Traditional and modern Greenlandic food - dietary composition, nutrients and contaminants.

OBJECTIVES: High levels of n-3 fatty acids and other nutrients in traditional Inuit food appear to provide some protection against the typical diseases of affluent industrialized societies: cardiovascular diseases and type 2 diabetes. An increased intake of imported food among Inuits will probably increase their frequency of these diseases. However, since the 1970s it has become evident that the marine-based Inuit diet also contains high levels of potentially toxic lipophilic organic pollutants and heavy metals. Since these two food related opposing health effects appear to be inseparable, the phenomenon has been known as "The Arctic Dilemma". However, both the fatty acid composition and the contaminant levels vary in Greenlandic food items. Thus in principle it is possible to compose a diet where the benefits and risks are better balanced. Our objectives of this study were to compare traditional and modern meals in Greenland concerning the dietary composition, nutrients, and health indicators among the consumers. STUDY DESIGN: The present study was a cross-sectional dietary survey as part of the Arctic Monitoring and Assessment, Human Health Programme (AMAP). These results were compared with older dietary surveys in Greenland. METHODS: Dietary components, fatty acids, and nutrients in 90 local meals collected by duplicate portion method in Uummannaq town, north Greenland 2004 and in Narsaq, south Greenland 2006, were compared with 177 duplicate meals sampled in the village of Igdslorsuit, Uummannaq, district, 1976 and also compared with other dietary studies in Greenland 1953-1987. Anthropometric measures (weight, height, and body mass index, BMI) and blood lipids were measured as health indicators among the participants. RESULTS: Between the traditional foods sampled or analysed 30-50 years ago and the modern food from 2004 to 2006, significant differences were found in the dietary composition. The percentage of local food had decreased, to a present average of about 20% and with it the dietary content of n-3 fatty acids. Also, the intakes of many vitamins and minerals had decreased, and were below Nordic Nutrient Recommendations in 2004 and 2006. Vitamin A, B(1), (B(2)), B(12), iron, iodine, phosphorus, and selenium contents were correlated with n-3 content, whereas vitamin C, folate, and calcium contents were not and the same time very low. In the traditional food, especially from the villages, the intakes of vitamin A, vitamin D, and iron were extremely high and borderline toxic. The levels of contaminants such as organochlorins and heavy metals were also strongly correlated with the relative content of local food in the diet. The best balance between potentially beneficial and harmful substances was found for 20-30% local food, corresponding to a daily intake of 3-5 g of n-3 fatty acids. Body weight, height, body mass index (BMI), cholesterol, and S-triglycerides had increased significantly between 1976 and 2004. CONCLUSION: The dietary changes to a more western fare were found to be negative resulting in less adequate nutrient coverage but at the same time lower contaminant load. Thus, we recommend not to increase the consumption of local products beyond the present level but rather to improve the quality of the imported food.

Contaminants, diet, plasma fatty acids and smoking in Greenland 1999-2005.

OBJECTIVES: The purpose of this study is to monitor and assess human exposure to pollution in the Arctic which presents a potential future health risk for the local populations. Epidemiological studies in Greenland have shown that human blood levels of several organic contaminants are very high, especially in the North where people depend on local food. In East Greenland (Ittoqqortoormiit (Scoresbysund)) the population shows the highest blood levels of several persistent organic pollutants found in Arctic countries, especially PCB, the levels of which exceed Canadian guideline levels. As in other Arctic countries, the predominant source of these contaminants is the local diet. However, other factors such as smoking may influence the metabolism and thereby the accumulation of toxic substances. STUDY DESIGN: This project is part of the human health program of the ongoing circumpolar "Artic Monitoring and Assessment Programme". Lifestyle, anthropometric factors, and dietary survey results covering 500 men and women from 6 Greenlandic districts were analyzed along with other factors blood lipids, fatty acid profiles, heavy metals and concentrations of persistent organic pollutants (POPs). RESULTS: The dietary survey showed that the traditional food on the average provided 20-30% of the total energy intake. However, the relative monthly meal intake of seal, whale, polar bear, fish and game, and the composition of imported food, varied between districts. Seal and polar bear intake, and, in particular all the plasma n-3 fatty acids, were significantly correlated with organic contaminant concentrations, (betaHCH, chlordanes, DDTs, Hexachlorobenzene, Mirex, PCBs, and toxaphenes) p<0.01(). After adjusting for age, district, dietary factors or plasma n-3 fatty acids, smoking was significantly correlated with high levels of all the above mentioned POPs. CONCLUSION: The main predictors of high contaminant levels in Greenland were age, district, male gender, smoking and high plasma n-3/n-6 ratio as a marker of high dietary intake of local marine mammals.

Human accumulation of mercury in Greenland.

In the Arctic, the traditional diet exposes its people to a high intake of mercury especially from marine mammals. To determine whether the mercury is accumulated in humans, we analyzed autopsy samples of liver, kidney and spleen from adult ethnic Greenlanders who died between 1990 and 1994 from a wide range of causes, natural and violent. Liver, kidney and spleen samples from between 33 and 71 case subjects were analyzed for total mercury and methylmercury, and liver samples also for selenium. Metal levels in men and women did not differ and were not related to age except in one case, i.e. for total mercury in liver, where a significant declining concentration with age was observed. The highest total mercury levels were found in kidney followed by liver and spleen. Methylmercury followed the same pattern, but levels were much lower, constituting only 19% of the total mercury concentration in liver and spleen and as little as 3% in kidney. In liver selenium was found in surplus to mercury on a molar basis. Mercury concentrations in the liver and kidneys of Greenlanders were elevated compared to levels in the general population in Japan, Korea and several European countries, except in the Faroe Islands where mercury levels were 2-3 times higher. This is in accordance with the expected exposure of mercury in the diet.

Accumulation of cadmium in livers and kidneys in Greenlanders.

In the Arctic, the traditional diet exposes its people to a very high intake of cadmium because it is highly concentrated in the liver and kidneys of commonly eaten marine mammals. In one study in Greenland, the cadmium intake was estimated to 182 microg/day/person in the fall and 346 in the spring. To determine whether the cadmium is accumulated in humans, we analyzed autopsy samples of liver and kidneys from 95 ethnic Greenlanders (aged 19-89) who died from a wide range of causes. The cadmium concentration in liver (overall mean 1.97 microg/g wet wt) appeared to be unrelated to any particular age group, whereas the concentrations in the kidneys peaked in Greenlanders between 40 and 50 years of age (peak concentration 22.3 microg/g wet wt). Despite the high cadmium levels in the typical Greenlander diet, we found that the cadmium concentrations in livers and kidneys were comparable to those reported from Denmark, Sweden, Australia and Great Britain. Furthermore, even though the mean cadmium intake from the diet was estimated to be 13-25 times higher in Greenlanders than in Danes, we found similar cadmium levels in the kidneys of both. Seal livers and kidneys are the main source of cadmium in the diet of Greenlanders, but these tissues are not eaten in Denmark. Thus, our results suggest that the accumulation of cadmium from Greenlander's marine diet is very low.

Dietary composition and contaminants in north Greenland, in the 1970s and 2004.

OBJECTIVES: The fatty acid composition and other nutrients in traditional Inuit food appear to provide some protection against diseases of affluent industrialized societies, such as cardiovascular diseases and type 2 diabetes. A transition towards increased amounts of imported food might increase the occurrence of these diseases among Inuit. However, since the 1970s it has become evident that the marine-based Inuit diet also contains high levels of potentially toxic lipophilic organic pollutants and heavy metals. Since these two opposing effects on health appear to be inseparable, the phenomenon has become known as "The Arctic Dilemma". However, both the fatty acid composition and the contaminant levels vary in Greenlandic food items. Thus, in theory, it is possible to compose a diet where the benefits outweigh the risks. Our objective was to compare traditional and modern meals in Greenland regarding dietary composition, content of n-3 fatty acids and contaminants. STUDY DESIGN: The present study was part of the Arctic Monitoring and Assessment Programme, AMAP, comparing the results of dietary composition and nutrients in 177 traditional meals collected in Uummannaq municipality, north Greenland in 1976 with 90 meals sampled in Uummannaq town in 2004 under similar conditions. Eleven pesticides, 14 PCB congeners, heavy metals, selenium, and fatty acids were analysed in meals and blood samples from the participants. Contaminant levels were compared between 1976 and 2004 after adjustment for n-3 fatty acids, indicating local food content. RESULTS: Between the traditional meals collected 30 years ago and the meals from 2004, dramatic and significant changes have occurred in the dietary composition. The percentage of local food has decreased, and with it the intake of n-3 fatty acids. Calculated as daily intake, all but three contaminants had decreased significantly. However, this could be explained by the lower intake of local food. After adjustment for n-3 fatty acid content in the food, significant declines of concentration in the local food were evident only for PCBs and lead, whereas for mercury, DDTs, and chlordanes the levels were unchanged, and for hexachlorobenzene, mirex, and toxaphenes, the levels had increased significantly. CONCLUSION: The consumption of locally produced food has decreased in Greenland during the last 30 years and this has led to a reduction in the daily intake of contaminants. However, the concentrations of contaminants in local food items have not decreased, except for PCB and Lead. Therefore, we recommend that the consumption of local products is not increased beyond the present level, until the level of contaminants is reduced to a safer level.

Relationship between mercury in blood and 24-h ambulatory blood pressure in Greenlanders and Danes.

BACKGROUND: Intake of mercury with food items from sea mammals and fish has been suggested to be involved in cardiovascular disease, but the relationship between mercury in blood and 24-h ambulatory blood pressure (BP) has never been studied. METHODS: We measured mercury in blood and 24-h BP in four groups of healthy subjects: group 1, Danes living in Denmark consuming European food; group 2, Greenlanders living in Denmark consuming European food; group 3, Greenlanders living in Greenland consuming European food; and group 4, Greenlanders living in Greenland consuming mainly traditional Greenlandic food. RESULTS: Mercury in blood was highest in Greenlanders and increased when they lived in Greenland and consumed traditional Greenlandic food (group 1: 2.2 microg/L (median), group 2: 4.8 microg/L, group 3: 10.8 microg/L, and group 4: 24.9 microg/L). The 24-h BP was the same in all three groups of Greenlanders. However, 24-h diastolic BP was lower among Greenlanders than Danes (71 v 76 mm Hg, P < .000) and 24-h pulse pressure was higher (54 v 50 mm Hg, P < .000). Mercury in blood was significantly and positively correlated to pulse pressure (rho = 0.272, P < .01). CONCLUSIONS: Pulse pressure was higher and diastolic BP was lower in Greenlanders than Danes. Pulse pressure increased with higher mercury content in the blood. Although genetic factors must be responsible to some extent for the difference in pulse pressure between Greenlanders and Danes, the present results seem to support the hypothesis that mercury intake from maritime food is involved in cardiovascular disease.

Exposure of Arctic populations to methylmercury from consumption of marine food: an updated risk-benefit assessment.

Recent and powerful epidemiological studies have been used as a basis for revising international and domestic guidelines for human exposure to mercury. Long-range transport of mercury into the Arctic makes some Arctic peoples consuming traditional marine foods, especially newborns, children and pregnant women, very vulnerable to harmful exposures. The WHO, the USEPA and Health Canada have all recently revised their mercury intake guidelines as a result of neurological effects reported in children exposed in utero and adults. Guidance values are equivalent to 0.23 microg/kg-bw/d, 0.1 microg/kg-bw/d and 0.2 microg/kg-bw/d respectively. Differences between the numbers represent slight differences in the uncertainty factors applied, rather than in toxicological interpretation. More recent findings suggest that mercury may also be a factor in ischemic heart disease, which could lower guidance values in the future. Considering the benefits of marine fatty acids (n-3 fatty acids) and guidance that populations consume 300-400g fish/week, consumers face a reality that most open ocean and relatively 'unpolluted' fish species contain levels of mercury that would lead to exposures at current guidance levels. Clearly, there is no more room for further mercury pollution and there is an urgent need for international action to reduce mercury emissions. Concomitantly, while there may be a need for public health authorities to provide consumption advisories to some highly exposed populations, such as in the Arctic, there remains a need to better understand the interactions and benefits associated with marine foods that may reduce health risks associated with low-level mercury exposure.

Inuit are protected against prostate cancer.

Incidence and mortality rates for prostate cancer are reported to be low among Inuit, but this finding must be additionally supported given the difficulty of obtaining a precise medical diagnosis in the Arctic. We conducted an autopsy study in 1990-1994 among 61 deceased males representative of all deaths occurring in Greenland and found only one invasive prostate cancer. Histological data were available for 27 autopsies and revealed no latent carcinoma. Our results suggest that in situ carcinoma is rare among Inuit and that their traditional diet, which is rich in omega-3 polyunsaturated fatty acids and selenium, may be an important protective factor.

Lead sources in human diet in Greenland.

Although blood lead levels have declined in Greenland, they are still elevated despite the fact that lead levels in the Greenland environment are very low. Fragments of lead shot in game birds have been suggested as an important source of dietary exposure, and meals of sea birds, particularly eider, contain high concentrations of lead. In a cross-sectional population survey in Greenland in 1993-1994, blood lead adjusted for age and sex was found to be associated with the reported consumption of sea birds. Participants reporting less than weekly intake of sea birds had blood lead concentrations of approximately 75 microg/L, whereas those who reported eating sea birds several times a week had concentrations of approximately 110 microg/L, and those who reported daily intake had concentrations of 170 microg/L (p = 0.01). Blood lead was not associated with dietary exposure to other local or imported food items.

Dietary composition in Greenland 2000, plasma fatty acids and persistent organic pollutants.

UNLABELLED: Human exposure to pollution in the Arctic presents a potential future health risk for the local populations. Epidemiological studies in Greenland have shown that human blood levels of several organic contaminants are very high, especially in the North where people depend on local food. In East Greenland (Ittoqqortoormiit (Scoresbysund)) the population shows the highest blood levels of several persistent organic pollutants found in Arctic countries, especially PCB, the levels of which exceed Canadian guideline levels. As in other Arctic countries, the direct source of these contaminants is the diet, and it is, therefore important to monitor the composition of the diet along with other factors which may influence the metabolism and thereby the accumulation of toxic substances. This project is part of the human health program of the ongoing circumpolar 'Arctic Monitoring and Assessment Programme'. Dietary survey results (Semiquantitative Food Frequency questionnaire from 192 men and women from East Greenland and 48 men from Uummannaq West Greenland) were analysed along with other factors (lifestyle and anthropometric factors), blood lipids, fatty acid profiles, and concentrations of persistent organic pollutants (POPs). The dietary survey showed that the contributions of traditional food provided 25-30% of the total energy intake. However, the relative monthly meal intake of seal, whale, polar bear, fish and game, and the composition of imported food, varied between districts. The blood fatty acids (FA), e.g. the n-3/n-6 ratio (Uummannaq 0.70, Ittoqqortoormiit 0.37 Tassiilaq 0.45) showed moderate associations with the overall reported food composition. The n-3 fatty acids were associated with the well-known lowering effect on serum-triglyceride levels. The strongest associations between diet and plasma fatty acids were found for docosapentaenoic acid, C: 22.5.3 which strongly correlated with reported seal, and polar bear intake (P=0.01** and 0.04*, respectively), consistent with the fact that seal and polar bear blubber contain much higher concentrations of C: 22.5.3 than other sea mammals and fish. Seal and polar bear intake, and in particular all the plasma n-3 fatty acids, were significantly correlated with organic contaminant concentrations, (betaHCH, chlordanes, DDTs, Hexachlorobenzene, Mirex, PCBs, and toxaphenes) P<0.01**. CONCLUSIONS: The strongest correlations between POPs and fatty acids were found with C: 22.5.3, strongly indicating seal and polar bear blubber as the main contributors of POPs to the local population.

Selenium status in Greenland Inuit.

In Greenland, the human intake of selenium has always been relatively high and is closely connected to intake of the traditional food of marine origin. Analyses of historic and present day human and animal hair samples have indicated that the selenium level in the marine environment has been constant over time, while the levels in humans have declined corresponding to a decrease in intake of traditional food. The Inuit population in Greenland is in dietary transition where western-style food will increasingly dominate. As a consequence, the ample supply of selenium may not be sustained in the future. We report here the selenium status in three Greenlandic population groups, Ittoqqortoormiit and Tasiilaq on the east coast and Uummannaq on the west coast. Mean whole blood concentrations ranged from 178 microg/l in Tasiilaq men to 488 microg/l in Uummannaq men. Plasma concentrations ranged from 79 microg/l in Tasiilaq women to 113 microg/l in Uummannaq men. With increasing Se concentrations in whole blood, the plasma concentrations increased but tended to stabilise a level approximately 140 microg/l. Selenium blood levels were highly significantly correlated with long chain marine fatty acids. Dietary survey and food composition data from the west coast showed that whale skin, muktuk, is the main source of Se followed by birds, seal meat and organs, and fish. Terrestrial animals contributed only insignificantly to the selenium intake. In West Greenland, daily Se intake (235 microg/day) was estimated by dietary survey; it corresponded well with a calculated intake (220 microg/day) based on the mean blood concentration.

Smoking as a determinant of high organochlorine levels in Greenland.

The authors investigated the accumulation of organochlorines among smoking and nonsmoking Inuit hunters (n = 48) in Uummanaq, Greenland, a population with high dietary exposure to persistent organic pollutants (POPs). Human plasma organochlorine levels were positively correlated with age, marine diet, and smoking or plasma cotinine in multiple linear-regression models (p < 0.001). Body mass index was inversely correlated with organochlorine accumulation, independent of smoking status. These findings confirm that the source of POPs among the Inuit in Greenland is diet, but smoking is an important determinant of POP bioaccumulation. Smoking cessation may provide a means to lower the body burden of POPs.

Neurobehavioral performance of Inuit children with increased prenatal exposure to methylmercury.

Exposure to methylmercury from marine mammals and other seafood may affect the development of the central nervous system. In a traditional Inuit community in Qaanaaq, Greenland, mercury concentrations in cord blood and maternal hair have been examined in connection with all births. We examined 43 children at age 7-12 years with a battery of neurobehavioral tests. The average mercury concentration in hair was 5.0 microg/g and 1.5 microg/g in children and mothers, respectively. Clinical neurological examination did not reveal any obvious deficits. However, neuropsychological tests showed possible exposure-associated deficits, though only in a few cases reaching statistical significance. In conjunction with data from other studies, peak latencies on brainstem auditory evoked potentials tended to be prolonged at increased exposure levels. The data from the present study therefore appears in accordance with other evidence that prenatal or early postnatal exposures to methylmercury may cause subtle neurobehavioral deficits.

Plasma amino acids in Greenlanders and Danes: influence of seasons, residence, ethnicity, and diet.

Basal metabolic rate is elevated among circumpolar populations. It has been our hypotheses that this is reflected in the levels of plasma amino acids, that amino acid concentration in plasma differs between Greenlanders and Danes, and that this difference is related to residence, ethnicity, diet, and season. The purpose of the study was to measure plasma amino acids in Greenlanders and Danes and to analyze the influence of residence, ethnicity, diet, and season. Amino acids in plasma were measured in four groups of healthy subjects both during summer and winter: Group 1, Danes living in Denmark consuming European food; Group 2, Greenlanders living in Denmark consuming European food; Group 3, Greenlanders living in Greenland consuming European food; and Group 4, Greenlanders living in Greenland consuming mainly traditional Greenlandic food. Amino acids were determined by pre-column derivatization with o-phthaldialdehyde and reverse-phase high-performance liquid chromatography with gradient elution and fluorescence detection. Most plasma amino acids were lower during summer than winter in Greenlanders living in Greenland. Comparison of the four groups showed that residence in Greenland was the most important influencing factor for the concentration of plasma amino acids, whereas ethnicity and diet had only a very modest or no effect. These findings could not be attributed to changes in thyroid function. However, the level of physical activity was significantly higher in Groups 3 and 4 than in Groups 1 and 2. Because exercise reduces the amino acid pool in plasma, it is possibly that the higher physical activity among Greenlanders living in Greenland explains the reduction in plasma amino acids during summer. It is concluded that plasma amino acids were lower during summer than winter in Greenlanders living in Greenland compared with Greenlanders in Denmark and Danes. This difference might be due to the higher level of physical activity among Greenlanders in Greenland during the summer period.

Ethnic, geographic and dietary influences upon vasoactive hormones and blood pressure among Greenland Inuit and Danes.

AIM: To study levels of vasoactive hormones and urinary excretion of sodium and potassium between groups of Greenland Inuit and Danes, and to analyse the relationship between these hormones and 24-h blood pressure, including nightly blood pressure dips and pulse pressure. METHODS: 145 Greenlandic participants were categorized in three groups according to degree of westernization, based on dietary habits and current place of residence; 41 Danes were included as controls. Twenty-four-hour blood pressure was measured. Venous plasma concentrations of vasoactive hormones were measured. Urine was collected for 24 hours for analysis of excretion of sodium and potassium. RESULTS: The Inuit population of Greenland had a lower diastolic blood pressure, a higher pulse pressure and lower nocturnal blood pressure dip than Danes had. Angiotensin II in plasma and urine excretion of potassium were higher among Greenlanders compared with Danes, irrespective of diet and place of residence. Aldosterone and urine excretion of sodium were significantly higher among participants in Denmark compared with participants in Greenland. Brain natriuretic peptide and atrial natriuretic peptide were independently and negatively associated with diastolic blood pressure, and vasopressin was positively associated with systolic blood pressure and pulse pressure. Ethnic differences in the effect of vasoactive hormones or urinary sodium and potassium excretion could not explain the difference in blood pressure. CONCLUSION: It is suggested that a high dietary intake of potassium and low sodium intake among Greenlanders may affect blood pressure. Further attention should be drawn to the occurrence of high pulse pressure and high activity in the renin-angiotensin system in Inuit populations.