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PubMed2006

'Why don't they get it?' Talk of medicine as science. St Luke's Hospital, Panniqtuuq, Baffin Island.

Using diaries, clinical notes and other sources, this contribution explores interactions between Dr J. A. Bildfell and Inuit at Panniqtuuq, Baffin Island, in 1933 and 1934. The article comprises a record of conflict, with two cultures colliding over the provision of health care. Scientific and technological advances in medicine were perceived by Bildfell as possessing the potential to address many of the problems diagnosed among Inuit. However, there was strong resistance to his practices. Bildfell was therefore caught between the promise and potential of his profession and a suppressed admiration for local belief-systems. The paper highlights Inuit resistance, particularly in relation to childbirth. In addition, Bildfell's writings are used to reveal how the construction of the 'other' can be understood as a heuristic device to explain antipathy to the introduction of western medicine. In the longer term, the latter imbedded itself into Qallunaat (non-Inuit)-Inuit relations. The paper also shows that colonial styles of rule are relevant to an appreciation of the foundation of post-colonial challenges to medical science and the consciousness that continues to follow professionals working in cross-cultural settings.

Canada↗
PubMed2004

Feasibility of Dual-Energy X-ray Absorptiometry in Arctic field studies.

BACKGROUND: Bone strength decreases with age. Bone mineral density (BMD) is a measure of bone strength. Data on BMD in present-day Inuit are limited, and data on circumpolar populations using Dual Energy X-ray Absorptiometry (DEXA scanning) are lacking. OBJECTIVES: Our aims were to validate DEXA scanning for use in field studies in the Arctic region and to obtain data on BMD in Greenland Inuit. METHODS: We measured BMD in 52 healthy Inuit living in Ilulissat and Saqqaq in North Greenland using a portable peripheral DEXA scanner. The measurement sites were forearms and calcaneal bones. Two measurements were performed at both radii and both calcanei. Triplicate measurements were performed in eleven Inuit. RESULTS: The portable scanner fitted into a standard bag suitable for transportation in the arctic winter. Imprecision was well within 2% for all calibrations. CV% were 0.16% to 1.79% in the forearms and 0.38% to 1.53% in the heels. The overall CV% was 1.09% in forearm and 1.01% in heel. Mean BMD in men was 0.569 g/cm2 in forearms and 0.542 in heel. In women it was 0.479 in forearms and 0.468 in heel. CONCLUSION: DEXA scanning is a feasible, reliable and comfortable method in rural Greenland. BMD values are now available for Greenland Inuit.

Absorptiometry, Photon↗
PubMed2003

Organochlorine levels in maternal and umbilical cord blood plasma in Arctic Canada.

A baseline for exposure to organochlorine and metal contaminants has been established for mothers and newborns in the Northwest Territories and Nunavut areas of Arctic Canada. Maternal and umbilical cord blood plasma organochlorine levels are described for Inuit, Dene, Métis, Caucasian and Other non-Aboriginal participants. Overall, 523 women volunteered to participate by giving their written informed consent between May 1994 and June 1999, resulting in the collection of 386 maternal blood samples, 407 cord blood samples and 351 maternal/cord pairs. Nearly half of all the participants regularly smoked cigarettes, including 77% of the Inuit participants. Maternal and cord results are presented for PCBs (as Aroclor 1260 and 14 congeners) and organochlorine pesticides, including p,p'-DDT, p,p'-DDE, beta-hexachlorocyclohexane (beta-HCH), hexachlorobenzene (HCB), cis and trans nonachlor, heptachlor epoxide, oxychlordane, mirex, dieldrin and toxaphene. Maternal PCB levels (as Aroclor 1260) averaged 4.42 (+/-9.03) microg/l in Inuit, which was 3.3 times higher than those found in Dene/Métis, and 3.4 times higher than levels in Caucasians. Mean DDE levels were 2.8 times higher in the Other non-Aboriginal group (Chinese, Filipino, East Indian and multiple ethnicity) than in the Inuit group, at 3.99 microg/l and 1.42 microg/l, respectively. Cord blood PCB levels (as Aroclor 1260) averaged 1.16 (+/-2.42) microg/l for Inuit participants, which was 3.3-4 fold higher than the other ethnic groups. PCBs, p,p'-DDE and hexachlorobenzene were detected in all maternal samples, and p,p'-DDE was detected in all cord samples. Regression coefficients for maternal/cord pairs are presented for selected organochlorines. Other results from this study, including maternal and cord metals data, will be presented elsewhere.

Adolescent↗
PubMed2004

Invasive pneumococcal disease in Greenland.

INTRODUCTION: The Inuit of Alaska and Canada have a higher incidence of invasive pneumococcal disease than non-inuit. The purpose of the present study was to evaluate incidence and outcome of these infections in Greenland with special reference to pneumococcal serotypes. STUDY DESIGN: Retrospective study of invasive pneumococcal infections in Greenland in the period 1996-2002. METHODS: Cases were defined as patients with positive cultures of Streptococcus pneumoniae from blood and/or CSF samples received at the microbiological laboratory of Dronning Ingrids Hospital Nuuk. Isolates were sent to Statens Serum Institut in Copenhagen for serotyping. Medical charts were reviewed. RESULTS: Fifty one cases were identified. The incidence among Inuit was 54 and among non-inuit 17 per 100,000 per year. Twenty one patients were in the age group 35-49 years and 20 in the age group 50-64 years. Twenty patients had meningitis (incidence 6 per 100,000/year). Seventeen patients died (33%). The most common serotypes were 1 (6 cases) and 12F (8 cases). The mortality rate was significantly higher among patients with 12F than among others (p < 0.01). No patients with serotype 1 died. CONCLUSION: As in Canada and Alaska the incidence of invasive pneumococcal disease, especially meningitis, is high among the Inuit in Greenland. Young and middle aged adults were most frequently affected. Pneumococcal serotype seems to be an important determinant for the outcome of invasive pneumococcal disease.

Adolescent↗
PubMed1990

Group A streptococcal pharyngeal carriage, pharyngitis, and impetigo in two northern Canadian native communities.

The prevalence of pharyngeal carriage of group A streptococci, streptococcal pharyngitis, and impetigo was determined in schoolchildren in two northern communities, one Inuit (mean number of schoolchildren surveyed, 233) and one native Indian (mean number of schoolchildren surveyed, 349). At three surveys from November 1984 to May 1985, pharyngeal group A streptococcal carriage was 5.3%, 22%, and 34% in the Inuit community and 5.3%, 5.1% and 10% in the native Indian, with impetigo prevalence 1.6%, 3.8% and 1.0%, and 2.4%, 4.2% and 0.6%, respectively. Increased pharyngeal carriage correlated with the increasing number of household residents and the lower school grade. In 12 months of observation the incidence of group A streptococcal pharyngitis was 49/100 schoolchildren for the Inuit and 9.4/100 for the native Indian community, with impetigo 13/100 and 11/100 respectively. The maximal incidence of pharyngitis was late winter in the Inuit community and midsummer in the native Indian. The incidence of impetigo peaked in January for both communities. M and T typing showed consecutive outbreaks of different serotypes in the Inuit community, but a persistent low level of endemic infection in the Indian community. These observations suggest a seasonal prevalence of group A streptococcal pharyngeal carriage consistent with other North American populations, but marked inter-community variation in pharyngeal carriage and disease. The midwinter peak of impetigo appears unique to these populations.

Adolescent↗
PubMed1989

Epidemiologic features of hepatitis B virus infection in northern Labrador.

We studied the epidemiologic features of hepatitis B virus (HBV) infection in northern Labrador to determine the prevalence of the infection and to obtain a database to develop a vaccination strategy. The study population included seven communities in which five ethnic groups were represented: Inuit, Innu, mixed Inuit and European ancestry ("settler"), nonnative/nonsettler transient population ("white") and people of Innu-white or Innu-Inuit origin ("mixed"). Blood samples from 2156 people (62% of the area residents) were tested for antibody to HBV core antigen (anti-HBc), HBV surface antigen (HBsAg), HBV e antigen (HBeAg), anti-HBc IgM and antibody to the surface antigen (anti-HBs). The overall crude prevalence rate of HBV seromarkers was 14.7% and the HBsAg carrier rate at least 3.2%; the rates were highest for Inuit (26.4% and 6.9% respectively), followed by settler (10.0% and 1.9% respectively) and Innu (7.6% and 0.4% respectively); the white and mixed groups had the lowest overall rates (2.5% and 3.3% respectively). Although the overall prevalence rates were about the same for the two sexes, the HBsAg carrier rate was higher in males (male:female ratio 1.6:1.0). No HBV carriers were positive for HBeAg or anti-HBc IgM antibody. The rate of exposure to HBV was 4% for those below the age of 20 years and reached a peak for those aged 45 to 54 years (85% for Inuit, 40% for settlers and 37% for Innu). There was also a wide variation in the age-standardized prevalence rates (0% to 27.9%) among the ethnic groups in the seven communities surveyed.

Adolescent↗
PubMed2006

Characteristics and prevalence of the metabolic syndrome among three ethnic groups in Canada.

OBJECTIVE: To compare the characteristics and prevalence of the metabolic syndrome (MetS) among Native Indians, Inuit, and non-Aboriginal Canadians. METHODS: The study was based on four cross-sectional studies conducted in the late 1980s and early 1990s involving three ethnic groups living in contiguous regions in central Canada: Oji-Cree Indians from several reserves in northern Ontario and Manitoba, Inuit from the Keewatin region of the Northwest Territories, and non-Aboriginal Canadians (predominantly of European heritage) in the province of Manitoba. The MetS was identified among adult subjects according to the National Cholesterol Education Program (NCEP) definition. Prevalence rates were standardized to the 1991 Canadian national population. RESULTS: The age-standardized prevalence of the MetS varied by ethnic group, ranging from as high as 45% among Native Indian women to as low as 8% among Inuit men. Compared with Canadians of European origin, Indians had a worse metabolic profile, while Inuit had a better metabolic profile except for a high rate of abdominal obesity. The NCEP criteria in identifying individuals with the MetS were compared to those of the World Health Organization (WHO) in a subset of subjects with the requisite laboratory data. There was moderate agreement between the NCEP and WHO definitions, with a kappa value of 0.63 (95% confidence interval 0.56-0.70). CONCLUSIONS: The results indicate that the MetS is prevalent in diverse ethnic groups in Canada but varies in the pattern of phenotypic expression. Given the diverse nature of these populations, careful consideration should be given to developing culturally appropriate community-based prevention strategies aimed at reducing the frequency of this syndrome.

Adult↗
PubMed1990

Smoking prevalence in the Canadian Arctic.

Two recent surveys of adults and of children in the Canadian Arctic obtained information on smoking behaviour. By age nineteen, 71% of Inuit youth were current smokers compared to 63% of Dene/Métis youth and 43% of the Non-Native. Within each ethnic group, the general pattern of higher smoking rates among girls in almost all age groups was apparent. Inuit girls age 15-19 had the highest smoking rates. Seventy seven percent reported that they were current cigarette smokers. Of all adolescent regular smokers, about 12% smoked more than 15 cigarettes per day. However, among Non-Native youth the percentage increased to 23%. Among both boys and girls, the frequency of smoking was highest among Non-Native youth, intermediate among Dene/Métis youth and lowest among the Inuit. In each ethnic group boys were more likely than girls to smoke over 15 cigarettes per day. Adult smoking rates in the Arctic were higher than rates in the national population. Inuit adults had the highest smoking rates, followed by the Dene and the Non-Native groups. Men and women in each of the ethnic groups in the Northwest Territories had higher smoking rates than their counterparts in the national population.

Adolescent↗
PubMed1986

Incidence of active tuberculosis in the native population of Canada.

We analysed the incidence rates of active tuberculosis reported between 1970 and 1981 in three groups of people born in Canada: Inuit, registered Indians and others (mainly of European origin). While the rates of tuberculosis were quite low in the last group, which constitutes about 82% of the population of Canada, they were 16 times higher among Indians and 24 times higher among Inuit. Some 20 to 30 years ago the Inuit had the highest recorded rate of tuberculosis in the world; with an intensive program the rate decreased sharply. Such a program has not been implemented among the Indian population, and the incidence rate has not decreased as rapidly. A major effort is required to satisfactorily control tuberculosis among Indians. In addition, we must not allow our efforts to slacken in the control of tuberculosis among the Inuit.

BCG Vaccine↗
PubMed1993

Cancer incidence by ethnic group in the Northwest Territories (NWT) 1969-1988.

Clear differences occurred in the cancer patterns among the population sub-groups in the NWT. When compared to those for the total Canadian population, rates for all cancers tended to be higher than expected among Inuit, lower than expected among Status Indians, and at expected levels for the Other NWT population. Among Inuit, traditional patterns still persist. Cancers of the lung, cervix, nasopharynx and salivary gland, and choriocarcinoma, occurred more often, and cancers of the breast, prostate, uterus and colon less often than in the total Canadian population. Among Status Indians, small numbers precluded definitive conclusions. However, several cancer sites occurred less often than expected, including colon, bladder and prostate among males, and uterus in females. While no cancer was significantly elevated in either males or females, SIRs for cervix and lung were above 1.0 for females, and kidney cancer was significantly higher when data for both sexes were combined (SIR = 2.0). For the Other NWT group--comprising about 50% of the population--most types of cancers occurred at about the expected rate, except that lung cancer was significantly elevated in females. Nevertheless, the generally high rates for lung and cervical cancer, which were particularly evident among the Inuit, are clearly targets for prevention programmes. It is hoped the cancer registry data now available for twenty years for the NWT, as well as for the overall Canadian Inuit population, can be used by researchers for studies to further determine the etiology of cancers, especially where distinctive patterns occur in these populations.

Breast Neoplasms↗
PubMed1993

Adult dental health in the Keewatin.

In 1990, as part of a major health status assessment, a dental survey was carried out on a 20 per cent random sample of the adult population in the Keewatin region of the Northwest Territories. A 73 per cent response rate was obtained. Of the 397 people examined, 334 (88 per cent) identified themselves as Inuit. More than 20 per cent of the respondents were edentulous, including 10 per cent of those 18 to 34 years old. The median DMFT was 24 for all respondents and 21 for dentulous respondents. There was a significant difference between Inuit and non-Inuit respondents, which was most marked in the 18 to 34 year old age group (mean DMFT 22.1 versus 15.6, p < .001). The proportion of filled to decayed and filled surfaces (F/DF) was 50 per cent. Periodontal disease was common and increased with age. More than 73 per cent of the dentate individuals had gingival bleeding at one or more sites. Very few were free of calculus. Mean pocket depth increased with age (1.3 mm at 18-34 years of age, rising to 2.3 at 55 plus, p < .001). Sixty per cent of adults needed at least one restorative procedure, 68 per cent needed prophylaxis, and 45 per cent needed periodontal treatment. Men required more treatment of all types than women. The results of this study confirm the clinical impression that dental disease is rampant among the Inuit population. There are major needs for both preventive and treatment services.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Heeding warnings ... from the canary, the whale, and the Jnuit, Part Two.

There is a tension between traditional and modern definitions of reproductive risk and normalcy. These experts describe that tension as it plays out among the Inuit of Northern Canada from the perspective of a community midwife who has worked with the Inuit. She presents an analytical framework which classifies and illuminates the types of logic that compete in most birth settings around the world--a framework useful for showing how some types of logic can be supervalued while others, such as cultural or intuitive logic, are devalued or simply ignored, often at great cost. Part One presented political, scientific, clinical and cultural logic, and the influence of time. We now go on to look at professionalization and training and describe legal, personal, intuitive and economic logic. The author describes how the Inuit settlement of Povungnituk (POV) attempts to re-integrate the authoritative knowledge of the community by allowing Inuit midwives at The Maternity to choose their own criteria for balancing the imperatives of each kind of logic in decision-making for birth.

Canada↗
PubMed1988

Comparative seroepidemiology of cytomegalovirus infection in the Canadian Arctic and an urban center.

We conducted a seroepidemiologic study of cytomegalovirus (CMV) infection among 9,928 Inuit (Eskimo), Dene (Indian) and non-native inhabitants of the Northwest Territories (NWT) of Canada between April 1983 and March 1985. 4,184 inhabitants of Edmonton, a large predominantly white urban center served as controls. Sera were screened for antibody to CMV by enzyme-linked immunosorbent assay (ELISA). The prevalence rates of CMV antibody increased with age in all ethnic groups. By the age of two years 69.2 percent of Dene, 63.5 percent of Inuit, 33.3 percent of non-native and 22.9 percent of Edmonton children had CMV antibody. Over the age of five years Inuit children had higher rates of CMV antibody than Dene children (P less than .05) reflecting differences in infant adoption, breastfeeding practices and patterns of child care in the two native groups. By the age of 15 to 19 years 81.1 percent of Dene and 88.5 percent of Inuit women had CMV antibody compared to 48.8 percent of non-native and 50.9 percent of Edmonton women (P less than .05). Native children had higher prevalence rates than non-native children living in the NWT (P less than .05). Compared to similarly aged Edmonton residents, non-native children in the NWT 2 to 4 years and 5 to 9 years of age had a higher prevalence of CMV antibody (P less than .05). We observed a higher prevalence rate of CMV antibody among non-native children (10-14 years) and young women (15-19 years) living in predominantly native communities compared to those living in predominantly non-native communities in the NWT (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Fish consumption and blood lipids in three ethnic groups of Québec (Canada).

The purpose of this study was to compare fish intake and plasma phospholipid concentrations of n-3 fatty acids, in particular of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), among representative population samples of Québecers, James Bay Cree, and Inuit of Nunavik (Canada). The relationships between these concentrations and cardiovascular disease (CVD) risk factors were also investigated and compared in the three populations. In 1990-1992, the study subjects had participated in the extensive Santé Québec health surveys conducted in southern Québec, James Bay, and Nunavik. Significant differences in levels of CVD risk factors were found among these three populations. Globally, Inuit showed the lowest risk status for CVD compared with Cree and Québecers, despite the high prevalence of cigarette smoking and obesity. Daily fish intakes varied significantly among the three groups, averaging 13, 60, and 131 g for Québecers, Cree, and Inuit, respectively. Concentrations of EPA + DHA in plasma phospholipids were highest among Inuit (8.0%), second-highest among Cree (3.9%), and lowest among Québecers (1.8%). When the three populations were grouped together, there was a positive association between concentrations of EPA + DHA stratified into quartiles and HDL cholesterol, with a significant relation in quartile 4 (EPA + DHA > or = 4.04%). An inverse relation was also found between EPA + DHA and triacylglycerols in quartile 4. Our results indicate that increased consumption of fish as a source of n-3 fatty acids is beneficially associated with levels of HDL cholesterol and triacylglycerols.

Adolescent↗
PubMed2004

Circumpolar maternal blood contaminant survey, 1994-1997 organochlorine compounds.

During the past 20 years a number of studies have found neurological and immunological effects in the developing fetus and infants exposed to background or only slightly elevated levels of persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs). To address concerns arising from possible increased human exposure in the Arctic and possible effects of POPs, all circumpolar countries agreed in 1994 to monitoring of specific human tissues for contaminants in the Arctic under the Arctic Monitoring and Assessment Program (AMAP). Mothers in eight circumpolar countries contributed blood samples that were analysed at a single laboratory for 14 PCB congeners (IUPAC No. 28, 52, 99, 105, 118, 128, 138, 153, 156, 170, 180, 183, 187) and 13 organochlorine pesticides (aldrin, beta-hexachlorocyclohexane (beta-HCH), dichlordiphenyltrichloroethane (p,p'-DDT), diphenyldichloroethylene (p,p'-DDE), dieldrin, heptachlorepoxide, hexachlorobenzene (HCB), mirex, and the chlordane derivatives alpha-chlordane, gamma-chlordane, cis-nonachlor, oxychlordane and trans-nonachlor). Inuit mothers from Greenland and Canada have significantly higher levels of oxychlordane, transnonachlor and mirex than mothers from Norway, Sweden, Iceland and Russia. Inuit mothers from Greenland also have significantly higher levels of these contaminants than Inuit mothers from Canada and Alaska. These differences among Inuit groups may represent regional dietary preferences or different contaminant deposition patterns across the Arctic. Levels of PCBs are also elevated among some arctic populations due to their consumption of marine mammals and are in the range where subtle effects on learning and the immune system have been reported. The Russian mothers who consume mainly food imported from southern Russia have elevated levels of DDT, DDE, beta-HCH and a higher proportion of lower chlorinated PCB congeners. This study has allowed an assessment of the variation of contaminants such as PCBs and various organochlorine pesticides (DDT, chlordane, etc.) in human populations around the circumpolar north.

Adult↗
PubMed1997

Factor VII polymorphisms in populations with different risks of cardiovascular disease.

Increased plasma factor VII coagulant activity (FVII:C) has been associated with the risk of ischemic heart disease (IHD). Differences in plasma FVII:C among individuals are associated with three common polymorphisms in the FVII gene. Therefore, we investigated FVII polymorphisms in four populations that differ in their risk of developing cardiovascular disease, namely, Europeans, Greenland Inuit, Gujarati Indians, and Afrocaribbeans. We studied (1) the promoter polymorphism, which is the result of a decanucleotide insertion in the FVII promoter at position -323 from the start of translation; (2) the hypervariable region 4 polymorphism (HVR4), which is the result of a variable number of tandem repeats in intron 7; and (3) the RQ353 polymorphism, a guanine-to-adenine substitution in the position of the codon for amino acid 353 resulting in an amino acid replacement of arginine (R) by glutamine (Q) in the FVII protein. The frequencies of these three polymorphisms and their linkage disequilibrium were different in the four populations studied. The frequencies of the alleles associated with higher plasma FVII:C were lower in the Europeans than in the Inuit, a population with a lower incidence of IHD. There was an association between both the promoter polymorphism and the RQ353 polymorphism and the plasma FVII:C in the Europeans, the Inuit, and the Gujarati Indians, and an association only between the RQ353 polymorphism and plasma FVII:C in the Afrocaribbeans. Only in the Inuit was the HVR4 polymorphism associated with plasma FVII:C. In multiple regression analysis, the additional information provided by the promoter polymorphism when the other polymorphisms were already included in the model was the most pronounced, suggesting that the promoter polymorphism may be the functional mutation having the greatest effect on determining plasma FVII:C.

Adult↗
PubMedDate not supplied

Prediction of cross-sectional geometry from metacarpal radiogrammetry: a validation study.

Regression models have been developed to adjust algebraic estimates of second metacarpal cortical bone geometry to actual values (as determined through invasive analysis). These models, derived from an archaeological sample of European origin, have high efficacy in predicting actual values but have not been validated on non-European samples. This paper reports a validation study for these models applied to a historic/proto-historic sample of Inuit from the central Canadian Arctic (n = 166; ages and sexes pooled as per the original study). In that the Inuit sample has been argued to exhibit distinct skeletal biology, this represents a robust test of the predictive models. The algebraic models again produced biased overestimates of actual values, whereas the predictive regression models were found to provide good estimates of actual values for measures of bone strength (Total Area, bending about the Ix and Iy axes), but not for estimates of mass (Cortical Area). This difference may exist in either functional or systemic differences in skeletal physiology and aging bone loss in the Inuit.

Humans↗
PubMedDate not supplied

Factor analysis of ethnic variation in the multiple metabolic (insulin resistance) syndrome in three Canadian populations.

This study describes and compares the pattern of risk factor clustering in multiple metabolic (insulin resistance) syndrome (MMS) in three Canadian ethnic groups (Indians, Inuit, non-Aboriginal Canadians). Three cross-sectional, population-based sample surveys in three contiguous regions of Canada were conducted during the late 1980s and early 1990s (Ontario, Manitoba, Northwest Territories). The combined dataset consists of 873 Cree-Ojibwa Indians from northern Ontario and Manitoba, 387 Inuit from the Northwest Territories, and 2,670 non-Aboriginal Canadians (predominantly of European origin) in the province of Manitoba. The samples are representative of the noninstitutionalized, adult population of their respective catchment areas. Factor analysis transformed 10 anthropometric and metabolic variables into three uncorrelated factors. Three factors, which together account for 64.3% of the variance, can be identified: an "obesity factor" (factor loadings for weight, height, waist and hip girth, and HDL-cholesterol); a "blood pressure factor" (factor loadings for mean systolic and diastolic BP and total cholesterol); and a "lipid/glucose factor" (factor loadings for triglycerides, total cholesterol, HDL, and fasting plasma glucose). Fasting insulin is available for only a subset of the data and separate analysis shows that it groups with glucose. Factor scores generated by the factor analysis differ according to ethnic group, diabetes status, and sex on multivariate analysis of variance. Indians have the highest scores for all three factors. Inuit have the lowest obesity scores and are not significantly different from non-Aboriginal people with regard to the other two factors. MMS is prevalent in diverse ethnic groups but varies in the pattern of phenotypic expression, with some components more prominent in some groups.

Adult↗