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Many Small Island Developing States (SIDS) are experiencing a nutrition transition, wherein high prevalence of malnutrition co-occurs with growing rates of diet-related non-communicable diseases. Sustainably managed and accessible aquatic foods can serve as a rich and bioavailable source of nutrients, helping communities achieve healthy diets and meet key sustainable development goals (e.g., SDG 1 No Poverty, SDG 2 Zero Hunger, and SDG 14 Life Below Water). However, to properly harness aquatic food systems in nutrition interventions, we must first understand aquatic food’s role in nutrient intake and adequacy. Here, using a nationally representative survey from Kiribati, we quantify the contribution of aquatic foods to nutrient intake and adequacy, and examine the spatial variability in nutrient intake adequacies. We find aquatic foods are the main contributors of most nutrients we examined, providing > 75% of vitamin B12, retinol, and heme iron, > 50% of niacin and total vitamin A, and > 25% of protein, vitamin E, potassium, and total iron consumed. Consumption of aquatic foods contributes to meeting key nutrient adequacies (e.g., niacin) and provides complete adequacy for vitamin B12 and protein. However, despite high aquatic food consumption, we find high levels of nutrient inadequacies (11 of the 17 nutrients with dietary reference intakes). Overall, our study quantifies the nutritional importance of aquatic foods in an emblematic SIDS, emphasizing their vulnerability to declining aquatic resources. We also highlight the need for cross-scale context-specific targeted nutrition interventions, even when aquatic food consumption is high, to enable SIDS to meet key SDGs. 

The Kiribati 2019 Integrated Household Income and Expenditure Survey (Integrated HIES) embeds novel ecological and human health research into an ongoing social and economic survey infrastructure implemented by the Pacific Community in partnership with national governments. This study seeks to describe the health status of a large, nationally representative sample of a geographically and socially diverse I-Kiribati population through multiple clinical measurements and detailed socio-economic surveys, while also conducting supporting food systems research on ecological, social, and institutional drivers of change. The specific hypotheses within this research relate to access to seafood and the potential nutritional and health benefits of these foods. We conducted this research in 21 of the 23 inhabited islands of Kiribati, excluding the two inhabited islands—Kanton Islands in the Phoenix Islands group with a population of 41 persons (2020 census) and Banaba Island in the Gilbert Islands group with a population of 333 persons (2020 census)—and focusing exclusively on the remaining islands in the Gilbert and Line Islands groups. Within this sample, we focused our intensive human health and ecological research in 10 of the 21 selected islands to examine the relationship between ecological conditions, resource governance, food system dynamics, and dietary patterns. Ultimately, this research has created a baseline for future Integrated HIES assessments to simultaneously monitor change in ecological, social, economic, and human health conditions and how they co-vary over time.