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

Abstract Objective: To describe changes over time in dietary risk factor prevalence and non-communicable disease in Pacific Island countries.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 risk factors in the most recent survey.Results: Pooled analysis revealed a reduction from 94% to 88% in the proportion of adults who consumed <5 servings of fruit and vegetables/day, however consumption was still low overall. Reductions were largest in the Solomon Islands and Tonga. The proportion of adults living with overweight or obesity increased from 76.9% to 82.1% overall and increased in Fiji, but did not increase in Cook Islands, Kiribati, Tonga, and the Solomon Islands. Prevalence of hypercholesterolaemia plateaued or decreased in the Cook Islands, Kiribati, Nauru and Tonga. The prevalence of hypertension increased in 6/8 countries, with hypertension now affecting one-third of all adults. Average daily serves of sugar sweetened beverages varied from 0.4/day in the Solomon Islands to 4.1 in Nauru, and urinary sodium analysis indicated an average daily salt intake over twice that recommended by WHO by adults in Tokelau (10.1/day) and Wallis and Futuna (10.2/day).Conclusions: Pacific Island Countries and Territories (PICTs) have experienced a mix of increased and decreased diet-related NCD risk over time. Higher fruit and vegetable consumption was encouraging, but higher rates of hypertension prevalence and overweight and obesity prevalence in some countries supported the need for countries to more strongly prioritise the implementation of diet-related NCD prevention policy. The value of STEPS surveys for monitoring trends in NCD risk will be fully realized when countries have conducted at least three surveys, although consistent measurement of risk factors over time is required to achieve this.