pacific food guide - ceconnection for allied health

Pacific Food GuideMarie Kainoa Fialkowski, PhD, RDN, LDNLenora Matanane, BS, MSW. Jay Gibson, BA, BBAEricka YiuJim Hollyer, MSKathryn Kolasa, PhD, RDN, LDNRachel Novotny, PhD, RDN, LDN

The US Affiliated Pacific Region includes 10 jurisdictionswith unique foods and food practices. Providing nutritioneducation to participants in this region is challengingbecause 2 different dietary guidelines are used: the USDietary Guidelines with MyPlate and the Secretariat forthe Pacific Community Dietary Guidelines. The purposeof this article is to describe the process used to develop aPacific Food Guide, a conduit for linking the 2 dietaryguidelines applied in the region. The Pacific Food Guidewas developed, piloted, and evaluated as being useful inan introductory college-level nutrition course that servesthe diverse student population of the US Affiliated PacificRegion. Nutr Today. 2016;51(2):72Y81

WHY A PACIFIC FOOD GUIDE?

Food GuidesFood guides are dynamic nutrition education tools1 thatserve as ‘‘encyclopedias of food.’’ Food guides are criticalresources for those designing programs and nutritioneducation materials, as well as for those who want toknow more about food. Science-based advice featured infood guides often includes food and nutrient recommen-dations, identification of foods consumed by the targetpopulation, and nutrient content of those foods.2 Since1916, the US Department of Agriculture (USDA) has beenpublishing food guides with as few as 4 to as many as 12food groups. These groups changed little over the yearsand included some combination of dairy, protein, grain,vegetables, fruit, and added energy-rich foods (fats, oils,and sugars).1 Food guides often provide portion recom-mendations as a number or range of volumetric servings(eg, cups) to be eaten daily.

The US Dietary GuidelinesIn the United States, the Dietary Guidelines for Americansserve as the basis of US nutrition policy and are updatedevery 5 years. A variety of icons have been used to rep-resent the recommendations given in the Dietary Guide-lines for Americans. For example, in 2011, the MyPlate3

icon replaced MyPyramid as the primary nutrition educationtool for promotinghealthy eating. TheDietaryGuidelines forAmericans presents information in both scientific language(eg, limit consumption of saturated fat) and as food-based recommendations, sometimes including graphicsand icons of food groups.4

Other GuidelinesOther countries and areas including but not limited toSingapore, Canada, Finland, Greece, Australia, and theSouth Pacific have their own guidelines.5,6 Agencies suchthe United Nation’s Food and Agriculture Organizationand the World Health Organization recommend Food-Based Dietary Guidelines that are consumer friendlydepicting familiar and accessible foods rather than lists ofnutrient recommendations.7,8 Developers of guidelinesand icons have increasingly included foods familiar toethnic and minority groups.

1.5 CPEUs and 2.0 ANCC Contact Hours

72 Nutrition Today\ Volume 51, Number 2, March/April 2016

Marie Kainoa Fialkowski, PhD, RDN, LDN, is an assistant professor inthe Department of Human Nutrition, Food, and Animal Science at theUniversity of Hawai‘i atManoa and assistant program director and trainingprogram leader for the Children’s Healthy Living Program working ondeveloping Native Hawaiian and Pacific Islander specific nutrition educa-tion materials and curricula.

Lenora,Matanane,BS,MS, is a graduate of theNutritional SciencesMasterof Science degree program in the Department of Human Nutrition, Food,and Animal Science at the University of Hawai‘i at Manoa and is a formerrecipient of the Children’s Healthy Living Training Scholarship Program.

W. Jay Gibson, BA, BBA, graduated from the Food Science and HumanNutrition bachelor degree program in the Department of Human Nu-trition, Food, and Animal Science at the University of Hawai‘i at Manoa.

Ericka Yiu, is an undergraduate student in the Food Science and HumanNutrition degree program in the Department of Human Nutrition, Food,and Animal Science at the University of Hawai‘i at Manoa.

Jim Hollyer, MS, is the External Communications leader for the Chil-dren’s Healthy Living Program at the University of Hawai‘i at Manoa.

Kathryn Kolasa, PhD, RDN, LDN, is professor emeritus of the BrodySchool of Medicine at East Carolina University and is an external advisorto the Children’s Healthy Living Program.

Rachel Novotny, PhD, RDN, LDN, is a professor in the Department ofHuman Nutrition, Food, and Animal Science at the University of Hawai‘iat Manoa and is principal investigator/program director of the Children’sHealthy Living Program.

Sources of funding: Agriculture and Food Research Initiative grant no.2011-68001-30335 from the USDA National Institute of Food andAgricultural Science Enhancement Coordinated Agricultural Program.

The authors have no conflicts of interest to disclose.

Correspondence: Marie Kainoa Fialkowski, PhD, RDN, LDN University ofHawai‘i at Manoa, 1955 East West Rd, Agricultural Science 314 J,Honolulu, HI 96822 ([email protected]).

DOI: 10.1097/NT.0000000000000145

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

mailto:[email protected]

No Specific Guidelines Exist for the USAffiliated Pacific RegionThe US Affiliated Pacific region (US Pacific) includes thestate of Hawai‘i, the US territories of American Samoa andGuam, and the Commonwealth of the Northern MarianaIslands. In addition, the US Pacific includes the indepen-dent countries of the Federates States of Micronesia, theRepublic of the Marshall Islands, and the Republic ofPalau, who are in a Compact of Free Association with theUS government and are here referred to as the Freely As-sociated States of Micronesia (Figure 1). These states haveaccess to many US domestic programs. The unique rela-tionship that all these jurisdictions have with the UnitedStates has been outlined in another publication.9 They areall part of the Land Grant system,10 one of the few unifyinginstitutions across the Pacific Region. In addition, AmericanSamoa, the Commonwealth of the Northern Mariana Islands,Guam, and Hawai‘i participate in Special SupplementalNutrition Program for Women, Infants, and Children,11 theExpanded Food and Nutrition Education Program,12 andthe Supplemental Nutrition Assistance Program.12

Two distinct dietary guideline systems are used in the USPacific, the current edition of the Dietary Guidelines forAmericans and a regional set, the Secretariat for the PacificCommunity dietary guidelines.6 The 2010 Dietary Guide-lines for Americans, which featured a 5-food group system(fruit, vegetable, protein, grains, and dairy) together withthe MyPlate icon,3 is used in the Special SupplementalNutrition Program for Women, Infants, and Children, theExpanded Food and Nutrition Education Program, andthe Supplemental Nutrition Assistance Program. Concur-rently, public health and health promotion programs usethe Secretariat for the Pacific Community, which reflectsfoods of the region in a 3-food group system (body building,energy, and protective foods).6 These 2 very different ap-proaches to food group classification make it challenging toconvey dietary information to people in the US Pacific. TheChildren’s Healthy Living Program (CHL), established in2011 as a partnership between the remote islands of theUS Pacific and Alaska, is a community-based approachto preventing childhood obesity in the US Pacific.13 TheCHL identified a need for an up-to-date comprehensive

FIGURE 1. Map of the US Affiliated Pacific Region indicating the locations of American Samoa, Commonwealth of the Northern Mariana Islands,Federated States of Micronesia, Guam, Hawai‘i, Republic of the Marshall Islands, the Republic of Palau, and the contiguous United States. The overlayof the contiguous United States, set between Hawai‘i and Guam, indicates that the width of the contiguous United States at its widest point is just400 miles short of the distance between these 2 Pacific islands.

Volume 51, Number 2, March/April 2016 Nutrition Today\ 73


resource describing Pacific Island foods for use in trainingand culturally relevant nutrition education materials.14,15

More information about this USDA funded initiative isavailable at: http://www.chl-pacific.org.This article describes the Pacific Food Guide developedfor use in an expansive underserved region that is cov-ered by more ocean than land (Figure 1). The purpose ofthis article is to describe the development of the PacificFood Guide and its use in a college-level introductorynutrition course taught in the US Pacific. Backgroundinformation, not readily available, about the people andfood practices of the remote, underserved populations ofthe US Pacific also is provided.

THE PACIFIC FOOD GUIDE

The GuideThe Guide is available at manoa.hawaii.edu/ctahr/pacificfoodguide. Figure 2 provides an example of anentry in the Pacific Food Guide. The Pacific Food Guidepresents over 100 traditional and regionally sourced foods,omitting imported and highly processed foods such as

canned meats and chips that have Nutrition Facts labels.The foods are organized into 3 general categories basedon where they can be found: Walks Along the Ground(eg, animals like coconut crab, chickens, and pig), ChosenFrom the Sea (eg, seafood like fish, seaweed, and crusta-ceans), and Grown From the Ground (eg, plant foods liketaro, coconut, and breadfruit). Unfortunately, nutrient com-position data are unavailable for 60 foods included in thePacific Food Guide. The lack of nutrient composition datafor so many foods (Table) creates a challenge for re-searchers as well as nutrition educators and registereddietitian nutritionists serving the people of the US Pacific.The Pacific Food Guide is arranged to reflect the rela-tionship between food systems and ecology, descriptionsof the food,16 and the regional languages, which lendcontext to food names and food subtypes and ensure thatreaders can identify a food without knowing its English orscientific name.Another unique feature of the Pacific Food Guide is theuse of a novel set of ‘‘pins’’ for both the 2010 DietaryGuidelines for Americans and MyPlate icon and the Sec-retariat for the Pacific Community dietary guidelines used

FIGURE 2. Excerpt on a food (breadfruit) from the Pacific Food Guide in which the scientific name(s), common name in English, and translations of afood are presented along with brief information on the physical appearance, selection, storage, preparation, nutrition facts, and dietary guideline pinsare presented. MyP indicates MyPlate dietary guideline pin; SPC, Secretariat for the Pacific Community dietary guideline pin.



http://www.chl-pacific.org

http://manoa.hawaii.edu/ctahr/pacificfoodguide


TABLE Foods Consumed by Adults and Children in the US Pacific that Lack FoodComposition Information

Food CategoryScientific

Classification Traditional Name(s)

Guide category: Walks Along the Ground

Crab

Coconut crab Birgus latro ChamorroVayuyu/ChuukeseVamwatang/KosraeanVaci/MarshalleseVchaninway/PalauanVketat/PohnpeianVemp/SamoanVªª/YapeseVyaffi

Land crab Johngarthia lagostoma ChamorroVpanglao/ChuukeseVnipwei/HawaiianVpapa¶i/KosraeanVacing/MarshalleseVbaru/PalauanVrekung/PohnpeianVporu, rokumw/SamoanVpa¶a/YapeseVragumwu

Dog Canis lupus familiaris ChuukeseVkonak/HawaiianV¶Mlio/KosraeanVkosro/MarshalleseVkidu/PalauanVbilis/PohnpeianVkidi/SamoanVmaile/YapeseVgelagiu

Fruit Bat Pteropus mariannus ChamorroVfanihi/ChuukeseVpeute/HawaiianVpe’a/KosraeanVfak/PalauanVolik/PohnpeianVpwehk/SamoanVpe¶a/YapeseVpaiu sheiu

Guide category: Chosen From the Sea

Brown ribbon weed Dictyota spp PalauanVchar

Crocodile Crocodylus porosus HawaiianVmo¶o nui/PalauanVius/YapeseVgaushe

Curly fishing line Chaetomorpha PalauanVchar

Emperor

Blackspot Lethrinus harak ChamorroVmafute’/KosraeanVsrinac/MarshalleseVrijun/PalauanVitotech, itoch/SamoanVfloa-vai/YapeseVligerigeri, uule

Orangefin Lethrinuserythracanthus

ChamorroVlililok managu/KosraeanVsrinkap/MarshalleseVberak/PalauanVmenges/PohnpeianVkadek mwei toantoal/SamoanVfiloa-apamumu/YapeseVorbwile

Yellowlip Lethrinus xanthochilus

Yellowstripe Lethrinus obsoletus ChamorroVmafute’/KosraeanVik sruasra/PalauanVudech/PohnpeianVkadek/SamoanVtolai/YapeseVsagurppiye

Flower limu Laurencia HawaiianVlimu pe¶epe¶e/PalauanVchar

Glassweed Scinaia PalauanVchar

Large wire weed Callophycus PalauanVchar/SamoanVlima uaea

Little wire weed Gelidiella PalauanVchar

Maidenhair Hypnea HawaiianVlimu huna/PalauanVchar

Mangrove Crab Aratus pisonii ChamorroVpanglao oron, atmangaog/ChuukeseVnipwei/HawaiianVpapa¶i/KosraeanVpowac/MarshalleseVjebarbar, baru/PalauanVchemang/PohnpeianVelimoang/SamoanVpa¶a/YapeseVragiumwul liuwen maliile

Mojarras Gerreidae ChamorroVguåguas/MarshalleseVilmok/SamoanVmatu/YapeseVyengaange

Papery sea bubble Colpomenia PalauanVchar

(continues)



TABLE Foods Consumed by Adults and Children in the US Pacific that Lack FoodComposition Information, Continued



Parrotfish

Bicolor Cetoscarus bicolor ChuukeseVmarau, uufoor/MarshalleseVmera/PalauanVbeadl,ngesngis/PohnpeianV mau, lawi/SamoanVfuga, laea, laea usi/YapeseVusha, yaregulungo

Bullethead Chlorurus sordidus HawaiianVuhu/PalauanVderbetelloi, butiliang/SamoanVfuga-gutumu/figausi, laea-tuavela/YapeseVmwogweimwe

Filament-fin Scarus altipinnis PalauanVudoud ngelel, meskelat/SamoanVlaea-sina/

Gibbus Chlorurus microrhinos PalauanVotord, chotord/SamoanVfuga, laea, laea usi/ulumato,galo/YapeseVumwashe

Humphead Bolbometoponmuricatum

ChamorroVpalakse’, låggua, pachak, fohmo, atuhong/KosraeanVmwesrihk, koimokut/PalauanVberdebed, kemedukl/PohnpeianVkemeik/YapeseVmamile gemasugulu

Pacific longnose Hipposcarus longiceps ChamorroVgualåfi, lågguan diso’, amariyu/ChuukeseVaar/MarshalleseVek mouj/PalauanVngyaoch, bergism/PohnpeianVmwomwmei/SamoanVulapokea, laeaulapokea/YapeseVlulef

Palenose Scarus psittacus HawaiianVuhu/PalauanVmul/SamoanVlaeamatapua¶a/YapeseVgawegawe

Redlip Scarus rubroviolaceus ChuukeseVamorochin/HawaiianVpalukaluka/PalauanVmelekelattelebt/PohnpeianVowen serehd/SamoanVlaea-mala, laea-mea/YapeseVngiicha

Tan-faced Chlorurus frontalis PalauanVmellemau

Yellowband Scarus schlegeli SamoanVfugamatapua¶a, laea-tusi/YapeseVgawegawe

Rabbitfish

Forktail Siganus argenteus ChamorroVmanåhak lesso’, hiteng kåhlao/KosraeanVluhluhk, muhlahp,nuesron/MarshalleseVmuramor/PalauanVmeas, kelsebuul,beduut/SamoanVlo, loloa, ¶ofe¶ofe, malava/YapeseVnnege

Scribbled Siganus spinus ChamorroVmanåhak ha’tang, sesyon/MarshalleseVmuramor/PalauanVreked, chepsall/SamoanVanefe, pa¶ulu

Red sea lettuce Halymenia HawaiianVlimu lepe ’ula’ula/PalauanVchar/SamoanVa’au

Reindeer limu Codium HawaiianVlimu wawae’iole/PalauanVchar

Rosy pudding plant Meristotheca PalauanVchar

Runners and scads Carangidae HawaiianVakule, halalª, ’npelu, kamanu, omaka/MarshalleseVbob ere

Rudderfish

Highfin Kyphosus cinerascens ChamorroVguili, guilen puengi/HawaiianVnenue/MarshalleseVbejrok/PalauanVkomud, beab/PohnpeianVkeriker, kertakai/SamoanVmata-mutu, mutumutu, nanue/YapeseVreeli

Lowfin Kyphosus vaigiensis ChamorroVguili, guilen puengi/HawaiianVnenue/PalauanVkomud,beab/PohnpeianVkeriker, kerlel/YapeseVreeli

Sea fan Padina PalauanVchar/SamoanVlimu ili

(continues)






Sea lettuce Ulva HawaiianV¶Llioha¶a/PalauanVchar

Sea moss Gracilaria HawaiianVlimu wawa/PalauanVchar

Sea oak Sargassum HawaiianVkala/PalauanVchar/SamoanVlimu vaovao

Slippery cushion Rosenvingea PalauanVchar

South sea colander Hydroclathrus PalauanVchar

Spiny leaf Turbinaria PalauanVchar/SamoanVlimu lautalatala

Spiny sea plant Acanthophora PalauanVchar/YapeseVlaariu

Supreme limu Asparagopsis HawaiianVlimu kohu/KosraeanVkohrmwek/PalauanVchar/SamoanVlimu

Surgeonfish andunicornfish

Bluebanded Acanthurus lineatus ChamorroVhiyok/KosraeanVkui/PalauanVbelai/PohnpeianVpwulak,wakapw/SamoanVpone, palagi, alogo/YapeseVfelange

Bluespine Naso unicornis ChamorroVguåsa, tåtaga/HawaiianVkala/KosraeanVik koac/PalauanVchum/PohnpeianVpwulangkin/SamoanVpone, palagi,ume-isu/YapeseVgiume

Convict Acanthurus triostegus ChamorroVkichu/HawaiianVmanini/KosraeanVlasrfol/MarshalleseVkuban/PalauanVchelas/SamoanVpone, palagi, manini/YapeseVlimeoniu

Orangspine Naso lituratus ChamorroVhangon/ChuukeseVpuna/HawaiianVumaumalei/KosraeanVik koac/PalauanVcherangle/PohnpeianVpulangkin/SamoanVpone, palagi, ili¶ilia, umelei/YapeseVbwulegalei

Yellowfin Acanthurus xantopterus ChamorroVhugupao dångkolo/HawaiianVpualu/KosraeanVkuhpaht/MarshalleseVkopat/PalauanVmesekuuk/YapeseVyefale

Tender golden weed Solieria PalauanVchar

Thorn grass Eucheuma orKappaphycus

PalauanVchar

Trevally

Bigeye Caranx sexfasciatus ChamorroVi’e’e, tarakitu/HawaiianVpake ulua/KosraeanVsrapsrap,lalot, sra/MarshalleseVikbwij/PalauanVesuuch/PohnpeianVoarong,adam/SamoanVmalaulimatalapo¶a/YapeseVlangiuwe, yetame

Brassy Caranx papuensis ChamorroVi’e’e, tarakitu/PalauanViab/PohnpeianVoarongpil/Samoan Vmalauili-sinasama

Bluefin Caranx melampygus ChamorroVi’e’e, tarakitu/HawaiianV’omilu/KosraeanVsrap/MarshalleseVlane/PalauanVoruidl/SamoanVatugaloloa, malauli-apamoana

Giant Caranx ignobilis ChamorroVmamulan/HawaiianVulua aukea/KosraeanVsrap/PalauanVcherobk, chederobk/SamoanVsapo-anae/YapeseVlangiuwe; yapwu

Tubular green weed Enteromorpha HawaiianVlimu ele¶ele/PalauanVchar

(continues)



to easily identify where foods fit into each set of guide-lines. These will be modified to reflect any changes in the2015 Dietary Guidelines for Americans. As seen in thebreadfruit example (Figure 2), each entry also includes adescription and photograph of the food together withselection, storage, and preparation information.Initially, the Pacific Food Guide was designed as a sup-plement to an online introductory nutrition course anddistributed to students in an Adobe Portable DocumentFormat (pdf ); it is now available as a searchable Web site.Access to this resource allowed the instructor to make theinstruction more relevant to the students and the clientsthey intended to serve by using familiar foods like taroand breadfruit rather than legumes such as black beans(not typically found in the Pacific) in discussions aboutcomplex carbohydrates in the diet.

Developing the Guide: Assessing Stakeholder Interestin a Pacific Food GuideIntroductory nutrition is taught in most of the 2- and 4-yearcolleges in the Pacific, but there are no textbooks ad-dressing the unique foods and practices of the region. TheUniversity of Hawai‘i at Manoa has the only accreditednutrition program in the region. In 2013, an e-mail survey ofrecipients of the CHL quarterly newsletter (n = 413, with 43responding) agreed (89%) that integrating Pacific contentinto an introductory nutrition course would be beneficialfor the development of a trained nutrition workforce for thePacific. Students (n = 1738, with 25 responding) who com-pleted the introductory nutrition course between Fall 2011and Spring 2013 were also surveyed, and of those, 76%indicated benefit. Comments from survey respondentsincluded the following:

Y We need to start talking about food and culture in regards to aperson’s sense of placeVotherwise it is not relatable.

Y Incorporate Pacific foods into MyPlate/Dietary Guidelines.Y Ethnic and cultural diversity of the region demands a curriculum,which differs from the typical American/mainland diet, presentedin regular nutrition classes.

With this supportive feedback, the ‘‘Traditional FoodGuide for Alaska Native Cancer Survivors,’’ used to teach

introductory nutrition though the Alaska Rural NutritionService,17 was selected as a model. In addition, a ‘‘place-based learning’’ learning approach, which links educationto the physical and cultural place of learning, was used asan effective way to enhance education in indigenouspopulations.18 A food guide that reflects the US Pacific’sfood system and rich cultural and ethnic diversity is a toolfor ‘‘place-based learning.’’ The process for developingthe Pacific Food Guide included a review of availableresources on the foods of the region to identify traditionaland local foods consumed, to identify nutrition facts forfood items from the USDA Nutrient Data Laboratory,Hawai‘i Foods Database, and the Hawai‘i Seafood Council,and to include foods without composition information(eg, coconut crab) without a Nutrition Facts label; anddesigning of the nutrition facts labels to reflect the mac-ronutrient and micronutrient content using the GenesisR&D SQL Version 9.9.2.0 Product Development and La-beling Software from Elizabeth Steward Hands and Asso-ciates Research; determination of serving sizes for foodsbased on Nutritional Labeling and Education Act stan-dards; creation of unique set of pins to weave togetherthe Dietary Guidelines for Americans and Secretariat forthe Pacific Community dietary guidelines; integrationof the unique languages of the US Pacific through inclusionof the traditional names of foods; organization foods into3 neutral categories to reflect the unique ecosystem ofthe region: Walks Along the Ground for animals, ChosenFrom the Sea for seafood, and Grown From the Groundfor plants; and inclusion of brief descriptions on physi-cal appearance, selection, storage, and preparation. Somefoods with similar characteristics were grouped together(eg, citrus fruits and the parrotfish family). Pictures wereidentified for each food item using open source photo-graphs and original photographs from the CHL network.

Introducing the Pacific Food Guide Into anIntroductory Nutrition CourseOne student wrote ‘‘I enjoy the topics that book [Guide]covers. It’s something I can use and apply to my diet.’’Reviewers from the CHL Pacific network and to otherexperts in the field suggested incorporating more cultural




Wrasse

Humphead/Napoleonfish

Cheilinus undulates ChamorroVtåsen guåguan, tangison/KosraeanVkuhsruhl/MarshalleseVlappo/PalauanVterrid, ngimr, mamel/PohnpeianVmerer,poaros/SamoanVsugale, lalafi, malakea, tagafa/YapeseVmaame

Tripletail Cheilinus trilobatus ChamorroVlalacha’ måmå’te/PalauanVngimr/SamoanVsugale,lalafi-matamumu/YapeseVporose



context, more specific details on the foods from certainislands, and further technical development (eg, photoimprovement) of the Pacific Food Guide. The secondedition has been used to teach 4 introductory nutritioncourses in the 2014Y2015 academic year at the Universityof Hawai‘i at Manoa.

Next StepsThe Guide will continue to evolve to include new infor-mation on frequently consumed foods in the region andtheir nutrient composition, as that information becomesavailable. This resource was developed with extramuralfunding, and options for sustainability include publishingthe Guide as a printed book, an eBook, or an online da-tabase. It is expected that the Pacific Food Guide will alsobe used outside the US Pacific for those teaching courseson cultural practices of foods, cultural competency, andcommunity nutrition. The Pacific Food Guide also hasapplication for working with Pacific Islander populationsin the clinical and community/public health settings, bothwithin and outside of the US Pacific.

BACKGROUND ON THE US AFFILIATEDPACIFIC REGION (US PACIFIC)

For those outside the Pacific region it is important to putthe Pacific Guide in context.

The Region’s PeopleThe US Pacific is diverse, with indigenous ethnicitiesincluding the natives of Hawai‘i (Native Hawaiian) andAmerican Samoa (Samoan) of Polynesian ancestry andthe natives of the Federated States of Micronesia (such asPohnpeian, Chuukese, Yapese, Kosraean), Palau (Palauan),Republic of the Marshall Islands (Marshallese), Guam(Chamorro), and the Commonwealth of the NorthernMariana Islands (Chamorro) of Micronesian ancestry. NativeHawaiians and other Pacific Islanders constitute 1.2 millionpeople (0.4%) of the total US population in 2010.19 Thepredominant nonindigenous racial/ethnic groups includenon-Hispanic whites and Asians.20 Mixing (eg, PacificIslander and Asian groups) and migration of ethnic popu-lations in the Pacific Region is widespread.21,22

The Indigenous Food SystemBefore first contact with people from outside the Pacific,the food systems of Pacific Island peoples reflected theislands’ unique ecosystems and environments. The islandsrelied on the ocean’s bounty23; however, other types offood, either indigenous or from canoe transport origin,24

were available depending on the islands’ endemic re-sources. For example, the high volcanic islands of Hawaiisupported an integrated agricultural system referred to asthe ahupua’a (land division/watershed),25 whereas theisland of Pohnpei in the Federated State of Micronesia

depended on agroforestry.26 In contrast, the atoll envi-ronment of the Republic of the Marshall Islands had foodcrops capable of growing in sandy soils, such as pandanusand coconut.27 Division of food production by gender,distinguishing food between genders, and special foodrules were common practices.25,28,29

The Role of Food in Pacific Islanders’Traditional LifeDespite the vast size of the Pacific, the Pacific Islandswere composed of great canoe voyaging societies thatregularly traveled the Pacific Ocean before first contactwith Westerners,24 lending to the sharing of similar foodpractices across Pacific Island cultures. For example,nature was believed to be the ultimate source of life, asboth a spiritual and physical place; humanity and naturewere intertwined.28 Life was structured around fishing,planting, and harvesting/gathering crops. Food was es-sential for survival and central to creating and maintain-ing social relationships. Food was shared among family,friends, and the communityVa reciprocal practice.29 Foodwas used to demonstrate respect for guests, elders, chiefs,and men, as well as for social prestige.30 Occasions forfood sharing brought together different sections of thecommunity, with the preparation and eating of foodhaving an important symbolic function.28 Feasts wereand remain a prominent part of Pacific life today.25

Despite the region’s ethnic diversity, Pacific Islanders con-sumedmanyof the same land-based foods suchas taro, yam,breadfruit, cassava, sweet potato, banana, plantain, pan-danus, and tapioca. Each ethnic group had a preferredstarchy staple food such as taro, breadfruit, or yam, whichcontain many micronutrients31 but required cooking toremove toxic substances or irritants. Meat, such as chickenor pig, or seafood was served with starchy foods to createa meal.28

Food’s Role in the Pacific Islands AfterWestern ContactTravelers from outside the US Pacific arrived from asearly as the 1500s in the Mariana Archipelago32 to the1700s in American Samoa33 and Hawai‘i.32 Missionarieswere among the first outsiders to establish a permanentpresence,34 followed soon after by the development ofplantations and other industries, which led to an influx ofFilipinos, Chinese, Japanese, and others seeking work aslaborers35 and introducing new foods and practices. Al-though cultural food practices generally remained intact,imported foods, including rice, flour, canned meat, andother canned goods, were incorporated into the diet.36

The Noncommunicable Disease Epidemic inthe IslandsThe US Pacific has one of the highest rates for obesity-related, noncommunicable disease in the world,9,37 which



has led to a state of emergency being declared by thePacific Island Health Officers Association.38 In addition,the region has a low proportion of health professionalstrained in noncommunicable disease prevention, 1 com-ponent of the World Health Organization’s 2013Y2020Global Action Plan to prevent and control noncommu-nicable diseases.39 An unhealthy diet is one of the majorcontributors to noncommunicable disease development,making nutrition training especially important for theregion. There are no registered dietitian nutritionists inthe Freely Associated States of Micronesia, only 5 in theCommonwealth of the Northern Mariana Islands, 10 inGuam, and363 inHawai‘i, at the timeof this publication.40,41

SUMMARY

The Pacific Food Guide will enhance the ability of nu-trition and extension educators, public health, and otherhealth professionals to prepare culturally appropriatefood and nutrition materials for children and adults of theUS Pacific both living in the region and on the mainland.This is especially urgent since Pacific Island people ex-perience some of the worst diet-related health disparitiesthat can be prevented or managed, in part, with lifestylechange. Incorporating the Pacific Food Guide into in-struction of introductory nutrition classes across the regionis 1 strategy to make the material more student centered.Dietitians and other healthcare professionals working inclinical settings can recommend dietary strategies usingfoods that are affordable, accessible, and preferred byPacific Island peoples.

AcknowledgmentsThe authors gratefully acknowledge the support provided by

the CHL team (National Institute of Food and Agriculture, US De-partment of Agriculture, award number 2011-68001-30335) andother stakeholders from across the US Affiliated Pacific. Theirfeedback was an instrumental contribution to the development ofthe Guide. Ashley Yamanaka is also acknowledged for her supportin formatting the manuscript for publication.

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