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We investigated the availability of health system performance indicator data in Canada's 18 northern regions and the feasibility of using the performance framework developed by the Canadian Institute for Health Information [CIHI]. We examined the variation in 24 indicators across regions and factors that might explain such variation. The 18 regions vary in population size and various measures of socioeconomic status, health-care delivery, and health status. The worst performing health systems generally include Nunavut and the northern regions of Québec, Manitoba and Saskatchewan where indigenous people constitute the overwhelming majority of the population, ranging from 70% to 90%, and where they also fare worst in terms of adverse social determinants. All northern regions perform worse than Canada nationally in hospitalisations for ambulatory care sensitive conditions and potentially avoidable mortality. Population size, socioeconomic status, degree of urbanisation and proportion of Aboriginal people in the population are all associated with performance. The North is far from homogenous. Inter-regional variation demands further investigation. The more intermediate pathways, especially between health system inputs, outputs and outcomes, are largely unexplored. Improvement of health system performance for northern and remote regions will require the engagement of indigenous leadership, communities and patient representatives.

Despite the importance of indigenous people in the Arctic, there is no accurate estimate of their size and distribution. We defined indigenous people as those groups represented by the "permanent participants" of the Arctic Council. The census in Canada, Russia and the United States records status as an indigenous person. In Greenland, a proxy measure is place of birth supplemented by other information. For the Nordic countries we utilized a variety of sources including registered voters' lists of the various Sami parliaments and research studies that established Sami cohorts. Overall, we estimated that there were about 1.13 million indigenous people in the northern regions of the 8 Member States of the Arctic Council. There were 8,100 Aleuts in Alaska and the Russian North; 32,400 Athabaskans in Alaska and northern Canada; 145,900 Inuit in Alaska, northern Canada and Greenland; 76,300 Sami in northern Norway, Sweden, Finland and Russia; and 866,400 people in northern Russia belonging to other indigenous groups. Different degrees and types of methodological problems are associated with estimates from different regions. Our study highlights the complexity and difficulty of the task and the considerable gaps in knowledge. We hope to spur discussion of this important issue which could ultimately affect strategies to improve the health of circumpolar peoples.

Introduction: Canada's northern territories are characterized by small, scattered populations separated by long distances. A major challenge to healthcare delivery is the reliance on costly patient transportation, especially emergency air evacuations (medevacs). The purpose of this study was to describe the patterns, costs and providers' perspectives on patient transportation, and identify potential factors associated with utilization and performance., Methods: Secondary analyses of medical travel databases and an online survey of nurses in the communities and physicians in regional centers were undertaken., Results: The proportion of the population living within 100 km of a hospital was 83% in Yukon, 63% in Northwest Territories (NWT) and 21% in Nunavut. In Nunavut and NWT, road access to a hospital was limited to residents of the cities where the hospitals were located, with the rest relying exclusively on air travel. Medevac rates varied among the three territories: 0.9 trips/1000 residents/year in Yukon, 32/1000 in NWT and 53/1000 in Nunavut. In Yukon, all communities except one are road-accessible whereas in Nunavut no communities are connected by roads. The relative absence of roads is a major reason why the patient transportation costs are high in Nunavut and NWT. The rate of medevacs originating from the remote, air-accessible-only communities varied greatly, which cannot be explained by the air distance from the nearest hospital, population size or frequency of health center visits. Medical travel accounts for 5% of the health expenditures in NWT and 20% in Nunavut. A medevac on average costs $218 per person per year in NWT and $700 in Nunavut. The providers survey detected only 66% or less in support of statements that nurses in the communities received timely access to clinical advice, whereas only 50% of physicians agreed with statements that the clinical information provided by the nurses was clear., Conclusion: Patient transportation, especially emergency air evacuations, is an essential but costly component of the healthcare system serving Canada's north. It is the 'glue' that binds an extensive network of facilities staffed by different categories of health professionals. While system design is largely dictated by geography, addressing human factors such as interprofessional communication is important for improving the system's effectiveness. This study is primarily descriptive and it points to additional areas for improved understanding of the performance of the system.

Background: Health surveys are a rich source of information on a variety of health issues, including health care., Objectives: This article compares various national and regional surveys in terms of their geographical coverage with respect to the Canadian North, especially their Aboriginal population, and the comparability of the survey contents relating to health care., Methods: Three surveys were selected as providing some information on health care, with separate estimates for the North and its Aboriginal populations. They are the Canadian Community Health Survey (CCHS), Aboriginal Peoples Survey (APS) and the First Nations Regional Health Survey (RHS)., Results: Different surveys focus on different categories of Aboriginal people, and no single survey has covered all categories of Aboriginal people in the North consistently. RHS is targeted at the on-reserve First Nations population only. APS and CCHS sample the off-reserve First Nations population as well as Métis and Inuit. To achieve adequate sample size for North-South comparisons and comparisons among Aboriginal groups within the North, several cycles of the biennial/annual CCHS can be merged, producing a large data set with consistent coverage of topics using comparable questions. The content areas of the 3 surveys can be broadly categorized as health status, health determinants and health care. Substantial variation exists across surveys in the domains covered. There are also changes over time in terms of definitions, questions and even basic concepts. The available health care content of the 3 surveys focus on access to different types of health services, contact with different categories of health professionals, unmet health needs and the use of preventive services. Many important dimensions of health care are not covered. Not all these basic indicators are available for the North or its Aboriginal populations., Conclusions: A comprehensive survey of health care in the North with sufficient sample size to provide reliable estimates for its subpopulations - urban and remote, Aboriginal and non-Aboriginal, and First Nations, Inuit and Métis - would provide useful information to decision-makers and service providers. Analytical studies can also be conducted to investigate the correlations and interactions among health status, health determinants and health care and assess whether such relationships differ among the different population groups.

Background: Inuit are considered to be vulnerable to cardiovascular disease because their lifestyles are becoming more Westernized. During sequence analysis of Inuit individuals at extremes of lipid traits, we identified 2 nonsynonymous variants in low-density lipoprotein receptor (LDLR), namely p.G116S and p.R730W., Methods and Results: Genotyping these variants in 3324 Inuit from Alaska, Canada, and Greenland showed they were common, with allele frequencies 10% to 15%. Only p.G116S was associated with dyslipidemia: the increase in LDL cholesterol was 0.54 mmol/L (20.9 mg/dL) per allele (P=5.6×10(-49)), which was >3× larger than the largest effect sizes seen with other common variants in other populations. Carriers of p.G116S had a 3.02-fold increased risk of hypercholesterolemia (95% confidence interval, 2.34-3.90; P=1.7×10(-17)), but did not have classical familial hypercholesterolemia. In vitro, p.G116S showed 60% reduced ligand-binding activity compared with wild-type receptor. In contrast, p.R730W was associated with neither LDL cholesterol level nor altered in vitro activity., Conclusions: LDLR p.G116S is thus unique: a common dysfunctional variant in Inuit whose large effect on LDL cholesterol may have public health implications., (© 2014 American Heart Association, Inc.)

Background: Very little population-based research has been conducted around the exclusive breastfeeding practices of Inuit Canadians., Objectives: This research aims to assess the distribution of exclusive breastfeeding among Inuit Canadians and to identify factors associated with exclusive breastfeeding as recommended., Methods: We use data from 188 infant-mother dyads who completed the Nunavut Inuit Child Health Survey, a cross-sectional, population-based survey of Inuit children aged 3 to 5 years. A series of multinomial logistic regression models were run to identify factors associated with 4 exclusive breastfeeding durations (≤ 1 month, > 1-< 5.5 months, 5.5-6.5 months, and > 6.5 months)., Results: Of infants, 23% were exclusively breastfed as recommended (ie, between 5.5 and 6.5 months; 95% CI, 16.2-29.3). Many infants (61%) were exclusively breastfed for less than 5.5 months and 16% (95% CI, 10.9-22.0) were exclusively breastfed for more than 6.5 months. Families receiving income support were less likely to discontinue exclusive breastfeeding before 5.5 months (pOR1- < 5.5 months = 0.34; 95% CI, 0.13, 0.85) relative to those not receiving income support, in adjusted models. No other measured factors were significantly related to exclusive breastfeeding duration., Conclusions: The majority of Inuit Canadian infants receive suboptimal exclusive breastfeeding. National, provincial, and community-specific interventions to protect, promote, and support exclusive breastfeeding should emphasize not only the benefits of exclusively breastfeeding to 6 months but also the importance of timely introduction of complementary foods into the infant's diet.

Introduction: We examined the concordance between the Canadian Community Health Survey (CCHS) "identity" and "ancestry" questions used to estimate the size of the Aboriginal population in Canada and whether the different definitions affect the prevalence of selected chronic diseases., Methods: Based on responses to the "identity" and "ancestry" questions in the CCHS combined 2009-2010 microdata file, Aboriginal participants were divided into 4 groups: (A) identity only; (B) ancestry only; (C) either ancestry or identity; and (D) both ancestry and identity. Prevalence of diabetes, arthritis and hypertension was estimated based on participants reporting that a health professional had told them that they have the condition(s)., Results: Of participants who identified themselves as Aboriginal, only 63% reported having an Aboriginal ancestor; of those who claimed Aboriginal ancestry, only 57% identified themselves as Aboriginal. The lack of concordance also differs according to whether the individual was First Nation, Métis or Inuit. The different method of estimating the Aboriginal population, however, does not significantly affect the prevalence of the three selected chronic diseases., Conclusion: The lack of concordance requires further investigation by combining more cycles of CCHS to compare discrepancy across regions, genders and socio-economic status. Its impact on a broader list of health conditions should be examined.

Background: The study's objective was to investigate the dietary correlates of an at-risk body mass index (BMI) among Inuit adults from thirty-six communities across the Canadian Arctic using data from the cross-sectional International Polar Year Inuit Health Survey, conducted in 2007-2008., Methods: The survey included assessments of 24-hr dietary recall, sociodemographics, physical activity, and anthropometry. Dietary characteristics of overweight and obesity were similar and therefore combined into one at- risk BMI category (≥25 kg/m2) for analyses. The relationship between an at-risk BMI and energy intake from macronutrients, high sugar drinks, high-fat foods, saturated fatty acids, and traditional foods were examined entering each dietary variable separately into a logistic regression model as an independent variable. Analyses were adjusted for age, sex, region, kcalories, walking, smoking and alcohol consumption. Further multivariable models considered selected dietary variables together in one model., Results: An at-risk BMI was present for 64% with a prevalence of overweight and obesity of 28% and 36%, respectively. Consumption of high-sugar drinks (>15.5% E) was significantly related with having an at-risk BMI (OR = 1.6; 95% CI 1.2; 2.2), whereas the % E from total carbohydrate evaluated as a continuous variable and as quartiles was inversely related to an at-risk BMI (P -trend < 0.05) in multivariable analyses. While % E from high-fat foods was positively related to an at-risk BMI, the findings were not significant in a model controlling for high-sugar drinks and % E from carbohydrates., Conclusions: The prevalence of overweight and obesity is of public health concern among Inuit. The current findings highlight the obesogenic potential of high-sugar drink consumption in an ethnically distinct population undergoing rapid cultural changes and raises concerns regarding carbohydrate restricted diets. Health promotion programs aimed at preventing the development of an unhealthy body weight should focus on physical activity and the promotion of healthy diets with reduced intake of sugar drinks.

Objectives: Aboriginal Canadians have a high burden of obesity and obesity-related chronic conditions. Body mass index (BMI) trajectories from 1994 to 2009 were estimated for Aboriginal and non-Aboriginal Canadians using self-reported height and weight data from the National Population Health Survey to explore age, period, and cohort effects of BMI change., Methods: Linear growth curve models were estimated for 311 Aboriginal and 10,967 non-Aboriginal respondents divided into five birth cohorts born in the 1940s, 50s, 60s, 70s, and 80s., Results: Overall, Aboriginal Canadians experienced higher rates of BMI increase over the 14-year period. Rate of BMI increase was specifically higher for Aboriginal adults born in the 1960s and 1970s when compared with non-Aboriginal adults. At ages 25, 35, and 45, recent-born cohorts had consistently higher BMIs compared with earlier-born cohorts with magnitudes of differences typically larger in the Aboriginal population. Recent-born cohorts also exhibited steeper BMI trajectories., Conclusions: Cohort effects may be responsible for the divergent BMI trajectories between Aboriginal and non-Aboriginal Canadians born in the 1960s and 1970s. Aboriginal Canadians, particularly of more recent-born cohorts, experienced faster increases in BMI from 1994 to 2009 than non-Aboriginal Canadians, suggesting that prevalence of obesity will continue to rise in this population without intervention., (Copyright © 2012 Wiley Periodicals, Inc.)

Objectives: Large disparities exist between Aboriginal and non-Aboriginal Canadians in both obesity and socio-economic status (SES). The purpose of this paper was to assess associations between obesity and three indicators of SES - employment, education and income - in conjunction with demographic and lifestyle factors., Methods: Using the nationally-representative Canadian Community Health Survey (CCHS) cycle 2.2 (2004), among 334 off-reserve Aboriginal and 6,259 non-Aboriginal Canadians aged 25-64 years in the 10 provinces, obesity status was determined by body mass index derived from measured height and weight. Logistic regression was used to assess the relationships between socio-demographic variables and obesity status., Results: Controlling for other socio-economic and lifestyle factors, odds for obesity were lower by 80% among Aboriginal men and 64% among Aboriginal women who were employed during the 12 months prior to the survey compared to Aboriginal men and women who were not employed. Employment was not significantly associated with obesity among non-Aboriginal adults. Probability for obesity increased as household income increased among Aboriginal men, but a negative association between income and obesity was observed among Aboriginal women. These associations persisted after adjustment for physical activity level, fruit and vegetable consumption, smoking, and marital status in the models., Conclusion: Unemployment among obese Aboriginal Canadians warrants attention. The knowledge that both high and low SES Aboriginal Canadians, of varying socio-demographic characteristics and lifestyle, experience high rates of obesity can lead to new hypotheses of how obesity develops in this population and influence how interventions are planned.

Background: Inuit have not experienced an epidemic in type 2 diabetes mellitus, and it has been speculated that they may be protected from obesity's metabolic consequences. We conducted a population-based screening for diabetes among Inuit in the Canadian Arctic and evaluated the association of visceral adiposity with diabetes., Methods: A total of 36 communities participated in the International Polar Year Inuit Health Survey. Of the 2796 Inuit households approached, 1901 (68%) participated, with 2595 participants. Households were randomly selected, and adult residents were invited to participate. Assessments included anthropometry and fasting plasma lipids and glucose, and, because of survey logistics, only 32% of participants underwent a 75 g oral glucose tolerance test. We calculated weighted prevalence estimates of metabolic risk factors for all participants., Results: Participants' mean age was 43.3 years; 35% were obese, 43.8% had an at-risk waist, and 25% had an elevated triglyceride level. Diabetes was identified in 12.2% of participants aged 50 years and older and in 1.9% of those younger than 50 years. A hypertriglyceridemic-waist phenotype was a strong predictor of diabetes (odds ratio [OR] 8.6, 95% confidence interval [CI] 2.1-34.6) in analyses adjusted for age, sex, region, family history of diabetes, education and use of lipid-lowering medications., Interpretation: Metabolic risk factors were prevalent among Inuit. Our results suggest that Inuit are not protected from the metabolic consequences of obesity, and that their rate of diabetes prevalence is now comparable to that observed in the general Canadian population. Assessment of waist circumference and fasting triglyceride levels could represent an efficient means for identifying Inuit at high risk for diabetes.

Introduction: Despite high diabetes rates among Canadian First Nations people, little is known about their cardiovascular disease risk. Our aim was to describe the apolipoprotein profile with respect to cardiovascular risk in a Canadian First Nation community., Methods: In 2003, a representative sample of adult members of a Manitoba First Nation (N = 483) participated in a screening study for diabetes and diabetes complications. We assessed their cardiovascular risk factors., Results: Sixty percent of women were at increased cardiovascular risk because of low apolipoprotein A1 (apoA1) levels, compared with 35% of men. The proportion of women with low apoA1 levels decreased with age, but the proportion with low high-density lipoprotein levels remained stable across age groups. Both apoB and apoA1 were significantly associated with obesity when age, sex, diastolic blood pressure, homocysteine, diabetes, and insulin resistance were controlled for., Conclusion: Apolipoprotein and lipid profiles in this First Nation population suggest high cardiovascular risk. Future research should characterize the lipoprotein particle size in this population.

Background: Information on arthritis and other musculoskeletal disorders among Aboriginal people is sparse. Survey data show that arthritis and rheumatism are among the most commonly reported chronic conditions and their prevalence is higher than among non-Aboriginal people., Objective: To describe the burden of arthritis among Aboriginal people in northern Canada and demonstrate the public health significance and social impact of the disease., Methods: Using cross-sectional data from more than 29,000 Aboriginal people aged 15 years and over who participated in the Aboriginal Peoples Survey 2006, we assessed regional differences in the prevalence of arthritis and its association with other risk factors, co-morbidity and health care use., Results: The prevalence of arthritis in the three northern territories ("North") is 12.7% compared to 20.1% in the provinces ("South") and is higher among females than males in both the North and South. The prevalence among Inuit is lower than among other Aboriginal groups. Individuals with arthritis are more likely to smoke, be obese, have concurrent chronic diseases, and are less likely to be employed. Aboriginal people with arthritis utilized the health care system more often than those without the disease., Conclusions: Aboriginal-specific findings on arthritis and other chronic diseases as well as recognition of regional differences between North and South will enhance program planning and help identify new priorities in health promotion.

Introduction: We investigated ethnic and geographic variations in major chronic diseases and risk factors in northern Canada, an area that is undergoing rapid changes in its social, cultural, and physical environments., Methods: Self-report data were obtained from the population-based Canadian Community Health Survey in 2000-2001 and 2005-2006 for Aboriginal and non-Aboriginal respondents from the 3 regions of northern Canada: Yukon, Northwest Territories, and Nunavut. Crude prevalence estimates, adjusted odds ratios (AORs), and confidence intervals were calculated for multiple chronic diseases and risk factors., Results: The percentage of Aboriginal respondents who reported having any chronic health condition increased between the 2 cycles of data collection, but did not change for non-Aboriginal respondents. AORs for heart disease, arthritis, and asthma varied by ethnicity or region. AORs for overweight, obesity, daily smoking, regular and binge drinking, and infrequent physical/leisure activity were also substantially different for Aboriginal and non-Aboriginal respondents or among respondents from the 3 northern regions., Conclusion: The changing profile of health in northern Canada suggests a need for action on health policy about the delivery of community-based primary prevention interventions and further research about the determinants of health and health care use.

Objective: Retinopathy status as a screening method to predict cognitive health is limited. The objective of this study was to examine the association between retinopathy and lowered cognitive performance in a Canadian First Nations population., Methods: Eligible individuals were assessed by the Clock Drawing Test (CDT) and the Trail Making Test Parts A and B, which were combined into an executive function score (TMT-exec). Digital fundus photographs were taken for both eyes to assess retinopathy. Anthropometric, vascular and metabolic risk factors were assessed by interview, clinical examinations and blood tests. Carotid atherosclerosis was assessed by Doppler ultrasonography., Results: Retinopathy was detected in 7.1% of the population. Individuals classified as having a previous history of cardiovascular disease, insulin resistance and diabetes were more likely to have retinopathy. No other cardiovascular risk factors were associated. In unadjusted analysis, there were no associations between retinopathy and lowered cognitive performance (CDT, odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.30–2.53; TMT-exec, OR: 1.79, 95% CI: 0.60–5.33). Multivariable adjusted analysis also showed no associations, although sample size may be limiting., Conclusions: Retinopathy was not associated with lowered cognitive performance. Associations for microvascular risk factors suggest a panel of cognitive tests is needed for future studies.

Background: In Canada, the prevalence of behavioural risk factors and chronic conditions differs for Aboriginal and non-Aboriginal populations, but little research has examined changes over time. This study compares several major risk factors and chronic conditions in Aboriginal and non-Aboriginal populations not living on reserves in the North (Yukon, Northwest Territories, Nunavut) and in southern Canada at two time points., Data and Methods: The data are from cycle 1.1 (2000/2001) and cycle 3.1 (2005/2006) of the Canadian Community Health Survey: 115,990 respondents aged 20 or older, and 118,716 respondents, respectively. Overall, 3.8% of respondents reported Aboriginal cultural or racial background. Crude prevalence estimates, adjusted odds ratios, and bootstrap-derived confidence intervals were calculated for seven risk factors and nine chronic conditions at each time point., Results: In 2000/2001, Aboriginal people in the North were more likely than those in southern Canada to be obese, smoke daily and have infrequent physical activity, but less likely report a number of chronic conditions. Between 2000/2001 and 2005/2006, the odds of reporting risk factors increased among Aboriginal people in the North, and differences in the prevalence of chronic diseases were less pronounced. Few differences between non-Aboriginal respondents in the North and in southern Canada were observed., Interpretation: Compared with southern Canada, the profile of health is changing more rapidly for Aboriginal than non-Aboriginal populations in the North, and appears to be worsening for the former.

Objective: The purpose of this study was to determine the prevalence of and risk factors for diabetic neuropathy in a Canadian First Nation population., Research Design and Methods: This was a community-based screening study of 483 adults. Measures included glucose, A1C, cholesterol, triglycerides, homocysteine, hypertension, waist circumference, height, weight, and foot examinations. Neuropathy was defined as loss of protective sensation determined through application of a 10-g monofilament., Results: Twenty-two percent of participants had a previous diagnosis of diabetes, and 14% had new diabetes or impaired fasting glucose (IFG). The prevalence of neuropathy increased by glucose level: 5% among those with normal glucose levels, 8% among those with new IFG and diabetes, and 15% among those with established diabetes (P < 0.01). Those with neuropathy were more likely to have foot deformities (P < 0.01) and callus (P < 0.001) than those without neuropathy. Among those with dysglycemia (>or=6.1 mmol/l), the mean number of foot problems for those with insensate feet was 3 compared with 0.3 among those with sensation (P < 0.001). In multivariate logistic regression female sex, low education, A1C, smoking, and homocysteine were independently associated with neuropathy, after controls for age., Conclusions: Neuropathy prevalence is high, given the young age of our participants (mean 40 years) and was present among those with undiagnosed diabetes. The high number and type of foot problems places this population at increased risk for ulceration; the low level of foot care in the community increases the risk. Homocysteine is a risk factor that may be related to lifestyle and requires further investigation.

Objectives: To examine if Aboriginal health research conducted within the field of social sciences reflects the population and geographic diversity of the Aboriginal population., Study Design: Review., Methods: We searched the Web of Science Social Science Citation Index, the Arts and Humanities Citation Index and Scholars Portal for the time period 1995-2005 using search terms to reflect different names used to refer to Canada's Aboriginal peoples. Citations that did not focus on health or Canada were eliminated. Each paper was coded according to 7 broad categories: Aboriginal identity group; geography; age; health status; health determinants; health services; and methods., Results: Based on the 96 papers reviewed, the results show an under-representation of Métis and urban Aboriginal peoples. Most of the papers are on health status and non-medical determinants of health, with a particular focus on chronic conditions and life-style behaviours. Only 6 papers examined traditional approaches to healing and/or access to traditional healers/medicines. A small number involved the use of community-based research methods., Conclusions: Further research is required to address gaps in the current body of literature. Community-based research studies are necessary to address gaps that are most relevant to Aboriginal peoples.

Background: The rs9939609 T>A single-nucleotide polymorphism (SNP) in the FTO gene has previously been found to be associated with obesity in European Caucasian samples. The objective of this study is to examine whether this association extends to metabolic syndrome (MetS) and applies in non-Caucasian samples., Methods: The FTO rs9939609 SNP was genotyped in 2121 subjects from four different non-Caucasian geographical ancestries. Subjects were classified for the presence or absence of MetS according to the International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III definitions., Results: Carriers of > or = 1 copy of the rs9939609 A allele were significantly more likely to have IDF-defined MetS (35.8%) than non-carriers (31.2%), corresponding to a carrier odds ratio (OR) of 1.23 (95% confidence interval [CI] 1.01 to 1.50), with a similar trend for the NCEP ATP III-defined MetS. Subgroup analysis showed that the association was particularly strong in men. The association was related to a higher proportion of rs9939609 A allele carriers meeting the waist circumference criterion; a higher proportion also met the HDL cholesterol criterion compared with wild-type homozygotes., Conclusion: Thus, the FTO rs9939609 SNP was associated with an increased risk for MetS in this multi-ethnic sample, confirming that the association extends to non-Caucasian population samples.

Background: Common polymorphisms in the promoter of the APOC3 gene have been associated with hypertriglyceridemia and may impact on phenotypic expression of the metabolic syndrome (MetS). The rs7566605 marker, located near the INSIG2 gene, has been found to be associated with obesity, making it also a potential genetic determinant for MetS. The objective of this study is to examine the APOC3 -455T>C and the INSIG2 rs7566605 polymorphisms as potential genetic determinants for MetS in a multi-ethnic sample., Methods: Subjects were genotyped for both the APOC3 -455T>C and INSIG2 rs7566605 polymorphisms, and classified for the presence or absence of MetS (NCEP ATP III and IDF definitions). The total study population included 2675 subjects (> or =18 years of age) from six different geographical ancestries., Results: For the overall study population, the prevalence of MetS was 22.6% (NCEP ATP III definition). Carriers of > or =1 copy of APOC3 -455C were more likely to have MetS (NCEP ATP III definition) than noncarriers (carrier odds ratio 1.73, 95% CI 1.40 to 2.14, adjusting for age and study group). The basis of the association was related not only to a higher proportion of -455C carriers meeting the triglyceride and high-density lipoprotein cholesterol criteria, but also the blood pressure criteria compared with wild-type homozygotes. Plasma apo C-III concentrations were not associated with APOC3 -455T>C genotype. The INSIG2 rs7566605 polymorphism was not associated with MetS or measures of obesity., Conclusion: Meta-analysis of the sample of multiple geographic ancestries indicated that the functional -455T>C promoter polymorphism in APOC3 was associated with an approximately 2-fold increased risk of MetS, whereas the INSIG2 rs7566605 polymorphism was not associated with MetS.

Objectives: We investigated the prevalence of obesity and the metabolic correlates of different levels of body mass index (BMI) and waist circumference among the Inuit in 3 countries., Methods: Data from 4 surveys of Inuit in Canada, Greenland, and Alaska conducted during 1990-2001 were pooled, with a total sample size of 2545 participants. These data were compared with data from a Canadian population of predominantly European origin., Results: Using the World Health Organization criteria for overweight and obesity, we found that the crude prevalence of overweight among Inuit men and women was 36.6% and 32.5%, respectively, and obesity was 15.8% and 25.5%, respectively. Inuit prevalences were similar to those of the highly developed countries of Europe and North America. As levels of obesity increased, as measured by BMI or waist circumference, the mean values of various metabolic indicators-lipid, glucose, and insulin levels and blood pressure-also increased. However, at each level of BMI or waist circumference, the Inuit had lower blood pressure and lipid levels than did Euro-Canadians., Conclusions: Our data indicate that universal criteria for obesity may not reflect the same degree of metabolic risk for populations such as the Inuit and suggest that ethnic-specific criteria are needed.

This paper summarizes available information on patterns of physical activity, their determinants and consequences, and the results of various interventions designed to increase the physical activity of Aboriginal peoples in Canada and the United States. There is a paucity of national data on this issue for Aboriginal peoples. The most recent data, from the First Nations Regional Longitudinal Health Survey of 2002-2003, indicate that 21% of adults (27% of men, 15% of women) were engaging in at least 30 min of moderate to vigorous physical activity on 4 d/week or more. The present paper highlights the unique challenges this group faces, underlining the need to integrate collective knowledge regarding how much physical activity is required for Aboriginal Canadians, and how this activity should be accomplished, to promote and maintain health. Efforts are currently underway to tailor Canada's physical activity guide for First Nations, Inuit, and Métis. Future research among Aboriginal groups should examine the minimal and optimal levels of physical activity required to achieve health benefits.

This paper summarizes available information on patterns of physical activity, their determinants and consequences, and the results of various interventions designed to increase the physical activity of Aboriginal peoples in Canada and the United States. There is a paucity of national data on this issue for Aboriginal peoples. The most recent data, from the First Nations Regional Longitudinal Health Survey of 2002-2003, indicate that 21% of adults (27% of men, 15% of women) were engaging in at least 30 min of moderate to vigorous physical activity on 4 d/week or more. The present paper highlights the unique challenges this group faces, underlining the need to integrate collective knowledge regarding how much physical activity is required for Aboriginal Canadians, and how this activity should be accomplished, to promote and maintain health. Efforts are currently underway to tailor Canada's physical activity guide for First Nations, Inuit, and Métis. Future research among Aboriginal groups should examine the minimal and optimal levels of physical activity required to achieve health benefits.

This article summarizes the main findings from the papers included in this journal supplement. It consolidates the evidence currently available to inform and advance the development of physical activity guidelines for Canadians, and it highlights the specific needs of various population subgroups. The challenges of translating guideline information into effective and persuasive physical activity messages, of campaigns to disseminate messages and of related evaluations are underlined. Recommendations on how to proceed are based on the evidence base provided by this series of papers; the immediate next steps mandated by this initiative are outlined and priorities for future research are indicated.

We sequenced the promoter and coding regions of PCK1 encoding cytosolic phosphoenolpyruvate carboxykinase from genomic DNA of subjects with type 2 diabetes mellitus (DM). We found nine single nucleotide polymorphisms (SNPs) that were present with varying allele frequencies and pairwise linkage disequilibrium relationships in different ethnic groups. The -232C-->G promoter SNP was within a cis-acting element required for basal and cAMP-mediated PCK1 gene transcription. The expression of a luciferase reporter construct containing -232G in three different cell lines showed significantly increased basal expression with no down-regulation by insulin compared with a construct containing -232C. The odds ratios for type 2 DM among subjects with one or two copies of -232G compared with -232C/C homozygotes were 1.9 (95% confidence interval, 1.2-3.0) in a Canadian aboriginal sample and 2.8 (95% confidence interval, 1.7-4.7) in a Caucasian sample. Thus, we report a promoter SNP in PCK1 that was resistant to down-regulation by insulin in vitro and was associated with type 2 DM in two independent study samples.

A population-based health interview and examination survey of 8 Inuit communities in the Kivalliq region of Nunavut, Canada, during the early 1990s has resulted in an increased understanding of the burden and extent of cardiovascular diseases and diabetes and their risk factors such as genetics, obesity, lipids, blood pressure and fatty acids. A recent national health interview survey which included a sample from Nunavut indicates that the Inuit still enjoy some advantages relative to other Canadians (lower level of self-reported diabetes and hypertension) and disadvantages (higher level of smoking, obesity, and heavy drinking). The pattern of health and disease among the Inuit is rapidly evolving, as the traditional lifestyle becomes further eroded. A long-term prospective cohort study that monitors this trend, investigates the etiology, and identifies potential interventions is urgently needed.

Objective: To determine if research has adequately examined the health needs of the aboriginal population of Canada., Design: Review., Study Selection: Medline search of journal articles published during 1992-2001. The search terms used were "Canada" and various synonyms and categories for Canadian aboriginal people. Each paper was categorised according to the aboriginal group, age-sex group, comparison group, geographic location, and type of research topic (health determinant, health status, or health care)., Results: Of 352 citations found, 254 were selected after elimination of those without abstracts, not containing data on Canada, or not focusing on health issues. The proportion of papers does not reflect the demographic composition of aboriginal people in Canada, with severe under-representation of Métis, urban aboriginal people, and First Nations people not living on reserves and over-representation of the Inuit. Children and women received less attention proportional to their share of the population. A few prolific research groups have generated a disproportionate amount of publications from a few communities and regions. 174 papers dealt with health determinants (for example, genetics, diet, and contaminants), 173 with health status, and 75 with health care. Injuries, which account for a third of all deaths, were studied in only 8 papers. None of the health care papers examined rehabilitation., Conclusion: Researchers have not adequately examined several important health needs of the aboriginal population.

Objectives: This article examines the prevalence and incidence of diabetes among Canadians aged 18 or older and risk factors associated with developing the condition., Data Sources: The data are from the 1994/95, 1996/97, 1998/99 and 2000/01 National Population Health Survey and the 2000/01 Canadian Community Health Survey, both conducted by Statistics Canada., Analytical Techniques: Descriptive statistics on the prevalence and incidence of self-reported diabetes were computed. Multiple logistic regression was used to identify predictors of incident diabetes. Age-adjusted rates were used to compare diabetic and non-diabetic respondents on a variety of health measures., Main Results: In 2000/01, 4.5% of Canadians aged 18 or older, an estimated 1.1 million, reported having diabetes. The incidence from 1994/95 to 2000/01 was 4.9 new cases per 1,000 person-years at risk. When the possible confounding effects of a number of factors were taken into account, advancing age, family history, sedentary leisure time and excess weight were associated with developing diabetes.

Objectives: To contrast the population and clinical approaches to stroke prevention and to review Canadian data relevant to estimating disease burden, assessing risk factors, designing preventive strategies and organizing health services., Method: A narrative review of the published literature and statistical data accessible through the Internet., Main Findings: Unlike the clinical approach, which emphasizes individual patients at high risk diagnosed and treated intensively, usually by medical or surgical means (or both), a population approach focuses on the entire population and bases interventions on behavioural and environmental changes. Stroke offers a particularly promising target for prevention. It represents a leading cause of serious disability, death and reduced quality of life. The aging of our population threatens to increase the already considerable burden. Stroke shares several risk factors with other chronic diseases, especially ischemic heart disease. These risk factors vary in their impact on Canadians (population attributable risk proportion), which is a function of their prevalence and strength of association with the occurrence of stroke. Although effective preventive measures are available for people at high risk, they are not being applied systematically among potential beneficiaries. Small reductions in the exposure to risk factors in the entire population offer an alternative, where even modest success may translate into major gain., Conclusions: The clinical and population approaches to stroke prevention are complementary. Existing national strategies directed at promotion of healthy life-styles (especially physical activity) and hypertension control, when fully implemented, will reduce the frequency, severity and impact of stroke on Canadian society.

Background: The notion that the incidence of ischemic heart disease (IHD) is low among the Inuit subsisting on a traditional marine diet has attained axiomatic status. The scientific evidence for this is weak and rests on early clinical evidence and uncertain mortality statistics., Methods: We reviewed the literature and performed new analyses of the mortality statistics from Greenland, Canada, and Alaska., Findings: The evidence for a low mortality from IHD among the Inuit is fragile and rests on unreliable mortality statistics. Mortality from stroke, however, is higher among the Inuit than among other western populations. Based on the examination of 15 candidate gene polymorphisms, the Inuit genetic architecture does not obviously explain putative differences in cardiovascular disease prevalence., Interpretation: The mortality from all cardiovascular diseases combined is not lower among the Inuit than in white comparison populations. If the mortality from IHD is low, it seems not to be associated with a low prevalence of general atherosclerosis. A decreasing trend in mortality from IHD in Inuit populations undergoing rapid westernization supports the need for a critical rethinking of cardiovascular epidemiology among the Inuit and the role of a marine diet in this population.

The promoter sequence variant -278A in the CYP7 gene, which encodes cholesterol 7-alpha hydroxylase, was previously reported to be associated with reduced plasma low density lipoprotein (LDL) cholesterol concentration. We tested for association of CYP7-278A with plasma lipoprotein traits in samples taken from three distinct Canadian populations: 594 Alberta Hutterites, 325 Ontario Oji-Cree and 190 Keewatin Inuit. The CYP7-278A allele frequencies in these three groups were 0.708, 0.466 and 0.490, respectively. The frequencies of CYP7-278A/A homozygotes were 0.481, 0.215 and 0.247, respectively. In the Hutterites, CYP7-278A was associated with reduced plasma HDL-cholesterol and apolipoprotein AI concentration. In the Oji-Cree, CYP7-278A was not significantly associated with any plasma lipoprotein trait. In the Inuit CYP7-278A was associated with elevated plasma total and LDL-cholesterol. There was no consistent relationship between the population mean plasma LDL-cholesterol concentration and the population CYP7-278A frequency. Our findings suggest that the common -278A promoter variant of CYP7 was inconsistently associated with variation in plasma LDL- and HDL-cholesterol in samples from three independent populations. The inconsistencies could be due to differences in genetic background or to unspecified environmental or genetic factors.

This review provides a status report on the epidemic of type 2 diabetes mellitus that is affecting many of Canada's First Nations. We focus on the published literature, especially reports published in the past 2 decades, and incorporate data from the Aboriginal Peoples Survey and the First Nations and Inuit Regional Health Survey. We look at the extent and magnitude of the problem, the causes and risk factors, primary prevention and screening, clinical care and education, and cultural concepts and traditional knowledge. The epidemic of type 2 diabetes is still on the upswing, with a trend toward earlier age at onset. Genetic-environmental interactions are the likely cause. Scattered intervention projects have been implemented and evaluated, and some show promise. The current health and social repercussions of the disease are considerable, and the long-term outlook remains guarded. A national Aboriginal diabetes strategy is urgently needed.

Serum paraoxonase circulates on a subfraction of high density lipoproteins and appears to use phospholipids on both low and high density lipoprotein particles as a physiological substrate. This functional relationship could explain the reported associations between common variation in the PON1 gene--at codons 55 and 192--and phenotypes related to atherosclerosis and lipoprotein metabolism. We evaluated associations between plasma lipoproteins and PON1 L/M55, PON1 Q/R192 and PON2 A/G148 polymorphisms in samples from two Canadian aboriginal populations, namely the Oji-Cree and the Inuit. In diabetic Oji-Cree, we found that carriers of PON1 M55 had a higher mean plasma triglyceride concentration than non-carriers. In non-diabetic Oji-Cree, we found that carriers of PON1 M55 had higher mean plasma concentrations of total and low density lipoporetein cholesterol and apo B than non-carriers. In Inuit, we found that carriers of PON1 M55 had higher mean plasma concentrations of total and low density lipoprotein cholesterol than non-carriers. The other polymorphic markers were not associated with variation in any plasma lipoprotein trait. Thus, the PON1 M55 allele appeared to be associated with deleterious changes in the plasma lipoprotein profile from two independent Canadian aboriginal samples. These results suggest that common variation in PON1 codon 55 is associated with variation of intermediate traits in plasma lipoprotein metabolism in aboriginal Canadians.

The GNB3 825T allele encodes a product that has enhanced activation of heterotrimeric G proteins in vitro and could play a role in adipogenesis. We therefore evaluated the possibility that the GNB3 825T allele was associated with obesity in a sample of 213 healthy Canadian Inuit. We found that body weight, body mass index, waist girth, hip girth, subscapular skinfold thickness, and triceps skinfold thickness were significantly higher in subjects with the GNB3 825T/T genotype than in subjects with other genotypes. Furthermore, two anthropometric ratios, namely that of waist to hip circumference and that of subscapular to triceps skinfold thickness, were not significantly different across genotypes. This suggested that the increased deposition of fat in subjects with the GNB3 825T/T genotype was generalized and not localized to particular subregions. There was no association of this genetic variation with blood pressure. The GNB3 825T/T genotype accounted for between 1.6% and 3.3% of the total variation (< or =13% of attributable variation) of the obesity-related traits. The potential for a genetic marker of obesity creates opportunities for future studies in the Inuit, not just to confirm the associations, but also to examine prospectively the influence of interventions and possible relationships between GNB3 825T and longer term complications of obesity.

The promoter sequence variant -480T in the hepatic lipase gene (LIPC) has been shown to be significantly associated with low post-heparin hepatic lipase activity. Some studies have also found that the -480T variant is associated with elevation in plasma HDL cholesterol. We tested for associations of LIPC -480T with plasma lipoprotein traits in samples taken from three distinct Canadian populations: 657 Alberta Hutterites, 328 Ontario Oji-Cree and 210 Keewatin Inuit. Plasma HL activity was not available for analyses. The LIPC -480T allele frequencies in these three groups, respectively, were 0.219, 0.527 and 0.383, and the prevalence of LIPC -480T/T homozygotes was, respectively, 0.042, 0.274 and 0.167. No significant association was found between LIPC -480T and plasma HDL cholesterol or apolipoprotein AI concentration, after adjusting for covariates including gender and body mass index. There was no consistent relationship between the population mean plasma HDL cholesterol concentration and the population LIPC -480T frequency. Our findings are consistent with the idea that the common promoter variation in LIPC, which has been reported to be associated with variation in post heparin HL activity and HDL triglyceride concentration, is not always associated with variation in plasma HDL cholesterol concentration, possibly due to yet unspecified environmental or genetic factors.

As part of the Keewatin Health Assessment Study, a comprehensive health interview and examination survey of Inuit and non-Inuit in the central Canadian Arctic during 1990-91, plasma samples were analyzed for phospholipid fatty acid composition. Compared to non-Inuit, the Inuit have reduced levels of dihomo-gamma-linoleic (DGLA) and arachidonic acid (ratios of 0.41 and 0.46) and the sum of all n-6 fatty acids (ratio of 0.65), but increased level of eicosapentaenoic (EPA) acid (ratio of 1.37). These trends are consistent with those reported from other circumpolar Inuit populations, especially the reduced arachidonic acid and increased EPA, although the Inuit excess in EPA is much less pronounced due to the greater importance of caribou rather than sea mammals in most of the Keewatin communities. The high linoleic/arachidonic acid ratio suggests increased inhibition of the metabolic pathway regulated by the enzyme delta-5 desaturase, which can be explained by the presence of high levels of highly unsaturated fatty acids of dietary origin, and/or a genetic deficiency. In multiple linear regression models with the independent variable list consisting of Inuit status, age, sex, education, physical activity, spending time on the land and consumption of wild meat and local fish, Inuit status is independently associated with lower levels of the n-6 acids but not the n-3 acids. This indicates that factors other than diet and lifestyle, perhaps genetic ones, may account for the observed "ethnic" differences. However, for those fatty acids in which Inuit differ from non-Inuit, there is no dose-response relationship in terms of self-reported degree ofnon-Inuit admixture. Dietary fatty acids play an important role in the risk of cardiovascular diseases and diabetes, diseases of increasing importance in the health transition experienced by the Inuit. Association studies of plasma fatty acids and DNA markers of candidate genes for atherosclerosis and insulin resistance may provide a clearer picture of the genetic basis for the observed differences in plasma fatty acid composition between Inuit and non-Inuit.

Background: In recent years, an increase in the prevalence of sexual abuse of women has been reported in Canada and elsewhere. However, there are few empirical data on the extent of the problem in Canadian aboriginal populations. The authors investigated the presence of a reported history of sexual abuse and other health determinants in a sample of women attending a community health centre with a substantial aboriginal population. This allowed determination of whether reported sexual abuse and its associated demographic and health-related effects were different for aboriginal and non-aboriginal women., Methods: A sample of 1696 women was selected from women attending a community health centre in a predominantly low-income inner-city area of Winnipeg for a cross-sectional survey designed to study the association between sexual behavior and cervical infections. The survey was conducted between November 1992 and March 1995 and involved a clinical examination, laboratory tests and an interviewer-administered questionnaire. A substudy was conducted among 1003 women who were asked 2 questions about sexual abuse., Results: The overall response rate for the main study was 87%. Of the 1003 women who were asked the questions about sexual abuse, 843 (84.0%) responded. Among the respondents, 368 (43.6%) were aboriginal. Overall, 308 (36.5%) of the respondents reported having been sexually abused, 74.0% of the incidents having occurred during childhood. The prevalence was higher among aboriginal women than among non-aboriginal women (44.8% v. 30.1%, p < 0.001). Women who had been sexually abused were younger when they first had sexual intercourse, they had multiple partners, and they had a history of sexually transmitted diseases. In addition, non-aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have had abnormal Papanicolaou smears. The proportion of smokers was higher among the abused women than among the non-abused women in both ethnic groups., Interpretation: A history of sexual abuse was associated with other clinical, lifestyle and reproductive factors. This suggests that sexual abuse may be associated with subsequent health behaviors, beyond specific physical and psychosocial disorders. Aboriginal and non-aboriginal women who have suffered sexual abuse showed substantial differences in their subsequent health and health-related behaviours.

Background: The Keewatin Inuit have a very low age-adjusted mortality rate from vascular diseases compared to the general population of Canada. Interethnic differences in both genetic and lifestyle factors have been offered as explanations for this observation. We previously found that compared to white subjects, the Inuit had a significantly increased prevalence of 4 candidate alleles for atherosclerosis-related phenotypes, namely AGT T235, FABP2 T54, PONI R192, and APOE E4, and a significantly decreased prevalence of 2 candidate alleles for atherosclerosis-related phenotypes, namely ACE D and MTHFR 677T., Methods: We tested the hypothesis that 165 Canadian Inuit would have a significantly different frequency of the thrombosis-associated F5 Q506 allele compared with reference controls., Results: We found a complete absence of F5 Q506 in 165 Inuit, which was significantly different from the frequency of 3.92% observed in regional control White subjects., Conclusions: The aggregate of results from our studies in Inuit to date suggests that the beneficial influence of the low prevalence of any or all of the ACE D, MTHFR 677T and F5 Q506 outweighs the deleterious influence of the high prevalence of any or all of the other disease-associated alleles. However, it remains possible that other genetic and/or environmental factors determine the low susceptibility to vascular disease in the Inuit.

I report on the occurrence and metabolic correlates of obesity among the Inuit (Eskimos) of the central Canadian Arctic using data from the Keewatin Health Assessment Study conducted during 1990 and 1991 in eight Inuit communities in the Northwest Territories (n = 434, adults aged 18 years and older). Data from the 1990 Manitoba Heart Health Survey among 2200 predominantly white residents of the province of Manitoba were used for comparison. Judging by body mass index and two skinfold thicknesses, obesity among the Inuit is as prevalent as it is in the general North American population. This is a new development over the past two or three decades, the result of rapidly changing physical activity, diet, and lifestyle. Obesity is more prevalent among women, among whom there is also a higher degree of central fat patterning based on the waist-to-hip ratio. When different categories of obesity are compared, blood pressure and one or more of the lipids show an increasing trend but glucose or insulin level shows no significant change. This observation distinguishes the Inuit from other populations. Even where a relationship exists, as with triglyceride and HDL cholesterol levels, the magnitude of the response is lower among the Inuit. The differential effect of obesity on glucose, blood pressure, and lipid levels in the Inuit compared with non-Inuit suggests a type of selective insulin resistance, the underlying mechanism of obesity and several chronic diseases. Inuit metabolism reflects their almost exclusive diet of fat and proteins traditionally. From the public health perspective it is important to monitor and ameliorate the impact of changing diet and physical activity on the prevalence of obesity and associated health effects.

Objectives: The purpose of this study was to review cardiovascular mortality, morbidity, and risk factors in the multiethnic population of the Northwest Territories, Canada., Methods: We analyzed death certificates and hospital records, and used a community health and examination survey., Results: The age-standardized mortality rate for ischemic heart disease (but not for other heart diseases or stroke) among the Northwest Territories population was lower than among the Canadian population. Among the indigenous Inuit/Eskimos and Indians, the age-standardized mortality rate for all circulatory diseases was lower than Canadians. Among Indian women, the rate approached the Canadian rate and exceeded that of Inuit and non-Natives. Compared with residents of Manitoba, Northwest Territories Inuit adults had a higher prevalence of smoking in all age-sex groups. Obesity was prevalent among older Inuit women and hypertension among young Inuit men. Except for women aged 25 to 44, the total cholesterol and triglyceride levels among Inuit were lower than or not different from Manitoba residents. Relatively high levels of high-density lipoprotein were found in older Inuits., Conclusions: The epidemiologic pattern of cardiovascular diseases in Arctic Canada differs from that among non-Native, southern Canadians. Rapid sociocultural changes may alter the situation, and health agencies must anticipate such transitions and intensify culturally appropriate control programs.

The prevalence of diagnosed diabetes in several genetically closely related indigenous populations in the circumpolar arctic and subarctic regions of Russia, Alaska and Canada is compared. The age-standardized (to the IARC's hypothetical world population) prevalence ranged from 1.8/1000 among the Chukchi and Eskimo of Chukotka, 3.6 and 7.9/1000 among the Eskimos/Inuit of the Canadian Northwest Territories (NWT) and Alaska respectively, 7.1, 9.3 and 18.6/1000 among Athapaskan Indians in the NWT, Yukon and Alaska respectively, to a high of 22.7/1000 among the Aleuts in Alaska. All are below the US all-race prevalence of 23.5/1000 and far below the extreme high prevalence reported from many North American Indian tribes. As a group, such arctic and subarctic peoples have a much shorter and less intense history of European contact and acculturation. Environmental factors are also likely to be responsible for the current differences between these indigenous populations in the circumpolar region, assuming that they share susceptibility genes for diabetes inferred from their close genetic relationships based on markers in other loci. Formal surveys of glucose tolerance and potential risk factors such as diet, physical activity, obesity, insulin resistance and genetic admixture in the circumpolar region would improve knowledge of the aetiology of diabetes in genetically and culturally diverse human populations.

Objective: To describe the distribution of weight and abdominal obesity among Canadian adults and to determine the association of obesity with other risk factors for cardiovascular disease., Design: Population-based cross-sectional surveys. Survey nurses administered a standard questionnaire and recorded two blood pressure measurements during a home visit. At a subsequent visit to a survey clinic two further blood pressure readings were made, anthropometric measurements recorded and a blood specimen taken for plasma lipid determination., Setting: Nine Canadian provinces, from 1986 to 1990., Participants: A probability sample of 26,293 men and women aged 18 to 74 years was selected from the health insurance registration files of each province. Anthropometry was performed on 17,858 subjects., Outcome Measures: Body mass index (BMI), ratio of waist to hip circumference (WHR), mean plasma lipid levels, prevalence of high blood pressure (diastolic greater than or equal to 90 mm Hg or patient on treatment) and self-reported diabetes mellitus., Main Results: The prevalence of obesity (BMI greater than or equal to 27) increased with age and was greater in men (35%) than in women (27%). Abdominal obesity was likewise higher in men and increased with both age and BMI. The prevalence of high blood pressure was greater in those with higher BMI, especially in those with a high WHR. Although total plasma cholesterol levels increased only modestly with BMI, levels of low density lipoprotein (LDL) cholesterol and triglycerides and the ratio of total cholesterol to high density lipoprotein (HDL) cholesterol increased steadily, while HDL-cholesterol decreased consistently with increasing BMI. High total cholesterol levels (greater than or equal to 5.2 mmol/L) were more prevalent among people with high BMI, especially those with a high WHR. The prevalence of diabetes increased with BMI among those 35 years or older, especially those with abdominal obesity. About half of men and two-thirds of women who were obese were trying to lose weight., Conclusion: Obesity remains common among Canadian adults. There is a need for broad-based programs that facilitate healthy eating and activity patterns for all age groups. Health professionals should incorporate measurement of BMI and WHR into their routine examinations of patients to enhance their evaluation of health risk.