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Increase in the intake of refined carbohydrates and sugar may have led to the health decline of the Greenland Eskimos
  1. James J DiNicolantonio
  1. Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
  1. Correspondence to Dr James J DiNicolantonio; jjdinicol{at}gmail.comtwitter@drjamesdinic

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Recently, Fodor et al1 performed a systematic review to determine if the claims made by Bang and Dyerberg in the 1970s were true that the Greenland Eskimo had a low incidence of coronary artery disease. The authors concluded, ‘The results of these investigations confirm that the prevalence of CAD in Inuits (Eskimos) is as high or higher compared to non-Eskimo populations’. Almost all of the evidence that was gathered by Fodor et al’s systematic review came from 1979 or afterwards. Based on the evidence, there can be little doubt that the Greenland Eskimos were indeed at a similar or even greater risk of atherosclerosis or coronary artery disease. However, the authors did find one study, from the late 1940s, that confirmed a lower risk of atherosclerotic disease in the Greenland Eskimo. Since western foods have been known to negatively impact the health of numerous isolated societies, the author decided to investigate what dietary changes may have occurred that might explain the increase in atherosclerotic disease in the Greenland Eskimos.

When looking at earlier evidence, there were two main publications discovered by Fodor et al that they considered as level of evidence I (the highest level of evidence), which were ‘based on actual investigation, clinical, autopsies imaging techniques’. Oddly enough, these two reports from the 1940s came to opposite conclusions, one in supporting the notion that the Greenland Eskimos had less atherosclerosis (Ehrstrom2), and one suggesting a similar or greater prevalence in the Eskimos (Bertelsen3).1

To address the supportive evidence first, Ehrstrom studied Eskimos in the same region as Bang and Dyerberg (Umanak district), which makes his findings a relevant comparison. Ehrstrom measured ‘sclerosis’ in 1071 …

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