Dietary Adequacy among Multi-Ethnic Urban Youth in Edmonton: Findings from the Wellness and Health in Youth - Aboriginal and All Communities in Transition NOW (WHY ACT NOW) Project.

OBJECTIVE: The development of obesity and chronic diseases in adulthood often results from a childhood pattern of dietary excesses. This study aimed to identify dietary inadequacies and excesses of multiethnic youth in Edmonton. METHODS: A cross-sectional survey of a convenience sample of 473 multiethnic youth between 11 and 18 years was conducted in 12 schools in Edmonton between October 2013 and March 2014. Data were analyzed to determine for each participant mean daily energy and nutrient intakes, dietary adequacy, and nutrient densities. Participants were divided by self-identified ethnicity (Indigenous, European, African and Middle Eastern, and Asian). RESULTS: For all nutrients examined, the mean percentage of calories from fat was higher among European (31.7%) and Indigenous youth (31.8%) compared to African and Middle Eastern (28.3%) and Asian youth (29.0%), while Asian youth had the highest percentage of calories from protein (17.7%) compared to other ethnic groups (Indigenous = 15.5%; African & Middle Eastern = 16.5%; European = 16.2%). The majority of youth fell below the recommended values for dietary fiber (83.3-92.0%), vitamins D (84.4-90.2%), and E (89.5-92.0%). More than 50% fell below the dietary reference intakes (DRIs) for vitamin A, vitamin B5, calcium, and magnesium; >30% were below the DRI for folate, zinc, and vitamins B6, and C. The diet of girls contained a greater density of fiber compared to boys (9.3 vs. 8.0 g/1000 kcal; p-value = 0.002). CONCLUSIONS: Inadequate dietary intake is evident among the majority of multiethnic youth in Edmonton. There is a need to develop strategies to reduce the burden of poor nutrition status for youth.

Elevated Blood Pressure and Associations with Sodium Intake Among Multiethnic Youth in Edmonton, Canada: Findings from WHY ACT NOW.

INTRODUCTION: This study examined the prevalence of pre-hypertension (PHT) and hypertension (HT) in urban youth, and assessed the effects of sodium intake and obesity on blood pressure (BP) by ethnicity. METHODS: A convenience sample of 557 multiethnic youth, aged 11-23 years, was recruited from 12 schools and institutions in Edmonton, Alberta, Canada. Participants were divided by self-identified ethnicity into four groups (Indigenous, African and Middle Eastern (AME), Asian, and European). RESULTS: Between October 2013 and March 2014, one-on-one interviews were conducted to collect data on demographics, physical activity, diet, and Body Mass Index (BMI). BP was obtained at two different times during the interview and measured a third time in cases of high variability. The standard deviation scores (SDS) of systolic BP (SBP) and diastolic BP (DBP) were used to estimate associations with sodium intake (per 1000 mg/day). Overall, 18.2% and 5.4% of the participants had PHT and HT, respectively. Indigenous and AME participants showed the highest rates of PHT (23.1%). Indigenous and European participants showed higher rates of HT (8.3% and 5.3%, respectively) than other ethnic groups (AME = 4.4%, Asian = 3.9%). There was a positive association between 1000 mg/day increase in sodium intake and SDS of SBP by 0.041 (95% CI 0.007-0.083; p = 0.04) among pre-hypertensive participants. Over 85% of participants exceeded the recommended dietary sodium intake. Mean BMI and dietary sodium intake were higher among pre-hypertensive participants (4219 mg/day) than normotensive (3475 mg/day). CONCLUSIONS: The prevalence of HT varied by ethnicity. High dietary sodium intake was of concern. There is a need for culturally-tailored, population-based interventions to reduce sodium intake.

Prevalence of Known Risk Factors for Type 2 Diabetes Mellitus in Multiethnic Urban Youth in Edmonton: Findings From the WHY ACT NOW Project.

OBJECTIVES: The Canadian Diabetes Risk Assessment Questionnaire (CANRISK) is a validated, evidence-based, self-administered tool to assess the risk for type 2 diabetes mellitus in multiethnic Canadian adults. Identifying individuals at high risk for type 2 diabetes allows early intervention that improves modifiable risk factors. This study examined the risk factors for type 2 diabetes in multiethnic urban youth in Edmonton, Alberta. METHODS: An interviewer-administered questionnaire was developed based on CANRISK variables, such as age, gender, ethnicity, family history of diabetes, medical history of high blood sugar or high blood pressure, anthropometric measurements, physical activity and dietary intake. Between October 2013 and March 2014, data were collected from a convenience sample of 557 (328 girls and 229 boys) multiethnic youth 11 to 23 years of age in 12 institutions in Edmonton, such as public schools, after-school programs and colleges. RESULTS: Participating youth (N=529) with self-identified ethnicity were included in the analyses: 109 Indigenous (20.6%); 96 African and Middle Eastern (18.1%); 129 Asian (24.4%); and 195 European (36.9%). More than 70% of the youth had 2 or more risk factors for type 2 diabetes. The participants were classified as low risk (75.6%; n=400); moderate risk (21.2%; n=112); or high risk (3.2%; n=17), with the highest proportion of moderate- and high-CANRISK score categories (52.7%) found in the Asian youth. Boys (p<0.0001) and Indigenous participants (p<0.001) were more likely to have a greater number of risk factors for type 2 diabetes compared to girls and non-Indigenous youth, respectively. Of the participants, 26.7% (n=141) were overweight or obese, more than 45% of the participants (n=245) were physically inactive, and 17.8% of the participants (n=94) did not consume sufficient amounts of fruits and vegetables to meet daily recommendations. CONCLUSIONS: Almost 25% of the participating multiethnic youth 11 to 23 years of age scored in the moderate or high category of CANRISK. The most prevalent risk factors were ethnicity, followed by physical inactivity, overweight or obesity and low fruit and vegetable consumption. A validated type 2 diabetes screening tool for youth as well as culturally appropriate, evidence-based and multidisciplinary diet and lifestyle interventions aiming to improve modifiable type 2 diabetes risk factors in multiethnic youth, particularly targeting socioeconomically disadvantaged and immigrant children and youth, should be developed, implemented and evaluated.