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The objective of this study was to determine iodine nutrition status and whether iodine status differs across salt intake levels among a sample of women aged 18-45 years living in Samoa. A cross-sectional survey was completed and 24-hr urine samples were collected and assessed for iodine (n=152) and salt excretion (n=119). The median urinary iodine concentration (UIC) among the women was 88 μg/L (Interquartile range (IQR)=54-121 μg/L). 62% of the women had a UIC100 μg/L. The crude estimated mean 24-hr urinary salt excretion was 6.6 (standard deviation 3.2) g/day. More than two-thirds (66%) of the women exceeded the World Health Organization recommended maximum level of 5 g/day. No association was found between median UIC and salt excretion (81 μg/L iodine where urinary salt excretion=5 g/day versus 76 μg/L where urinary salt excretion5 g/day; p=0.4). Iodine nutrition appears to be insufficient in this population and may be indicative of iodine deficiency disorders in Samoan women. A collaborative approach in monitoring iodine status and salt intake will strengthen both programs and greatly inform the level of iodine fortification required to ensure optimal iodine intake as population salt reduction programs take effect.该研究旨在确定萨摩亚18-45 岁女性居民碘营养状况及碘状况是否随着盐摄入 水平的不同而不同。采用横断面调查，收集24 小时尿液样本，分析碘 （n=152）和盐排泄（n=119）。女性尿碘浓度（UIC）的中位数为88 μg/L （四分位间距（IQR）=54-121 μg/L）。62%的女性UIC100 μg/L。粗略估计 24 小时尿盐排泄量的均数为6.6（标准差3.2）克/天。超过2/3（66%）的妇女 尿盐排泄量超过世界卫生组织推荐的最高水平5 克/天。UIC 的中位数和盐排 泄之间无关系（尿盐排泄量=5 克/天的人群碘水平为81 μg/L，尿盐排泄量5 克/天的人群碘水平为76 μg/L；p=0.4）。萨摩亚妇女碘营养不足表明可能该 人群有碘缺乏病。部门间的协作将加强在监测碘营养状况和盐摄入量两个项目 和极大地告知碘强化所要求的水平，以确保人群减盐计划有效实施时有最佳的 碘摄入量。.

The prevalence of metabolic syndrome has reached epidemic levels in the Samoan Islands. In this cross-sectional study conducted in 2002-2003, dietary patterns were described among American Samoan (n = 723) and Samoan (n = 785) adults (> or =18 y) to identify neo-traditional and modern eating patterns and to relate these patterns to the presence of metabolic syndrome using Adult Treatment Panel III criteria. The neo-traditional dietary pattern, similar across both polities, was characterized by high intake of local foods, including crab/lobster, coconut products, and taro, and low intake of processed foods, including potato chips and soda. The modern pattern, also similar across both polities, was characterized by high intake of processed foods such as rice, potato chips, cake, and pancakes and low intake of local foods. The neo-traditional dietary pattern was associated with significantly higher serum HDL-cholesterol in American Samoa (P-trend = 0.05) and a decrease in abdominal circumference in American Samoa and Samoa (P-trend = 0.004 and 0.01, respectively). An inverse association was found with metabolic syndrome, although it did not reach significance (P = 0.23 in American Samoa; P = 0.13 in Samoa). The modern pattern was significantly positively associated with metabolic syndrome in Samoa (prevalence ratio = 1.21 for the fifth compared with first quintile; 95% CI: 0.93.1.57; P-trend = 0.05) and with increased serum triglyceride levels in both polities (P < 0.05). Reduced intake of processed foods high in refined grains and adherence to a neo-traditional eating pattern characterized by plant-based fiber, seafood, and coconut products may help to prevent growth in the prevalence of metabolic syndrome in the Samoan islands.

Objective To describe the dietary intake of American and Western Samoans, with emphasis on nutrients conventionally related to risk factors for cardiovascular disease. Design Cross-sectional dietary survey. Intake estimates were based on 24-hour recall interviews. Subject Community-based samples of 946 men and women (455 American Samoans, 491 Western Samoans) aged 25 to 55 years. Statistical analyses Tests of differences in means ( t tests) and proportions (Chi 2 tests). Correlation and multivariate linear regression analyses were conducted to describe correlates of energy and nutrient intakes. Results Few differences were noted between the energy and nutrient intakes of men and women, but substantial differences were found between residents of American Samoa and those of the less modernized country of Western Samoa. American Samoans consumed significantly more energy as carbohydrate (47% vs 44%) and protein (18% vs 13%) and less as fat (36% vs 46%) and saturated fat (16% vs 30%). Energy-adjusted intakes of cholesterol and sodium were higher among American Samoans. These differences persisted after adjustment for age, gender, years of education, occupation, and categories of a 10-point material lifestyle score. Samoans in the lowest category of material lifestyle had significantly lower energy-adjusted intakes of protein, cholesterol, and sodium and higher intakes of saturated fat than those in the upper 2 categories. Additional analyses described the contribution of specific foods to the intakes of energy and macronutrients. Conclusions/applications The observed energy and nutrient intake patterns are consistent with previously reported levels of obesity and risk factors for cardiovascular disease among Samoans and suggest dietary modification for those at highest risk. Dietetics practitioners who counsel Samoan and other Pacific Islander clients should be aware of these intake patterns, which seem particularly malleable to levels of personal income. More generally, results from this study illustrate that the food choices of certain ethnic groups may be profoundly affected by the process of modernization within a country or by migration to a more economically developed locale. J Am Diet Assoc. 1999;99:184–190 .

This article describes pathways through which trade policy change in two Pacific Island countries has contributed to changes in the food supply, and thereby to the nutrition transition. The effect of various trade policies from 1960 to 2005 on trends in food imports and availability is described, and case studies are presented for four foods associated with the nutrition transition and chronic disease in the Pacific. Trade policies (including liberalization, export promotion, protection of the domestic meat industry and support for foreign direct investment) have contributed to a reduced availability of traditional staples, and increased availability of foods associated with the nutrition transition, including refined cereals (particularly polished rice and white flour), meat, fats and oils, and processed food products. This study suggests that promoting healthier imports and increasing production of healthier traditional foods, in both of which trade policy has an important effect, has the potential to improve diets and health, in conjunction with other public health intervention.

A tax on soft drinks is often proposed as a health promotion strategy for reducing their consumption and improving health outcomes. However, little is known about the processes and politics of implementing such taxes. We analysed four different soft drink taxes in Pacific countries and documented the lessons learnt regarding the process of policy agenda-setting and implementation. While local social and political context is critically important in determining policy uptake, these case studies suggest strategies for health promotion practitioners that can help to improve policy uptake and implementation. The case studies reveal interaction between the Ministries of Health, Finance and Revenue at every stage of the policy making process. In regard to agenda-setting, relevance to government fiscal priorities was important in gaining support for soft drink taxes. The active involvement of health policy makers was also important in initiating the policies, and the use of existing taxation mechanisms enabled successful policy implementation. While the earmarking of taxes for health has been widely recommended, the revenue may be redirected as government priorities change. Health promotion practitioners must strategically plan for agenda-setting, development and implementation of intersectoral health-promoting policies by engaging with stakeholders in finance at an early stage to identify priorities and synergies, developing cross-sectoral advocacy coalitions, and basing proposals on existing legislative mechanisms where possible.

Introduction In 1988, David Tua, a Samoan raised on the island of Upolu, stormed the world's heavyweight boxing circles. He is one of the many Samoans who have become known internationally for their athleticism, whether in the boxing ring, on the rugby field, in American football or in paddling traditional outrigger canoes. While such athletes train and remain fit, Samoan communities in the archipelago and abroad are experiencing the negative health effects of the nutrition transition. Shifts in diet and physical activities are leading to chronic positive energy balance and high prevalence rates of obesity and related non-communicable diseases (NCD). In 2003 in the nation of Samoa, about one-third of men and over half of women aged 25 to 74 years were obese by Polynesian standards for body mass index (BMI). In 2002, 100 km across the ocean in American Samoa, about 60% of men and almost three-quarters of women were obese by the same standard. Along with these marked levels of adulthood overweight and obesity, Samoan people suffer from high levels of cardiovascular disease, type 2 diabetes, and other associated metabolic disorders (McGarvey 2001; McGarvey et al . 2005). Recently there has been a distinct rise in childhood and adolescent obesity in Samoa (Roberts et al . 2004), which threatens to exacerbate NCDs at earlier ages in the future. This chapter describes the putative causes and health consequences of the changes in nutritional status among Samoans in the early twenty-first century.

Blood pressure (BP) levels were studied in 524 youth ages 4-19.9 years who reside in Samoa. The data were collected in two separate cross-sectional samples taken in 1979 (n = 292) and in 1991-93 (n = 232). BP was compared between these two study samples to evaluate the temporal change in BP among youth in response to the processes of economic modernization in Samoa, and specifically on how temporal increases in body size influenced BP levels. Proportions of youth with elevated BP levels were estimated using the Second Task Force criteria. In males and females 10-19 years, age-adjusted systolic BP was significantly higher in the 1991-93 sample than in the 1979 sample, and the difference became insignificant after adjustment for body mass index. The proportion of those ages 10-19 years with elevated BP ranged from 11-15% in the 1979 study sample and was approximately 25% in the 1991-93 study sample. There appears to be a temporal trend of increasing adiposity and BP in those 10-19 years and the BP differences are attributable to the higher levels of adiposity.

Pancreatic extracts, even in high doses, usually fail to completely control steatorrhoea in cystic fibrosis (CF), due to inactivation of the enzymes by acid and pepsin. Pancrease is a new formulation consisting of pH-sensitive, enteric coated beads which protect the pancreatic enzymes from acid and pepsin denaturation. Twelve patients with CF entered an outpatient study to examine the effectiveness of this product compared with that of a conventional product (Viokase®). Two doses for each product were used during four sequential 4-week periods. Twenty-two capsules of Pancrease® daily was significantly better than 32 capsules of Viokase® daily (faecal fat excretion 8.7 ± 4.1 g/day, 17.3 ± 9.1 g/day, p < 0.01; coefficient of absorption 89.5 ± 4.2%, 79.3 ± 9.9%, p < 0.01; bowel actions/day 1.7 ± 0.7, 2.2 ± 0.9, p < 0.05; rank scores of stool odour and stool consistency, both p < 0.05; parent's treatment preference p < 0.01). No difference was detected between Viokase® 32 capsules daily and Pancrease® 11 capsules daily, but both were significantly better than 16 capsules of Viokase® daily.