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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.