served as the baseline parameters of model input.

RESULTS

Inuit traditional diet contained both high level of EPA, DHA and MeHg and their combined net effect was estimated to reduce the relative risk of MI by 1% for men and 2% for women. Arctic char meat provided the largest amount of EPA and DHA. Ringed seal liver was the main source for MeHg. Increase intake of selected fish, like salmon, herring and Arctic char by 75g per day can reduce the relative risk of MI (RR 0.70, 0.78 and 0.90 respectively).

CONCLUSIONS

In the Inuit diet, the beneficial effect on MI of EPA and DHA is diminished by the adverse effect of MeHg. Promoting the increase consumption of fish species with high EPA+DHA and low MeHg may help to prevent MI among Inuit.

Mechanosensory Neuron Aging: Differential Trajectories with Lifespan-Extending Alaskan Berry and Fungal Treatments in Caenorhabditis elegans

Many nutritional interventions that increase lifespan are also proposed to postpone age-related declines in motor and cognitive function. Potential sources of anti-aging compounds are the plants and fungi that have adapted to extreme environments. We studied the effects of four commonly consumed and culturally relevant Interior Alaska berry and fungus species (bog blueberry, lowbush cranberry, crowberry, and chaga) on the decline in overall health and neuron function and changes in touch receptor neuron morphology associated with aging. We observed increased wild-type Caenorhabditis elegans lifespan and improved markers of healthspan upon treatment with Alaskan blueberry, lowbush cranberry, and chaga extracts. Interestingly, although all three treatments increased lifespan, they differentially affected the development of aberrant morphologies in touch receptor neurons. Blueberry treatments decreased anterior mechanosensory neuron (ALM) aberrations (i.e., extended outgrowths and abnormal cell bodies) while lowbush cranberry treatment increased posterior mechanosensory neuron (PLM) aberrations, namely process branching. Chaga treatment both decreased ALM aberrations (i.e., extended outgrowths) and increased PLM aberrations (i.e., process branching and loops). These results support the large body of knowledge positing that there are multiple cellular strategies and mechanisms for promoting health with age. Importantly, these results also demonstrate that although an accumulation of abnormal neuron morphologies is associated with aging and decreased health, not all of these morphologies are detrimental to neuronal and organismal health.

Fatty acids linked to cardiovascular mortality are associated with risk factors

Background

Although saturated fatty acids (FAs) have been linked to cardiovascular mortality, it is not clear whether this outcome is attributable solely to their effects on low-density lipoprotein cholesterol (LDL-C) or whether other risk factors are also associated with FAs. The Western Alaskan Native population, with its rapidly changing lifestyles, shift in diet from unsaturated to saturated fatty acids and dramatic increase in cardiovascular disease (CVD), presents an opportunity to elucidate any associations between specific FAs and known CVD risk factors.

Objective

We tested the hypothesis that the specific FAs previously identified as related to CVD mortality are also associated with individual CVD risk factors.

Methods

In this community-based, cross-sectional study, relative proportions of FAs in plasma and red blood cell membranes were compared with CVD risk factors in a sample of 758 men and women aged ≥35 years. Linear regression analyses were used to analyze relations between specific FAs and CVD risk factors (LDL-C, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, systolic blood pressure, diastolic blood pressure, heart rate, body mass index, fasting glucose and fasting insulin, 2-hour glucose and 2-hour insulin).

Results

The specific saturated FAs previously identified as related to CVD mortality, the palmitic and myristic acids, were adversely associated with most CVD risk factors, whereas unsaturated linoleic acid (18:2n-6) and the marine n-3 FAs were not associated or were beneficially associated with CVD risk factors.

Conclusions

The results suggest that CVD risk factors are more extensively affected by individual FAs than hitherto recognized, and that risk for CVD, MI and stroke can be reduced by reducing the intake of palmitate, myristic acid and simple carbohydrates and improved by greater intake of linoleic acid and marine n-3 FAs.

Apolipoprotein E isoforms 3/3 and 3/4 differentially interact with circulating stearic, palmitic, and oleic fatty acids and lipid levels in Alaskan Natives

Lifestyle changes in Alaskan Natives have been related to the increase of cardiovascular disease and metabolic syndrome in the last decades. Variation of the apolipoprotein E (Apo E) genotype may contribute to the diverse response to diet in lipid metabolism and influence the association between fatty acids in plasma and risk factors for cardiovascular disease. The aim of this investigation was to analyze the interaction between Apo E isoforms and plasma fatty acids, influencing phenotypes related to metabolic diseases in Alaskan Natives. A sample of 427 adult Siberian Yupik Alaskan Natives was included. Fasting glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, Apo A1, and Apo B plasma concentrations were measured using reference methods. Concentrations of 13 fatty acids in fasting plasma were analyzed by gas chromatography, and Apo E variants were identified. Analyses of covariance were conducted to identify Apo E isoform and fatty acid main effects and multiplicative interactions. The means for body mass index and age were 26 ± 5.2 and 47 ± 1.5, respectively. Significant main effects were observed for variation in Apo E and different fatty acids influencing Apo B levels, triglycerides, and total cholesterol. Significant interactions were found between Apo E isoform and selected fatty acids influencing total cholesterol, triglycerides, and Apo B concentrations. In summary, Apo E3/3 and 3/4 isoforms had significant interactions with circulating levels of stearic, palmitic, oleic fatty acids, and phenotypes of lipid metabolism in Alaskan Natives.

Dietary adequacy among rural Yup'ik women in western Alaska

OBJECTIVES

To assess (1) energy and nutrient intake; (2) dietary adequacy; (3) traditional and nontraditional foods consumed; and (4) main foods contributing to energy and selected nutrient intake among Yup'ik women in Western Alaska.

METHODS

Up to 3 24-hour dietary recalls were collected to assess the dietary intake. Dietary adequacy was determined by comparing women's daily nutrient intakes to corresponding dietary reference intakes (DRIs).

RESULTS

Mean daily energy intake for the women was 2172 kcal, exceeding the DRI for energy. The majority of women (90-100%) fell below the recommendations for dietary fiber, calcium, and vitamins D and E. More than 50% of women fell below the recommendations for vitamin A, and more than one third were below the DRI for zinc and vitamins C and B6. Juices/pop (including Tang, Kool-Aid, soda/pop, fruit juice, and energy drink), coffee, and traditional fish were the most frequently reported food items. Sweetened beverages and pop were the main contributors to energy, carbohydrate, and sugar intake. Traditional foods provided 34% of protein, 27% of iron, 23% of vitamin A, and 21% of zinc.

CONCLUSIONS

Among Yup'ik women, juices/pop were the most frequently consumed foods contributing to the high energy intake. However, traditional food still contributes substantially to certain nutrients. These data contribute to an understanding of dietary adequacy in this population and will aid in the development of a nutritional intervention program.

Common low-density lipoprotein receptor p.G116S variant has a large effect on plasma low-density lipoprotein cholesterol in circumpolar inuit populations

BACKGROUND

Inuit are considered to be vulnerable to cardiovascular disease because their lifestyles are becoming more Westernized. During sequence analysis of Inuit individuals at extremes of lipid traits, we identified 2 nonsynonymous variants in low-density lipoprotein receptor (LDLR), namely p.G116S and p.R730W.

METHODS AND RESULTS

Genotyping these variants in 3324 Inuit from Alaska, Canada, and Greenland showed they were common, with allele frequencies 10% to 15%. Only p.G116S was associated with dyslipidemia: the increase in LDL cholesterol was 0.54 mmol/L (20.9 mg/dL) per allele (P=5.6×10(-49)), which was >3× larger than the largest effect sizes seen with other common variants in other populations. Carriers of p.G116S had a 3.02-fold increased risk of hypercholesterolemia (95% confidence interval, 2.34-3.90; P=1.7×10(-17)), but did not have classical familial hypercholesterolemia. In vitro, p.G116S showed 60% reduced ligand-binding activity compared with wild-type receptor. In contrast, p.R730W was associated with neither LDL cholesterol level nor altered in vitro activity.

CONCLUSIONS

LDLR p.G116S is thus unique: a common dysfunctional variant in Inuit whose large effect on LDL cholesterol may have public health implications.

Use of glycosylated haemoglobin as diagnostic tool in Greenland: prevalence of diagnosed diabetes mellitus

BACKGROUND

The prevalence of undiagnosed diabetes mellitus (DM) in Greenland has been reported very high with only 30% of cases diagnosed. In 2010, glycosylated hemoglobin (A1C) was introduced as a diagnostic tool in Greenland. However, the current use of A1c is unknown as well as the current prevalence of diagnosed DM.The aim of this study was firstly to estimate the use of A1C as diagnostic tool within the first 27 months after introducing the method and secondly to estimate the age and gender specific prevalence of diagnosed DM in Greenland in 2012.

METHODS

This study was perfomed as a cross-sectional register study using data from electronic medical records (EMR). To analyse the use of A1C as diagnostic tool:A sample amongst all Greenlanders at or above age 35 old was used to determine the number of individuals screened with A1C within a 27 month period, excluding those already known to have DM.To estimate the prevalence of diagnosted DM: Patients with DM were identified electronically using a statistic module run on data in the EMR. Age and gender specific prevalence was estimated using the Greenlandic population as of 1 January 2012 as the background population.

RESULTS

The test sample resulted in a study group of 1008 individuals from which 2.3% (23) were excluded because they were already known to have DM. Among the remaining 985, 13.6% were tested with A1C at least once during the 27 months of observation. DM was diagnosed in 7.5% (10) of the tested persons and in 1.0% of the whole group.Regarding prevalence, a total of 920 patients with diagnosed DM were identified. The total prevalence among adults aged 20-79 years old was 2.20% (95% CI: 2.05-2.34) with no significant difference between genders.

CONCLUSION

Testing for DM using A1C as diagnostic tool is used in Greenland. The prevalence of diagnosed DM in Greenland remains low although increasing. Undiagnosed DM may still be an important issue in Greenland.

Frequent use of primary health care service in Greenland: an opportunity for undiagnosed disease case-finding

OBJECTIVES

To estimate the age- and gender-specific consultation rates of patients who availed primary health care service in Greenland and to analyse contact patterns among patients in Nuuk.

DESIGN

Observational and cross-sectional register study using data captured from the medical records.

MATERIALS AND METHODS

The number of patients specified by age and gender who had contacted the primary health care centres within the last year was identified using a statistic module applied to the electronic medical records system. The population as it was on the 1st of January 2011 was used as the background population. The age- and gender-specific consultation rates were calculated. Review of most recent contact was performed in a subsample of patients from Nuuk, and information of the type of contact and diagnoses was obtained.

RESULTS

Eighty-three percent of the population in Greenland had been in contact with the primary health care centre within the last year. Females were more frequent users than males. A subsample of 400 patients in Nuuk was identified. Personal contact was the most frequent type of consultation (75.8%), followed by telephone (14.8%) and e-mail (9.8%) consultations. Musculoskeletal symptoms accounted for the most frequent bases for diagnoses.

CONCLUSION

More than 80% of the whole population has been in contact with the primary health care system within the last year. This indicates that opportunistic case-finding of chronic diseases such as diabetes, hypertension, etc. providing a possible strategy for decreasing the number of undiagnosed cases.

Obesity studies in the circumpolar Inuit: a scoping review

BACKGROUND

Among circumpolar populations, recent research has documented a significant increase in risk factors which are commonly associated with chronic disease, notably obesity.

OBJECTIVE

The present study undertakes a scoping review of research on obesity in the circumpolar Inuit to determine the extent obesity research has been undertaken, how well all subpopulations and geographic areas are represented, the methodologies used and whether they are sufficient in describing risk factors, and the prevalence and health outcomes associated with obesity.

DESIGN

Online databases were used to identify papers published 1992-2011, from which we selected 38 publications from Canada, the United States, and Greenland that used obesity as a primary or secondary outcome variable in 30 or more non-pregnant Inuit ("Eskimo") participants aged 2 years or older.

RESULTS

The majority of publications (92%) reported cross-sectional studies while 8% examined retrospective cohorts. All but one of the studies collected measured data. Overall 84% of the publications examined obesity in adults. Those examining obesity in children focused on early childhood or adolescence. While most (66%) reported 1 or more anthropometric indices, none incorporated direct measures of adiposity. Evaluated using a customized quality assessment instrument, 26% of studies achieved an "A" quality ranking, while 18 and 39% achieved quality rankings of "B" and "C", respectively.

CONCLUSIONS

While the quality of studies is generally high, research on obesity among Inuit would benefit from careful selection of methods and reference standards, direct measures of adiposity in adults and children, studies of preadolescent children, and prospective cohort studies linking early childhood exposures with obesity outcomes throughout childhood and adolescence.

Prevalence of the use of antihypertensive medications in Greenland: a study of quality of care amongst patients treated with antihypertensive drugs

OBJECTIVES

The primary objective was to estimate the prevalence of patients diagnosed with hypertension using the proxy marker of antihypertensive drug therapy in Greenland and to compare the prevalences within the 5 health regions in Greenland. The second objective was to review 2 quality indicators in antihypertensive care.

STUDY DESIGN

Observational and cross-sectional study reviewing electronic medical records.

METHODS

Information about age and gender was collected from all patients receiving antihypertensive drug prescriptions within a 2-year period prior to the data extraction in January 2011. Only patients aged 20 or above were included. The age- and gender-specific prevalence of patients in antihypertensive treatment was calculated using the population as it was 1 January 2010 in Greenland as background population. A subsample consisting of patients in antihypertensive treatment aged 20 or above born within the first 5 days of each month was identified. Review of electronic medical records 1 year back in time (1 January 2010 onwards) was carried out and information on blood pressure obtained. The quality of care was evaluated with respect to 2 indicators: follow-up management and blood pressure level, respectively.

RESULTS

The total number of patients in treatment with antihypertensive drugs was 4,462 (1,998 males and 2,464 females) corresponding to a prevalence of 11.4% (4,462/39,231). The prevalence was higher among females than among males. The prevalence increased with age and differed among the 5 health regions. The percentage of patients in antihypertensive treatment with minimum 1 follow-up visit within 1 year (blood pressure measured and registered in a health clinic) was only 77.7%. Some 45% of patients in antihypertensive treatment achieved blood pressure below 140/90 mmHg.

CONCLUSION

Hypertension is a common disorder in Greenland. The quality of antihypertensive care is suboptimal and leaves room for improvement. A national strategy based on guidelines, use of electronic drug prescriptions and recording of blood pressures combined with continuous monitoring the quality is recommended in order to prevent complications of untreated hypertension.

The legacy of the Alaska Siberia Medical Research Program: a historical perspective

BACKGROUND

The Alaska Siberia Medical Research Program was established at the University of Alaska (UA) at a time when there was no research funded by the National Institutes of Health (NIH) that was concerned with Alaska Native health issues. The program grew out of a dire need for an understanding of the apparently rapidly growing health problems in the Native community. The initial plan included the following objectives.

OBJECTIVES

The objectives are to develop a self-sustaining infrastructure for biomedical research by gaining support from Alaska Natives, UA, national political leaders, NIH and the Russian Academy of Medical Science (RAMS); to identify researchers committed to helping Alaska Natives; to develop meaningful, Native-driven participatory research; to carry out necessary research to form the foundation for future research; and to develop circumpolar collaborations.

RESULTS

The objectives were achieved because of the extraordinary and cheerful contributions by all participants in the program. The collaborative research resulted in some 70 published manuscripts identifying and characterizing research-neglected health problems. Unique risk factors for diabetes, cardiovascular disease, alcoholism and seasonal affective disorders were characterized and institutionalized prevention programs were established. The effort of the program led to U.S. Congressional action establishing the University of Alaska as a minority institution, leading to the funding of a variety of successful NIH-funded research centres and programs at the university that are concerned with Native health problems.

CONCLUSION

A small, visionary investment by the University of Alaska for establishing the program led to a co-operative effort by the UA, RAMS, Alaska Native Health communities and the NIH that resulted in the development of self-sustaining medical research efforts in Alaska and Siberia. The program spawned pilot studies, leading to NIH-funded research that has provided fundamental insights into the etiology of health problems and their reduction by research-based intervention and prevention programs.

A QTL for genotype by sex interaction for anthropometric measurements in Alaskan Eskimos (GOCADAN Study) on chromosome 19q12-13

Variation in anthropometric measurements due to sexual dimorphism can be the result of genotype by sex interactions (G×S). The purpose of this study was to examine the sex-specific genetic architecture in anthropometric measurements in Alaskan Eskimos from the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study. Maximum likelihood-based variance components decomposition methods, implemented in SOLAR, were used for G×S analyses. Anthropometric measurements included BMI, waist circumference (WC), waist/height ratio, percent body fat (%BF), and subscapular and triceps skinfolds. Except for WC, mean values of all phenotypes were significantly different in men and women (P < 0.05). All anthropometric measures were significantly heritable (P < 0.001). In a preliminary analysis not allowing for G×S interaction, evidence of linkage was detected between markers D19S414 and D19S220 on chromosome 19 for WC (logarithm of odds (lod) = 3.5), %BF (lod = 1.7), BMI (lod = 2.4), waist/height ratio (lod = 2.5), subscapular (lod = 2.1), and triceps skinfolds (lod = 1.9). In subsequent analyses which allowed for G×S interaction, linkage was again found between these traits and the same two markers on chromosome 19 with significantly improved lod scores for: WC (lod = 4.5), %BF (lod = 3.8), BMI (lod = 3.5), waist/height ratio (lod = 3.2), subscapular (lod = 3.0), and triceps skinfolds (lod = 2.9). These results support the evidence of a G×S interaction in the expression of genetic effects resulting in sexual dimorphism in anthropometric phenotypes and identify the chromosome 19q12-13 region as important for adiposity-related traits in Alaskan Eskimos.

Assessing diet and lifestyle in the Canadian Arctic Inuit and Inuvialuit to inform a nutrition and physical activity intervention programme

Inuit in Nunavut (NU) and Inuvialuit in the Northwest Territories (NWT), Canada, were traditionally nomadic peoples whose culture and lifestyle were founded on hunting and gathering foods from the local environment, primarily land and marine mammals. Lifestyle changes within the last century have brought about a rapid nutrition transition, characterised by decreasing consumption of traditional foods and an associated increase in the consumption of processed, shop-bought foods. This transition may be attributed to a multitude of factors, such as acculturation, overall food access and availability, food insecurity and climate change. Obesity and risk for chronic disease are higher in the Canadian Arctic population compared with the Canadian national average. This present review describes the study population and methodologies used to collect data in order to study the nutrition transition amongst Aboriginal Arctic populations and develop Healthy Foods North (HFN), a novel, multi-institutional and culturally appropriate programme that aims to improve dietary adequacy and reduce risk of chronic disease. Included in this special issue of the Journal of Human Nutrition and Dietetics are papers describing dietary intake patterns, physical activity levels, dietary behaviours, chronic disease prevalence and psychosocial factors that potentially mediate behaviour. A further paper describes how these data were utilised to inform and develop Healthy Foods North.

Development and use of FFQ among adults in diverse settings across the globe

In nutritional epidemiology, development of valid dietary assessment instruments specific to populations in diverse settings is of paramount importance. Such instruments are essential when trying to characterise dietary patterns and intake, investigate diet-disease associations, inform and evaluate nutrition interventions, assess nutrient-gene interactions, conduct cross-country comparison studies and monitor nutrition transitions. The FFQ is a relatively inexpensive tool for measuring long-term dietary intake for large populations and for allowing researchers to track dietary changes over time. However, FFQ must be population specific to capture the local diet and available foods. Collecting 24-h dietary recalls and utilising community feedback to build the FFQ ensures that a culturally appropriate instrument is developed. This article presents several examples describing FFQ development and utilisation in different settings globally. In the Canadian Arctic, FFQ were developed and utilised to inform and evaluate a community-based intervention programme, characterise the diet and track dietary changes occurring among Inuit and Inuvialuit, populations experiencing rising rates of chronic disease and likely to be extremely vulnerable to the potential effects of climate change. Another example is an FFQ developed to assess sodium intake and evaluate a sodium reduction trial in a high-risk population in Barbados. An example is provided from Brazil, where an FFQ was developed to assess associations between diet, heterocyclic aromatic amines and colorectal adenoma among Japanese Brazilians and to conduct cross-country comparisons. These and other case studies highlight the diversity in dietary intake between populations and the need for FFQ to be developed to capture this diversity.

Individual saturated fatty acids are associated with different components of insulin resistance and glucose metabolism: the GOCADAN study

OBJECTIVES

Type 2 diabetes and the consumption of saturated fatty acids (FAs) are on the rise among Alaska Inuits. This analysis, based on a cross-sectional study, explores the possible associations of saturated FA content in red blood cells (RBCs) and parameters of glucose metabolism in a sample of Alaska Natives.

STUDY DESIGN AND METHODS

The sample included 343 women and 282 men aged 35-74. Statistical analyses explored the associations of selected RBC (myristic, palmitic and stearic acids) FAs with fasting glucose (plasma), fasting insulin (plasma), 2h glucose (2-hour glucose tolerance test), 2h insulin and homeostasis model assessment (HOMA) index. The models included sex and glucose metabolism status as fixed factors and age, body mass index (BMI), waist circumference, physical activity (METS) and FA content in RBCs as covariates. Measures of insulin, glucose and HOMA index were used as dependent variables.

RESULTS

Myristic acid was positively associated with fasting insulin (β=0.47, p<0.001), 2h insulin (β=0.53, p=0.02) and HOMA index (β=0.455, p<0.001). Palmitic acid was associated with 2h glucose (β=2.3×10(-2), p<0.001) and 2h insulin (β=5.6×10(-2), p=0.002) and stearic acid was associated with fasting glucose (β=4.8×10(-3), p=0.006).

CONCLUSIONS

These results strongly support the hypothesis that saturated fatty acids are associated with insulin resistance and glucose intolerance and that saturated fatty acids are significant risk factors for type 2 diabetes.

Cardiovascular burden and related risk factors among Nunavik (Quebec) Inuit: insights from baseline findings in the circumpolar Inuit health in transition cohort study

BACKGROUND

The Inuit are commonly portrayed to be somehow protected from cardiovascular diseases (CVDs) through their traditional lifestyle and diet. However, actual sociocultural transition and related major, modifiable risk factors have scarcely been quantified in the Inuit population. Such knowledge is extremely valuable in terms of public health intervention.

METHODS

A total of 887 Inuit residents from Nunavik, Quebec, participated in a cohort study. The estimates presented were derived from anthropometric and biological measurements gathered at the time of recruitment and enhanced by information collected in the medical file of each participant. All estimates were corrected for a complex sampling strategy and bootstrapped to ensure the representativeness of the general Nunavik population.

RESULTS

Overall, 19% of Inuit had a disease of the circulatory system according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Among all disorders, peripheral circulatory system disease was the most prevalent (9%). Prevalences of ischemic heart disease and cerebrovascular disease were of similar magnitude (2.5%). No significant difference in disease prevalence was noted between sexes. The major modifiable CVD risk factors were smoking (84%), obesity (49%) [corrected] (body mass index of greater than 30 kgm2) and elevated blood pressure (13085 mmHg or greater) (18%). Prevalences were globally higher among women.

CONCLUSION

The current belief that the Inuit are protected from CVD is seriously questioned by the results of the present study. Considering the extremely high prevalence of CVD risk factors, a population-based intervention reinforced for women is urgently needed to reduce their risk.

Heart rate is associated with red blood cell fatty acid concentration: the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study

BACKGROUND

Consumption of omega-3 fatty acids (FAs) is associated with a reduction in deaths from coronary heart disease, arrhythmia, and sudden death. Although these FAs were originally thought to be antiatherosclerotic, recent evidence suggests that their benefits are related to reducing risk for ventricular arrhythmia and that this may be mediated by a slowed heart rate (HR).

METHODS

The study was conducted in Alaskan Eskimos participating in the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) Study, a population experiencing a dietary shift from unsaturated to saturated fats. We compared HR with red blood cell (RBC) FA content in 316 men and 391 women ages 35 to 74 years.

RESULTS

Multivariate linear regression analyses of individual FAs with HR as the dependent variable and specific FAs as covariates revealed negative associations between HR and docosahexaenoic acid (22:6n-3; P = .004) and eicosapentaenoic acid (20:5n-3; P = .009) and positive associations between HR and palmitoleic acid (16:1n-7; P = .021), eicosanoic acid (20:1n9; P = .007), and dihomo-gamma-linolenic acid (DGLA; 20:3n-6; P = .021). Factor analysis revealed that the omega-3 FAs were negatively associated with HR (P = .003), whereas a cluster of other, non-omega-3 unsaturated FAs (16:1, 20:1, and 20:3) was positively associated.

CONCLUSIONS

Marine omega-3 FAs are associated with lower HR, whereas palmitoleic and DGLA, previously identified as associated with saturated FA consumption and directly related to cardiovascular mortality, are associated with higher HR. These relations may at least partially explain the relations between omega-3 FAs, ventricular arrhythmia, and sudden death.

Organic nutrients and contaminants in subsistence species of Alaska: concentrations and relationship to food preparation method

OBJECTIVES

To determine nutrient and contaminant concentrations, document concentration changes related to common preparation methods and provide a basic risk-benefit analysis for select subsistence foods consumed by residents of Kotzebue, Alaska.

STUDY DESIGN

Eleven organic nutrients and 156 persistent organic pollutants (POPs) were measured in foods derived from spotted seals and sheefish.

METHODS

Nutrients in foodstuffs were compared to Daily Recommended Intake criteria. POPs were compared to Tolerable Daily Intake Limits (TDIL).

RESULTS

Cooking, as well as absence/presence of skin during sheefish processing, altered nutrient and contaminant concentrations in seals and fish. Sheefish muscle and seal blubber were particularly rich in omega-3 fatty acids and seal liver in vitamin A. Seal liver exceeded the recommended upper limit for vitamin A. POP contribution to TDIL was >25% in all tissues except blubber, in which 4 POPS were present at >25% TDIL. No POPs exceeded TDIL in a serving of any tissue studied. The most prominent concerns identified were levels of vitamin A in spotted seal liver and certain POPs in blubber, warranting consideration when determining how much and how often these foods should be consumed.

CONCLUSIONS

Preparation methods altering tissues from their raw state significantly affect nutrient and contaminant concentrations, thus direct evaluation of actual food items is highly recommended to determine risk-benefits ratios of traditional diets. Traditional foods provide essential nutrients with very limited risk from contaminants. We encourage the consumption of traditional foods and urge public health agencies to develop applicable models to assess overall food safety and quality.

Dietary patterns are linked to cardiovascular risk factors but not to inflammatory markers in Alaska Eskimos

Despite the tradition of a diet high in fish oils and abundant physical activity, coronary artery disease is increasing among Alaska Eskimos. Explanations for this observation include lifestyle changes. In this cross-sectional analysis, we evaluated dietary patterns of Alaska Eskimos and investigated the relations between these dietary patterns and known cardiovascular risk factors, including inflammatory markers. We used a principal component analysis with data from FFQ collected in 2000-2004 to determine dietary patterns of Alaska Eskimos. Four dietary patterns were identified: a traditional pattern, plus 3 patterns based on purchased food, one of which reflected healthy food choices. The traditional dietary pattern was associated with lower triglycerides (P < 0.001) and blood pressure (P = 0.04) and slightly higher LDL cholesterol (LDL-C) (P = 0.05). Whereas the healthy purchased diet was associated with a trend toward lower LDL-C (P = 0.09), the beverages and sweets diet was positively associated with LDL-C (P = 0.02). Diet pattern was not associated with inflammatory markers or pathogen burden. Our data show that the traditional diet is related to a better profile of cardiovascular disease risk factors and should be encouraged. Programs are needed to encourage the availability of healthy food choices for those not able to obtain traditional foods.

Assessing dietary intake in a population undergoing a rapid transition in diet and lifestyle: the Arctic Inuit in Nunavut, Canada

The aims of the present study were to (1) characterise the diets of adult Inuit; (2) highlight foods for a nutritional and lifestyle intervention programme; (3) develop a quantitative FFQ (QFFQ) to evaluate the programme and monitor changes in dietary intake in this population over time. A dietary survey using single 24-h dietary recalls was conducted among Inuit aged between 19 and 87 years in two communities in Nunavut, Canada. Eighty-seven subjects completed the recalls (response rate was approximately 73 %). The mean energy intake for men and women was 9530 and 6939 kJ, respectively. The intakes of dietary fibre and the majority of vitamins and minerals (especially vitamins A, D, and E, total folate and Ca) were far below the recommendations. Traditional foods contributed 40 and 42 %, respectively, to protein and Fe intakes. Non-nutrient-dense store-bought foods were consumed much more frequently than the nutrient-dense traditional foods. Foods high in fat and sugar were highlighted, and will be replaced by healthier, more nutrient-dense alternatives to address the dietary inadequacies for the nutritional intervention programme. A 154-item QFFQ was developed and pilot tested in the Arctic Inuit. The present study highlighted foods to be targeted for a nutritional and lifestyle intervention programme not previously undertaken in this population. This QFFQ is culturally appropriate and specific for evaluating the effectiveness of the programme, as well as monitoring nutritional transition in this population.

Diagnostic accuracy of urine dipsticks for detecting albuminuria in indigenous and non-indigenous children in a community setting

Albuminuria predicts cardiovascular and end-stage kidney disease in indigenous populations. Early detection in indigenous children may identify those who could benefit from early treatment. Community-based detection of albuminuria needs to be performed using a reliable, inexpensive, and widely available test, such as a proteinuria dipstick. Dipstick accuracy for detecting albuminuria in a community setting has not been evaluated. We assessed the accuracy of Multistix 10 SG dipsticks to detect baseline albuminuria and predict for persistent albuminuria at a 2-year follow-up in a population-based cohort of Australian Aboriginal and non-Aboriginal elementary-school-aged children. Variability in the accuracy of dipsticks in subgroups of higher risk children was analyzed using the relative diagnostic odds ratio (RDOR). Using Multistix 10 SG dipsticks, index-test-positive cases were defined as >/=0.30 g/L (1+) proteinuria and index-test-negative cases as <0.30 g/L (negative or trace) proteinuria. Referent-test-positive cases were defined as spot albumin:creatinine (ACR) >/=3.4 mg/mmol, and referent-test-negative cases as ACR <3.4 mg/mmol. There were 2,266 children (55.1% Aboriginal, 51.0% boys, mean age 8.9 years) enrolled. At the 2-year follow-up, 1,432 (63.0%) children were retested (54.0% Aboriginal, 50.5% boys, mean age 10.5 years). Prevalence of baseline albuminuria was 7.3%, and persistent albuminuria was 1.5%. Dipsticks had a sensitivity of 62% and specificity of 97% at baseline. In predicting persistent albuminuria, sensitivity was 75% and specificity 93%. Accuracy did not vary with ethnicity, gender, or body mass index. Accuracy was less in younger children (4.0-7.9 years), and in those with hematuria. The performance characteristics of Multistix dipsticks make them suitable for albuminuria detection in Aboriginal and other higher-risk groups of children. More than two thirds of children detected at a single test will have transient rather than persistent albuminuria. Multistix dipsticks are particularly useful for detecting children who will have persistent albuminuria.

Inorganic nutrients and contaminants in subsistence species of Alaska: linking wildlife and human health

OBJECTIVES

To determine inorganic nutrient and contaminant concentrations in subsistence foods consumed by Alaska Natives, concentration changes related to common preparation methods and provide a basic risk-benefit analysis for these foods.

STUDY DESIGN

Eleven essential and six non-essential elements were measured in foods derived from spotted seals and sheefish.

METHODS

Essential nutrients in foodstuffs were compared to Daily Recommended Intake (DRI) criteria. Non-essential elements were compared to Tolerable Daily Intake Limits (TDIL). These comparisons serve as a risk-benefit analysis, not as consumption advice.

RESULTS

Cooking altered nutrient and contaminant concentrations. Spotted seal muscle and kidney are rich in Fe and Se; liver in Cu, Fe, Mo and Se; and sheefish muscle in Se. TDIL was exceeded in a 100 g serving of seal for THg in raw and fried liver and boiled kidney; MeHg in dried muscle and raw and fried liver; Cd in raw and boiled kidney; and As in raw and rendered blubber. Arsenic exceeded TDIL in sheefish muscle. However, toxicity potential is likely reduced by the element form (i.e., organic As, inorganic Hg) and the presence of protective nutrients such as Se.

CONCLUSIONS

Preparation methods alter wildlife tissues from their raw state, significantly affecting element concentrations. Direct evaluation of actual food items is warranted to determine risk-benefit ratios of traditional diets. Traditional foods provide many essential nutrients with a very limited risk from contaminants. We encourage continued consumption of traditional foods, and urge public health agencies to develop applicable models for providing consumption advice, incorporating food processing considerations.

Surveillance for health behaviors of American Indians and Alaska Natives-findings from the behavioral risk factor surveillance system, 2000-2006

BACKGROUND

The authors compared estimates for cancer risk factors, use of cancer screening tests, health status indicators, and access to care for American Indians and Alaska Natives (AI/ANs) and non-Hispanic whites (NHWs) in the US and for AI/ANs in 6 Indian Health Service regions.

METHODS

Behavioral Risk Factor Surveillance System data were aggregated from the years 2000 through 2006 and were used to calculate weighted prevalence estimates by gender for key variables except demographic variables.

RESULTS

Compared with NHWs, AI/ANs had lower prevalence estimates for income, educational attainment, insurance coverage, and access to personal healthcare providers. AI/ANs in Alaska and NHWs had similar estimates for diabetes (approximately 6%); however, the prevalence was nearly twice as high among AI/ANs in the other regions. The prevalence of obesity was higher for AI/ANs (29.6%) than for NHWs (20.9%). The prevalence of binge drinking was higher among AI/AN males (24.9%) than among AI/AN females (8.5%). Heavy drinking was more prevalent among NHW females (5.3%) than among AI/AN females (3.5%). AI/ANs were more likely to be current smokers (31.1%) than NHWs (22.8%). The prevalence of AI/ANs who never smoked ranged from 31.5% in Alaska to 56.9% in the Southwest. In 5 of the 6 regions, AI/AN females had lower prevalence estimates of both Papanicolaou and mammography testing than NHW females. The use of colorectal cancer screening tests was more common among NHWs (53.8%) than among AI/ANs (44%).

CONCLUSIONS

Although cancer health disparities persist among AI/ANs, the current analysis indicated that variation in the prevalence of their chronic disease risk factors may be obscured when national data are not examined by smaller geographic areas such as regions.

Fatty acid consumption and metabolic syndrome components: the GOCADAN study

Fatty acids (FAs) have been related to changes in glucose and lipid metabolism. In this article, the authors assess the association between intake of specific FAs and components of the metabolic syndrome (MS) in adult Eskimos. A total of 691 Inupiat Eskimos (325 men and 366 women), aged 34 to 75 years, were examined as part of the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study. The investigation included a physical examination, blood pressure measurements, blood sampling under fasting conditions, 2-hour oral glucose tolerance test, and a personal interview including a validated food frequency questionnaire. Components of MS were defined according to the Third Report of the National Cholesterol Education Program Adult Treatment Panel criteria. Consumption of individual FAs showed associations with MS components. Long-chain omega-3 FAs, from fish and sea mammals, were associated with lower blood pressure, serum triglycerides, and 2-hour glucose and higher high-density lipoprotein cholesterol, fasting insulin, and homeostasis model assessment. Saturated fat consumption was associated with higher triglyceride levels and blood pressure. Trans-FA consumption was associated with higher blood pressure. Consumption of long-chain omega-3 FAs from marine sources may improve certain MS components, and thus may reduce risk for cardiovascular disease. High consumption of saturated FAs and trans-FAs may have an adverse effect on MS.

A successful diabetes prevention study in Eskimos: the Alaska Siberia project

OBJECTIVES

To test the efficacy of a simple intervention method to reduce risk factors for type 2 diabetes (DM) and cardiovascular disease (CVD) in Alaskan Eskimos.

STUDY DESIGN

The study consisted of 1) a comprehensive screening for risk factors of 454 individuals in 4 villages, 2) a 4-year intervention and 3) a repetition of the screening in year 5 to test the efficacy of the intervention.

METHODS

Personal counseling (1hr/year) stressed the consumption of more traditional foods high in omega-3 fatty acids and less of certain specific store-bought foods high in palmitic acid, which was identified as being associated with glucose intolerance.

RESULTS

The intervention resulted in significant reductions in plasma concentrations of total cholesterol (p = 0.0001), LDL cholesterol (p = 0.0001), fasting glucose (p = 0.0001), diastolic blood pressure (p = 0.0007) and improved glucose tolerance (p = 0.0006). This occurred without loss of body weight. Sixty percent of the participants had improved glucose tolerance; only one of the 44 originally identified with impaired glucose tolerance (IGT) developed DM during the study.

CONCLUSIONS

Dramatic improvements of risk factors for DM and CVD were achieved in the intervention by primarily stressing the need for changes in the consumption of specific fats. The results suggest that fat consumption is an important risk factor for DM.