The aim of this study was to describe the dietary patterns of Inuvialuit women of childbearing age who smoke compared with those who do not smoke. The results show that, overall, Inuvialuit women of childbearing age had a high prevalence of smoking, and most importantly, for all women regardless of smoking status, diets were characterized by high energy intake and inadequate micronutrient intake. There were no significant differences in energy and nutrient intakes and nutrient density for most nutrients between smokers and non-smokers.
Aboriginal populations are the fastest growing populations in Canada. Inuvialuit are Indigenous to the NWT and represent a young population with an average age of 22 years compared to 40 years for the rest of the non-Aboriginal Canadian population . The high prevalence of smoking in this population is in line with that reported recently by Statistics Canada . The prevalence rate of smoking was reported as 61% which is three times that for the rest of Canada (17%). It is widely accepted that smoking impacts on diet through altering of dietary patterns and impacts the absorption of certain micronutrients [14, 18]. As such, smokers are assumed to have poorer diets than non-smokers. In this group, there were no significant differences in dietary adequacy between smokers and non-smokers. However, it is well established that smokers compared with non-smokers require a greater intake of nutrients compared with non-smokers. For example, people who smoke may need as much as 140 mg/day of vitamin C compared with 60 mg/day for non-smokers . Thus women who smoke in this population are likely to face greater effects of dietary inadequacy than non-smokers.
Living in isolated communities in Northern Canada with limited resources, large geographic distances, varying language groups, and differing cultural beliefs and traditions all contribute to the complexity of providing adequate access to healthcare and affordable and nutritious foods [31, 32]. The high prevalence of smoking and dietary inadequacy has been reported in other Indigenous populations of women of childbearing age. In rural communities in North Queensland, Aboriginal and Torres Strait Islander women had a high prevalence of obesity, poor dietary adequacy, and alcohol and tobacco use, which increased the rates of poor maternal health outcomes . Traditionally, the Inuvialuit diet contained abundant sources of nutrient rich foods which contributed considerably to micronutrient status. The current nutrition transition occurring in this population is creating a shift from traditional foods to greater consumption of non-nutrient-dense store bought foods, which is occurring rapidly among Indigenous Canadians in Arctic communities [34–36]. This diet transition is associated with high energy intake and low intake of key micronutrients [25, 37]. Indeed this explains the excessive energy intake among Inuvialuit women of childbearing age shown in this study. This pattern of dietary inadequacy has been previously reported for Inuvialuit in Arctic Canada [38, 39].
The diets of all women were low in micronutrients and in particular vitamins D, E and potassium. For women of childbearing age the effect of poor nutrition follows both infant and mother for decades, and in particular induces fetal programming for increased risk of chronic diseases in later life for the infant . Poor maternal nutritional status affects infant birth weight, increases risk of neural tube defects and causes cognitive delays and learning difficulties . The teratogenic effects of cigarette smoking are well established [2, 6, 42] and include preterm birth, small-for-gestational-age, stillbirth, neonatal/post-neonatal death and cognitive and learning difficulties. It is also known that Aboriginal women experience a higher rate of these poor pregnancy outcomes compared with their non-Aboriginal counterparts [4, 5, 7]. In this population of women of childbearing age, the combined effect of high smoking prevalence and dietary inadequacy has major implications for future healthcare delivery in this population.
Dietary and lifestyle information on this unique population is limited and this study provides valuable information on diet and smoking behavior. However, this study is not without its limitations. Dietary information collected from the QFFQ may include over-reporting. However, the QFFQ was developed and validated specifically for this population and our previous results showed that when nutrient intakes were categorized into quartiles, the QFFQ and 24-h recalls indicated relative agreement for 77% for energy and macronutrients, 86% for total sugar and 72% for micronutrients . Inuvialuit are a relatively small population and because of the high prevalence of smoking it was difficult to include a sizable group of non-smokers. Dietary adequacy among smokers and non-smokers could have been better analyzed by stratification of smokers according to number of cigarettes smoked. In addition, past smoking behavior was not accounted for.