Giving birth in rural Arctic Greenland results from an Eastern Greenlandic birth cohort.

Eastern Greenland is one of the most remote areas in the world. Approximately 3,500 people lives in two small towns and five villages. There is limited information on birth outcomes in Eastern Greenland. A cohort of all birthing women from Eastern Greenland from 2000 to 2017 was established and pregnancy, birth, and neonatal outcomes were described. A total of 1,344 women and 1,355 children were included in the cohort where 14.5% of the women were 18 years or younger, and 36.2% were single parents. Most women, 84.8% gave birth in East Greenland and 92.9%, experienced a vaginal, non-instrumental birth. The overall caesarean section rate was 6.5%. The rate of premature births was 10.1% and 2.2% of the children were born with malformations. The rate of premature births was high, preventive initiatives such as midwifery-led continuity of care including a stronger focus on the pregnant woman's social and mental life situation may be recommended. Organisation of maternity services in East Greenland may benefit from a strong focus on public health, culture, and setting specific challenges, including the birth traditions of the society.

Serum selenium levels and asthma among seafood processing workers in Greenland.

Selenium levels in the Inuit population of Greenland have been declining during the last decades. The association between Selenium and asthma has been investigated previously, but with conflicting results. The objective was to measure human serum Se (s-Se) in Greenlandic seafood processing workers, to compare with levels recorded in previous decades and to establish if s-Se is associated with asthma or lung function. Data, including questionnaire answers, spirometry, skin-prick test and s-Se from 324 seafood processing workers in Greenland were collected during 2016-2017. Mean s-Se values were compared by t-test and one-way ANOVA. Associations between s-Se and asthma, symptoms from the lower airways at work and lung function were assessed using linear regression. The mean s-Se was 96.2 µg/L. S-Se was higher among non-smokers and workers living in settlements. Workers with asthma did not have s-Se levels significantly different from those of non-asthmatics. We found a positive association between s-Se levels and FEV1 values. Selenium levels appear to continue declining in Greenland, presumably because of a more Westernised lifestyle. The health effects of declining Selenium levels remain unclear. We did not establish an association between s-Se and asthma, but we did record a positive association between s-Se and FEV1.

Implementation of AUDIT in the treatment planning process for alcohol use disorder in Greenland.

INTRODUCTION: The aim was to describe the treatment-seeking population with alcohol use disorder by means of data from the AUDIT questionnaire at referral and to evaluate and discuss if this information can be of use in treatment and service planning. METHODS: Data from 2016 to 2018 were extracted from the National Database on Substance Abuse Treatment. The sample included 1281 individual treatment seekers from all over Greenland. RESULTS: Mean age was 38.2 years (SD 12.1 years). Only 60.1% had a total AUDIT score suggesting dependency, and 15.5% had a harmful use. While most only drank 2-4 times a month, about 95% binge drank. Half reported loss of control at least weekly, and one of three had been unable to do what was expected of them, or needed a drink first thing in the morning weekly or more often. In two-third others had been concerned about the drinking. Users of cannabis had a higher AUDIT score, while gambling was unassociated to alcohol use. Substantial gender and regional differences were seen. DISCUSSION: The AUDIT screening was found useful in individual and national treatment planning. Data suggested that particular focus should be given to women in treatment, and the service offered to the East Greenlandic population.

Polysubstance abuse among sexually abused in alcohol, drug, and gambling addiction treatment in Greenland: a cross sectional study.

This study aims to investigate the association between earlier sexual abuse and polysubstance abuse among persons in alcohol, drug and gambling addiction treatment in Greenland. The study included 431 individuals treated in 2017-2019. Data on exposure (sexual abuse), outcome (polysubstance abuse), and potential confounders (age, sex, school education, further education, labour market affiliation, physical abuse and emotional abuse) were extracted from The National Database on Substance Abuse Treatment. Polysubstance abuse was defined as both smoking cannabis more than once a week and having an AUDIT score >15. Logistic regression was used to estimate odds ratios (ORs). In total, 61% reported having been sexually abused. Women were more often sexually abused and had more often been physically and emotionally abused when compared to men. Polysubstance abuse (OR 2.06, 95% CI: 1.22; 3.48) and cannabis abuse (OR 1.89, 95% CI: 1.20; 2.98), but not alcohol abuse, were more frequent in sexually abused when compared to non-victims of sexual abuse. This study found polysubstance abuse to be more frequent in sexually abused treatment seekers. It is recommended that the findings are taken into account in the planning of treatment services and in training of counsellors.

Could Intensive Screening for Gonorrhea/Chlamydia in Preexposure Prophylaxis Cohorts Select for Resistance? Historical Lessons From a Mass Treatment Campaign in Greenland.

INTRODUCTION: Neisseria gonorrhoeae has developed resistance to all classes of antimicrobials used against it. Current strategies to prevent the emergence of pan-resistance include increased gonorrhea screening in high-prevalence populations such as men who have sex with men taking HIV preexposure prophylaxis. By increasing antimicrobial exposure, others have argued that intensive screening may inadvertently promote the emergence of antimicrobial resistance. AIM/METHODOLOGY: To contribute to this discussion, we conducted a historical review of the effect of a mass gonorrhea treatment campaign in Greenland from 1965 to 1968 on the incidence of gonorrhea and antimicrobial resistance. We conducted a literature review using PubMed and Google Scholar to find relevant studies. Data on the incidence of gonorrhea, antimicrobial susceptibility, and antimicrobials dispensed were extracted and analyzed. RESULTS: Eight articles were found with relevant information. The cornerstone of the campaign involved the repeated treatment for all persons with a diagnosis of gonorrhea in the past 6 months as well as all remaining unmarried persons between 15 and 30 years of age. There was a small and temporary decline in the incidence of gonorrhea during the campaign. The campaign was, however, associated with an increase in the proportion of gonococci that were not susceptible to penicillin. Gonococcal incidence continued to climb after the campaign ended but did decline dramatically after reductions in risk behavior after the global AIDS epidemic. DISCUSSIONS: The mass gonorrhea treatment campaign in Greenland was associated with only a temporary decline in the incidence of gonorrhea. It was, however, followed by an increase in penicillin nonsusceptibility. Intense gonorrhea screening and treatment strategies should be aware of the risk of inducing antimicrobial resistance.

Susceptibility patterns in Neisseria gonorrhoeae in Nuuk, Greenland, 2015-2018: a short communication.

Antimicrobial resistance in Neisseria gonorrhoeae (GC) has made gonorrhoea control and treatment more complex globally. In Greenland, the incidence of gonorrhoea is high and there is a need for continued surveillance of antimicrobial susceptibility.This study investigated gonococcal isolates obtained in Greenland's capital Nuuk between January 2015 and June 2018. Subsequent to collection, isolates were tested for ciprofloxacin and ceftriaxone susceptibility in order to monitor the resistance pattern among GC strains. 150 GC strains were isolated in Nuuk during the observation period (139 males, 93%; 11 females, 7%). All strains were fully susceptible to ceftriaxone. 49% of the GC strains were susceptible to ciprofloxacin. The median minimal inhibitory concentration (MIC) for ceftriaxone among GC strains resistant to ciprofloxacin was higher than among GC strains susceptible to ciprofloxacin. No differences in ciprofloxacin susceptibility and median MICs for ceftriaxone were observed by collection year. In conclusion no ceftriaxone resistance has been found in Nuuk to date. Continued easy access to diagnostics and treatment combined with increased and more systematic surveillance of antimicrobial susceptibility in Nuuk is recommended. Further, it is advisable to investigate the possibilities for intermittent sampling in Greenland outside of Nuuk, if obstacles in relation to sending sampling material to Nuuk can be bypassed.

Vitamin D Deficiency in Europeans Today and in Viking Settlers of Greenland.

The vast majority of the Earth's population lives between the 20th and 40th parallel north and south. It seems that right here humans have found the best living conditions relating not only to temperature and food recourses, but also to UV radiation necessary for the production of vitamin D by human skin. An exception to this general rule is Europe. Nearly half a billion people live between the 40th and 60th parallel north of the equator despite the fact that the amounts of UV radiation there are much lower. Moreover, since the time of the Vikings, there has always been a part of the European population that lived even further north than the 60th parallel (the northern parts of Europe, including Greenland). In this work, we present the potential role that vitamin D deficiency might have played in the extinction of the Vikings of Greenland. We analyze factors that contribute to the discrepancy between the theoretical distribution of areas with vitamin D deficiency and today's reality, like the impact of civilization, religious traditions, as well as vitamin D supplementation in food products and as a biologically active dietary additive. The global migration of people on a scale and speed never seen before is now even more important for this discrepancy.

Rapid change in the ciprofloxacin resistance pattern among Neisseria gonorrhoeae strains in Nuuk, Greenland: time to reconsider preventive and treatment strategies.

OBJECTIVES: Sexually transmitted infections (STIs), including infections with Neisseria gonorrhoeae (GC), are highly incident in Greenland. Since January 2011, GC testing has been performed on urine with nucleic acid amplification tests (NAATs) by strand displacement amplification (Becton Dickinson ProbeTec). Monitoring of GC antibiotic susceptibility by culture was introduced in Nuuk in 2012. Until 2014, no cases of ciprofloxacin-resistant GC strains were reported. In this paper, we report the finding of ciprofloxacin-resistant GC and describe the most recent incidence of GC infections in Greenland. METHODS: The number of urine NAATs and culture-positive swabs from January to October 2014 were obtained from the Central Laboratory at Queens Ingrid's Hospital in Nuuk and stratified on gender, place and period of testing. Incidence rates were estimated as number of urine NAAT * (12/10) per 100,000 inhabitants. Men in Nuuk with a positive NAAT for GC were encouraged to provide a urethral swab for culture and susceptibility testing. RESULTS: From January to October 2014, a total of 5,436 urine GC NAATs were performed on patients from Nuuk and 9,031 from the rest of Greenland. Of these, 422 (8%) and 820 (9%) were positive, respectively. From January to August, 6 (15%) cultures from Nuuk were ciprofloxacin resistant while in September and October, 26 (59%) were ciprofloxacin resistant (p<0.01). In total, 35 (40%) of 88 culture-positive isolates showed ciprofloxacin resistance. GC incidence in Nuuk was 3,017 per 100,000 inhabitants per year, compared to 2,491 per 100,000 inhabitants per year in the rest of Greenland. CONCLUSION: Within a short period, a rapid and dramatic change in ciprofloxacin susceptibility among GC strains isolated in Nuuk was documented and recommendation for first line treatments has changed. Continued monitoring and rethinking of primary and secondary preventive initiatives is highly recommended in this high GC incidence setting.

Low prevalence of ciprofloxacin-resistant Neisseria gonorrhoeae in Nuuk, Greenland.

During a 35-day period, 32 isolates of Neisseria gonorrhoeae strains were collected by culture from patients with positive nucleic acid amplification test results in Nuuk, Greenland, where ciprofloxacin is the preferred treatment. All isolates were quinolone susceptible, suggesting that resistance is rare. Sampling patients for culture before treatment may prove useful in reestablishing surveillance.

Exposure to persistent organic pollutants and risk of hypertension among Inuit from Greenland.

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.

Clinical risk factors for osteoporosis are common among elderly people in Nuuk, Greenland.

BACKGROUND: Osteoporosis is a debilitating condition characterized by fractures, pain and premature death. Risk factors for osteoporosis predict the risk of fragility fractures. AIM: To describe the occurrence of risk factors for osteoporosis among populations in Nuuk, the capital of Greenland. METHODS: A random sample of women born in 1934-42, 1945-47, 1956, and men born in 1956 were selected from the national civil registry. A questionnaire was sent out in Greenlandic and Danish on risk factors for osteoporosis: family history, smoking habits, alcohol intake, presence of disease, sun exposure, intake of dairy products, age at menopause (women) and number of falls. Additional questions included the frequency of back pain, previous fractures, intake of vitamin D and calcium supplements, use of anti-osteoporotic drugs, steroids and other drugs. RESULTS: The questionnaire was sent to 317 subjects confirmed to be living at an address in Nuuk and 181 (57.1%) responded. More young women than older women were smokers (60.6% vs. 35.0%; p=0.022) while limited sun exposure was reported by more of the old women (37.2% vs. 5.6%; p=0.003). Family history of osteoporosis was reported by 15.0%, without difference between groups. Alcohol and milk intake did not differ between groups. Premature menopause was reported by 17.9% of the women. Falls within the last year were reported by 42.4% with fewer falls in the oldest age group (21.9% vs. 50.0%; p=0.005). Frequency of fragility fractures increased with age (5.7% vs. 24.3% vs. 30.4%; p=0.02) and the risk of a fragility fracture increased with age (p=0.004; OR, 95% CI: 4.5, 1.6-12.2, reference: below 70 years), when adjusted for smoking, gender and falls. The use of anti-osteoporotic drugs was low (3.4%) while 28.8% took calcium and vitamin D supplements. CONCLUSIONS: Age is a dominating risk factor for fragility fractures in Greenland. The use of anti-osteoporotic drugs is low in Greenland, even if osteoporotic fractures are common in old age.

Vitamin D status in Greenland is influenced by diet and ethnicity: a population-based survey in an Arctic society in transition.

Vitamin D status as measured by plasma 25-hydroxyvitamin D (25(OH)D) is important to human health. Circumpolar people rely on dietary sources and societal changes in the Arctic are having profound dietary effects. The objective of the present study was to determine plasma 25(OH)D status and factors important to plasma 25(OH)D in populations in Greenland. Inuit and non-Inuit aged 50-69 years in the capital in West Greenland (latitude 64°15'N) and in a major town and remote settlements in East Greenland (latitude 65°35'N) were surveyed. Supplement use and lifestyle factors were determined by questionnaires. Inuit food scores were computed from a FFQ of seven traditional Inuit and seven imported food items. 25(OH)D2 and 25(OH)D3 levels were measured in the plasma. We invited 1 % of the population of Greenland, and 95 % participated. 25(OH)D3 contributed 99·7 % of total plasma 25(OH)D. Non-Inuit had the lowest median plasma 25(OH)D of 41 (25th-75th percentile 23-53) nmol/l compared with 64 (25th-75th percentile 51-81) nmol/l in Inuit (P< 0·001). Plasma 25(OH)D was below 20 and 50 nmol/l in 13·8 and 60·1 % of participants, respectively, with Inuit food item scores below 40 % (P< 0·001), and in 0·2 and 25·0 % of participants, respectively, with higher scores (P< 0·001). The Inuit diet was an important determinant of plasma 25(OH)D (P< 0·001) and its effect was modified by ethnicity (P= 0·005). Seal (P= 0·005) and whale (P= 0·015) were major contributors to plasma 25(OH)D. In conclusion, a decrease in the intake of the traditional Inuit diet was associated with a decrease in plasma 25(OH)D levels, which may be influenced by ethnicity. The risk of plasma 25(OH)D deficiency in Arctic populations rises with the dietary transition of societies in Greenland. Vitamin D intake and plasma 25(OH)D status should be monitored.

Both high and low serum vitamin D concentrations are associated with tuberculosis: a case-control study in Greenland.

Vitamin D deficiency has been associated with increased risk of tuberculosis (TB). Changes from a traditional to a Westernised diet among Greenlanders have resulted in reduced serum vitamin D, leading to considerations of whether preventive vitamin D supplementation should be introduced. The association between vitamin D status and TB was examined to assess the feasibility of vitamin D supplementation in Greenland. This was examined in a case-control study involving seventy-two matched pairs of TB patients (cases) and controls aged 8-74 years. Cases were diagnosed with TB during 2004-6 based on clinical findings in combination with either (1) positive Mycobacterium tuberculosis culture, (2) characteristic X-ray abnormalities together with a positive tuberculin skin test or a positive interferon-γ release assay or (3) characteristic histology. Controls were individually matched on age ( ± 5 years), sex and district. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured and OR of TB were the outcome. Compared with individuals with 25(OH)D concentrations between 75 and 140 nmol/l, individuals with concentrations < 75 nmol/l (OR 6.5; 95% CI 1.8, 23.5) or > 140 nmol/l (OR 6.5; 95% CI 1.9, 22.2) had higher risks of active TB (P = 0.003; adjustment for alcohol and ethnicity). Supplementing individuals with low vitamin D to normalise serum 25(OH)D concentrations was estimated to result in a 29% reduction in the number of TB cases. The study indicated that vitamin D supplementation may be beneficial to individuals with insufficient vitamin D concentrations but may increase the risk of TB among individuals with normal or high concentrations.

Is nasopharyngeal cancer really a "Cantonese cancer"?

Nasopharyngeal cancer (NPC) is endemic in Southern China, with Guandong province and Hong Kong reporting some of the highest incidences in the world. The journal Science has called it a "Cantonese cancer". We propose that in fact NPC is a cancer that originated in the Bai Yue ("proto Tai Kadai" or "proto Austronesian" or "proto Zhuang") peoples and was transmitted to the Han Chinese in southern China through intermarriage. However, the work by John Ho raised the profile of NPC, and because of the high incidence of NPC in Hong Kong and Guangzhou, NPC became known as a Cantonese cancer. We searched historical articles, articles cited in PubMed, Google, monographs, books and Internet articles relating to genetics of the peoples with high populations of NPC. The migration history of these various peoples was extensively researched, and where possible, their genetic fingerprint identified to corroborate with historical accounts. Genetic and anthropological evidence suggest there are a lot of similarities between the Bai Yue and the aboriginal peoples of Borneo and Northeast India; between Inuit of Greenland, Austronesian Mayalo Polynesians of Southeast Asia and Polynesians of Oceania, suggesting some common ancestry. Genetic studies also suggest the present Cantonese, Minnans and Hakkas are probably an admixture of northern Han and southern Bai Yue. All these populations have a high incidence of NPC. Very early contact between southern Chinese and peoples of East Africa and Arabia can also account for the intermediate incidence of NPC in these regions.

Role of n-3 fatty acids in the treatment of hypertriglyceridemia and cardiovascular disease.

n-3 Fatty acids (FAs) when used in doses of 3-4 g/d eicosapentaenoic acid and docosahexaenoic acid have profound effects on triacylglycerol (TG) concentrations. The mechanism for their TG reduction relates to their favorable effects on reducing hepatic production and secretion of VLDL and VLDL apolipoprotein B particles, along with favorable effects on plasma lipolytic activity through lipoprotein lipase-mediated clearance, as well as stimulation of beta-oxidation of other FAs in the liver. Their hypotriglyceridemic properties are related to both the dose of n-3 FAs used and the baseline TG concentrations of the population. In patients with TG concentrations >500 mg/dL, 4 g n-3 FAs have been shown to reduce TGs by 45%, VLDL by 42%, and non-HDL by 10.2%. A recent pooled meta-analysis with multiple doses of n-3 FAs ranging from 0.8 to 5.4 g revealed changes in TGs of -27 mg/dL (95% CI: -33, -20), in HDL of +1.6 mg/dL (95% CI: + 0.8, +2.3), and in LDL cholesterol of +6 mg/dL (95% CI: + 3, +8). The clinical uses of n-3 FAs include treatment of severe and moderate hypertriglyceridemia, use in statin-treated patients with elevated TG concentrations or non-HDL cholesterol (mixed hyperlipidemia), and use in the secondary and primary prevention of cardiovascular disease. Existing large-scale clinical trials such as the GISSI-Prevenzione Study and JELIS with low doses of n-3 FAs (1-2 g) show clinical benefit in reducing coronary heart disease without substantial changes in concentrations of TGs or other lipids. Future clinical trials need to determine whether the TG-lowering doses of n-3 FAs (3-4 g/d) result in additional risk reduction.

Fish and n-3 fatty acids for the prevention of fatal coronary heart disease and sudden cardiac death.

Large observational studies, randomized clinical trials, and experimental studies have evaluated the effects of fish and n-3 fatty acid consumption on fatal coronary heart disease (CHD) and sudden cardiac death (SCD), clinically defined events that most often share the final common pathway of fatal ventricular arrhythmia. These different study designs, each having complementary strengths and limitations, provide strong concordant evidence that modest consumption of fish or fish oil (1-2 servings/wk of oily fish, or approximately 250 mg/d of EPA+DHA) substantially reduces the risk of CHD death and SCD. Pooled analysis of prospective cohort studies and randomized clinical trials demonstrates the magnitude and dose-response of this effect, with 36% lower risk of CHD death comparing 0 and 250 mg/d of EPA+DHA consumption (P < 0.001), but then little additional benefit with higher intakes. Reductions in risk are even larger in observational studies utilizing tissue biomarkers of n-3 fatty acids that more accurately measure dietary consumption. The concordance of findings from different studies also suggests that effects of fish or fish oil on CHD death and SCD do not vary depending on presence or absence of established CHD. The strength and consistency of the evidence, and the magnitude of this effect are each notable. Because more than one-half of all CHD deaths and two-thirds of SCD occur among individuals without recognized heart disease, modest consumption of fish or fish oil, together with smoking cessation and regular moderate physical activity, should be among the first-line treatments for prevention of CHD death and SCD.

High prevalence of markers of coronary heart disease among Greenland Inuit.

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.

Vitamin D insufficiency in Greenlanders on a westernized fare: ethnic differences in calcitropic hormones between Greenlanders and Danes.

We studied the influence of age, gender, latitude, season, diet and ethnicity on plasma 25-hydroxyvitamin D 25 OHD, PTH, 1,25-dihydroxyvitamin D, vitamin D-binding protein, bone-specific alkaline phosphatase, and osteocalcin levels in 46 Greenlanders living in Nuuk (64 degrees N) on a traditional fare (group A), 45 Greenlanders living in Nuuk on a westernized fare (group B), 54 Greenlanders (group C), and 43 Danes (Group D) living in Denmark (55 degrees N) on a westernized fare. Blood specimens were drawn both summer and winter. Vitamin D insufficiency (plasma 25 OHD <40 nmol/l) was common in all four study groups during summer (23-74%) and winter (42-81%). Compared to groups A and D, vitamin D insufficiency was significantly more frequent in groups B and C. In all groups, summer levels of 25 OHD were above winter levels. Multiple regression analysis revealed a significant effect of ethnicity. Compared to Danes, Greenlanders had higher 1,25-dihydroxyvitamin D levels, but lower 25 OHD and PTH levels despite relatively low plasma calcium concentrations. In addition to ethnicity, 25(OH)D levels were influenced by age, season (summer > winter), and diet (a traditional Inuit diet>westernized diet). Ethnic differences exist between Greenlanders and Danes. Our results suggest that Greenlanders may have an inherent lower "set-point" for calcium-regulated PTH release or an enhanced renal 1,25(OH)(2)D production. In addition to ethnicity, age, season, and diet were important determinants of vitamin D status. Changes from a traditional to a westernized fare are associated with a reduced vitamin D status in Greenlanders. Vitamin D supplementation should be considered.