The Impact of Waiting List BMI Changes on the Short-term Outcomes of Lung Transplantation.

BACKGROUND: Obesity and underweight are associated with a higher postlung transplantation (LTx) mortality. This study aims to assess the impact of the changes in body mass index (BMI) during the waiting period for LTx on early postoperative outcomes. METHODS: Medical records of 502 consecutive cases of LTx performed at our institution between 1999 and 2015 were reviewed. Patients were stratified per change in BMI category between pre-LTx assessment (candidate BMI) and transplant BMI as follows: A-candidate BMI, less than 18.5 or 18.5 to 29.9 and transplant BMI, less than 18.5; B-candidate BMI, less than 18.5 and transplant BMI, 18.5 to 29.9; C-candidate BMI, 18.5 to 29.9 and transplant BMI, 18.5 to 29.9; D-candidate BMI, 30 or greater and transplant BMI, 18.5 to 29.9; and E-candidate BMI, 30 or greater or 18.5 to 29.9 and transplant BMI, 30 or greater. Our primary outcome was in-hospital mortality and secondary outcomes were length of mechanical ventilation, intensive care unit length of stay (LOS), hospital LOS and postoperative complications. RESULTS: BMI variation during the waiting time was common, as 1/3 of patients experienced a change in BMI category. Length of mechanical ventilation (21 days vs 9 days; P = 0.018), intensive care unit LOS (26 days vs 15 days; P = 0.035), and rates of surgical complications (76% vs 44%; P = 0.018) were significantly worse in patients of group E versus group D. Obese candidates who failed to decrease BMI less than 30 by transplant exhibited an increased risk of postoperative mortality (odds ratio, 2.62; 95% confidence interval, 1.01-6.48) compared with patients in group C. Pre-LTx BMI evolution had no impact on postoperative morbidity and mortality in underweight patients. CONCLUSIONS: Our results suggest that obese candidates with an unfavorable pretransplant BMI evolution are at greater risk of worse post-LTx outcomes.

Facilitators and Barriers to Traditional Food Consumption in the Cree Community of Mistissini, Northern Quebec.

To identify barriers to traditional food consumption and factors that facilitate it among the Cree community of Mistissini, a series of four focus groups was conducted with a total of twenty-three people. Two ecological models were created, one for facilitating factors and a second for obstacles, illustrating the role of numerous interconnected influences of traditional food consumption. Environmental impact project, laws and regulation, local businesses, traditional knowledge, youth influence, employment status, and nonconvenience of traditional food were named among numerous factors influencing traditional food consumption. The findings of this study can be used by political and public health organizations to promote traditional food where more emphasis should be invested in community and environmental strategies.

A mixed methods inquiry into the determinants of traditional food consumption among three Cree communities of Eeyou Istchee from an ecological perspective.

BACKGROUND: The Aboriginal nations of Canada have higher incidences of chronic diseases, coinciding with profound changes in their environment, lifestyle and diet. Traditional foods can protect against the risks of chronic disease. However, their consumption is in decline, and little is known about the complex mechanisms underlying this trend. OBJECTIVE: To identify the factors involved in traditional food consumption by Cree Aboriginal people living in 3 communities in northern Quebec, Canada. Design. A mixed methods explanatory design, including focus group interviews to interpret the results of logistic regression. METHODS: This study includes a secondary data analysis of a cross-sectional survey of 3 Cree communities (n=374) and 4 focus group interviews (n=23). In the first, quantitative phase of the study, data were collected using a food-frequency questionnaire along with a structured questionnaire. Subsequently, the focus group interviews helped explain and build on the results of logistic regressions. RESULTS: People who consume traditional food 3 days or more weekly were more likely to be 40 years old and over, to walk 30 minutes or more per day, not to have completed their schooling, to live in Mistissini and to be a hunter (p<0.05 for all comparisons). The focus group participants provided explanations for the quantitative analysis results or completed them. For example, although no statistical association was found, focus group participants believed that employment acts as both a facilitator and a barrier to traditional food consumption, rendering the effect undetectable. In addition, focus group participants suggested that traditional food consumption is the result of multiple interconnected influences, including individual, family, community and environmental influences, rather than a single factor. CONCLUSION: This study sheds light on a number of factors that are unique to traditional foods, factors that have been understudied to date. Efforts to promote and maintain traditional food consumption could improve the overall health and wellbeing of Cree communities.

Can an integrated approach reduce child vulnerability to anaemia? Evidence from three African countries.

Addressing the complex, multi-factorial causes of childhood anaemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a "buffering" of risk associated with known causes of anaemia would be observed among children living in areas benefiting from a community-based health and nutrition program intervention. Cross-sectional data on the nutrition and health status of children 24-59 mo (N=2405) were obtained in 2000 and 2004 from program evaluation surveys in Ghana, Malawi and Tanzania. Linear regression models estimated the association between haemoglobin and immediate, underlying and basic causes of child anaemia and variation in this association between years. Lower haemoglobin levels were observed in children assessed in 2000 compared to 2004 (difference -3.30 g/L), children from Tanzania (-9.15 g/L) and Malawi (-2.96 g/L) compared to Ghana, and the youngest (24-35 mo) compared to oldest age group (48-59 mo; -5.43 g/L). Children who were stunted, malaria positive and recently ill also had lower haemoglobin, independent of age, sex and other underlying and basic causes of anaemia. Despite ongoing morbidity, risk of lower haemoglobin decreased for children with malaria and recent illness, suggesting decreased vulnerability to their anaemia-producing effects. Stunting remained an independent and unbuffered risk factor. Reducing chronic undernutrition is required in order to further reduce child vulnerability and ensure maximum impact of anaemia control programs. Buffering the impact of child morbidity on haemoglobin levels, including malaria, may be achieved in certain settings.

Consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community.

OBJECTIVE: The present study describes the consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community and examines its associations with physical activity, sedentary behaviours and BMI. DESIGN: A two-stage cross-sectional design was used. In Stage 1 (n 42), 24 h recalls enabled the identification of sweetened products. In Stage 2 (n 192), an FFQ was administered to measure the daily consumption of these products and to collect sociodemographic and behavioural data. Sweetened products were defined as processed culinary ingredients and ultra-processed products for which total sugar content exceeded 20% of total energy. SETTING: Three Catholic Middle Eastern churches located in Montreal, Canada. SUBJECTS: Normoglycaemic men and women (18-60 years old). RESULTS: Twenty-six sweetened products represented an average consumption of 75·4 g total sugars/d or 15·1% of daily energy intake (n 190, 56% women). Soft drinks, juices, sweetened coffee, chocolate, cookies, cakes and muffins were the main sources of consumption and mostly consumed between meals. Age (exp (ß) = 0·99; P < 0·01), physical activity (exp (ß) = 1·08; P < 0·01) and recreational computer use (exp (ß) = 1·17; P < 0·01) were independently associated with sweetened product consumption. The association between sweetened product consumption and physical activity was U-shaped. BMI was not significantly associated with sweetened product consumption but all participants regardless of BMI were above the WHO recommendation for free sugars. CONCLUSIONS: Being physically active and spending less time using a computer may favour a reduced consumption of sweetened products. Very active individuals may, however, overconsume such products.

Pilot project of the Nutrition-Friendly School Initiative (NFSI) in Ouagadougou, Burkina Faso and Cotonou, Benin, in West Africa.

This paper describes the first African experience with the Nutrition-Friendly School Initiative (NFSI) in two large West African cities: Ouagadougou, Burkina Faso and Cotonou, Benin. NFSI was launched by the World Health Organization (WHO) and its partners in 2006, as a means of preventing the double burden of malnutrition: the coexistence of undernutrition and overnutrition among school-children. NFSI pilot-testing is one component of the Partnership Project on the Double Burden of Malnutrition, funded by the Canadian International Development Agency for 6 years (2008-2014). The Project assisted the government in the selection of pilot schools, fostered the installation of health and nutrition committees in selected schools, and helped with the initial school self-assessments. In accordance with the empowering philosophy of health promotion, pilot schools did not follow a pre-defined schedule of interventions, except for the training of teachers in nutrition education and the nutritional (anthropometric) surveillance of schoolchildren. For the latter activities, technical assistance and seminal funds were provided. Yearly planning workshops were held for school committees, with WHO support. In both settings, training was given to street vendors in order to improve the hygiene and nutritional value of food sold to schoolchildren. Other activities included special nutrition events and sanitation measures. In both cities, NFSI showed promising results in terms of school and community mobilization towards improved nutrition and health; however, NFSI must be better understood as an endogenous and self-sustaining approach. Furthermore, household poverty and scarce school resources appear as major barriers to gaining full impact of NFSI in low-income populations.

Predisposing, facilitating and reinforcing factors of healthy and unhealthy food consumption in schoolchildren: a study in Ouagadougou, Burkina Faso.

OBJECTIVE: African schoolchildren's dietary habits are likely changing in the realm of the nutrition transition, particularly in urban areas, but data on their diet and on determinants are scanty. In order to design relevant interventions for this priority target group, the study aimed to assess food habits and their determinants in schoolchildren of Ouagadougou. METHODS: In a cross-sectional survey, fifth-grade schoolchildren filled during school hours a questionnaire to assess consumption frequency of 'healthy' foods (fruits, vegetables, meat, fish, legumes) and 'unhealthy' (superfluous) items (cake, cookies, candies, ice, soda) and underlying factors, using Green's PRECEDE model. RESULTS: The study included 769 schoolchildren, mean age 11.7 ± 1.4 years, from eight public and four private schools. Consumption scores of unhealthy items were significantly higher than healthy foods (p = 0.001). During the week prior to the survey, 25% of children had eaten no fruit, 20% no meat, 20% no legumes, 17% no fish and 17% no vegetables. While less than 4% ate fruits or vegetables every day, 18.3% ate ice pop every day. Children eating cookies, cakes and candy every day were up to seven-fold those eating fruits, vegetables or legumes. Compared to public-school pupils, those from private schools consumed both healthy and unhealthy items more frequently (p = 0.002 and p = 0.007, respectively). Urban schoolchildren had significantly higher unhealthy food scores (p = 0.027) compared to peri-urban schools. Children's healthy and unhealthy food consumption was primarily explained by perceived decisional power and availability [facilitating factors] for both types of foods, and maternal reinforcement for healthy foods and peers' reinforcement for consumption of unhealthy items. Overall, facilitating factors rated higher for unhealthy than healthy foods. CONCLUSION: The study showed that city schoolchildren's eating behaviours are far from optimal. Nutrition interventions should be tailored to address the underlying factors in order to impact on behaviours, thereby preventing both dietary inadequacies and excess.

Psychological distress mediates the association between daytime sleepiness and consumption of sweetened products: cross-sectional findings in a Catholic Middle-Eastern Canadian community.

OBJECTIVE: To examine the associations between consumption of sweetened products, daytime sleepiness (DS) and psychological distress (PD) in a Catholic Middle-Eastern Canadian community, and to test the hypothesis that the association between DS and consumption of sweetened products is mediated by PD. DESIGN: A cross-sectional study. SETTING: A Catholic Middle-Eastern Canadian community. PARTICIPANTS: 186 men and women aged between 18 and 60 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Sweetened product consumption was measured using a food frequency questionnaire (total sugars/day). DS and PD were measured using standardised questionnaires. The generalised linear model was used to estimate associations between sweetened product consumption, age, sex, self-reported body mass index, DS and PD. Baron and Kenny's four-step approach in addition to the Sobel test were used to establish mediation. RESULTS: Average DS score was 8.2 (SD=4.5) with 19.5% having excessive scores (>12). Mean PD score was 20.8 (SD=6.2) with 11.8% having high distress scores. Average consumption of sweetened products was 15.5 g/day (SD=13.9). Baron and Kenny's three steps to establish partial mediation were confirmed. First, DS was associated with consumption of sweetened products (p<0.03). Second, DS and PD were correlated (r=0.197; p<0.04). Third, PD was associated with consumption of sweetened products (p<0.01) when both PD and DS were entered as predictors in a multivariate regression. However, Baron and Kenny's fourth step to establish complete mediation was not met. The effect of DS on consumption of sweetened products controlling for PD was reduced, but it was not zero. Finally, the Sobel test was significant (2.14; p<0.03). CONCLUSIONS: The association between DS and consumption of sweetened products in the Catholic Middle-Eastern Canadian community is partially mediated by psychological distress. Further work should test this mediation relationship in larger samples and verify the potential effects of other sleep variables in this relationship.

Describing the situational contexts of sweetened product consumption in a Middle Eastern Canadian community: application of a mixed method design.

Little is known about the situational contexts in which individuals consume processed sources of dietary sugars. This study aimed to describe the situational contexts associated with the consumption of sweetened food and drink products in a Catholic Middle Eastern Canadian community. A two-stage exploratory sequential mixed-method design was employed with a rationale of triangulation. In stage 1 (n = 62), items and themes describing the situational contexts of sweetened food and drink product consumption were identified from semi-structured interviews and were used to develop the content for the Situational Context Instrument for Sweetened Product Consumption (SCISPC). Face validity, readability and cultural relevance of the instrument were assessed. In stage 2 (n = 192), a cross-sectional study was conducted and exploratory factor analysis was used to examine the structure of themes that emerged from the qualitative analysis as a means of furthering construct validation. The SCISPC reliability and predictive validity on the daily consumption of sweetened products were also assessed. In stage 1, six themes and 40-items describing the situational contexts of sweetened product consumption emerged from the qualitative analysis and were used to construct the first draft of the SCISPC. In stage 2, factor analysis enabled the clarification and/or expansion of the instrument's initial thematic structure. The revised SCISPC has seven factors and 31 items describing the situational contexts of sweetened product consumption. Initial validation of the instrument indicated it has excellent internal consistency and adequate test-retest reliability. Two factors of the SCISPC had predictive validity for the daily consumption of total sugar from sweetened products (Snacking and Energy demands) while the other factors (Socialization, Indulgence, Constraints, Visual Stimuli and Emotional needs) were rather associated to occasional consumption of these products.

Household food insecurity and Canadian Aboriginal women's self-efficacy in food preparation.

PURPOSE: Determinants of self-efficacy related to food preparation using store-bought food were examined in women belonging to the Atikamekw Nation. Also examined was whether self-efficacy was associated with household food insecurity. METHODS: A cross-sectional survey was conducted with 107 women responsible for household food supplies. Two self-efficacy scores were calculated, one for healthy food preparation and one for food preparation in general. Household food insecurity was measured with an adapted version of the United States Food Security Core Module. The other variables were household composition, income sources, food supplies, tobacco use, participants' health status, and lifestyle and sociodemographic characteristics. Multiple linear regression was used to analyze associations between self-efficacy and household food insecurity in 99 participants. RESULTS: Severe household food insecurity was associated with significantly lower healthy food preparation scores in Atikamekw women. Other associated variables were food supplies, marital status, alcohol consumption, weight status, and understanding of the native language. CONCLUSIONS: Application of the concept of self-efficacy contributes to a better understanding of the factors influencing food preparation in Atikamekw women. In this study, self-efficacy in healthy food preparation was linked to food insecurity and obesity, particularly in the most serious cases. Efforts to improve diet will require not only behavioural interventions, but public policies.

Poor nutritional status of schoolchildren in urban and peri-urban areas of Ouagadougou (Burkina Faso).

BACKGROUND: Malnutrition is still highly prevalent in developing countries. Schoolchildren may also be at high nutritional risk, not only under-five children. However, their nutritional status is poorly documented, particularly in urban areas. The paucity of information hinders the development of relevant nutrition programs for schoolchildren. The aim of this study carried out in Ouagadougou was to assess the nutritional status of schoolchildren attending public and private schools. METHODS: The study was carried out to provide baseline data for the implementation and evaluation of the Nutrition Friendly School Initiative of WHO. Six intervention schools and six matched control schools were selected and a sample of 649 schoolchildren (48% boys) aged 7-14 years old from 8 public and 4 private schools were studied. Anthropometric and haemoglobin measurements, along with thyroid palpation, were performed. Serum retinol was measured in a random sub-sample of children (N = 173). WHO criteria were used to assess nutritional status. Chi square and independent t-test were used for proportions and mean comparisons between groups. RESULTS: Mean age of the children (48% boys) was 11.5 ± 1.2 years. Micronutrient malnutrition was highly prevalent, with 38.7% low serum retinol and 40.4% anaemia. The prevalence of stunting was 8.8% and that of thinness, 13.7%. The prevalence of anaemia (p = 0.001) and vitamin A deficiency (p < 0.001) was significantly higher in public than private schools. Goitre was not detected. Overweight/obesity was low (2.3%) and affected significantly more children in private schools (p = 0.009) and younger children (7-9 y) (p < 0.05). Thinness and stunting were significantly higher in peri-urban compared to urban schools (p < 0.05 and p = 0.004 respectively). Almost 15% of the children presented at least two nutritional deficiencies. CONCLUSION: This study shows that malnutrition and micronutrient deficiencies are also widely prevalent in schoolchildren in cities, and it underlines the need for nutrition interventions to target them.

Psychosocial correlates of body mass index in four groups of Quebec adults.

The objective of the present analysis was to study the associations between body weight psychosocial correlates and body mass index (BMI) among four groups of adults in the Quebec population. Data were taken from the Social Lifestyles and Health 1998 Survey performed by the Institut de la Statistique du Québec (ISQ). The suggested guidelines of the ISQ were used to estimate the population's proportions and for statistical analysis. The groups studied were 25- to 44- and the 45- to 64-year-old men and women. In all groups, currently trying to lose weight increased the odds of reporting an excess weight. Better perceived eating habits was associated with lower BMI in most groups except in the 25- to 44-year-old women, where the trend was not significant. Higher number of physical activities related to transport and cigarette smoking were associated with lower BMI in both men groups. In both women groups, more frequent consumption of alcoholic beverages decreased significantly the odds of reporting excess body weight. A university degree was associated with a lower BMI only in the 25- to 44-year-old men. Regular practise of leisure time physical activity was associated with a lower BMI only in 45- to 64-year-old women. Opposite associations were observed between perceived health and BMI. In the 45- to 64-year-old men, better perceived health increased the odds of reporting an excess weight. Conversely, the odds of reporting excess weight decreased with better health in 25- to 44-year-old women. Many correlates differ between age group and sex. The identification of these factors illustrates the need to adapt obesity-related programmes toward specific sub-groups within the general population.

Are snacking patterns associated with risk of overweight among Kahnawake schoolchildren?

OBJECTIVE: To understand more specifically how the quality, quantity and frequency of snack food consumption differs in different BMI categories. DESIGN: Four hundred and forty-nine school-aged children (grade 4-6) from a Kanien'kehaka (Mohawk) community provided a 24 h recall and their height and weight in 1994, 1998 and 2002, in three independent cross-sectional samples. Food consumed between two consecutive meals was defined as a snacking occasion. ANOVA and chi2 tests were used to compare food choices between BMI categories according to food quality criteria and food groups in 2006. Logistic regression models were performed to compare results between normal-weight children and those at risk of overweight and between normal-weight and overweight children. RESULTS: Energy intake from snacks tended to be higher for children at risk of overweight, compared with the other two BMI categories. Food groups with a higher energy density were also consumed more frequently by these children, with larger average portions of cereal bars (P < 0.05). Except for dessert consumption, which was less frequent among overweight children, no other variable distinguished risk of overweight in the two logistic regression models tested. CONCLUSIONS: Differences detected in snack food intake between normal-weight children and children at risk of overweight could explain in part the relationship between food choices and risk of overweight. Studies of dietary differences in conjunction with body weight would benefit from considering children at risk of overweight and normal-weight children, rather than children with excess weight only.

Impact of a positive deviance approach to improve the effectiveness of an iron-supplementation program to control nutritional anemia among rural Senegalese pregnant women.

BACKGROUND: Iron supplementation through prenatal care remains the most widespread strategy to control anemia during pregnancy, but its effectiveness is only partial, showing the need to address other approaches. OBJECTIVE: This study was conducted to measure the impact of a positive deviance approach to improve an iron-supplementation program among pregnant women in a rural Senegalese area. METHODS: A positive deviance approach (PD Micah) was compared with an ongoing integrated nutrition and health program intervention (Micah) in a rural Senegalese area. A pre-post evaluation was conducted using independent cross-sectional samples with a total of 371 pregnant women. A sociodemographic questionnaire was administered, and biologic and anthropometric measurements were performed. RESULTS: After 9 months of activities, the mean hemoglobin level rose from 93.9 to 100.7 g/L in the PD Micah group. Distribution of iron supplements through community volunteers and implementation of healthy pregnancy promotion sessions on a monthly basis improved the accessibility to 23.3% in the PD Micah group. No significant change was observed in the Micah group. Logistic regression analysis showed a significantly reduced risk of anemia in the PD Micah area (adjusted odds ratio, 0.25; 95% confidence interval, 0.12 to 0.53). CONCLUSIONS: This intervention shows that a community-based strategy, such as the positive deviance approach, can contribute to improving the effectiveness of iron supplementation during pregnancy.

Multilevel modelling of sociodemographic predictors of various levels of anaemia among women in Mali.

OBJECTIVE: Anaemia currently affects 40-80% of women in Africa. While risk factors for anaemia have been intensively studied, research has rarely compared risk factors between mild anaemia and moderate/severe anaemia. Also, the contribution of neighbourhood to the prevalence of anaemia has been rarely studied. The aim of the present study was to identify and compare individual and contextual factors associated with various levels of anaemia among women. DESIGN: A multilevel analysis of data from the 2001 Mali Demographic and Health Survey (n 3763) was carried out. Outcomes variables were mild anaemia, moderate-to-severe anaemia and any anaemia. Multilevel regression analyses were performed for each outcome. SETTING: Mali, West Africa. SUBJECTS: Women (n 3763) aged 15 to 49 years, including 512 pregnant women. RESULTS: Among the eleven potential risk factors included in the models, two factors were associated with mild anaemia (BMI and education), three with any anaemia (pregnancy, BMI and education) and six with moderate-to-severe anaemia (pregnancy, BMI, education, wealth, childhood residency and region of residence). Clustering of anaemia within communities was 20% for moderate-to-severe anaemia and 13% for mild anaemia. Despite significant differences in the prevalence of anaemia across regions in Mali, no difference between regions in the risk of mild anaemia was found and only the region of Gao showed a significantly higher risk of moderate-to-severe anaemia. CONCLUSIONS: The findings indicate that sociodemographic risk factors as well as clustering of anaemia varies with the severity of anaemia. Specific studies are needed to identify risk factors of mild anaemia as well as its consequences, as mild anaemia accounts for 20-40% of total prevalence of anaemia in Africa.

Consumption of key food items is associated with excess weight among elementary-school-aged children in a Canadian first nations community.

The present analyses aim to identify differences in selected dimensions of diet quality and quantity across body mass index (BMI) categories for Mohawk children in grades 4 through 6 so as to enhance ongoing community intervention strategies within the Kahnawake School Diabetes Prevention Project (KSDPP). Using 24-hour recalls (n=444), no observable differences in energy intake, percent fat, energy density, or diet diversity across BMI categories were observed. Using a new method, we compared the frequency of use and the amounts consumed for only the most-frequently consumed food items across BMI categories. Compared to normal-weight children, and after adjusting for age, children "at risk of overweight" consume potato chips more frequently (P=0.017) and crackers less frequently (P=0.153), while overweight children consumed larger portions of french fries (P=0.027). We conclude that, in this group of children, consuming slightly more french fries or potato chips than what is already consumed by normal-weight children appears to compromise diet quality as far as overweight is concerned.

Is obesity related to the type of dietary fatty acids? An ecological study.

BACKGROUND: Animal studies and a few clinical trials lend credibility to the hypothesis that not all types of fatty acids carry the same potential for weight gain. Only a few epidemiological studies concerning this issue are currently available and results are conflicting. AIM: The purpose of the present ecological study was to test the existence of an association between obesity prevalence and the types of fat available in 168 countries. METHODS: Data on the prevalence of obesity (BMI >or= 30 kg/m2) for women over 15 years of age were obtained from the WHO Global InfoBase. Food balance sheets for the years 1998 to 2002 were obtained from the FAOSTAT database. Five-year means for energy, total fat, MUFA, PUFA, SFA and 'other fat' per capita were calculated, with their standard deviations, for each country. Bivariate correlations and a multiple linear regression model were used to test for the association between prevalence of obesity and types of fat available in these countries. RESULTS: Not surprisingly, dietary energy supply, SFA, PUFA and 'other fat' were positively associated with the prevalence of obesity. We also found, however, a strong negative association between MUFA availability and obesity prevalence (beta= -0.68, P<0.0001). CONCLUSION: Populations with a lower prevalence of obesity seem to consume a greater amount of MUFA. Considering the partial correlations between variables, our results suggest that in countries with higher obesity prevalence, it is the shift from MUFA to PUFA that particularly appears to be associated with the risk of obesity.

Could the quality of dietary fat, and not just its quantity, be related to risk of obesity?

This review focuses on the possible association between types of fatty acids and weight change. It examines the biological plausibility underlining these associations and the evidence obtained to date from clinical trials and epidemiological studies. Animal studies have shown that dietary short- and medium-chain fatty acids compared to long-chain fatty acids appear to promote weight loss. Similarly, monounsaturated fatty acids (MUFAs) appear to favor weight loss compared to saturated fatty acids (SFAs) in human studies. The structure of fatty acids seems to affect their degree of oxidation and deposition. Although results are conflicting, human studies follow the general trend reported in animal studies. These trials suggest that some fatty acids are prone to oxidation and some others lead to fat storage when comparing isocaloric diets. For instance, n-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic and docosahexaenoic acids are preferentially oxidizied to other PUFA but results remain inconsistent. Epidemiological studies concerning this issue reported that total dietary fat, which includes MUFA, PUFA, and SFA could increase the risk of obesity, but results are few and conflicting. The rising biological plausibility linking dietary fat quality and risk of obesity, together with the rather recent addition of fatty acids content in food composition tables, support the need for major epidemiological studies in that area.

Unique patterns of dietary adequacy in three cultures of Canadian Arctic indigenous peoples.

BACKGROUND: Information is needed on dietary adequacy of Arctic indigenous populations in Canada. Extensive work has been completed on composition of Arctic food and food use, and dietary reference intakes are available. OBJECTIVE: To complete the first comprehensive dietary adequacy assessment of three populations of adult Arctic indigenous people. SETTING AND SUBJECTS: Dietary assessment interviews were conducted with randomly selected indigenous adults during two seasons in 44 representative communities of Yukon First Nations (n = 797), Dene/Métis, (n = 1007) and Inuit (n = 1525). METHODS: Twenty-four-hour recalls were used to derive adjusted distributions of usual nutrient intakes in four age/gender groups for assessment of dietary adequacy for carbohydrate, dietary fibre, protein, n-3 fatty acids, n-6 fatty acids, calcium, copper, iron, magnesium, manganese, phosphorus, selenium, zinc, vitamin A, riboflavin, folate, vitamin B6, vitamin C, vitamin D and vitamin E. RESULTS: Nutrients with high prevalence of adequacy for most age/gender groups in all three cultures were protein, carbohydrate, n-3 fatty acids, iron, copper, zinc, manganese, selenium, riboflavin and vitamin B6; some individuals exceeded the upper intake level for iron, zinc, selenium, vitamin A and vitamin D. Estimated average requirement nutrients of concern for adequacy were magnesium, folate, vitamin A, vitamin C and vitamin E; however, a few age/gender groups were exceptions. Prevalence of inadequacy for AI nutrients which may be undesirably high were fibre, n-6 fatty acids and calcium. Vitamin D was more adequate in Inuit women and men than for Yukon First Nations or Dene/Métis. CONCLUSIONS: Unique patterns of dietary adequacy exist among Arctic indigenous peoples. Local wildlife food sources and market food sources should be maximised for their nutrient contributions to Arctic diets.

Traditional food attributes must be included in studies of food security in the Canadian Arctic.

OBJECTIVES: The objective was to explore some typically understudied characteristics of food security in Arctic Canada: observed changes to traditional food systems, perceived advantages and health benefits of traditional food and traditional food preferences. STUDY DESIGN: Data analysis used a cross-sectional survey of Yukon First Nations, Dene/Métis and Inuit women in 44 Arctic communities. METHODS: Open-ended responses to 4 questions were used to qualitatively investigate roles traditional foods play in Arctic food security. Chi-square tests were applied to responses to ascertain differences by age and region. A fifth question explored agreement with cultural responses to harvesting and using traditional food. RESULTS: Traditional food was regarded as natural and fresh, tasty, healthy and nutritious, inexpensive, and socially and culturally beneficial. Between 10% and 38% of participants noticed recent changes in the quality or health of traditional food species, with physical changes and decreasing availability being reported most often. Caribou, moose and seal were among the foods considered particularly healthy and held special values in these populations. The opinion that all traditional food was healthy was also popular. More than 85%, of participants agreed with most cultural attributes of traditional food. CONCLUSIONS: This study confirms that traditional food remains important to Arctic indigenous women and that food security in the Arctic is contingent upon access to these foods.