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“Ola Tuputupua’e” (Growing Up) Study (Samoa)

The “Ola Tuputupua’e” or (Growing Up) Study is a cohort study that began in 2015 with the recruitment of 319 mother-child pairs from 10 villages across the Samoan island of Upolu. Children were two-four years of age in 2015 and will be followed at two-year intervals into adolescence with the goal of understanding how the household and school environments contribute to obesity risk throughout childhood. In each bi-annual wave of the study participants provide physical measurements (height, weight, blood pressure) and a finger-stick blood sample for the detection of anemia. Mothers complete questionnaires detailing household characteristics (socioeconomic position, household composition, food security), child behaviors (diet and physical activity), and child health. A sub-sample of the cohort also wear accelerometers for seven days to objectively measure physical activity.

Longitudinal assessment of growth, health, and development in the Samoan setting will allow us to determine at what age obesity is established and what factors – from early life into adolescence – may be the most important targets for preventative intervention.

Timeline: This study will be actively recruiting for the second study wave (child age 4-6 years) between May and August 2017.

Principal Investigators: Nicola Hawley (YSPH), Courtney Choy (Fulbright Research Scholar, Samoan Ministry of Health), Christina Soti-Ulberg (Ministry of Health, Samoa), Take Naseri (Ministry of Health, Samoa) and Sefuiva Reupena (Samoa Bureau of Statistics)

Funding Source: Yale Faculty Funds

Affiliated Faculty & Students: Nicole Deziel (YSPH Faculty), Rachel Duckham (Faculty, Deakin University, Australia), Lauren Sherar (Faculty, Loughborough University, UK), Avery Thompson (YSPH), Trevor Anesi (Brown University), Veeraya Tanawattanacharoen (Yale) and Luis Gonzalez (Wesleyan College)

Relevant Publications:

If you can not access any of the full publications, please reach out to Nicola Hawley

1. Child, maternal, and household level correlates of nutritional status: a cross-sectional study among Samoan children.

Choy C.C., Desai, M.M., Park, J.J., Frame, E.A., Thompson A.A., Naseri, T., Reupena, M.S., Duckham, R.L., Deziel, N.C., & Hawley, N.L. (2017). Public Health Nutrition 20 (7): 1235-1247.

This study aimed to document the prevalence, coexistence and correlates of nutritional status (stunting, overweight/obesity and anaemia) in Samoan children aged 24-59 months. Using a cross-section community-based survey in ten villages on the Samoan island of Upolu, we found—in a sample of 305 mother-child pairs—stunted growth in 20.3% of children, obesity/overweight status in 16.1% of children, and anaemia in 34.1% of children. These findings—observed prevalences of stunting, overweight/obesity and anaemia—suggest that it is critical to invest in nutrition and develop health programs targeting early childhood growth and development in Samoa.

2. Dietary patterns are associated with child, maternal, and household-level characteristics and overweight/obesity among young Samoan children.

Choy, C.C., Wang, D., Baylin, A., Soti-Ulberg, C., Naseri, T., Reupena, M.S., Thompson, A.A., Duckham, R.L. & Hawley, N.L. Public Health Nutrition (in press).

This study aimed to identify dietary patterns among 24-59-month-old Samoan children and evaluate their association with: child, maternal and household characteristics, and nutritional status indicators (stunting, overweight/obesity, anaemia). We identified two dietary patterns: modern (loaded with “westernized foods”) and neo-traditional. Moderns diets were associated with urban residence, greater maternal educational attainment, higher socioeconomic status, lower vitamin C intake and higher sugar intake and neo-traditional diets were associated with rural residence, lower socioeconomic status, higher vitamin C intake and lower sugar intake. These findings recommend further longitudinal monitoring and evaluation of early childhood growth and development in Samoa.

3. Nutrient intake among Samoan children aged 2 to 4 years in 2015.

Choy, C.C., Thompson, A.A., Soti-Ulberg, C., Naseri, T., Reupena, M.S., Duckham, R.L. & Hawley, N.L. Annals of Human Biology (in press).

This study aimed to examine the adequacy of macro- and micronutrient intake among Samoan children ages 2 to 4.99. Using a 117-item food frequency questionnaire, we found most children met or exceeded recommendations for carbohydrate, fat, and protein intake, but did not meet the Recommended Dietary Allowances for calcium, potassium, and Vitamin and E. The findings show inadequate dietary micronutrient intake to be more common among older children (4-4.99 years) and those in the rural regions, and recommend interventions be targeted at those groups.

4. Gender differences in the associations of physical activity and nutritional intake with child body composition: a cross-sectional study of 3-7 year-olds in Samoa.

Thompson, A.A., Duckham, R.L, Desai, M.M., Choy, C.C., Sherar, L.B., Naseri, T., Soti-Ulberg, C., Reupena, S., Wetzel, A. & Hawley, N.L. Pediatric Obesity (in press).

The purpose of this cross-sectional study was to examine gender differences in the impact of nutritional and physical activity factors on the body composition of Samoan children through dual energy x-ray absorptiometry (DXA.) Studying a sample of 83 children between the ages of 3 and 7, the researchers tracked physical activity, using accelerometers, and nutritional intake, via questionnaires filled out by the childrens’ mothers. The team found that body composition differed by gender at 3-7 years of age. In girls, carbohydrate intake was negatively associated with percent body fat and positively associated with percent lean mass. In boys, physical activity was negatively associated with trunk to peripheral fat ratio. Additionally, though there was a significant interaction between gender and carbohydrates, physical activity did not attenuate the effect of carbohydrate intake on body composition in either boys or girls. This study highlights important gender differences in the effect of nutrition and physical activity on body composition among Samoan children, and recommends further research on the topic.

5. Piloting a food photo sorting activity in Samoa to assess maternal beliefs and their role in child diet.

Tanawattanacharoen,V.K., Choy, C.C., Anesi, T.J., Naseri, T., Soti-Ulberg, C., Reupena, M.S., & Hawley N.L. Maternal and Child Nutrition (in press).

The purpose of this study was to test a tool to understand how mothers make decisions about their children’s dietary intake. Forty-four Samoan mothers sorted photographs of 26 foods commonly consumed in children in Samoa by cost, social status, and nutritional value (healthfulness). We then looked at the association of these beliefs about food with what children actually consumed (using a food frequency questionnaire). Samoan mothers showed that they had strong nutritional knowledge - their responses about the healthfulness of the 26 foods matched closely with nutritional experts. Mothers also had a good understanding of cost. The perceived cost of food was more strongly associated with child dietary intake than either healthfulness or social status, with decreasing consumption reported with increasing food cost. Our findings contradicted the notion that the high social status of imported foods may be contributing to increased intake and rising prevalence of childhood obesity in this developing country setting. Despite their nutritional knowledge, Samoan mothers may need additional support in applying their knowledge/beliefs to provide a healthy child diet, including support for access to reasonably priced healthy foods.