Jessy El Hayek et al. Table I. Selected characteristics of Inuit preschool children: Nunavut Inuit Child Health Survey, 2007 2008a Characteristics Demographics Age (years) Boys (%) Anthropometry BMI (kg/m2) BMI percentile (%)b BMI-for-age z-score Weight-for-age z-score Height-for-age z-score BUA (Ddb/DMHz) SoS (m/s) Dietary intake Energy (Kcal/d) Carbohydrate (g/d) Protein (g/d) Fat (g/d) SFA (g/d) MUFA (g/d) PUFA (g/d) Vitamin D (mg/d) Calcium (mg/d) Supplemental intake Vitamin D (% yes) Multivitamins including vitamin D (% yes) Biochemistry 25(OH)D (nmol/L) PTH (pmol/L) Calcium (mmol/L) ALP (U/L) CRP (ng/mL) n 285 132 284 284 284 284 285 285 285 276 276 276 276 276 276 276 276 276 13 47 219 205 168 169 222 4.490.8 46.3 18.2 [17.1 19.3] 96.8 [88.1 99.3] 1.85 [1.18 2.48] 1.03 [0.43 1.72] 0.39 [ 0.93 to 0.25] 40.6 [36.2 47.8] 1541.7 [1532.7 1549.1] 1762 [1336 2234] 239.6 [186.1 311.3] 66.2 [45.6 90.9] 54.3 [38.6 75.8] 18.6 [12.0 25.5] 19.6 [12.8 28.8] 7.8 [5.0 12.2] 4.9 [2.7 8.1] 812 [522 1111] 4.6 16.8 46.7 [30.2 68.9] 2.33 [1.68 3.29] 2.34 [2.29 2.39]c 183.0 [160.0 207.5]d 0.7 [0.2 2.3]e aValues are percent, mean9SD, or median [IQR]. bAccording to World Health Organization (23). cNormal range: [2.0 2.4] mmol/L. dNormal range: [111 356] U/L. eCRP values ]8 ng/mL indicating active infection (40) were excluded (n 8). Anthropometric variables, including WAZ, HAZ and BAZ correlated significantly (p B0.01) with SoS (r2 0.21, 0.19 and 0.19, respectively). Anthropometric variables, including WAZ, HAZ and BAZ correlated significantly (p B0.01) with BUA (r2 0.39, 0.28 and 0.32, respectively). None of the dietary variables, includ- ing energy (Kcal/d), carbohydrates (g/d), fat (g/d), SFA (g/d), MUFA (g/d), PUFA (g/d), vitamin D (mg/d) and calcium (mg/d) correlated significantly with either BUA or SoS, except protein (g/d). Protein intake corre- lated positively with SoS (r2 0.12, p 0.03). None of the food groups, including milk intake (mL/d), dairy 4 (page number not for citation purpose) products including milk (servings/d), fruits and vegeta- bles (servings/d), TF (g/d), frequency of fish consumption (times/month) and frequency of marine mammals con- sumption (times/month) correlated significantly with BUA or SoS. None of the biochemical variables, including 25(OH)D (nmol/L), PTH (pmol/L), calcium (mmol/L) or CRP (mg/ L), correlated with SoS and BUA, except ALP (U/L). ALP correlated positively with SoS (r2 0.17, p 0.02). From the lifestyle variables, latitude inversely correlated with SoS (r2 0.11, p 0.04) while it did not correlate with BUA and the number of hours spent outside (h/d) did not correlate with either variables. Children in the SoS and BUA quartiles were not different by age (years), sex (M/F), presence of an active hunter in the household (yes/no), carbohydrates intake, milk intake, fruits and vegetables intake, TF intake, fish and marine mammals, plasma CRP, calcium, PTH and latitude. However, children in the highest quartile of SoS or BUA had higher BMI and BAZ compared to those in quartiles 1 (Tables II and III). Also, children in SoS quartile 4 had higher ALP compared to those in quartile 3, while results were not different by BUA quartiles. Using multivariate linear regression, higher BMI and MUFA intake plus older age were the only positive predictors of BUA in Inuit preschool children (Table IV), while age, sex, number of hours spent outside, vitamin D status (0 B75 and 1 ]75 nmol/L), energy, saturated fat, vitamin D, protein and calcium intake did not contribute to the model. On the other hand, only higher BMI was a significant predictor of SoS in Inuit preschoolers (r2 0.19, p B0.01) (Table V). Discussion This is the first study to report upon parameters of bone health in Inuit children. Children in the highest SoS and BUA quartile had higher adiposity, as measured using BMI than those in quartile 1. The strongest predictors of BUA were higher BMI, older age and higher MUFA while only higher BMI was a predictor of SoS. Previous studies suggest Aboriginal children as a group are at a higher risk for low bone mass compared to other Canadian infants as a function of low vitamin D status (23). It appears from this sample that median vitamin D concentration of Inuit preschoolers was below the 50 nmol/L cut-off recommended by the Institute of Medicine (20). In contrast to the suggested hypothesis, vitamin D intake and plasma 25(OH)D concentration, regardless of the definition of optimal concentration ( ]50 or 75 nmol/L) in the regression model, were not associated with SoS and BUA in our cross-sectional analysis. Very few children (18%) had 25(OH)D values in the range suggested to enhance bone health ( ]75 nmol/ L) based on adult studies (24). Our results were in concordance with other studies that used a quantitative Citation: Int J Circumpolar Health 2012, 71: 18999 - http://dx.doi.org/10.3402/ijch.v71i0.18999