Dietary Patterns Are Associated with Metabolic Outcomes among Adult Samoans in a Cross-Sectional Study.

Background: The Samoan population has been undergoing a nutrition transition toward more imported and processed foods and a more sedentary lifestyle.Objectives: We aimed to identify dietary patterns in Samoa and to evaluate their associations with metabolic outcomes.Methods: The sample of this cross-sectional study includes 2774 Samoan adults recruited in 2010 (1104 with metabolic syndrome compared with 1670 without). Principal component analysis on food items from a 104-item food-frequency questionnaire was used to identify dietary patterns. Adjusted least squares means of each component of metabolic syndrome were estimated by quintiles of factor scores for each dietary pattern. Metabolic syndrome status was regressed on quintiles of scores by using log-binomial models to obtain prevalence ratios.Results: We identified a modern pattern, a mixed-traditional pattern, and a mixed-modern pattern. The modern pattern included a high intake of imported and processed foods, including pizza, cheeseburgers, margarine, sugary drinks, desserts, snacks, egg products, noodles, nuts, breads, and cakes and a low intake of traditional agricultural products and fish. The mixed-traditional pattern had a high intake of neotraditional foods, including fruits, vegetables, soup, poultry, and fish, and imported and processed foods, including dairy products, breads, and cakes. The mixed-modern pattern was loaded with imported and processed foods, including pizza, cheeseburgers, red meat, egg products, noodles, and grains, but also with neotraditional foods, such as seafood and coconut. It also included a low intake of fish, tea, coffee, soup, and traditional agricultural staples. Higher adherence to the mixed-modern pattern was associated with lower abdominal circumference (P-trend < 0.0001), lower serum triglycerides (P-trend = 0.03), and higher serum HDL cholesterol (P-trend = 0.0003). The mixed-modern pattern was inversely associated with prevalence of metabolic syndrome (the highest quintile: prevalence ratio = 0.79; 95% CI: 0.69, 0.91; P-trend = 0.006).Conclusion: Mixed dietary patterns containing healthier foods, rather than a largely imported and processed modern diet, may help prevent metabolic syndrome in Samoa.

Antimicrobial susceptibility of bacterial isolates from clinical specimens in four Pacific Island countries, 2017-2021.

Background: There are limited antimicrobial resistance (AMR) surveillance data from low- and middle-income countries, especially from the Pacific Islands region. AMR surveillance data is essential to inform strategies for AMR pathogen control. Methods: We performed a retrospective analysis of antimicrobial susceptibility results from the national microbiology laboratories of four Pacific Island countries - the Cook Islands, Kiribati, Samoa and Tonga - between 2017 and 2021. We focused on four bacteria that have been identified as 'Priority Pathogens' by the World Health Organization: Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Findings: Following deduplication, a total of 20,902 bacterial isolates was included in the analysis. The most common organism was E. coli (n = 8455) followed by S. aureus (n = 7830), K. pneumoniae (n = 2689) and P. aeruginosa (n = 1928). The prevalence of methicillin resistance among S. aureus isolates varied between countries, ranging from 8% to 26% in the Cook Islands and Kiribati, to 43% in both Samoa and Tonga. Ceftriaxone susceptibility remained high to moderate among E. coli (87%-94%) and K. pneumoniae (72%-90%), whereas amoxicillin + clavulanate susceptibility was low against these two organisms (50%-54% and 43%-61%, respectively). High susceptibility was observed for all anti-pseudomonal agents (83%-99%). Interpretation: Despite challenges, these Pacific Island laboratories were able to conduct AMR surveillance. These data provide valuable contemporary estimates of AMR prevalence, which will inform local antibiotic formularies, treatment guidelines, and national priorities for AMR policy. Funding: Supported by the National Health and Medical Research Council.

Does Samoa Have Adequate Policies to Reduce Obesity and Obesity-Related Disease?

In obesity, abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications, and results in decreased lifespan. There are many long-term medical complications to consider, such as heart disease, cancer, stroke, type 2 diabetes mellitus, and non-alcoholic fatty liver disease, among others. These are all difficult and expensive conditions to treat in a small developing country like Samoa. The prevalence of obesity in Samoa has steadily increased since the 1960s, and today, 53% of Samoa's adult population are obese. People living in the small island country of Samoa, with a total population of fewer than 200 thousand people, are one of the most obese people in the world today. Factors that have contributed to obesity over the previous four decades include urbanization, the dependence on a dietary transition from one based on fresh local food to highly processed imported food, poverty, as well as probable genetic predisposition. Efforts by the Samoa Ministry of Health and partners to reverse the trend of obesity have mainly relied on behavior change strategies since the 1970s, with no clinical evidence of success. This study critically reviews current policies and strategic plans in Samoa to reduce the obesity problem and proposes that because of the contributing structural factors, the health sector alone cannot achieve its objective without matching multi-sectorial government initiatives.

The protective effect of rs373863828 on type 2 diabetes does not operate through a body composition pathway in adult Samoans.

OBJECTIVE: The aim of this study was to understand whether the paradoxical association of missense variant rs373863828 in CREB3 regulatory factor (CREBRF) with higher BMI but lower odds of diabetes is explained by either metabolically favorable body fat distribution or greater fat-free mass. METHODS: This study explored the association of the minor allele with dual-energy x-ray absorptiometry-derived body composition in n = 421 Samoans and used path analysis to examine the mediating role of fat and fat-free mass on the relationship between rs373863828 and fasting glucose. RESULTS: Among females, the rs373863828 minor A allele was associated with greater BMI. There was no association of genotype with percent body fat, visceral adiposity, or fat distribution in either sex. In both females and males, lean mass was greater with each A allele: 2.16 kg/copy (p = 0.0001) and 1.73 kg/copy (p = 0.02), respectively. Path analysis showed a direct negative effect of rs373863828 genotype on fasting glucose (p = 0.004) consistent with previous findings, but also an indirect positive effect on fasting glucose operating through fat-free mass (p = 0.027). CONCLUSIONS: The protective effect of rs373863828 in CREBRF, common among Pacific Islanders, on type 2 diabetes does not operate through body composition. Rather, the variant's effects on body size/composition and fasting glucose likely operate via different, tissue-specific mechanisms.

Prevalence of Sepsis Continuum in Patients With Type 2 Diabetes Mellitus at Tupua Tamasese Meaole Hospital in Samoa.

Background Individuals with longstanding type 2 diabetes mellitus (T2DM) have a significantly higher risk for infection caused by immune dysfunction, resulting in sepsis continuum (sepsis, severe sepsis, and septic shock) if not adequately addressed. In sepsis, organ dysfunction occurs because the host's response to infection is impaired, more so in severe sepsis. In septic shock, persistent hypotension happens, requiring vasopressors despite aggressive fluid management. The internal medicine (IM) ward plays a critical part in managing patients with sepsis. However, the prevalence of sepsis has been investigated extensively in an intensive care unit (ICU) setting instead of the IM ward. This study aimed to determine the prevalence rates of sepsis, severe sepsis, and septic shock in patients with T2DM admitted at an IM ward in Samoa. Methods This retrospective hospital record-based study was conducted over four months on 100 patients with T2DM admitted to the IM ward within the sepsis continuum. Participants were selected by convenience sampling, and the diagnosis was determined from the admission notes. Results The prevalence rates of sepsis, severe sepsis, and septic shock in patients with T2DM admitted to the IM ward were 80%, 12%, and 8%, respectively. Conclusion The most frequent presentation in individuals with T2DM who are within the sepsis continuum upon admission to the IM ward was sepsis, followed by severe sepsis and septic shock.

Novel Relationship Between Hemoglobin A1c Levels and Foot Ulcer Development Among Patients With Type 2 Diabetes Mellitus Admitted at Tupua Tamasese Meaole Hospital.

BACKGROUND: Diabetes mellitus is one of the leading chronic conditions worldwide. One of its most debilitating complications is diabetic foot ulcers (DFUs), which appear to have an increased incidence in the Pacific Islands. However, this report has not been studied extensively in Samoa. Nevertheless, DFUs may be prevented through strict glycemic control by hemoglobin A1c (HbA1c) level monitoring. OBJECTIVE: This study aimed to identify a specific cutoff point for HbA1C to reduce the occurrence of DFUs in patients with type 2 diabetes mellitus (T2DM) admitted to an internal medicine ward in Samoa. Increased HbA1c levels are hypothesized to be strongly associated with DFU development. METHODS: A retrospective unmatched case-control study examined 100 patients with T2DM (50 patients with DFUs [case] and 50 patients without DFUs [control]) over four months. Participants were selected by convenience sampling. RESULTS: The HbA1c results were available in 32 cases and 29 controls. The receiver operating characteristic curve showed that the area under the curve was 51% (95% CI, 36%-66%; standard error, 0.075; P = 0.8966), and no cutoff point could be established. CONCLUSION: The HbA1c is not an ideal test to readily predict DFUs in patients with T2DM.

Exploring the Paradoxical Relationship of a Creb 3 Regulatory Factor Missense Variant With Body Mass Index and Diabetes Among Samoans: Protocol for the Soifua Manuia (Good Health) Observational Cohort Study.

BACKGROUND: The prevalence of obesity and diabetes in Samoa, like many other Pacific Island nations, has reached epidemic proportions. Although the etiology of these conditions can be largely attributed to the rapidly changing economic and nutritional environment, a recently identified genetic variant, rs373863828 (CREB 3 regulatory factor, CREBRF: c.1370G>A p.[R457Q]) is associated with increased odds of obesity, but paradoxically, decreased odds of diabetes. OBJECTIVE: The overarching goal of the Soifua Manuia (Good Health) study was to precisely characterize the association of the CREBRF variant with metabolic (body composition and glucose homeostasis) and behavioral traits (dietary intake, physical activity, sleep, and weight control behaviors) that influence energy homeostasis in 500 adults. METHODS: A cohort of adult Samoans who participated in a genome-wide association study of adiposity in Samoa in 2010 was followed up, based on the presence or absence of the CREBRF variant, between August 2017 and March 2019. Over a period of 7-10 days, each participant completed the main study protocol, which consisted of anthropometric measurements (weight, height, circumferences, and skinfolds), body composition assessment (bioelectrical impedance and dual-energy x-ray absorptiometry), point-of-care glycated hemoglobin measurement, a fasting blood draw and oral glucose tolerance test, urine collection, blood pressure measurement, hand grip strength measurement, objective physical activity and sleep apnea monitoring, and questionnaire measures (eg, health interview, cigarette and alcohol use, food frequency questionnaire, socioeconomic position, stress, social support, food and water insecurity, sleep, body image, and dietary preferences). In January 2019, a subsample of the study participants (n=118) completed a buttock fat biopsy procedure to collect subcutaneous adipose tissue samples. RESULTS: Enrollment of 519 participants was completed in March 2019. Data analyses are ongoing, with results expected in 2020 and 2021. CONCLUSIONS: While the genetic variant rs373863828, in CREBRF, has the largest known effect size of any identified common obesity gene, very little is currently understood about the mechanisms by which it confers increased odds of obesity but paradoxically lowered odds of type 2 diabetes. The results of this study will provide insights into how the gene functions on a whole-body level, which could provide novel targets to prevent or treat obesity, diabetes, and associated metabolic disorders. This study represents the human arm of a comprehensive and integrated approach involving humans as well as preclinical models that will provide novel insights into metabolic disease. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/17329.