Catherine Pirkle

Food insecurity and nutritional biomarkers in relation to stature in Inuit children from Nunavik

OBJECTIVES: Inuit in Canada experience alarming levels of food insecurity, but nutritional and physiological consequences are poorly documented, especially in school-age children. The objective of this study was to assess the relation of food insecurity to iron deficiency and stature in school-aged Inuit children from Nunavik (Northern Quebec).METHODS: Food insecurity, iron deficiency, and stature were assessed in a cohort of children. Food insecurity was determined by interviewing the children’s mothers. Multiple logistic regression was used to evaluate the association of food insecurity to iron deficiency and short stature. We defined short stature as a height in the lowest tertile for age and sex, based on Canadian growth charts. The relation of food insecurity to height (cm) was analyzed with a general linear model. Statistical models controlled for age, sex, normal/overweight/obese status, prenatal lead exposure and postnatal polychlorinated biphenyls exposure.RESULTS: Half of the children (49.7%, n=145) were food insecure, while one third were iron depleted, 12.6% had anaemia, and 8.7% had irondeficiency anaemia. The multivariate odds ratio of anaemia was 1.82 (95% CI: 0.97, 3.42, p=0.06) for food-insecure children. Prevalence of short stature was 18.7%. Food-insecure children were an average of 2 cm shorter (95% CI: -0.48, -3.17) than food-secure children (p<0.01).CONCLUSION: In this population, food-insecure children have greater burdens of nutritional deficiencies and slower linear growth. Considering the high prevalence of food insecurity among Inuit children in Nunavik, nutritional deficiencies and adverse effects on development should be carefully monitored.RésuméOBJECTIFS : Les Inuits du Canada présentent des niveaux d’insécurité alimentaire alarmants dont les conséquences nutritionnelles et physiologiques sont méconnues, surtout chez les enfants d’âge scolaire. L’objectif de notre étude était d’évaluer la relation entre l’insécurité alimentaire, d’une part, et la carence en fer et la taille, d’autre part, chez les enfants inuits du Nunavik (Nord-du-Québec) en âge de fréquenter l’école.MÉTHODE : Nous avons évalué l’insécurité alimentaire, la carence en fer et la taille dans une cohorte d’enfants. L’insécurité alimentaire a été déterminée en interviewant les mères des enfants. Par régression logistique multiple, nous avons évalué l’association entre l’insécurité alimentaire et la carence en fer et la petite taille. Nous avons défini la petite taille comme étant la taille dans le tertile inférieur pour l’âge et le sexe, selon les fiches de croissance canadiennes. Le rapport entre l’insécurité alimentaire et la taille (en centimètres) a été analysé selon un modèle linéaire général. Des modèles statistiques ont permis de rajuster les données selon l’âge, le sexe, le poids normal/le surpoids/l’obésité, l’exposition prénatale au plomb et l’exposition postnatale aux biphényles polychlorés.RÉSULTATS : La moitié des enfants (49,7 %, n=145) étaient confrontés à l’insécurité alimentaire, le tiers des enfants étaient carencés en fer, 12,6 % faisaient de l’anémie, et 8,7 % présentaient une anémie ferriprive. Le rapport de cotes multivarié de l’anémie était de 1,82 (IC de 95 %: 0,97, 3,42, p=0,06) chez les enfants confrontés à l’insécurité alimentaire. La prévalence de la petite taille était de 18,7 %. Les enfants touchés par l’insécurité alimentaire mesuraient en moyenne 2 cm de moins (IC de 95 %: -0,48, -3,17) que les enfants épargnés par l’insécurité alimentaire (p<0,01).CONCLUSION : Dans cette population, les enfants confrontés à l’insécurité alimentaire avaient un plus lourd fardeau de carences alimentaires et une croissance linéaire plus lente. Étant donné la forte prévalence de l’insécurité alimentaire chez les enfants inuits du Nunavik, les carences alimentaires et leurs effets indésirables sur le développement devraient être suivis attentivement.

Examining the Impact of a Public Health Message on Fish Consumption in Bermuda.

Background In 2003 mean cord blood mercury concentrations in pregnant Bermudian women exceeded levels associated with adverse health outcomes in children. The principal mercury source was local fish species. Public health messages were developed suggesting pregnant women reduce consumption of fish species with higher mercury concentrations (e.g. swordfish), substituting species containing lower mercury concentrations, and elevated omega-3 fatty acids (e.g. anchovies). Recent evidence indicates mercury concentrations in Bermuda’s pregnant women have fallen five- fold. Objectives Assess whether changes in women’s fish eating patterns during pregnancy are consistent with the public health messaging. Determine who is making changes to their diet during pregnancy and why. Methods Mixed methods study with a cross-sectional survey of 121 pregnant women, including 13 opened-ended interviews. Health system, social vulnerability, public health messaging, and socio-demographic variables were characterized and related to changes in fish consumption during pregnancy. Qualitative data were coded according to nutritional advice messages, comprehension of communication strategies, and sources of information. Results 95% of women surveyed encountered recommendations about fish consumption during pregnancy. 75% reported modifying fish eating behaviors because of recommendations. Principal sources of information about fish consumption in pregnancy were health care providers and the Internet. 71% of women reported reducing consumption of large fish species with greater mercury levels, but 60% reported reduced consumption of smaller, low mercury fish. No participant mentioned hearing about the benefits of fish consumption. More frequent exposure to public health messages during pregnancy was associated with lower reported consumption. Bermudian born women were less likely to reduce consumption of large fish species during pregnancy. Conclusions In Bermuda, public health messages advocating reduced consumption of larger, higher mercury-containing fish species appear effective, but masked the nutritional value message of small fish species, with low mercury concentration. Adjustment is needed to better balance the risk communication.

Managing mercury exposure in northern Canadian communities

Mercury is a toxic metal that can cause deleterious neurologic effects at any age, although the fetus is especially at risk.[1][1] Most Canadians are exposed to mercury through diet, specifically fish consumption.[2][2] Several Canadian clinical guidance publications assist health professionals in

Menopausal Status and Physical Performance in Middle Aged Women: A Cross-Sectional Community-Based Study in Northeast Brazil

Objective To examine associations between menopausal status and physical performance in middle-aged women from the Northeast region of Brazil. Methods Cross-sectional study of women between 40 to 65 years old living in Parnamirim. Women were recruited by advertisements in primary care neighborhood centers across the city. Physical performance was assessed by grip strength, gait speed and chair stands. Menopausal status was determined using the Stages of Reproductive Aging Workshop classification and women were classified in: premenopausal, perimenopausal or postmenopausal. Multiple linear regression analyses were performed to model the effect of menopausal status on each physical performance measure, adjusting for covariates (age, family income, education, body mass index, parity and age at first birth). Results The premenopausal women were significantly stronger and performed better in chair stands than perimenopausal and postmenopausal women. Gait speed did not vary significantly by menopausal status. In multivariate analyses, menopausal status remained statistically significant only for grip strength. In fully adjusted analyses, premenopausal women had grip strength mean of 2.226 Kgf (95% CI: 0.361 – 4.091) higher than the postmenopausal group. Conclusions This study provides further evidence for the associations between menopause and physical performance in middle-aged women, since grip strength is weaker in peri and postmenopausal women compared to premenopausal, even adjusted for age and other covariates.

Psychometric validation of the household food insecurity access scale among Inuit pregnant women from Northern Quebec

Background Globally, food insecurity is a major public health concern. In North America, it is particularly prevalent in certain sub-groups, including Indigenous communities. Although many Indigenous and remote communities harvest and share food, most food security assessment tools focus on economic access. This study describes the psychometric evaluation of a modified Household Food Insecurity Access Scale (HFIAS), developed for mixed economies, to assess food insecurity among pregnant Inuit women. Methods The HFIAS was administered to 130 pregnant women in Nunavik (Arctic region of Quebec), Canada. Data were fit to a Rasch Rating Scale Model (RSM) to determine the discrimination ability of the HFIAS. Person parameter (Theta) estimates were calculated based on the RSM to provide a more accurate scoring system of the modified HFIAS for this population. Theta values were compared to known correlates of food insecurity. Results Comparative fit indices showed preference for a modified version of the HFIAS over the original. Theta values displayed a continuum of severity estimates and those values indicating greater food insecurity were consistently linked to known correlates of food insecurity. Participants living in households with more than 1 hunter (Theta = -.45) or more than 1 fisher (Theta = -.43) experienced less food insecurity than those with no hunters (Theta = .48) or fishers (Theta = .49) in their household. The RSM indicated the scale showed good discriminatory ability. Subsequent analyses indicated that most scale items pertain to the classification of a household as moderately food insecure. Conclusions The modified HFIAS shows potential for measuring food insecurity among pregnant women in Nunavik. This is an efficient instrument that can inform interventions targeting health conditions impacting groups that obtain food through both monetary and non-monetary means.

Economic Adversity Transitions From Childhood to Older Adulthood Are Differentially Associated With Later-Life Physical Performance Measures in Men and Women in Middle and High-Income Sites

Objective: This study examines the relationship between economic adversity transitions from childhood to older adulthood and older adulthood physical performance among 1,998 community-dwelling older adults from five demographically diverse sites from middle and high-income countries. Method: The principal exposure variable was economic adversity transition. No adversity encompassed not experiencing poverty in both childhood and older adulthood, improved described having only experienced poverty in childhood, worsened captured having experienced poverty in older adulthood, and severe is having experienced poverty in both childhood and older adulthood. The short physical performance battery (SPPB) was used for outcome measures. Analyses of the continuous SPPB score used linear regression, while analysis of a binary outcome (SPPB < 8 vs. ≥8) used Poisson regression models with robust error variance, both adjusting for sex, education, and site location. Result: In sex-stratified models, the SPPB < 8 prevalence rate ratio (PRR) was higher for the severe (PRR: 2.80, 95% confidence interval [CI] = [1.70, 4.61]), worsened (PRR: 2.40, 95% CI = [1.41, 4.09]), and improved (PRR: 1.82, 95% CI = [1.11, 3.01]) groups, compared with those with no adversity in childhood or as adults, but only for females. Discussion: Findings from this study indicate that persistent economic adversity has a negative effect on older adult physical performance, especially among women.

Assessment of the implementation fidelity of the Arctic Char Distribution Project in Nunavik, Quebec

Background In September 2011, the Nunavik Regional Board of Health and Social Services began supporting the Arctic Char Distribution Project (AC/DP) for pregnant women. This initiative promoted consumption of the fish Arctic char—a traditional Inuit food—by pregnant women living in villages of Nunavik, an area in northern Quebec (Canada) inhabited predominantly by people of Inuit ethnicity. This intervention was intended to reduce exposure to contaminants and improve food security in Inuit communities. Methods We assessed the projects implementation based on data collected from background documentation, field notes and qualitative interviews with project recipients and implementers. Themes emerging from the data are critically discussed in the light of the framework for implementation fidelity developed by Carroll et al in 2007. Results Pregnant women fully embraced the initiative because of its cultural appropriateness. However, project implementation was incomplete: first because it did not cover all intended geographic areas, and second because of a recurring inconsistency in the supply and distribution of the fish. In addition, the initiative has been inconsistently funded and relies on multiple funding sources. Discussion This work highlights the extent to which project complexity can impede successful implementation, particularly in terms of communication and coordination. We provide recommendations for improving project implementation and suggest amendments to the implementation fidelity framework.

Fear of Falling Predicts Incidence of Functional Disability 2 Years Later: A Perspective From an International Cohort Study

Objective To study the extent to which fear of falling (FOF) is associated with the onset of functional disability over a 2-year period in older adults using self-reported and performance-based measures. Methods In 2012, 1,601 participants (aged 65-74 years) were recruited from four sites: Kingston and Saint-Hyacinthe, Canada; Manizales, Colombia; and Natal, Brazil. They were re-assessed in 2014. We quantified FOF using the Fall Efficacy Scale-International (FES-I; range: 16-64). Functional disability measures were (i) self-reported incident mobility disability, defined as difficulty climbing a flight of stairs or walking 400 m and (ii) incident poor physical performance, defined as a score <9 on the Short Physical Performance Battery. In the Poisson regression analysis, we included only those participants without functional disability at baseline to calculate incident risk ratios in 2014. Results 1,355 participants completed the 2014 assessment, of which 917 and 1,078 had no mobility disability and poor physical performance at baseline, respectively. In 2014, 131 (14.3%), and 166 (15.4%) participants reported incident mobility disability and poor physical performance, respectively. After adjusting for age, sex, socioeconomic, and health covariates, a one-point increase in FES-I at baseline was significantly associated with a 4% increase in the risk of reporting incident mobility disability (95% CI: 1.02-1.05) and a 3% increase in the risk of developing poor physical performance at follow up in the overall sample (95%CI: 1.01-1.05). Conclusions FOF is associated with a higher risk of incident mobility disability and poor physical performance in a cohort of older adults. It is increasingly important to study FOFs effect on functional disability and to take necessary measures to prevent the transition to end-stage disability.