Dietary intake in undernourished adults living in Guinea-Bissau; a cross-sectional study.

BACKGROUND: Data on dietary intake in Guinea-Bissau is limited. The main purpose of this study was to compare mean daily energy intake (EI) with mean daily energy expenditure (EE) for a moderately active lifestyle in health-seeking individuals with a body mass index < 20.0 kg/m2. Furthermore, dietary composition was evaluated by estimates of macronutrient energy distribution, individual dietary diversity scores, and the identification of frequently consumed food items, stratified by sex. METHODS: A cross-sectional dietary survey was conducted at the suburban health- and demographic surveillance site in Guinea-Bissau, West Africa, from May 2014-February 2015. Each participant answered one interviewer-administered 24-h dietary recall at baseline, from which dietary intake was assessed. Differences in dietary intake between men and women were analysed using the X 2 test or Fisher's Exact test for categorical outcomes, and the Student's t-test for continuous variables. RESULTS: Forty-three men and forty-eight women were included. Mean EI for men was 6326 kJ/d (sd 2104) and for women 6822 kJ/d (sd 2210). Mean EE for a moderately active lifestyle with a physical activity level of 1.75 was 10,479 kJ/d (sd 658) for men and 8729 kJ/d (sd 731) for women. Both men and women had a significantly lower mean EI compared with mean EE (p-values both < 0.001). Dietary diversity was low with a score of 3.5 (sd 1.0) for men and 4.0 (sd 1.3) for women, p-value 0.046. Macronutrient energy was distributed as 66% (sd 11) carbohydrate, 15% (sd 5) protein, and 19% (sd 9) fat, with no significant difference in distribution between men and women. Consumption of starchy and sugary carbohydrates accounted for two thirds of mean EI. Cereals were the main source of protein, in place of animal protein. CONCLUSIONS: Both men and women in this study had low mean EI compared with mean EE for a moderately active lifestyle. Dietary intake was characterized by a seemingly low dietary diversity and imbalanced macronutrient energy distribution, comprising insufficient fat intake and excess carbohydrate intake. Cereals were the main source of protein. TRIAL REGISTRATION: PACTR2009110001673419. Registered 22 Oct 2009.

National study of the prevalence of gestational diabetes mellitus among Danish women from 2004 to 2012.

AIMS: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. We studied the prevalence of GDM from 2004 to 2012 in Danish women aged 15-49 years using registries with records of the diagnosis of GDM at delivery. METHODS: We conducted a national register-based study of 12,538 women with a diagnosis of GDM during a pregnancy leading to a live birth in the period 2004-2012. The diagnosis of GDM was taken from the National Patient Registry and combined with the total number of births at the national level from Statistics Denmark. Prevalence estimates were reported as crude and age-standardized using Danish and international data for women aged 15-49 years. RESULTS: A total of 566,083 live births was registered in Denmark from 2004 to 2012. The age-standardized prevalence of GDM increased from 1.7% (1095/63,465) of the total births in 2004 to 2.9% (1721/56,894) of the total births in 2012. During the period 2004-2012, the age-stratified prevalence increased from 1.1 to 1.8% among women aged 15-24 years, from 1.5 to 2.6% among women aged 25-34 years and from 2.9 to 4.7% among women aged 35-49 years. The prevalence was higher among immigrants and their descendants than in native Danish women (4.06 and 2.09% in 2007 vs. 4.51 and 2.72% in 2012, respectively). CONCLUSIONS: The prevalence of GDM in Denmark has increased across all age groups. Although the prevalence is low on a global scale, attention should be paid to this development by preventive health services.

Association between whole blood mercury and glucose intolerance among adult Inuit in Greenland.

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.

The forgotten risk? A systematic review of the effect of reminder systems for postpartum screening for type 2 diabetes in women with previous gestational diabetes.

BACKGROUND: Screening for type 2 diabetes is recommended for women with previous gestational diabetes (GDM). However, the screening rates remain low. We aimed to evaluate the reminders and reminder systems for women with previous GDM and the health professionals in primary and secondary health care with screening rate among postpartum women as primary outcome. METHODS: Observational and intervention studies were included and the PRISMA guidelines were followed for the literature extraction. RESULTS: Six studies were included: two long-term follow up studies and four early terms. Five studies focused on secondary care settings and one on primary care. Three studies focused on reminders to postpartum women only, two studies to both the women and health care professional, and one study on the health care provider only. Types of reminders varied from letters, emails, and personal telephone calls to the women to register-based reminders or letters to the health care professionals. Reminders were efficient but efficiency varied between studies. Two studies found that direct telephone calls strengthened the reminding of the women. The effect of reminding both the women and the health professional screening rates decreased compared to reminding either health professionals or reminding the women separately. CONCLUSIONS: Reminders have a potential for early detection and prevention of type 2 diabetes in this high risk group of women; however, the kind of reminder and the frequency of reminders should be carefully considered accordingly to the target group.

Decrease in vitamin D status in the Greenlandic adult population from 1987-2010.

BACKGROUND: Low vitamin D status may be pronounced in Arctic populations due to limited sun exposure and decreasing intake of traditional food. OBJECTIVE: To investigate serum 25(OH)D3 as a measure of vitamin D status among adult Inuit in Greenland, predictors of low serum 25(OH)D3 concentrations and the trend from 1987 to 2005-2010. DESIGN: A total of 2877 randomly selected Inuit (≥ 18 years) from the Inuit Health in Transition study were included. A sub-sample (n = 330) donated a blood sample in 1987 which allowed assessment of time trends in vitamin D status. RESULTS: The geometric mean serum 25(OH)D3 (25[OH]D2 concentrations were negligible and not reported) in 2005-2010 was lowest among the 18-29 year old individuals (30.7 nmol/L; 95% CI: 29.7; 31.7) and increased with age. In all age-groups it decreased from 1987 to 2005-2010 (32%-58%). Low 25(OH)D3 concentrations (<50 nmol/L) were present in 77% of the 18-29 year old and decreased with age. A characteristic seasonal variation in 25(OH)D3 concentrations was observed (range 33.2-57.1 nmol/L, p<0.001), with the highest concentrations in August to October. Age (2.0% per year increase; CI: 1.7, 2.2), female gender (7.1%; CI: 2.0; 12.5), alcohol intake (0.2% per increase in drinks/week; 0.0; 0.4), and traditional diet (10.0% per 100 g/d increase; CI: 7.9; 12.1) were associated with increased serum 25(OH)D3, whereas smoking (-11.6%; CI: -16.2; -6.9), BMI (-0.6%; CI: -1.1; -0.2) and latitude (-0.7% per degree increase; CI: -1.3; -0.2) were associated with decreased concentrations. CONCLUSION: We identified a remarkable decrease in vitamin D status from 1987 to 2005-2010 and a presently low vitamin D status among Inuit in Greenland. A change away from a traditional diet may well explain the observed decline. The study argues for the need of increased dietary intake of vitamin D and supplementation might be considered.

Update of the German Diabetes Risk Score and external validation in the German MONICA/KORA study.

AIMS: Several published diabetes prediction models include information about family history of diabetes. The aim of this study was to extend the previously developed German Diabetes Risk Score (GDRS) with family history of diabetes and to validate the updated GDRS in the Multinational MONItoring of trends and determinants in CArdiovascular Diseases (MONICA)/German Cooperative Health Research in the Region of Augsburg (KORA) study. METHODS: We used data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study for extending the GDRS, including 21,846 participants. Within 5 years of follow-up 492 participants developed diabetes. The definition of family history included information about the father, the mother and/or sibling/s. Model extension was evaluated by discrimination and reclassification. We updated the calculation of the score and absolute risks. External validation was performed in the MONICA/KORA study comprising 11,940 participants with 315 incident cases after 5 years of follow-up. RESULTS: The basic ROC-AUC of 0.856 (95%-CI: 0.842-0.870) was improved by 0.007 (0.003-0.011) when parent and sibling history was included in the GDRS. The net reclassification improvement was 0.110 (0.072-0.149), respectively. For the updated score we demonstrated good calibration across all tenths of risk. In MONICA/KORA, the ROC-AUC was 0.837 (0.819-0.855); regarding calibration we saw slight overestimation of absolute risks. CONCLUSIONS: Inclusion of the number of diabetes-affected parents and sibling history improved the prediction of type 2 diabetes. Therefore, we updated the GDRS algorithm accordingly. Validation in another German cohort study showed good discrimination and acceptable calibration for the vast majority of individuals.

Impact of the adipokine adiponectin and the hepatokine fetuin-A on the development of type 2 diabetes: prospective cohort- and cross-sectional phenotyping studies.

BACKGROUND: Among adipokines and hepatokines, adiponectin and fetuin-A were consistently found to predict the incidence of type 2 diabetes, both by regulating insulin sensitivity. OBJECTIVE: To determine to what extent circulating adiponectin and fetuin-A are independently associated with incident type 2 diabetes in humans, and the major mechanisms involved. METHODS: Relationships with incident diabetes were tested in two cohort studies: within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study (628 cases) and the Nurses' Health Study (NHS; 470 cases). Relationships with body fat compartments, insulin sensitivity and insulin secretion were studied in the Tübingen Lifestyle Intervention Program (TULIP; N = 358). RESULTS: Circulating adiponectin and fetuin-A, independently of several confounders and of each other, associated with risk of diabetes in EPIC-Potsdam (RR for 1 SD: adiponectin: 0.45 [95% CI 0.37-0.54], fetuin-A: 1.18 [1.05-1.32]) and the NHS (0.51 [0.42-0.62], 1.35 [1.16-1.58]). Obesity measures considerably attenuated the association of adiponectin, but not of fetuin-A. Subjects with low adiponectin and concomitantly high fetuin-A had the highest risk. Whereas both proteins were independently (both p<1.8×10(-7)) associated with insulin sensitivity, circulating fetuin-A (r = -0.37, p = 0.0004), but not adiponectin, associated with insulin secretion in subjects with impaired glucose tolerance. CONCLUSIONS: We provide novel information that adiponectin and fetuin-A independently of each other associate with the diabetes risk. Furthermore, we suggest that they are involved in the development of type 2 diabetes via different mechanisms, possibly by mediating effects of their source tissues, expanded adipose tissue and nonalcoholic fatty liver.

Dietary patterns in Greenland and their relationship with type 2 diabetes mellitus and glucose intolerance.

OBJECTIVE: Traditional Inuit dietary patterns have been found to be beneficial for CVD but have not been investigated in relation to glucose intolerance. We examined the association between dietary patterns and type 2 diabetes mellitus (T2DM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). DESIGN: Cross-sectional design with a priori derived dietary patterns from an FFQ resulted in five patterns: imported meat (n 196), traditional food (n 601), balanced diet (n 126), unhealthy diet (n 652) and standard diet (n 799). SETTING: Associations between dietary patterns and glucose-related outcomes were tested by linear and logistic regression analyses. Data included: dietary intake by FFQ, waist circumference, ethnicity, frequency of alcohol intake and smoking, physical activity, and oral glucose tolerance test results. Fasting participants and those without diagnosed T2DM were classified into normal glucose tolerance, IGT, IFG or T2DM. HOMA-IR (homeostatic model assessment-insulin resistance index) and HOMA-ß (homeostatic model assessment of ß-cell function) were calculated. SUBJECTS: Data included 2374 Inuit, aged 18+ years. RESULTS: Participants with a traditional dietary pattern had higher fasting plasma glucose (mean 5·73 (95% CI 5·68, 5·78) mmol/l, P < 0·0001) and lowest HOMA-ß (48·66 (95% CI 46·86, 50·40), P < 0·0001). The traditional diet gave significantly higher odds for IFG and T2DM than the balanced diet, imported meat diet, standard diet and unhealthy diet. CONCLUSIONS: Traditional food was positively associated with T2DM, IFG and fasting plasma glucose, and negatively associated with ß-cell function, compared with a standard diet. The imported meat diet seemed the best in relation to glucose intolerance, with lowest fasting plasma glucose and lowest odds for IFG and T2DM.

The value of genetic information for diabetes risk prediction - differences according to sex, age, family history and obesity.

BACKGROUND: Genome-wide association studies have identified numerous single nucleotide polymorphisms associated with type 2 diabetes through the past years. In previous studies, the usefulness of these genetic markers for prediction of diabetes was found to be limited. However, differences may exist between substrata of the population according to the presence of major diabetes risk factors. This study aimed to investigate the added predictive value of genetic information (42 single nucleotide polymorphisms) in subgroups of sex, age, family history of diabetes, and obesity. METHODS: A case-cohort study (random subcohort N = 1,968; incident cases: N = 578) within the European Prospective Investigation into Cancer and Nutrition Potsdam study was used. Prediction models without and with genetic information were evaluated in terms of the area under the receiver operating characteristic curve and the integrated discrimination improvement. Stratified analyses included subgroups of sex, age (<50 or ≥50 years), family history (positive if either father or mother or a sibling has/had diabetes), and obesity (BMI< or ≥30 kg/m(2)). RESULTS: A genetic risk score did not improve prediction above classic and metabolic markers, but - compared to a non-invasive prediction model - genetic information slightly improved the area under the receiver operating characteristic curve (difference [95%-CI]: 0.007 [0.002-0.011]). Stratified analyses showed stronger improvement in the older age group (0.010 [0.002-0.018]), the group with a positive family history (0.012 [0.000-0.023]) and among obese participants (0.015 [-0.005-0.034]) compared to the younger participants (0.005 [-0.004-0.014]), participants with a negative family history (0.003 [-0.001-0.008]) and non-obese (0.007 [0.000-0.014]), respectively. No difference was found between men and women. CONCLUSION: There was no incremental value of genetic information compared to standard non-invasive and metabolic markers. Our study suggests that inclusion of genetic variants in diabetes risk prediction might be useful for subgroups with already manifest risk factors such as older age, a positive family history and obesity.

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.

Omega-3 and omega-6 fatty acids and type 2 diabetes.

Polyunsaturated fatty acids are of particular interest in the nutritional therapy for diabetes, given their potential role in several pathophysiological processes related to cardiovascular disease. Both omega-3 and omega-6 fatty acids are beneficial for improving lipid profiles in healthy individuals and among type 2 diabetic patients: Supplementation with omega-3 fatty acids lowers triglycerides and VLDL-cholesterol. However, they might also increase LDL-cholesterol. Omega-3 fatty acids are, from the latest evidence, not related to mortality and cardiovascular disease. Similarly, glucose control and hypertension, as well as risk of microvascular complications, seem unaffected by omega-3 supplementation. Most studies involved mainly patients with type 2 diabetes, and future research needs to focus on the type 1 diabetic patient. Also, the role of omega-6 fatty acids remains largely unknown.

Consumption of traditional food and adherence to nutrition recommendations in Greenland.

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.

Obesity studies in the circumpolar Inuit: a scoping review.

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.

Assessment of consumption of marine food in Greenland by a food frequency questionnaire and biomarkers.

OBJECTIVES: We studied the association and agreement between questionnaire data and biomarkers of marine food among Greenland Inuit. DESIGN: Cross sectional study. METHODS: The study population comprised 2,224 Inuit, age 18+ (43% men); data collected 2005-2008 in Greenland. Using a food frequency questionnaire (FFQ), we calculated consumption of seal, whale, and fish (g/day) and as meals/month, intake of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), total N3, and mercury. We measured erythrocyte membrane fatty acids (FA) and whole blood mercury (Hg). Associations were assessed by Pearson correlation and agreement between the 2 methods was assessed by Bland-Altman plots depicting mean difference between the methods. Using multiple linear regressions, the associations were studied between whole blood mercury, erythrocyte FA and frequency or gram per day of seal, whale, and fish. RESULTS: Partial correlations ranged from r=0.16, p<0.0001 (DHA) to r=0.56, p<0.0001 (mercury). The best fitted lines were found for mercury and DHA. Mean difference was negative for mercury but positive for all the FA biomarkers. In a multiple logistic regression analysis, the best association was found between whole blood mercury and seal consumption, both as frequency in meals and actual intake gram per day: ß=1.07 µg (95% CI: 1.06; 1.08) and ß=1.04 µg (95% CI: 1.03; 1.04), respectively. CONCLUSION: Mercury showed the best correlation and agreement between calculated and measured values. Calculated actual intake in gram per day and frequency of meals showed similar associations with whole blood mercury and erythrocyte membrane FAs.

Glycemic index and glycemic load in relation to glucose intolerance among Greenland's Inuit population.

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-%ß. 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-%ß 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.

Inuit dietary patterns in modern Greenland.

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.