Grace M Egeland

McGill University, Montréal, Quebec, Canada

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Publications (115)462.35 Total impact

  • J. Poirier · S. Kubow · M. Noël · C. Dupont · G.M. Egeland
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    H.V. Kuhnlein · L.H.M. Chan · G. Egeland · O. Receveur
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    ABSTRACT: To investigate self-reported family history (FH) of premature myocardial infarction (MI) in first-degree relatives as a risk factor for coronary heart disease (CHD) mortality, and assess whether any observed effect could be explained by current or life course socioeconomic position. 130,066 participants from Cohort of Norway were examined during 1994-2003. A subgroup (n=84,631) had additional life course socioeconomic data. Using Cox proportional hazard analyses, we calculated hazard ratios (HR) for CHD mortality, assessed by linkages to the Norwegian Cause of Death Registry through 2009. For subgroup analyses, we created an index of life course socioeconomic position, and assessed its role as a potential confounder in the association of FH with CHD. For men, MI in parents and siblings were both a significant risk factor for CHD mortality after adjusting for established risk factors and current socioeconomic conditions; the highest risk was with MI in siblings (HR: 1.44 [1.19-1.75]). For women, FH constituted significant risk after similar adjustment only for those with MI in parents plus siblings (HR: 1.78 [1.16-2.73]). Adjusting for current and life course socioeconomic conditions only marginally lowered the estimates, and those with FH did not have worse life course socioeconomic position than those without. FH of premature MI is an independent risk factor for CHD mortality that differs in magnitude of effect by the sex of the index person and type of familial relationship. Life course socioeconomic position has little impact on the association between FH and CHD, suggesting the effect is not confounded by this. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 07/2015; 190(1). DOI:10.1016/j.ijcard.2015.04.160 · 4.04 Impact Factor
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    ABSTRACT: In studies using patient administrative data, the identification of the first (incident) acute myocardial infarction (AMI) in an individual is based on retrospectively excluding previous hospitalizations for the same condition during a fixed time period (lookback period [LP]). Our aim was to investigate whether the length of the LP used to identify the first AMI had an effect on trends in AMI incidence and subsequent survival in a nationwide study. All AMI events during 1994 to 2009 were retrieved from the Cardiovascular Disease in Norway project. Incident AMIs during 2004 to 2009 were identified using LPs of 10, 8, 7, 5, and 3 years. For each LP, we calculated time trends in incident AMI and subsequent 28-day and 1-year mortality rates. Results obtained from analyses using the LP of 10 years were compared with those obtained using shorter LPs. In men, AMI incidence rates declined by 4.2% during 2004 to 2009 (incidence rate ratio, 0.958; 95% confidence interval, 0.935-0.982). The use of other LPs produced similar results, not significantly different from the LP of 10 years. In women, AMI incidence rates declined by 7.3% (incidence rate ratio, 0.927; 95% confidence interval, 0.901-0.955) when an LP of 10 years was used. The decline was statistically significantly smaller for the LP of 5 years (6.2% versus 7.3%; P=0.02) and 3 years (5.9% versus 7.3%; P=0.03). The choice of LP did not influence trends in 28-day and 1-year mortality rates. The length of LP may influence the observed time trends in incident AMIs. This effect is more evident in older women. © 2015 American Heart Association, Inc.
    Circulation Cardiovascular Quality and Outcomes 06/2015; 8(4). DOI:10.1161/CIRCOUTCOMES.114.001703 · 5.66 Impact Factor
  • Tracey Galloway · Louise Johnson-Down · Grace M. Egeland
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    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
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    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. Conclusion 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.
    Nutrition Metabolism and Cardiovascular Diseases 08/2014; 25(1). DOI:10.1016/j.numecd.2014.08.002 · 3.32 Impact Factor
  • Cassandra Racicot-Matta · Markus Wilcke · Grace M Egeland
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    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
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    Helga Bjornoy Urke · Zhirong R. Cao · Grace M. Egeland
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    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.
    PEDIATRICS 06/2014; 133(6):1616. DOI:10.1542/peds.2013-3663 · 5.47 Impact Factor
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    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.
    05/2014; 22(7). DOI:10.1177/2047487314535681
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    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
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    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
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    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
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    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
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    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. Methods 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. Results 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. Conclusions 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
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    Louise M Johnson-Down · Grace M Egeland
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    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.
    Applied Physiology Nutrition and Metabolism 03/2013; 38(3):300-5. DOI:10.1139/apnm-2012-0167 · 2.34 Impact Factor
  • T. Galloway · B. Niclasen · G. Muckle · K. Young · G. Egeland
    International journal of circumpolar health 01/2013; 72:346-347. · 0.58 Impact Factor
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    Helga Saudny · Donna Leggee · Grace Egeland
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    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.
    11/2012; 71(1). DOI:10.3402/ijch.v71i0.19752
  • R Lazzinnaro · G.M. Egeland
    Nutrition, metabolism, and cardiovascular diseases: NMCD 11/2012; 23(1). DOI:10.1016/j.numecd.2012.08.006 · 3.32 Impact Factor
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    ABSTRACT: The contributions of several IPY health projects are highlighted in the context of population health indicators for Inuit Nunangat. Food and housing are two critical social determinants of health contributing to health issues on many levels. The nutritional deficit associated with food insecurity and the transition away from traditional and towards market foods represents a dual risk with profound consequences. Knowledge of the physiological benefits associated with traditional food consumption is increasing, including for mental health and chronic disease. Ensuring the safety of traditional foods in terms of zoonotic diseases is thus highly valuable and efforts to institute adequate monitoring and address knowledge gaps are underway. Acute respiratory disease among the young remains a significant public health issue with potential long term effects. The human papilloma virus is manifesting itself among women across northern Canada with high risk types that are more similar to profiles observed in Europe than in North America with possible implications for immunization programs. Despite a high prevalence of Hepatitis B virus infections among residents of Inuit Nunangat, the outcomes appear to be relatively benign. Communication of new knowledge on the manifestation of this virus among northern populations is provided to health care providers in the North through modern technology.
    Climatic Change 11/2012; 115(1). DOI:10.1007/s10584-012-0569-3 · 3.43 Impact Factor
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    ABSTRACT: Aim: The present study reports findings from a study of preschool-age Inuit children living in the Arctic regions of Canada and Greenland. Methods: We compare stature and obesity measures using cutoffs from the Centers for Disease Control and the International Obesity Task Force references. The sample is comprised of 1121 Inuit children (554 boys and 567 girls) aged 3-5 years living in Nunavut (n=376) and Nunavik (n=87), Canada, in the capital city of Nuuk, Greenland (n=86), and in Greenland's remaining towns and villages (n=572). Results: Greenland Inuit children were significantly taller than their Canadian counterparts, with greatest height and weight observed among children from Nuuk. Overall prevalence of stunting was low with the three cutoffs yielding similar values for height-for-age z-scores. Obesity prevalence was higher among Canadian Inuit children than their Greenland counterparts. Conclusions: Inuit children have stature values consistent with those of the Centers for Disease Control reference and low prevalence of stunting, though geographic variability in mean stature values between Canadian and Greenlandic samples likely reflects differences in both socioeconomic status and genetic admixture. Obesity prevalence is high among both Canadian and Greenland Inuit preschoolers, with children living in the city of Nuuk exhibiting lower obesity prevalence than children living in either Nunavut or Nunavik, Canada or Greenland's towns and villages. Varying obesity prevalence may reflect varying degrees of food security in remote locations as well as the influence of stature and sitting height which have not been well studied in young Inuit children.
    Scandinavian Journal of Public Health 10/2012; 40(8). DOI:10.1177/1403494812462495 · 1.83 Impact Factor

Publication Stats

2k Citations
462.35 Total Impact Points


  • 2004–2014
    • McGill University
      • • Centre for Indigenous Peoples' Nutrition and Environment
      • • School of Dietetics and Human Nutrition
      • • Department of Geography
      • • Department of Obstetrics and Gynecology
      Montréal, Quebec, Canada
  • 2001–2014
    • University of Bergen
      • Department of Public Health and Primary Health Care
      Bergen, Hordaland, Norway
  • 1991–1997
    • Centers for Disease Control and Prevention
      • • National Center for Environmental Health
      • • Division of Environmental Hazards & Health Effects
      Druid Hills, GA, United States