Abstract
Objectives
The Truth and Reconciliation Commission includes a call to action to close gaps in health outcomes, including type 2 diabetes, of which diet quality must be considered an important mediator. The objectives of this study were to compare diet quality between off-reserve Indigenous and non-Indigenous adults in 2004 and 2015, and examine food security as a predictor of diet quality.
Methods
We employed a repeated cross-sectional design using the 2004 and 2015 Canadian Community Health Surveys-Nutrition. Both surveys include a representative sample of the Canadian population in the 10 provinces, excluding the northern territories and people living on-reserve. Healthy Eating Index (HEI) values were estimated, using 24-hour dietary recalls, for the Indigenous and non-Indigenous population in each time period. After matching, a generalized linear model was applied to test for differences in HEI between groups across time period, adjusting for household food security.
Results
Overall, HEI scores were not significantly different for Indigenous men and women in 2015 as compared with 2004, but continued to be lower compared with those of the non-Indigenous population. Indigenous adults reported significantly lower diet quality independent of food security status and other factors. Scores pertaining to percent energy from ‘other’ foods improved in 2015 compared with 2004.
Conclusion
Dietary disparities persist between Indigenous and non-Indigenous populations. While addressing household food insecurity among Indigenous populations is necessary to improve diet quality, it is not sufficient. Results suggest that factors other than food insecurity and socio-economic status are impacting disparities in diet quality among Indigenous adults.
Résumé
Objectifs
L’un des appels à l’action lancé par la Commission de vérité et réconciliation vise à combler les écarts dans les résultats cliniques, notamment pour le diabète de type 2, dont la qualité du régime doit être considérée comme un médiateur important. Nous avons cherché à comparer la qualité du régime des adultes autochtones vivant hors réserve et des adultes non autochtones en 2004 et en 2015 et à examiner la sécurité alimentaire comme variable prédictive de la qualité du régime.
Méthode
Nous avons employé un plan transversal répété en utilisant les Enquêtes sur la santé dans les collectivités canadiennes – Nutrition de 2004 et de 2015. Les deux enquêtes incluent un échantillon représentatif de la population canadienne dans les 10 provinces, sans les territoires nordiques ni les populations vivant dans les réserves. Les valeurs de l’Indice d’alimentation saine (IAS) ont été estimées, à l’aide de rappels alimentaires de 24 heures, pour la population autochtone et non autochtone durant chaque intervalle. Après appariement des données, nous avons appliqué un modèle linéaire généralisé pour découvrir les différentes valeurs de l’IAS entre les groupes au fil du temps, en apportant des ajustements pour tenir compte de la sécurité alimentaire des ménages.
Résultats
Dans l’ensemble, les valeurs de l’IAS n’étaient pas significativement différentes chez les hommes et les femmes autochtones en 2015 comparativement à 2004, mais elles restaient inférieures aux valeurs de l’IAS pour la population non autochtone. Les adultes autochtones ont déclaré une qualité du régime significativement inférieure, indépendamment de leur statut de sécurité alimentaire et d’autres facteurs. Les valeurs afférentes au pourcentage d’énergie provenant d’ « autres » aliments s’étaient améliorées en 2015 par rapport à 2004.
Conclusion
Les disparités du régime alimentaire persistent entre les populations autochtones et non autochtones. Bien qu’il soit nécessaire d’aborder l’insécurité alimentaire des ménages dans les populations autochtones pour améliorer la qualité du régime, ce n’est pas suffisant. Nos résultats indiquent que d’autres facteurs que l’insécurité alimentaire et le statut socioéconomique accentuent les disparités dans la qualité du régime chez les adultes autochtones.
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Notes
Indigenous People in Canada are composed of First Nations, Métis, and Inuit, as defined in Section 35 of the Canadian Constitution of 1982. Where applicable we have used the most specific name to refer to the Indigenous group or population.
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Acknowledgements
We would like to acknowledge Didier Garriguet of Statistics Canada for graciously sharing code with us in developing the Healthy Eating Index variable. We thank Dr. Joyce Slater for her review and feedback on earlier drafts. We also thank Riel Dubois for his feedback on these results and manuscript, and for hosting a community event with us in Winnipeg to share these results and obtain feedback from community members. Last, we thank the anonymous reviewers for their generous feedback, which greatly improved the manuscript.
Availability of data and material
Data are available through Canadian Research Data Centres (https://crdcn.org/).
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Please contact the corresponding author for code.
Funding
This work was funded by the Canadian Institutes of Health Research (CIHR), Canadian Community Health Survey Nutrition Analysis (Grant #151546). NDR is the recipient of a CIHR Early Career Investigator Award (2018-2022; grant #155435). Research at the Manitoba Research Data Centre is supported by funds to the Canadian Research Data Centre Network (CRDCN) from the Social Sciences and Humanities Research Council (SSHRC), CIHR, the Canadian Foundation for Innovation (CFI), and Statistics Canada. Although the research and analysis are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada.
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NR was involved in formulating the research question, designing the study, carrying it out, and writing the article. JL was involved in formulating the research question, designing the study, contributing to interpretation, and reviewing the manuscript for intellectual content. AM was involved in designing the study, carrying it out, analyzing the data, contributing to interpretation, and reviewing the manuscript for intellectual content. LC was involved in designing the study, carrying it out, analyzing the data, contributing to interpretation, and reviewing the manuscript for intellectual content.
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This article does not contain any studies with human participants performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of Statistics Canada (Microdata research contract 17-SSH-WIN-5184) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Riediger, N.D., LaPlante, J., Mudryj, A. et al. Examining differences in diet quality between Canadian Indigenous and non-Indigenous adults: results from the 2004 and 2015 Canadian Community Health Survey Nutrition Surveys. Can J Public Health 113, 374–384 (2022). https://doi.org/10.17269/s41997-021-00580-x
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DOI: https://doi.org/10.17269/s41997-021-00580-x
Keywords
- Diet quality
- Healthy Eating Index
- Canadian Community Health Survey
- Food security
- Indigenous
- First Nations
- Off-reserve
- Métis