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

Research on the changes and predictions of the burden of type 2 diabetes mellitus in Pacific Island countries from 1990 to 2019

AIMS

To assess the burden of type 2 diabetes in Pacific Island countries and predict future trends.

METHODS

We analyzed and processed data using R and Excel software, performed Joinpoint 4.7.0 software analysis to investigate changing trends in disease burden, and used an autoregressive integrated moving average model to forecast future trends.

RESULTS

Our study showed that from 1990 to 2019, the burden of type 2 diabetes in Pacific Island countries continues to increase, with the standardized incidence rate showing the most significant growth. Moreover, there were significant differences in the burden of type 2 diabetes between regions. In 2019, American Samoa had the highest standardized incidence rate, while Fiji had the highest standardized death rate and disability-adjusted life year rate. The standardized incidence rate peaked at ages 65-69 years, while the standardized death rate and disability-adjusted life year rate peaked at ages 95 years and 70-74 years respectively. Type 2 diabetes burden was higher among males than females. Based on our forecasting, from 2020 to 2030, the standardized incidence rate is expected to continue to rise, while the standardized death rate and disability-adjusted life year rate will slowly decline.

CONCLUSIONS

Our study highlights that the burden of type 2 diabetes in Pacific Island countries has been increasing from 1990 to 2019. Therefore, it is imperative to strengthen disease prevention and control measures in the region.

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.

The tide of dietary risks for noncommunicable diseases in Pacific Islands: an analysis of population NCD surveys

OBJECTIVE

To describe changes over time in dietary risk factor prevalence and non-communicable disease in Pacific Island Countries (PICTs).

METHODS

Secondary analysis of data from 21,433 adults aged 25-69, who participated in nationally representative World Health Organization STEPs surveys in 8 Pacific Island Countries and Territories between 2002 and 2019. Outcomes of interest were changes in consumption of fruit and vegetables, hypertension, overweight and obesity, and hypercholesterolaemia over time. Also, salt intake and sugar sweetened beverage consumption for those countries that measured these.

RESULTS

Over time, the proportion of adults consuming less than five serves of fruit and vegetables per day decreased in five countries, notably Tonga. From the most recent surveys, average daily intake of sugary drinks was high in Kiribati (3.7 serves), Nauru (4.1) and Tokelau (4.0) and low in the Solomon Islands (0.4). Average daily salt intake was twice that recommended by WHO in Tokelau (10.1 g) and Wallis and Futuna (10.2 g). Prevalence of overweight/obesity did not change over time in most countries but increased in Fiji and Tokelau. Hypertension prevalence increased in 6 of 8 countries. The prevalence of hypercholesterolaemia decreased in the Cook Islands and Kiribati and increased in the Solomon Islands and Tokelau.

CONCLUSIONS

While some Pacific countries experienced reductions in diet related NCD risk factors over time, most did not. Most Pacific adults (88%) do not consume enough fruit and vegetables, 82% live with overweight or obesity, 33% live with hypertension and 40% live with hypercholesterolaemia. Population-wide approaches to promote fruit and vegetable consumption and reduce sugar, salt and fat intake need strengthening.

Consumption of Traditional Fruits and Vegetables among Children in the US-Affiliated Pacific Region

Background

Traditional Pacific diets have many health benefits, including maintenance of a healthy weight and prevention of various diseases. Few studies have evaluated the frequency at which traditional diets are consumed in the Pacific, especially among children.

Objectives

This study examined the frequency of traditional and acculturated fruit and vegetable (F&V) intake among children in the US-affiliated Pacific (USAP) region.

Methods

Diet records of 3319 children ages 2 to 8 y old were analyzed for frequency of traditional or acculturated F&V intake within USAP jurisdictions of American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM; FSM island states include Chuuk, Kosrae, Pohnpei, and Yap), Guam, Hawaii, Republic of the Marshall Islands (RMI), and Republic of Palau.

Results

Of the 95,304 food items recorded among participating children in the USAP jurisdictions, 15.2% were F&Vs. Of the 10 jurisdictions, children in the islands of Chuuk, Kosrae, Yap, and Pohnpei recorded the highest frequencies of traditional F&V intake relative to their total F&V intake (67.8%, 64.8%, 56.7%, and 52.5%, respectively). American Samoa and RMI recorded moderate frequency of traditional F&V intake (38.9% and 46.4%, respectively), whereas children in Hawaii, Guam, and CNMI recorded the lowest frequencies of traditional F&V intake relative to their total F&V intake (10.4%, 12.4%, and 15.3%, respectively). Children in Hawaii, Guam, Palau, and CNMI recorded high frequencies of acculturated F&V intake (37.8%, 31.2%, 34.5%, and 27.9%, respectively).

Conclusions

Overall, children in the USAP jurisdictions participating in this study recorded a low frequency of F&V intake. The differences in traditional F&V intake found between the USAP islands may be due to variation in economic income level and external influences on social and cultural norms among the island populations and variations of cost, accessibility, and convenience of each category of food to each island's population.

Modeling thiamine fortification: a case study from Kuria atoll, Republic of Kiribati

In 2014, there was an outbreak of beriberi on Kuria, a remote atoll in Kiribati, a small Pacific Island nation. A thiamine‐poor diet consisting mainly of rice, sugar, and small amounts of fortified flour was likely to blame. We aimed to design a food fortification strategy to improve thiamine intakes in Kuria. We surveyed all 104 households on Kuria with a pregnant woman or a child 0–59 months. Repeat 24‐h dietary recalls were collected from 90 men, 17 pregnant, 44 lactating, and 41 other women of reproductive age. The prevalence of inadequate thiamine intakes was >30% in all groups. Dietary modeling predicted that rice or sugar fortified at a rate of 0.3 and 1.4 mg per 100 g, respectively, would reduce the prevalence of inadequate thiamine intakes to <2.5% in all groups. Fortification is challenging because Kiribati imports food from several countries, depending on price and availability. One exception is flour, which is imported from Fiji. Although resulting in less coverage than rice or sugar, fortifying wheat flour with an additional 3.7 mg per 100 g would reduce the prevalence of inadequacy to under 10%. Kiribati is small and has limited resources; thus, a regional approach to thiamine fortification is needed.

Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries

The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85–90% of premature deaths among 30–69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs.

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Sugar-Sweetened Beverage Consumption and Associated Factors in School-Going Adolescents of New Caledonia

This cross-sectional study assessed sugar-sweetened beverage (SSB) consumption and its associations with the sociodemographic and physical characteristics, behavior and knowledge of New Caledonian adolescents. The survey data of 447 adolescents from ages 11 to 16 years were collected in five secondary public schools of New Caledonia between July 2015 and April 2016. These data included measured height and weight, SSB consumption, sociodemographic characteristics, body weight perception, physical activity, and knowledge (sugar quantity/SSB unit; energy expenditure required to eliminate a unit) and opinions about the SSB‒weight gain relationship. Ninety percent of these adolescents declared regularly drinking SSBs. Quantities were associated with living environment (1.94 L·week⁻¹ in urban environment vs. 4.49 L·week⁻¹ in rural environment, p = 0.001), ethnic community (4.77 L·week⁻¹ in Melanesians vs. 2.46 L·week⁻¹ in Caucasians, p < 0.001) and knowledge about energy expenditure (6.22 L·week⁻¹ in unknowledgeable adolescents vs. 4.26 L·week⁻¹ in adolescents who underestimated, 3.73 L·week⁻¹ in adolescents who overestimated, and 3.64 L·week⁻¹ in adolescents who correctly responded on the energy expenditure required to eliminate an SSB unit, p = 0.033). To conclude, community-based health promotion strategies should (1) focus on the physical effort needed to negate SSB consumption rather than the nutritional energy from SSB units and (2) highlight how to achieve sustainable lifestyles and provide tools for greater understanding and positive action.