Dietary Change and Obesity Associated with Glucose Intolerance in Alaska Natives

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Abstract

Objective To investigate frequency of food intake, body weight, and glucose intolerance in Alaska Natives.

Design Height, weight, and random blood glucose levels were measured and a frequency-of-food-intake questionnaire was obtained. This questionnaire classified persons as consumers of indigenous foods or nonindigenous foods within three food groups. Those with a random blood glucose measurement ≥6.72 mmol/L received an oral glucose tolerance test.

Setting Community screening in 15 villages in Alaska.

Subjects Nutrition screenings were done for 1,124 Alaska Native residents aged 20 years or older. An oral glucose tolerance test was done for 202 subjects.

Outcomes measured Subjects were classified as consumers of indigenous or nonindigenous foods within three food groups. A diagnosis of non–insulin-dependent diabetes mellitus (NIDDM) was made on the basis of World Health Organization criteria. A determination of overweight was made on the basis of National Center for Health Statistics criteria.

Statistical analysis A χ2 test with Yates correction, t test, and linear regression, with two-sided P values.

Results Athabascan Indians had twice the rate of NIDDM as Yup’ik Eskimos with significantly higher frequency of non-indigenous food intake, plus lower frequency of indigenous carbohydrate and fat intake. Subjects ≤30 years old consumed significantly more nonindigenous protein and fat and low-nutrient-density carbohydrates than those ≥60 years old. Persons who had glucose intolerance reported significantly greater consumption of nonindigenous protein and less seal oil. Incidence of overweight was significantly higher than was found 25 years ago. Participants with glucose intolerance were significantly more overweight than others.

Conclusion A pattern of increased frequency of non-indigenous protein, low-nutrient-density carbohydrate, and fat intake with less indigenous carbohydrate and fat consumption was found in subjects ≤30 years old and in association with the higher rate of NIDDM found in the Athabascan Indians. Persons with glucose intolerance were significantly more overweight than others.

Applications Although the nutritional value of indigenous foods for reducing disease risk should be promoted, nutrition education, especially among young adults, should also include building skills to select and prepare nonindigenous foods to attain a healthful diet. Although snacking is a concern, dietary fat was the most significant factor in obesity and NIDDM. J Am Diet Assoc. 1995; 95:676-682.

Section snippets

Subjects and Methods

Residents ≥20 years old from 15 villages along the Yukon and Kuskokwim rivers were screened at village-based health fairs and in village clinics in the winter months from January 1987 to February 1988 (Figure 1). Each participant provided demographic information and informed consent. Measurements of height and weight were obtained using a standard beam-balance scale.

A food frequency questionnaire (FFQ) inquired about intake frequency (daily, weekly, monthly, yearly, or never). The FFQ was

Results

A total of 1,124 village residents aged 20 years or older were screened (52.7% of the 2,131 residents aged 20 or older) (Figure 1). Subjects included 492 men and 632 women; 895 were Eskimo and 229 were Athabascan Indian (Table 1). Mean age was 46.8 for men and 44.1 for women. Forty-two persons had NIDDM and 21 had IGT for a TGI of 63. Age-adjusted rates for NIDDM per 1,000 were 17.3 in Eskimos and 33.7 in Indians.

Discussion

In this study we found more frequent intake of nonindigenous protein, low-nutrient-density carbohydrate, and fat among Eskimos ≤30 years of age than among Eskimos ≥60 years of age. A similar pattern was found among Indians, although Indians had twice the rate of TGI (11). Subjects with TGI reported a significantly more frequent use of nonindigenous protein and less seal oil, and they had a significantly higher prevalence of overweight.

Interpretation of the study results may be limited by the

Applications

Education should emphasize the health value of indigenous foods and take advantage of the growing interest in preserving traditional customs and skills. Consumption of salmon should be promoted, especially among Athabascans. Reliance on indigenous foods may not be practical for many in the future, so education should target discarding visible fat when nonindigenous protein foods are substituted for game animals which are lower in saturated fat. Care should also be taken when vegetable oil is

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