Community and International Nutrition

Arctic Indigenous Peoples Experience the Nutrition Transition with

Changing Dietary Patterns and Obesity1–3
H. V. Kuhnlein,*†4 O. Receveur,* ** R. Soueida,* and G. M. Egeland*†
*Centre for Indigenous Peoples’ Nutrition and Environment (CINE) and †School of Dietetics and Human
Nutrition, McGill University, Ste. Anne de Bellevue, Canada; and **Department of Nutrition,
University of Montreal, Montreal, Canada

ABSTRACT Indigenous Peoples globally are part of the nutrition transition. They may be among the most extreme
for the extent of dietary change experienced in the last few decades. In this paper, we report survey data from 44
representative communities from 3 large cultural areas of the Canadian Arctic: the Yukon First Nations, Dene/Métis,
and Inuit communities. Dietary change was represented in 2 ways: 1) considering the current proportion of
traditional food (TF) in contrast to the precontact period (100% TF); and 2) the amount of TF consumed by older
vs. younger generations. Total diet, TF, and BMI data from adults were investigated. On days when TF was
consumed, there was significantly less (P ⬍ 0.01) fat, carbohydrate, and sugar in the diet, and more protein, vitamin
A, vitamin D, vitamin E, riboflavin, vitamin B-6, iron, zinc, copper, magnesium, manganese, phosphorus, potassium,
and selenium. Vitamin C and folate, provided mainly by fortified food, and fiber were higher (P ⬍ 0.01) on days
without TF for Inuit. Only 10 –36% of energy was derived from TF; adults ⬎ 40 y old consistently consumed more
(P ⬍ 0.05) TF than those younger. Overall obesity (BMI ⱖ 30 kg/m2) of Arctic adults exceeded all-Canadian rates.
Measures to improve nutrient-dense market food (MF) availability and use are called for, as are ways to maintain
or increase TF use. J. Nutr. 124: 1447–1453, 2004.

KEY WORDS: ● indigenous peoples ● nutrition transition ● dietary change ● Arctic Canada
● traditional food

Indigenous Peoples are recognized as having unique social,
cultural, and health needs, often within larger mainstream
societies to which they are expected to adapt. Whether Indig-
enous Peoples live concentrated on reservations, integrated
within populations of their countries, or maintain residence in
large territories under their control, they strive to maintain
close cultural ties to land and nature, and the resources they
provide (1–3). This integration invariably associates use of
traditional food (TF)5 resources and other cultural practices
with health.
The nutrition transition taking place in less-developed
countries (LDCs) is now widely documented, with changes
1
Presented in part at Experimental Biology 02, April 2002, New Orleans, LA
[Kuhnlein, H. V., Receveur, O. & Soueida, R. (2002) Nutrition transition in the
Canadian Arctic: traditional food and dietary energy as indicators and determi-
nants of change. FASEB J. 16: A616 (abs.)] and at the Canadian Federation of
Biological Societies, June 2002, Montreal, Canada [Kuhnlein, H. V., Receveur, O.,
Soueida, R. & Egeland G. M. (2002) Arctic dietary change, use of Indigenous
Peoples’ traditional food, and increasing obesity. Proceedings of the 45th Annual
Meeting of the Canadian Federation of Biological Societies, Abstract F066].
2
Some data for the Dene/Métis were adapted from Ref. 21.
3
Supported by the Arctic Environmental Strategy and the Northern Contam-
inants Program (Canada), as well as the Canadian Institutes of Health Research
(CIHR), Institute of Nutrition, Metabolism and Diabetes (INMD), and the Institute of
Aboriginal Peoples’ Health (IAPH).
4
To whom correspondence should be addressed.
E-mail: harriet.kuhnlein@mcgill.ca.
5
Abbreviations used: CINE, Centre for Indigenous Peoples’ Nutrition and
Environment; LDC, less-developed country; LSM, least-square means; MF, mar-
ket food; NWT, Northwest Territories; TF, traditional food.
in food availability and receding famine, increases in non-
communicable disease, and shifts to decreasing physical
activity and increasing use of processed food high in starch,
fat, and sugar (4). Upward trends in obesity seen in LDCs
have been linked to genetics, malnutrition in fetal and
young child development, and poor dietary patterns and
lifestyle factors later in life (5,6). Female gender, degree of
urbanization, education, and income are all associated with
increasing obesity, and the chronic disease correlates of
obesity. Uauy et al. (7) described the extent of obesity and
metabolic complications by gender among rural and urban
Mapuche and Aymara Indigenous People in Chile, demon-
strating that being female and living in urban areas in-
creased the risk.
Several health researchers refer to an epidemiologic tran-
sition for LDCs and Aboriginal People in developed countries.
They describe reflection and study on national communicable
and noncommunicable disease patterns, life expectancy, and
other vital statistics (8 –12). For Indigenous Peoples, health
patterns are often disparate from the national norms, if in fact
it is possible to disaggregate health data by cultural subgroups
within a population. Ethnicity together with poverty are often
key determinants of poor health. As part of the International
Decade of the World’s Indigenous Peoples, the WHO has led
the call for development of methods to identify and compile
health information at national and district levels to identify
marginalized populations by their cultural identity, and to seek

0022-3166/04 $8.00 © 2004 American Society for Nutritional Sciences.

Manuscript received 7 November 2003. Initial review completed 12 January 2004. Revision accepted 23 March 2004.

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 1448 KUHNLEIN ET AL.
new strategies for understanding and influencing health deter-
minants for these special populations (13).
In Canada, research to understand issues specifically for
Indigenous Peoples has been developing steadily, with recog-
nition that trends in Indigenous Peoples’ health parallel those
in national data from LDCs (14,15). Increasing obesity and
changing health lifestyles for circumpolar Inuit have been
noted (16 –18). Dietary patterns researched among Canadian
Arctic peoples point to the high quality of foods taken from
animal and plant species of hunter-gatherer subsistence pat-
terns still recognized by Dene/Métis, Yukon First Nations, and
Inuit communities (19 –23). Arctic TF is understood to be
animal and plant species culturally identified as food and
harvested from the local environment, whereas market food
(MF) is that shipped from the South and purchased in stores
(24). Techniques to delineate dietary components by TF and
MF were used successfully to understand nutritional and cul-
tural benefits in contrast to contaminant risks of TF in the
context of the total diet (21,23,25). However, data on TF and
MF use that are generalizable to the entire Canadian Arctic
are not currently available.
As part of the research program of the Northern Contam-
inants Program of Indian and Northern Affairs Canada, we
conducted studies on dietary intake from 44 communities of
Indigenous Peoples over a 10-y period in 3 major cultural areas
in the Canadian Arctic.6 Research partnerships were devel-
oped with communities through leadership within the Gov-
erning Board of the Centre for Indigenous Peoples’ Nutrition
and Environment (CINE). To devise consistent research strat-
egies and participatory research technique, we worked closely
with the collective aboriginal organizations of the regions:
Dene Nation, Métis Nation of the Northwest Territories
(NWT), Council of Yukon First Nations, and the Inuit Ta-
piriit Kanatami. Results of these studies were reported back to
the organizations and the communities using workshops, post-
ers, and media interviews, as recognized for good participatory
technique (26). Partial results from the Dene/Métis segment of
this effort were published earlier (21,22). This paper presents
TF, MF, and nutrient intakes by age and gender for these 3
cultural groups in the Canadian Arctic, and BMI correlates of
diet for Yukon and Inuit. Estimations of contemporary nutri-
ent inadequacy will be reported separately. The extent of the
nutrition transition is represented as the percentage of TF
energy (in contrast to 100% TF at the turn of the century,
before influx of food stores), and as the contrasting amounts of
TF consumed by young (20 – 40 y), middle-aged (41– 60 y) and
elder (⬎60 y) adults.
SUBJECTS AND METHODS
The vast territories of Arctic Canada whose Indigenous Peoples and
TF resources are the subject of this report are Yukon Territory (483,450
km2), the NWT (1,171,918 km2), Nunavut (2,093,190 km2), and La-
brador (294,330 km2). Ten Yukon First Nations, 16 Dene/Métis com-
munities in the NWT, and 18 Inuit communities in the NWT, Nu-
navut, and Labrador were selected by the aboriginal organizations to
represent the breadth of TF system environments in their regions. These
3 major cultural areas represent the major language families of Athapas-
kan (10 language groups in Yukon First Nations and Denendeh), Tlingit
(Yukon), Eyak (Yukon), and Inuktitut (Inuvialuktun in the NWT). In
all, the research represents populations of 7000 Yukon First Nations,
18,000 Dene/Métis, 24,000 Inuit in Nunavut, 5000 Inuvialuit in the
NWT, and 4500 Inuit in Labrador. This comprises 58,500 of Canada’s
Aboriginal People6 (27–29).
6
Supplement Appendix Figure 1, a map of surveyed communities, is available
with the online posting of this paper at www.nutrition.org.
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Research took place during 2 seasons, a season of high TF use
(September–November) and a season of low TF use (February–
April). Interviews included 24-h recalls, a food-frequency interview
(TF only), a sociocultural interview, and a 7-d food record (Inuit
communities only). This report emphasizes information from 24-h
recall and frequency interviews, and height and weight data from men
and nonpregnant or lactating women ⱖ 20 y old. Interviews were
conducted in Denendeh during 1994, in Yukon during 1995, and in
Inuit communities in 1998 –1999. Each cultural group (Dene/Métis,
Yukon, Inuit) study was reviewed separately by the McGill University
Human Ethics Committee, and each community maintained a re-
search agreement with CINE to ensure completion of procedures
using locally resident research assistants. Collective consent was
obtained from the Council of Yukon First Nations, Dene Nation,
Métis Nation of the NWT, and the Inuit Tapiriit Kanatami. Science
licenses were obtained from the territorial authorities. The research
also included sampling of TF used in homes for analysis of nutrients
and other components, when needed for dietary analysis. Results of
these analyses were reported separately (30 –33).
Random sampling of 10% of households was done using commu-
nity household or utility lists; in smaller communities, all households,
up to a maximum of 25 households, were interviewed. In each
household, 1 adult man and 1 adult woman were selected by conve-
nience and interviewed. In Inuit communities, interviews were also
conducted with 1 adolescent aged 13–19 y, when available (data not
included). In the absence of an adult man or woman in the home,
another random household was contacted. The interviewing season
was selected to avoid periods of mass absence of community members
due to intensive hunting or fishing. Participation was voluntary and
confidential, conducted in English or the traditional language, and
interviewers were trained in confidential process. In each community,
a project coordinator trained in the research methodology, usually a
nutrition graduate, supervised the interviews conducted for complete-
ness and data entry. Having the research coordinator on site fre-
quently to screen completed interviews ensured quality control. In-
terviews on 24-h food intake were conducted in the homes of the
participants. Interviewers used portion models (prepared from locally
available bowls, cups and spoons), a two-dimensional drawing of
bannock (the frequently consumed homemade bread), and a note-
book of TF photos with local names to prompt recognition. Fre-
quency of TF use was captured with an instrument developed in close
consultation in workshops with representatives from each commu-
nity. Individuals were asked how many days each week the food was
consumed, without portion size. Participation exceeded 90% of indi-
viduals contacted for Dene/Métis and Yukon First Nations commu-
nities, and ⬎75% for communities in the 5 Inuit regions. These high
participation rates were due to publicity and encouragement by the
collective leadership organizations (Dene Nation, Métis Nation of
NWT, Council of Yukon First Nations, Inuit Tapiriit Kanatami). The
interview process and materials were consistent in all 3 major studies.
Due to the prohibition of alcohol consumption in some communities,
alcohol intake was recorded when the information was reported in
24-h recall interviews, but it was not probed. Participants were asked
whether the day was “usual” or not, including special occasions.
Records were discarded when energy intakes were ⫾4 SD from the
mean.
For the Yukon and Inuit studies, heights and weights were either
reported or measured, if the respondents did not know their own data.
Weight measurements were taken in light clothing without shoes
using ordinal personal scales (precision ⫾ 100 g) tared to zero. Height
measurements were taken with rigid vertical tape to the nearest 0.5
cm. BMI was calculated as weight (kg) divided by height squared
(m2). There were no significant differences between self-reported and
measured weights, heights, or BMI for subsamples of participant
volunteers in the Yukon and Inuit studies, and all measures and
self-reported data were in good agreement (not shown).
Two food composition databases were used for nutrient intake
analyses: 1) a TF database derived from our own published work on
Arctic TF (30 –38), and 2) a MF database (39) derived from Agri-
culture Handbook 8, adjusted to Canadian nutrient fortification
levels. The carotenoid content of foods was updated (40). In addition,
the MF database was fine-tuned for recent requirements of dietary
 DIETARY CHANGE AMONG ARCTIC INDIGENOUS PEOPLES 1449

TABLE 1 40-y-old age group, men consumed more TF than did women,
and this pattern occurred in the 41- to 60-y-old age group for
Top 16 market foods mentioned in 24-h recalls of Yukon, Inuit. Other than these, there were no differences between
Dene/Métis, and Inuit adults in 44 representative communities genders among the cultural age groups. Mean intake of all TF
from 3 large cultural areas of the Canadian Arctic1 was ⬎100 g/d, and for older individuals, could exceed 400 g/d
(Fig. 1). Because many individuals did not consume TF on the
Yukon Dene/Métis Inuit days interviewed, intakes of TF derived from the 24-h recalls
Food item (n ⫽ 797) (n ⫽ 1007) (n ⫽ 1604)

Sugar2 72 82 74
Coffee2 77 76 63
Tea2 47 59 53
Bread, white, enriched2 43 64 50
Potatoes, baked, boiled or mashed 42 42 26
Butter 43 45 22
Eggs 37 42 18
Cream, light or powdered 18 42 30
Margarine 17 24 27
Rice, white, enriched 32 20 21
Milk, evaporated 21 21 19
Chicken, all types 15 21 16
Hamburger, beef 17 14 16
Lard 25 45 12
Crystal drinks 11 29 34
Bannock3 7 27 20

1 Percentage of recalls that mentioned the food item. Items in each

recall were compiled as a sum for the day (1 mention maximum per
recall).
2 Top 4 items in all 3 surveys.
3 A quickbread similar to a biscuit.

reference intake procedures (41), and new nutrient data reported by

the USDA (42). There were no missing nutrient values in either data
base.
Data are reported from 1007 interviews of Dene/Métis, 797 inter-
views of Yukon First Nations, and 1604 of Inuit. BMI data from 375
Yukon adults and 960 Inuit are reported. In each study, data were
entered into Epi-Info, version 6 (USD). Extensive checking and
double entry of a 10% random subset were completed and analyses
were conducted with SAS, versions 6 and 8 (SAS Institute). Means
or least-square means (LSM) with SEM were compiled as descriptive
statistics. Adjusting for unbalanced sample sizes across communities,
age groups, and seasons was done using LSM. When nutrient intakes
did not meet the assumption of normality, differences between groups
were tested by Kruskal-Wallis nonparametric ANOVA (43). Bonfer-
roni multiple comparisons were used to identify significant differences
between mean values during multiple comparisons (42). All statisti-
cal analyses used P ⬍ 0.05 for the level of significance.

RESULTS
Estimates of consumption frequency by region (2-season
mean of number of days per week)7 revealed that moose,
caribou, fish (whitefish, char, trout), and seal were the most
heavily consumed TF items in all cultures and regions. Using
all 24-h recall datasets, the ranked top 16 MF in each of the 3
cultural areas were consistent across the Canadian Arctic
(Table 1). A total of ⬎200 MF items were mentioned in the
recalls; a more detailed description of MF items in food groups
frequently consumed in the Dene/Métis area is presented in
Receveur et al. (21).
In all three cultures, significantly more TF was consumed by
FIGURE 1 Traditional food intake by Yukon (A), Dene/Métis (B),
older individuals than by those younger (Fig. 1). In the 20- to and Inuit (C) men and women of different ages, adjusted for season,
site, and day of week. Total participants were considered in all regions
within each cultural area. Values are means from 2 seasons ⫾ SEM for
7
Supplement Appendix Table 1 gives frequency of TF use, and is available the n given above each bar. Means without a common letter differ, P
with the online posting of this paper at www.nutrition.org. ⬍ 0.05. *Different from men of the same age, P ⬍ 0.05.

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 1450 KUHNLEIN ET AL.

TABLE 2
Micronutrient, fiber, and energy intake on days with and without traditional food (TF) for Yukon, Dene/Métis, and Inuit adults1

Yukon Dene/Métis Inuit

Days with TF Days without TF Days with TF Days without TF Days with TF Days without TF
Nutrient (n ⫽ 410) (n ⫽ 387) (n ⫽ 661) (n ⫽ 346) (n ⫽ 968) (n ⫽ 632)

Vitamin A,2 ␮g RAE 697 ⫾ 45 523 ⫾ 52 1245 ⫾ 424 825 ⫾ 578 911 ⫾ 136a 433 ⫾ 179b
Vitamin D, ␮g 7.3 ⫾ 0.6a 2.1 ⫾ 0.7b 7.9 ⫾ 0.9a 3.5 ⫾ 1.3b 25.1 ⫾ 1.3a 8.6 ⫾ 1.7b
Vitamin E, mg 4.8 ⫾ 0.1a 3.5 ⫾ 0.2b 6.5 ⫾ 0.4a 3.9 ⫾ 0.5b 5.4 ⫾ 0.2a 3.1 ⫾ 0.3b
Vitamin C, mg 61.8 ⫾ 5.2 68.9 ⫾ 5.9 52.6 ⫾ 4.3 60.9 ⫾ 5.9 62.1 ⫾ 3.4a 70.6 ⫾ 4.5b
Riboflavin, mg 2.2 ⫾ 0.1a 1.5 ⫾ 0.1b 2.5 ⫾ 0.1a 1.6 ⫾ 0.1b 2.9 ⫾ 0.1a 1.3 ⫾ 0.1b
Vitamin B-6, mg 3.3 ⫾ 0.1a 1.7 ⫾ 0.1b 3.7 ⫾ 0.1a 1.9 ⫾ 0.1b 4.0 ⫾ 0.1a 1.4 ⫾ 0.1b
Folate, ␮g DFE 311 ⫾ 9 307 ⫾ 11 303 ⫾ 10 316 ⫾ 14 317 ⫾ 10a 319 ⫾ 13b
Calcium, mg 461 ⫾ 20 508 ⫾ 23 533 ⫾ 17 526 ⫾ 24 443 ⫾ 12 451 ⫾ 16
Iron, mg 23.3 ⫾ 0.6a 14.1 ⫾ 0.7b 26.5 ⫾ 0.9a 15.6 ⫾ 1.3b 37.4 ⫾ 1.1a 15.0 ⫾ 1.4b
Zinc, mg 27.7 ⫾ 0.9a 13.1 ⫾ 1.1b 23.8 ⫾ 1.0a 15.4 ⫾ 1.3b 21.5 ⫾ 0.5a 9.5 ⫾ 0.6b
Copper, ␮g 1655 ⫾ 46a 1163 ⫾ 53b 2025 ⫾ 89a 1439 ⫾ 122b 2076 ⫾ 44a 1041 ⫾ 58b
Magnesium, mg 297 ⫾ 6a 240 ⫾ 7b 305 ⫾ 5a 237 ⫾ 7b 597 ⫾ 31a 280 ⫾ 40b
Manganese, mg 3.7 ⫾ 0.1a 3.3 ⫾ 0.1b 3.6 ⫾ 0.1a 3.3 ⫾ 0.1b 3.3 ⫾ 0.1a 2.7 ⫾ 0.1b
Phosphorus, mg 1602 ⫾ 35a 1155 ⫾ 40b 1759 ⫾ 31a 1224 ⫾ 43b 1663 ⫾ 27a 947 ⫾ 36b
Sodium, mg 2334 ⫾ 89a 2692 ⫾ 102b 2544 ⫾ 80a 3050 ⫾ 109b 2199 ⫾ 73a 2437 ⫾ 95b
Potassium, mg 3520 ⫾ 76a 2608 ⫾ 87b 3516 ⫾ 63a 2561 ⫾ 86b 2997 ⫾ 53a 1999 ⫾ 70b
Selenium, ␮g 160 ⫾ 4a 124 ⫾ 5b 151 ⫾ 3a 132 ⫾ 5b 195 ⫾ 10a 107 ⫾ 13b
Dietary fiber, g 14.6 ⫾ 0.4 15.2 ⫾ 0.5 12.6 ⫾ 0.3 12.9 ⫾ 0.4 9.7 ⫾ 0.3a 11.2 ⫾ 0.4b
Total energy, kJ 8735 ⫾ 193 1971 ⫾ 221 9677 ⫾ 173 8759 ⫾ 236 8577 ⫾ 149a 7456 ⫾ 196b

1 Values are LSM ⫾ SEM (Kruskal-Wallis nonparametric ANOVA within each cultural area adjusted for food source, age, gender, season, site, and
day of week): means in a row with superscripts without a common letter differ, P ⬍ 0.01.
2 RAE, retinol activity equivalents; DFE, dietary folate equivalents.

of only those who consumed TF yielded a range of TF intake
by age and gender groups from a low of 242 g (Yukon women
aged 20 – 40 y, n ⫽ 103) to a high of 567 g (Inuit men 61⫹ y,
n ⫽ 63) (data not shown).
Dichotomizing recall data for all ages combined into those
containing TF and those without TF8 (Table 2), days with TF
had a consistent pattern across cultural groups. TF days had
higher (P ⬍ 0.01) total energy and percentage of energy as
protein. Days without TF had significantly higher percentage
of energy as carbohydrate, fat, sucrose, SFA, and PUFA. The
phenomenon of TF providing significantly more nutrients was
emphasized. In all cultural groups, TF days contained more (P
⬍ 0.01) vitamin D, vitamin E, riboflavin, vitamin B-6, iron,
zinc, copper, magnesium, manganese, phosphorus, potassium,
and selenium. However, differences in nutrient patterns ex-
isted among the 3 groups (Table 2). Vitamin A, with consid-
erable variance, differed significantly between days with and
without TF only for Inuit. Vitamin C, folate, and fiber (fiber
determined from MF only) were also significantly higher on
days without TF for Inuit. Calcium was low in all dietary
records, and vitamin D, primarily in the TF component, for
Inuit was 3 times that of Yukon and Dene/Métis. Sodium was
significantly higher for all cultural groups on days when only
MF was consumed (added table salt not considered).
BMI was computed with data from Yukon and Inuit women
and men, excluding known pregnant and lactating women
from this data set (Table 3). As is the case in most population
groups, BMI tended to increase with age, and men tended to
be slimmer than women. Obesity (BMI ⱖ 30 kg/m2) was more
prevalent in Inuit adults than among Yukon First Nations.
To check the association between TF use and BMI, we
determined the percentage of energy from TF according to
BMI categories for both Inuit and Yukon First Nations partic-
ipants (Table 4). Using the robust Bonferroni multiple com-
parisons, there were no significant differences by BMI category
for TF use within age groups of either cultural group. Data
showing increased TF use by age within BMI category rein-
force those shown in Figure 1. Total TF percentage of energy
varied from 10.5 ⫾ 2.0 (Yukon young women with BMI ⬍ 25
kg/m2) to 36.0 ⫾ 4.9 (Inuit older men with BMI ⱖ 30 kg/m2).
Sources of energy from both TF and MF did not differ
significantly by BMI category.9 The exception was for younger
Inuit men; those in the higher BMI category consumed signif-
icantly more fat than those in the lower category. Cell sizes for
Yukon were extremely small in the high BMI categories.
DISCUSSION
TF systems in the Arctic, as currently used and reported
during this research, include a rich diversity of animal and
plant species. Arctic cultural areas are among the most distant
from centers of commerce in all of North America, and one
would therefore anticipate the maximum current use of TF.
Dene/Métis, Yukon First Nations, and Inuit communities have
the contemporary traditional knowledge for use of a surpris-
ingly high number of food species: 62, 53, and 129 species of
animals (including fish) used, and 40, 48, and 42 species of
plants, respectively (22). The average community TF percent-
age of energy was earlier noted as 6 – 40% with differences
associated with proximity to urban areas, accessibility to roads,
and Northern latitudes (21,22). However, although these
⬎100 species per cultural group are known, the extent of use

8 9
Supplement Appendix Table 2 gives the percentage of energy from macro- Supplement Appendix Figure 2 gives sources of energy by BMI categories,
nutrients, and is available with the online posting of this paper at www.nutrition. age, and cultural group. This is available with the online posting of this paper at
org. www.nutrition.org.

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 DIETARY CHANGE AMONG ARCTIC INDIGENOUS PEOPLES 1451

TABLE 3 45– 69 y increased from 1970 to 1992, from 8.1 to 13.4% for
men and 12.7 to 15.4% for women. Further, obesity in women
BMI of Yukon and Inuit women and men1 was 10.6% in the younger group compared with 22.9% in the
older group in the 1986 –1992 time period. Men were slimmer,
20–40 y 41–60 y ⬎60 y
with 12 and 15.7% in the same age categories, respectively.
Yukon Education and income levels were inversely associated with
women higher obesity in Canada (48,49). Brazilian data demonstrate
BMI, kg/m2 25 ⫾ 4.4 28 ⫾ 5.3 28 ⫾ 5.7 opposite trends in obesity by income in this LDC. Over a
n 123 49 26 similar time period in the 1990s, the overall country preva-
% obese2 7 31 38 lence of obesity increased from 2.1 to 6.4% in men and from
Inuit women 6.0 to 12.4% in women, with the 25% richest of the popula-
BMI, kg/m2 27 ⫾ 5.5 28 ⫾ 5.7 29 ⫾ 7.0
n 272 156 36 tion usually being more obese (8 –10% obesity in this segment)
% obese 23 38 44 (50). Yukon and Inuit women exceeded these obesity preva-
Yukon men lences with 31 and 38% in older age groups, and Yukon and
BMI, kg/m2 25 ⫾ 3.0 26 ⫾ 2.9 29 ⫾ 4.6 Inuit men demonstrated 8 and 21% in older age groups,
n 106 48 23 respectively. Overall, the prevalence of obesity for Yukon and
% obese 5 8 35 Inuit women (17 and 30%, respectively) exceeded the all-
Inuit men
BMI, kg/m2 26 ⫾ 3.9 27 ⫾ 5.0 26 ⫾ 5.4 Canadian data reported in 1996 –1997 of 12% for women (49).
n 289 163 44 Similar data for Yukon men (10%) was slightly lower than the
% obese 16 21 23 all-Canadian male (11%), but Inuit men were at 18%. In the
Alaskan Arctic, both Yup’ik and Athabascan Indigenous Peo-
1 Values are means ⫾ SD. ples had levels of obesity similar to those found in Arctic
2 BMI ⱖ30 kg/m2.
Canada, i.e., 25.7 and 27.4% of men (Yup’ik and Athabascan
men) and 29 and 27.4% of women (Yup’ik and Athabascan
women) ⬎ 40 y old were obese (46). Inuit in Greenland had
as shown here was limited. Appendix Table 17 demonstrates a somewhat lower overall obesity (BMI ⱖ 30 kg/m2) preva-
that the 4th and 5th most commonly used seasonal species lence of 19.7%, with 16.4% among men and 22.4% among
were limited in use frequency to 0.7– 0.1 d/wk (⬃1– 8 d/sea- women (51). Thus, overall, indigenous Arctic men and
son). women have obesity prevalence that exceeds North American
Changing patterns of TF use over time are one way in national prevalence, and that also exceeds the prevalence
which to document the nutrition transition among Indigenous from the lowest education and income strata in Canada.
Peoples. Before colonial contact in the Americas, Indigenous The global phenomenon of increasing population obesity is
Peoples had 100% of dietary energy from their TF resources. well documented (4 – 8), but the data disaggregated for Indig-
This pattern persisted in the Canadian Arctic until the advent enous People are sparse. High obesity prevalence and conse-
of Hudson’s Bay stores at the turn of the 20th century. Today quent chronic disease are reported throughout aboriginal com-
only 10 –36% of adult dietary energy is derived from TF munities in North America (52,53) and Uauy et al. (7)
(Table 4). demonstrated that Mapuche women and men in Chile became
An additional measure of dietary change is the difference in more obese when living in an urban area, in contrast to those
TF use between older and younger population subsets. In the living in a rural environment. Urban and rural women had a
research reported here, individuals ⬎ 40 y old consistently
consumed significantly more TF than those younger (20 – 40 y)
(Fig. 1). From Table 1 it is clear that the kinds of MF used TABLE 4
consistently and most frequently across the Canadian Arctic
are least-cost sources of energy, and as a whole, have poor The percentage of energy from traditional food by BMI
nutrient density. It is therefore no surprise that in Appendix categories of Yukon and Inuit women and men1
Table 2,8 the days reported without TF were significantly
higher in carbohydrate, fat, and sucrose, and this was consis- Women Men
tent across all cultural groups. Protein and most micronutri-
ents were superior in recalls from days containing TF. This is BMI, kg/m2 20–40 y 41–60 y 20–40 y 41–60 y
especially meaningful when so little total dietary energy is
%
consumed as TF. Although the effect of markets on the health
of rural Indigenous Peoples is still controversial (44), a poor Yukon
quality diet has long been associated with increasing obesity, ⬍25 10.5 ⫾ 2.0 18.8 ⫾ 5.2# 18.5 ⫾ 3.1 24.1 ⫾ 4.8
diabetes, and glucose intolerance in many North American n 83 18 68 28
indigenous groups (24,45,46). Gittelsohn et al. (47) showed an ⱖ25 and ⬍30 15.1 ⫾ 2.6 21.7 ⫾ 4.8 12.9 ⫾ 3.8 20.1 ⫾ 4.9
association with diabetes risk by junk food and bread/butter n 48 22 46 24
ⱖ30 16.3 ⫾ 6.2 28.1 ⫾ 5.8 23.5 ⫾ 9.8 18.6 ⫾ 12.9
(high-sugar, low-fiber, high-fat) in an Ontario First Nation n 8 15 6 4
community. It is intuitive that meat and fish contribute sub- Inuit
stantially to micronutrient intakes, but it may be less intuitive ⬍25 17.7 ⫾ 2.0 22.6 ⫾ 3.7 15.8 ⫾ 2.1 28.8 ⫾ 3.9*
to realize that Arctic TF systems are most likely the best global n 122 51 123 56
examples of Indigenous Peoples’ food being far superior to the ⱖ25 and ⬍30 17.0 ⫾ 2.3 27.5 ⫾ 3.7# 16.0 ⫾ 2.1 33.2 ⫾ 3.6*
MF presented as alternatives. n 87 47 121 72
ⱖ30 14.1 ⫾ 2.8 30.3 ⫾ 3.4* 18.0 ⫾ 3.5 36.0 ⫾ 4.9*
We demonstrate for Canadian Arctic adults the widely n 3 59 45 34
recognized phenomenon that BMI increases with age. Tor-
rance et al. (48) showed that all Canadian average obesity 1 Values are the LSM estimates ⫾ SEM, adjusted for site. Symbols
(BMI ⱖ 30 kg/m2) rates for men and women 20 – 44 and indicate different from 20 – 40 y group (t test, # P ⬍ 0.05 and * P ⬍ 0.01).

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 1452 KUHNLEIN ET AL.
prevalence of obesity of 44.7 and 32.1%, respectively; that for
men was 28.3 and 15%, respectively. It is thus clear from the
available data for Indigenous People that these women and
men exceed the national averages for becoming obese. When
TF is lost, and low-cost but high-energy MF is substituted, the
basis for developing obesity exists. This is coincident with
additional circumstances of changing activity patterns and
possible genetic predisposition.
Micronutrient nutrition, with the dietary transition de-
scribed here, is also of concern. When traditional Arctic food
is consumed, even in small amounts, nutrition for most mi-
cronutrients is improved (Table 2). Even vitamin C, a nutrient
commonly associated with fresh fruit and vegetables, was
shown to exist in ample quantities in Arctic TF meats (31).
Formerly, all parts of animals, fish, and many plants were
consumed, which gave a rich micronutrient base; but fre-
quency data reported here showed that few organ meats now
consumed, and that amounts and frequency of animal/fish flesh
food consumption declined with age. If MF of sufficient quality
(meat, low-fat dairy items, vegetables, whole grains) is not
available and consumed to replace the missing micronutrients
from traditional meats, fish and organs, the nutrition of the
entire community is at risk. Our research makes clear that this
type of MF is not used regularly.
In this study, as is customary with 24-h recalls, total energy
intake may have been slightly underestimated, if only because
alcohol intake was not regularly recorded. Because energy
intake was higher with TF (Table 2), it may be interpreted
that TF was consumed in addition to MF, rather than as a
substitute for MF. Alternatively, when TF was available, large
portions were consumed, whereas smaller amounts of MF
meats were eaten by adults, and fat intakes increased.
For all Indigenous Peoples, food is at the heart of culture
and health, and it is considered to be part of the environmen-
tal whole in which families live. Close ties to the land for its
health-giving properties are part of cultural identity (2).
Global warming and other environmental insults such as con-
taminants in air and water resources are signaled by elders and
indigenous leaders as serious threats because of the potential
effect on TF quality (1,54). Although recognized as an essen-
tial part of life, the all-Arctic average of TF energy is now
⬃22% (Yukon at 17%, Dene/Métis at 21%, and Inuit at 28%).
Even at these average portions of daily energy, TF is critical for
providing many essential nutrients in adult diets. A variety of
intervention programs to improve MF availability and choices,
as well as acceptable preparation methods, are called for. At
the same time, policies and programs should be developed so
that communities can maintain or improve, if possible, the
availability and accessibility of nutrient-dense, excellent qual-
ity traditional Arctic foods. It is also salient to note that
protection of TF environments is critical for this to happen.
ACKNOWLEDGMENTS
This project was successful because of the many fine research
collaborators we worked with during the 10-year research period. We
appreciated keenly the support, concern, and understanding of the
many community members and staff of the Dene Nation, Métis
Nation (NWT), the Council of Yukon First Nations, and the Inuit
Tapiriit Kanatami. In particular, we thank Bill Erasmus, Carole Mills,
William Carpenter, Barney Masuzumi, Ed Schultz, Betsy Jackson,
Norma Kassi, Cindy Dickson, Rosemary Kuptana, Okalik Eegeesiak,
Maryann Demmer, Peter Usher, Craig Boljkovak, and Eric Loring.
Community organizations upon which we heavily relied were Dene
Community Councils, Métis Locals, Yukon Community Councils,
Inuit Hamlet Councils, Hunters and Trappers Associations, the La-
brador Inuit Association, and the Inuvialuit Regional Corporation.
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Special thanks for work well done is extended to the 16 CINE
research coordinators and 97 trained interviewers. Additionally, we
are grateful for special and very competent work on the project by
Annie May Propert, Amy Ing, Marjolaine Boulay, and Peter Berti.
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