Association of food insecurity with dietary patterns and expenditure on food, alcohol and tobacco amongst indigenous Inuit in Greenland: results from a population health survey

Abstract

Background Amongst the indigenous Greenlandic Inuit, the experience of food insecurity has been attributed to a lack of money to buy enough food of sufficient quality to sustain a family, although a preference for alcohol and tobacco over food has also been cited. The purpose of the article was to compare dietary patterns and expenditure on food, alcoholic beverages and tobacco between survey participants who reported food insecurity and those who did not. Methods A countrywide cross-sectional health survey was carried out among 1886 adult Greenlandic Inuit in 2018. Diet was estimated by a food frequency questionnaire. Food insecurity status was based on the household hunger scale. Analyses were carried out by univariate general linear models adjusted for age, sex and social position. Results Nine percent of the participants reported food insecurity. Food insecurity was higher among younger participants, men and participants with low social position. Food insecure participants more often chose an unhealthy dietary pattern (43% vs. 32%) and they reported a higher energy intake. The food insecure spent the same amount of money on food as other participants but less on nutritious food and more on non-nutritious food. The cost per kilojoule (kJ) of the food of the food insecure was lower than that of the food secure (DKK 8.0 and 9.0 per 1000 kJ, respectively). The food insecure participants also spent considerably more on alcohol and tobacco. Conclusions The results suggest that it is not only unemployment and lack of money that creates food insecurity and unhealthy dietary patterns in Greenland. Food insecure participants gave higher priority to buying non-nutritious food, alcohol and tobacco than did food secure participants. There seems to be at least two population subgroups in Greenland with poverty and substance use, respectively, as the immediate determinants for food insecurity. The results are important for the design of interventions against food insecurity and unhealthy dietary patterns.

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“…Food insecurity is associated with higher consumption of carbohydrates, prioritization of fast food for lack of time, and higher body mass index 16,17 . In addition, there is evidence suggesting that food insecurity is associated with increased alcohol consumption and binge drinking, as well as smoking across the life span 18,19 . Compared with food-secure persons, food-insecure individuals may also be associated with reduced intake a critical micronutrients such as vitamins A, B-6, and E; niacin; riboflavin; calcium; magnesium; and zinc 20,21 .…”

“…16,17 In addition, there is evidence suggesting that food insecurity is associated with increased alcohol consumption and binge drinking, as well as smoking across the life span. 18,19 Compared with food-secure persons, foodinsecure individuals may also be associated with reduced intake a critical micronutrients such as vitamins A, B-6, and E; niacin; riboflavin; calcium; magnesium; and zinc. 20,21 Second, food insecurity has also been associated with gut dysbiosis favoring the predominance of proinflammatory bacterial species, 22,23 and fibrotic liver disease, in turn, is associated with dysbiosis.…”

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“…A study conducted in Canada, 2021 revealed that Food insecure individuals prioritized purchasing non-nutritious foods, alcohol, and tobacco over food secure participants. 18…”

Reproducibility and validity of a 45 item food-frequency questionnaire for inuit in Greenland

“…This FFQ was considered to be too lengthy for a general health survey and was subsequently reduced to an FFQ with 45 food items with portion sizes but not seasonal variation [ 4 ]. [ 5 ] This is now considered the standard FFQ in Greenland. An earlier version of the FFQ was validated by 24- and 48-h dietary interviews on traditional food and by blood mercury analyses with good agreement between the methods [ 6 ].…”