title: Dietary Patterns and Type 2 Diabetes Mellitus in a First Nations Community.
abstract: BACKGROUND
  Type 2 diabetes mellitus is a growing concern worldwide, particularly in Indigenous communities, which have undergone a marked nutrition transition characterized by reduced intakes of traditional foods and increased intakes of market foods. Few studies have assessed the relationships between differing dietary patterns and risk for type 2 diabetes in Indigenous communities in Canada. The objective of the study was to characterize dietary patterns using factor analysis (FA) and to relate these patterns to the incidence of type 2 diabetes after 10 years of follow up in a First Nations community in Ontario, Canada.
  
  
  METHODS
  We conducted a prospective analysis of 492 participants in the SLHDP who did not have diabetes at baseline (1993 to 1995) and were followed for 10 years. A food-frequency questionnaire was administered, and FA was used to identify patterns of food consumption. Multivariate logistic regression analyses determined associations of food patterns with incident type 2 diabetes, adjusting for sociodemographic and lifestyle confounders.
  
  
  RESULTS
  At follow up, 86 participants had developed incident type 2 diabetes. FA revealed 3 prominent dietary patterns: Balanced Market Foods, Beef and Processed Foods and Traditional Foods. After adjustment for age, sex, waist circumference, interleukin-6 and adiponectin, the Beef and Processed Foods pattern was associated with increased risk for incident type 2 diabetes (OR=1.38; 95% CI 1.02, 1.86). In contrast, the Balanced Market Foods and Traditional Foods Patterns were not significantly associated with type 2 diabetes.
  
  
  CONCLUSIONS
  Dietary interventions should encourage reduced consumption of unhealthful market foods, in combination with improvements in local food environments so as to increase access to healthful foods and reduce food insecurity in Indigenous communities.
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Reeds
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sudaba
authors.initials: S
authors.lastname: Mansuri
authors.affiliation: Sandy Lake Health and Diabetes Project, Sandy Lake, Ontario, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Mamakeesick
authors.affiliation: Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Stewart B
authors.initials: SB
authors.lastname: Harris
authors.affiliation: Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Zinman
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Gittelsohn
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Thomas M S
authors.initials: TM
authors.lastname: Wolever
authors.affiliation: Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Phillip W
authors.initials: PW
authors.lastname: Connelly
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Sandy Lake Health and Diabetes Project, Sandy Lake, Ontario, Canada. Electronic address: anthony.hanley@utoronto.ca.
authors.forename: Anthony
authors.initials: A
authors.lastname: Hanley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D002170:Canada / Q000453:epidemiology; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D005247:Feeding Behavior / Q000208:ethnology*; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
keywords: First Nations; Premières Nations; alimentation; autochtone; diabète sucré de type 2; food patterns; indigenous; modèles de consommation alimentaire; nutrition; type 2 diabetes mellitus