Elsevier Editorial System(tm) for Nutrition, Metabolism & Cardiovascular Diseases
Title: High-sugar drink consumption: an associate of obesity, insulin resistance, and impaired fasting
glucose in Canadian Indigenous (Cree) Communities.
Article Type: Letter to the Editor (max. 500 words)
Keywords: obesity, glucose intolerance, Aboriginal Peoples, diet
Corresponding Author: Dr. Grace Egeland, Ph.D.
Corresponding Author's Institution: McGill University
First Author: Robert R Lazzinnaro, M.Sc.
Order of Authors: Robert R Lazzinnaro, M.Sc.; Hugues Plourde, Ph.D.; Louise Johnson-Down, R.D., M.Sc.;
Eric Dewailly, M.D., Ph.D.; Grace Egeland, Ph.D.
Click here to download high resolution image
High-sugar drink consumption: an associate of
obesity and impaired fasting glucose in
Canadian Indigenous (Cree) communities.
Robert R Lazzinnaro 1,2 Hugues Plourde 1 Louise Johnson-Down
1,2 Eric Dewailly 3 Grace M Egeland 1,2*
* Corresponding author
1School of Dietetics & Human Nutrition, McGill University 2Centre
for Indigenous Peoples’ Nutrition and Environment (CINE), McGill
University, 3Social and Preventive Medicine, Laval University
Prof. Grace M Egeland
McGill University, Macdonald Campus
21,111 Lakeshore Rd.
Tel.: 514-398-8642 Fax: 514-398-1020
Word Count : 492
Funding: Niskamoon Corporation
Indigenous continue to experience nutrition and epidemiologic transitions (1). We,
therefore, evaluated dietary habits for their association with body mass index (BMI), homeostasis
model assessment of insulin resistance (HOMA-IR), and impaired fasting glucose (IFG) in a cross-
sectional health survey in an Indigenous population (Cree) residing in 5 communities within
northern Québec, Canada. University ethics was obtained and randomly selected participants
signed informed consent. Sixty-one percent of 1099 adults approached participated, and the
current study was restricted to those without diabetes, leaving 269 women and 217 men for the
analyses. Assessment of dietary intake was carried out through an abbreviated past 30 day market
food frequency questionnaire (FFQ) which assessed usual beverage consumption in which high-
sugar drinks were defined as soda pop, powder drink mixes, sport drinks and fruit drinks (fruit
juice and diet soda were not included). Details of 24-hour dietary assessment methods and the
Canadian version of the healthy eating index (HEI) are published elsewhere (2). Walking, which
correlated more strongly with adiposity than total METs among Cree, was measured via the short
form of the International Physical Activity Questionnaire (3). Fasting glucose and insulin was
assessed using spectrophotometric assay (Vitros 950, Vitro Chemistry, Ortho-Clinical Diagnostics,
Rochester, NY), and a commercial double-antibody radioimmunoassay (LINCO Research, St
Louis), respectively. A glucose level ≥ 5.6 mmol/L identified IFG. HOMA-IR was calculated
using the HOMA2-IR calculator program (Oxford University, 2004). Multivariable analyses were
performed using linear and logistic regressions.
Sixty-four percent of participants had a BMI of > 30 kg/m2. The daily frequency of high-
sugar drinks over a one month period was positively associated with BMI in analyses adjusting for
age, sex, and walking (P = .02) (Table). Further, the percent of energy from carbohydrates was
inversely associated with BMI in analyses adjusting for age, sex, walking, frequency of high-sugar
drinks, total energy and percentage of energy from traditional food (P = .03). The Canadian HEI
was inversely, but not significantly, associated with BMI. Any consumption of high-sugar drinks
when compared to no consumption was associated with a significantly higher BMI. In
multivariable modeling high consumption of high-sugar drinks was not related to HOMA-IR, but
was related to IFG (OR = 1.49, 95% CI [1.02-2.17]).
The results add to the limited literature on the association of high-sugar drinks with BMI and
glucose intolerance in adults (4-6). The Framingham Heart Study and the Nurses’ Health Study II
have reported that sugar-sweetened beverages are related to impaired fasting glucose and/or
diabetes (5-6). Our study identified a highly deleterious relationship of sugar-sweetened
beverages with BMI and IFG in a largely obese Indigenous population. However, total percent
energy from carbohydrate, controlling for sugar drink intake, showed beneficial directions in its
association with BMI suggesting that the quality of carbohydrates are important in weight
management. Sugar drinks in Canada are primarily in the form of fructose and recent studies
suggest that fructose may not stimulate leptin as effectively as other sugars, thus disabling the
ability to recognize satiety (7-8). 38
1. Kuhnlein HV, Receveur O, Soueida R, Egeland GM (2004) Arctic Indigenous Peoples experience
the nutrition transition with changing dietary patterns and obesity. J Nutr;124:1447-1453.
2. Egeland GM, Denomme D, Lejeune P, Pereg D (2008) Concurrent validity of the International
Physical Activity Questionnaire (IPAQ) in an Iiyiyiu Aschii (Cree) community. Can J Public
3. Bou Khalil C, Johnson-Down L, Egeland GM (2010) Emerging obesity and dietary habits among
James Bay Cree youth. Public Health Nutr;13:1829-1837.
4. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampher MJ, Willet WC et al (2004) Sugar-
Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged
5. Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB et al (2007) Soft Drink
Consumption and Risk of Developing Cardiometabolic Risk Factors and the Metabolic Syndrome in
Middle-Aged Adults in the Community. Circulation;116:480-488.
6. Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L (2008) Sugar-Sweetened
Beverages and Incidence of Type 2 Diabetes Mellitus in African American Women. Arch Intern
7. Huang BW, Chiang MT, Yao HT, Chiang W (2004) The effect of high-fat and high-fructose diets
on glucose tolerance and plasma lipid and leptin levels in rats. Diabetes Obes Metab;6:120-126.
8. Melanson KJ, Zukley L, Lowndes J, Nguyen V, Angelopoulos TJ, Rippe JM (2007) Effects of high-
fructose corn syrup and sucrose consumption on circulating glucose, insulin, leptin, and ghrelin and
on appetite in normal-weight women. Nutrition;23:103-11.
Table. Linear and logistic regression analyses for body mass index (BMI), insulin resistance (HOMA-IR), and Download full-text
Impaired Fasting Glucose (IFG) in 473 Cree Adults, 2005-2008.
Daily Walking (yes vs. no)
%E Traditional Food
Protein, energy %
Fat, energy %
Saturated fat, energy %
1 Log of HOMA-IR.
2 Each variable presented was considered together in a multivariable model.
3 0=male, 1=female.
4 Past-month daily frequency of high-sugar drinks.
5 Each dietary factor considered separately in a model adjusting for age (years), sex, BMI, daily walking (yes vs.
no), and frequency of high-sugar drink consumption.
6 Dietary factors considered separately in a model adjusting for variables in Model I & II.
Odds Ratio [CI]
1.06 [1.04 - 1.08]
1.46 [0.94 - 2.29]
1.09 [1.05 - 1.14]
1.38 [0.89 - 2.16]
1.49 [1.02 - 2.17]
1.0 [1.00 - 1.00]
0.98 [0.96 - 1.01]
1.00 [0.96 - 1.04]
1.01 [0.99 - 1.03]
0.98 [0.92 - 1.04]
1.04 [0.86 -1.27]
1.02 [0.98 -1.07]
0.98 [0.93 - 1.02]