Cindy Roache

Assessing dietary intake in a population undergoing a rapid transition in diet and lifestyle: The Arctic Inuit in Nunavut, Canada

The aims of the present study were to (1) characterise the diets of adult Inuit; (2) highlight foods for a nutritional and lifestyle intervention programme; (3) develop a quantitative FFQ (QFFQ) to evaluate the programme and monitor changes in dietary intake in this population over time. A dietary survey using single 24-h dietary recalls was conducted among Inuit aged between 19 and 87 years in two communities in Nunavut, Canada. Eighty-seven subjects completed the recalls (response rate was approximately 73 %). The mean energy intake for men and women was 9530 and 6939 kJ, respectively. The intakes of dietary fibre and the majority of vitamins and minerals (especially vitamins A, D, and E, total folate and Ca) were far below the recommendations. Traditional foods contributed 40 and 42 %, respectively, to protein and Fe intakes. Non-nutrient-dense store-bought foods were consumed much more frequently than the nutrient-dense traditional foods. Foods high in fat and sugar were highlighted, and will be replaced by healthier, more nutrient-dense alternatives to address the dietary inadequacies for the nutritional intervention programme. A 154-item QFFQ was developed and pilot tested in the Arctic Inuit. The present study highlighted foods to be targeted for a nutritional and lifestyle intervention programme not previously undertaken in this population. This QFFQ is culturally appropriate and specific for evaluating the effectiveness of the programme, as well as monitoring nutritional transition in this population.

Dietary adequacy of Inuit in the Canadian Arctic.

BACKGROUND Food intake amongst Canadian Inuit is currently in transition with a concurrent increase in diet-related chronic disease. There is a lack of current data on nutrient intake and dietary adequacy in this population. The present study aimed to assess dietary intake and adequacy amongst Inuit adults in a community in Nunavut, Canada. METHODS Random sampling of 130 households in a remote Inuit community in the Kitikmeot region of Nunavut, Canada, was used for this cross-sectional study. Up to three 24-h dietary recalls were collected on nonconsecutive days, capturing weekday and weekend consumption. Data were analysed to estimate energy and nutrient intake, to determine dietary adequacy, and to summarise the most commonly reported foods and the top food contributors to selected nutrients. RESULTS The response rate was 69%, with 75 Inuit adults participating (mean (standard deviation (SD)) age 44 (SD=17) years). Mean (SD) daily energy intake was 9.3 (4.4) MJ and 8.7 (3.5) MJ for men and women, respectively. Intakes of dietary fibre, calcium, total folate and vitamins A, D and E were below the Dietary Reference Intakes (Estimated Average Requirements where available) for 60-100% of all men and women. Traditional foods contributed substantially to protein and iron intake, whilst shop-bought foods were primary contributors to total fat, carbohydrate and sugar intake. CONCLUSIONS The present study reports an in-depth assessment of total dietary quality amongst Inuit adults in Nunavut, Canada. The results obtained indicate inadequate intakes of several essential nutrients, as well as a reliance on a nontraditional diet. A nutrition intervention is needed to prevent a continued rise in diet-related chronic disease incidence.

Socioeconomic indicators and frequency of traditional food, junk food, and fruit and vegetable consumption amongst Inuit adults in the Canadian Arctic.

BACKGROUND Increasing consumption of non-nutrient-dense foods (NNDF), decreasing consumption of traditional foods (TF) and low consumption of fruit and vegetables (FV) may contribute to increasing chronic disease rates amongst Inuit. The present study aimed to assess the daily frequency and socioeconomic and demographic factors influencing consumption of TF, FV and NNDF amongst Inuit adults in Nunavut, Canada. METHODS Using a cross-sectional study design and random household sampling in three communities in Nunavut, a food frequency questionnaire developed for the population was used to assess frequency of NNDF, TF and FV consumption amongst Inuit adults. Socioeconomic status (SES) was assessed by education level, ownership of items in working condition, and whether or not people in the household were employed or on income support. Mean frequencies of daily consumption were compared across gender and age groups, and associations with socioeconomic indicators were analysed using logistic regression. RESULTS Two hundred and eleven participants (36 men, 175 women; mean (standard deviation) ages 42.1 (15.0) and 42.2 (13.2) years, respectively; response rate 69-93%) completed the study. Mean frequencies of consumption for NNDF, TF and FV were 6.3, 1.9 and 1.6 times per day, respectively. On average, participants ≤50 years consumed NNDF (P=0.003) and FV (P=0.01) more frequently and TF (P=0.01) less frequently than participants >50 years. Education was positively associated with FV consumption and negatively associated with TF consumption. Households on income support were more likely to consume TF and NNDF. CONCLUSIONS These results support the hypothesis that the nutrition transition taking place amongst Inuit in Nunavut results in elevated consumption of NNDF compared with TF and FV.

High levels of physical activity and obesity co-exist amongst Inuit adults in Arctic Canada.

BACKGROUND Existing evidence indicates that Inuit in Arctic Canada are undergoing a lifestyle transition leading to decreased physical activity (PA) and increased body mass index (BMI). Data specific to PA and BMI amongst Inuit in Nunavut, Canada, are currently limited. The present study aimed to characterise current PA and BMI levels in a sample of Inuit adults. METHODS Inuit adults randomly selected from a cross-sectional survey of three communities in Nunavut, Canada, completed an adapted International Physical Activity Questionnaire (IPAQ) and an anthropometric survey. Data were analysed by gender and age group using standardised IPAQ protocol. RESULTS Response rates ranged from 69-93%. Two hundred and eighteen Inuit adults [180 women, 38 men; mean (standard deviation (SD)) ages 42.3 (13.0) and 42.4 (14.8) years respectively; age range 19-89 years] completed the IPAQ. All men and 97% of women allowed height and weight measurements; the remainder were self-reported. Mean (SD) BMI was 27.7 (6.3) kg/m(2) for males and 30.3 (8.0) kg/m(2) for females. The largest proportion of women and participants in both age groups had a BMI in the obese category; males were evenly split between the normal and obese categories. Self-reported PA was high, with most men, women and participants ≤50 years in the high category of PA. Participants >50 years were evenly split across the medium and high categories. Most participants (72%) were classified as being overweight or obese, yet reported medium or high levels of PA (89%). CONCLUSIONS The findings obtained in the present study indicate the co-existence of high BMI and high self-reported PA amongst Inuit adults.

Healthy food intentions and higher socioeconomic status are associated with healthier food choices in an Inuit population

BACKGROUND Changing food behaviours amongst Canadian Inuit may contribute to rising chronic disease prevalence, and research is needed to develop nutritional behaviour change programmes. The present study examined patterns of food acquisition and preparation behaviours amongst Inuit adults in Nunavut and associations with psychosocial and socioeconomic factors. METHODS Developed from behavioural theories and community workshops, Adult Impact Questionnaires were conducted with adult Inuit (≥19 years) from randomly selected households in three remote communities in Nunavut, Canada, to determine patterns of healthy food knowledge, self-efficacy and intentions, frequencies of healthy and unhealthy food acquisition and healthiness of preparation methods. Associations between these constructs with demographic and socioeconomic factors were analysed using multivariate linear regressions. RESULTS Amongst 266 participants [mean (SD) age 41.2 (13.6) years; response rates 69-93%], non-nutrient-dense foods were acquired a mean (SD) of 2.9 (2.3) times more frequently than nutrient-dense, and/or low sugar/fat foods. Participants tended to use preparation methods that add fat. Intentions to perform healthy dietary behaviours was inversely correlated with unhealthy food acquisition (β=-0.25, P<0.001), and positively associated with healthy food acquisition (β=0.22, P<0.001) and healthiness of preparation methods (β=0.15, P=0.012). Greater healthy food knowledge and self-efficacy were associated with intentions (β=0.21, P=0.003 and β=0.55, P<0.001, respectively). Self-efficacy was associated with healthier preparation (β=0.14, P=0.025) and less unhealthy food acquisition (β=-0.27, P<0.001), whilst knowledge was associated with acquiring healthy foods (β=0.13, P=0.035). Socioeconomic status was positively associated with healthy preparation and food acquisition behaviours. CONCLUSIONS Interventions to improve diet in Nunavut Inuit should target healthy food intentions, knowledge and self-efficacy. Behaviour change strategies emphasising economic benefits of a healthy diet should be employed to target individuals of low socioeconomic status.

Participatory research for chronic disease prevention in inuit communities

OBJECTIVE To develop a community-based chronic disease prevention program for Inuit in Nunavut, Canada. METHODS Stake-holders contributed to intervention development through formative research (in-depth interviews (n = 45), dietary recalls (n = 42)), community workshops, group feedback and implementation training. RESULTS Key cultural themes included the perceived healthiness of country foods, food sharing, and importance of family. During community workshops, key problem foods for intervention were identified as well as healthier culturally and economically acceptable alternatives for these foods. Behaviors for promotion were identified and prioritized. CONCLUSIONS This approach resulted in project acceptance, stakeholder collaboration, and a culturally appropriate program in stores, worksites, and other community venues.

A Community-Based, Environmental Chronic Disease Prevention Intervention to Improve Healthy Eating Psychosocial Factors and Behaviors in Indigenous Populations in the Canadian Arctic:

Diet-related chronic diseases are highly prevalent among indigenous populations in the Canadian Arctic. A community-based, multi-institutional nutritional and lifestyle intervention—Healthy Foods North—was implemented to improve food-related psychosocial factors and behaviors among Inuit and Inuvialuit in four intervention communities (with two comparison communities) in Nunavut and the Northwest Territories, Canada, in 2008. The 12-month program was developed from theory (social cognitive theory and social ecological models), formative research, and a community participatory process. It included an environmental component to increase healthy food availability in local stores and activities consisting of community-wide and point-of-purchase interactive educational taste tests and cooking demonstrations, media (e.g., radio ads, posters, shelf labels), and events held in multiple venues, including recreation centers and schools. The intervention was evaluated using pre- and postassessments with 246 adults from intervention and 133 from comparison communities (311 women, 68 men; mean age 42.4 years; 78.3% retention rate). Outcomes included psychosocial constructs (healthy eating knowledge, self-efficacy, and behavioral intentions), frequency of healthy and unhealthy food acquisition, healthiness of commonly used food preparation methods, and body mass index (kg/m2). After adjustment for demographic, socioeconomic status, and body mass index variables, respondents living in intervention communities showed significant improvements in food-related self-efficacy (β = 0.15, p = .003) and intentions (β = 0.16, p = .001) compared with comparison communities. More improvements from the intervention were seen in overweight, obese, and high socioeconomic status respondents. A community-based, multilevel intervention is an effective strategy to improve psychosocial factors for healthy nutritional behavior change to reduce chronic disease in indigenous Arctic populations.

Eating habits of a population undergoing a rapid dietary transition: portion sizes of traditional and non-traditional foods and beverages consumed by Inuit adults in Nunavut, Canada

BackgroundTo determine the portion sizes of traditional and non-traditional foods being consumed by Inuit adults in three remote communities in Nunavut, Canada.MethodsA cross-sectional study was carried out between June and October, 2008. Trained field workers collected dietary data using a culturally appropriate, validated quantitative food frequency questionnaire (QFFQ) developed specifically for the study population.ResultsCaribou, muktuk (whale blubber and skin) and Arctic char (salmon family), were the most commonly consumed traditional foods; mean portion sizes for traditional foods ranged from 10 g for fermented seal fat to 424 g for fried caribou. Fried bannock and white bread were consumed by >85% of participants; mean portion sizes for these foods were 189 g and 70 g, respectively. Sugar-sweetened beverages and energy-dense, nutrient-poor foods were also widely consumed. Mean portion sizes for regular pop and sweetened juices with added sugar were 663 g and 572 g, respectively. Mean portion sizes for potato chips, pilot biscuits, cakes, chocolate and cookies were 59 g, 59 g, 106 g, 59 g, and 46 g, respectively.ConclusionsThe present study provides further evidence of the nutrition transition that is occurring among Inuit in the Canadian Arctic. It also highlights a number of foods and beverages that could be targeted in future nutritional intervention programs aimed at obesity and diet-related chronic disease prevention in these and other Inuit communities.

Nutrient intakes, major food sources and dietary inadequacies of Inuit adults living in three remote communities in Nunavut, Canada.

BACKGROUND Inuit in Nunavut, Canada, are currently undergoing a nutritional transition that may contribute to an increased prevalence of chronic disease. Information is lacking about the extent to which contemporary Inuit diets are meeting current dietary recommendations. METHODS A culturally appropriate quantitative food frequency questionnaire (QFFQ) developed and validated for Inuit in Nunavut, Canada, was used to assess food and nutrient intake in a cross-sectional sample of adults. RESULTS Participants included 175 women and 36 men with mean (SD) ages of 42.4 (13.2) and 42.1 (15.0) years, respectively. The response rate for those who completed the study was 79% with 208 QFFQs included for analysis. Reported mean daily energy intakes were: men 15,171 kJ (3626 kcal); women 11,593 kJ (2771 kcal). Dietary inadequacy was expressed as the percentage of participants reporting intakes below the sex- and age-specific estimated average requirements (EARs). For nutrients without EARs, adequate intakes were used. Energy and sodium intakes exceeded the recommendations. Less than 10% of participants met recommendations for dietary fibre intake. Vitamin E intakes were below EARs for ≥97% of participants, whereas >20% reported inadequate vitamin A, folate and magnesium intakes. Among women, >50% reported inadequate calcium and vitamin D intakes. Non-nutrient-dense foods contributed 30% of energy, 73% of sugars and 22% of fat. Traditional foods contributed 56% of protein and 49% of iron. CONCLUSIONS The present study demonstrates a relatively high prevalence of inadequate nutrient intakes among Inuit. The results may be used to monitor the nutrition transition among Inuit, evaluate nutritional interventions, and inform public health policy decision-making.

Dietary Adequacy of Vitamin D and Calcium among Inuit and Inuvialuit Women of Child-Bearing Age in Arctic Canada: A Growing Concern

Background Arctic populations are at an increased risk of vitamin D inadequacy due to geographic latitude and a nutrition transition. This study aimed to assess the adequacy of dietary vitamin D and calcium among women of child-bearing age in Arctic Canada. Methods This study collected data from 203 randomly selected women of child-bearing age (19-44 years) in Nunavut and the Northwest Territories of Arctic Canada. Cross-sectional surveys using a validated quantitative food frequency questionnaire were analysed to determine the dietary adequacy of vitamin D and calcium and summarize the top foods contributing to vitamin D and calcium intake among traditional food eaters (TFE) and non-traditional food eaters (NTFE). Results The response rate was between 69-93% depending on the community sampled. Mean BMIs for both TFE and NTFE were above the normal range. Traditional food eaters had a significantly higher median vitamin D intake compared with non-traditional eaters (TFE = 5.13±5.34 µg/day; NTFE = 3.5±3.22 µg/day, p = 0·004). The majority of women (87%) were below the Estimated Average Requirements (EAR) for vitamin D. Despite adequate median daily calcium intake in both TFE (1299±798 mg/day) and NTFE (992±704 mg/day; p = 0.0005), 27% of the study population fell below the EAR for calcium. Dairy products contributed the most to intake of vitamin D (TFE = 30.7%; NTFE = 39.1%) and calcium (TFE = 25.5%; NTFE = 34.5%). Conclusions Inadequate dietary vitamin D intake is evident among Inuit and Inuvialuit women of child-bearing age in Arctic Canada. Promotion of nutrient-rich sources of traditional foods, supplementation protocols and/or expanded food fortification should be considered to address this nutrition concern.