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,4
* Centre for Indigenous Peoples’ Nutrition and Environment (CINE) and
School of Dietetics and Human Nutrition, McGill University, Ste. Anne de Bellevue, Canada; and
** Department of Nutrition, University of Montreal, Montreal, Canada
4To whom correspondence should be addressed. E-mail: harriet.kuhnlein{at}mcgill.ca.
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ABSTRACT |
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 TOP ABSTRACT SUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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30 kg/m2) of Arctic adults exceeded all-Canadian rates. Measures to improve nutrient-dense market food (MF) availability and use are called for, as are ways to maintain or increase TF use.
KEY WORDS: • indigenous peoples • nutrition transition • dietary change • Arctic Canada • traditional food
Indigenous Peoples are recognized as having unique social, cultural, and health needs, often within larger mainstream societies to which they are expected to adapt. Whether Indigenous Peoples live concentrated on reservations, integrated within populations of their countries, or maintain residence in large territories under their control, they strive to maintain close cultural ties to land and nature, and the resources they provide (1–3). This integration invariably associates use of traditional food (TF)5 resources and other cultural practices with health.
The nutrition transition taking place in less-developed countries (LDCs) is now widely documented, with changes in food availability and receding famine, increases in noncommunicable disease, and shifts to decreasing physical activity and increasing use of processed food high in starch, fat, and sugar (4). Upward trends in obesity seen in LDCs have been linked to genetics, malnutrition in fetal and young child development, and poor dietary patterns and lifestyle factors later in life (5,6). Female gender, degree of urbanization, education, and income are all associated with increasing obesity, and the chronic disease correlates of obesity. Uauy et al. (7) described the extent of obesity and metabolic complications by gender among rural and urban Mapuche and Aymara Indigenous People in Chile, demonstrating that being female and living in urban areas increased the risk.
Several health researchers refer to an epidemiologic transition for LDCs and Aboriginal People in developed countries. They describe reflection and study on national communicable and noncommunicable disease patterns, life expectancy, and other vital statistics (8–12). For Indigenous Peoples, health patterns are often disparate from the national norms, if in fact it is possible to disaggregate health data by cultural subgroups within a population. Ethnicity together with poverty are often key determinants of poor health. As part of the International Decade of the World’s Indigenous Peoples, the WHO has led the call for development of methods to identify and compile health information at national and district levels to identify marginalized populations by their cultural identity, and to seek new strategies for understanding and influencing health determinants for these special populations (13).
In Canada, research to understand issues specifically for Indigenous Peoples has been developing steadily, with recognition that trends in Indigenous Peoples’ health parallel those in national data from LDCs (14,15). Increasing obesity and changing health lifestyles for circumpolar Inuit have been noted (16–18). Dietary patterns researched among Canadian Arctic peoples point to the high quality of foods taken from animal and plant species of hunter-gatherer subsistence patterns still recognized by Dene/Métis, Yukon First Nations, and Inuit communities (19–23). Arctic TF is understood to be animal and plant species culturally identified as food and harvested from the local environment, whereas market food (MF) is that shipped from the South and purchased in stores (24). Techniques to delineate dietary components by TF and MF were used successfully to understand nutritional and cultural benefits in contrast to contaminant risks of TF in the context of the total diet (21,23,25). However, data on TF and MF use that are generalizable to the entire Canadian Arctic are not currently available.
As part of the research program of the Northern Contaminants Program of Indian and Northern Affairs Canada, we conducted studies on dietary intake from 44 communities of Indigenous Peoples over a 10-y period in 3 major cultural areas in the Canadian Arctic.6 Research partnerships were developed with communities through leadership within the Governing Board of the Centre for Indigenous Peoples’ Nutrition and Environment (CINE). To devise consistent research strategies and participatory research technique, we worked closely with the collective aboriginal organizations of the regions: Dene Nation, Métis Nation of the Northwest Territories (NWT), Council of Yukon First Nations, and the Inuit Tapiriit Kanatami. Results of these studies were reported back to the organizations and the communities using workshops, posters, and media interviews, as recognized for good participatory technique (26). Partial results from the Dene/Métis segment of this effort were published earlier (21,22). This paper presents TF, MF, and nutrient intakes by age and gender for these 3 cultural groups in the Canadian Arctic, and BMI correlates of diet for Yukon and Inuit. Estimations of contemporary nutrient inadequacy will be reported separately. The extent of the nutrition transition is represented as the percentage of TF energy (in contrast to 100% TF at the turn of the century, before influx of food stores), and as the contrasting amounts of TF consumed by young (20–40 y), middle-aged (41–60 y) and elder (>60 y) adults.
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SUBJECTS AND METHODS |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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Research took place during 2 seasons, a season of high TF use (September–November) and a season of low TF use (February–April). Interviews included 24-h recalls, a food-frequency interview (TF only), a sociocultural interview, and a 7-d food record (Inuit communities only). This report emphasizes information from 24-h recall and frequency interviews, and height and weight data from men and nonpregnant or lactating women 20 y old. Interviews were conducted in Denendeh during 1994, in Yukon during 1995, and in Inuit communities in 1998–1999. Each cultural group (Dene/Métis, Yukon, Inuit) study was reviewed separately by the McGill University Human Ethics Committee, and each community maintained a research agreement with CINE to ensure completion of procedures using locally resident research assistants. Collective consent was obtained from the Council of Yukon First Nations, Dene Nation, Métis Nation of the NWT, and the Inuit Tapiriit Kanatami. Science licenses were obtained from the territorial authorities. The research also included sampling of TF used in homes for analysis of nutrients and other components, when needed for dietary analysis. Results of these analyses were reported separately (30–33).
Random sampling of 10% of households was done using community household or utility lists; in smaller communities, all households, up to a maximum of 25 households, were interviewed. In each household, 1 adult man and 1 adult woman were selected by convenience and interviewed. In Inuit communities, interviews were also conducted with 1 adolescent aged 13–19 y, when available (data not included). In the absence of an adult man or woman in the home, another random household was contacted. The interviewing season was selected to avoid periods of mass absence of community members due to intensive hunting or fishing. Participation was voluntary and confidential, conducted in English or the traditional language, and interviewers were trained in confidential process. In each community, a project coordinator trained in the research methodology, usually a nutrition graduate, supervised the interviews conducted for completeness and data entry. Having the research coordinator on site frequently to screen completed interviews ensured quality control. Interviews on 24-h food intake were conducted in the homes of the participants. Interviewers used portion models (prepared from locally available bowls, cups and spoons), a two-dimensional drawing of bannock (the frequently consumed homemade bread), and a notebook of TF photos with local names to prompt recognition. Frequency of TF use was captured with an instrument developed in close consultation in workshops with representatives from each community. Individuals were asked how many days each week the food was consumed, without portion size. Participation exceeded 90% of individuals contacted for Dene/Métis and Yukon First Nations communities, and >75% for communities in the 5 Inuit regions. These high participation rates were due to publicity and encouragement by the collective leadership organizations (Dene Nation, Métis Nation of NWT, Council of Yukon First Nations, Inuit Tapiriit Kanatami). The interview process and materials were consistent in all 3 major studies. Due to the prohibition of alcohol consumption in some communities, alcohol intake was recorded when the information was reported in 24-h recall interviews, but it was not probed. Participants were asked whether the day was "usual" or not, including special occasions. Records were discarded when energy intakes were ±4 SD from the mean.
For the Yukon and Inuit studies, heights and weights were either reported or measured, if the respondents did not know their own data. Weight measurements were taken in light clothing without shoes using ordinal personal scales (precision ± 100 g) tared to zero. Height measurements were taken with rigid vertical tape to the nearest 0.5 cm. BMI was calculated as weight (kg) divided by height squared (m2). There were no significant differences between self-reported and measured weights, heights, or BMI for subsamples of participant volunteers in the Yukon and Inuit studies, and all measures and self-reported data were in good agreement (not shown).
Two food composition databases were used for nutrient intake analyses: 1) a TF database derived from our own published work on Arctic TF (30–38), and 2) a MF database (39) derived from Agriculture Handbook 8, adjusted to Canadian nutrient fortification levels. The carotenoid content of foods was updated (40). In addition, the MF database was fine-tuned for recent requirements of dietary reference intake procedures (41), and new nutrient data reported by the USDA (42). There were no missing nutrient values in either data base.
Data are reported from 1007 interviews of Dene/Métis, 797 interviews of Yukon First Nations, and 1604 of Inuit. BMI data from 375 Yukon adults and 960 Inuit are reported. In each study, data were entered into Epi-Info, version 6 (USD). Extensive checking and double entry of a 10% random subset were completed and analyses were conducted with SAS, versions 6 and 8 (SAS Institute). Means or least-square means (LSM) with SEM were compiled as descriptive statistics. Adjusting for unbalanced sample sizes across communities, age groups, and seasons was done using LSM. When nutrient intakes did not meet the assumption of normality, differences between groups were tested by Kruskal-Wallis nonparametric ANOVA (43). Bonferroni multiple comparisons were used to identify significant differences between mean values during multiple comparisons (42). All statistical analyses used P < 0.05 for the level of significance.
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RESULTS |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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30 kg/m2) was more prevalent in Inuit adults than among Yukon First Nations.
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30 kg/m2).
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DISCUSSION |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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1–8 d/season). Changing patterns of TF use over time are one way in which to document the nutrition transition among Indigenous Peoples. Before colonial contact in the Americas, Indigenous Peoples had 100% of dietary energy from their TF resources. This pattern persisted in the Canadian Arctic until the advent of Hudson’s Bay stores at the turn of the 20th century. Today only 10–36% of adult dietary energy is derived from TF (Table 4).
An additional measure of dietary change is the difference in TF use between older and younger population subsets. In the research reported here, individuals > 40 y old consistently consumed significantly more TF than those younger (20–40 y) (Fig. 1). From Table 1 it is clear that the kinds of MF used consistently and most frequently across the Canadian Arctic are least-cost sources of energy, and as a whole, have poor nutrient density. It is therefore no surprise that in Appendix Table 2,8 the days reported without TF were significantly higher in carbohydrate, fat, and sucrose, and this was consistent across all cultural groups. Protein and most micronutrients were superior in recalls from days containing TF. This is especially meaningful when so little total dietary energy is consumed as TF. Although the effect of markets on the health of rural Indigenous Peoples is still controversial (44), a poor quality diet has long been associated with increasing obesity, diabetes, and glucose intolerance in many North American indigenous groups (24,45,46). Gittelsohn et al. (47) showed an association with diabetes risk by junk food and bread/butter (high-sugar, low-fiber, high-fat) in an Ontario First Nation community. It is intuitive that meat and fish contribute substantially to micronutrient intakes, but it may be less intuitive to realize that Arctic TF systems are most likely the best global examples of Indigenous Peoples’ food being far superior to the MF presented as alternatives.
We demonstrate for Canadian Arctic adults the widely recognized phenomenon that BMI increases with age. Torrance et al. (48) showed that all Canadian average obesity (BMI 30 kg/m2) rates for men and women 20–44 and 45–69 y increased from 1970 to 1992, from 8.1 to 13.4% for men and 12.7 to 15.4% for women. Further, obesity in women was 10.6% in the younger group compared with 22.9% in the older group in the 1986–1992 time period. Men were slimmer, with 12 and 15.7% in the same age categories, respectively. Education and income levels were inversely associated with higher obesity in Canada (48,49). Brazilian data demonstrate opposite trends in obesity by income in this LDC. Over a similar time period in the 1990s, the overall country prevalence of obesity increased from 2.1 to 6.4% in men and from 6.0 to 12.4% in women, with the 25% richest of the population usually being more obese (8–10% obesity in this segment) (50). Yukon and Inuit women exceeded these obesity prevalences with 31 and 38% in older age groups, and Yukon and Inuit men demonstrated 8 and 21% in older age groups, respectively. Overall, the prevalence of obesity for Yukon and Inuit women (17 and 30%, respectively) exceeded the all-Canadian data reported in 1996–1997 of 12% for women (49). Similar data for Yukon men (10%) was slightly lower than the all-Canadian male (11%), but Inuit men were at 18%. In the Alaskan Arctic, both Yup’ik and Athabascan Indigenous Peoples had levels of obesity similar to those found in Arctic Canada, i.e., 25.7 and 27.4% of men (Yup’ik and Athabascan men) and 29 and 27.4% of women (Yup’ik and Athabascan women) > 40 y old were obese (46). Inuit in Greenland had a somewhat lower overall obesity (BMI 30 kg/m2) prevalence of 19.7%, with 16.4% among men and 22.4% among women (51). Thus, overall, indigenous Arctic men and women have obesity prevalence that exceeds North American national prevalence, and that also exceeds the prevalence from the lowest education and income strata in Canada.
The global phenomenon of increasing population obesity is well documented (4–8), but the data disaggregated for Indigenous People are sparse. High obesity prevalence and consequent chronic disease are reported throughout aboriginal communities in North America (52,53) and Uauy et al. (7) demonstrated that Mapuche women and men in Chile became more obese when living in an urban area, in contrast to those living in a rural environment. Urban and rural women had a prevalence of obesity of 44.7 and 32.1%, respectively; that for men was 28.3 and 15%, respectively. It is thus clear from the available data for Indigenous People that these women and men exceed the national averages for becoming obese. When TF is lost, and low-cost but high-energy MF is substituted, the basis for developing obesity exists. This is coincident with additional circumstances of changing activity patterns and possible genetic predisposition.
Micronutrient nutrition, with the dietary transition described here, is also of concern. When traditional Arctic food is consumed, even in small amounts, nutrition for most micronutrients is improved (Table 2). Even vitamin C, a nutrient commonly associated with fresh fruit and vegetables, was shown to exist in ample quantities in Arctic TF meats (31). Formerly, all parts of animals, fish, and many plants were consumed, which gave a rich micronutrient base; but frequency data reported here showed that few organ meats now consumed, and that amounts and frequency of animal/fish flesh food consumption declined with age. If MF of sufficient quality (meat, low-fat dairy items, vegetables, whole grains) is not available and consumed to replace the missing micronutrients from traditional meats, fish and organs, the nutrition of the entire community is at risk. Our research makes clear that this type of MF is not used regularly.
In this study, as is customary with 24-h recalls, total energy intake may have been slightly underestimated, if only because alcohol intake was not regularly recorded. Because energy intake was higher with TF (Table 2), it may be interpreted that TF was consumed in addition to MF, rather than as a substitute for MF. Alternatively, when TF was available, large portions were consumed, whereas smaller amounts of MF meats were eaten by adults, and fat intakes increased.
For all Indigenous Peoples, food is at the heart of culture and health, and it is considered to be part of the environmental whole in which families live. Close ties to the land for its health-giving properties are part of cultural identity (2). Global warming and other environmental insults such as contaminants in air and water resources are signaled by elders and indigenous leaders as serious threats because of the potential effect on TF quality (1,54). Although recognized as an essential part of life, the all-Arctic average of TF energy is now 22% (Yukon at 17%, Dene/Métis at 21%, and Inuit at 28%). Even at these average portions of daily energy, TF is critical for providing many essential nutrients in adult diets. A variety of intervention programs to improve MF availability and choices, as well as acceptable preparation methods, are called for. At the same time, policies and programs should be developed so that communities can maintain or improve, if possible, the availability and accessibility of nutrient-dense, excellent quality traditional Arctic foods. It is also salient to note that protection of TF environments is critical for this to happen.
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ACKNOWLEDGMENTS |
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FOOTNOTES |
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2 Some data for the Dene/Métis were adapted from Ref. 21.
3 Supported by the Arctic Environmental Strategy and the Northern Contaminants Program (Canada), as well as the Canadian Institutes of Health Research (CIHR), Institute of Nutrition, Metabolism and Diabetes (INMD), and the Institute of Aboriginal Peoples’ Health (IAPH).
5 Abbreviations used: CINE, Centre for Indigenous Peoples’ Nutrition and Environment; LDC, less-developed country; LSM, least-square means; MF, market food; NWT, Northwest Territories; TF, traditional food.
6 Supplement Appendix Figure 1, a map of surveyed communities, is available with the online posting of this paper at www.nutrition.org.
7 Supplement Appendix Table 1 gives frequency of TF use, and is available with the online posting of this paper at www.nutrition.org.
8 Supplement Appendix Table 2 gives the percentage of energy from macronutrients, and is available with the online posting of this paper at www.nutrition.org.
9 Supplement Appendix Figure 2 gives sources of energy by BMI categories, age, and cultural group. This is available with the online posting of this paper at www.nutrition.org.
Manuscript received 7 November 2003. Initial review completed 12 January 2004. Revision accepted 23 March 2004.
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