The observed prevalences of stunting, overweight/obesity and anaemia suggest that it is critical to invest in nutrition and develop health programmes targeting early childhood growth and development in Samoa.

The Samoan population has been undergoing a nutrition transition toward more imported and processed foods and a more sedentary lifestyle. We aimed to identify dietary patterns in Samoa and to evaluate their associations with metabolic outcomes. The sample of this cross-sectional study includes 2774 Samoan adults recruited in 2010 (1104 with metabolic syndrome compared with 1670 without). Principal component analysis on food items from a 104-item food-frequency questionnaire was used to identify dietary patterns. Adjusted least squares means of each component of metabolic syndrome were estimated by quintiles of factor scores for each dietary pattern. Metabolic syndrome status was regressed on quintiles of scores by using log-binomial models to obtain prevalence ratios. We identified a modern pattern, a mixed-traditional pattern, and a mixed-modern pattern. The modern pattern included a high intake of imported and processed foods, including pizza, cheeseburgers, margarine, sugary drinks, desserts, snacks, egg products, noodles, nuts, breads, and cakes and a low intake of traditional agricultural products and fish. The mixed-traditional pattern had a high intake of neotraditional foods, including fruits, vegetables, soup, poultry, and fish, and imported and processed foods, including dairy products, breads, and cakes. The mixed-modern pattern was loaded with imported and processed foods, including pizza, cheeseburgers, red meat, egg products, noodles, and grains, but also with neotraditional foods, such as seafood and coconut. It also included a low intake of fish, tea, coffee, soup, and traditional agricultural staples. Higher adherence to the mixed-modern pattern was associated with lower abdominal circumference (-trend < 0.0001), lower serum triglycerides (-trend = 0.03), and higher serum HDL cholesterol (-trend = 0.0003). The mixed-modern pattern was inversely associated with prevalence of metabolic syndrome (the highest quintile: prevalence ratio = 0.79; 95% CI: 0.69, 0.91; -trend = 0.006). Mixed dietary patterns containing healthier foods, rather than a largely imported and processed modern diet, may help prevent metabolic syndrome in Samoa.

Further longitudinal monitoring and evaluation of early childhood growth and development are needed to understand the influences of early diet on child health in Samoa.

Since inadequate dietary micronutrient intake was more common among older children (4-4.99 years) and those in the rural region, intervention should be targeted at those groups.

Summary Background Overweight/obesity is prevalent among children in the Pacific Islands, but its aetiology is poorly understood. Few studies have considered body composition in addition to body mass index–based measures. Objectives To describe body composition among Samoan children and determine sex‐specific associations among dietary intake, physical activity, and body composition. Methods Body composition (percent body fat [%BF], lean mass, and trunk‐to‐peripheral fat ratio) of n = 83 Samoan children (3‐7 y) was assessed using dual‐energy X‐ray absorptiometry. Children completed 7 days of objective physical activity monitoring. Mothers reported child nutritional intake using a 115‐item food frequency questionnaire. Stepwise generalized linear regression was used to determine independent associations of nutritional intake and physical activity with body composition. Results Samoan children had higher average %BF than reported among other ethnic groups but lower trunk‐to‐peripheral fat ratios. In sex‐stratified analyses, quartile of carbohydrate intake was negatively associated with %BF (β = −2.02 SE = 0.58; P < .001) in girls only. Among boys, physical activity (quartile of accelerometer counts per minute) was negatively associated with %BF (β = −1.66 SE = 0.55; P < .01). Conclusions Sex differences in the associations among nutritional intake, physical activity, and body composition may be important to consider as interventions are developed to address overweight/obesity among Samoan children.