Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Nicola Hawley


Background: In recent years, Samoa has been experiencing rapid increases in diabetes, especially among children. Objective: The aim of this study was to investigate the association between dietary patterns (glycemic load scores) and HbA1c levels in children using a 117 item food frequency questionnaire (FFQ). Methods: Foods from the FFQ were categorized into food groups to run a reduced rank regression, modeling glycemic load as the outcome. The RRR generated a dietary score for each child, which was then categorized into tertiles (based on the score distribution). Bivariate analysis of glycemic load factor score was performed on the child, family, and household factors. All variables that met the p-value cutoff of 0.1 in bivariate analyses were included in the multivariable linear regression model. Four different models were run sequentially, incorporating fixed factors (sex, age, region, and caloric intake) along with child level variables (hours of sleep), family level variables (household income), and a fully adjusted model incorporated all variables. Results: Glycemic load score was not statistically associated with HbA1c. In model 2, hours of sleep showed a significant association with HbA1c (p=0.038), with children sleeping 10-10.99 hours having higher HbA1c values compared to those sleeping less than 9 hours. In model 3, sex was significantly associated with HbA1c (p=0.042), with girls having lower HbA1c values compared to boys. In model 4, only household income was significantly associated with HbA1c (p=0.006), with children living in households with higher income levels having higher HbA1c values. In the final fully adjusted model, only income remained significantly associated with HbA1c (p=0.002). Conclusion: This study suggests that glycemic load scores may not be directly associated with HbA1c levels in children, but other factors such as hours of sleep, sex, and household income may play a role. Further research is needed to elucidate the complex relationship between these variables and HbA1c levels in children.


This is an Open Access Thesis.

Open Access

This Article is Open Access