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Objectives To identify food sources of nutrients in First Nations adults in Canada and to establish whether these populations are meeting their nutrient requirements and whether traditional foods (TF) contribute to better nutrient intake. Methods The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of First Nations adults living south of the 60th parallel. Twenty-four-hour recalls were conducted in 92 First Nations communities from 2008 to 2016. Repeat recalls were attempted with 20% of participants to adjust for within-person variation and estimate the proportion of individuals below recommendations according to Institute of Medicine guidelines. Nutrients from days with and without TF were compared. The main food sources of select nutrients were identified, including TF. Results Mean energy intakes among women and men ranged from 1664 to 1864 and from 1761 to 2298 kcal/day respectively. Most macronutrients were within the acceptable macronutrient diet range except for fat in most age groups and carbohydrates in men 71 years of age and older. Saturated fat was above recommendations for all ages. Only niacin was identified as above recommendations in all age and sex categories. Days where TF were eaten showed greater intakes of key nutrients. Conclusion It is imperative that we find culturally appropriate ways to improve the quality and nutritional value of First Nations Peoples food intake by improving TF access and use on the one hand and conversely providing better quality store-bought foods. For success in this, we must empower First Nations communities and health practitioners to collaboratively overcome these challenges.

Objective To describe the traditional food (TF) systems of First Nations in Canada, including intake, barriers and promoters. Methods The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of First Nations adults below the 60th parallel that obtained data for communities excluded from other national studies. A food frequency questionnaire was used to establish frequency of TF intake (number of days in a year) to allow comparisons across ecozones/regions in Canada. Grams of TF intake were also calculated using frequency multiplied by average portions from 24-h recalls. Closed- and open-ended questions attempted to identify some of the key barriers and concerns regarding TF access and use. Multivariable analyses were run to determine what factors are associated with increased TF consumption. Results Across communities, there is a strong preference by adults to have TF in the diet more often. Consumption of land animals was most frequently reported in most ecozones except for the Pacific Maritime and Mixedwood Plains, where fish and plants, respectively, were more frequently consumed. First Nations identified structural and environmental challenges such as development, government regulations and climate change, along with household barriers such as insufficient capital for equipment and transportation, lack of time and absence of a hunter in the household. Multivariable analyses revealed that the highest intake of TF occurred in the Taiga Plains ecozone, and for older individuals and men. Conclusion Identifying solutions that empower First Nations at all levels is required to overcome the multiple challenges to the inclusion of TF in the diet.

To investigate the relationships between fish/seafood consumption patterns and food security status among First Nations (FN) communities in Canada. We estimated the contribution of fish/seafood to daily nutrient requirements. Barriers to traditional food (TF) access including fish were summarized.Data were collected by the First Nations Food, Nutrition and Environment Study (2008-2018). The sample of this participatory study comprised 6258 randomly selected FN adults. Fish/seafood consumption was estimated with a food frequency questionnaire. Food security status was assessed with the Household Food Security Survey Module. The contribution of fish/seafood to protein, n-3 fatty acid, vitamin (A, B12, D, niacin) and mineral (selenium, zinc) requirements was assessed by comparison to Dietary Reference Intakes.Regional differences were observed in fish/seafood consumption patterns and their relationship with food security status. In the eastern regions (Ontario, Quebec/Labrador and the Atlantic region), consumption of fish/seafood and other TF was significantly higher among food insecure compared with food secure FN participants. Severely food insecure men (particularly in British Columbia, Alberta, Quebec/Labrador and the Atlantic region) tended to eat a higher amount of TF, including fish/seafood, compared with food secure and moderately food insecure men, while no difference was observed in women. Fish/seafood provided good sources of selected nutrients. However, the high cost of harvesting equipment, industry-related activities and climate change reduce access to fish/seafood and other wildlife.Fish/seafood continues to be vital to the diet of FN communities. Focusing on policies that support FN increased access to fish/seafood has the potential to decrease food insecurity and support sustainable livelihoods. Future policies should focus on socio-economic determinants of food insecurity and support traditional harvesting and sustainable fisheries among FN communities.RéSUMé: OBJECTIF: Étudier les relations entre les modèles de consommation de poissons/fruits de mer et l’état de la sécurité alimentaire chez les Premières Nations (PN) au Canada. Nous avons estimé la contribution des poissons/fruits de mer aux besoins quotidiens en nutriments. Les obstacles à l’accès aux aliments traditionnels (AT), y compris le poisson, ont été résumés. MéTHODES: Les données ont été recueillies dans le cadre de l’Étude sur l’alimentation, la nutrition et l’environnement chez les Premières Nations (2008–2018). L’échantillon de cette étude participative comprenait 6 258 adultes PN sélectionnés au hasard. La consommation de poissons/fruits de mer a été estimée à l’aide d’un questionnaire de fréquence alimentaire. Le niveau de sécurité alimentaire a été évalué à l’aide du Module d’enquête sur la sécurité alimentaire des ménages. La contribution des poissons/fruits de mer aux besoins en protéines, en acides gras n-3, en vitamines (A, B12, D, niacine) et en minéraux (sélénium, zinc) a été évaluée par rapport aux apports nutritionnels de référence. RéSULTATS: Des différences régionales ont été observées dans les modes de consommation de poissons/fruits de mer et leur relation avec le niveau de sécurité alimentaire. Dans les régions de l’Est (Ontario, Québec/Labrador et région atlantique), la consommation de poissons/fruits de mer et d’autres AT était significativement plus élevée chez les personnes vivant dans les ménages en situation d’insécurité alimentaire que chez celles en sécurité alimentaire. Les hommes en situation d’insécurité alimentaire sévère (en particulier en Colombie-Britannique, en Alberta, au Québec/Labrador et en région atlantique) avaient tendance à manger une plus grande quantité d’AT, y compris du poisson/fruits de mer, par rapport aux hommes en sécurité alimentaire et en insécurité alimentaire modérée, alors qu’aucune différence n’a été observée chez les femmes. Les poissons/fruits de mer ont fourni de bonnes sources de nutriments sélectionnés. Cependant, le coût élevé du matériel de chasse, les activités liées à l’industrie et le changement climatique réduisent l’accès aux poissons/fruits de mer et à d’autres espèces sauvages. CONCLUSION: Les poissons/fruits de mer continuent d’être essentiels à l’alimentation des PN. L’amélioration de l’accès aux poissons/fruits de mer a le potentiel de promouvoir la sécurité alimentaire et des moyens de subsistance durables. Les politiques futures devraient se concentrer sur les déterminants socio-économiques de l’insécurité alimentaire et soutenir la récolte traditionnelle et la pêche durable chez les PN.

We previously examined the associations between dietary dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs) intake from fish consumption and type 2 diabetes (T2D) prevalence in Ontario and Manitoba. This study aims to further explore the relationship in a regionally representative sample of First Nations adults living on-reserve across Canada.Dietary, health and lifestyle data collected by the cross-sectional First Nations Food, Nutrition and Environment Study (2008-2018) were analyzed. This participatory study included 6091 First Nations adult participants who answered questions on T2D. The consumption of locally caught fish was estimated with a food frequency questionnaire. A total of 551 samples from 96 fish species were collected and analyzed for the presence of DDE and PCBs. The associations between fish and dietary DDE/PCBs intake with self-reported T2D were investigated using multiple logistic regression models adjusted for confounders.Dietary exposure to DDE (2.11 ng/kg/bw) and PCBs (1.47 ng/kg/bw) vs no exposure was positively associated with T2D with ORs of 2.33 (95% CI: 1.24-4.35) for DDE and 1.43 (95% CI: 1.01-3.59) for PCBs. The associations were stronger among females (DDE OR = 3.11 (1.41-6.88); PCBs OR = 1.76 (1.10-3.65)) and older individuals (DDE OR = 2.64 (1.12-6.20); PCBs OR = 1.44 (1.01-3.91)) as compared with males and younger participants. Also, significant dose-response relationships were found for fish consumption in females only.This study confirms our previous findings that dietary DDE/PCBs exposure may increase the risk of T2D. The effect of DDE/PCBs from fish consumption is driven by geographical differences in DDE/PCBs concentrations in fish and by the amount of fish consumed, and is more prominent in females than in males.RéSUMé: OBJECTIF: Nous avons précédemment examiné les associations entre l’apport alimentaire de dichlorodiphényldichloroéthylène (DDE) et de polychlorobiphényles (PCB) provenant de la consommation de poisson et la prévalence du diabète de type 2 (DT2) en Ontario et au Manitoba. Cette étude vise à explorer davantage la relation dans un échantillon régionalement représentatif d’adultes des Premières Nations vivant dans des réserves partout au Canada. MéTHODE: Les données sur l’alimentation, la santé et le mode de vie recueillies par l’Étude transversale sur l’alimentation, la nutrition et l’environnement chez les Premières Nations (2008–2018) ont été analysées. Cette étude participative comprenait 6 091 participants adultes des Premières Nations qui ont répondu à des questions sur le DT2. La consommation de poisson pêché localement a été estimée à l’aide d’un questionnaire de fréquence alimentaire. Au total, 551 échantillons de 96 espèces de poissons ont été prélevés et analysés pour la présence de DDE et de PCB. Les associations entre la consommation de poisson et l’exposition aux DDE/PCB avec le DT2 auto-déclaré ont été étudiées à l’aide de modèles de régression logistique multiples ajustés pour les facteurs de confusion. RéSULTATS: L’exposition alimentaire au DDE (2,11 ng/kg/pc) et aux PCB (1,47 ng/kg/pc) par rapport à l’absence d’exposition était positivement associée au DT2 avec des OR de 2,33 (IC à 95% : 1,24–4,35) pour le DDE et 1,43 (IC à 95% : 1,01–3,59) pour les PCB. Les associations étaient plus fortes chez les femmes (DDE OR = 3,11 (1,41–6,88); PCB OR = 1,76 (1,10–3,65)) et les individus plus âgés (DDE OR = 2,64 (1,12–6,20); PCB OR = 1,44 (1,01–3,91)) par rapport aux hommes et aux participants plus jeunes. De plus, des relations dose-réponse significatives ont été trouvées pour la consommation de poisson chez les femmes seulement. CONCLUSION: Cette étude confirme nos conclusions précédentes selon lesquelles l’exposition à travers l’alimentation aux DDE/PCB peut augmenter le risque de DT2. L’effet du DDE/PCB sur la consommation de poisson est lié aux différences géographiques dans les concentrations de DDE/PCB dans le poisson et à la quantité de poisson consommée, et est plus important chez les femmes que chez les hommes.

Pharmaceuticals are emerging contaminants in the environment. Little has been published about the presence of pharmaceuticals in waterbodies nearby or on reserve land of First Nations in Canada. The objectives of this study were to (1) quantify the level of pharmaceuticals in First Nations' surface waters, (2) calculate the human health risks of the mixtures found, and (3) measure the exposure to pharmaceuticals in First Nations' drinking water where source water was highly contaminated.This participatory study measured the levels of 43 pharmaceuticals from surface water samples taken at three water sampling sites chosen by the 95 participating First Nations. The sites were in proximity to recreational areas, fishing areas, drinking water sources, and/or wastewater outflows. When elevated levels of pharmaceutical mixtures were found in samples, drinking water samples were obtained and analyzed for potential pharmaceuticals. Human health risks were calculated by an established protocol.In total, 432 samples were collected at 302 water sampling sites (285 surface water, 11 drinking water, and 6 wastewater sites). Quantifiable levels of 35 pharmaceuticals were found in 79 of the 95 (83%) participating First Nations at 193 of the 285 surface water sites (68%). Overall, the levels found were comparable to or lower than those found in other studies in Canada and worldwide.In almost all participating First Nations, there is no human health risk from consuming surface water for drinking. However, surface water in the vicinity of major urban centres should not be used as secondary untreated water sources due to the elevated human health risk associated with exposure to the mixtures of multiple pharmaceuticals detected.RéSUMé: OBJECTIFS: Les produits pharmaceutiques sont des contaminants émergents dans l’environnement. Peu d’articles ont été publiés sur la présence de produits pharmaceutiques dans les plans d’eau à proximité ou sur les terres des réserves des Premières Nations au Canada. Les objectifs de cette étude étaient de 1) quantifier le niveau de produits pharmaceutiques dans les eaux de surface des Premières Nations, 2) calculer les risques pour la santé humaine des mélanges trouvés, et 3) mesurer l’exposition aux produits pharmaceutiques dans l’eau potable des Premières Nations où la source d’eau était fortement contaminée. MéTHODES: Cette étude participative a mesuré les niveaux de 43 produits pharmaceutiques à partir d’échantillons d’eau de surface prélevés dans trois sites d’échantillonnage d’eau choisis par les 95 Premières Nations participantes. Les sites se trouvaient à proximité d’aires récréatives, de pêche, d’eau potable et/ou d’eaux usées. Lorsque des niveaux élevés de mélanges pharmaceutiques ont été trouvés dans les échantillons, des échantillons d’eau potable ont été prélevés et analysés pour la présence possible de produits pharmaceutiques. Les risques pour la santé humaine ont été calculés selon un protocole établi. RéSULTATS: Au total, 432 échantillons ont été prélevés sur 302 sites d’échantillonnage d’eau (285 eaux de surface, 11 sites d’eau potable et 6 sites d’eaux usées). Des niveaux quantifiables de 35 produits pharmaceutiques ont été trouvés dans 79 des 95 (83 %) Premières Nations participantes, soit sans 193 des 285 sites d’eau de surface (68 %). Dans l’ensemble, les niveaux trouvés étaient comparables ou inférieurs à ceux trouvés dans d’autres études au Canada, aux États-Unis et dans le monde. CONCLUSION: Dans presque toutes les Premières Nations participantes, il n’y a aucun risque pour la santé humaine lié à la consommation d’eau de surface pour la boisson. Cependant, les eaux de surface à proximité des grands centres urbains ne devraient pas être utilisées comme sources d’eau secondaires non traitées en raison du risque élevé pour la santé humaine associé à l’exposition aux mélanges de plusieurs produits pharmaceutiques détectés.

Assess the diet quality of First Nations adults in Canada using percentage energy from traditional foods (TF) and ultra-processed products (UPP), food portions from the 2007 Eating Well with Canada's Food Guide - First Nations, Inuit and Métis (EWCFG-FNIM) and a Healthy Eating Index (HEI).Data collection for this participatory research occurred in 92 First Nations reserves across Canada from 2008 to 2016. Percent daily energy intakes were estimated from 24-hour recalls for TF and NOVA food categories. Portions of food groups from the 2007 EWCFG-FNIM were compared to recommendations. A Canadian-adapted HEI was calculated for each participant.The percent energy from TF was 3% for all participants and 18% for consumers. Meat and alternatives were above the EWCFG-FNIM recommendations and all other food groups were below these. HEI was "low" with only older individuals attaining "average" scores. HEI was above "average" in 4 regions. UPP represented 55% of energy, the largest proportion from a NOVA category.The diet quality of First Nations adults in Canada is nutritionally poor. The nutrition, food security and health of First Nations would be improved by better access to TF and healthy store-bought food. However, poor diet is only one aspect of the difficulties facing First Nations in Canada. Researchers and policy makers must strive to better understand the multiple challenges facing First Nations Peoples in order to foster empowerment and self-determination to develop First Nations living conditions and lifestyles that are more culturally sound and more conducive to health.RéSUMé: OBJECTIFS: Évaluer la qualité de l’alimentation des adultes des Premières Nations du Canada en calculant l’énergie provenant des aliments traditionnels (AT) et des produits ultra-transformés, en comparant les portions consommées avec celles recommandées dans Bien manger avec le Guide alimentaire canadien Premières Nations, Inuit et Métis (BMGAC-PNIM) de 2007 et en mesurant l’indice d’alimentation saine. MéTHODE: La collecte de données pour cette recherche participative a eu lieu dans 92 réserves des Premières Nations au Canada entre les années 2008 et 2016. À partir des rappels de 24 heures, la proportion d’énergie provenant des AT pour les individus les ayant consommés ou non a été comparée, les portions des catégories d’aliments proposées par le BMGAC-PNIM ont été comparées aux recommandations, l’indice d’alimentation saine adapté pour le Canada a été calculé pour chaque participant et la proportion d’énergie des produits ultra-transformés a été établie. RéSULTATS: La proportion d’énergie provenant des AT chez les consommateurs et non-consommateurs était de 3 % et celle pour les consommateurs d’AT était de 18 %. Seuls les viandes et substituts dépassaient les recommandations du BMGAC-PNIM tandis que la consommation de toutes les autres catégories était inférieure aux recommandations. L’indice d’alimentation saine était “bas” avec seulement les individus plus âgés atteignant un score “moyen”. L’indice d’alimentation saine était supérieur à “moyen” dans 4 régions. Les aliments ultra-transformés représentaient 55 % de l’énergie, la plus grande proportion de toutes les catégories NOVA. CONCLUSION: La qualité de l’alimentation des Premières Nations n’est pas optimale. Leur alimentation pourrait être améliorée avec un meilleur accès aux AT et aux aliments sains provenant du marché. Une mauvaise alimentation n’est toutefois pas la seule difficulté à laquelle font face les Premières Nations du Canada. Les Peuples des Premières Nations doivent être impliquées avec les chercheurs et les responsables politiques pour mieux comprendre les défis multiples auxquels ils font face et instaurer des conditions de vie qui soient culturellement sécuritaires et plus propices à la santé.

Objective:To further understandings of household food insecurity in First Nations communities in Canada and its relationship with obesity.Design:Analysis of a cross-sectional dataset from the First Nations Food, Nutrition and Environment Study representative of First Nations communities south of the 60th parallel. Multivariate logistic regression was used to assess associations between food insecurity and sociodemographic factors, as well as the odds of obesity among food-insecure households adjusting for sociodemographic characteristics.Setting:Western and Central Canada.Participants:First Nations peoples aged ≥19 years.Results:Forty-six percent of First Nations households experienced food insecurity. Food insecurity was highest for respondents who received social assistance; had ≤10 years of education; were female; had children in the household; were 19–30 years old; resided in Alberta; and had no year-round road access into the community. Rates of obesity were highest for respondents residing in marginally food-insecure households (female 56·6 %; male 54·6 %). In gender-specific analyses, the odds of obesity were highest among marginally food-insecure households in comparison with food-secure households, for both female (OR 1·57) and male (OR 1·57) respondents, adjusting for sociodemographic variables. For males only, those in severely food-insecure (compared with food-secure) households had lower odds of obesity after adjusting for confounding (OR 0·56).Conclusions:The interrelated challenges of food insecurity and obesity in First Nations communities emphasise the need for Indigenous-led, culturally appropriate and food sovereign approaches to food security and nutrition in support of holistic wellness and prevention of chronic disease.

A multi-stage sampling strategy selected 1387 on-reserve First Nations adults in Ontario. Foods from a 24-hour dietary recall were assigned to the 100 most common food groups for men and women. Nutrients from market foods (MF) and traditional foods (TF) harvested from the wild as well as MF costs were assigned based on the proportions of total grams consumed. Linear programming was performed imposing various constraints to determine whether it was possible to develop diets that included the most popular foods while meeting Institute of Medicine guidelines. Final models were obtained for both sexes with the top 100 food groups consumed while limiting the nutrient-poor foods to no more than the actual observed intake. These models met all nutrient constraints for men but those for dietary fibre, linoleic acid, phosphorus, and potassium were removed for women. MF costs were obtained from community retailers and online resources. A grocery list was then developed and MF were costed for a family of 4. The grocery list underestimated the actual weekly food cost because TF was not included. Contemporary observed diets deviated from healthier historic First Nations diets. A culturally appropriate diet would include more traditional First Nations foods and fewer MF. Novelty: Linear programming is a mathematical approach to evaluating the diets of First Nations. The grocery list is representative of food patterns within Ontario First Nations and can be used as an alternative to the nutritious food basket used for public health food costing.

Objective To describe the rationale, the participatory nature of the methodology, and the lessons learned during the First Nations Food, Nutrition and Environment Study (FNFNES), a community-based participatory research project implemented in eight Assembly of First Nations regions, which includes the entirety of Canada south of the 60th parallel. Methods FNFNES respected the First Nations principles of Ownership, Control, Access and Possession (OCAP®) (https://fnigc.ca/ocap). A random sampling strategy based on an ecosystem framework comprising 11 ecozones was adopted to collect representative nutritional and environmental health results for all First Nations adults living on-reserve south of the 60th parallel. Data collection occurred during the fall months from 2008 to 2016. Respective First Nations were involved in the planning and implementation of data collection for the five principal components: household interviews, tap water sampling for metals, surface water sampling for pharmaceuticals, hair sampling for mercury, and traditional food sampling for contaminants. Results A total of 6487 adults from 92 First Nations participated in the Study (participation rate 78%). A higher percentage of females (66%) participated than males (34%). The average age of males and females was similar (44 and 45 years, respectively). This study offers a novel body of coherent and regionally representative evidence on the human dimension of the ongoing environmental degradation affecting First Nations. Conclusion FNFNES serves as a good example of participatory research. We encourage public health professionals to develop policy and programs building on the participatory dimension of the research as well as on its results. The information collected by the FNFNES is also important for community empowerment, environmental stewardship and the general promotion of good health by and for First Nations peoples in Canada.

ObjectiveThe primary objective of this participatory study was to assess the current body burden of mercury among First Nations adults.MethodsThe First Nations Food, Nutrition and Environment Study (2008–2018) collected regionally representative data from First Nations adults living on reserves south of the 60thparallel. Mercury was analyzed in hair as a preferred biomarker for prolonged exposure. Hair samples, a 5 mm bundle cut from the occipital region, were collected from the participants who gave consent and measured for total mercury concentrations using cold vapor atomic fluorescence spectrophotometry.ResultsIn total, 3404 First Nations adults living in 92 communities provided hair samples. This represents 52.5% of the respondents to the household surveys. The mean hair mercury concentrations were 0.56 μg/g among all participants and 0.34 μg/g among women of childbearing age (WCBA). There were 64 exceedances of Health Canada’s mercury biomonitoring guidelines (44 WCBA, 8 women aged 51+ years, 3 men aged 19–50 years, and 9 men aged 51+ years).ConclusionCurrent mercury exposure no longer presents a significant clinical health risk in most of the First Nations population south of the 60thparallel across Canada. However, mercury exposure continues to be an ongoing environmental public health concern that requires continued monitoring and assessment. Women of childbearing age (19–50 years) and older individuals living in northern ecozones and Quebec have higher mercury exposures, often exceeding Health Canada’s guidelines. Careful risk communication and risk management programs need to focus on northern ecozones and Quebec.

The First Nations Food, Nutrition and Environment Study (FNFNES), a community-based participatory research project, measured the levels of metals of health concern and the levels of metals that have operational guidance (OG) and aesthetic objectives (AO) in drinking water of First Nations (FN) south of the 60Both stagnant (first draw) and flushed tap water samples were collected from participating households in 91 FN representing 11 ecozones. The concentrations of metals were quantified and compared to Health Canada's Guidelines for Canadian Drinking Water Quality (GCDWQ).In total, 1516 FN households participated in this study component. Exceedances of the 2019 GCDWQ for the health-based maximum acceptable concentration (MAC) were found for five metals: lead 8.4% of households (first draw), manganese 4.0%, uranium 1.6%, aluminum 1.3%, and copper 0.2% (flushed). Flushing taps resulted in a decrease to 0.7% of households exceeding the lead MAC. Exceedances of the current OG for aluminum were found in 14.2% and the exceedances of the proposed OG were found in 18.1% of households (flushed). Exceedances of the AO (flushed) were as follows: manganese 12.8%, sodium 5.1%, iron 3.5%, and copper 0.4%. Results of the study were compared to provincial surveys where the data were available. Taste and colour were reported to be the main reasons for limiting the use of tap water.Overall, the quality of drinking water with respect to trace metals of human health concern is satisfactory. However, elevated lead levels were found in some FN communities. Until appropriate action can take place, it was recommended to flush the water before use to reduce the lead levels.RéSUMé: OBJECTIFS: L’Étude sur l’alimentation, la nutrition et l’environnement chez les Premières Nations (EANEPN), un projet de recherche participative communautaire, a mesuré la concentration de métaux préoccupants pour la santé et ceux ayant une directive opérationnelle et des objectifs esthétiques dans l’eau potable des Premières Nations (PN) au sud du 60

Objective Our objective is to describe self-reported health status, prevalence of diabetes and obesity and their associations in participants from the First Nations Food, Nutrition and Environment Study (FNFNES) in order to identify possible correlates of health in First Nations adults. Methods FNFNES is a participatory study with First Nations Peoples living on reserve lands south of the 60th parallel. Health and diabetes were self-reported, and prevalence of obesity was evaluated. Socio-demographic and lifestyle factors and traditional food (TF) activities were investigated for associations with health parameters. Results High prevalence rates of overweight/obesity (78–91%) and diabetes (19% age-standardized prevalence) were found. Smoking rates were high and physical activity was low. In multivariable analyses, obesity was associated with region, income source, age, gender, smoking and self-reported health; diabetes and lesser self-reported health were associated with obesity and lower education. Diabetes was strongly associated with lesser self-reported health and weakly associated with being a smoker. Conclusion We have identified possible correlates of health in this population that can help to better understand the underlying concerns and identify solutions for First Nations and their partners. We urge governments and First Nations to address the systemic problems identified with a holistic ecosystem approach that takes into consideration the financial and physical access to food, particularly TF, and the facilitation of improved health behaviour. New mechanisms co-developed with First Nations leadership should focus on supporting sustainable, culturally safe and healthy lifestyles and closing the gaps in nutrition and food insecurity.

ObjectiveTo quantify associations of the dietary share of ultra-processed foods (UPF) with the overall diet quality of First Nations peoples.DesignA cross-sectional analysis of data from the First Nations Food, Nutrition and Environment Study, designed to contribute to knowledge gaps regarding the diet of First Nations peoples living on-reserve, south of the 60th parallel. A multistage sampling of communities was conducted. All foods from 24 h dietary recalls were categorized into NOVA categories and analyses were performed to evaluate the impact of UPF on diet quality.SettingWestern and Central Canada.SubjectsFirst Nations participants aged 19 years or older.ResultsThe sample consisted of 3700 participants. UPF contributed 53·9 % of energy. Compared with the non-UPF fraction of the diet, the UPF fraction had 3·5 times less vitamin A, 2·4 times less K, 2·2 times less protein, 2·3 times more free sugars and 1·8 times more Na. As the contribution of UPF to energy increased so did the overall intakes of energy, carbohydrate, free sugar, saturated fat, Na, Ca and vitamin C, and Na:K; while protein, fibre, K, Fe and vitamin A decreased. Diets of individuals who ate traditional First Nations food (e.g. wild plants and game animals) on the day of the recall were lower in UPF.ConclusionsUPF were prevalent in First Nations diets. Efforts to curb UPF consumption and increase intake of traditional First Nations foods and other fresh or minimally processed foods would improve diet quality and health in First Nations peoples.

To describe the prevalence of food insecurity in First Nations households across Canada while identifying barriers and enablers to traditional food (TF) consumption.The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of on-reserve First Nations from 2008 to 2018. The Household Food Security Survey Module was used to capture income-related challenges experienced by First Nations households. Households were classified as food secure, or marginally, moderately, or severely food insecure. Barriers and enablers to TF access and use were identified describing the Indigenous experience.Almost half of on-reserve First Nations households were food insecure and the prevalence was higher than that for non-Indigenous households in Canada. On-reserve food insecurity prevalence was higher in western regions of Canada. First Nations households with children experienced greater food insecurity than those without children. More adults experienced severe food insecurity than children. Most adults would like to have more TF in their diet but state that factors such as financial and household constraints, industrial activities, government regulations, climate change, and fear of contamination impede greater access. Food costs were substantially higher in remote First Nations communities, but remoteness was not associated with food security in multivariable analysis.Existing systems have been unsuccessful in curbing the food insecurity in First Nations households. Improving food security hinges on achieving Indigenous Food Sovereignty, the key to long-term conservation and stewardship of the land and the co-management of these by Indigenous Peoples. Studies investigating the feasibility of increasing TF from an Indigenous perspective are required.RéSUMé: OBJECTIFS: Décrire la prévalence de l’insécurité alimentaire chez les ménages des Premières Nations du Canada tout en identifiant les obstacles et les facilitateurs de l’alimentation traditionnelle (AT). MéTHODES: L’étude sur l’alimentation, la nutrition et l’environnement des Premières Nations dans les réserves est une étude participative pancanadienne des ménages des Premières Nations. Le module d’enquête sur la sécurité alimentaire des ménages a été utilisé pour tenir compte des défis liés au revenu qui confrontent les ménages des Premières Nations. Les ménages ont été classés comme étant en sécurité alimentaire ou insécurité alimentaire marginale, modérée ou sévère. Des obstacles et facilitateurs à l’accès et à l’utilisation des AT ont été identifiés pour décrire l’expérience autochtone. RéSULTATS: Près de la moitié des ménages dans les réserves des Premières Nations dans notre étude étaient en situation d’insécurité alimentaire et la prévalence était supérieure aux ménages non-Autochtones du Canada. L’insécurité alimentaire dans les réserves était plus élevée dans les régions de l’Ouest. Les ménages des Premières Nations ayant des enfants ont connu une plus grande insécurité alimentaire que ceux qui n’en ont pas. Plus d’adultes que d’enfants ont connu une insécurité alimentaire sévère. La plupart des adultes aimeraient avoir plus d’AT dans leur alimentation, mais affirment que des facteurs tels que les contraintes financières et domestiques, les activités industrielles, les réglementations gouvernementales, les changements climatiques et la peur de la contamination empêchent un meilleur accès. Les coûts des aliments étaient considérablement plus élevés dans les communautés isolées des Premières Nations, mais l’isolement n’était pas associé à la sécurité alimentaire dans l’analyse multivariée. CONCLUSION: Les systèmes existants ont échoué à freiner l’insécurité alimentaire chez les ménages des Premières Nations. L’amélioration de la sécurité alimentaire dépend de la réalisation de la souveraineté alimentaire autochtone, une clé pour la conservation à long terme des ressources naturelles et pour une gestion partagée de ces ressources par les peuples autochtones. Des études menées dans une perspective autochtone sur la faisabilité d’améliorer l’accès aux AT sont encore nécessaires.

We examined the feasibility of linear programming (LP) to develop diets that were economical, included traditional (cultural, non-market) foods and met the dietary reference intakes (DRI) in a Canadian Indigenous population. Diet optimisation using LP is a mathematical technique that can develop food-based dietary guidelines for healthy eating in Indigenous populations where food insecurity, availability and cost are important considerations. It is a means of developing nutritionally optimal food combinations that are based on economical and culture-specific foods. Observed food consumption data were derived using 24-h food recalls from the First Nations Food, Nutrition and Environment Study. The LP models were constructed to develop diets meeting DRI, cost and food constraints. Achieving the recommended food intake was not feasible in a model meeting all nutrient requirements. Models that met most nutrient requirements at reduced cost were designed for men and women, separately. In women, it was necessary to increase energy intake to meet most nutrient requirements. Nutrient requirements could not be met for fibre, linoleic and linolenic acids, vitamin D, Ca and K in both sexes, P in women, and Mg and vitamin A in men. Using LP to develop optimal diets for First Nations people, we found simultaneous achievement of all DRI was difficult, suggesting that supplementation might be necessary which goes against recommendations for individuals to meet their nutrient needs through healthy eating patterns. Additionally, to make diets feasible, programmes to reduce market food costs and to support First Nations people in traditional food harvesting are recommended.

Background Traditional food systems are under pressure from various stressors, including climate change which is projected to negatively alter the abundance of marine species harvested by coastal First Nations (FNs) in British Columbia (BC). Objective To model the potential impacts of the climate-related declines in seafood production on the nutritional status of coastal BC FNs. In addition, we projected potential changes in nutrient intakes, under different scenarios of substitution where traditional seafood is replaced with alternative non-traditional foods. Methods The study design is a mixed-method approach that combines two datasets: projected scenarios of climate-related change on seafood catch potential for coastal BC FNs and data derived from the cross-sectional First Nations Food, Nutrition, and Environment Study. The consumption of seafood was estimated using a food frequency questionnaire among 356 FNs. The contribution of seafood consumption to protein, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), vitamins (A, B12, D, niacin), and minerals (zinc, selenium and iron) requirements was assessed using Dietary Reference Intakes (DRIs). Results Traditional seafood consumption provided daily recommendations of EPA+DHA (74-184%) and vitamin B12 (84-152%) and substantial levels of niacin (28-55%), selenium (29-55%), vitamin D (15-30%) and protein (14-30%). Projected climate change was estimated to reduce the intakes of essential nutrients by 21% and 31% under 'strong mitigation' (Representative Concentration Pathway, RCP2.6) and 'business-as-usual' (RCP8.5) climate change scenarios, respectively, by the year 2050 relative to 2000. The hypothetical substitution of seafood with selected alternative non-traditional foods does not provide adequate amounts of nutrients. Conclusion Traditionally-harvested seafood remains fundamental to the contemporary diet and health of coastal BC FNs. Potential dietary shifts aggravated by climate-related declines in seafood consumption may have significant nutritional and health implications for BC FN. Strategies to improve access to seafood harvest potential in coastal communities are needed to ensure nutritional health and overall well-being and to promote food security and food sovereignty in coastal FNs.

ObjectiveTo describe seafood consumption patterns in First Nations (FN) in British Columbia (BC) and examine lifestyle characteristics associated with seafood consumption; to identify the top ten most consumed seafood species and their contributions to EPA and DHA intake; and to estimate dietary exposure to methylmercury, polychlorinated biphenyls and dichlorodiphenyldichloroethylene.DesignDietary and lifestyle data from the First Nations Food Nutrition and Environment Study, a cross-sectional study of 1103 FN living in twenty-one communities across eight ecozones in BC, Canada, were analysed. Seafood consumption was estimated using a traditional FFQ. Seafood samples were analysed for contaminant contents.ResultsSeafood consumption patterns varied significantly across BC ecozones reflecting geographical diversity of seafood species. The top ten most consumed species represented 64 % of total seafood consumption by weight and contributed 69 % to the total EPA+DHA intake. Mean EPA+DHA intake was 660·5 mg/d in males, 404·3 mg/d in females; and 28 % of FN met the Recommended Intake (RI) of 500 mg/d. Salmon was the most preferred species. Seafood consumption was associated with higher fruit and vegetable consumption, lower smoking rate and increased physical activity. Dietary exposure to selected contaminants from seafood was negligible.ConclusionsIn FN in BC, seafood continues to be an essential part of the contemporary diet. Seafood contributed significantly to reaching the RI for EPA+DHA and was associated with a healthier lifestyle. Given numerous health benefits, seafood should be promoted in FN. Efforts towards sustainability of fishing should be directed to maintain and improve access to fisheries for FN.

We previously studied the association between fish consumption and prevalence of type 2 diabetes (T2D) in Manitoba and Ontario First Nations (FNs), Canada and found different results. In this study, we used a difference in difference model to analyze the data. Dietary and health data from the First Nations Food Nutrition and Environment Study, a cross-sectional study of 706 Manitoba and 1429 Ontario FNs were analyzed. The consumption of fish was estimated using a food frequency questionnaire. Fish samples were analyzed for dichloro diphenyldichloro ethylene (DDE) and polychlorinated biphenyls (PCBs) content. Difference in difference model results showed that persistent organic pollutant (POP) exposure was positively associated with T2D in a dose-response manner. Stronger positive associations were found among females (OR = 14.96 (3.72–60.11)) than in males (OR = 2.85 (1.14–8.04)). The breakpoints for DDE and PCB intake were 2.11 ng/kg/day and 1.47 ng/kg/day, respectively. Each further 1 ng/kg/day increase in DDE and PCB intake increased the risk of T2D with ORs 2.29 (1.26–4.17) and 1.44 (1.09–1.89), respectively. Our findings suggest that the balance of risk and benefits associated with fish consumption is highly dependent on the regional POP concentrations in fish.

We investigated the food types consumed by 3276 First Nations citizens from the First Nations Food Nutrition and Environment Study (FNFNES) living on-reserve in Canada. Data from 24-h dietary recalls were classified into NOVA categories: fresh or minimally processed foods (MPF), processed culinary ingredients, processed foods, and ultra-processed foods (UPF). Individuals were classified as traditional food (TF) eaters if they ate MPF of their First Nations culture. UPF accounted for 54.0% of energy intake; 23% of participants ate TF. Increasing age and household size, living in British Columbia and TF eating were associated with a lower intake of energy from UPF. Eating TF appeared to be protective against intake of UPF.