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Reply to EC Westman

¹ Laval University Medical Research Center Centre Hospitalier Universitaire de Quebec Public Health Research Unit 2400 d'Estimauville Beauport, Quebec G1E 7G9 Canada
² Laval University Department of Food Sciences and Nutrition Ste-Foy, Quebec G1K 7P4 Canada

Dear Sir:

In response to Westman, we acknowledge that no information regarding macronutrient intake was presented or considered in our estimation of cardiovascular risk among the Inuit of Nunavik. We are aware that factors other than those considered in our study may be partially responsible for the observed differences in the incidence of cardiovascular disease between the Inuit and Western populations. However, on the basis of current knowledge and data from the Santé Québec Health Survey (1,2), we believe that the associations among variables in our study were well quantified and met the goal of the study (3), which was to verify the relation between plasma phospholipid concentrations of the n-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and various cardiovascular disease risk factors among the Inuit of Nunavik.

As mentioned in the introduction section of our article, important changes occurred in the traditional Inuit diet, primarily between 1950 and 1970 when the Inuit population settled into permanent communities. Previous to this time period, the Inuit lived off the land, rivers, lakes, and the sea and appear to have avoided nutritional deficiencies by eating all animal parts (4). Their diet was traditionally high in protein and fat and low in carbohydrate. However, even though the Inuit diet is still rich in meat and fish today (including game), the Santé Québec Health Survey conducted among the Inuit of Nunavik in 1992 showed no evidence of a very low carbohydrate intake among this population. On the basis of a 24-h dietary recall, the average carbohydrate intake in this population was estimated to be 202 g [or, 24.38 g MJ (102 g/1000 kcal)] on the day before the survey (2).

The mean contribution of carbohydrate (42%) to the total energy intake of the Inuit population appeared to be somewhat lower than that reported (47%) in the survey conducted among the Quebec population in 1990, and tended to be higher in the younger than in the older Inuit (2). On the other hand, the percentage contribution of energy from protein (20%) and lipids (37%) was, on average, higher in the Inuit population than in the Quebec population (16% and 34%, respectively). However, the contribution of saturated fatty acids tended to be slightly lower in the Inuit than in the Quebecers, and the n-3 fatty acid intake of the Inuit was substantially higher than that of the Quebecers.

As described in Subjects and Methods, a 24-h dietary recall was used to assess the amounts of marine foods consumed by men and women in the Inuit community on the day before the survey. The value of the 24-h dietary recall in assessing the intake of groups is well established (5). It provides a fairly accurate estimate of a population's average intake. As reported by Willett (5), we believe that the investigation of relations between cardiovascular disease risk factors and macronutrient intakes requires the use of an estimate of individual intakes over >1 d. For this reason, we did not want to present correlations between individual macronutrient intakes (including carbohydrates) on a single day and cardiovascular disease risk factors. On the other hand, plasma concentrations of n-3 fatty acids are good biomarkers of fish intake. Indeed, it is generally recognized that the measurement of eicosapentaenoic acid and docosahexaenoic acid in plasma phospholipids discriminates long-term fish eaters from nonfish eaters quite well (6–8).

In conclusion, even though the carbohydrate intake of the Inuit population is slightly lower than that of the Quebec population, we do not consider this intake to be very low. Moreover, we believe that the traditional diet of the Inuit must be maintained because it provides a high intake of n-3 fatty acids, which contributes to the low prevalence of cardiovascular diseases in this population.

REFERENCES

1. Santé Québec. Report of the Santé Québec Health Survey among the Inuit of Nunavik (1992). Montréal: Ministère de la Santé et des Services Sociaux du Québec, Gouvernement du Québec, 1994.
2. Santé Québec. Report of the Santé Québec Health Survey among the Inuit of Nunavik (1992): diet, a health determining factor. Montréal: Ministère de la Santé et des Services Sociaux, Gouvernement du Québec, 1995.
3. Dewailly E, Blanchet C, Lemieux S, et al. n-3 Fatty acids and cardiovascular disease risk factors among the Inuit of Nunavik. Am J Clin Nutr 2001;74:464–73.[Abstract/Free Full Text]
4. Health Canada. Native foods and nutrition: an illustrated reference manual. Ottawa: Minister of National Health and Welfare, 1994:125.
5. Willett W. 24-hour Dietary recall and food record methods. In: Willett W, ed. Nutritional epidemiology. 2nd ed. Monographs in epidemiology and biostatistics. Vol 30. New York: Oxford University Press, 1998:50–100.
6. Harris WS. Fish oils and plasma lipid and lipoprotein metabolism in humans: a critical review. J Lipid Res 1989;30:785–807.[Abstract]
7. Silverman DI, Reis GJ, Sacks FM, Boucher TM, Pasternak RC. Usefulness of plasma phospholipid n-3 fatty acid levels in predicting dietary fish intake in patients with coronary artery disease. Am J Cardiol 1990;66:860–2.[Medline]
8. Holub BJ. Fish oils and cardiovascular disease. Can Med Assoc J 1989;141:1063–4.[Medline]

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