Search

Background For the Syilx Okanagan Nation in Canada, salmon has vital nutritional, cultural, and spiritual significance. Yet, the Okanagan Sockeye salmon population came to near extinction, resulting in a drastic decline in salmon consumption from high historical levels. Thus, restoring and protecting salmon is crucial to Syilx well-being and way of life. A Syilx-led food sovereignty initiative re-established the Okanagan Sockeye salmon population, which has resulted in a rise in fish harvesting. The aim of this study was to assess whether engaging with this initiative was associated with health, well-being, and cultural connectedness (i.e., degree to which one is integrated in their culture) among Syilx adults. Eating Okanagan Sockeye salmon was conceptualized as a proxy for engaging with this Indigenous food sovereignty initiative. Methods 265 Syilx adults completed a survey including a traditional food frequency questionnaire and questions on health status (e.g., BMI, self-assessed physical health), well-being (e.g., life satisfaction, stress levels), and cultural connectedness (e.g., sense of belonging, importance of cultural practices). Participants were divided into 3 groups based on their wild salmon eating during the year prior to the survey: (1) adults who ate Okanagan Sockeye salmon, (2) adults who ate salmon but did not usually know the species of the salmon they ate, or who solely ate salmon that were not Okanagan Sockeye; and (3) adults who did not eat any salmon. Results A statistically significant gradient was observed for enhanced well-being and cultural connectedness, with individuals in group 1 having better indicators than those in group 2, and adults in groups 1 and 2 having better indicators than adults in group 3. No differences were observed in physical health outcomes between the three groups. Conclusion Findings suggest that the initiative to re-establish Okanagan Sockeye salmon in the Okanagan River system may have led to better well-being and cultural connectedness among Syilx adults. This study highlights the importance of Indigenous food sovereignty as a way to enhance well-being and cultural connectedness among First Nations in Canada. Findings also reinforce the importance of assessing health and well-being in a wholistic way in Indigenous health research.

Objective To describe the traditional food (TF) systems of First Nations in Canada, including intake, barriers and promoters. Methods The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of First Nations adults below the 60th parallel that obtained data for communities excluded from other national studies. A food frequency questionnaire was used to establish frequency of TF intake (number of days in a year) to allow comparisons across ecozones/regions in Canada. Grams of TF intake were also calculated using frequency multiplied by average portions from 24-h recalls. Closed- and open-ended questions attempted to identify some of the key barriers and concerns regarding TF access and use. Multivariable analyses were run to determine what factors are associated with increased TF consumption. Results Across communities, there is a strong preference by adults to have TF in the diet more often. Consumption of land animals was most frequently reported in most ecozones except for the Pacific Maritime and Mixedwood Plains, where fish and plants, respectively, were more frequently consumed. First Nations identified structural and environmental challenges such as development, government regulations and climate change, along with household barriers such as insufficient capital for equipment and transportation, lack of time and absence of a hunter in the household. Multivariable analyses revealed that the highest intake of TF occurred in the Taiga Plains ecozone, and for older individuals and men. Conclusion Identifying solutions that empower First Nations at all levels is required to overcome the multiple challenges to the inclusion of TF in the diet.

Objectives To identify food sources of nutrients in First Nations adults in Canada and to establish whether these populations are meeting their nutrient requirements and whether traditional foods (TF) contribute to better nutrient intake. Methods The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of First Nations adults living south of the 60th parallel. Twenty-four-hour recalls were conducted in 92 First Nations communities from 2008 to 2016. Repeat recalls were attempted with 20% of participants to adjust for within-person variation and estimate the proportion of individuals below recommendations according to Institute of Medicine guidelines. Nutrients from days with and without TF were compared. The main food sources of select nutrients were identified, including TF. Results Mean energy intakes among women and men ranged from 1664 to 1864 and from 1761 to 2298 kcal/day respectively. Most macronutrients were within the acceptable macronutrient diet range except for fat in most age groups and carbohydrates in men 71 years of age and older. Saturated fat was above recommendations for all ages. Only niacin was identified as above recommendations in all age and sex categories. Days where TF were eaten showed greater intakes of key nutrients. Conclusion It is imperative that we find culturally appropriate ways to improve the quality and nutritional value of First Nations Peoples food intake by improving TF access and use on the one hand and conversely providing better quality store-bought foods. For success in this, we must empower First Nations communities and health practitioners to collaboratively overcome these challenges.

Assess the diet quality of First Nations adults in Canada using percentage energy from traditional foods (TF) and ultra-processed products (UPP), food portions from the 2007 Eating Well with Canada's Food Guide - First Nations, Inuit and Métis (EWCFG-FNIM) and a Healthy Eating Index (HEI).Data collection for this participatory research occurred in 92 First Nations reserves across Canada from 2008 to 2016. Percent daily energy intakes were estimated from 24-hour recalls for TF and NOVA food categories. Portions of food groups from the 2007 EWCFG-FNIM were compared to recommendations. A Canadian-adapted HEI was calculated for each participant.The percent energy from TF was 3% for all participants and 18% for consumers. Meat and alternatives were above the EWCFG-FNIM recommendations and all other food groups were below these. HEI was "low" with only older individuals attaining "average" scores. HEI was above "average" in 4 regions. UPP represented 55% of energy, the largest proportion from a NOVA category.The diet quality of First Nations adults in Canada is nutritionally poor. The nutrition, food security and health of First Nations would be improved by better access to TF and healthy store-bought food. However, poor diet is only one aspect of the difficulties facing First Nations in Canada. Researchers and policy makers must strive to better understand the multiple challenges facing First Nations Peoples in order to foster empowerment and self-determination to develop First Nations living conditions and lifestyles that are more culturally sound and more conducive to health.RéSUMé: OBJECTIFS: Évaluer la qualité de l’alimentation des adultes des Premières Nations du Canada en calculant l’énergie provenant des aliments traditionnels (AT) et des produits ultra-transformés, en comparant les portions consommées avec celles recommandées dans Bien manger avec le Guide alimentaire canadien Premières Nations, Inuit et Métis (BMGAC-PNIM) de 2007 et en mesurant l’indice d’alimentation saine. MéTHODE: La collecte de données pour cette recherche participative a eu lieu dans 92 réserves des Premières Nations au Canada entre les années 2008 et 2016. À partir des rappels de 24 heures, la proportion d’énergie provenant des AT pour les individus les ayant consommés ou non a été comparée, les portions des catégories d’aliments proposées par le BMGAC-PNIM ont été comparées aux recommandations, l’indice d’alimentation saine adapté pour le Canada a été calculé pour chaque participant et la proportion d’énergie des produits ultra-transformés a été établie. RéSULTATS: La proportion d’énergie provenant des AT chez les consommateurs et non-consommateurs était de 3 % et celle pour les consommateurs d’AT était de 18 %. Seuls les viandes et substituts dépassaient les recommandations du BMGAC-PNIM tandis que la consommation de toutes les autres catégories était inférieure aux recommandations. L’indice d’alimentation saine était “bas” avec seulement les individus plus âgés atteignant un score “moyen”. L’indice d’alimentation saine était supérieur à “moyen” dans 4 régions. Les aliments ultra-transformés représentaient 55 % de l’énergie, la plus grande proportion de toutes les catégories NOVA. CONCLUSION: La qualité de l’alimentation des Premières Nations n’est pas optimale. Leur alimentation pourrait être améliorée avec un meilleur accès aux AT et aux aliments sains provenant du marché. Une mauvaise alimentation n’est toutefois pas la seule difficulté à laquelle font face les Premières Nations du Canada. Les Peuples des Premières Nations doivent être impliquées avec les chercheurs et les responsables politiques pour mieux comprendre les défis multiples auxquels ils font face et instaurer des conditions de vie qui soient culturellement sécuritaires et plus propices à la santé.

A multi-stage sampling strategy selected 1387 on-reserve First Nations adults in Ontario. Foods from a 24-hour dietary recall were assigned to the 100 most common food groups for men and women. Nutrients from market foods (MF) and traditional foods (TF) harvested from the wild as well as MF costs were assigned based on the proportions of total grams consumed. Linear programming was performed imposing various constraints to determine whether it was possible to develop diets that included the most popular foods while meeting Institute of Medicine guidelines. Final models were obtained for both sexes with the top 100 food groups consumed while limiting the nutrient-poor foods to no more than the actual observed intake. These models met all nutrient constraints for men but those for dietary fibre, linoleic acid, phosphorus, and potassium were removed for women. MF costs were obtained from community retailers and online resources. A grocery list was then developed and MF were costed for a family of 4. The grocery list underestimated the actual weekly food cost because TF was not included. Contemporary observed diets deviated from healthier historic First Nations diets. A culturally appropriate diet would include more traditional First Nations foods and fewer MF. Novelty: Linear programming is a mathematical approach to evaluating the diets of First Nations. The grocery list is representative of food patterns within Ontario First Nations and can be used as an alternative to the nutritious food basket used for public health food costing.

This review summarizes aspects of the 2017 Canadian Nutrition Society symposium, “Modelling diets for quality and cost: examples from Inuit and First Nations in Canada”. Indigenous peoples in Canada experience a high prevalence of nutrition-related chronic disease because of the poor quality and high cost of their food supply. Since European colonization, they have transitioned from a diet of minimally processed traditional foods (game, fish, and plants) procured using pursuits such as hunting, fishing, gathering, and horticulture to a diet comprised mostly of processed market foods. This nutrition transition is the result of factors such as colonial policies and practices; climate change; environmental degradation; contaminants in traditional foods; and limited availability of, or access to, economical and healthful market foods. Presenters Malek Batal and Laurie Chan characterized the contemporary diets of First Nations and Inuit populations and demonstrated novel methods for modelling more optimal diets using 2 datasets: the First Nations Food, Nutrition, and Environment Study and the Inuit Health Survey. It was demonstrated how the NOVA classification characterized the portion of the diet consisting of processed foods. Dietary components were then manipulated to reduce ultra-processed food and drink intake to increase the Healthy Eating Index score. Linear programming was explained as a way to mathematically design theoretical diets that aim to optimize food cost, nutrition quality, and contaminant level of traditional foods. While diet-modelling methodologies have limitations, they provide a basis for engaging Indigenous peoples and governments to develop nutrition goals and policies anchored in contemporary food realities.

Objective Our objective is to describe self-reported health status, prevalence of diabetes and obesity and their associations in participants from the First Nations Food, Nutrition and Environment Study (FNFNES) in order to identify possible correlates of health in First Nations adults. Methods FNFNES is a participatory study with First Nations Peoples living on reserve lands south of the 60th parallel. Health and diabetes were self-reported, and prevalence of obesity was evaluated. Socio-demographic and lifestyle factors and traditional food (TF) activities were investigated for associations with health parameters. Results High prevalence rates of overweight/obesity (78–91%) and diabetes (19% age-standardized prevalence) were found. Smoking rates were high and physical activity was low. In multivariable analyses, obesity was associated with region, income source, age, gender, smoking and self-reported health; diabetes and lesser self-reported health were associated with obesity and lower education. Diabetes was strongly associated with lesser self-reported health and weakly associated with being a smoker. Conclusion We have identified possible correlates of health in this population that can help to better understand the underlying concerns and identify solutions for First Nations and their partners. We urge governments and First Nations to address the systemic problems identified with a holistic ecosystem approach that takes into consideration the financial and physical access to food, particularly TF, and the facilitation of improved health behaviour. New mechanisms co-developed with First Nations leadership should focus on supporting sustainable, culturally safe and healthy lifestyles and closing the gaps in nutrition and food insecurity.

To describe the prevalence of food insecurity in First Nations households across Canada while identifying barriers and enablers to traditional food (TF) consumption.The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of on-reserve First Nations from 2008 to 2018. The Household Food Security Survey Module was used to capture income-related challenges experienced by First Nations households. Households were classified as food secure, or marginally, moderately, or severely food insecure. Barriers and enablers to TF access and use were identified describing the Indigenous experience.Almost half of on-reserve First Nations households were food insecure and the prevalence was higher than that for non-Indigenous households in Canada. On-reserve food insecurity prevalence was higher in western regions of Canada. First Nations households with children experienced greater food insecurity than those without children. More adults experienced severe food insecurity than children. Most adults would like to have more TF in their diet but state that factors such as financial and household constraints, industrial activities, government regulations, climate change, and fear of contamination impede greater access. Food costs were substantially higher in remote First Nations communities, but remoteness was not associated with food security in multivariable analysis.Existing systems have been unsuccessful in curbing the food insecurity in First Nations households. Improving food security hinges on achieving Indigenous Food Sovereignty, the key to long-term conservation and stewardship of the land and the co-management of these by Indigenous Peoples. Studies investigating the feasibility of increasing TF from an Indigenous perspective are required.RéSUMé: OBJECTIFS: Décrire la prévalence de l’insécurité alimentaire chez les ménages des Premières Nations du Canada tout en identifiant les obstacles et les facilitateurs de l’alimentation traditionnelle (AT). MéTHODES: L’étude sur l’alimentation, la nutrition et l’environnement des Premières Nations dans les réserves est une étude participative pancanadienne des ménages des Premières Nations. Le module d’enquête sur la sécurité alimentaire des ménages a été utilisé pour tenir compte des défis liés au revenu qui confrontent les ménages des Premières Nations. Les ménages ont été classés comme étant en sécurité alimentaire ou insécurité alimentaire marginale, modérée ou sévère. Des obstacles et facilitateurs à l’accès et à l’utilisation des AT ont été identifiés pour décrire l’expérience autochtone. RéSULTATS: Près de la moitié des ménages dans les réserves des Premières Nations dans notre étude étaient en situation d’insécurité alimentaire et la prévalence était supérieure aux ménages non-Autochtones du Canada. L’insécurité alimentaire dans les réserves était plus élevée dans les régions de l’Ouest. Les ménages des Premières Nations ayant des enfants ont connu une plus grande insécurité alimentaire que ceux qui n’en ont pas. Plus d’adultes que d’enfants ont connu une insécurité alimentaire sévère. La plupart des adultes aimeraient avoir plus d’AT dans leur alimentation, mais affirment que des facteurs tels que les contraintes financières et domestiques, les activités industrielles, les réglementations gouvernementales, les changements climatiques et la peur de la contamination empêchent un meilleur accès. Les coûts des aliments étaient considérablement plus élevés dans les communautés isolées des Premières Nations, mais l’isolement n’était pas associé à la sécurité alimentaire dans l’analyse multivariée. CONCLUSION: Les systèmes existants ont échoué à freiner l’insécurité alimentaire chez les ménages des Premières Nations. L’amélioration de la sécurité alimentaire dépend de la réalisation de la souveraineté alimentaire autochtone, une clé pour la conservation à long terme des ressources naturelles et pour une gestion partagée de ces ressources par les peuples autochtones. Des études menées dans une perspective autochtone sur la faisabilité d’améliorer l’accès aux AT sont encore nécessaires.

ObjectiveTo quantify associations of the dietary share of ultra-processed foods (UPF) with the overall diet quality of First Nations peoples.DesignA cross-sectional analysis of data from the First Nations Food, Nutrition and Environment Study, designed to contribute to knowledge gaps regarding the diet of First Nations peoples living on-reserve, south of the 60th parallel. A multistage sampling of communities was conducted. All foods from 24 h dietary recalls were categorized into NOVA categories and analyses were performed to evaluate the impact of UPF on diet quality.SettingWestern and Central Canada.SubjectsFirst Nations participants aged 19 years or older.ResultsThe sample consisted of 3700 participants. UPF contributed 53·9 % of energy. Compared with the non-UPF fraction of the diet, the UPF fraction had 3·5 times less vitamin A, 2·4 times less K, 2·2 times less protein, 2·3 times more free sugars and 1·8 times more Na. As the contribution of UPF to energy increased so did the overall intakes of energy, carbohydrate, free sugar, saturated fat, Na, Ca and vitamin C, and Na:K; while protein, fibre, K, Fe and vitamin A decreased. Diets of individuals who ate traditional First Nations food (e.g. wild plants and game animals) on the day of the recall were lower in UPF.ConclusionsUPF were prevalent in First Nations diets. Efforts to curb UPF consumption and increase intake of traditional First Nations foods and other fresh or minimally processed foods would improve diet quality and health in First Nations peoples.

We examined the feasibility of linear programming (LP) to develop diets that were economical, included traditional (cultural, non-market) foods and met the dietary reference intakes (DRI) in a Canadian Indigenous population. Diet optimisation using LP is a mathematical technique that can develop food-based dietary guidelines for healthy eating in Indigenous populations where food insecurity, availability and cost are important considerations. It is a means of developing nutritionally optimal food combinations that are based on economical and culture-specific foods. Observed food consumption data were derived using 24-h food recalls from the First Nations Food, Nutrition and Environment Study. The LP models were constructed to develop diets meeting DRI, cost and food constraints. Achieving the recommended food intake was not feasible in a model meeting all nutrient requirements. Models that met most nutrient requirements at reduced cost were designed for men and women, separately. In women, it was necessary to increase energy intake to meet most nutrient requirements. Nutrient requirements could not be met for fibre, linoleic and linolenic acids, vitamin D, Ca and K in both sexes, P in women, and Mg and vitamin A in men. Using LP to develop optimal diets for First Nations people, we found simultaneous achievement of all DRI was difficult, suggesting that supplementation might be necessary which goes against recommendations for individuals to meet their nutrient needs through healthy eating patterns. Additionally, to make diets feasible, programmes to reduce market food costs and to support First Nations people in traditional food harvesting are recommended.

The Eeyouch are a First Nations (Cree) population that live above 49.6°N latitude in Eeyou Istchee in northern Quebec. Eeyouch rely on traditional foods (TF) hunted, fished or gathered from the land. The overarching aim of this study was to achieve an understanding of the factors associated with TF intake among Eeyouch. Data were from 465 women and 330 men who participated in the Nituuchischaayihtitaau Aschii Multi-Community Environment-and-Health (E&H) study. The relationship between TF consumption and dietary, health, sociodemographic and food sovereignty (i.e. being a hunter or receiving Income Security to hunt, trap or fish) variables was examined using linear and logistic regression. Analyses were stratified by sex because of the male/female discrepancy in being a hunter. Among respondents, almost all (99.7%) consumed TF, 51% were hunters and 10% received Income Security. Higher intake of TF was associated with lower consumption of less nutritious ultra-processed products (UPP). In women, TF intake increased with age, hunting and receiving Income Security, but decreased with high school education. In men, TF intake increased with age and speaking only Cree at home. The findings suggest that increased food sovereignty would result in improved diet quality among Eeyouch through increased TF intake and decreased UPP intake.

To describe exposure to methylmercury among Cree, focusing on women of childbearing age, we used data from 2 studies. Multiple regression was employed to examine associations between blood and hair mercury concentrations and consumption of locally harvested fish. Approximately 9.9% of non-pregnant women aged 15–44 y and 3.9% of pregnant women required follow-up according to Health Canada’s blood mercury guidance value of 40 nmol/L. 8% of hair mercury observations in the non-pregnant women and 2.5% among pregnant women exceeded the equivalent threshold of 10 nmol/g. The geometric mean blood mercury concentration was 12.7 nmol/L in 1,429 persons aged 8 and over, and 17.7 nmol/L in adults aged 18 and older. The proportion of hair mercury concentrations greater than 12.5 nmol/g decreased in all age-sex groups when comparing the 2002–2009 data to published values for 1993–1994. Among women of childbearing age, local fish consumption was associated with increased blood and hair mercury concentrations. While over 90% of women of childbearing age in this population have acceptable levels of mercury, ongoing intake of mercury suggests that their consumption of fish with known high mercury content be minimised. Reducing consumption of fish known to be high in mercury content needs to be balanced with promoting ongoing connection to Cree culture and land-based activities that are also important determinants of health.

We investigated the food types consumed by 3276 First Nations citizens from the First Nations Food Nutrition and Environment Study (FNFNES) living on-reserve in Canada. Data from 24-h dietary recalls were classified into NOVA categories: fresh or minimally processed foods (MPF), processed culinary ingredients, processed foods, and ultra-processed foods (UPF). Individuals were classified as traditional food (TF) eaters if they ate MPF of their First Nations culture. UPF accounted for 54.0% of energy intake; 23% of participants ate TF. Increasing age and household size, living in British Columbia and TF eating were associated with a lower intake of energy from UPF. Eating TF appeared to be protective against intake of UPF.

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.The cross-sectional 'Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Study in Eeyou Istchee' 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 trend0.001). 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.

ObjectiveTo assess associations between three diet quality indices and metabolic syndrome (MetS) in the Cree (Eeyouch) of northern Québec, Canada, as well as to evaluate their pertinence in this Indigenous context.DesignThe alternative-Healthy Eating Index 2010 (aHEI-2010), the Food Quality Score (FQS) and the contribution of ultra-processed products (UPP) to total daily dietary energy intake using the NOVA classification were calculated from 24 h food recalls. MetS was determined with the latest harmonized definition. Logistic regressions assessed the relationship between quintiles of dietary quality scores with MetS and its components.SettingStudy sample from the 2005–2009 cross-sectionalNituuchischaayihititaau AschiiEnvironment-and-Health Study.SubjectsEeyouch (n811) from seven James Bay communities (≥18 years old).ResultsMetS prevalence was 56·6 % with 95·4 % abdominal adiposity, 50·1 % elevated fasting plasma glucose, 43·4 % hypertension, 38·6 % elevated TAG and 44·5 % reduced HDL cholesterol. Comparing highest and lowest quintiles of scores, adjusted OR (95 % CI) of MetS was 0·70 (0·39, 1·08;P-trend=0·05) for aHEI-2010, 1·06 (0·63, 1·76;P-trend=0·87) for FQS and 1·90 (1·14, 3·17;P-trend=0·04) for the contribution of UPP to total daily dietary energy intake.ConclusionsAlthough diet quality indices have been associated with cardiometabolic risk, only the dietary intake of UPP was significantly associated with MetS in the Eeyouch. Indices tailored to the food environment of northern communities are essential to further understand the impact of diet quality in this context.

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.

ObjectiveThe 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.DesignCross-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.SettingCanadian International Polar Year Inuit Health Survey (2007–2008).SubjectsInuit adults (n 777).ResultsGlucose 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).ConclusionsThe results contribute to the existing literature on high protein and cholesterol intakes as they may relate to diabetes risk.

Food insecurity and the nutrition transition have been noted in arctic communities. We therefore evaluated biomarkers of nutritional status and nutrient intakes by traditional food (TF) and food security status among Inuit in Canada. A cross-sectional health survey of Inuit (≥18 y) in 36 arctic communities was conducted in 2007-2008. Food security was assessed by 24-h dietary recalls using USDA questionnaires and nutrient intakes. Biomarkers included serum 25-hydroxy vitamin D [25(OH)D], hemoglobin, serum ferritin, and erythrocyte RBC fatty acids (FA). Analyses were stratified by past-day TF consumption (yes vs. no) and food security status (secure vs. insecure). Food insecurity was prevalent (62.6%) and associated with higher RBC trans-FA and lower hemoglobin levels and serum ferritin, whereas TF consumption was associated with higher serum 25(OH)D, (n-3) FA, and serum ferritin (P ≤ 0.05). In men, food insecurity was associated with lower intake of energy and energy-adjusted fiber, vitamin C, iron, zinc, and magnesium. In women, food insecurity was associated with a higher intake of carbohydrates and lower intake of fiber, dietary folate equivalent, vitamin C, iron, magnesium, calcium, and vitamin D. For both sexes, when TF was consumed, there was a higher intake of protein, protein-related micronutrients, and vitamins A and C and a lower intake of carbohydrates, saturated fat, and fiber and a lower sodium:potassium ratio (P ≤ 0.05). Nutrition transition and food insecurity are associated with a multifaceted shift in nutrient status and intakes with implications for increased risk of diet-sensitive chronic diseases.

ObjectiveTo describe dietary habits and extent of overweight and obesity among Cree youth.DesignDietary intake and habits were assessed by a 24 h recall and FFQ as part of a cross-sectional survey.SettingThree Cree communities in northern Québec, Canada.SubjectsA total of 125 youth aged 9–18 years.ResultsOverall 67·6 % of the study population was either at risk of overweight or overweight. Over 98 % had a usual saturated fat intake over 10 % of energy while 65 % had a lower consumption of fruit/vegetables and 95 % had a lower consumption of milk and milk products than recommended by Canada’s Food Guide. The majority (96·8 %) consumed high-fat foods (>40 % of total energy as fat), which accounted for 39 % of total energy intake (EI). Similarly, 92·8 % consumed high-sugar food and beverages (>25 % of total energy as sugar), which accounted for 12·8 % of total EI. Furthermore, 95 % of the youth had a Healthy Eating Index (HEI) below the recommended score of 80 or above. Certain measures of diet quality (traditional food (TF) consumption, HEI and vegetables and fruit consumption) were significantly correlated with adiposity measures.ConclusionsA high prevalence of low-diet quality was found with a high degree of sugar and fat intake and a low consumption of vegetables/fruit and milk/milk alternates and any weekly TF. Dietary interventions are sorely needed.

Purpose: We examined the impact of socioeconomic and cultural factors on dietary quality in adult Inuit living in the Canadian Arctic. Methods: Interviews and a 24-h dietary recall were administered to 805 men and 1292 women from Inuit regions in the Canadian Arctic. We examined the effect of age, sex, education, income, employment, and cultural variables on respondents' energy, macronutrient intake, sodium/potassium ratio, and healthy eating index. Logistic regression was used to assess the impact of socioeconomic status (SES) on diet quality indicators. Results: Age was positively associated with traditional food (TF) consumption and greater energy from protein but negatively associated with total energy and fibre intake. Associations between SES and diet quality differed considerably between men and women and there was considerable regional variability in diet quality measures. Age and cultural variables were significant predictors of diet quality in logistic regression. Increased age and use of the Inuit language in the home were the most significant predictors of TF consumption. Conclusions: Our findings are consistent with studies reporting a nutrition transition in circumpolar Inuit. We found considerable variability in diet quality and complex interaction between SES and cultural variables producing mixed effects that differ by age and gender.

Purpose: Food sources of nutrients in the Canadian diet were explored. Knowledge of these sources is important to public health professionals and to those in clinical practice.Methods: Using data from the Food Habits of Canadians study, we investigated nutrient sources from detailed food groupings in a sample of 1,543 adults (971 women, 572 men) from across Canada. Subjects were interviewed by trained dietitians. At the time of the interview, a sociodemographic questionnaire and a 24-hour dietary recall were completed.Results: The response rate was 30%. Subjects aged 18 to 34 reported eating more prepared and convenience foods than did those aged 35 to 65. Energy was contributed mainly by breads, pasta, rice, grains, and fluid milk. Protein intake was primarily derived from meat and dairy products; legumes, nuts, seeds, and eggs were not high contributors. For men aged 35 to 65 and women aged 18 to 65, butter, margarine, and oil were the primary fat sources; they were the second most common source for men aged 18 to 34. Fibre was provided by foods that are not usually considered good sources, but because of the large total consumption of these foods, they are important in Canadians’ diet. The main source of calcium was dairy products, and iron came mainly from non-heme sources.Conclusions: We must understand the contributions of foods to nutrients, and distinguish “important” sources of nutrients (those consumed by many in substantial amounts) from “good” sources (foods rich in particular nutrients, whether eaten or not).

Fortification with calcium to increase dietary intakes of this mineral is currently under evaluation in Canada. To model the potential dietary consequences of food fortification, data from a large national survey of Canadians (n = 1543) were used. Food fortification scenarios were based on reference amounts for labeling requirements. Consumption of milk, cheese and other dairy products was associated with high calcium intakes, and there was a low prevalence of inadequacy in men < 50 y old; however, other age-sex groups had lower intakes. The aim of the fortification modeling was to determine which scenario would most effectively reduce the proportion of the population with low intakes of calcium while minimizing the proportion of individuals who exceeded the tolerable upper intake level (UL). Given the correlation between energy and calcium (r = 0.60, P < 0.01), it appeared that any fortification scenario sufficient to increase the mean intake for women to near the adequate intake led to 6-7% of the men having calcium intakes above the UL. The results suggest that fortification of widely consumed foods is not a realistic way to address the issue of low calcium intakes and illustrate the need for concern about the growing use of fortification practices.

First Nations children are at higher risk for vitamin D deficiency and rickets.To assess the prevalence of vitamin D deficiency and the correlations between fat mass, parathyroid hormone and dietary habits with serum vitamin D level in a random sample of Cree children eight to 14 years of age.Serum 25-hydroxyvitamin D (25[OH]D) levels and additional information regarding anthropometrics and dietary habits were obtained from participants in two Cree communities. Vitamin D deficiency and insufficiency was defined as serum 25(OH)D levels30 nmol/L and50 nmol/L, respectively. Proportions to estimate the vitamin D status were weighted to account for the complex sampling design, and Pearson's correlation coefficients were used to estimate the associations of milk and fish intake, parathyroid hormone and fat mass with serum 25(OH)D levels.Data from 52 healthy Cree children (mean [± SD] age 11.1±2.0 years; 27 boys) were included in the analyses. The median serum 25(OH)D level was 52.4 nmol/L (range 22.1 nmol/L to 102.7 nmol/L). Forty-three percent (95% CI 29% to 58%) and 81% (95% CI 70% to 92%) of Cree children had vitamin D levels50 nmol/L and75 nmol/L, respectively. Vitamin D intake was positively associated with serum 25(OH)D levels. Obese children had lower vitamin D levels; however, the difference was nonsignificant.There may be a substantial proportion of Cree children who are vitamin D deficient. Increasing age, lower dietary vitamin D intake and, possibly, higher body mass index were associated with decreased vitamin D levels; however, causality cannot be inferred.Les enfants des Premières nations sont plus vulnérables à une insuffisance en vitamine D et au rachitisme.Évaluer la prévalence de carence en vitamine D et les corrélations entre, d’une part, la masse grasse, la parathormone et les habitudes alimentaires et, d’autre part, le taux sérique de vitamine D dans un échantillon d’enfants cris de huit à 14 ans sélectionnés au hasard.On a obtenu le taux sérique de 25(OH)D des participants provenant de deux communautés cries, qui ont également fourni de l’information sur leurs données anthropométriques et leurs habitudes alimentaires. La carence et l’insuffisance en vitamine D étaient définies par des taux sériques de 25(OH)D inférieurs à 30 nmol/L et à 50 nmol/L, respectivement. Les proportions pour évaluer le taux de vitamine D ont été pondérées pour tenir compte de la méthodologie complexe de l’échantillon, et les coefficients de corrélation de Pearson ont permis d’évaluer les associations entre le taux sérique de 25(OH)D, d’une part, et la consommation de lait et de poisson, la parathormone et la masse grasse, d’autre part.Les analyses incluaient les données provenant de 52 enfants cris en bonne santé (âge moyen [± ÉT] de 11,1±2,0 ans; 27 garçons). Le taux sérique médian de 25(OH)D s’élevait à 52,4 nmol/L (plage de 22,1 nmol/L à 102,7 nmol/L). Quarantetrois pour cent (95 % IC 29 % à 58 %) et 81 % (95 % IC 70 % à 92 %) des enfants cris présentaient un taux de vitamine D inférieur à 50 nmol/L et à 75 nmol/L, respectivement. La consommation de vitamine D était associée de manière positive au taux sérique de 25(OH)D. Les enfants obèses présentaient des taux de vitamine D plus faibles, mais la différence n’était pas significative.Une forte proportion d’enfants cris présente peutêtre une carence en vitamine D. L’âge, une moins grande consommation alimentaire de vitamine D et, peutêtre, un indice de masse corporelle plus élevé étaient liés à un taux moins élevé de vitamine D. Cependant, on ne peut en induire une causalité.

Purpose: A national survey of adult Canadians (n=1,544) was recently undertaken (19971998) to monitor whether changes in dietary intake have occurred since the last Canadian dietary survey, conducted a generation ago (1970). Methods: Individuals from randomly selected households from a stratified sample of 80 enumeration areas from five regions of Canada were interviewed by a dietitian at home for a 24-hour dietary recall and food frequency questionnaire. Results: The mean dietary % energy from protein (16-18%), carbohydrate (50-56%) and fat (29-31%) was close to recommended levels in the different age-sex groups. Fat intake was reduced from previous surveys. Intakes of dairy products and fruits and vegetables are lower than recommended. Nutrient values at the 25th percentile of the nutrient distribution, were below recommended levels for calcium, folate, iron and zinc among women. Conclusion: Despite the growing problem of obesity, Canadians are eating less fat than a generation ago but intake of certain nutrients are still suboptimal. ABREGE Objectif : Une etude nationale sur des Canadiens adultes (n=1 544) fut recemment entreprise (1997-1998) pour verifier si des changements dans la prise alimentaire etaient survenus depuis la derniere etude il y a une generation (1970).

OBJECTIVES: Aboriginal peoples affected by a nutrition transition and living at high latitudes are among the ethnic groups most at risk of vitamin D deficiency. The objectives of this study were to determine the prevalence of meeting predefined cut-off concentrations of vitamin D and to examine associated factors among James Bay Cree aged ³15 years. METHODS: A cross-sectional study was conducted between the months of May and September from 2005 to 2009. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined by radioimmunoassay. Anthropometrics were measured and additional information on socio-demographic characteristics, lifestyle and dietary habits was obtained using questionnaires. A logistic regression model predicting vitamin D insufficiency (

Objectives. To evaluate correlates of food insecurity among Inuit preschoolers. Study design. Cross-sectional health survey. Methods. Correlates of food insecurity were assessed in 3–5 year old children (n=388) residing in 16 Nunavut communities (2007–2008) in whom a high prevalence of child food insecurity (56%) has been documented. A bilingual team conducted interviews, including 24-hour dietary recalls and past-year food security assessment involving monetary access to market foods. Results. Children residing in child food insecure homes were more likely to have consumed traditional food (TF) (51.7% vs. 39.9%, p≤0.01), and less likely to have consumed any milk (52.2% vs. 73.2%, p≤0.001) compared to children in child food secure homes. Median healthy eating index scores were significantly lower (77.1 vs. 79.9, p≤0.01) and sugar drink intake higher (429 vs. 377 g/day, p≤0.05) in children from child food insecure than food secure households. Children that consumed TF had higher protein and lower carbohydrate intake (p≤0.05) and tendencies for a lower prevalence of iron deficiency (plasma ferritin

Objectives. The International Polar Year (IPY) Inuit Health Survey provided an opportunity to compare dietary and body mass index (BMI) data with data collected a decade earlier for the same communities. Study design. A dietary survey included 1,929 randomly selected participants aged 15 years or older, selected from 18 Inuit communities in 1998–1999. The IPY survey included 2,595 randomly selected participants aged 18 years or older, selected from 36 Inuit communities in 2007–2008. Data from the same 18 communities included in both surveys were compared for adults 20 years and older. Methods. Twenty-four-hour dietary recall data were analysed to assess the percentage of energy from traditional and market foods by sex and age groups. Body mass index (BMI) was assessed to establish the prevalence of obesity by sex and age groups in both surveys. Results. There was a significant decrease (p≤0.05) in energy contribution from traditional food and a significant increase in market food consumption over time. Sugar-sweetened beverages, chips and pasta all increased as percentages of energy. BMI increased overall for women and for each age stratum evaluated (p

Dietary habits among Arctic preschoolers are unknown. A cross-sectional health survey of 388 Inuit, aged 3-5 y, was conducted in 16 communities in Canada's Nunavut Territory. Twenty-four-hour recall and FFQ with parents and primary caregivers quantified diet from market and traditional foods (TF). The Institute of Medicine's Dietary Reference Intakes estimated adequacy comparing intakes with Estimated Average Requirement or Adequate Intakes (AI). High-sugar and high-fat food and sugar beverage consumption and the extent to which dietary habits followed the Canadian Food Guide were evaluated. The children's mean age was 4.4 +/- 0.9 y and the mean BMI percentile was 90.2%. Consumption of nutrient-poor and energy-dense food and beverages contributed to 35% of energy. Most children met the requirements for many nutrients despite not eating the recommended servings from Eating Well with Canada's Food Guide First Nations, Inuit and Metis. Higher intake of TF resulted in higher intakes of cholesterol, vitamins A and D, iron, magnesium, and zinc. The percent above the AI for vitamin D was 43.1, 56.8, and 83.2% among no, low, and high TF consumers, respectively (chi2 test; P-trend < 0.0001). Dietary habits indicate a population at risk for overweight, obesity, and tooth decay. Interventions should encourage TF, including plant-based TF; healthy market food choices, including fruit and vegetables; and milk or alternative sources of vitamin D and calcium and discourage unhealthy market food choices.

Currently there are no recommendations for vitamin/mineral supplementation for lactating women but supplementation may be important, particularly for those women who choose to restrict milk intake during lactation. The objective of this study was to assess nutrient adequacy for lactating women and compare their dietary intake, including supplements, between those who restrict milk and those who do not.A cohort of 175 healthy exclusively breast-feeding women (19-45 yrs) recruited from prenatal classes were divided into milk restrictors (RS) defined as milk intakeor = 250 ml/day and non-restrictors (NRS) (250 ml/day) and followed for six months postpartum. Participants provided repeated 24-hr dietary recalls, detailed use of vitamin/mineral supplements and reasons for restricting milk.Observed intakes were adjusted to remove day-to-day variability. Nutrient intakes were estimated for macronutrients and vitamins C, D, thiamin, riboflavin, niacin, and minerals, calcium and zinc, with and without vitamin/mineral supplements. Chi-square was used to compare the number of RS and NRS with intakes less than the Estimated Average Requirement (EAR).Milk restriction was practiced by 23% of the sample. Sixty per cent of RS reported protein intakesEAR compared to 38% of NRS (chi(2) = 6.22, p0.05). Prior to supplementation, mean levels of calcium and vitamin D intakes for RS were below the adequate intake level (AI) and lower than NRS estimated intakes (p0.05). Following supplementation, mean levels of these nutrients reached AI for both groups. RS remained lower than NRS. RS had lower energy intakes than NRS (p0.05) but no difference in weight loss at 6 months was noted. A higher proportion of RS were below the EAR for thiamin, riboflavin and zinc.Milk restriction compromised protein and nutrient intakes in lactating women who restricted milk to250 mL. Vitamin/mineral supplements helped exclusively breastfeeding milk restrictors improve their vitamin D and calcium intakes. Milk restriction is not recommended during lactation and where unavoidable, nutrients provided by milk should be compensated for by other foods or supplements.

The objective of the study was to assess the prevalence of obesity and/or undernutrition and evaluate diet and activity patterns among schoolchildren from an ethnically diverse low income urban population. A cross-sectional survey of 498 children aged 9-12 y from 24 schools in low income multiethnic neighborhoods in Montreal, Canada was undertaken. Height, weight, dietary intake, physical activity record, and lifestyle and demographic characteristics were measured. There was no evidence of undernutrition because linear growth was appropriate for age, but 39.4% of children were overweight (>85th percentile NHANES II). Dietary fat intake was higher in children from single-parent families (P < 0.001) and those with mothers born in Canada. Intake of vitamins A, C, iron and folate was directly related to income sufficiency. Children who did more physical activity had significantly higher intakes of energy, calcium, iron, zinc and fiber but were not heavier. Dietary intake was systematically underreported among overweight children, i.e., their reported intakes did not meet calculated energy needs. This underreporting makes it difficult to attribute the accumulated energy imbalance to either energy intake or expenditure.