{
  "abstract": "Background The Republic of Palau is facing a growing burden of non-communicable diseases (NCDs). Dietary diversity is a recognised indicator of diet quality and is linked to body mass index (BMI) and perceived health. However, its role in the rapidly changing food environment in Palau remains unclear. This study aimed to examine associations among dietary diversity, BMI and perceived health among adults and identify region-specific dietary patterns and food items linked to health outcomes.Methods A cross-sectional survey using structured door-to-door interviews was conducted between August and December 2023 with 263 Palauan adults aged 20 years and older across urban and rural areas. Data on dietary intake, anthropometry and self-rated health were collected. Dietary diversity was assessed using a modified 11-item Food Diversity Score Kyoto (FDSK-11), which categorised meat and fish into fresh and processed forms. Multiple and logistic regression analyses were performed, adjusting for sociodemographic covariates.Results FDSK-11 scores ranged from 3 to 11 (mean: 9.0), with no statistically significant difference between urban and rural areas. However, the consumption of root crops, fresh fish, processed meat and fruits was statistically higher in rural areas, while egg and dairy consumption was more common in urban areas. The obesity rate reached 58.8%, while 57.1% of participants rated their health as poor. The study found no statistically significant association between dietary diversity and BMI or perceived health. In rural areas, higher fruit intake was inversely associated with BMI, and root crop consumption was positively associated with better perceived health. In urban areas, higher intake of fresh fish, processed fish, dairy products and vegetables was linked to better perceived health.Conclusion These findings imply that promoting culturally relevant, high-quality local foods may be more effective than emphasising dietary diversity. Thus, public health strategies should prioritise the revitalisation of traditional food systems to address the increasing NCD burden in Palau.",
  "authors": [
    {
      "affiliations": [
        "Kobe University Graduate School of Health Sciences, Kobe, Japan"
      ],
      "name": "Chihiro Tsuchiya-Theorin"
    },
    {
      "affiliations": [
        "Department of Urban Engineering, The University of Tokyo, Bunkyo, Japan"
      ],
      "name": "Akiko Iida"
    },
    {
      "affiliations": [
        "Palau Community College, Koror, Palau"
      ],
      "name": "Christopher Kitalong"
    },
    {
      "affiliations": [
        "Palau Community College, Koror, Palau",
        "University of Guam, Mangilao, Guam"
      ],
      "name": "Nwe Yin Yin"
    },
    {
      "affiliations": [
        "Solid Waste Management Office, Koror State Government, Republic of Palau, Koror, Palau"
      ],
      "name": "Bachat Arsenio"
    },
    {
      "affiliations": [
        "Kyoto University Graduate School of Asian and African Area Studies, Kyoto, Japan"
      ],
      "name": "Takuro Furusawa"
    }
  ],
  "title": "Dietary diversity and its associations with body mass index and perceived health among adults in Palau",
  "uid": "215e9baf-1f81-55a7-a941-cc811a9c3d52"
}