The Pacific region is experiencing a non-communicable disease epidemic largely driven by an ongoing nutrition transition from nutrient rich whole foods to imported staples and highly processed foods. Food trade is a major driver of this transition. We characterize regional and sub-regional trade from 1995 to 2018 for 18 Pacific Island Countries and Territories using the Pacific Food Trade Database. The analysis shows the growing dependence on imports of rice from South-East Asia and wheat from Australia, and recent growth in imports of meat from Australia, New Zealand and USA, and highly processed foods from South-East Asia. Findings are discussed in terms of policy and trade agreements, and global shocks including COVID-19 and the war in Ukraine.