Nutrition intervention programs may be beneficial for Inuit and Inuvialuit populations, which have an estimated threefold higher prevalence of heart disease compared to the Canadian national average [19, 36] and increased risk factors for diabetes, obesity, and hypertension . It is well established that decreasing animal fats, including high-fat dairy products and partially hydrogenated fats, aids in the reduction and prevention of obesity and its related comorbidities [38, 39]. Evidence also strongly supports an inverse relationship between the consumption of fruit and vegetables and risk of several cancers, heart disease, and overall mortality . This may be due to the naturally occurring essential nutrients (e.g. antioxidants, fiber, and folic acid) within fruit and vegetables [38, 41]. Thus, the year-long pilot HFN intervention was designed in part to reduce reliance on high fat, high sugar, non-nutrient-dense foods and beverages and unhealthy preparation methods that added fat, and to increase utilization of healthier cooking methods, in an attempt to reduce chronic disease risk. The results of the intervention were successful in reducing the consumption of de-promoted foods and in the utilization of unhealthy cooking. There was a significant increase in the use of healthy preparation methods within 12 months. The pre-intervention evaluation of this population indicated that pan-frying with fat was one of the most frequently reported methods of preparation [18, 19]. Post-intervention results from the intervention communities indicated a decrease in the use of this method and a concurrent increase in the use of pan-frying methods that did not add fat, thereby reducing added fat consumption in the population under intervention. Several epidemiological studies suggest that the consumption of fried, boiled or roasted red meat is associated with the development of cancer; it has been proposed that heterocyclic aromatic amines, potent mutagens present at ng/kg levels in cooked foods play an important role in the aetiology of human cancer [42, 43]. Therefore, avoiding high-temperature cooking methods may lower the risk of cancer.
Compared to the control group, the intervention group had a greater reduction in intake of de-promoted high-fat meats, high-fat dairy, refined grain products, and unhealthy drinks, all of which are commonly consumed food groups in this population [11, 12, 27, 29]. Baseline studies determined that sweetened juices/drinks made the largest contribution to energy, carbohydrate, and sugar in NU and the first and second largest contribution in the NWT. Regular soft drinks and white bread were also top contributors to energy, carbohydrate, and sugar for both populations. Furthermore, butter, margarine, lard, and high-fat meats, including sausages and lunchmeats, were the top contributors to fat [16, 17, 27, 29]. The reduced consumption of de-promoted food groups (particularly refined grains, unhealthy drinks, high-fat dairy products and high-fat meats) in the intervention group compared to control could explain the decreases in energy intake (average of 317 kcal/day), protein intake (21 g/day), carbohydrate intake (37 g/day), and overall Body Mass Index (BMI) (p = 0.002) . Improved intake of vitamin A and D were also observed. These nutrients are naturally abundant in the traditional foods consumed by Arctic Indigenous populations [10, 13, 45]. Therefore, it may be inferred that dietary adequacy improved, in part, as a result of the observed significant increase in traditional food intake (from 1.4 to 1.7 times/day within the intervention group).
To our knowledge, there have been no studies on the impact of interventions within Inuit/Inuvialuit populations; therefore, the effectiveness of HFN’s community-based program must be compared with interventions targeting other Indigenous and/or remote populations. A recent review on the community-based interventions in prepared-food sources found some promising results however the outcome measures were limited . Many of the interventions included in this review were not formal studies but rather certification or campaign programs operated by local health departments. Therefore, the voluntary nature of the programs may explain why they varied in levels of reach. Similar to the present study, a store-based intervention targeting Native American adults living on Arizona reservations saw no change in the consumption of high-sugar, high-fat snacks and fast food. They found that the consumption of the comparison group increased significantly for less healthy foods over the year of the intervention program, which may indicate that in general, people are eating less healthy. It is possible that the program helped keep the intervention group’s diets from getting unhealthier .
A family-based intervention conducted with the Six Nations Reserve in Ohsweken, Ontario made similar observations . They reported a decrease in intake of fatty foods, oils, and sodas paralleling HFN’s decrease in high-fat meat consumption, unhealthy drinks, and unhealthy cooking methods. However, some interventions among Indigenous populations outside of North America have shown promising results. Promotion of local foods and a traditional diet have resulted in increased intake of local accessible foods as well as increased nutrient intake in Indigenous populations in Micronesia , the Dalit in India , and Australia .
HFN was a community-based and community-driven intervention project. Community interventions have much greater potential to reduce weight and related health risks than individual weight loss programs [48, 51]. There is greater possibility for sustainability if the programs partner with community-based institutions such as schools and stores . However, it is important to consider the remoteness of these Arctic populations and the economic and environmental barriers that limit the feasibility of an active lifestyle and access to fresh nutritious foods. Future program development should focus on mitigating these barriers by improving the accessibility and affordability of healthy foods (e.g. fruit and vegetables and low-fat, low-sugar store bought items); furthermore, traditional foods high in protein, iron, and vitamins should be promoted [10, 16, 17, 53]. Marine omega-3 fatty acids, contained in Arctic char and other fish and marine mammals, have proven protective effects against coronary heart disease in several diverse populations . Continued efforts to revitalize traditional food systems, such as hunting, gathering, and food-sharing, are equally important as they have a multitude of health and well-being benefits. Ongoing trials with longer intervention periods and larger sample populations are needed to monitor HFN’s impact on chronic disease risk.
Strengths and limitations
The sample was predominantly female (80-82%) because the study targeted the primary food shoppers and preparers. Bias may also have been introduced by the lower response rates that were observed for some communities. Given the potential for variation in access to store bought and traditional foods throughout the year, differences in the time of year for collection of baseline and follow up data, particularly for the NWT communities, may also have led to bias. In addition, limited data were available for potential confounders. However, baseline dietary differences between control and intervention groups were unchanged when stratified analyses were examined for age and income support (variables that were differentially distributed among the control and intervention groups). It is unlikely that the control groups were exposed to the intervention content that was disseminated via television and radio, as access to media between communities is limited in this remote region. Therefore, results may not be generalizable to male Inuit and Inuvialuit populations. Recall bias, which may occur with QFFQs, is another potential limitation . However, validation studies of the QFFQs used in this study confirmed relative agreement with multiple 24-hour recalls in this population [33, 34].
This study provides the first data on the impact of a multi-institutional, community-based nutrition intervention program among Inuit in NU and Inuvialuit in the NWT. These data will contribute not only to the limited literature, but may also contribute to government policy decision-making related to Inuit and Inuvialuit nutrition and health. The data collection instruments are current and culturally relevant for this population.