Inuit Population Research Articles

Carnitine palmitoyltransferase 1A P479L and infant death: policy implications of emerging data.

Carnitine palmitoyltransferase 1 isoform A (CPT1A) is a crucial enzyme for the transport of long-chain fatty acids into the mitochondria. The CPT1A p.P479L variant is found in high frequencies among indigenous populations residing on the west and north coasts of Alaska and Canada and in northeast Siberia and Greenland. Epidemiological studies have reported a statistical association between P479L homozygosity and infant death in Alaska Native and Canadian Inuit populations. Here, we review the available evidence about the P479L variant and apply to these data the epidemiological criteria for assessing causal associations. We found insufficient evidence to support a causal association with infant death and, further, that if a causal association is present, then the genotype is likely to be only one of a complex set of factors contributing to an increased risk of infant death. We conclude that additional research is needed to clarify the observed association and to inform effective preventative measures for infant death. In light of these findings, we discuss the policy implications for public health efforts because policies based on the observed association between P479L homozygosity and infant death data are premature.Genet Med advance online publication 26 January 2017.

Nunavik Rhodiola rosea Attenuates Expression of Fear-Potentiated Startle

Rhodiola rosea is a plant with adaptogenic qualities used by Inuit populations of Nunavik, Quebec (Canada) for general mental and physical rejuvenation. Previous studies have demonstrated that the Canadian populations of R. rosea significantly attenuate the expression of learned fear and anxiety-like behaviors in rodent models. In order to further characterize the anxiolytic activity of Nunavik R. rosea, experiments were conducted to assess the effects of oral administration of the plant extract on both the fear-potentiated startle response and corticosterone levels. Findings suggest that oral administration of R. rosea ethanolic extract (75 mg/kg) significantly attenuated fear-potentiated startle, but did not produce any effects on stress-induced secretion of corticosterone.

Adult idiopathic cholestasis: a condition more common in the Canadian Inuit?

ABSTRACTDespite extensive investigations, some patients have no identifiable cause for their cholestatic liver enzyme abnormalities. The aim of this study was to document the clinical, laboratory, radiologic and histologic features of adult patients with idiopathic cholestasis (AIC). A computerised database of referred patients to a tertiary care hospital outpatient department for assessment of hepatobiliary disorders between 2005 and 2015 was employed to identify and describe features associated with AIC. Of 6,560 patient referrals, sufficient documentation to warrant a diagnosis of AIC was present in 17 (0.26%) cases. Of the 17, a disproportionate number were Canadian Inuit (7/60, 12% Inuit referrals vs. 10/6,500, 0.16% non-Inuit referrals, p<0.0001). The median age of the 17 subjects was 57 years and nine (53%) were female. Clinical and/or laboratory evidence of autoimmune disorders was present in six (35%) cases. Clinical features of hepatic decompensation, radiologic findings in keeping with cirrhosis and histologic confirmation of cirrhosis were present in 47%, 31% and 42% of individuals, respectively. There were no significant improvements in cholestatic liver enzymes and function tests in those treated with ursodiol and/or immunomodulants (n=7) compared to those left untreated (n=10). In conclusion, AIC is a rare condition diagnosed by exclusion. It appears to be more common in the Canadian Inuit population and those with autoimmune disorders. Advanced liver disease is a frequent finding at presentation. Intervention with ursodiol and/or immunomodulants does not appear to be of therapeutic value.

Relocation Redux: Labrador Inuit Population Movements and Inequalities in the Land Claims Era

The importance of community relocation experiences for aboriginal land claims movements is well documented; the role played by successful land claims in prompting ongoing out-migration is not. Data collected in 2011 on the lives of migrants are used to test three hypotheses: H1, Inuit leaving the land claims area for a nearby nonaboriginal city show markedly different social outcomes based on the length of time since migration; H2, these social outcomes map onto patterns of intergroup boundaries in their new communities; and H3, both of these outcomes are better explained by migration patterns after the land claims than by the ethnic/racial exclusion that has been the focus of past research on inequality in the region. This analysis takes advantage of social network techniques used to study hard-to-reach populations, showing how these methods can be used to address broader questions of community structure and cohesion during rapid social change. Conclusions focus on the experiences of migrants on the marg...

Profile: Joseph Marek: 2016-17 ASCP President.

It was four months in Alaska, in the middle of winter, that changed Joseph Marek's view of what it means to be a pharmacist. Marek was on his last rotation in pharmacy school when he experienced the kind of practice that he wanted for himself. He found that kind of practice as a consultant pharmacist, and next month, Marek, 49, will become the 2016-2017 president of the American Society of Consulting Pharmacists. Working at the Public Health Service (PHS) in the Arctic Circle in 1990, he dispensed and carried out clinical duties with the chief pharmacist and provided care to the native Inuit population through the Indian Health Service. "PHS had a walk-in clinic where the physicians worked closely with the pharmacist to do medication management for the patients," he said. The pharmacists also provided medications to the surrounding villages (50,000 square miles) and had to coordinate the dispensing/delivery of these medications when the physicians visited them. "The doctors highly valued the pharmacists' clinical knowledge, and it was a great environment to learn how to collaborate with the medical/health care team to benefit the Inuits," he said. "Everyone worked together and you could see the outcomes quickly."

Claims for disease-modifying therapy by Alberta non-insured health benefits clients.

BackgroundUncontrolled disease activity in inflammatory diseases of the joints, skin and bowel leads to morbidity and disability. Disease-modifying therapies are widely used to suppress this disease activity, but cost-coverage is variable. For Treaty First Nations and Inuit people in Canada without alternative private or public health insurance, cost-coverage for disease-modifying therapy is provided through Non-Insured Health Benefits (NIHB). Our objective was to describe the prevalence and patterns of treatment with disease-modifying therapy for the NIHB claimant population, and also examine adjuvant therapy (analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids) use.MethodsCases (n = 2512) were defined by ≥1 claim for a disease-modifying anti-rheumatic drug (DMARD) or biologic between 1999 and 2012 in the NIHB pharmacy claim database. The proportion of the population with claims for individual agents and drug classes annually was calculated to estimate annual incidence and prevalence rates for use of disease-modifying therapy, and the prevalence of use of individual DMARDs, biologics and adjuvants. Differences in the proportion accessing adjuvant therapies and median doses in the 6 months following initiation of disease-modifying therapies was estimated.ResultsThe incidence rate of treatment was calculated at an average of 127.5 cases per 100,000 population between 2001 and 2012, and the cumulative prevalence, accounting for patients lost to the database, increased and then stabilized at 1.3 % in the last three years of the study. Annual dispensation of methotrexate, combination DMARD therapy and biologic therapy approached 35 %, 19 %, and 10 % of the cohort respectively. A declining prevalence of claims for acetaminophen (28 % to 15 %) and anti-inflammatories (73 % to 63 %) occurred from 2000 to 2012, however corticosteroid (32 %) and opioid (65 %) dispensation remained stable. The proportion of patients with claims for NSAIDs (69.9 % to 61.1 %, p = 0.002), oral corticosteroids (45.4 % to 33.6 %, p < 0.001) and parenteral corticosteroids (16.2 % to 8.3 %, p = 0.002) decreased in the 6 months following biologic initiation.ConclusionsThe proportion of NIHB clients with active claims for disease-modifying therapy is lower than expected based on existing epidemiologic knowledge of the prevalence of inflammatory conditions in the First Nations and Inuit populations. These findings should be further explored in order to optimize treatment outcomes for NIHB claimants with inflammatory disease.

Variations in survival time for amalgam and resin composite restorations: a population based cohort analysis.

To estimate the association between the restorative material used and time to further treatment across population cohorts with universal coverage for dental treatment. Cohort study of variation in survival time for tooth restorations over time and by restoration material used based on an Accelerated Failure Time model. Primary dental care clinics. Members of Canada's First Nations and Inuit population covered by the Non-Insured Health Benefits program of Health Canada for the period April 1, 1999 to March 31, 2012. Tooth restorations using resin composite or amalgam material. Survival time of restoration to further treatment. Median survival time for resin composite was 51 days longer than amalgam, for restorations placed in 1999-2000. This difference was not statistically significant (p⟩0.05). Median survival times were lower for females, older subjects. Those visiting the dentist annually, and decreased monotonically over time from 11.2 and 11.3 years for resin composite and amalgam restorations respectively placed in 1999-2000 to 6.9 and 7.0 years for those placed in 2009-10. Resin composite restorations performed no better than amalgams over the study period, but cost considerably more. With the combination of the overall decrease in survival times for both resin composite and amalgam restorations and the increase in use of resin composite, the costs of serving Health Canada's Non-Insured Health Benefits population will rise considerably, even without any increase in the incidence of caries.

Protective role of biliverdin against bile acid-induced oxidative stress in liver cells

The accumulation of bile acids affects mitochondria causing oxidative stress. Antioxidant defense is accepted to include biotransformation of biliverdin (BV) into bilirubin (BR) through BV reductase α (BVRα). The mutation (c.214C>A) in BLVRA results in a non-functional enzyme (mutBVRα). Consequently, homozygous carriers suffering from cholestasis develop green jaundice. Whether BVRα deficiency reduces BV-dependent protection against bile acids is a relevant question because a screening of the mut-BLVRA allele (a) in 311 individuals in Greenland revealed that this SNP was relatively frequent in the Inuit population studied (1% a/a and 4.5% A/a). In three human liver cell lines an inverse correlation between BVRα expression (HepG2>Alexander>HuH-7) and basal reactive oxygen species (ROS) levels was found, however the ability of BV to reduce oxidative stress and cell death induced by deoxycholic acid (DCA) or potassium dichromate (PDC) was similar in these cells. The transduction of BVRα or mutBVRα in human placenta JAr cells with negligible BVRα expression or the silencing of endogenous BVRα expression in liver cells had no effect on DCA-induced oxidative stress and cell death or BV-mediated cytoprotection. DCA stimulated both superoxide anion and hydrogen peroxide production, whereas BV only inhibited the latter. DCA and other dihydroxy-bile acids, but not PDC, induced up-regulation of both BVRα and heme oxygenase-1 (HO-1) in liver cells through a FXR independent and BV insensitive mechanism. In conclusion, BV exerts direct and BVRα-independent antioxidant and cytoprotective effects, whereas bile acid accumulation in cholestasis stimulates the expression of enzymes favoring the heme biotransformation into BV and BR.

Medevacs in Nunavut: a critical component in the primary care system

Nunavut Territory is a large (2 million sq km) Arctic territory with a small (32,000) mostly Inuit population who live in 26 small isolated communities with only air access and some boat access in summer. Primary health care is delivered by nurses in most communities in health centres with limited diagnostic and treatment facilities. Air Medevacs are a critical part of the health care delivery systems in Nunavut. In many small remote communities resources for dealing with serious acute illness and injury are limited. Improvements in acute health care and rising expectations from both health care providers and the public have confirmed the need for these services. The logistical challenges in providing such emergency services in many regions are considerable. Relatively long distances to secondary and tertiary care, short gravel runways in many communities, highly variable demand for services and the need to provide acute care for the full spectrum of patients all conspire to make medevacs challenging. Data concerning medevacs performed in Nunavut for 4 years (2010-2014) were obtained from the Department of Health and from medevac providers. The data recorded included volumes, origins, destinations, and patient data (age, gender, primary diagnosis, interventions performed). The results were then analyzed to determine per capita rate for each of the administrative regions of Nunavut, to identify the most common causes for medevacs and the type of medical personnel involved in the medevacs. The role of medevacs in providing care in remote areas will be reviewed as well as alternate management options.This abstract was presented at the Innovative Solutions in Remote Healthcare - 'Rethinking Remote' conference, 23-24 May 2016, Inverness, Scotland.

Suicide Rates in Aboriginal Communities in Labrador, Canada.

To compare suicide rates in Aboriginal communities in Labrador, including Innu, Inuit, and Southern Inuit, with the general population of Newfoundland, Canada. In partnership with Aboriginal governments, we conducted a population-based study to understand patterns of suicide mortality in Labrador. We analyzed suicide mortality data from 1993 to 2009 from the Vital Statistics Death Database. We combined this with community-based methods, including consultations with Elders, youths, mental health and community workers, primary care clinicians, and government decision-makers. The suicide rate was higher in Labrador than in Newfoundland. This trend persisted across all age groups; however, the disparity was greatest among those aged 10 to 19 years. Males accounted for the majority of deaths, although suicide rates were elevated among females in the Inuit communities. When comparing Aboriginal subregions, the Innu and Inuit communities had the highest age-standardized mortality rates of, respectively, 165.6 and 114.0 suicides per 100 000 person-years. Suicide disproportionately affects Innu and Inuit populations in Labrador. Suicide rates were high among male youths and Inuit females.

Increased F3-Isoprostanes in the Canadian Inuit Population Could Be Cardioprotective by Limiting F2-Isoprostane Production

F3-isoprostanes (F3-IsoPs), derived from peroxidation of eicosapentaenoic acid (C20:5n-3), could be cardioprotective by limiting production of F2-isoprostanes (F2-IsoPs), a cardiovascular disease risk factor. The objective of the study was to determine whether the n-3-polyunsaturated (PUFA)-rich Inuit diet is associated with a lower plasma ratio of F2-IsoPs to F3-IsoPs. This was a cross-sectional observational study. The study was conducted in 36 Canadian Arctic Inuit communities. Participants included a random subset (n = 233) of Inuit adults taken from a population-based survey. Plasma F2-IsoPs and F3-IsoPs, cardiometabolic risk factors (blood lipids, C-reactive protein, blood pressure, fasting glucose) and markers of dietary exposure (erythrocyte n-3 and n-6 PUFA, blood levels of Se, mercury, polychlorinated biphenyls) were measured. Inuit aged 40 years old and older vs younger Inuit showed higher concentrations of plasma F3-IsoPs and erythrocyte n-3 PUFA and lower plasma F2-IsoPs concentrations despite having higher blood lipids, fasting glucose, systolic blood pressure, and percentage body fat. Plasma F3-IsoPs were not associated with any cardiometabolic measures. When subjects were categorized into tertiles according to total n-3 PUFA erythrocyte concentrations, F3-IsoPs increased with increasing tertiles, whereas the F2-IsoP to F3-IsoP ratio was lowest at the highest n-3 tertile. The F2-IsoP to F3-IsoP ratio was significantly predicted by C20:5n-3 (β= -.365, P = .002); C20:4n-6:C20:5n-3 (β = .056, P = .006), blood mercury (β = -.812, P =.015), blood Se (β = -1.95, P = .015), and smoking (β = .745, P = .025). Plasma F3-IsoPs were not associated with cardiometabolic risk factors previously seen with F2-IsoPs. Higher n-3 fatty acid status was associated with lower plasma F2-IsoPs and higher plasma F3-IsoPs, which provides partial explanation to the cardioprotective effects of the n-3 PUFA-rich Inuit diet.

Associations between Vitamin D Status and Type 2 Diabetes Measures among Inuit in Greenland May Be Affected by Other Factors.

ObjectiveEpidemiological studies have provided evidence of an association between vitamin D insufficiency and type 2 diabetes. Vitamin D levels have decreased among Inuit in Greenland, and type 2 diabetes is increasing. We hypothesized that the decline in vitamin D could have contributed to the increase in type 2 diabetes, and therefore investigated associations between serum 25(OH)D3 as a measure of vitamin D status and glucose homeostasis and glucose intolerance in an adult Inuit population.Methods2877 Inuit (≥18 years) randomly selected for participation in the Inuit Health in Transition study were included. Fasting- and 2hour plasma glucose and insulin, C-peptide and HbA1c were measured, and associations with serum 25(OH)D3 were analysed using linear and logistic regression. A subsample of 330 individuals who also donated a blood sample in 1987, were furthermore included.ResultsAfter adjustment, increasing serum 25(OH)D3 (per 10 nmol/L) was associated with higher fasting plasma glucose (0.02 mmol/L, p = 0.004), 2hour plasma glucose (0.05 nmol/L, p = 0.002) and HbA1c (0.39%, p<0.001), and with lower beta-cell function (-1.00 mmol/L, p<0.001). Serum 25(OH)D3 was positively associated with impaired fasting glycaemia (OR: 1.08, p = 0.001), but not with IGT or type 2 diabetes.ConclusionsOur results did not support an association between low vitamin D levels and risk of type 2 diabetes. Instead, we found weak positive associations between vitamin D levels and fasting- and 2hour plasma glucose levels, HbA1c and impaired fasting glycaemia, and a negative association with beta-cell function, underlining the need for determination of the causal relationship.

Human Rights, Environmental Justice, and the North-South Divide

From the Ogoni people devastated by oil drilling in Nigeria to the Inuit and other indigenous populations threatened by climate change, communities disparately burdened by environmental degradation are increasingly framing their demands for environmental justice in the language of environmental human rights. However, some scholars have expressed scepticism about the environmental human rights project. First, they remind us that the human rights governance capacity of many states in the global South has been compromised by the neoliberal economic reforms imposed by the International Monetary Fund and the World Bank as well as by trade and investment agreements. Second, they question the ability of human rights law to adequately articulate and advance the aspirations and resistance strategies of diverse grassroots social justice movements, and warn us about the susceptibility of human rights law to co-optation by powerful Northern states. This Chapter examines the promise and the peril of environmental human rights as a means of challenging environmental injustice within nations and the North-South dimension of environmental injustice.

Missionaries, merchants, and Inuit entrepreneurs: An examination of trade relations along the Labrador coast

The study of Inuit-European contact in Labrador has often divided the coast into north and south, creating a dichotomy that ignores Inuit mobility and emphasizes the arrival and placement of Europeans along the coast. This has caused some researchers to focus too heavily on missionary trade involvement in the north while ignoring merchant activity in the south, and vice versa. This paper seeks to provide further evidence in support of Inuit entrepreneurs as catalysts for the abundance and diversity of European-made trade goods along the coast, rather than the missionaries or merchants themselves. This study presents an analysis of four Inuit dwellings dating from the mid-18th through early 19th centuries, both pre- and post- missionary arrival, from two distinct regions: Nain and Hamilton Inlet. The results show no significant difference in the quantity of trade goods between the two regions, either before or after the arrival of Moravian missionaries. There may have been another factor at work: influential Inuit traders who were a key component of the trade network, who likely rose to entrepreneurial status prior to the arrival of missionaries, and who continued to move items along the coast thereafter. Thus, the increasing European presence did not largely affect the trade network that had emerged by the early 18th century, aside from providing the Inuit population with access to additional resources and more options.

Exposure to persistent organic pollutants and sperm DNA methylation changes in Arctic and European populations.

Persistent organic pollutants (POPs), such as PCBs (polychlorinated biphenyls) and DDT [1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane], are environmental contaminants with potential endocrine disrupting activity. DNA methylation levels in peripheral blood lymphocytes have been associated with serum concentrations of POPs in Greenland Inuit and Korean populations. Greenland Inuits are characterized by the highest worldwide POP levels. In this cross-sectional study we evaluated the relationship between serum POP concentrations and DNA methylation levels in sperm of non-occupationally exposed fertile men from Greenland, Warsaw (Poland), and Kharkiv (Ukraine). Serum levels of PCB-153 [1,2,4-trichloro-5-(2,4,5-trichlorophenyl)benzene], as a proxy of the total PCBs body burden, and of p,p'-DDE [1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene], the main metabolite of DDT were measured. Sperm DNA methylation level was assessed globally by flow cytometric (FCM) immunodetection of 5-methyl-cytosines and at specific repetitive DNA sequences (Alu, LINE-1, Satα) by PCR-pyrosequencing after bisulfite conversion. Multivariate linear regression analysis was applied to investigate correlations between serum POP concentrations and DNA methylation. No consistent associations between exposure to POPs and sperm DNA methylation at repetitive DNA sequences were detected. A statistically significant global decrease in methylation was associated with exposure to either POP by FCM analysis. This is the first study to investigate environmental exposure to POPs and DNA methylation levels considering sperm as the target cells. Although POP exposure appears to have a limited negative impact on sperm DNA methylation levels in adult males, the global hypomethylation detected by one of the methods applied suggests that further investigation is warranted.

Inequality and social processes in Inuit Nunangat

This article seeks to shed light on the way whereby the social inequalities typifying social formations stemming from a colonial situation become established. In particular, it takes up the case of the Canadian North and attempts to bring out the mechanisms through which the region’s Inuit and non-Aboriginal populations systematically receive differentiated access to socially coveted resources. Working from a study material based on the 2006 Canadian census and 2011 National Household Survey, we developed a socio-economic profile for these populations and measured the degree of association between the variables used; education appears to play a decisive role in the access to other resources. According to our thesis, development processes framed by modernisation theory, such as those that were implemented in the second half of the twentieth century, contributed to the establishment of a system of inequality. The importing of industrial social organisation and the establishment of the market and techno-bureaucracy in Inuit Nunangat resulted in new mechanisms of resource allocation in which employment, education and income combined in ways working to the advantage of some and to the detriment of others.

Increased asthma and adipose tissue inflammatory gene expression with obesity and Inuit migration to a western country

BackgroundAn overlap between obesity and asthma exists, and inflammatory cells in adipose tissue could drive the development of asthma. Comparison of adipose tissue gene expression among Inuit living in Greenland to those in Denmark provides an opportunity to assess how changes in adipose tissue inflammation can be modified by migration and diet. ObjectiveTo examine mast cell and inflammatory markers in adipose tissue and the association with asthma. MethodsTwo Inuit populations were recruited, one living in Greenland and another in Denmark. All underwent adipose subcutaneous biopsy, followed by clinical assessment of asthma, and measurement of AHR. Adipose tissue biopsies were homogenised, RNA extracted, and PCR was performed to determine the relative gene expression of mast cell (tryptase, chymase, CPA3) and inflammatory markers (IL-6, IL-1β, and CD163). ResultsOf the 1059 Greenlandic Inuit participants, 556 were living in Greenland and 6.4% had asthma. Asthma was increased in Denmark (9%) compared to Greenland (3.6%, p < 0.0001) and associated with increased adipose tissue IL-6 gene expression and increased BMI. There was no association between asthma and adipose tissue mast cell gene expression. Pro-inflammatory gene expression (IL-6, IL-1β) was higher in those living in Denmark, and with increasing BMI and dietary changes. The anti-inflammatory (M2) macrophage marker, CD163, was higher in Greenland-dwelling Inuit (p < 0.01). ConclusionsNo association was found between gene expression of mast cell markers in adipose tissue and asthma. Among Greenlandic Inuit, adipose tissue inflammation is also increased in those who migrate to Denmark, possibly as a result of dietary changes.

MG-107 Congenital sucrase-isomaltase deficiency: Identification of the common inuit founder mutation

Objective Congenital sucrase-isomaltase deficiency (CSID) is a rare hereditary cause of chronic diarrhoea in children. Persons with CSID lack the intestinal brush-border enzyme required for digestion of di- and oligosaccharides, including sucrose and isomaltose. Malabsorption results in abdominal pain, distention, copious diarrhoea, and failure to thrive. If recognised, dietary avoidance of the offending carbohydrates is highly effective. Although CSID is known to be highly prevalent (˜5–10%) in several Inuit populations, the genetic basis for this condition has not been described. Methods We sequenced the sucrase-isomaltase gene, SI, in a single Inuit CSID proband with severe fermentative diarrhoea and failure to thrive. We then genotyped a further 128 anonymized Inuit control individuals from a variety of circumpolar locales to assess for a possible founder effect. Results We identified a novel, homozygous frameshift mutation, c.273_274delAG (p. Gly92Leufs*8) in exon 4 of SI in the proband, that is predicted to result in complete absence of functional protein product. This change is indeed very common among Inuit control specimens, with an observed allele frequency of 0.17 (95% confidence interval 0.13–0.22). The predicted Hardy-Weinberg prevalence of CSID in the Inuit, based on this single founder allele is ˜3% (95% confidence interval 1.6–5.0%), comparable with previous estimates. Interpretation Targeted mutation testing for the c.273_274delAG allele should afford a simple and minimally invasive means of diagnosing CSID in persons of Inuit descent. Because CSID is a readily treatable disorder, such testing should be considered at an early stage in the assessment of Inuit patients with chronic diarrhoea.

High protein and cholesterol intakes associated with emergence of glucose intolerance in a low-risk Canadian Inuit population.

The rate of type 2 diabetes mellitus among Inuit is 12·2 % in individuals over 50 years of age, similar to the Canadian prevalence. Given marked dietary transitions in the Arctic, we evaluated the dietary and other correlates of not previously diagnosed glucose intolerance, defined as type 2 diabetes mellitus, impaired fasting glucose or impaired glucose tolerance. Cross-sectional analyses were limited to adults with a completed 2 h oral glucose tolerance test and without pre-existing diabetes. Anthropometric assessments, health and medication usage questionnaires and a 24 h dietary recall were administered. Canadian International Polar Year Inuit Health Survey (2007-2008). Inuit adults (n 777). Glucose intolerance was associated with older age and adiposity. Percentage of energy from protein above the Acceptable Macronutrient Distribution Range of 35 %, compared with intake within the range, was associated with increased odds of glucose intolerance (OR=1·98; 95 % CI 1·09, 3·61) in multivariable analyses. Further, cholesterol intake in the highest three quartiles combined (median exposures of 207, 416 and 778 mg/d, respectively) compared with the lowest quartile (median intake of 81 mg/d) was associated with glucose intolerance (OR=2·15; 95 % CI 1·23, 3·78) in multivariable analyses. Past-day traditional food consumption was borderline protective of glucose intolerance (P=0·054) and high fibre intake was not significantly protective (P=0·08). The results contribute to the existing literature on high protein and cholesterol intakes as they may relate to diabetes risk.

The Feasibility, Accuracy, and Impact of Xpert MTB/RIF Testing in a Remote Aboriginal Community in Canada

Xpert MTB/RIF testing for Mycobacterium tuberculosis and rifampin resistance is being used extensively in countries with a high burden of TB. However, recent evidence suggests that it may not have the same accuracy or impact in high-income, low-burden TB countries. A prospective, pragmatic study was done between March 2012 and March 2014 to determine the feasibility, accuracy, and impact on TB disease management provided by the Xpert test in a remote, medically underserved, predominantly Inuit population in Iqaluit, Nunavut, Canada. A total of 453 Xpert tests were run on sputum samples from 344 patients with suspected TB. Twenty-seven patients were identified as having active TB disease by culture. There were no cases of drug-resistant TB. Using culture as the gold standard, one Xpert test compared with one, two, or three sputum samples cultured per patient had a sensitivity of 85% (95% CI, 66%-95%) and a specificity of 99% (95% CI, 97%-100%) for detection of M tuberculosis. The indeterminate rate was 4.4% of all samples run. Treatment initiation was significantly shortened using Xpert vs the national standard of three smears (1.8 days vs 7.7 days, P < .007) and particularly shorter in smear-negative, culture-positive cases (1.8 days vs 37.1 days, P < .008). In a predominantly Inuit population in a remote region of Canada where the burden of TB is high and no TB testing facilities are available, onsite Xpert testing was feasible and accurate and shortened the time to TB treatment initiation.