Traditional and market food access in Arctic Canada is affected by economic factors

OBJECTIVES

This study aimed to evaluate the access that Indigenous women have to traditional and market foods in 44 communities across Arctic Canada.

STUDY DESIGN

This secondary data analysis used a cross-sectional survey of 1771 Yukon First Nations, Dene/Métis and Inuit women stratified by age.

METHODS

Socio-cultural questionnaires were used to investigate food access and chi-square testing was used to ascertain the distribution of subject responses by age and region.

RESULTS

There was considerable regional variation in the ability to afford adequate food, with between 40% and 70% saying they could afford enough food. Similarly, regional variation was reflected in the percentage of the population who could afford, or had access to, hunting or fishing equipment. Up to 50% of the responses indicated inadequate access to fishing and hunting equipment, and up to 46% of participants said they could not afford to go hunting or fishing.

CONCLUSIONS

Affordability of market food and accessibility to hunting and fishing in Arctic Canada were major barriers to Indigenous women's food security.

Facilitators and Barriers to Traditional Food Consumption in the Cree Community of Mistissini, Northern Quebec

To identify barriers to traditional food consumption and factors that facilitate it among the Cree community of Mistissini, a series of four focus groups was conducted with a total of twenty-three people. Two ecological models were created, one for facilitating factors and a second for obstacles, illustrating the role of numerous interconnected influences of traditional food consumption. Environmental impact project, laws and regulation, local businesses, traditional knowledge, youth influence, employment status, and nonconvenience of traditional food were named among numerous factors influencing traditional food consumption. The findings of this study can be used by political and public health organizations to promote traditional food where more emphasis should be invested in community and environmental strategies.

A mixed methods inquiry into the determinants of traditional food consumption among three Cree communities of Eeyou Istchee from an ecological perspective

BACKGROUND

The Aboriginal nations of Canada have higher incidences of chronic diseases, coinciding with profound changes in their environment, lifestyle and diet. Traditional foods can protect against the risks of chronic disease. However, their consumption is in decline, and little is known about the complex mechanisms underlying this trend.

OBJECTIVE

To identify the factors involved in traditional food consumption by Cree Aboriginal people living in 3 communities in northern Quebec, Canada. Design. A mixed methods explanatory design, including focus group interviews to interpret the results of logistic regression.

METHODS

This study includes a secondary data analysis of a cross-sectional survey of 3 Cree communities (n=374) and 4 focus group interviews (n=23). In the first, quantitative phase of the study, data were collected using a food-frequency questionnaire along with a structured questionnaire. Subsequently, the focus group interviews helped explain and build on the results of logistic regressions.

RESULTS

People who consume traditional food 3 days or more weekly were more likely to be 40 years old and over, to walk 30 minutes or more per day, not to have completed their schooling, to live in Mistissini and to be a hunter (p<0.05 for all comparisons). The focus group participants provided explanations for the quantitative analysis results or completed them. For example, although no statistical association was found, focus group participants believed that employment acts as both a facilitator and a barrier to traditional food consumption, rendering the effect undetectable. In addition, focus group participants suggested that traditional food consumption is the result of multiple interconnected influences, including individual, family, community and environmental influences, rather than a single factor.

CONCLUSION

This study sheds light on a number of factors that are unique to traditional foods, factors that have been understudied to date. Efforts to promote and maintain traditional food consumption could improve the overall health and wellbeing of Cree communities.

Can an integrated approach reduce child vulnerability to anaemia? Evidence from three African countries

Addressing the complex, multi-factorial causes of childhood anaemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a "buffering" of risk associated with known causes of anaemia would be observed among children living in areas benefiting from a community-based health and nutrition program intervention. Cross-sectional data on the nutrition and health status of children 24-59 mo (N=2405) were obtained in 2000 and 2004 from program evaluation surveys in Ghana, Malawi and Tanzania. Linear regression models estimated the association between haemoglobin and immediate, underlying and basic causes of child anaemia and variation in this association between years. Lower haemoglobin levels were observed in children assessed in 2000 compared to 2004 (difference -3.30 g/L), children from Tanzania (-9.15 g/L) and Malawi (-2.96 g/L) compared to Ghana, and the youngest (24-35 mo) compared to oldest age group (48-59 mo; -5.43 g/L). Children who were stunted, malaria positive and recently ill also had lower haemoglobin, independent of age, sex and other underlying and basic causes of anaemia. Despite ongoing morbidity, risk of lower haemoglobin decreased for children with malaria and recent illness, suggesting decreased vulnerability to their anaemia-producing effects. Stunting remained an independent and unbuffered risk factor. Reducing chronic undernutrition is required in order to further reduce child vulnerability and ensure maximum impact of anaemia control programs. Buffering the impact of child morbidity on haemoglobin levels, including malaria, may be achieved in certain settings.

Consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community

OBJECTIVE

The present study describes the consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community and examines its associations with physical activity, sedentary behaviours and BMI.

DESIGN

A two-stage cross-sectional design was used. In Stage 1 (n 42), 24 h recalls enabled the identification of sweetened products. In Stage 2 (n 192), an FFQ was administered to measure the daily consumption of these products and to collect sociodemographic and behavioural data. Sweetened products were defined as processed culinary ingredients and ultra-processed products for which total sugar content exceeded 20% of total energy.

SETTING

Three Catholic Middle Eastern churches located in Montreal, Canada.

SUBJECTS

Normoglycaemic men and women (18-60 years old).

RESULTS

Twenty-six sweetened products represented an average consumption of 75·4 g total sugars/d or 15·1% of daily energy intake (n 190, 56% women). Soft drinks, juices, sweetened coffee, chocolate, cookies, cakes and muffins were the main sources of consumption and mostly consumed between meals. Age (exp (β) = 0·99; P < 0·01), physical activity (exp (β) = 1·08; P < 0·01) and recreational computer use (exp (β) = 1·17; P < 0·01) were independently associated with sweetened product consumption. The association between sweetened product consumption and physical activity was U-shaped. BMI was not significantly associated with sweetened product consumption but all participants regardless of BMI were above the WHO recommendation for free sugars.

CONCLUSIONS

Being physically active and spending less time using a computer may favour a reduced consumption of sweetened products. Very active individuals may, however, overconsume such products.

Pilot project of the Nutrition-Friendly School Initiative (NFSI) in Ouagadougou, Burkina Faso and Cotonou, Benin, in West Africa

This paper describes the first African experience with the Nutrition-Friendly School Initiative (NFSI) in two large West African cities: Ouagadougou, Burkina Faso and Cotonou, Benin. NFSI was launched by the World Health Organization (WHO) and its partners in 2006, as a means of preventing the double burden of malnutrition: the coexistence of undernutrition and overnutrition among school-children. NFSI pilot-testing is one component of the Partnership Project on the Double Burden of Malnutrition, funded by the Canadian International Development Agency for 6 years (2008-2014). The Project assisted the government in the selection of pilot schools, fostered the installation of health and nutrition committees in selected schools, and helped with the initial school self-assessments. In accordance with the empowering philosophy of health promotion, pilot schools did not follow a pre-defined schedule of interventions, except for the training of teachers in nutrition education and the nutritional (anthropometric) surveillance of schoolchildren. For the latter activities, technical assistance and seminal funds were provided. Yearly planning workshops were held for school committees, with WHO support. In both settings, training was given to street vendors in order to improve the hygiene and nutritional value of food sold to schoolchildren. Other activities included special nutrition events and sanitation measures. In both cities, NFSI showed promising results in terms of school and community mobilization towards improved nutrition and health; however, NFSI must be better understood as an endogenous and self-sustaining approach. Furthermore, household poverty and scarce school resources appear as major barriers to gaining full impact of NFSI in low-income populations.

Predisposing, facilitating and reinforcing factors of healthy and unhealthy food consumption in schoolchildren: a study in Ouagadougou, Burkina Faso

Objective:

African schoolchildren’s dietary habits are likely changing in the realm of the nutrition transition, particularly in urban areas, but data on their diet and on determinants are scanty. In order to design relevant interventions for this priority target group, the study aimed to assess food habits and their determinants in schoolchildren of Ouagadougou.

Methods:

In a cross-sectional survey, fifth-grade schoolchildren filled during school hours a questionnaire to assess consumption frequency of ‘healthy’ foods (fruits, vegetables, meat, fish, legumes) and ‘unhealthy’ (superfluous) items (cake, cookies, candies, ice, soda) and underlying factors, using Green’s PRECEDE model.

Results:

The study included 769 schoolchildren, mean age 11.7 ± 1.4 years, from eight public and four private schools. Consumption scores of unhealthy items were significantly higher than healthy foods ( p = 0.001). During the week prior to the survey, 25% of children had eaten no fruit, 20% no meat, 20% no legumes, 17% no fish and 17% no vegetables. While less than 4% ate fruits or vegetables every day, 18.3% ate ice pop every day. Children eating cookies, cakes and candy every day were up to seven-fold those eating fruits, vegetables or legumes. Compared to public-school pupils, those from private schools consumed both healthy and unhealthy items more frequently ( p = 0.002 and p = 0.007, respectively). Urban schoolchildren had significantly higher unhealthy food scores ( p = 0.027) compared to peri-urban schools. Children’s healthy and unhealthy food consumption was primarily explained by perceived decisional power and availability [facilitating factors] for both types of foods, and maternal reinforcement for healthy foods and peers’ reinforcement for consumption of unhealthy items. Overall, facilitating factors rated higher for unhealthy than healthy foods.

Conclusion:

The study showed that city schoolchildren’s eating behaviours are far from optimal. Nutrition interventions should be tailored to address the underlying factors in order to impact on behaviours, thereby preventing both dietary inadequacies and excess.

Household food insecurity and Canadian Aboriginal women's self-efficacy in food preparation

PURPOSE

Determinants of self-efficacy related to food preparation using store-bought food were examined in women belonging to the Atikamekw Nation. Also examined was whether self-efficacy was associated with household food insecurity.

METHODS

A cross-sectional survey was conducted with 107 women responsible for household food supplies. Two self-efficacy scores were calculated, one for healthy food preparation and one for food preparation in general. Household food insecurity was measured with an adapted version of the United States Food Security Core Module. The other variables were household composition, income sources, food supplies, tobacco use, participants' health status, and lifestyle and sociodemographic characteristics. Multiple linear regression was used to analyze associations between self-efficacy and household food insecurity in 99 participants.

RESULTS

Severe household food insecurity was associated with significantly lower healthy food preparation scores in Atikamekw women. Other associated variables were food supplies, marital status, alcohol consumption, weight status, and understanding of the native language.

CONCLUSIONS

Application of the concept of self-efficacy contributes to a better understanding of the factors influencing food preparation in Atikamekw women. In this study, self-efficacy in healthy food preparation was linked to food insecurity and obesity, particularly in the most serious cases. Efforts to improve diet will require not only behavioural interventions, but public policies.

Psychological distress mediates the association between daytime sleepiness and consumption of sweetened products: cross-sectional findings in a Catholic Middle-Eastern Canadian community

OBJECTIVE

To examine the associations between consumption of sweetened products, daytime sleepiness (DS) and psychological distress (PD) in a Catholic Middle-Eastern Canadian community, and to test the hypothesis that the association between DS and consumption of sweetened products is mediated by PD.

DESIGN

A cross-sectional study.

SETTING

A Catholic Middle-Eastern Canadian community.

PARTICIPANTS

186 men and women aged between 18 and 60 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sweetened product consumption was measured using a food frequency questionnaire (total sugars/day). DS and PD were measured using standardised questionnaires. The generalised linear model was used to estimate associations between sweetened product consumption, age, sex, self-reported body mass index, DS and PD. Baron and Kenny's four-step approach in addition to the Sobel test were used to establish mediation.

RESULTS

Average DS score was 8.2 (SD=4.5) with 19.5% having excessive scores (>12). Mean PD score was 20.8 (SD=6.2) with 11.8% having high distress scores. Average consumption of sweetened products was 15.5 g/day (SD=13.9). Baron and Kenny's three steps to establish partial mediation were confirmed. First, DS was associated with consumption of sweetened products (p<0.03). Second, DS and PD were correlated (r=0.197; p<0.04). Third, PD was associated with consumption of sweetened products (p<0.01) when both PD and DS were entered as predictors in a multivariate regression. However, Baron and Kenny's fourth step to establish complete mediation was not met. The effect of DS on consumption of sweetened products controlling for PD was reduced, but it was not zero. Finally, the Sobel test was significant (2.14; p<0.03).

CONCLUSIONS

The association between DS and consumption of sweetened products in the Catholic Middle-Eastern Canadian community is partially mediated by psychological distress. Further work should test this mediation relationship in larger samples and verify the potential effects of other sleep variables in this relationship.

Describing the situational contexts of sweetened product consumption in a Middle Eastern Canadian community: application of a mixed method design

Little is known about the situational contexts in which individuals consume processed sources of dietary sugars. This study aimed to describe the situational contexts associated with the consumption of sweetened food and drink products in a Catholic Middle Eastern Canadian community. A two-stage exploratory sequential mixed-method design was employed with a rationale of triangulation. In stage 1 (n = 62), items and themes describing the situational contexts of sweetened food and drink product consumption were identified from semi-structured interviews and were used to develop the content for the Situational Context Instrument for Sweetened Product Consumption (SCISPC). Face validity, readability and cultural relevance of the instrument were assessed. In stage 2 (n = 192), a cross-sectional study was conducted and exploratory factor analysis was used to examine the structure of themes that emerged from the qualitative analysis as a means of furthering construct validation. The SCISPC reliability and predictive validity on the daily consumption of sweetened products were also assessed. In stage 1, six themes and 40-items describing the situational contexts of sweetened product consumption emerged from the qualitative analysis and were used to construct the first draft of the SCISPC. In stage 2, factor analysis enabled the clarification and/or expansion of the instrument's initial thematic structure. The revised SCISPC has seven factors and 31 items describing the situational contexts of sweetened product consumption. Initial validation of the instrument indicated it has excellent internal consistency and adequate test-retest reliability. Two factors of the SCISPC had predictive validity for the daily consumption of total sugar from sweetened products (Snacking and Energy demands) while the other factors (Socialization, Indulgence, Constraints, Visual Stimuli and Emotional needs) were rather associated to occasional consumption of these products.

Poor nutritional status of schoolchildren in urban and peri-urban areas of Ouagadougou (Burkina Faso)

BACKGROUND

Malnutrition is still highly prevalent in developing countries. Schoolchildren may also be at high nutritional risk, not only under-five children. However, their nutritional status is poorly documented, particularly in urban areas. The paucity of information hinders the development of relevant nutrition programs for schoolchildren. The aim of this study carried out in Ouagadougou was to assess the nutritional status of schoolchildren attending public and private schools.

METHODS

The study was carried out to provide baseline data for the implementation and evaluation of the Nutrition Friendly School Initiative of WHO. Six intervention schools and six matched control schools were selected and a sample of 649 schoolchildren (48% boys) aged 7-14 years old from 8 public and 4 private schools were studied. Anthropometric and haemoglobin measurements, along with thyroid palpation, were performed. Serum retinol was measured in a random sub-sample of children (N = 173). WHO criteria were used to assess nutritional status. Chi square and independent t-test were used for proportions and mean comparisons between groups.

RESULTS

Mean age of the children (48% boys) was 11.5 ± 1.2 years. Micronutrient malnutrition was highly prevalent, with 38.7% low serum retinol and 40.4% anaemia. The prevalence of stunting was 8.8% and that of thinness, 13.7%. The prevalence of anaemia (p = 0.001) and vitamin A deficiency (p < 0.001) was significantly higher in public than private schools. Goitre was not detected. Overweight/obesity was low (2.3%) and affected significantly more children in private schools (p = 0.009) and younger children (7-9 y) (p < 0.05). Thinness and stunting were significantly higher in peri-urban compared to urban schools (p < 0.05 and p = 0.004 respectively). Almost 15% of the children presented at least two nutritional deficiencies.

CONCLUSION

This study shows that malnutrition and micronutrient deficiencies are also widely prevalent in schoolchildren in cities, and it underlines the need for nutrition interventions to target them.

Environmental contaminants and human health in the Canadian Arctic

The third Canadian Arctic Human Health Assessment conducted under the Canadian Northern Contaminants Program (NCP), in association with the circumpolar Arctic Monitoring and Assessment Programme (AMAP), addresses concerns about possible adverse health effects in individuals exposed to environmental contaminants through a diet containing country foods. The objectives here are to: 1) provide data on changes in human contaminant concentrations and exposure among Canadian Arctic peoples; 2) identify new contaminants of concern; 3) discuss possible health effects; 4) outline risk communication about contaminants in country food; and 5) identify knowledge gaps for future contaminant research and monitoring. The nutritional and cultural benefits of country foods are substantial; however, some dietary studies suggest declines in the amount of country foods being consumed. Significant declines were found for most contaminants in maternal blood over the last 10 years within all three Arctic regions studied. Inuit continue to have the highest levels of almost all persistent organic pollutants (POPs) and metals among the ethnic groups studied. A greater proportion of people in the East exceed Health Canada's guidelines for PCBs and mercury, although the proportion of mothers exceeding these guidelines has decreased since the previous assessment. Further monitoring and research are required to assess trends and health effects of emerging contaminants. Infant development studies have shown possible subtle effects of prenatal exposure to heavy metals and some POPs on immune system function and neurodevelopment. New data suggest important beneficial effects on brain development for Inuit infants from some country food nutrients. The most successful risk communication processes balance the risks and benefits of a diet of country food through input from a variety of regional experts and the community, to incorporate the many socio-cultural and economic factors to arrive at a risk management decision that will be the most beneficial in Arctic communities.

Impact of a Positive Deviance Approach to Improve the Effectiveness of an Iron-Supplementation Program to Control Nutritional Anemia among Rural Senegalese Pregnant Women

Background

Iron supplementation through prenatal care remains the most widespread strategy to control anemia during pregnancy, but its effectiveness is only partial, showing the need to address other approaches.

Objective

This study was conducted to measure the impact of a positive deviance approach to improve an iron-supplementation program among pregnant women in a rural Senegalese area.

Methods

A positive deviance approach (PD Micah) was compared with an ongoing integrated nutrition and health program intervention (Micah) in a rural Senegalese area. A pre-post evaluation was conducted using independent cross-sectional samples with a total of 371 pregnant women. A sociodemographic questionnaire was administered, and biologic and anthropometric measurements were performed.

Results

After 9 months of activities, the mean hemoglobin level rose from 93.9 to 100.7 g/L in the PD Micah group. Distribution of iron supplements through community volunteers and implementation of healthy pregnancy promotion sessions on a monthly basis improved the accessibility to 23.3% in the PD Micah group. No significant change was observed in the Micah group. Logistic regression analysis showed a significantly reduced risk of anemia in the PD Micah area (adjusted odds ratio, 0.25; 95% confidence interval, 0.12 to 0.53).

Conclusions

This intervention shows that a community-based strategy, such as the positive deviance approach, can contribute to improving the effectiveness of iron supplementation during pregnancy.

Unique patterns of dietary adequacy in three cultures of Canadian Arctic indigenous peoples

Background

Information is needed on dietary adequacy of Arctic indigenous populations in Canada. Extensive work has been completed on composition of Arctic food and food use, and dietary reference intakes are available.

Objective

To complete the first comprehensive dietary adequacy assessment of three populations of adult Arctic indigenous people.

Setting and subjects

Dietary assessment interviews were conducted with randomly selected indigenous adults during two seasons in 44 representative communities of Yukon First Nations (n= 797), Dene/Métis, (n= 1007) and Inuit (n= 1525).

Methods

Twenty-four-hour recalls were used to derive adjusted distributions of usual nutrient intakes in four age/gender groups for assessment of dietary adequacy for carbohydrate, dietary fibre, protein,n–3 fatty acids,n–6 fatty acids, calcium, copper, iron, magnesium, manganese, phosphorus, selenium, zinc, vitamin A, riboflavin, folate, vitamin B6, vitamin C, vitamin D and vitamin E.

Results

Nutrients with high prevalence of adequacy for most age/gender groups in all three cultures were protein, carbohydrate,n–3 fatty acids, iron, copper, zinc, manganese, selenium, riboflavin and vitamin B6; some individuals exceeded the upper intake level for iron, zinc, selenium, vitamin A and vitamin D. Estimated average requirement nutrients of concern for adequacy were magnesium, folate, vitamin A, vitamin C and vitamin E; however, a few age/gender groups were exceptions. Prevalence of inadequacy for AI nutrients which may be undesirably high were fibre,n–6 fatty acids and calcium. Vitamin D was more adequate in Inuit women and men than for Yukon First Nations or Dene/Métis.

Conclusions

Unique patterns of dietary adequacy exist among Arctic indigenous peoples. Local wildlife food sources and market food sources should be maximised for their nutrient contributions to Arctic diets.

Could the quality of dietary fat, and not just its quantity, be related to risk of obesity?

This review focuses on the possible association between types of fatty acids and weight change. It examines the biological plausibility underlining these associations and the evidence obtained to date from clinical trials and epidemiological studies. Animal studies have shown that dietary short- and medium-chain fatty acids compared to long-chain fatty acids appear to promote weight loss. Similarly, monounsaturated fatty acids (MUFAs) appear to favor weight loss compared to saturated fatty acids (SFAs) in human studies. The structure of fatty acids seems to affect their degree of oxidation and deposition. Although results are conflicting, human studies follow the general trend reported in animal studies. These trials suggest that some fatty acids are prone to oxidation and some others lead to fat storage when comparing isocaloric diets. For instance, n-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic and docosahexaenoic acids are preferentially oxidizied to other PUFA but results remain inconsistent. Epidemiological studies concerning this issue reported that total dietary fat, which includes MUFA, PUFA, and SFA could increase the risk of obesity, but results are few and conflicting. The rising biological plausibility linking dietary fat quality and risk of obesity, together with the rather recent addition of fatty acids content in food composition tables, support the need for major epidemiological studies in that area.

Risk factors for moderate to severe anemia among children in Benin and Mali: insights from a multilevel analysis

BACKGROUND

Anemia currently affects 2 billion people throughout the world. Although the immediate causes of anemia among children are known (including malnutrition and infections), the importance of contextual determinants and their relationships with individual effects have rarely been explored.

OBJECTIVE

To identify anemia risk factors at the individual, household, and community levels among Beninese and Malian children, using simple and multilevel regression methods.

METHODS

An analysis was undertaken of nationally representative data collected in 2001 in Benin (n = 2,284) and Mali (n = 2,826) by the Demographic and Health Surveys. Sixteen potential risk factors for anemia were considered at the individual, household, and community levels. Comparative analyses were carried out using simple and multilevel logistic regression models.

RESULTS

Simple and multilevel logistic regression analyses yielded broadly similar results. Risk factors for moderate to severe anemia included incomplete immunization, stunted growth, recent infection, absence of bednet, low household living standard, rural residency (Mali), low maternal education, and low community development index (Benin). In addition, multilevel analysis indicated a clustering level of anemia in communities (intraclass correlation) of 14% and 19% in Benin and Mali, respectively.

CONCLUSIONS

Risk factors for child anemia appeared at all three levels (individual, household and community). Community-level clustering seemed to be low. Therefore, interventions to address anemia need not be village- or region-specific. Identifying a successful and replicable program is now a priority in child survival endeavors. It is likely that such a program would include a focus on improving immunization coverage, increased bednet usage, and reduced protein-energy malnutrition.

Local cultural animal food contributes high levels of nutrients for Arctic Canadian Indigenous adults and children

Food systems of Canadian Arctic Indigenous Peoples contain many species of traditional animal and plant food, but the extent of use today is limited because purchased food displaces much of the traditional species from the diet. Frequency and 24-h dietary interviews of Arctic adults and children were used to investigate these trends. The most frequently consumed Arctic foods were derived from animals and fish. In adults these foods contributed 6-40% of daily energy of adults. Children ate much less, 0.4-15% of energy, and >40% of their total energy was contributed by "sweet" and "fat" food sources. Nevertheless, for adults and children, even a single portion of local animal or fish food resulted in increased (P < 0.05) levels of energy, protein, vitamin D, vitamin E, riboflavin, vitamin B-6, iron, zinc, copper, magnesium, manganese, phosphorus, and potassium; although children had similar results for these nutrients, they did not reach significance for energy, vitamin D, or manganese. Because market foods are the major source of energy in the Arctic, traditional animal-source foods are extremely important to ensure high dietary quality of both adults and children.

Correlates of diet quality in the Quebec population

Objective:

To determine the correlates of a high-fat diet in urban, suburban and rural areas of Quebec, Canada.

Design:

A secondary analysis of data collected as part of a 5-year multi-factorial, multi-setting, community-intervention project.

Setting:

Urban, suburban and rural settings of the province of Quebec, 1997.

Subjects:

Data were analysed from a sample of 5214 participants (2227 males, 2987 females). A food-frequency questionnaire was completed and a global index of food quality was calculated. Logistic regression was used to identify correlates of a diet high in total fats, saturated fat and cholesterol.

Results:

In both genders, lower level of education, smoking status, French and English languages compared with other languages spoken at home, and a rural environment were associated with poor diet quality. Having no intention to eat low-fat dairy products more often was associated with a high-fat diet. In men, obesity (body mass index >30 kg m−2) and absence of reported health problems were correlates of a high-fat diet, while, in women, lower physical activity was a correlate.

Conclusions:

Future health interventions in Quebec should target people with low education, smokers and those living in a rural environment. Obese men and sedentary women should have access to specific dietetic resources.

Human health implications of environmental contaminants in Arctic Canada: A review

The objectives of this paper are to: assess the impact of exposure to current levels of environmental contaminants in the Canadian Arctic on human health; identify the data and knowledge gaps that need to be filled by future human health research and monitoring; examine how these issues have changed since our first assessment [Van Oostdam, J., Gilman, A., Dewailly, E., Usher, P., Wheatley, B., Kuhnlein, H. et al., 1999. Human health implications of environmental contaminants in Arctic Canada: a review. Sci Total Environ 230, 1-82]. The primary exposure pathway for contaminants for various organochlorines (OCs) and toxic metals is through the traditional northern diet. Exposures tend to be higher in the eastern than the western Canadian Arctic. In recent dietary surveys among five Inuit regions, mean intakes by 20- to 40-year-old adults in Baffin, Kivalliq and Inuvialuit communities exceeded the provisional tolerable daily intakes (pTDIs) for the OCs, chlordane and toxaphene. The most recent findings in NWT and Nunavut indicate that almost half of the blood samples from Inuit mothers exceeded the level of concern value of 5 microg/L for PCBs, but none exceeded the action level of 100 microg/L. For Dene/Métis and Caucasians of the Northwest Territories exposure to OCs are mostly below this level of concern. Based on the exceedances of the pTDI and of various blood guidelines, mercury and to a lesser extent lead (from the use of lead shot in hunting game) are also concerns among Arctic peoples. The developing foetus is likely to be more sensitive to the effects of OCs and metals than adults, and is the age groups of greatest risk in the Arctic. Studies of infant development in Nunavik have linked deficits in immune function, an increase in childhood respiratory infections and birth weight to prenatal exposure to OCs. Balancing the risks and benefits of a diet of country foods is very difficult. The nutritional benefits of country food and its contribution to the total diet are substantial. Country food contributes significantly more protein, iron and zinc to the diets of consumers than southern/market foods. The increase in obesity, diabetes and cardiovascular disease has been linked to a shift away from a country food diet and a less active lifestyle. These foods are an integral component of good health among Aboriginal peoples. The social, cultural, spiritual, nutritional and economic benefits of these foods must be considered in concert with the risks of exposure to environmental contaminants through their exposure. Consequently, the contamination of country food raises problems which go far beyond the usual confines of public health and cannot be resolved simply by risk-based health advisories or food substitutions alone. All decisions should involve the community and consider many aspects of socio-cultural stability to arrive at a decision that will be the most protective and least detrimental to the communities.

Estimation of traditional food intake in indigenous communities in Denendeh and the Yukon

OBJECTIVES

Chronic non-communicable diseases related to excessive or unbalanced dietary intakes are on the rise among some Indigenous populations in Canada. Nutritional problems of Indigenous peoples arise in the transition from a traditional diet to a market diet characterized by highly processed foods with reduced nutrient density. This study aimed at assessing traditional food intake of Indigenous people in 18 communities.

STUDY DESIGN

This study was cross-sectional with a sample size of 1,356.

METHODS

This study used food frequency and 24-hour recall questionnaires to quantify traditional food intake in 18 communities in the McKenzie basin of the Northwest Territories (Denendeh and the Yukon).

RESULTS

Typical daily intakes of groups of traditional food items were generated and intake of an extensive list of traditional food detailed for adult men and women. Per capita intake of traditional food items was also calculated.

CONCLUSION

Reliance on traditional food intake is still high in Denendeh, as well as in the Yukon. The detailed description of the traditional food system presented here allows an accurate identification of the contribution of traditional food items to nutrient and contaminant intake by Indigenous people for future studies.

Impact of a diabetes prevention program on body size, physical activity, and diet among Kanien'keha:ka (Mohawk) children 6 to 11 years old: 8-year results from the Kahnawake Schools Diabetes Prevention Project

OBJECTIVES

Report the 8-year impact on body size, physical activity, and diet of a community-based diabetes prevention program for elementary-school children in a Kanien'keha:ka (Mohawk) community in Canada.

METHODS

Follow-up (1994-1996) of subjects in the intervention and comparison community and repeat cross-sectional measurements in the intervention community alone from 1994 to 2002. Measures included triceps and subscapular skinfold thicknesses, body mass index (BMI), weekly number of 15-minute episodes of physical activity, run/walk test times, television watching, and consumption of sugared foods, fatty foods, and fruits and vegetables.

RESULTS

The longitudinal data of 1994-1996 showed some early positive effects of the program on skinfold thickness but not on BMI, physical activity, fitness, or diet. Repeat cross-sectional measures from 1994 to 2002 showed increases in skinfold thickness and BMI. Physical activity, fitness, and television watching showed favorable trends from 1994 to 1999 that were not sustained in 2002. Key high-fat and high-sugar foods consumption decreased, as did consumption of fruits and vegetables.

CONCLUSIONS

Although early results showed some successes in reducing risk factors for type 2 diabetes, these benefits were not maintained over 8 years.

Age differences in vitamin A intake among Canadian Inuit

BACKGROUND

Inuit traditional food provides ample amounts of preformed vitamin A. However, the dietary transition away from traditional food raises concerns regarding dietary adequacy. Vitamin A is an essential nutrient with inadequate and excessive exposures having adverse effects.

OBJECTIVE

To evaluate total dietary vitamin A intake for Canadian Inuit from market food and traditional food sources and to evaluate retinol concentrations in liver and blubber.

METHODS

Dietary surveys were conducted in 18 communities representing 5 Inuit regions, and traditional food items were evaluated for nutrient content.

RESULTS

Among those 15-40 years of age, 68% of men and 60% of women had a dietary vitamin A intake below the estimated average requirement (EAR) for retinol activity equivalents (RAE)/day. Among those over 40 years of age, only 11 % of men and 15% of women had a dietary vitamin A intake below the EAR. Young Inuit men had a relative risk of 6.2 (95% CI= 4.5-8.4), and young Inuit women had a relative risk of 4.0 (95% CI= 3.1-5.0) for dietary inadequacy compared to the older Inuit men and women, respectively. The median retinol content of liver of ringed seal, caribou, and fish were comparable to levels observed in market food liver. Liver was less frequently consumed by those 15-40 years of age than among older Inuit.

DISCUSSION

Sub-optimal vitamin A intake is the predominant nutritional concern rather than excessive exposures. Public health education campaigns are needed to improve vitamin A intake among the younger generations of Inuit men and women.

Ecuadorian Andean Women's Nutrition Varies with Age and Socioeconomic Status

An agricultural project in Highland Ecuador provided a model context to better understand the nutrition of rural women. The adequacy of women's nutrition and the strength of associations with age and socioeconomic status were studied in 104 rural households over four rounds (two seasons) during the 1995–1996 agricultural year using a cross-sectional with repeated-measures design. Women were at high risk for micronutrient deficiencies (calcium, iron, riboflavin, and vitamin B12) due to low intakes of animal products. Two distinct constructs representing socioeconomic status were identified: modern lifestyle and farming wealth. In multivariate models, farming wealth was associated with quality of women's diet (animal protein adjusted for energy, p = 0.01). Diet quality, in turn, was positively associated with anthropometric status (p = 0.02). Women over the age of 50 weighed approximately 3.7 kg less than younger women and consumed less energy (300 kcal) and micronutrients (p < 0.05). Age was positively associated with respiratory morbidity (p = 0.01). These findings, while directly relevant to a specific context, suggest the need for cross-cultural studies to identify the extent of, and factors contributing to, the risk of nutritional inadequacy in postreproductive women in developing countries.

Arctic indigenous peoples experience the nutrition transition with changing dietary patterns and obesity

Indigenous Peoples globally are part of the nutrition transition. They may be among the most extreme for the extent of dietary change experienced in the last few decades. In this paper, we report survey data from 44 representative communities from 3 large cultural areas of the Canadian Arctic: the Yukon First Nations, Dene/Métis, and Inuit communities. Dietary change was represented in 2 ways: 1) considering the current proportion of traditional food (TF) in contrast to the precontact period (100% TF); and 2) the amount of TF consumed by older vs. younger generations. Total diet, TF, and BMI data from adults were investigated. On days when TF was consumed, there was significantly less (P < 0.01) fat, carbohydrate, and sugar in the diet, and more protein, vitamin A, vitamin D, vitamin E, riboflavin, vitamin B-6, iron, zinc, copper, magnesium, manganese, phosphorus, potassium, and selenium. Vitamin C and folate, provided mainly by fortified food, and fiber were higher (P < 0.01) on days without TF for Inuit. Only 10-36% of energy was derived from TF; adults > 40 y old consistently consumed more (P < 0.05) TF than those younger. Overall obesity (BMI > or = 30 kg/m(2)) of Arctic adults exceeded all-Canadian rates. Measures to improve nutrient-dense market food (MF) availability and use are called for, as are ways to maintain or increase TF use.

Fish-seafood consumption, obesity, and risk of type 2 diabetes: an ecological study

OBJECTIVES

There is substantial evidence that type 2 diabetes increases with the degree and duration of obesity. This study was conducted to examine the association, at the international level, between fish and seafood consumption and the prevalence of type 2 diabetes, taking into account the prevalence of obesity.

METHODS

An ecological study of 41 countries in five continents with different socio-demographic characteristics and sanitary conditions was carried out. Data on the prevalence of diabetes and obesity as well as food balance sheets were collected from websites. Correlations between the variables studied were followed by an exploration of their interaction.

RESULTS

After adjustment for total energy intake, there was a significant correlation (rho=0.81, P<0.0001) between the prevalence of type 2 diabetes in the 20- to 44- and 45- to 64-year age groups. Type 2 diabetes in the 45- to 64-year age group was about 5 times higher than in the 20- to 44-year age group. Obesity was positively associated with type 2 diabetes in both age groups (rho=0.39; P=0.012 and rho=0.48; P=0.002 in the 20- to 44- and 45- to 64-year age groups, respectively). An interaction effect was found between diabetes, obesity and total fish and seafood consumption. In countries with low fish and seafood consumption, the prevalence of type 2 diabetes increased significantly with obesity (0.8 +/- 0.3% vs. 2.5 +/- 1.8%; P=0.002 and 3.3 +/- 2.6% vs. 11.0 +/- 3.9%; P<0.0001 for the 20- to 44- and 45- to 64-year age groups, respectively). In countries with a greater prevalence of obesity, there was evidence of significantly reduced type 2 diabetes with high fish and seafood consumption (2.5 +/- 1.8% vs. 0.9 +/- 0.7%; P=0.007 and 11.0 +/- 3.9% vs. 6.2 +/- 4.1%; P=0.041 for the 20- to 44- and 45- to 64-year age groups, respectively).

CONCLUSION

The results of this study suggest that high fish and seafood intake may reduce the risk of type 2 diabetes in populations with a high prevalence of obesity.

Comparison of the dietary intakes of two different groups of children (grades 4 to 6) before and after the Kahnawake Schools Diabetes Prevention Project

The diet of Mohawk children (grades 4 through 6) was assessed using 24-hour recalls after 4 years' participation in the Kahnawake Schools Diabetes Prevention Project. Analysis compared mean intakes of energy, fat, and sucrose, and proportions of children consuming each food. No significant difference was found in the mean intake of energy, fat, and sucrose. There was a significant decrease in the frequency of consumption of high-fat foods (P<.05) and fruits (P<.001), and a significant increase in the energy contribution of white sugar (P<.05). Results illustrate the complexity of food choices and suggest that specific nutrition education targets need to reflect newly available food-items.

The contribution of breast milk to toddler diets in western Kenya

OBJECTIVE

To understand the relative contributions of breast milk and the weaning diet to overall nutrient intake, with a view to designing and implementing appropriate programmes to improve complementary feeding in developing countries.

METHODS

Complementary food intake was measured in a sample of 250 toddlers (mean baseline age: 13.9 +/- 2.4 months) using 24-h dietary recall interviews administered once every 3 weeks over a 6-month period. Breast-milk intake over a 24-h period was measured using the test-weighing method in a subsample of 50 children. Regression effects of age and sex on observed milk intakes were estimated and imputed to the whole sample to estimate mean intake over the observation period. Total energy and nutrient intakes were evaluated for adequacy with reference to published estimates of toddler requirements.

FINDINGS

Total energy intake (1029 kcal/day) was adequate, with breast milk supplying an average of 328 kcal/day (32%), but vitamin A, riboflavin, calcium, iron and zinc intakes were below current estimates of required intakes. Observed limitations in nutrient intake were consistent with the finding that almost half of the toddlers were stunted. The prevalence of wasting was 6% at baseline and 4% at final assessment. Although food consumption increased when breastfeeding stopped, it could not fully compensate for the fat and vitamin A previously supplied by breast milk.

CONCLUSIONS

The nutritional role of mother's milk in the second year is inversely related to the adequacy of the complementary diet. In this study, breast milk was an irreplaceable source of fat and vitamin A. When the weaning diet is inadequate for key nutrients because of low intake or poor bioavailability, breast milk assumes greater nutritional significance in the second year of life but does not guarantee adequate nutrient intakes.

Contribution of Selected Traditional and Market Foods to the Diet of Nunavik Inuit Women

Food composition data were determined for food consumed by 226 Inuit women in Nunavik, estimating the relative contribution of traditional and market food for energy, protein, lipid, carbohydrate, vitamin A, vitamin D, iron, calcium, magnesium, phosphorus, selenium, zinc, and eicosapentaenoic and docosahexaenoic acids. Traditional Inuit food was an important source of protein, vitamin D, iron, selenium, and phosphorus, as well as the main source of eicosapentaenoic and docosahexaenoic acids. The mean contribution of traditional and market food to energy and nutrients was analyzed according to age groups (18-39 and 40-74). Analysis of Inuit women's nutrient intake showed that the contribution of traditional food was greater in the older group than in the younger group, for whom the contribution of market food was greater. Market food contributed the most to Inuit women's energy intake, while 40% of the intake of several nutrients, including protein, vitamin D, iron, phosphorus, and zinc, was derived from traditional food. Inuit women had low vitamin A and calcium intakes. Traditional food had low calcium and vitamin A concentrations, and the Inuit infrequently consumed market food such as milk, dairy products, and yellow and green vegetables. Thus, even though the present study showed that traditional food was the major source of many nutrients in the Inuit diet, market food was also important for the nutritional status of this population, particularly young women. In promoting safe nutritional habits among the Inuit, dietitians must help them maintain traditional food use, which has provided some health advantages (e.g., a lower incidence of cardiovascular disease); encourage consumption of nutritious market foods; and consider the societal values reflected in the traditional diet.

Food Use and Nutrient Adequacy in Baffin Inuit Children and Adolescents

In evaluating adequacy of nutrient intake and relative contribution of locally harvested food (i.e., "traditional" food) and imported market food for 164 Baffin Inuit children and adolescents, 604 24-hour recalls were obtained over a one-year period (1987 to 1988). Market food contributed an average of 84% of dietary energy and traditional food, 16%. Total and saturated fat intakes corresponded closely to current recommendations, while sucrose intakes were higher than recommended. Most age and gender categories had a low prevalence of inadequate intakes of iron, zinc, and protein; over 50% of dietary iron and zinc was provided by traditional food. Calcium and vitamin A were obtained largely through market food, and there was a high risk of inadequacy for both nutrients in all age groups. The diets of 16-18-year-old girls were the most often inadequate, due to high consumption of low nutrient-dense food and low consumption of traditional food. Food items rich in vitamin A and calcium should be promoted, and 16-18-year-old girls specifically targeted for education on food choices and health.

Association between vitamin A status and lung function level in children aged 6--9 years in Wukro wereda, Northern Ethiopia

BACKGROUND

In developing countries, studies using morbidity recalls to evaluate the benefits of vitamin A on respiratory health in children under 6 years of age have been inconclusive. This relationship has not been examined in older children. Spirometric measurements, an objective means of assessing respiratory health, require the subject's collaboration and have been successfully used in children over 6 years of age. This report describes a cross-sectional analysis of the relationship between lung function and vitamin A status in an area endemic to vitamin A deficiency.

METHODS

The data on which this report is based were gathered prior to the implementation of a prospective trial of the effect of vitamin A supplementation on lung function level in Northern Ethiopia. Vitamin A status was assessed by the Modified Relative Dose Response (MRDR) method and lung function assessed by spirometry in 702 rural children aged 6--9 years. Demographic, personal health, household, environmental and socioeconomic data were gathered by questionnaire.

RESULTS

In children with low vitamin A reserve, the unadjusted forced expiratory volume in one second (FEV(1)) was 48.8 ml (P = 0.006) lower than in those with adequate reserve. This difference was 23.1 ml (P = 0.04) when adjusted for age, gender and height and 14.1 ml (P = 0.20) when adjusted for children's demographic, general health, lung function and household-related characteristics.

CONCLUSION

Although these findings suggest that vitamin A plays a relatively minor role in determining FEV(1) level, interpretation is limited by the cross-sectional design. Further clarification of its role requires a trial of vitamin A supplementation.

Traditional food systems research with Canadian Indigenous Peoples

Traditional food systems research with Canadian Indigenous Peoples has revealed many aspects of benefits and risks of the use of this food. Traditions based in hunting, fishing and gathering contain a great variety of species of wildlife plants and animals that provide rich cultural and nutritional benefits. Dietary change for Indigenous Peoples in Canada has resulted in the use of traditional food to provide usually less than 30% of total dietary energy; however this portion of the total diet contributes significantly more of essential nutrients. It also results in exposure to organochlorine and heavy metal contaminants that exceed the tolerable intake levels for some areas. A successful research and education intervention program with one British Columbia community demonstrated that increasing traditional food use can improve health status for vitamin A, iron and folic acid. It is concluded that traditional food systems are rich with potential for research and public health education intervention programs for Indigenous Peoples.

Prevalence of vitamin A deficiency in children aged 6-9 years in Wukro, northern Ethiopia

OBJECTIVE

To determine the prevalence of vitamin A deficiency in children aged 6-9 years in northern Ethiopia.

METHODS

A cross-sectional study was carried out and the data were analysed for 824 (61.5%) of 1339 eligible children for whom there was complete information on biochemical vitamin A status, dietary vitamin A intake, ocular examination for xerophthalmia, and anthropometry.

FINDINGS

The prevalence of xerophthalmia was 5.8%; serum retinol levels were below 0.35 mumol/l and between 0.35 and 0.70 mumol/l in 8.4% and 51.1% of the children respectively. The liver vitamin A reserve (modified relative dose response ratio > or = 0.06) was low in 41.0% of the children.

CONCLUSION

The high prevalence of severe vitamin A deficiency in children aged 6-9 years indicates the need to reevaluate the practice of targeting vitamin A supplementation programmes on children under 6 years of age in areas where vitamin A deficiency is endemic.

Mercury in the traditional diet of indigenous peoples in Canada

Traditional food of indigenous people in Canada, particularly fish and marine mammal meat, has mercury (Hg) concentrations exceeding the Canadian consumption guideline level of 0.5 microg/g. Health effects of Hg in traditional food are, therefore, a concern. We conducted contaminant exposure assessments in 28 indigenous communities in Canada. Hg exposure was greatest among communities with high use of marine mammals as food. Exposure among other communities was variable. Recent adoption of a lower intake guideline for women of reproductive age and by Health Canada may decrease the use of traditional food, and could result in other health problems, such as increased risk of diabetes and cardiovascular disease.

Dietary intake and body mass index of adults in 2 Ojibwe communities

OBJECTIVE

To describe and compare dietary intake and prevalence of overweight in a sample of adults in 2 Ojibwe communities in Mille Lacs, Minn, and Lac Courte Oreilles, Wis.

DESIGN

Cross-sectional survey based on interviews that included a 24-hour recall, food frequency questionnaire, and a sociocultural questionnaire.

SUBJECTS/SETTING

One hundred four adult Band (tribe) members were selected randomly from current housing lists; pregnant and lactating women were excluded.

STATISTICAL ANALYSES PERFORMED

Nonparametric Wilcoxon rank sum tests were used to determine differences in absolute nutrient intakes where normality could not be assumed. Two-tailed t tests were conducted to test for differences between nutrient densities. A significance level of alpha = .05 was used; procedurewise adjustments were made using the Bonferroni method when adjusting for multiple comparisons.

RESULTS

The importance of the traditional food system was evident: at least 50% of respondents engaged in hunting and fishing practices. Prevalence of overweight was 47%. Mean nutrient intakes were below the Recommended Dietary Allowance for women for vitamin A, folate, calcium, iron, and zinc and for men for vitamin A and calcium, despite energy intakes that met the Recommended Dietary Allowance. Nutrient densities were lower than those in the third National Health and Nutrition Examination Survey for women for carbohydrate, vitamin C, folate, calcium, and dietary fiber and for men for folate and dietary fiber. Fat contributed 37% (for men) and 40% (for women) of energy intake.

APPLICATIONS/CONCLUSIONS

Areas of focus for culturally relevant education programs (eg, promotion of traditional foods that provide nutrients of low intake status and low-fat traditional food preparation methods) and research needs are suggested to reduce risks for nutrition-related chronic disease among Native Americans.

Sources of bias in estimates of calcium and vitamin A intakes of indigenous peoples in the Northwest Territories, Canada

Calcium and vitamin A have consistently been reported as nutrients at risk among northern indigenous peoples in Canada. Using a data set recently collected in the Sahtú region of Denendeh, Northwest Territories, potential sources of bias and their effect on estimates of dietary intake are investigated. Calcium and vitamin A intakes appear to be underestimated to differing extents and for differing reasons specific to each nutrient. Underestimation of calcium intake may affect a large portion of the dietary records and is most likely due to insufficient probing for methods of food preparation during dietary interviews. Underestimation of vitamin A intake appears to affect a smaller proportion of the food records and be related to the difficulty of recording the occurrence of rare and seasonal events. In both cases, more precise nutrient composition data are needed to reflect nutrient content of traditional food as consumed.

Benefits of traditional food in Dene/Métis communities

Data collected in 16 Dene/Métis communities are used to illustrate the many nutritional, economic, and sociocultural benefits associated with the harvest and consumption of traditional food by indigenous peoples. These include exceptional nutrient composition, absence of industrial processing that changes quality and taste properties, taste preference, reasonable cost compared to market food, quality of the time spent on the land, increased physical activity, sharing of the harvest within the community, opportunity to practice spirituality, and encouragement for children to discover the natural environment. The importance of traditional food to the health of individuals and communities can be directly related to the nutritional value of the food itself, the physical activity associated with its procurement, and its role in mediating positive health determinants such as self-efficacy and locus of control.

Consumption of freshwater fish in Kahnawake: risks and benefits

Kahnawake is a Mohawk community located on the south shore of the Saint Lawrence River near Montreal. A comprehensive study was conducted in 1996-1997 to address the local concern regarding health risks of contaminant exposure associated with freshwater fish consumption. Forty-two participants, including most of the identified active fishermen (n=33), were interviewed. Walleye, perch, bullhead, and smallmouth bass were the species most consumed. Average daily intake of locally caught fish was 23 g/day. Nutrient and contaminant levels of locally collected fish were analyzed. Fish were good sources of protein, polyunsaturated fatty acids (particularly omega-3 fatty acids), calcium, zinc, and iron. Levels of cadmium, lead, arsenic, polychlorinated biphenyls (PCBs), and other chlorinated pesticides were at least 10 times lower than the guideline levels. Mercury levels of some predatory fish exceeded the guideline of 0.5 microgram/g. Average daily intakes of all contaminants were below the guideline levels by a factor of 10 except for mercury. Average mercury intake rate was about one-third that of the guideline level (200 micrograms/week). Contrary to residents' perception, Kahnawake fish were not particularly contaminated. In view of the nutritional as well as cultural benefits, fishing and fish consumption may be promoted.

Risk assessment of cadmium exposure in Fort Resolution, Northwest Territories, Canada

The aim of this study is to investigate the cadmium (Cd) exposure level from traditional food in Fort Resolution, Northwest Territories. We used 24-h dietary recalls and traditional food use frequency to obtain information on traditional food consumption, and analysed cadmium concentrations in traditional food. We also estimated total cadmium intake via market and traditional food, and cigarette smoking. Traditional food accounted for only 10% of the dietary energy. About 30 species of wildlife and plants were used. The most important foods in the community were moose, caribou, and whitefish. The range of cadmium concentrations measured was 0 to 1869 micrograms/g wet weight, with the lowest found in cranberry, and the highest in moose kidney. Cadmium concentrations in traditional food groups were comparable with those of Canadian market food. Highest levels of cadmium were found in the liver and kidney of caribou and moose. Cadmium intakes from traditional food estimated by dietary recall ranged from 0.01 to 1713 micrograms/g/day/person. Average cadmium intakes for women and men from traditional food were estimated to be 9% and 6% respectively, of the Provisional Tolerable Weekly Intake (PTWI, 400-500 micrograms) established by the World Health Organization. The average cadmium inhaled from cigarette smoking was 2.31 +/- 1.00 micrograms/day/person. There was no difference between the total cadmium intakes of smokers and nonsmokers. The total cadmium intake via market and traditional food and cigarette smoking was 136.6 micrograms/ week, which was lower than the PTWI. However, about 20% of the population may consume caribou and moose organ more frequently than the others. The potential health effects on this sub-population needs further clarification.

Population exposure to radioactivity from consumption of caribou among the Dene/Métis of Denendeh (western Northwest Territories, Canada)

There has been long-standing concern with exposure to radioactivity through the consumption of caribou, particularly in indigenous populations in the western Northwest Territories, Canada, who are traditionally high consumers. We conducted a dietary survey in this region in 1994 to estimate population exposure levels. Dietary information was collected from 1012 individuals in sixteen communities (1012 days of 24-hour dietary recalls, 1012 food frequency questionnaires) and radionuclide levels in caribou flesh, liver and kidneys were measured. Monte Carlo statistical methods were employed to integrate these data sets and estimate the distribution of radiation exposure for people in five regions (Gwich'in, Sahtú, Dogrib, Deh-Cho, South Slave). The exposure levels were highest in the South Slave region and in older males (40+ years), and lowest in the Gwich'in region and in younger females (20-40 years). Median exposure level ranged from 0.95 to 5.31 mSv per year (mean of medians = 2.96 mSv/y). In each group the 95th percentile of exposure was 2-3 times greater than the median. These exposure levels are comparable to exposure levels in Alaskan Eskimos and Marshall Island residents, and are much higher than European or American urban populations. Caribou meat is a very nutritious food. We conclude that, although there is some radiation exposure from consuming caribou, the associated health risks are low and are outweighed by the physical, social and cultural benefits derived from hunting and eating caribou.

Dietary exposure to chemical contaminants from traditional food among adult Dene/Métis in the western Northwest Territories, Canada

Environmental contaminants such as organochlorines and heavy metals have been reported to bioaccumulate in Arctic and subarctic wildlife. The Indigenous Peoples in northern and Arctic Canada rely on local wildlife as an important food source, and it is thus hypothesized that they may have high intakes of these contaminants. Herein, an assessment of dietary exposure to selected organochlorines and heavy metals for Indigenous Peoples of the western Northwest Territories (NWT) is presented. Dietary data were collected from 1012 adults with 24-h recalls in 16 communities in the western NWT (Denendeh). A comprehensive survey of the literature, as well as in-house analysis, formed the basis of a large traditional food-contaminant database. By combining the dietary and contaminant data, dietary exposure to 11 chemical contaminants was calculated. Dietary exposure to chemical contaminants in Denendeh is generally low and there is little, if any, associated health risk. However there are specific contaminants in certain communities for which exposure on a single day approaches the tolerable daily intake levels. These situations are detailed and monitoring needs are described.