Dissertationen zum Thema „Aboriginal nutrition“

This thesis incorporates social history and consultative action research to analyse the development of cross-cultural nutrition services for Indigenous communities in the Northern Territory from 1974-2000 and promote the development of stronger partnerships in 1999-2001.The historical development of nutrition services is analysed against current theory and a model of capacity building for health promotion. Nutrition infrastructure and services have developed systematically, incrementally and substantially. Strengths include the development of enduring and successful inter-cultural partnerships and leadership.Two facilitative narratives which aim to improve inter-cultural knowledge sharing, strengthen capacity and promote participatory action in community based projects were developed, implemented and partially evaluated. Services can be further strengthened by long-term commitments to examining power issues, promoting improved Indigenous control and problem solving and comprehensive bi cultural evaluation that identifies significant indicators to improving outcomes. Participatory action research, facilitative story telling, capacity building, Indigenous education theory and critical social science can inform and guide these efforts in complementary ways.
Master of Arts (Hons) (Critical Social Science)

This thesis incorporates social history and consultative action research to analyse the development of cross-cultural nutrition services for Indigenous communities in the Northern Territory from 1974-2000 and promote the development of stronger partnerships in 1999-2001.The historical development of nutrition services is analysed against current theory and a model of capacity building for health promotion. Nutrition infrastructure and services have developed systematically, incrementally and substantially. Strengths include the development of enduring and successful inter-cultural partnerships and leadership.Two facilitative narratives which aim to improve inter-cultural knowledge sharing, strengthen capacity and promote participatory action in community based projects were developed, implemented and partially evaluated. Services can be further strengthened by long-term commitments to examining power issues, promoting improved Indigenous control and problem solving and comprehensive bi cultural evaluation that identifies significant indicators to improving outcomes. Participatory action research, facilitative story telling, capacity building, Indigenous education theory and critical social science can inform and guide these efforts in complementary ways.

This thesis explores the impact of climate changes on the harvest of traditional foods and characterizes the implication of these changes on the diet of Aboriginal Peoples in northern Canada. Combinations of qualitative and quantitative methods were used to document and estimate the local harvest pattern of key species of traditional food. Overall results between the estimated amount of available food from the harvest and the estimated amount of dietary intake did not agree, however, strong agreements were seen in two species: moose and whitefish. The relationship of harvest data to dietary intake is complex and requires two accurate and complete data sets. If these exist, predicting the intake of traditional foods from harvest data is possible. Qualitative results portray that community members are witnessing variable changes in climate which are affecting their traditional food harvest and are altering their harvest mechanisms to adapt to these changes.
Cette thèse regard l'impact des changements environmentales sur la récolte des aliments traditionnels et characterise l'implication de ses changements sur la diète des membres de la communauté. Une combinaison de méthode quantitative et qualitative ont été utilisé pour documenter et estimer la séquence de la récolte des animaux clées locales. En général, les résultats entre la nourriture disponible estimé provennant de la récolte et le montant estimé pour la consumption alimentaire n'étaient pas égaux, parcontre, la ratio entre aurignal et poisson blanc étaient bonne. La relation entre les résultats numériques concernent la récolte et la consumption alimentaire sont complèxes et requièrent deux coordonnées d'informations numériques completes. Si cela existe, il serait possible de prédir la consumption des aliments traditionalles provenant de la récolte. Les résultats qualitatifs dénoncent des changements climatiques affectant la récolte des aliments traditionnels et alterent la façon dont les membres de la communauté font leur récolte pour adapter à ces changements climatiques.

It has been established that diabetes does have an effect and impacts greatly on the life expectancy of Indigenous Australians. A possible explanation is that Indigenous Australians generally have different needs, primarily because of the variation in culture differences. For this reason it is imperative that health officials have an understanding of these additional pre-disposing factors and the associated complications which have resulted as a part of the colonisation process. These factors including diet, nutrition, exercise, obesity and have influenced and resulted, in a change to the way of life for many Indigenous Australians, primarily from a traditional to modern diet.

Globally, the prevalence of Type 2 diabetes is rising. The most affected populations are those that have undergone recent and rapid transition towards a Western lifestyle, characterised by energy-dense diets and physical inactivity.¶ Two major hypotheses have attempted to explain the variation in diabetes prevalence, both between and within populations, beyond the contributions made by adult lifestyle. The thrifty genotype hypothesis proposes that some populations are genetically well adapted to surviving in a subsistence environment, and are predisposed to develop diabetes when the dietary environment changes to one that is fat and carbohydrate rich. The programming hypothesis focuses on the developmental environment, particularly on prenatal and early postnatal conditions: nutritional deprivation in utero and early postnatal life, measured by low birthweight and disrupted child growth, is proposed to alter metabolism permanently so that risk of diabetes is increased with subsequent exposure to an energy-dense diet. Both hypotheses emphasise discord between adaptation (genetic or developmental) and current environment, and both now put forward insulin resistance as a likely mechanism for predisposition.¶ Diabetes contributes significantly to morbidity and mortality among Australia’s Indigenous population. Indigenous babies are more likely to be low birthweight, and typical patterns of child growth include periods of faltering and rapid catch-up. Although there have been numerous studies in other populations, the programming hypothesis has not previously been tested in an Australian Indigenous community. The framework of the programming hypothesis is thus expanded to consider exposure of whole populations to adverse prenatal and postnatal environments, and the influence this may have on diabetes prevalence.¶ The present study took place in Cherbourg, a large Aboriginal community in southeast Queensland with a high prevalence of diabetes. Study participants were adults with diagnosed diabetes and a random sample of adults who had never been diagnosed with diabetes. Data were collected on five current risk factors for diabetes (general and central obesity, blood pressure, age and family history), in addition to fasting blood glucose levels. A lifestyle survey was also conducted. Participants’ medical records detailing weight growth from birth to five years were analysed with regard to adult diabetes risk to determine whether childhood weight and rate of weight gain were associated with subsequent diabetes. Adult lifestyle factors were xiialso explored to determine whether variation in nutrition and physical activity was related to level of diabetes risk.¶ Approximately 20% of adults in Cherbourg have diagnosed diabetes. Prevalence may be as high as 38.5% in females and 42% in males if those who are high-risk (abnormal fasting glucose and three additional factors) are included. Among those over 40 years, total prevalence is estimated to be 51% for females and 59% for males.¶ Patterns of early childhood growth may contribute to risk of diabetes among adults. In particular, relatively rapid weight growth to five years is associated with both general and central obesity among adult women. This lends some qualified support to the programming hypothesis as catch-up growth has previously been incorporated into the model; however, although the most consistent association was found among those who gained weight more rapidly, it was also found that risk is increased among children who are heavier at any age.¶ No consistent associations were found between intrauterine growth retardation (as determined by lower than median birthweight and higher than median weight growth velocity to one and three months) and diabetes risk among women or men. A larger study sample with greater statistical power may have yielded less ambiguous results.¶ Among adults, levels of physical activity may be more important than nutritional intake in moderating diabetes risk, although features of diet, such as high intake of simple carbohydrates, may contribute to risk in the community overall, especially in the context of physical inactivity. A genetic component is not ruled out. Two additional areas which require further investigation include stress and high rates of infection, both of which are highly relevant to the study community, and may contribute to the insulin resistance syndrome.¶ Some accepted thresholds indicating increased diabetes risk may not be appropriate in this population. Given the relationship between waist circumference and other diabetes risk factors and the propensity for central fat deposition among women even with low body mass index (BMI), it is recommended that the threshold where BMI is considered a risk be lowered by 5kg/m2 for women, while no such recommendation is made for men.¶ There are a number of social barriers to better community health, including attitudes to exercise and obesity, patterns of alcohol and tobacco use and consumption of fresh foods. Some of these barriers are exacerbated by gender roles and expectations.¶

碩士
弘光科技大學
食品科技所
102
The research is aimed at investigating the relevance and relationship among nutritional knowledge, attitudes and eating behaviors of Taiwanese aboriginal junior high school students. Based on the students in the school district, 1063 questionnaires are given and 938 of them are retrieved (the response rate is up to 88.24%). 839 questionnaires are valid to be analyzed in the survey. The statistics approaches include descriptive statistics, average value and standard variation, independent sample t test, one-way ANOVA, Pearson’s Correlation and univariate. Two of the findings are worth summarizing: 1 Fundamental variances: First, gender is obviously relevant to nutritional knowledge and eating behaviors. Besides, there is significant relation between glade and eating behaviors. Parents’ educational degree has great effect on nutritional knowledge; however, only father’s educational degree influences upon eating behaviors significantly. What’s more, the economic conditions of the students’ families play an important role in nutritional attitudes and eating behaviors. School education is the main source of the information about nutrition and food. 2 The score regarding nutritional knowledge is not good; in contrast, the one regarding nutritional attitudes is better. In addition, the score related to eating behaviors is the most excellent, which reveals their positive eating behaviors. Further, nutritional knowledge and attitudes correlate positively, and so do nutritional attitudes and eating behaviors. Suggestions of the research result: 1 Tribal culture should be included in school education in the aboriginal area to enhance the students’ absorption about nutritional knowledge and understanding about the characteristics of their tribal eating culture. 2 Encourage the parents to upgrade their nutritional knowledge and improve their eating behaviors in expectation of affecting children’s eating attitudes. 3 To increase the books on nutrition in the school library to make the students absorb relevant information. 4 Cultivate good nutritional attitudes and eating behaviors by means of the provision of educational resources to the aboriginal tribal churches and the holdings of the activities concerning nutrition supported by community resources. 5 The incorporation of health education and lunch hygiene education into school courses can contribute to promote students’ knowledge and attitudes with reference to nutrition.

Research Doctorate - Doctor of Philosophy (PhD)
Aboriginal Australians have high rates of many chronic diseases, the causes of which are multi-factorial. Optimal nutrition throughout life is protective against a number of adverse health outcomes, and can begin with setting the scene for lifelong health in utero and in the first years of life. However, little is currently known about the dietary intakes of Aboriginal Australian women in pregnancy and in the postpartum period, and their children, particularly in early infancy. This thesis by publication is presented as a series of published research articles. Specific research aims and the results of studies arising from this thesis are summarised below. Dietitians are well-placed to support and work alongside Aboriginal communities in developing and supporting strategies to optimise nutrition for Aboriginal woman and children. Dietitians must demonstrate cultural competency, however opportunities for practical experiences working with Aboriginal communities are limited during undergraduate nutrition degree programs. The aim of the first study was to evaluate the cultural awareness experiences of student and new-graduate dietitians working in an Aboriginal ArtsHealth setting. Six participants reported on their experiences through either written feedback (via email) or oral feedback (via semi-structured interview). A generic inductive approach was used for qualitative data analysis. Key themes emerged around ‘building rapport’ and ‘developing cultural understanding’. Some participants reported an increased understanding of the context around health disparity for Aboriginal Australians, and the experiences of the student and new-graduate dietitians were overwhelmingly positive. To optimise nutrition, current nutrition practices and dietary intakes need to be quantified. The second study of this thesis reports on the dietary intakes and anthropometric and body composition measures of a sample of women and their infants from the Gomeroi gaaynggal study, a prospective longitudinal cohort of Aboriginal women and their children in regional NSW from pregnancy to five years postpartum. A cross-sectional analysis of n=73 mother-child dyads from three months to five years postpartum found a breastfeeding initiation rate of 85.9%, with a median (interquartile range [IQR]) duration of 1.4 months (0.5 – 4.0). Introduction of infants to solid foods and cow’s milk were at 5.0 months (4.0–6.0) and 12.0 months (10.0–13.0) respectively. At one year postpartum 66.7% of women were overweight or obese, and 63.7% were overweight or obese at 2 years postpartum. Results from the Gomeroi gaaynggal cohort were preliminary, but suggest that women in this cohort may benefit from further support to optimise nutrition for themselves and their children. Providing women with tailored nutrition advice requires appropriate tools for dietary assessment. Image-based dietary records are emerging as a novel method for dietary assessment that limits some of the participant burden associated with traditional methods of dietary assessment. The Diet Bytes and Baby Bumps study used image-based dietary records captured via smartphones and a purpose-built brief tool (the Selected Nutrient and Diet Quality [SNaQ] tool) to assess nutrient and food group intakes of pregnant women and to inform the delivery of tailored nutrition advice to participants during their pregnancy. Twenty-five women (27 recruited, including 8 Aboriginal Australians, one withdrawn, one incomplete), had image-based records appropriate for analysis. Median intakes of core food groups of grains and cereals, vegetables, fruit, meat and dairy were reported as being below recommendations, but intakes of energy-dense, nutrient-poor foods exceeded recommendations. Cohen kappa showed moderate to substantial agreement between the SNaQ tool and the nutrient analysis software when assessing adequacy of micronutrient intakes. Relative validity was established by comparison of the image-based dietary records and 24-hour food recalls. There were significant correlations between the two methods of dietary assessment for energy, macronutrients and micronutrient intakes (r=.40–.94, all P<.05), with acceptable agreement between methods. Seventeen women reported changing their diets as a result of receiving personalised nutrition advice. The DietBytes method of image-based dietary assessment was well-received, with 88% of participants stating they would use the method again, including all Aboriginal participants. A systematic review was conducted to identify existing programs that have aimed to improve nutrition-related outcomes in Indigenous pregnant women worldwide, and to identify positive factors contributing to successful programs. This review consisted of 27 studies (20 programs) from Australia, Canada, and the United States of America; the most prevalent outcome measures were breastfeeding initiation/duration (n=11 programs) and birth weight (n=9 programs). Activities employed within programs that resulted in statistically significant improvements in health and/or nutrition outcomes included individual counselling and education, and involvement of peer counsellors or other Indigenous program staff. In successful programs, emphasis was placed on designing nutrition interventions in collaboration with Indigenous communities. This research thesis has highlighted key areas for improving dietary intake and nutrition-related health of Aboriginal Australian women and their children, including breastfeeding duration, appropriate timing of introduction to solid food and cow’s milk, nutrient and food group intake of pregnant and postpartum women, and improving rates of overweight and obesity in women postpartum. An image-based dietary record method of dietary assessment has demonstrated relative validity and acceptability for dietary assessment of Aboriginal pregnant women and acceptability to guide nutrition counselling. Dietitians can best support Aboriginal women and children by working in collaboration with communities to optimise nutrition, and support practice-based student experiences during university training where possible to assist in development of cultural competency skills.

Objectives: To assess the intake of milk and alternatives, calcium, and vitamin D in on-reserve First Nations youth in Ontario, Canada; and the relationship of these nutrients to body mass index. To assess the impact of a simple food provision program on the intakes of milk and alternatives among First Nations youth in Kashechewan First Nation and Attawapiskat First Nation, Ontario, Canada. To assess the process of implementing a comprehensive school nutrition education program, as well as its effects on the intake of milk and alternatives, as well as knowledge, intentions, and self-efficacy among First Nations youth in Fort Albany First Nation, Ontario. Methods: Twenty-four hour diet recall data collected by web-based survey between November 2003 and June 2010 (including pre- and post-program) were used to assess intakes. Milk and alternatives, calcium, and vitamin D intakes were described and compared to food and nutrition standards and to intakes in the general population (CCHS cycle 2.2), and related to BMI. Data collected in different years for the same community and season were used to assess yearly effects on milk and alternatives intake (four communities). Data collected in the same year and season but from different communities were used to assess latitudinal effects on milk and alternatives intake (four community pairs). Paired change in intakes was evaluated one week-post snack program implementation in Kashechewan and Attawapiskat, as well as one year post-program in Kashechewan. Change in intakes as well as knowledge, self-efficacy, and intentions were evaluated in Fort Albany after the completion of a comprehensive school-based program. Student (grades 6-8), teacher (from grades K-8), and parent impressions were collected via questionnaires and focus groups. Results: Mean intakes of milk and alternatives, calcium, and vitamin D were below recommendations and levels seen in the general population. No relationship between body mass index and milk and alternatives, calcium, or vitamin D intake was detected. Latitudinal and yearly variation in intakes was detected in the communities under study. Pilot school food provision programs improved intakes in the short-term under close to ideal circumstances, including adequate dedicated personnel and resource support. After one week, calcium intake increased in Kashechewan (p=0.044), while milk and alternatives (p=0.034) and vitamin D (p=0.022) intakes increased in Attawapiskat. Multiple logistical barriers meant that these improvements were not sustained in the long-term. A comprehensive program in Fort Albany was successful in increasing knowledge (p=0.050) and intentions (p=0.010) towards milk and alternatives intake. Students were generally grateful for the snack programs, and especially enjoyed the hands-on lessons in Fort Albany. Teachers in Kashechewan thought that the snack program was very valuable for students and helped with their alertness and attentiveness. In Fort Albany, teachers noted that it was helpful to have an outside person who could devote all of their time to teaching the students about nutrition; they thought that the students gained a whole new perspective about nutrition via the program. Parents in Fort Albany were enthusiastic about the school nutrition program, but noted availability and cost as major barriers to healthy eating. Conclusions: The low milk and alternatives, calcium, and vitamin D intakes seen in the study population parallel results seen in studies of other Canadian Aboriginal populations. Further study is needed to clarify the relationship between milk & alternatives intake and BMI in this population. Latitudinal and yearly variations in intake were identified, and therefore should be accounted for when tailoring interventions to specific First Nations; the needs, opportunities, and barriers in each case may differ significantly. This study demonstrated that school food provision programs were valued by students, parents, and teachers; and were efficacious in improving short-term intakes. Comprehensive programs were shown to improve student knowledge and intentions to make healthy food choices. In order to support long-term effectiveness, the barriers identified through this research, including the need for adequate and sustainable resources, must be addressed.

This is primarily a study of dietary practices and nutrient intakes in relation to health in an urban Aboriginal community in New South Wales. It examines the assumption that poor diet is one of the major, if not the major, contributing factors in poor Aboriginal health. The data indicate that in the community studied dietary patterns were consistent with those of the wider society. Intakes of nutrients were not always optimal compared with recommended dietary intakes (RDIs) for Australia, but compared to the rest of the Australian population, and different sub-sections within it, they were not as poor as expected. In particular, the high fat, high sugar, largely vitamin deficient diet frequently assumed to be ubiquitous in Aboriginal communities is not supported by this study. Consequently, it is argued that the importance of the role of diet in poor Aboriginal health may have been over-stated. In re-evaluating the current emphasis on diet and other 'lifestyle' factors it is suggested that the scope of the analysis needs to be considerably broadened to include other factors which may be more ambiguous in terms of their effects on health. What seems particularly important is the high level of stress evident in the community studied. This stress seems to be derived from a particular set of historical and contemporary social conditions which, it is argued, need to be more fully considered as part of the totality of environmental factors which impinge on the health of Aborigines in settled Australia.

Introduction: The high prevalence of obesity in Aboriginal Canadian youth is a major public health concern. Although little is known about the diets of children on-reserve, it is hypothesized that high intake of low nutrient dense foods has a negative impact on overall diet quality. Objectives: To describe the dietary quality of First Nation students using a Canadian adaptation of the Healthy Eating Index (HEI-C) and determine the relationships between HEI-C and BMI, intake of non-food group (“other”) foods, game consumption, frequency of eating outside the home and remoteness (latitude, °N). Methods: Between 2004-2009, from a 24 h dietary recall data were obtained using a validated web-based food behaviour questionnaire, from students in grades 6,7 & 8 from the First Nations communities of Georgina Island, Christian Island, Fort Albany, Attawapiskat, Peawanuck, Moose Factory, Kashechewan and Ouje-Bougoumou (Quebec). HEI-C was assessed as good (81-100), needs improvement (51-80) or poor (0-50). Results: Mean community HEI-C scores ranged from 57.38-70.04, with differences by community (p=0.027) and season (p=0.007); more northerly communities seemed to have lower HEI-C scores and fall seemed to have higher HEI-C scores compared to winter and spring. A non-significant negative correlation between BMI and HEI-C was observed (r=-0.107, NS). As percent energy from ‘other foods’ increased, the HEI-C score tended to decrease. Game consumption appeared to contribute to higher HEI-C scores. Eating outside the home did not seem to affect HEI-C. Conclusions: Poor diet quality in remote on-reserve youth populations is a concern. Lack of consistent access to healthy foods may have a negative impact on diet quality. Programs that help improve the provision of healthy foods, decrease the intake of “other foods” and that emphasize game may help to improve diet quality.

Résumé La prédominance de l'obésité qui touche les enfants et les adultes a augmenté dans le monde entier ces dernières décennies. Les différentes études épidémiologiques ont prouvé que l'obésité est devenue une préoccupation profonde de santé aux États-Unis et au Canada. Il a été montré que l'obésité a beaucoup d’effets sur la santé ainsi il serait important de trouver différentes causes pour le gain de poids. Il est clair que l'obésité soit la condition de multiples facteurs et implique des éléments génétiques et environnementaux. Nous nous concentrons sur les facteurs diététiques et particulièrement le fructose où sa consommation a parallèlement augmenté avec l'augmentation du taux d'obésité. La forme principale du fructose est le sirop de maïs à haute teneur en fructose (HFCS) qui est employé en tant qu'édulcorant primordial dans la plupart des boissons et nourritures en Amérique du Nord. Il a été suggéré que la prise du fructose serait probablement un facteur qui contribue à l’augmentation de la prédominance de l'obésité. L'objectif de cette étude était d'évaluer s'il y a un rapport entre la consommation du fructose et le risque d'obésité. Nous avons travaillé sur deux bases de données des nations Cree et Inuit. Nous avons eu un groupe de 522 adultes Cree, (263 femmes et 259 hommes) dans deux groupes d'âge : les personnes entre 20 et 40 ans, et les personnes de 40 à 60 ans. Nous les avons classés par catégorie en quatre groupes d'indice de masse corporelle (IMC). L'outil de collecte de données était un rappel de 24 heures. En revanche, pour la base de données d'Inuit nous avons eu 550 adultes (301 femmes et 249 hommes) dans deux groupes d'âge semblables à ceux du Cree et avec 3 catégories d’indice de masse corporelle. Les données dans la base d'Inuit ont été recueillies au moyen de deux rappels de 24 heures. Nous avons extrait la quantité de fructose par 100 grammes de nourriture consommés par ces deux populations et nous avons créé des données de composition en nourriture pour les deux. Nous avons pu également déterminer les sources principales du fructose pour ces populations. Aucun rapport entre la consommation du fructose et l’augmentation de l’indice de masse corporelle parmi les adultes de Cree et d'Inuit n’a été détecté. Nous avons considéré l’apport énergétique comme facteur confondant potentiel et après ajustement, nous avons constaté que l'indice de masse corporelle a été associé à l’apport énergétique total et non pas à la consommation du fructose. Puisque dans les études qui ont trouvé une association entre la consommation de fructose et l’obésité, le niveau de la consommation de fructose était supérieure à 50 grammes par jour et comme dans cette étude ce niveau était inférieur à cette limite (entre 20.6 et 45.4 g/jour), nous proposons que des effets negatifs du fructose sur la masse corporelle pourraient être testés dans des populations à plus haute consommation. Les essais cliniques randomisés et éventuelles études cohortes avec différents niveaux de consommation de fructose suivis à long terme pourraient aussi être utiles. Mots clés : fructose, sirop de maïs à haute teneur en fructose (HFCS), obésité et poids excessif
Summary The prevalence of obesity has increased worldwide in recent decades in both children and adults. Different epidemiologic studies have shown that obesity has become a serious health concern in United States and Canada. It has been proved that obesity has many adverse health outcomes so it is important to identify the different causes of weight gain. It is clear that obesity is a multifactor condition and involves both genetic and environmental elements. In this study, we focus on dietary factors, specifically the consumption of fructose that has increased in parallel to the increase in the obesity rate. The main form of fructose in the diet is high fructose corn syrup (HFCS) that is used principally as a sweetener in most beverages and foods in North America. It has been suggested that the intake of fructose may possibly be a contributing factor to the increased incidence of obesity. The objective of this study was to assess if there is a relationship between consumption of fructose and risk of obesity. We worked on two databases. The first database contained 24-hour recall data collected from a sample of 522 Cree adults (263 women and 259 men), divided into two age groups: people between 20 and 40 years old, and people from 40 to 60 years old. We categorized them into four body mass index (BMI) groups. The second database contained data from two 24-hour recalls administered to 550 Inuit adults (301 women and 249 men). These adults were divided into two age groups similar to Cree and with three BMI categories. The amount of fructose per 100 grams of food consumed by these two samples was calculated and we created food composition data for both. We also determined the main sources of fructose in these populations that was sugar sweetened beverages. Based on our results, we could not detect any relationship between consumption of fructose and an increase in BMI among Cree and Inuit adults. We considered energy intake as a potential cofounding factor and, after adjustment, we found that BMI was associated with total energy intake and not with the consumption of fructose. Since in studies that have found this association the level of fructose consumption was more than 50 grams per day but in this study, this level was lower than this limit ( from 20.6 to 45.4 g / day) , we suggest that negative effects of fructose on body weight may appear only at higher dose. Randomized clinical trials and prospective cohort studies using different levels of consumption with long term follow up could be useful. Key words: Fructose, High Fructose Corn Syrup (HFCS), Obesity, and Overweight

Objectives: To investigate the vegetable and fruit, “other” foods, fibre, folate, vitamin A, and vitamin C intakes of First Nations children and adolescents residing in seven communities in northern and southern Ontario, including variations by year and community, and comparisons to current dietary standards and national averages based on age and sex. Also, to implement and assess the impact of two school nutrition programs (in Kashechewan and Fort Albany, Ontario) on dietary intakes of vegetable and fruit, “other” foods, fibre, folate, vitamin A, and vitamin C. Also, to evaluate the two school nutrition programs, one a simple food provision program in Kashechewan, Ontario and the other a more comprehensive school nutrition program in Fort Albany, Ontario, in terms of student and teacher impressions and program integrity. For the program in Fort Albany, the impact of the program on nutrition knowledge, self-efficacy, and intentions to eat more vegetables and fruit will also be assessed. Finally, to investigate the association between Body Mass Index (BMI) and vegetable and fruit and fibre intake in First Nations children and adolescents living on reserve in Ontario. Methods: Dietary intakes were evaluated using 24-hour dietary recall data collected via the validated Web-Based Eating Behaviour Questionnaire (WEB-Q) between 2003 and 2010 in seven First Nations communities in northern (Attawapiskat, Fort Albany, Kashechewan, Moose Factory, and Peawanuck) and southern (Christian Island and Georgina Island) Ontario. Vegetable and fruit, “other” foods, fibre, folate, vitamin A, and vitamin C intakes were compared to current dietary standards and Canadian Community Health Survey Cycle 2.2 (CCHS). Yearly and community differences in intakes were assessed using specific dataset pairs to control for season, year, and community, where conditions were comparable. The association between vegetable and fruit and fibre intake and BMI was investigated using the weight classifications described by Cole and colleagues (2000) and based on selfreported heights and weights. The impact of a simple food provision program in Kashechewan First Nation was examined in terms of vegetable and fruit, “other” foods, fibre, folate, vitamin A, and vitamin C intakes pre-, oneweek post, and one-year post program using the WEB-Q. Finally, the impact of a comprehensive school vegetable and fruit education program was evaluated in terms of vegetable and fruit, “other” foods, fibre, folate, vitamin A, and vitamin C intakes, nutrition knowledge and preferences, and intentions and self-efficacy to eat more vegetables and fruit pre- and post-program using validated questionnaires. Within each program, parent/guardian, student, and teacher impressions of the program were evaluated via questionnaires and focus groups. iv Results: The majority of participants (n=443 students from seven communities) had intakes of vegetables and fruit and relevant nutrients below current standards, with the exception of vitamin C. Mean intakes of vegetables and fruit fell below Canadian Community Health Survey averages. Mean intakes of “other” foods exceeded vegetable and fruit intakes in all age and sex groups in terms of servings. There was no significant association between vegetable and fruit or fibre intake and BMI. In certain instances, significant variation in intakes existed between different years and communities. Under ideal conditions (short-term, investigator-run portion of the program), the school food provision program in Kashechewan First Nation produced improvements in vegetable and fruit intakes (n.s.). Long-term intakes did not improve. Teacher and principal impressions of the program were overwhelmingly positive. In the short term, the vegetable and fruit, relevant nutrient, and “other” foods intakes of students in Fort Albany did not significantly change following a comprehensive school nutrition education program, and neither did intentions or self-efficacy to eat more vegetables and fruit. However, the program resulted in significantly improved nutrition knowledge, as well as significant improvements in the number of vegetables and fruit that participants had been exposed to and liked. The majority of parents, teachers, and students had positive impressions of the program. Conclusions: Overall, the dietary intakes of the study participants were characterized by poor intakes of vegetables and fruit and intakes of “other” foods that exceeded vegetable and fruit intakes in all age and sex groups. Rates of overweight and obesity were higher than those reported in the CCHS. With adequate resources and support, school nutrition programs have the potential to improve the vegetable and fruit intakes of children and adolescents living in the communities involved in this research. However, it is probable that the numerous barriers to healthy eating identified in the communities examined blunted the positive effects of the program piloted in this study. Future initiatives should include community-based approaches to improve accessibility of affordable, healthy foods of reasonable quality. In conjunction with school nutrition programs, such programs may have the ability to positively impact the dietary intakes of children and adolescents living on reserve in Ontario.

Aboriginal Head Start Urban and Northern Communities (AHSUNC) Initiative in Ontario provides an early childhood development program specifically for urban Aboriginal children between 3 and 5 years old. Twenty-nine families from Waabinong Head Start in Sault Ste Marie, Ontario, completed two questionnaires given four months apart covering a range of health and education topics. The completed surveys supported a trend toward healthier lifestyle choices, improved education of the children, upward mobility in employment, increases in self-perceived general and mental health of primary and second caregivers, and decreases in smoking, illegal drug use, and alcohol use. Families reported an increased sense of pride in being Aboriginal shown by their children, plus learning of culture and Ojibwe language, which has lead to improvement in all of the child’s skills and abilities.

Globally, the prevalence of Type 2 diabetes is rising. The most affected populations are those that have undergone recent and rapid transition towards a Western lifestyle, characterised by energy-dense diets and physical inactivity. Two major hypotheses have attempted to explain the variation in diabetes prevalence, both between and within populations, beyond the contributions made by adult lifestyle. The thrifty genotype hypothesis proposes that some populations are genetically well adapted to surviving in a subsistence environment, and are predisposed to develop diabetes when the dietary environment changes to one that is fat and carbohydrate rich. The programming hypothesis focuses on the developmental environment, particularly on prenatal and early postnatal conditions: nutritional deprivation in utero and early postnatal life, measured by low birthweight and disrupted child growth, is proposed to alter metabolism permanently so that risk of diabetes is increased with subsequent exposure to an energy-dense diet. Both hypotheses emphasise discord between adaptation (genetic or developmental) and current environment, and both now put forward insulin resistance as a likely mechanism for predisposition.¶ Diabetes contributes significantly to morbidity and mortality among Australia’s Indigenous population. Indigenous babies are more likely to be low birthweight, and typical patterns of child growth include periods of faltering and rapid catch-up. Although there have been numerous studies in other populations, the programming hypothesis has not previously been tested in an Australian Indigenous community. The framework of the programming hypothesis is thus expanded to consider exposure of whole populations to adverse prenatal and postnatal environments, and the influence this may have on diabetes prevalence.¶ The present study took place in Cherbourg, a large Aboriginal community in southeast Queensland with a high prevalence of diabetes. Study participants were adults with diagnosed diabetes and a random sample of adults who had never been diagnosed with diabetes. Data were collected on five current risk factors for diabetes (general and central obesity, blood pressure, age and family history), in addition to fasting blood glucose levels. A lifestyle survey was also conducted. Participants’ medical records detailing weight growth from birth to five years were analysed with regard to adult diabetes risk to determine whether childhood weight and rate of weight gain were associated with subsequent diabetes. Adult lifestyle factors were also explored to determine whether variation in nutrition and physical activity was related to level of diabetes risk. ...

Contexte: L'utilisation de suppléments alimentaires est répandue chez les populations américaines et canadiennes en général, mais on en sait peu sur la consommation de suppléments alimentaires dans la population autochtone canadienne. Objectif: L'objectif général de cette étude est de prendre en compte l'utilisation de suppléments alimentaires dans l'évaluation nutritionnelle des apports alimentaires des adultes des Premières nations vivant dans les réserves en Colombie-Britannique et Manitoba. Conception: Les données ont été recueillies par l’étude ‘First Nations Food, Nutrition, and Environment Study’ de 1103 (Colombie-Britannique) et 706 (Manitoba) adultes des Premières Nations âgés de 19 à 70 ans. L'étude a utilisé un rappel alimentaire des dernières 24 heures (avec un deuxième rappel pour un sous-échantillon) pour évaluer la diète alimentaire. L'utilisation de suppléments alimentaires et des antiacides ont été recueillis par un questionnaire de fréquence. En utilisant le logiciel SIDE pour tenir compte des variations intra-individuelles dans la prise alimentaire et la technique du bootstrap pour obtenir des estimations représentatives des différentes régions, l'utilisation de suppléments de la vitamine A, D, C et de calcium ont été intégrées aux estimations de la consommation alimentaire. Résultats: Environ 30% des adultes des Premières Nations de la Colombie-Britannique et seulement 13,2% des adultes des Premières Nations du Manitoba âgés entre 19-70 ans vivant dans les réserves ont déclaré utiliser au moins un supplément alimentaire durant les 30 jours précédents. Lors de l'examen des nutriments d'intérêt, un plus faible pourcentage de la population en a fait usage, de 14,8 à 18,5% en Colombie-Britannique et de 4,9 à 8% de la population du Manitoba. La prévalence de l'usage de tout supplément alimentaire était plus élevée chez les femmes que chez les hommes dans tous les groupes d'âge et augmente avec l'âge dans les deux sexes. La plus forte prévalence d'un apport insuffisant provenant de la nourriture a été observée pour la vitamine D et le calcium en Colombie-Britannique et Manitoba, variant de 75 à 100%, et de la vitamine A dans le Manitoba (73-96%). Après avoir examiné l'utilisation de suppléments alimentaires, plus des trois quarts des participants n’ont toujours pas réussi à répondre au besoin moyen estimatif pour ces nutriments. La vitamine C est l'oligo-élément avec le plus faible pourcentage sous le besoin moyen estimatif (avec au sans suppléments) pour la Colombie-Britannique et le Manitoba. Conclusion: La majorité des adultes des Premières nations de la Colombie-Britannique et du Manitoba, même après prise en compte de l'utilisation de suppléments alimentaires, avaient des apports en vitamines A, D et des apports de calcium sous les niveaux recommandés. L'utilisation de compléments alimentaires n'a pas contribué de façon significative à l'apport total en nutriments sélectionnés sauf pour la vitamine C dans certains groupes d'âge.
Background: The use of dietary supplements is prevalent among general US and Canadian populations; however, little is known about consumption of nutritional supplements among the Canadian Aboriginal population. Objective: The overall goal of this study was to integrate supplement use into dietary intake for the assessment of nutritional adequacy in British Columbia and Manitoba First Nation adults living on reserve. Design: Data were collected by the First Nations Food, Nutrition, and Environment Study from 1103 BC and 706 MA First Nation adults aged 19-70 years old. The study used 24-hour food recalls (with a second recall in a subsample) to assess diet. Dietary supplement and antacid use were collected by a frequency questionnaire. Using SIDE software to account for intra-individual variation in food intake and bootstrap weights to obtain regionally representative estimates, vitamin A, D, C, and calcium supplement use were incorporated to food intake estimates. Results: About 30% of British Columbia and only 13.2% of Manitoba First Nation people aged 19-70 y living on reserve reported use of at least one dietary supplement within the prior 30 days. When considering the nutrients of interest, a smaller percentage of the populations took them varying from nutrient to nutrient from 14.8 to 18.5% in British Columbia and from 4.9 to 8% in Manitoba population. The prevalence of use of any dietary supplement was higher among women than men in all age groups and increased with age in both genders. The highest prevalence of inadequate intakes from food alone was observed for vitamin D and calcium in both British Columbia and Manitoba varying from 75 to 100%, and for vitamin A in Manitoba (73-96%). After considering the use of dietary supplements, more than three fourth of participants still failed to meet the EAR for these nutrients. Vitamin C was the micronutrient with the lowest percentage of BC and Manitoba participants bellow the EAR with or without supplements consumption.

Research Doctorate - Doctor of Philosophy (PhD)
Wide disparities in health between Aboriginal and Torres Strait Islander and non-Indigenous Australians persist, with chronic diseases responsible for much of this gap. Type 2 diabetes is one of the key chronic diseases suffered by Aboriginal and Torres Strait Islander peoples, at a rate of at least 3.4 times that of non-Indigenous Australians. It is also a growing health problem for the non-Indigenous population and is associated with the increasing rates of obesity seen internationally over the past 10 to 20 years. Poor food habits and physical inactivity are the modifiable lifestyle risk factors for both type 2 diabetes and obesity. Little, however, little is known about these in Australian Aboriginal and Torres Strait Islander children or in rural children from disadvantaged areas in general. It is recognised that these risk factors track from childhood into adulthood, and that childhood offers an important opportunity to implement appropriate preventative health strategies. Appropriate programs to address poor food habits and physical inactivity cannot be developed without a thorough understanding of the risk factors pertinent to each population group. A search of the literature (Chapter 1) reveals that such information is very limited for Australian rural Aboriginal and Torres Strait Islander children and to a somewhat lesser extent for rural children in general, with evidence still very limited and little intervention research reported. Monitoring and evaluation of interventions to address risk factors require the use of validated population-level measurement tools. Currently, there are no such tools available for measuring Aboriginal and Torres Strait Islander children’s dietary intake and only one for measuring their physical activity. This severely compromises the capacity of health professionals to monitor this population’s health and to rigorously evaluate the effect of health strategies. There are urgent calls for research to evaluate the effect of interventions conducted in Aboriginal and Torres Strait Islander communities, with little evidence currently available in any field of health. In response to the issues raised above, the series of studies which constitute this thesis explores the physical activity characteristics and the food and nutrient intake of rural Aboriginal and Torres Strait Islander and non-Indigenous primary school-aged children (Chapters 3 and 5). The studies also validate a 7-day self-report physical activity recall questionnaire and a short food frequency questionnaire with the same populations (Chapters 2 and 4). Aboriginal and Torres Strait Islander children were found to provide self-report data regarding both physical activity and food intake that were at least as valid as those for non-Indigenous children, provided they received appropriate cultural support (detailed in the methods section of the relevant chapters). These results indicate that the measurement tools validated in this series of studies can be used with either group. All children were found to more than meet Australian guidelines for daily physical activity levels, with Aboriginal and Torres Strait Islander children demonstrating a tendency for higher activity than their non-Indigenous counterparts. All children who participated in this series of studies were found to possess excessive intakes of energy-dense nutrient-poor (EDNP) foods, with Aboriginal and Torres Strait Islander children demonstrating clinically important higher intakes than non-Indigenous children. Macro-nutrient and sodium intakes of Aboriginal and Torres Strait Islander children were significantly higher than those of their non-Indigenous counterparts. Finally, in response to findings of the studies, further research and intervention strategies are suggested in the conclusions (Chapter 6). A description of the community-controlled governance structure that guided and supported this program of research is provided.

Thesis (M. Sc. (Dietectics)) -- University of Limpopo, 2017
Introduction: Bodybuilders around Polokwane municipality are adhering to different dietary practices some of which are not evidence based. These practices may predispose these athletes to negative health outcomes sooner or later in life. The aim of this study was to investigate the anthropometric status and dietary intake of bodybuilders around Polokwane Municipality. Methodology: This was a descriptive analytical study where purposive sampling method was used to obtain 51 out of 65 registered bodybuilders within the training gyms around Polokwane. Weight and Height were measured to determine BMI. Four skinfold sites (triceps, biceps, subscapular and suprailliac) were measured using caliper and non-stretchable tape to estimate total body fat percentage. Dietary information was collected using the 24 hour-recall collected for three different days which was validated by the Food Frequency Questionnaire. Results: of the 51 body builders, 94.1% were men and 5.8% women. Few athletes (15.7%) were using ergogenic agents such as powders (13.7%) and tablets (2%). Also, 64.7% of the athletes had normal body weight while 33.3% and 2.0% were overweight and obese respectively. Majority of the athletes (78.4%) had an acceptable body fat percentage. Dietary results showed that majority of the athletes consumed energy (98%) and carbohydrates (100%) below the ISSN bodybuilding recommendations. Conclusion: The dietary intake of the bodybuilding athletes around Polokwane municipality is below the ISSN (2010) bodybuilding recommendations; however, their anthropometric status and body composition is normal.

Aboriginal and Torres Strait Islander (hereafter ‘Indigenous’) cultures are among the longest-surviving in the world. There is a significant gap between the health of Indigenous and non-Indigenous Australians, stemming from Australia's history of colonisation. High Body Mass Index (BMI) is a leading contributor to this health gap; Indigenous Australians aged 15 years and over are 20% more likely to be overweight and 60% more likely to be obese than non-Indigenous Australians. Limited cross-sectional data indicate an elevated prevalence of overweight and obesity among Indigenous, versus non-Indigenous, Australian children. Despite the high burden, there is no evidence specific to Indigenous Australians on trajectories of BMI across childhood, or on the relation of key factors to the development of overweight and obesity. This thesis provides the first evidence on BMI trajectories and associated factors in Indigenous Australian children, using data from up to 1,759 children aged 0-10 years participating in the national Longitudinal Study of Indigenous Children. The majority of children were in the normal BMI range across waves of the study; the prevalence of overweight/obesity increased from 12.1% to 41.9% of children aged around 3 and 9 years, respectively. There was a rapid onset of overweight/obesity in the sample: 31.9% of children who had a normal BMI at age 3-6 years had become overweight or obese three years later. Children born large-for-gestational age (versus appropriate-for-gestational age) and exposed to smoke in utero (versus not exposed) had significantly higher BMI at age 3-8 years. Female (versus male) and Torres Strait Islander (versus Aboriginal) children increased in BMI at a faster rate. We observed cross-sectional and longitudinal evidence of lower childhood BMI in disadvantaged areas. Findings were consistent with a protective effect of healthier diets (low consumption of sugar-sweetened beverages and high-fat foods) on children’s BMI trajectories. This thesis provides the first detailed analysis of the relationship between diet – a key risk factor for high BMI – and sociocultural and environmental factors in the Indigenous Australian context. Financial security, high parental education, quality housing, and community cohesion were associated with improved child nutrition (reduced odds of consuming soft drink; reduced likelihood of facing barriers to accessing fruit and vegetables). This work confirms the pervasiveness of issues surrounding food availability, quality, and affordability in remote/outer regional settings, and identifies that disadvantaged Indigenous families in urban/inner regional settings also face these barriers to a healthy diet. Efforts are critically required to reduce the prevalence of overweight and obesity among Indigenous Australian children in the first 3 years of life, and to slow the rapid onset of overweight/obesity from age 3-9 years. Improving maternal risk profiles during pregnancy and improving nutrition in the first decade of life are likely to promote healthy BMI trajectories. However, improving nutrition will require both addressing the underlying determinants of nutrition and improving the food environment in urban, regional, and remote settings. Throughout the course of this project, I have identified, developed, and applied methods for conducting meaningful large-scale Indigenous health research, and have demonstrated their suitability for broader adoption.

Les taux d’insécurité alimentaire (IA) chez les Premières Nations au Canada sont plus élevés que chez les Canadiens de la population générale. L’IA est généralement associée à des apports nutritionnels moins avantageux, toutefois peu d’études se sont penchées sur cette question pour les Premières Nations vivant sur-réserve. Le but de cette recherche est de déterminer, à partir de 550 observations, s’il existe une association entre le niveau de sécurité alimentaire et les apports nutritionnels chez des adultes (> 18 ans) des Premières Nations sur-réserve du Manitoba et d’identifier les types d’aliments qui pourraient expliquer les différences statistiquement significatives. Chez les hommes, aucune des différences statistiquement significatives entre les niveaux de sécurité alimentaire pourraient avoir un effet notable sur la santé nutritionnelle puisque les nutriments en question ne sont pas « à risque » dans la population. Chez les femmes, les apports sont significativement différents entre les niveaux de sécurité alimentaire pour quelques nutriments qui sont « à risque » dans la population. Pour les femmes de 19-30 ans en IA, les apports sont supérieurs en vitamine A, en folate et en calcium. En contraste, les apports sont inférieurs en vitamines A et B6 et en potassium pour les femmes de 31-50 ans en IA, et inférieurs en vitamine B6 pour les femmes de 51-70 ans en IA. Lorsque les apports sont ajustés pour les apports énergétiques, les différences demeurent seulement statistiquement significatives pour la vitamine B6 chez les femmes de 31-50 ans et 51-70 ans. Les groupes d’aliments potentiellement responsables des différences sont identifiés. En conclusion, chez les Premières Nations du Manitoba, peu d’associations statistiquement significatives ont été identifiées entre le niveau de sécurité alimentaire et les apports en nutriments considérés « à risque » dans la population. Ceci est particulièrement le cas après ajustement pour la multiplicité des tests statistiques effectués.
Food insecurity (FI) rates in First Nations of Canada are much higher as compared to Canada’s general population. FI is generally related to lower quality diets, however, few studies have evaluated this in First Nations on-reserve. The goal of this study was to identify, using data from 550 individuals, whether nutrient intakes were related to food security status in Manitoba First Nation adults (>18 years old) on-reserve. Furthermore, the types of foods that could be responsible for the statistically significant differences were identified. In men, none of the significant differences between food security levels could have had an effect on either group’s nutritional health given that these nutrients are not considered « at risk » in the population. As for women, intakes were significantly different between food security groups for a few nutrients at risk in the population. For women 19 to 30 years of age, intakes of vitamin A, folate and calcium were significantly higher in those with FI status. On the other hand, intakes of vitamins A and B6 and potassium were significantly lower in FI 31-50 year old women, and intakes of vitamin B6 were lower in FI 51-70 year old women. Only intakes of vitamin B6 in 31-50 and 51-70 year old women remained significant in the analysis where nutrient intakes are adjusted for energy intakes. Foods that are potentially responsible for these significant differences were identified. In conclusion, few nutrients at risk were significantly associated with food security status in Manitoba First Nations. This is particularly true if statistics are adjusted for the multiple comparisons problem (Bonferroni correction).