A stable isotope biomarker of marine food intake captures associations between n-3 fatty acid intake and chronic disease risk in a Yup'ik study population, and detects new associations with blood pressure and adiponectin.

The nitrogen isotope ratio (δ(15)N) of RBCs has been proposed as a biomarker of marine food intake in Yup'ik people based on strong associations with RBC eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, EPA and DHA derive from marine fats, whereas elevated δ(15)N derives from marine protein, and these dietary components may have different biologic effects. Whether δ(15)N is similarly associated with chronic disease risk factors compared with RBC EPA and DHA is not known. We used covariate-adjusted linear models to describe biomarker associations with chronic disease risk factors in Yup'ik people, first in a smaller (n = 363) cross-sectional study population using RBC EPA, DHA, and δ(15)N, and then in a larger (n = 772) cross-sectional study population using δ(15)N only. In the smaller sample, associations of RBC EPA, DHA, and δ(15)N with obesity and chronic disease risk factors were similar in direction and significance: δ(15)N was positively associated with total, HDL, and LDL cholesterol, apolipoprotein A-I, and insulin-like growth factor binding protein-3 (IGFBP-3), and inversely associated with triglycerides. Based on comparisons between covariate-adjusted ß-coefficients, EPA was more strongly associated with circulating lipids and lipoproteins, whereas δ(15)N was more strongly associated with adipokines, the inflammatory marker interleukin-6, and IGFBP-3. In the larger sample there were new findings for this population: δ(15)N was inversely associated with blood pressure and there was a significant association (with inverse linear and positive quadratic terms) with adiponectin. In conclusion, δ(15)N is a valid measure for evaluating associations between EPA and DHA intake and chronic disease risk in Yup'ik people and may be used in larger studies. By measuring δ(15)N, we report beneficial associations of marine food intake with blood pressure and adiponectin, which may contribute to a lower incidence of some chronic diseases in Yup'ik people.

Enculturation, perceived stress, and physical activity: implications for metabolic risk among the Yup'ik--the Center for Alaska Native Health Research Study.

OBJECTIVES: American Indians and Alaska Natives (ANs) report among the lowest levels of physical activity in the USA, but there is very little systematic research examining the determinants of physical activity patterns in these populations. This study investigated the relationships between enculturation (or cultural traditionality), psychosocial stress, and physical activity in a community-based sample of Yup'ik women and men living in rural AN communities. Associations between these variables and several metabolic risk factors were also examined. DESIGN: A sample of 488 Yup'ik participants (284 women and 204 men) from six villages in the Yukon-Kuskokwim Delta region completed a wellness survey and an array of physiological assessments [e.g., body mass index (BMI), blood pressure]. A subset of 179 participants also completed a 3-day pedometer assessment of physical activity. RESULTS: Multivariate linear regression models indicated that participants who were more enculturated (i.e., living more of a traditional lifestyle) and who experienced lower levels of psychosocial stress were significantly more physically active. In turn, both lower levels of psychosocial stress and higher levels of physical activity were associated with lower BMI, lower percent body fat, and lower waist circumference. CONCLUSIONS: Findings underscore the importance of gaining a culturally specific understanding of physical activity patterns in indigenous groups in order to inform effective health promotion strategies.

A community engagement process identifies environmental priorities to prevent early childhood obesity: the Children's Healthy Living (CHL) program for remote underserved populations in the US Affiliated Pacific Islands, Hawaii and Alaska.

Underserved minority populations in the US Affiliated Pacific Islands (USAPI), Hawaii, and Alaska display disproportionate rates of childhood obesity. The region's unique circumstance should be taken into account when designing obesity prevention interventions. The purpose of this paper is to (a), describe the community engagement process (CEP) used by the Children's Healthy Living (CHL) Program for remote underserved minority populations in the USAPI, Hawaii, and Alaska (b) report community-identified priorities for an environmental intervention addressing early childhood (ages 2-8 years) obesity, and (c) share lessons learned in the CEP. Four communities in each of five CHL jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Hawai'i) were selected to participate in the community-randomized matched-pair trial. Over 900 community members including parents, teachers, and community leaders participated in the CEP over a 14 month period. The CEP was used to identify environmental intervention priorities to address six behavioral outcomes: increasing fruit/vegetable consumption, water intake, physical activity and sleep; and decreasing screen time and intake of sugar sweetened beverages. Community members were engaged through Local Advisory Committees, key informant interviews and participatory community meetings. Community-identified priorities centered on policy development; role modeling; enhancing access to healthy food, clean water, and physical activity venues; and healthy living education. Through the CEP, CHL identified culturally appropriate priorities for intervention that were also consistent with the literature on effective obesity prevention practices. Results of the CEP will guide the CHL intervention design and implementation. The CHL CEP may serve as a model for other underserved minority island populations.

Stable nitrogen and carbon isotope ratios indicate traditional and market food intake in an indigenous circumpolar population.

The transition of a society from traditional to market-based diets (termed the nutrition transition) has been associated with profound changes in culture and health. We are developing biomarkers to track the nutrition transition in the Yup'ik Eskimo population of Southwest Alaska based on naturally occurring variations in the relative abundances of carbon and nitrogen stable isotopes (δ(15)N and δ(13)C values). Here, we provide three pieces of evidence toward the validation of these biomarkers. First, we analyzed the δ(15)N and δ(13)C values of a comprehensive sample of Yup'ik foods. We found that δ(15)N values were elevated in fish and marine mammals and that δ(13)C values were elevated in market foods containing corn or sugar cane carbon. Second, we evaluated the associations between RBC δ(15)N and δ(13)C values and self-reported measures of traditional and market food intake (n = 230). RBC δ(15)N values were correlated with intake of fish and marine mammals (r = 0.52; P < 0.0001). RBC δ(13)C values were correlated with intake of market foods made from corn and sugar cane (r = 0.46; P < 0.0001) and total market food intake (r = 0.46; P < 0.0001). Finally, we assessed whether stable isotope ratios captured population-level patterns of traditional and market intake (n = 1003). Isotopic biomarkers of traditional and market intake were associated with age, community location, sex, and cultural identity. Self-report methods showed variations by age and cultural identity only. Thus, stable isotopes show potential as biomarkers for monitoring dietary change in indigenous circumpolar populations.

The Affordability of a Thrifty Food Plan-based Market Basket in the United States-affiliated Pacific Region.

In an effort to characterize food costs in the United States (US)-affiliated Pacific Region, a first-time food cost survey was conducted in March 2014. A market basket survey was developed using an adaptation of the US Department of Agriculture Thrifty Food Plan. Surveys were conducted in the states of Alaska and Hawai'i; Portland, Oregon; the US-affiliated Pacific Islands of American Samoa (American Samoa); Commonwealth of the Northern Mariana Islands; the island of Pohnpei within the Federated States of Micronesia; Guam; Republic of the Marshall Islands; and Republic of Palau. Urban and rural communities were included. Multiple stores in multiple communities were surveyed in each jurisdiction. Food retailers (N = 74) ranged from convenience markets to supermarkets. Not all foods in the market basket survey were available in each of the communities. Inspection of available income data also showed that food costs represented a higher percentage of household income for American Samoa than those of Alaska, Hawai'i, and Portland. Thrifty Food Plan weighted weekly totals for the region ranged from $181.90 to $264.30. Weighting was based on the amount of the item converted to grams required for the Thrifty Food Plan menu. These food costs are significantly higher than those of Portland ($142.00) for the survey period. Protein foods, grains, vegetables, fruit, and dairy were the 5 most costly components, in descending order. Food affordability was assessed by comparing food costs across jurisdictions and examining estimated food costs to reported average jurisdiction incomes. The survey is intended to help inform public health policy and educational programs in the region. A locally adapted food survey would benefit future analyses, regional policy, and educational efforts.

Westernizing diets influence fat intake, red blood cell fatty acid composition, and health in remote Alaskan Native communities in the center for Alaska Native health study.

OBJECTIVE: To investigate the impact of a Westernizing diet on fat intake, red blood cell fatty acid composition, and health risks among Yup'ik Eskimos living in rural Alaskan Native communities. DESIGN: Diet data and blood specimens were collected from 530 Yup'ik Eskimos aged 14 to 94 years old. Height, weight, and waist circumference were measured. STATISTICAL ANALYSES: Comparisons of select fatty acid intake between participants in quintiles of traditional food intake (percent energy) were made using analyses of variance and post hoc Bonferroni tests. General linear models were used to determine the association between traditional food intake and health outcomes. RESULTS: Fatty acid composition of the diet differed according to the level of traditional food intake. Traditional food intake was positively associated with higher total fat, eicosapentaenoic acid, and docosahexaenoic acid intake. No association was observed between traditional food intake and saturated fatty acid intake; indeed, participants consuming more traditional foods derived a substantially smaller proportion of their dietary fatty acids from saturated fatty acids (P<0.001). Analyses of red blood cell fatty acid composition supported these findings. After multivariable adjustment, traditional food intake was significantly positively associated with high-density lipoprotein cholesterol concentration and significantly negatively associated with triglyceride concentration (P<0.001). CONCLUSIONS: Diets emphasizing traditional Alaskan Native foods were associated with a fatty acid profile promoting greater cardiovascular health than diets emphasizing Western foods. Further research needs to evaluate the effects of a Westernizing diet on the overall diet of Alaskan Natives.

Resilience and Adaptation: Yukon River Watershed Contaminant Risk Indicators.

River watersheds are among the most complex terrestrial features in Alaska, performing valuable ecosystem functions and providing services for human society. Rivers are vital to both estuarine and aquatic biota and play important roles in biogeochemical cycles and physical processes. The functions of watersheds have been used as vulnerability indicators for ecosystem and socioeconomic resilience. Despite a long history of human activity, the Yukon River has not received the holistic and interdisciplinary attention given to the other great American river systems. By using hypothesis-based monitoring of key watershed functions, we can gain insight to regime-shifting stresses such as fire, toxins, and invasive species development. Coupling adaptive risk management practices involving stakeholders with place-based education, especially contaminants and nutrition related, can maintain resilience within communities. The Yukon watershed provides a broadscale opportunity for communities to monitor the environment, manage resources, and contribute to stewardship policy formation. Monitoring keystone species and community activities, such as citizen science, are critical first steps to following changes to resiliency throughout the Yukon watershed. Creating a policy environment that encourages local experimentation and innovation contributes to resilience maintenance during development-imposed stress.

Nutrient intakes are associated with adherence to a traditional diet among Yup'ik Eskimos living in remote Alaska Native communities: the CANHR Study.

OBJECTIVES: To determine whether dietary westernization is associated with intake of select nutrients among Alaska Natives living in remote communities. To investigate participant characteristics associated with adherence to the traditional Alaska Native diet. STUDY DESIGN: Cross-sectional survey. METHODS: A 24-hour recall was collected from 241 men and 307 women aged 14-94 years living in seven remote communities of Western Alaska. Bivariate analyses and ANOVA were used to examine the relationship between energy from traditional foods (the primary variable of interest), participant characteristics and intake of select nutrients. RESULTS: Traditional foods accounted for 22% of energy intake.overall. This estimate varied by age, educational attainment, and geographic location. Participants in the highest quintile of traditional food intake consumed significantly more vitamin A, vitamin D, Vitamin E, Iron, and n-3 fatty acids than participants in the lowest quintile (p < 0.001). Intake of vitamin C, calcium, and total dietary fiber decreased with increased consumption of traditional foods (p < 0.001). CONCLUSIONS: The degree of dietary westernization contributes to nutrient intake, both positively and negatively, in a dose response manner. Participant characteristics, particularly age, must be addressed in the development of a nutrition education program since they are associated with distinct dietary intakes.

The Center for Alaska Native Health Research Study: a community-based participatory research study of obesity and chronic disease-related protective and risk factors.

OBJECTIVES: To describe the background, approach and general results of the Center for Alaska Native Health Research (CANHR) study. STUDY DESIGN: This was a cross-sectional Community-Based Participatory Research (CBPR) study with one tribal group to assess risk and protection for obesity and the risk factors related to chronic disease, diabetes and cardiovascular disease. METHODS: A combination of biological, genetic, nutritional and psychosocial measurements were taken on 922 Alaska Native participants in ten communities in Southwestern Alaska. The paper reports on data from 753 adult participants. RESULTS: The prevalence of type 2 diabetes is 3.3% in the sample population. Metabolic syndrome is significantly lower among the males and equal for females when compared with Caucasians in the NHANES III sample. Obesity among adults is now at the national average. Risk factors for chronic disease include a shift to a Westernized diet, stress, obesity and impaired fasting glucose and protective factors include high levels of polyunsaturated fatty acid dietary intake. Articles in this issue present specific results in these areas. CONCLUSIONS: The data strongly indicate that, in general, Yup'ik people in our study are metabolically healthy and that diet and life style provide a delicate combination of protective and risk factors. The results strongly indicate that solution focused research utilizing primary and secondary prevention strategies may provide evidence for how to intervene to prevent further increases of chronic diseases. Research that focuses on relating the intrinsic strengths of indigenous worldviews and practices with basic research may contribute to positive transformations in community health.

Diet quality among Yup'ik Eskimos living in rural communities is low: the Center for Alaska Native Health Research Pilot Study.

OBJECTIVE: The objectives of this pilot study were to describe the nutrient intake of Yup'ik Eskimos in comparison with national intake, identify dietary sources of key nutrients, and assess the utility of the Healthy Eating Index (HEI) to measure diet quality of Yup'ik Eskimos living in rural Alaskan Native communities. PARTICIPANTS AND DESIGN: A single 24-hour recall was collected from 48 male and 44 female Yup'ik Eskimos (aged 14 to 81 years), who resided in three villages in the Yukon Kuskokwim River Delta, AK, during September 2003. MAIN OUTCOME MEASURES: HEI scores, nutrient intake, and traditional food intake. STATISTICAL ANALYSES PERFORMED: Spearman correlations for associations between variables. RESULTS: Youth scored higher than elders despite similar nutrient intakes. Overall diet quality was generally low; 63% of all participants' diets were classified as poor. Although the HEI serves to identify areas of concern with respect to diet quality, it is limited in its ability to detect the positive value of traditional foods. CONCLUSIONS: Traditional foods and healthful market foods, including rich sources of fiber and calcium, should be encouraged. Although traditional foods were important sources of energy and nutrients, market foods composed the preponderance of the diet, emphasizing the importance of appropriately modifying a diet quality index based on a Western framework, such as the HEI.

Validation of the Actical Accelerometer in Multiethnic Preschoolers: The Children's Healthy Living (CHL) Program.

This study aimed to determine the validity and reliability of the Actical accelerometer for measuring physical activity (PA) in preschool children of mixed ethnicity, compared with direct observation via a modified System for Observing Fitness Instruction Time (SOFIT) protocol and proxy parental reports (PA Logs). Fifty children in Hawai'i wore wrist-mounted accelerometers for two 7-day periods with a washout period between each week. Thirty children were concurrently observed using SOFIT. Parents completed PA Logs for three days. Reliability and validity were measured by intra-class correlation coefficient and proportions of agreement concurrently. There was slight agreement (proportion of agreement: 82%; weighted Kappa=.17, P <.001) between the accelerometer and SOFIT as well as between the accelerometer and the PA Logs (proportions of agreement: 40%; weighted Kappa=0.15, P <.001). PA logs underestimated the PA levels of the children, while the Actical was found to be valid and reliable for estimating PA levels of multiethnic, mixed ethnicity preschoolers. These findings suggest that accelerometers can be objective, valid, and accurate physical activity assessment tools compared to conventional PA logs and subjective reports of activity for preschool children of mixed ethnicity.

Building a community-based participatory research center to investigate obesity and diabetes in Alaska Natives.

The Center for Alaska Native Health Research (CANHR) is a community-based participatory research project aimed at understanding current risk factors for obesity, diabetes, and cardiovascular disease in Alaska Natives living in Southwest Alaska. We utilize a multidisciplinary approach that includes assessment of genetic, nutritional and behavioral risk factors and their interrelationships with one another in the overall development of disease. The design of the CANHR project involved community participation in the development, implementation and interpretation of research results. We have developed a participatory research program that is designed to be culturally appropriate, relevant to community needs and interests, and respectful to our participants. This manuscript describes the organizational development of our CANHR study and the procedures employed in its progression to date.

Improved Overall Quality of Diets Reported by Expanded Food and Nutrition Education Program Participants in the Mountain Region.

OBJECTIVE: To evaluate the Expanded Food and Nutrition Education Program, a large US Department of Agriculture nutrition education program for low-income people, by comparing the overall quality and cost of diets when entering and exiting the program. METHODS: Secondary analysis of data collected in 2011 from female participants in the Mountain region. Dietary recalls were collected by paraprofessionals. Outcome measures were the differences between Healthy Eating Index-2005 scores and costs of diets at entry and exit. Significance was determined using the Wilcoxon signed-rank test. RESULTS: At entry the mean total Healthy Eating Index-2005 score was 49.1 (out of a possible 100) and at exit, 55.2 (P < .001) (n = 3,338). Eight of 12 component scores also improved significantly whereas the sodium score worsened. The estimated median cost of diets was 13% higher at exit compared with entry. CONCLUSIONS: Participants' overall diet quality improved and was accompanied by an increase in food cost.

Locally harvested foods support serum 25-hydroxyvitamin D sufficiency in an indigenous population of Western Alaska.

BACKGROUND: Low serum vitamin D is associated with higher latitude, age, body fat percentage and low intake of fatty fish. Little documentation of vitamin D concentrations is available for Alaska Native populations. OBJECTIVE: This study was undertaken to investigate serum 25-hydroxyvitamin D (25(OH)D) concentrations of the Yup'ik people of southwestern Alaska in relation to demographic and lifestyle variables, particularly with the use of locally harvested (local) foods. DESIGN: Cross-sectional study. METHODS: We estimated 25(OH)D, dietary vitamin D and calcium, percent of energy from local foods and demographic variables in 497 Yup'ik people (43% males) aged 14-92 residing in southwestern Alaska. Sampling was approximately equally divided between synthesizing and non-synthesizing seasons, although the preponderance of samples were drawn during months of increasing daylight. RESULTS: Mean vitamin D intake was 15.1 ± 20.2 µg/d, while local foods accounted for 22.9 ± 17.1% of energy intake. The leading sources of vitamin D were local fish (90.1%) followed by market foods. Mean 25(OH)D concentration was 95.6 ± 40.7 nmol/L. Participants in the upper 50th percentile of 25(OH)D concentration tended to be older, male, of lower body mass index, sampled during the synthesizing season, and among the upper 50th percentile of local food use. CONCLUSIONS: A shift away from locally harvested foods will likely increase the risk for serum 25(OH)D insufficiency in this population.

Associations of very high intakes of eicosapentaenoic and docosahexaenoic acids with biomarkers of chronic disease risk among Yup'ik Eskimos.

BACKGROUND: Few studies have examined the associations of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) with biomarkers of chronic disease risk in populations with high intakes. OBJECTIVE: We examined the associations of red blood cell (RBC) EPA and DHA, as percentages of total fatty acids, with biomarkers of chronic disease risk across a wide range of EPA and DHA intakes. DESIGN: In a cross-sectional study of 357 Yup'ik Eskimos, generalized additive models were used to plot covariate-adjusted associations of EPA and DHA with chronic disease biomarkers. Linear regression models were used to test for the statistical significance of these associations. RESULTS: Means (5th-95th percentiles) for RBC EPA and DHA were 2.8% (0.5-5.9%) and 6.8% (3.3-9.0%), respectively. Associations of EPA and DHA were inverse and linear for triglycerides (beta +/- SE = -0.10 +/- 0.01 and -0.05 +/- 0.01, respectively) and positive and linear for HDL cholesterol (beta +/- SE = 2.0 +/- 0.5 and 0.9 +/- 0.6, respectively) and apolipoprotein A-I (beta +/- SE = 2.6 +/- 0.8 and 1.7 +/- 0.8, respectively). Positive linear associations of DHA with LDL and total cholesterol (beta +/- SE = 7.5 +/- 1.4 and 6.80 +/- 1.57, respectively) were observed; for EPA, these associations were nonlinear and restricted to concentrations approximately <5% of total fatty acids. Associations of EPA and DHA with C-reactive protein were inverse and nonlinear: for EPA, the association appeared stronger at concentrations approximately >3% of total fatty acids; for DHA, it was observed only at concentrations approximately >7% of total fatty acids. CONCLUSION: Increasing EPA and DHA intakes to amounts well above those consumed by the general US population may have strong beneficial effects on chronic disease risk.

Red blood cell delta15N: a novel biomarker of dietary eicosapentaenoic acid and docosahexaenoic acid intake.

BACKGROUND: The long-chain omega-3 (n-3) fatty acids derived from fish, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are associated with a reduced risk of cardiovascular disease and other chronic diseases. Study of the associations between EPA and DHA intake and disease requires a valid biomarker of dietary intake; however, the direct measurement of tissue fatty acid concentrations is expensive and time consuming. OBJECTIVE: Because the nitrogen stable isotope ratio ((15)N/(14)N, expressed as delta(15)N) is elevated in fish, we investigated whether delta(15)N is a valid alternative biomarker of EPA and DHA intake. DESIGN: We examined the relation between red blood cell (RBC) delta(15)N and RBC EPA and DHA in a community-based sample of 496 Yup'ik Eskimos with widely varying intake of n-3 fatty acids. We also assessed the correlation between delta(15)N and dietary EPA and DHA intake based on 24-h dietary recalls and 3-d food records completed by a subset of 221 participants. RESULTS: RBC delta(15)N was strongly correlated with RBC EPA and DHA (r = 0.83 and 0.75, respectively). These correlations differed only modestly by sex and age class. RBC delta(15)N also correlated with dietary EPA and DHA intake (r = 0.47 and 0.46, respectively) and did not differ by sex and age. CONCLUSIONS: The results strongly support the validity of RBC delta(15)N as a biomarker of EPA and DHA intake. Because the analysis of RBC delta(15)N is rapid and inexpensive, this method could facilitate wide-scale assessment of EPA and DHA intake in clinical and epidemiologic studies.