Tony Sheehy

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.

Food patterns and socioeconomic indicators of food consumption amongst Inuvialuit in the Canadian Arctic.

BACKGROUND Inuvialuit in the Canadian Arctic have been experiencing a nutrition transition resulting in a decrease in nutrient-dense food consumption, which may, in part, explain this populations increasing chronic disease rates. Because the available literature is limited, the present study aimed to document the extent of this transition by examining current dietary patterns and socioeconomic factors affecting food group consumption. METHODS This cross-sectional study was conducted in three Inuvialuit communities in the Northwest Territories between 2007 and 2008. A validated food frequency questionnaire determined intake frequency of fruit and vegetables (FV), traditional foods (TF) and non-nutrient-dense foods (NNDF). Socioeconomic status (SES) was assessed by questions on education, ownership of items in working condition used to create a Material Style of Life (MSL) scale and residents in household employed/on income support. Daily intake frequencies were compared by gender and age group using Wilcoxon rank sum test. SES association with food group intake was determined using logistic regression. RESULTS The response rate was 65-85%. One hundred and seventy-five participants were female and 55 were male, aged 19-84 years [mean (SD) 44 (14)]. Mean frequencies of FV and TF consumption were 1.6 (1.5) and 1.6 (1.7) times per day, respectively. NNDF were reported 9.2 (3.0) times per day. The highest MSL score (>12) was significantly associated with higher fruit (≥0.7 times per day) and higher TF intake (≥1.1 times per day) compared with the lowest score (≤7). An intermediate MSL score (8-12) was related to higher vegetable consumption (≥0.4 times per day). CONCLUSIONS NNDF were consumed approximately seven times more frequently than TF in the present study, indicating that the dietary transition is well underway amongst Inuvialuit. Participants with higher SES were more likely to consume nutrient-dense foods, suggesting possible cost barriers.

Assessment of dietary adequacy in a remote Inuvialuit population

BACKGROUND Traditional foods are rich sources of essential nutrients, but Inuvialuit in the Northwest Territories (NWT), Canada, have been undergoing a nutrition transition, characterised by an increased consumption of non-nutrient-dense foods. The present study aimed to characterise energy, nutrient and food intakes amongst adult Inuvialuit. METHODS The study collected up to three 24-h dietary recalls on nonconsecutive days for each participant in spring/summer of 2008 in one remote community in the NWT. Recall data were analysed for energy and nutrient intake, dietary adequacy, most commonly reported foods, and food contributors to energy and nutrients. RESULTS Participants included 14 men and 50 women (response rate 79%). Median daily energy intake was 9.4 (interquartile range=5.7) MJ for men and 8.3 (3.6) MJ for women. The majority of adult Inuvialuit did not meet the recommendation for vitamins A [median intake=344.7 (246.3) μg-RAE in men, 248.9 (213.8) μg-RAE in women], B(6) [0.9 (0.8) mg in men, 1.0 (0.5) mg in women] and E [2.4 (2.1) mg in men, 1.8 (1.0) mg in women], dietary fibre [7.7 (5.7) g in men, 8.7 (4.4) g in women], calcium [779.6 (842.0) mg in men, 610.4 (431.5) mg in women] and total folate [222.6 (57.7) μg in men, 264.6 (127.5) μg in women]. Vitamin D intake was below the recommendation for most women [median intake=100.0 (119.2) IU]. Traditional foods contributed substantially to protein and iron intake. Juices were the main contributors to energy, carbohydrate and calcium. CONCLUSIONS The present study revealed an inadequate consumption of essential nutrients in an Inuvialuit population. If these nutrient deficiencies continue, this population will face an increased burden of chronic diseases and malnutrition.

Vitamin D deficiency and disease risk among aboriginal Arctic populations

Aboriginal populations living above the Arctic Circle are at particularly high risk of vitamin D deficiency due to limited ultraviolet B exposure (related to geographic latitude) and inadequate dietary intake (recently related to decreased traditional food consumption). Major changes in diet and lifestyle over the past 50 years in these populations have coincided with increased prevalence rates of rickets, cancer, diabetes, and obesity, each of which may be associated with vitamin D inadequacy. This review examines the risk factors for vitamin D inadequacy, the associations between vitamin D and disease risk at high geographic latitudes, and the recommendations for improving vitamin D status particularly among aboriginal Arctic populations. Traditional foods, such as fatty fish and marine mammals, are rich sources of vitamin D and should continue to be promoted to improve dietary vitamin D intake. Supplementation protocols may also be necessary to ensure adequate vitamin D status in the Arctic.

Contribution of meat to vitamin B12, iron and zinc intakes in five ethnic groups in the USA: implications for developing food‐based dietary guidelines

BACKGROUND To describe the sources of meat and their contributions to vitamin B₁₂, iron and zinc in five ethnic groups in the USA. METHODS Dietary data for the Multiethnic Cohort, established in Hawaii and Los Angeles, were collected using a quantitative food frequency questionnaire from more than 215,000 subjects, aged 45-75 years at baseline (1993-1996). Participants included African American, Latino, Japanese American, Native Hawaiian and Caucasian men and women. Servings of meat items were calculated based on the US Department of Agriculture recommendations and their contributions to intakes of total meat, red meat, vitamin B₁₂, iron and zinc were determined. RESULTS Of all types of meat, poultry contributed the most to meat consumption, followed by red meat and fish among all ethnicities, except for Latino (born in Mexico and Central/South America) men who consumed more beef. Lean beef was the most commonly consumed red meat for all ethnic-sex groups (9.3-14.3%), except for Native Hawaiian and Japanese American men, and Japanese American women whose top contributor was stew/curry with beef/lamb and stir-fried beef/pork with vegetables, respectively. The contribution of meat was most substantial for zinc (11.1-29.3%) and vitamin B₁₂ (19.7-40%) and, to a lesser extent, for iron (4.3-14.2%). CONCLUSIONS This is the first large multiethnic cohort study to describe meat sources and their contributions to selected nutrients among ethnic minorities in the USA. These findings may be used to develop ethnic-specific recommendations for meat consumption aiming to improve dietary quality among these groups.

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.

Ethnic differences in grains consumption and their contribution to intake of B-vitamins: results of the Multiethnic Cohort Study.

BackgroundResearch indicates that a diet rich in whole grains may reduce the risk of prevalent chronic diseases, including cardiovascular disease, diabetes, and some cancers, and that risk for these diseases varies by ethnicity. The objective of the current study was to identify major dietary sources of grains and describe their contribution to B vitamins in five ethnic groups.MethodsA cross-sectional mail survey was used to collect data from participants in the Multiethnic Cohort Study in Hawaii and Los Angeles County, United States, from 1993 to 1996. Dietary intake data collected using a quantitative food frequency questionnaire was available for 186,916 participants representing five ethnic groups (African American, Latino, Japanese American, Native Hawaiian and Caucasian) aged 45–75 years. The top sources of grain foods were determined, and their contribution to thiamin, riboflavin, niacin, vitamin B6, and folic acid intakes were analyzed.ResultsThe top source of whole grains was whole wheat/rye bread for all ethnic-sex groups, followed by popcorn and cooked cereals, except for Native Hawaiian men and Japanese Americans, for whom brown/wild rice was the second top source; major contributors of refined grains were white rice and white bread, except for Latinos. Refined grain foods contributed more to grain consumption (27.1-55.6%) than whole grain foods (7.4-30.8%) among all ethnic-sex groups, except African American women. Grain foods made an important contribution to the intakes of thiamin (30.2-45.9%), riboflavin (23.1-29.2%), niacin (27.1-35.8%), vitamin B6 (22.9-27.5%), and folic acid (23.3-27.7%).ConclusionsThis is the first study to document consumption of different grain sources and their contribution to B vitamins in five ethnic groups in the U.S. Findings can be used to assess unhealthful food choices, to guide dietary recommendations, and to help reduce risk of chronic diseases in these populations.

The nutrition transition in Barbados: trends in macronutrient supply from 1961 to 2003.

Barbados has been experiencing increasing rates of obesity and chronic non-communicable diseases characteristic of a country in nutrition transition. However, few studies have been carried out on how precisely the diet has changed in recent decades. Our aim was to analyse the FAO food balance sheets for Barbados from 1961 to 2003 in order to characterise the changes that have taken place in the macronutrient supply of the country during that period. Annual food balance sheets were downloaded from the FAOSTAT database, and per capita supply for twelve commodity groupings was analysed for energy and macronutrient levels using WISP dietary analysis software (Tinuviel Software, Llanfechell, Anglesey, UK). The food supply in 2003 provided over 2500 kJ (about 600 kcal) more energy per capita per d than it did in 1961. Energy from carbohydrate as a percentage of total energy has fallen from 70% in 1961 to 57% in 2003 and is now at the lower end of WHO recommendations. Energy from fat as a percentage of total energy increased from 19% to 28% and now lies at the upper end of WHO recommendations. Sugars, at over 17% of dietary energy, are well above the upper limit set by the WHO. Despite having methodological limitations associated with the use of food balance statistics, our data suggest that these imbalances need to be addressed as a matter of priority in order to try to reverse the incidence of nutrition-related chronic diseases that are projected to cause increasing disability and premature death in the country in the coming years.

Sources of vegetables, fruits and vitamins A, C and E among five ethnic groups: Results from a multiethnic cohort study

Objectives:Data are limited on how dietary sources of food and nutrients differ among ethnic groups. The objective of this study was to determine the main sources of fruit, vegetables and vitamins A, C and E for five ethnic groups.Subjects/methods:Dietary data were collected using a validated quantitative food frequency questionnaire from participants in a multiethnic cohort in Hawaii and Los Angeles county between 1993 and 1996. Data were analyzed for 186 916 participants representing five ethnic groups: African-Americans, Japanese-Americans, native Hawaiians, Latinos and Caucasians.Results:Lettuce was the most consumed vegetable (6.0–9.9%) in all ethnic–sex groups, except among African-American women and Mexican-born Latino men and women. Oranges and bananas contributed more than one-quarter to total fruit intake among all groups. Overall, more ethnic variation in food choices was observed for the top 10 vegetables than for fruits. The top sources of vitamins A, C and E were carrots, orange/grapefruit/pomelo and combined dishes, respectively. Among the micronutrients studied, the greatest ethnic variation in foods consumed was observed for the top 10 food sources of vitamin A.Conclusions:This is the first study providing data on the main types of fruit and vegetables consumed and the major sources of vitamins A, C and E among these ethnic groups in the U.S. Such data are valuable for developing and implementing public health strategies to meet the USDA dietary recommendations and for guiding ethnicity-specific nutrition education and intervention programs.

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.