Annie Ferland

Cardiovascular burden and related risk factors among Nunavik (Quebec) Inuit: Insights from baseline findings in the circumpolar Inuit Health in Transition cohort study

BACKGROUND The Inuit are commonly portrayed to be somehow protected from cardiovascular diseases (CVDs) through their traditional lifestyle and diet. However, actual sociocultural transition and related major, modifiable risk factors have scarcely been quantified in the Inuit population. Such knowledge is extremely valuable in terms of public health intervention. METHODS A total of 887 Inuit residents from Nunavik, Quebec, participated in a cohort study. The estimates presented were derived from anthropometric and biological measurements gathered at the time of recruitment and enhanced by information collected in the medical file of each participant. All estimates were corrected for a complex sampling strategy and bootstrapped to ensure the representativeness of the general Nunavik population. RESULTS Overall, 19% of Inuit had a disease of the circulatory system according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Among all disorders, peripheral circulatory system disease was the most prevalent (9%). Prevalences of ischemic heart disease and cerebrovascular disease were of similar magnitude (2.5%). No significant difference in disease prevalence was noted between sexes. The major modifiable CVD risk factors were smoking (84%), obesity (49%) [corrected] (body mass index of greater than 30 kgm2) and elevated blood pressure (13085 mmHg or greater) (18%). Prevalences were globally higher among women. CONCLUSION The current belief that the Inuit are protected from CVD is seriously questioned by the results of the present study. Considering the extremely high prevalence of CVD risk factors, a population-based intervention reinforced for women is urgently needed to reduce their risk.

Association between trans-fatty acids in erythrocytes and pro-atherogenic lipid profiles among Canadian Inuit of Nunavik: possible influences of sex and age.

Dietary exposure to trans-fatty acids (TFA) is likely to be high among Canadian Inuit; yet no data are available on the physiological effects of TFA in this population. The purpose of the present study was to assess the association between TFA and plasma lipid profiles in Inuit men and women living in Nunavik (Québec, Canada). In a cross-sectional, population-based survey, a total of 795 Nunavik Inuit eligible participants gave a blood sample. Exposure to TFA was assessed by their relative proportion in erythrocyte membrane. We performed multiple regression analysis using plasma lipids or their linear combinations as the dependent variables and TFA as the main predictor, adjusting for potential confounders. The associations varied markedly between the sexes and according to age. In men (n 357, aged 36.3 (sd 14.3) years, TFA 1.24 (sd 0.54) %), TFA tended to be negatively associated with HDL-cholesterol (HDL-C), apoA1 and LDL particle size, and positively associated with non-HDL-C, LDL-cholesterol (LDL-C), apoB100, the apoB100:apoA1 ratio and the ratios of total cholesterol (TC), LDL-C and TAG to HDL-C. No such trends were observed in women (n 438, aged 37.0 (sd 14.1) years, TFA 1.16 (sd 0.54) %), except for HDL-C and apoA1 in women aged 50 years and more. These results suggest that TFA could raise the risk of CHD in Inuit men at least through their physiological effects on plasma lipids. The differential associations reported in pre- and postmenopausal women need to be reproduced in other populations and in experimental studies addressing the influence of sex hormones in response to dietary fats.

Safety and magnitude of changes in blood glucose levels following exercise performed in the fasted and the postprandial state in men with type 2 diabetes

Background Information on the extent to which acute exercise reduces blood glucose levels (BGL) in type 2 diabetes is lacking. For this reason, the effects of exercise initiated at different preexercise BGL were assessed in men with type 2 diabetes both in the fasted (FS) and the postprandial states (PS). Design and methods Forty-three men with type 2 diabetes, 12 on diet alone and 31 on hypoglycaemic agents, completed a total of 1555 exercise sessions performed in the FS and 0-1, 1-2, 2-3, 3-4, 4-5, and 5-8 h in the PS. Capillary BGL were measured before and immediately after a 1h standardized aerobic exercise session on an ergocycle at 60% of Vo2 peak. Results In the FS, there was an increase in postexercise BGL of 27 ± 21% (mean±SD; P < 0.001) when preexercise BGL was ≤ 6 mmol/l, no change when preexercise BGL were between 6 and 8 mmol/l, and a significant decrease of 12 ± 13% when preexercise BGL were >8 mmol/l (P < 0.001). In the PS, most exercise sessions were associated with significant decreases in BGL ranging between 18 ± 17 and 50 ± 12% (P < 0.001), depending on the time interval between meals and the onset of exercise. Regarding the metabolic PS, the decline in BGL was most pronounced with high preexercise BGL. Conclusions Our observations not only demonstrate that it was safe for middle-aged obese men with type 2 diabetes to exercise in the FS, but also show that the decrease in BGL during aerobic exercise was largely dependent on preexercise BGL. Eur J Cardiovasc Prev Rehabil 14: 831-836

Hypertension among the Inuit from Nunavik: should we expect an increase because of obesity?

Objectives. Because of their recent adoption of a Westernized lifestyle, an increased risk of developing hypertension (HTN) is suspected among Inuit populations. This study aimed to assess the exact prevalence of HTN in Nunavik Inuit and to examine its association with other major risk factors of cardiovascular disease. Study design. A cross-sectional population-based study. Methods. We analysed biological and anthropometric data and the medical history of 832 Inuit. Results. The overall prevalence of HTN (≥140/90 mmHg or the use of medication) was 19% with no gender difference. Obesity (body mass index [BMI] ≥30 kg/m2) was the highest prevalent cardiovascular risk factor (23%), and was significantly associated with HTN (OR for BMI&25 kg/m2 vs. BMI 30–34 kg/m2: 7.9 [3.5–17.9]; OR for BMI&25 kg/m2 vs. BMI ≥35 kg/m2: 14.4 [5.6–36.7]). An increase in odds of prehypertension (preHTN) (130–139/80–89 mmHg) was also observed as the BMI increased (p for trend, p&0.0001). Conclusion. The prevalence of HTN in the Inuit populations has reached values similar to those of their Westernized counterparts. Furthermore, not only HTN but also preHTN states are significantly associated with obesity even after adjusting for confounding variables. These results clearly indicate that HTN is becoming a growing health challenge in Nunavik because of pandemic obesity.

Is Aspartame Really Safer in Reducing the Risk of Hypoglycemia During Exercise in Patients With Type 2 Diabetes

In addition to physical activity and healthy food choices, low-calorie sweetening agents, such as aspartame, are a recommended alternative to sugar for patients with type 2 diabetes in order to obtain a better control of carbohydrate intake and blood glucose levels (1–3). The safety of aspartame has been a controversial issue for quite some time now. This noncarbohydrate sweetener is currently found in over 6,000 food products and beverages throughout the world. At present, its attractiveness as an artificial sweetener in the dietary management of diabetes is related to its ∼200-fold sweetening power and the lack of effect on plasma glucose levels compared with sucrose. We have recently investigated the effect of different …

Blood pressure assessment in severe obesity: validation of a forearm approach.

Obesity is frequently associated with systemic hypertension. Blood pressure measure is inaccurate in severely obese patients because of poor cuff size fitting. The aim of the study is to assess the degree of agreement between the intra‐arterial method as the gold standard vs. noninvasive methods, i.e., forearm blood pressure and upper‐arm blood pressure measures.

Dairy Product Intake and Its Association with Body Weight and Cardiovascular Disease Risk Factors in a Population in Dietary Transition

Objective: Higher dairy product intake has shown beneficial effects on body weight, blood pressure, type 2 diabetes, and cardiovascular disease (CVD) risk factors in Caucasian populations. This study evaluated dairy product intake and its association with body weight and CVD risk profile among a population undergoing a dietary transition in Canada, the Nunavik Inuit. Methods: Data were collected from August 27 to October 1, 2004, in the 14 villages of Nunavik on a Canadian research icebreaker (Canadian Coast Guard ship Amundsen). Dairy product intake and calcium intake were evaluated in 543 Inuit using a food frequency questionnaire. Physiological (lipid profile, fasting glucose, and insulin) and anthropometrical measurements were also obtained. Results: The range of median dairy product intake extended from 120 g/d in the lowest tertile to 290 g/d in the highest tertile. The median of calcium intake was 524 mg/d. Participants in the highest tertile of dairy product consumption had higher body weight, fat-free mass, waist circumference, waist-to-hip ratio, and fasting glucose concentrations than participants in the lowest tertile (all p < 0.01). After adjustments for potential cofactors, no significant association was observed. A higher prevalence of Inuit participants with metabolic syndrome was observed in the higher tertile compared with the first tertile (10.3% vs 1.6%; p < 0.001). Conclusions: Higher dairy product intake in Nunavik Inuit is not related to protective effects on body weight and CVD. The consumption of dairy products in Nunavik Inuit is probably not sufficient to withdraw beneficial effects on body weight or CVD risk factors, as observed in North American populations.

Impact of type 2 diabetes on cardiorespiratory function and exercise performance

The aim of this study was to examine the impact of well‐controlled uncomplicated type 2 diabetes (T2D) on exercise performance. Ten obese sedentary men with T2D and nine control participants without diabetes matched for age, sex, and body mass index were recruited. Anthropometric characteristics, blood samples, resting cardiac, and pulmonary functions and maximal oxygen uptake (VO2max) and ventilatory threshold were measured on a first visit. On the four subsequent visits, participants (diabetics: n = 6; controls: n = 7) performed step transitions (6 min) of moderate‐intensity exercise on an upright cycle ergometer from unloaded pedaling to 80% of ventilatory threshold. VO2 (τVO2) and HR (τHR) kinetics were characterized with a mono‐exponential model. VO2max (27.0 ± 3.4 vs. 26.7 ± 5.0 mL kg−1 min−1; P = 0.85), τVO2 (43 ± 6 vs. 43 ± 10 sec; P = 0.73), and τHR (42 ± 17 vs. 43 ± 13 sec; P = 0.94) were similar between diabetics and controls respectively. The remaining variables were also similar between groups, with the exception of lower maximal systolic blood pressure in diabetics (P = 0.047). These results suggest that well‐controlled T2D is not associated with a reduction in VO2max or slower τVO2 and τHR.