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Background: Food consumption, sleep duration and overweight were assessed in rural and urban Melanesian adolescents. Methods: A cross-sectional survey of 312 rural and 104 urban adolescents (11-16 years old) was conducted. Food intakes were assessed by a 26-item food frequency questionnaire and then categorised into the number of serves from each of the three recommended Pacific food groups (energy foods, protective foods, bodybuilding foods), with two additional categories for foods and drinks to be avoided i.e., processed foods and sugary drinks. Number of food serves were compared with the guidelines of 50% serves from energy foods, 35% serves from protective foods and 15% serves from bodybuilding foods. Sleep duration as hours per day was self-reported and body mass index (BMI) was calculated from measured weight and height. Results: Approximately 17.9% of rural and 26.9% of urban adolescents met the guidelines for energy foods; 61.5% rural and 69.2% urban met the serves for protective foods and 88.5% and 94.2% met the serves for bodybuilding foods. Less than 6.4% rural and 1.9% urban adolescents avoided processed foods but 61.5% rural and 56.7% urban avoided sugary beverages. Sleep duration for school days was below the international recommendations and did not significantly differ between rural and urban groups: respectively, 8.16 ± 1.10 and 8.31 ± 1.29 h. Overweight/obesity percentage was 38.1% for rural and 31.7% for urban adolescents. Conclusions: Although traditional foods, including protective food, are still part of the adolescents' diet, low consumption of the energy food group and high consumption of processed food occurs regardless of location. As poor eating habits and insufficient sleep may contribute to overweight/obesity, educational nutrition programs should target these lifestyle variables.
Living in Rural and Urban Areas of New Caledonia:
Impact on Food Consumption, Sleep Duration and
Anthropometric Parameters Among
Melanesian Adolescents
Olivier Galy 1, * , Emilie Paufique 1, Akila Nedjar-Guerre 1, Fabrice Wacalie 1,
Guillaume Wattelez 1, Pierre-Yves Le Roux 1, Solange Ponidja 1, Paul Zongo 1,
Christophe Serra-Mallol 2, Margaret Allman-Farinelli 3and Stéphane Frayon 1
1Interdisciplinary Laboratory for Research in Education, EA 7483, University of New Caledonia,
Avenue James Cook, 98800 Nouméa, New Caledonia; (E.P.); (A.N.-G.); (F.W.); (G.W.); (P.-Y.L.R.); (S.P.); (P.Z.); (S.F.)
2CERTOP—University of Toulouse Jean Jaurès, 5 Allée Antonio Machado, 31058 Toulouse, France;
3Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia;
*Correspondence:; Tel.: +687-290-545
Received: 15 February 2020; Accepted: 15 June 2020; Published: 10 July 2020
Background: Food consumption, sleep duration and overweight were assessed in rural
and urban Melanesian adolescents. Methods: A cross-sectional survey of 312 rural and 104 urban
adolescents (11–16 years old) was conducted. Food intakes were assessed by a 26-item food frequency
questionnaire and then categorised into the number of serves from each of the three recommended
Pacific food groups (energy foods, protective foods, bodybuilding foods), with two additional
categories for foods and drinks to be avoided i.e., processed foods and sugary drinks. Number of
food serves were compared with the guidelines of 50% serves from energy foods, 35% serves from
protective foods and 15% serves from bodybuilding foods. Sleep duration as hours per day was
self-reported and body mass index (BMI) was calculated from measured weight and height. Results:
Approximately 17.9% of rural and 26.9% of urban adolescents met the guidelines for energy foods;
61.5% rural and 69.2% urban met the serves for protective foods and 88.5% and 94.2% met the serves
for bodybuilding foods. Less than 6.4% rural and 1.9% urban adolescents avoided processed foods
but 61.5% rural and 56.7% urban avoided sugary beverages. Sleep duration for school days was
below the international recommendations and did not significantly dier between rural and urban
groups: respectively, 8.16
1.10 and 8.31
1.29 h. Overweight/obesity percentage was 38.1% for
rural and 31.7% for urban adolescents. Conclusions: Although traditional foods, including protective
food, are still part of the adolescents’ diet, low consumption of the energy food group and high
consumption of processed food occurs regardless of location. As poor eating habits and insucient
sleep may contribute to overweight/obesity, educational nutrition programs should target these
lifestyle variables.
food habits; nutrition behaviour; ethnicity; lifestyle; adolescents; sustainable
development; Pacific
Nutrients 2020,12, 2047; doi:10.3390/nu12072047
Nutrients 2020,12, 2047 2 of 14
1. Introduction
Pacific Island Countries and Territories (PICTs) have been undergoing a brutal socioeconomic
transition over the past 70 years. Pacific cultures have been exposed to a military presence during
and after World War II [
], the development of centralised political rule, monetisation of economic
systems and increased trade globalisation. Clearly, a lifestyle transition has been underway, and a
diet once based on fresh seafood, vegetables and tubers has shifted to include canned meat or fish,
oil, sugar, rice and processed foods [
]. At the same time, daily activity, which was once based on
fishing and agriculture, has shifted to more sedentary activities that have had a major impact on
health [
]. More recently, the mechanisation and digitisation of environments have also influenced
daily behaviour and activity, including physical activity and sleep duration. Indeed, when sleep
is less than optimal, energy expenditure is aected: sleep-deprived individuals are prone to feel
sleepy and tired in the daytime, thus preferring sedentary activities to physical activities, which then
lowers the energy expenditure [
]. Sleep deprivation negatively impacts metabolism, with rises in
the hunger hormone ghrelin and increases in energy intake, particularly poor-nutrient energy-dense
foods, as reported in Western populations [
]. These combined lifestyle variables are the root cause
(but not unique) of noncommunicable diseases, and the young Pacific population is extremely exposed.
The prevalence of overweight and obesity is very high in New Caledonian adolescents (from 36% to
43%, depending on age and the reference used to assess overweight) [
], and this is particularly
the case for Melanesians. Indeed, a recent study showed that the prevalence of overweight/obesity
was higher in 11 to 16-year-old Melanesian and Polynesian adolescents than in Caucasian adolescents,
respectively, 38.2%, 30.4% and 21.3% [12].
In New Caledonia, where per capita income is much higher than in other PICTs [
], small-scale
family farming is the predominant form of the agricultural system, particularly in the Loyalty Islands
and Northern Province, inhabited mostly by the Melanesian people. In Melanesian culture, family
farming remains prevalent [
], although sometimes household members leave the tribe to seek work
in towns. Agricultural activities, hunting and fishing remain strong, despite the proliferation of
development hubs, rising education levels and improved living conditions [
]. Nevertheless,
young people continue to be exposed to new food environments and have thus enlarged their food
choices and diversified their eating habits in both positive and negative ways [
]. Emergent food
environments in low-to-middle-income countries have created conditions that facilitate the choice
of lower-cost, less-healthy, more energy-dense foods, which may lead to overweight and obesity as
access to healthy foods diminishes [
]. The Pacific Guidelines for Healthy Living provide advice
about diet, physical activity, smoking and alcohol. These guidelines outline the proportions of foods to
be consumed from three ‘healthy’ food groups (energy, protective and bodybuilding) and indicate the
foods that should be limited. Water is the beverage of choice and sugar-sweetened beverages (SSBs)
should be avoided [
]. Comparing food intakes with these guidelines can yield valuable insight
into the food environments that these Pacific communities are experiencing [
]. In New Caledonia,
another way to gain insight into the eects of the ongoing lifestyle transition might be to determine the
proportion of ‘healthy foods’ versus ‘limited foods’ consumed by adolescents living in rural versus
urban areas. In this context, ‘healthy food’ consumption can be defined as eating a variety of fresh
local foods from the three food groups in the appropriate amounts each day (energy: 50% of food,
protective: 35% and bodybuilding: 15%) and limiting food and beverages high in salt, sugar and fat.
This means that imported processed food/drinks from the food industry should only be eaten in small
amounts. Recent studies have demonstrated that the lifestyles of New Caledonian adolescents have
undergone striking changes, characterised by a preference for highly processed drinks like SSBs [
breakfast skipping [
] and relatively low physical activity [
]. These changes may have contributed
to the prevalence of overweight and obesity in Melanesian adolescents, especially those living in rural
areas, although no study has yet investigated this hypothesis. Yet Melanesian girls from rural areas
were found to be less physically active than their urban counterparts [
], and this may result in the
higher prevalence of overweight and obesity as previously observed for body fat mass with 27.5%
Nutrients 2020,12, 2047 3 of 14
and 23.9% in rural and urban adolescents of similar age [
]. In addition, sleep behaviour is widely
associated with overweight and obesity, and several associated factors, like the influence of media at
home in the evening and school transport in isolated areas, impact sleep duration [
]. We therefore
hypothesised that food consumption, with the respective contributions of ‘healthy food’ and ‘limited
food’, and sleep duration would dier according to the living environment (i.e., urban and rural) of the
Melanesian adolescents and have an impact on anthropometric parameters.
This study aimed to assess food consumption, sleep duration and anthropometric parameters of
Melanesian adolescents living in rural and urban areas in New Caledonia to provide baseline measures
as the Pacific region undergoes transition.
2. Materials and Methods
2.1. Data Collection and Participants
This research is part of a community-based food culture project underway in New Caledonia and
its provinces: Northern Province, Southern Province and Loyalty Islands. All dier substantially in
terms of ethnic distribution, socioeconomic status and urbanisation. The ethnic groups are as follows:
Melanesian: 39.0%, European: 34.4%, Polynesian: 10.0%, Asian: 2.7% and other groups 14.1% [
The Melanesian community is distributed as follows: 77.0% live in rural areas and 23.0% in urban
areas [
]. Forty percent of the public schools are in rural areas (n=13) and 60% in urban areas
(n=20) [
]. The criteria for selecting the schools for this study were (1) location (rural and urban),
(2) sucient school size (n>200) and (3) the agreement of the school’s principal. Five schools were
eligible in Southern Province (urban area), two in Northern Province (one on each coast) and only one
in Loyalty Islands (Lifou Island). Participating classes were then randomly drawn from within these
eligible schools. The school and participant selection processes are more fully described elsewhere [
We gathered data from July 2018 to April 2019 from 1060 adolescents from the community-based
food culture project, 11 to 16 years old from several ethnic community. In the current study, only
Melanesian adolescents were considered, providing a final sample of 416 Melanesian adolescents
representing 39.2% of the total sample and reflecting the percentage of Melanesians in the New
Caledonian population [13].
We obtained informed written consent from all parents before their children entered the study.
The research met the legal requirements and the Declaration of Helsinki, and the protocol was approved
by the Ethics Committee of the University of New Caledonia: CCE 2018-06 001.
2.2. Measures
2.2.1. Anthropometric Parameters
A trained stacollected the anthropometric data in the school nurse’s oce. A portable stadiometer
(Leicester Tanita HR 001, Tanita Corporation, Tokyo, Japan) measured height to the nearest 0.1 cm.
Weight was assessed to the nearest 0.1 kg using a scale (Tanita HA 503, Tanita Corporation, Tokyo,
Japan), with the adolescents wearing light clothing. From these measurements, body mass index (BMI)
was calculated as follows BMI =weight [kg]/([height [m])2.
We used the International Obesity Task Force (IOTF) criteria for children to define the adolescents
as thin (underweight), normal weight, overweight or obese. The IOTF criteria provide BMI cut-os for
weight status based on BMI values according to age and sex [25].
2.2.2. Sociodemographic Characteristics
The adolescents used an anonymous survey tool to report ethnicity, and the ethnic groups
were categorised following the recommendations from the report on New Caledonia [
] by the
Institut National de la Sant
Et de la Recherche M
dicale (INSERM; National Institute of Health
and Medical Research). Three SES categories were determined based on the National Statistics
Nutrients 2020,12, 2047 4 of 14
Socio-Economic Classification [
]: managerial and professional occupations (high), intermediate
occupations (medium), and routine and manual occupations (low). We referred to the latest census in
New Caledonia [
] and a European standard to determine the degrees of urbanisation [
]: Noumea
and its suburbs were classified as urban and the other areas were classified as rural.
2.2.3. Food Frequency Questionnaire (FFQ)
The short FFQ was adapted from the validated version of the FFQ for Aboriginal and Torres
Strait Islanders by Gwynn et al. [
], in the absence of a validated FFQ for New Caledonia. Minor
modifications were made by the research team to include foods identified as important in the diet
of Melanesian adolescents [
] (Table 1). For example, tubers such as cassava, yams and taro are
consumed rather than white potatoes, and a common snack food is reconstituted noodle soup, e.g.,
Maggi noodles. The FFQ contains 26 questions on food and beverage intake with additional questions
on the purchase of food on the journey to and from school and at the school canteen.
For each participant, we calculated the number of serves for each of the following ten food
categories: (1) cereals (bread, pasta and rice); (2) vegetables and legumes (all varieties excluding
tubers); (3) fruit (all varieties including dried); (4) dairy (milk, yoghurt and cheese); (5) fats/oils (butter);
(6) red meat, pork, fish, poultry and eggs; (7) water; (8) SSBs; (9) extra foods high in salt or sugar
or saturated fat (french fries, salty processed meats, chocolate and confectionary, cakes, pastries and
biscuits); and (10) other (tubers such as cassava, yams, taro, sweet potato; noodle soup; take-away
food and breakfast cereals). To gain a global understanding of how well the food consumption in
rural and urban areas met the Pacific guidelines, the above ten food categories were condensed to
the three main food groups for the Pacific communities, plus limited foods, limited beverages and
water [
] as described in Table 1. These groups are: (1) energy foods (cereals and tubers), which
should comprise 50% of the food intake corresponding to a minimum of 6 serves per day; (2) protective
foods (vegetables, fruits), which should comprise 35% of food intake corresponding to a minimum of
5 serves per day; (3) bodybuilding foods (red meat, pork, fish, poultry and eggs, dairy and legumes),
which should comprise 15% of all foods corresponding to a minimum of 1.5 serves per day; (4) limited
foods (extra foods high in salt or sugar or saturated fat); (5) limited beverages (SSBs); and (6) water.
It should be noted that extra foods and other foods like noodle soup with Maggi sauce, cakes and
confectionary, as well as SSBs, are not recommended, but the number of serves of these was calculated.
Nutrients 2020,12, 2047 5 of 14
Table 1.
Dietary intake extracted from Gwynn’s FFQ [
] was analysed using the Pacific Food Group
Guidelines from the South Pacific Community [19].
Pacific Guidelines
Food Groups Main Nutrients Provided Food Question Extracted from Gwynn’s FFQ
Dietary fibre
How often do you eat bread (piece)? This
includes baguette bread, baby bread,
coconut bread, sandwich bread, etc.
Pasta and rice How often do you eat pasta or rice?
How often do you eat tubers (cassava, yam,
taro, sweet potato, etc.)?
Dietary fibre
How often do you usually eat vegetables
per day (for example, salad, green beans,
cabbage, carrots, tomatoes, etc.)? This
includes all fresh, frozen and
canned vegetables.
How often do you eat fruits per day (for
example, papaya, banana, mango, orange,
apple, etc.)? This includes all fresh, dried,
frozen and canned fruits.
Proteins and essential amino acids
Fatty acids
Fibre (from dried beans and nuts)
Lentils, beans How often do you eat lentils, split peas or
dried beans?
What is the total amount of milk you
generally drink each day? Take into
account all types of milk (brick, powder,
milk consumed with cereals, etc.)
Cheese How often do you eat cheese?
Yoghurt How often do you eat yoghurt?
Red meat
How often do you eat red meat (such as
beef, deer or lamb)? This includes all steaks,
ribs, roasts, minced meat, stirfries
and stews.
White meat How often do you eat white meat
like chicken?
Fish How often do you eat fish?
Pork How often do you eat pork?
Eggs How often do you eat eggs?
Limited beverage SSB How many sweetened drinks do you
usually drink (juice, soda, lemonade)?
Limited food
How often do you eat your bread with
butter or margarine
(for example, Meadowlea)?
Canned meat
How often do you eat canned meat (corned
beef, ouaco beef, etc.)?
Deli meats How often do you eat cold cuts, sausages,
pâté, canned ham?
French fries How often do you eat french fries?
Salty snacks
How often do you eat potato chips or other
salty snacks (Twisties, Doritos, etc.)?
Sweeties How often do you eat confectionery
(lollipops, chocolate etc.)?
Sweet foods How often do you eat sweet foods such as
sweet biscuits, cake or pastries?
Breakfast cereals How often do you eat breakfast cereals?
Noodle soup
How often do you usually eat noodle soup
(bowl of soup, Maggi soup, Yum Yum
soup, etc.)?
Take-away food
How often do you eat meals such as
hamburgers, pizzas, fries from places
selling take-away food?
Water Water
How much water do you usually drink
each day? It can be tap water or bottled
water (a small bottle =two glasses).
Nutrients 2020,12, 2047 6 of 14
2.2.4. Sleep
The sleep duration was determined with the following four questions: ‘What time do you fall
asleep on school days?’, ‘What time do you fall asleep on the weekend?’, ‘What time do you wake
up in the school week?’ and ‘What time do you wake up on the weekend?’ There were 13 available
categories for the time an adolescent might fall asleep from ‘Around 9 pm or before’ to ‘Around
3 am or later’ with a 30-min interval between each category. There were 15 available categories for
the wake-up time from ‘Around 5 am or before’ to ‘Around midday or later’ with a 30-min interval
between each category. Answers were converted to numerical values by using the median value of
the time interval in the categorised answer or by using 30 min before (respectively after) for the first
(respectively the last) category. The final sleep duration was the dierence between the wake-up time
and the falling-asleep time.
First, answers about sleeping duration during the school week and the weekend were separately
processed and then both factors were combined to get a total sleeping duration for the full week
as follows:
Sleep (Total Week)=
×Sleep (Week days)+
×Sleep (weekend)
. Sleep durations were
determined according to the recommendations from Hirshkowitz et al. [
] about sleeping, with a
threshold of 9 h 30 min for these 11- to 16-year-old adolescents.
2.3. Statistics
Analyses were conducted using R 3.5.1. [
], with an accepted type I error probability set at
0.05. We tested the dierences between adolescents living in rural and urban areas for each
parameter. For categorical parameters, the
test was performed when Cochran’s rule was verified,
otherwise Fisher’s exact test was used. For numerical parameters, Student’s t-test of means equality
was used when the assumption of variance equality was not rejected after an F test to compare
variances, otherwise the Welch test of means equality was used. The sample size (both in rural and
urban Melanesian adolescents) authorised these two parametric tests.
The percentages of adolescents meeting the dietary guidelines for each of the Pacific food groups
(energy: 6 serves/day, protective: 5 serves/day, bodybuilding: 1.5 serves/day) was calculated in the
whole sample and according to sex, weight status and the living area. The dierences in proportions
between rural and urban adolescents meeting the guidelines were tested with the
test when
Cochran’s rule was verified and otherwise with the Fisher’s exact test.
3. Results
3.1. SES, Anthropometry and Sleep Duration
The descriptive data, both overall and by sex, are presented in Table 2. The sample of 204 boys
and 212 girls was all within the age range of 11 to 16 years. The breakdown of SES was: 11.8% high
status, 11.3% intermediate status and 76.2% low status.
The percentage of overweight or obesity was 38.1% for rural and 31.7% for urban adolescents.
No significant dierences emerged between adolescents living in rural and urban areas, both in girls
and boys. No other significant dierences in demographic characteristics, such as place of residence or
SES, were found.
Sleep duration in the school week or the weekend did not dier between rural and urban groups.
However, average sleep duration was substantially below the international recommendations (9.50 h
per night) [23] in both living areas, with 8.34 and 8.55 h per night in rural and urban areas.
Nutrients 2020,12, 2047 7 of 14
Table 2.
Anthropometric (weight, height, weight status) and sociodemographic characteristics (SES) and sleep duration according to the adolescents’ living area (rural
or urban) and sex. Numbers represent ‘Mean (Standard deviation)’ for the numerical variables (Age, Anthropometry and Sleep duration) and ‘Size (%)’ for the
categorical variables (SES, Weight status and Meals). Statistical significance was noted in the p-value column.
Whole Sample Female Male
(n=104) p-Value Rural
(n=45) p-Value Rural
(n=59) p-Value
Subjects [Mean (sd)] Age (months) 160.52
(12.60) 0.011 162.16
(11.68) 0.020 158.64
(13.36) 0.381
SES [n(%)]
Higher 35 (11.2%) 14 (13.4%)
17 (10.2%) 4 (8.9%)
18 (12.4%) 10 (17.0%)
Intermediate 29 (9.3%) 18 (17.3%) 17 (10.2%) 8 (17.8%) 12 (8.3%) 10 (17.0%)
Lower 245 (78.5%) 72 (69.2%) 131 (78.4%) 33 (73.3%) 114 (78.6%) 39 (66.1%)
[Mean (sd)]
Height (cm) 156.5 (8.9) 157.3 (8.9) 0.417 156.7 (7.2) 157.0 (5.3) 0.762 156.2 (10.5) 157.5 (11.0) 0.427
Weight (kg) 54.4 (14.4) 54.1 (14.0) 0.846 55.4 (13.2) 55.4 (11.6) 1.000 53.3 (15.7) 53.1 (15.6) 0.942
Weight status [n(%)] Underweight and Normal 193 (61.9%) 71 (68.3%) 0.290 98 (58.7%) 29 (64.4%) 0.597 95 (65.5%) 42 (71.2%) 0.537
Overweight and obese 119 (38.1%) 33 (31.7%) 69 (41.3%) 16 (35.6%) 50 (34.5%) 17 (28.8%)
Sleep duration
[Mean (sd)]
Weekday (h/day) 8.16 (1.10) 8.31 (1.29) 0.302 8.15 (1.11) 8.29 (1.26) 0.459 8.18 (1.09) 8.32 (1.32) 0.427
Weekend (h/day) 8.80 (1.69) 8.84 (1.99) 0.854 8.96 (1.63) 9.01 (2.02) 0.854 8.61 (1.74) 8.70 (1.98) 0.740
All week (h/week) 58.40 (7.03) 59.21 (8.46) 0.380 58.65 (7.22) 59.47 (8.35) 0.516 58.12 (6.81) 59.02 (8.61) 0.475
Meals [n(%)]
Lunch at school 205 (65.7%) 96 (92.3%)
108 (64.7%) 43 (95.6%)
97 (66.9%) 53 (89.8%)
No lunch at school 15 (4.8%) 8 (7.7%) 6 (3.6%) 2 (4.4%) 9 (6.2%) 6 (10.2%)
In boarding school 92 (29.5%) 0 (0.0%) 53 (31.7%) 0 (0.0%) 39 (26.9%) 0 (0.0%)
Nutrients 2020,12, 2047 8 of 14
3.2. Food Consumption and Frequency on School Days
Food consumption for the energy, protective and bodybuilding groups did not significantly dier
between the rural and urban adolescents (Figure 1). The extra and other foods defined as limited and
SSBs showed no dierences, with high consumption observed for those living in both rural and urban
areas (Table 3and Figure 1). The average contribution of the food groups for the rural and urban
adolescents was, respectively: energy: 22% and 23%, protective: 32% and 30% and bodybuilding:
19% and 20% (Figure 1). Moreover, the percentage of limited food averaged 21% and limited drinks
reached 6% for both rural and urban Melanesian adolescents. We also assessed the percentage of the
sample meeting the Pacific guidelines for the three food groups (using number of serves compared
with recommended daily intake) and found no dierences between rural and urban adolescents for the
whole sample, the underweight and normal-weight subgroup, or the overweight and obese subgroup
(Table 3). Most adolescents met the Pacific guidelines for bodybuilding foods. 61.5% of rural and
69.2% of urban adolescents consumed suciently protective foods including fruits and vegetables.
The recommended intake for the energy group was only achieved by 18.0% of rural and 26.9% of urban
adolescents. Less than 10% of these adolescents avoided limited foods and those in urban areas who
were normal or underweight all consumed these foods, with none totally avoiding them. More than
half the adolescents managed to avoid SSBs.
Nutrients 2020, 12, x FOR PEER REVIEW 8 of 14
3.2. Food Consumption and Frequency on School Days
Food consumption for the energy, protective and bodybuilding groups did not significantly
differ between the rural and urban adolescents (Figure 1). The extra and other foods defined as
limited and SSBs showed no differences, with high consumption observed for those living in both
rural and urban areas (Table 3 and Figure 1). The average contribution of the food groups for the
rural and urban adolescents was, respectively: energy: 22% and 23%, protective: 32% and 30% and
bodybuilding: 19% and 20% (Figure 1). Moreover, the percentage of limited food averaged 21% and
limited drinks reached 6% for both rural and urban Melanesian adolescents. We also assessed the
percentage of the sample meeting the Pacific guidelines for the three food groups (using number of
serves compared with recommended daily intake) and found no differences between rural and urban
adolescents for the whole sample, the underweight and normal-weight subgroup, or the overweight
and obese subgroup (Table 3). Most adolescents met the Pacific guidelines for bodybuilding foods.
61.5% of rural and 69.2% of urban adolescents consumed sufficiently protective foods including fruits
and vegetables. The recommended intake for the energy group was only achieved by 18.0% of rural
and 26.9% of urban adolescents. Less than 10% of these adolescents avoided limited foods and those
in urban areas who were normal or underweight all consumed these foods, with none totally
avoiding them. More than half the adolescents managed to avoid SSBs.
Figure 1. Food group proportions (percentages) and structure (yellow for energy group; green for
protective group, orange for bodybuilding group, red for limited food and red and white dots for
limited drinks) of rural (n = 312, middle column) and urban (n = 104, right column) adolescents
compared with the Pacific guidelines (left column) [19]. Data are expressed in percentages (%) per
Figure 1.
Food group proportions (percentages) and structure (yellow for energy group; green for
protective group, orange for bodybuilding group, red for limited food and red and white dots for
limited drinks) of rural (n=312, middle column) and urban (n=104, right column) adolescents
compared with the Pacific guidelines (left column) [
]. Data are expressed in percentages (%) per day.
Nutrients 2020,12, 2047 9 of 14
Table 3.
Food frequency, food group consumption expressed in serves per week (with school meals according to each adolescent‘s living area: rural or urban) and sex.
Statistical significance was noted in the p-value column.
Whole Sample Female Male
Serves per Day
[Mean (sd)] % Meeting the Guidelines Serves per Day
[Mean (sd)] % Meeting the Guidelines Serves per Day
[Mean (sd)] % Meeting the Guidelines
Rural Urban Rural Urban p-Values Rural Urban Rural Urban p-Values Rural Urban Rural Urban p-Values
Whole sample
Energy group 4.06 (2.20) 4.56 (2.54) 18.0 26.9 0.067 4.04 (2.28) 4.08 (2.30) 19.2 20.0 1.000 4.07 (2.12) 4.92 (2.66) 16.6 32.2 0.022
Protective group 5.55 (2.30) 5.60 (2.06) 61.5 69.2 0.196 5.47 (2.28) 5.67 (2.09) 60.5 73.3 0.158 5.65 (2.33) 5.55 (2.05) 62.8 66.1 0.772
Bodybuilding group 3.51 (1.77) 3.87 (2.15) 88.5 94.2 0.133 3.27 (1.65) 3.40 (1.83) 86.2 91.1 0.535 3.79 (1.85) 4.23 (2.32) 91.0 96.6 0.277
Limited foods 4.01 (2.63) 4.41 (2.80) 6.4 1.9 0.129 4.07 (2.63) 4.20 (2.82) 4.8 4.4 1.000 3.95 (2.64) 4.58 (2.80) 8.3 0.0 0.020
Limited beverages 1.16 (1.22) 1.36 (1.37) 61.5 56.7 0.452 1.11 (1.19) 1.40 (1.37) 62.9 53.3 0.321 1.21 (1.25) 1.33 (1.37) 60.0 59.3 1.000
Water 3.14 (1.14) 3.39 (1.07) 2.99 (1.19) 3.11 (1.06) 3.30 (1.07) 3.61 (1.03)
Underweight and
normal weight
Energy group 4.10 (2.23) 4.71 (2.50) 18.1 28.1 0.108 3.88 (2.26) 4.09 (2.13) 16.3 17.2 1.000 4.32 (2.19) 5.14 (2.66) 20.0 35.7 0.080
Protective group 5.54 (2.36) 5.70 (2.12) 60.1 69.0 0.237 5.23 (2.31) 5.74 (2.24) 55.1 72.4 0.147 5.86 (2.39) 5.67 (2.06) 65.3 66.7 1.000
Bodybuilding group 3.53 (1.76) 3.81 (2.14) 89.1 94.4 0.292 3.25 (1.65) 3.07 (1.61) 85.7 89.7 0.813 3.83 (1.83) 4.32 (2.33) 92.6 97.6 0.452
Limited foods 4.32 (2.81) 4.55 (2.91) 6.2 0.0 0.041 4.26 (2.82) 4.21 (2.85) 6.1 0.0 0.335 4.38 (2.80) 4.78 (2.97) 6.3 0.0 0.177
Limited beverages 1.21 (1.29) 1.40 (1.35) 61.7 53.5 0.293 1.19 (1.25) 1.37 (1.37) 60.2 89.7 0.788 1.23 (1.34) 1.43 (1.36) 63.1 52.4 0.319
Water 3.09 (1.15) 3.39 (1.10) 2.91 (1.20) 3.17 (1.11) 3.27 (1.08) 3.54 (1.08)
and obese
Energy group 3.99 (2.17) 4.23 (2.63) 17.7 24.2 0.547 4.28 (2.32) 4.07 (2.66) 23.3 25.0 1.000 3.60 (1.90) 4.37 (2.66) 10.0 23.5 0.216
Protective group 5.58 (2.20) 5.40 (1.93) 63.9 69.7 0.678 5.81 (2.20) 5.54 (1.84) 68.1 75.0 0.812 5.25 (2.17) 5.26 (2.06) 58.0 64.7 0.841
Bodybuilding group 3.47 (1.77) 4.00 (2.20) 87.4 93.9 0.457 3.29 (1.67) 3.99 (2.10) 87.0 93.8 0.742 3.72 (1.90) 4.01 (2.36) 88.0 94.1 0.669
Limited foods 3.52 (2.25) 4.12 (2.55) 6.7 6.1 1.000 3.80 (2.34) 4.17 (2.84) 2.9 12.5 0.328 3.13 (2.08) 4.08 (2.34) 12.0 0.0 0.325
Limited beverages 1.07 (1.09) 1.27 (1.40) 61.3 63.6 0.970 0.99 (1.10) 1.45 (1.41) 66.7 50.0 0.337 1.18 (1.08) 1.11 (1.42) 54.0 76.5 0.179
Water 3.21 (1.13) 3.39 (1.02) 3.11 (1.17) 3.00 (0.99) 3.36 (1.07) 3.76 (0.92)
Nutrients 2020,12, 2047 10 of 14
4. Discussion
By focusing on food consumption and sleep, this study confirmed an advanced transition in
one of the PICTs, New Caledonia. Both rural and urban Melanesian adolescents failed to meet
recommendations for the consumption of traditional energy sources and instead showed high
consumption of processed foods, although about three out of five avoided SSBs. Their sleep duration
was low, irrespective of the place of living. Overall, these behaviour patterns may have contributed to
the high rate of overweight and obesity in both rural and urban areas.
The Melanesian adolescents had retained some of the positive aspects of the traditional diet,
with 61.5% of the rural and 69.2% of the urban adolescents meeting the guidelines for the protective food
group with adequate daily serves (5.55 and 5.60 serves per day in rural and urban areas, respectively).
These findings contrast with the findings in Western countries like Australia, where many fail to meet
the national guidelines for fruit and vegetables (albeit 7–7.5 serves is recommended in Australia) [
and even in Fiji, where 60% of Melanesian adolescents fail to meet them [
]. In both rural and urban
areas, the adolescents more than met the daily serves for the bodybuilding group, which provides
the main sources of dietary protein and many micronutrients. However, rather than local traditional
sources of carbohydrate-rich foods, they tended to select snack foods and two out of five drank SSBs
whatever the living area. Moreover, we noted that water consumption is slightly lower in the rural
areas (3.14 serves/day) when compared with the urban areas (3.39 serves/day). We previously reported
on the high intake of SSBs and suggested such explanations as safety concerns about tap water and the
extensive marketing of these beverages [
]. However, the amount of limited beverages consumed
in the rural areas is also slightly lower on average (1.16 serves/day) when compared with the urban
areas (1.36 serves/day). The dierences between the rural and urban areas in beverages consumption
(water and limited beverages) are not statistically significant but the urban adolescents seem to drink
more beverages than their rural counterparts, especially in girls (rural: 4.10 serves/day and urban:
4.51 serves/day). Studies on other Pacific islands have shown how changes in food and beverage
intakes have led to unbalanced diets and predisposed to malnutrition characterised by overweight and
obesity, with possible micronutrient deficiency [
]. Nevertheless, our findings for the Melanesian
adolescents of New Caledonia are described for the first time. Substitution of traditional food energy
sources with highly processed foods high in sugar, fat and salt are consistent with Western diets
consumed in countries where obesity is epidemic. These dietary changes might explain the high
percentage of overweight and obesity (38.1% for rural and 31.7% for urban adolescents) observed in
this study and those of other studies [1012].
The pattern of lower consumption of ‘healthy food’ and higher consumption of ‘limited food’
of the Melanesians in the Pacific was apparent in both rural and urban dwellers. No dierences were
found for most food categories based on location. This might be because the adolescents have lunchtime
meals prepared at school (part-time boarders) and some also have dinner at school (full-time boarders).
These meals have standardised food intakes across regions. Other students had easy access to shops
to purchase food on their way to and from school. The types of foods on oer are typically those
high in added sugar, saturated fat or salt that should be limited in diets, and yet almost three in five
Melanesian adolescents reported buying food in the morning journey and a little over half on the trip
home. Not only are limited foods easily accessible, but they are also extensively marketed, persuading
adolescents to purchase them despite their low dietary quality. The abandonment of recommended
food groups in favour of ‘extra’ foods that should be limited has long been recognised in neighbouring
countries like Australia, where as much as 40% of the energy in adolescent diets comes from these
foods [
]. Such food patterns may result in excessive energy intake (in the present case, corresponding
to 27% of daily food intake, Figure 1), which would lead to weight gain in children [
]. By replacing
more nutritious foods, ‘extra’ foods might also lead to marginal intakes of some micronutrients [
One explanation for the current pattern of dietary intake is the reduced place of family farming in
the community. Family farming has played a central role in the Melanesian community and has fed
populations for decades in both rural and urban areas (urban gardens) [
]. Yet, population growth
Nutrients 2020,12, 2047 11 of 14
and climate change together have weaken food safety (Sustainable Goal Development number 2)
and health (Sustainable Goal Development number 3) in the Pacific population [
]. Second, traditional
foods with higher-fibre content are now juxtaposed with modern highly processed foods and beverages
that are highly visible in the marketplace. Indeed, the socioeconomic transition in the Pacific region
has accelerated over the past few decades and is characterised by the integration of commercial and
processed foods into the traditional diet, with both contributing to food over-abundance for meals [
Third, both what time and how frequently meals or snacks are consumed need to be considered.
One review suggested that how many and when meals are consumed throughout the day are not as
important as how energy is distributed across the meals [
]. This suggests that the combination of
breakfast skipping [
] and the timing and frequency of meals and snacks might play a major role in
adolescent weight status.
As one of the lifestyle components, sleep duration during the school week and the weekend
was substantially below the international recommendations [
] (Table 2). Indeed, adolescents in
both rural and urban areas wake up very early, as school begins between 7 and 7.30 am. When
the school transport time is factored in, sleep duration is de facto reduced, with wake-up times
between 5 and 5.30 am—even before 5 am for some of these families. The rhythms observed during
a typical school day added to a contemporary lifestyle at home in the evening (media, screen time,
etc.,) may be additional influences on food consumption, as already observed in Vanuatu adults [
Moreover, media messages are known to influence eating behaviours in adolescents [
] and may lead
to eating disorders [
]. Childhood obesity has traditionally been ascribed to habits of high-calorie
eating and sedentary lifestyles. Importantly, more recent research suggests that sleep duration may
also have a role in the development of obesity, as sleep is crucially implicated in hormonal release,
metabolic changes and lifestyle, all factors that contribute to overweight and obesity [
]. The exact
mechanisms underlying the relationship between sleeping and overweight and obesity require further
elucidation [
], but the link between insucient sleep and weight gain through high caloric intake
might involve increased ghrelin levels and decreased leptin levels, both of which stimulate appetite and
the intake of excessive food [45]. In addition, it has been shown that insucient sleep can aect food
choices, resulting in lower protective food consumption and higher consumption of limited food and
drinks [
]. In adolescents with sedentary activities (media use), there are many more opportunities to
eat highly processed food and drinks. Not least, insucient sleep impacts energy expenditure, with
sleep-deprived people feeling sleepy and tired in the daytime, prompting them to choose sedentary
activities over physical activity and exercise [4].
In the present context, the combined eects of unhealthy food behaviours, including increased
consumption of limited foods and daily snacking, and reduced sleeping time most likely contribute
to the high proportion of overweight and obesity in Melanesian adolescents across places of living.
It is clear that these behaviours will contribute to the development of chronic diseases among the
population over the long term.
Limitations and Strengths of the Study
As this study was cross-sectional, we cannot point to causal relationships or long-term trends.
However, we collected data directly in the participating schools: anthropometric measurements were
made by trained staduring medical examinations, which ensured reliable assessments, and the
FFQ was completed on days when the researchers were present. Yet, as with all self-report dietary
assessments, bias may have been introduced by the participants due to recall diculties and social
desirability in the reporting.
The short FFQ presents limitations regarding the interpretation of food intake. While it was
possible to group the food categories into the three recommended food groups, plus limited foods and
drinks and water, the questions were not exhaustive and may not have fully captured the diversity of
dietary intakes in a population undergoing nutritional transition. We did not quantitatively assess
the macronutrient and micronutrient intakes or the portion sizes for the serves. Future studies will
Nutrients 2020,12, 2047 12 of 14
therefore include other more comprehensive dietary assessment methods and further qualitative
assessment of food habits to permit a more comprehensive and powerful analysis of food behaviour
in Melanesian adolescents. In addition, the use of self-reported information for sleep time duration
does not inform the quality of sleep or the time of falling asleep, which might influence the global
sleep of these adolescents. Another important point is energy expenditure via objective measure of
accelerometery, which is known to have major impact on anthropometric parameters and could help
to better understanding of adolescents’ lifestyle. So, future directions needs to consider the place of
physical activity.
5. Conclusions
In both rural and urban areas, processed food is omnipresent in the diets of Melanesian adolescents,
although some of the traditional food patterns are nevertheless still present. Overall, sleep durations
are low whatever the place of living. These lifestyle factors may contribute to overweight and obesity,
which lead to chronic diseases and will thus have a major impact on the Melanesian population in the
coming decades. A more comprehensive approach to macro- and micronutrient intakes, combined with
the assessment of physical activity levels and other lifestyle and sociodemographic factors, is needed.
The findings could be used to enhance health education programs in the schools and for families
in New Caledonia and other Pacific communities and perhaps for policy to maintain the healthier
traditional food supply.
Author Contributions:
O.G., A.N.-G., G.W., C.S.-M., M.A.-F. and S.F. conceived and designed the study. O.G.,
E.P., A.N.-G., F.W., G.W., P.-Y.L.R., S.P., P.Z., C.S.-M., S.F. collected data. O.G., G.W., S.F. conducted the statistical
analyses and O.G., E.P., A.N.-G., F.W., G.W., C.S.-M., M.A.-F., S.F., P.-Y.L.R. drafted the manuscript. All authors
have read and agreed to the published version of the manuscript.
Funding: The Fondation NestléFrance supported this study.
We thank the school teaching teams and administrative stafor their help and support in our
investigations, especially the Department ‘Promotion de la sant
en milieu scolaire’ of the Vice-Rectorat of New
Caledonia. We would like to thank Seila Muliava, Oriane Pourcelot, Malia Lasalo, Jeremy Sechet, Eloise Vendegou.
Conflicts of Interest: The authors declare no conflict of interest.
McLennan, A.K.; Ulijaszek, S.J. Obesity emergence in the Pacific islands: Why understanding colonial history
and social change is important. Public Health Nutr. 2015,18, 1499–1505. [CrossRef] [PubMed]
The Global Syndemic of Obesity, Undernutrition and Climate Change: The Lancet Commission
Report—The Lancet. Available online:
32822-8/fulltext (accessed on 4 December 2019).
Regional Framework for Accelerating Action on Food Security and Nutrition in Pacific SIDS.
Available online:
(accessed on 19 June 2020).
Chen, M.-Y.; Wang, E.K.; Jeng, Y.-J. Adequate sleep among adolescents is positively associated with health
status and health-related behaviors. BMC Public Health 2006,6, 59. [CrossRef] [PubMed]
Markwald, R.R.; Melanson, E.L.; Smith, M.R.; Higgins, J.; Perreault, L.; Eckel, R.H.; Wright, K.P. Impact of
insucient sleep on total daily energy expenditure, food intake, and weight gain. Proc. Natl. Acad. Sci. USA
2013,110, 5695–5700. [CrossRef] [PubMed]
Chapman, C.D.; Benedict, C.; Brooks, S.J.; Birgir Schiöth, H. Lifestyle determinants of the drive to eat:
A meta-analysis. Am. J. Clin. Nutr. 2012,96, 492–497. [CrossRef] [PubMed]
Benedict, C.; Brooks, S.J.; O’Daly, O.G.; Almen, M.S.; Morell, A.; Aberg, K.; Gingnell, M.; Schultes, B.;
Hallschmid, M.; Broman, J.-E. Acute sleep deprivation enhances the brain’s response to hedonic food stimuli:
An fMRI study. J. Clin. Endocrinol. Metab. 2012,97, E443–E447. [CrossRef]
St-Onge, M.-P. Sleep–obesity relation: Underlying mechanisms and consequences for treatment. Obes. Rev.
2017,18, 34–39. [CrossRef]
Nutrients 2020,12, 2047 13 of 14
Frayon, S.; Cherrier, S.; Cavaloc, Y.; Wattelez, G.; Lerrant, Y.; Galy, O. Relationship of body fat and body mass
index in young Pacific Islanders: A cross-sectional study in European, Melanesian and Polynesian groups.
Pediatric Obes. 2017,13, 357–364. [CrossRef]
Zongo, P.; Frayon, S.; Antoine-Jonville, S.; Wattelez, G.; Le Roux, P.-Y.; Hue, O.; Galy, O. Anthropometric
Characteristics and Physical Fitness in Rural and Urban 11- to 16-Year-Old Melanesian Adolescents:
A Cross-sectional Study in New Caledonian Schools. Asia Pac. J. Public Health
,29, 589–598. [CrossRef]
Frayon, S.; Cavaloc, Y.; Wattelez, G.; Cherrier, S.; Touitou, A.; Zongo, P.; Yacef, K.; Caillaud, C.; Lerrant, Y.;
Galy, O. Body image, body dissatisfaction and weight status of Pacific adolescents from dierent ethnic
communities: A cross-sectional study in New Caledonia. Ethn. Health 2017,25, 1–16. [CrossRef]
Frayon, S.; Cavaloc, Y.; Wattelez, G.; Cherrier, S.; Lerrant, Y.; Ashwell, M.; Galy, O. Potential for waist-to-height
ratio to detect overfat adolescents from a Pacific Island, even those within the normal BMI range. Obes. Res.
Clin. Pract. 2017,12, 351–357. [CrossRef]
Broustet, D.; Rivoilan, P. ISEE Structure de la Population et
volutions; Institut de la Statistique et des Etudes
Economiques—Nouvelle-Calédonie: Nouvelle-Calédonie, France, 2014.
Leblic, I. Ignames, interdits et anc
tres en Nouvelle-Cal
donie. J. Soc. Oc
,114–115, 115–127.
Bouard, S.; Apithy, L.; Guyard, S. Family Farming in Contemporary Kanak Society. In Diversity of
Family Farming around the World: Existence, Transformations and Possible Futures of Family Farms; Bosc, P.-M.,
Sourisseau, J.-M., Bonnal, P., Gasselin, P., Valette,
., B
res, J.-F., Eds.; Springer: Dordrecht, The Netherlands,
2018; pp. 285–296. ISBN 978-94-024-1617-6.
Sabinot, C.; David, G.; Juncker, M.; Bouard, S.; Fossier, C.; Mallet, J.; Kombouare, F. P
ches identitaires,
res et commerciales dans les
mes r
cifaux. In Nouvelle-Cal
donie: Archipel de Corail;
Payri, C., Ed.; IRD: Marseille, France, 2018; pp. 191–198.
HLPE. Nutrition and Food Systems. A Report by the High Level Panel of Experts on Food Security and Nutrition of
the Committee on World Food Security; Committee on World Food Security: Rome, Italy, 2017; p. 152.
FAO; IFAD; UNICEF; WFP; WHO. The State of Food Security and Nutrition in the World 2018. Building Climate
Resilience for Food Security and Nutrition; FAO: Rome, Italy, 2018.
Anon. Pacifc Guidelines for Healthy Living: A Handbook for Health Professionals and Educators;
Pacific Community (SPC): Noumea, New Caledonia, 2017; 44p.
Wattelez, G.; Frayon, S.; Cavaloc, Y.; Cherrier, S.; Lerrant, Y.; Galy, O. Sugar-Sweetened Beverage Consumption
and Associated Factors in School-Going Adolescents of New Caledonia. Nutrients
,11, 452. [CrossRef]
Frayon, S.; Cherrier, S.; Cavaloc, Y.; Touitou, A.; Zongo, P.; Wattelez, G.; Yacef, K.; Caillaud, C.; Lerrant, Y.;
Galy, O. Nutrition behaviors and sociodemographic factors associated with overweight in the multi-ethnic
adolescents of New Caledonia. Ethn. Health 2017,24, 1–17. [CrossRef] [PubMed]
Galy, O.; Yacef, K.; Caillaud, C. Improving Pacific Adolescents’ Physical Activity toward International
Recommendations: Exploratory Study of a Digital Education App Coupled with Activity Trackers.
JMIR mHealth uHealth 2019,7, e14854. [CrossRef] [PubMed]
Hirshkowitz, M.; Whiton, K.; Albert, S.M.; Alessi, C.; Bruni, O.; DonCarlos, L.; Hazen, N.; Herman, J.;
Katz, E.S.; Kheirandish-Gozal, L. National Sleep Foundation’s sleep time duration recommendations:
Methodology and results summary. Sleep Health 2015,1, 40–43. [CrossRef] [PubMed]
Frayon, S.; Cherrier, S.; Cavaloc, Y.; Wattelez, G.; Touitou, A.; Zongo, P.; Yacef, K.; Caillaud, C.; Lerrant, Y.;
Galy, O. Misperception of weight status in the pacific: Preliminary findings in rural and urban 11-to
16-year-olds of New Caledonia. BMC Public Health 2017,17, 25. [CrossRef] [PubMed]
Cole, T.J.; Lobstein, T. Extended international (IOTF) body mass index cut-os for thinness, overweight and
obesity. Pediatric Obes. 2012,7, 284–294. [CrossRef]
Hamelin, C.; Salomon, C.; Lert, F.; Vignier, N.; Bonenfant, S.; Kanieswski, N.; Carole, C. Situation
sociale et comportements de sant
des jeunes en Nouvelle-Cal
donie. In INSERM; H
pital Paul Brousse:
Villejuif, France, 2008.
Krieger, N. A Researcher’s Guide to the National Statistics Socio-Economic Classification; Palgrave Macmillan
Journals: Basingstoke, UK, 2003; ISBN 0197-5897.
Nutrients 2020,12, 2047 14 of 14
The European Union Labour Force Survey—Methods and Definitions—2001 (Eurostat, Guidelines, Labour
Statistics, Survey). Available online:
aspx (accessed on 4 December 2019).
Gwynn, J.D.; Flood, V.M.; D’Este, C.A.; Attia, J.R.; Turner, N.; Cochrane, J.; Wiggers, J.H. The reliability and
validity of a short FFQ among Australian Aboriginal and Torres Strait Islander and non-Indigenous rural
children. Public Health Nutr. 2011,14, 388–401. [CrossRef]
R: A Language and Environment for Statistical Computing. Available online:
81287/r-a-language-and-environment-for-statistical-computing (accessed on 4 December 2019).
Australian Health Survey: Nutrition First Results—Food and Nutrients, 4364.0.55.007-2011-12.
Available online:
(accessed on 4 December 2019).
Swinburn, B.A.; Kraak, V.I.; Allender, S.; Atkins, V.J.; Baker, P.I.; Bogard, J.R.; Brinsden, H.; Calvillo, A.;
Schutter, O.D.; Devarajan, R.; et al. The Global Syndemic of Obesity, Undernutrition, and Climate Change:
The Lancet Commission report. The Lancet 2019,393, 791–846. [CrossRef]
Johnson, B.J.; Bell, L.K.; Zarnowiecki, D.; Rangan, A.M.; Golley, R.K. Contribution of Discretionary Foods
and Drinks to Australian Children’s Intake of Energy, Saturated Fat, Added Sugars and Salt. Children
4, 104. [CrossRef]
Swinburn, B.A.; Caterson, I.; Seidell, J.C.; James, W.P.T. Diet, nutrition and the prevention of excess weight
gain and obesity. Public Health Nutr. 2004,7, 123–146. [PubMed]
Kant, A.K. Reported Consumption of Low-Nutrient-Density Foods by American Children and Adolescents:
Nutritional and Health Correlates, NHANES III, 1988 to 1994. Arch. Pediatr. Adolesc. Med.
,157, 789–796.
[CrossRef] [PubMed]
Webb, K.L.; Lahti-Koski, M.; Rutishauser, I.; Hector, D.J.; Knezevic, N.; Gill, T.; Peat, J.K.; Leeder, S.R.;
Team, C. Consumption of ‘extra’ foods (energy-dense, nutrient-poor) among children aged 16–24 months
from western Sydney, Australia. Public Health Nutr. 2006,9, 1035–1044. [CrossRef] [PubMed]
Satterthwaite, D.; McGranahan, G.; Tacoli, C. Urbanization and its implications for food and farming.
Philos. Trans. R. Soc. B Biol. Sci. 2010,365, 2809–2820. [CrossRef] [PubMed]
Serra-Mallol, C. Bien manger, c’est manger beaucoup: Comportements alimentaires et repr
corporelles àTahiti. Sci. Soc. Santé2008,26, 81–112.
Newby, P.K. Are Dietary Intakes and Eating Behaviors Related to Childhood Obesity? A Comprehensive
Review of the Evidence. J. Law Med. Ethics 2007,35, 35–60. [CrossRef] [PubMed]
Sun, C.; Pomer, A.; Dancause, K.N.; Chan, C.W.; Olszowy, K.M.; Silverman, H.; Lee, G.; Tarivonda, L.;
Taleo, G.; Regenvanu, R. Ownership of consumer electronics is associated with measures of adiposity during
health transition in Vanuatu. Am. J. Hum. Biol. 2017,29, e22928. [CrossRef]
Eagle, L.; Bulmer, S.; De Bruin, A.; Kitchen, P.J. Exploring the link between obesity and advertising in New
Zealand. J. Mark. Commun. 2004,10, 49–67. [CrossRef]
Becker, A.E.; Burwell, R.A.; Herzog, D.B.; Hamburg, P.; Gilman, S.E. Eating behaviours and attitudes
following prolonged exposure to television among ethnic Fijian adolescent girls. Br. J. Psychiatry
509–514. [CrossRef]
Sleep Duration and Obesity in Children: A Systematic Review and Meta-Analysis of Prospective Cohort
Studies—Li—2017—Journal of Paediatrics and Child Health—Wiley Online Library. Available online: (accessed on 4 December 2019).
Li, L.; Zhang, S.; Huang, Y.; Chen, K. Sleep duration and obesity in children: A systematic review and
meta-analysis of prospective cohort studies. J. Paediatr. Child Health 2017,53, 378–385. [CrossRef]
Bayon, V.; Leger, D.; Gomez-Merino, D.; Vecchierini, M.-F.; Chennaoui, M. Sleep debt and obesity. Ann. Med.
2014,46, 264–272. [CrossRef] [PubMed]
Kjeldsen, J.S.; Hjorth, M.F.; Andersen, R.; Michaelsen, K.F.; Tetens, I.; Astrup, A.; Chaput, J.-P.; Sjödin, A.
Short sleep duration and large variability in sleep duration are independently associated with dietary risk
factors for obesity in Danish school children. Int. J. Obes. 2014,38, 32. [CrossRef] [PubMed]
2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons Attribution
(CC BY) license (
... The short questions on this FFQ are able to discriminate between different categories of food intake and provide information on relative intakes [54] . Moreover, this FFQ has been validated in a pluri-ethnic population composed with non-indigenous Australians (with European background) and Torres Strait Islanders (with a Melanesian background), and it was previously used in New Caledonia [56] . Minor modifications were made by the research team to include foods identified as important in the Melanesian diet. ...
... In rural areas, high scores for traditional ONENA Fruits and vegetables pattern and low scores for the Dairies and breakfast pattern were observed. These trends can be partly explained by the availability and affordability of these products [56,71] . Fruits and vegetables are commonly cultivated in rural areas by traditional Melanesian family farms or bigger European farms and thus are widely available and affordable. ...
... Another possible way to explain our results was to consider the physical activity (PA) of the adolescents. It has been shown that low PA may be correlated with overweight in adolescent populations [1,38,40,56] . PA may differ across ethnic subgroups and thus explain the disparities in overweight prevalence. ...
Full-text available
Background A high prevalence of overweight and obesity has been found in adolescents of New Caledonia and other Pacific Island Countries and Territories. Although Westernization may contribute to the weight gain in populations of Oceanian, Non-European, Non-Asian ancestry (ONENA), little is known about the sociodemographic and lifestyle factors associated with overweight in the Melanesian and Polynesian adolescents of New Caledonia. Methods In this cross-sectional study, a pluri-ethnic sample of New Caledonian adolescents (N = 954; age M = 13.2 years) completed a survey to estimate sleep duration, screen time, and dietary pattern using a food frequency questionnaire. Demographic data (gender, ethnicity, socioeconomic status: SES, area of residence) were collected, and anthropometric measures were used to compute weight status. Findings We found a higher risk for being overweight in Melanesian (OR = 1.67) and Polynesian (OR = 5.40) adolescents compared with European adolescents, even after controlling for age, SES, area of residence, dietary pattern, sleep duration and screen time. We also found that low SES (OR = 3.43) and sleep duration (OR = 0.65 per hour) were independently associated with overweight status in the European but not in ONENA adolescents. Interpretation In this study, the main contribution to being overweight was ethnic background, i.e. being Melanesian or Polynesian. The hypothesis of a genetic influence thus seems attractive and merits further analyses. Funding This project was funded by the University of New Caledonia and the Fondation Nestlé France.
... Globalization, trade liberalization and increasing urbanization have all contributed to shifts in PA and diet, leading to a steadily increasing prevalence of overweight (30)(31)(32)(33)(34)(35). The Polynesian and Melanesian populations of the French territories in the Pacific are particularly exposed to lifestyle Westernization (36)(37)(38)(39). New Caledonia has the particularity of approaching the economic level of Western countries due to industrial and mining activities. ...
... Adolescents are thus generally involved in these activities with extended family and friends (16,30). Despite the lifestyle transition occurring in New Caledonia and other PICTs, promoting outdoor activities and traditional foods, especially for rural Melanesians (39), might encourage the population to maintain healthy PA levels and limit unhealthy sedentary time. Providing spaces for leisure-time PA, such as sports, is another way to promote physically active behavior in adolescents, but Bauman et al. (5), who studied energy expenditures in young adults living in China, found this kind of PA insufficient to prevent obesity. ...
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Physical activity (PA) is an important factor for the prevention of overweight and obesity, particularly during adolescence. This study focuses on the understudied adolescent population of New Caledonia with the aim to (1) determine the daily PA levels and estimate the sedentary time through out-of-school sitting time; (2) highlight the influence of sociodemographic and environmental factors, and (3) assess the associations of PA and sitting time with overweight and obesity. A sample of 508 school-going adolescents living in New Caledonia was surveyed about their PA habits using the International Physical Activity Questionnaire–Short Form, as well as about the context in which they usually engage in PA. The influences of the place of living and ethnic community were also investigated. Results indicated that about 66% of the adolescents performed an average of at least 60 min of PA daily. Both Melanesian adolescent boys and girls were more active than Caucasian adolescents but only when they lived in rural areas (females: 115 vs. 93 min/day, p = 0.018; males: 133 vs. 97 min/day, p = 0.018). Indeed, PA was reduced in an urban environment (females: 88 min/day; males: 95 min/day, p = 0.028; rural vs. urban in Melanesian adolescents). Melanesian adolescents also spent less time in out-of-school sitting than Caucasian adolescents independently of where they lived (females: 164 vs. 295 min/day, p < 0.001; males: 167 vs. 239 min/day, p = 0.001). Feeling safe was positively associated with PA levels (females: OR adj = 2.85, p < 0.001; males: OR adj = 4.45, p < 0.001). In the adolescent boys, accessibility to a suitable place was also an important factor (OR adj = 2.94, p = 0.002). Finally, while PA and sitting time were negatively associated with overweight in male adolescents (OR adj = 0.28, p = 0.044 and OR adj = 0.39, p = 0.004), they were not in females. Living in a rural area allowed the Melanesian adolescents to maintain a more active lifestyle with more physical activities and less sitting time. Our results also indicated that safety was an important driver for engagement in PA. The urban environment in New Caledonia appears to be a contributor of a less active lifestyle in adolescents.
... High unhealthy food consumption with 27% of daily food intake was recently observed in Melanesian adolescents from New Caledonia. These dietary changes might explain the high percentage of overweight and obesity (38.1% for rural and 31.7% for urban adolescents) observed in this study, therefore, further comprehensive investigation of dietary intakes is needed [16]. In the future, the food and nutrient data within this database will be validated, in the context of the iRecall.24 ...
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The food environment in New Caledonia is undergoing a transition, with movement away from traditional diets towards processed and discretionary foods and beverages. This study aimed to develop an up-to-date food composition database that could be used to analyze food and nutritional intake data of New Caledonian children and adults. Development of this database occurred in three phases: Phase 1, updating and expanding the number of food items to represent current food supply; Phase 2, refining the database items and naming and assigning portion size images for food items; Phase 3, ensuring comprehensive nutrient values for all foods, including saturated fat and total sugar. The final New Caledonian database comprised a total of 972 food items, with 40 associated food categories and 25 nutrient values and 615 items with portion size images. To improve the searchability of the database, the names of 593 food items were shortened and synonyms or alternate spelling were included for 462 foods. Once integrated into a mobile app-based multiple-pass 24-h recall tool, named iRecall.24, this country-specific food composition database would support the assessment of food and nutritional intakes of families in New Caledonia, in a cross-sectional and longitudinal manner, and with translational opportunities for use across the wider Pacific region.
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Þrátt fyrir fjölda svefnrannsókna á undanförnum árum er enn margt á huldu um útbreiðslu svefnvenja meðal ungmenna. Nægur nætursvefn er mikilvægur fyrir þroska, heilsu og námsgetu ungs fólks. Markmið rannsóknarinnar var að skoða hvort svefnlengd íslenskra skólanema samræmdist svefnráðleggingum, hver meðalsvefnlengd nemendanna væri og hver munur væri á tíðni ráðlagðs svefns og svefnlengd milli einstakra hópa nemenda.Landskönnunin „Heilsa og lífskjör skólanema“ (HBSC) fór fram árið 2018 meðal nemenda í 6., 8. og 10. bekk. Alls svöruðu 7.159 nemendur á landinu öllu stöðluðum spurningalista. Nemendurnir voru meðal annars spurðir um háttatíma sinn og fótaferðartíma. Viðmið um nægilegan svefn voru borin saman við alþjóðlegar ráðleggingar ungmenna í 6. bekk (9–11 klst./nóttu), og fyrir nemendur í 8. og 10. bekk (8–10 klst./ nóttu).Niðurstöður sýndu að um 30% nemenda í 6., 8. og 10. bekk ná ekki viðmiðum um ráðlagða svefnlengd á virkum dögum. Piltar náðu síður ráðlagðri svefnlengd en stúlkur, og 10. bekkingar mun síður en nemendur í yngri bekkjardeildum. Nemendur sem áttu foreldra af erlendum uppruna sváfu skemur og náðu síður ráðlögðum svefni en aðrir nemendur. Nemendur sem bjuggu með báðum lífforeldrum sínum sváfu lengur og fengu oftar ráðlagðan svefn en nemendur í öðrum fjölskyldugerðum. Þá kom í ljós að nemendur á höfuðborgarsvæðinu sváfu lengur og náðu frekar ráðlögðum svefni en nemendur af landsbyggðinni. Ekki var marktækur munur á lengd nætursvefns eftir efnahag fjölskyldunnar.Umtalsverður hluti íslenskra ungmenna nær ekki nægum nætursvefni. Mikilvægt er að gefa nánari gaum að nætursvefni íslenskra ungmenna, einkum meðal þeirra ungmenna sem fá hvað stystan nætursvefn.
In the Melanesian culture, traditional activities are organized around family farming, although the lifestyle transition taking place over the last several decades has led to imbalances in diet and physical activity, with both leading to obesity. The aim of this interdisciplinary study was to understand the links between family farming (produced, exchanged, sold, and consumed food), diet (focused on produced, hunted, and caught food), physical activity (sedentary, light, and moderate-to-vigorous physical activity) and obesity in Melanesian Lifou Island families (parents and children). Forty families, including 142 adults and children, completed individual food frequency questionnaires, wore tri-axial accelerometers for seven continuous days, and had weight and height measured with a bio-impedance device. A family farming questionnaire was conducted at the household level concerning family farming practices and sociodemographic variables. Multinomial regression analyses and logistic regression models were used to analyze the data. Results showed that family farming production brings a modest contribution to diet and active lifestyles for the family farmers of Lifou Island. The drivers for obesity in these tribal communities were linked to diet in the adults, whereas parental socioeconomic status and moderate-to-vigorous physical activity were the main factors associated to being overweight and obesity in children. These differences in lifestyle behaviors within families suggest a transition in cultural practices at the intergenerational level. Future directions should consider seasonality and a more in-depth analysis of diet including macro- and micro- nutrients to acquire more accurate information on the intergenerational transition in cultural practices and its consequences on health outcomes in the Pacific region.
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Background and purpose: Use of yoga or meditation has increased decisively in recent years. Factors associated with the use of yoga and meditation are not well understood. The aim was to focus on the relationship of yoga and meditation to sociodemographic background, religiosity, healthcare-related attitudes, mental and physical health, and physician visits. Materials and methods This study builds on data from a national health survey of a random sample of Icelandic adults, aged 18–75 (n = 1599; response rate of 58%). Results The overall use of yoga or meditation reached 19.3% in 2015. This is an increase of 12.5% points over a nine-year period. The increase was much greater for women. Yoga or meditation use was positively related to the female gender, younger age, higher levels of education, and not belonging to a religious denomination. It was also positively related to higher anxiety, previous visits to a physician, and a positive attitude toward CAM services, but it was negatively related to having chronic medical conditions. Conclusion Increased use of yoga or meditation may reflect public interest in Icelander's self-care and health promotion. Further studies are needed to better understand the predictors and effects of yoga and meditation.
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In recent decades, the food cultures of the Pacific populations have undergone a profound transition, particularly because the increasing trade exchanges with Western countries have facilitated access to a wide range of processed foods. Essentially, a new normative model of eating is now taking the place of the traditional models. The aims of this qualitative study were to explore what ‘eating well’, ‘good food’ and ‘bad food’ now mean in the New Caledonian family context and, more broadly, to categorise the current food practices and representations in adolescents’ families. A double qualitative methodology was applied: 59 face-to-face interviews with 30 parents and 29 adolescents in both rural and urban areas and 15 collective structured discussions with middle-school classes (11- to 16-year-olds) of almost 25 students each. The main results showed various normative frames for nutrition, food quantities, local provenance, and personal taste. Food practices were related to food availability (having a home garden or involvement in family farming), socioeconomic status and community. In addition, access to nutritional information, temporal and financial constraints mostly in the urban area, and the role of food socialisation between parents and children had an impact on food practices and perceptions. The permanence of food cultures, mainly observed in families in rural areas, and the social inequalities in urban areas regarding food availability are highlighted. The positive perception of ‘local food’ as ‘cultural’, ‘organic’ and ‘healthy’ may help policymakers communicate clear messages to reach a sustainable food system.
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Background: The prevalence of overweight and obesity in children and adolescents has dramatically increased in the Pacific Island countries and territories over the last decade. Childhood overweight and obesity not only have short-term consequences but are also likely to lead to noncommunicable diseases in adulthood. A major factor contributing to the rising prevalence is an insufficient amount of daily moderate-to-vigorous physical activity (MVPA). In the Pacific region, less than 50% of children and adolescents meet the international recommendations of 11,000 steps and 60 min of MVPA per day. Although studies have shown the potential of digital technologies to change behaviors, none has been proposed to guide adolescents toward achieving these recommendations. Objective: The aims of this study were (1) to investigate whether a technology-based educational program that combines education, objective measures of physical activity (PA), and self-assessment of goal achievement would be well received by Pacific adolescents and help change their PA behaviors toward the international PA recommendations and (2) to create more insightful data analysis methods to better understand PA behavior change. Methods: A total of 24 adolescents, aged 12 to 14 years, participated in a 4-week program comprising 8 1-hour modules designed to develop health literacy and physical skills. This self-paced user-centered program was delivered via an app and provided health-related learning content as well as goal setting and self-assessment tasks. PA performed during the 4-week program was captured by an activity tracker to support learning and help the adolescents self-assess their achievements against personal goals. The data were analyzed using a consistency rate and daily behavior clustering to reveal any PA changes, particularly regarding adherence to international recommendations. Results: The consistency rate of daily steps revealed that the adolescents reached 11,000 steps per day 48% (approximately 3.4 days per week) of the time in the first week of the program, and this peaked at 59% (approximately 4.1 days per week) toward the end of the program. PA data showed an overall increase during the program, particularly in the less active adolescents, who increased their daily steps by 15% and ultimately reached 11,000 steps more frequently. The consistency of daily behavior clustering showed a 27% increase in adherence to international recommendations in the least active adolescents. Conclusions: Technology-supported educational programs that include self-monitored PA via activity trackers can be successfully delivered to adolescents in schools in remote Pacific areas. New data mining techniques enable innovative analyses of PA engagement based on the international recommendations.
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This cross-sectional study assessed sugar-sweetened beverage (SSB) consumption and its associations with the sociodemographic and physical characteristics, behavior and knowledge of New Caledonian adolescents. The survey data of 447 adolescents from ages 11 to 16 years were collected in five secondary public schools of New Caledonia between July 2015 and April 2016. These data included measured height and weight, SSB consumption, sociodemographic characteristics, body weight perception, physical activity, and knowledge (sugar quantity/SSB unit; energy expenditure required to eliminate a unit) and opinions about the SSB‒weight gain relationship. Ninety percent of these adolescents declared regularly drinking SSBs. Quantities were associated with living environment (1.94 L·week−1 in urban environment vs. 4.49 L·week−1 in rural environment, p = 0.001), ethnic community (4.77 L·week−1 in Melanesians vs. 2.46 L·week−1 in Caucasians, p < 0.001) and knowledge about energy expenditure (6.22 L·week−1 in unknowledgeable adolescents vs. 4.26 L·week−1 in adolescents who underestimated, 3.73 L·week−1 in adolescents who overestimated, and 3.64 L·week−1 in adolescents who correctly responded on the energy expenditure required to eliminate an SSB unit, p = 0.033). To conclude, community-based health promotion strategies should (1) focus on the physical effort needed to negate SSB consumption rather than the nutritional energy from SSB units and (2) highlight how to achieve sustainable lifestyles and provide tools for greater understanding and positive action.
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Introduction: Waist-to-height ratio (WHtR) is a simple anthropometric proxy for central body fat; it is easy to use from a health education perspective. A WHtR value >0.5 has been proposed as a first level indicator of health risk. The first aim of this study was to compare WHtR with values based on body mass index (BMI) in their prediction of the percentage of body fat (%BF) in a multi-ethnic population of adolescents from New-Caledonia (age 11-16year). Secondly, to see whether WHtR >0.5 could be used to detect overfat subjects whose BMI was in the normal range. Materials and methods: Body fat percentage (%BF, based on skinfold measurements), BMI and WHtR were calculated for New Caledonian adolescents from different ethnic backgrounds. The relationship between %BF, BMI and WHtR was determined using quadratic models and from linear regression equations. The sensitivity and specificity of WHtR for detecting overfat adolescents (%BF >25% in boys and >30% in girls) were assessed and compared with those from the BMI-based classification. Results: WHtR showed better correlation with %BF than BMI-based measurements. WHtR >0.5 was also more accurate than BMI in detecting overfat adolescents. Moreover, using this boundary value, 8% of adolescents in the normal BMI range were shown to be over-fat. Conclusions: WHtR is a good anthropometric proxy to detect overfat adolescents. Detecting overfat adolescents within the normal BMI range is particularly important for preventing non communicable diseases. We therefore recommend using WHtR for health education programs in the Pacific area and more generally.
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Interventions are required to reduce children's consumption of discretionary foods and drinks. To intervene we need to identify appropriate discretionary choice targets. This study aimed to determine the main discretionary choice contributors to energy and key nutrient intakes in children aged 2-18 years. Secondary analyses were performed with population weighted, single 24 h dietary recall data from the 2011-2012 National Nutrition and Physical Activity Survey. Cakes, muffins, and slices; sweet biscuits; potato crisps and similar snacks; and, processed meats and sugar-sweetened drinks were relatively commonly consumed and were within the top three to five contributors to per capita energy, saturated fat, sodium, and/or added sugars. Per consumer intake identified cereal-based takeaway foods; cakes, muffins and slices; meat pies and other savoury pastries; and, processed meats as top contributors to energy, saturated fat, and sodium across most age groups. Subgroups of sugar-sweetened drinks and cakes, muffins and slices were consistently key contributors to added sugars intake. This study identified optimal targets for interventions to reduce discretionary choices intake, likely to have the biggest impact on moderating energy intake while also reducing intakes of saturated fat, sodium and/or added sugars.
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We evaluated anthropometric characteristics and physical fitness in 556 Melanesian adolescents from rural and urban New Caledonia to build health education programs focused on physical activity. In 2013, body weight, height, skinfold thickness, lean body mass (LBM), percentage fat body mass (%FBM), physical fitness (power, agility, speed, maximal aerobic speed [MAS], estimated VO2max), and self-reported physical activity were assessed. Rural adolescents were significantly shorter and faster, had lower weight, %FBM, LBM, and power output and similar MAS and VO2max, and were more active than urban adolescents. Rural girls were significantly shorter, had higher MAS and VO2max, and were faster and significantly more active than urban girls while similar %BFM was observed in both groups of girls. Rural boys showed significantly lower height, weight, %FBM, and power and were significantly faster and more active than urban boys. In conclusion, rural Melanesian adolescents are more active, with good physical fitness (especially boys), although high %FBM was noted (especially in girls).
Executive summary Malnutrition in all its forms, including obesity, undernutrition, and other dietary risks, is the leading cause of poor health globally. In the near future, the health effects of climate change will considerably compound these health challenges. Climate change can be considered a pandemic because of its sweeping effects on the health of humans and the natural systems we depend on (ie, planetary health). These three pandemics—obesity, undernutrition, and climate change—represent The Global Syndemic that affects most people in every country and region worldwide. They constitute a syndemic, or synergy of epidemics, because they co-occur in time and place, interact with each other to produce complex sequelae, and share common underlying societal drivers. This Commission recommends comprehensive actions to address obesity within the context of The Global Syndemic, which represents the paramount health challenge for humans, the environment, and our planet in the 21st century. The Global Syndemic Although the Commission's mandate was to address obesity, a deliberative process led to reframing of the problem and expansion of the mandate to offer recommendations to collectively address the triple-burden challenges of The Global Syndemic. We reframed the problem of obesity as having four parts. First, the prevalence of obesity is increasing in every region of the world. No country has successfully reversed its epidemic because the systemic and institutional drivers of obesity remain largely unabated. Second, many evidence-based policy recommendations to halt and reverse obesity rates have been endorsed by Member States at successive World Health Assembly meetings over nearly three decades, but have not yet been translated into meaningful and measurable change. Such patchy progress is due to what the Commission calls policy inertia, a collective term for the combined effects of inadequate political leadership and governance to enact policies to respond to The Global Syndemic, strong opposition to those policies by powerful commercial interests, and a lack of demand for policy action by the public. Third, similar to the 2015 Paris Agreement on Climate Change, the enormous health and economic burdens caused by obesity are not seen as urgent enough to generate the public demand or political will to implement the recommendations of expert bodies for effective action. Finally, obesity has historically been considered in isolation from other major global challenges. Linking obesity with undernutrition and climate change into a single Global Syndemic framework focuses attention on the scale and urgency of addressing these combined challenges and emphasises the need for common solutions. Syndemic drivers The Commission applied a systems perspective to understand and address the underlying drivers of The Global Syndemic within the context of achieving the broad global outcomes of human health and wellbeing, ecological health and wellbeing, social equity, and economic prosperity. The major systems driving The Global Syndemic are food and agriculture, transportation, urban design, and land use. An analysis of the dynamics of these systems sheds light on the answers to some fundamental questions. Why do these systems operate the way they do? Why do they need to change? Why are they so hard to change? What leverage points (or levers) are required to overcome policy inertia and address The Global Syndemic? The Commission identified five sets of feedback loops as the dominant dynamics underlying the answers to these questions. They include: (1) governance feedback loops that determine how political power translates into the policies and economic incentives and disincentives for companies to operate within; (2) business feedback loops that determine the dynamics for creating profitable goods and services, including the externalities associated with damage to human health, the environment, and the planet; (3) supply and demand feedback loops showing the relationships that determine current consumption practices; (4) ecological feedback loops that show the unsustainable environmental damage that the food and transportation systems impose on natural ecosystems; and (5) human health feedback loops that show the positive and negative effects that these systems have on human health. These interactions need to be elucidated and methods for reorienting these feedback systems prioritised to mitigate The Global Syndemic. Double-duty or triple-duty actions The common drivers of obesity, undernutrition, and climate change indicate that many systems-level interventions could serve as double-duty or triple-duty actions to change the trajectory of all three pandemics simultaneously. Although these actions could produce win-win, or even win-win-win, results, they are difficult to achieve. A seemingly simple example shows how challenging these actions can be. National dietary guidelines serve as a basis for the development of food and nutrition policies and public education to reduce obesity and undernutrition and could be extended to include sustainability by moving populations towards consuming largely plant-based diets. However, many countries' efforts to include environmental sustainability principles within their dietary guidelines failed due to pressure from strong food industry lobbies, especially the beef, dairy, sugar, and ultra-processed food and beverage industry sectors. Only a few countries (ie, Sweden, Germany, Qatar, and Brazil) have developed dietary guidelines that promote environmentally sustainable diets and eating patterns that ensure food security, improve diet quality, human health and wellbeing, social equity, and respond to climate change challenges. The engagement of people, communities, and diverse groups is crucial for achieving these changes. Personal behaviours are heavily influenced by environments that are obesogenic, food insecure, and promote greenhouse-gas emissions. However, people can act as agents of change in their roles as elected officials, employers, parents, customers, and citizens and influence the societal norms and institutional policies of worksites, schools, food retailers, and communities to address The Global Syndemic. Across systems and institutions, people are decision makers who can vote for, advocate for, and communicate their preferences with other decision-makers about the policies and actions needed to address The Global Syndemic. Within the natural ecosystems, people travel, recreate, build, and work in ways that can preserve or restore the environment. Collective actions can generate the momentum for change. The Commission believes that the collective influence of individuals, civil society organisations, and the public can stimulate the reorientation of human systems to promote health, equity, economic prosperity, and sustainability. Changing trends in obesity, undernutrition, and climate change Historically, the most widespread form of malnutrition has been undernutrition, including wasting, stunting, and micronutrient deficiencies. The Global Hunger Index (1992–2017) showed substantial declines in under-5 child mortality in all regions of the world but less substantial declines in the prevalence of wasting and stunting among children. However, the rates of decline in undernutrition for children and adults are still too slow to meet the Sustainable Development Goal (SDG) targets by 2030. In the past 40 years, the obesity pandemic has shifted the patterns of malnutrition. Starting in the early 1980s, rapid increases in the prevalence of overweight and obesity began in high-income countries. In 2015, obesity was estimated to affect 2 billion people worldwide. Obesity and its determinants are risk factors for three of the four leading causes of non-communicable diseases (NCDs) worldwide, including cardiovascular diseases, type 2 diabetes, and certain cancers. Extensive research on the developmental origins of health and disease has shown that fetal and infant undernutrition are risk factors for obesity and its adverse consequences throughout the life course. Low-income and middle-income countries (LMICs) carry the greatest burdens of malnutrition. In LMICs, the prevalence of overweight in children less than 5 years of age is rising on the background of an already high prevalence of stunting (28%), wasting (8·8%), and underweight (17·4%). The prevalence of obesity among stunted children is 3% and is higher among children in middle-income countries than in lower-income countries. The work of the Intergovernmental Panel on Climate Change (IPCC), three previous Lancet Commissions related to climate change and planetary health (2009–15), and the current Lancet Countdown, which is tracking progress on health and climate change from 2017 to 2030, have provided extensive and compelling projections on the major human health effects related to climate change. Chief among them are increasing food insecurity and undernutrition among vulnerable populations in many LMICs due to crop failures, reduced food production, extreme weather events that produce droughts and flooding, increased food-borne and other infectious diseases, and civil unrest. Severe food insecurity and hunger are associated with lower obesity prevalence, but mild to moderate food insecurity is paradoxically associated with higher obesity prevalence among vulnerable populations. Wealthy countries already have higher burdens of obesity and larger carbon footprints compared with LMICs. Countries transitioning from lower to higher incomes experience rapid urbanisation and shifts towards motorised transportation with consequent lower physical activity, higher prevalence of obesity, and higher greenhouse-gas emissions. Changes in the dietary patterns of populations include increasing consumption of ultra-processed food and beverage products and beef and dairy products, whose production is associated with high greenhouse-gas emissions. Agricultural production is a leading source of greenhouse-gas emissions. The economic burden of The Global Syndemic The economic burden of The Global Syndemic is substantial and will have the greatest effect on the poorest of the 8·5 billion people who will inhabit the earth by 2030. The current costs of obesity are estimated at about $2 trillion annually from direct health-care costs and lost economic productivity. These costs represent 2·8% of the world's gross domestic product (GDP) and are roughly the equivalent of the costs of smoking or armed violence and war. Economic losses attributable to undernutrition are equivalent to 11% of the GDP in Africa and Asia, or approximately $3·5 trillion annually. The World Bank estimates that an investment of $70 billion over 10 years is needed to achieve SDG targets related to undernutrition, and that achieving them would create an estimated $850 billion in economic return. The economic effects of climate change include, among others, the costs of environmental disasters (eg, drought and wildfires), changes in habitat (eg, biosecurity and sea-level rises), health effects (eg, hunger and diarrhoeal infections), industry stress in sectors such as agriculture and fisheries, and the costs of reducing greenhouse-gas emissions. Continued inaction towards the global mitigation of climate change is predicted to cost 5–10% of global GDP, whereas just 1% of the world's GDP could arrest the increase in climate change. Actions to address The Global Syndemic Many authoritative policy documents have proposed specific, evidence-informed policies to address each of the components of The Global Syndemic. Therefore, the Commission decided to focus on the common, enabling actions that would support the implementation of these policies across The Global Syndemic. A set of principles guided the Commission's recommendations to enable the implementation of existing recommended policies: be systemic in nature, address the underlying causes of The Global Syndemic and its policy inertia, forge synergies to promote health and equity, and create benefits through double-duty or triple-duty actions. The Commission identified multiple levers to strengthen governance at the global, regional, national, and local levels. The Commission proposed the use of international human rights law and to apply the concept of a right to wellbeing, which encompasses the rights of children and the rights of all people to health, adequate food, culture, and healthy environments. Global intergovernmental organisations, such as the World Trade Organization, the World Economic Forum, the World Bank, and large philanthropic foundations and regional platforms, such as the European Union, Association of Southeastern Nations, and the Pacific Forum, should play much stronger roles to support national policies that address The Global Syndemic. Many states and municipalities are leading efforts to reduce greenhouse-gas emissions by incentivising less motorised travel and improving urban food systems. Civil society organisations can create a greater demand for national policy actions with increases in capacity and funding. Therefore, in addition to the World Bank's call for $70 billion for undernutrition and the Green Climate Fund of $100 billion for LMICs to address climate change, the Commission calls for $1 billion to support the efforts of civil society organisations to advocate for policy initiatives that mitigate The Global Syndemic. A principal source of policy inertia related to addressing obesity and climate change is the power of vested interests by commercial actors whose engagement in policy often constitutes a conflict of interest that is at odds with the public good and planetary health. Countering this power to assure unbiased decision making requires strong processes to manage conflicts of interest. On the business side, new sustainable models are needed to shift outcomes from a profit-only model to a socially and environmentally viable profit model that incorporates the health of people and the environment. The fossil fuel and food industries that are responsible for driving The Global Syndemic receive more than $5 trillion in annual subsidies from governments. The Commission recommends that governments redirect these subsidies into more sustainable energy, agricultural, and food system practices. A Framework Convention on Food Systems would provide the global legal structure and direction for countries to act on improving their food systems so that they become engines for better health, environmental sustainability, greater equity, and ongoing prosperity. Stronger accountability systems are needed to ensure that governments and private-sector actors respond adequately to The Global Syndemic. Upstream monitoring is needed to measure implementation of policies, examine the commercial, political, economic and sociocultural determinants of obesity, evaluate the impact of policies and actions, and establish mechanisms to hold governments and powerful private-sector actors to account for their actions. Similarly, platforms for stakeholders to interact and secure funding, such as that provided by the EAT Forum for global food system transformation, are needed to allow collaborations of scientists, policy makers, and practitioners to co-create policy-relevant empirical, and modelling studies of The Global Syndemic and the effects of double-duty and triple-duty actions. Bringing indigenous and traditional knowledge to this effort will also be important because this knowledge is often based on principles of environmental stewardship, collective responsibilities, and the interconnectedness of people with their environments. The challenges facing action on obesity, undernutrition, and climate change are closely aligned with each other. Bringing them together under the umbrella concept of The Global Syndemic creates the potential to strengthen the action and accountabilities for all three challenges. Our health, the health of our children and future generations, and the health of the planet will depend on the implementation of comprehensive and systems-oriented responses to The Global Syndemic.
Objective(s): The prevalence of adolescent obesity is high among the various ethnic groups native to the Pacific region (European, Melanesian and Polynesian). An important factor of weight gain or loss is body size satisfaction; however, little is known about adolescent body self-perception in the Pacific region. Design: Body dissatisfaction was evaluated using the Stunkard Figure Rating Scale in a sample of 699 adolescents from rural and urban areas of New Caledonia. The socio-demographic factors associated with higher body dissatisfaction were determined by multiple linear regression modeling. Results: Our results showed a high rate of body dissatisfaction (over 70%) in the adolescents. Body dissatisfaction was strongly related to the body mass index z-score. Melanesians boys had higher body dissatisfaction scores when they felt 'too thin' while Melanesian girls showed lower body dissatisfaction when they felt 'too fat.'. Conclusion: These results showed that social pressure for thinness or musculature may be different among adolescents living in New Caledonia. These results should be taken into account in education overweight prevention programs.
Background: Body mass index is the most often used indicator of obesity but does not distinguish between lean and fat mass. Adiposity at the same body mass index differs across ethnic groups. Objectives: The twofold aim of this study was to determine whether body mass index (BMI)-based references are correlated with body fat percentage (%BF) in a pluri-ethnic population of Pacific Islanders and to assess the diagnostic accuracy of these references by using the percentage of body fat as the gold standard. Methods: Height and weight were obtained, and triceps and subscapular skinfold thicknesses were measured in a sample of 796 adolescents (11-16 years) from the three main ethnic groups in New Caledonia: Melanesian, European and Polynesian. %BF was derived from the Slaughter equations, and BMI z score was calculated by using various international and national references. Results: Melanesian teens had lower %BF compared with their European counterparts for the same BMI z score. Whatever the BMI-based reference used to detect overfatness (%BF >25% for boys and >30% for girls), sensitivity was higher in Melanesian adolescents, while specificity was higher in their European counterparts. Diagnostic accuracy was better in Melanesian compared with European adolescents. Conclusions: This study shows that Melanesian adolescents have lower %BF than their European counterparts for the same BMI z score. Therefore, the diagnostic accuracy of BMI to detect overfatness is related to ethnicity. Whatever the BMI-based reference, sensitivity was higher in the Melanesian group, while specificity was higher in the European group.