PREVALENCE OF OBESITY AND TYPE 2 DIABETES AMONG CHILDREN IN A REMOTE FIRST NATIONS COMMUNITY.

Abstract

Background Type 2 diabetes mellitus (T2D) in children and adolescents is becoming a growing public health concern and reflects the increasing rates of obesity in our society. The prevalence of T2D in Canadian Aboriginal children and youth has been documented to be as high as 1%, with the highest prevalence in the Plains Cree people of Central Canada. However, no such pediatric data are available for any First Nations community in British Columbia. Hartley Bay is an isolated First Nations community in BC, accessible only by air or water, with a population of 184 members living on reserve. Members of this community have multiple known risk factors for developing T2D, including First Nations ethnicity, obesity, and a family history of T2D. Purpose The purpose of this study was to determine the prevalence of obesity, glucose intolerance, and metabolic syndrome in the community of Hartley Bay. Methods All children in the community of Hartley Bay, ages 6 to 18, were invited to participate in the study. A medical history was obtained to document risk factors and symptoms associated with T2D. Measurements including height, weight, blood pressure, and waist and hip circumferences were documented. Body mass index (BMI) was standardized for age and sex. Overweight was defined as a BMI ≥ 85th percentile and obese was defined as a BMI ≥ 95th percentile for age and sex. Presence of acanthosis nigricans, hirsutism, and acne were recorded. Children fasted overnight, and a standard oral glucose tolerance test was administered the following morning. Baseline and 2-hour levels of glucose and insulin were measured. Glycosylated hemoglobin, fasting C-peptide, and fasting lipid profile were also obtained. Results There were 33 eligible children, and 29 children (88%) (age 11.8 years ± 3.4; 16 females and 13 males) participated in the study. Nine (31%) of the children were obese and 5 (17%) were overweight, with a total of 48% obese or overweight. One child had fasting and 2-hour glucose levels consistent with impaired glucose tolerance. One other child, absent from the community at the time of the screening, was previously recently diagnosed by this team to have T2D. The incidence of glucose intolerance (T2D/IGT) in this community is 2/34 (5.9%), which is greater than previously reported in other pediatric Aboriginal populations in Canada. Conclusions Our findings suggest that the prevalence of obesity and overweight as well as glucose intolerance in this population is higher than previously reported in other pediatric Aboriginal populations in Canada. This study will generate interest, knowledge, and the willingness within the community to support modifications in lifestyle and nutrition practices required for the primary and secondary prevention of T2D.