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Patterns of childhood and adolescent overweight and obesity during health transition in Vanuatu

  • Kelsey N Dancause (a1) (a2), Miguel Vilar (a2) (a3), Chim Chan (a2), Christa DeHuff (a2), Michelle Wilson (a2) (a4), Laura E Soloway (a2) (a5), Len Tarivonda (a6), Ralph Regenvanu (a7), Akira Kaneko (a8) (a9), Ralph M Garruto (a2) and J Koji Lum (a2)...

Rapid economic development and subsequent changes in lifestyle and disease burdens (‘health transition’) is associated with increasing prevalence of obesity among both adults and children. However, because of continued infectious diseases and undernutrition during the early stages of transition, monitoring childhood obesity has not been prioritized in many countries and the scope of the problem is unknown. Therefore we sought to characterize patterns of childhood overweight and obesity in an early transitional area, the South Pacific archipelago of Vanuatu.


We completed an anthropometric survey among children from three islands with varying levels of economic development, from rural areas (where adult obesity prevalence is low) to urban areas (where adult obesity prevalence is high).


The islands of Ambae (rural), Aneityum (rural with tourism) and Efate (urban).


Boys and girls (n 513) aged 6–17 years.


Height-, weight- and BMI-for-age did not vary among islands, and prevalence of overweight/obesity based on BMI was low. However, girls from Aneityum – a rural island where the tourism industry increased rapidly after malaria eradication – had increased central adiposity compared with girls from the other islands. This is contrary to adult patterns, which indicate higher obesity prevalence in urban areas. Multiple factors might contribute, including stunting, biological responses after malaria control, sleeping patterns, diet and physical activity levels.


Measures of central adiposity highlight an emerging obesity risk among girls in Vanuatu. The data highlight the synergistic relationship among infectious diseases, undernutrition and obesity during the early stages of health transition.

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1.Cole, TJ, Bellizzi, MC, Flegal, KM et al. (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320, 12401243.
2.Griffiths, LJ, Hawkins, SS, Cole, TJ et al. (2010) Risk factors for rapid weight gain in preschool children: findings from a UK-wide prospective study. Int J Obes (Lond) 34, 624632.
3.World Health Organization (2010) Global Strategy on Diet, Physical Activity and Health: Overweight and Obesity. Geneva: WHO.
4.Popkin, BM (2004) The nutrition transition: an overview of world patterns of change. Nutr Rev 62, 7 Pt 2, S140S143.
5.Amuna, P & Zotor, FB (2008) Epidemiological and nutrition transition in developing countries: impact on human health and development. Proc Nutr Soc 67, 8290.
6.Delisle, HF (2008) Poverty: the double burden of malnutrition in mothers and the intergenerational impact. Ann N Y Acad Sci 1136, 172184.
7.Khan, NC & Khoi, HH (2008) Double burden of malnutrition: the Vietnamese perspective. Asia Pac J Clin Nutr 17, Suppl. 1, S116S118.
8.Uauy, R, Kain, J, Mericq, V et al. (2008) Nutrition, child growth, and chronic disease prevention. Ann Med 40, 1120.
9.Flick, AA, Brookfield, KF, de la Torre, L et al. (2010) Excessive weight gain among obese women and pregnancy outcomes. Am J Perinatol 27, 333338.
10.Freeman, DJ (2010) Effects of maternal obesity on fetal growth and body composition: implications for programming and future health. Semin Fetal Neonatal Med 15, 113118.
11.Baird, J, Fisher, D, Lucas, P et al. (2005) Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 331, 929.
12.Fisher, D, Baird, J, Payne, L et al. (2006) Are infant size and growth related to burden of disease in adulthood? A systematic review of literature. Int J Epidemiol 35, 11961210.
13.Law, C (2005) Early growth and chronic disease: a public health overview. Matern Child Nutr 1, 169176.
14.Hales, CN & Barker, DJ (1992) Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35, 595601.
15.Lebenthal, E & Bier, DM (2007) Novel concepts in the developmental origins of adult health and disease. J Nutr 137, 10731075.
16.Stocker, CJ, Arch, JR & Cawthorne, MA (2005) Fetal origins of insulin resistance and obesity. Proc Nutr Soc 64, 143151.
17.Schaible, UE & Kaufmann, SH (2007) Malnutrition and infection: complex mechanisms and global impacts. PLoS Med 4, e115.
18.Hung, LQ, de Vries, PJ, Giao, PT et al. (2005) Nutritional status following malaria control in a Vietnamese ethnic minority commune. Eur J Clin Nutr 59, 891899.
19.World Health Organization (2010) Programmes and Projects: Glossary of Globalization, Trade and Health Terms, Health Transition. Geneva: WHO.
20.Baker, P & Garruto, R (1992) Symposium on changes in disease patterns in the Western Pacific and Southeast Asia. Hum Biol 64, 84.
21.Ohtsuka, R & Ulijaszek, SJ (2007) Health Change in the Asia-Pacific Region: Biocultural and Epidemiological Approaches. Cambridge: Cambridge University Press.
22.Carlot-Tary, M (2000) 1998 Vanuatu Non-communicable Disease Survey Report. SPC Technical Paper. Noumea: Secretariat of the Pacific Community.
23.Vanuatu National Statistics Office (2009) 2009 Census Household Listing Counts. Port Vila: Vanuatu National Statistics Office.
24.Vanuatu Ministry of Health (2008) Monitoring the Situation of Children and Women: Vanuatu Multiple Indicator Cluster Survey 2007 Final Report. Port Vila: Vanuatu Ministry of Health.
25.Vanuatu Ministry of Health (1998) Report of the Second National Nutrition Survey, 1996. Port Vila: Vanuatu Ministry of Health.
26.Renzaho, AM (2006) Food insecurity, malnutrition and mortality in Maewo and Ambae Islands, Vanuatu. Public Health Nutr 9, 798807.
27.United Nations (2010) World Statistics Pocketbook: Vanuatu. New York: UN Publications.
28.Garruto, RM, Little, MA, James, GD et al. (1999) Natural experimental models: the global search for biomedical paradigms among traditional, modernizing, and modern populations. Proc Natl Acad Sci USA 96, 1053610543.
29.Dancause, KN, Dehuff, C, Soloway, LE et al. (2011) Behavioral changes associated with economic development in the South Pacific: health transition in Vanuatu. Am J Hum Biol 23, 366376.
30.Maguire, JD, Bangs, MJ, Brennan, L et al. (2006) Cross-sectional characterization of malaria in Sanma and Shefa Provinces, Republic of Vanuatu: malaria control implications. P N G Med J 49, 2231.
31.Kaneko, A (2010) A community-directed strategy for sustainable malaria elimination on islands: short-term MDA integrated with ITNs and robust surveillance. Acta Trop 114, 177183.
32.Dancause, K (2010) Modernization and population health: A natural experimental model of health transition in Vanuatu, South Pacific. Doctoral Dissertation, Binghamton University.
33.Lohman, TG, Roche, AF & Martorell, R (1988) Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books.
34.World Health Organization (2010) Growth Reference Data for 5–19 Years. Geneva: WHO.
35.World Health Organization (2010) WHO Child Growth Standards. Geneva: WHO.
36.Zemel, BS, Riley, EM & Stallings, VA (1997) Evaluation of methodology for nutritional assessment in children: anthropometry, body composition, and energy expenditure. Annu Rev Nutr 17, 211235.
37.Hung, M (1983) Republic of Vanuatu National Nutrition Survey Report. Port Vila: Vanuatu Ministry of Health.
38.Hamill, PV, Drizd, TA, Johnson, CL et al. (1979) Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr 32, 607629.
39.McCarthy, HD & Ashwell, M (2006) A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message – ‘keep your waist circumference to less than half your height’. Int J Obes (Lond) 30, 988992.
40.Ashwell, M & Hsieh, SD (2005) Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 56, 303307.
41.Ezzati, M, Vander Hoorn, S, Lawes, CM et al. (2005) Rethinking the ‘diseases of affluence’ paradigm: global patterns of nutritional risks in relation to economic development. PLoS Med 2, e133.
42.UNICEF (2005) Vanuatu: A Situation Analysis of Children, Women and Youth. Suva: UNICEF Pacific Office.
43.Poskitt, EM (2009) Countries in transition: underweight to obesity non-stop? Ann Trop Paediatr 29, 111.
44.Aeberli, I, Spinas, GA, Lehmann, R et al. (2009) Diet determines features of the metabolic syndrome in 6- to 14-year-old children. Int J Vitam Nutr Res 79, 1423.
45.Maffeis, C, Banzato, C & Talamini, G (2008) Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr 152, 207213.
46.Corvalan, C, Kain, J, Weisstaub, G et al. (2009) Impact of growth patterns and early diet on obesity and cardiovascular risk factors in young children from developing countries. Proc Nutr Soc 68, 327337.
47.Lemos, JO, Rondo, PH, Pereira, JA et al. (2010) The relationship between birth weight and insulin resistance in childhood. Br J Nutr 103, 386392.
48.Dubois, L & Girard, M (2006) Early determinants of overweight at 4.5 years in a population-based longitudinal study. Int J Obes (Lond) 30, 610617.
49.Stettler, N, Kumanyika, SK, Katz, SH et al. (2003) Rapid weight gain during infancy and obesity in young adulthood in a cohort of African Americans. Am J Clin Nutr 77, 13741378.
50.Yanovski, JA (2003) Rapid weight gain during infancy as a predictor of adult obesity. Am J Clin Nutr 77, 13501351.
51.Ibanez, L, Ong, K, Dunger, DB et al. (2006) Early development of adiposity and insulin resistance after catch-up weight gain in small-for-gestational-age children. J Clin Endocrinol Metab 91, 21532158.
52.Kuh, D, Hardy, R, Chaturvedi, N et al. (2002) Birth weight, childhood growth and abdominal obesity in adult life. Int J Obes Relat Metab Disord 26, 4047.
53.Stein, AD, Thompson, AM & Waters, A (2005) Childhood growth and chronic disease: evidence from countries undergoing the nutrition transition. Matern Child Nutr 1, 177184.
54.Gewa, CA (2010) Childhood overweight and obesity among Kenyan pre-school children: association with maternal and early child nutritional factors. Public Health Nutr 13, 496503.
55.Robert, V, Bourgouin, C, Depoix, D et al. (2008) Malaria and obesity: obese mice are resistant to cerebral malaria. Malar J 7, 81.
56.Kurtis, JD, Mtalib, R, Onyango, FK et al. (2001) Human resistance to Plasmodium falciparum increases during puberty and is predicted by dehydroepiandrosterone sulfate levels. Infect Immun 69, 123128.
57.Leenstra, T, Phillips-Howard, PA, Kariuki, SK et al. (2003) Permethrin-treated bed nets in the prevention of malaria and anemia in adolescent schoolgirls in western Kenya. Am J Trop Med Hyg 68, 8693.
58.Rush, EC, Freitas, I & Plank, LD (2009) Body size, body composition and fat distribution: comparative analysis of European, Maori, Pacific Island and Asian Indian adults. Br J Nutr 102, 632641.
59.Bibiloni, MM, Martinez, E, Llull, R et al. (2011) Metabolic syndrome in adolescents in the Balearic Islands, a Mediterranean region. Nutr Metab Cardiovasc Dis 21, 446454.
60.Miranda, JJ, Kinra, S, Casas, JP et al. (2008) Non-communicable diseases in low- and middle-income countries: context, determinants and health policy. Trop Med Int Health 13, 12251234.
61.Government of Vanuatu (2010) Millenium Development Goals: 2010 Report for Vanuatu. Port Vila: Government of Vanuatu.
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