Dietary patterns are linked to cardiovascular risk factors but not to inflammatory markers in Alaska Eskimos.

Despite the tradition of a diet high in fish oils and abundant physical activity, coronary artery disease is increasing among Alaska Eskimos. Explanations for this observation include lifestyle changes. In this cross-sectional analysis, we evaluated dietary patterns of Alaska Eskimos and investigated the relations between these dietary patterns and known cardiovascular risk factors, including inflammatory markers. We used a principal component analysis with data from FFQ collected in 2000-2004 to determine dietary patterns of Alaska Eskimos. Four dietary patterns were identified: a traditional pattern, plus 3 patterns based on purchased food, one of which reflected healthy food choices. The traditional dietary pattern was associated with lower triglycerides (P < 0.001) and blood pressure (P = 0.04) and slightly higher LDL cholesterol (LDL-C) (P = 0.05). Whereas the healthy purchased diet was associated with a trend toward lower LDL-C (P = 0.09), the beverages and sweets diet was positively associated with LDL-C (P = 0.02). Diet pattern was not associated with inflammatory markers or pathogen burden. Our data show that the traditional diet is related to a better profile of cardiovascular disease risk factors and should be encouraged. Programs are needed to encourage the availability of healthy food choices for those not able to obtain traditional foods.

Developing a validated Alaska Native food frequency questionnaire for western Alaska, 2002-2006.

OBJECTIVES: The purpose of this study was to develop a dietary instrument (food frequency questionnaire [FFQ]) that measured total dietary intake over 1 year among Alaska Native people in 2 regions. Ways of assessing diet are needed in order to accurately evaluate how the diets of Alaska Natives relate to their health. STUDY DESIGN: Seasonal 24-hour (24-h) diet recalls were collected for developing an FFQ that described the average dietary foods and nutrients consumed. Alaska Native people living in 12 small communities in 2 regions of the state were eligible to participate. METHODS: Each participant was to provide 4 24-h diet recalls, 1 per season. Recalls were used to develop an FFQ using regression techniques. The FFQ was administered to 58 of the 333 original participants. Responses to the FFQ were compared to the averages of their 24-h recalls using the Spearman Correlation Coefficient. RESULTS: Energy-adjusted correlations ranged from 0.15 for protein to 0.49 for monounsaturated fatty acids. Fifteen of 26 nutrients examined were significantly correlated (total carbohydrates, sucrose, fructose, total fat, fatty acids [monounsaturated, polyunsaturated, omega 3, EPA, DHA], folate, vitamins A, C, D, potassium and selenium). CONCLUSIONS: The FFQ can be used to evaluate intakes of Alaska Natives in western Alaska for the correlated nutrients.

Dietary intake of Alaska Native people in two regions and implications for health: the Alaska Native Dietary and Subsistence Food Assessment Project.

OBJECTIVES: To calculate the energy and nutrient intake in 2 regions of Alaska and to describe the implications for development of chronic disease among Alaska Native people (AN). STUDY DESIGN: Cross-sectional observation; 10 villages and 2 hub communities in rural Alaska; 333 participants ages 13 to 88 years old. METHODS: Trained interviewers collected 24-hour diet recalls during 4 seasons. RESULTS: In both regions, AN reported a combination of traditional Native foods and store bought foods; most of the energy comes from store-bought foods; a high proportion of nutrients come from Native foods, especially protein, iron and omega-3 fatty acids. Mean intakes of omega-3 fatty acids, from fish and sea mammals, are over twenty times greater than those of the general U.S. population. Mean intakes of protein, iron, selenium, vitamin A, vitamin C (men) and folate (men) met recommended levels; intakes of calcium and fiber were below recommended levels; carbohydrate and saturated fat (% energy) were above. CONCLUSIONS: Traditional foods continue to contribute a significant amount of nutrients to the diet in rural Alaska. Excess simple sugars may be contributing to the rise in obesity and diabetes. Low intakes of calcium, dietary fiber, fruits and vegetables may contribute to the increased incidence of cancers of the digestive system. Emphasis on the positive aspects of Native foods and increased consumption of fruits, vegetables and calcium-rich foods are warranted.

Research with Arctic peoples: unique research opportunities in heart, lung, blood and sleep disorders. Working group summary and recommendations.

Arctic peoples are spread over eight countries and comprise 3.74 million residents, of whom 9% are indigenous. The Arctic countries include Canada, Finland, Greenland (Denmark), Iceland, Norway, Russia, Sweden and the United States. Although Arctic peoples are very diverse, there are a variety of environmental and health issues that are unique to the Arctic regions, and research exploring these issues offers significant opportunities, as well as challenges. On July 28-29, 2004, the National Heart, Lung, and Blood Institute and the Canadian Institutes of Health Research co-sponsored a working group entitled "Research with Arctic Peoples: Unique Research Opportunities in Heart, Lung, Blood and Sleep Disorders". The meeting was international in scope with investigators from Greenland, Iceland and Russia, as well as Canada and the United States. Multiple health agencies from Canada and the United States sent representatives. Also attending were representatives from the International Union for Circumpolar Health (IUCH) and the National Indian Health Board. The working group developed a set of ten recommendations related to research opportunities in heart, lung, blood and sleep disorders; obstacles and solutions to research implementation; and ways to facilitate international comparisons. These recommendations are expected to serve as an agenda for future research.

Springtime macronutrient intake of Alaska natives of the Bering Straits Region: the Alaska Siberia Project.

OBJECTIVES: The diet of Alaska Natives is a complicated mix of native and imported foods. Dietary intake, which may have changed considerably in the past several decades, has important implications for risk of chronic disease. The objective of this study was to add to the knowledge of dietary intake of Alaska Natives of the Bering Straits Region by describing the macronutrient intake of adults. STUDY DESIGN: Observational study of dietary intake. METHODS: A 24-hour dietary recall was administered among all consenting, non-pregnant residents of four villages, aged 25 years, or more. RESULTS: Data are presented for 209 men and 225 women, who represent 48% of eligible participants. Dietary intake was higher in proportion of energy from protein and lower in proportion of carbohydrate than non-Hispanic white Americans overall. Higher energy and protein intakes were reported for men. Comparisons were also made among Alaskan ethnic groups and previous Alaskan surveys. CONCLUSION: This study of diet among Alaska Natives demonstrates consistency with other recent work. Differences in diet from earlier 20th century observations, such as higher carbohydrate and lower protein intake, are consistent with documented acculturation in Alaska and other circumpolar regions.

Comparison of BMI and body fat determinations in rural Alaska women: results of the WIC Healthy Mom Survey, Summer 2001.

OBJECTIVES: Evaluate two field methods to assess body composition of rural Alaska women. Excess body fat has been correlated with chronic diseases. METHODS: This exploratory study used an orally administered survey of a self-selected sample from five rural Alaskan villages. Electrical impedance technique was used to determine percent of body fat. Body Mass Index (BMI) was calculated based on clinically obtained height and weight and compared to historical data by geographical regions. Self-reported health data and fingerstick screenings were used to assess health status. RESULTS: The body mass index tool assessed more women at excessive weight than did the percent body fat assessment tool. Fingerstick screenings for glucose, cholesterol, and hemoglobin were generally found to be in normal ranges. CONCLUSIONS: Percent of body fat may be more accurate to determine weight status for many Alaska Native women. Historical body mass indices may indicate periods of prolonged limited food supplies for a geographic region.

Factors related to fruit, vegetable and traditional food consumption which may affect health among Alaska Native People in Western Alaska.

OBJECTIVES: Determine intake of fruits, vegetables and traditional foods (TF), availability of foods, and attitudes towards increasing their consumption. STUDY DESIGN: Establish community baseline through a cross-sectional sample of residents who were weighed, measured and interviewed. Village stores were surveyed for food availability, price and quality. METHODS: Eighty-eight respondents self-identified as the household member primarily responsible for food shopping and cooking were surveyed in 3 Western Alaska Native villages using a food frequency questionnaire, and village stores were evaluated using food environment surveys. RESULTS: Overweight (BMI[kg/m(2)] > 25) was present in 68% of participants. Fruit and vegetable intake (3.3 median servings/day) was low in comparison to recommended intakes of 5-9 servings/d. Seventy-two per cent were eating less than 5 servings/d of fruits and vegetables combined. Thirty-four per cent of respondents were trying to eat more vegetables; 41% were trying to eat more fruits. The median number of servings of TF was 3.2/d (mean 4.3/d). Seventy-seven per cent of respondents reported that they ate enough TF. CONCLUSION: Recommendations to continue use of TF and increase intake of fruits and vegetables are consistent with local attitudes. Our findings indicate that increasing the availability of fruits and vegetables would be well received. Information from this study provides a basis for nutrition education and food supplement programs that is responsive to the needs and perceptions of the residents. Continued TF intake and increased fruit and vegetable intake have the potential to benefit the health of rural residents.

Consumption of omega-3 fatty acids is not associated with a reduction in carotid atherosclerosis: the Genetics of Coronary Artery Disease in Alaska Natives study.

OBJECTIVE: This study was designed to evaluate the relation between omega-3 fatty acid (FA) consumption and atherosclerosis. BACKGROUND: The hypothesis that omega-3 FAs protect against atherosclerosis has not been tested with objective measures of atherosclerosis. METHODS: A population-based sample of 1131 Alaskan Eskimos of age >or=18 underwent ultrasound assessment of carotid atherosclerosis. Those of age >35 (N=686) were included in the analysis. Diet was assessed by a food frequency questionnaire. Intimal-medial thickness (IMT) of the far wall of the distal common carotid arteries and plaque score (number of segments containing plaque) were assessed. RESULTS: Mean consumption of total omega-3 FAs was 4.76 g/day in those without and 5.07 g/day in those with plaque. In models adjusting for relevant risk factors, presence and extent of plaque were unrelated to intake of C20-22 omega-3 FAs or total omega-3 FAs. In contrast, the odds of plaque rose significantly with quartiles of palmitic (p=0.02) and stearic acid intake (p=0.04). The extent of plaque (or plaque score) was also associated with a higher percentage intake of palmitic acid (p=0.01). IMT was negatively associated with grams of C20-22 omega-3 FAs (p=0.05), total omega-3 (p=0.05), palmitate (p=0.03), and stearate (p=0.03) consumed. CONCLUSIONS: Dietary intake of omega-3 FAs in a moderate-to-high range does not appear to be associated with reduced plaque, but is negatively associated with IMT. The presence and extent of carotid atherosclerosis among Eskimos is higher with increasing consumption of saturated FAs.

Fatty acid consumption and metabolic syndrome components: the GOCADAN study.

Fatty acids (FAs) have been related to changes in glucose and lipid metabolism. In this article, the authors assess the association between intake of specific FAs and components of the metabolic syndrome (MS) in adult Eskimos. A total of 691 Inupiat Eskimos (325 men and 366 women), aged 34 to 75 years, were examined as part of the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study. The investigation included a physical examination, blood pressure measurements, blood sampling under fasting conditions, 2-hour oral glucose tolerance test, and a personal interview including a validated food frequency questionnaire. Components of MS were defined according to the Third Report of the National Cholesterol Education Program Adult Treatment Panel criteria. Consumption of individual FAs showed associations with MS components. Long-chain omega-3 FAs, from fish and sea mammals, were associated with lower blood pressure, serum triglycerides, and 2-hour glucose and higher high-density lipoprotein cholesterol, fasting insulin, and homeostasis model assessment. Saturated fat consumption was associated with higher triglyceride levels and blood pressure. Trans-FA consumption was associated with higher blood pressure. Consumption of long-chain omega-3 FAs from marine sources may improve certain MS components, and thus may reduce risk for cardiovascular disease. High consumption of saturated FAs and trans-FAs may have an adverse effect on MS.

Dietary intakes vary with age among Eskimo adults of Northwest Alaska in the GOCADAN study, 2000-2003.

Dietary factors influence the development of cardiovascular disease (CVD). The diet of Alaskan Eskimos differs from that of other populations. We surveyed Eskimo adults in Northwest Alaska to document their usual dietary intakes, differences based on gender and age, and sources of selected nutrients, and to generate appropriate dietary advice to reduce CVD. Interviewers surveyed 850 men and women 17-92 y old, using a quantitative food-frequency instrument. We observed many significant (chi(2) analysis P < 0.05) differences in nutrient intakes among 3 age-groups. Energy intake from carbohydrate was negatively related to participant age-group (P < or = 0.01). Energy intake from all fats (P < 0.001) and polyunsaturated fat (P < or = 0.01) was positively related to age-group among both men and women in contrast to other studies in which age differences were either not observed or decreased with age. Native foods were major sources of monounsaturated and polyunsaturated fats, including 56% of (n-3) fatty acids primarily from seal oil and salmon. However, Native foods contributed significantly less to the diets of young adults than to those of elders, especially among women. Store-bought foods were the main sources of energy, carbohydrate, fat, saturated fat, and fiber for all adults. Based on their nutrient density and potential to inhibit CVD, continued consumption of traditional foods is recommended. Variations in intake by age may portend changing eating patterns that will influence CVD as participants age. These data will contribute to understanding dietary risk factors for cardiovascular disease in this population.