Associations of health status and diabetes among First Nations Peoples living on-reserve in Canada.

OBJECTIVE: Our objective is to describe self-reported health status, prevalence of diabetes and obesity and their associations in participants from the First Nations Food, Nutrition and Environment Study (FNFNES) in order to identify possible correlates of health in First Nations adults. METHODS: FNFNES is a participatory study with First Nations Peoples living on reserve lands south of the 60th parallel. Health and diabetes were self-reported, and prevalence of obesity was evaluated. Socio-demographic and lifestyle factors and traditional food (TF) activities were investigated for associations with health parameters. RESULTS: High prevalence rates of overweight/obesity (78-91%) and diabetes (19% age-standardized prevalence) were found. Smoking rates were high and physical activity was low. In multivariable analyses, obesity was associated with region, income source, age, gender, smoking and self-reported health; diabetes and lesser self-reported health were associated with obesity and lower education. Diabetes was strongly associated with lesser self-reported health and weakly associated with being a smoker. CONCLUSION: We have identified possible correlates of health in this population that can help to better understand the underlying concerns and identify solutions for First Nations and their partners. We urge governments and First Nations to address the systemic problems identified with a holistic ecosystem approach that takes into consideration the financial and physical access to food, particularly TF, and the facilitation of improved health behaviour. New mechanisms co-developed with First Nations leadership should focus on supporting sustainable, culturally safe and healthy lifestyles and closing the gaps in nutrition and food insecurity.

RéSUMé: OBJECTIFS: Décrire l'état de santé autodéclaré, les prévalences de diabète et d'obésité et leurs associations chez les participants de l'Étude sur l'alimentation, la nutrition et l'environnement des Premières Nations (EANEPN) afin d'identifier d'éventuelles associations avec la santé chez les adultes des Premières Nations. MéTHODE: L'EANEPN est une étude participative entreprise avec les Peuples des Premières Nations vivant dans les réserves au sud du 60e parallèle. L'état de santé et le diabète ont été autodéclarés et la prévalence de l'obésité a été évaluée. Les facteurs sociodémographiques et de style de vie et les activités d'apports en aliments traditionnels (AT) ont été étudiés pour leurs associations avec les paramètres de santé. RéSULTATS: Une prévalence élevée de surpoids/obésité (78­91%) et de diabète (19% ­ taux normalisé selon l'âge) a été observée. Le taux de tabagisme était élevé et l'activité physique était faible. Dans les analyses multivariées, l'obésité était associée avec la région, la source de revenu, l'âge, le sexe, le tabagisme et l'état de santé autodéclaré; le diabète et l'état de santé faible autodéclarés étaient positivement associés à l'obésité et à moins d'années d'éducation. Le diabète était fortement associé à un faible état de santé autodéclaré et légèrement avec le tabagisme. CONCLUSION: Nous avons identifié des corrélats de santé potentiels dans cette population qui peuvent nous aider à mieux comprendre les préoccupations sous-jacentes. Nous exhortons les gouvernements et les Premières Nations à s'attaquer de concert aux problèmes systémiques identifiés avec une approche écosystémique holistique qui prend en considération l'accès financier et physique à la nourriture, en particulier les AT, et qui facilite une amélioration dans les comportements en santé. De nouveaux mécanismes élaborés conjointement avec les dirigeants des Premières Nations devraient viser à soutenir des modes de vie durables, culturellement sécuritaires et sains et à combler les lacunes en matière de nutrition et d'insécurité alimentaire.

Predictors of household food insecurity and relationship with obesity in First Nations communities in British Columbia, Manitoba, Alberta and Ontario.

OBJECTIVE: To further understandings of household food insecurity in First Nations communities in Canada and its relationship with obesity. DESIGN: Analysis of a cross-sectional dataset from the First Nations Food, Nutrition and Environment Study representative of First Nations communities south of the 60th parallel. Multivariate logistic regression was used to assess associations between food insecurity and sociodemographic factors, as well as the odds of obesity among food-insecure households adjusting for sociodemographic characteristics. SETTING: Western and Central Canada. PARTICIPANTS: First Nations peoples aged ≥19 years. RESULTS: Forty-six percent of First Nations households experienced food insecurity. Food insecurity was highest for respondents who received social assistance; had ≤10 years of education; were female; had children in the household; were 19-30 years old; resided in Alberta; and had no year-round road access into the community. Rates of obesity were highest for respondents residing in marginally food-insecure households (female 56·6 %; male 54·6 %). In gender-specific analyses, the odds of obesity were highest among marginally food-insecure households in comparison with food-secure households, for both female (OR 1·57) and male (OR 1·57) respondents, adjusting for sociodemographic variables. For males only, those in severely food-insecure (compared with food-secure) households had lower odds of obesity after adjusting for confounding (OR 0·56). CONCLUSIONS: The interrelated challenges of food insecurity and obesity in First Nations communities emphasise the need for Indigenous-led, culturally appropriate and food sovereign approaches to food security and nutrition in support of holistic wellness and prevention of chronic disease.

Optimisation modelling to improve the diets of First Nations individuals.

We examined the feasibility of linear programming (LP) to develop diets that were economical, included traditional (cultural, non-market) foods and met the dietary reference intakes (DRI) in a Canadian Indigenous population. Diet optimisation using LP is a mathematical technique that can develop food-based dietary guidelines for healthy eating in Indigenous populations where food insecurity, availability and cost are important considerations. It is a means of developing nutritionally optimal food combinations that are based on economical and culture-specific foods. Observed food consumption data were derived using 24-h food recalls from the First Nations Food, Nutrition and Environment Study. The LP models were constructed to develop diets meeting DRI, cost and food constraints. Achieving the recommended food intake was not feasible in a model meeting all nutrient requirements. Models that met most nutrient requirements at reduced cost were designed for men and women, separately. In women, it was necessary to increase energy intake to meet most nutrient requirements. Nutrient requirements could not be met for fibre, linoleic and linolenic acids, vitamin D, Ca and K in both sexes, P in women, and Mg and vitamin A in men. Using LP to develop optimal diets for First Nations people, we found simultaneous achievement of all DRI was difficult, suggesting that supplementation might be necessary which goes against recommendations for individuals to meet their nutrient needs through healthy eating patterns. Additionally, to make diets feasible, programmes to reduce market food costs and to support First Nations people in traditional food harvesting are recommended.

Association between fish consumption, dietary omega-3 fatty acids and persistent organic pollutants intake, and type 2 diabetes in 18 First Nations in Ontario, Canada.

BACKGROUND: First Nations (FNs) populations in Canada experience a disproportionally higher rate of obesity and type 2 diabetes (T2D) compared to the general population. Recent data suggest that a high consumption of fish may help prevent T2D. On the other hand, fish might also be a potential source of environmental contaminants which could potentially be a risk factor for T2D. OBJECTIVE: To investigate the potential associations between self-reported T2D and consumption of locally-harvested fish, dietary long-chain omega-3 fatty acids (n-3FAs) and persistent organic pollutants intake among adult FNs living on reserve in Ontario. DESIGN: Data from the First Nations Food Nutrition and Environment Study, which included a cross-sectional study of 1429 Ontario FNs adults living in 18 communities across 4 ecozones in 2012 were analyzed. Social and lifestyle data were collected using household interviews. The consumption of locally-harvested fish was estimated using a traditional food frequency questionnaire along with portion size information obtained from 24hr recalls. Fish samples were analyzed for the presence of contaminants including dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs). Dietary intakes of DDE and PCBs were estimated using community-specific levels of DDE/PCBs in fish species. Multiple logistic regression models adjusted for potential covariates including age, gender, body mass index, physical activity, total energy intake, smoking, and education were developed. RESULTS: The prevalence of T2D in Ontario FNs was 24.4%. A significant positive association between fish consumption of one portion per week and more and T2D compared to no fish consumption was found (OR=2.5 (95% CI: 1.38-4.58). Dietary DDE and PCBs intake was positively associated with T2D (OR=1.09 (95%CI: 1.05-1.75) for DDE and OR=1.07 (95%CI: 1.004-1.27) for PCBs) per unit increase in DDE/PCBs while n-3-FAs intake, adjusted for DDE/PCBs intake, showed an inverse effect against T2D among older individuals (OR=0.86 (95% CI: 0.46-0.99). CONCLUSION: Our results support previous findings that exposure to DDE and PCBs may increase the risk of T2D. Elevated levels of contaminants in fish may counteract with potentially beneficial effects of n-3FAs from fish consumption. However, the overall health benefits of high consumption of fish with a high n-3 FAs content may outweigh the adverse effect of contaminants.

Dietary nutrients and anthropometry of Dene/Métis and Yukon children.

OBJECTIVE: To describe nutrient intakes and anthropometry of 10-12-year-old Dene/Métis and Yukon children in the Canadian Arctic. STUDY DESIGN: 24 h-recall interviews (n = 222 interviews) were conducted on Canadian Dene/Métis and Yukon children in five communities during two seasons in 2000-2001; the children were measured for height and weight (n = 216). METHODS: Assessment of nutrient adequacy used Dietary Reference Intakes (DRIs) including cut-point procedures. Anthropometric measurements (height and weight) were assessed and body mass index (BMI) was compared to the 2000 CDC Growth Charts. RESULTS: Thirty-two percent of the children were above the 85th percentile of BMI-for-age. More than 50 percent of children were below the Estimated Average Requirement (EAR) for vitamins A and E, phosphorus and magnesium; mean intakes were below the Adequate Intake (AI) for vitamin D, calcium, dietary fiber, omega-6 fatty acids, and omega-3 fatty acids. Nutrients that were probably adequate for some gender/season groups were protein, carbohydrate, iron, copper, selenium, zinc, manganese, riboflavin and vitamins B6 and C. CONCLUSIONS: Excessive prevalence of overweight and inadequacy of some nutrients were observed among Dene/Métis and Yukon children, suggesting a necessity for dietary improvement. However, many nutrients were adequate, in some cases probably due to continued traditional food use.