This study sought to determine the impact of a ketogenic dietary intervention on the quality of life of stage II and III cancer patients.A randomized controlled trial was implemented whereby patien...

Introduction Food security in Small Island Developing States (SIDS) is an international policy priority. SIDS have high rates of nutrition-related non-communicable diseases, including obesity and type 2 diabetes, micronutrient deficiencies and, in many, persistent childhood stunting. This is associated with an increasing reliance on imported processed food of poor nutritional quality. Calls have been made for strengthening local food systems, resilient to climate change, to increase the consumption of nutritious locally produced food. We aimed to systematically review interventions intended to improve diet in SIDS, and specifically explore whether these interventions applied a local food approach. Methods The search strategy was applied to 11 databases, including in health, social science and agriculture. Screening of titles, abstracts and data extraction was undertaken in duplicate. Risk of bias was assessed using Cochrane tools. Narrative synthesis of the results was undertaken. The study protocol was registered (PROSPERO registration number: 2020CRD42020201274). Results From 26 062 records, 154 full texts were reviewed and 24 were eligible. Included studies were from the Caribbean, Pacific, Mauritius and Singapore. Five were a randomised study design, one an interrupted time series analysis, eight controlled and ten uncontrolled pre-test and post-test. Nine studies included some aspect of a local food approach. Most interventions (n=15) included nutrition education, with evidence of effectiveness largely limited to those that also included practical skills training, such as vegetable gardening or food preparation. Three studies were considered low risk of bias, with the majority (n=13) of moderate risk. Conclusion There is a lack of robust evidence on interventions to improve diet in SIDS. The evidence suggests that multifaceted approaches are likely to be the most effective, and local food approaches may promote effectiveness, through mechanisms of cultural and contextual relevance. Further development and evaluation of interventions is urgently required to increase the comparability of these studies, to help guide policy on improving nutrition in SIDS.

Small Island Developing States (SIDS) have high burdens of nutrition-related chronic diseases. This has been associated with lack of access to adequate and affordable nutritious foods and increasing reliance on imported foods. Our aim in this study was to investigate dietary patterns and food insecurity and assess their associations with socio-demographic characteristics and food sources. We recruited individuals aged 15 years and above from rural and urban areas in Fiji (n = 186) and St. Vincent and the Grenadines (SVG) (n = 147). Data collection included a 24 h diet recall, food source questionnaire and the Food Insecurity Experience Scale. We conducted latent class analysis to identify dietary patterns, and multivariable regression to investigate independent associations with dietary patterns. Three dietary patterns were identified: (1) low pulses, and milk and milk products, (2) intermediate pulses, and milk and milk products and (3) most diverse. In both SIDS, dietary pattern 3 was associated with older age, regularly sourcing food from supermarkets and borrowing, exchanging, bartering or gifting (BEB). Prevalence of food insecurity was not statistically different across dietary patterns. In both SIDS, food insecurity was higher in those regularly sourcing food from small shops, and in SVG, lower in those regularly using BEB. These results complement previous findings and provide a basis for further investigation into the determinants of dietary patterns, dietary diversity and food insecurity in these settings.

Small island developing states (SIDS) have a high burden of nutrition-related disease associated with nutrient-poor, energy-dense diets. In response to these issues, we assessed the effectiveness of nutrition-based interventions on nutritional status (under-nutrition) and metabolic health (over-nutrition) among persons in SIDS. We included SIDS-based nutrition studies with change in nutrition status (e.g., markers of anaemia) or metabolic status (e.g., markers of glycaemia) as outcomes. The PRISMA framework was applied and MEDLINE, Embase, CINAHL, OARE library, Web of Science, Scopus, ASSIA, EconLit, AGORA, AGRICOLA, AGRIS, WHO-EMRO, and LILACS were searched (2000–2020). Cochrane risk of bias (ROB) and Cochrane ROBINS-I tools assessed ROB for randomised and non-randomised studies, respectively. PROSPERO registration (CRD42021236396) was undertaken. We included 50 eligible interventions, involving 37,591 participants: 14 trials reported on nutritional status, 36 on metabolic health. Effective interventions, evaluated at the individual level, took a multifaceted approach for metabolic outcomes; while nutrition outcomes utilised supplements. Most intervention types were suitable for issues related to ‘over’ nutrition versus ‘under’ nutrition. Twenty-six studies (nutrition status (six); metabolic health (twenty)) were effective (p < 0.05). With the current rise of nutrition-related public health challenges, there is a need for further development and evaluation of these and related interventions at the population level.

Background: Small Island Developing States (SIDS) face high rates of non-communicable diseases (NCDs), and a key structural driver includes SIDS’ heavy reliance on imported food. Yet, our knowledge about food sources in SIDS is limited. Methods: We systematically searched 14 peer-reviewed databases and 17 grey literature repositories, identifying 56 articles and 96 documents concerning food sources in SIDS. Our study aimed to map these sources while considering broader societal, cultural, and environmental aspects. Results: We found high heterogeneity of food sources beyond store-bought foods, highlighting the complexity of food landscapes in this context. To explore these food sources and their interconnections, we developed a classification including Aid, Buy, Grow, Share, State and Wild food sources, and offered contextually-sensitive insights into their variety (types), extent (relevance), nature (characteristics) and changes over time. We developed an interactive open-access evidence map that outlined the identified interconnections between food sources following our proposed classification. There are numerous interrelations between food sources, showing that pathways from food sourcing to consumption can be unexpected and complex. Conclusions: In 2014, SIDS governments collectively committed to ending malnutrition by 2030. A deeper understanding of food sourcing is essential to achieve this goal.

Background Complex factors drive inconsistent access to safe and nutritious food among Small Island Developing States (SIDS), including geographic isolation, limited natural resources, urbanisation, and extreme weather events, leading to decreasing food production and increasing reliance on food imports. However, this may have been impacted by recent COVID-19 related restrictions. Our study aims to assess the impact of COVID-19 on food production and food security in St. Vincent and the Grenadines (SVG), a middle-income SIDS. Methods We conducted a mixed-methods cross-sectional study between September 2021 and February 2022 with consenting adults (>=18) from 50 households within rural areas, participating in a backyard garden intervention. Survey tools were the adapted version of the Caribbean COVID-19 Food Security & Livelihoods Impact Survey and the COVID-19 version of the Food Insecurity Experience Scale Survey Module for individual respondents. The qualitative component aimed to gain in-depth and contextual insight on the impact of COVID-19 on own food production. Open-ended interviews were undertaken with one family member of 10 of the 50 intervention families, over a six-month period. Qualitative data were recorded, transcribed, and coded using ATLAS-ti to facilitate thematic analysis. Results Ninety-three participants completed the survey. Most participants were 50–69 years old, female, completed a primary school level education, resided in a household of > four members, and were self-employed. Almost half of the participants were unable to secure their necessities during the pandemic with more than a third changing their main food source. Own food production as the main food source decreased from 46% to 37%. Engagement in farming and backyard gardening decreased by 8% from 93%. Using FAO standards, 66% of participants were classified as moderately or severely food insecure and more than half of the participants attributed these challenges to the pandemic. The qualitative data highlighted that while own food production was perceived as a means for household food security, lower importation and the consequent increased cost of food supplies impacted most. Social distancing and other restrictions hampered social networking and shared labour activities. Conclusion At the height of the COVID-19 pandemic, an assumption was that local food systems would be strengthened, through self-sufficiency farming. Here, in this small study, it appears that one impact of the pandemic is an increased burden to engage in local food production with findings that are similar to outcomes observed in Pacific SIDS and with FAO data.