The study of chronic disease risk factors of children living in American Samoa: A comparison to the National Health and Nutrition Examination Survey (NHANES) 1999--2002

Studies show alarming levels of chronic diseases in adult American Samoans, with obesity and heart disease among the leading causes of morbidity and mortality. Despite the high prevalence of these diseases, little information exists regarding lipid and obesity levels of children in American Samoa, a U.S. territory. An overarching goal of Healthy People 2010 is to eliminate health disparities among sub-populations, including differences that occur by ethnicity. To that end, this study's objectives were to: determine baseline lipid and obesity levels and assess disparities between American Samoan and U.S. children; and evaluate the validity of body mass index (BMI) as an early screening tool for identifying children with adverse lipids using receiver operating characteristic (ROC) curves. Children 2--10 years (n=365) from 25 villages were examined and compared to U.S. children from the National Health and Nutrition Examination Survey, 1999-2002 (n=3009). Cholesterol, low density lipoprotein and triglycerides were higher (p<0.001) in children in American Samoa than in the U.S.; Sixty-six percent of American Samoan children had 1 adverse lipid compared to only 19% of U.S. children. Even American Samoan children with no adverse lipids, and those with normal BMI-for-age (≥5th to 85th BMI-for-age percentile), had higher mean lipids than U.S. children. Obesity prevalence in American Samoan children (28%) was twice that of U.S. children (13%) (p<0.001). Significant positive predictors of BMI (VSE) in American Samoan children were age (1.36+/-0.36) and birth weight (0.42+/-0.14), whereas daily intake of local starches (-0.92+/-0.38) and household participation in the Supplemental Nutrition Program for Women, Infants and Children (-1.05+/-0.38) were inversely related to BMI. Finally, a single BMI cut-point was better at identifying children with adverse lipids than ≥85th (at risk of overweight) and ≥95th BMI-for-age (obesity) percentiles. More than 3 times as many children in American Samoa had adverse lipids while twice as many suffered from obesity as compared to U.S. children, clear health disparities. Lipid and obesity levels in American Samoan children raise concerns because they track into adulthood. This baseline prevalence data is intended to facilitate prioritization of population strategies, while providing representative data to measure progress towards Healthy People 2010 goals.