Development of a nutrition exchange booklet for Guam using culturally accepted foods.

Providing nutrition counseling for people on Guam presents a major challenge because of the cultural diversity of the populace. Guam is a US territory in the western Pacific Ocean. Despite its small size, 212 square miles, the population consists of 133,152 residents: 48% Chamorro, 25% Filipino, 16% white, 8% other Asian, and 2% Micronesian (1). Chamorros are the earliest known inhabitants of the Mariana Islands. Development of educational materials is difficult because of the varied use and type of foods in these population sub-groups. Information about food consumption of these groups is also limited.

Another challenge to the provision of nutrition counseling to Guam islanders relates to their rate of chronic disease. Currently, rates of chronic diseases among the people of Guam are some of the highest in the Pacific islands (2). Deaths from chronic diseases are increasing (3) rather than decreasing as in the US mainland (4). The death rate for heart diseases has increased 19% since 1980. Heart disease and diabetes accounted for 21.7% and 7.2%, respectively, of all deaths on Guam in 1992 (3). Obesity is prevalent in young (5) and adult Chamorros and Micronesians (6). Although obesity does not appear to carry the negative stereotype common in the United States (7), the high levels of obesity may contribute to chronic disease (8,9). These health concerns profoundly influence the demand for appropriate nutrition education materials from health care providers and patients who have been advised to change their diet.

Local diets tend to be high in fat as a result of the high consumption of meats, fried foods, and coconut milk. White rice and sweet drinks are dietary staples. The supply of local produce is unreliable, so residents either use imported produce, which is expensive and often of poor quality, or restrict produce consumption. Cow's milk and dairy products are not a traditional part of the diet. Lactose intolerance is thought to …