Review of the potential for harmonisation of sustainable food system indicators, and the assessment of key aspects of nutrition and health in two atoll Islands of Kiribati, a West Pacific Island State : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Wellington, New Zealand

Abstract

Sustainable diets, which links nutrition and food systems, cuts across all seventeen Sustainable Development Goals (SDG), with particular relevance to SDG 2. Despite much recent attention being given to sustainable diets and food systems, methodologies for assessing sustainable diets are complex and may not be generally applicable. This thesis describes a series of studies, which aimed to review the methodologies for assessing sustainable diets and potential for development of a harmonized indicators; assess the knowledge, attitude and practice (KAP) on nutrition of the households in South Tarawa and Butaritari Islands; conduct dietary assessments amongst the household members using a 24-h diet recall and weighed food records methodology in the Islands; and carry out anthropometric and body adiposity measurements of the householders and secondary school students. A total 468 households were randomly selected in South Tarawa (n=161) and Butaritari (n=307) for the 24-h dietary recall and a sub-sample of 28 households participated in the weighed food record. Another 320 subjects were recruited for the KAP study on nutrition; and 483 adults and 194 adolescents were selected for the anthropometric and body adiposity study respectively. Food consumption patterns of the households in the islands reflected high consumption of non-traditional diets and refined foods, which manifested in inadequate micronutrient intake estimates and low dietary diversity The KAP study showed the majority of respondents had good knowledge and attitudes towards good nutrition, however, these were not adequately reflected in their nutritional practices. Based on measures of bioelectric impedance, two-thirds of the subjects (68.4%) had a very high body fat (BF) %, 22.2% had high BF%, 8.8% had normal BF% and 0.6% had low BF%. Based on body mass index (BMI), about three-quarters of the subjects (73.2%) were obese and 22.5% were overweight. Obesity prevalence among the adolescents was low based on BMI and BF% criteria. In conclusion, despite the investments on nutrition programmes in Kiribati, no change was noticed from the results of 1985 Kiribati National Nutrition Survey and the findings of this study. Policies and interventions to sustainably improve diets in Kiribati, and thus reduce diet-related morbidity and mortality, need to address elements of sustainable diets.