Food Consumption Patterns of Women

1 3 1 J. Lawn , N. Langner, D. Brule , N. Thompson4, P. Lawn , and F. Hill5

1 Dialogos Educational Consultants, Quebec, Canada 2 NRL Research, Nepean, Ontario, Canada 3 Nutrition Surveys Section, Nutrition Research Division, Health Canada, Ottawa, Ontario., Canada 4 Ottawa, Ontario, Canada 5 Northern Affairs Program, Department of Indian Affairs and Northern Development, Ottawa, Ontario, Canada

Abstrac.: To evaluate nutrient intake and food consumption patterns of Inuit women of child-bearing age, a 24-hour diet recall and general health and food frequency questionnaire was administered to 688 Inuit women aged 15-44 in six isolated communities. Data were analyzed using the 1991 Canadian Nutrient File. Mean intakes of essential nutrients were expressed as percentages of Health Canada's 1990 Recommended Nutrient Intakes (RNI). Chi-square tests were used to determine relationships be­ tween categorical variables. Folacin intake ranged from 49% to 95% of the RNI in most communities (median= 76%) and was only 37% of the RNI for pregnant and 54% for lactating women. Mean calcium intake for pregnant and lactating women averaged 55% and 47% of the RNI, respectively. Average vitamin A intakes ranged from 26% to 87% of the RNI (median= 65% ), with intake for pregnant Inuit women and lactating women 79% and 54% of the RNI, respectively. Country food was the major source of protein and iron, and store foods the major source of calories, calcium, folacin, and vitamin A. Low intakes of folacin, calcium. and vitamin A, especially among pregnant and lactating women, place Inuit women of childbearing age at risk. Women on social assistance are nutritionally vulnerable. Keywords: Inuit; Canada; Quebec; Pregnancy and lactation; Nutrients; Diet; Women; Surveys

BACKGROUND The present report addresses nutrient intake The continuing shift of the Inuit diet away and food consumption patterns of Inuit women from indigenous foods toward marketed foods of childbearing age in six air stage communi­ has been observed in a number of studies. 1-4 This ties in 1992 and 1993. It is part of a larger study trend has led to nutrient imbalances and created which includes two Indian communities. a growing concern over the long-term health consequences. u.4 In particular, a high consump­ METHODS tion of sweets increases the risk of dental dis­ Repulse Bay, Nain, and agreed ease, and low folate status increases the risk of to participate in nutrition surveys planned for maternal anemia, spontaneous abortions, low 1992 and 1993. However, the full implementa­ 5 7 birthweight, and neural tube defects. · Inad­ tion of rate changes was postponed until July of equate vitamin A may increase the susceptibil­ 1993, and NWT rates were reduced only mar­ ity to respiratory infection. ginally in 1992. The survey was no longer go­ In 1991 all isolated communities became ing to be able to document food-pattern changes eligible for the Northern Air Stage Program. a resulting from changes in transportation rates. federal food air transportation subsidy. A uni­ Therefore, only Pond Inlet repeated the survey, form transportation ratF of $0.80 (Canadian) a and the information base was broadened by in­ kilogram was established for "Nutritious Per­ cluding , , and Arctic ishable Foods." Rate changes were to be gradu­ Bay in 1993. ally phased in on October I, 199 l, and October We decided to survey all Inuit women of l, 1992.8 childbearing age ( 15 to 44 years) in the selected

198 96 Circumpolar Health -----~---- I Table 1. Mean energy and macronutrient inta\...1c: of Inuit \\~>men. I, ·-r Nutrient RN! Repulse Bay i Pond Inlet i .\'ain Intake Mean %RN/ Mean r, RSI I .Hean 'le R.\'J 1992 intake intake I intake

n 62 116 114 Calories 1900 2015.2 106 2147.+ 113 1470.2 1114 % calories % calorie~ ,__ ')(calories Protein (g) 51 I JO.I 22 133.6 25 ]l11.2 "-- Carbohydrates (gl 246.5 49 221.l 41 232.0 47 I Fat (g! 64.7 29 84.6 35 64.I 24 Saturated fats (g I 23.4 \() 26.l \I 211.9 \(\ Cholesterol (mg) 282.3 431.0 352.5 Fiber (g) 5.1 7.0 6.8

Nutrient RN/ Repulse Bay Pond Inlet Coral Harbor Gjoa Haven Intake Mean %RNI Mean %RNI Mean o/oRNI Mean '7c R.Nl 1993 intake intake intake intake

n 74 l23 78 121 Calories 1900 2076.5 114 2156.5 113 2297.5 121 2758.5 145 % calories % calories % calories % calories Protein (gl 51 119.1 22 111.2 21 115.2 20 116.7 17 Carbohydrates (g) m.9 44 26().9 4\l, 261.0 46 340.8 49 Fat (gl 85.7 35 74.5 31 87.6 Jl 105.4 3..; Saturated fats (gl 26.4 11 22.l 9 29.9 12 3(1 ~ IO Cholesterol (mg) 375.6 331.7 339.7 371.2 I Fiber (g) 8.3 8.0 8.2 9.7

Source: Health and Welfare Canada. Nutrition Recommendations. Report of the Sciennfic Review Committe Ottav.a. J990. communities. This age group is at high risk for niques and proper procedures for conducting the nutritional deficiencies, is more dependent on 24-hour diet recall and food frequency question­ store-bought foods. and is important because naires, including the appropriate use of Nutri­ their nutritional status has a bearing on the health tion Canada's food models. Nutrition surveys of future generations. were conducted in April/May 1992 and in A general sociodemographic and health March/April 1993. questionnaire, a 24-hour diet recall. and a Food Data were processed at Health Canada·s Frequency Questionnaire were developed in Nutrition Research Division of the Bureau of collaboration with the Nutrition Research Divi­ Nutritional Sciences, Data were entered into sion of Health Canada and in consultation with the CANDI software program. which was u~ed hamlet councils; NWT Health and Social Ser­ to perform the nutrient anal)' sis. u~ing the 1991 vices; and Medical Services Branch, Health Canadian Nutrient File. tvlissing value~ for Canada. The questionnaire was pretested and country foods were obtained from the scientific translated into the Baffin dialect; a training man­ literature and the Al.:iska Area NatiYe Health ual was developed for use in all communities. Service. Data were analyzed using SYSTAT Local interviewer:. received a five-dav according to community. pregnancy/lactation training program in general interviewing tech- status. food groups. and Northern Air Stage cat-

96 Circumoofor Health 199 Table 2. Mean micronutrient intake of Inuit women.

Nutrient RNI Repulse Bay Pond Inlet Nain Intake Mean %RNI Mean %RNI Mean %RNI 1992 intake intake intake

Iron (mg) 13.0 24.3 187 28.2 217 20.7 159 Calcium (mg) 700.0 385.7 55 488.2 70 406.l 58 Vitamin A (RE)A 800.0 208.3 26 692.6 87 387.9 48 Vitamin C (mg)8 45.0 49.8 Ill 82.5 183 92.8 206 Folacn (µg) 185.0 90.1 49 131.2 71 140.2 76 Thiamin (mgl .8 l.2 150 1.5 188 1.3 156 Niacin (NE)c 13.7 42.9 313 49.3 360 39.7 290 B 12 (µg) 1.0 11.3 1130 14.8 1480 10.9 1090 Bfifmg) .8 l.O 125 1.4 175 1.3 162 Caffeine (m~I 769.0 324.5 264.2

Nutrient RNI Repulse Bay Pond Inlet Coral Harbor Gjoa Haven intake Mean %RN/ Mean %RN/ Mean %RNI Mean %RNI 1993 intake intake intake intake

Iron (mgl 13 0 22.7 174 29.3 225 20.8 160 17.9 137 Calcium (mg) 700.0 520.1 74 474.0 68 541.4 77 758.3 108 Vitamin A (RE)A 800.0 654.7 82 519.5 65 511.6 64 643.5 80 Vitamin C (mg)8 45.0 67 I 149 58.6 130 76.6 170 161.8 360 Folacin (µg) 185.0 198.0 107 141.3 76 119.9 65 165.7 90 Thianim (mgl .8 1.4 181 1.5 184 1.6 200 1.8 219 Niacin 1~E( 13.7 49.3 360 46.7 341 48.4 353 50.2 366 B 12 iµg) 1.0 13.2 1321 14.0 1396 13.5 1346 14.5 1453 B 6 (mg) .8 1.5 187 1.3 162 1.5 187 1.6 200 Caffeine (mg) 284.0 415.7 614.2 331.3

' Retinol equivalents 8 Includes additional requirements for smokers c Niacin equivalents Source: Health and Welfare Canada. Nutrition Recommendations. Report of the Scientific Review Committe, Ottawa, 1990.

egories using frequencies, means, and cross­ lactating women. Eighty-three women in Pond tabulations where appropriate. Mean nutrient Inlet participated in both surveys. Mean age intakes were expressed as a percentage of Health ranged from 24.7 years in Gjoa Haven to 29.2 Canada's 1990 Recommended Nutrient Intakes years in Nain. In , 24% of women (R.Nl). Recommended intakes for Vitamin C had no formal education, and most women in included the additional requirement for smok­ Repulse Bay, Arctic Bay, Coral Harbour. and ers. T-tests and chi-square tests were used to Gjoa Haven had only elementary school educa­ test differences between means, and chi-square tion. Nain was the only community with a mod­ tests were used to analyze relationships between erately high proportion of women who had com­ categorical variables. pleted high school or attended college or uni­

.1 versity (24% ). From 23% (Gjoa Haven) to 50% RESULTS (Nain) of women were employed. In most com­ A total of 688 interviews was completed, munities approximately 40% to 50% of fami­ including interviews with 60 pregnant and 115 lies had received social assistance in the previ-

200 96 Circumpolar Health Table 3a. Mean energy and macronutrient intake of pregnant and lactating lnuit women.

Nutrient Pregnant Lactating Intake RNI Mean SEA %RNI RNI Mean SEA %RNI I992 intake intake

N 60 115 Calories 2200 2375.0 147.0 108 2350.0 2341.9 129.9 100 % calories % calories Protein (g) 75 110.1 12.1 19 73 130.2 9.3 22 Carbohydrates (g) 309.0 23.9 52 256.6 15.5 44 Fat (g) 77.2 6.0 29 91.9 7.9 35 Saturated fats (g) 25.8 2.0 \0 7.1 s \.9 l\ Cholesterol (mg) 332.6 43.5 404.1 33.8 Fiber (gJ 8.0 .8 7.9 7

Table 3b. Mean micronutrient intake of pregnant and lactating Inuit women.

Nutrient Pregnant Lactating Intake RNI Mean SE* %RNI RNI Mean SE* %RNI I992 intake intake

Iron (mg) 23.0 24.7 4.0 108 13.0 28.9 2.9 222 Calcium (mg) 1200.0 658.4 69.0 55 1200.0 560.9 41.9 41 Vitamin A (REf 800.0 635.1 161.9 79 1200.0 644.4 143.3 54 Vitamin C (mg)8 55.0 117.1 20.2 213 70.0 93.6 12.2 134 Folacin (µg) 385.0 141.5 16.5 37 285.0 152.5 12.3 54 Thiamin (mg) .9 1.4 . I 160 .9 1.6 .I 178 Niacin (NEf 17.0 43.6 4.4 257 17.0 51.3 3.5 302 B 12 (µg) 1.2 l l.l 2.4 927 1.2 14.8 1.7 1234 B6(mg) 1.65 1.3 .1 79 1.95 1.4 .I 72 Caffeine (mg) 345.2 59.9 349.5 36.4

8 * Standard error of the mean A Retinol equivalents Includes additional requirements for smokers c Niacm equivalents Source: Health and Welfare Canada. Nutrition Recommendations. Report of the Scientific Review Committe, Ottawa, 1990.

2 ous month. Dependence on social assistance Gjoa Haven (28.3 kg/m ). About a fifth to a was highest in Gjoa Haven (55%) and lowest in quarter of women rated their health as fair or Nain (29% ). Unemployment insurance benefits poor. From 70% to 88% of all women smoked, were an important source of income to women and 67% to 82% of pregnant and lactating in Repulse Bay (39% ), Nain (54% ), and Coral women were regular smokers. Most women Harbour (27% ). Total family income was gen­ were moderately active. In Nain, Repulse Bay, erally low, with 33% to 59% of families earn­ and Pond Inlet, approximately 25% of women ing less than $1,500 per month. and even lower spent one to three months on the land and were in Gjoa Haven, where 79% earned less than this more active while on the land. From 10% of amount. women in Repulse Bay to 38% of women in Mean BMis were within the healthy range Nain expressed "extreme concern" over alco­ in Nain, Pond Inlet, and Arctic Bay, but high in hol and drug abuse. From 13% of women (Re-

96 Circumpolar Health 201 pulse Bay) to 57% of women (Nain) were "ex­ the RNI (Tables 2 and 3b ). Caffeine intake was tremely concerned" about family violence. Not above healthy levels in Repulse Bay (769 mg/ being able to get country food was of "extreme day), Pond Inlet (1993)(415.7 mg), and Coral concern" to more women in Nain (30%) and Harbour (614.2 mg) (Table 2). Among preg­ Gjoa Haven (22%). nant and lactating women, average caffeine in­ Mean energy intake ranged from 2100 to take was 345.2 mg and 349.5 mg, respectively 27 59 Cal (Table 1) but was in the narrower range (Table 3b). of 2100-2300 Cal in five of the communities. Generally, country food was the most im­ For pregnant and lactating women, mean energy portant source of protein (50% to 60%) and iron intakes were close to recommended levels (56% to 70% ). The exception was Gjoa Haven, (Table 3a); however, in some communities, where 40% of dietary iron was obtained from about half the women did not meet energy re­ country food. Country food was the major quirements. For all women protein supplied source of thiamin. riboflavin, and niacin in Pond 20% to 25% of energy. fat 29% to 35%, satu­ Inlet, Arctic Bay; Coral Harbour, and Repulse rated fat 10% to 12% of energy, and carbohy­ Bay and an important source of vitamin A in drate 41%to49%. Fiber intake was generally Pond Inlet. Store foods were the major sources low, especially ;n Repulse Bay (mean of five of energy, fat, carbohydrate, calcium, vitamin grams) (Table I). C, and folacin. Nutritious Perishable Foods Mean intake~ of most essential nutrients were the most important sources of fat, vitamin met or exceeded recommended levels, except A, folacin, and energy. Non-perishable Foods for calcium, folacin, and vitamin A (Table 2). were the principal sources of vitamin C and cal­ In Gjoa Haven, average calcium intakes ex­ cium in all communities except Arctic Bay. The ceeded recommended levels, but elsewhere cal­ major sources of calories were meat, poultry, cium intakes ranged from 55% of the RNI in fish (26% to 33% ), sugar, sweets and foods of Repulse Bay to 77% in Coral Harbour. Preg­ little nutritional value (LNV) (22% to 38% ). and nant women met only 55% and lactating women breads and cereals (13% to 20%). In Gjoa Ha­ 47% of the RNl for calcium. Calcium intakes ven, the LNV group was a more important were significantly lower among women over 25 source of energy (26%) than meat, poultry, and years of age (p = .000) and those receiving so­ fish (22%). cial assistance< p == .007) and higher among those Meat, poultry, and fish (especially store who were pregnant (p = .014). There was no meat) were the major source of fat (34% to relationship between intakes of calcium, fola­ 49% ). Frozen fried breaded chicken, regular cin. or vitamin A and education or income. Iron ground beef. packaged and canned luncheon intakes ranged from a mean of 17 .3 mg/day in meats, and wieners were the most frequently Gjoa Haven to 29.3 mg in Pond Inlet (1993). consumed store meats. Sweets and LNV foods Arctic Bay was the only community to meet the (potato chips, chocolate bars, etc.) were impor­ RNI for folacin. Mean intakes for folacin were tant sources of fat. particularly in Pond Inlet less than half the RNI in Repulse Bay and 65 % (21 % ), Gjoa Haven (24% ), and in Repulse Bay of the RNI in Coral Harbour. Pregnant and lac­ (26% ), and the major sources of carbohydrate tating women met 37% and 54% of the RNI for (from 42% in Nain to 57% in Repulse Bay). folacin. respectively. and in Repulse Bay mean Sweets and LNV (fruit drink crystals) were the intake was only 57.7 mcg. 95.5% confidence most important source of calcium in Repulse intervals: 34.9 - 80.6 mcg (Table 3J. Folacin Bay and Gjoa Haven (32% ). In Pond Inlet intakes were significantly lower among women ( 1993) and Arctic Bay, the major sources of cal­ on social assistance (p = .003) and among cium were Miscellaneous Foods (including women over age 25 (p = .02). Average vitamin macaroni and cheese dinner. pizza, and baking A intakes ranged from 26% of the RNI in Re­ powder). Tea and other Miscellaneous Foods pulse Bay to 87% in Pond Inlet (1992) (median (e.g., pizza) were the principal sources of fola­ 65% ), with intakes for J>regnant women being cin. Country food was an important source of 79% of the RNI and lactating women 54% of vitamin A in all communities except Repulse

202 96 Circumpolar Health Bay and Nain, providing from 29% (Arctic Bay) due to its concentration in only a few foods. to 45% (Pond Inlet 1993) of intake. Vegetables However, a high percentage of women reported were an important source of vitamin A in Pond low consumption of foods, such as liver, coun­ Inlet (1992), Nain, Coral Harbour, and Arctic try fat, and carrots, over the previous month. Bay. Miscellaneous Foods (macaroni and Therefore they may not be meeting their require­ cheese dinner, canned stew) were a major source ments. Country food was a less important source of vitamin A (30%) in Repulse Bay. In 1993 of energy and nutrients than in previous stud­ the consumption of country food declined and ies.1·3 Carbohydrate intakes are similar to those LNV foods increased in Pond Inlet. in Northern Quebec, and carbohydrates are a The Food Frequency Questionnaire con­ more important energy source than reported in 1 2 firmed the consumption of country foods re­ earlier studies. · .4 Mean intakes of fat, vitamin ported on the 24-hour diet recall. However, in A, and folacin are lower than in Northern Que­ Gjoa Haven, women reported a higher consump­ bec, as is the consumption of country fat, per­ tion of country food on the food frequency ques­ ishable citrus fruit or juice, and vegetables. Dif­ tionnaire. ferences in nutrient intake between 1992 and 1993 in Pond Inlet may be partly due to the tim­ DISCUSSION ing of the surveys. The survey took place dur­ The use of both a 24-hour diet recall and a ing the first part of the month in 1992 and dur­ food frequency questionnaire provides a better ing the latter part of the month in 1993, when picture of food consumption patterns of a group many families on social assistance have run out than is possible with a single dietary recall. In­ of money for food. tensive training of local interviewers and trans­ lation of the questionnaire into the local dialect CONCLUSIONS helps improves the validity of the results. How­ Low intakes of folacin, calcium, and vita­ ever, the results do not permit the identification min A and a high consumption of foods of little of the number of individuals at risk for a par­ nutritional value, especially during pregnancy ticular nutrient. and lactation, place many women of child-bear­ Education levels were generally lower than ing age at risk. High smoking levels further in the Canadian population and unemployment compromise folate and vitamin C status. Wo­ levels were high compared to Canadians in gen­ men on social assistance may be at risk for in­ eral. 9· 10 adequate intakes of folacin and calcium. Inter-community variation in nutrient intake Health and nutritional status are dependent and food consumption patterns was noted on a on many socioeconomic factors, the interplay regional basis among Inuit communities in of which varies by family, community, and re­ Northern Quebec.4 In this study certain trends gion. Improvements in nutritional status require were common across most communities: name­ that all of these factors be addressed in a com­ ly, a high consumption of sweets and foods of prehensive manner. little nutritional value and low intakes of cal­ cium, folacin, and vitamin A. findings which are REFERENCES consistent with other studies. H Folacin intakes I. Bureau of Nutritional Science, Nutrition were considerably lower than for Inuit women Canada. Food consumption patterns report. in Northern Quebec and much lower than for Ottawa: Department of National Health and 4 10 Nova Scotia women. • This survey also docu­ Welfare. 1975. mented low intakes of calcium and folacin 2. Kuhnlein HV. Nutrition of the Inuit: a brief among pregnant and lactating women, and low overview. Circumpolar Health. 1991 :90:728- vitamin A intakes among lactating women. 730. Missing data and generally low income levels 3. Schaefer 0. Changing dietary patterns in the : health, social and economic may explain the lack of association between consequences. Jou ma/ ofthe Canadian Dietetic income and nutrient intake. Wide intra-indi­ Association. 1976:38: 17-25. vidual variation in vitamin A intake is expected

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204 96 Cirr:umpolar Health