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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 Health Impacts of Artificial Reef Advancement (HIARA; in the Malagasy language, “together”) study cohort was set up in December 2022 to assess the economic and nutritional importance of seafood for the coastal Malagasy population living along the Bay of Ranobe in southwestern Madagascar. Over the course of the research, which will continue until at least 2026, the primary question we seek to answer is whether the creation of artificial coral reefs can rehabilitate fish biomass, increase fish catch, and positively influence fisher livelihoods, community nutrition, and mental health. Through prospective, longitudinal monitoring of the ecological and social systems of Bay of Ranobe, we aim to understand the influence of seasonal and long-term shifts in marine ecological resources and their benefits to human livelihoods and health. Fourteen communities (12 coastal and two inland) were enrolled into the study including 450 households across both the coastal (n = 360 households) and inland (n = 90 households) ecosystems. In the ecological component, we quantify the extent and health of coral reef ecosystems and collect data on the diversity and abundance of fisheries resources. In the social component, we collect data on the diets, resource acquisition strategies, fisheries and agricultural practices, and other social, demographic and economic indicators, repeated every 3 months. At these visits, clinical measures are collected including anthropometric measures, blood pressure, and mental health diagnostic screening. By analyzing changes in fish catch and consumption arising from varying distances to artificial reef construction and associated impacts on fish biomass, our cohort study could provide valuable insights into the public health impacts of artificial coral reef construction on local populations. Specifically, we aim to assess the impact of changes in fish catch (caused by artificial reefs) on various health outcomes, such as stunting, underweight, wasting, nutrient intake, hypertension, anxiety, and depression.