Diabetes-related weight change in a Canadian First Nation cohort.

The Canadian First Nations population is disproportionately burdened by diabetes and diabetes complications. Body weight management is purported to be important in the prevention and management of diabetes. In this study, we sought to describe weight change in a First Nation cohort according to diabetes status and management. Study data were from two diabetes screening studies in Sandy Bay First Nation in Manitoba, Canada, collected in 2002/2003 (baseline) and 2011/2012 (follow-up). The cohort was composed of respondents to both screening studies (n=171). Fasting blood samples, anthropometric, health and demographic data were collected. At baseline, 24.8% (n=41) of the cohort members had diabetes. At follow-up, an additional 20.6% (n=34) developed diabetes. Among all participants with diabetes (long-term and incident cases), 66.6% lost weight between the two study periods. Among only participants with long-term diabetes (>8 years), 31.7% lost >10 kg. HbA1c at baseline, positive change in HbA1c over time, and use of metformin were significantly associated with weight loss ≥5%, independent of age, sex, and BMI at baseline. Further research is needed to better understand if and how diabetes-related weight loss contributes to morbidity and mortality in this First Nation population.

Chronic disease and chronic disease risk factors among First Nations, Inuit and Métis populations of northern Canada.

INTRODUCTION: Aboriginal populations in northern Canada are experiencing rapid changes in their environments, which may negatively impact on health status. The purpose of our study was to compare chronic conditions and risk factors in northern Aboriginal populations, including First Nations (FN), Inuit and Métis populations, and northern non-Aboriginal populations. METHODS: Data were from the Canadian Community Health Survey for the period from 2005 to 2008. Weighted multiple logistic regression models tested the association between ethnic groups and health outcomes. Model covariates were age, sex, territory of residence, education and income. Odds ratios (ORs) are reported and a bootstrap method calculated 95% confidence intervals (CIs) and p values. RESULTS: Odds of having at least one chronic condition was significantly lower for the Inuit (OR = 0.59; 95% CI: 0.43-0.81) than for non-Aboriginal population, but similar among FN, Métis and non-Aboriginal populations. Prevalence of many risk factors was significantly different for Inuit, FN and Métis populations. CONCLUSION: Aboriginal populations in Canada's north have heterogeneous health status. Continued chronic disease and risk factor surveillance will be important to monitor changes over time and to evaluate the impact of public health interventions.

TITRE: Maladies chroniques et facteurs de risque chez les membres des Premières Nations, les Inuits et les Métis du Nord canadien. INTRODUCTION: Les populations autochtones du Nord canadien subissent des changements rapides dans leur environnement, ce qui peut avoir des effets nuisibles sur leur état de santé. Nous avons voulu comparer les maladies chroniques et les facteurs de risque des populations autochtones du Nord canadien, à savoir les Premières nations, les Inuits et les Métis, avec les populations non autochtones de la même zone. MÉTHODOLOGIE: Les données sont tirées de l'Enquête sur la santé dans les collectivités canadiennes de 2005 à 2008. Des modèles de régression logistique multiple pondérée ont servi à analyser l'association entre les groupes ethniques et les résultats de santé. Les covariables du modèle étaient l'âge, le sexe, le territoire de résidence, le niveau de scolarité et le revenu. Nous présentons les rapports de cotes (RC) et nous avons utilisé la méthode d'échantillonnage bootstrap pour calculer les intervalles de confiance (IC) à 95% et les valeurs p. RÉSULTATS: La probabilité d'avoir au moins une maladie chronique était significativement plus faible chez les Inuits (RC = 0,59; IC à 95 % : 0,43 à 0,81) que chez les non-Autochtones, mais elle était similaire chez les Premières nations, les Métis et les non-Autochtones. La prévalence de nombreux facteurs de risque était significativement différente chez les Inuits, les membres des Premières nations et les Métis. CONCLUSION: Les Autochtones du Nord canadien ont des états de santé hétérogènes. Le maintien d'une surveillance continue des maladies chroniques et des facteurs de risque va jouer un rôle important dans la mesure des évolutions et dans l'évaluation de l'impact des interventions en santé publique les concernant.

Obesity and obesity-related comorbidities in a Canadian First Nation population.

INTRODUCTION: Rates of obesity are higher among Canada's Aboriginal First Nations populations than among non-First Nations populations. We studied obesity and obesity-related illness in a Manitoba First Nation community. METHODS: We conducted a screening study of diabetes and diabetes complications in 2003, from which we drew a representative sample of Manitoba First Nation adults (N = 483). We assessed chronic disease and chronic disease risk factors. RESULTS: Prevalence of obesity and associated comorbidities was higher among women than men. By using multivariate analysis, we found that factors significantly associated with obesity among women were diastolic blood pressure, insulin resistance, and employment status. Among men, factors were age, apolipoprotein A1 level, apolipoprotein B level, and insulin resistance. Seventy-five percent of study participants had at least 1 of the following conditions: obesity, dyslipidemia, hypertension, or diabetes. Comorbidity was high even among the youngest age groups; 22% of men and 43% of women aged 18 to 29 had 2 or more chronic conditions. Twenty-two percent of participants had undiagnosed hypertension. Participants with undiagnosed hypertension had significantly more chronic conditions and were more likely to have microalbuminuria than were those without hypertension. The number of chronic conditions was not significantly different for participants with newly diagnosed hypertension than for those with previously diagnosed hypertension. CONCLUSION: The prevalence of obesity and other chronic conditions in the study community is high, especially considering the number of young people. Community-based interventions are being undertaken to reduce the excessive rate of illness.

Cardiovascular risk according to plasma apolipoprotein and lipid profiles in a Canadian First Nation.

INTRODUCTION: Despite high diabetes rates among Canadian First Nations people, little is known about their cardiovascular disease risk. Our aim was to describe the apolipoprotein profile with respect to cardiovascular risk in a Canadian First Nation community. METHODS: In 2003, a representative sample of adult members of a Manitoba First Nation (N = 483) participated in a screening study for diabetes and diabetes complications. We assessed their cardiovascular risk factors. RESULTS: Sixty percent of women were at increased cardiovascular risk because of low apolipoprotein A1 (apoA1) levels, compared with 35% of men. The proportion of women with low apoA1 levels decreased with age, but the proportion with low high-density lipoprotein levels remained stable across age groups. Both apoB and apoA1 were significantly associated with obesity when age, sex, diastolic blood pressure, homocysteine, diabetes, and insulin resistance were controlled for. CONCLUSION: Apolipoprotein and lipid profiles in this First Nation population suggest high cardiovascular risk. Future research should characterize the lipoprotein particle size in this population.

The impact of diabetes mellitus among the Métis of western Canada.

OBJECTIVES: To examine the impact of diabetes mellitus on the lives of the Métis of western Canada, and to determine the extent of co-morbidity among Métis with diabetes. DESIGN: The source of data was the Aboriginal Peoples Survey (APS), conducted by Statistics Canada in 1991. The survey was administered to a representative sample of Aboriginal peoples throughout Canada. Analysis was completed on self-identified Métis participants from the Canadian provinces of Manitoba, Saskatchewan and Alberta. RESULTS: Métis participants with diabetes were more likely than those without diabetes to report their health status as poor. Significantly greater numbers of Métis with diabetes reported activity limitations at work, at home and in leisure activities, the need for assistance with activities of daily living and difficulties with ambulation than did those without diabetes. The extent of co-morbidity was also significant. Métis with diabetes were almost three times more likely to report hypertension and heart problems and twice as likely to report sight impairments than were those without diabetes. CONCLUSIONS: This research represents the first account of the effects of diabetes on the lives of the Métis. The APS data have provided a clear picture of the impairments in physical functioning experienced by the Métis with diabetes and the impact upon quality of life. In addition, the strong associations between diabetes and hypertension, heart problems and sight impairments suggest profound morbidity in this population that warrants prompt attention.