Quadruple Burden of Young Child Malnutrition in the Children’s Healthy Living Program, United States–Affiliated Pacific

BACKGROUND: The Pacific region has undergone nutrition transition. OBJECTIVES: This study aimed to examine the quadruple burden of malnutrition in children among jurisdictions of the United States-affiliated Pacific (USAP) region. METHODS: A total of 3480 children in 11 jurisdictions from the USAP region [Alaska, American Samoa, Commonwealth of the Mariana Islands (CNMI), Federated States of Micronesia (FSM), Guam, Hawai'i]. Jurisdictions were categorized according to the World Bank income categories of lower middle income (FSM), upper middle income [American Samoa, Palau, Republic of the Marshall Islands (RMI)], and high income (Hawai'i, Alaska, Guam, CNMI). The following 4 population indicators were evaluated: 1) obesity and 2) stunting using standardized measured anthropometry, 3) inadequacy, and 4) excess of dietary intake of micronutrients of concern globally (iron, zinc, and vitamin A) and in the region (vitamin D, vitamin E, calcium, niacin, folate, and sodium). Frequencies of each malnutrition form were computed. RESULTS: Across the USAP region, there were ≥10% of children with each form of malnutrition. The overall prevalence of stunting across all jurisdictions was 11.4%; varying from a low in American Samoa at 1.7% to a high in RMI at 40%. Overall prevalence of obesity was 13.6%, ranging from a low in RMI of 0% to a high in American Samoa of 25.4%. Overall prevalence of (any of the 9 studied) micronutrient inadequacies was 98.1%, driven by dietary vitamin D inadequacy (96.0%). Overall prevalence of micronutrient excess was 96.2%, driven by sodium excess (92.4%). CONCLUSIONS: There is a quadruple burden of malnutrition in the USAP. Micronutrient inadequacy and excess are the most important forms of malnutrition at 98.1% and 96.2%, respectively. Nutrition promotion should focus on healthy diets, especially in regions undergoing nutrition transition.