Émilie Counil, PhD (Emilie.Counil@crchul.ulaval.ca),M-L Château-Degat, A Ferland, P Julien & É Dewailly

December 11th, 2008 Arctic Change Conference,

Québec City

36

22

9

3

30

0 10 20 30 40

Other foods

Cereal products

Fruits and vegetables

Milk products

Meat and alternatives

About 70% of Inuit people declared consuming one bad quality food at least 3 times a day

Percentage of daily energy (24h-recall)

As an introduction

Source: Nunavik Inuit Health Survey 2004

Percentage of daily energy (24h-recall)

8

12

6

5

6

0 5 10 15

Fat

Sweetbeverages

Sweets

Snacks

Other

9% soft drinks

36

22

9

3

30

0 10 20 30 40

Other foods

Cereal products

Fruits and vegetables

Milk products

Meat and alternatives

Source: Nunavik Inuit Health Survey 2004

As an introduction

George River, November 2007

Akulivik Northern Store,

March 2008

Epidemiological studies:Consumption of carbonated drinks and obesity in children and teenagers (James et al. 2004, Ludwig et al. 2001)

Sugar-sweetened beverages, weight gain, and type 2 diabetesin women (Schulze et al. 2004)

Soft drink, cardio-metabolic risk factors, and the MetS in adults(Dhingra et al. 2007)

Possible mechanisms:

Physiological effectsDietary behaviorEconomics of food choice

Does the association hold among Inuit?

Research Hypothesis

Study sample:14 villages, people aged 18 and aboveExclusions: non Inuit, pregnant, incomplete data, abnormaly high/low energy

Biochemical analysis:

Blood lipoprotein profiles, fasting glucoseFatty acids in RBC membranes

Clinical measures:

Blood pressureWeight, height, waist circumference

Questionnaires:

LifestyleQuantitative Food Frequency Questionnaire

The Circumpolar Inuit Health in Transition Cohort Study: Nunavik

Inuit Health Survey 2004(n=1006)

Study Sample (n=552)

Inuit Health inTransition Cohort

(n=929)

Study sample

International Diabetes Federation (IDF): Central obesity (abnormal waist or BMI>30 kg/m2) + at least 2 criteria:

1. Raised triglycerides (≥1.7mmol/l) or medication2. Reduced HDL-c (<1.03 and <1.29mmol/l in M and F) or medication3. Raised blood pressure (SBP ≥130 or DBP ≥85 mm Hg) or treated HTA4. Raised fasting plasma glucose (FPG ≥5.6mmol/l) or history of DM

Identify those with «incident MetS»:Central obesity (abnormal waist or BMI>30 kg/m2) + at least 2 criteria:

1. Raised triglycerides and NO MEDICATION2. Reduced HDL-c and NO MEDICATION3. Raised blood pressure and NO HISTORY OF TREATED HTA4. Raised fasting plasma glucose and NO HISTORY OF DM

IDF definition and «incident» cases

Definition of the MetS

Bootstrap (SAS callable SUDDAN 9.0)Complex sampling design and partial non response

Descriptive statistics adjusted on age and genderF-test (continuous) and Wald chi-square (categorical variables)Satterthwaite correction for degrees of freedom

Logistic regression, covariates: Model 1: age, sexModel 2: + smoking (5 class), energy (FFQ)Model 3: + SFA (FFQ), trans-, n3- & n6-FA (red blood cell)

Statistical analyses

All sweet beverages 733.8 [668.6;799.0]

+ Diet sodaAll drinks 811.2 [732.6;888.8]

Drink

So sweet

n=552Median (ml/day) 95%CI

Fruit juice 152.1 [122.0;182.2]

Regular soda 354.8 [268.3;441.4]

1 can (12 oz) = 355ml = up to 50g of sugars = 1.6 to 2.9$!

Median consumption exceeds 2 cans per day

Consumption of sweet beverages

+ Tang, Punch, …Soft drinks 399.3 [349.1;449.5]

0

200

400

600

800

1000

1200

1400

1600All

18-29y

30-39y

40-49y

50-59y

60-89y

Fruit JuiceRegular Soda

Consumption of different types of sweet beverages by age group

0

200

400

600

800

1000

1200

1400

1600All

18-29y

30-39y

40-49y

50-59y

60-89y

Fruit JuiceRegular SodaSoft Drink

Consumption of different types of sweet beverages by age group

0

200

400

600

800

1000

1200

1400

1600All

18-29y

30-39y

40-49y

50-59y

60-89y

Fruit JuiceRegular SodaSoft DrinkAll sweet beverages

Consumption of different types of sweet beverages by age group

Consumption of different types of sweet beverages by age group

0

200

400

600

800

1000

1200

1400

1600All

18-29y

30-39y

40-49y

50-59y

60-89y

Fruit JuiceRegular SodaSoft DrinkAll sweet beveragesAll drinks

More than 17% of participants were defined as having the MetS

«Prevalence» of the Metabolic Syndrome

Mets/component Frequency (n) 95%CIMets (IDF) 17.4 (96) [14.7;20.6]

Mets (new) 6.0 (35) [4.3;8.2]

Mets (known) 11.4 (61) [9.2;14.1]38.3y56.4y

50.2y

22.0% HTA4.5% DM

Central obesity 58.3 (340) [54.1;61.6]

Abnormal TRIG 20.8 (115) [17.5;24.5]

Abnormal HDL-c 20.4 (109) [17.3;23.9]

Abnormal BP 31.4 (167) [27.7;35.4]

Abnormal GLU 9.9 (55) [7.8;12.6]

p

Age 47.1 36.6 29.9 <10-5

Energy (kcal/d) 1731.7 2133.4 2672.1 <10-5

Carbohydrates (g/d) 227.9 304.2 422.4 <10-5

Total fat (g/d) 54.6 64.7 69.9 0.0001

Saturated fat (g/d) 19.8 23.1 24.8 0.001

Caffeine (mg/d) 232.3 282.6 384.7 <10-5

Tertile 1 Tertile 2 Tertile 3

0.0-1.3 can 1.3-3.4 can >3.4 can

Participants intakes by tertiles of all beverages consumption

Other patients characteristics

Triglycerides (mmol/l) 1.04 1.17 1.27 0.008

Waist circumf. (cm) 90.7 91.9 93.4 0.14

Non smokers (%) 34.7 22.1 17.5 <10-5

Data are reported as least square means (adjusted on age and sex) except for smoking

Model 1AgeSex

Model 2+ Energy

+ Smoking

Model 3+ SFA

+ trans-FA+ n3-FA+ n6-FA

Tertile 2 Tertile 3 Tertile 2 Tertile 3 Tertile 2 Tertile 3

All Cases of Metabolic Syndrome

2,19[0,97;4,93]1,13

[0,56;2,29]

2,39[1,06;5,39]1,15

[0,58;2,28]

1,58[0,78;3,22]0,88

[0,48;1,60]

-1

1

3

5

7

9

11

13

15

OR

Results:Odds Ratio

Newly diagnosed cases of Metabolic Syndrome

7,12[1,54;32,9]

3,51[0,99;12,48]

7,00[1,53;32,00]

3,44[1,01;11,37]

4,52[1,36;15,00]

2,69[0,96;7,51]

-1

1

3

5

7

9

11

13

15

OR

Model 1 Model 2 Model 3

Tertile 2 Tertile 3 Tertile 2 Tertile 3 Tertile 2 Tertile 3

Results:Odds Ratio

Model 1 Model 2 Model 3

Tertile 2 Tertile 3 Tertile 2 Tertile 3 Tertile 2 Tertile 3

Results:Odds Ratio Cases of Metabolic Syndrome with previous knowledge

1,12[0,32;3,90]

0,77[0,28;2,14]

1,23[0,38;4,02]0,82

[0,31;2,11]0,81

[0,28;2,39]0,57

[0,25;1,30]

-1

1

3

5

7

9

11

13

15

OR

Limitations & Discussion

Lower consumption of SSB reported by people with known risk factors for MetS:

True lower consumption: concern about diet and/or age (taste)?Or under-report (social desirability)?

Stratification on prior knowledge about risk factor(s):Reduces sample size and powerCannot fully overcome limitations of cross-sectional design

Still, strong associations are reported in relatively young Inuit: Clinical significance of the definition based on other populationsClustering of deleterious life-style habits

November 2008, Nunavik

Marie-Ludivine Château-Degat

Annie Ferland

Éric Dewailly

My co-authors at the

Public Health Research Unit

Lipid Research Centre

Pierre Julien

Aknowledgements

Financial support

Nasivvik, Arctic Net, IPY2007-2008

Nunavik

All Inuit participants!

Thank you for your

attention!