Adolescent dietary patterns in Fiji and their relationships with standardized body mass index

Intake of foods high in saturated fats, vegetarian dietary pattern, and sociodemographic characteristics associated with body weight in Peruvian university students

Background

The prevalence of obesity continues to increase among university students and the general population. Consumption of a diet high in saturated fats could be one of the risk factors.

Objective

The consumption of foods high in saturated fats, the vegetarian diet pattern, and sociodemographic characteristics associated with excess body weight (overweight/obesity) were evaluated in Peruvian university students.

Methods

A cross-sectional study was carried out selecting 5,608 Peruvian university students through no probabilistic convenience sampling. The survey was carried out during the months of February and April 2022. The Chi-square test and binary logistic regression analysis were used to evaluate the association between diet (saturated fats intake and dietary pattern) and sociodemographic factors with excess body weight in a cross-sectional analysis.

Results

It was observed that students who reported high consumption of foods high in saturated fats (ORB = 1.14) and those who had a non-vegetarian dietary pattern (ORB = 2.76) were found to be more likely to have excess body weight. On the contrary, students who reported adherence to the vegetarian diet pattern for more than 5 years were less likely to be overweight or obese (ORB = 0.84). Being ≥26 years of age (ORB = 3.28), living in urban areas (ORB = 1.68) and coastal areas of the country (ORB = 1.17), and enrolled in the engineering faculty (ORB = 1.19), were significantly associated with excess body weight.

Conclusion

The findings of the current study evidenced several factors associated with excess body weight in university students. Therefore, it is necessary to promote and implement healthy lifestyle programs, considering sociodemographic and dietary aspects such as age and dietary intake to control and prevent obesity in university students.

Analysis of adherence to a healthy lifestyle among vegetarian and non-vegetarian Peruvian university students: A cross-sectional survey

BACKGROUND

Evidence shows that a healthy lifestyle can promote physical and mental well-being in the general population. However, there are few studies that assess the adherence to a healthy lifestyle in vegetarian and non-vegetarian university students. The purpose of this study was to evaluate the differences in adherence to a healthy lifestyle between vegetarian and non-vegetarian university students in Peru.

METHODS

A cross-sectional study was carried out considering data from 6,846 students selected by non-probabilistic convenience sampling. The Diet and Healthy Lifestyle Scale (DEVS), the Peruvian validation of the Vegetarian Lifestyle Index (VLI), was used. In addition, sociodemographic and anthropometric data such as weight and height were collected. Body mass index (BMI) was also calculated.

RESULTS

Semi-vegetarian and vegetarian students had a high healthy lifestyle score compared to non-vegetarians. In addition, vegetarian diets showed a significantly higher proportion among students with a lower BMI (normal and underweight). Students with excess body weight (overweight and obesity) were less likely to report healthy lifestyle. In the overall population analyzed, it was observed that the levels of health and lifestyle behaviors, such as daily exercise and sunlight exposure, were mostly moderate and low. Additionally, sweets intake was high, while healthy food consumption such as fruits, vegetables, legumes, and whole grains was low.

CONCLUSION

The current findings show that although vegetarians had better adherence to a healthy lifestyle, interventions in the university setting are needed to improve healthy lifestyle in university students.

Prevalence, causes and contexts of childhood overweight and obesity in the Pacific region: a scoping review

Background

Non-communicable diseases (NCDs) are a major threat to health and development and account for 75% of deaths in the Pacific Islands Countries and Territories (PICTs). Childhood obesity has been identified as a main risk factor for NCDs later in life. This review compiled overweight and obesity (OWOB) prevalence (anthropometric data) for children aged six to 12 years old living in the Pacific region and identified possible related causes.

Methods

We conducted a systematic search using PubMed, Google Scholar and ScienceDirect for articles published between January 1980 and August 2022. We also searched for technical reports from Ministries of Health. Guided by the eligibility criteria, two authors independently read the selected articles and reports to extract and summarise relevant information related to overweight and obesity.

Results

We selected 25 articles, two worldwide analyses of population-based studies and four national reports. Information revealed that childhood OWOB prevalence reached 55% in some PICTs. This review also indicated that age, gender and ethnicity were linked to children's weight status, while dietary practices, sleep time and level of physical activity played a role in OWOB development, as well as the living environment (socio-economic status and food availability), parenting practices and education level.

Conclusion

This review highlighted that anthropometric data are limited and that comparisons are difficult due to the paucity of surveys and non-standardized methodology. Main causes of overweight and obesity are attributed to individual characteristics of children and behavioural patterns, children's socio-economic environment, parenting practices and educational level. Reinforcement of surveillance with standardised tools and metrics adapted to the Pacific region is crucial and further research is warranted to better understand root causes of childhood OWOB in the Pacific islands. More robust and standardized anthropometric data would enable improvements in national strategies, multisectoral responses and innovative interventions to prevent and control NCDs.

Perceptions on Healthy Eating Impact the Home Food Environment: A Qualitative Exploration of Perceptions of Indigenous Food Gatekeepers in Urban Fiji

The home food environment (HFE) can have important direct and indirect impacts on dietary practices. Nutrient transitions in the HFE of Pacific Island countries (PICs) are key contributors of the high rates of adult and childhood overweight and obesity in the region. Pacifica mothers are important sociocultural agents who play critical roles in their HFE through setting eating-appropriateness standards and mitigating the impacts of food availability and accessibility on the HFE. This study used an interpretative phenomenological approach to explore how urban indigenous Fijian mothers perceive healthy eating and how these perceptions impacted the food decisions they made for their families. Mothers in this study held complex, multifaceted perceptions on healthy eating and these perceptions had both positive and negative impacts on the family food choices they made, the strategies they adopted for healthy eating and their perceived motivators for healthy eating. The findings of this study underscore the need for a deeper understanding and analysis of uptake of public health messaging related to healthy and unhealthy eating and the importance of targeted promotion of healthful nutrition in this community. Promoting consumption of traditional and locally grown foods can enhance nutrition and food security and combat nutrition transition in the region.

Assessing rural household's food groups-and-sources and dietary diversity pattern in Malaita Province

Access to and availability of various food sources is not an issue in rural communities. However, there is no guarantee that households are not affected by nutritional inadequacy, which is still a problem in most underdeveloped nations. A mixed-methods study was conducted to determine the HDDS through the snowballing method for the last 12 months' food groups-and-sources and the 48-h diet recall. Ninety-eight households in two rural communities surrounding Sikwafta (zone one) and Malu'u (zone two) participated in the interview between April and May 2019. The results were then analyzed through SPSS and QDA MINER. The aim is to analyze the household dietary patterns of the communities between the two zones. The study also hypothesizes that the dietary pattern of households has not changed. Results showed that a total of nine food groups were consumed: grain, white roots, tubers, plantains, oils/fats (95.90%), condiments (83.70%), and meat/poultry/sea foods (77.60%). The majority of the food consumed comes from the gardens, followed by other food sources, which make up the average HDDS of five. A correlation analysis found a statistically significant relationship between HDDS and total meal (0.504*), with no relationships between demographics. When comparing 48-h food sources-and-groups to the previous year, there was little to no difference in accessibility and availability. This implies that the majority of households are likely to achieve their nutritional needs within the parameters of their dietary trend. Even though households have adequate access to food, there is a significant need to improve their nutritional needs, even if they consume the average amount of the required food groups.

Rapid review of factors influencing dietary behaviors in Fiji

Introduction

In Fiji, multiple burdens of malnutrition including undernutrition, overweight/obesity, and micronutrient deficiencies coexist at the individual, household, and population levels. The diets of children, adolescents, and adults are generally unhealthy. The objective of this review was to understand how the dietary behaviors of children, adolescents, and women in Fiji are influenced by individual, social, and food environment factors.

Methods

This rapid review was conducted to synthesize existing evidence, identify research gaps in the evidence base, and make recommendations for future research. The Cochrane Rapid Reviews Methods and the updated guideline for reporting systematic reviews were used. The search strategy for this rapid review was based on the Population Context Outcome [P(E)CO] framework, including search terms for population (children, adolescents, and adults), context (Fiji), and outcome (dietary behaviors). Searches were conducted in PubMed, Scopus, PsycINFO, and Google Scholar.

Results

The 22 studies included in this review identified different factors influencing dietary behaviors in Fiji. Individual preferences for processed and imported foods, especially of younger generations, and social dynamics, especially gender norms and social pressure, to serve meat and overeat appeared to be prominent in driving dietary habits. The ongoing nutrition transition has led to increasing availability and affordability of ultra-processed and fast foods, especially in urban areas. Concerns about food safety and contamination and climate change and its effect on local food production also appear to influence dietary choices.

Discussion

This review identified different dynamics influencing dietary behaviors, but also research gaps especially with regard to the food environment, calling for an integrated approach to address these factors more systemically.

Understanding Sociocultural Influences on Physical Activity in Relation to Overweight and Obesity in a Rural Indigenous Community of Fiji Islands

INTRODUCTION

Given health disparities and increased rates of obesity and non-communicable diseases seen in Indigenous populations worldwide and the evidence connecting sociocultural knowledge with physical activity, health, and wellbeing, this research was undertaken to understand the social and cultural components contributing to obesity in the Indigenous Fijian rural areas.

METHODS

This research is a community-based participatory research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data was analysed using descriptive thematic analysis.

RESULTS

Four major themes emerged associated with sociocultural, economic, political, and physical environmental factors. Males emphasised sports and working on farmlands as preferred types of physical activity, while females focused on family activities and daily activities and support for females' separate playgrounds. There was a focus on previous health promotion programs that did not incorporate the cultural values, cultural competence beliefs, and traditional ways of the rural Indigenous Fijian community.

CONCLUSION

The healthcare providers and policymakers need to recognise the iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. These findings should inform future research and community-based health programs to address the physical activity levels of the rural Indigenous community and may be relevant to other Indigenous peoples.

Mudanças na frequência do consumo de refeições em adolescentes residentes em área de vulnerabilidade social da região metropolitana do Rio de Janeiro, Brasil

Resumo O objetivo deste estudo foi descrever as mudanças na frequência do consumo de refeições de adolescentes residentes na região metropolitana do Rio de Janeiro, em período de 5 anos. Utilizaram-se dados de dois estudos transversais, de base populacional, que foram realizados por meio de visitas domiciliares. Em 2005, a amostra final foi de 1089 domicílios com 511 adolescentes (de 12 a 18 anos), e em 2010 de 1121 domicílios com 314 adolescentes. A frequência do consumo de refeições foi obtida por meio de questionário autopreenchido e a avaliação da adequação de peso dos adolescentes foi realizada com base nos pontos de corte do IMC por sexo e faixa etária. Houve aumento da substituição diária do almoço tradicional por lanche (3,7% para 13,7%) e no consumo do jantar tradicional (62,9% para 72,0%). Os adolescentes com sobrepeso consumiram o desjejum com menor frequência do que aqueles sem sobrepeso (2005: 68,3% vs 79,3% p=0,02, 2010: 59,5% vs 77,4% p=0,03). Conclui-se que houve aumento da substituição diária do almoço tradicional por lanche e no consumo do jantar tradicional no período de 5 anos. Ademais, a prática do desjejum diário se associou com a classificação de IMC nos dois momentos do estudo, de modo que aqueles com sobrepeso consomem o desjejum com menor frequência.

Physical Activity in Adolescents Living in Rural and Urban New Caledonia: The Role of Socioenvironmental Factors and the Association With Weight Status

Physical activity (PA) is an important factor for the prevention of overweight and obesity, particularly during adolescence. This study focuses on the understudied adolescent population of New Caledonia with the aim to (1) determine the daily PA levels and estimate the sedentary time through out-of-school sitting time; (2) highlight the influence of sociodemographic and environmental factors, and (3) assess the associations of PA and sitting time with overweight and obesity. A sample of 508 school-going adolescents living in New Caledonia was surveyed about their PA habits using the International Physical Activity Questionnaire-Short Form, as well as about the context in which they usually engage in PA. The influences of the place of living and ethnic community were also investigated. Results indicated that about 66% of the adolescents performed an average of at least 60 min of PA daily. Both Melanesian adolescent boys and girls were more active than Caucasian adolescents but only when they lived in rural areas (females: 115 vs. 93 min/day, p = 0.018; males: 133 vs. 97 min/day, p = 0.018). Indeed, PA was reduced in an urban environment (females: 88 min/day; males: 95 min/day, p = 0.028; rural vs. urban in Melanesian adolescents). Melanesian adolescents also spent less time in out-of-school sitting than Caucasian adolescents independently of where they lived (females: 164 vs. 295 min/day, p < 0.001; males: 167 vs. 239 min/day, p = 0.001). Feeling safe was positively associated with PA levels (females: OR_adj = 2.85, p < 0.001; males: OR_adj = 4.45, p < 0.001). In the adolescent boys, accessibility to a suitable place was also an important factor (OR_adj = 2.94, p = 0.002). Finally, while PA and sitting time were negatively associated with overweight in male adolescents (OR_adj = 0.28, p = 0.044 and OR_adj = 0.39, p = 0.004), they were not in females. Living in a rural area allowed the Melanesian adolescents to maintain a more active lifestyle with more physical activities and less sitting time. Our results also indicated that safety was an important driver for engagement in PA. The urban environment in New Caledonia appears to be a contributor of a less active lifestyle in adolescents.

A Survey on Wellness and Its Predictors Amongst Fiji High School Students

Background: Adolescent population face a number of health concerns which calls for objective and comprehensive assessment of their wellness during their critical development phase. This study aimed to determine adolescent wellness and its predictors amongst adolescents in secondary schools in Fiji. Methods: This quantitative cross sectional study was conducted in four purposively selected schools in Suva and the greater Suva area, Fiji, between August and September, 2019. Students of Fijian nationality, enrolled into years 11-13 in the selected schools were purposively selected. A structured self-administered questionnaire was used to collect data on four dimensions of wellness including physical, emotional, social, and spiritual. Spearman's Rho correlation was conducted to test for associations. Descriptive and inferential statistical tests were applied to analyze the data by the SPSS software version 25. A p-value < 0.05 was considered significant. Results: A total of 350 students participated in the study. Mean raw scores for wellness dimensions were as follows: physical = 51 (out of 60), psychological = 63 (out of 80), social = 42 (out of 50), and spiritual = 34 (out of 40). For overall wellness, two significant differences were observed: students of Fijian Itaukei descent (193.68 ± 14.2) and participants with a family income of $40,000-50,000 (199.08 ± 12.60) (p = 0.04) had a higher overall wellness score. There were three significant differences observed for psychological wellness dimension; Fijians of Indian descent (64.68 ± 9.30), participants enrolled into year 13 (64.68 ± 9.30) and those with a family income of $40,000-50,000 had higher psychological score. For social wellness, a significant difference was observed: Itaukei participants had higher scores (43.34 ± 4.42) when compared to other ethnic groups (p < 0.05). In terms of spiritual wellness, a significant difference was observed for ethnicity: Itaukei participants had a higher mean score (35.59 ± 4.26) when compared to other ethnic groups (p < 0.05). Strong correlations were observed for all dimensions of wellness. Conclusions: Findings of this study highlighted different factors affecting adolescents' wellness in Fiji. It is recommended that health education and awareness program be carried out for developing adolescent wellness by considering these factors. It is also recommended that parental and family support are provided to adolescents.

Double Burden of Malnutrition in the Asia-Pacific Region-A Systematic Review and Meta-analysis

Background: Double Burden of Malnutrition (DBM)—the coexistence of undernutrition along with overnutrition—is a significant public health issue in the Asia-Pacific region. The scope of the DBM in this region is largely unknown. This review aims to determine the prevalence of under- and overnutrition as major DBM components and to investigate whether there has been a shift from under- to overnutrition in the Asia-Pacific region.

Methods: Online databases including PubMed and Web of Science were searched for original studies on DBM prevalence in the Asia-Pacific region; particularly, those published from January 2008 to December 2018 were screened for eligibility. We collected data on indicators of under- and overnutrition on the population level and adapted the ratio of prevalence of overweight/obesity versus prevalence of underweight as the main outcome indicator. Pooled prevalence estimates of DBM and the ratio of overnutrition versus undernutrition were generated using R (3.4.0).

Results: In total, 33 studies were included in this review. Pooled analysis demonstrated that DBM was generally presented among countries/areas in the Asia-Pacific region except in high-income countries (HICs). Overall, the prevalence of undernutrition was 8.8% (95% CI 7.3–10.6%) while overnutrition among the same population reached 23.0% (95% CI 20.3–26.0%). Countries in the Oceania region or HICs reported low level of undernutrition (less than 3%). All subgroup analysis (geolocation, income level, sex, age) reported pooled prevalence of overweight/obesity as more than 18%. Overall, the whole region and all subgroups were more likely to experience a higher prevalence of overnutrition than undernutrition, except that low- and lower-middle-income countries (L-MICs) had similar prevalence for over- and undernutrition.

Conclusion: DBM in the Asia-Pacific region is alarmingly high and is titled toward overnutrition. As a result, future interventions/policy targeting to maintain a healthy weight for the population should not just focus on prevention and treatment toward one direction.

Moderating effects of plastic packaged food on association of urinary phthalate metabolites with emotional symptoms in Chinese adolescents

Previous research reports that diet is the main source of phthalate exposure to adolescents, and phthalate is associated with adolescent mental and behavioral problems. However, no study has explored the moderating effects of eating behavior in this association. This study aimed to analyze the moderating effects of plastic packaged food consumption in the longitudinal association between phthalate metabolite concentration and emotional symptoms in adolescents. This school-based survey was carried out among adolescents in two Chinese provinces. We conducted a baseline and follow-up surveys for 893 freshmen using the purposive sampling method from December 2018 to November 2019. We used food frequency questionnaire to assess eating behavior. The Chinese version of 21-item Depression Anxiety Stress Scales was used to assess emotional symptoms, and high-performance liquid chromatography-tandem mass spectrometry was used to analyze the concentration of six urine phthalate metabolites. The results of latent moderation model indicated that plastic packaged food consumption moderated the association of low molecular weight phthalate (LMWP) with depressive symptoms (β = 0.27, P = 0.002), anxiety symptoms (β = 0.89, P < 0.01), and stress symptoms (β = 0.23, P = 0.019). The moderating effects were significant at the higher scores (β = 0.14-0.35, P < 0.05) and/or the lower scores (β = -0.35 to -0.12, P < 0.05) of plastic packaged food consumption. The results suggest that plastic packaged food consumption to some extent moderates the longitudinal association of phthalate exposure with emotional symptoms in adolescents.

The Western diet: a blind spot of eating disorder research?-a narrative review and recommendations for treatment and research

Over the last 50 years, in parallel with the obesity epidemic, the prevalence of eating disorders has increased and presentations have changed. In this narrative review, we consider recent research exploring the implications of changing patterns of food consumption on metabolic and neurobiological pathways, a hitherto neglected area in eating disorder research. One of the major changes over this time has been the introduction of ultra-processed (NOVA-4) foods, which are gradually replacing unprocessed and minimally processed foods. This has resulted in the increased intake of various sugars and food additives worldwide, which has important metabolic consequences: triggering insulin and glucose response, stimulating appetite, and affecting multiple endocrine and neurobiological pathways, as well as the microbiome. A paradigm shift is needed in the conceptual framework by which the vulnerability to, and maintenance of, different eating disorders may be understood, by integrating recent knowledge of the individual metabolic responses to modern highly processed foods into existing psychological models. This could stimulate research and improve treatment outcomes.

Understanding socio-cultural influences on food intake in relation to overweight and obesity in a rural indigenous community of Fiji Islands

ISSUE ADDRESSED

Obesity and non-communicable diseases (NCDs) are largely preventable by understanding the connection between socio-cultural knowledge, yet intervention effectiveness may hinder changes in lifestyles and behaviours in Indigenous health. This study performed to understand the social and cultural components, which contribute to obesity in rural areas of the Indigenous Fijian.

METHODS

This study is a Community-Based Participatory Research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data were analysed using descriptive thematic analysis.

RESULTS

Food intake was associated with socio-cultural, economic, political and physical environmental factors. Participants reveal previous health promotion programs did not incorporate the cultural values, cultural competence beliefs and traditional ways of rural Indigenous Fijian community.

CONCLUSION

The health care providers and policymakers need to be involved in recognising iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. SO WHAT?: Community-wide lifestyle interventions, conceptual approaches based on communal perceptions of the problem at hand can also be the basis for future research on identifying socio-cultural factors, for example, the community and family support that can help shape behaviours.

Association Between Screen Time, Fast Foods, Sugar-Sweetened Beverages and Depressive Symptoms in Chinese Adolescents

OBJECTIVE

Although previous studies have shown that screen time (ST), fast foods (FFs) and sugar-sweetened beverages (SSBs) consumption are associated with depressive symptoms in adolescents, research on these associations in Chinese adolescents is scarce. This study aimed to examine the association between ST, FFs, SSBs and depressive symptoms in Chinese adolescents, and explore the mediating effects of FFs and SSBs in the association between ST and depressive symptoms.

METHODS

This school-based nationwide survey was carried out among 14,500 students in four provinces of China. The Children's Depression Inventory was used to assess the participants' depressive symptoms. ST, FFs and SSBs consumption was measured by a self-reported questionnaire. The Bayesian multiple mediation model was used to analyze the mediation effect.

RESULTS

ST, FFs and SSBs, were more likely to be associated with depressive symptoms, and ORs (95%CI) was 1.075 (1.036-1.116), 1.062 (1.046-1.078) and 1.140 (1.115-1.166), after we adjusted for sociodemographic variables. Additionally, in Bayesian multiple mediation model, direct effect, mediating effect, total effect, the ratio of mediating effect to total effect was 0.125, 0.034, 0.159, and 0.214, respectively. All path coefficients of the three mediation paths are statistically significant (p < 0.05).

CONCLUSIONS

Our study demonstrates that ST, FFs and SSBs consumption are associated with depressive symptoms in Chinese adolescents. It is likely that FFs and SSBs partially mediate the association between ST and depressive symptoms by chain-mediating effects.

Improving Pacific Adolescents' Physical Activity Toward International Recommendations: Exploratory Study of a Digital Education App Coupled With Activity Trackers

BACKGROUND

The prevalence of overweight and obesity in children and adolescents has dramatically increased in the Pacific Island countries and territories over the last decade. Childhood overweight and obesity not only have short-term consequences but are also likely to lead to noncommunicable diseases in adulthood. A major factor contributing to the rising prevalence is an insufficient amount of daily moderate-to-vigorous physical activity (MVPA). In the Pacific region, less than 50% of children and adolescents meet the international recommendations of 11,000 steps and 60 min of MVPA per day. Although studies have shown the potential of digital technologies to change behaviors, none has been proposed to guide adolescents toward achieving these recommendations.

OBJECTIVE

The aims of this study were (1) to investigate whether a technology-based educational program that combines education, objective measures of physical activity (PA), and self-assessment of goal achievement would be well received by Pacific adolescents and help change their PA behaviors toward the international PA recommendations and (2) to create more insightful data analysis methods to better understand PA behavior change.

METHODS

A total of 24 adolescents, aged 12 to 14 years, participated in a 4-week program comprising 8 1-hour modules designed to develop health literacy and physical skills. This self-paced user-centered program was delivered via an app and provided health-related learning content as well as goal setting and self-assessment tasks. PA performed during the 4-week program was captured by an activity tracker to support learning and help the adolescents self-assess their achievements against personal goals. The data were analyzed using a consistency rate and daily behavior clustering to reveal any PA changes, particularly regarding adherence to international recommendations.

RESULTS

The consistency rate of daily steps revealed that the adolescents reached 11,000 steps per day 48% (approximately 3.4 days per week) of the time in the first week of the program, and this peaked at 59% (approximately 4.1 days per week) toward the end of the program. PA data showed an overall increase during the program, particularly in the less active adolescents, who increased their daily steps by 15% and ultimately reached 11,000 steps more frequently. The consistency of daily behavior clustering showed a 27% increase in adherence to international recommendations in the least active adolescents.

CONCLUSIONS

Technology-supported educational programs that include self-monitored PA via activity trackers can be successfully delivered to adolescents in schools in remote Pacific areas. New data mining techniques enable innovative analyses of PA engagement based on the international recommendations.

Predictors of Dietary Diversity of Indigenous Food-Producing Households in Rural Fiji

Fiji, like other Pacific Islands, are undergoing economic and nutrition transitions that increase the risk of noncommunicable diseases (NCDs) due to changes of the food supply and dietary intake. This study aimed to examine dietary diversity (DD) in indigenous food-producing households in rural Fiji. Surveys were conducted with households from the Nadroga-Navosa, Namosi and Ba Provinces of Western Fiji in August 2018. Participants reported on foods consumed in the previous 24 h per the Household Dietary Diversity Score. Data was analysed using multinomial logistic regression. Of the 161 households, most exhibited medium DD (66%; M = 7.8 ± 1.5). Commonly consumed foods included sweets (98%), refined grains (97%) and roots/tubers (94%). The least consumed foods were orange-fleshed fruits (23%) and vegetables (35%), eggs (25%), legumes (32%) and dairy (32%). Households with medium DD were more likely to be unemployed (OR 3.2, p = 0.017) but less likely to have ≥6 occupants (OR = 0.4, p = 0.024) or purchase food ≥2 times/week (OR = 0.2, p = 0.023). Households with low DD were more likely to have low farm diversity (OR = 5.1, p = 0.017) or be unemployed (OR = 3.7, p = 0.047) but less likely to have ≥6 occupants (OR = 0.1, p = 0.001). During nutrition transitions, there is a need for public health initiatives to promote traditional diets high in vegetables, fruits and lean protein and agricultural initiatives to promote farm diversity.

Nutrition behaviors and sociodemographic factors associated with overweight in the multi-ethnic adolescents of New Caledonia

Objectives: New Caledonia is a multi-ethnic French territory in the Pacific, characterized by communities with widely varying nutritional habits. Little is currently known about adolescent food behaviors and habits and their association with overweight. This study therefore determined the sociodemographic factors and food behaviors associated with overweight and underweight in this population, as well as the factors associated with skipping breakfast. Methods: A cross-sectional survey was conducted among New Caledonian adolescents using a self-administered questionnaire; anthropometric measurements were also taken. Weight status was determined using international cutoffs, and the factors associated with overweight and underweight were identified with multiple logistic regression analysis. The factors associated with breakfast skipping were also determined. Results: Skipping breakfast, being Melanesian, living in a rural area and having low economic status were positively associated with overweight in these adolescents. Skipping breakfast was relatively infrequent, reported by 18% and 13% of the males and females, respectively. Logistic regression models found that the main factors associated with breakfast consumption habits were gender, weight status and ethnicity. Conclusions: Several factors are associated with overweight status in New Caledonian adolescents. Breakfast education should be improved for adolescents living in rural areas and from low socioeconomic status.

Tackling the Consumption of High Sugar Products among Children and Adolescents in the Pacific Islands: Implications for Future Research

The Pacific Islands are experiencing an obesity epidemic with a rate of overweight and obesity as high as 80% among adults in some Pacific Island nations. Children and adolescents in the region are also affected by overweight and obesity, which is alarming due to the increased likelihood of remaining overweight as an adult. Research supports an association between poor diet and an increased risk of obesity and development of non-communicable diseases (NCDs). Excess consumption of free sugars is associated with poorer overall diet quality and increased risk of weight gain, chronic inflammation and dental caries. Traditional diets in the Pacific Islands are being supplemented with processed, high-sugar foods and beverages; thus, there is a clear need for effective interventions promoting positive dietary behaviors in the region. School and community based interventions offer an opportunity to promote positive behavior change among children and adolescents. This review aims to evaluate interventions targeting the consumption of high-sugar products in this population in the Pacific Islands.

INTAKE OF SUGAR-SWEETENED BEVERAGES, MILK AND ITS ASSOCIATION WITH BODY MASS INDEX IN ADOLESCENCE: A SYSTEMATIC REVIEW

OBJECTIVE

To systematize literature references addressing the association of sugar-sweetened beverage (SSB) and milk intake with body mass index (BMI) in adolescents.

DATA SOURCE

A search was carried out in PubMed (US National Library of Medicine National Institutes of Health) and BVS (Virtual Library in Health). The descriptors used were: adolescents, young adult, beverages, drinking, obesity, overweight, BMI, and nutritional status. The following filters were applied: age ranging from 10 to 19 years, studies published in Portuguese or English language between 2011-2015.

DATA SYNTHESIS

Thirty studies were selected (22 cross-sectional studies, 4 cohort studies, 1 randomized clinical trial, 1 case-control study, and 1 quasi-experimental study). There was association between the intake of these beverages and increase in BMI in 55% of all 20 studies that dealt with sugary drinks. When it came to soft drinks, 100% of studies reported association with increase in BMI. As to milk intake, only one article showed association with increased BMI. Three articles reported milk as a protection factor against increase in BMI; three studies found no association between this intake and BMI. Nineteen studies had representative samples and 20 surveys reported random samples. Among papers using questionnaires, 84% had been validated.

CONCLUSIONS

There is no consensus in the literature about the association between SSB or milk intake and BMI in adolescents.

Anthropometric Characteristics and Physical Fitness in Rural and Urban 11- to 16-Year-Old Melanesian Adolescents: A Cross-sectional Study in New Caledonian Schools

We evaluated anthropometric characteristics and physical fitness in 556 Melanesian adolescents from rural and urban New Caledonia to build health education programs focused on physical activity. In 2013, body weight, height, skinfold thickness, lean body mass (LBM), percentage fat body mass (%FBM), physical fitness (power, agility, speed, maximal aerobic speed [MAS], estimated VO_2max), and self-reported physical activity were assessed. Rural adolescents were significantly shorter and faster, had lower weight, %FBM, LBM, and power output and similar MAS and VO_2max, and were more active than urban adolescents. Rural girls were significantly shorter, had higher MAS and VO_2max, and were faster and significantly more active than urban girls while similar %BFM was observed in both groups of girls. Rural boys showed significantly lower height, weight, %FBM, and power and were significantly faster and more active than urban boys. In conclusion, rural Melanesian adolescents are more active, with good physical fitness (especially boys), although high %FBM was noted (especially in girls).

Adolescent Snacking Behaviors Are Associated with Dietary Intake and Weight Status

BACKGROUND

Most adolescents consume ≥1 snack/d; exploring the relevance of snacking patterns for overall diet and weight status is important to guide dietary counseling and public health strategies for obesity prevention.

OBJECTIVE

This study examined intake of common energy-dense snack foods, total number of snacks consumed, frequency of consuming snacks prepared away from home, and frequency of snacking while watching television in adolescents and how these behaviors may be linked to diet and weight status. Relations were examined with attention to potential confounders that may help explain the mixed findings of previous research.

METHODS

Survey measures of snacking behavior, a food-frequency questionnaire, and anthropometric measurements were completed by 2793 adolescents (53.2% girls, mean age = 14.4 y) in Minneapolis-St. Paul school classrooms in 2009-2010. Linear regression was used to examine associations with adjustment for sociodemographic characteristics and other potential confounding factors, such as meal skipping, underreporting energy intake, dieting to lose weight, and physical activity.

RESULTS

Adolescents reported consuming a mean of 2.2 energy-dense snack food servings/d and 4.3 snacks/d and purchasing snacks prepared away from home on 3.2 occasions/wk. More than two-thirds of adolescents reported that they sometimes, usually, or always consumed a snack while watching television. The measures of snacking were directly associated (P < 0.01) with higher energy, lower fruit/vegetable, higher sugar-sweetened beverage, and more frequent fast-food intakes in all models except for one: energy-dense snack food servings were not related to sugar-sweetened beverage intake. A direct relation between daily servings of energy-dense snack foods and body mass index (BMI) z score was found; however, the snacking behaviors were inversely related to BMI z score (P < 0.01).

CONCLUSIONS

The observed cross-sectional associations suggest that snack consumption is a risk factor for poor diet, but unless energy-dense foods are consumed, snacking does not consistently contribute to overweight in US adolescents.

Evaluation of Body Mass Index (BMI) Percentile cut-off Levels with Reference to Insulin Resistance: A Comparative Study on South Indian Obese and Non-Obese Adolescents

OBJECTIVES

To investigate the relationship of Body Mass Index (BMI) percentile cut off with Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), a surrogate marker for insulin resistance in obese, overweight and non-obese adolescents.

STUDY DESIGN

A cross-sectional analysis of 120 adolescents (divided into sixty overweight/obese and an equal number of non-obese) was performed on nondiabetic, nonpregnant (11 to 18 year old school going) adolescents in south Indian (Puducherry) population. The main outcome measure of insulin resistance was calculated as HOMA-IR (greater than 3.16). Obesity was defined as per the BMI criteria, BMI greater than or equal to 95(th) percentile,overweight greater than or equal to 85(th) percentile and non-obese less than 84.9(th) percentile. All adolescents were subjected to analysis of anthropometric parameters that included weight, height and BMI (body mass index). Biochemical parameters, namely venous plasma glucose (fasting) and venous plasma insulin (fasting) were included for insulin resistance calculation by HOMA-IR.

RESULTS

Having a BMI of greater than or equal to 85(th) percentilewas associated with high HOMA-IR levels. As the BMI percentile increased, HOMA-IR levels also increased. Prevalence of insulin resistance for a BMI percentile of less than 84.9 was nil. Prevalence of insulin resistance for a BMI percentile of 85-94.9 was 26%.Prevalence of insulin resistance for BMI of greater than or equal to 95(th) percentile was 64%.

CONCLUSION

Insulin resistance is highly prevalent in obese and overweight adolescents as compared to that in non-obese adolescents. The onset of Impaired Fasting Glucose (IFG) is associated with the development of severe hyper-insulinaemia in obese adolescents and early primordial and primary prevention can thus alleviate the burden of future cardiometabolic disorders.