MODERNIZATION AND THE DIET OF ADULTS ON RAROTONGA, THE COOK ISLANDS

The significance of DOHaD for Small Island Developing States

Small Island Developing States (SIDS) are island nations that experience specific social, economic and environmental vulnerabilities associated with small populations, isolation and limited resources. Globally, SIDS exhibit exceptionally high rates of non-communicable disease (NCD) risk and incidence. Despite this, there is a lack of context-specific research within SIDS focused on life course approaches to NCD prevention, particularly the impact of the early-life environment on later disease risk as defined by the Developmental Origins of Health and Disease (DOHaD) framework. Given that globalization has contributed to significant nutritional transitions in these populations, the DOHaD paradigm is highly relevant. SIDS in the Pacific region have the highest rates of NCD risk and incidence globally. Transitions from traditional foods grown locally to reliance on importation of Western-style processed foods high in fat and sugar are common. The Cook Islands is one Pacific SIDS that reports this transition, alongside rising overweight/obesity rates, currently 91%/72%, in the adult population. However, research on early-life NCD prevention within this context, as in many low- and middle-income countries, is scarce. Although traditional research emphasizes the need for large sample sizes, this is rarely possible in the smaller SIDS. In these vulnerable, high priority countries, consideration should be given to utilizing 'small' sample sizes that encompass a high proportion of the total population. This may enable contextually relevant research, crucial to inform NCD prevention strategies that can contribute to improving health and well-being for these at-risk communities.

Long-term trends in food availability, food prices, and obesity in Samoa

OBJECTIVES

To describe long-term food availability and prices from 1961 to 2007 and body mass index (BMI) trends from 1980 to 2010 in Samoa, and to contextualize these trends within political, economic, cultural, behavioral, and climatic influences.

METHODS

National level data on food availability and pricing were obtained from the open access database FAO (http://faostat.fao.org). Data for Samoa were collected from annual food balance sheets available for the period 1961-2007. Mean BMI for Samoan men and women aged 35-44 years of age is reported from four different time periods, 1979-1982, 1991, 2003, and 2010.

RESULTS

Total energy availability increased substantially, by 47%, with more than 900 extra calories available per capita per day in 2007 than in 1961. Many of these extra calories are supplied by dietary fat, the availability of which rose by a proportionally greater amount, 73%. Availability of both meat and vegetable oils rose substantially. Poultry meat increased the most proportionally, from 10 to 117 kcal per capita per day. Coconut products, fruits, and starchy root crops-all locally grown-showed little to no increase over this time. As import prices for poultry and mutton increased their availability decreased, but the availability of vegetable oils rose despite a rise in their price. Mean BMI for men and women aged 35-44 years rose 18% rise from 1980 to 2010.

CONCLUSIONS

These long-term trends in food availability and prices, and the temporal pattern of BMI provide national level data for understanding the process of the nutritional transition in Samoa. Further work on consumer food prices, diet, food security, and health is needed to further contextualize the transformation of the local food system in Samoa.

Dietary Westernisation: conceptualisation and measurement in Mauritius

Objectives

The aims of the study were to provide information that will contribute to conceptualising what is called ‘dietary Westernisation’, and to provide an example of measuring it on an individual level.

Design

Food consumption frequency and demographic data on adults in Mauritius were examined in 1988, 1992 and 1998. In 1992, a 24-hour recall was also included. The cross-sectional samples consisted of 1115 (age 25–74 years) Mauritians in 1987/88, 1917 (age 30–74 years) in 1992 and 2239 (age 20–74 years) in 1998. Principal components analysis was carried out on daily consumption frequencies of 10 indicator foods (white rice, white bakery bread, pulses, processed meat, poultry, fresh/frozen fish, butter, margarine, whole milk and skimmed/low-fat milk). Correlations between dietary patterns and selected food consumption frequencies were examined in each survey year.

Results

Four dietary patterns were identified as being related to dietary Westernisation. The Traditional dietary pattern was characterised by higher consumption frequencies of Indian breads, salted/smoked fish and sugar-sweetened tea. The Western dietary pattern was characterised by higher consumption frequencies of cakes/pastries, meat and many Western fast foods like burgers, but, surprisingly, also by brown bread, breakfast cereals and salad. The Bread/butter dietary pattern predominantly described more frequent consumption of bread compared with rice. The Margarine/milk dietary pattern was inconsistently related with staple foods. Younger, educated and wealthier Mauritians appeared to adopt Western dietary patterns earlier.

Conclusions

This study suggests that relatively few indicator foods are needed for measuring dietary Westernisation. Dietary Westernisation in a non-Western country may also include shifts towards voluntary consumption of healthier foods.

Trends in body size, diet and food availability in the Cook Islands in the second half of the 20th century

The body size of adult Cook Islanders on Rarotonga for the years 1952, 1966 and 1996 has been increasing. The rate of increase in stature of women aged 20-39 years was 0.5cm per decade across the period 1952-1966, and 0.8cm per decade for the period 1966-1996. The rate of increase of weight in the 20-29 years age group was 0.6kg per decade in period 1, and 7.3kg per decade in period 2. In the age group 30-39 years, the rates were 3.2kg per decade and 5.1kg per decade respectively. Changing food availability for the period 1961-2000 is used to compare estimates of dietary energy availability with estimates of physiological energy requirements. There has been reduced availability of traditional staples, a likely reduction in consumption of fish, increased consumption of meat, and a decline in the availability of dietary fats and oils. Daily per capita energy intakes in 1952 and 1966 greatly exceed an hypothetical physiological maximum value for energy expenditure, suggesting a large positive energy balance in 1952 and an even greater one in 1966, both predisposing to weight gain. Although daily per capita energy availability in 1996 is similar to the hypothetical physiological maximum value for energy expenditure, it exceeds the measured level of energy expenditure at that time. It is speculated that excessive energy intake relative to requirement is more likely to predispose to positive energy balance and weight gain than decline in energy expenditure, although to a lower extent than in 1966 and 1952.