the first point the paper somewhat covered
your second point the paper has covered
Living conditions are considerably different in Greenland and Denmark. However, differences in physical activity, smoking habits, and alcohol consumption could not explain the findings in our study. There may be other important environmental factors that influence the pattern of obesity. Owing to the differences in the questionnaires used, we were unable to analyse the impact of diet and socioeconomic status on obesity and metabolic risk factors in the two popu-lations. Especially the traditional Greenlandic diet, which is rich in omega-3 polyunsaturated fatty acids, is suggested to contribute to the favourable cardiovascular risk profile.7
An alternative explanation is that anthropometrical measurements such as BMI, WHR, and waist circumference do not reflect the same amount of fat or the same pattern of fat distribution in different populations. It is well established that there are differences in the relationship between body fat and BMI in different populations.20,21,22 These differences may be due to differences in body composition, as well as differences in energy intake and physical activity. Indeed, excess abdominal fat is more important as a cardiovascular risk factor than excess body fat per se.23,24 There is not much information about the relationship between intra-abdominal adipose tissue and anthropometrical measurements, such as waist circumference and WHR, in different populations. Epidemiological studies have mainly used the WHR to estimate the proportion of abdominal adipose tissue.25 However, magnetic resonance imaging and computed tomography showed that a simple measurement such as waist circumference is the best anthropometric correlate of the amount of visceral adipose tissue.26 This has led to the inclusion of waist circumference as the only obesity criteria in a newly suggested definition of the metabolic syndrome.27
The WHO has defined critical waist circumference values of 102 cm for men and 88 cm for women.25 However, the WHO waist approach has been developed in white men and women,23 and its impact on metabolic factors should not uncritically be extrapolated to other ethnic groups. In a previous study of the same population, we defined the cutpoints for large waist circumferences as the 90% percentile for slim persons, that is, persons with a BMI below 23 kg/m2. The cutpoints for high waist circumference were >86 cm (men) and >80 cm (women).8 However, for the present interethnic comparison, we chose the WHO guidelines.