title: Liver biochemistry and associations with alcohol intake, hepatitis B virus infection and Inuit ethnicity: a population-based comparative epidemiological survey in Greenland and Denmark.
abstract: BACKGROUND
  Hepatitis B virus (HBV) infection is common in Arctic populations and high alcohol intake has been associated with an increased risk of a number of diseases. Yet, a description of the influence of alcohol intake in persons with HBV infection on liver biochemistry is lacking.
  
  
  OBJECTIVE
  We aimed to describe the association between reported alcohol intake and liver biochemistry taking into account also HBV infection, ethnicity, Inuit diet, body mass index (BMI), gender and age in an Arctic population.
  
  
  METHODS
  Population-based investigation of Inuit (n=441) and non-Inuit (94) in Greenland and Inuit living in Denmark (n=136). Participants filled in a questionnaire on alcohol intake and other life style factors. Blood samples were tested for aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), bilirubin, albumin, hepatitis B surface antigen, hepatitis B surface antibody and hepatitis B core antibody. We also performed physical examinations.
  
  
  RESULTS
  Participation rate was 95% in Greenland and 52% in Denmark. An alcohol intake above the recommended level was reported by 12.9% of non-Inuit in Greenland, 9.1% of Inuit in East Greenland, 6.1% of Inuit migrants and 3.4% of Inuit in the capital of Greenland (p=0.035). Alcohol intake was associated with AST (p<0.001) and GGT (p=0.001), and HBV infection was associated with ALP (p=0.001) but not with AST, GGT, bilirubin or albumin in the adjusted analysis. Inuit had higher AST (p<0.001), GGT (p<0.001) and ALP (p=0.001) values than non-Inuit after adjustment for alcohol, diet, BMI and HBV exposure. Ethnic origin modified the association between alcohol and AST, while HBV infection did not modify the associations between alcohol and liver biochemistry.
  
  
  CONCLUSIONS
  Non-Inuit in Greenland reported a higher alcohol intake than Inuit. Ethnic origin was more markedly associated with liver biochemistry than was alcohol intake, and Greenlandic ethnicity modified the effect of alcohol intake on AST. HBV infection was slightly associated with ALP but not with other liver biochemistry parameters.
authors.affiliation: Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland.|Arctic Health Research Centre, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; karsten_rex@hotmail.com.
authors.forename: Karsten Fleischer
authors.initials: KF
authors.lastname: Rex
authors.affiliation: Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Henrik Bygum
authors.initials: HB
authors.lastname: Krarup
authors.affiliation: Arctic Health Research Centre, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.|Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Laurberg
authors.affiliation: Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland.|Arctic Health Research Centre, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.|Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Stig
authors.initials: S
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001671:Biochemistry; D003718:Denmark / Q000453:epidemiology; D004032:Diet; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006116:Greenland / Q000453:epidemiology; D006306:Health Surveys; D006509:Hepatitis B / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology*; D006801:Humans; D004930:Inuit / Q000706:statistics & numerical data*; D008019:Life Style; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase
keywords: Denmark Arctic Greenland; alcohol intake; ethnicity Greenland Inuit; hepatitis B virus infection; liver biochemistry; migration