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Whyte M, Fowler-Woods M, Fowler-Woods A, Shingoose G, Hatala A, Daeninck F, Vergis A, Clouston K, He W, Hardy K. Sacred Sharing Circles: Urban Indigenous Experience with Bariatric Surgery in Manitoba. Obes Surg 2024; 34:3348-3357. [PMID: 39096443 DOI: 10.1007/s11695-024-07405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 06/26/2024] [Accepted: 07/15/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION Obesity and type 2 diabetes (T2DM) are growing global health concerns. A disproportionate number of Indigenous Peoples live with obesity and its complications. Bariatric surgery offers superior weight loss and comorbidity resolution when compared to medical management. There is a paucity of literature regarding the experiences of Indigenous Peoples undergoing bariatric surgery. The aim of this study was to employ two-eyed seeing and a decolonizing approach to explore the experiences of urban Indigenous bariatric surgery patients. METHODS An Indigenous Advisory Committee guided the conception and design of the study. Four urban Indigenous bariatric surgery patients with T2DM participated in two sequential sharing circles and individual interviews facilitated by an Elder. Audio transcripts were analyzed for emerging themes using inductive thematic analysis. RESULTS Themes generated from shared participant experiences and knowledge included the following: (1) Experiencing hardship or challenges; (2) Reflecting on the importance of supports; (3) Understanding relationships with food; and (4) Healing and recovery. Overall, the participants described a generally positive experience with the bariatric pathway. Participants also described varied connectedness to their Indigenous identity but uniformly expressed interest in more culturally diverse supports such as sharing circles, access to an elder, and Indigenous peer mentorship. CONCLUSIONS Indigenous Peoples have strong motivators for pursuing bariatric surgery and desire access to culturally relevant supports. Suggestions for program improvement included offering sharing circles, providing access to an elder, and Indigenous peer mentorship. This study is the first to qualitatively explore the bariatric surgery experiences of Indigenous Peoples in Canada.
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Affiliation(s)
- Marta Whyte
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Melinda Fowler-Woods
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Amanda Fowler-Woods
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Geraldine Shingoose
- Faculty of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
| | - Andrew Hatala
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Felicia Daeninck
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Ashley Vergis
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Kathleen Clouston
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Wenjing He
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Krista Hardy
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada.
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Misra SL, Slater JA, Makam R, Braatvedt GD, Beban G, Pradhan M, Mankowski JL, Oakley JD, McGhee CNJ. Remission of corneal and peripheral neuropathy after bariatric surgery in people with diabetes. Ocul Surf 2024; 34:140-145. [PMID: 39053583 DOI: 10.1016/j.jtos.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/09/2024] [Accepted: 07/22/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Diabetic peripheral neuropathy can be detected using non-invasive in vivo confocal microscopy of the cornea (IVCM) and such abnormalities may precede the development of clinical neuropathy. The current study aimed to assess any progression or remission of corneal and peripheral neuropathy in patients with type 2 diabetes undergoing bariatric surgery. METHODS People with known type 2 diabetes for at least five years and listed for bariatric surgery were recruited. Participants were assessed before, and 12, 26, and 52 weeks following bariatric surgery. IVCM and corneal sensitivity measurements were performed. A modified total neuropathy score (mTNS) was obtained from neuropathy questionnaire, clinical assessment and biothesiometry. RESULTS Twenty-nine participants (M:F, 11:18) with mean BMI of 44.7 ± 6.4 kg/m2, and 11 ± 7.6 years duration of diabetes, were assessed. Corneal sub-basal nerve fibre length (CNFL), displayed an increase from a baseline mean of 12.20 ± 1.00 to 17.48 ± 0.92 mm/mm2 at 52 weeks (p < 0.0001). Corneal sensitivity threshold displayed a decrease over time, thus corneal sensitivity improved, falling from a mean of 1.11 ±0 .15 to 0.62 ± 0.11 (mBAR) (p < 0.0001). Clinical neuropathy scores demonstrated significant improvements from baseline, displaying a decrease in average mTNS score from 3.29 ± 0.68 to 0.76 ± 0.30 (p < 0.0001). A significant inverse relationship was shown between CNFL and sensitivity (β coefficient = -0.047, p < 0.001), and CNFL and mTNS (β coefficient = -0.178, p < 0.001). CONCLUSION Bariatric surgery led to an improvement in metabolic control of diabetes and weight loss, along with improvement in corneal nerve microstructure, corneal sensitivity, and neuropathic symptoms, suggesting a reversal of both small and large fibre neuropathy.
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Affiliation(s)
- Stuti L Misra
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
| | - James A Slater
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Rahul Makam
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Geoffrey D Braatvedt
- Department of Endocrinology, Greenlane Clinical Centre, Auckland District Health Board, Te Whatu Ora, Auckland, New Zealand
| | - Grant Beban
- Department of Surgery, Auckland Hospital, Auckland District Health Board, Te Whatu Ora, Auckland, New Zealand
| | - Monika Pradhan
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Joseph L Mankowski
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Charles N J McGhee
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024; 12:556-574. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Eisenkraft Klein D, Shawanda A. Bridging the commercial determinants of Indigenous health and the legacies of colonization: A critical analysis. Glob Health Promot 2024; 31:15-22. [PMID: 37522186 DOI: 10.1177/17579759231187614] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
To date, there has been scarce effort to consider the intertwining of colonization and the commercial determinants of Indigenous health. This is a vital omission, and one that this paper proposes to address. We propose how four losses of tradition borne out of colonialism are intertwined with four respective commercial determinants of Indigenous health: 1) loss of traditional diets and the ultra-processed food industry; 2) loss of traditional ceremony and the tobacco industry; 3) loss of traditional knowledge and the infant formula industry; and 4) loss of traditional support networks and the alcohol industry. Building on Indigenous efforts to decolonize spaces and assert control over their own lives, we argue that analyzing the mechanisms through which industry activities intersect with colonial legacies will improve broader understandings of Indigenous health disparities.
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Affiliation(s)
| | - Amy Shawanda
- Waakebiness Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Canada
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5
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Kirchengast S. Changes in weight status among "Ju/'hoansi" San hunter-gatherers between 1968/69 and 1987-The effects of nutritional transition, sex and age. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 184:e24935. [PMID: 38572687 DOI: 10.1002/ajpa.24935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/16/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Changes in lifestyle and dietary habits that hunter-gatherer populations have undergone in recent decades have often led to rising obesity rates with disastrous consequences for their health. OBJECTIVES The associations between dietary habits and weight status were studied in 238 "Ju/'hoansi" San (93 women and 145 men) aged between 18 and 65 years in northern Namibia in 1987. Weight status was estimated based on the World Health Organization body mass index (BMI) categories, and dietary habits were recorded using food recall methods. Anthropometrics and weight status were compared with those of a sex- and age-matched sample of "Ju/'hoansi" San people collected by Nancy Howell in 1968/69. RESULTS Body weight had increased significantly among "Ju/'hoansi" San people from 1968/69 to 1987. The number of underweight people decreased from 1968/69 to 1987. In 1987, most participants (60.9%) were of normal weight. Overweight was found in 1.3% of the women, but not among men. No participants were obese. Less than 4% of the women and less than 2% of the men consumed exclusively traditional hunter-gatherer food. Westernized food products were significantly (p < 0.001) more common among men and younger people. Dietary patterns were significantly associated with weight status. The less traditional the diet, the higher the BMI (p < 0.001). CONCLUSION The transition to domestic agricultural and westernized foods was positively associated with increasing BMI. Overweight, however, was still an extremely rare condition in this population in 1987.
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Affiliation(s)
- Sylvia Kirchengast
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria
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Kaur G, Masket D, Reddy T, Revankar S, Satish P, Paquin A, Mulvagh S, O'Donoghue ML, Zieroth S, Farkouh M, Gulati M. Socioeconomic Disparities in Women's Cardiovascular Health in the United States and Canada. Can J Cardiol 2024; 40:1056-1068. [PMID: 38593915 DOI: 10.1016/j.cjca.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
Cardiovascular disease has been the leading cause of death in the United States and Canada for decades. Although it affects millions of people across a multitude of backgrounds, notable disparities in cardiovascular health are observed among women and become more apparent when accounting for race and socioeconomic status. Although intrinsic sex-specific physiologic differences predispose women to poorer outcomes, social determinants of health (SDOH) and biases at both the individual provider and the larger health care system levels play an equal, if not greater, role. This review examines socioeconomic disparities in women compared with men regarding cardiovascular risk factors, treatments, and outcomes. Although various at-risk subpopulations exist, we highlight the impact of SDOH in specific populations, including patients with disabilities, transgender persons, and South Asian and Indigenous populations. These groups are underrepresented in studies and experience poorer health outcomes owing to structural barriers to care. These findings emphasise the significance of understanding the interplay of different socioeconomic factors and how their stacking can negatively affect women's cardiovascular health. To address these disparities, we propose a multipronged approach to augment culturally sensitive and patient-centred care. This includes increased cardiovascular workforce diversity, inclusion of underrepresented populations into analyses of cardiovascular metrics, and greater utilisation of technology and telemedicine to improve access to health care. Achieving this goal will necessitate active participation from patients, health care administrators, physicians, and policy makers, and is imperative in closing the cardiovascular health gap for women over the coming decades.
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Affiliation(s)
- Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diane Masket
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Tina Reddy
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shruti Revankar
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Priyanka Satish
- Ascension Texas Cardiovascular, University of Texas at Austin Dell School of Medicine, Austin, Texas, USA
| | - Amelie Paquin
- Barbra Streisand Women's Heart Center, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michelle L O'Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelley Zieroth
- Division of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Farkouh
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
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7
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Chai L. Interplay between actual and perceived weight on mental health among Canadian Indigenous post-secondary students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-9. [PMID: 38592936 DOI: 10.1080/07448481.2024.2338419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Research increasingly focuses on the mental health implications of both actual and perceived weight, particularly among post-secondary students. Considering their unique socio-cultural context and the frequent oversight in research, this study examines these implications specifically among Canadian Indigenous post-secondary students. Recent evidence indicates that students with normal weight may also experience increased mental health risks due to negative weight perceptions. Therefore, this study explores the independent and combined effects of actual and perceived weight on the mental health of this group. PARTICIPANTS AND METHODS This study utilized data from the 2017 Aboriginal Peoples Survey, a nationally representative sample of First Nations peoples living off-reserve, Métis, and Inuit. The focus was on Canadian Indigenous post-secondary students aged 19-34 years (n = 1,518). Logistic regression models, stratified by sex, were employed to analyze the data. RESULTS Perceptions of being overweight were linked to a higher risk of mood and anxiety disorders, poor self-rated mental health, and suicidal ideation among female students. This pattern was less evident among male students. Notably, female students who were overweight and perceived themselves as such were more likely to report poor mental health across all four indicators examined. In contrast, male students exhibited a less clear pattern. Diverging from recent studies, the findings indicated less robust mental health disparities among students with normal weight who perceived themselves as overweight, potentially due to the insufficient cell size of this category among Indigenous post-secondary students. CONCLUSIONS The study highlights the complex interplay between actual and perceived weight and its impact on mental health, particularly among female Indigenous post-secondary students.
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Affiliation(s)
- Lei Chai
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
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8
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Whyte M, Daeninck F, Linton J, Fowler-Woods M, Fowler-Woods A, Shingoose G, Vergis A, He W, Hardy K. Experiences and Outcomes of Indigenous Patients Undergoing Bariatric Surgery: a Mixed-Method Scoping Review. Obes Surg 2024; 34:1343-1357. [PMID: 38400946 DOI: 10.1007/s11695-024-07089-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/26/2024]
Abstract
Obesity and type 2 diabetes (T2D) are growing global health concerns. Evidence suggests that Indigenous peoples are at higher lifetime risk of obesity and its associated conditions. Obesity increases the risk of T2D, cardiovascular disease, and all-cause mortality. Bariatric surgery is the most sustained and effective intervention for treating obesity-associated medical problems. This review aims to explore the experiences and outcomes of Indigenous peoples undergoing bariatric surgery in Canada, the USA, Australia, and New Zealand (CANZUS). Analysis of quantitative data revealed that Indigenous patients had fewer bariatric procedures, poorer clinic attendance, similar weight loss outcomes and slightly higher post-operative complication rates. Qualitative data analysis revealed that Indigenous patients living with obesity have a desire to improve their health and quality of life.
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Affiliation(s)
- Marta Whyte
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Felicia Daeninck
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Melinda Fowler-Woods
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Amanda Fowler-Woods
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, MB, Canada
| | - Geraldine Shingoose
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ashley Vergis
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Wenjing He
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Krista Hardy
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
- St. Boniface General Hospital, Z3053-409 Taché Avenue, Winnipeg, MB, R2H 2A6, Canada.
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Lajeunesse-Trempe F, Piché ME, Poirier P, Tchernof A, Ayotte P. Adiposity Phenotypes and Associated Cardiometabolic Risk Profile in the Inuit Population of Nunavik. Nutrients 2024; 16:725. [PMID: 38474854 DOI: 10.3390/nu16050725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
The Inuit population of Nunavik is faced with a significant rise in the prevalence of obesity [body mass index (BMI) ≥ 30 kg/m2], but the impact on cardiometabolic health is unclear. The aim of this study was to characterize adiposity phenotypes and explore their associations with cardiometabolic risk factors among Nunavimmiut men and women. We used data obtained from 1296 Inuit who participated in the Qanuilirpitaa? 2017 Nunavik Inuit Health survey. Collected information included demographics, anthropometric measurements including visceral fat level (VFL) measured using electrical bioimpedance, biomarkers, hemodynamics, medical history and medication list. Adjusted population-weighted linear regressions were conducted to assess associations between body fat distribution and cardiometabolic risk factors. The accuracy and cut-off points of anthropometric indices to detect cardiometabolic abnormalities was evaluated by area under the receiver operator characteristic curve (AUROC) and a maximum Youden index analysis. Among Nunavimmiut (mean age 38.8 years [95%CI: 38.4 to 39.3]), obesity was observed in 42.8% of women and 25.6% of men. Compared to men, women presented a higher prevalence of abdominal obesity (78.8% vs. 46.4% in men, p < 0.05) and elevated VFL (54.4% vs. 20.1% with an InBody level ≥ 13, p < 0.05). Indices of global fat distribution and abdominal adiposity including VFL provided poor to moderate ability to detect cardiometabolic abnormalities (AUROC between 0.64 and 0.79). This analysis revealed that despite a high prevalence of abdominal obesity, particularly among women, anthropometric measurements of adiposity are inconsistently associated cardio-metabolic risk factors in Inuit adults of Nunavik.
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Affiliation(s)
- Fannie Lajeunesse-Trempe
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada
- Faculté de Pharmacie, Université Laval, Québec, QC G1V 0A6, Canada
| | - Marie-Eve Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada
- Département de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada
- Faculté de Pharmacie, Université Laval, Québec, QC G1V 0A6, Canada
| | - André Tchernof
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada
| | - Pierre Ayotte
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1V 0A6, Canada
- Institut National de Santé Publique du Québec, Québec, QC G1V 5B3, Canada
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10
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Olstad DL, Nejatinamini S, Blanchet R, Moubarac JC, Polsky J, Vanderlee L, Livingstone KM, Hosseini Pozveh S. Protecting traditional cultural food practices: Trends in diet quality and intake of ultra-processed foods by Indigenous status and race/ethnicity among a nationally representative sample of adults in Canada. SSM Popul Health 2023; 24:101496. [PMID: 37701069 PMCID: PMC10493595 DOI: 10.1016/j.ssmph.2023.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2023] [Accepted: 08/20/2023] [Indexed: 09/14/2023] Open
Abstract
Background The traditional cultural food practices of Indigenous people and adults from racial/ethnic minority groups may be eroded in the current food system where nutrient-poor and ultra-processed foods (UPF) are the most affordable and normative options, and where experiences of racism may promote unhealthy dietary patterns. We quantified absolute and relative gaps in diet quality and UPF intake of a nationally representative sample of adults in Canada by Indigenous status and race/ethnicity, and trends between 2004 and 2015. Methods Adults (≥18 years) in the Canadian Community Health Survey-Nutrition self-reported Indigenous status and race/ethnicity and completed a 24-h dietary recall in 2004 (n = 20,880) or 2015 (n = 13,970) to calculate Healthy Eating Index-2015 (HEI-2015) scores from 0 to 100 and proportion of energy from UPF. Absolute and relative dietary gaps were quantified for Indigenous people and six racial/ethnic minority groups relative to White adults and trends between 2004 and 2015. Results Adults from all six racial/ethnic minority groups had higher mean HEI-2015 scores (58.7-61.9) than White (56.3) and Indigenous adults (51.9), and lower mean UPF intake (31.0%-41.0%) than White (45.9%) and Indigenous adults (51.9%) in 2015. As a result, absolute gaps in diet quality were positive and gaps in UPF intake were negative among racial/ethnic minority groups-indicating more favourable intakes-while the reverse was found among Indigenous adults. Relative dietary gaps were small. Absolute and relative dietary gaps remained largely stable. Conclusions Adults from six racial/ethnic minority groups had higher diet quality and lower UPF intake, whereas Indigenous adults had poorer diet quality and higher UPF intake compared to White adults between 2004 and 2015. Absolute and relative dietary gaps remained largely stable. Findings suggest racial/ethnic minority groups may have retained some healthful aspects of their traditional cultural food practices while highlighting persistent dietary inequities that affect Canada's Indigenous people.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Rosanne Blanchet
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, 7101 Avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Jean-Claude Moubarac
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, Montréal, Québec, H3T 1A8, Canada
| | - Jane Polsky
- Health Analysis Division, Statistics Canada, 150 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Lana Vanderlee
- École de Nutrition, Université Laval, Québec, Québec, G1V 0A6, Canada
| | - Katherine M. Livingstone
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap St, Geelong, Victoria, 3220, Australia
| | - Seyed Hosseini Pozveh
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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11
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Hill CM, Nash SH, Hopkins SE, Boyer BB, OBrien DM, Bersamin A. Diet quality is positively associated with intake of traditional foods and does not differ by season in remote Yup'ik communities. Int J Circumpolar Health 2023; 82:2221370. [PMID: 37312577 PMCID: PMC10269404 DOI: 10.1080/22423982.2023.2221370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
This study evaluated whether traditional food intake and diet quality differed by season in Yup'ik communities and examined the relationship between intake of traditional food groups and diet quality. Data were collected from 38 participants, ages 14-79 years, from two Yup'ik communities in Southwest Alaska from 2008 to 2010. Self-reported intake (24-h recalls) and dietary biomarker (nitrogen stable isotope ratio) data were collected twice in distinct seasons. Diet quality was assessed using the Healthy Eating Index. A paired sample t-test was used to test for seasonal differences in traditional food intake and diet quality, and linear regression was used to evaluate associations between traditional food intake and diet quality. Total traditional food intake and overall diet quality did not significantly differ by season, but there were differences in traditional food group intake and diet quality component scores. Diet quality was strongly associated with intake of traditional food groups including fish, tundra greens, and berries. Given the strong relationship between traditional food intake and diet quality, policies should aim to ensure continued access to traditional foods in Yup'ik communities amid environmental changes in the circumpolar North.
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Affiliation(s)
- Courtney M Hill
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
| | - Sarah H. Nash
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Scarlett E. Hopkins
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Diane M. OBrien
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Andrea Bersamin
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
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12
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Kshatriya M, Wang KW, Hildebrand J, Crawford R, Nadarajah A, Youssef M, Rivas A, Kaushal A, Banfield LE, Thabane L, Samaan MC. The Effectiveness of Indigenous Knowledge-Based Lifestyle Interventions in Preventing Obesity and Type 2 Diabetes Mellitus in Indigenous Children in Canada: A Systematic Review. Adolesc Health Med Ther 2023; 14:175-193. [PMID: 37790916 PMCID: PMC10544169 DOI: 10.2147/ahmt.s405814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
Background Indigenous children in Canada have high rates of obesity and type 2 diabetes mellitus (T2DM). Culturally appropriate interventions, guided by an Indigenous knowledge-based view of health, are crucial to target these conditions. The objective of this systematic review was to assess the impact of indigenous Knowledge-based lifestyle interventions on the prevention of obesity and T2DM in Indigenous children in Canada. Methods Database searches were conducted from inception until February 22, 2022. The main outcomes were changes in Body Mass Index (BMI) z-score and the development of T2DM. The other outcomes included adiposity, metabolic, and lifestyle determinants of health. The GRADE approach was used to assess confidence in the evidence. Results Four non-randomized controlled trials (non-RCTs) and six uncontrolled studies were identified. Peer-led interventions led to a reduction in BMI z-score and waist circumference. GRADE assessment revealed very low quality of evidence due to a lack of randomization and small sample sizes. There were no diabetes-specific reported programs. Conclusion Limited evidence from non-randomized studies suggest that peer-led indigenous Knowledge-based lifestyle interventions improve BMI z-score and central adiposity. There is a need for community-owned and adequately powered randomized studies for interventions that aim to treat and prevent obesity and T2DM in Indigenous children in Canada. Systematic Review Registration PROSPERO CRD42017072781.
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Affiliation(s)
- Maya Kshatriya
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Global Health Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Kuan-Wen Wang
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Julia Hildebrand
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Rebecca Crawford
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Indigenous Undergraduate Summer Research Program, McMaster University, Hamilton, Ontario, Canada
| | - Ajantha Nadarajah
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Global Health Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Michael Youssef
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Angelica Rivas
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ashleen Kaushal
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Laura E Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, St. Joseph’s Healthcare-Hamilton, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, St. Joseph’s Health Care, Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Global Health Graduate Program, McMaster University, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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13
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Frehlich L, Amson A, Doyle-Baker P, Black T, Boustead D, Cameron E, Crowshoe LL, McBrien K, Ji YJ, McGuire A, Oliver A, Tuttauk L, Zhang J, Checholik C, Wicklum S. Spread of Makoyoh'sokoi (Wolf Trail): a community led, physical activity-based, holistic wellness program for Indigenous women in Canada. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:80. [PMID: 37573348 PMCID: PMC10422705 DOI: 10.1186/s41043-023-00427-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
Globally, Indigenous populations have been impacted by colonization. Populations who have endured colonization are at higher risk of developing chronic diseases. Canada's Truth and Reconciliation Commission emphasizes reducing barriers to participation in physical activity and recommends the creation of culturally relevant and supportive policies and programing. Physical activity is a cornerstone in health promotion and public health to combat chronic diseases; however, in Canada, Indigenous developed physical activity programing is sparse, and those targeting women are non-existent in some regions. Makoyoh'sokoi (The Wolf Trail Program) is an 18-week long, holistic wellness program that was created by and for Indigenous women. Makoyoh'sokoi was developed by communities following extensive consultation and cultural oversight. Makoyoh'sokoi's core program consists of 12 weeks of weekly physical activity programing and health education, followed by another 6 weeks of weekly health education. Notably, communities have control over the program to modify based on individual needs and challenges. Programs commence and conclude with a ceremony with Elders giving a blessing and opening each other to connection. The goals of Makoyoh'sokoi are to empower women, improve health outcomes, and to implement a sustainable program by training a network of community members in their respective communities to facilitate delivery.
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Affiliation(s)
| | | | | | - Tia Black
- University of Calgary, AB, Calgary, Canada
| | | | - Erin Cameron
- Northern Ontario School of Medicine, Sudbury, ON, Canada
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14
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Bailey NGN, Knott R, Grenier G, Craig KD, Kramer JLK. Physical pain among Indigenous Peoples in Canada: a scoping review. Can J Anaesth 2023; 70:1047-1063. [PMID: 37341897 DOI: 10.1007/s12630-023-02461-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Pain is a multifaceted experience shaped by various factors including context of pain, previous life events, and ongoing ethnocultural circumstances. Moreover, the definition of pain is inconsistent across cultures. Western medicine views physical pain (e.g., associated with a bone fracture) and nonphysical mental pain (e.g., depression) as two distinct conditions. Indigenous perspectives are often more wholistic, encompassing mental, spiritual, emotional, and physical hurt. The subjective nature of pain invites ample opportunity for discrimination in both its assessment and management. As such, it is important to consider Indigenous perspectives of pain in research and clinical practice. To investigate which aspects of Indigenous pain knowledge are currently considered by Western research, we conducted a scoping review of the literature on pain in Indigenous Peoples of Canada. SOURCE In June 2021, we searched nine databases and downloaded 8,220 papers after removal of duplicates. Two independent reviewers screened abstracts and full-text articles. PRINCIPLE FINDINGS Seventy-seven papers were included in the analysis. Using grounded theory, five themes emerged: pain measures/scales (n = 7), interventions (n = 13), pharmaceuticals (n = 17), pain expression/experiences (n = 45), and pain conditions (n = 70). CONCLUSION This scoping review shows that there is a paucity of research on pain measurement in Indigenous Peoples of Canada. This finding is concerning in light of numerous studies reporting that Indigenous Peoples experience their pain as ignored, minimized, or disbelieved. Furthermore, a clear disconnect emerged between pain expression in Indigenous Peoples and assessment in medical professionals. We hope that this scoping review will serve to translate current knowledge to other non-Indigenous academics and to initiate meaningful collaboration with Indigenous partners. Future research led by Indigenous academics and community partners is critically needed to better address pain needs in Canada.
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Affiliation(s)
- Nicole G N Bailey
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada.
- Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
| | - Robbie Knott
- Indigenous Research Support Initiative, The University of British Columbia, Vancouver, BC, Canada
| | - Georgia Grenier
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | - Kenneth D Craig
- Department of Psychology, Faculty of Arts, The University of British Columbia, Vancouver, BC, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
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15
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Leclerc AM, Boulanger M, Miquelon P, Rivard MC. First Nations Peoples' Eating and Physical Activity Behaviors in Urban Areas: A Mixed-Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10390. [PMID: 36012023 PMCID: PMC9407990 DOI: 10.3390/ijerph191610390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
The dietary transition from traditional to commercial foods and a decrease in physical activity (PA) have impacted the health of the First Nations people of Quebec (Canada), resulting in many suffering from multiple chronic diseases. This study had two objectives: (1) to examine eating and PA behaviors among First Nations peoples in urban areas and (2) to explore the associated health representations. To achieve these objectives, a mixed-methods approach, including a questionnaire (n = 32) and a semi-structured interview (n = 14), was used to explore the participants' lifestyle profiles and health experiences. The questionnaire focused on the eating and PA behaviors of First Nations people and their underlying motivations. At the same time, the interviews investigated their health views on diet and PA behaviors based on the conceptual framework of health and its determinants. According to the participants, health is the autonomy to live without pain by maintaining a balance between physical and psychological aspects, eating healthy and exercising. Family and work influence participants' PA and eating behaviors. Exploring First Nations people's beliefs and perceptions and the motivations underlying their health behaviors could help encourage the maintenance of a healthy lifestyle despite multiple chronic health conditions.
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Affiliation(s)
- Anne-Marie Leclerc
- Department of Nursing, Université du Quebec à Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada
| | - Maude Boulanger
- Department of Human Kinetics, Université du Quebec à Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada
| | - Paule Miquelon
- Department of Psychology, Université du Quebec à Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada
| | - Marie-Claude Rivard
- Department of Human Kinetics, Université du Quebec à Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada
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16
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Kuhnlein HV, Chotiboriboon S. Why and How to Strengthen Indigenous Peoples' Food Systems With Examples From Two Unique Indigenous Communities. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.808670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Indigenous Peoples' food systems contain extensive and sophisticated knowledge that is often undocumented and underutilized in contemporary society that has increasingly poor nutrition and loss of food biodiversity. Indigenous Peoples in all global regions are among the most vulnerable to marginalization, food insecurity and chronic disease and will benefit greatly from strengthening their resource-rich food systems to make them more resilient and sustainable. It is in this spirit that we contribute to the databases of Indigenous Peoples' food system knowledge with information on unique traditional foods from the Nuxalk Nation in British Columbia, Canada, and the Pwo Karen People of Sanephong Community, Thailand. Several publications from these case studies originated from interdisciplinary mixed-method research, in part through the United Nations Food and Agriculture Organization. We highlight selected foods with nutrient data and various qualitative and quantitative methods used to identify and promote their use within these unique communities. Our intent is to stimulate complementary strengthening efforts among other traditional and Indigenous Peoples that will contribute to global intercultural food system evidence and advances.
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17
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Cordova-Marks FM, Carson WO, Monetathchi A, Little A, Erdrich J. Native and Indigenous Populations and Gastric Cancer: A Worldwide Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5437. [PMID: 35564831 PMCID: PMC9100179 DOI: 10.3390/ijerph19095437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023]
Abstract
Gastric cancer is a worldwide concern, particularly for Indigenous populations who face greater disparities in healthcare. With decreased access to screening and critical treatment delays, this group is experiencing adverse health effects. To determine what factors drive these disparities, a systematic review was performed in PubMed. This revealed a lack of research on gastric cancer specific to this population. The literature primarily focused on subset analyses and biological aspects with sparse focus on determinants of health. The results informed this presentation on factors related to Indigenous gastric cancer, which are influenced by colonialism. Indigenous populations encounter high rates of food shortage, exposure to harmful environmental agents, structural racism in the built environment, H. pylori, and compromised healthcare quality as an effect of colonialism, which all contribute to the gastric cancer burden. Putting gastric cancer into a cultural context is a potential means to respond to colonial perspectives and their negative impact on Indigenous patients. The objective of this manuscript is to examine the current state of gastric cancer literature from a global perspective, describe what is currently known based on this literature review, supplemented with additional resources due to lack of published works in PubMed, and to present a model of gastric cancer through the lens of a modified medicine wheel as a potential tool to counter colonial healthcare perspectives and to honor Indigenous culture.
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Affiliation(s)
- Felina M. Cordova-Marks
- Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - William O. Carson
- Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Angela Monetathchi
- Cellular Molecular Medicine, College of Medicine, University of Arizona, Tucson, AZ 85724, USA;
| | | | - Jennifer Erdrich
- Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ 85724, USA;
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18
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Wahi G, Wilson J, Burning M, George S, Hill P, Homer J, Jacobs L, Lickers A, Smoke S, Davis AD, Desai D, Jack SM, Williams N, de Souza RJ, Anand SS. Impact of Maternal Health Behaviours and Social Conditions on Infant Diet at Age 1-Year: Results from a Prospective Indigenous Birth Cohort in Ontario, Canada. Nutrients 2022; 14:nu14091736. [PMID: 35565704 PMCID: PMC9102994 DOI: 10.3390/nu14091736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Understanding the impact of maternal health behaviours and social conditions on childhood nutrition is important to inform strategies to promote health during childhood. Objective: To describe how maternal health sociodemographic factors (e.g., socioeconomic status, education), health behaviours (e.g., diet), and traditional health care use during pregnancy impact infant diet at age 1-year. Methods: Data were collected from the Indigenous Birth Cohort (ABC) study, a prospective birth cohort formed in partnership with an Indigenous community-based Birthing Centre in southwestern Ontario, Canada. 110 mother-infant dyads are included in the study and were enrolled between 2012 and 2017. Multiple linear regression analyses were performed to understand factors associated with infant diet scores at age 1-year, with a higher score indicating a diet with more healthy foods. Results: The mean age of women enrolled during pregnancy was 27.3 (5.9) years. Eighty percent of mothers had low or moderate social disadvantage, 47.3% completed more than high school education, and 70% were cared for by a midwife during their pregnancy. The pre-pregnancy body mass index (BMI) was <25 in 34.5% of women, 15.5% of mothers smoked during pregnancy, and 14.5% of mothers had gestational diabetes. Being cared for by an Indigenous midwife was associated with a 0.9-point higher infant diet score (p = 0.001) at age 1-year, and lower maternal social disadvantage was associated with a 0.17-point higher infant diet quality score (p = 0.04). Conclusion: This study highlights the positive impact of health care provision by Indigenous midwives and confirms that higher maternal social advantage has a positive impact on child nutrition.
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Affiliation(s)
- Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- Correspondence:
| | - Julie Wilson
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Melanie Burning
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Stephanie George
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Phyllis Hill
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Janet Homer
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Laurie Jacobs
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Ashley Lickers
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Sharon Smoke
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Albertha D. Davis
- Six Nations Health Services, Six Nations of the Grant River, Ohsweken, ON N0A 1M0, Canada;
| | - Dipika Desai
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada;
| | - Susan M. Jack
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- School of Nursing, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Natalie Williams
- Chanchlani Research Centre, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada;
| | - Sonia S. Anand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada;
- Chanchlani Research Centre, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
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19
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Lytvyak E, Straube S, Modi R, Lee KK. Trends in obesity across Canada from 2005 to 2018: a consecutive cross-sectional population-based study. CMAJ Open 2022; 10:E439-E449. [PMID: 35609927 PMCID: PMC9259440 DOI: 10.9778/cmajo.20210205] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity is increasingly prevalent worldwide and is becoming an epidemic in many countries, including Canada. We sought to describe and analyze temporal obesity trends in the Canadian adult population from 2005 through 2018 at the national and provincial or territorial levels. METHODS We conducted a consecutive, cross-sectional study using data from 7 sequential Canadian Community Health Survey (CCHS) cycles (2005 to 2017/18). We included data from Canadian adults (age ≥ 18 yr) who participated in at least 1 of the 7 consecutive CCHS cycles and who had body mass index values (calculated by Statistics Canada based on respondents' self-reported weight and height). Obesity prevalence (adjusted body mass index ≥ 30) was a primary outcome variable. We analyzed temporal trends in obesity prevalence using Pearson χ2 tests with Bonferroni adjustment, and the Cochran-Armitage test of trend. RESULTS We included data from 746 408 (403 582 female and 342 826 male) CCHS participants. Across Canada, the prevalence of obesity increased significantly between 2005 and 2017/18, from 22.2% to 27.2% (p < 0.001). We observed increases across both sexes, all age groups and all Canadian provinces and territories (p < 0.001). In 2017/18, the prevalence of obesity was higher among males than females (28.9% v. 25.4%; p < 0.001); the prevalence among adults aged 40-69 years exceeded 30%. In 2017/18, Newfoundland and Labrador had the highest prevalence (39.4%), and British Columbia had the lowest (22.8%) prevalence of obesity. Over the 14-year study period, Quebec and Alberta exhibited the largest relative increases in obesity. INTERPRETATION In 2017/18, more than 1 in 4 adult Canadians lived with obesity, and from 2005 to 2017/18, the prevalence of obesity among adults in Canada increased substantially across sexes, age groups and all Canadian provinces and territories to 27.2%. Our findings call for urgent actions to identify, implement and evaluate solutions for obesity prevention and management in all Canadian provinces and territories.
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Affiliation(s)
- Ellina Lytvyak
- Division of Preventive Medicine (Lytvyak, Straube, Lee); Department of Family Medicine (Modi), University of Alberta; Edmonton Adult Bariatric Specialty Clinic (Modi), Alberta Health Services, Edmonton, Alta.
| | - Sebastian Straube
- Division of Preventive Medicine (Lytvyak, Straube, Lee); Department of Family Medicine (Modi), University of Alberta; Edmonton Adult Bariatric Specialty Clinic (Modi), Alberta Health Services, Edmonton, Alta
| | - Renuca Modi
- Division of Preventive Medicine (Lytvyak, Straube, Lee); Department of Family Medicine (Modi), University of Alberta; Edmonton Adult Bariatric Specialty Clinic (Modi), Alberta Health Services, Edmonton, Alta
| | - Karen K Lee
- Division of Preventive Medicine (Lytvyak, Straube, Lee); Department of Family Medicine (Modi), University of Alberta; Edmonton Adult Bariatric Specialty Clinic (Modi), Alberta Health Services, Edmonton, Alta
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20
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Zuk A, Liberda EN, Tsuji LJS. Environmental contaminants and the disproportionate prevalence of type-2 diabetes mellitus among Indigenous Cree women in James Bay Quebec, Canada. Sci Rep 2021; 11:24050. [PMID: 34911968 PMCID: PMC8674294 DOI: 10.1038/s41598-021-03065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 11/23/2021] [Indexed: 11/09/2022] Open
Abstract
Indigenous populations are disproportionately affected by type 2 diabetes (T2DM) compared to non-Indigenous people. Of importance, the prevalence of T2DM is greater amongst females than males in First Nations communities, in contrast to higher male prevalence reported in non-Indigenous Canadians. Therefore, in this study we extend our previously published work with respect to females, and the potential association between environmental exposures to organochlorine pesticides, such as dichlorodiphenyltrichloroethane (DDT), and dichlorodiphenyldichloroethylene (DDE) to explain the greater prevalence of T2DM among Indigenous females compared to males. Using data from the Multi-Community Environment-and-Health Study, Principal Component Analysis (PCA), examined 9-polychlorinated biphenyl congeners, 7-organic pesticides, and 4-metal/metalloids. Modified Poisson regression with robust error variance estimated adjusted prevalence ratios (PR) and corresponding 95% confidence intervals (95% CI), regressing prevalent T2DM on the newly derived principal components (PC), adjusting for a priori covariates, including parity. We further examined the relationship between high detection concentrations of DDT and tertials of categorized DDE exposures on T2DM among Indigenous Cree women. Among 419 female participants, 23% (n = 95) had physician-diagnosed T2DM. PCA analysis show that DDT and Lead (Pb) loaded highly on the second axis (PC-2), although in opposite directions, indicating the different exposure sources. As previously published, T2DM was significantly associated with PC-2 across adjusted models, however, after further adjusting for parity in this analysis, T2DM was no longer significantly associated with increasing PC-2 scores (PR = 0.88, 95% 0.76, 1.03). Furthermore, we found that the highest detectable levels of DDT, and tertiles of DDE were significantly associated with prevalent T2DM in the fully adjusted model (PR = 1.93, 1.17, 3.19), and (PR = 3.58, 1.10, 11.70), respectively. This cross-sectional analysis suggests organochlorines, specifically, detectable high exposure concentrations of DDT and DDE are associated with prevalent type 2 diabetes, signifying a possible important link between parity and environmental organochlorines pesticides among Indigenous Cree women.
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Affiliation(s)
- Aleksandra Zuk
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, Toronto, ON, Canada.
- School of Nursing, Faculty of Health Sciences, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada.
| | - Eric N Liberda
- School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada
| | - Leonard J S Tsuji
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, Toronto, ON, Canada
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21
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Cole KM, Hutton B, Hamel C, Bourque JM, Arnaout A, Clemons M. Breast cancer in Indigenous women living in Canada: a scoping review protocol. JBI Evid Synth 2021; 19:3412-3422. [PMID: 34171894 DOI: 10.11124/jbies-20-00522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to describe and synthesize the current state of knowledge pertaining to breast cancer in Indigenous women living in Canada. We will examine the continuum of breast cancer care in this population, including breast cancer screening, diagnosis, treatment, and surveillance. INTRODUCTION Breast cancer in Indigenous women is an evolving health care concern in Canada, with mounting evidence suggesting that these women present at later stages, and have poorer survival rates compared with the general population. A comprehensive overview of the state of knowledge of breast cancer in this population is required. INCLUSION CRITERIA The population of interest will include Indigenous women living in Canada aged 18 years or older who have been screened or require screening for breast cancer, or who have been diagnosed with breast cancer. "Indigenous" will include women who identify as First Nations, Métis, or Inuit. Eligible sources must report on breast cancer risk factors, tumor characteristics, health systems access, screening, diagnosis, treatment, surveillance, or breast cancer outcomes. We will include analytic studies, surveys, case series, reviews, meta-analyses, and gray literature. METHODS We will conduct a search of five health sciences databases for relevant studies published in English or French from database inception onward. We will utilize dual independent screening for titles, abstracts, and full-text articles, and will utilize a similar method for gray literature sources. Data will be synthesized using a narrative approach, and outcomes of interest will be compared with data from the general breast cancer population. REGISTRATION Open Science Framework https://osf.io/xkde5.
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Affiliation(s)
- Katherine Marie Cole
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Candyce Hamel
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jean-Marc Bourque
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Angel Arnaout
- Department of Surgery, Division of General Survey, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
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Batal M, Kenny TA, Johnson-Down L, Ing A, Fediuk K, Sadik T, Chan HM, Willows N. Development of an optimal grocery list based on actual intake from a cross-sectional study of First Nations adults in Ontario, Canada. Appl Physiol Nutr Metab 2021; 47:379-394. [PMID: 34826224 DOI: 10.1139/apnm-2020-0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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 four. 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.
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Affiliation(s)
- Malek Batal
- CP 6128 succ Centre-Ville, Département de nutrition, Montréal, Quebec, Canada.,Centre de recherche en santé publique [CReSP], Département de nutrition, Montréal, Quebec, Canada;
| | - Tiff-Annie Kenny
- Université Laval, 4440, Département de médecine sociale et préventive, Quebec, Quebec, Canada;
| | - Louise Johnson-Down
- CP 6128 succ Centre-Ville, Département de nutrition, Montréal, Quebec, Canada;
| | - Amy Ing
- CP 6128 succ Centre-Ville, Département de nutrition, Montréal, Quebec, Canada;
| | - Karen Fediuk
- University of Ottawa, 6363, Ottawa, Canada, K1N 6N5;
| | - Tonio Sadik
- Assembly of First Nations, Ottawa, Ontario, Canada;
| | - Hing Man Chan
- University of Ottawa, 6363, Department of Biology, Ottawa, Canada, K1N 6N5;
| | - Noreen Willows
- University of Alberta, 3158, Food & Nutri Sci Dept, Edmonton, Canada, T6G 2R3;
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Diet quality and food security amongst Indigenous children in Canada: facing the legacy of decades of dispossession and governmental neglect. Public Health Nutr 2021; 25:133-135. [PMID: 34392867 PMCID: PMC8825963 DOI: 10.1017/s1368980021003487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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24
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Blanchet R, Batal M, Johnson-Down L, Johnson S, Willows N. An Indigenous food sovereignty initiative is positively associated with well-being and cultural connectedness in a survey of Syilx Okanagan adults in British Columbia, Canada. BMC Public Health 2021; 21:1405. [PMID: 34271895 PMCID: PMC8283975 DOI: 10.1186/s12889-021-11229-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/03/2021] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Rosanne Blanchet
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Ave, Mailbox #54, Edmonton, AB, T6G 2P5, Canada
| | - Malek Batal
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada.
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-Sud-de-l'Île-de-Montréal [CReSP], 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada.
| | - Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Suzanne Johnson
- Okanagan Nation Alliance, 3535 Old Okanagan Hwy, West Kelowna, BC, V4T 3L7, Canada
| | - Noreen Willows
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Ave, Mailbox #54, Edmonton, AB, T6G 2P5, Canada
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Maudrie TL, Colón-Ramos U, Harper KM, Jock BW, Gittelsohn J. A Scoping Review of the Use of Indigenous Food Sovereignty Principles for Intervention and Future Directions. Curr Dev Nutr 2021; 5:nzab093. [PMID: 34345758 PMCID: PMC8321882 DOI: 10.1093/cdn/nzab093] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 05/11/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022] Open
Abstract
Indigenous food sovereignty (IFS) represents a community-led movement with potential to reduce health inequities, but no scoping review of the impact of taking an IFS approach on intervention research has been conducted. This review sought to: 1) describe intervention studies that employ IFS principles, and 2) describe the impact of studies using IFS principles on food access, eating patterns, diet quality, physical activity, and health. Through a literature review, 4 IFS principles were identified: 1) community ownership, 2) inclusion of traditional food knowledge, 3) inclusion and promotion of cultural foods, and 4) environmental/intervention sustainability. Twenty intervention studies published between January 1, 2000 and February 5, 2020 were included. Most of the studies that scored high in IFS principles saw a positive impact on diet. This review found evidence supporting the value of IFS principles in the development, implementation, and evaluation of health interventions for Indigenous communities.
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Affiliation(s)
- Tara L Maudrie
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Uriyoán Colón-Ramos
- Department of Global Health, Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health at The George Washington University, Washington, DC, USA
| | - Kaitlyn M Harper
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brittany W Jock
- School of Human Nutrition, Centre for Indigenous Peoples’ Nutrition and Environment (CINE), McGill University, Montreal, Quebec, Canada
| | - Joel Gittelsohn
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Marushka L, Hu X, Batal M, Tikhonov C, Sadik T, Schwartz H, Ing A, Fediuk K, Chan HM. The relationship between dietary exposure to persistent organic pollutants from fish consumption and type 2 diabetes among First Nations in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:168-182. [PMID: 34181231 PMCID: PMC8239090 DOI: 10.17269/s41997-021-00484-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We previously examined the associations between dietary dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs) intake from fish consumption and type 2 diabetes (T2D) prevalence in Ontario and Manitoba. This study aims to further explore the relationship in a regionally representative sample of First Nations adults living on-reserve across Canada. METHODS Dietary, health and lifestyle data collected by the cross-sectional First Nations Food, Nutrition and Environment Study (2008-2018) were analyzed. This participatory study included 6091 First Nations adult participants who answered questions on T2D. The consumption of locally caught fish was estimated with a food frequency questionnaire. A total of 551 samples from 96 fish species were collected and analyzed for the presence of DDE and PCBs. The associations between fish and dietary DDE/PCBs intake with self-reported T2D were investigated using multiple logistic regression models adjusted for confounders. RESULTS Dietary exposure to DDE (>2.11 ng/kg/bw) and PCBs (>1.47 ng/kg/bw) vs no exposure was positively associated with T2D with ORs of 2.33 (95% CI: 1.24-4.35) for DDE and 1.43 (95% CI: 1.01-3.59) for PCBs. The associations were stronger among females (DDE OR = 3.11 (1.41-6.88); PCBs OR = 1.76 (1.10-3.65)) and older individuals (DDE OR = 2.64 (1.12-6.20); PCBs OR = 1.44 (1.01-3.91)) as compared with males and younger participants. Also, significant dose-response relationships were found for fish consumption in females only. CONCLUSION This study confirms our previous findings that dietary DDE/PCBs exposure may increase the risk of T2D. The effect of DDE/PCBs from fish consumption is driven by geographical differences in DDE/PCBs concentrations in fish and by the amount of fish consumed, and is more prominent in females than in males.
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Affiliation(s)
- Lesya Marushka
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Xuefeng Hu
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Malek Batal
- Département de Nutrition, Faculté de Médecine, Pavillon Liliane de Stewart, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 avenue du Parc, Montréal, QC, H3N 1X7, Canada
| | - Constantine Tikhonov
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Harold Schwartz
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Amy Ing
- Département de Nutrition, Faculté de Médecine, Pavillon Liliane de Stewart, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Karen Fediuk
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada.
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Batal M, Chan HM, Fediuk K, Ing A, Berti P, Sadik T, Johnson-Down L. Associations of health status and diabetes among First Nations Peoples living on-reserve in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:154-167. [PMID: 34181230 PMCID: PMC8239104 DOI: 10.17269/s41997-021-00488-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/28/2021] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Malek Batal
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada.
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada.
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Karen Fediuk
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
- First Nations Food, Nutrition and Environment Study, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Amy Ing
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Peter Berti
- HealthBridge Foundation of Canada, 1 Nicholas Street, Suite 1004, Ottawa, ON, K1N 7B7, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
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Batal M, Chan HM, Ing A, Fediuk K, Berti P, Sadik T, Johnson-Down L. Comparison of measures of diet quality using 24-hour recall data of First Nations adults living on reserves in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:41-51. [PMID: 34181223 PMCID: PMC8239112 DOI: 10.17269/s41997-021-00489-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 01/28/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE 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). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Malek Batal
- Département de nutrition, Faculté de Médecine, Pavillon Liliane de Stewart, Université de Montréal, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada.
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada.
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Amy Ing
- Département de nutrition, Faculté de Médecine, Pavillon Liliane de Stewart, Université de Montréal, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Karen Fediuk
- First Nations Food, Nutrition and Environment Study, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Peter Berti
- HealthBridge Foundation of Canada, 1 Nicholas Street, Suite 1004, Ottawa, ON, KIN 7B7, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Pavillon Liliane de Stewart, Université de Montréal, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
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Batal M, Chan HM, Fediuk K, Ing A, Berti P, Sadik T, Johnson-Down L. Importance of the traditional food systems for First Nations adults living on reserves in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:20-28. [PMID: 34181221 PMCID: PMC8239073 DOI: 10.17269/s41997-020-00353-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/04/2020] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Malek Batal
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada.
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada.
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Karen Fediuk
- First Nations Food, Nutrition and Environment Study, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Amy Ing
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Peter Berti
- HealthBridge Foundation of Canada, 1 Nicholas Street, Suite 1004, Ottawa, ON, K1N 7B7, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
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Chan HM, Fediuk K, Batal M, Sadik T, Tikhonov C, Ing A, Barwin L. The First Nations Food, Nutrition and Environment Study (2008-2018)-rationale, design, methods and lessons learned. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:8-19. [PMID: 34181220 PMCID: PMC8239066 DOI: 10.17269/s41997-021-00480-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the rationale, the participatory nature of the methodology, and the lessons learned during the First Nations Food, Nutrition and Environment Study (FNFNES), a community-based participatory research project implemented in eight Assembly of First Nations regions, which includes the entirety of Canada south of the 60th parallel. METHODS FNFNES respected the First Nations principles of Ownership, Control, Access and Possession (OCAP®) ( https://fnigc.ca/ocap ). A random sampling strategy based on an ecosystem framework comprising 11 ecozones was adopted to collect representative nutritional and environmental health results for all First Nations adults living on-reserve south of the 60th parallel. Data collection occurred during the fall months from 2008 to 2016. Respective First Nations were involved in the planning and implementation of data collection for the five principal components: household interviews, tap water sampling for metals, surface water sampling for pharmaceuticals, hair sampling for mercury, and traditional food sampling for contaminants. RESULTS A total of 6487 adults from 92 First Nations participated in the Study (participation rate 78%). A higher percentage of females (66%) participated than males (34%). The average age of males and females was similar (44 and 45 years, respectively). This study offers a novel body of coherent and regionally representative evidence on the human dimension of the ongoing environmental degradation affecting First Nations. CONCLUSION FNFNES serves as a good example of participatory research. We encourage public health professionals to develop policy and programs building on the participatory dimension of the research as well as on its results. The information collected by the FNFNES is also important for community empowerment, environmental stewardship and the general promotion of good health by and for First Nations peoples in Canada.
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Affiliation(s)
- Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada.
| | - Karen Fediuk
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Malek Batal
- Département de nutrition, Faculté de Médecine, Pavillon Liliane de Stewart, Université de Montréal, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 avenue du Parc, Montréal, HQ H3N 1X7, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Constantine Tikhonov
- First Nations and Inuit Health Branch, Department of Indigenous Services Canada, Ottawa, Canada
| | - Amy Ing
- Département de nutrition, Faculté de Médecine, Pavillon Liliane de Stewart, Université de Montréal, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Lynn Barwin
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
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Marushka L, Batal M, Tikhonov C, Sadik T, Schwartz H, Ing A, Fediuk K, Chan HM. Importance of fish for food and nutrition security among First Nations in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:64-80. [PMID: 34181225 PMCID: PMC8239089 DOI: 10.17269/s41997-021-00481-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the relationships between fish/seafood consumption patterns and food security status among First Nations (FN) communities in Canada. We estimated the contribution of fish/seafood to daily nutrient requirements. Barriers to traditional food (TF) access including fish were summarized. METHODS Data were collected by the First Nations Food, Nutrition and Environment Study (2008-2018). The sample of this participatory study comprised 6258 randomly selected FN adults. Fish/seafood consumption was estimated with a food frequency questionnaire. Food security status was assessed with the Household Food Security Survey Module. The contribution of fish/seafood to protein, n-3 fatty acid, vitamin (A, B12, D, niacin) and mineral (selenium, zinc) requirements was assessed by comparison to Dietary Reference Intakes. RESULTS Regional differences were observed in fish/seafood consumption patterns and their relationship with food security status. In the eastern regions (Ontario, Quebec/Labrador and the Atlantic region), consumption of fish/seafood and other TF was significantly higher among food insecure compared with food secure FN participants. Severely food insecure men (particularly in British Columbia, Alberta, Quebec/Labrador and the Atlantic region) tended to eat a higher amount of TF, including fish/seafood, compared with food secure and moderately food insecure men, while no difference was observed in women. Fish/seafood provided good sources of selected nutrients. However, the high cost of harvesting equipment, industry-related activities and climate change reduce access to fish/seafood and other wildlife. CONCLUSION Fish/seafood continues to be vital to the diet of FN communities. Focusing on policies that support FN increased access to fish/seafood has the potential to decrease food insecurity and support sustainable livelihoods. Future policies should focus on socio-economic determinants of food insecurity and support traditional harvesting and sustainable fisheries among FN communities.
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Affiliation(s)
- Lesya Marushka
- First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, Canada
| | - Malek Batal
- Département de nutrition, Faculté de médecine, Université de Montréal, Pavillon Liliane de Stewart, C.P. 6128, succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada
| | - Constantine Tikhonov
- First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Harold Schwartz
- First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, Canada
| | - Amy Ing
- Département de nutrition, Faculté de médecine, Université de Montréal, Pavillon Liliane de Stewart, C.P. 6128, succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Karen Fediuk
- First Nations Food, Nutrition and Environment Study, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada.
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Domingo A, Spiegel J, Guhn M, Wittman H, Ing A, Sadik T, Fediuk K, Tikhonov C, Schwartz H, Chan HM, Batal M. Predictors of household food insecurity and relationship with obesity in First Nations communities in British Columbia, Manitoba, Alberta and Ontario. Public Health Nutr 2021; 24:1021-1033. [PMID: 32366338 PMCID: PMC8025097 DOI: 10.1017/s1368980019004889] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 10/20/2019] [Accepted: 11/21/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To further understandings of household food insecurity in First Nations communities in Canada and its relationship with obesity. DESIGN Analysis of a cross-sectional dataset from the First Nations Food, Nutrition and Environment Study representative of First Nations communities south of the 60th parallel. Multivariate logistic regression was used to assess associations between food insecurity and sociodemographic factors, as well as the odds of obesity among food-insecure households adjusting for sociodemographic characteristics. SETTING Western and Central Canada. PARTICIPANTS First Nations peoples aged ≥19 years. RESULTS Forty-six percent of First Nations households experienced food insecurity. Food insecurity was highest for respondents who received social assistance; had ≤10 years of education; were female; had children in the household; were 19-30 years old; resided in Alberta; and had no year-round road access into the community. Rates of obesity were highest for respondents residing in marginally food-insecure households (female 56·6 %; male 54·6 %). In gender-specific analyses, the odds of obesity were highest among marginally food-insecure households in comparison with food-secure households, for both female (OR 1·57) and male (OR 1·57) respondents, adjusting for sociodemographic variables. For males only, those in severely food-insecure (compared with food-secure) households had lower odds of obesity after adjusting for confounding (OR 0·56). CONCLUSIONS The interrelated challenges of food insecurity and obesity in First Nations communities emphasise the need for Indigenous-led, culturally appropriate and food sovereign approaches to food security and nutrition in support of holistic wellness and prevention of chronic disease.
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Affiliation(s)
- Ashleigh Domingo
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ONN2L 3G1, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BCV6T 1Z3, Canada
| | - Jerry Spiegel
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BCV6T 1Z3, Canada
| | - Martin Guhn
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BCV6T 1Z3, Canada
| | - Hannah Wittman
- Faculty of Land and Food Systems, Centre for Sustainable Food Systems, University of British Columbia, Vancouver, BCV6T 1Z4, Canada
| | - Amy Ing
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Montréal, QCH3T 1A8, Canada
| | - Tonio Sadik
- Environment, Assembly of First Nations, Ottawa, ONK1P 6L5, Canada
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ONK1N 6N5, Canada
| | - Karen Fediuk
- First Nations Food, Nutrition and Environment Study, University of Ottawa, Ottawa, ON, Canada
| | - Constantine Tikhonov
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Harold Schwartz
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, Ottawa, ONK1N 6N5, Canada
| | - Malek Batal
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Montréal, QCH3T 1A8, Canada
- Centre de recherche en santé publique (CReSP), 7101 Avenue du Parc, Montreal, QCH3N 1X7, Canada
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Hardy K, Zmudzinski M, Fowler-Woods M, Shingoose G, Fowler-Woods A, Daeninck F, Hatala A, Vergis A. Decolonising qualitative research to explore the experiences of Manitoba's urban Indigenous population living with type 2 diabetes mellitus, obesity and bariatric surgery. BMJ Open 2020; 10:e036595. [PMID: 33004389 PMCID: PMC7534700 DOI: 10.1136/bmjopen-2019-036595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Obesity and type 2 diabetes mellitus (T2DM) are growing global health concerns associated with significant morbidity, mortality and healthcare expenditures. Due to histories of colonisation and contemporary marginalisation, Canada's Indigenous populations are disproportionately burdened by obesity, T2DM and many other chronic illnesses. Culturally appropriate research on experiences and outcomes of Indigenous patients undergoing bariatric surgery in Canada is scarce. This qualitative study protocol will use a decolonising approach guided by an Indigenous Elder to explore the perspectives and experiences of urban Indigenous Manitobans with respect to T2DM, obesity and bariatric surgery. This knowledge will guide the development and implementation of culturally sensitive bariatric care. METHODS AND ANALYSIS Sequential sharing circles (SSCs) and semistructured conversational interviews that have been purposefully designed to be culturally relevant with the guidance of an Indigenous Elder and advisory group (IAG) will be carried out in Winnipeg, Manitoba, Canada. Indigenous adults who are obese (body mass index >35 kg/m2), have T2DM and live in an urban centre will be recruited. Three groups will be investigated: (1) those who have had bariatric surgery; (2) those on the wait list for bariatric surgery and (3) those not associated with a bariatric surgery programme. Each group of 10-12 participants will be guided through a semistructured script led by an Indigenous Elder. Elder-facilitated conversational interviews will also be completed following the SSCs. All content will be audio recorded and transcribed. Thematic analysis will be used to identify emerging patterns using a constructive grounded theory approach. ETHICS AND DISSEMINATION This study has received ethical approval from the University of Manitoba Health Research Ethics Board. Findings will inform the development and implementation of culturally sensitive programmes at Manitoba's Centre for Metabolic and Bariatric Surgery. Results will be disseminated in peer-reviewed scientific journals, at obesity and Indigenous health conferences, and knowledge sharing ceremonies.
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Affiliation(s)
- Krista Hardy
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marta Zmudzinski
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melinda Fowler-Woods
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geraldine Shingoose
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda Fowler-Woods
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Felicia Daeninck
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Hatala
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashley Vergis
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Cordier S, Anassour-Laouan-Sidi E, Lemire M, Costet N, Lucas M, Ayotte P. Association between exposure to persistent organic pollutants and mercury, and glucose metabolism in two Canadian Indigenous populations. ENVIRONMENTAL RESEARCH 2020; 184:109345. [PMID: 32172074 DOI: 10.1016/j.envres.2020.109345] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The body burden of metals and persistent organic pollutants (POPs) is particularly high in populations that rely on fish and other marine species for sustenance. This exposure has been associated with an increased risk of type 2 diabetes, but results remain contrasted. OBJECTIVE We studied this association in two Indigenous populations of northern Québec (Canada) with markedly different prevalences of diabetes and levels of exposure to POPs and mercury. METHODS As part of health surveys conducted in 2004-2009, diabetes prevalence and glucose metabolism (glucose, insulin, HOMA-IR, HOMA-B) in non-diabetic fasting adults were assessed using similar protocols in two populations: Inuit from Nunavik (n = 877) and Cree from Eeyou Istchee territory (n = 780). Blood mercury, plasma polychlorinated biphenyls (PCBs), organochlorine (OC) pesticides/metabolites and polybrominated diphenylethers (PBDEs) levels were measured in samples collected at the time of examination. Logistic and linear regressions and restricted cubic splines analyses were conducted adjusting for sex, age, waist circumference, smoking and omega-3 fatty acid content in plasma phospholipids. RESULTS Diabetes prevalence was higher in Cree (20%) than in Inuit (7%), whereas environmental exposure was 2 to 3-fold greater in Inuit than in Cree participants. In the range of exposure common to the two populations, we observed similar linear increases in the risk of diabetes with increasing contaminant exposure. Among Cree participants, fasting glucose was positively associated with plasma PBDE level, and HOMA-B negatively associated with concentrations of ∑PCBs, dichlorodiphenyldichloroethylene, PBDEs and ∑OC pesticides. Among Inuit participants, a trend towards reduced insulin secretion was observed in association with most contaminants, but the relation was nonlinear (greater reduction at intermediate levels of exposure). A significant increase in fasting glucose levels was observed at elevated blood mercury levels (>16 μg/L). CONCLUSION The observed association between POPs exposure and diabetes risk in the two populations studied should be confirmed using prospective design. Our results suggest the need for additional research on the physiopathological process through which POPs exposure may induce type 2 diabetes in these Indigenous populations.
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Affiliation(s)
- S Cordier
- Centre de Recherche du CHU de Québec - Université Laval, Québec, Canada; Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé. environnement et travail) - UMR_S1085, F-35000, Rennes, France.
| | | | - M Lemire
- Centre de Recherche du CHU de Québec - Université Laval, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - N Costet
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé. environnement et travail) - UMR_S1085, F-35000, Rennes, France
| | - M Lucas
- Centre de Recherche du CHU de Québec - Université Laval, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - P Ayotte
- Centre de Recherche du CHU de Québec - Université Laval, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de toxicologie du Québec, Institut national de santé publique du Québec, Québec, Canada
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du Preez R, Wanyonyi S, Mouatt P, Panchal SK, Brown L. Saskatoon Berry Amelanchier alnifolia Regulates Glucose Metabolism and Improves Cardiovascular and Liver Signs of Diet-Induced Metabolic Syndrome in Rats. Nutrients 2020; 12:nu12040931. [PMID: 32230955 PMCID: PMC7231198 DOI: 10.3390/nu12040931] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022] Open
Abstract
Saskatoon berry (Amelanchier alnifolia) is a potential functional food containing anthocyanins and flavonols, as well as ellagitannins and phenolic acids. We have determined the potential therapeutic effects of Saskatoon berry in diet-induced metabolic syndrome. Nine- to ten-week-old male Wistar rats were randomly assigned to four groups. Two groups were fed on control diets, either corn starch (C) or high-carbohydrate, high-fat diet (H) respectively, for 16 weeks. Two further groups were fed on C or H diet for 16 weeks with Saskatoon berry powder added to the diet for the final 8 weeks (CSSK, HSSK). After 16 weeks, H rats showed symptoms of metabolic syndrome, including increased body weight, visceral adiposity, systolic blood pressure, cardiac fibrosis, plasma concentrations of triglycerides and non-esterified fatty acids, and plasma activities of alanine transaminase and aspartate transaminase. Saskatoon berry intervention normalised body weight and adiposity, improved glucose tolerance, decreased systolic blood pressure, improved heart and liver structure and function with decreased infiltration of inflammatory cells, and decreased plasma total cholesterol. Further, Saskatoon berry normalised liver expression of hexokinase 1 and glycogen phosphorylase and increased glucose 6-phosphatase relative to H rats. These results suggest that Saskatoon berry regulates glycolysis, gluconeogenesis and glycogenesis to improve metabolic syndrome.
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Affiliation(s)
- Ryan du Preez
- Functional Foods Research Group, University of Southern Queensland, Toowoomba, QLD 4350, Australia; (R.d.P.); (S.W.); (S.K.P.)
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Stephen Wanyonyi
- Functional Foods Research Group, University of Southern Queensland, Toowoomba, QLD 4350, Australia; (R.d.P.); (S.W.); (S.K.P.)
| | - Peter Mouatt
- Southern Cross Plant Science, Southern Cross University, Lismore, NSW 2480, Australia;
| | - Sunil K. Panchal
- Functional Foods Research Group, University of Southern Queensland, Toowoomba, QLD 4350, Australia; (R.d.P.); (S.W.); (S.K.P.)
| | - Lindsay Brown
- Functional Foods Research Group, University of Southern Queensland, Toowoomba, QLD 4350, Australia; (R.d.P.); (S.W.); (S.K.P.)
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, QLD 4350, Australia
- Correspondence: ; Tel.: +61-7-3812-6366
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Herrmann TM, Lamalice A, Coxam V. Tackling the question of micronutrients intake as one of the main levers in terms of Inuit food security. Curr Opin Clin Nutr Metab Care 2020; 23:59-63. [PMID: 31688094 DOI: 10.1097/mco.0000000000000613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The Inuit population living in North Canada is facing a drastic change in lifestyle, which has brought about a dramatic nutrition transition characterized by a decrease in the traditional foods consumption and an increasing reliance on processed, store-bought foods. This rapid dietary shift leads to a significant public health concern, as wild-harvested country foods are rich in many micronutrients including vitamins, trace elements and minerals while the most frequently eaten Western foods mainly provide energy, fat, carbohydrates and sodium. This review addresses the emerging strategies to tackle food insecurity in this population. RECENT FINDINGS Recent studies indicate that diets with a higher fraction of traditional foods (and a lower fraction of ultra-processed foods) exhibit a better Healthy Eating Index. This provides a basis to develop new dietary policies anchored in contemporary food realities. SUMMARY In Northern remote communities, improving food security requires holistic approaches. A mixed strategy that targets the revitalization of traditional foods systems and local food production initiatives seems the most promising strategy, to meet the dietary needs in terms of micronutrients, with respect to the cultural identity of local populations.
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Affiliation(s)
- Thora M Herrmann
- Department of Geography, Université de Montréal, Montréal, Quebec, Canada INRA, UMR 1019, UNH, CRNH Auvergne Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, Clermont-Ferrand, France
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