Preventing diabetes after pregnancy with gestational diabetes in a Cree community: an inductive thematic analysis.

INTRODUCTION: Historical and political factors underpin the disproportional burden of type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) in women, a harbinger of future T2DM, in Indigenous populations. There is a need for T2DM prevention strategies driven by the voices of Indigenous women. In this study, we aimed to understand the perspectives of Cree women with prior GDM living in northern Quebec, where over a quarter of pregnancies are complicated by GDM. RESEARCH DESIGN AND METHODS: A local healthcare worker invited women with GDM in the prior 5 years to participate in semistructured interviews. A Cree-origin research partner and a researcher jointly conducted interviews in-person or by teleconference. Open-ended questions addressed GDM experience, maintaining a healthy lifestyle, and needs/preferences pertinent to designing a T2DM prevention program aimed at women affected by GDM. We adopted an inductive thematic analysis framework to categorize experiences and opinions. RESULTS: Among the 13 mothers interviewed, some success with health behavior changes during pregnancy was reported but there were difficulties postpartum resulting from time constraints, costs of healthy foods, discomfort at the gym related to not being perceived as athletic, and safety concerns. They acknowledged the existence of programs addressing T2DM prevention in their community but did not participate. They endorsed preferences for group sessions, with family collaboration and childcare, that addressed healthy cooking and physical activity and incorporated traditional elements. CONCLUSION: Cree mothers with a history of GDM highlighted several barriers to diabetes prevention. We are working to address these barriers through the creation of a Cree-facilitator-led community-based intervention.

Diet quality of Montreal-area adults needs improvement: estimates from a self-administered food frequency questionnaire furnishing a dietary indicator score.

OBJECTIVE/DESIGN: Time and budget constraints limit nutrition evaluation in Canadian health surveys. To encourage regular population diet monitoring in Canada, we developed and assessed the relative validity of a population-based food frequency questionnaire (FFQ) to assess usual diet in Quebecers. A 73-item, self-administered semiquantitative FFQ was designed in French and English from the Block National Cancer Institute Health Habits and History Questionnaire to capture usual food consumption among Quebec adults. The US Department of Agriculture Healthy Eating Index (HEI) (maximum score=100) was adapted to Canadian age- and sex-specific dietary recommendations, validated, and programmed to score the FFQ for diet quality. SUBJECTS: The FFQ was pretested, pilot tested, and administered by mail to a random sample of 248 adults aged 18 to 82 years in the Montreal area (57% women) who were recruited by random digit dialing (64% response rate). A subgroup (n=94) furnished four nonconsecutive 1-day food records for validation of the FFQ. RESULTS: Mean FFQ energy intakes were 2,216 kcal (median 2,110 kcal) for men and 1,785 kcal (median 1,680 kcal) for women. Proportional median macronutrient consumption was similar in both sexes at 17% protein, 34% to 35% fats, and 48% to 49% carbohydrates, but differed by age group in women. Adequacy of micronutrient intakes relative to Dietary Reference Intakes varied by age, sex, and nutrient. Whereas most mean or median intakes were at or exceeded recommendations, calcium intakes were low overall and levels of several other nutrients were very low at the 10th percentile. Mean Canadian HEI (range 46 to 99) was higher in women (74.9) than men (70.3, P<.001). Women's scores showed they met recommendations for intakes of vegetables and fruit, cholesterol, and sodium better than men (P ranged from <.01 to <.0001), while men fared better at meeting recommended fat intake levels (P<.05). CONCLUSIONS: The Canadian HEI adequately discriminates overall diet quality based on dietary data estimated from our FFQ. Examination of subscores within and between quartiles may best reveal which food groups require attention to improve diet quality, providing valuable information for teaching and planning. Future studies should test diet quality indicators in populations recruited to reflect greater dietary diversity and reporting ability and include members of disadvantaged groups to provide a broader set of behaviors that could shed light on factors influencing diet quality.

Development and validation of a food frequency questionnaire.

Regular diet monitoring requires a tool validated in the target population. A 73-item, semiquantitative, self-administered food frequency questionnaire (FFQ), was adapted in French and English from the Block National Cancer Institute Health Habits and History Questionnaire. The FFQ was used to capture usual long-term food consumption among adults living in Quebec. A representative sample of adults aged 18 to 82 (57% female) was recruited by random digit dialling in the Montreal region. Approximately 64% of recruits completed and returned the instrument by mail (n=248). The FFQ was validated in a subsample (n=94, 61% female) using four nonconsecutive food records (FRs). Median energy intakes (in kcal) for men and women, respectively, were FFQ (total sample) 2,112 and 1,823, FFQ (subsample) 2,137 and 1,752, and FR (subsample) 2,510 and 1,830. Spearman correlation analyses between FFQ and FR nutrients were positive (with r ranging from 0.32 for folate to 0.58 for saturated fatty acids) and statistically significant (p<0.001), with better results among women. On average, cross-classification of energy and 24 nutrients from the FFQ and means of four FRs placed 39% into identical quartiles and 78% into identical and contiguous quartiles, with only 4% frankly misclassified. These results suggest that the FFQ is a relatively valid instrument for determining usual diet in Quebec adults.

Absence of cardiovascular benefits and sportfish consumption among St. Lawrence River anglers.

The benefits of sportfish consumption and omega-3 fatty acid (omega3-FA) intake for cardiovascular risk factors were evaluated in a sample of 112 male fishers from the St. Lawrence River in the Montreal area during the 1996 winter and fall fishing seasons. A questionnaire on fishing practices and fish consumption was administered, and fasting blood samples were collected for lipid and phospholipid determination. Linear regression analyses, which considered the confounding effect of major risk factors, did not show any significant association between measured omega3-FAs or reported fish intake and blood lipids or blood pressure. This study is limited by its low statistical power due to the small sample size and the possibility that the fish eaten by the participants were low in omega3-FAs or that the participants diets contained foods high in cholesterol-raising fat.