{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T23:39:44Z","timestamp":1782862784938,"version":"3.54.5"},"reference-count":50,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T00:00:00Z","timestamp":1632960000000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["17OC0028136"],"award-info":[{"award-number":["17OC0028136"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["17SH0027192"],"award-info":[{"award-number":["17SH0027192"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"},{"name":"Steno Diabetes Center Aarhus, Aarhus, Denmark"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2021,9,4]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Diabetes is increasing among Greenlandic Inuit; however, the prevalence of cardiovascular autonomic neuropathy (CAN) is yet unknown. The assessment of CAN requires an ability to differentiate between normal and abnormal. The aim was to establish normative reference data of cardiovascular autonomic function in Greenlandic Inuit.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>In this cross-sectional study, cardiovascular autonomic function was evaluated in participants without diabetes during the <jats:italic>Greenlandic Population Study 2018<\/jats:italic> and in the town Qasigiannguit in 2020. Assessment included cardiovascular autonomic reflex tests (CARTs) and power spectral analysis of heart rate variability (HRV). Normative reference limits were estimated by applying quantile regression models at the lowest fifth percentile, with age as the exposure variable and adjusted for sex. HRV models were additionally adjusted for resting heart rate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Based on examinations of 383 participants (60.6% females), normative reference data was established for all outcomes. Mean age was 52 years (SD 12.9). Higher age was inversely associated with all outcomes of CARTs and HRV. A linear fall in cardiovascular autonomic function tended to level off beyond age of 60 years for supine-to-upright position ratio. However, the number of observations in subjects older than 60 years was limited, which may have caused a flattening of the curve around that age. No other associations were found.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The general level of the CARTs and HRV for all age groups is notably lower than in previous studies from other nationalities. We speculate that sociodemographic and cultural aspects of the Greenlandic Inuit population including body mass index, smoking, physical activity and alcohol consumption may have affected the cardiovascular autonomic function.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2021-002121","type":"journal-article","created":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T01:25:03Z","timestamp":1633051503000},"page":"e002121","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Normative data on cardiovascular autonomic function in Greenlandic Inuit"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7055-6835","authenticated-orcid":false,"given":"Marie Mathilde Bjerg","family":"Christensen","sequence":"first","affiliation":[{"name":"Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark"},{"name":"Department of Public Health, Aarhus Universitet, Aarhus, Midtjylland, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5782-3476","authenticated-orcid":false,"given":"Christian Stevns","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Complication Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper","family":"Fleischer","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Aarhus, Aarhus, Denmark"},{"name":"Steno Diabetes Center Zealand, Holb\u00e6k, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorte","family":"Vistisen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stine","family":"Byberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5070-4231","authenticated-orcid":false,"given":"Trine","family":"Larsen","sequence":"additional","affiliation":[{"name":"Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Ilulissat, Greenland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5036-8159","authenticated-orcid":false,"given":"Jens Christian","family":"Laursen","sequence":"additional","affiliation":[{"name":"Department of Complication Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark"},{"name":"University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8356-5565","authenticated-orcid":false,"given":"Marit Eika","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark"},{"name":"Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,30]]},"reference":[{"key":"2025073111523164000_9.1.e002121.1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2012.21"},{"key":"2025073111523164000_9.1.e002121.2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2005-0754"},{"key":"2025073111523164000_9.1.e002121.3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4093\/dmj.2018.0259","article-title":"Update on the impact, diagnosis and management of cardiovascular autonomic neuropathy in diabetes: what is defined, what is new, and what is unmet","volume":"43","author":"Spallone","year":"2019","journal-title":"Diabetes Metab J"},{"key":"2025073111523164000_9.1.e002121.4","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.5.1553"},{"key":"2025073111523164000_9.1.e002121.5","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.6.1895"},{"key":"2025073111523164000_9.1.e002121.6","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-2042"},{"key":"2025073111523164000_9.1.e002121.7","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1411"},{"key":"2025073111523164000_9.1.e002121.8","doi-asserted-by":"publisher","DOI":"10.1177\/1932296814528616"},{"key":"2025073111523164000_9.1.e002121.9","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.294914"},{"key":"2025073111523164000_9.1.e002121.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706245"},{"key":"2025073111523164000_9.1.e002121.11","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.1239"},{"key":"2025073111523164000_9.1.e002121.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2011.03527.x"},{"key":"2025073111523164000_9.1.e002121.13","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.10.1766"},{"key":"2025073111523164000_9.1.e002121.14","unstructured":"Larsen CVL , Hansen CB , Ingemann C . Befolkningsunders\u00f8gelsen I gr\u00f8nland 2018. levevilk\u00e5r, livsstil og helbred: oversigt over indikatorer for folkesundhed. Copenhagen: Syddansk Universitet. Statens Institut for Folkesundhed, 2019. https:\/\/www.sdu.dk\/da\/sif\/rapporter\/2019\/befolkningsundersoegelsen_i_groenland"},{"key":"2025073111523164000_9.1.e002121.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2010.07.005"},{"key":"2025073111523164000_9.1.e002121.16","doi-asserted-by":"publisher","DOI":"10.1007\/BF02291400"},{"key":"2025073111523164000_9.1.e002121.17","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199712)20:12<1561::AID-MUS11>3.0.CO;2-3"},{"key":"2025073111523164000_9.1.e002121.18","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s10286-015-0310-1","article-title":"Cardiovascular responses to various autonomic tests in males and females","volume":"25","author":"Ndayisaba","year":"2015","journal-title":"Clincal Autonomic Research"},{"key":"2025073111523164000_9.1.e002121.19","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.55.4.348"},{"key":"2025073111523164000_9.1.e002121.20","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(86)90074-2"},{"key":"2025073111523164000_9.1.e002121.21","first-page":"151","article-title":"I test che valutano La risposta riflessa cardiovascolare","volume":"2","author":"Cardone","year":"1990","journal-title":"Neuropatia Diabetica: rassegnabibliografica"},{"key":"2025073111523164000_9.1.e002121.22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.1992.tb01754.x"},{"key":"2025073111523164000_9.1.e002121.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2003.09.065"},{"key":"2025073111523164000_9.1.e002121.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.03.056"},{"key":"2025073111523164000_9.1.e002121.25","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.115.002365","article-title":"Are changes in heart rate variability in middle-aged and older people normative or caused by pathological conditions? findings from a large population-based longitudinal cohort study","volume":"5","author":"Jandackova","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"2025073111523164000_9.1.e002121.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(97)00554-8"},{"key":"2025073111523164000_9.1.e002121.27","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000000133"},{"key":"2025073111523164000_9.1.e002121.28","unstructured":"Greenland S . Population in localities January 1st 1977-2020, 2020. Available: https:\/\/bank.stat.gl\/pxweb\/en\/Greenland\/Greenland__BE__BE01__BE0120\/BEXST4.PX\/?rxid=a1551b20-d1d5-4bcf-a80c-de114c001595 [Accessed 03 Nov 2020]."},{"key":"2025073111523164000_9.1.e002121.29","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a014868"},{"key":"2025073111523164000_9.1.e002121.30","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-012-2744-5"},{"key":"2025073111523164000_9.1.e002121.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2005.01.003"},{"key":"2025073111523164000_9.1.e002121.32","unstructured":"World Health Organization . Classification of diabetes mellitus. 13, 2019. https:\/\/www.who.int\/publications\/i\/item\/classification-of-diabetes-mellitus"},{"key":"2025073111523164000_9.1.e002121.33","unstructured":"World Health Organization . Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. 3, 2006."},{"key":"2025073111523164000_9.1.e002121.34","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1249\/MSS.0b013e31827a6b40","article-title":"Validity of the International physical activity questionnaire in the Arctic","volume":"45","author":"Dahl-Petersen","year":"2013","journal-title":"Med Sci Sports Exerc"},{"key":"2025073111523164000_9.1.e002121.35","unstructured":"The IPAQ group: guidelines for data processing and analysis of IPAQ\u2014short and long forms, 2005. Available: https:\/\/docs.google.com\/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnx0aGVpcGFxfGd4OjE0NDgxMDk3NDU1YWRlZTM [Accessed 29 May 2021]."},{"key":"2025073111523164000_9.1.e002121.36","doi-asserted-by":"crossref","DOI":"10.3402\/ijch.v72i0.20314","article-title":"Validation of survey information on smoking and alcohol consumption against import statistics, Greenland 1993-2010","volume":"72","author":"Bjerregaard","year":"2013","journal-title":"Int J Circumpolar Health"},{"key":"2025073111523164000_9.1.e002121.37","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1993.tb02093.x"},{"key":"2025073111523164000_9.1.e002121.38","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1002\/mus.21489","article-title":"Developing reference data for nerve conduction studies: an application of quantile regression","volume":"40","author":"Peng","year":"2009","journal-title":"Muscle Nerve"},{"key":"2025073111523164000_9.1.e002121.39","doi-asserted-by":"crossref","unstructured":"Koenker R . Quantile regression. Cambridge University Press, 2005.","DOI":"10.1017\/CBO9780511754098"},{"key":"2025073111523164000_9.1.e002121.40","doi-asserted-by":"publisher","DOI":"10.2307\/1913643"},{"key":"2025073111523164000_9.1.e002121.41","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J Royal Statistical Society: Series B"},{"key":"2025073111523164000_9.1.e002121.42","doi-asserted-by":"publisher","DOI":"10.1161\/01.Hyp.0000100444.71069.73"},{"key":"2025073111523164000_9.1.e002121.43","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1093\/oxfordjournals.eurheartj.a060650","article-title":"Spectral components of short-term RR interval variability in healthy subjects and effects of risk factors","volume":"15","author":"M\u00f8lgaard","year":"1994","journal-title":"Eur Heart J"},{"key":"2025073111523164000_9.1.e002121.44","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-009-9317-z"},{"key":"2025073111523164000_9.1.e002121.45","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2010.02841.x"},{"key":"2025073111523164000_9.1.e002121.46","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3402\/ijch.v70i1.17800","article-title":"Influence of n-3 fatty acids on cardiac autonomic activity among Nunavik Inuit adults","volume":"70","author":"Valera","year":"2011","journal-title":"Int J Circumpolar Health"},{"key":"2025073111523164000_9.1.e002121.47","doi-asserted-by":"publisher","DOI":"10.1186\/1476-069X-7-29"},{"key":"2025073111523164000_9.1.e002121.48","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-015-3534-7"},{"key":"2025073111523164000_9.1.e002121.49","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s10286-019-00618-8","article-title":"Alcohol-Induced autonomic dysfunction: a systematic review","volume":"30","author":"Julian","year":"2020","journal-title":"Clin Auton Res"},{"key":"2025073111523164000_9.1.e002121.50","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2008.07.006"}],"updated-by":[{"DOI":"10.1136\/bmjdrc-2021-002121corr1","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000}}],"container-title":["BMJ Open Diabetes Research &amp; Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjdrc-2021-002121","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T18:52:41Z","timestamp":1753987961000},"score":1,"resource":{"primary":{"URL":"https:\/\/drc.bmj.com\/lookup\/doi\/10.1136\/bmjdrc-2021-002121"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,9,30]]},"published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1136\/bmjdrc-2021-002121"],"URL":"https:\/\/doi.org\/10.1136\/bmjdrc-2021-002121","relation":{"correction":[{"id-type":"doi","id":"10.1136\/bmjdrc-2021-002121corr1","asserted-by":"object"}]},"ISSN":["2052-4897"],"issn-type":[{"value":"2052-4897","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9]]}}}