Food insecurity, COVID-19 and diets in Fiji – a cross-sectional survey of over 500 adults.

Introduction: Food insecurity is associated with inadequate nutrition and increased rates of chronic disease. The
primary aim of this study was to assess self-reported food insecurity and the perceived impact of COVID-19 on food
security, in two regional districts of Central Fiji, as part of a broader program of work on strengthening and monitoring
food policy interventions. The secondary aim was to explore the relationship between food insecurity and salt, sugar,
and fruit and vegetable intake.
Methods: Seven hundred adults were randomly sampled from the Deuba and Waidamudamu districts of Viti Levu,
Fiji. Interview administered surveys were conducted by trained research assistants with data collected electronically.
Information was collected on demographics and health status, food security, the perceived impact of COVID-19
on food security, and dietary intake. Food insecurity was assessed using nine questions adapted from Fiji’s 2014/5
national nutrition survey, measuring markers of food insecurity over the last 12 months. Additional questions were
added to assess the perceived effect of COVID-19 on responses. To address the secondary aim, interview administered
24-hour diet recalls were conducted using Intake24 (a computerized dietary recall system) allowing the calculation of
salt, sugar and fruit and vegetable intakes for each person. Weighted linear regression models were used to determine
the relationship between food insecurity and salt, sugar and fruit and vegetable intake.
Results: 534 people participated in the survey (response rate 76%, 50.4% female, mean age 42 years). 75% (75.3%,
95% CI, 71.4 to 78.8%) of people reported experiencing food insecurity in the 12 months prior to the survey. Around
one fifth of people reported running out of foods (16.8%, 13.9 to 20.2%), having to skip meals (19.3%, 16.2 to 22.9%),
limiting variety of foods (19.0%, 15.9 to 22.5%), or feeling stressed due to lack of ability to meet food needs (19.5%,
16.4 to 23.0%). 67% (66.9%, 62.9 to 70.7%) reported becoming more food insecure and changing what they ate due
to COVID-19. However, people also reported positive changes such as making a home garden (67.8%, 63.7 to 71.6%),
growing fruit and vegetables (59.5%, 55.6 to 63.8%), or trying to eat healthier (14.7%, 12.0 to 18.0%). There were no
significant associations between food insecurity and intakes of salt, sugar or fruit and vegetables.
Conclusion: Participants reported high levels of food insecurity, exceeding recommendations for salt and sugar
intake and not meeting fruit and vegetable recommendations and becoming more food insecure due to COVID-19.