The International Inuit Cohort: Emergence of Chronic Diseases (Project 1.5) Eric Dewailly, Grace Egeland, Kue Young Laval U., Mc Gill U.

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1 The International Inuit Cohort: Emergence of Chronic Diseases (Project 1.5) Eric Dewailly, Grace Egeland, Kue Young Laval U., Mc Gill U., U of Toronto

2 It is better to be healthy than ill or dead. That is the beginning and the end of the only real argument for public health. It is sufficient. Geoffrey Rose Any questions?

3 Figure 8 Arctic Net Ship time Inuit Health Study Project 1.5 E. Dewailly (PL) G. Egeland (CoL) K. Young (CoL) Project 3.5 P. Ayotte (PL) L. Chan (CoL) QANUIPPITAA É. Dewailly (PL) S. Déry (PL) MSSS RRSSS CVD diseases CIHR E. Dewailly (PL) Environmental contaminants NCP E. Dewailly (PL) Studies on waterborne diseases and zoonoses Project 2.3 B. Lévesque (PL) Project W. Vincent (PL) É. Dewailly (CoL) D. Martin (NI)

4 The Inuit Diet and Health Study An International Study of the Impact of Diet on Health and Disease among the Inuit and Yupik

5 Prospective cohort The Inuit Health in Transition Cohort Study: A circumpolar study of the impacts of diet on health and disease among the Inuit and the Yupik The Inuit Health in Transition Cohort Study is a prospective study that will be repeated every 7 years In 2004 the Inuit Health in Transition study was merged with the Nunavik Health Survey (Quanuippitaa?) The cohort study results of Nunavik allows a comparison with Inuit population of Greenland, Alaska, Nunavut and Siberia

6 Circumpolar Inuit Health Cohort: Circumpolar Inuit Health Cohort: The Qanuippitaa Survey

7 Nunavik Inuit Health Survey Photos: Isabelle Dubois

8 Study Population All permanent Nunavik residents Exception of exclusively non-inuit households and persons living full time in public institutions A total 600 Inuit households randomly chosen Respondents aged 15 and over. Total participants: 1058 (117 aged 15-17)

9 Data were collected in the 14 Nunavik communities between August and October 2004 Data were gathered onboard the Amundsen Participants were transported by barge and helicopter from the community to the ship

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12 Ethics Use of video to explain the study Consent forms for the survey and the cohort

13 Data collection - questionnaires data were gathered through structured interviews with survey participants household questionnaire individual questionnaire confidential questionnaire (self-administered) 24 hour dietary recall + food consumption frequency (except pregnant women) clinical questionnaire

14 Dietary and clinical questionnaires The clinical questionnaire (18 and over) collected information on personal and family medical history (cardiovascular disease, cancer, and associated risk factors). The 24 hour dietary recall and food consumption frequency questionnaire assessed: average food, calorie, and macro- and micro-nutrient intake; the contribution of main food groups to calorie and nutrient intake; the frequency with which traditional and commercial foods are consumed on a daily, seasonal, and yearly basis.

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16 Clinical measurements Blood pressure Height, sitting height, waist and hip Corporal impedance + weight Cardiac variability (Holter : + than 40 years old) Atherosclerosis measurement (carotid) Osteoporosis (bone density: women + 35 years old) Hearing tests (+ than 18 years old)

17 Blood analyses Cardiovascular risk factors (classical) Cholesterol total HDL-cholesterol LDL-cholesterol Triglycerides Glucose + OGTT Insulinemia New markers Oxidative markers (LDL-Ox) APO B, A1 Inflammatory markers: CRP, IL-6, TNF-a LDL phenotype

18 Some research questions Are trans fatty acids from junk food an issue? How blood lipids evolved since 1992 Is atherosclerosis prevalent among Inuit? Is obesity associated with inflammation? Are LDL particles dense (atherogenic)? Are carbohydrates and omega-3 an explosive mix for diabetes? Are omega-3 protecting Inuit against ischemic heart diseases? By which mechanisms: cardiac variability, lipids, etc.?

19 Taux mortalité coronarienne (par ) Quintiles MRFIT États-Unis Québécois non autochtones Espagne y = -2,8075x + 211,97 R 2 = 0,9573 Cris Baie-James Inuits Nunavik Japon Groenland % HUFA n-3 (des HUFA totaux) Association entre taux de mortalités coronariennes ajustés pour l âge (pour pers.) et proportions d oméga-3 dans les acides gras hautement insaturés (HUFA) totaux des tissus. Figure reproduite Lands (2003) avec permission de l auteur. %HUFAn-3 (des HUFA totaux)=(hufan-3/hufa totaux) * 100 Résultats de Lands et al BBA. (1180): Lands et al FASEB J.( 6): Dewailly E. et al Am J Clin Nutr. 76(1): Dewailly E. et al Am J Clin Nutr. 76(1): Dewailly E et al Am J Clin Nutr 74(5):

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21 Transfats?

22 Transfatty acids (% plasma PhL) according to age Europe: 0.36 % Age groups years N Mean

23 Results:.since the 1992 s health survey (SEE ORAL PRESENTATION ML CHÂTEAU-DEGAT ET AL.) Male Female ESI92 ESI p<0.01 Male Female p< p<0.01 Male Female p<0.01 ESI92 ESI Male Female ESI92 ESI04 ESI92 ESI04 Prevalence of low HDL( 0.9 mmol/l) in % Prevalence of total cholesterol High ( 6.2 mmol/l) in % Prevalence of abnormally high level ( 2.3 mmol/l) of triglycerides in % Prevalence of high LDL ( 3.4 mmol/l) in %

24 Tot Chol/HDL according to Body Mass Index Body Mass Index (kg/m 2 ) N Mean IC Normal:<= Overweight: Obesity: Severe Obesity:>=

25 Fasting glucose (mmol/l) according to Body Mass Index Body Mass Index (kg/m2) N Mean IC Normal:<= Overweight: Obesity: Severe Obesity2:>=

26 Tot Chol/HDL according to fasting glucose Fasting glucose (mmol/l) N Mean IC Normal:< Prediabetes: Diabetes: >=

27 Triglycerides (mmol/l) according to Body Mass Index Body mass index (kg/m2) N Mean IC Normal:<= Overweight: Obesity: Severe Obesity >=

28 Triglycerides (mmol/l) according to fasting glucose Fasting glucose mmol/l N Mean IC Normal:< Prediabete: Diabete: >=

29 HDL (mmol/l) according to age groups Age groups(years) N Mean IC Total

30 Tot Chol/HDL according to fasting glucose Fasting glucose (mmol/l) N Mean IC Normal:< Prediabete: Diabete: >=

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33 Omega-3 (% plasma PhL) according to age Age groups years N Mean

34 Glycemia and omega-3

35 Omega-3 (% plasma PhL) according to diabetes status Fasting glucose N Mean Normal:< 5.6 mmol Prediabetes: Diabetes: >=

36 Omega-3 (% PhL) according to Body Mass Index Body mass index N Mean Normal:<= Overweight: Obesity: Severe Obesity2:>=

37 IMT measure Early diagnosis of atherosclerosis Non invasive Portable Carotid Ultrasound (E Lonn Mc Master)

38 Intima - Medial Thickness (IMT) 0.70mm 1.15mm 2.43mm

39 The Role of Carotid IMT in Predicting Coronary Events and Stroke The Cardiovascular Health Study 5858 subjects 65 yrs 4476 subjects - no CVD at baseline Follow-up: 6.2 years O Leary et al. NEJM, 1999;340: Unadjusted cumulative event-free rates for the combined endpoint MI and stroke by quintiles of IMT

40 Mean maximum carotid artery intimal medial thickness (mm) in the entire population and by gender according to various determinants Overall Women Men Mean SD Mean SD Mean SD BMI Age years years years Fasting glucose Normal < At risk Diabetes >=7.0*

41 Fasting glucose (mmol/l) according to IMT IMT(mm) N Mean IC Q1: Q2: Q3: Q4:

42 Omega-3 (% PhL) according to IMT IMT(mm) N Mean Q1: Q2: Q3: Q4:

43 IL-6 (pg/ml) according to IMT IMT (mm) N Mean IC Q1: Q2: Q3: Q4:

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45 LDL size (Ǻ) according to IMT IMT(mm) N Mean IC Q1: Q2: Q3: Q4:

46 Some prelminary conclusion CVD classical risk factors including diabetes are still low compared to other aboriginal groups. Obesity has increased particularly abdominal obesity among women Transfats are high among yound adults Atherosclerosis is present but moderate, inflammation too. Electrical protection by omega- 3?

47 Is cardiac variability the 2-h duration Predictor of IHD prognosis key? Improved by n-3 FA

48 Bikkina et al., 1998

49 Film with Glacialis Media com. Talk shows Posters Web site Reports Communications

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51 Nasivvik Onboard Training ArcticNet International Training Fund $40K per year to provide access to training Schools

52 Thanks to all collaborators The Qanuippitaa Staff Institut National de la Santé Publique Staff CRCHUL Staff Nunavik Health staff Students: Beatriz Valera (MSc), Dre Émilie Counil (Post Doc), Dre Ludivine Château- Degat (Post Doc), Françoise Proust (PhD) Dr P Julien Dr Dr Benoit Lamarche Dr Jean Bergeron Dr Paul Poirier Dr Eva Lonn Dr Katherine Cianflone Dr Jean Marie Ékoé

53 ArcticNet, IRIS J. of Peperoni Res. Int. J. of Garlic Am. J. Mozz.

54 Greenland:Status for data collection

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56 Status for data collection Community Target Result Remaining Nanortalik bygder Qaqortoq Narsaq Nuuk Nuuk bygder Maniitsoq Maniitsoq bygder Aasiaat Qasigiannguit Ilulissat bygder Upernavik Upernavik bygder Tasiilaq Total

57 IHT Greenland - Fall 2006 visit to villages Community Sample Result Participation rate Upernavik Kullorsuaq Innaarsuit Aappilattoq All IHT

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62 Thank you

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