Prevalence and associated factors of obesity, hypertension, and diabetes in French Polynesia: results from a nationwide cross-sectional study

Background: Non-communicable diseases (NCDs) represent a major global health challenge, particularly in the Pacific. This study assessed the prevalence and associated factors of obesity, hypertension, and diabetes among adults in French Polynesia. Methods: or a revised definition incorporating ethnicity-specific thresholds and additional anthropometric criteria). Findings: A total of 1893 adults were included (987 women; 906 men). Among them, 669 (weighted prevalence: 35·5%, 95% CI: 33-38) had hypertension, 214 (weighted prevalence: 12·2%, 95% CI: 10-14) had diabetes (including 53 undiagnosed, weighted prevalence: 3·1%, 95% CI: 2-4), and 1022 (weighted prevalence: 51·1%, 95% CI: 48-54) or 847 (weighted prevalence: 42·7%, 95% CI: 40-46) were classified as obese, using BMI-based or revised definitions, respectively. Among those with revised obesity, 439 (weighted prevalence: 52·2%, 95% CI: 48-57) presented metabolic abnormalities typically associated with the condition, while 408 (weighted prevalence: 47·8%, 95% CI: 43-52) were metabolically healthy, a phenotype that declined with age.Women were less likely than men to have hypertension (OR = 0·59, 95% CI: 0·45-0·78), but more likely to present BMI-based obesity (OR = 1·61, 95% CI: 1·23-2·11). Hypertension odds were higher in Leeward versus Windward Islands (OR = 1·61, 95% CI: 1·24-2·09). Revised obesity was associated with low fruit/vegetable intake (OR = 1·53, 95% CI: 1·13-2·09), high meat consumption (OR = 1·52, 95% CI: 1·10-2·10), high fish consumption (OR = 1·54, 95% CI: 1·10-2·16), and low physical activity (OR = 1·58, 95% CI: 1·15-2·15). Obesity increased the odds of diabetes (OR = 2·99, 95% CI: 1·97-4·53) and hypertension (OR = 2·38, 95% CI: 1·80-3·14). Lower odds of obesity were observed in self-declared Polynesians of mixed ancestry (OR = 0·64, 95% CI: 0·42-0·96) and European immigrants (OR = 0·21, 95% CI: 0·07-0·61), as well as lower odds of diabetes in European immigrants (OR = 0·04, 95% CI: 0·01-0·19) compared to self-identified Polynesians. Interpretation: The high prevalence of obesity, a key driver of hypertension and diabetes, highlights the need for both population-wide prevention and targeted interventions across all archipelagos. Using standard indicators alongside locally revised definitions allows a more accurate mapping of NCDs, while the analysis of associated factors supports behavioural changes to reduce risk. Funding: Research Delegation of French Polynesia (Grant N°03557/MED/REC-05/29/2019); ANR France2030-EPIGEMI (Grant N°ANR-23-CHBS-0007); ANRS-MIE EMERGENCES (Grant N°23583).