Nutrient intake among Samoan children aged 2–4 years in 2015

Background: Young children are particularly vulnerable to malnutrition as nutrition transition progresses. The aim of this study was to examine the adequacy of macro- and micronutrient intake among 2–4.99-year-old Samoan children. Methods: Child dietary intake was measured using a 117-item food frequency questionnaire (FFQ) with a 30-day reference period. Daily total energy and nutrient intake was calculated by multiplying the frequency of daily consumption by the nutrient content of a fixed, standard portion size. Adequacy of macro- and micronutrient intake was determined using age-specific US Dietary Guidelines. Results: Most children met or exceeded recommendations for carbohydrate, fat and protein intake. More than half of the sample were not meeting the Recommended Dietary Allowance (RDA) for calcium (59.0%), 44.6% were not meeting RDA for potassium and intake of vitamin A and E was inadequate among 25.9% and 25.6%, respectively. Eighty per cent of children exceeded the tolerable upper limit for sodium. Adequacy of intake varied by age and census region of residence. Conclusion: 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

Longitudinal assessment of childhood dietary patterns: Associations with body mass index z-Score among children in the Samoan Ola Tuputupua\u27e (Growing Up) cohort

Background: Intervention strategies to prevent childhood obesity in the Pacific Islands encourage eating a variety of local and traditional foods, but context-specific data to support this approach are limited. The objective was to assess the association between 2-year adherence to modern and neotraditional dietary patterns and body mass index z-scores (BMIz) among Samoan children. Methods: A convenience sample of 214 Samoan biological mother-child dyads who participated in the Ola Tuputupua'e “Growing Up” cohort study in 2015 and 2017 was included. At each time point, modern and neotraditional dietary patterns were identified using food frequency data and factor analysis. Children were assigned to categories based on diet pattern adherence: consistently high, high to low, low to high, and consistently low. Associations between 2-year adherence to dietary patterns, BMIz (in 2017 and 2015–2017), and weight and height z-scores were examined using linear models adjusted for potential confounders. Results: Consistently high adherence to the modern pattern was associated with a 0.36 standard deviation (SD)-adjusted change in BMIz between 2015 and 2017 (95% confidence interval [CI]: 0.04–0.69, p = 0.03). While the estimates for the individual components of BMI were imprecise, on average, children with consistently high adherence to the modern pattern had a 0.13 SD greater change in weight z-score (95% CI: −0.10 to 0.37) and 0.15 SD lower change in height z-score (95% CI: −0.43 to 0.13). The change in BMIz between 2015 and 2017 did not significantly differ by adherence to the neotraditional pattern. Conclusion: A neotraditional dietary pattern, comprising local produce, should be encouraged as a possible childhood obesity prevention strategy in Samoa

Comparability of The Netherlands Physical Activity Questionnaire with Accelerometer-Measured Physical Activity in Samoan Children: A Retrospective Analysis of Ola Tuputupua’e Data

Accurate measurement of physical activity is critical to understand its role in cardiometabolic health and obesity development in children and to monitor trends in behavior and evaluate interventions. An ongoing mixed-longitudinal study of child growth and development in Samoa is collecting physical activity data with both accelerometers and the Netherlands Physical Activity Questionnaire (NPAQ). The aims of our analyses were to (1) describe the response frequency and correlations of individual questions in the NPAQ, (2) develop modified NPAQ scores with selected questions and (3) examine the concordance of modified NPAQ scores with accelerometer outcomes among children aged 2–4 years. We developed two modified NPAQ scores with combinations of questions and assessed concordance of the modified scores with accelerometer data using estimated marginal means adjusted for monitor wear time. Although the evenly distributed tertiles of the modified 15-point NPAQ score showed promising trends of increasing minutes of accelerometer-assessed high-intensity physical activity with increasing tertile, the estimated marginal means were imprecise with high variance, demonstrating that NPAQ score could not accurately assess physical activity levels of preschool-aged children in Samoa. Considering that questionnaires are often considered more cost-effective tools for physical activity measurement than accelerometry, further research is necessary to develop a culturally and age-appropriate physical activity questionnaire in this population

Comparability of The Netherlands Physical Activity Questionnaire with Accelerometer-Measured Physical Activity in Samoan Children: A Retrospective Analysis of Ola Tuputupua’e Data

Accurate measurement of physical activity is critical to understand its role in cardiometabolic health and obesity development in children and to monitor trends in behavior and evaluate interventions. An ongoing mixed-longitudinal study of child growth and development in Samoa is collecting physical activity data with both accelerometers and the Netherlands Physical Activity Questionnaire (NPAQ). The aims of our analyses were to (1) describe the response frequency and correlations of individual questions in the NPAQ, (2) develop modified NPAQ scores with selected questions and (3) examine the concordance of modified NPAQ scores with accelerometer outcomes among children aged 2–4 years. We developed two modified NPAQ scores with combinations of questions and assessed concordance of the modified scores with accelerometer data using estimated marginal means adjusted for monitor wear time. Although the evenly distributed tertiles of the modified 15-point NPAQ score showed promising trends of increasing minutes of accelerometer-assessed high-intensity physical activity with increasing tertile, the estimated marginal means were imprecise with high variance, demonstrating that NPAQ score could not accurately assess physical activity levels of preschool-aged children in Samoa. Considering that questionnaires are often considered more cost-effective tools for physical activity measurement than accelerometry, further research is necessary to develop a culturally and age-appropriate physical activity questionnaire in this population

Prevalence of malnutrition among Samoan children aged 5 to 11 years in 2019–2020

Background Globally, rapid economic development, urbanisation, and nutrition transitions have led to rising levels of malnutrition in all forms. Aim The study objective was to document the prevalence of overweight/obesity, underweight, stunting, and anaemia among Samoan children in 2019–2020. Subjects and methods Children from the Ola Tuputupua’e “Growing Up” in Samoa study at ages 5–11 years with complete physical assessments were included. Overweight/obesity, underweight, and stunting were classified using World Health Organisation Z-scores for body mass index-for-age (BMIZ> +1), weight-for-age (WAZ< −2SD), and height-for-age (HAZ< −2SD), respectively. Anaemia was defined as haemoglobin concentration <11.5 g/dL. Prevalence was compared by child age, sex, and census region of residence (representing urbanicity and exposure to nutrition transition) using Wilcoxon two-sample, Chi-square, or Fisher’s exact tests. Results The prevalence of overweight/obesity, underweight, stunting, and anaemia was 36.2%, 0.5%, 1.6%, and 31.6%, respectively. Overweight/obesity in children was positively associated with age and highly prevalent in periurban and urban regions. While children living in the rural region with the lowest exposure to nutrition transition had the highest prevalence of mild-to-moderate stunting, anaemia prevalence was lower compared to those in the urban region. No sex differences in malnutrition were observed. Conclusion Moderate-to-high levels of overweight/obesity and anaemia call for comprehensive intervention strategies

Samoan abstract.

Physical activity is a key component of many obesity prevention strategies. The aim of this analysis was to identify child, family, and household characteristics associated with parent-reported physical activity in Samoan children aged 3–8 years. Children (n = 445; 51.2% female, mean age 5.4 years) were part of an ongoing, mixed-longitudinal study of child growth, development, and wellbeing (the Ola Tuputupua’e cohort). Bivariate analyses and multivariate generalized linear regressions were conducted to investigate the relationship of child, family, and household characteristics with physical activity level, measured using the Netherlands Physical Activity Questionnaire (NPAQ). Children were classified as being ‘highly active’ if they had NPAQ scores in the 75th percentile or above. Among the n = 111 children classified as ‘highly active’, n = 67 (60.4%) were boys. After adjusting for child, family, and household-level characteristics, hours of child sleep per night was the only variable significantly associated with odds of being highly active. Compared to children who slept less than 9 hours at night, those who slept 10–10.99 hours (OR: 5.97, 95% CI: 2.14–18.13) and 11+ hours (OR: 25.75, 95% CI: 8.14–90.12) had higher odds of being ‘highly active’. Future research should examine the mechanisms driving the relationship between nighttime sleep and physical activity among Samoan children. Intervening on sleep duration and quality may improve physical activity and, in turn, obesity risk in this setting.</div

Prediction of fat mass from anthropometry at ages 7 to 9 years in Samoans: a cross-sectional study in the Ola Tuputupua’e cohort

Background/Objective: With increasing obesity prevalence in children globally, accurate and practical methods for quantifying body fat are critical for effective monitoring and prevention, particularly in high risk settings. No population is at higher risk of obesity than Pacific Islanders, including children living in the independent nation of Samoa. We developed and validated sex-specific prediction models for fat mass in Samoan children. Subjects/Methods: Dual x-ray absorptiometry (DXA) assessments of fat mass and weight, height, circumferences, and skinfolds were obtained from 356 children aged 7-9 years old in the Ola Tuputupua’e “Growing Up” study. Sex-specific models were developed from a randomly selected model development sample (n=118 females, n=120 males) using generalized linear regressions. In a validation sample (n=59 females; n=59 males), Lin’s concordance and Bland-Altman limits-of-agreement (LoA) of DXA-derived and predicted fat mass from this study and other published models were examined to assess precision and accuracy. Results:  Models to predict fat mass in kilograms were: e^[(-0.0034355*Age8-0.0059041*Age9+1.660441*l n⁡(Weight(kg))-0.0087281 *Height(cm)+0.1393258 *ln⁡[Suprailiac(mm)]-2.661793)]  for females and e^[-0.0409724 *Age8-0.0549923*Age9+336.8575*[Weight(kg)]^(-2)-22.34261 *l n⁡(Weight(kg)) [Weight(kg)]^(-1)+0.0108696*Abdomen(cm)+ 6.811015 *〖Subscapular (mm)〗^(-2)-8.642559 *l n⁡(Subscapular(mm)) 〖Subscapular(mm)〗^(-2)-1.663095 *Tricep(mm)^(-1)  +3.849035]  for males, where Age8=Age9=0 for children at age 7 years, Age8 =1 and Age9=0 at 8 years, Age8 =0  and Age9 = 1 at 9 years. Models showed high predictive ability, with substantial concordance (ρ_C>0.96), and agreement between DXA-derived and model-predicted fat mass (LoA female= -0.235, 95% CI:-2.924-2.453; male= -0.202, 95% CI:-1.977-1.572). Only one of four existing models, developed in a non-Samoan sample, accurately predicted fat mass among Samoan children. Conclusions: We developed models that predicted fat mass in Samoans aged 7-9 years old with greater precision and accuracy than the majority of existing models that were tested. Monitoring adiposity in children with these models may inform future obesity prevention and interventions.</p

Logistic regression models of child physical activity on child, family, and household-level characteristics.

Logistic regression models of child physical activity on child, family, and household-level characteristics.</p