Indigenous health
=================

* Gerry K. Schwalfenberg

In the Feb. 23, 2010, issue of *CMAJ*, the health of indigenous people regarding food insecurity, 1 epidemiology of diabetes 2 and birth outcomes 3 was summarized. Traditional indigenous foods were not studied in the food security study. These foods, which include fish, would provide some vitamin D and significant levels of omega 3 fatty acids. However, environmental contaminants in these foods are rising and mercury is certainly a concern. There is emerging evidence that inadequate maternal vitamin D levels may increase the risk of developing diabetes in the offspring, pre-eclampsia in pregnancy, primary cesarean section rates and increased bacterial vaginosis in the first trimester. Low omega 3 fatty acid intake may contribute to the development of pre-eclampsia, preterm births and other adverse pregnancy outcomes.

In 2007, the Canadian Pediatric Society recommended increased vitamin D levels, especially in the Inuit and First Nations who live at higher latitudes. Improving vitamin D status is a very inexpensive intervention costing pennies a day. Omega 3 fatty acid intake recommendations in pregnancy have been around since 1999. Providing purified omega 3 supplements, although more expensive, would avoid the mercury and other toxicants found in contaminated traditional foods. Studies applying these recommendations and following outcomes may show considerable improvement in the health of the indigenous population and the rest of the nation as a whole.

## Footnotes

*   **For the full letter, go to:** [www.cmaj.ca/cgi/eletters/182/3/243#297970](http://www.cmaj.ca/cgi/eletters/182/3/243#297970)

## REFERENCES

1.  1. Egeland GM, Pacey A, Cao Z, et al. Food insecurity among Inuit preschoolers: Nunavut Inuit Child Health Survey, 2007–2008. CMAJ 2010;182:243–8.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxODIvMy8yNDMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTgyLzYvNTkyLjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Dyck R, Osgood N, Lin TH, et al. Epidemiology of diabetes mellitus among First-Nations and non-First Nations adults. CMAJ 2010;182:249–56.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxODIvMy8yNDkiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTgyLzYvNTkyLjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  3. Luo Z.-C, Senécal S, Simonet F, et al. Birth outcomes in the Inuit-inhabited areas of Canada. CMAJ 2010;182:235–42.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxODIvMy8yMzUiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTgyLzYvNTkyLjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)