The present study provides up-to-date information on portion sizes of traditional and non-traditional foods and beverages as consumed by Inuit adults in three remote communities in Nunavut in the Canadian Arctic. Caribou, muktuk and Arctic char were the most widely consumed traditional foods. However, sugar-sweetened beverages and energy-dense, nutrient-poor foods (e.g. potato chips, pilot biscuits, cakes, chocolate, cookies and crackers) were widely consumed also. A number of factors may have contributed to the decline in traditional food consumption that has been reported among Arctic indigenous peoples in recent years; these include lack of time for hunting due to increased involvement in the wage economy, high cost of hunting equipment, ammunition and fuel, a decline in communal food sharing networks, concerns about food supply contamination by organochlorines and heavy metals, and reduced animal populations and changing migration patterns due to climate change [7, 8, 58].
The present study also revealed that apart from apple, banana, oranges and grapes, which were consumed by roughly three-quarters of participants, fruit and vegetable consumption by Inuit participants in these 3 communities was generally low. The landscape in this region is tundra and is covered in snow for most of the year; hence there is an almost total reliance on fruits and vegetables that are grown elsewhere and transported to the communities primarily by air freight . Mean daily temperatures are below 0°C for approximately nine months of the year and below −30°C for about four months of the year . Transportation and preservation of fresh fruits and vegetables under these conditions is difficult and costly; thus, the produce that is available in the stores is often of poor quality and prohibitively expensive [7, 8]. Basic nutrition education and healthy dietary skills may also be a barrier to fruit and vegetable consumption in these communities [7, 19].
Sweetened beverages were consumed by over three-quarters of participants in the present study and the average portion sizes were large. Juices consumed by this population are mainly high sugar beverages such as Kool-Aid™ (Kraft Foods Inc., Northfield, IL, USA) or Tang™ (Kraft Foods Inc., Northfield, IL, USA) . The average portion size for sweetened juices with added sugar was 572 g, which in terms of caloric intake would provide some 879–1130 kJ (210–270 kcal) . Similarly, the average portion size for regular pop was 663 g (equivalent to about two standard 330 ml cans), which would provide about 1151–1339 kJ (275–320 kcal) . By comparison, in the United States, the average portion size of sweetened beverages consumed per eating occasion increased from 386 g to 595 g between 1977 and 1996 . Energy from caloric beverages is poorly regulated and therefore can add excess calories to daily energy intake [47, 62]. Sugar-sweetened beverage intake is a significant contributor to weight gain and can lead to increased risk of type 2 diabetes mellitus and cardiovascular disease . Recently, the American Heart Association issued a scientific statement recommending that in order to achieve and maintain healthy weights and decrease cardiovascular risk while at the same time meeting essential nutrient needs, most American women should eat or drink no more than 100 calories per day from added sugars, and most American men should eat or drink no more than 150 calories per day from added sugars . This suggests that Inuit consumers in these communities would need to reduce portion sizes of sugar-sweetened beverages by a very considerable margin and to replace them with water, tea or coffee (provided that caloric sweeteners and whiteners are used sparingly) or with diet- or sugar-free varieties of the same products.
In the present study, potato chips were consumed by over four-fifths of participants, with an average portion size of 59 g; this would provide roughly 1151–1381 kJ (275–330 kcal), depending on brand . Likewise, chocolate was consumed by almost 60% of participants, and the energy provided by an average portion (59 g) would be around 1046–1339 kJ (250–320 kcal), depending on brand . Cakes and muffins were consumed by some 60% of participants and the average portion size was 106 g. In terms of energy content, commercial muffins provide approximately 1159–1360 kJ (277–325 kcal)/100 g, while commercial cake varieties (e.g. fruit cake, sponge cake, chocolate cake, coffee cake, white cake) provide some 1205–1736 kJ (288–415 kcal)/100 g . Certain other types of refined grain products (e.g. spaghetti, macaroni and noodles) also contributed substantial amounts of energy to consumers in this population due to the large portion sizes consumed. On the other hand, the popularity of soups among participants could be exploited because soups have a high satiety value and elicit strong dietary compensation ; eating a low energy-dense soup as a pre-load before a test meal resulted in a 20% reduction in total energy intake at the meal with no significant effect on hunger or satiety ratings . Thus, the present study has highlighted a number of different types of foods and beverages that could be targeted in future nutritional intervention programs aimed at obesity and diet-related chronic disease prevention in these and other Inuit communities.
Due to its geographic remoteness, the cost of treating chronic disease in Nunavut is extremely high as a result of the necessity to transport patients to southern cities for medical assessment and treatment . This situation will get markedly worse if, as is predicted, the global obesity epidemic that is currently happening is followed by an epidemic of type 2 diabetes and other cardiovascular disease risk factors [66, 67]. Recently, the American Heart Association endorsed the concept of ‘primordial prevention’ for cardiovascular disease prevention . This approach is based on evidence from the Framingham Heart Study cohort showing that compared with individuals with ≥2 major risk factors, those individuals who had maintained a profile of ideal cardiovascular risk factor levels from young adulthood into middle age had greatly reduced lifetime CVD and non-CVD mortality rates, thereby resulting in an additional 10 years’ longevity . Capewell et al.  demonstrated that if the majority of the US population reached middle age with this ideal phenotype, more than 90% of expected coronary heart disease deaths might be prevented. However, it was also argued that to bring about such a change would require an environment that supports health, rather than, as now, promoting obesity, hypertension, diabetes and inactivity . For Nunavut, the implication of these findings is that investment in programs and public health policies that prevent the development of adverse CVD risk factors in its young population could be expected to yield substantial returns in the long term in the form of greatly reduced medical costs and increased longevity and quality of life for its citizens. On the other hand, failure to do so would place its health care system under an increasingly unsustainable burden as its young population ages.
The results of the present study were obtained as part of Healthy Foods North (HFN), a community-based, culturally-appropriate, multi-institutional chronic disease prevention program that has worked at the individual, household, community and institutional level to improve diet and increase physical activity among Inuit in Nunavut [8, 55]. These data will be useful in developing other nutritional intervention programs designed to reduce dietary risk factors for obesity and chronic diseases in Inuit populations.
A major strength of the present study is the fact that the QFFQ was developed specifically for this Inuit population and thus contains the complete list of foods commonly consumed by them. Also, portion sizes were assessed using three dimensional food models and household units that were chosen with the input of local Inuit residents. The study does, however, have some limitations. Firstly, men were not as well represented as women since the intention was to target the family member who was primarily responsible for purchasing and preparing foods. Therefore, our ability to generalize these results to Inuit men is limited. Secondly, there may have been recall biases among the participants when they reported foods and beverages consumed in the last 30 days. Thirdly, the study only captured summer and autumn consumption and, consequently, did not account for seasonal variability, especially during the winter months. Finally, it should not be assumed that data collected in these three specific communities can be generalized to all Inuit populations.