Eight countries, Cook Islands, Fiji, Kiribati, Nauru, Solomon Islands, Tokelau, Tonga and Wallis and Futuna, have two published NCD survey reports giving us an overall sample of 12,076 for first round survey and 9,357 for second round survey (Table 2 and 3). The time between surveys in each country ranged from 8 to 11 years (mean = 9.75 years).
Table 2
Population included from Survey 1, number of participants with information on dietary NCD risk factors
Country
|
Survey 1
|
Age range
|
Five fruit and veg
|
Overweight and obesity
|
Hypertension
|
Hypercholesterol
|
Cook Islands
|
2003
|
45-64
|
985
|
939
|
950
|
871
|
Fiji
|
2002
|
25-64
|
NA
|
4190
|
5012
|
NA
|
Kiribati
|
2004
|
25-64
|
1329
|
1351
|
1368
|
741
|
Nauru
|
2004
|
25-64
|
1653
|
1710
|
1705
|
1726
|
Solomon Islands
|
2005
|
25-69
|
1910
|
1665
|
1702
|
470
|
Tokelau
|
2006
|
25-64
|
392
|
427
|
333
|
427
|
Tonga
|
2004
|
24-64
|
848
|
844
|
848
|
847
|
Wallis and Futuna
|
2009
|
45-64
|
146
|
162
|
158
|
NA
|
Total
|
|
|
7263
|
11279
|
12076
|
5236
|
Table 3
Population included from Survey 2, time between surveys, number of participants with information on dietary NCD risk factors
Country
|
Survey 2
|
Approximate timeframe since Survey 1 (years)
|
Age range
|
Five fruit and veg
|
SSB Daily
|
Overweight and obesity
|
Hypertension
|
Hyperglycemia
|
Hypercholesterol
|
Cook Islands
|
2013
|
10
|
45-64
|
611
|
NA
|
430
|
411
|
346
|
368
|
Fiji
|
2011
|
9
|
25-64
|
NA
|
NA
|
2526
|
2548
|
2378
|
NA
|
Kiribati
|
2015
|
11
|
30-69
|
1329
|
1900
|
1351
|
1368
|
861
|
741
|
Nauru
|
2015
|
11
|
25-64
|
838
|
1317
|
861
|
691
|
667
|
668
|
Solomon Islands
|
2015
|
10
|
30-69
|
1856
|
2443
|
1440
|
1472
|
1340
|
1342
|
Tokelau
|
2015
|
9
|
30-69
|
390
|
547
|
384
|
387
|
382
|
288
|
Tonga
|
2012
|
8
|
25-69
|
2438
|
NA
|
2273
|
2332
|
2287
|
2065
|
Wallis and Futuna
|
2019
|
10
|
45-64
|
661
|
NA
|
626
|
628
|
606
|
NA
|
Total
|
8123
|
6207
|
9195
|
8187
|
8851
|
9195
|
Fruit and vegetable consumption
Figure 1 reports age-standardized prevalence of adults consuming less than 5 serves of fruits and vegetables per day. Prevalence decreased significantly in Tonga from 92.2% (95%CI: 90.4, 94.0) to 73.4% (95%CI: 71.6, 75.1) over 8 years, and in the Solomon Islands from 93.8% (95%CI: 92.6, 94.9) to 87.4% (95%CI: 85.9, 88.9) over 9 years. In both countries statistically significant reductions were observed for both women and men (see appendix 1). In Nauru and Wallis and Futuna, prevalence decreased statistically significantly for men only, from 98.4% (95%CI: 97.6, 99.4) to 94.84% (95%CI: 92.5, 97.2) and 96.3% (95%CI: 92.3, 100.3) to 88.3 (95%CI: 83.9, 91.8) respectively. In Tokelau on the other hand, prevalence increased from 90.8% to 96.5% over the 9 years between 2006 and 2015.
The pooled analysis revealed a significant decrease in the proportion of adults consuming less than 5 serves of fruit and vegetables per day, from 94% (95%CI: 93.9, 94.5) to 88% (95%CI: 87.5, 88.2), significant for both men and women.
Sugary drink consumption
Four of the countries measured sugary drink consumption in Survey 2. Adults in Kiribati, Nauru and Tokelau (across both sexes) reported consuming over 3.5 sugary drinks each per day. In contrast, Solomon Islands adults reported consuming an average of 0.4 sugary drinks per day. SSB consumption did not vary significantly between men and women (Table 4).
Table 4
Average daily consumption of sugary drinks by adults in Survey 2
Country (survey year)
|
Age group
|
Average serves* per day (95%CI)
|
Men (%)
|
Women (%)
|
Both (%)
|
Kiribati (2015)
|
18-69
|
3.5 (1.6-5.4)
|
3.9 (1.9-5.8)
|
3.7 (2.0-5.5)
|
Nauru (2015)
|
18-69
|
3.9 (3.4-4.4)
|
4.3 (3.4-5.2)
|
4.1 (3.6-4.6)
|
Solomon Islands (2015)
|
18-69
|
0.3 (0.3-0.4)
|
0.3 (0.2-0.4)
|
0.4 (0.3-0.5)
|
Tokelau** (2014)
|
18-69
|
3.9
|
4.1
|
4.0
|
*A sugary drink is defined as fizzy drink, squash, cordial, drink concentrates and juice drinks excluding pure unsweetened fruit juice. One serving is defined as one can of drink, or one large glass.
** No CI as entire target population was included in the survey
|
Adding salt to meals before consumption
Mechanisms for measuring salt varies significant across the included surveys. Five countries (table above) asked about ‘always or often’ adding salt before eating or when eating (Cooks, Kiribati, Tokelau, Solomon Islands, Nauru)(Table 5). Nauru and Cook Islands reported the per cent of participants ‘always or often’ eating processed food high in salt (Cook Islands, Nauru), and applied a likert scale querying participants on the importance of lowering dietary salt. Because of this variation we only extracted data on the percent of adults in Survey 2 ‘always of often’ adding salt to meals before eating.
The proportion of adults ‘always or often’ adding salt to meals before eating ranged from 31.6% in Tokelau (higher for women than men) to 65.4% (60.5-70.3) in Nauru. Based on urinary analysis, adults in Tokelau, consumed an average of 10.1g/day of salt, and consumption was higher for men (12.0g/day) than women (8.6g/day). In Wallis and Futuna salt consumption was 10.2g/day, also higher for men (11.7g/day) than women (8.8g/day).
Table 5
Percent of adults ‘always or often’ adding salt before eating
Survey
|
Age group (years)
|
Adults who add salt ‘always or often’ before eating or when eating (95%CI)*
|
|
|
Men (%)
|
Women (%)
|
Both (%)
|
Cook Islands
|
18-64
|
37.3 (33.9-40.7)
|
35.7 (32.9-38.5)
|
36.4 (34.3-38.6)
|
Kiribati
|
18-69
|
34.5 (27.6-41.4)
|
47.0 (37.4-56.6)
|
41.3 (33.7-48.9)
|
Nauru
|
18-69
|
63.5 (60.5-66.4)
|
67.1 (60.1-74.2)
|
65.4 (60.5-70.3)
|
Solomon Islands (2015)
|
18-69
|
48.8 (43.0-54.7)
|
44.6 (39.9-49.2)
|
46.6 (42.0-51.1)
|
Tokelau (2014)**
|
18-69
|
25.8
|
36.6
|
31.6
|
|
|
Average salt intake based on urinary sodium (g/day)
|
Tokelau (2014)**
|
18-69
|
12.0
|
8.6
|
10.1
|
Wallis and Futuna (2019)
|
18-69
|
11.7 (11.5-12.0)
|
8.8 (8.7-9.0)
|
10.2 (9.8-10.5)
|
* Dietary salt includes ordinary table salt, unrefined salt such as sea salt, iodized salt, salty stock cubes and powders, and salty sauces such as soya sauce or fish sauce. This question relates to salt added directly before consumption (regardless of meal composition).
** No CI due to measuring entire population
|
Overweight and obesity
Figure 2 reports age-standardized prevalence of overweight and obesity. There was a statistically significant increase in overweight and obesity from 59.1% (95%CI: 57.5, 60.5) to 67.96% (95%CI: 66.1, 69.8) in Fiji largely attributable to an increase for women from 75.2% (95%CI: 74.1, 76.3) to 85.3% (95%CI: 84.4, 86.3). Prevalence also increased in Tokelau from 93.3% to 95.2% largely driven by a 1 percentage point increase in prevalence for women from 94.5% to 95.4%. Indeed, women live with a higher prevalence of overweight and obesity in all countries except Nauru. No significant differences were observed between surveys for the Cook Islands, Kiribati, the Solomon Islands or Tonga.
The pooled analysis revealed a significant increase from 76.9% (95%CI: 76.1, 77.7) to 82.1% (95%CI: 81.3, 82.9) in the proportion of adults living with overweight or obesity.
Adults living with hypertension
Prevalence of hypertension increased in 6 countries. In Kiribati prevalence increase from 18.4% (95%CI: 16.4, 20.4) to 42.13% (95%CI: 38.9, 45.4)], in the Solomon Islands from 9.6% (95%CI: 8.1, 11.1) to 26.83% (95%CI: 23.5, 27.9)], in Nauru from 29.5% (95%CI: 27.3, 31.8) to 37.6% (95%CI: 33.9, 41.2)], in Tokelau from 35.6% to 42.4%), in Tonga from 23.9% (95%CI: 21.1, 26.7) to 29.8% (95%CI: 28.1, 31.6) and in Fiji from 25.7% (95%CI: 24.6, 26.8) to 30.81% (95%CI: 29.2, 32.5) (figure 3). Increases were significant for women in all countries and for men except in Nauru and Tonga. Against this pattern, hypertension prevalence decreased from 58.6 (95%CI: 55.5, 61.8) to 47.2 (95%CI: 42.3, 52.2) in the Cook Islands driven by a large decrease for men.
The pooled analysis showed an overall increase in the prevalence of hypertension from 25.4% (95%CI: 24.7, 26.2) to 33.41% (95%CI: 32.5, 34.4) for the 8 countries
Adults living with hypercholesterolemia
Six countries had comparable measures of hypercholesterolaemia (Figure 4). Prevalence increased from 25.1% (95%CI: 21.1, 29.1) to 35.8% (33.2, 38.4) in the Solomon Islands and from 42.22% to 65.96% in Tokelau. Prevalence decreased from 80.0% (95%CI: 77.3, 82.8) to 58.24% (95%CI: 63.2, 52.9) in the Cook Islands, and from 27.7% (95%CI: 24.4, 30.9) to 17.8% (95%CI: 20.4, 15.2) in Kiribati. Significant reductions were observed for men and women in both countries.