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Since 1993, dietary assessment has been carried out in Greenland as part of recurrent population health surveys. In preparation for the next survey in 2024, 91 participants from the survey in 2018 were selected for a validation study of the Food Frequency Questionnaire (FFQ). The 91 participants were reinterviewed 38-50 months after the first FFQ and invited to complete a food diary. As part of the 2018 survey, blood was analysed for mercury. The food diary was completed by 65 participants. The agreement between the two FFQ interviews was very good for macronutrients and fatty acids ( p  > 0.20), whereas the calculated intake of mercury was 22% higher in the second FFQ ( p  = 0.04) due to a higher intake of whale meat and muktuk (whale skin). The agreement between the second FFQ and the food diary was good for local food, imported meat and cakes/sweets/snacks but fruit and vegetables, dairy products, beverages and added sugar were significantly underreported in the food diary. Food items not included in the FFQ were identified from the food diaries. The correlation between the intake of marine mammals and blood mercury was moderate (Spearman's rho = 0.41-0.50; p  < 0.0001). The results will inspire future dietary studies in the circumpolar North.

Background: Adverse Childhood Experiences (ACEs) have been identified as a major public health challenge in Greenland. No previous studies have created a multi-item ACE- scale among an Arctic Indigenous population., Objective: To develop a multi-item ACE-scale among Inuit youth in Greenland (the ACEIG scale)., Methods: The ACEIG scale was created with data from the 'Wellbeing among Inuit youth in Greenland'-survey. Scale items were based on a recognised ACE-scale and further adapted to the context of Inuit youth in Greenland by adding items relevant for the population. The scale was validated through item response theory (IRT) and reliability was assessed by Cronbach's alpha., Results: Four items relevant for Inuit youth in Greenland were added to the recognised ACE scale (bullying, death of parent, gambling problems in close family, and suicide in close relations). The scale was reduced by IRT, as three items (bullying, divorce of parents and parents passing away) exceeded the difficulty index threshold. The ACEIG scale therefore consists of 10 items: alcohol problems in close family, marijuana use in close family, domestic violence, being victim of physical violence, being victim of psychological violence, any type of sexual abuse, sexual abuse (intercourse), sexual abuse (more than once), suicide in close relations, and gambling problems in close family. Cronbach's alpha was 0.7., Conclusion: The ACEIG scale includes 10 items with acceptable reliability. The scale can inform future screening tools to identify vulnerable youth and target interventions. Future studies should investigate the association between the ACEIG scale and health outcomes., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Consumption of traditional foods is decreasing amid a lifestyle transition in Greenland as incidence of type 2 diabetes (T2D) increases. In homozygous carriers of a TBC1D4 variant, conferring postprandial insulin resistance, the risk of T2D is markedly higher. We investigated the effects of traditional marine diets on glucose homoeostasis and cardio-metabolic health in Greenlandic Inuit carriers and non-carriers of the variant in a randomised crossover study consisting of two 4-week dietary interventions: Traditional (marine-based, low-carbohydrate) and Western (high in imported meats and carbohydrates). Oral glucose tolerance test (OGTT, 2-h), 14-d continuous glucose and cardio-metabolic markers were assessed to investigate the effect of diet and genotype. Compared with the Western diet, the Traditional diet reduced mean and maximum daily blood glucose by 0·17 mmol/l (95 % CI 0·05, 0·29; P = 0·006) and 0·26 mmol/l (95 % CI 0·06, 0·46; P = 0·010), respectively, with dose-dependency. Furthermore, it gave rise to a weight loss of 0·5 kg (95 % CI; 0·09, 0·90; P = 0·016) relative to the Western diet and 4 % (95 % CI 1, 9; P = 0·018) lower LDL:HDL-cholesterol, which after adjustment for weight loss appeared to be driven by HDL elevation (0·09 mmol/l (0·03, 0·15), P = 0·006). A diet-gene interaction was indicated on insulin sensitivity in the OGTT (p = 0·093), which reflected a non-significant increase of 1·4 (-0·6, 3·5) mmol/l in carrier 2-h glucose. A Traditional diet marginally improved daily glycaemic control and plasma lipid profile compared with a Westernised diet in Greenlandic Inuit. Possible adverse effects on glucose tolerance in carriers of the TBC1D4 variant warrant further studies.

Muscle strength is an important predictor for function and mortality among older adults. We measured hand grip strength among 1442 participants aged 15+ years and carried out a 30 second chair stand test among 786 participants aged 55+ years. Neither test has been carried out among the Inuit before. We present reference values for men and women as means with standard deviations and medians with 10 th , 25 th , 75 th and 90 th percentiles. Hand grip strength was higher among men than among women (means 45.2 kg and 25.8 kg; p < 0.0001), in linear regression analyses it increased with height (β men  = 0.69; β women  = 0.46), weight (β men  = 0.24; β women  = 0.08) and body mass index (β men  = 0.56; β women  = 0.24), and decreased with age (β men  = -0.49; β women  = -0.29) and Inuit genetic ancestry (β men  = -0.96; β women  = -0.59). Chair stand score showed similar associations with sex (mean score for men and women 13.8 and 11.5; p < 0.0001), age (β men  = -0.22; β women  = -0.20) and Inuit genetic ancestry (β men  = -0.38; β women  = -0.41). The hand grip strength of the Inuit was at the same level as in European and North American populations whereas chair stand score was lower than that of a mostly white US population.

Aims: This study aims to investigate the association between household crowding and household composition and self-rated health and mental health (GHQ scale) among the Inuit in Greenland. Poor housing conditions are a concern in Greenland, especially in the villages, where socioeconomic standards in general are lower. Methods: A cohort of 1282 adults participated in two population-based surveys in Greenland, the Inuit Health in Transition survey 2005-2010 (baseline) and The Health Survey in Greenland 2014 (follow-up). Associations between household conditions at baseline and health outcomes at follow-up (poor self-rated health and mental health measured by the GHQ scale) were examined using logistic regression models, adjusting for covariates at baseline. Results: Participants living in an overcrowded dwelling (more than one person per room) at baseline were more likely to report poor self-rated health at follow-up (OR 1.47; 95% CI 1.09; 1.99) compared with those not living in an overcrowded dwelling. In addition, participants who lived alone at baseline were more likely (OR 1.98; 95% CI 1.09; 3.58) to experience poor mental health at follow-up compared with those who lived with children. Conclusions: Results indicate that household conditions are related to health in Greenland. Public health authorities should work to ensure affordable housing of good quality in all communities.

Objective: Dietary transition, obesity and risky use of alcohol and tobacco are challenges to public health among indigenous peoples. The aim of the article was to explore the role of social position in dietary patterns and expenditures on food and other commodities., Design: Countrywide population health survey., Setting: Greenland., Participants: 2436 Inuit aged 15+ years., Results: Less than half of the expenditures on commodities (43 %) were used to buy nutritious food, and the remaining to buy non-nutritious food (21 %), alcoholic beverages (18 %) and tobacco (18 %). Participants were classified according to five dietary patterns. The cost of a balanced diet and an unhealthy diet was similar, but the cost per 1000 kJ was higher and the energy consumption was lower for the balanced diet. Participants with low social position chose the unhealthy pattern more often than those with high social position (40 % v. 24 %; P < 0·0001), whereas those with high social position more often chose the balanced alternative. Participants with low social position spent less money on the total food basket than those with high social position but more on non-nutritious food, alcohol and tobacco., Conclusions: Cost seems to be less important than other mechanisms in the shaping of social dietary patterns and the use of alcohol and tobacco among the Inuit in Greenland. Rather than increasing the price of non-nutritious food or subsidising nutritious food, socially targeted interventions and public health promotion regarding food choice and prevention of excessive alcohol use and smoking are needed to change the purchase patterns.

The Inuit ancestors of the Greenlandic people arrived in Greenland close to 1,000 years ago. 1 Since then, Europeans from many different countries have been present in Greenland. Consequently, the present-day Greenlandic population has ∼25% of its genetic ancestry from Europe. 2 In this study, we investigated to what extent different European countries have contributed to this genetic ancestry. We combined dense SNP chip data from 3,972 Greenlanders and 8,275 Europeans from 14 countries and inferred the ancestry contribution from each of these 14 countries using haplotype-based methods. Due to the rapid increase in population size in Greenland over the past ∼100 years, we hypothesized that earlier European interactions, such as pre-colonial Dutch whalers and early German and Danish-Norwegian missionaries, as well as the later Danish colonists and post-colonial immigrants, all contributed European genetic ancestry. However, we found that the European ancestry is almost entirely Danish and that a substantial fraction is from admixture that took place within the last few generations., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Several recent studies have found signs of recent selection on the carnitine palmitoyl-transferase 1A (CPT1A) gene in the ancestors of Arctic populations likely as a result of their traditional diet. CPT1A is involved in fatty acid transportation and is known to affect circulating fatty acid profiles in Inuit as does the unique traditional diet rich in marine animals. We aimed to assess which fatty acids may have driven the selection of rs80356779, a c.1436C>T (p.(Pro479Leu)) variant in CPT1A, by analyzing a potential interaction between the variant and traditional Inuit diet. We included 3005 genome-wide genotyped individuals living in Greenland, who had blood cell membrane fatty acid levels measured. Consumption of 25 traditional food items was expressed as percentage of total energy intake. We tested for CPT1A × traditional diet interaction while taking relatedness and admixture into account. Increasing intakes of traditional diet was estimated to attenuate the effect of 479L on 20:3 omega-6 levels (p = 0.000399), but increase the effect of the variant on 22:5 omega-3 levels (p = 0.000963). The 479L effect on 22:5 omega-3 more than doubled in individuals with a high intake of traditional diet (90% percentile) compared with individuals with a low intake (10% percentile). Similar results were found when assessing interactions with marine foods. Our results suggest that the association between traditional diet and blood cell fatty acid composition is affected by the CPT1A genotype, or other variants in linkage disequilibrium, and support the hypothesis that omega-3 fatty acids may have been important for adaptation to the Arctic diet.

The genetic architecture of the small and isolated Greenlandic population is advantageous for identification of novel genetic variants associated with cardio-metabolic traits. We aimed to identify genetic loci associated with body mass index (BMI), to expand the knowledge of the genetic and biological mechanisms underlying obesity. Stage 1 BMI-association analyses were performed in 4,626 Greenlanders. Stage 2 replication and meta-analysis were performed in additional cohorts comprising 1,058 Yup'ik Alaska Native people, and 1,529 Greenlanders. Obesity-related traits were assessed in the stage 1 study population. We identified a common variant on chromosome 11, rs4936356, where the derived G-allele had a frequency of 24% in the stage 1 study population. The derived allele was genome-wide significantly associated with lower BMI (beta (SE), -0.14 SD (0.03), p = 3.2x10-8), corresponding to 0.64 kg/m2 lower BMI per G allele in the stage 1 study population. We observed a similar effect in the Yup'ik cohort (-0.09 SD, p = 0.038), and a non-significant effect in the same direction in the independent Greenlandic stage 2 cohort (-0.03 SD, p = 0.514). The association remained genome-wide significant in meta-analysis of the Arctic cohorts (-0.10 SD (0.02), p = 4.7x10-8). Moreover, the variant was associated with a leaner body type (weight, -1.68 (0.37) kg; waist circumference, -1.52 (0.33) cm; hip circumference, -0.85 (0.24) cm; lean mass, -0.84 (0.19) kg; fat mass and percent, -1.66 (0.33) kg and -1.39 (0.27) %; visceral adipose tissue, -0.30 (0.07) cm; subcutaneous adipose tissue, -0.16 (0.05) cm, all p<0.0002), lower insulin resistance (HOMA-IR, -0.12 (0.04), p = 0.00021), and favorable lipid levels (triglyceride, -0.05 (0.02) mmol/l, p = 0.025; HDL-cholesterol, 0.04 (0.01) mmol/l, p = 0.0015). In conclusion, we identified a novel variant, where the derived G-allele possibly associated with lower BMI in Arctic populations, and as a consequence also leaner body type, lower insulin resistance, and a favorable lipid profile., Competing Interests: The authors have declared that no competing interests exist.

Aims: To examine the association between birth weight and glucose intolerance in adult Greenlandic Inuit., Methods: We examined 1429 participants aged 18-56 years from two population-based, cross-sectional studies in Greenland with information on birth weight. Oral glucose tolerance tests, anthropometric measures and ultrasound of abdominal tissue were performed. Associations of birth weight with glucose markers were analysed using linear or logistic regressions. Spline analyses were conducted to examine u-shaped associations. Adjustments were done for age, sex, birth place, family history of diabetes, genetic admixture, TBC1D4 p.Arg684Ter carrier status, BMI and visceral adipose tissue., Results: The median birthweight was 3300 g and 3.9% had type 2 diabetes, T2DM. Spline analyses indicated overall linear associations. In fully adjusted analyses, an increase in birth weight of 1 kg was associated with a change in fasting plasma glucose of -0.06 mmol/L (95%CI: -0.11, -0.01), 2-h plasma glucose of -0.16 mmol/L (95%CI: -0.35, 0.02), HOMA-IR of -5.45% (95%CI: -10.34, -0.29), insulin sensitivity index of 7.04% (95%CI: 1.88, 12.45) and a trend towards a reduced risk of hyperglycaemia and T2DM, although statistically insignificant., Conclusions: Birth weight was inversely associated with hepatic and peripheral insulin resistance independently of adult adiposity. Thus, the findings support low birth weight as a contributing factor for glucose intolerance in adult Inuit in Greenland., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Studies have found mercury to be associated with cardiovascular disease (CVD), however, primarily in populations with low exposure. The highest levels, and variations in the levels, of whole blood mercury (WBM) worldwide have been found in Greenland. We prospectively assessed the association between WBM and the risk of developing CVD in the Greenlandic population., Methods: We assessed the effects of WBM levels on incident CVD among 3083 Greenlandic Inuit, participating in a population-based cohort study conducted from 2005 to 2010. WBM was measured at baseline. Participants were followed in the National Patient Registries for Denmark and Greenland and in the causes of death register for CVD events from inclusion in the study until CVD event, emigration, death or end of follow-up (30/9-2013). Using Cox regression analyses, we calculated the incidence rates and the hazard ratio of CVD events according to WBM levels. Potential interactions with sex were also investigated., Results: The highest levels of WBM were found in men, who had a significantly higher median level (19 μg/L (IQR:1-44)), compared with women (15 μg/L (IQR: 1-32), (p < 0.001)). The crude hazard ratio (HR) for incident CVD was 1.00 (95% CI 1.00-1.00) for 5 µg/l increase in WBM. After adjusting for several potential confounders, there was still no association between WBM and incident CVD (HR 0.99; 95%CI:0.99-1.00). We found no interactions with sex., Conclusions: In a population with high levels of WBM, we found no association between WBM and the risk of developing CVD in Greenland., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Aims: Low levels of vitamin D are suspected to be a risk factor for cardiovascular disease and atherosclerosis. The aim of this study was to assess the prevalence of subclinical atherosclerosis among Inuit in Greenland, and to evaluate the association with vitamin D status. We hypothesized that low vitamin D status could be associated with higher carotid intima-media thickness (IMT) as a marker of atherosclerosis., Methods: 756 adults from the Inuit Health in Transition (IHIT) study carried out in Greenland in the period 2005-2010 were included. A blood sample donated in 1987 was available for a sub-sample of 102 individuals. Serum 25(OH)D3 from the IHIT study and the 1987 survey was used as a measure of vitamin D status. IMT measurements were conducted by ultrasound scanning. The prevalence of atherosclerosis was estimated, and the association between serum 25(OH)D3 and IMT measurements was examined by linear regression., Results: The overall prevalence of subclinical atherosclerosis was 20.1% (n = 152). The linear regression analyses indicated a weak positive association between serum 25(OH)D3 level and IMT measurements from the IHIT study, though not statistically significant after adjustment for potential confounders (β = 0.35% per 10 nmoL/L 25(OH)D3, p = 0.06). Linear regression analyses of the association between serum 25(OH)D3 level in the 1987 survey and IMT measurements also indicated a positive, though not statistically significant, association after adjustment (β = 0.07% per 10 nmoL/L 25(OH)D3, p = 0.86)., Conclusions: Our findings did not support the hypothesis of an association between low vitamin D levels and risk of atherosclerosis., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: We examined how total volume of physical activity and reallocation of time spent at various objectively measured intensities of physical activity (PA) were associated with overall and abdominal fat distribution in adult Inuit in Greenland., Methods: Data were collected as part of a countrywide cross-sectional health survey in Greenland. A combined accelerometer and HR monitor measured total physical activity energy expenditure (PAEE) and intensities of PA (N = 1536). Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were assessed by ultrasonography. Isotemporal substitution modeling was used to analyze the association between substitution of 1 h of sedentary time to light- or moderate-intensity PA and 1 h light-intensity PA to moderate- or vigorous-intensity PA in relation to body mass index (BMI), waist circumference (WC), SAT, and VAT., Results: A negative linear association was found for total PAEE and BMI, WC, VAT, and SAT. Exchanging 1 h of sedentary time with light-intensity PA was associated with lower WC (-0.6 cm, P = 0.01), SAT (-0.08 cm, P < 0.001), and VAT (-0.04 cm, P = 0.359). Exchanging light-intensity PA with vigorous-intensity PA resulted in -6.1-cm lower WC (P < 0.001), -0.7-cm lower VAT (P = 0.018) and -0.7-cm lower SAT (P < 0.001). When further adjusting for BMI, the associations were attenuated; however, most of them remained significant, and the directions were mostly unchanged. All 1-, 5-, and 10-min bouts of MVPA were negatively associated with overall and abdominal fat distribution., Conclusion: Physical activity energy expenditure is associated with lower BMI, WC, and abdominal fat among Greenland Inuit. The importance of promoting an upward shift of the whole PA intensity distribution and to spur even short bouts of MVPA to limit excessive accumulation of SAT and VAT is highlighted.

The genetic consequences of population bottlenecks on patterns of deleterious genetic variation in human populations are of tremendous interest. Based on exome sequencing of 18 Greenlandic Inuit we show that the Inuit have undergone a severe ∼20,000-year-long bottleneck. This has led to a markedly more extreme distribution of allele frequencies than seen for any other human population tested to date, making the Inuit the perfect population for investigating the effect of a bottleneck on patterns of deleterious variation. When comparing proxies for genetic load that assume an additive effect of deleterious alleles, the Inuit show, at most, a slight increase in load compared to European, East Asian, and African populations. Specifically, we observe <4% increase in the number of derived deleterious alleles in the Inuit. In contrast, proxies for genetic load under a recessive model suggest that the Inuit have a significantly higher load (20% increase or more) compared to other less bottlenecked human populations. Forward simulations under realistic models of demography support our empirical findings, showing up to a 6% increase in the genetic load for the Inuit population across all models of dominance. Further, the Inuit population carries fewer deleterious variants than other human populations, but those that are present tend to be at higher frequency than in other populations. Overall, our results show how recent demographic history has affected patterns of deleterious variants in human populations., (Copyright © 2017 by the Genetics Society of America.)

Background: Despite abundant evidence that socio-economic status (SES) is a fundamental determinant of health, there is a dearth of research examining association between SES, measured at the individual and community levels, and cardiovascular risk factors and morbidity among indigenous populations., Objectives: To examine the influence of individual-level and community-level SES on systolic and diastolic blood pressure among Greenlandic Inuit., Methods: Multilevel analysis of cross-sectional data from the Inuit Health in Transition - Greenland Survey, to which 3,108 Greenlandic Inuit aged 18 years and older participated. Blood pressure is measured using an automatic device, according to standardized protocol. Individual SES is measured by education. Community socio-economic conditions are measured using combined information on average disposable household income and settlement type., Results: Education was not significantly associated with blood pressure. There was an inverse U-shape association between community socio-economic conditions and blood pressure with significantly lower SBP and DBP among participants living in remote traditional villages characterized by lower average disposable household income and in affluent more urbanized towns. Sex-stratified analyses demonstrate the salience of community conditions for men., Conclusions: The association observed between blood pressure and community-level socio-economic conditions suggests that public health and social policies, programmes and interventions aiming to improve living conditions might improve cardiovascular health in Greenland. Studies are required to further examine social gradients in cardiovascular risk factors and morbidity among indigenous populations using different measures of SES., Competing Interests: and funding Financial support for the Inuit Health in Transition – Greenland Survey was received from Karen Elise Jensen's foundation, NunaFonden and the Danish Medical Research Council. Mylene Riva is supported by an FRQ-S Research Scholars - Junior 1 award.

Background: Previous studies of Greenlandic children's disease pattern and contacts to the health care system are sparse and have focused on the primary health care sector., Objective: We aimed to identify the disease pattern and use of health care facilities of children aged 0-10 in two Greenlandic cohorts., Methods and Design: In a retrospective, descriptive follow-up of the Ivaaq (The Greenland Child Cohort) and the CLEAR (climate changes, environmental contaminants and reproductive health) birth cohorts (total n=1,000), we reviewed medical records of children aged 6-10 in 2012 with residence in Nuuk or Ilulissat (n=332). Data on diseases and health care system contacts were extracted. Diagnoses were validated retrospectively. Primary health care contacts were reviewed for a random sample of 1:6., Results: In 311 children with valid social security number, the total number of health care system contacts was 12,471 equalling 4.6 contacts per child per year. The annual incidence rate of hospital admissions was 1:10 children (total n=266, 1,220 days, 4.6 days/admission), outpatient contacts 2:10 children and primary care 3.6 per child. Contacts were overall more frequent in boys compared with girls, 39.5 versus 34.6 during the study period, p=0.02. The highest annual contact rates for diseases were: hospitalisations/acute respiratory diseases 13.9:1,000; outpatient contacts/otitis media 5.1:1,000; primary care/conjunctivitis or nasopharyngitis 410:1,000 children. Outpatient screening for respiratory tuberculosis accounted 6.2:1,000, primary care non-disease (Z-diagnosis) 2,081:1,000 annually. Complete adherence to the child vaccination programme was seen in 40%, while 5% did not receive any vaccinations., Conclusions: In this first study of its kind, the health care contact pattern in Greenlandic children showed a relatively high hospitalisation rate and duration per admission, and a low primary health care contact rate. The overall contact rate and disease pattern resembled those in Denmark, except for tuberculosis screening. Adherence to the vaccination programme was low. These findings may be helpful for the organisation and dimensioning of the Greenlandic health care system for children., Competing Interests: and funding The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

Objectives: The Arctic diet is partly constituted by traditional food characterized by top predator animals such as whales, walrus, and seals with high mercury content. Mercury exposure has been associated with glucose intolerance in Western populations. We studied the association between whole blood mercury and glucose intolerance in a highly exposed non-Western population, Methods: Cross-sectional study of 2640 Inuit (18+ years) with information on ancestry, smoking, waist circumference, total energy intake, and physical activity. Mercury, fasting- and 2-h plasma glucose, insulin, and c-peptide were measured in blood. Fasting participants without diabetes were classified into normal glucose tolerance, impaired glucose tolerance, impaired fasting glycemia, or type 2 diabetes. We calculated hepatic insulin resistance with homoeostatic model assessment - insulin resistance index, peripheral insulin sensitivity by ISI0,120., and relative beta cell function by c-peptide/insulin ratio. We conducted adjusted linear- and logistic regression analyses., Results: For an increase in whole blood mercury of 5 µg/L we found a positive association with fasting glucose [% change=0.25 (95% CI: 0.20; 0.30); p<0.001], and 2-h glucose [% change=0.23 (95% CI: 0.05; 0.40); p=0.01]. Mercury was weakly associated with impaired fasting glycemia [OR=1.03 (95% CI: 1.02; 1.05)], and type 2 diabetes [OR=1.02 (95% CI: 1.01; 1.04)]., Conclusion: While the study found a weak but statistically significant association between whole blood mercury and both impaired fasting glycemia and type 2 diabetes, no associations were found with measures of underlying disturbances in glucose homoeostasis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The indigenous people of Greenland, the Inuit, have lived for a long time in the extreme conditions of the Arctic, including low annual temperatures, and with a specialized diet rich in protein and fatty acids, particularly omega-3 polyunsaturated fatty acids (PUFAs). A scan of Inuit genomes for signatures of adaptation revealed signals at several loci, with the strongest signal located in a cluster of fatty acid desaturases that determine PUFA levels. The selected alleles are associated with multiple metabolic and anthropometric phenotypes and have large effect sizes for weight and height, with the effect on height replicated in Europeans. By analyzing membrane lipids, we found that the selected alleles modulate fatty acid composition, which may affect the regulation of growth hormones. Thus, the Inuit have genetic and physiological adaptations to a diet rich in PUFAs., (Copyright © 2015, American Association for the Advancement of Science.)

Cardiovascular disease (CVD) is a major public health issue in indigenous populations in the Arctic. These diseases have emerged concomitantly with profound social changes over the past 60 years. The aim of this study was to summarize the literature on CVD risk among Arctic Inuit. Literature on prevalence, incidence, and time trends for CVD and its risk factors in Arctic Inuit populations was reviewed. Most evidence supports a similar incidence of coronary heart disease and a higher incidence of cerebrovascular disease among Arctic Inuit than seen in western populations. Factors that may increase CVD risk include aging of the population, genetic susceptibility, and a rapid increase in obesity, diabetes, and hypertension in parallel with decreasing physical activity and deterioration of the lipid profile. In contrast, and of great importance, there has been a decrease in smoking and alcohol intake (at least documented in Greenland), and contaminant levels are declining. Although there have been marked socioeconomic and dietary changes, it remains unsolved and to some extent controversial how this may have influenced cardiovascular risk among Arctic Inuit. The increase in life expectancy, in combination with improved prognosis for patients with manifest CVD, will inevitably lead to a large increase in absolute numbers of individuals affected by CVD in Arctic Inuit populations, exacerbated by the rise in most CVD risk factors over the past decades. For preventive purposes and for health care planning, it is crucial to carefully monitor disease incidence and trends in risk factors in these vulnerable Arctic populations., (Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: There is growing evidence that living conditions at birth play a role in medical conditions later in life. Population-based studies from the Northern Hemisphere have shown that persons born in the spring or summer are at greater risk of committing suicide. A statistical correlation with light availability at birth has been observed in past research, but the cause remains unknown. Greenland is one of the most extreme of natural human habitats with regard to seasonal changes in light. The combination of rapid social changes and reliable population statistics offers a unique opportunity to make comparisons between persons born into a Traditional Lifestyle and those born into a Modern Lifestyle. The aim of this work was to assess whether season of birth differed between suicide victims born into an old or into a modern lifestyle., Methods: Official population and mortality registers were used. Suicide victims born (1903-1950) into the Traditional Lifestyle were compared with those born into the Modern Lifestyle (1961-1980). Rayleigh's test for circular distributions was used to assess the season of birth in suicide victims. Data regarding season of birth in the general population were collected., Results: Persons born in March-June in the Traditional Lifestyle were much less likely to commit suicide than those born during other periods of the year. This is contrary to the findings of other studies. The seasonal differences had disappeared for those born into the Modern Lifestyle. The suicide rate increased from very low rates to about 140 suicides/100 000 person-years in the 1980s., Conclusions: The reason behind a variation in season of birth in suicide victims born into the old lifestyle is unknown. It is also unknown why the seasonal difference had disappeared with modern lifestyle. Possible influence of artificial light, nutrition, microbiota and seasonal infections are discussed. The underlying causes behind suicides may be different in traditional and modern Greenland.

Background: Suicides remain a major public health problem in Greenland. Their increase coincides with the modernization since 1950. Serious suicidal thoughts are reported by a significant proportion of participants in countrywide surveys., Objective: To analyze the time trend by region of suicides and suicidal thoughts among the Inuit in Greenland., Design: Data included the Greenland registry of causes of death for 1970-2011 and 2 cross-sectional health surveys carried out in 1993-1994 and 2005-2010 with 1,580 and 3,102 Inuit participants, respectively., Results: Suicide rates were higher among men than women while the prevalence of suicidal thoughts was higher among women. Suicide rates for men and women together increased from 1960 to 1980 and have remained around 100 per 100,000 person-years since then. The regional pattern of time trend for suicide rates varied with an early peak in the capital, a continued increase to very high rates in remote East and North Greenland and a slow increase in villages relative to towns on the West Coast. Suicidal thoughts followed the regional pattern for completed suicides. Especially for women there was a noticeable increasing trend in the villages. The relative risk for suicide was highest among those who reported suicidal thoughts, but most suicides happened outside this high-risk group., Conclusion: Suicide rates and the prevalence of suicidal thoughts remain high in Greenland but different regional trends point towards an increased marginalization between towns on the central West Coast, villages and East and North Greenland. Different temporal patterns call for different regional strategies of prevention.

Background: Inuit are considered to be vulnerable to cardiovascular disease because their lifestyles are becoming more Westernized. During sequence analysis of Inuit individuals at extremes of lipid traits, we identified 2 nonsynonymous variants in low-density lipoprotein receptor (LDLR), namely p.G116S and p.R730W., Methods and Results: Genotyping these variants in 3324 Inuit from Alaska, Canada, and Greenland showed they were common, with allele frequencies 10% to 15%. Only p.G116S was associated with dyslipidemia: the increase in LDL cholesterol was 0.54 mmol/L (20.9 mg/dL) per allele (P=5.6×10(-49)), which was >3× larger than the largest effect sizes seen with other common variants in other populations. Carriers of p.G116S had a 3.02-fold increased risk of hypercholesterolemia (95% confidence interval, 2.34-3.90; P=1.7×10(-17)), but did not have classical familial hypercholesterolemia. In vitro, p.G116S showed 60% reduced ligand-binding activity compared with wild-type receptor. In contrast, p.R730W was associated with neither LDL cholesterol level nor altered in vitro activity., Conclusions: LDLR p.G116S is thus unique: a common dysfunctional variant in Inuit whose large effect on LDL cholesterol may have public health implications., (© 2014 American Heart Association, Inc.)

Aims: The aim of the present study was to investigate whether there are differences in plasma levels of YKL-40 between Inuit in Greenland and in Denmark and in Danes, as well as to study the relationship between alcohol intake, plasma YKL-40 and other factors in Inuit., Methods: Plasma YKL-40 levels were measured on 1645 people from The Greenland Population Study (a cross-sectional population study of Inuit from Denmark and West Greenland) and were compared with the plasma YKL-40 levels of 8899 people from The Copenhagen City Heart Study (a population-based, prospective study of the Danish general population)., Results: The plasma concentrations of YKL-40 were significantly (P = 0.001) lower in Inuit living in Greenland (median 46 µg/l, range 10-2164, n = 1164) compared with the plasma YKL-40 levels of Inuit living in Denmark (median 63 µg/l, range 20-2827, n = 481) and of Danes living in Denmark (median 55 µg/l, range 10-2909, n = 8899). In Inuit, increased alcohol intake was significantly associated with increased plasma YKL-40 levels (P < 0.001), and high plasma YKL-40 levels were associated with high values of alkaline phosphatase and low values of albumin. Smoking, gender and bilirubin were not associated with the plasma YKL-40 level. High levels of YKL-40 and alcohol were associated with where people lived., Conclusion: The plasma concentrations of YKL-40 are significantly lower in Inuit living in Greenland than Inuit and Danes living in Denmark. A number of factors, including different alcohol intake patterns, nutrition and genes may play a role in these findings., (© The Author 2014. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Background: Variation in genes involved in alcohol metabolism is associated with drinking patterns worldwide. We compared variation in these genes among the Inuit with published results from the general population of Denmark and, due to the Asian ancestry of the Inuit, with Han Chinese. We analyzed the association between gene variations and drinking patterns among the Inuit., Methods: We genotyped 4162 Inuit participants from two population health surveys. Information on drinking patterns was available for 3560. Seven single nucleotide polymorphisms (SNPs) were examined: ADH1B arg48his, ADH1C ile350val, ADH1C arg272gln, ALDH2 glu504lys, ALDH2 5'-UTR A-357G, ALDH1B1 ala86val and ALDH1B1 arg107leu., Results: The allele distribution differed significantly between Inuit and the general population of Denmark. A protective effect on heavy drinking was found for the TT genotype of the ALDH1B1 arg107leu SNP (OR=0.59; 95% CI 0.37-0.92), present in 3% of pure Inuit and 37% of Danes. The ADH1C GG genotype was associated with heavy drinking and a positive CAGE test (OR 1.34; 95% CI 1.05-1.72). It was present in 27% of Inuit and 18% of Danes. The Asian genotype pattern with a high frequency of the ADH1B A allele and an ALDH2 gene coding for an inactive enzyme was not present in Greenland., Conclusions: ADH1C and ALDH1B1 arg107leu SNPs play a role in the shaping of drinking patterns among the Inuit in Greenland. A low frequency of the ALDH1B1 arg107leu TT genotype compared with the general population in Denmark deserves further study. This genotype was protective of heavy drinking among the Inuit., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Poor housing conditions experienced by many Indigenous peoples threaten their health and well-being. This study examines whether household crowding is associated with poorer psychosocial health among Greenlanders, and the mediating role of social support. It also assesses whether Inuit men and women are differently influenced by their housing conditions., Methods: Data on more than 3,000 Inuit aged 18 years and older are from the Inuit health in transition Greenland survey. Associations between household crowding and composition, and mental well-being and binge drinking were examined using logistic regression models, adjusting for individuals' characteristics., Results: Household crowding was associated with poorer mental well-being. Binge drinking was more common among people living in households without children. These effects were more important for women than for men. The association between household crowding and mental well-being was significantly mediated by social support. This suggests that having a strong social network may buffer the deleterious impacts of household crowding., Conclusions: Targeting housing conditions and fostering social support as part of population health interventions might contribute to improving psychosocial health and well-being in Greenland.

An increase in social pathologies is a key feature in indigenous populations undergoing transition. The Greenland Inuit are a large indigenous population constituting a majority in their own country, which makes it possible to investigate differences within the population. This led us to study gambling behavior and problem gambling among Greenland Inuit in relation to the ongoing social transition and traumatic events during childhood. A large representative cross-sectional study was conducted among Greenland Inuit (n = 2,189). Data was collected among adults (18+) in 9 towns and 13 villages in Greenland from 2005 to 2010. Problem gambling, gambling behavior and traumatic childhood events were measured through a self-administered questionnaire. The lie/bet screen was used to identify past year and lifetime problem gambling. Social transition was measured as place of residence and a combination of residence, education and occupation. The lifetime prevalence of problem gambling was 16 % among men and 10 % among women (p < 0.0001); and higher in towns (19 %) compared to the capital of Nuuk (11 %) and in villages (12 %) (men only, p = 0.020). Lifetime problem gambling was associated with social transition (p = 0.023), alcohol problems in childhood home (p = 0.001/p = 0.002) and sexual abuse in childhood (women only, p = 0.030). A comparably high prevalence of lifetime problem gambling among Greenland Inuit adds problem gambling to the list of social pathologies in Greenland. A significant association between lifetime problem gambling, social transition and traumatic childhood events suggests people caught between tradition and modern ways of life are more vulnerable to gambling problems.

Aims: Indigenous populations throughout the Arctic are experiencing a rapid increase in the prevalence of obesity and type 2 diabetes. The role of physical activity in relation to glucose metabolism in Arctic populations is not well studied. We examined the association between objectively measured physical activity energy expenditure (PAEE) and glucose metabolism in a population-based study of adult Inuit in Greenland., Methods: Cross-sectional data were collected by combined accelerometry and heart rate monitoring (ACC+HR) among Inuit (18+ years) in Greenland during 2005-2010 (n=1545). PAEE was calculated and the associations with fasting glucose, 2-h glucose, fasting insulin, 2-h insulin concentrations and body composition were analysed by linear regression., Results: An inverse association between PAEE and fasting insulin, 2-h insulin, 2-h glucose, fat percentage, BMI and waist circumference (WC) was found after adjustments by age and sex. Only the association between PAEE and 2-h insulin remained significant after adjustment by WC (P=0.01), most pronounced at low levels of PAEE indicating a threshold around 35-40kJ/kg/day. No overall linear trend was found for fasting glucose and 2-h glucose., Conclusions: This population-based study showed that PAEE was associated with 2-h insulin independently of obesity in an inverse dose-response relation. Insufficient physical activity may contribute to impaired glucose tolerance through a pathway including alterations in obesity and fat distribution. Both obesity and low levels of PAEE may be important contributing risk factors for the increasing prevalence of type 2 diabetes mellitus among Inuit in Greenland, but additional risk factors should be examined in this indigenous population., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: The purpose of the study was to analyze the temporal trend of obesity among Inuit in Greenland during 1993-2010 according to sex and relative social position., Methods: Data (N = 5,123) were collected in cross-sectional health surveys among the Inuit in Greenland in 1993-1994, 1999-2001, and 2005-2010. Sociodemographic information was obtained by interview. Information on obesity (body mass index (BMI) and waist circumference) was obtained by clinical examination and in 1993-1994 by interview. Statistics included multiple linear regression and Univariate General Linear Models., Results: Among men the prevalence of overweight (BMI 25-29.9) decreased while general obesity (BMI ≥ 30) did not change. Central obesity increased from 16.0% in 1993-1994 to 25.4% in 2005-2010 (P < 0.001). Among women general and central obesity increased. Central obesity increased from 31.3% in 1993-1994 to 54.2% in 2005-2010 (P < 0.001). In 2005-2010 both general and central obesity showed significantly increasing trends with social position (general obesity: P < 0.001 for men, P = 0.04 for women; central obesity: P < 0.001 for both men and women). The social trend was absent in the earlier surveys., Conclusion: General and central obesity is increasing among the Inuit in Greenland. There is an increasing positive association of obesity with social position for both men and women. The high prevalence of obesity is a serious public health problem that is expected to affect the already high prevalence of Type 2 diabetes and its complications., (Copyright © 2013 Wiley Periodicals, Inc.)

Background: Exposure to persistent organic pollutants (POPs) is of concern in Arctic populations since these contaminants accumulate in fish and marine mammals, which is an important part of the traditional diet of these populations. Epidemiological and experimental studies have reported significant associations between POPs and increased blood pressure (BP) in populations with different degrees of exposure., Objective: We aimed to assess the risk of hypertension related to increasing levels of polychlorinated biphenyls (PCBs) and organochlorine (OC) pesticides., Methods: Fifteen PCBs and 11 OC pesticides or their metabolites were determined in plasma of 1614 Inuit adults ≥ 18 years living in 9 towns and 13 villages in Greenland. BP was measured using a standardized protocol. The risk of hypertension was estimated through logistic regression using POPs as continuous variables (log-transformed). Hypertension was defined as systolic BP ≥ 140 mm Hg, diastolic BP ≥ 90 mm Hg and/or antihypertensive treatment., Results: Overall, the odd ratios (ORs) of hypertension were not statistically significant for dioxin-like PCBs, non-dioxin-like PCBs and OC pesticides after adjusting for confounders. Once the analyses were stratified by age category (18-39 and ≥ 40 years), increased risk of hypertension was observed for total dioxin-like PCBs among the youngest [OR: 1.34 (95% CI: 1.03-1.74)] while a borderline protective effect was observed for total non-dioxin-like PCBs [OR: 0.81 (95% CI: 0.66-0.99)] among the oldest. Higher risk of hypertension was also associated with increasing p,p'-dichlorodiphenyltrichloroethane (DDT) concentrations among the youngest [OR: 1.42 (95% CI: 1.08-1.85)]., Conclusion: Overall, no significant associations were observed between PCBs, OC pesticides and blood pressure in this highly exposed population although the associations differed by age category., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background and Objectives: Public health research has pointed to alcohol and substance abuse as the most significant public health challenges in Greenland with the negative impact on families and communities that entail, but few studies have investigated the role of problem gambling as addictive behaviour among Inuit. The objectives of the present study were to investigate (a) the association between lifetime problem gambling and harmful alcohol use as well as frequent use of marijuana and (b) the prevalence of cross-addictive behaviour among Greenland Inuit., Design: A representative cross-sectional study among Greenland Inuit (n=2,189). Data was collected among adults (18+) in 8 towns and 13 villages in Greenland from 2006-2010. Lifetime problem gambling, harmful alcohol use and frequent use of marijuana were measured through a self-administered questionnaire., Results: The odds ratio for harmful alcohol use and frequent use of marijuana was significantly higher among lifetime problem gamblers compared to non-problem gamblers/non-gamblers. One or more addictive behaviours were present among more than half of the men (53%) and one third of the women (37%), and the co-occurrence of lifetime problem gambling with either harmful alcohol use, frequent use of marijuana or both was found among 12.2% of men and 3.7% of women. The prevalence of one or more addictive behaviours was 44% in households with children., Conclusions: For lifetime problem gamblers, the gambling problems were more often than not combined with harmful alcohol use, frequent use of marijuana or both--especially among men. The high prevalence of addictive behaviours in households with children indicates that many families are presently affected negatively by alcohol, gambling and marijuana. This suggests that pathological gambling should be included systematically in future public health strategies, treatment programs and interventions in Greenland.

Objectives: Self-rated health (SRH) and associated risk and protective correlates were investigated among two indigenous adolescent populations, Greenlandic Inuit and Norwegian Sami., Design: Cross-sectional data were collected from "Well-being among Youth in Greenland" (WBYG) and "The Norwegian Arctic Adolescent Health Study" (NAAHS), conducted during 2003-2005 and comprising 10th and 11th graders, 378 Inuit and 350 Sami., Methods: SRH was assessed by one single item, using a 4-point and 5-point scale for NAAHS and WBYG, respectively. Logistic regressions were performed separately for each indigenous group using a dichotomous measure with "very good" (NAAHS) and "very good/good" (WBYG) as reference categories. We simultaneously controlled for various socio-demographics, risk correlates (drinking, smoking, violence and suicidal behaviour) and protective correlates (physical activity, well-being in school, number of close friends and adolescent-parent relationship)., Results: A majority of both Inuit (62%) and Sami (89%) youth reported "good" or "very good" SRH. The proportion of "poor/fair/not so good" SRH was three times higher among Inuit than Sami (38% vs. 11%, p≤0.001). Significantly more Inuit females than males reported "poor/fair" SRH (44% vs. 29%, p≤0.05), while no gender differences occurred among Sami (12% vs. 9%, p≤0.08). In both indigenous groups, suicidal thoughts (risk) and physical activity (protective) were associated with poor and good SRH, respectively., Conclusions: In accordance with other studies of indigenous adolescents, suicidal thoughts were strongly associated with poorer SRH among Sami and Inuit. The Inuit-Sami differences in SRH could partly be due to higher "risk" and lower "protective" correlates among Inuit than Sami. The positive impact of physical activity on SRH needs to be targeted in future intervention programs.

Objective: To explore the association between dietary n-3 fatty acids and serum lipids in a population with a high intake of marine food. Specifically to test interaction with sex and ethnicity., Methods: Information was obtained from 2280 Inuit who participated in a countrywide health survey in Greenland in 2005-2009. n-3 intake was estimated from an FFQ and analyses of Red Blood Cell (RBC) membranes. Serum total, HDL and LDL cholesterol and triglyceride were analysed. Obesity was measured. Information on ethnicity, smoking, alcohol consumption, and physical activity was obtained from an interview., Results: In linear regression models adjusted for age, sex, obesity, ethnicity, alcohol, and smoking serum HDL, LDL and triglyceride were associated with n-3 intake estimated as eicosapentaenoic acid (EPA) in RBC membranes. For HDL the interaction between EPA and sex was significant (p < 0.001). No significant interactions were observed for EPA and ethnicity., Conclusion: A positive association of EPA with serum HDL and LDL and a negative association with triglyceride was observed among both men and women. For HDL, the association was stronger for men. The association of EPA with serum HDL was similar among Inuit with full Inuit ancestry and those with part Inuit ancestry. Diet and overweight are both realistic candidates for a population based intervention against dyslipidemia. Further studies of ethnic differences in the effect of n-3 fatty acids on cardiovascular risk factors are recommended., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Intake of carbohydrates which elicit a large glycemic response is hypothesized to increase the risk of diabetes. However, studies assessing the relationship between glycemic index (GI) and glycemic load (GL) and diabetes are inconsistent. Only few studies have studied the relationship between GI and GL and markers of glucose metabolism, mostly in western populations., Objective: To determine the relationship between GI and GL and indices of glucose metabolism and prevalence of diabetes in Greenland's Inuit population., Design: The Inuit Health in Transition Study is a geographically representative cross-sectional study among aged ≥18years. Diet was assessed using a 67-item food frequency questionnaire. Logistic and linear regression was used to assess the association between GI and GL and diabetes, impaired fasting glucose, impaired glucose tolerance, HbA(1c), fasting plasma glucose, 2h plasma glucose, HOMA2-IR and HOMA2-%β., Results: No association was found between GI and GL and diabetes. GL was significantly inversely associated with IFG (OR: 0.91 (0.84-0.98)). While GI was positively associated with FPG, GL was positively associated with both HOMA2-IR and HOMA2-%β and inversely associated with IFG., Conclusion: These findings do not support a link between dietary GI or GL and risk of type 2 diabetes among Greenland's Inuit population., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Among circumpolar populations, recent research has documented a significant increase in risk factors which are commonly associated with chronic disease, notably obesity., Objective: The present study undertakes a scoping review of research on obesity in the circumpolar Inuit to determine the extent obesity research has been undertaken, how well all subpopulations and geographic areas are represented, the methodologies used and whether they are sufficient in describing risk factors, and the prevalence and health outcomes associated with obesity., Design: Online databases were used to identify papers published 1992-2011, from which we selected 38 publications from Canada, the United States, and Greenland that used obesity as a primary or secondary outcome variable in 30 or more non-pregnant Inuit ("Eskimo") participants aged 2 years or older., Results: The majority of publications (92%) reported cross-sectional studies while 8% examined retrospective cohorts. All but one of the studies collected measured data. Overall 84% of the publications examined obesity in adults. Those examining obesity in children focused on early childhood or adolescence. While most (66%) reported 1 or more anthropometric indices, none incorporated direct measures of adiposity. Evaluated using a customized quality assessment instrument, 26% of studies achieved an "A" quality ranking, while 18 and 39% achieved quality rankings of "B" and "C", respectively., Conclusions: While the quality of studies is generally high, research on obesity among Inuit would benefit from careful selection of methods and reference standards, direct measures of adiposity in adults and children, studies of preadolescent children, and prospective cohort studies linking early childhood exposures with obesity outcomes throughout childhood and adolescence.

Aims: The purpose was to study the composition of the Inuit diet, to assess the adherence to nutritional recommendations among the Inuit in Greenland, and to discuss the potential role of traditional food in improving dietary quality., Methods: Cross-sectional study of adult Inuit (18+ years) from Greenland (n=2752, 43% men). Data were collected by a food frequency questionnaire. Dietary contribution of nutrients was compared between quartiles of traditional food intake. A recommended macronutrient distribution range (RMDR) was constructed from the recommendations of Nordic Nutrition Recommendations (2004). The adherence to the RMDR was estimated and the food items' contribution to energy, macronutrients, subclasses of fats, fibres, and refined sugar were calculated., Results: Consumption of refined sugar and saturated fat decreased by increasing consumption of traditional food whereas the fat profile improved due to increasing consumption of polyunsaturated fatty acids and monounsaturated fatty acids. Fibre intake decreased with increasing traditional food and 18% among both men and women complied to fibre recommendations. Compliance with polyunsaturated fatty acid recommendations was 27% for men and 36% for women. Compliance with n-3 fatty acids was 88% for men and 85% for women., Conclusions: Increasing consumption of traditional food could benefit the dietary fat profile but will result in low fibre intake. Promotion of healthy-fibre-dense and low-fat imported food will increase the compliance to the fibre recommendation while traditional food could stay an integrated part of the Inuit diet and provide less saturated fat.

Background and Aim: Most studies show that diabetes increases with migration and urbanization. Previous studies from Greenland have shown inconsistent associations between cardiovascular risk and urbanization. Thus, the aim was to study the association between diabetes and urbanization among Greenland Inuit., Methods: A total of 3089 adult Inuit aged 18 years and older participated in a geographically representative, population-based study 'Inuit Health in Transition Study'. The examination included a 75 g oral glucose tolerance test and anthropometric measurements. Information on socio-demographic characteristic and health behaviour was obtained by interview or questionnaire. The participants were categorized according to degree of urbanization into three groups based on current place of residence: (1) participants living in towns (> 2000 inhabitants), (2) participants living in small towns (< 2000 inhabitants) and (3) participants living in villages (< 500 inhabitants)., Results: The total prevalence of diabetes was 9% of which 79% were previously unknown. Nine per cent had impaired glucose tolerance and 19% had impaired fasting glycaemia (IFG). Compared with towns, odds rations (ORs) for diabetes and impaired fasting glycaemia were higher in small towns [OR(diabetes) = 1.5 (1.0-2.3), OR(IFG) = 1.9 (1.2-2.3)] and villages [OR(diabetes) = 1.2 (0.8-1.9), OR(IFG) = 1.3 (0.9-2.0)], whereas no association was seen for impaired glucose tolerance. The inverse association between urbanization and diabetes and impaired fasting glycaemia persisted after adjustment for relevant confounders., Conclusion: Diabetes and impaired fasting glycaemia decreased with urbanization contrary to the results of most studies. It appears that Greenland Inuit follow the pattern usually observed in industrialized countries with the highest risk of diabetes in the lower socio-economic groups., (© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.)

Aims: To examine differences in physical activity patterns among Inuit in Greenland in relation to social transition. The Inuit in Greenland are an indigenous population in the circumpolar north who are experiencing rapid social transition., Methods: Physical activity patterns were assessed by the International Physical Activity Questionnaire (long version). The population was divided into six groups according to different stages of social change, measured on the basis of education, current residence and occupation. Data were collected in a country-wide cross-sectional population survey among adult Inuit in Greenland from 2005 to 2009., Results: Men with long vocational or academic education living in towns (latest stage of social change) spent significantly less time on occupational physical activity (p = 0.001) compared with hunters and fishermen in villages (earliest stage of social change) (trend test p = 0.01). Women in the latest stage of change spent significantly less time on domestic physical activity (p < 0.001) (trend test p = 0.06) compared with women in the earliest stage of social change. This was also found for physical activity during transportation (p = 0.02 and p = 0.01 for men and women, respectively). No significant difference was found for leisure time physical activity. Men and women in the latest stage of social change spent more time on sedentary activity (p < 0.001)., Conclusions: Differences in physical activity patterns among Inuit in Greenland included decreasing time spent on domestic and occupational physical activity and increasing time spent on sedentary activities along with social change. Knowledge of changes in physical activity patterns in relation to social transition is important in prevention of obesity, type 2 diabetes and lifestyle diseases.

Objectives: The social and cultural transition among the Inuit in Greenland over the last generations has in ecological studies been linked to changes in cardiovascular risk factors. To permit analyses at the individual level, we propose a categorization of participants in a cross-sectional study according to their relative position in the process of social change., Methods: Data was included from two cross-sectional population surveys in 1993-1994 (N = 1,580) and 2005-2009 (N = 2,834). Socioeconomic factors, mental health, health behavior, obesity, blood lipids, blood pressure, and prevalence of diabetes were compared between the surveys and among groups at various degree of social change defined from current residence, job, and education. General linear models and logistic regression analysis were applied., Results: Most outcome variables showed statistically significant difference between the two studies indicating secular change, and for most the gradient in the ranked social groups was in agreement with the observed secular change. This included housing conditions, wealth, diet, smoking, alcohol, physical activity, obesity, and for women also non-HDL cholesterol and hypertension. Anxiety and depression increased over time but decreased with social group for women. Prevalence of type 2 diabetes has increased, but we found no differences among social groups. Serum triglyceride and for men non-HDL cholesterol and hypertension showed inconsistent results., Conclusions: For a majority of the examined cardiovascular risk factors, social population groups defined from cross-sectional data adequately mirror secular change., (Copyright © 2011 Wiley-Liss, Inc.)

Height and obesity are risk factors for cardiovascular disease and other physical and mental health conditions. Their association with childhood socioeconomic position has been demonstrated in studies among European and a few third world populations. In a random sample of adult Greenland Inuit (N = 2302) we studied the association between childhood socioeconomic conditions and height as well as prevalence of obesity (BMI > or = 30) in a cross sectional design. In block recursive graphical independence models, height was associated with mother's place of birth, birth cohort, childhood residence, alcohol problems in childhood home, and education among both men and women. Obesity was associated with mother's place of birth (for men) and with alcohol problems (for women). In General Linear Models, men with an all rural background and no education beyond primary school measured on average 165.1 cm compared with 172.1 cm for men with an all urban background (P < 0.001); women measured 153.9 and 161.1 cm (P < 0.001). Rural-urban differences in prevalence of obesity were not statistically significant. The height differences were considerably larger than between educational groups in European countries and of the same order of magnitude as those reported between men from the 17th century and men from 400 BC in the European and Mediterranean region. The rural-urban gradient in height follows the socioeconomic gradient and may negatively affect cardiovascular risk among the rural Greenlanders, while their physically active lifestyle and high consumption of n-3 fatty acids may counteract this.

Objectives: To genotype common genetic variants found in the adipose triglyceride lipase (ATGL) gene and test them for association with cardiovascular disease risk factors in the Greenland Inuit., Study Design: Candidate gene association study of discrete and quantitative traits related to cardiovascular health., Methods: ATGL was sequenced in 10 European subjects to identify DNA sequence variants. The identified polymorphisms were subsequently genotyped in a population-based cohort of 1,218 unrelated Greenland Inuit subjects, ascertained from the Greenland Population Study. Genotypes and reconstructed haplotypes were tested for association with cardiovascular disease risk factors using additive, dominant or recessive models, corrected for age, sex and body mass index., Results: Five single nucleotide polymorphisms and one 4-base pair deletion were identified in the European sample and were similarly polymorphic in the Greenland Inuit. Independently, variants were not associated with any cardiovascular traits. However, reconstructed rare ATGL haplotypes were associated with increased plasma triglyceride (TG) concentrations compared to the major haplotype under a dominant model (1.21+/-0.7 mmol/L and 1.11+/-0.6 mmol/L, respectively, p=0.006)., Conclusions: Rare ATGL haplotypes are associated with increased plasma TG concentrations in the Greenland Inuit.

Objectives: The purpose of the study was to apply two different approaches of dietary pattern definition to data from Greenland and to analyse the contemporary dietary patterns of the Inuit in Greenland in relation to urbanization and socio-economic positions., Study Design: Cross-sectional population survey., Methods: A total of 2,247 Inuit aged 18+ from 15 towns and villages in West Greenland (25% of all communities) were interviewed about their diet as part of a general health survey. A 67-item Food Frequency Questionnaire (FFQ) with portion sizes was used as the survey instrument. The analyses were based on 2,026 individuals who reported realistic daily energy intakes. Dietary patterns were determined by two different methods: a factor-cum-cluster analysis, and a normative approach based on adherence to dietary recommendations., Results: The 2 approaches resulted in 6 respective and 5 partly overlapping dietary patterns. The distribution of patterns varied significantly according to age, gender, urbanization and socio-economic position. A healthy diet was most often reported by women aged 35+, who lived in towns and who belonged to the upper social stratum; an unhealthy diet was reported by young men and women irrespective of urbanization or social position; and a traditional diet was reported increasingly with age, among village residents and by hunters/fishermen and their families., Conclusions: The two methodological approaches gave comparable results. The normative approach can be extended to other data sets and its results are directly applicable to dietary intervention, while the data-driven approach can identify novel patterns but is tied to the actual data set.

Objectives: To examine the association between the content of n-3 fatty acids and insulin resistance in an Inuit population., Study Design: The Inuit Health in Transition Study was carried out between 2003 and 2007 in Greenland as a cross-sectional study. Our preliminary results are based on the first 452 participants aged 18 and above. Only participants with at least 1 Inuit grandparent and without diabetes were included., Methods: The contents of n-3 fatty acids and the n-3/n-6 ratio were measured in the erythrocyte membrane phospholipids. BMI was calculated and questions concerning diabetes and ethnicity were answered. Insulin resistance was estimated using the HOMA-IR index based on fasting-glucose and fasting-insulin., Results: We found an inverse association between C20:5 n-3 (EPA), C22:3 n-3, the n-3/n-6 ratio and HOMA-IR and a positive association between C18:3 n-3 cis and HOMA-IR. When adjusted for age, gender, BMI and ethnicity, the association remained statistically significant for C20:5 n-3 (EPA), C22:3 n-3 and C18:3 n-3 cis., Conclusions: Our findings suggest that some types of n-3 fatty acids may have a protective effect against insulin resistance. The role of potential confounders such as physical activity, diet, energy intake, socio-economic status and contaminants deserves further exploration.

Carnitine palmitoyltransferase IA, encoded by CPT1A, is a key regulator of fatty acid metabolism. Previously, a loss-of-function mutation, namely, c.1436 C-->T (p.P479L), was reported in CPT1A in the homozygous state in Canadian aboriginal male with presumed CPT1A deficiency. To determine the population frequency of this variant, we determined CPT1A p.P479L genotypes in 1111 Greenland Inuit. Associations between genotype and variation in plasma total cholesterol, triglycerides, LDL, HDL, apolipoprotein (apo) B, and apoA-I was also investigated. We found the L479 allele occurs at a high frequency in this sample (0.73), while it was completely absent in 285 nonaboriginal samples. This suggests that the original proband's symptoms were not likely due to the CPT1A p.P479L mutation because it is very common in Inuit and because symptoms suggesting CPT1A deficiency have not been reported in any carrier subsequently studied. However, CPT1A p.P479L was associated with elevated plasma HDL and apoA-I levels. The association with increased levels of HDL and apoA-I suggest that the polymorphism might protect against atherosclerosis.

As part of the rapid socio-cultural transition observed in Arctic populations, the Inuit diet is changing. We present original data derived from the baseline Inuit Health in Transition cohort study regarding biological levels of n-3 fatty acids and trans-fatty acids (TFA), lipids with opposite health effects found respectively in traditional marine diets and recently introduced low-quality imported foods. A total of 524 Inuit from the Disko Bay area (Greenland) and 888 Inuit from the fourteen communities of Northern Québec (Nunavik) participated in the study. We measured the fatty acid profile of erythrocyte (RBC) membrane phospholipids (PL) as a surrogate for individual intakes. Moreover, the contribution of store-bought foods to energy intakes was assessed through dietary questionnaires. Our results show that while n-3 fatty acid levels were slightly lower in Nunavik (9.4% of RBC membrane PL) than in Greenland (12.1%), TFA levels were on average nearly thrice as high in Nunavik Inuit (1.20%) as they were in Greenlanders (0.43%). Moreover, younger Nunavik Inuit accumulated higher intakes of TFA and lower intakes of n-3 fatty acids. Finally, the average proportion of energy derived from store-bought foods was high in both groups (77.5% and 83.5%), especially in youth. Our results call for action to rehabilitate and recover access to country foods and point to the importance for Nunavik and the entire circumpolar world to follow the example of Denmark and Greenland, which imposed a maximum content of 2 g/100 g fat on industrially produced trans-fats in 2003.

Aims/hypothesis: Some evidence supports the hypothesis that persistent organic pollutants (POPs) may increase the risk of type 2 diabetes. The Inuit population in Greenland, which is highly exposed to POPs due to a high intake of marine mammals, has experienced a rapid increase in diabetes prevalence over the last 30 years. Thus the aim was to study the association between POPs and glucose intolerance and markers of insulin resistance and insulin secretion using a population-based design., Methods: From 1999 to 2002 the Greenland population study was carried out among adult Inuit living in Greenland. The examination included a 75 g OGTT, anthropometric measurements, a structured interview, and blood tests. Plasma glucose and serum insulin were analysed, and three defined subclasses of POPs were analysed in a subgroup. Associations were adjusted for age, sex, waist circumference, Inuit heritage, cigarette smoking, alcohol consumption and educational level., Results: Data on POPs were available on 692 individuals, 305 men (mean age 50 years) and 387 women (mean age 49 years). The prevalence of diabetes was 10.3%, and 10.5% had impaired glucose tolerance. The concentrations of several POPs were exceptionally high. While no associations were found between POPs and stages of glucose intolerance or markers of insulin resistance, POPs were significantly inversely associated with stimulated insulin concentrations and homeostasis model assessment of beta cell function., Conclusions/interpretation: The study indicates that POPs may affect insulin secretion rather than being involved in the pathogenesis of insulin resistance. No association was seen between POPs and glucose intolerance or markers of insulin resistance.

Background: The rs9939609 T>A single-nucleotide polymorphism (SNP) in the FTO gene has previously been found to be associated with obesity in European Caucasian samples. The objective of this study is to examine whether this association extends to metabolic syndrome (MetS) and applies in non-Caucasian samples., Methods: The FTO rs9939609 SNP was genotyped in 2121 subjects from four different non-Caucasian geographical ancestries. Subjects were classified for the presence or absence of MetS according to the International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III definitions., Results: Carriers of > or = 1 copy of the rs9939609 A allele were significantly more likely to have IDF-defined MetS (35.8%) than non-carriers (31.2%), corresponding to a carrier odds ratio (OR) of 1.23 (95% confidence interval [CI] 1.01 to 1.50), with a similar trend for the NCEP ATP III-defined MetS. Subgroup analysis showed that the association was particularly strong in men. The association was related to a higher proportion of rs9939609 A allele carriers meeting the waist circumference criterion; a higher proportion also met the HDL cholesterol criterion compared with wild-type homozygotes., Conclusion: Thus, the FTO rs9939609 SNP was associated with an increased risk for MetS in this multi-ethnic sample, confirming that the association extends to non-Caucasian population samples.

Objective: It is a common notion that coronary heart disease (CHD) is rare among the Inuit, possibly due to a high intake of omega-3-fatty acids. The scientific evidence for this is weak and to some extent based on uncertain mortality statistic. The aim of this study was to assess the prevalence of markers of CHD among Greenland Inuit, and to study associations between markers of CHD and behavioral and biological variables., Design: We studied prevalence of angina pectoris (AP), self-reported myocardial infarction (MI), and ECG defined MI and ischaemia in a population survey among 1316 Inuit living in Greenland. Blood tests were supplemented by structured interviews, anthropometry, and measurements of blood pressure, and the participants received an oral glucose tolerance test., Results: The prevalence of symptomatic CHD (AP, self-reported MI) was 7.3% among men and 6.9% among women, and 12.2% and 13.4% of men and women had ischaemic ECG changes. The overall prevalence of CHD (AP+self-reported MI+ECG defined MI) was 10.8% in men and 10.2% in women. The highest prevalence was observed in the least westernized areas in Greenland. Physical inactivity, low education, dyslipidemia, hypertension and diabetes were associated with CHD., Conclusion: The prevalence of markers of CHD was not different from that in Western populations. The Inuit is a population undergoing rapid social and health transitions, with the emergence of cardiovascular risk factors, and there is a need for critical rethinking of cardiovascular epidemiology in this population.

Objectives: We investigated the prevalence of obesity and the metabolic correlates of different levels of body mass index (BMI) and waist circumference among the Inuit in 3 countries., Methods: Data from 4 surveys of Inuit in Canada, Greenland, and Alaska conducted during 1990-2001 were pooled, with a total sample size of 2545 participants. These data were compared with data from a Canadian population of predominantly European origin., Results: Using the World Health Organization criteria for overweight and obesity, we found that the crude prevalence of overweight among Inuit men and women was 36.6% and 32.5%, respectively, and obesity was 15.8% and 25.5%, respectively. Inuit prevalences were similar to those of the highly developed countries of Europe and North America. As levels of obesity increased, as measured by BMI or waist circumference, the mean values of various metabolic indicators-lipid, glucose, and insulin levels and blood pressure-also increased. However, at each level of BMI or waist circumference, the Inuit had lower blood pressure and lipid levels than did Euro-Canadians., Conclusions: Our data indicate that universal criteria for obesity may not reflect the same degree of metabolic risk for populations such as the Inuit and suggest that ethnic-specific criteria are needed.

Aims: The effects of migration on cardiovascular risk factors are often gender specific. The purpose of the present study was to analyse the association of migration from Greenland to Denmark with cardiovascular risk factors in a gender-specific perspective., Methods: Cross-sectional population surveys among adult Inuit in Greenland and Inuit migrants in Denmark (n = 1542). General Linear Models adjusted for age, smoking, diet (seal, fish, and fruit), and alcohol consumption., Results: Blood pressure was significantly higher among Inuit migrants of either sex than among the Inuit in Greenland. Among women, HDL-cholesterol concentrations were 1.59 mmol/l in Greenland and 1.83 among migrants (p<0.001), while obesity and HbA(1c) were significantly lower among the migrants. Blood lipids, HbA(1c), and obesity did not differ between men in Greenland and migrants. Smoking, diet, and alcohol consumption differed significantly among migrants and non-migrants. Adjusted for the consumption of seal meat and alcohol, the difference in HDL cholesterol for men (1.44 and 1.66 mmol/l; p = 0.002) was of a similar magnitude to that of women., Conclusions: Migration was associated with cardiovascular risk factors in different ways among men and women. Some of the gender difference could be explained by dietary differences among male and female migrants and non-migrants, or in the case of HDL cholesterol by a different association with the consumption of seal meat for men and women, but a large unexplained residual remained. Overall cardiovascular risk was higher among migrant than non-migrant males, while for women some risk factors were better and some worse among the migrants.