[Show abstract][Hide abstract] ABSTRACT: Objective:
The rate of type 2 diabetes mellitus among Inuit is 12·2 % in individuals over 50 years of age, similar to the Canadian prevalence. Given marked dietary transitions in the Arctic, we evaluated the dietary and other correlates of not previously diagnosed glucose intolerance, defined as type 2 diabetes mellitus, impaired fasting glucose or impaired glucose tolerance.
Cross-sectional analyses were limited to adults with a completed 2 h oral glucose tolerance test and without pre-existing diabetes. Anthropometric assessments, health and medication usage questionnaires and a 24 h dietary recall were administered.
Canadian International Polar Year Inuit Health Survey (2007-2008).
Inuit adults (n 777).
Glucose intolerance was associated with older age and adiposity. Percentage of energy from protein above the Acceptable Macronutrient Distribution Range of 35 %, compared with intake within the range, was associated with increased odds of glucose intolerance (OR=1·98; 95 % CI 1·09, 3·61) in multivariable analyses. Further, cholesterol intake in the highest three quartiles combined (median exposures of 207, 416 and 778 mg/d, respectively) compared with the lowest quartile (median intake of 81 mg/d) was associated with glucose intolerance (OR=2·15; 95 % CI 1·23, 3·78) in multivariable analyses. Past-day traditional food consumption was borderline protective of glucose intolerance (P=0·054) and high fibre intake was not significantly protective (P=0·08).
The results contribute to the existing literature on high protein and cholesterol intakes as they may relate to diabetes risk.
Public Health Nutrition 10/2015; DOI:10.1017/S1368980015003080 · 2.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and aims:
For primary prevention of cardiovascular disease (CVD), Canadian guidelines recommend that asymptomatic Canadians with abdominal obesity undergo Framingham risk score (FRS) assessment, and that in Indigenous Peoples, indicators of metabolic syndrome also be used to identify at-risk individuals. The hypertriglyceridemic-waist phenotype (HTGW) has been proposed to be a surrogate marker of visceral obesity and a simple proxy measure for metabolic syndrome. The primary aim of this study was to evaluate whether the HTGW and the FRS associated with sub-clinical atherosclerosis.
Methods and results:
Asymptomatic Cree participants in a cross-sectional study conducted 2005-2009 (n = 446, 18-81 y) were assessed for the HTGW using NCEP-ATP-III gender-specific-cutoffs (waist circumference: for men, ≥102 cm; for women ≥88 cm) and fasting triglycerides ≥1.7 mmol/L. Sub-clinical atherosclerosis was defined by the presence of a high sex-specific common-carotid-intimal-medial-wall-thickness (≥75th percentile). HTGW was present in 26.7% and a 10-y FRS greater than 10% was present in 18.8% of participants. The multivariate adjusted OR (95% CI) for sub-clinical atherosclerosis associated with an FRS greater than 10% was 4.10 (2.20-7.50) while that associated with the HTGW phenotype was 1.74 (95% CI 1.61-1.88) from a model including age, body mass index, alcohol consumption, FRS and the HTGW.
The HTGW phenotype is prevalent in the Cree. Our findings support further study on the utility of combining the HTGW with the FRS in the prediction of cardiovascular disease outcomes and in health screening and intervention programs among indigenous peoples.
[Show abstract][Hide abstract] ABSTRACT: We examined the impact of socioeconomic and cultural factors on dietary quality in adult Inuit living in the Canadian Arctic.
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.
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.
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.
Canadian Journal of Dietetic Practice and Research 05/2015; 76(3):1-9. DOI:10.3148/cjdpr-2015-006 · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and Aims
Indigenous people worldwide have a greater disease burden than their non-aboriginal counterparts with health challenges that include increased obesity and higher prevalence of diabetes. We investigate the relationships of dietary patterns with nutritional biomarkers, selected environmental contaminants and measures of insulin resistance in the Cree (Eeyouch) of northern Québec Canada.
Methods and Results
The cross-sectional ‘Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Study in Iiyiyiu Aschii’ recruited 835 adult participants (≥18 y) from 7 communities in the James Bay region of northern Québec. The three dietary patterns identified by principal component analysis (PCA) were: inland and coastal patterns with loadings on traditional foods, and a junk food pattern with high-fat and high-sugar foods. We investigated dietary patterns scores (in quantiles) in relation with nutritional biomarkers, environmental contaminants, anthropometry, blood pressure, fasting plasma glucose and insulin, and insulin resistance.
Homeostatic model assessment (HOMA-IR) was used as surrogate markers of insulin resistance. ANCOVA ascertained relationships between dietary patterns relationship and outcomes. Greater scores for the traditional patterns were associated with higher levels of n-3 fatty acids, mercury and polychlorinated biphenyls (PCBs) (P trend <0.001). Higher scores for the junk food pattern were associated with lower levels of PCBs and Vitamin D, but higher fasting plasma insulin and HOMA-IR.
Our results suggest that poor diet quality accompanied greater insulin resistance. Impacts of diet quality on insulin resistance, as a sign of metabolism perturbation, deserve more attention in this indigenous population with high rates of obesity and diabetes.
[Show abstract][Hide abstract] ABSTRACT: A mixed-methods approach was used to develop a culturally appropriate health intervention over radio within the Inuit community of Pangnirtung, Nunavut (NU), Canada. The radio dramas were developed, recorded and tested pre-intervention through the use of Participatory Process and informed by the extended elaboration likelihood model (EELM) for education-communication. The radio messages were tested in two focus groups (n = 4 and n = 5) to determine fidelity of the radio dramas to the EELM theory. Focus group feedback identified that revisions needed to be made to two characteristics required of educational programmes by the EELM theorem: first, the quality of the production was improved by adding Inuit youth recorded music and second, the homophily (relatability of characters) of radio dramas was improved by re-recording the dramas with voices of local youth who had been trained in media communication studies. These adjustments would not have been implemented had pre-intervention testing of the radio dramas not taken place and could have reduced effectiveness of the overall intervention. Therefore, it is highly recommended that media tools for health communication/education be tested with the intended target audience before commencement of programmes. Participatory Process was identified to be a powerful tool in the development and sustainability of culturally appropriate community health programming.
Health Promotion International 06/2014; DOI:10.1093/heapro/dau024 · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: Assess sensitivity and specificity of each of the 18 US Department of Agriculture (USDA) Household Food Security Scale Module (HFSSM) questionnaire items to determine whether a rapid assessment of child and adult food insecurity is feasible in an Inuit population.
METHODS: Food insecurity prevalence was assessed by the 18-item USDA HFSSM in a randomized sample of Inuit households participating in the Inuit Health Survey and the Nunavut Inuit Child Health Survey. Questions were evaluated for sensitivity, specificity, predictive value (+/−), and total percent accuracy for adult and child food insecurity (yes/no). Child food security items were evaluated for both surveys.
RESULTS: For children, the question “In the last 12 months, were there times when it was not possible to feed the children a healthy meal because there was not enough money?” had the best performance in both samples with a sensitivity and specificity of 92.3% and 97.3%, respectively, for the Inuit Health Survey, and 88.5% and 95.4% for the Nunavut Inuit Child Health Survey. For adults, the question “In the last 12 months, were there times when the food for you and your family just did not last and there was no money to buy more?” demonstrated a sensitivity of 93.0% and a specificity of 93.4%.
CONCLUSIONS: Rapid assessment of child and adult food insecurity is feasible and may be a useful tool for health care and social service providers. However, as prevalence and severity of food insecurity change over time, rapid assessment techniques should not replace periodic screening by using the full USDA HFSSM questionnaire.
[Show abstract][Hide abstract] ABSTRACT: to prospectively evaluate the risk of acute myocardial infarction (AMI) associated with non-fasting triglyceride levels.
a health survey of 140,790 Norwegians free of known coronary heart disease at baseline (1994-2003) were followed through December 2009 via record linkages to the Cause of Death Registry and hospital discharge diagnoses in the CVDNOR project, and evaluated in Cox proportional hazards analyses.
a total of 3219 (4.8%) men and 1434 (1.9%) women developed an AMI. Women had a steeper gradient risk with increasing triglyceride decile than men, where the highest (≥2.88 mmol/l) compared to the lowest decile (<0.7 mmol/l) was associated with an age-adjusted 4.7-fold excess risk in women in contrast to a 2.8-fold excess risk in men (interaction term, p < 0.001). A significant at-risk HDL-C (<1.0 mmol/l for men and <1.3 mmol/l for women) by triglyceride interaction term was observed. HRs increased with increasing triglyceride quartile in participants with a favourable HDL-C after multivariable adjustment (p for trend <0.001), but triglycerides did not significantly predict AMI among those with low HDL-C. For those with favourable HDL-C, net reclassification index identified a 10% and 14% improvement in classification for men and women, respectively.
non-fasting triglyceride levels among individuals with favourable HDL-C may help identify a subset of individuals at risk for CHD. Further research is warranted in evaluating non-fasting triglycerides in CHD prediction.
[Show abstract][Hide abstract] ABSTRACT: Objective
The aim of this study was to investigate the trends in 28-day and 1-year mortality rates in patients hospitalized for a first acute myocardial infarction (AMI) in Norway during the period 2001–2009. Potential age group and gender differences in these trends were also examined.Design, subjects and settingIn this retrospective nationwide cohort study, patients hospitalized for a first AMI between 2001 and 2009 were identified in the Cardiovascular Disease in Norway 1994–2009 (CVDNOR) project and followed for 1 year.Main outcome measuresTrends in 28-day and 1-year mortality [both all-cause and cardiovascular disease (CVD) mortality] were investigated.ResultsA total of 115,608 patients (60.6% men) were hospitalized for a first AMI during the study period. Mortality at 28 days was reduced annually by 3.8% overall, and by 6.7%, 4.1% and 2.6% in patients aged 25–64, 65–84 and ≥85 years, respectively (all Ptrend < 0.001). In addition, 1-year all-cause mortality was reduced annually by 2.0% overall (Ptrend < 0.001) and by 3.7% (Ptrend = 0.02), 2.5% (Ptrend < 0.001) and 1.1% (Ptrend < 0.001) in patients aged 25–64, 65–84 and ≥85 years, respectively. Furthermore, 1-year CVD mortality was reduced overall by 6.2% annually; a reduction was observed in all age groups. Finally, 1-year non-CVD mortality increased annually overall by 3.9%, due to an increase in patients aged ≥65 years.Conclusion
Mortality at 28 days after the first AMI declined in Norway between 2001 and 2009 in both men and women and in all age groups. All-cause mortality at 1 year also declined both in men and women due to decreases in CVD mortality rates, while non-CVD mortality rates increased among patients ≥65 years of age.This article is protected by copyright. All rights reserved.
Journal of Internal Medicine 05/2014; 277(3). DOI:10.1111/joim.12266 · 6.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We explored trends in acute myocardial infarction (AMI) event rates in Norway during 1994 to 2009 and trends in the 6-month, 1-year, and 3-year risk of recurrences after an incident AMI during 2001 to 2008 in men and women ≥25 years. Trends in AMI event rates (incident and recurrent) were analyzed using joinpoint regression analyses and expressed as annual percentage change (APC) in rates. Trends in AMI recurrences were explored using conditional risk models for ordered events in Cox regression. Analyses were stratified by gender and age group. Overall, AMI rates were stable during 1994 to 2002 but declined during 2002 to 2009 (APC = -2.0; 95% confidence interval [CI] -3.1 to -0.9 in men; APC = -2.1; 95% CI -3.8 to -0.5 in women). In the younger age group, rates declined during the whole study period in men (APC = -0.6; 95% CI -1.0 to -0.3) but not in women. Among older patients, no changes were observed during 1994 to 2002, whereas rates declined during 2002 to 2009 (APC = -2.6; 95% CI -3.8 to -1.4 in men; APC = -2.4; 95% CI -4.0 to -0.7 in women). During 2001 to 2008, in the older age group, the 6-month, 1-year, and 3-year risks of recurrences were reduced annually by 4.7%, 4.3%, and 5.4% in men and 5.2%, 5.0%, and 5.7% in women (all ptrend <0.001), respectively. No changes were observed in the younger age group. In conclusion, favorable trends in AMI event rates and recurrences observed in Norway were mostly seen among patients aged 65+ years, whereas less favorable trends were observed among younger patients, especially among women.
The American journal of cardiology 03/2014; 113(11). DOI:10.1016/j.amjcard.2014.03.006 · 3.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite animal and in vitro studies demonstrating pro-oxidative effects of Hg, previous human work showed no relationship between tissue Hg and plasma levels of F2- isoprostanes (F2-IsoPs), a whole body oxidative stress marker. We hypothesized that another isoprostane species, isofurans (IsoFs), was a more sensitive indicator of Hgmediated oxidative stress, which can be modified by tissue Se status. A cross-sectional study was carried out involving from a random subset (n=233) of Inuit adults from a population-based survey (n=2595) of 36 Canadian Arctic Inuit Communities to assess the relationships of plasma isoprostanes to Se and Hg status indicators. F2-IsoPs were inversely correlated with blood Se (r=-.186, p=.005) and toenail Se (r=-.146, p=.044) but not correlated with Hg. IsoFs were inversely correlated with blood Se (r=-.164, p=.014) and positively correlated with Hg (r=.228, p<.001) and Hg:Se (r=.340, p<.001). The strength of the correlations remained unchanged after multivariate adjustments. Multivariate analysis showed that F2-IsoPs were not positively associated with Hg but with Hg:Se (β=.148, p=.021). We conclude that Se and Hg status and their interactions are important factors modulating F2-IsoPs and IsoFs levels such that the Inuit may be protected from Hg-induced oxidative stress because of their high Se status.
The Journal of Lipid Research 05/2013; 54(7). DOI:10.1194/jlr.M033068 · 4.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Elevated concentrations of mercury (Hg) are commonly found in the traditional foods, including fish and marine mammals, of Inuit living in Canada's Arctic. As a result, Inuit often have higher dietary Hg intake and elevated Hg blood concentrations. However, these same traditional foods are excellent sources of essential nutrients. The goals of this study were 1) to identify the traditional food sources of Hg exposure for Inuit, 2) to estimate the percentage of Inuit who meet specific nutrient Dietary Reference Intakes and/or exceed the Toxicological Reference Values (TRVs), and 3) to evaluate options that maximize nutrient intake while minimizing contaminant exposure. A participatory cross-sectional survey was designed in consultation with Inuit in 3 Canadian Arctic jurisdictions (Nunatsiavut, Nunavut, and the Inuvialuit Settlement Region). Estimated intakes for EPA (20:5n3) and DHA (22:6n3) met suggested dietary targets, and estimated selenium (Se) intake fell within the Acceptable Range of Oral Intake. Estimated intakes of Hg (rs = 0.41, P < 0.001), Se (rs = 0.44, P < 0.001), EPA (rs = 0.32, P < 0.001), and DHA (rs = 0.28, P < 0.001) were correlated with their respective blood concentrations. Mean estimated Hg intake (7.9 μg ⋅ kg(-1) ⋅ wk(-1)) exceeded the TRV of 5.0 μg ⋅ kg(-1) ⋅ wk(-1), with 35% of the population above this guideline. Because the estimated intakes of each of the nutrients were strongly correlated (Se: rs = 0.92, P < 0.001; EPA: rs = 0.82, P < 0.001; DHA: rs = 0.81, P < 0.001) with estimated Hg intake, efforts to decrease Hg exposure must emphasize the overall healthfulness of traditional foods and be designed to prevent concomitant harm to the nutrient intakes of Inuit.
Journal of Nutrition 04/2013; 143(6). DOI:10.3945/jn.112.173351 · 3.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
High rates of iron deficiency and anemia are common among Inuit and Arctic women despite a traditional diet based on animal source foods. However, representative data on iron status and relevant determinants for this population are lacking. The objectives were to determine the prevalence of anemia and depletion of iron stores, then to identify correlates of iron status in non-pregnant Canadian Inuit women.
In a cross-sectional survey of 1550 women in the International Polar Year Inuit Health Survey, 2007-2008, hemoglobin, serum ferritin, soluble transferrin receptor (on a subset), C-reactive protein (CRP), RBC fatty acid composition, and H pylori serology were analyzed on fasting venous blood. Sociodemographic, food security status, anthropometric, dietary, and health data were collected. Correlates of iron status were assessed with multivariate linear and logistic models.
Anemia was observed in 21.7% and iron deficient erythropoiesis in 3.3% of women. For women with CRP ≤ 10 mg/L (n = 1260) 29.4% had depleted iron stores. Inadequate iron intakes were observed in 16% of premenopausal and <1% of postmenopausal women. Among food insecure women, higher long-chain (n-3) polyunsaturated fatty acid (LC-PUFA) status, which reflects a more traditional food pattern, was associated with reduced risk of iron depletion.
Iron depletion and anemia are a concern for Inuit women despite adequate total dietary iron intake primarily from heme sources. The high prevalence of H. pylori exposure, together with dietary iron adequacy, suggests an inflammation-driven iron deficiency and mild anemia. The anti-inflammatory properties of LC-PUFA may be important for iron status in this population.
BMC Public Health 04/2013; 13(1):289. DOI:10.1186/1471-2458-13-289 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rapid development, including the building of hydroelectric projects and roads in remote areas of Northern Quebec, Canada, has led to concerns about the contamination of traditional foods (TF) and a transition to a diet characterized by increased commercial food intake. A cross-sectional study of 850 Cree adults, aged ≥19 years, from 7 of the 9 Eeyouch communities was conducted during the spring and summer seasons of 2005-2008. Anthropometric measures were collected. TF and dietary intake were assessed using food-frequency questionnaires (FFQs) and 24-h recalls. Obesity was high, with 77% of the women and 64% of the men classified as obese. Past-year TF consumption was 100%, and 41% of participants reported eating TF on the 24-h recall. TF intake as reported on both the FFQs and the 24-h recalls was higher in individuals aged >50 years of age and in men, relative to younger adults and women, respectively. TF consumption increased protein, vitamin D, iron, and magnesium in all individuals, and energy, cholesterol, magnesium, sodium, and zinc in men aged 19-50 years; it decreased vitamin C in men and women aged ≥51 years. Participants reported drinking a mean daily 0.78 ± 1.34 cans of soft drinks or other high-sugar beverages per day or 5.28% ± 8.92% of total energy. It is important to identify behaviours that are contributing to obesity and its health consequences in this population and to find culturally appropriate ways to promote the consumption of TF and to reduce the consumption of energy-dense and nutrient-poor beverages and food items.
[Show abstract][Hide abstract] ABSTRACT: The Canadian International Polar Year (IPY) program made it possible to undertake much needed health research in 3 jurisdictions within the Canadian Inuit Nunangat (homeland) over a 2-year period: Inuvialuit Settlement Region (ISR), Nunavut Territory, and Nunatsiavut.
The Adult Inuit Health Survey (IHS) was a cross-sectional survey and provides baseline data upon which future comparisons can be made for prospectively assessing factors leading to the progression of chronic diseases among Canadian Inuit. With the help of the Canadian Coast Guard Ship Amundsen, which was equipped with research and laboratory facilities, 33 coastal communities were visited; land survey teams visited 3 inland communities.
The Adult IHS succeeded in obtaining important baseline information concerning the health status and living conditions of 2,595 adults living in ISR, Nunavut and Nunatsiavut.
Information from this survey will be useful for future comparisons and the opportunity to link with the International Inuit Cohort, a follow-up evaluation, and for the development of future health policies and public health interventions.