Pohnpei, FSM case study in a global health project documents its local food resources and successfully promotes local food for health.

This paper presents a summary of Pohnpei, Federated States Micronesia's involvement in a global health study focused on documenting traditional food systems in different parts of the world and providing evidence that local resources are critical for food security, nutrition and health. The Pohnpei study was based in Mand Community, Madolenihmw. The study found that there was a great diversity of foods locally available (381 food items documented), but these were underused. Overweight, obesity, diabetes, and vitamin A deficiency were identified as serious problems. Interventions included community meetings, school activities, and agriculture workshops, cooking classes, charcoal oven development, weight loss and planting competitions, poster campaigns and other relevant mass media. Significant dietary improvements were achieved following the intervention efforts, as well as positive changes in attitude towards local food including: decrease in average daily rice consumption from 846 g/person in 2005 to 544 g/person in 2007 (p = 0.0002); increase in provitamin A carotenoid intake from 227 microg/person in 2005 to 475 microg/person in 2007 (p = 0.02); increased frequency of consumption of local banana (53%), giant swamp taro (476%), local vegetables (130%); and increased dietary diversity (4.8 local food groups consumed in 2005 to 5.5 in 2007). Another positive outcome in Pohnpei was the popularization of the slogan "Let's Go Local."

Traditional food diversity predicts dietary quality for the Awajún in the Peruvian Amazon.

OBJECTIVE: Our goal was to assess the potential for evaluating strengths of the Awajún traditional food system using dietary assessment, a traditional food diversity score and ranking of local foods. DESIGN: The method was used for dietary data obtained from mothers and children in the Awajún culture of the Peruvian Amazon where >90% of the dietary energy is derived from local, traditional food. Traditional food diversity scores were calculated from repeat 24-hour recalls. Group mean intakes of energy, fat, protein, iron, vitamin A and vitamin C from each food item were used to rank foods by nutrient contribution. SETTING: The study took place in six remote communities along the lower Cenepa River in the Amazonas District of Peru, South America. SUBJECTS: Dietary data were collected from 49 Awajún mothers and 34 children aged 3-6 years, representative of the six communities. RESULTS: Higher traditional food diversity was associated with greater protein, fibre, vitamin and mineral intakes when controlling for energy (partial correlations = 0.37 to 0.64). Unique sources for iron, total vitamin A and vitamin C were found in the Awajún traditional food system. CONCLUSIONS: A traditional food diversity score was a useful tool for predicting nutrient adequacy for the Awajún. Promotion of the Awajún traditional food system should focus on dietary diversity and unique nutrient-dense local foods.

Traditional food consumption and nutritional status of Dalit mothers in rural Andhra Pradesh, South India.

OBJECTIVES: To describe prevalence of malnutrition and their correlates of nutrient and traditional food consumption in rural Dalit mothers. DESIGN: In a cross-sectional study, we used socio-cultural questionnaires, anthropometric measurements and clinical eye examinations during the rainy season in 2003. Food frequency questionnaires and 24-h recalls were conducted during both summer and rainy seasons. SETTING: Dalit mothers with young children were recruited from 37 villages in the Medak District of rural Andhra Pradesh, India. SUBJECTS: Dalit mothers (n = 220) participated. RESULTS: The prevalence of chronic energy-deficient (CED) mothers (body mass index <18.5 kg/m2) was 58%. Illiterate women and active women were more likely to have CED than those literate and non-active (relative risks (RR) = 1.6 and 1.4, respectively, P < or = 0.05), but literacy and activity level were not significant in multivariable analyses including sanitation and number of children < or =5 years of age. Increasing levels of fat intake, as a percent of total energy, was significantly associated with lower risk of CED (RR of the lowest 25th percentile compared to those in the 75th percentile or above was 1.6, P < or = 0.05), findings that remained significant in multivariable analyses. Consumption of pulses (g/day) was also inversely related to CED in univariate and multivariable analyses. Carbohydrate intake, as a percent of total energy, was inversely related to percent energy from fat (r = -0.96, P < or = 0.01), and, although positively related to CED in univariate analyses, carbohydrate consumption was not significant in multivariable analyses. Mothers' age in years and income was positively related to vitamin A deficiency. CONCLUSIONS: These results confirm that CED and vitamin A malnutrition among Dalit women are predominant problems in this area. Increased consumption of local traditional Dalit food (particularly sorghum, pulses, vegetables and animal source food) should be incorporated as an important component of intervention strategies to improve nutritional status.

Human health implications of environmental contaminants in Arctic Canada: A review.

The objectives of this paper are to: assess the impact of exposure to current levels of environmental contaminants in the Canadian Arctic on human health; identify the data and knowledge gaps that need to be filled by future human health research and monitoring; examine how these issues have changed since our first assessment [Van Oostdam, J., Gilman, A., Dewailly, E., Usher, P., Wheatley, B., Kuhnlein, H. et al., 1999. Human health implications of environmental contaminants in Arctic Canada: a review. Sci Total Environ 230, 1-82]. The primary exposure pathway for contaminants for various organochlorines (OCs) and toxic metals is through the traditional northern diet. Exposures tend to be higher in the eastern than the western Canadian Arctic. In recent dietary surveys among five Inuit regions, mean intakes by 20- to 40-year-old adults in Baffin, Kivalliq and Inuvialuit communities exceeded the provisional tolerable daily intakes (pTDIs) for the OCs, chlordane and toxaphene. The most recent findings in NWT and Nunavut indicate that almost half of the blood samples from Inuit mothers exceeded the level of concern value of 5 microg/L for PCBs, but none exceeded the action level of 100 microg/L. For Dene/Métis and Caucasians of the Northwest Territories exposure to OCs are mostly below this level of concern. Based on the exceedances of the pTDI and of various blood guidelines, mercury and to a lesser extent lead (from the use of lead shot in hunting game) are also concerns among Arctic peoples. The developing foetus is likely to be more sensitive to the effects of OCs and metals than adults, and is the age groups of greatest risk in the Arctic. Studies of infant development in Nunavik have linked deficits in immune function, an increase in childhood respiratory infections and birth weight to prenatal exposure to OCs. Balancing the risks and benefits of a diet of country foods is very difficult. The nutritional benefits of country food and its contribution to the total diet are substantial. Country food contributes significantly more protein, iron and zinc to the diets of consumers than southern/market foods. The increase in obesity, diabetes and cardiovascular disease has been linked to a shift away from a country food diet and a less active lifestyle. These foods are an integral component of good health among Aboriginal peoples. The social, cultural, spiritual, nutritional and economic benefits of these foods must be considered in concert with the risks of exposure to environmental contaminants through their exposure. Consequently, the contamination of country food raises problems which go far beyond the usual confines of public health and cannot be resolved simply by risk-based health advisories or food substitutions alone. All decisions should involve the community and consider many aspects of socio-cultural stability to arrive at a decision that will be the most protective and least detrimental to the communities.

Arctic indigenous peoples experience the nutrition transition with changing dietary patterns and obesity.

Indigenous Peoples globally are part of the nutrition transition. They may be among the most extreme for the extent of dietary change experienced in the last few decades. In this paper, we report survey data from 44 representative communities from 3 large cultural areas of the Canadian Arctic: the Yukon First Nations, Dene/Métis, and Inuit communities. Dietary change was represented in 2 ways: 1) considering the current proportion of traditional food (TF) in contrast to the precontact period (100% TF); and 2) the amount of TF consumed by older vs. younger generations. Total diet, TF, and BMI data from adults were investigated. On days when TF was consumed, there was significantly less (P < 0.01) fat, carbohydrate, and sugar in the diet, and more protein, vitamin A, vitamin D, vitamin E, riboflavin, vitamin B-6, iron, zinc, copper, magnesium, manganese, phosphorus, potassium, and selenium. Vitamin C and folate, provided mainly by fortified food, and fiber were higher (P < 0.01) on days without TF for Inuit. Only 10-36% of energy was derived from TF; adults > 40 y old consistently consumed more (P < 0.05) TF than those younger. Overall obesity (BMI > or = 30 kg/m(2)) of Arctic adults exceeded all-Canadian rates. Measures to improve nutrient-dense market food (MF) availability and use are called for, as are ways to maintain or increase TF use.

Traditional food systems research with Canadian Indigenous Peoples.

Traditional food systems research with Canadian Indigenous Peoples has revealed many aspects of benefits and risks of the use of this food. Traditions based in hunting, fishing and gathering contain a great variety of species of wildlife plants and animals that provide rich cultural and nutritional benefits. Dietary change for Indigenous Peoples in Canada has resulted in the use of traditional food to provide usually less than 30% of total dietary energy; however this portion of the total diet contributes significantly more of essential nutrients. It also results in exposure to organochlorine and heavy metal contaminants that exceed the tolerable intake levels for some areas. A successful research and education intervention program with one British Columbia community demonstrated that increasing traditional food use can improve health status for vitamin A, iron and folic acid. It is concluded that traditional food systems are rich with potential for research and public health education intervention programs for Indigenous Peoples.

Environment and contaminants in traditional food systems of northern indigenous peoples.

Traditional food resources of indigenous peoples are now recognized as containing a variety of environmental contaminants which reach food species through local or long-range transport avenues. In this chapter we review the published reports of contaminants contained in traditional food in northern North America and Europe as organochlorines, heavy metals, and radionuclides. Usually, multiple contaminants are contained in the same food species. Measurement of dietary exposure to these environmental contaminants is reviewed, as are major issues of risk assessment, evaluation, and management. The dilemma faced by indigenous peoples in weighing the multiple nutritional and socioeconomic benefits of traditional food use against risk of contaminants in culturally important food resources is described.

Human health implications of environmental contaminants in Arctic Canada: a review.

This paper assesses the impact on human health of exposure to current levels of environmental contaminants in the Canadian Arctic, and identifies the data gaps that need to be filled by future human health research and monitoring. The concept of health in indigenous groups of the Arctic includes social, cultural, and spiritual dimensions. The harvesting, sharing and consumption of traditional foods are an integral component to good health among Aboriginal people influencing both physical health and social well-being. Traditional foods are also an economic necessity in many communities. Consequently, the contamination of country food raises problems which go far beyond the usual confines of public health and cannot be resolved by health advisories or food substitutions alone. The primary exposure pathway for the contaminants considered in this paper is through the traditional northern diet. For the Inuit, the OCs of primary concern at this time from the point of view of exposure are chlordane, toxaphene, and PCBs. Exposures are higher in the eastern than in the western region of the North. For Dene/Metis, exposure to OCs is in general below a level of concern. However, estimated intake of chlordane and toxaphene has been found to be elevated for certain groups and is a cause for concern if exposures are elevated on a regular basis. The developing foetus and breast-fed infant are likely to be more sensitive to the effects of OCs and metals than individual adults and are the age groups at greatest risk in the Arctic. Extensive sampling of human tissues in the Canadian north indicate that a significant proportion of Dene, Cree and Inuit had mean maternal hair mercury levels within the 5% risk-range proposed by the WHO for neonatal neurological damage. Based on current levels, lead does not appear to pose a health threat while cadmium is likely only a major risk factor for heavy smokers or consumers of large amounts of organ meats. Consumers of traditional foods are exposed to an approximately seven-fold higher radiation dose than non-consumers of traditional foods due predominantly to the bioaccumulation of natural radionuclides in the food chain. Risk determination for contaminants in country food involves a consideration of the type and amounts of food consumed and the sociocultural, nutritional, economic, and spiritual benefits associated with country foods. Risk management options that minimize the extent to which nutritional and sociocultural aspects of Aboriginal societies are compromised must always be considered.

Dietary intake and body mass index of adults in 2 Ojibwe communities.

OBJECTIVE: To describe and compare dietary intake and prevalence of overweight in a sample of adults in 2 Ojibwe communities in Mille Lacs, Minn, and Lac Courte Oreilles, Wis. DESIGN: Cross-sectional survey based on interviews that included a 24-hour recall, food frequency questionnaire, and a sociocultural questionnaire. SUBJECTS/SETTING: One hundred four adult Band (tribe) members were selected randomly from current housing lists; pregnant and lactating women were excluded. STATISTICAL ANALYSES PERFORMED: Nonparametric Wilcoxon rank sum tests were used to determine differences in absolute nutrient intakes where normality could not be assumed. Two-tailed t tests were conducted to test for differences between nutrient densities. A significance level of alpha = .05 was used; procedurewise adjustments were made using the Bonferroni method when adjusting for multiple comparisons. RESULTS: The importance of the traditional food system was evident: at least 50% of respondents engaged in hunting and fishing practices. Prevalence of overweight was 47%. Mean nutrient intakes were below the Recommended Dietary Allowance for women for vitamin A, folate, calcium, iron, and zinc and for men for vitamin A and calcium, despite energy intakes that met the Recommended Dietary Allowance. Nutrient densities were lower than those in the third National Health and Nutrition Examination Survey for women for carbohydrate, vitamin C, folate, calcium, and dietary fiber and for men for folate and dietary fiber. Fat contributed 37% (for men) and 40% (for women) of energy intake. APPLICATIONS/CONCLUSIONS: Areas of focus for culturally relevant education programs (eg, promotion of traditional foods that provide nutrients of low intake status and low-fat traditional food preparation methods) and research needs are suggested to reduce risks for nutrition-related chronic disease among Native Americans.

Nutrient intake of food bank users is related to frequency of food bank use, household size, smoking, education and country of birth.

The number of individuals and families accessing food assistance programs has continued to grow throughout the 1990s. Despite the increased health risk among low-income people, few studies have addressed nutrient intake throughout the month or at the end of the month when food and financial resources are thought to be compromised, and no study has described dietary status of a random sample of food bank users. Nutrient intakes of adult female and male food bank users in metropolitan Montreal, Quebec, Canada, were monitored week-by-week over a month by dietitian-administered 24-h recall interviews. A total of 428 participants from a stratified random sample of 57 urban area food banks completed all four interviews. Mean energy intake, as an indicator of diet quantity, was similar to other adult populations (10.2 +/- 4.8 and 7.9 +/- 3.6 MJ for men and women, respectively, age 18-49 y) and not related to sociodemographic variables except the expected biological variation of age and sex. Macronutrient intake was stable throughout the month. Overall median intakes of calcium, vitamin A, and zinc were below recommended levels for all age and sex groups. Intakes of several micronutrients were related to frequency of food bank use, household size, smoking, education, and country of birth. High nutrient intake variability characterized these adult food bank users.

Food bank users: sociodemographic and nutritional characteristics.

BACKGROUND: The continued expansion of food assistance programs makes it important to examine the sociodemographic characteristics and nutritional profiles of people relying on this service. The authors undertook such a study in a large urban centre. METHODS: A total of 490 food bank users were randomly selected from a stratified random sample of 57 urban food banks in Montreal. A questionnaire and a dietary recall interview were given by a dietitian-interviewer to determine socioeconomic, demographic and cultural characteristics and macronutrient intake. These data were compared with national and provincial data. RESULTS: The mean age of the participants (256 men and 234 women) was 41 years; 204 (41.6%) were living alone and most (409 [83.5%]) were receiving social assistance benefits. These food bank users were well educated (190 [38.8%] had completed technical school or had a college or university education), and the sample included few elderly or disabled people. The median body mass index was greater than 24, which indicated that energy intake, although below recommended levels, was not a chronic problem. The people using the food banks had a monthly shortfall in their food budget of between $43 and $46. INTERPRETATION: Food banks are used regularly, primarily by young healthy adults. They are though of as a necessary community resource.

Population exposure to radioactivity from consumption of caribou among the Dene/Métis of Denendeh (western Northwest Territories, Canada).

There has been long-standing concern with exposure to radioactivity through the consumption of caribou, particularly in indigenous populations in the western Northwest Territories, Canada, who are traditionally high consumers. We conducted a dietary survey in this region in 1994 to estimate population exposure levels. Dietary information was collected from 1012 individuals in sixteen communities (1012 days of 24-hour dietary recalls, 1012 food frequency questionnaires) and radionuclide levels in caribou flesh, liver and kidneys were measured. Monte Carlo statistical methods were employed to integrate these data sets and estimate the distribution of radiation exposure for people in five regions (Gwich'in, Sahtú, Dogrib, Deh-Cho, South Slave). The exposure levels were highest in the South Slave region and in older males (40+ years), and lowest in the Gwich'in region and in younger females (20-40 years). Median exposure level ranged from 0.95 to 5.31 mSv per year (mean of medians = 2.96 mSv/y). In each group the 95th percentile of exposure was 2-3 times greater than the median. These exposure levels are comparable to exposure levels in Alaskan Eskimos and Marshall Island residents, and are much higher than European or American urban populations. Caribou meat is a very nutritious food. We conclude that, although there is some radiation exposure from consuming caribou, the associated health risks are low and are outweighed by the physical, social and cultural benefits derived from hunting and eating caribou.

Dietary exposure to chemical contaminants from traditional food among adult Dene/Métis in the western Northwest Territories, Canada.

Environmental contaminants such as organochlorines and heavy metals have been reported to bioaccumulate in Arctic and subarctic wildlife. The Indigenous Peoples in northern and Arctic Canada rely on local wildlife as an important food source, and it is thus hypothesized that they may have high intakes of these contaminants. Herein, an assessment of dietary exposure to selected organochlorines and heavy metals for Indigenous Peoples of the western Northwest Territories (NWT) is presented. Dietary data were collected from 1012 adults with 24-h recalls in 16 communities in the western NWT (Denendeh). A comprehensive survey of the literature, as well as in-house analysis, formed the basis of a large traditional food-contaminant database. By combining the dietary and contaminant data, dietary exposure to 11 chemical contaminants was calculated. Dietary exposure to chemical contaminants in Denendeh is generally low and there is little, if any, associated health risk. However there are specific contaminants in certain communities for which exposure on a single day approaches the tolerable daily intake levels. These situations are detailed and monitoring needs are described.

Ooligan grease: a traditional food fat of western Canada and Alaska.

First Nations Peoples prepare ooligan grease by ripening several tons of the small fish, Thaleichthys pacificus, and rendering the fish oil. Eighteen samples from different family preparations of five cultural areas were analyzed for a spectrum of nutrients, organochlorines, and heavy metals. Ooligan grease was found to be a rich source of retinol (2444 +/- 1198 RE/100 g) and n-3 fatty acids, but had less vitamin A compared to fat of raw fish. There was a 10-fold increase in n-3 fatty acids in grease compared to raw fish fat, which may be attributed to microbial conversion of other fatty acids to DHA. Whole fish were good sources of Ca, Fe, and Zn; heavy metals were below guideline levels in grease. Chlorinated pesticides and PCB increased from north to south locations in British Columbia, with mean levels being 110 ng/g lipid of total chlorinated pesticides and 30 ng/g lipid of PCB. These levels are below regulation limits established by Health Canada. It is concluded that ooligan grease is a superior food fat and safe for human consumption.

Sources of bias in estimates of calcium and vitamin A intakes of indigenous peoples in the Northwest Territories, Canada.

Calcium and vitamin A have consistently been reported as nutrients at risk among northern indigenous peoples in Canada. Using a data set recently collected in the Sahtú region of Denendeh, Northwest Territories, potential sources of bias and their effect on estimates of dietary intake are investigated. Calcium and vitamin A intakes appear to be underestimated to differing extents and for differing reasons specific to each nutrient. Underestimation of calcium intake may affect a large portion of the dietary records and is most likely due to insufficient probing for methods of food preparation during dietary interviews. Underestimation of vitamin A intake appears to affect a smaller proportion of the food records and be related to the difficulty of recording the occurrence of rare and seasonal events. In both cases, more precise nutrient composition data are needed to reflect nutrient content of traditional food as consumed.

Benefits of traditional food in Dene/Métis communities.

Data collected in 16 Dene/Métis communities are used to illustrate the many nutritional, economic, and sociocultural benefits associated with the harvest and consumption of traditional food by indigenous peoples. These include exceptional nutrient composition, absence of industrial processing that changes quality and taste properties, taste preference, reasonable cost compared to market food, quality of the time spent on the land, increased physical activity, sharing of the harvest within the community, opportunity to practice spirituality, and encouragement for children to discover the natural environment. The importance of traditional food to the health of individuals and communities can be directly related to the nutritional value of the food itself, the physical activity associated with its procurement, and its role in mediating positive health determinants such as self-efficacy and locus of control.

Decreasing traditional food use affects diet quality for adult Dene/Métis in 16 communities of the Canadian Northwest Territories.

We assessed diets in 16 Dene/Métis communities in the Canadian Arctic. We described nutrient intakes and identified nutrients at risk among adult Dene/Métis, evaluated the influence of traditional food on diet quality, and examined the direction of dietary change by comparing intergenerational and between-community differences in dietary intake. Diet varied according to sex, age and community. Nutrients of possibly inadequate intake (irrespective of subject sex, age or community) included calcium, vitamin A and folic acid. Dietary fiber intake was also of concern. Traditional food (animals and plants harvested from the local environment) was consumed on 65. 4% of interview days; on those days intakes of iron, zinc and potassium were higher (P < 0.05) and those of sodium, fat, saturated fat and sucrose were lower (P < 0.05) than on days when market food only was consumed. In this population, the shift away from traditional food towards a diet composed exclusively of market food was characterized by an increase (P < 0.05) in absolute energy intake and an increase (P < 0.01) in the relative contributions of carbohydrate (particularly sucrose), fat and saturated fat. This pattern of change calls for initiatives to document the current health status of this population and to prevent potential negative health consequences of dietary change.

Evaluation of the population distribution of dietary contaminant exposure in an Arctic population using Monte Carlo statistics.

Organochlorines and heavy metals have bioaccumulated in Arctic wildlife, which is an important food source for the Inuit. In this study, we have developed a statistical model to describe the population distribution of contaminant exposure and the usual intake of the high-end contaminant consumers. Monte Carlo methods are used to account for variations due to seasonal dietary pattern and contaminant concentrations. Distribution of the dietary intake of the contaminants of most concern-mercury, polychlorinated biphenyls (PCBs), chlordane, and toxaphenes-are described. Over 50% of the residents had dietary exposure levels exceeding the tolerable daily intake or provisional tolerable daily intake for Hg, toxaphene, and chlordane (83, 91, and 71% for men and 73, 85, and 56% for women, respectively). The high-end consumers (i.e. the 95th centile) have intake levels 6 times higher than the provisional tolerable weekly intake of Hg, and over 20 times the tolerable daily intake of chlordane and toxaphene. Assessment of health risks of the relative high contaminant exposure in this community must also consider the nutritional, economical, cultural, and social importance of these traditional foods. A comprehensive risk management scheme has yet to be developed.