National surveys in India, through measures of anthropometry and biomarkers, have identified a triple burden of malnutrition (undernutrition, micronutrient deficiencies and overnutrition) in adolescents(1). However, there is a dearth of high-quality data on individual dietary behaviour of this population(2) and the importance of sub-national dietary surveys in filling this gap has been identified(3). The objective of this study was to assess the intake of energy (E) and macronutrients and the contribution of macronutrients to E in a random sample of 11–13-year-old schoolchildren in Delhi, India. Method: The study was approved by The University of Adelaide Human Research Ethics Committee and the Independent Ethics Committee of the Centre for Chronic Disease Control, New Delhi. The target sample size of 360 was based on a ± 5% margin of error in estimated sugars intakes. Using the list of private schools in Delhi (n = 1374), a statistician external to the research team generated a random sample of 150 schools stratified by districts (n = 11). Using this list, schools were invited to participate, and recruitment continued until 10 schools consented. Teachers shared study information with parents; interested parents filled in the online consent form. Assent was obtained from schoolchildren. Participants recorded all food and drink consumed over three consecutive days, including one weekend day, in a food diary. Information recorded was entered into an online dietary assessment tool, Intake24 Southeast Asia version, during an interview with each participant. The Intake24 database of over 2400 food photographs of more than 100 foods was used to ascertain portion size. The Intake24 database converts food and drink reported into the intake of nutrients through integrated food compositional tables. Of 514 pupils providing consent, 393 participants (76.4%) (169 girls, 224 boys) completed the study. The median daily E intake was 10.8 (IQR 9.0 −12.5) MJ for girls, and 12.3 (IQR 10.3- 15.2) MJ for boys. For the 97 girls and 144 boys providing body weight data, Physical Activity Level ratios were 2.0 and 2.1 respectively. The median daily intakes for girls were: protein 64.6 (IQR 54.8-79.3) g; carbohydrate 336.5 (IQR 285.3- 393.6) g; and saturated fat 45.6 (IQR 34.8-58.3) g. The respective values in boys were: protein 74.4 (IQR 61.4; 89.4) g; carbohydrate 379.6 (IQR 317.8; 461.8) g; and saturated fat 54.6 (IQR 41.9-69.5) g. There were no significant between-gender differences in percent E from protein (10.2 (IQR 9.2; 11.4)), or carbohydrate (52.4 (IQR 48.7; 56.7)). Girls obtained less E from saturated fat (16.1 (IQR 11.0-18.2) compared with boys 16.3 (IQR 14.2 - 19.1) (P<0.05). In conclusion, in this sample of adolescents from private schools in Delhi, E intake was above FAO recommended levels and median total fat intake exceeded the recommended threshold of 35%(4).

Adolescent obesity requires effective and accessible intervention options and there is potential for intensive dietary interventions to be used as adjunctive therapy to behavioural weight management for some individuals(1). The aim of this study was to determine the effect of two novel diet therapies, delivered in the as part of an intensive behavioural weight management intervention, in adolescents with metabolic complications associated with obesity. The Fast Track to Health study (HREC/17/SCHN/164; ACTRN12617001630303) was a multi-site 52-week RCT, conducted 2018 – 2023, comparing a very-low-energy diet (800kcal/day) followed by i) an intermittent energy restricted (IER) diet; and ii) a continuous energy restricted diet (CER), for adolescents (13-17years) with ≥1 obesity associated complication. Interventions were delivered as part of an intensive behavioural weight management intervention by a multidisciplinary team2. Anthropometry, body composition and cardiometabolic health were assessed at baseline and week-52. The primary outcome was change in BMI z-score at week-52. Dyslipidaemia was defined as HDL <1.03mmol/L and/or triglycerides ≥1.7mmol/l, and elevated liver function tests (LFTs) as ALT and/or GGT ≥1.5 upper limit of 30U/L3. The difference in BMI z-score between groups at week-52 (±4) was assessed using a t-test. Mixed models was used to investigate changes over time. Descriptive statistics were used to describe participants above and below clinical cut-points at baseline and week-52. In total, 141 adolescents (70 female) were enrolled and 97 (48 female) completed the intervention. At week-52, BMI z-score reduced by −0.23 [95%CI −0.37 to −0.22], BMI expressed as a percentage of 95th percentile reduced by −8.86 [95%CI −12.46 to −7.47] and Fat Mass Index reduced by −1.49 [95%CI −2.36 to −1.08]. There was no significant difference for weight or cardiometabolic outcomes between diet groups. The occurrence of dyslipidaemia was unchanged between baseline and week-52 (n = 60 [43%] and n = 37 [43%] respectively) and a small improvement in the occurrence of impaired LFTs (n = 37 [27%] to n = 15 [17.2%] respectively). There were no differences in change of occurrence of dyslipidaemia or impaired LFTs between intervention groups. These findings suggest that both IER and CER, delivered as part of an intensive behavioural weight management program, are equally effective for improving weight and cardiometabolic outcomes for adolescents with obesity.

Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas(1). This research aims to describe the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. Active participants in the co-design process were adults ≥18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process(2) was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population through eight online workshops and a 21-item online community survey between July and December 2021. Prioritisation methods were used to help workshop participants identify the ‘Must-have, Should-have, Could-have, and Won’t-have or will not have right now’ (MoSCoW) features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, ii) access to personalisation options and behaviour change support, and iii) improving the community food environment by providing information on and access to local food initiatives. Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This co-design process will inform the development of a prototype (evaluation phase) and feasibility testing (post-design phase) of this intervention. The resulting intervention is anticipated to reduce barriers and support enablers, across individual and community levels, to facilitate higher consumption of vegetables among rural Australians. These outcomes have the potential to contribute to improved wellbeing in the short term and reduced chronic disease risk in the long term, decreasing public health inequities.

The increasing rates of obesity among children and adolescents are significant issues worldwide and in the Pacific Island Nations(1). An energy imbalance between calorie intake and expenditure is linked to overweight and obesity for children and adolescents. Epidemiological, nutritional, and technological changes are linked to altered eating habits, including an increase in energy consumption. Conversely, technological advancements and market globalization are responsible for declines in physical activity (PA)(2). During COVID-19 outbreak a more sedentary lifestyle than before the outbreak has been adopted by children and adolescents as a result of lockdown measures, which include shutting of schools, restrictive travel outside the home, and limiting social interactions has made the issue worse(3). Studies have shown that 40% to 70 % of obese children become obese adults(4). Since children spend a large portion of their day in school and eat their main meals there, school settings are suitable for interventions aimed at preventing childhood obesity. Additionally, school environments will reduce the number of dropouts brought on by problems with accessibility or transit(5). The selection of primary school children is important for interventions as the dietary and physical activity habits acquired at this age are ingrained in children and continue into adulthood. So, it is important to have a robust nutrition and physical activity curriculum in all the primary schools. There are many challenges faced by the governments in implementing such curriculum which includes lack of trained in country staff, limited infrastructures in schools for physical activity, culturally relevant information which can be easily understood by local populations, proper monitoring, and evaluation of the existing guidelines. Community engagement and partnership with local health ministries and departments are crucial for the success of these curriculum (6). To fill this gap robust evidence on effectiveness and implementation of school-based wellness intervention programs in primary schools are in dire needs in Pacific Island nations. Given this, the project titled “Healthy Child Promising Future-Promoting health in primary school settings was conducted in all schools in Wallis & Futuna and piloted in one urban school in Fiji. A knowledge, attitude, practice (KAP) questionnaire was used to evaluate the effectiveness of the intervention which was conducted for all the children (7-9 years) and their care takers. Intervention was conducted on 15 pre identified themes by face-to-face sessions every week and 30 minutes physical activity session was conducted every day in all the schools for children. For caretakers intervention was conducted around 5 themes. In both the countries the intervention had shown significant improvement in KAP scores both for caretakers and children related to the healthy diet consumption and promotion of physical activity. The results indicate that the developed intervention package had a positive impact on KAP.

Lutein and zeaxanthin (LZ) are the major constituents of macular pigment (MP), helping to protect the human retina from blue light and oxidative damage(1). Many studies have suggested that higher concentrations of retina LZ may reduce the risk of age-related macular degeneration (AMD) and improve retinal health(1–3). MP and serum L have shown positive linear response with L dose(4) but the combined effect (LZ + omega-3 suppl) has not been fully explored in healthy Australian adults. Understanding their bioavailability in relation to the effect of omega-3 fatty acid intakes along with LZ supplements could provide a useful indication of the potential to reduce the risk of AMD, preserve vision, and improve retinal health. LZ uptake and the associated oxidative stress levels were evaluated in two groups fed with commercially sourced supplements. The control group was given only LZ, while the intervention group was given LZ combined with omega-3 supplements containing Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA). 10 men and 6 women with an average age of 31.4 ± 1.3yrs participated in this randomised, non-blinded controlled study for a total of 19-d. The control group (9) consumed the LZ supplement (12mg/d) only, while the intervention group (7) consumed the LZ supplement along with 900mg/d of an omega-3 supplement (540mg EPA + DHA 360mg). Each group adhered to a comprehensive low-carotenoid and omega-3 diet list for the 12-d intervention period and the 7-d washout period. Participants reported daily foods consumed in their diet logbooks, and Automated Self-Administered 24 diet assessment log over the study period. The body composition of each subject from the two groups was assessed before and after the study using a SECA body composition analyser and blood samples (2-time point) collected over a 12-d test period. Mean ± SEM for serum LZ ranged from 2.23 ± 0.24 – 2.98 ± 0.24µg/ml for the control group and 1.10 ± 0.21–3.02 ± 0.73µg/ml for the intervention group. Percentage change in serum LZ concentration from (T0-T312h) and (T312h-T456h) were 26% and 34% (control) and 139% and 175% for (intervention), respectively. The Area Under the Curve (AUC0-456h) differed significantly (P<0.0469) during the entire study period (between groups) and related to the cumulative effect of intakes at various times of blood draw. LZ from the intervention group was 68% more bioavailable than the control group. The highest peak relative response in subjects in the control group was ≈33% (a 9.1-fold increase from baseline) at AUC (168-312h) and ≈46% (a 6.6-fold increase from baseline) at AUC (312-456h) for the intervention group. No significant (p>0.05) effect of omega-3-supplement addition on oxidative stress levels was observed. Omega-3- addition to intakes of supplement LZ was responsible for the increased absorption (intervention) observed but did not affect oxidative stress levels and the Red Blood Cell omega-3-status.

Cardiometabolic diseases are highly prevalent in Aotearoa New Zealand(1). Dietary intake is a modifiable risk factor for such diseases and certain dietary patterns, specifically the Mediterranean diet (MedDiet), are associated with improved metabolic health(2). This study aims to test whether an intervention of a Mediterranean dietary pattern incorporating high quality New Zealand foods (NZMedDiet pattern) using behaviour change science can improve the metabolic health of participants and their household/whānau. This is a multi-centre, three-stage trial, with two randomised controlled trials (RCTs), both parallel groups, superiority trials, and a longitudinal cohort study. The first RCT (RCT1) is a comparison of the NZMedDiet pattern implemented using behaviour science compared to usual diet for 12 weeks, and the second (RCT2) is a behaviour-change intervention compared to no intervention for 12 weeks, administered after participants have been exposed to the intervention in RCT1. The third stage is a longitudinal cohort study where all participants are followed for up to a year. The primary outcome measure for each stage is the metabolic syndrome severity score (MetSSS). Two hundred index participants and their household/whānau have been recruited and randomised into the trial. Participants are from four centres, two of which are University research units (University of Auckland (n = 57) and University of Otago, Christchurch (n = 60)), one a community-based traditional meeting place (Tu¯ Kotahi Māori Asthma and Research Trust at Ko¯kiri Marae in Lower Hutt, Wellington (n = 19)), and the other based at a hospital-based research unit (the Centre for Endocrine Diabetes and Obesity Research (CEDOR) in Wellington (n = 64). The trial will test whether the NZMedDiet pattern and behaviour change support improves the cardiometabolic health of people in New Zealand.

Polycystic Ovary Syndrome PCOS is an endocrine disorder affecting 8 to 13% of reproductive aged women(1). Dietary and physical activity changes are the first-line therapy to assist with symptom and weight management and to reduce the risk of reproductive, metabolic and psychological comorbidities(2). However, women with PCOS have a higher weight, experience weight gain, and a higher prevalence of living in a larger body. Health care professionals (HCPs) play a crucial role in delivering diet and physical activity advice for people with PCOS. Thus, the aim of this systematic review is to understand the barriers, facilitators, experiences, and perceptions of engagement and compliance with diet and physical activity modifications in people with PCOS and in HCPs providing or referring people with PCOS to diet and physical activity modifications. A mixed-method systematic review was conducted with quantitative studies narratively synthesised and all studies thematically analysed. There were 68 eligible papers, including n = 59 (n = 5198) people with PCOS and n = 17 (n = 2,622) HCPs. Several themes were identified as impacting people with PCOS’ ability to make diet and physical activity changes. HCP education on PCOS management through diet and physical activity was viewed by HCPs and people with PCOS to be inadequate, further impacting the quality of care and health outcomes. Dietary and physical activity advice delivered by a multidisciplinary team, including dietitians, was identified as a key component for change. Both people with PCOS and HCPs agreed that there was a need for individualised and PCOS-specific diet and physical activity advice. However, HCPs viewed that there was limited evidence supporting these recommendations and a lack of time to deliver this care. Weight stigma was identified as impacting both those in larger and smaller bodies with PCOS, reducing the quality of care and affecting self-perception and mental health. People with PCOS perceived that diet and physical activity are overly focused on weight loss and fertility, independent of their own personal motivations and goals. Systemic changes, including receiving diet and physical activity advice that meet the individual’s needs, are necessary for leading to long-term sustainable changes and improvements in health outcomes. A multidisciplinary team approach and an overhaul of HCPs’ perceptions and mentality of weight and weight-centric care for those with PCOS are essential in delivering effective diet and physical activity advice.

An acute increase in intestinal epithelium permeability is induced by prolonged exertion in the heat, resulting in the translocation of pathogenic bacteria and endotoxins from the lumen into the circulation, causing a systemic inflammatory response and debilitating symptoms(1). Acute exercise-induced gastrointestinal syndrome mimics chronic health conditions with which an impaired intestinal barrier function is associated, including coeliac disease, inflammatory bowel disease, diabetes, Alzheimer’s and liver diseases(2). Intestinal epithelium permeability is typically assessed using a dual sugar absorption test, by administering a drink containing non-metabolisable sugars (e.g. lactulose [L] and L-rhamnose [R]) that can enter the circulation by paracellular translocation when the epithelium is compromised, and are subsequently excreted and measured cumulatively in the urine(3). We aimed to demonstrate that our recently developed ion chromatography protocol(4) can be used to accurately quantify L/R ratio in the plasma of participants exercising in hot ambient conditions and to determine the impact of nutritional intervention on intestinal epithelium permeability. Further, we hypothesised that measuring L/R in plasma collected at intervals during the post-exercise recovery period would reveal more information about intestinal permeability compared to previously published cumulative urine L/R data(3). Endurance-trained participants completed a set of randomised crossover studies, consisting of 2 h running at 60% V˙O2max in temperate, warm and hot ambient conditions (n = 8) and/or in the heat while consuming water, carbohydrate or protein (n = 9). The dual sugar solution was ingested at 90 min of exercise and blood was sampled at 0, 1, 2 and 4 h post-exercise. Plasma sugars were quantified by high-performance anion exchange chromatography with pulsed amperometric detection (HPAEC-PAD) and L/R ratios were compared by two-way repeated measures ANOVA with Tukey’s multiple comparisons. Plasma L/R increased immediately post-exercise in the heat (0.15 ± 0.11) compared with temperate (0.06 ± 0.04, p<0.001) and warm (0.09 ± 0.08, p<0.01) conditions, while consuming glucose before and during exercise alleviated this (0.02 ± 0.02, p<0.001), and this novel information was otherwise missed when measuring urine L/R. Consuming glucose or whey protein hydrolysate during exercise attenuated intestinal permeability from exertional heat stress throughout recovery, with the mean plasma L/R over 4 h reduced from 0.11 ± 0.05 to 0.04 ± 0.03 (p<0.001) and 0.06 ± 0.04 (p<0.01) with glucose and protein, respectively. We recommend using the dual sugar test with quantification of plasma sugars at intervals by HPAEC-PAD to maximise intestinal permeability data collection in exercise gastroenterology research and beyond, as this gives additional acute response information compared to urinary measurements. Our approach can be employed to investigate and develop personalised nutrition strategies that prevent intestinal hyperpermeability during exertional heat stress. This has implications for athlete performance and safety, and can also build upon occupational health and safety practices and inform chronic disease management.

Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305 Australia.Cardiovascular disease (CVD) remains a major cause of global mortality. Poor diet quality, characterised by excessive consumption of energy-dense, nutrient-poor foods and insufficient intake of fruits, vegetables, and whole grains, is associated with an increased risk of CVD(1). This study compares the impact of two short-term dietary interventions, a Healthy Australian Diet adhering to national guidelines and a Typical Australian Diet representing current national consumption patterns, on several cardiometabolic outcomes. These outcomes include body weight, waist circumference (WC), body fat percentage (BFP), blood pressure (BP), fasting blood lipids and glucose concentrations. Data from an eight-week randomised, cross-over feeding study involving 34 adults (53% female, age 38.4 ± 18.1 years) were analysed, with participants randomly assigned to consume each diet for two weeks, separated by a two-week washout period. During each feeding phase, all food items were provided to ensure compliance. The Healthy Australian Diet adhered to the Australian Dietary Guidelines(2), including a balanced intake of the five food groups and meeting Acceptable Macronutrient Distribution Range targets(3), with saturated fat limited to ≤10% of energy. The Typical Australian Diet was formulated based on apparent consumption patterns in Australia(4), setting total fat intake at 40% of energy and total saturated fat at 15% of energy. Comprehensive data collection occurred at four key visits: week 0 (end of run-in; baseline 1), week 2 (post-feeding phase 1), week 4 (end of washout, baseline 2), and week 8 (post-feeding phase 2). Trained personnel measured WC using a tensible tape, while body weight and BFP measurements were obtained using bioimpedance analysis (Inbody 270; Biospace Co, Seoul, Korea). Blood pressure was recorded using the Uscom BP+ supra-systolic oscillometric central blood pressure device. Blood glucose and lipid (triglycerides, total-, low-density lipoprotein- [LDL] and high-density lipoprotein- [HDL] cholesterol) concentrations were measured after a 12-hour fast by an accredited pathology service. Differential changes in cardiometabolic variables between intervention groups were evaluated using linear mixed-effect models, adjusting for diet sequence, feeding phase, and subject ID as a random variable to account for potential autocorrelation. Post-hoc pairwise comparisons were conducted to assess the impact effects of each diet. There were no significant differences between the Healthy Australian Diet and the Typical Australian Diet with respect to weight, BFP, WC, blood triglycerides, systolic and diastolic BP. However, the Healthy Australian Diet led to a significantly greater decrease in total-, LDL-, HDL- and non-HDL cholesterol, and fasting blood glucose relative to the Typical Australian Diet (p<0.001). The results underscore the importance of promoting dietary intakes that align with Australian Dietary Guidelines for optimising the risk of CVD and impaired glucose tolerance. Conversely, the Typical Australian Dietary pattern demonstrated detrimental cardiometabolic effects over a short period of just two weeks.

The physical location of liquor stores near schools can strongly influence the chances of youth accessing and consuming alcohol(1). As children transit to and from school, it is feasible that the presence of liquor stores near schools could also increase their exposure to alcohol advertising. Cumulative exposure to advertising influences alcohol attitudes, intentions and alcohol use(2), so reducing children’s exposure to alcohol advertising is important to delay the initiation of drinking and reduce future harms. As this has not yet been investigated in Australia, the aim of this study was to investigate whether the presence of a liquor store near a school was associated with an increased prevalence of outdoor alcohol advertising in Perth, Western Australia. We identified all outdoor alcohol advertising within a 500m radius (audit zone) of 64 randomly selected primary and secondary schools from low and high socio-economic areas across metropolitan Perth. We recorded the size, type, setting, and location of each advertisement during field data collection. Each zone was categorised by the presence or absence of at least one liquor store within the school audit zone, and results compared across these stratifications. Over half (56%) of the 64 school audit zones had at least one alcohol advertisement. On average, there were 5.9 alcohol advertisements per zone. School audit zones that contained a liquor store (59%) had over thirty times the average number of alcohol advertisements compared with audit zones that did not contain a liquor store (9.7 vs 0.3). The majority of all the alcohol advertisements identified (63%) were located outside a liquor outlet as opposed to other food businesses (2%), along the roadside (31%), on a bus shelter (3%) or on/outside another business (0.5%). Our findings that Perth schools with a liquor store nearby had more outdoor alcohol advertising within a 500m radius, compared with schools without a nearby liquor store, were independent of school type (primary or secondary) or the socio-economic status of the area. This poses significant concerns about the exposure of underage populations to outdoor alcohol advertising, and the resultant influence on alcohol use. These results underscore the necessity for policy interventions to mitigate children’s exposure to alcohol marketing, especially during the daily school commute, by regulating the location of liquor stores and alcohol promotion near schools. It will be important to incorporate the voices of children when developing future policies to assert their right to be consulted, heard and appropriately influence their environments.

Diet is implicated in the development of Inflammatory Bowel Disease (IBD). However, the role of diet in reducing inflammation and managing prevalent disease is unclear (1–3). Previous studies have analysed the relationship between dietary patterns and occurrence of flares or symptoms, but not disease activity or inflammation (4–5). It is important to explore the role of habitual diet in management of IBD to provide targeted dietary recommendations. We explored the relationship between dietary intake with disease activity and inflammation in an Australian adult cohort with and without IBD. We analysed dietary and clinical data from the Australian IBD Microbiome (AIM) study. AIM is a prospective longitudinal cohort study of adults and children with Crohn’s Disease (CD), Ulcerative colitis (UC) and healthy controls (HC). Habitual dietary intake of food groups, fibre, polyphenols and fermented foods was collected by merging dietary data from 3-day food records and food frequency questionnaires with PhenolExplorer and the Australian Fibre Categories Database. Dietary patterns were explored using Principal Component Analysis (PCA) and cluster analysis (CA) in IBM SPSS Statistics (V29). Associations between dietary intake, clinical disease activity categorised as remission or active, and faecal calprotectin (FCAL) were explored in adult participants. A total of 412 participants (IBD = 223, HC = 189) were included. FCAL data was available for 211 participants (HC = 100, CD = 49, UC = 62). Median (IQR) FCAL at baseline was 20 (20) mg/kg for HC and 33 (127) mg/kg for IBD, indicating clinically irrelevant inflammation (FCAL >50mg/kg = clinical inflammation). PCA identified 7 distinct dietary patterns for adults with IBD. A dietary pattern of high plant diversity was associated with active CD. In the total IBD cohort, low association to a 'Prudent’ pattern was positively associated with low FCAL, and high association to a 'Meat-eaters’ dietary pattern was positively associated with moderate FCAL. CA revealed 3 distinct clusters amongst participants with IBD. No significant difference between diet cluster and disease activity or FCAL was seen. There were no significant differences in intake of fibre or polyphenols between remission vs active disease in participants with IBD. A significant difference between total, soluble and insoluble fibre and FCAL categories was seen with a higher fibre intake associated with lower FCAL. Higher plant-diversity and 'Prudent’ dietary patterns are associated with active disease and higher FCAL in Australian adults with IBD. Reverse causality cannot be ruled out, with analysis of larger cohorts and clinical trial data needed to clarify this.

Non-communicable diseases (NCDs) have become a major health concern worldwide, with Samoa being no exception(1). This presentation delves into the intricate dynamics of NCDs in Samoa, from the historical perspective before colonization to the contemporary challenges and initiatives taken by the government to address this pressing issue. Samoa, before colonization, maintained traditional diets that were largely plant-based and rich in local fruits and vegetables(2). The evolution of these diets over time has played a significant role in the rise of NCDs. The incorporation of imported processed foods, high in sugars and unhealthy fats, has led to a shift in dietary patterns. Recognizing the urgency of the situation, the Samoan government has initiated a series of policies aimed at addressing NCDs. These include the NCD Policy and Nutrition Policy, which focus on promoting healthier lifestyles through dietary changes and increased physical activity(3). The Samoa Health System Strengthening Program for Results is a crucial component of the government’s approach to combat NCDs. It encompasses several key areas, including the “First 1000 Days” initiative, emphasizing the importance of proper nutrition during pregnancy and early childhood, and breastfeeding promotion, vital for the health and development of infants(4). Furthermore, the School Nutrition program is designed to instill healthy eating habits from a young age(5). Nutrition guidelines, monitored quarterly, are in place to ensure the quality of school meals, with a strong focus on reducing the consumption of instant noodles and sugary drinks among schoolchildren. For adults, the “Healthy eating for Adults” program is pivotal. It introduces Food-Based Dietary Guidelines in Samoa that categorize foods into carbohydrates (energy foods), proteins (body-building foods), and fruits and vegetables (protective foods)(6). These guidelines also recommend reducing the intake of sugary foods, salt, and foods high in fats and oils. An intriguing approach to improving dietary habits is the “Grow the Colors of the Rainbow” initiative, which encourages the consumption of a diverse range of colorful fruits and vegetables(7). By emphasizing the importance of a balanced diet, this initiative aims to address the imbalance that has contributed to the NCD epidemic. Through this presentation, attendees will gain a comprehensive understanding of the historical, dietary, and governmental aspects surrounding NCDs in Samoa. It highlights the urgency of addressing NCDs in the region and underscores the importance of ongoing efforts to promote healthier eating habits and lifestyle choices. By examining government policies and initiatives, as well as the challenges faced, we aim to shed light on the path toward a healthier, NCD-free Samoa.