Higher Imported Food Patterns Are Associated with Obesity and Severe Obesity in Tuvalu: A Latent Class Analysis

José Francisco López-Gil; Stephanie M Wu; Tai-Lin Irene Lee; Chih-Wei Shih; Selotia Tausi; Vine Sosene; Pauke P Maani; Malo Tupulaga; Yu-Tien Hsu; Chia-Rui Chang; Shi-Chian Shiau; Yuan-Hung Lo; Chih-Fu Wei; Po-Jen Lin; Maria Soledad Hershey

doi:10.1016/j.cdnut.2024.102080

Higher Imported Food Patterns Are Associated with Obesity and Severe Obesity in Tuvalu: A Latent Class Analysis

Curr Dev Nutr. 2024 Jan 24;8(2):102080. doi: 10.1016/j.cdnut.2024.102080. eCollection 2024 Feb.

Authors

José Francisco López-Gil¹, Stephanie M Wu², Tai-Lin Irene Lee³, Chih-Wei Shih^{4

5}, Selotia Tausi⁶, Vine Sosene⁷, Pauke P Maani⁷, Malo Tupulaga⁷, Yu-Tien Hsu⁸, Chia-Rui Chang², Shi-Chian Shiau^{4

5}, Yuan-Hung Lo^{4

5}, Chih-Fu Wei^{5

9}, Po-Jen Lin^{4

10

11}, Maria Soledad Hershey⁹

Affiliations

¹ One Health Research Group, Universidad de Las Américas, Quito, Ecuador.
² Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
³ Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA, United States.
⁴ Taiwan International Cooperation and Development Fund (ICDF), Taipei, Taiwan.
⁵ Taiwan Technical Mission to Tuvalu, Funafuti, Tuvalu.
⁶ Ministry of Local Government and Agriculture, Department of Agriculture, Tuvalu.
⁷ Department of Public Health, Ministry of Health, Tuvalu.
⁸ Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
⁹ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
¹⁰ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
¹¹ Department of Medicine, Nuvance Health Danbury Hospital, Danbury, CT, United States.

Abstract

Background: Tuvalu is a Pacific Island country within the small island developing states that has observed a significant and alarming increase in obesity rates over the past 40 years, affecting ∼60 %-70 % of the current population.

Objectives: This study aimed to investigate the association between food patterns and the proportion of obesity in a Pacific Island country.

Methods: The 2022 COMmunity-based Behavior and Attitude survey in Tuvalu (COMBAT) included 985 adults with complete data on sociodemographic information and the frequency of consumption of 25 common foods. A latent class analysis determined 4 food patterns. Bayesian multilevel logistic and linear regression models estimated the association between food patterns and the proportion of obesity [body mass index (BMI) ≥30 kg/m²], severe obesity (BMI ≥40 kg/m²), and weight (kg), adjusting for potential confounders and accounting for clustering by region.

Results: The latent class analysis revealed 4 food patterns with an entropy of 0.94 and an average posterior probability of class assignment for each individual of 0.97, described as follows: 1) local: locally produced foods with moderate food diversity (proportion of individuals = 28 %); 2) diverse-local: local with greater food diversity (17 %); 3) restricted-imported: more imported with restricted diversity (29 %); and 4) imported: heavily imported with high diversity (26 %). Compared to those following the diverse-local pattern, the odds of having obesity were greater for those classified with the imported pattern [odds ratio (OR): 2.52; 95 % credible interval (CrI): 1.59, 3.99], restricted-imported pattern (OR: 1.89; 95 % CrI: 1.59, 3.99), and local pattern (OR: 1.54; 95 % CrI: 0.94, 2.50). Similar trends were observed for severe obesity while body weight was positively associated with both restricted-imported and imported food patterns.

Conclusions: The high consumption of imported foods, together with the low consumption of plant-based foods and protein-rich foods, could be a relevant modifiable lifestyle factor explaining the high levels of obesity and severe obesity in Tuvalu, a Pacific Island country.

Keywords: climate; diet; food systems; global health; nutrition and health; public health nutrition.