The Association Between Food Security and Diet Quality Among First Nations Living On-Reserve in Canada
Background: First Nations (FN) experience high levels of food insecurity that greatly exceed those of the non-aboriginal population. Associated with this burden are alarming rates of obesity and nutrition-related chronic disease. Little is known about food insecurity’s relationship to diet quality outcomes for FN living on-reserve. Objective: This study explores the associations between household food insecurity (FI) and poor diet quality for FN adults living on-reserve in 5 Canadian regions (south of the 60th parallel).  Methods: Dietary recall data from the First Nation Food Nutrition and Environment Study (FNFNES), a cross-sectional study, were analyzed using two diet quality indices: a Canadian Healthy Eating Index (HEI) and NOVA, which assesses diet by level of food processing. Regression analyses explored socio-demographic correlates of FI and diet quality. HEI total and component scores and the caloric contribution of NOVA groups and subgroups were compared between food security levels.  Results: FI prevalence was high (35.7%), notably in households with children (40.4%), those where all members are unemployed (45.4%), and those receiving social assistance (55.5%). Sex, age group, and education level were also correlated with FI. The mean total HEI score was low (49.0  12.65). Total HEI mean scores were associated with sex, age group, region, social assistance, traditional food consumption, any household TF activity, and education. They were also significantly higher for people from food secure households compared to FI (49.7 vs. 48.1, respectively), though not after adjusting for socio-demographic variables. After adjustments, FI remained significantly associated with higher intakes of processed culinary ingredients (sugars and plant oils), lower intakes of homemade dishes, and less fruit and vegetable consumption. Conclusions: This study found a small, but significant, relationship between food insecurity and diet quality. Findings also emphasized the need to address income, social assistance benefits and access to traditional foods to improve food security and nutritional outcomes for First Nations.
HEI NOVA Autochtones Food security Food insecurity Diet quality Food processing Aboriginal First Nations