Prevalence and associated factors of obesity, hypertension, and diabetes in French Polynesia: results from a nationwide cross-sectional study.

Background: Non-communicable diseases (NCDs) represent a major global health challenge, particularly in the Pacific. This study assessed the prevalence and associated factors of obesity, hypertension, and diabetes among adults in French Polynesia. Methods: A cross-sectional survey (2019-2021) was conducted on a nationally representative sample of adults across all five archipelagos (Tuamotu, Gambier, Marquesas, Austral, and Society including the Leeward and Windward Islands). Data included anthropometrics, blood pressure, biochemical markers (lipids, renal function), sociodemographic, lifestyle, and health history. NCDs were defined as hypertension (systolic BP >140 mmHg, diastolic BP >90 mmHg, and/or self-report of anti-hypertension medication use), diabetes (HbA1c >6·5%, and/or self-report of previous medical diagnosis), and obesity (using either BMI ≥30 kg/m2 or a revised definition incorporating ethnicity-specific thresholds and additional anthropometric criteria). Findings: A total of 1893 adults were included (987 women; 906 men). Among them, 669 (weighted prevalence: 35·5%, 95% CI: 33-38) had hypertension, 214 (weighted prevalence: 12·2%, 95% CI: 10-14) had diabetes (including 53 undiagnosed, weighted prevalence: 3·1%, 95% CI: 2-4), and 1022 (weighted prevalence: 51·1%, 95% CI: 48-54) or 847 (weighted prevalence: 42·7%, 95% CI: 40-46) were classified as obese, using BMI-based or revised definitions, respectively. Among those with revised obesity, 439 (weighted prevalence: 52·2%, 95% CI: 48-57) presented metabolic abnormalities typically associated with the condition, while 408 (weighted prevalence: 47·8%, 95% CI: 43-52) were metabolically healthy, a phenotype that declined with age.Women were less likely than men to have hypertension (OR = 0·59, 95% CI: 0·45-0·78), but more likely to present BMI-based obesity (OR = 1·61, 95% CI: 1·23-2·11). Hypertension odds were higher in Leeward versus Windward Islands (OR = 1·61, 95% CI: 1·24-2·09). Revised obesity was associated with low fruit/vegetable intake (OR = 1·53, 95% CI: 1·13-2·09), high meat consumption (OR = 1·52, 95% CI: 1·10-2·10), high fish consumption (OR = 1·54, 95% CI: 1·10-2·16), and low physical activity (OR = 1·58, 95% CI: 1·15-2·15). Obesity increased the odds of diabetes (OR = 2·99, 95% CI: 1·97-4·53) and hypertension (OR = 2·38, 95% CI: 1·80-3·14). Lower odds of obesity were observed in self-declared Polynesians of mixed ancestry (OR = 0·64, 95% CI: 0·42-0·96) and European immigrants (OR = 0·21, 95% CI: 0·07-0·61), as well as lower odds of diabetes in European immigrants (OR = 0·04, 95% CI: 0·01-0·19) compared to self-identified Polynesians. Interpretation: The high prevalence of obesity, a key driver of hypertension and diabetes, highlights the need for both population-wide prevention and targeted interventions across all archipelagos. Using standard indicators alongside locally revised definitions allows a more accurate mapping of NCDs, while the analysis of associated factors supports behavioural changes to reduce risk. Funding: Research Delegation of French Polynesia (Grant N°03557/MED/REC-05/29/2019); ANR France2030-EPIGEMI (Grant N°ANR-23-CHBS-0007); ANRS-MIE EMERGENCES (Grant N°23583).