Quality of diet is associated with insulin resistance in the Cree (Eeyouch) indigenous population of northern Québec
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,
References (42)
- et al.
Specific patterns of food consumption and preparation are associated with diabetes and obesity in a native Canadian community
J Nutr
(1998) - et al.
Serum 25-hydroxyvitamin D is not associated with insulin resistance or beta cell function in Canadian Cree
J Nutr
(2011) - et al.
Westernizing diets influence fat intake, red blood cell fatty acid composition, and health in remote Alaskan native communities in the center for Alaska native health study
J Am Diet Assoc
(2008) - et al.
Impact of mercury exposure on blood pressure and cardiac autonomic activity among Cree adults (James Bay, Quebec, Canada)
Environ Res
(2011) - et al.
Carcinogenicity of polychlorinated biphenyls and polybrominated biphenyls
Lancet Oncol
(2013) - et al.
Low dietary fiber and high protein intakes associated with newly diagnosed diabetes in a remote aboriginal community
Am J Clin Nutr
(1997) - et al.
Nutrient intake and food use in an Ojibwa-Cree community in Northern Ontario assessed by 24h dietary recall
Nutr Res
(1997) Dietary patterns and health outcomes
J Am Diet Assoc
(2004)- et al.
Dietary patterns are linked to cardiovascular risk factors but not to inflammatory markers in Alaska Eskimos
J Nutr
(2009) - et al.
Relations between n-3 fatty acid status and cardiovascular disease risk factors among Quebecers
Am J Clin Nutr
(2001)
Hyperinsulinemia drives diet-induced obesity independently of brain insulin production
Cell Metab
How is nutrition transition affecting dietary adequacy in Eeyouch (Cree) adults of Northern Quebec, Canada?
Appl Physiol Nutr Metab
Diabetes in Canada: facts and figures from a public health perspective
A comparison of the metabolic response to abdominal obesity in two Canadian inuit and first nations population
Obes (Silver Spring)
Nituuchischaayihtitaau aschii multi-community environment-and-health study in Eeyou Istchee 2005–2009
The evolution of health status and health determinants in the Cree region (Eeyou Istchee): eastmain-1-A powerhouse and rupert diversion sectoral report
Eastern James Bay Cree Indians: changing patterns of wild food use and nutrition
Ecol Food Nutr
Empirically derived eating patterns using factor or cluster analysis: a review
Nutr Rev
Metabolic profile in two physically active inuit groups consuming either a western or a traditional inuit diet
Int J Circumpolar Health
How is the nutrition transition affecting the dietary adequacy affecting the dietary adequacy in Eeyouch (Cree) adults of Northern Quebec Canada?
Appl Phys Nutr Metabol
Cited by (26)
Associations between vitamin D status and atherosclerosis among Inuit in Greenland
2018, AtherosclerosisCitation Excerpt :Information on age, sex and smoking was collected by interviews as part of the IHIT study. Hepatic insulin resistance (HOMA-IR) was calculated using the formula: fasting plasma glucose (mmol/L) x fasting plasma insulin (mU/L)/22.5 [21]. Systolic BP was measured three times with an automatic measuring device (Kivex UA-779) with an appropriately sized cuff.
Dietary Patterns and Type 2 Diabetes Mellitus in a First Nations Community
2016, Canadian Journal of DiabetesCitation Excerpt :As mentioned previously, we found that the Beef and Processed Foods pattern was associated with an increased risk for type 2 diabetes. This finding is consistent with former studies of diet and type 2 diabetes in First Nations communities in Canada (37,40). However, the current study extends this literature because it is the first to examine food patterns and risk for type 2 diabetes prospectively in a First Nations community in Canada.
Associations between diet and cardiometabolic risk among Yup'ik Alaska Native people using food frequency questionnaire dietary patterns
2015, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :However Nash et al., also reported δ13C as negatively associated with LDL-C, HDL-C and positively associated with SBP and DBP [23], associations not observed in this study. Using FFQ data Johnson-Down et al., identified a positive association between a junk food dietary pattern and SBP among Cree people [25]. Also using FFQ data, Eilat-Adiar et al., identified 2 dietary patterns in Inupiat people that share similarities with our processed foods dietary pattern, a “beverages and sweets” pattern and “western foods” pattern, and neither was significantly associated with HDL-C, TG, or SBP [24].
Prevalence of overweight and obesity in the adult indigenous population in Brazil: A systematic review with meta-analysis
2019, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :This may be related to socioeconomic transitions, generally linked to changes in subsistence activities and new forms of work, which may lead to changes in eating habits and physical activity practice [6,7]. In recent years, there has been a reduction in traditional hunting and farming activities and an increase in the access to industrialized products [8]. In addition, indigenous dietary habits vary according to geographical location, ethnicity, level of education, and socioeconomic status [9].
Perfluoroalkyl acid and bisphenol-A exposure via food sources in four First Nation communities in Quebec, Canada
2023, Public Health Nutrition
- †
Deceased.