Persistence of antibody to Hepatitis A virus 20 years after receipt of Hepatitis A vaccine in Alaska.

Hepatitis A vaccine is recommended for children ≥1 year old to prevent hepatitis A virus (HAV) infection. However, the duration of vaccine-induced immunity is unknown. We evaluated a cohort of Alaska Native persons 20 years after HAV vaccination. Children aged 3-6 years had been previously randomized to receive three doses of HAV vaccine (360 ELISA units/dose) at: (i) 0,1,2 months; (ii) 0,1,6 months; and (iii) 0,1,12 months. We measured anti-HAV antibody concentrations every 2-3 years; described geometric mean concentrations (GMC) and the proportion with protective antibody (≥20 mIU mL-1 ) over time; and modelled the change in GMC using fractional polynomial regression. Of the 144 participants, after 20 years 52 (36.1%) were available for the follow-up (17, 18, 17 children in Groups A, B and C, respectively). Overall, 46 (88.5%) of 52 available participants had anti-HAV antibody concentrations ≥20 mIU mL-1 , and overall GMC was 107 mIU mL-1 . Although GMC levels were lower in Group A (60; CI 34-104) than in Group B (110; CI 68-177) or Group C (184; CI 98-345) (B vs C: P=.168; A vs B/C: P=.011), there was no difference between groups after adjusting for peak antibody levels post-vaccination (P=.579). Models predicted geometric mean concentrations of 124 mIU mL-1 after 25 years, and 106 mIU mL-1 after 30 years. HAV vaccine provides protective antibody levels 20 years after childhood vaccination. Lower antibody levels in Group A may be explained by a lower initial peak response. Our results suggest a booster vaccine dose is unnecessary for at least 25-30 years.

Human papillomavirus (HPV) types among Alaska native women attending a colposcopy clinic in Anchorage, Alaska, 2009-2011.

BACKGROUND: The first HPV vaccines licensed targeted two HPV types responsible for most cervical cancers. A 9-valent vaccine (9vHPV), targeting 5 additional types, was introduced in 2016 and is currently the only HPV vaccine available in the United States. Previous studies demonstrated high rates of HPV infection in Alaska Native (AN) women. We sought to measure prevalence of high risk HPV types in AN women undergoing colposcopy and to determine those preventable by vaccination. METHODS: For this cross-sectional study, we recruited women who were undergoing colposcopy for clinical indications at Alaska Native Medical Center to obtain cervical brush biopsy samples. Specimens were shipped to Atlanta, Georgia for DNA extraction, HPV detection, and typing using L1 PCR with type-specific hybridization to detect 37 HPV types. RESULTS: Four hundred eighty eight specimens from 489 women were tested. At least one HPV type was found in 458 (94%) specimens. Of 458 participants who were HPV positive, 332 (72%) had two or more types. At least one type targeted by 9vHPV was detected in 95% of participants with CIN 3 (21/22), 82% with CIN 2 (37/45), and 65% with CIN 1 (119/184). (p < 0.001) HPV 16 or 18 were detected in 77% (17/22) with CIN 3, 53% (24/45) with CIN 2, and 36% (67/184) with CIN 1. (p < 0.001). CONCLUSIONS: A substantial proportion of AN women attending colposcopy clinic had evidence of HPV 16/18 infection, as well as other high risk types targeted by 9vHPV. At least one 9vHPV type was detected in 62% of the participants overall, and 95% of participants with CIN3. AN women are expected to benefit from vaccination against HPV 16/18, and will have greater benefit from 9vHPV. Information from this study could be used to develop public health strategies to increase vaccine uptake, or to track HPV genotype prevalence over time.

Nested case-control study: hepatocellular carcinoma risk after hepatitis B surface antigen seroclearance.

BACKGROUND: Hepatocellular carcinoma (HCC) risk after resolving chronic hepatitis B virus (HBV) infection is unclear. AIM: To compare HCC risk between Alaska Native (AN) patients with and without hepatitis B surface antigen (HBsAg) seroclearance. METHODS: We selected persons with (case-patients) and without (control-patients) HBsAg seroclearance from a cohort of 1346 chronically HBV-infected AN patients followed during 1982-2013. We attempted to match two control-patients/case-patient on sex, HBV genotype, and age. Person-years of follow-up for case-patients began on the date of HBsAg resolution and for control-patients began on the date equivalent to the cohort entry date plus the years of HBsAg duration for their corresponding case-patient. We compared HCC risk using a Cox proportional hazards model. RESULTS: The 238 case-patients (4 with HCC) and 435 control-patients (9 with HCC) were similar in age [P-value (P) = 0.30], sex (P = 0.53) and HBV genotype (P = 0.99). Case-patients had longer person-years of follow-up than control-patients (11.7 vs. 10.1 years; P = 0.04). The HCC rate/100 000 persons was similar between case- (132) and control-patients (178; P = 0.65). The adjusted hazard ratio comparing case- and control-patients was similar for HCC [0.7; 95% confidence interval (CI): 0.2-2.4], increased for each 1-year increment for age (1.1; CI: 1.0-1.1; P < 0.01), and was greater if the initial HBeAg was positive (3.5; CI: 1.1-11.0; P = 0.03). CONCLUSIONS: Hepatitis B surface antigen seroclearance was not associated with reduced HCC risk; the HCC risk estimates are limited by wide 95% confidence intervals. Persons meeting HCC surveillance indications prior to HBsAg seroclearance could benefit from continued surveillance after seroclearance.

Protection provided by hepatitis B vaccine in a Yupik Eskimo population. Seven-year results.

The long-term immunogenicity and protection provided by a plasma-derived hepatitis B vaccine (Heptavax B) was determined in a cohort of susceptible persons immunized in 1981. In this study 1581 susceptible persons were immunized with the recommended three-dose regimen of hepatitis B vaccine. After 7 years, 74% of vaccinees retained antibody to hepatitis B surface antigen (anti-HBs) levels of 10 mIU/mL or more. Anti-HBs levels at 7 years varied inversely with age and directly with the level of anti-HBs attained 1 year after the first dose. During the 7 years after the first dose of vaccine, five vaccine responders and three other persons developed antibody to hepatitis B core antigen and their level of anti-HBs increased. None developed detectable hepatitis B surface antigen or clinical hepatitis. This update of an ongoing study continues to suggest that the risk of hepatitis B virus infection to most persons with an initial anti-HBs response to hepatitis B virus vaccine of 10 mIU/mL or greater is low, regardless of the initial antibody level.

Immunogenicity of pneumococcal revaccination in patients with chronic disease.

BACKGROUND: To prevent serious pneumococcal infections, 23-valent pneumococcal polysaccharide vaccine is recommended for individuals over 24 months of age with chronic predisposing diseases and for healthy older adults. This nonrandomized controlled study in rural Alaska assessed the immunogenicity of revaccination in adults. METHODS: Twenty-six adults, 33 to 88 years of age, vaccinated a mean of 7.4 years before this study, were matched to 26 previously unvaccinated subjects by age, number of chronic diseases, sex, and ethnicity. One or more chronic diseases were validated in 62% of subjects (32 of 52). All received a first or second intramuscular dose of pneumococcal vaccine. Antibody levels were determined by radioimmunoassay for 12 pneumococcal capsular serotypes immediately before and 20 to 84 days after vaccination. RESULTS: Six to 9 years after primary vaccination, over one third of serotype-specific antibody levels were below 500 ng of antibody nitrogen per milliliter, equal to the percentage in unvaccinated subjects of similar age. Antibody levels against all pneumococcal serotypes rose to similar levels after primary vaccination and revaccination, and 54% and 55%, respectively, of subjects who received primary vaccination and revaccination had at least a 1.4-fold increase in antibody levels. Only the antibody level for serotype 4 remained low. Neither gender nor age affected peak response. For those with chronic diseases, there was a trend toward fewer low antibody levels against three or more serotypes after revaccination (two subjects [13%]) than after primary vaccination (five subjects [31%]). CONCLUSIONS: Following the initial immunization of high-risk and elderly patients with pneumococcal polysaccharide, pneumococcal antibody levels appear to wane with time. Primary vaccination and revaccination 6 or more years after a first dose of pneumococcal vaccine stimulate comparable mean antibody levels.

Diabetes mellitus in Alaskan Yup'ik Eskimos and Athabascan Indians after 25 yr.

OBJECTIVE: To estimate the prevalence of diabetes mellitus and overweight in two populations of Alaska Natives and to compare the results with previous data. RESEARCH DESIGN AND METHODS: Participants' heights, weights, and random plasma glucose levels were determined. Those with a glucose of greater than or equal to 6.72 mM received a follow-up glucose-tolerance test, interpreted by WHO criteria. Overweight was defined by National Center for Health Statistics criteria and also by criteria used in previous studies. The subjects were Eskimo and Athabascan residents greater than or equal to 40 yr of age in 15 villages in southwestern Alaska. RESULTS: Diabetes prevalence was 4.7% for Eskimos and 10.0% for Indians. Among Eskimo men and women, the prevalence of overweight was 34 and 56%, respectively, among Indian men and women, it was 29 and 55%, respectively. Comparisons with past data indicate that the prevalence of diabetes has increased from 1.7% in 1962 for Eskimos and 1.8% in 1969 for Indians. CONCLUSIONS: The prevalence of diabetes appears to have increased among Eskimos and Indians in Alaska. Overweight appears to be a significant problem in both groups.

Diabetes prevalence, incidence, and complications among Alaska Natives, 1987.

OBJECTIVE: To provide descriptive epidemiological data on diabetes mellitus among Alaska Natives, including incidence, updated prevalence, and incidence rates of ESRD, LEA, MI, and stroke in the diabetic population. RESEARCH DESIGN AND METHODS: In IHS and tribal contract hospitals and clinics throughout Alaska, Alaskan Indians, Eskimos, and Aleuts living in Alaska with documented diabetes mellitus were studied from 1986 to 1987. RESULTS: The number of diabetic patients increased from 610 to 708, and the prevalence changed from 15.7 to 17.4/1000 (not a statistically significant increase). Incidence rates per 10,000 diabetic person-yr for complications were 38 for ESRD, 69 for LEA, 92 for MI, and 92 for stroke. CONCLUSIONS: The prevalence of diabetes mellitus increased during the period of observation, but not to a statistically significant degree. Incidence rates for diabetes are lower than for the U.S. general population, but complications rates are as high as those in other diabetic populations.

Prevalence of diabetes mellitus in pregnancy among Yup'ik Eskimos, 1987-1988.

OBJECTIVE: To evaluate the prevalence of diabetes mellitus in pregnancy in Yup'ik Eskimos. RESEARCH DESIGN AND METHODS: A retrospective review of consecutive birth-log data and medical records was conducted. Records were taken from the primary care and tertiary referral facilities in Alaska Area Native Health Service. Some 630 consecutive deliveries were reviewed from 1 March 1987 to 29 February 1988, with 25 excluded for ancestry other than Alaska Native. Another 605 Alaska Native patient charts were reviewed, with 545 Alaska Native patients screened for diabetes in pregnancy. The study population had a mean age of 25.6 yr, mean gravidity of 3.4, mean parity of 1.9, and mean birth weight of 3567 +/- 493 g. RESULTS: Patients were screened with a 50-g glucose oral load with a plasma glucose 1 h later. 156 of 605 (25.7%) patients, with a screen > or = 7.8 mM received a 100-g OGTT. Of 605, 35 (5.8%) patients met O'Sullivan criteria, and 2 of 605 (0.3%) patients met WHO criteria for previous diabetes mellitus, for a total 37 of 605 (6.7% [corrected]) women with diabetes in pregnancy. The subjects who met O'Sullivan criteria had statistically greater mean age (29.9 yr), gravidity (4.9), parity (2.9), and birth weight of their infants (3678 +/- 389 g), compared with women with a screen < 7.8 mM. CONCLUSIONS: The prevalence of diabetes in pregnancy among Yup'ik Eskimos is twice the rate for the U.S. for all races, despite the Yup'ik having the lowest rate of diabetes mellitus among Alaska Natives. This may represent a large number of undiagnosed patients with impaired glucose tolerance, and may reflect the wide-spread dietary and life-style changes that have occurred in the Yup'ik in the last 30 yr. The Yup'ik present a unique opportunity to apply prevention techniques in a population with an emerging problem with glucose tolerance.

Elevated concentrations of plasma omega-3 polyunsaturated fatty acids among Alaskan Eskimos.

Eskimos living in rural southwestern Alaska depend on fish and marine mammals as major sources of subsistence food. Fatty acid concentrations in 80 Yupik Eskimos living in either a coastal or river village of southwestern Alaska were compared with those of non-Native control subjects. Concentrations of total plasma omega-3 fatty acids, eicosapentaenoic acid (20:5 omega-3), and docosahexaenoic acid (22:6 omega-3) were 4.3, 13, and 6.8 times higher, respectively, in Native participants than in non-Native control subjects. Concentrations of these fatty acids were higher in coastal-village than in river-village participants; concentrations paralleled consumption of marine mammal oil and marine fish. The ratios of eicosapentaenoic to arachidonic acid for adult coastal- and river-village participants were 1.16 and 0.70, respectively, 14 and 9 times those of non-Native adults, respectively. There was no increase in the mean bleeding times of Native participants of either village.

Comparative immunogenicity of four Haemophilus influenzae type b conjugate vaccines in Alaska Native infants.

We compared the immunogenicity of the four available Haemophilus influenzae type b (Hib) conjugate vaccines in Alaska Native infants. Three of the vaccines, Hib oligosaccharide-CRM197 (HbOC), polyribosylribitol phosphate-diphtheria toxoid (PRP-D) and polyribosylribitol phosphate-tetanus toxoid (PRP-T), were given at 2, 4 and 6 months of age, and the PRP Neisseria meningitidis outer membrane protein (PRP-OMP) conjugate vaccine was given at 2 and 4 months of age. Enrollment was largely sequential by vaccine availability beginning with HbOC and ending with PRP-T. A total of 225 infants completed the full vaccination series. Groups of infants receiving the different vaccines did not differ significantly by sex, ethnicity, degree Alaska Native or age at vaccination. The only vaccine that induced a response with the first 2-month dose was PRP-OMP; 91% of infants had > or = 0.15 micrograms/ml and 57% had > or = 1.0 microgram/ml of anti-PRP antibody by 4 months of age. After two doses it also remained the most immunogenic. After the full three vaccine series, trials that requires cough of 21 days is excessively restrictive.

Decline of Haemophilus influenzae type b disease in a region of high risk: impact of passive and active immunization.

Haemophilus influenzae type b (Hib) is a major cause of serious childhood bacterial infections. Before 1989 Alaska Native infants in the Yukon Kuskokwim Delta (YKD) had the highest recorded Hib disease rate, 2960:100,000 in children less than 1 year of age with 6 to 35 (mean, 13) cases/year between 1980 and 1988. In July, 1989, Alaska Area Native Health Service initiated a passive immunization project in the YKD using bacterial polysaccharide immunoglobulin (BPIG) administered at 3-month intervals to prevent Hib infections in infants less than 13 months of age. On January 1, 1991, after licensure of Hib conjugate vaccines for infants, the program was modified to a passive-active strategy using BPIG at birth and PedvaxHIB at 2, 4 and 12 months of age. Between July 1, 1989, and December 31, 1990, 80% of YKD children less than 1 year of age received at least 1 dose of BPIG. During this period there were 7 Hib cases in this age group, but only 1 of the cases had received any BPIG. Between January 1, 1991, and December 31, 1992, 4 Hib cases occurred in 2 YKD children. During the combined period, July 1, 1989, to December 31, 1992, the incidence of Hib disease for infants less than 1 year of age was 302:100,000. A dramatic decrease in Hib disease was observed in this high incidence region concurrent with implementation of passive and passive-active immunization strategies.

Hospitalizations for respiratory syncytial virus infection in Alaska Native children.

To characterize the epidemiology of Alaska Native children hospitalized for respiratory syncytial virus infections, we reviewed records of hospitalizations during the winter seasons of 1991 to 1992 and 1992 to 1993 at a hospital in Anchorage and a rural hospital in the Yukon Kuskokwim Delta (YKD) region of southwestern Alaska. The median age of hospitalization for respiratory syncytial virus infection was 2 months of age for YKD residents and 4.5 months for Anchorage residents. Sixteen percent of the hospitalized YKD children were less than 1 month of age, whereas the same was true for only 3% of the Anchorage children. Eight percent of the YKD patients required mechanical ventilation, whereas none of the Anchorage patients required ventilation. The median hospital stay was 4.8 days for YKD patients and 3.2 days for Anchorage patients. Hospitalization rates for infants less than 1 year of age were 33/1000 for Alaska Natives in Anchorage and 100/1000 for those in the YKD region. The extremely high hospitalization rate, especially among very young infants in the rural YKD region, points to a need for early preventive efforts.

Cardiac mortality in Alaska's indigenous and non-Native residents.

Cardiac disease mortality in Alaska, from both ischaemic and rheumatic heart disease, is of interest given the high consumption of fish and high streptococcal disease rates in the indigenous population. Uniformly coded underlying cause-of-death data for the period 1979-1988, compared with that from 1955-1965, indicated that deaths from all cardiac diseases combined, have been increasing in Alaska Natives over the past 30 years. Recent mortality from all cardiac, ischaemic, and rheumatic heart diseases in Alaska Natives were 80%, 61%, and 202% of those corresponding levels in Alaskan whites, whose cardiac mortality closely profiles US whites. Alaska Native men aged 30-45 years had higher overall mortality rates for cardiac diseases than did whites because of higher mortality rates of rheumatic heart disease and cardiomyopathy. Elderly Alaska Native men had lower rates than whites, reflecting less ischaemic heart disease mortality. The lowest levels of ischaemic heart disease mortality, less than one-third that of US whites, occurred in Alaskan Eskimos who lived in an area with documented patterns of high salmon consumption by individuals with high blood concentrations of omega-3 fatty acids. Elevated mortality from non-ischaemic heart disease and previously documented genetic markers suggest associations deserving further study.

Incidence of invasive cervical cancer preceded by negative screening in high-risk Alaska Native women.

BACKGROUND: Alaska Native women experience higher invasive cervical cancer incidence and mortality rates than US whites despite a long-standing cancer screening programme including recommendations for annual Pap smears. METHODS: To determine the frequency and results of cytological screening preceding their diagnoses, a histological and medical record review was completed for 44 of 46 Alaska Native cases of invasive cervical cancer from a defined population. An interval cancer (no prior dysplasia and a negative screening report within 3 years of diagnosis) was determined for 23 women. Mean number of negative reports during the 3- and 5-year intervals before diagnosis was 1.7 and 2.6 respectively. The age-adjusted incidence rate for all cervical cancer was 24.0/100,000 women/year and for interval cancer with single and multiple negative reports during the 3-year interval before diagnosis it was 11.6, and 9.6 respectively. Sensitivity of a Pap smear to demonstrate dysplasia during the year before diagnosis was 51%. CONCLUSIONS: Annual cytological screening of all Alaska Native women with current methods would provide earlier diagnoses for only an additional 15% of cervical cancer cases. Plausible but unproven explanations include rapid progression through precursor stages of neoplasia or random screening errors. Improved or ancillary screening methods appear necessary.

Bronchiectasis in Alaska Native children: causes and clinical courses.

Although bronchiectasis has become a rare condition in U.S. children, it is still commonly diagnosed in Alaska Native children in the Yukon Kuskokwim Delta. The prevalence of bronchiectasis has not decreased in persons born during the 1980s as compared with those born in the 1940s. We reviewed case histories of 46 children with bronchiectasis. We observed that recurrent pneumonia was the major preceding medical condition in 85% of patients. There was an association between the lobes affected by pneumonia and the lobes affected by bronchiectasis. Eight (17%) patients had surgical resection of involved lobes. We conclude that the continued high prevalence of bronchiectasis appears to be related to extremely high rates of infant and childhood pneumonia. Pediatr Pulmonol. 2000;29:182-187. Published 2000 Wiley-Liss, Inc.

Dietary change and obesity associated with glucose intolerance in Alaska Natives.

OBJECTIVE: To investigate frequency of food intake, body weight, and glucose intolerance in Alaska Natives. DESIGN: Height, weight, and random blood glucose levels were measured and a frequency-of-food-intake questionnaire was obtained. This questionnaire classified persons as consumers of indigenous foods or nonindigenous foods within three food groups. Those with a random blood glucose measurement > or = 6.72 mmol/L received an oral glucose tolerance test. SETTING: Community screening in 15 villages in Alaska. SUBJECTS: Nutrition screenings were done for 1,124 Alaska Native residents aged 20 years or older. An oral glucose tolerance test was done for 202 subjects. OUTCOMES MEASURED: Subjects were classified as consumers of indigenous or nonindigenous foods within three food groups. A diagnosis of non-insulin-dependent diabetes mellitus (NIDDM) was made on the basis of World Health Organization criteria. A determination of overweight was made on the basis of National Center for Health Statistics criteria. STATISTICAL ANALYSIS: A chi 2 test with Yates correction, t test, and linear regression, with two-sided P values. RESULTS: Athabascan Indians had twice the rate of NIDDM as Yup'ik Eskimos with significantly higher frequency of nonindigenous food intake, plus lower frequency of indigenous carbohydrate and fat intake. Subjects < or = 30 years old consumed significantly more nonindigenous protein and fat and low-nutrient-density carbohydrates than those > or = 60 years old. Persons who had glucose intolerance reported significantly greater consumption of nonindigenous protein and less seal oil. Incidence of overweight was significantly higher than was found 25 years ago. Participants with glucose intolerance were significantly more overweight than others. CONCLUSION: A pattern of increased frequency of nonindigenous protein, low-nutrient-density carbohydrate, and fat intake with less indigenous carbohydrate and fat consumption was found in subjects < or = 30 years old and in association with the higher rate of NIDDM found in the Athabascan Indians. Persons with glucose intolerance were significantly more overweight than others. APPLICATIONS: Although the nutritional value of indigenous foods for reducing disease risk should be promoted, nutrition education, especially among young adults, should also include building skills to select and prepare nonindigenous foods to attain a healthful diet. Although snacking is a concern, dietary fat was the most significant factor in obesity and NIDDM.

Cancer in Alaskan Indians, Eskimos, and Aleuts, 1969-83: implications for etiology and control.

The authors collected and analyzed cancer incidence data for Alaska Natives (Indians, Eskimos, and Aleuts) for the 15-year period 1969-83 by ethnic and linguistic groups. Compared with U.S. whites, observed-to-expected ratios are high in more than one ethnic group for cancer of the nasopharynx, salivary gland, liver, gallbladder, and cervix. Low ratios were found for cancer of the breast, uterus, bladder, and melanoma. In Alaska, Eskimos have the highest risk for cancer of the esophagus and liver and the lowest risk for breast and prostate cancer. Risk for multiple myeloma in Indian men in Alaska exceeds not only those of other Native groups in Alaska but that in U.S. whites as well. Despite the short period studied, increases in cancer incidence over time can be documented for lung cancer in Eskimo men and women combined, and for cervical cancer, especially in Indian women.

Pneumococcal vaccination in a remote population of high-risk Alaska Natives.

In response to an increasing prevalence of serious pneumococcal disease among adult Alaska Natives of northwest Alaska, a 3-year program was begun in 1987 to identify residents of that remote region who were at high risk for developing invasive pneumococcal disease, to determine their pneumococcal vaccination status, and to deliver vaccine to at least 80 percent of those at risk. After reviewing public health nursing and Indian Health Service data bases, the authors identified 1,337 persons, 20 percent of the 6,692 residents of the region, at high risk for invasive pneumococcal infection, defined either by having a specific chronic disease or by age criteria. Cardiovascular disease and alcoholism were the two most common chronic diseases. Only 30 percent of those determined to be at high risk had received one or more doses of pneumococcal vaccine previously. Half of those persons had received their most recent vaccination 6 or more years earlier. The program used both customary and innovative methods to deliver 23-valent polysaccharide vaccine to 1,046 of those at high risk (78 percent), including 388 persons who were revaccinated. At the completion of the project, 1,123 persons, 84 percent of those at high risk, had received at least 1 dose. They included 1,088 persons, 81 percent of those at high risk, with vaccination within the previous 5 years as a result of the project, compared with a 15-percent rate prior to the vaccination phase of the project. The program demonstrated that high levels of vaccination against pneumococcal disease, exceeding Year 2000 objectives of 60 percent, are attainable in a remote rural Alaskan population.

Associations between dietary factors and plasma lipids related to cardiovascular disease among Siberian Yupiks of Alaska.

The diet of northern Native people has been postulated to protect against cardiovascular disease. We asked whether nutrient and food intakes of Eskimos were correlated with their plasma cholesterol, LDL, HDL, triglycerides and LDL-HDL ratio. Frequency of consumption of 91 foods among 64 Siberian Yupik adults was measured during home-based interviews. Intake of monounsaturated fat by men was negatively correlated with LDL. Foods and nutrients that contribute to the LDL-HDL ratio explained 42% of its variation among all subjects. Inclusion of the body mass index (BMI) explained 59% of the variation in the LDL-HDL ratio. Coefficients were negative for alpha-tocopherol, fresh bird, evaporated milk and cheese, and positive for BMI, syrup and pizza. BMI had a positive effect on the LDL-HDL ratio among younger adults, women and the entire sample, but did not contribute to explaining the variation among older adults or men. This emphasizes the importance of weight control among younger Siberian Yupik women. While coefficients were both positive and negative for traditional and western foods, the presence of traditional foods that were negatively correlated in the regression supports the hypothesis that consumption of traditional foods is important for maintaining cardiovascular health among Siberian Yupiks.

Dietary intakes among Siberian Yupiks of Alaska and implications for cardiovascular disease.

We describe dietary intake for 65 Siberian Yupik residents of Gambell, AK using 24-h recalls and annual food frequencies collected in October 1992. The objectives were to describe dietary characteristics important in risk of cardiovascular disease, determine the extent that their diet differs from the diet of general US and northern populations, assess how the diet met national guidelines for the prevention of cardiovascular disease, and propose dietary recommendations. Compared to US intakes in general (NHANES III), intakes of Siberian Yupiks expressed as percent of energy were: 8-10% higher in fat, 6% higher in protein, 5-7% higher in monounsaturated fats and 12-15% lower in carbohydrate. Energy from saturated and polyunsaturated fats was similar (11% and 8% respectively). Cholesterol intakes were not significantly different. Mean intakes of selenium, a-topocopherol, folacin (men), and vitamin C (men) met Recommended Dietary Allowances, which may contribute to cardiovascular health. Mean intake of n-3 fatty acids (7.0 g/d), twice the 3 g/d associated with favorable effects, was comparable with intake of Greenlandic Eskimos. Dietary risk factors included high intakes of % energy from fat and saturated fat, and low intakes of fiber. Native foods were important sources of monounsaturated fats, n-3 fatty acids and selenium.