The diet of Alaska Native adults: 1987-1988.

Although in the past, rates of heart disease, cancer, and diabetes were lower in Alaska Natives than in US whites, these diseases are now increasing. The rate of iron-deficiency anemia for Alaska Natives continues to be higher than that in the general population. To understand the role of diet in these chronic diseases, seasonal dietary intakes of 351 Alaska Native adults from 11 communities were assessed during 1987-1988. Alaska Natives consumed more energy (19%), protein (39%), fat (21%), carbohydrate (13%), iron (25%), vitamin A (53%), and vitamin C (31%), but less calcium (19%) than did the general US adult population [National Health and Nutrition Examination Survey II (NHANES II)]; Alaska Natives consumed six times more fish but less fruits and vegetables. Results suggest that energy and protein intakes decreased in the last 30 y but the proportion of energy from fat (37%) remained unchanged. High fish consumption and large seasonal dietary variations persisted, which may protect against chronic diseases. However, excess energy and fat and low calcium, fruit, and vegetable intakes may be contributing to recent increases in chronic diseases. Dietary guidelines are proposed.

Dietary intake among Alaska native women resident of Anchorage, Alaska.

OBJECTIVE: We summarized data from a study of Alaska Native women living in predominantly urban communities to assess the quality of their dietary intakes and compare to current US dietary recommendations. STUDY DESIGN: Descriptive cross sectional study of seventy-four Alaska Native women living in and around Anchorage, Alaska. Each completed up to four 24-h diet recalls during one year. Participants were enrolled in 1996 and 1997. Blood samples were analyzed for hematocrit, vitamin A, vitamin C, vitamin E and folate. RESULTS: Results were compared with current US dietary guide lines for food groups and nutrients. Mean intake of these women fell below recommendations for all food groups except the Meat and Beans Group. Mean intakes of sweets, sodium and energy from fat and saturated fat exceeded recommendations. Red blood cell folate levels were low in 32% of the women. Only one-quarter of the women reported eating Native foods. CONCLUSIONS: The survey shows room for improvement in diet to include reduced intakes of saturated fat, and increased intakes of folate, calcium, and dietary fiber by increasing consumption of fruits and vegetables, whole grain breads and cereals, non-fat milk products, and Native foods.

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.

Glucose tolerance and insulin-resistance syndrome among St. Lawrence Island Eskimos.

OBJECTIVES: Non-insulin-dependent diabetes mellitus (NIDDM) prevalence in Alaska Natives is rising but remains lower than the U.S. average. We conducted a screening study for diabetes mellitus and cardiovascular disease in a remote Yup'ik Eskimo community in Alaska. RESEARCH DESIGN AND METHODS: The study population included Siberian Yup'ik Eskimo residents of Gambell, Alaska, > or = age 40 years who underwent a 2 h 75 gm oral glucose tolerance test interpreted by WHO criteria. Other measurements included fasting serum insulin and lipid levels, bioimpedance body fat %, body-mass-index (BMI), waist-to-hip ratio (WHR), and blood pressure. RESULTS: Of 114 eligible subjects, 65 (57%) participated. These subjects had lower mean systolic or diastolic blood pressure, lower triglyceride, and higher mean HDL cholesterol levels compared to a similarly aged U.S. all races sample. The mean fasting insulin level of 50.9 pmol/L appeared low given the high mean BMI (27.2). Six subjects had NIDDM (9%, 95% CI 2%-16%) and eight had impaired glucose tolerance (IGT) (12%, 95% CI 4%-20%). Compared to normoglycemic subjects, diabetic subjects were more frequently female (83% vs 53%) and had higher mean systolic BP (138 mm Hg vs 117 mm Hg) than normoglycemic subjects. We used multiple regression to analyze associations between fasting insulin and either blood pressure or serum lipids, while adjusting for % body fat, WHR, age, sex, and antihypertensive medication use. Fasting insulin was significantly related to both diastolic blood pressure (p = .0430) and fasting serum triglyceride (p = .0182) but not to systolic BP, total cholesterol, or LDL and HDL subfractions. CONCLUSIONS: Although NIDDM prevalence was not high compared to non-Native U.S. residents, elements of the insulin-resistance syndrome exist in this subarctic population.

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.

A comparison of the diets of Siberian Chukotka and Alaska Native adults and recommendations for improved nutrition, a survey of selected previous studies.

Diet plays an important role in the development of common diseases among Northern indigenous people, i.e. heart disease, cancer, diabetes and iron deficiency. Their unique diets may contribute to or protect from these diseases. The diets consumed by Siberian Chukotka Natives (Russia) and Alaska Natives (United States) during the 1980's are described. Traditional foods still play a major role, although the extent of their use varies. Alaska Natives' diets are more "western" than are those of Chukotka Natives. They consumed a greater proportion of kilocalories as carbohydrates and fat than Chukotka Natives. Coastal Chukotka Natives had lower average serum LDL-cholesterol and higher HDL-cholesterol levels than tundra Chukotka Natives, despite their high fat and kilocalorie intakes. Dietary recommendations common to both groups are presented which encourage the use of traditional foods as the foundation of the diet supplemented with western type foods of appropriate quality and quantity.

Lipoprotein profiles in Alaskan Siberian Yupik Eskimos.

Coronary heart disease and diabetes, once rare in Eskimos, is on the increase in some Alaskan communities. As part of a detailed assessment of the prevalence of these diseases and associated risk factors in several villages, we report here on the plasma concentrations of lipoprotein and apoprotein in a sample of Siberian Yupik Eskimos aged 40-87 years living in the village of Gambell on St. Lawrence Island. Mean cholesterol levels for females were 242 mg/dl and 223 for males. LDL levels were 161 for females and 149 for males, while HDL levels were 67 for females and 58 for males. The mean ApoB and Apo-A1 values were 112 mg/dl and 167 mg/dl for males and females. Triglycerides were 73 for females and 77 for males. The allele frequency of APOE*3 and APOE*4 were .900 and .100 respectively. There was a total absence of the APOE*2 allele in this sample. Mean total cholesterol concentrations in this sample were markedly higher than those reported in 1958 from this village and from those recently reported for closely related Yupik Eskimos living in Siberia. The cholesterol levels were higher and the triglyceride levels were lower than in U.S. Indian populations. The data suggest the possibility of recent increased risk of cardiovascular disease for this Eskimo population. The new information indicates a need for comprehensive epidemiological studies to identify and characterize cardiovascular disease risk factors in all Alaska Native populations in order to provide a database for meaningful interventions. The lipoprotein profiles reported here are significantly different from Amerind groups, a finding that may reflect both dietary and genetic differences.

Overweight and obesity among Alaskan Eskimos of the Bering Straits Region: the Alaska Siberia project.

OBJECTIVE: To document the height, weight, BMI and prevalence of obesity for Eskimo residents of four villages of the Bering Straits Region of Alaska. DESIGN AND SUBJECTS: 454 Non-pregnant residents over 24 y of age, with at least one Eskimo grandparent participated in one cross sectional survey within each village. MEASUREMENTS: Height, weight, calculation of BMI (kg/m2), proportion of 'overweight' (BMI 25-29.9), and proportion of 'obese' (BMI>/=30). RESULTS: For women and men, respectively, mean heights were 153.4 and 165.2 cm; weights were 64.2 and 71.6 kg; and BMI were 27.2 and 26.2 kg/m2 after age standardization. For women, 27.9% were overweight, and 32.8% were obese compared with 36.2% and 15.6%, respectively, for men. Alaskan Eskimo participants of the Alaska Siberia Project had a significantly lower proportion of total overweight (BMI>/=25, 54.9% for women, and 32.0% for men) compared with the three sites of the Strong Heart Study, which ranged from 65.9 to 80.2% for women and 53.6 to 66.7% for men. Compared with American men of all races, the proportion of overweight and obese participants was similar for Eskimo men. The proportion of obese was significantly higher for Eskimo women compared with American women of all races, but the proportion of overweight was similar. CONCLUSION: Although the prevalence of obesity among the Alaskan Eskimos is lower than for American Indians, the high proportion of overweight observed in this study is of concern for Alaskan Eskimo adults, especially for women.

Iron deficiency anemia among Alaska Natives may be due to fecal loss rather than inadequate intake.

To define more fully the nature of a persistently high prevalence of iron deficiency anemia observed among Alaska Native children, we examined dietary iron intake, hemoglobin concentrations, and storage iron (serum ferritin) based on multiple cross-sectional surveys of Alaska Natives between 1983 and 1989. Approximately 30 to 50% of the children studied < 12 y of age had depleted iron stores. Anemia and depleted iron stores also were prevalent among adult men and women, about twice as prevalent as in the U.S. population based on the Second National Health and Nutrition Examination Survey (NHANES II). The higher rate of iron deficiency, occurring even when the dietary assessment found Alaska Native iron intake to be higher than the U.S. average with an ample intake of food high in bioavailable iron, suggests blood loss as a possible cause of the unusual pattern of iron deficiency observed. In a pilot study of stool blood loss in two villages, 65% of the samples had a significantly elevated stool heme concentration. Further investigation of iron deficiency due to gastrointestinal blood loss for the Alaska Native is warranted.

Body fat distribution in Alaskan Eskimos of the Bering Straits region: the Alaskan Siberia Project.

OBJECTIVE: To describe the body fat content and distribution of adult Alaska Natives of the Bering Straits Region. DESIGN: Cross-sectional screening in the spring of 1994. SUBJECTS: 454 non-pregnant native residents from four rural Alaskan villages. MEASUREMENTS: Height, weight, waist, hip and thigh circumference, bioelectrical impedance, sagittal abdominal diameter, and triceps, biceps, suprailiac, subscapular and thigh skinfolds. RESULTS: Mean height, weight and subscapular-to-triceps ratio were higher in men than women. The women had larger waist, hip and thigh circumferences, higher body fatness, as well as larger skinfolds than the men. There were no demonstrable differences between men and women in measures of body fat distribution. The proportions of women and men with high waist-to-hip ratio (>/=0.8 for women, >/=0.9 for men) for low (<25 kg/m2), medium (25-30 kg/m2) and high (>30 kg/m2) body mass index (BMI) groups were compared with a Canadian study of all races. 1 In the lowest BMI subgroup (<25 kg/m2) a much higher proportion of Eskimo women exhibited a high waist-to-hip ratio (91%) than Eskimo men (42%) or Canadian women (29%) or men (51%). In the highest BMI subgroup (>30 kg/m2) Eskimo women were similar in proportion of high waist-to-hip ratio (99%) compared to Eskimo men (100%), but still demonstrated a much greater proportion of subjects with high waist-to-hip ratio than either Canadian men (90%) or women (76%). CONCLUSIONS: The large abdominal fat depots found in Eskimo women were similar to men, and may indicate that future increases in diabetes mellitus and other metabolic alterations can be anticipated. International Journal of Obesity (2000) 24, 171-179

Pervasive occult gastrointestinal bleeding in an Alaska native population with prevalent iron deficiency. Role of Helicobacter pylori gastritis.

OBJECTIVE: To confirm prevalent iron deficiency among Yupik Eskimos living in Alaska and to explore the frequency of and potential lesions accounting for occult gastrointestinal bleeding. DESIGN: Descriptive survey. SETTING: Rural Arctic community. SUBJECTS: A total of 140 adult volunteers from 3 villages in the Yukon-Kuskokwim Delta region of western Alaska. MAIN OUTCOME MEASURES: Daily iron intake, hematologic and biochemical indexes of iron status, fecal hemoglobin levels, stool parasites, and endoscopic findings. RESULTS: While dietary iron intake by Yupiks was similar to that of a reference population, iron deficiency prevalence was increased 13-fold in Yupik men and 4-fold in Yupik women. Fecal hemoglobin levels were elevated in 90% of subjects contrasted with only 4% of a reference group; median levels were 5.9 and 0.5 mg of hemoglobin per gram of stool, respectively. Among 70 Yupik subjects with elevated fecal hemoglobin levels who had endoscopy performed, 68 (97%) had an abnormal gastric appearance consisting of erythema, mucosal thickening, diffuse mucosal hemorrhages, erosions, or ulcerations. Gastric biopsies revealed chronic active gastritis with associated Helicobacter pylori in 68 (99%) of 69. No other hemorrhagic gastrointestinal disease was detected. CONCLUSIONS: Based on this study sample, occult gastrointestinal bleeding appears to be pervasive in the Yupik population and likely underlies the prevalent iron deficiency. An atypical hemorrhagic gastritis associated with H pylori infection is present almost universally and may represent the bleeding source.