Intake of carbohydrates and SFA and risk of CHD in middle-age adults: the Hordaland Health Study (HUSK).

OBJECTIVE: Limiting SFA intake may minimise the risk of CHD. However, such reduction often leads to increased intake of carbohydrates. We aimed to evaluate associations and the interplay of carbohydrate and SFA intake on CHD risk. DESIGN: Prospective cohort study. SETTING: We followed participants in the Hordaland Health Study, Norway from 1997-1999 through 2009. Information on carbohydrate and SFA intake was obtained from a FFQ and analysed as continuous and categorical (quartiles) variables. Multivariable Cox regression estimated hazard ratios (HR) and 95 % CI. Theoretical substitution analyses modelled the substitution of carbohydrates with other nutrients. CHD was defined as fatal or non-fatal CHD (ICD9 codes 410-414 and ICD10 codes I20-I25). PARTICIPANTS: 2995 men and women, aged 46-49 years. RESULTS: Adjusting for age, sex, energy intake, physical activity and smoking, SFA was associated with lower risk (HRQ4 v. Q1 0·44, 95 % CI 0·26, 0·76, Ptrend = 0·002). For carbohydrates, the opposite pattern was observed (HRQ4 v. Q1 2·10, 95 % CI 1·22, 3·63, Ptrend = 0·003). SFA from cheese was associated with lower CHD risk (HRQ4 v. Q1 0·44, 95 % CI 0·24, 0·83, Ptrend = 0·006), while there were no associations between SFA from other food items and CHD. A 5 E% substitution of carbohydrates with total fat, but not SFA, was associated with lower CHD risk (HR 0·75, 95 % CI 0·62, 0·90). CONCLUSIONS: Higher intake of predominantly high glycaemic carbohydrates and lower intake of SFA, specifically lower intake from cheese, were associated with higher CHD risk. Substituting carbohydrates with total fat, but not SFA, was associated with significantly lower risk of CHD.

Evaluation of incomplete maternal smoking data using machine learning algorithms: a study from the Medical Birth Registry of Norway.

BACKGROUND: The Medical Birth Registry of Norway (MBRN) provides national coverage of all births. While retrieval of most of the information in the birth records is mandatory, mothers may refrain to provide information on her smoking status. The proportion of women with unknown smoking status varied greatly over time, between hospitals, and by demographic groups. We investigated if incomplete data on smoking in the MBRN may have contributed to a biased smoking prevalence. METHODS: In a study population of all 904,982 viable and singleton births during 1999-2014, we investigated main predictor variables influencing the unknown smoking status of the mothers' using linear multivariable regression. Thereafter, we applied machine learning to predict annual smoking prevalence (95% CI) in the same group of unknown smoking status, assuming missing-not-at-random. RESULTS: Overall, the proportion of women with unknown smoking status was 14.4%. Compared to the Nordic country region of origin, women from Europe outside the Nordic region had 15% (95% CI 12-17%) increased adjusted risk to have unknown smoking status. Correspondingly, the increased risks for women from Asia was 17% (95% CI 15-19%) and Africa 26% (95% CI 23-29%). The most important machine learning prediction variables regarding maternal smoking were education, ethnic background, marital status and birth weight. We estimated a change from the annual observed smoking prevalence among the women with known smoking status in the range of - 5.5 to 1.1% when combining observed and predicted smoking prevalence. CONCLUSION: The predicted total smoking prevalence was only marginally modified compared to the observed prevalence in the group with known smoking status. This implies that MBRN-data may be trusted for health surveillance and research.

Low Calcium Intake in Midpregnancy Is Associated with Hypertension Development within 10 Years after Pregnancy: The Norwegian Mother and Child Cohort Study.

Background: Low dietary calcium intake may be a risk factor for hypertension, but studies conflict.Objective: We evaluated the ability to predict hypertension within 10 y after delivery based on calcium intake during midpregnancy.Methods: The Norwegian Mother and Child Cohort Study of women delivering in 2004-2009 was linked to the Norwegian Prescription Database (2004-2013) to ascertain antihypertensive medication usage >90 d after delivery. Women with hypertension before pregnancy were excluded, leaving 60,027 mothers for analyses. Age and energy-adjusted cubic splines evaluated dose-response curves, and Cox proportional hazard analyses evaluated HR and 95% CIs by calcium quartiles adjusting for 7 covariates. Analyses were stratified by gestational hypertension and by sodium-to-potassium intake ratio (<0.76 compared with ≥0.76).Results: Participants had a mean ± SD age of 30.5 ± 4.6 y, a body mass index (in kg/m2) of 24.0 ± 4.3 before pregnancy, and a mean follow-up duration of 7.1 ± 1.6 y. Cubic spline graphs identified a threshold effect of low calcium intake only within the range of dietary inadequacy related to increased risk. The lowest calcium quartile (≤738 mg/d; median: 588 mg/d), relative to the highest quartile (≥1254 mg/d), had an HR for hypertension of 1.34 (95% CI: 1.05, 1.70) among women who were normotensive during pregnancy, and an HR of 1.62 (95% CI: 1.14, 2.35) among women who had gestational hypertension, after adjusting for covariates. Women with gestational hypertension, who were in the lowest quartile of calcium intake, and who had a high sodium-to-potassium intake ratio had a risk of hypertension more than double that of their counterparts with a calcium intake in the highest quartile. Results were attenuated by adjusting for covariates (HR: 1.92; 95% CI: 1.09, 3.39).Conclusions: The results suggest that low dietary calcium intake may be a risk factor or risk marker for the development of hypertension, particularly for women with a history of gestational hypertension.

Development of Social and Demographic Differences in Maternal Smoking Between 1999 and 2014 in Norway.

INTRODUCTION: The Medical Birth Registry of Norway provides national coverage of all births in Norway. In this study trends of smoking at the beginning of pregnancy and the variation of these trends across different sociodemographic groups are analyzed. This knowledge is important for planning interventions both in the general population and specifically among pregnant women. METHODS: All births registered in Medical Birth Registry of Norway 1999-2014 with information on mothers' smoking status were included in the overall analyses of the smoking trends (806 298). Records from 210 268 births in two time periods 1999-2000 and 2013-2014 were selected, and for the multivariate analyses we used general linear models to provide adjusted risk ratios. RESULTS: The prevalence of maternal smoking at the beginning of pregnancy decreased from 25% to 8% over the 15-year period. Mothers with low, medium, and high education, respectively, had a 46% (RR 0.54, CI 0.52-0.55), 62% (RR 0.38, CI 0.37-0.40), and 80% (RR 0.20, CI 0.19-0.22) reduction in maternal smoking between the two time periods. Similarly, the decline in smoking was greater for mothers who were married or living together (64%; RR 0.36, CI 0.35-0.37) than for single mothers (39%; RR 0.61, CI 0.58-0.64). Immigrants had a lower smoking prevalence than Norwegians in the entire period 1999-2014. CONCLUSION: The prevalence of smoking during pregnancy in Norway decreased in all population groups, but the relative differences between the educational groups increased from 1999-2000 to 2013-2014. This is a public health concern and a strong contributor to health disparities. IMPLICATIONS: Women with low and medium education level and single mothers had the highest smoking prevalence and the lowest decline over the two time periods. These groups constitute 45% of our study population, the relatively high maternal smoking in these groups continues to be of public health concern for maternal and child health.

Educational inequalities in mortality of patients with atrial fibrillation in Norway.

OBJECTIVES: We explored the educational gradient in mortality in atrial fibrillation (AF) patients. DESIGN: We prospectively followed patients hospitalized with AF as primary discharge diagnosis in the Cardiovascular Disease in Norway 2008-2012 project. The average length of follow-up was 2.4 years. Mortality by educational level was assessed by Cox proportional hazard models. Population attributable fractions (PAF) were calculated. Analyses stratified by age (≤75 and >75 years of age), and adjusted for age, gender, medical intervention, and Charlson Comorbidity Index. RESULTS: Of 42,138 AF patients, 16% died by end of 2012. Among younger patients, those with low education (≤10 years) had a HR of 2.3 (95% confidence interval 2.0, 2.6) for all-cause mortality relative to those with any college or university education. Similar results were observed for cardiovascular mortality. Disparities in mortality were greater among younger than older patients. A PAF of 35.9% (95% confidence interval 27.9, 43.1) was observed for an educational level of high school/vocational school or less versus higher education in younger patients. CONCLUSIONS: Increasing educational level associated with better prognosis suggesting underlying education-related behavioral and medical determinants of mortality. A considerable proportion of mortality within 5 years following hospital discharge could be prevented.

High protein and cholesterol intakes associated with emergence of glucose intolerance in a low-risk Canadian Inuit population.

OBJECTIVE: The rate of type 2 diabetes mellitus among Inuit is 12·2 % in individuals over 50 years of age, similar to the Canadian prevalence. Given marked dietary transitions in the Arctic, we evaluated the dietary and other correlates of not previously diagnosed glucose intolerance, defined as type 2 diabetes mellitus, impaired fasting glucose or impaired glucose tolerance. DESIGN: Cross-sectional analyses were limited to adults with a completed 2 h oral glucose tolerance test and without pre-existing diabetes. Anthropometric assessments, health and medication usage questionnaires and a 24 h dietary recall were administered. SETTING: Canadian International Polar Year Inuit Health Survey (2007-2008). SUBJECTS: Inuit adults (n 777). RESULTS: Glucose intolerance was associated with older age and adiposity. Percentage of energy from protein above the Acceptable Macronutrient Distribution Range of 35 %, compared with intake within the range, was associated with increased odds of glucose intolerance (OR=1·98; 95 % CI 1·09, 3·61) in multivariable analyses. Further, cholesterol intake in the highest three quartiles combined (median exposures of 207, 416 and 778 mg/d, respectively) compared with the lowest quartile (median intake of 81 mg/d) was associated with glucose intolerance (OR=2·15; 95 % CI 1·23, 3·78) in multivariable analyses. Past-day traditional food consumption was borderline protective of glucose intolerance (P=0·054) and high fibre intake was not significantly protective (P=0·08). CONCLUSIONS: The results contribute to the existing literature on high protein and cholesterol intakes as they may relate to diabetes risk.

Development of radio dramas for health communication pilot intervention in Canadian Inuit communities.

A mixed-methods approach was used to develop a culturally appropriate health intervention over radio within the Inuit community of Pangnirtung, Nunavut (NU), Canada. The radio dramas were developed, recorded and tested pre-intervention through the use of Participatory Process and informed by the extended elaboration likelihood model (EELM) for education-communication. The radio messages were tested in two focus groups (n = 4 and n = 5) to determine fidelity of the radio dramas to the EELM theory. Focus group feedback identified that revisions needed to be made to two characteristics required of educational programmes by the EELM theorem: first, the quality of the production was improved by adding Inuit youth recorded music and second, the homophily (relatability of characters) of radio dramas was improved by re-recording the dramas with voices of local youth who had been trained in media communication studies. These adjustments would not have been implemented had pre-intervention testing of the radio dramas not taken place and could have reduced effectiveness of the overall intervention. Therefore, it is highly recommended that media tools for health communication/education be tested with the intended target audience before commencement of programmes. Participatory Process was identified to be a powerful tool in the development and sustainability of culturally appropriate community health programming.

Socioeconomic and Cultural Correlates of Diet Quality in the Canadian Arctic: Results from the 2007-2008 Inuit Health Survey.

PURPOSE: We examined the impact of socioeconomic and cultural factors on dietary quality in adult Inuit living in the Canadian Arctic. METHODS: Interviews and a 24-h dietary recall were administered to 805 men and 1292 women from Inuit regions in the Canadian Arctic. We examined the effect of age, sex, education, income, employment, and cultural variables on respondents' energy, macronutrient intake, sodium/potassium ratio, and healthy eating index. Logistic regression was used to assess the impact of socioeconomic status (SES) on diet quality indicators. RESULTS: Age was positively associated with traditional food (TF) consumption and greater energy from protein but negatively associated with total energy and fibre intake. Associations between SES and diet quality differed considerably between men and women and there was considerable regional variability in diet quality measures. Age and cultural variables were significant predictors of diet quality in logistic regression. Increased age and use of the Inuit language in the home were the most significant predictors of TF consumption. CONCLUSIONS: Our findings are consistent with studies reporting a nutrition transition in circumpolar Inuit. We found considerable variability in diet quality and complex interaction between SES and cultural variables producing mixed effects that differ by age and gender.

Intake of different types of seafood and meat and risk of type 2 diabetes in women: a prospective study supported by a dietary intervention in mice.

Detailed knowledge regarding the associations between intake of different types of seafood and meat and the risk of type 2 diabetes (T2D), and insight into possible mechanisms are warranted. In this study we aimed to evaluate the associations between intake of different types of seafood and meat and the subsequent risk of T2D using the Norwegian Mother, Father, and Child Cohort Study (MoBa), and furthermore, by using a mouse model to gain further insight into possible molecular mechanisms contributing to the associated metabolic changes. Women in MoBa who were free of pharmacologically treated diabetes at baseline (n = 60,777) were prospectively evaluated for incident T2D, identified on the basis of medication usages > 90 days after delivery, ascertained by the Norwegian Prescription Database. Dietary intake was obtained with a validated 255-item food frequency questionnaire which assessed habitual diet during the first 4-5 months of pregnancy. Metabolic phenotypes and plasma metabolome were investigated in female mice fed isocaloric diets with different types of seafood and meat mimicking the dietary intake in the human cohort. During maximum 10-year and mean (SD) 7.2 (1.6) years follow-up time, 681 (1.1%) women developed pharmacologically treated T2D. All statistical models identified a higher risk of T2D with increased shellfish intake, whereas no associations were observed for total seafood, fatty fish, total meat and red meat in the adjusted models. In mice, the shellfish-based western diet induced reduced glucose tolerance and insulin secretion compared to the diet based on lean fish, and we identified a number of metabolites elevated in plasma from shellfish-fed mice that correlated with glucose intolerance. Mice fed a western diet based on meat also exhibited reduced glucose tolerance in comparison to lean fish fed mice, whereas mice fed fatty fish, total seafood or red meat did not differ from lean fish fed mice. We observed a diet-specific metabolic signature in plasma demonstrating five distinct metabolite profiles in mice fed shellfish, fatty fish, total seafood/lean fish, a mixed diet and meat. In conclusion, these findings demonstrate that different types of seafood have different outcome on T2D risk. In women, intake of shellfish was associated with higher risk of T2D. In female mice, a shellfish enriched diet reduced glucose tolerance and altered the abundance of several distinct plasma metabolites correlating with glucose tolerance.

New insights regarding tissue Se and Hg interactions on oxidative stress from plasma IsoP and IsoF measures in the Canadian Inuit population.

Despite animal and in vitro studies demonstrating pro-oxidative effects of Hg, previous human work showed no relationship between tissue Hg and plasma levels of F2-isoprostanes (IsoPs), a whole-body oxidative stress marker. We hypothesized that another IsoP species, isofurans (IsoFs), was a more sensitive indicator of Hg-mediated oxidative stress, which can be modified by tissue Se status. A cross-sectional study was carried out involving individuals from a random subset (n = 233) of Inuit adults from a population-based survey (n = 2,595) of 36 Canadian Arctic Inuit communities to assess the relationships of plasma IsoPs to Se and Hg status indicators. F2-IsoPs were inversely correlated with blood Se (r = -0.186, P = 0.005) and toenail Se (r = -0.146, P = 0.044), but not correlated with Hg. IsoFs were inversely correlated with blood Se (r = -0.164, P = 0.014) and positively correlated with Hg (r = 0.228, P < 0.001) and Hg:Se (r = 0.340, P < 0.001). The strength of the correlations remained unchanged after multivariate adjustments. Multivariate analysis showed that F2-IsoPs were not positively associated with Hg but with Hg:Se (ß = 0.148, P = 0.021). We conclude that Se and Hg status and their interactions are important factors modulating F2-IsoP and IsoF levels such that the Inuit may be protected from Hg-induced oxidative stress because of their high Se status.

Dietary advice on Inuit traditional food use needs to balance benefits and risks of mercury, selenium, and n3 fatty acids.

Elevated concentrations of mercury (Hg) are commonly found in the traditional foods, including fish and marine mammals, of Inuit living in Canada's Arctic. As a result, Inuit often have higher dietary Hg intake and elevated Hg blood concentrations. However, these same traditional foods are excellent sources of essential nutrients. The goals of this study were 1) to identify the traditional food sources of Hg exposure for Inuit, 2) to estimate the percentage of Inuit who meet specific nutrient Dietary Reference Intakes and/or exceed the Toxicological Reference Values (TRVs), and 3) to evaluate options that maximize nutrient intake while minimizing contaminant exposure. A participatory cross-sectional survey was designed in consultation with Inuit in 3 Canadian Arctic jurisdictions (Nunatsiavut, Nunavut, and the Inuvialuit Settlement Region). Estimated intakes for EPA (20:5n3) and DHA (22:6n3) met suggested dietary targets, and estimated selenium (Se) intake fell within the Acceptable Range of Oral Intake. Estimated intakes of Hg (rs = 0.41, P < 0.001), Se (rs = 0.44, P < 0.001), EPA (rs = 0.32, P < 0.001), and DHA (rs = 0.28, P < 0.001) were correlated with their respective blood concentrations. Mean estimated Hg intake (7.9 µg · kg(-1) · wk(-1)) exceeded the TRV of 5.0 µg · kg(-1) · wk(-1), with 35% of the population above this guideline. Because the estimated intakes of each of the nutrients were strongly correlated (Se: rs = 0.92, P < 0.001; EPA: rs = 0.82, P < 0.001; DHA: rs = 0.81, P < 0.001) with estimated Hg intake, efforts to decrease Hg exposure must emphasize the overall healthfulness of traditional foods and be designed to prevent concomitant harm to the nutrient intakes of Inuit.

Higher n3-fatty acid status is associated with lower risk of iron depletion among food insecure Canadian Inuit women.

BACKGROUND: High rates of iron deficiency and anemia are common among Inuit and Arctic women despite a traditional diet based on animal source foods. However, representative data on iron status and relevant determinants for this population are lacking. The objectives were to determine the prevalence of anemia and depletion of iron stores, then to identify correlates of iron status in non-pregnant Canadian Inuit women. METHODS: In a cross-sectional survey of 1550 women in the International Polar Year Inuit Health Survey, 2007-2008, hemoglobin, serum ferritin, soluble transferrin receptor (on a subset), C-reactive protein (CRP), RBC fatty acid composition, and H pylori serology were analyzed on fasting venous blood. Sociodemographic, food security status, anthropometric, dietary, and health data were collected. Correlates of iron status were assessed with multivariate linear and logistic models. RESULTS: Anemia was observed in 21.7% and iron deficient erythropoiesis in 3.3% of women. For women with CRP ≤ 10 mg/L (n = 1260) 29.4% had depleted iron stores. Inadequate iron intakes were observed in 16% of premenopausal and <1% of postmenopausal women. Among food insecure women, higher long-chain (n-3) polyunsaturated fatty acid (LC-PUFA) status, which reflects a more traditional food pattern, was associated with reduced risk of iron depletion. CONCLUSIONS: Iron depletion and anemia are a concern for Inuit women despite adequate total dietary iron intake primarily from heme sources. The high prevalence of H. pylori exposure, together with dietary iron adequacy, suggests an inflammation-driven iron deficiency and mild anemia. The anti-inflammatory properties of LC-PUFA may be important for iron status in this population.

Fetal Exposure to Preeclampsia and Later Risk of Cardiometabolic Disorders: A Population-Based Cohort Study.

BACKGROUND: Fetal preeclampsia exposure has been associated with later cardiometabolic disease. However, this association has been investigated in few large population-wide studies, and it is unknown whether the association represents a causal relationship or is the result of shared etiological factors. METHODS: To further investigate the relationship between preeclampsia exposure and later cardiometabolic disease, we identified 1 692 944 singleton infants born in Norway during 1967 to 1997, where 44 299 were exposed to preeclampsia in utero. The individuals were followed for hypertension, diabetes, and dyslipidemia as defined by dispensed medication. We used Cox regression models to calculate the association between preeclampsia exposure and cardiometabolic outcomes adjusting for measured confounders. We also used full sibling comparisons and stratified Cox regression to control for unmeasured familial confounders. RESULTS: On the population level, exposed individuals had increased risk of hypertension (adjusted hazard ratio [aHR] 1.51 [95% CI, 1.41-1.63]), diabetes (aHR 1.33 [95% CI, 1.24-1.43], and dyslipidemia (aHR 1.28 [95% CI, 1.13-1.45]) compared with unexposed individuals. In sibling data, individuals not exposed to preeclampsia, but with an exposed sibling, had higher risk of hypertension and diabetes than individuals where no siblings were exposed to preeclampsia. Moreover, when comparing siblings discordant on preeclampsia exposure, there were no associations between preeclampsia and hypertension (aHR 1.05 [95% CI, 0.88-1.26]), diabetes (aHR 0.96 [95% CI, 0.80-1.14]), and dyslipidemia (aHR 0.86 [95% CI, 0.62-1.20]). CONCLUSIONS: Fetal preeclampsia exposure was associated with adult life hypertension, diabetes, and dyslipidemia, but these associations were likely due to shared etiological factors, rather than exposure to the preeclamptic condition itself.

Low serum magnesium concentrations are associated with a high prevalence of premature ventricular complexes in obese adults with type 2 diabetes.

BACKGROUND: Premature ventricular complexes (PVC) predict cardiovascular mortality among several adult populations. Increased arrhythmia prevalence has been reported during controlled magnesium (Mg) depletion studies in adults. We thus hypothesized that serum magnesium (sMg) concentrations are inversely associated with the prevalence of PVC in adults at high cardiovascular risk. METHODS: Anthropometric, demographic and lifestyle characteristics were assessed in 750 Cree adults, aged > 18 yrs, who participated in an age-stratified, cross-sectional health survey in Quebec, Canada. Holter electrocardiograms recorded heart rate variability and cardiac arrhythmias for two consecutive hours. Multivariate logistic regression was used to evaluate the associations between sMg and PVC. RESULTS: PVC prevalence in adults with hypomagnesemia (sMg ≤ 0.70 mmol/L) was more than twice that of adults without hypomagnesemia (50% vs. 21%, p = 0.015); results were similar when adults with cardiovascular disease history were excluded. All hypomagnesemic adults with PVC had type 2 diabetes (T2DM). Prevalence of PVC declined across the sMg concentration gradient in adults with T2DM only (p < 0.001 for linear trend). In multivariate logistic regressions adjusted for age, sex, community, body mass index, smoking, physical activity, alcohol consumption, kidney disease, antihypertensive and cholesterol lowering drug use, and blood docosahexaenoic acid concentrations, the odds ratio of PVC among T2DM subjects with sMg > 0.70 mmol/L was 0.24 (95% CI: 0.06-0.98) p = 0.046 compared to those with sMg ≤ 0.70 mmol/L. CONCLUSIONS: sMg concentrations were inversely associated with the prevalence of PVC in patients with T2DM in a dose response manner, indicating that suboptimal sMg may be a contributor to arrhythmias among patients with T2DM.

The prevalence of food insecurity is high and the diet quality poor in Inuit communities.

Indigenous peoples experience a disproportionate burden of food insecurity and the Arctic is no exception. We therefore evaluated the prevalence, socio-demographic, and dietary correlates of food insecurity in the most comprehensive assessment of food insecurity in Arctic Canada. A cross-sectional survey of 1901 Inuit households was conducted in 2007-2008. Measurements included food insecurity, 24-h dietary recalls, socio-demographics, and anthropometry. Food insecurity was identified in 62.6% of households (95% CI = 60.3-64.9%) with 27.2% (95% CI = 25.1-29.3%) of households severely food insecure. The percent with an elevated BMI, waist circumference, and percent body fat was lower among individuals from food insecure households compared to food secure households (P ≤ 0.001). Adults from food insecure households had a significantly lower Healthy Eating Index score and consumed fewer vegetables and fruit, grains, and dairy products, and consumed a greater percent of energy from high-sugar foods than adults from food secure households (P ≤ 0.05). Food insecurity was associated with household crowding, income support, public housing, single adult households, and having a home in need of major repairs (P ≤ 0.05). The prevalence of having an active hunter in the home was lower in food insecure compared to food secure households (P ≤ 0.05). Food insecurity prevalence is high in Inuit communities, with implications for diet quality that over the long-term would be anticipated to exacerbate the risk of diet-related chronic diseases. Actions are required to improve food security that incorporate the traditional food system and healthy market food choices.

Traditional food intake is correlated with iron stores in Canadian Inuit men.

Accelerated loss of traditional lifestyles may place Inuit at risk of iron depletion given that anemia has been observed among Arctic men. The objectives of this study were to determine the prevalence of anemia, storage iron depletion, and iron overload and to identify correlates of iron status in Canadian Inuit men. In a cross-sectional survey of 994 men in the International Polar Year Inuit Health Survey, 2007-2008, hemoglobin, serum ferritin (SF), soluble transferrin receptor (on a subset), CRP, RBC fatty acid composition, and Helicobacter pylori serology were measured in venous blood drawn from fasting men. Anthropometric, dietary, sociodemographic, and health data were collected. Dietary and nondietary correlates of iron status were assessed with multiple linear and logistic models. For men with CRP ≤10 mg/L (n = 804), 6.5% had depleted, 19.8% had low, and 10.3% had elevated iron stores. Anemia was moderately prevalent (16.1%), but iron deficiency anemia was less common (2.4%). There was a low probability of dietary iron inadequacy (2.4% < Estimated Average Requirement) and excess iron intakes (10.7% > Tolerable Upper Intake Level). Food-insecure men and those without a household hunter had a higher risk of low or depleted iron stores. Adiposity, traditional food intake, long-chain RBC PUFA status, and inflammation were positively associated with SF and food insecurity, smoking, and H. pylori seropositivity were negatively associated with SF. Despite a moderate prevalence of anemia, iron stores are largely adequate in this population, although lower than expected based on iron intake. The regulation of iron metabolism in this population and the high prevalence of anemia in older men warrants further investigation.

Dietary correlates of an at-risk BMI among Inuit adults in the Canadian high arctic: cross-sectional international polar year Inuit health survey, 2007-2008.

BACKGROUND: The study's objective was to investigate the dietary correlates of an at-risk body mass index (BMI) among Inuit adults from thirty-six communities across the Canadian Arctic using data from the cross-sectional International Polar Year Inuit Health Survey, conducted in 2007-2008. METHODS: The survey included assessments of 24-hr dietary recall, sociodemographics, physical activity, and anthropometry. Dietary characteristics of overweight and obesity were similar and therefore combined into one at- risk BMI category (≥25 kg/m2) for analyses. The relationship between an at-risk BMI and energy intake from macronutrients, high sugar drinks, high-fat foods, saturated fatty acids, and traditional foods were examined entering each dietary variable separately into a logistic regression model as an independent variable. Analyses were adjusted for age, sex, region, kcalories, walking, smoking and alcohol consumption. Further multivariable models considered selected dietary variables together in one model. RESULTS: An at-risk BMI was present for 64% with a prevalence of overweight and obesity of 28% and 36%, respectively. Consumption of high-sugar drinks (>15.5% E) was significantly related with having an at-risk BMI (OR = 1.6; 95% CI 1.2; 2.2), whereas the % E from total carbohydrate evaluated as a continuous variable and as quartiles was inversely related to an at-risk BMI (P -trend < 0.05) in multivariable analyses. While % E from high-fat foods was positively related to an at-risk BMI, the findings were not significant in a model controlling for high-sugar drinks and % E from carbohydrates. CONCLUSIONS: The prevalence of overweight and obesity is of public health concern among Inuit. The current findings highlight the obesogenic potential of high-sugar drink consumption in an ethnically distinct population undergoing rapid cultural changes and raises concerns regarding carbohydrate restricted diets. Health promotion programs aimed at preventing the development of an unhealthy body weight should focus on physical activity and the promotion of healthy diets with reduced intake of sugar drinks.

Growth measures among preschool-age Inuit children living in Canada and Greenland.

AIM: The present study reports findings from a study of preschool-age Inuit children living in the Arctic regions of Canada and Greenland. METHODS: We compare stature and obesity measures using cutoffs from the Centers for Disease Control and the International Obesity Task Force references. The sample is comprised of 1121 Inuit children (554 boys and 567 girls) aged 3-5 years living in Nunavut (n=376) and Nunavik (n=87), Canada, in the capital city of Nuuk, Greenland (n=86), and in Greenland's remaining towns and villages (n=572). RESULTS: Greenland Inuit children were significantly taller than their Canadian counterparts, with greatest height and weight observed among children from Nuuk. Overall prevalence of stunting was low with the three cutoffs yielding similar values for height-for-age z-scores. Obesity prevalence was higher among Canadian Inuit children than their Greenland counterparts. CONCLUSIONS: Inuit children have stature values consistent with those of the Centers for Disease Control reference and low prevalence of stunting, though geographic variability in mean stature values between Canadian and Greenlandic samples likely reflects differences in both socioeconomic status and genetic admixture. Obesity prevalence is high among both Canadian and Greenland Inuit preschoolers, with children living in the city of Nuuk exhibiting lower obesity prevalence than children living in either Nunavut or Nunavik, Canada or Greenland's towns and villages. Varying obesity prevalence may reflect varying degrees of food security in remote locations as well as the influence of stature and sitting height which have not been well studied in young Inuit children.

Intake of sucrose-sweetened beverages and risk of developing pharmacologically treated hypertension in women: cohort study.

Objective: To investigate the association between intake of sucrose-sweetened beverages (SSBs) and risk of developing pharmacologically treated hypertension in a population of Norwegian mothers followed up to 10 years after delivery. Design: Women without hypertension at baseline in the Norwegian Mother, Father and Child Cohort Study (n=60 027) who delivered between 2004 and 2009 were linked to the Norwegian Prescription Database to ascertain antihypertensive medication use after the first 90 days following delivery. Diet was assessed by a validated semiquantitative Food Frequency Questionnaire in mid pregnancy. Cox proportional hazard analyses evaluated HRs for the development of hypertension associated with SSB consumption as percent energy by quintiles in multivariable models. Supplemental analyses were stratified by gestational hypertension and by a low versus high sodium-to-potassium intake ratio (<0.78 compared with ≥0.78). Results: A total of 1480 women developed hypertension within 10 years of follow-up. The highest relative to the lowest quintile of SSB intake was associated with an elevated risk for hypertension after adjusting for numerous covariates in adjusted models (HR: 1.20 (95% CI: 1.02 to 1.42)). Consistency in results was observed in sensitivity analyses. In stratified analyses, the high SSB intake quintile associated with elevated hypertension risk among women who were normotensive during pregnancy (HR: 1.25 (95% CI: 1.03 to 1.52)), who had normal body mass index (HR: 1.49 (95% CI: 1.13 to 1.93)) and among women with low sodium to potassium ratio (HR: 1.33 (95% CI: 1.04 to 1.70)). Conclusions: This study provides strong evidence that SSB intake is associated with an increased risk of hypertension in women.

Food insecurity and nutrition transition combine to affect nutrient intakes in Canadian arctic communities.

Food insecurity and the nutrition transition have been noted in arctic communities. We therefore evaluated biomarkers of nutritional status and nutrient intakes by traditional food (TF) and food security status among Inuit in Canada. A cross-sectional health survey of Inuit (≥18 y) in 36 arctic communities was conducted in 2007-2008. Food security was assessed by 24-h dietary recalls using USDA questionnaires and nutrient intakes. Biomarkers included serum 25-hydroxy vitamin D [25(OH)D], hemoglobin, serum ferritin, and erythrocyte RBC fatty acids (FA). Analyses were stratified by past-day TF consumption (yes vs. no) and food security status (secure vs. insecure). Food insecurity was prevalent (62.6%) and associated with higher RBC trans-FA and lower hemoglobin levels and serum ferritin, whereas TF consumption was associated with higher serum 25(OH)D, (n-3) FA, and serum ferritin (P ≤ 0.05). In men, food insecurity was associated with lower intake of energy and energy-adjusted fiber, vitamin C, iron, zinc, and magnesium. In women, food insecurity was associated with a higher intake of carbohydrates and lower intake of fiber, dietary folate equivalent, vitamin C, iron, magnesium, calcium, and vitamin D. For both sexes, when TF was consumed, there was a higher intake of protein, protein-related micronutrients, and vitamins A and C and a lower intake of carbohydrates, saturated fat, and fiber and a lower sodium:potassium ratio (P ≤ 0.05). Nutrition transition and food insecurity are associated with a multifaceted shift in nutrient status and intakes with implications for increased risk of diet-sensitive chronic diseases.