Framework for Identifying Signature Foods for Health in the Children’s Healthy Living Program in the United States Affiliated Pacific Region

BACKGROUND: Since diet adequacy depends in part on the quality of the local food supply, policy makers, farmers, and nutritionists need to know which foods to focus on to improve dietary adequacy and nutrition related health. OBJECTIVES: The Children's Healthy Living (CHL) Food Systems resilience project, which includes 5 United States-Affiliated Pacific (USAP) jurisdictions, developed a framework to identify "Signal Nutrients" and "Signature Foods" for food-system interventions to improve the diet and health of USAP children. METHODS: The framework identifies "Signature Foods," defined as foods consumed by the population and associated with health conditions, which can be used as leverage points to affect health and the food system. The framework was applied to 2543 CHL children aged 2-8 y using food records and anthropometric measures. The intermittent consumption of foods made direct identification of foods associated with health difficult. Therefore, the framework first identified "Signal Nutrients" associated with health conditions (overweight, obesity, and acanthosis nigricans) using logistic regression. The analysis was then repeated for Signal Nutrients sourced from specific food types and food classes to identify the food items driving nutrient associations. Foods strongly associated (standardized [Std] β: >0.025 in absolute value) with health conditions, and in the same direction as the Signal Nutrients, were designated as Signature Foods. RESULTS: The framework identified 6 Signal Nutrients and 26 Signature Foods. For example, the Signal Nutrient calcium was found to be inversely associated with obesity (P = 0.0002). Twenty-four foods that contributed to calcium intake were examined for their association with obesity. Signature Foods identified for obesity and calcium were milk (Std β: ∼0.08), dairy other than milk (Std β: 0.06), fresh fish (Std β: 0.03), and cereal (Std β: 0.11). CONCLUSIONS: Identifying strategic uses of limited resources for nutrition and health promotion can be aided by a framework that utilizes objective data sources and knowledge of community partners. Fish may be considered a potential intervention point to promote, given its importance to the USAP region and because campaigns to increase child milk consumption already exist.