Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: a scoping review of the qualitative literature.

BACKGROUND: Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date. Therefore, the objective of this scoping review was to identify and summarize the qualitative literature regarding Indigenous infant feeding experiences within Canada, the United States, Australia, and Aotearoa. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews and the Joanna Briggs Institute Guidelines, in October 2020, Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for relevant papers focusing on Indigenous infant feeding experiences. Screening and full-text review was completed by two independent reviewers. A grey literature search was also conducted using country-specific Google searches and targeted website searching. The protocol is registered with the Open Science Framework and published in BMJ Open. RESULTS: Forty-six papers from the five databases and grey literature searches were included in the final review and extraction. There were 18 papers from Canada, 11 papers in the US, 9 studies in Australia and 8 studies conducted in Aotearoa. We identified the following themes describing infant feeding experiences through qualitative analysis: colonization, culture and traditionality, social perceptions, family, professional influences, environment, cultural safety, survivance, establishing breastfeeding, autonomy, infant feeding knowledge, and milk substitutes, with family and culture having the most influence on infant feeding experiences based on frequency of themes. CONCLUSIONS: This review highlights key influencers of Indigenous caregivers' infant feeding experiences, which are often situated within complex social and environmental contexts with the role of family and culture as essential in supporting caregivers. There is a need for long-term follow-up studies that partner with communities to support sustainable policy and program changes that support infant and maternal health.

Landscapes of inequities, structural racism, and disease during the COVID-19 pandemic: Experiences of immigrant and racialized populations in Canada.

The COVID-19 pandemic has disproportionately affected immigrant and racialized communities globally and revealed another public health crisis - structural racism. While structural racism is known to foster discrimination via mutually reinforcing systems, the unevenness of COVID-19 infections, hospitalizations, and deaths across societies has precipitated attention to the impacts of structural racism. Research highlights the inequitable burden of COVID-19 among immigrant and racialized groups; however, little is known about the synergistic impacts of structural racism and COVID-19 on the health and wellbeing of these groups. Fewer studies examine how structural racism and COVID-19 intersect within neighbourhoods to co-produce landscapes of disease exposure and management. This article examines the pathways through which structural racism shapes access, use, and control of environmental resources among immigrant and racialized individuals in the neighbourhoods of the Peel Region and how they converged to shape health and disease dynamics during the height of Canada's COVID-19 pandemic. Findings from in-depth interviews reveal that mutually reinforcing inequitable systems created environments for COVID-19 to reinscribe disparities in access, use, and control of key resources needed to manage health and disease, and created new forms of disparities and landscapes of inequality for immigrants and racialized individuals. We close with a discussion on the impacts for policy and practice.

Determinants of Anishinabeck infant and early childhood growth trajectories in Northwestern Ontario, Canada: a cohort study.

BACKGROUND: The Developmental Origins of Health and Disease (DOHaD) paradigm emphasizes the significance of early life factors for the prevention of chronic health conditions, like type 2 diabetes (T2DM) and obesity, which disproportionately affect First Nations communities in Canada. Despite increasing DOHaD research related to maternal health during pregnancy, early childhood growth patterns, and infant feeding practices with many populations, data from First Nations communities in Canada are limited. In partnership with Sandy Lake First Nation, the aims of this project were to characterize birthweights and growth patterns of First Nations infants/children over the first 6 years of life and to study the impact of maternal and infant social and behavioral factors on birthweight and growth trajectories. METHODS: We recruited 194 families through community announcements and clinic visits. Infant/child length/height and weight were measured at 1 and 2 weeks; 1, 2, 6, 12, and 18 months; and 2, 3, 4, 5 and 6 years. Maternal and infant/child questionnaires captured data about health, nutrition, and social support. Weight-for-Age z-score (WAZ), Height-for-Age z-score (HAZ), and BMI-for-Age z-score (BAZ) were calculated using WHO reference standards and trajectories were analyzed using generalized additive models. Generalized estimating equations and logistic regression were used to determine associations between exposures and outcomes. RESULTS: WAZ and BAZ were above the WHO mean and increased with age until age 6 years. Generalized estimating equations indicated that WAZ was positively associated with age (0.152; 95% CI 0.014, 0.29), HAZ was positively associated with birthweight (0.155; 95% CI 0.035, 0.275), and BAZ was positively associated with caregiver's BMI (0.049; 95% CI 0.004, 0.090). There was an increased odds of rapid weight gain (RWG) with exposure to gestational diabetes (OR: 7.47, 95% CI 1.68, 46.22). Almost 70% of parents initiated breastfeeding, and breastfeeding initiation was modestly associated with lower WAZ (-0.18; 95% CI -0.64, 0.28) and BAZ (-0.23; 95% CI -0.79, 0.34). CONCLUSIONS: This work highlights early life factors that may contribute to T2DM etiology and can be used to support community and Indigenous-led prevention strategies.

Envisioning Indigenous and biomedical healthcare collaboration at Stanton Territorial Hospital, Northwest Territories.

Background: To improve the quality of care for Indigenous patients, local Indigenous leaders in the Northwest Territories, Canada have called for more culturally responsive models for Indigenous and biomedical healthcare collaboration at Stanton Territorial Hospital.Objective: This study examined how Indigenous patients and biomedical healthcare providers envision Indigenous healing practices working successfully with biomedical hospital care at Stanton Territorial Hospital.Methods: We carried out a qualitative study from May 2018 - June 2022. The study was overseen by an Indigenous Community Advisory Committee and was made up of two methods: (1) interviews (n = 41) with Indigenous Elders, patient advocates, and healthcare providers, and (2) sharing circles with four Indigenous Elders.Results: Participants' responses revealed three conceptual models for Indigenous and biomedical healthcare collaboration: the (1) integration; (2) independence; and (2) revisioning relationship models. In this article, we describe participants' proposed models and examine the extent to which each model is likely to improve care for Indigenous patients at Stanton Territorial Hospital. By surfacing new models for Indigenous and biomedical healthcare collaboration, the study findings deepen and extend understandings of hospital-based Indigenous wellness services and illuminate directions for future research.

Are at-risk sociodemographic attributes stable across COVID-19 transmission waves?

COVID-19 health impacts and risks have been disproportionate across social, economic, and racial gradients (Chen et al., 2021; Thompson et al., 2021; Mamuji et al., 2021; COVID-19 and Ethnicity, 2020). By examining the first five waves of the pandemic in Ontario, we identify if Forward Sortation Area (FSAs)based measures of sociodemographic status and their relationship to COVID-19 cases are stable or vary by time. COVID-19 waves were defined using a time-series graph of COVID-19 case counts by epi-week. Percent Black visible minority, percent Southeast Asian visible minority and percent Chinese visible minority at the FSA level were then integrated into spatial error models with other established vulnerability characteristics. The models indicate that area-based sociodemographic patterns associated with COVID-19 infection change over time. If sociodemographic characteristics are identified as high risk (increased COVID-19 case rates) increased testing, public health messaging, and other preventative care may be implemented to protect populations from the inequitable burden of disease.

Protocol for a scoping review of the qualitative literature on Indigenous infant feeding experiences.

INTRODUCTION: Prudent infant nutrition, including exclusive breastfeeding to 6 months, is essential for optimal short-term and long-term health. Quantitative research to date has documented that many Indigenous communities have lower breastfeeding rates than the general population and that this gap in breastfeeding initiation and maintenance may have an important impact on chronic disease risk later in life. However, there are critical knowledge gaps in the literature regarding factors that influence infant feeding decisions. Qualitative research on infant feeding experiences provides a broader understanding of the challenges that Indigenous caregivers encounter, and insights provided by this approach are essential to identify research gaps, community engagement strategies, and programme and policy development. The objective of this review is to summarise the qualitative literature that describes breastfeeding and other infant feeding experiences of Indigenous caregivers. METHODS AND ANALYSIS: This scoping review will follow guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, the Joanna Briggs Institute and the methodological framework from Arksey and O'Malley. In October 2020, we will conduct an electronic database search using Medline, Embase, The Cumulative Index to Nursing & Allied Health Literature (CINAHL), PsycINFO, and Scopus, and will focus on qualitative studies. Publications that have a focus on infant feeding in Canada, the USA, Australia and New Zealand, and the Indigenous caregiver experience from the caregiver perspective, will be included. We will conduct a grey literature search using Indigenous Studies Portal, country-specific browser searches, and known government, association, and community websites/reports. We will map themes and concepts of the publications, including study results and methodologies, to identify research gaps, future directions, challenges and best practices in this topic area. ETHICS AND DISSEMINATION: Ethical approval is not required for this review as no unpublished primary data will be included. The results of this review will be shared through peer-reviewed publications and conference presentations. This protocol is registered through the Open Science Framework (osf.io/4su79).

Education in uncertainty: Academic life as Indigenous health scholars during COVID-19.

As the COVID-19 crisis continues to develop, communities around the world find themselves living in new and uncertain times. School and university closures are significantly disrupting the lives of students, educators and researchers alike. With the sudden shift to online learning platforms, the limitations on research projects and the lack of standardised policies and procedures, many concerns arise surrounding the unequal impacts of this crisis. This article brings together diverse perspectives on the effects of COVID-19 on post-secondary life for students and scholars engaged in the field of Indigenous health research. The authors reflect on how this time has impacted them as a graduating student, incoming PhD student, junior faculty member and mid-career faculty member respectively. Their experiences of teaching and learning at a large, research-intensive university in Toronto, Canada have been profoundly transformed, and will continue to change the way they work, research and interact at the graduate level. Working with Indigenous communities and organisations requires relationship building, collaboration and ceremony. In these unprecedented times, scholars cannot simply continue "business as usual". They must adapt everything, including how they teach, learn and work with Indigenous peoples, who are particularly vulnerable to this pandemic. Reflecting on the impacts that have already occurred and those that are still likely to come, the authors discuss what changes may need to be made in academia to support diverse actors within their scholarly community. They suggest changes to their scholarship with Indigenous communities in Canada to help them continue to work in a respectful, reciprocal and culturally appropriate way.

L'éducation dans des temps incertains : la vie universitaire pour les chercheurs dans le domaine de la santé des autochtones à l'heure de la COVID-19 ­ La crise de la COVID-19, qui continue de prendre de l'ampleur, plonge des communautés du monde entier dans des périodes inédites et incertaines. Les fermetures d'écoles et d'universités perturbent considérablement la vie des étudiants au même titre que celle des éducateurs et des chercheurs. Le brusque passage aux plateformes d'apprentissage en ligne, les restrictions imposées aux projets de recherche et l'absence de politiques et de procédés standardisés ont fait apparaître des préoccupations concernant l'impact hétérogène de la crise en cours. Cet article réunit différents points de vue sur les effets qu'a la COVID-19 sur la vie des étudiants de troisième cycle et des chercheurs dans le domaine de la recherche sur la santé des autochtones. Les auteures se penchent sur la façon dont cette période a impacté leur existence respectivement en tant qu'étudiante en fin de deuxième cycle, future doctorante et membres du corps professoral en début et en milieu de carrière ; une période qui a profondément marqué leur expérience de l'enseignement et de l'apprentissage dans une université centrée sur la recherche dans la ville canadienne de Toronto, et qui continuera à transformer leur façon de travailler, de faire de la recherche et d'interagir au niveau de l'enseignement supérieur. Travailler avec des communautés et organisations autochtones exige de construire des relations et de collaborer avec elles, et de respecter leurs usages. En cette période sans précédent, les universitaires ne peuvent pas faire comme si de rien n'était. Ils doivent tout adapter, y compris leur façon d'enseigner, d'apprendre et de travailler avec les peuples autochtones, particulièrement vulnérables face à cette pandémie. Dans une réflexion sur les conséquences qui se sont déjà fait sentir et sur celles probablement à venir, les auteures se penchent sur les changements susceptibles de devenir indispensables dans la sphère universitaire pour soutenir différents acteurs de leur communauté scientifique. Elles proposent des changements à leur travail avec les communautés autochtones au Canada pour les aider à continuer à opérer dans le respect et la réciprocité, et de façon adaptée sur le plan culturel.

Synergies between the Developmental Origins of Health and Disease framework and multiple branches of evolutionary anthropology.

The Developmental Origins of Health and Disease (DOHaD) hypothesis derives from the epidemiological and basic/mechanistic health sciences. This well-supported hypothesis holds that environment during the earliest stages of life-pre-conception, pregnancy, infancy-shapes developmental trajectories and ultimately health outcomes across the lifespan. Evolutionary anthropologists from multiple subdisciplines are embracing synergies between the DOHaD framework and developmentalist approaches from evolutionary biology. Even wider dissemination and employment of DOHaD concepts will benefit evolutionary anthropological research. Insights from experimental DOHaD work will focus anthropologists' attention on biochemical/physiological mechanisms underpinning observed links between growth/health/behavioral outcomes and environmental contexts. Furthermore, the communication tools and wide public appeal of developmentalist health scientific research may facilitate the translation/application of evolutionary anthropological findings. Evolutionary Anthropology, in turn, can increase mainstream DOHaD research's use of evolutionary theory; holistic, longitudinal, and community-based perspectives; and engagement with populations whose environmental exposures differ from those most commonly studied in the health sciences.

Perspectives of Nunavut patients and families on their cancer and end of life care experiences.

The present study arose from a recognition among service providers that Nunavut patients and families could be better supported during their care journeys by improved understanding of people's experiences of the health-care system. Using a summative approach to content analysis informed by the Piliriqatigiinniq Model for Community Health Research, we conducted in-depth interviews with 10 patients and family members living in Nunavut communities who experienced cancer or end of life care. Results included the following themes: difficulties associated with extensive medical travel; preference for care within the community and for family involvement in care; challenges with communication; challenges with culturally appropriate care; and the value of service providers with strong ties to the community. These themes emphasise the importance of health service capacity building in Nunavut with emphasis on Inuit language and cultural knowledge. They also underscore efforts to improve the quality and consistency of communication among health service providers working in both community and southern referral settings and between service providers and the patients and families they serve.

Food insecurity in Nunavut following the introduction of Nutrition North Canada.

BACKGROUND: Household food insecurity, a measure of income-related problems of food access, is a pressing public health problem in Canada's North, especially in Nunavut. We aimed to assess the impact of Nutrition North Canada, a food retail subsidy intended to improve food access and affordability in isolated communities, on household food insecurity in Nunavut. METHODS: Using data from 3250 Nunavut households sampled in the annual components of the Canadian Community Health Survey (2007 to 2016), we conducted interrupted time series regression analyses to determine whether the introduction of Nutrition North Canada was associated with changes in the rates of self-reported food insecurity, according to a validated instrument. We used propensity score weighting to control for several sociodemographic characteristics associated with food insecurity. RESULTS: Food insecurity affected 33.1% of households in 2010 (the year before the launch of Nutrition North Canada), 39.4% of households in 2011 (the year of the launch) and 46.6% of households in 2014 (the year after full implementation). After controlling for several covariates, we found the rate of food insecurity increased by 13.2 percentage points (95% confidence interval [CI] 1.7 to 24.7) after the full implementation of the subsidy program, and the increase in food insecurity first occurred in 2011 (9.6 percentage points, 95% CI 2.7 to 16.4), the year Nutrition North Canada was launched. INTERPRETATION: Food insecurity was a pervasive problem in Nunavut before Nutrition North Canada, but it has become even more prevalent since the program was implemented. Given the important health consequences of food insecurity, more effective initiatives to address food insecurity in Canada's North are urgently needed.

Promotion of physical activity in rural, remote and northern settings: a Canadian call to action. / Promotion de l'activité physique en milieu rural ou éloigné et dans les régions du Nord : un appel pancanadien à l'action.

INTRODUCTION: The lack of policy, practice and research action on physical activity and features of the physical (built and natural) environments in rural, remote and northern settings is a significant threat to population health equity in Canada. This paper presents a synthesis of current evidence on the promotion of physical activity in non-urban settings, outcomes from a national priority-setting meeting, and a preliminary call to action to support the implementation and success of population-level initiatives targeting physical activity in non-urban settings. METHODS: We conducted a "synopses of syntheses" scoping review to explore current evidence on physical activity promotion in rural, remote, northern and natural settings. Next, we facilitated a collaborative priority-setting conference with 28 Canadian experts from policy, research and practice arenas to develop a set of priorities on physical activity in rural, remote and northern communities. These priorities informed the development of a preliminary Canadian call to action. RESULTS: We identified a limited number of reviews that focused on physical activity and the built environment in rural, remote and northern communities. At the prioritysetting conference, participants representing rural, remote and northern settings identified top priorities for policy, practice and research action to begin to address the gaps and issues noted in the literature. These priorities include self-identifying priorities at the community level; compiling experiences; establishing consistency in research definitions and methods; and developing mentorship opportunities. CONCLUSION: Coordinated action across policy, practice and research domains will be essential to the success of the recommendations presented in this call to action.

INTRODUCTION: L'absence d'interventions en matière de recherche, de pratiques et de politiques relativement à l'activité physique et les particularités de l'environnement physique (bâti et naturel) en milieu rural ou éloigné et dans les régions du Nord constituent des freins importants à l'équité en santé de la population au Canada. Cet article présente une synthèse des données probantes pertinentes sur l'activité physique en milieu non urbain, les résultats d'une rencontre sur l'établissement de priorités nationales ainsi qu'un appel préliminaire à l'action en vue de favoriser la mise en place et la réussite, à l'échelle de la population, d'initiatives axées sur l'activité physique en milieu non urbain. MÉTHODOLOGIE: Nous avons d'abord réalisé un examen de la portée des synopsis de synthèses pour étudier les données probantes pertinentes en lien avec la promotion de l'activité physique en milieu rural, éloigné ou naturel et dans les régions du Nord. Nous avons ensuite organisé une conférence à laquelle ont pris part 28 experts canadiens spécialisés en politiques, en recherche et en pratiques, afin de concevoir de manière concertée un ensemble de priorités sur l'activité physique en milieu rural ou éloigné et dans les régions du Nord. À la suite de cette rencontre, nous avons rédigé un appel à l'action préliminaire pour tout le Canada. RÉSULTATS: Nous avons relevé relativement peu de travaux axés sur l'activité physique et l'environnement bâti en milieu rural ou éloigné et dans les régions du Nord. Lors de la conférence sur l'établissement de priorités, des participants représentant des milieux ruraux ou éloignés et des collectivités du Nord ont formulé les grandes priorités d'action en matière de politiques, de pratiques et de recherche pour commencer à réduire les écarts et résoudre les problèmes soulevés dans la littérature : le besoin d'identification au niveau communautaire; la compilation d'expériences; l'assurance d'une cohésion dans les définitions et les méthodes de recherche et enfin la création de possibilités de mentorat. CONCLUSION: Une action concertée entre les domaines des politiques, des pratiques et de la recherche est essentielle au succès des recommandations formulées dans cet appel à l'action.

Canada's northern food subsidy Nutrition North Canada: a comprehensive program evaluation.

BACKGROUND: Nutrition North Canada (NNC) is a retail subsidy program implemented in 2012 and designed to reduce the cost of nutritious food for residents living in Canada's remote, northern communities. The present study evaluates the extent to which NNC provides access to perishable, nutritious food for residents of remote northern communities. DESIGN: Program documents, including fiscal and food cost reports for the period 2011-2015, retailer compliance reports, audits of the program, and the program's performance measurement strategy are examined for evidence that the subsidy is meeting its objectives in a manner both comprehensive and equitable across regions and communities. RESULTS: NNC lacks price caps or other means of ensuring food is affordable and equitably priced in communities. Gaps in food cost reporting constrain the program's accountability. From 2011-15, no adjustments were made to community eligibility, subsidy rates, or the list of eligible foods in response to information provided by community members, critics, the Auditor General of Canada, and the program's own Advisory Board. Measures to increase program accountability, such as increasing subsidy information on point-of-sale receipts, make NNC more visible but do nothing to address underlying accountability issues Conclusions: The current structure and regulatory framework of NNC are insufficient to ensure the program meets its goal. Both the volume and cost of nutritious food delivered to communities is highly variable and dependent on factors such as retailers' pricing practices, over which the program has no control. It may be necessary to consider alternative forms of policy in order to produce sustainable improvements to food security in remote, northern communities.

Socioeconomic and Cultural Correlates of Diet Quality in the Canadian Arctic: Results from the 2007-2008 Inuit Health Survey.

PURPOSE: We examined the impact of socioeconomic and cultural factors on dietary quality in adult Inuit living in the Canadian Arctic. METHODS: Interviews and a 24-h dietary recall were administered to 805 men and 1292 women from Inuit regions in the Canadian Arctic. We examined the effect of age, sex, education, income, employment, and cultural variables on respondents' energy, macronutrient intake, sodium/potassium ratio, and healthy eating index. Logistic regression was used to assess the impact of socioeconomic status (SES) on diet quality indicators. RESULTS: Age was positively associated with traditional food (TF) consumption and greater energy from protein but negatively associated with total energy and fibre intake. Associations between SES and diet quality differed considerably between men and women and there was considerable regional variability in diet quality measures. Age and cultural variables were significant predictors of diet quality in logistic regression. Increased age and use of the Inuit language in the home were the most significant predictors of TF consumption. CONCLUSIONS: Our findings are consistent with studies reporting a nutrition transition in circumpolar Inuit. We found considerable variability in diet quality and complex interaction between SES and cultural variables producing mixed effects that differ by age and gender.

Is the Nutrition North Canada retail subsidy program meeting the goal of making nutritious and perishable food more accessible and affordable in the North?

The Nutrition North Canada program is a federal retail subsidy designed to make nutritious, perishable food more widely available and affordable in northern communities. Implemented in April 2011, Nutrition North replaced the Food Mail freight subsidy long used to offset the high cost of transporting perishable food to remote towns and villages lacking year-round road access. An examination of program and government reporting to date reveals little evidence that Nutrition North is meeting its goal of improving the availability and affordability of nutritious food. The fiscal reporting and food costing tools used by the program are insufficiently detailed to evaluate the accuracy of community subsidy rates and the degree to which retailers are passing on the subsidy to consumers. Action is needed to modify the program reporting structure to achieve greater accountability among retailers, and lower and more consistent food pricing across northern communities.

Growth measures among preschool-age Inuit children living in Canada and Greenland.

AIM: The present study reports findings from a study of preschool-age Inuit children living in the Arctic regions of Canada and Greenland. METHODS: We compare stature and obesity measures using cutoffs from the Centers for Disease Control and the International Obesity Task Force references. The sample is comprised of 1121 Inuit children (554 boys and 567 girls) aged 3-5 years living in Nunavut (n=376) and Nunavik (n=87), Canada, in the capital city of Nuuk, Greenland (n=86), and in Greenland's remaining towns and villages (n=572). RESULTS: Greenland Inuit children were significantly taller than their Canadian counterparts, with greatest height and weight observed among children from Nuuk. Overall prevalence of stunting was low with the three cutoffs yielding similar values for height-for-age z-scores. Obesity prevalence was higher among Canadian Inuit children than their Greenland counterparts. CONCLUSIONS: Inuit children have stature values consistent with those of the Centers for Disease Control reference and low prevalence of stunting, though geographic variability in mean stature values between Canadian and Greenlandic samples likely reflects differences in both socioeconomic status and genetic admixture. Obesity prevalence is high among both Canadian and Greenland Inuit preschoolers, with children living in the city of Nuuk exhibiting lower obesity prevalence than children living in either Nunavut or Nunavik, Canada or Greenland's towns and villages. Varying obesity prevalence may reflect varying degrees of food security in remote locations as well as the influence of stature and sitting height which have not been well studied in young Inuit children.

Obesity studies in the circumpolar Inuit: a scoping review.

BACKGROUND: Among circumpolar populations, recent research has documented a significant increase in risk factors which are commonly associated with chronic disease, notably obesity. OBJECTIVE: The present study undertakes a scoping review of research on obesity in the circumpolar Inuit to determine the extent obesity research has been undertaken, how well all subpopulations and geographic areas are represented, the methodologies used and whether they are sufficient in describing risk factors, and the prevalence and health outcomes associated with obesity. DESIGN: Online databases were used to identify papers published 1992-2011, from which we selected 38 publications from Canada, the United States, and Greenland that used obesity as a primary or secondary outcome variable in 30 or more non-pregnant Inuit ("Eskimo") participants aged 2 years or older. RESULTS: The majority of publications (92%) reported cross-sectional studies while 8% examined retrospective cohorts. All but one of the studies collected measured data. Overall 84% of the publications examined obesity in adults. Those examining obesity in children focused on early childhood or adolescence. While most (66%) reported 1 or more anthropometric indices, none incorporated direct measures of adiposity. Evaluated using a customized quality assessment instrument, 26% of studies achieved an "A" quality ranking, while 18 and 39% achieved quality rankings of "B" and "C", respectively. CONCLUSIONS: While the quality of studies is generally high, research on obesity among Inuit would benefit from careful selection of methods and reference standards, direct measures of adiposity in adults and children, studies of preadolescent children, and prospective cohort studies linking early childhood exposures with obesity outcomes throughout childhood and adolescence.

Does sitting height ratio affect estimates of obesity prevalence among Canadian Inuit? Results from the 2007-2008 Inuit Health Survey.

OBJECTIVES: High sitting height ratio (SHR) is a characteristic commonly associated with Inuit morphology. Inuit are described as having short leg lengths and high trunk-to-stature proportions such that cutoffs for obesity derived from European populations may not adequately describe thresholds of disease risk. Further, high SHR may help explain the reduced impact of BMI on metabolic risk factors among Inuit relative to comparison populations. This study investigates the relationship between SHR and body mass index (BMI) in Inuit. METHODS: Subjects are 2,168 individuals (837 males and 1,331 females) from 36 Inuit communities in the Canadian Arctic. Mean age is 42.63 ± 14.86 years in males and 41.71 ± 14.83 years in females. We use linear regression to examine the association between age, sex, height, sitting height, SHR, waist circumference (WC), and BMI. We then evaluate the efficacy of the relative sitting height adjustment as a method of correcting observed BMI to a population-standardized SHR. RESULTS: Mean BMI is significantly higher than among non-Inuit Canadians. Obesity prevalence is high, particularly among Inuit women. In the regression, only age and WC are significant predictors of BMI. While SHR is significantly greater than that of the US population, there is substantial agreement between overweight and obesity prevalence using observed and corrected BMI. CONCLUSIONS: We find no consistent relationship between SHR and BMI and suggest the unique anthropometric and metabolic profile observed in Inuit arise from factors not yet delineated. More complex anthropometric and imaging studies in Inuit are needed.

Emerging obesity among preschool-aged Canadian Inuit children: results from the Nunavut Inuit Child Health Survey.

OBJECTIVES: The study goal was to evaluate the growth status of preschool-age Canadian Inuit children. STUDY DESIGN: As part of a larger study of population health across the Canadian High Arctic, the International Polar Year Inuit Health Survey collected growth and nutrition data on 388 children aged 3 to 5 years. METHODS: Data collection included anthropometric measures, health history, food frequency and 24-hour recall. Height and BMI were compared with the 2000 Centers for Disease Control and Prevention (CDC) growth reference (1); 24-hour recall and FFQ results were tabulated to produce daily and monthly frequencies of consumption of market and country foods. RESULTS: Mean height-for-age z-scores were comparable, but body mass index z-scores were significantly greater than the U.S. standard reference population for all age and sex categories. The overall prevalence of overweight was 50.8%. There were significantly more boys (57.1%) than girls (45.2%) in the overweight category. An examination of biological, socio-economic and dietary factors, including birth weight, breastfeeding, day care attendance, traditional and market food consumption and sweetened beverage consumption revealed no significant associations that could explain the development of obesity risk in this population. CONCLUSIONS: Stature in preschool-age Inuit children is comparable to the U.S. reference, indicating that the previously reported secular trend toward increasing height has continued. Overweight prevalence is higher than that previously reported in Inuit children and may be occurring at an earlier age. The gender difference in child overweight prevalence runs counter to that reported in adults, leading to concern that contemporary growth atterns may result in significant increases in obesity-related illness for young Inuit men.