Development of an optimal grocery list based on actual intake from a cross-sectional study of First Nations adults in Ontario, Canada.

A multi-stage sampling strategy selected 1387 on-reserve First Nations adults in Ontario. Foods from a 24-hour dietary recall were assigned to the 100 most common food groups for men and women. Nutrients from market foods (MF) and traditional foods (TF) harvested from the wild as well as MF costs were assigned based on the proportions of total grams consumed. Linear programming was performed imposing various constraints to determine whether it was possible to develop diets that included the most popular foods while meeting Institute of Medicine guidelines. Final models were obtained for both sexes with the top 100 food groups consumed while limiting the nutrient-poor foods to no more than the actual observed intake. These models met all nutrient constraints for men but those for dietary fibre, linoleic acid, phosphorus, and potassium were removed for women. MF costs were obtained from community retailers and online resources. A grocery list was then developed and MF were costed for a family of 4. The grocery list underestimated the actual weekly food cost because TF was not included. Contemporary observed diets deviated from healthier historic First Nations diets. A culturally appropriate diet would include more traditional First Nations foods and fewer MF. Novelty: Linear programming is a mathematical approach to evaluating the diets of First Nations. The grocery list is representative of food patterns within Ontario First Nations and can be used as an alternative to the nutritious food basket used for public health food costing.

An Indigenous food sovereignty initiative is positively associated with well-being and cultural connectedness in a survey of Syilx Okanagan adults in British Columbia, Canada.

BACKGROUND: For the Syilx Okanagan Nation in Canada, salmon has vital nutritional, cultural, and spiritual significance. Yet, the Okanagan Sockeye salmon population came to near extinction, resulting in a drastic decline in salmon consumption from high historical levels. Thus, restoring and protecting salmon is crucial to Syilx well-being and way of life. A Syilx-led food sovereignty initiative re-established the Okanagan Sockeye salmon population, which has resulted in a rise in fish harvesting. The aim of this study was to assess whether engaging with this initiative was associated with health, well-being, and cultural connectedness (i.e., degree to which one is integrated in their culture) among Syilx adults. Eating Okanagan Sockeye salmon was conceptualized as a proxy for engaging with this Indigenous food sovereignty initiative. METHODS: 265 Syilx adults completed a survey including a traditional food frequency questionnaire and questions on health status (e.g., BMI, self-assessed physical health), well-being (e.g., life satisfaction, stress levels), and cultural connectedness (e.g., sense of belonging, importance of cultural practices). Participants were divided into 3 groups based on their wild salmon eating during the year prior to the survey: (1) adults who ate Okanagan Sockeye salmon, (2) adults who ate salmon but did not usually know the species of the salmon they ate, or who solely ate salmon that were not Okanagan Sockeye; and (3) adults who did not eat any salmon. RESULTS: A statistically significant gradient was observed for enhanced well-being and cultural connectedness, with individuals in group 1 having better indicators than those in group 2, and adults in groups 1 and 2 having better indicators than adults in group 3. No differences were observed in physical health outcomes between the three groups. CONCLUSION: Findings suggest that the initiative to re-establish Okanagan Sockeye salmon in the Okanagan River system may have led to better well-being and cultural connectedness among Syilx adults. This study highlights the importance of Indigenous food sovereignty as a way to enhance well-being and cultural connectedness among First Nations in Canada. Findings also reinforce the importance of assessing health and well-being in a wholistic way in Indigenous health research.

Importance of the traditional food systems for First Nations adults living on reserves in Canada.

OBJECTIVE: To describe the traditional food (TF) systems of First Nations in Canada, including intake, barriers and promoters. METHODS: The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of First Nations adults below the 60th parallel that obtained data for communities excluded from other national studies. A food frequency questionnaire was used to establish frequency of TF intake (number of days in a year) to allow comparisons across ecozones/regions in Canada. Grams of TF intake were also calculated using frequency multiplied by average portions from 24-h recalls. Closed- and open-ended questions attempted to identify some of the key barriers and concerns regarding TF access and use. Multivariable analyses were run to determine what factors are associated with increased TF consumption. RESULTS: Across communities, there is a strong preference by adults to have TF in the diet more often. Consumption of land animals was most frequently reported in most ecozones except for the Pacific Maritime and Mixedwood Plains, where fish and plants, respectively, were more frequently consumed. First Nations identified structural and environmental challenges such as development, government regulations and climate change, along with household barriers such as insufficient capital for equipment and transportation, lack of time and absence of a hunter in the household. Multivariable analyses revealed that the highest intake of TF occurred in the Taiga Plains ecozone, and for older individuals and men. CONCLUSION: Identifying solutions that empower First Nations at all levels is required to overcome the multiple challenges to the inclusion of TF in the diet.

RéSUMé: OBJECTIFS: Décrire les systèmes alimentaires traditionnels (AT) des adultes provenant des Premières Nations du Canada, y compris la consommation, les barrières et les promoteurs. MéTHODE: L'Étude sur l'alimentation, la nutrition et l'environnement chez les Premières Nations est une étude participative pancanadienne avec les Premières Nations demeurant dans les réserves au sud du 60e parallèle et qui a permis d'obtenir des données sur les communautés exclues d'autres études nationales. Un questionnaire sur la fréquence des aliments fut utilisé pour établir la fréquence de l'apport en AT (nombre de jours par année) afin de permettre des comparaisons entre les ecozones et régions du Canada. Les grammes d'apport en AT furent également calculés en utilisant la fréquence multipliée par les portions moyennes provenant des rappels de 24 heures. Des questions fermées et ouvertes ont tenté d'identifier certains des principaux obstacles et préoccupations concernant l'accès et l'utilisation des AT. Des analyses multivariées furent effectuées pour identifier quels facteurs sont associés à une consommation plus élevée des AT. RéSULTATS: Dans toutes les communautés, les adultes préfèrent avoir un apport plus fréquent des AT. La consommation des animaux terrestres a été mentionnée le plus souvent dans la plupart des écozones, sauf dans les Maritimes Pacifiques et les Plaines Boismixtes, où les poissons et les plantes, respectivement, étaient plus fréquemment consommés. Les Premières Nations ont identifié des défis structurels et environnementaux tels que le développement, la réglementation gouvernementale et les changements climatiques, ainsi que des obstacles pour les ménages comme l'insuffisance de capitaux pour l'équipement et le transport, le manque de temps et l'absence de chasseur dans le ménage. Une analyse multivariée a révélé que la consommation la plus élevée d'AT avait lieu dans l'écozone de la Taïga des Plaines, ainsi que pour les personnes plus âgées et les hommes. CONCLUSION: Il est important d'identifier des solutions qui renforcent le pouvoir des Premières Nations à surmonter les défis multiples qui entravent la consommation des AT.

Nutrient adequacy and nutrient sources of adults among ninety-two First Nations communities across Canada.

OBJECTIVES: To identify food sources of nutrients in First Nations adults in Canada and to establish whether these populations are meeting their nutrient requirements and whether traditional foods (TF) contribute to better nutrient intake. METHODS: The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of First Nations adults living south of the 60th parallel. Twenty-four-hour recalls were conducted in 92 First Nations communities from 2008 to 2016. Repeat recalls were attempted with 20% of participants to adjust for within-person variation and estimate the proportion of individuals below recommendations according to Institute of Medicine guidelines. Nutrients from days with and without TF were compared. The main food sources of select nutrients were identified, including TF. RESULTS: Mean energy intakes among women and men ranged from 1664 to 1864 and from 1761 to 2298 kcal/day respectively. Most macronutrients were within the acceptable macronutrient diet range except for fat in most age groups and carbohydrates in men 71 years of age and older. Saturated fat was above recommendations for all ages. Only niacin was identified as above recommendations in all age and sex categories. Days where TF were eaten showed greater intakes of key nutrients. CONCLUSION: It is imperative that we find culturally appropriate ways to improve the quality and nutritional value of First Nations Peoples food intake by improving TF access and use on the one hand and conversely providing better quality store-bought foods. For success in this, we must empower First Nations communities and health practitioners to collaboratively overcome these challenges.

RéSUMé: OBJECTIFS: Établir si l'alimentation des adultes des Premières Nations au Canada est satisfaisante et si les aliments traditionnels (AT) contribuent à un meilleur apport en nutriments et identifier les sources alimentaires des nutriments. MéTHODE: L'étude sur l'alimentation, la nutrition et l'environnement chez les Premières Nations est une étude participative pancanadienne visant les adultes des Premières Nations vivant au sud du 60e parallèle. Des rappels de 24 heures ont été effectués dans 92 communautés des Premières Nations de 2008 à 2016. Les rappels ont été répétés avec 20 % des participants pour ajuster la variation intra-individuelle et estimer la proportion d'individus à risque de consommation insuffisante de nutriments selon les apports nutritionnels de référence de l'« Institute of Medicine ¼. Les sources alimentaires (incluant les AT) de certains nutriments ont été identifiées. RéSULTATS: La moyenne des apports énergétiques moyens chez les femmes et les hommes variaient de 1 664 à 1 864 et 1 761 à 2 298 kilocalories/jour respectivement. La plupart des macronutriments se situaient dans l'intervalle établi par l'étendue des valeurs acceptables des macronutriments, à l'exception des lipides dans la plupart des groupes d'âge et des glucides chez les hommes de 71 ans et plus. Les acides gras saturés étaient supérieurs aux recommandations pour tous les âges. Seule la niacine était supérieure au besoin moyen estimatif. Les jours où les AT sont consommés, une augmentation notable dans les apports en certains nutriments-clés est observée. CONCLUSION: Il est important de trouver des moyens pour améliorer la qualité et la valeur nutritionnelle de l'apport alimentaire des Peuples des Premières Nations en respectant leur culture et en offrant un meilleur accès et une utilisation améliorée des AT d'une part et en fournissant des aliments provenant du magasin de meilleure qualité d'autre part. Pour réussir, les communautés des Premières Nations et les professionnels de la santé devraient être impliqués de manière collaborative.

First Nations households living on-reserve experience food insecurity: prevalence and predictors among ninety-two First Nations communities across Canada.

OBJECTIVE: To describe the prevalence of food insecurity in First Nations households across Canada while identifying barriers and enablers to traditional food (TF) consumption. METHODS: The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of on-reserve First Nations from 2008 to 2018. The Household Food Security Survey Module was used to capture income-related challenges experienced by First Nations households. Households were classified as food secure, or marginally, moderately, or severely food insecure. Barriers and enablers to TF access and use were identified describing the Indigenous experience. RESULTS: Almost half of on-reserve First Nations households were food insecure and the prevalence was higher than that for non-Indigenous households in Canada. On-reserve food insecurity prevalence was higher in western regions of Canada. First Nations households with children experienced greater food insecurity than those without children. More adults experienced severe food insecurity than children. Most adults would like to have more TF in their diet but state that factors such as financial and household constraints, industrial activities, government regulations, climate change, and fear of contamination impede greater access. Food costs were substantially higher in remote First Nations communities, but remoteness was not associated with food security in multivariable analysis. CONCLUSION: Existing systems have been unsuccessful in curbing the food insecurity in First Nations households. Improving food security hinges on achieving Indigenous Food Sovereignty, the key to long-term conservation and stewardship of the land and the co-management of these by Indigenous Peoples. Studies investigating the feasibility of increasing TF from an Indigenous perspective are required.

RéSUMé: OBJECTIFS: Décrire la prévalence de l'insécurité alimentaire chez les ménages des Premières Nations du Canada tout en identifiant les obstacles et les facilitateurs de l'alimentation traditionnelle (AT). MéTHODES: L'étude sur l'alimentation, la nutrition et l'environnement des Premières Nations dans les réserves est une étude participative pancanadienne des ménages des Premières Nations. Le module d'enquête sur la sécurité alimentaire des ménages a été utilisé pour tenir compte des défis liés au revenu qui confrontent les ménages des Premières Nations. Les ménages ont été classés comme étant en sécurité alimentaire ou insécurité alimentaire marginale, modérée ou sévère. Des obstacles et facilitateurs à l'accès et à l'utilisation des AT ont été identifiés pour décrire l'expérience autochtone. RéSULTATS: Près de la moitié des ménages dans les réserves des Premières Nations dans notre étude étaient en situation d'insécurité alimentaire et la prévalence était supérieure aux ménages non-Autochtones du Canada. L'insécurité alimentaire dans les réserves était plus élevée dans les régions de l'Ouest. Les ménages des Premières Nations ayant des enfants ont connu une plus grande insécurité alimentaire que ceux qui n'en ont pas. Plus d'adultes que d'enfants ont connu une insécurité alimentaire sévère. La plupart des adultes aimeraient avoir plus d'AT dans leur alimentation, mais affirment que des facteurs tels que les contraintes financières et domestiques, les activités industrielles, les réglementations gouvernementales, les changements climatiques et la peur de la contamination empêchent un meilleur accès. Les coûts des aliments étaient considérablement plus élevés dans les communautés isolées des Premières Nations, mais l'isolement n'était pas associé à la sécurité alimentaire dans l'analyse multivariée. CONCLUSION: Les systèmes existants ont échoué à freiner l'insécurité alimentaire chez les ménages des Premières Nations. L'amélioration de la sécurité alimentaire dépend de la réalisation de la souveraineté alimentaire autochtone, une clé pour la conservation à long terme des ressources naturelles et pour une gestion partagée de ces ressources par les peuples autochtones. Des études menées dans une perspective autochtone sur la faisabilité d'améliorer l'accès aux AT sont encore nécessaires.

Comparison of measures of diet quality using 24-hour recall data of First Nations adults living on reserves in Canada.

OBJECTIVE: Assess the diet quality of First Nations adults in Canada using percentage energy from traditional foods (TF) and ultra-processed products (UPP), food portions from the 2007 Eating Well with Canada's Food Guide - First Nations, Inuit and Métis (EWCFG-FNIM) and a Healthy Eating Index (HEI). METHODS: Data collection for this participatory research occurred in 92 First Nations reserves across Canada from 2008 to 2016. Percent daily energy intakes were estimated from 24-hour recalls for TF and NOVA food categories. Portions of food groups from the 2007 EWCFG-FNIM were compared to recommendations. A Canadian-adapted HEI was calculated for each participant. RESULTS: The percent energy from TF was 3% for all participants and 18% for consumers. Meat and alternatives were above the EWCFG-FNIM recommendations and all other food groups were below these. HEI was "low" with only older individuals attaining "average" scores. HEI was above "average" in 4 regions. UPP represented 55% of energy, the largest proportion from a NOVA category. CONCLUSION: The diet quality of First Nations adults in Canada is nutritionally poor. The nutrition, food security and health of First Nations would be improved by better access to TF and healthy store-bought food. However, poor diet is only one aspect of the difficulties facing First Nations in Canada. Researchers and policy makers must strive to better understand the multiple challenges facing First Nations Peoples in order to foster empowerment and self-determination to develop First Nations living conditions and lifestyles that are more culturally sound and more conducive to health.

RéSUMé: OBJECTIFS: Évaluer la qualité de l'alimentation des adultes des Premières Nations du Canada en calculant l'énergie provenant des aliments traditionnels (AT) et des produits ultra-transformés, en comparant les portions consommées avec celles recommandées dans Bien manger avec le Guide alimentaire canadien Premières Nations, Inuit et Métis (BMGAC-PNIM) de 2007 et en mesurant l'indice d'alimentation saine. MéTHODE: La collecte de données pour cette recherche participative a eu lieu dans 92 réserves des Premières Nations au Canada entre les années 2008 et 2016. À partir des rappels de 24 heures, la proportion d'énergie provenant des AT pour les individus les ayant consommés ou non a été comparée, les portions des catégories d'aliments proposées par le BMGAC-PNIM ont été comparées aux recommandations, l'indice d'alimentation saine adapté pour le Canada a été calculé pour chaque participant et la proportion d'énergie des produits ultra-transformés a été établie. RéSULTATS: La proportion d'énergie provenant des AT chez les consommateurs et non-consommateurs était de 3 % et celle pour les consommateurs d'AT était de 18 %. Seuls les viandes et substituts dépassaient les recommandations du BMGAC-PNIM tandis que la consommation de toutes les autres catégories était inférieure aux recommandations. L'indice d'alimentation saine était "bas" avec seulement les individus plus âgés atteignant un score "moyen". L'indice d'alimentation saine était supérieur à "moyen" dans 4 régions. Les aliments ultra-transformés représentaient 55 % de l'énergie, la plus grande proportion de toutes les catégories NOVA. CONCLUSION: La qualité de l'alimentation des Premières Nations n'est pas optimale. Leur alimentation pourrait être améliorée avec un meilleur accès aux AT et aux aliments sains provenant du marché. Une mauvaise alimentation n'est toutefois pas la seule difficulté à laquelle font face les Premières Nations du Canada. Les Peuples des Premières Nations doivent être impliquées avec les chercheurs et les responsables politiques pour mieux comprendre les défis multiples auxquels ils font face et instaurer des conditions de vie qui soient culturellement sécuritaires et plus propices à la santé.

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.

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.

Modelling optimal diets for quality and cost: examples from Inuit and First Nations communities in Canada 1.

This review summarizes aspects of the 2017 Canadian Nutrition Society symposium, "Modelling diets for quality and cost: examples from Inuit and First Nations in Canada". Indigenous peoples in Canada experience a high prevalence of nutrition-related chronic disease because of the poor quality and high cost of their food supply. Since European colonization, they have transitioned from a diet of minimally processed traditional foods (game, fish, and plants) procured using pursuits such as hunting, fishing, gathering, and horticulture to a diet comprised mostly of processed market foods. This nutrition transition is the result of factors such as colonial policies and practices; climate change; environmental degradation; contaminants in traditional foods; and limited availability of, or access to, economical and healthful market foods. Presenters Malek Batal and Laurie Chan characterized the contemporary diets of First Nations and Inuit populations and demonstrated novel methods for modelling more optimal diets using 2 datasets: the First Nations Food, Nutrition, and Environment Study and the Inuit Health Survey. It was demonstrated how the NOVA classification characterized the portion of the diet consisting of processed foods. Dietary components were then manipulated to reduce ultra-processed food and drink intake to increase the Healthy Eating Index score. Linear programming was explained as a way to mathematically design theoretical diets that aim to optimize food cost, nutrition quality, and contaminant level of traditional foods. While diet-modelling methodologies have limitations, they provide a basis for engaging Indigenous peoples and governments to develop nutrition goals and policies anchored in contemporary food realities.

Factors associated with the intake of traditional foods in the Eeyou Istchee (Cree) of northern Quebec include age, speaking the Cree language and food sovereignty indicators.

The Eeyouch are a First Nations (Cree) population that live above 49.6°N latitude in Eeyou Istchee in northern Quebec. Eeyouch rely on traditional foods (TF) hunted, fished or gathered from the land. The overarching aim of this study was to achieve an understanding of the factors associated with TF intake among Eeyouch. Data were from 465 women and 330 men who participated in the Nituuchischaayihtitaau Aschii Multi-Community Environment-and-Health (E&H) study. The relationship between TF consumption and dietary, health, sociodemographic and food sovereignty (i.e. being a hunter or receiving Income Security to hunt, trap or fish) variables was examined using linear and logistic regression. Analyses were stratified by sex because of the male/female discrepancy in being a hunter. Among respondents, almost all (99.7%) consumed TF, 51% were hunters and 10% received Income Security. Higher intake of TF was associated with lower consumption of less nutritious ultra-processed products (UPP). In women, TF intake increased with age, hunting and receiving Income Security, but decreased with high school education. In men, TF intake increased with age and speaking only Cree at home. The findings suggest that increased food sovereignty would result in improved diet quality among Eeyouch through increased TF intake and decreased UPP intake.

Blood and hair mercury concentrations among Cree First Nations of Eeyou Istchee (Quebec, Canada): time trends, prenatal exposure and links to local fish consumption.

To describe exposure to methylmercury among Cree, focusing on women of childbearing age, we used data from 2 studies. Multiple regression was employed to examine associations between blood and hair mercury concentrations and consumption of locally harvested fish. Approximately 9.9% of non-pregnant women aged 15-44 y and 3.9% of pregnant women required follow-up according to Health Canada's blood mercury guidance value of 40 nmol/L. 8% of hair mercury observations in the non-pregnant women and 2.5% among pregnant women exceeded the equivalent threshold of 10 nmol/g. The geometric mean blood mercury concentration was 12.7 nmol/L in 1,429 persons aged 8 and over, and 17.7 nmol/L in adults aged 18 and older. The proportion of hair mercury concentrations greater than 12.5 nmol/g decreased in all age-sex groups when comparing the 2002-2009 data to published values for 1993-1994. Among women of childbearing age, local fish consumption was associated with increased blood and hair mercury concentrations. While over 90% of women of childbearing age in this population have acceptable levels of mercury, ongoing intake of mercury suggests that their consumption of fish with known high mercury content be minimised. Reducing consumption of fish known to be high in mercury content needs to be balanced with promoting ongoing connection to Cree culture and land-based activities that are also important determinants of health.

Sociodemographic associations of the dietary proportion of ultra-processed foods in First Nations peoples in the Canadian provinces of British Columbia, Manitoba, Alberta and Ontario.

We investigated the food types consumed by 3276 First Nations citizens from the First Nations Food Nutrition and Environment Study (FNFNES) living on-reserve in Canada. Data from 24-h dietary recalls were classified into NOVA categories: fresh or minimally processed foods (MPF), processed culinary ingredients, processed foods, and ultra-processed foods (UPF). Individuals were classified as traditional food (TF) eaters if they ate MPF of their First Nations culture. UPF accounted for 54.0% of energy intake; 23% of participants ate TF. Increasing age and household size, living in British Columbia and TF eating were associated with a lower intake of energy from UPF. Eating TF appeared to be protective against intake of UPF.

Diet quality indices in relation to metabolic syndrome in an Indigenous Cree (Eeyouch) population in northern Québec, Canada.

OBJECTIVE: To assess associations between three diet quality indices and metabolic syndrome (MetS) in the Cree (Eeyouch) of northern Québec, Canada, as well as to evaluate their pertinence in this Indigenous context. DESIGN: The alternative-Healthy Eating Index 2010 (aHEI-2010), the Food Quality Score (FQS) and the contribution of ultra-processed products (UPP) to total daily dietary energy intake using the NOVA classification were calculated from 24 h food recalls. MetS was determined with the latest harmonized definition. Logistic regressions assessed the relationship between quintiles of dietary quality scores with MetS and its components. SETTING: Study sample from the 2005-2009 cross-sectional Nituuchischaayihititaau Aschii Environment-and-Health Study. SUBJECTS: Eeyouch (n 811) from seven James Bay communities (≥18 years old). RESULTS: MetS prevalence was 56·6 % with 95·4 % abdominal adiposity, 50·1 % elevated fasting plasma glucose, 43·4 % hypertension, 38·6 % elevated TAG and 44·5 % reduced HDL cholesterol. Comparing highest and lowest quintiles of scores, adjusted OR (95 % CI) of MetS was 0·70 (0·39, 1·08; P-trend=0·05) for aHEI-2010, 1·06 (0·63, 1·76; P-trend=0·87) for FQS and 1·90 (1·14, 3·17; P-trend=0·04) for the contribution of UPP to total daily dietary energy intake. CONCLUSIONS: Although diet quality indices have been associated with cardiometabolic risk, only the dietary intake of UPP was significantly associated with MetS in the Eeyouch. Indices tailored to the food environment of northern communities are essential to further understand the impact of diet quality in this context.

Quantifying associations of the dietary share of ultra-processed foods with overall diet quality in First Nations peoples in the Canadian provinces of British Columbia, Alberta, Manitoba and Ontario.

OBJECTIVE: To quantify associations of the dietary share of ultra-processed foods (UPF) with the overall diet quality of First Nations peoples. DESIGN: A cross-sectional analysis of data from the First Nations Food, Nutrition and Environment Study, designed to contribute to knowledge gaps regarding the diet of First Nations peoples living on-reserve, south of the 60th parallel. A multistage sampling of communities was conducted. All foods from 24 h dietary recalls were categorized into NOVA categories and analyses were performed to evaluate the impact of UPF on diet quality. SETTING: Western and Central Canada. SUBJECTS: First Nations participants aged 19 years or older. RESULTS: The sample consisted of 3700 participants. UPF contributed 53·9 % of energy. Compared with the non-UPF fraction of the diet, the UPF fraction had 3·5 times less vitamin A, 2·4 times less K, 2·2 times less protein, 2·3 times more free sugars and 1·8 times more Na. As the contribution of UPF to energy increased so did the overall intakes of energy, carbohydrate, free sugar, saturated fat, Na, Ca and vitamin C, and Na:K; while protein, fibre, K, Fe and vitamin A decreased. Diets of individuals who ate traditional First Nations food (e.g. wild plants and game animals) on the day of the recall were lower in UPF. CONCLUSIONS: UPF were prevalent in First Nations diets. Efforts to curb UPF consumption and increase intake of traditional First Nations foods and other fresh or minimally processed foods would improve diet quality and health in First Nations peoples.

Fatty acid composition of birds and game hunted by the Eastern James Bay Cree people of Québec.

BACKGROUND: Indigenous peoples have traditionally relied on foods hunted and gathered from their immediate environment. The Eastern James Bay Cree people consume wild game and birds, and these are believed to provide health as well as cultural benefits. OBJECTIVE: To determine the fatty acid (FA) composition of traditional game and bird meats hunted in the Eastern James Bay area. DESIGN: Harvested traditional game and birds were analysed for FA composition. A total of 52 samples from six wildlife species were collected in the areas of Chisasibi, Waswanipi and Mistissini, of which 35 were from birds (white partridge and Canada goose) and 17 were from land animals (beaver, moose, caribou and black bear). RESULTS: Alpha-linolenic acid (ALA) was the most common n-3 polyunsaturated fatty acid (PUFA) in all samples except for the black bear flesh, in which it was docosapentaenoic acid (DPAn-3). In white partridge, beaver and caribou flesh, PUFAs (mainly n-6) were the most common category of fats while in goose, moose and black bear flesh, monounsaturated fatty acids (MUFAs) predominated. In all species, saturated fatty acids (SFAs) were the second most important FAs. It would appear that in the land animals and birds that were analysed, the SFA content was lower and the PUFA content was higher than store-bought meats giving them a more heart-healthy profile. CONCLUSIONS: These results showed that the FA composition of game species consumed by the James Bay Cree population is consistent with a beneficial diet and that traditional foods should continue to be promoted among the Cree people to provide better physical health as well as social and spiritual benefits.

High protein and cholesterol intakes associated with emergence of glucose intolerance in a low-risk Canadian Inuit population.

OBJECTIVE: The rate of type 2 diabetes mellitus among Inuit is 12·2 % in individuals over 50 years of age, similar to the Canadian prevalence. Given marked dietary transitions in the Arctic, we evaluated the dietary and other correlates of not previously diagnosed glucose intolerance, defined as type 2 diabetes mellitus, impaired fasting glucose or impaired glucose tolerance. DESIGN: Cross-sectional analyses were limited to adults with a completed 2 h oral glucose tolerance test and without pre-existing diabetes. Anthropometric assessments, health and medication usage questionnaires and a 24 h dietary recall were administered. SETTING: Canadian International Polar Year Inuit Health Survey (2007-2008). SUBJECTS: Inuit adults (n 777). RESULTS: Glucose intolerance was associated with older age and adiposity. Percentage of energy from protein above the Acceptable Macronutrient Distribution Range of 35 %, compared with intake within the range, was associated with increased odds of glucose intolerance (OR=1·98; 95 % CI 1·09, 3·61) in multivariable analyses. Further, cholesterol intake in the highest three quartiles combined (median exposures of 207, 416 and 778 mg/d, respectively) compared with the lowest quartile (median intake of 81 mg/d) was associated with glucose intolerance (OR=2·15; 95 % CI 1·23, 3·78) in multivariable analyses. Past-day traditional food consumption was borderline protective of glucose intolerance (P=0·054) and high fibre intake was not significantly protective (P=0·08). CONCLUSIONS: The results contribute to the existing literature on high protein and cholesterol intakes as they may relate to diabetes risk.

Socioeconomic and Cultural Correlates of Diet Quality in the Canadian Arctic: Results from the 2007-2008 Inuit Health Survey.

PURPOSE: We examined the impact of socioeconomic and cultural factors on dietary quality in adult Inuit living in the Canadian Arctic. METHODS: Interviews and a 24-h dietary recall were administered to 805 men and 1292 women from Inuit regions in the Canadian Arctic. We examined the effect of age, sex, education, income, employment, and cultural variables on respondents' energy, macronutrient intake, sodium/potassium ratio, and healthy eating index. Logistic regression was used to assess the impact of socioeconomic status (SES) on diet quality indicators. RESULTS: Age was positively associated with traditional food (TF) consumption and greater energy from protein but negatively associated with total energy and fibre intake. Associations between SES and diet quality differed considerably between men and women and there was considerable regional variability in diet quality measures. Age and cultural variables were significant predictors of diet quality in logistic regression. Increased age and use of the Inuit language in the home were the most significant predictors of TF consumption. CONCLUSIONS: Our findings are consistent with studies reporting a nutrition transition in circumpolar Inuit. We found considerable variability in diet quality and complex interaction between SES and cultural variables producing mixed effects that differ by age and gender.

Prevalence of vitamin D insufficiency among healthy school-age Cree children.

BACKGROUND: First Nations children are at higher risk for vitamin D deficiency and rickets. OBJECTIVE: To assess the prevalence of vitamin D deficiency and the correlations between fat mass, parathyroid hormone and dietary habits with serum vitamin D level in a random sample of Cree children eight to 14 years of age. METHODS: Serum 25-hydroxyvitamin D (25[OH]D) levels and additional information regarding anthropometrics and dietary habits were obtained from participants in two Cree communities. Vitamin D deficiency and insufficiency was defined as serum 25(OH)D levels <30 nmol/L and <50 nmol/L, respectively. Proportions to estimate the vitamin D status were weighted to account for the complex sampling design, and Pearson's correlation coefficients were used to estimate the associations of milk and fish intake, parathyroid hormone and fat mass with serum 25(OH)D levels. RESULTS: Data from 52 healthy Cree children (mean [± SD] age 11.1±2.0 years; 27 boys) were included in the analyses. The median serum 25(OH)D level was 52.4 nmol/L (range 22.1 nmol/L to 102.7 nmol/L). Forty-three percent (95% CI 29% to 58%) and 81% (95% CI 70% to 92%) of Cree children had vitamin D levels <50 nmol/L and <75 nmol/L, respectively. Vitamin D intake was positively associated with serum 25(OH)D levels. Obese children had lower vitamin D levels; however, the difference was nonsignificant. CONCLUSION: There may be a substantial proportion of Cree children who are vitamin D deficient. Increasing age, lower dietary vitamin D intake and, possibly, higher body mass index were associated with decreased vitamin D levels; however, causality cannot be inferred.

HISTORIQUE: Les enfants des Premières nations sont plus vulnérables à une insuffisance en vitamine D et au rachitisme. OBJECTIF: Évaluer la prévalence de carence en vitamine D et les corrélations entre, d'une part, la masse grasse, la parathormone et les habitudes alimentaires et, d'autre part, le taux sérique de vitamine D dans un échantillon d'enfants cris de huit à 14 ans sélectionnés au hasard. MÉTHODOLOGIE: On a obtenu le taux sérique de 25(OH)D des participants provenant de deux communautés cries, qui ont également fourni de l'information sur leurs données anthropométriques et leurs habitudes alimentaires. La carence et l'insuffisance en vitamine D étaient définies par des taux sériques de 25(OH)D inférieurs à 30 nmol/L et à 50 nmol/L, respectivement. Les proportions pour évaluer le taux de vitamine D ont été pondérées pour tenir compte de la méthodologie complexe de l'échantillon, et les coefficients de corrélation de Pearson ont permis d'évaluer les associations entre le taux sérique de 25(OH)D, d'une part, et la consommation de lait et de poisson, la parathormone et la masse grasse, d'autre part. RÉSULTATS: Les analyses incluaient les données provenant de 52 enfants cris en bonne santé (âge moyen [± ÉT] de 11,1±2,0 ans; 27 garçons). Le taux sérique médian de 25(OH)D s'élevait à 52,4 nmol/L (plage de 22,1 nmol/L à 102,7 nmol/L). Quarantetrois pour cent (95 % IC 29 % à 58 %) et 81 % (95 % IC 70 % à 92 %) des enfants cris présentaient un taux de vitamine D inférieur à 50 nmol/L et à 75 nmol/L, respectivement. La consommation de vitamine D était associée de manière positive au taux sérique de 25(OH)D. Les enfants obèses présentaient des taux de vitamine D plus faibles, mais la différence n'était pas significative. CONCLUSION: Une forte proportion d'enfants cris présente peutêtre une carence en vitamine D. L'âge, une moins grande consommation alimentaire de vitamine D et, peutêtre, un indice de masse corporelle plus élevé étaient liés à un taux moins élevé de vitamine D. Cependant, on ne peut en induire une causalité.

Prevalence of vitamin D insufficiency and associated factors among Canadian Cree: a cross-sectional study.

OBJECTIVES: Aboriginal peoples affected by a nutrition transition and living at high latitudes are among the ethnic groups most at risk of vitamin D deficiency. The objectives of this study were to determine the prevalence of meeting predefined cut-off concentrations of vitamin D and to examine associated factors among James Bay Cree aged ≥ 15 years. METHODS: A cross-sectional study was conducted between the months of May and September from 2005 to 2009. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined by radioimmunoassay. Anthropometrics were measured and additional information on socio-demographic characteristics, lifestyle and dietary habits was obtained using questionnaires. A logistic regression model predicting vitamin D insufficiency (<50 nmol/L) included known covariates. RESULTS: Data were obtained from 944 Cree (406 men (43%); mean age 37.4 years), with an effective participation rate of 49% among women and 41% among men. Mean serum 25(OH)D concentrations (nmol/L) by gender were 52.9 (95% CI 51.4-54.5) in men and 47.5 (95% CI 46.2-48.9) in women, and by age group were 46.0 (95% CI 44.9-48.9) in those 15-39 years and 59.6 (95% CI 57.9-61.4) in those ≥ 40 years of age. Overall, 5.8%, 42.6%, 40.0%, and 11.7% of the participants had 25(OH)D concentrations <30, 30-49.9, 50-74.9 and ≥ 75 nmol/L, respectively. Female gender, obesity, younger age, spring, low fish and milk intake, and low vigorous physical activity predicted vitamin D insufficiency (all p<0.05). CONCLUSION: The vitamin D status in Eastern James Bay Cree is suboptimal with nearly half of the population having insufficient concentrations for optimum bone health.

How is nutrition transition affecting dietary adequacy in Eeyouch (Cree) adults of Northern Quebec, Canada?

Rapid development, including the building of hydroelectric projects and roads in remote areas of Northern Quebec, Canada, has led to concerns about the contamination of traditional foods (TF) and a transition to a diet characterized by increased commercial food intake. A cross-sectional study of 850 Cree adults, aged ≥19 years, from 7 of the 9 Eeyouch communities was conducted during the spring and summer seasons of 2005-2008. Anthropometric measures were collected. TF and dietary intake were assessed using food-frequency questionnaires (FFQs) and 24-h recalls. Obesity was high, with 77% of the women and 64% of the men classified as obese. Past-year TF consumption was 100%, and 41% of participants reported eating TF on the 24-h recall. TF intake as reported on both the FFQs and the 24-h recalls was higher in individuals aged >50 years of age and in men, relative to younger adults and women, respectively. TF consumption increased protein, vitamin D, iron, and magnesium in all individuals, and energy, cholesterol, magnesium, sodium, and zinc in men aged 19-50 years; it decreased vitamin C in men and women aged ≥51 years. Participants reported drinking a mean daily 0.78 ± 1.34 cans of soft drinks or other high-sugar beverages per day or 5.28% ± 8.92% of total energy. It is important to identify behaviours that are contributing to obesity and its health consequences in this population and to find culturally appropriate ways to promote the consumption of TF and to reduce the consumption of energy-dense and nutrient-poor beverages and food items.