Abstract
ObjectivesAnemia and iron deficiency (ID) are frequent among Indigenous children of Canada, but few data are available in Quebec. The present study aimed to characterize anemia and ID prevalence and associated protective and risk factors among First Nations youth in Quebec.MethodsThe 2015 First Nations (JES!-YEH!) pilot study was conducted among children and adolescents (3 to 19 years; n = 198) from four First Nations communities in Quebec. Blood and urine samples and anthropometric measurements were collected. Hemoglobin (Hb), serum ferritin (SF), plasma hs-CRP, and urinary cotinine levels were measured. Factors associated with anemia and ID (including traditional and market food consumption) were assessed using an interview-administered food frequency questionnaire, based on which nutritional intakes were calculated. Structural equation models were used to test associations.ResultsThe prevalence of anemia and ID was elevated (16.8% and 20.5% respectively). Traditional meat, fruit, and fruit juice (natural and powdered)—via their positive association with vitamin C intake—were the only food variables positively associated with SF (coefficient [95% CI] 0.017 [0.000, 0.114]; 0.090 [0.027, 0.161]; and 0.237 [0.060, 0.411]). Male sex was also associated with higher SF (0.295 [0.093, 0.502]). Inflammation status (hs-CRP > 5 mg/L) was inversely associated with Hb (− 0.015 [− 0.025, − 0.005]), whereas SF was positively associated with Hb (0.066 [0.040, 0.096]). Fruit and juice consumption was also positively associated with Hb, via vitamin C intake and SF (0.004 [0.001, 0.010]; 0.008 [0.003, 0.017]).ConclusionsInterventions fostering healthier food environments as well as higher consumption of traditional meats and foods naturally rich in vitamin C, which is known to enhance iron absorption, and fighting inflammation could contribute to decrease the high prevalence of anemia and ID in this young Indigenous population.
Highlights
Canada is among countries with the lowest prevalence of childhood anemia
Dietary shifting from traditional foods, largely composed of wild animal, fish, birds, fruits, and plants, to poor-quality market foods lower in iron often results in iron deficiency (ID) (INSPQ 2015) and if severe enough to impair erythropoiesis, to iron deficiency anemia (IDA) (Christofides et al 2005)
Model 1 results of Structural equation modeling (SEM) analysis showed that male sex, inflammation, and vitamin C intake were associated with higher serum ferritin (SF)
Summary
Canada is among countries with the lowest prevalence of childhood anemia. In 2009–2011, 97% to 99% of Canadian children and adolescents had sufficient hemoglobin (Hb) levels, which means that less than 3% of the Canadian youth general population presented anemia (Cooper et al 2012). Individuals with mild to moderate forms of anemia are physically limited by the fatigability, shortness of breath, dizziness, and muscle weakness due to inadequate tissue supply of oxygen Those with severe cases of anemia can progress to heart failure and even death (Turkoski 2003). Indigenous populations in Canada refer to First Nations, Métis, and Inuit Peoples. Each First Nation is composed of many communities that share common language, culture, and traditional diet (Chan et al 2019) In these communities, dietary shifting from traditional foods, largely composed of wild animal, fish, birds, fruits, and plants, to poor-quality market foods lower in iron often results in iron deficiency (ID) (INSPQ 2015) and if severe enough to impair erythropoiesis, to iron deficiency anemia (IDA) (Christofides et al 2005). Other possible causes of anemia are hemorrhagic, hemolytic, and anemia linked to hemoglobinopathies, they are all less common in First Nation contexts (Jamieson and Kuhnlein 2008)
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