Skip to main content Accessibility help

The significance of DOHaD for Small Island Developing States

  • S. Tu’akoi (a1), M. H. Vickers (a1), K. Tairea (a2), Y. Y. M. Aung (a3), N. Tamarua-Herman (a2), M. ’Ofanoa (a4) and J. L. Bay (a1)...


Small Island Developing States (SIDS) are island nations that experience specific social, economic and environmental vulnerabilities associated with small populations, isolation and limited resources. Globally, SIDS exhibit exceptionally high rates of non-communicable disease (NCD) risk and incidence. Despite this, there is a lack of context-specific research within SIDS focused on life course approaches to NCD prevention, particularly the impact of the early-life environment on later disease risk as defined by the Developmental Origins of Health and Disease (DOHaD) framework. Given that globalization has contributed to significant nutritional transitions in these populations, the DOHaD paradigm is highly relevant. SIDS in the Pacific region have the highest rates of NCD risk and incidence globally. Transitions from traditional foods grown locally to reliance on importation of Western-style processed foods high in fat and sugar are common. The Cook Islands is one Pacific SIDS that reports this transition, alongside rising overweight/obesity rates, currently 91%/72%, in the adult population. However, research on early-life NCD prevention within this context, as in many low- and middle-income countries, is scarce. Although traditional research emphasizes the need for large sample sizes, this is rarely possible in the smaller SIDS. In these vulnerable, high priority countries, consideration should be given to utilizing ‘small’ sample sizes that encompass a high proportion of the total population. This may enable contextually relevant research, crucial to inform NCD prevention strategies that can contribute to improving health and well-being for these at-risk communities.


Corresponding author

*Address for correspondence: Liggins Institute, University of Auckland, 2-6 Park Avenue, Grafton, Auckland, Auckland 1023, New Zealand.E-mail:


Hide All
1. World Health Organization. Small Island Developing States Health and WHO: Country Presence Profile. 2017. WHO: Geneva.
2. United Nations. Small Island Developing States, 2017. United Nations: New York.
3. The United Nations Office of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States. Small Island Developing States in Numbers, 2015. United Nations: New York.
4. World Health Organization. Global Status Report on Noncommunicable Diseases. 2014. WHO: Geneva.
5. United Nations. United Nations conference on trade and development: Is a special treatment of small island developing states possible?, 2004. United Nations: New York and Geneva.
6. Thow, AM, Heywood, P, Schultz, J, et al. Trade and the nutrition transition: strengthening policy for health in the Pacific. Ecol Food Nutr. 2011; 50, 1842.
7. Gluckman, P, Hanson, M. Mismatch: Why Our World No Longer Fits Our Bodies. 2006. OUP: Oxford.
8. Hanson, M, Gluckman, P. Early developmental conditioning of later health and disease: physiology or pathophysiology? Physiol Rev. 2014; 94, 10271076.
9. Aiken, CE, Ozanne, SE. Transgenerational developmental programming. Hum Reprod Update. 2014; 20, 6375.
10. Hanson, MA, Gluckman, PD, Ma, RC, Matzen, P, Biesma, RG. Early life opportunities for prevention of diabetes in low and middle income countries. BMC Public Health. 2012; 12, 1025.
11. Uauy, R, Kain, J, Corvalan, C. How can the Developmental Origins of Health and Disease (DOHaD) hypothesis contribute to improving health in developing countries? Am J Clin Nutr. 2011; 94(Suppl.), 1759S1764S.
12. Norris, SA, Daar, A, Balasubramanian, D, et al. Understanding and acting on the developmental origins of health and disease in Africa would improve health across generations. Glob Health Action. 2017; 10, 1334985.
13. World Health Organization. Nutrition: Stunting in a Nutshell. 2017. World Health Organization: Geneva.
14. UNICEF. UNICEF Statement at SIDS Meeting on Non Communicable Diseases, 2014. UNICEF: New York.
15. Bay, JL, Morton, SM, Vickers, MH. Realizing the potential of adolescence to prevent transgenerational conditioning of noncommunicable disease risk: multi-sectoral design frameworks. Healthcare. 2016; 4, 39.
16. Unwin, N, Samuels, TA, Hassell, T, Brownson, RC, Guell, C. The development of public policies to address non-communicable diseases in the Caribbean country of Barbados: the importance of problem framing and policy entrepreneurs. Int J Health Policy Manag. 2017; 6, 71.
17. Van Beurden, EK, Kia, AM, Zask, A, Dietrich, U, Rose, L. Making sense in a complex landscape: how the Cynefin Framework from Complex Adaptive Systems Theory can inform health promotion practice. Health Promot Int. 2011; 28, 7383.
18. United Nations Population Fund. Population and development profiles: Pacific island countries. 2014. United Nations Population Fund: Pacific Sub-Regional Office: Fiji.
19. World Health Organization. Western Pacific Region Health Information and Intelligence Platform (HIIP): Noncommunicable Disease Mortality, Data by Country. 2008. World Health Organization: Geneva.
20. World Health Organization. Global School-Based Student Health Survey: Cook Islands 2015 Fact Sheet. 2015. WHO: Geneva.
21. Cook Islands Ministry of Health. Cook Islands NCD risk Factors: STEPS Report, 2011. Cook Islands Ministry of Health: Suva.
22. Cook Islands Ministry of Health. National Health Information Bulletin. 2017. Cook Islands Ministry of Health: Rarotonga.
23. Ulijaszek, SJ. Trends in body size, diet and food availability in the Cook Islands in the second half of the 20th century. Econ Hum Biol. 2003; 1, 123137.
24. Food and Agriculture Organization of the United Nations. Trouble in paradise: nutritional challenges in the Cook Islands, 2014. Retrieved September 2017 from
25. Fry, PC. Dietary survey on Rarotonga, Cook Islands I. General description, methods and food habits. Am J Clin Nutr. 1957; 5, 4250.
26. Ulijaszek, SJ. Modernization and the diet of adults on Rarotonga, the Cook Islands. Ecol Food Nutr. 2002; 41, 203228.
27. Ferguson, M, Brown, C, Georga, C, et al. Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory, Australia. Aust N Z J Public Health. 2017; 41, 294298.
28. Airhihenbuwa, CO, Ford, CL, Iwelunmor, JI. Why culture matters in health interventions: lessons from HIV/AIDS stigma and NCDs. Health Educ Behav. 2014; 41, 7884.
29. Etz, KE, Arroyo, JA. Small sample research: considerations beyond statistical power. Prev Sci. 2015; 16, 10331036.
30. Korngiebel, DM, Taualii, M, Forquera, R, Harris, R, Buchwald, D. Addressing the challenges of research with small populations. Am J Public Health. 2015; 105, 17441747.


Related content

Powered by UNSILO

The significance of DOHaD for Small Island Developing States

  • S. Tu’akoi (a1), M. H. Vickers (a1), K. Tairea (a2), Y. Y. M. Aung (a3), N. Tamarua-Herman (a2), M. ’Ofanoa (a4) and J. L. Bay (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.