Ka Wai Ola - Office of Hawaiian Affairs, Volume 8, Number 4, 1 April 1991 — Hawaiian Health Horizons [ARTICLE]

Hawaiian Health Horizons

Nutrition and dental health in Hawaiians

This is the third article in a five-part series summarizing the findings of the E Ola Mau Native Hawaiian Health Needs Study conducted in 1985. Its findings and recommendations led, in part, to the passage of the Native Hawaiian Health Care Act of 1988 whieh established the Papa Oia Lokahi Hawaiian health consortium. The consortium's five member agencies-the state Department of Health, E Ola Mau, the University of Hawai'i, Alu Like and Office of Hawaiian Affairs — are working with island communities to develop a comprehensive health care master plan for Native Hawaiians and a network of Native Hawaiian health care systems statewide.

Report of the E Ola Mau Native Hawaiian Health Needs Study Part 3 of a series: Nutrition and Dental Health The purpose of the task force whieh developed this report was to determine the nutritional and dental needs of Native Hawaiians in order to plan effective treatment. Three areas were selected for study: • materna! and child health, because mothers and children are vulnerable to nutritional deficiencies whieh have lasting effects in later life. • the relationship between diet and chronic diseases such as heart disease, diabetes, arthritis, gout and cancer. • dental problems and their importance to physical health, and the relationship between diet and dental health. Nutrition Early reports have described ancient Hawaiians as having a fine physique and being generally in good health prior to their contact with foreign civilization. Their principal foods were fish, taro, sweet potato, breadfruit, yams, banana, greens, limu (seaweed), coconut, sugar eane and mountain apple. This diet was simple and limited in variety but adequate to promote growth and maintain good health. Since foreign contact there has been overall decline of the diet of the ancient Hawaiian from a simple, nutritious diet of fish, taro, breadfruit, yams and greens to one that is high in fat and sugar. By 1954, dietary surveys showned a decline in the nutritional value of the diet of the Native Hawaiian. A survey conducted in 48 families on O'ahu of whieh half were Native Hawaiians, showed that 50 percent of them had diets deficient in calories, protein, phosphorous, iron and vitamin C; three-fourths had insufficient amounts of vitamin A and thiamine. Modern Native Hawaiians still eat their traditional taro and poi, but since these are no longer abundant and are expensive, Hawaiians have resorted to readily available foods in the supermarkets. The change in dietary practices with urbanization and westernization seems to be a pattern whieh has occured in other countries of the Pacific Basin. Pregnant women Compared with other ethnic groups in Hawai'i, studies showed Native Hawaiian women have poor pregnancy outcomes: more fetal deaths, higher infant mortality rates and a higher percentage of low birth weight infants. They also have a high number of teenage pregnancies. Rates of miscarriage increased in the 1980s over the 1970s. Pregnant Native Hawaiian women in the 1980s weighed less, sought prenatal care early in their pregnancy and used more government programs such as Medicaid and the Supplemental Food Program for Women, Infants and Children (WIC) than in the 1970s. Infants The practice of breast-feeding after childbirth

increased among Native Hawaiian mothers from 29 percent to 81.5 percent in 1984. However, only half of these mothers were exclusively breastfeeding when they left the hospital and 22 percent stopped breast-feeding at eight weeks; mainly due to insufficient milk production and sore nipples. Laek of support from the hospital and family contributed to the failure to eonhnue breastfeeding. PreschooI children Both extremes of energy malnutrition (overweight and underweight) were found among preschool-age Hawaiian children in studies in the 1970s and 1980s. Native Hawaiian preschoolers were taller and heavier than their Oriental counterparts. Among the children attending the Supplement Food Program for Women, lnfants and Children (WIC) in the 1980s, 10 percent were overweight. On the other hand, more than 10 percent of Native Hawaiian children at various ages were shorter or weighed less than average, indicating undernutrition.

Other data indicated that Native Hawaiian preschool children in the 1980s weighed lessat one to three years than children in the 1970s. However, by four years of age they were more overweight than children in the 1970s. More children in the 1980s were shorter at three to six years than children in the 1970s. Children in the 1980s were better fed than children in the 1970s and fewer children had anemia. The shorter height at three to six years and lighter weights at one to three years of children in the 1980s may be due to the mother's poor diet during pregnancy. However, with the use of additional foods from the WIC program they were able to catch up in weight by three to five years. This showed the beneficial effect of the WIC program in improving the health of children. School-age children Native Hawaiian school-age children were as tall as mainland United States children but heavier than mainland and Oriental children in Hawai'i. A study of diet in school-age children in 1980 showed Native Hawaiian elementary school children had the highest energy intake among all the other ethnic groups. They also ate more sugar and fatty foods. In junior high school, they consumed the most sugar and second highest amounts of fat and calories. In senior high, they still ranked third highest among all others in caloric intake. Adults The Native Hawaiian adult was at greatest risk of other ethnic groups in Hawai'i for cardiovascular disease, myocardial infarction ("heart attack"), diabetes, hypertension, arthritis, gout and cancer of the breast, lung and stomach. Two nutritional factors contributing to high heart disease in Hawaiians were being overweight and a diet high in energy and saturated fat. A high fat diet has also been tied to the rate of prostate and breast cancers. Diet studies at the Cancer Research Center of Hawai'i showed that Native Hawaiians had the second highest intake of fat next to Caucasians. Some popular Hawaiian foods such as dry/salted fish and kalua pig are believed to contain high concentrations of substances thought to contribute to cancer. Dental Before 1778, there was very little tooth decay among young Native Hawaiians and it was virtually non-existent in the young child. By 1930, tooth decay was widespread in Hawai'i and the majority of Native Hawaiian children had dental decay. Dental caries was identified as a serious public health problem and the most prevalent chronic disease affecting the people of Hawaii in 1960. Native Hawaiian children had one of the highest rates of decayed, missing and filied teeth. Subsequent studies also showed that they have one of the highest periodontal disease rates and

the poorest dental hygiene. The decline in dental health is due in part to a change to a mode-n high sugar, low starch diet. Native Hawaiian children ate more cavityproducing foods such as soda and juice, dessert, snacks and candy or gum. Other favorite food whieh contribute to dental plaque and then cavities include sweet rolls, sweet breads and manapua (Chinese dim sum or meat and vegetable wrapped in a wheat or rice flour casing). Ironically, poi, the traditional staple food of the Hawaiians, was shown to also contribute to heavy plaque aeeumulahon.

Recommendations — nutrition • Nutrition education programs should help Native Hawaiians recognize the essentials of a good diet. Pregnant women need to understand how diet and drinking or taking drugs affect pregnancy. Children need to leam how to select a balanced diet at home and in school to prevent obesity, anemia and other nutritional problems. Nutrition education should be taught in day care centers and in elementary and high schools. Adults need to see how a sensible diet ean prevent of chronic disease. A sensible diet means: eating a variety of foods; maintaining a desirable body weight; avoiding excessive fat, saturated fat, cholesterol, sugar and salt intake; eating foods with adequate starch and fiber; and limiting the consumption of aleohol. • Research is needed on the nutritional status of pregnant and lactating women, infants, preschool children and adults. Studies are needed to determine how diet affects the quality and quantity of breast milk and her infant's nutritional wellbeing. New research data is needed on the dietary intakes of Native Hawaiian infants, preschool children and adults. • Health professionals in the hospital and community need to encourage women to breastfeed. Pregnant women need to be taught the advantages of breast-feeding and how to breastfeed before delivery. Support groups in the community need to be established to help new mothers breast-feed successfully. • Nutrition programs for at-risk pregnant women, infants and children, such as the Maternity and Infant Care project in Waimanalo, the WIC program, Headstart, School Luneh, Expanded Food and Nutrition Education, Nutrition Education and Training program should continue to be funded. The Native Hawaiian population has increased their use of these programs and in some instances, such as the WIC program, they were shown to be the greatest users of this program. • Sources of Native Hawaiian foods such asfish, taro, sweet potato and yams have decreased due to urbanization. Legislation is needed to restore these food supplies by promoting eeonomie feasibility for farming and restoration of fishing rights. The use of traditional foods should also be encouraged among the Native Hawaiians. Recommendations — dental • Education on proper oral hygiene, routine preventive dental care for caries and periodontal disease control should be made available to all families. Children in public and private schools should be taught about dental health and hygiene using methods that are geared to the Native Hawaiian populahon. • Public and private agencies should work together to do regular surveys of the dental status of Hawaii's populahon, especially of children. Immediate and appropriate treatment should be provided close to the survey site at no or low cost to those without dental insurance. • Fluoridation of the water supply and development of alternative means of fluoridation were also recommended.