Nacua is descended from Portuguese, Hawaiian, and Samoan people. Due to his large stature as a baby, he was given the nickname “Puka” in Samoan, which means plump and chubby.  He was born and raised in Provo, Utah, and went to Orem High School in Orem. Nacua set state records for Utah in his final high school season with 260 catches, 5,226 receiving yards, and 58 receiving touchdowns.

Nacua attended Washington to start his college career. Before sustaining a fractured foot, he caught seven passes for 168 yards and two scores in the first eight games of his rookie campaign.[7] In the three games that the team played in 2020 before COVID-19 cut short, Nacua had nine receptions for 151 yards and one touchdown.[8] He used the NCAA transfer site after the season ended.

Nacua moved to BYU in preparation for the 2021 campaign.[10] He caught 43 catches for 805 yards and six touchdowns in his rookie campaign.[11] In the 2021 season, he went over 100 yards in four different games.
He had eight receptions for 141 yards and a receiving touchdown on October 15, 2022, in addition to two rushing touchdowns, versus Arkansas.[13] He recorded 14 receptions for 157 yards and two touchdowns on November 5 in a victory over Boise State, including the game-winning touchdown on fourth and goal to put BYU ahead 31-28 with 32 seconds remaining.[14] He had 48 receptions for 625 receiving yards and five receiving touchdowns in the 2022 campaign.[15] In the rushing game, he was also heavily utilized, carrying the ball 39 times.

On September 10, 2023, in a game against the rival Seattle Seahawks in Seattle, Nacua made his debut for the Rams as a starter. The Rams were coming off a season marred by injuries, and the Seahawks were strong favorites because the team was without star receiver Cooper Kupp due to a hamstring ailment.

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