Association between iq’mik smokeless tobacco use and cardiometabolic risk profile among Yup’ik Alaska Native people

ABSTRACT

Objective: The traditional lifestyle of Yup’ik Alaska Native people, including a diet abundant in marine-based foods and physical activity, may be cardio-protective. However, iq’mik, a traditional form of smokeless tobacco used by >50% of Yup’ik adults, could increase cardiometabolic (CM) risk. Our objective was to characterize the associations between iq’mik use and biomarkers of CM status (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], systolic blood pressure [SBP] and diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], fasting blood glucose [FBG], waist circumference [WC], and body mass index [BMI]).

Design: We assessed these associations using data from a cross-sectional sample of Yup’ik adults (n = 874). Current iq’mik use, demographic, and lifestyle data were collected through interviews. Fasting blood samples were collected to measure LDL-C, HDL-C, TG, HbA1c, and FBG. SBP, DBP, WC, and BMI were obtained by physical examination. We characterized the association between current iq’mik use and continuous biomarkers of CM status using multiple approaches, including adjustment for measures of Yup’ik lifestyle and a propensity score.

Results: Based on either adjustment method, current iq’mik use was significantly and positively associated with at least 5% higher HDL-C, and significantly associated but in an inverse direction with multiple biomarkers of CM status including 7% lower TG, 0.05% lower HbA1c, 2% lower FBG, 4% lower WC, and 4% lower BMI. Observed associations for LDL-C, SBP, and DBP varied by adjustment method.

Conclusions: This inverse association between iq’mik use and cardiometabolic risk status has not been previously reported. Additional research is needed to replicate these findings and explore physiological mechanisms and/or confounding factors.

KEYWORDS:

• Iq’mik
• smokeless tobacco
• Alaska Native
• Yup’ik cardiometabolic

Acknowledgements

We gratefully acknowledge the Center for Alaska Native Health Research field research team, including Eliza Orr and Jynene Black. This work was improved by comments from Barbara Kavanaugh, Amanda Phipps, and Nick Au. The authors also thank the community field research assistants who helped with the development of the FFQ, study recruitment, and data collection. Finally, the Center for Alaska Native Health Research team would like to express our sincere appreciation to all of our study participants and their communities for welcoming us and teaching us so much about the Yup’ik way of life. Quyana!

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by National Institutes of Health [P20RR016430, P30GM103325, R01DK074842, TL1 TR000422, U01GM092676].