Quality of diet is associated with insulin resistance in the Cree (Eeyouch) indigenous population of northern Québec

https://doi.org/10.1016/j.numecd.2014.08.002Get rights and content

Highlights

  • We investigate diet quality and insulin resistance in Cree of northern Québec.

  • Three dietary patterns are identified: inland, coastal and junk food.

  • Traditional diet is associated with higher n-3 fatty acids and contaminants.

  • Poor diet quality (junk food) is accompanied by greater insulin resistance.

Abstract

Background and aims

Indigenous people worldwide have a greater disease burden than their non-aboriginal counterparts with health challenges that include increased obesity and higher prevalence of diabetes. We investigate the relationships of dietary patterns with nutritional biomarkers, selected environmental contaminants and measures of insulin resistance in the Cree (Eeyouch) of northern Québec Canada.

Methods and results

The cross-sectional ‘Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Study in Eeyou Istchee’ recruited 835 adult participants (≥18 y) from 7 communities in the James Bay region of northern Québec. The three dietary patterns identified by principal component analysis (PCA) were: inland and coastal patterns with loadings on traditional foods, and a junk food pattern with high-fat and high-sugar foods. We investigated dietary patterns scores (in quantiles) in relation with nutritional biomarkers, environmental contaminants, anthropometry, blood pressure, fasting plasma glucose and insulin, and insulin resistance.

Homeostatic model assessment (HOMA-IR) was used as surrogate markers of insulin resistance. ANCOVA ascertained relationships between dietary patterns relationship and outcomes. Greater scores for the traditional patterns were associated with higher levels of n-3 fatty acids, mercury and polychlorinated biphenyls (PCBs) (P trend <0.001). Higher scores for the junk food pattern were associated with lower levels of PCBs and Vitamin D, but higher fasting plasma insulin and HOMA-IR.

Conclusion

Our results suggest that poor diet quality accompanied greater insulin resistance. Impacts of diet quality on insulin resistance, as a sign of metabolism perturbation, deserve more attention in this indigenous population with high rates of obesity and diabetes.

Introduction

Indigenous people worldwide have a greater disease burden than their non-native counterparts [1]. Health challenges include increased incidence of obesity [2] and a high prevalence type 2 diabetes (T2D) [3].

The Cree (Eeyouch) of the northern Québec area of Canada are not exempt from the health challenges facing indigenous people in North America [2]. The prevalence of obesity in Cree adults is 71.5% [2] and it is accompanied by high rates of elevated insulin [4]. A subset of this population without diabetes had impaired fasting glucose (IFG) in 35% of adults [5]. The consequences of insulin resistance and obesity are of particular concern in this population for whom the crude prevalence of T2D is 17.3%, a 300% increase over the previous 16 years [6].

A reduction in traditional hunting and gathering activities [7] and the introduction of better road access has led to increased intake of store-bought foods. It is difficult to evaluate the resultant dietary changes and it is the more challenging because the diet was traditionally high in meat and fat [8]. But unlike Western diets — which are elevated in industrial meat, refined grains, sweets, etc. — higher traditional food (TF) intake has been associated with better fatty acid profiles, consistent with better health in individuals [9]. The Cree TF includes game (moose, caribou, etc.), birds (geese and ducks), fish and wild berries [6].

In Northern populations, high concentrations of environmental contaminants in the food chain (especially TF) raise important public health concerns. These indigenous populations are vulnerable to the body burden of mercury, lead and polychlorinated biphenyls (PCBs). Higher mercury adversely impacts cardiovascular health [10]. Exposure to lead can have multiple effects on cardiovascular, neurological and developmental health [11]. PCBs are human carcinogens and may also be harmful to the immune, reproductive and endocrine systems [12].

Patterns of food consumption are associated with diabetes and obesity in aboriginal Canadian communities [13], [14]. Unlike studies investigating single nutrients or food, investigations of dietary patterns consider prevailing dietary characteristics that reflect diet complexity [15]. Examining overall diet can also help guide formulation of dietary interventions [16]. Among indigenous populations, few studies — in Alaska [17], Ojibwa-Cree of Ontario, Canada [1] and Greenlandic Inuit [18] — have examined the association between dietary patterns and health indicators.

To our knowledge, dietary pattern analysis has never been examined in the Cree of northern Québec. We investigated dietary patterns associated with nutritional biomarkers, selected environmental contaminants and measures of insulin resistance.

Section snippets

Study population

The cross-sectional ‘Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Study in Eeyou Istchee’ was a collaboration of the Cree Board of Health and Social Services of James Bay (CBHSSJB) with McMaster, Laval, and McGill Universities. Eight hundred thirty five participants were recruited from 7 northern Québec communities of latitude greater than 49.6°. An age-stratified random sample was used representing 12% of the total population (target size of 929 men and non-pregnant

Results

The mean age of our sample was 39 years old and 58% were female (Table 2). The mean BMI was 34 kg/m2 and only 8.5% were normal weight. Half of the participants were current smokers and 25% reported drinking alcohol in the past month. One third had IFG and 15.7% had levels characterized as diabetes. Rates of high SBP and DBP were 11% and 7%, respectively.

Three dietary patterns were retained: inland TF, coastal TF and junk food. In total these patterns explained 25.7% of the variance in the data (

Discussion

In this study population of Cree living in Northern Québec, characterized by a very high prevalence of obesity and T2D, we found increased insulin resistance (HOMA-IR, high insulin) with a junk food dietary pattern. However, no association with these measures was observed for TF dietary patterns.

The Cree in our study were predominantly obese (70%) — approximately 3 times higher than the Canadian rate [26]. Other First Nations populations in Canada have reported obesity rates of 32–40% [27]. The

Funding

This scientific communication is a report from Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Study in Eeyou Istchee supported by the Eeyou people of northern Québec, the Cree First Nations, and the Cree Board of Health and Social Services of James Bay through financial contributions from the Niskamoon Corporation (agreement number 2005.06).

Acknowledgments

We would like to thank the Eeyou communities that participated and all the staff from the communities, the CBHSSJB and universities who made this project a success. E.D., E.N. and G.E. designed the research; M.L. I.M. AND L.T. designed the analysis; M.E.L. conducted the analyses; L.J.D. participated in the data collection, wrote the manuscript, and had primary responsibility for its final content. All authors read and approved the final version of the manuscript. Dr. Éric Dewailly passed away,

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