Exploring Differences in Dietary Diversity and Micronutrient Adequacy between Costa Rican and Mexican Adolescents

Diet diversity becomes especially relevant during adolescence to satisfy the adequate micronutrient intake. Diet diversity (DD) and micronutrient probability of adequacy (PA) were studied in 818 Costa Rican (CR) and 1202 Mexican (MX) adolescents aged 13-18 years. DD was compared using the Minimum Dietary Diversity (MDD) score. Receiver-operating characteristic (ROC) curves were employed to identify the optimal MDD for each sample from the respective countries. The mean MDD for the overall CR sample was 4.17 ± 1.43 points, and for the MX sample, the mean MDD was 4.68 ± 1.48 points. The proportion of adolescents with a DD was significantly higher in Costa Rica than in Mexico (66.5% vs. 55.6%; p < 0.0001). Also, DD was higher in rural Costa Rican adolescents, while no difference was found in the MX adolescents by area of residence. CR adolescents reported significantly higher PA than MX participants for 6 of the 11 micronutrients assessed. The calcium PA in MX adolescents was significantly higher than in the CR sample (MX: 0.84 vs. CR: 0.03; p < 0.0001), while low PA was obtained for iron in both countries (CR: 0.01 vs. MX: 0.07; p < 0.0001). In Costa Rica and Mexico, nutritional interventions and assessing the compliance of food-fortifying programs are needed to improve the PA of diverse micronutrients.

A Landscape of Micronutrient Dietary Intake by 15- to 65-Years-Old Urban Population in 8 Latin American Countries: Results From the Latin American Study of Health and Nutrition

BACKGROUND

Latin American countries have shifted from traditional diets rich in micronutrients to a Westernized diet rich in high energy-dense foods and low in micronutrients.

OBJECTIVE

This study aimed to determine the prevalence of adequate micronutrient intakes in urban populations of 8 Latin American countries.

METHOD

Micronutrient dietary intake data were collected from September 2014 to August 2015 from 9216 men and women aged 15.0 to 65.0 years living in urban populations of 8 Latin American countries. Dietary intake was collected using two 24-hour recalls on nonconsecutive days. Micronutrient adequacy of intake was calculated using the Estimated Average Requirement cut-off method.

RESULTS

In general terms, the prevalence of inadequate intake of thiamine, riboflavin, niacin, folate, cobalamin, iron, phosphorus, copper, and selenium ranged from 0.4% to 9.9%. In contrast, the prevalence of inadequacy of pyridoxine, zinc, vitamin C, and vitamin A ranged from 15.7% to 51.5%. The nutrients with a critical prevalence of inadequacy were magnesium (80.5%), calcium (85.7%), and vitamin D (98.2%). The highest prevalence of inadequate intakes was observed in the low educational level, participants with overweight/obesity, in men, and varies according to socioeconomic status.

CONCLUSIONS

There is an urgent need to define direct regional actions and strategies in Latin America aimed at improving micronutrient adequacy, either through staple food fortification programs, agronomic biofortification, or food policies that facilitate economic access to micronutrient-rich foods.

Reducing dietary intake of added sugars could affect the nutritional adequacy of vitamin A in adolescents: the Costa Rica case

BACKGROUND

In countries where sugar fortification with vitamin A is mandatory, strategies to reduce the prevalence of overweight/obesity in adolescents that involve lowering added sugar intake could lead to vitamin A inadequate intakes, since vitamin A-fortified sugar for home consumption contributes to a high proportion of this vitamin intake in the adolescent diet.

METHODS

The study employed a hierarchical linear model to perform a mediation analysis on a cross-sectional sample of adolescents (13-18 years old) in the province of San José, Costa Rica.

RESULTS

Lowering the total energy intake derived from added sugars to less than 10% significantly increases the prevalence of vitamin A inadequate intake in adolescents by 12.1% (from 29.6% to 41.7%). This is explained by the mediation model in which, the reduced adequacy of vitamin A intake is mediated by a reduction in total energy intake derived from added sugars fortified with vitamin A.

CONCLUSIONS

The vitamin A fortification of sugar for household consumption should be reassessed according to the current epidemiological profile in Costa Rica to promote strategies that reduce the prevalence of overweight/obesity in adolescents by lowering the consumption of added sugars without affecting vitamin A intake.

Exploratory Analysis of Social Networks Linked to the Provision of Beverages in Costa Rican Schools

Sugar-sweetened beverages (SSBs) are implicated in weight gain and adverse cardiometabolic heath. Social networks of stakeholders involved in providing potable water and sugar-sweetened beverages (SSBs) in high schools in Costa Rica were studied using social analysis network. In public and private schools, the interactions between the stakeholders in charge of providing beverages are fragmented and their role in preventing the availability of SSBs is weak. School canteen owners ultimately decide what beverages are available at school, which may cause students to choose beverages that increase the risk of overweight/obesity. It is therefore urgently necessary to improve the capacity for two-way interactions between the stakeholders to enhance their roles in the provision of beverages. Hence, it is essential to reinforce the stakeholders' leadership, and set up innovative ways to exert it in order to develop a shared vision of the types of drinks that should be available in the school environment.

Use of a Water Filter at Home Reduces Sugary Drink Consumption among Parents and Infants/Toddlers in a Predominantly Hispanic Community: Results from the Water Up!@ Home Intervention Trial

BACKGROUND

Water is recommended as an alternative for sugar-sweetened beverages (SSBs). Low-income, minority groups in the United States continue to exhibit high SSB and low water consumption, and are more likely to exceed 100% fruit juice recommendations.

OBJECTIVE

To test the effects of a home-based intervention designed to replace SSBs with tap water and reduce excess juice consumption among parents and their infants/toddlers.

DESIGN

Randomized controlled trial.

PARTICIPANTS

Parents (n = 92) of infants/toddlers who participated in three Early Head Start home-visiting programs that serve predominantly Hispanic, low-income communities during 2019-2021.

INTERVENTION

The 12-week intervention (Water Up!@Home) simultaneously addressed physical barriers to tap water consumption (via a water filter) and sociocultural barriers to replacing SSBs and juice with water (via a curriculum). Comparison group received a water filter only. We hypothesized that the intervention would lead to a reduction of 6 fl oz/d in SSB and juice consumption.

MAIN OUTCOMES

Parent-reported self and infant/toddler SSBs, water (filtered, tap, or bottled), and 100% fruit juice consumption.

STATISTICAL ANALYSES

Analysis of covariance to compare changes in consumption between experimental groups was performed. We also conducted t tests to assess changes within groups.

RESULTS

Participants in both groups reported significant reductions in SSBs from baseline (parents: intervention [-11.2 fl oz/d; P < 0.01]; comparison [-8.0 fl oz/d; P < 0.01]; children: intervention [-1.50 fl oz/d; P = 0.03]; comparison [-1.56 fl oz/d; P = 0.02]), increased water consumption (parents in both groups [+5.6 fl oz/d]; children: intervention [+3.61 fl oz/d; P = 0.01], comparison [+2.24 fl oz/d; P = 0.05]), mostly from filtered tap water. Differences between groups were not statistically significant. Intervention participants reported significant reductions in 100% fruit juice vs comparison (parents: -3.6 fl oz/d vs -1.0 fl oz/d; P < 0.01; children: -0.73 fl oz/d vs +0.48 fl oz/d; P = .03).

CONCLUSIONS

The intervention effectively reduced 100% fruit juice consumption. Water security should be examined as a contributor to SSB consumption in this population.

Role of Residence Area on Diet Diversity and Micronutrient Intake Adequacy in Urban and Rural Costa Rican Adolescents

Dietary diversity might be essential to meet nutritional demands during adolescence. Diet diversity among 818 urban and rural Costa Rican adolescents aged 13−18 years was studied using the Minimum Dietary Diversity Score for Women. The Nutrient Adequacy Ratio (NAR) was calculated for 11 nutrients to estimate the nutrient adequacy of the diet. A NAR < 0.7 was considered inadequate for micronutrient intake. The optimal Diet Diversity Score (DDS) cut-off point for this study was 4, established using receiver-operating characteristic curves. The mean DDS for the overall sample was 4.17 ± 1.43, although DDS was significantly higher in adolescents from rural vs. urban areas (4.33 ± 1.43 vs. 4.00 ± 1.42, p-value = 0.001). The odds of having a diverse diet were 62% higher in rural vs. urban adolescents. Overall, 80−95% of adolescents reached a NAR ≥ 0.70 for 8 nutrients except for calcium, zinc, and vitamin A. The residence area plays a key role in adolescent dietary diversity. Although overall DDS was low, foods that make up the rural adolescent diet were nutritionally dense enough to satisfy the EAR for most micronutrients. A high DDS is not necessarily required for the diet to meet most micronutrient demands in adolescence. Improved dietary adequacy of vitamin A, zinc, and calcium is required due to the importance of these micronutrients in maintaining optimal health.

Association Between Parental Feeding Styles and Excess Weight, and Its Mediation by Diet in Costa Rican Adolescents

Objectives

Parental feeding styles (PFS) influence children's diet and weight; we aimed to evaluate this relationship in adolescents.

Methods

Cross-sectional study in 686 Costa Rican adolescents (13–18y). Parents responded to a questionnaire from which four validated PFS scores were derived: promotion (verbal encouragement of healthy eating); verbal sanctions/scolding (indirect control of healthy food intake); direct control over diet; instrumental/emotional (food to regulate emotions). Adolescents completed a 3-day food record, from which the validated Traditional Costa Rica Adolescents Diet Score (TCRAD) was defined. Excess weight was dichotomized following standards. Multivariate regression-based mediation analysis estimated the natural direct, indirect, and total effects (NDE/NID/TE) of the following pathway (general/sex-stratified): PFS → TCRAD → excess weight.

Results

Excess weight was present in 33% of adolescents. TCRAD mean was similar between excess weight categories. Each additional point of the direct control PFS score was associated with higher odds of excess weight [(TE-OR: 1.55; 95%CI: 1.04–2.31; p = 0.033), (NDE-OR: 1.52; 95%CI: 1.02–2.27; p = 0.039)]. This association was accentuated in boys vs. girls. A non-significant tendency for lower odds of excess weight was observed for the emotional PFS in boys [(TE-OR: 0.44; 95%CI: 0.19–1.05; p = 0.064), (NDE-OR: 0.43; 95%CI: 0.18–1.02; p = 0.056)] and the promotion PFS in the total sample (TE-OR: 0.74; 95%CI: 0.47–1.17; p = 0.202). TCRAD seemed to have a mediation role between the promotion PFS and excess weight (NID-OR: 0.94; 95%CI: 0.88–1.00; p = 0.056).

Conclusions

Healthy eating behaviors encouraged by parents might benefit Costa Rican adolescents’ weight via dietary intake. In contrast, parents directly controlling food access and intake may adversely influence adolescents’ weight, especially in boys. Our work constitutes a first approach studying PFS and obesity among adolescents. Further research is needed to confirm the role of the promotion PFS in obesity prevention and evaluate the contribution of PFS to other diet-related outcomes among adolescents in diverse cultural contexts.

Funding Sources

The Mexican Council of Science and Technology; Fundación México en Harvard; The Costa Rican Ministry of Health; Inciensa Foundation.

Lessons Learned for Emergency Feeding During Modifications to 11 School Feeding Programs in Latin America and the Caribbean During the COVID-19 Pandemic

BACKGROUND

School feeding programs (SFPs) can play a crucial role in the emergency food and nutrition response, but there is a dearth of information on how SFPs operate during emergencies.

DESIGN AND METHODS

A rapid comparative assessment of 11 SFPs throughout Latin America and the Caribbean during the COVID-19 pandemic. Data from (1) systematic document search and (2) surveys with key informants (n = 23) about barriers/facilitators to modifications were systematically analyzed using a multiple case study approach.

RESULTS

During the pandemic, all SFPs continued (although continuation plans varied from a few days in Chile to >1 month in Puerto Rico) via food kits, food vouchers, and/or grab n' go meals. The SFP implementation was highly dependent on the programs' autonomy and financial support, which impacted their logistics to acquire and distribute foods during the pandemic. The types of foods offered in some SFPs suggest that established nutritional guidelines were not always followed. Key informants expressed concerns about the deterioration of the nutritional quality of foods offered during the pandemic and lack of community engagement that impeded distribution to the neediest.

CONCLUSIONS

Results underscore the urgency for clear implementation guidance on how to modify SFP during emergencies. Public health implications include (1) allocation of autonomous resources to an intersectoral working group to safeguard nutritional benefits during emergencies, (2) strengthening efforts of SFP community engagement before and during emergencies, and (3) establishing guidelines of the types of foods that can be distributed to meet the nutritional needs of beneficiaries during emergencies.

[Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos]

The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.

Gender-based eating norms, the family environment and food intake among Costa Rican adolescents

OBJECTIVE

To examine the association between family environment variables (parenting styles, family meal atmosphere), gender-based stereotypes and food intake in Latin American adolescents.

DESIGN

Structural equation modelling applied to cross-sectional data, 2017.

SETTING

Urban and rural sites of San José, Costa Rica.

PARTICIPANTS

n 813; 13-18 years old.

RESULTS

Data suggest direct associations between gender-based stereotypes and intake of fruits and vegetables (FV) (β = 0·20, P < 0·05), unhealthy foods (fast food (FF)) (β = -0·24, P < 0·01) and ultra-processed foods (β = -0·15, P < 0·05) among urban girls; intake of legumes among rural girls (β = 0·16, P < 0·05) and intake of sugar-sweetened beverages (SSB) among rural boys (β = 0·22, P < 0·05). Family meal atmosphere was associated with legume intake (β = 0·19, P <·05) among rural girls. Authoritative parenting style was associated with FV intake (β = 0·23, P < 0·05) among urban boys and FF intake (β = 0·17, P < 0·05) among urban girls. Authoritarian parenting style was associated with FV consumption (β = 0·19, P < 0·05) among rural boys, and with SSB and FF consumption (β = 0·21, P < 0·05; β = 0·14, P < 0·05, respectively) among urban girls.

CONCLUSIONS

Findings are the first to describe the complex family environment and gender-based stereotypes within the context of a Latin American country. They emphasise the need for culturally relevant measurements to characterise the sociocultural context in which parent-adolescent dyads socialise and influence food consumption.

A Traditional Costa Rican Adolescents' Diet Score Is a Valid Tool to Capture Diet Quality and Identify Sociodemographic Groups With Suboptimal Diet

Traditional diet indices may capture diet quality according to local food culture. Higher adherence to traditional diet scores may help prevent disease, yet evidence in adolescents is limited. This cross-sectional study aimed to develop and validate a Traditional Costa Rica Adolescents Diet Score (TCRAD) and determine its association with sociodemographic characteristics, under the hypothesis that girls, adolescents from rural areas, and with low socioeconomic status, have a more traditional healthy diet. A total of 804 urban and rural adolescents (13-18 years old) participated in the study. The TCRAD showed adequate internal validity as shown by significant associations with intake of 14 traditional foods and nutrients (legumes, vegetables, fruits, oils, dairy, and corn tortilla scored as healthy; and white rice, red/processed meat, solid fats, desserts/pastries, sugar-sweetened beverages, snacks, fast food, and bread and cookies scored as unhealthy). A high TCRAD score, indicative of a healthier and more traditional diet, was observed among adolescents in the low socioeconomic group vs. medium or high socioeconomic categories (42.9, 41.2, and 38.2%, respectively, p < 0.05), adolescents living in rural areas vs. urban (47.6 vs. 34.2%, p < 0.05), and among boys vs. girls (46.9 vs. 37.5%, p < 0.05). The TCRAD score is a valid tool to capture diet quality of adolescents in Costa Rica and could be used to measure association of diet with disease outcomes in this and similar populations. Public health nutrition programs in Costa Rica should focus on improving intake of foods and nutrients, and prioritize girls, adolescents in urban areas, and adolescents with high socioeconomic status.

Intersectionality between parenting styles, area of residence and gender on food group consumption among Costa Rican adolescents

Little is known about how parenting styles can influence the adolescent's consumption of sugar-sweetened beverages (SSB), fruits and vegetables (FV) and beans in Latin America. This study uses hierarchical moderated regression models to examine such association by area of residence, sex of the parent and of the adolescent in Costa Rica. Results showed that fathers' authoritarian style was significantly associated with lower intake of sugar-sweetened beverages (SSB) among boys (b = -0.163, p = 0.050), but not girls (b = 0.097, p = 0.114) while mother's authoritarian style was associated with lower SSB intake among girls (b = -0.138, p = 0.031), but not boys (b = 0.159, p = 0.059). Fathers' authoritative style was associated with higher consumption of fruits and vegetables (FV) among boys in rural areas (b=0.440, p= 0.017), but this association was not significant for girls (b=-0.033, p= 0.800) in rural areas or for either gender in urban areas. Parenting styles of the mothers' and fathers' were not significantly associated with Costa Rican adolescent bean consumption, in general or for any of the subgroups. Findings suggest an intersectionality in the effects of parentchild interactions by child and parent sex, cultural and geographic context, and the eating behaviors examined.

Modelling Longitudinal Directional Associations Between Self-regulation, Physical Activity, and Habit: Results from a Cross-lagged Panel Model

BACKGROUND

The directionality of associations between self-regulatory variables, behavior, and automaticity is seldomly tested. In this study, we aimed to examine a volitional, self-regulatory sequence of variables proposed in the Health Action Process Approach framework (intention → action plans → action control → behavior) and its relationship with the construct of automaticity of the physical activity habit.

METHODS

Longitudinal data was collected from high school students (N = 203, M_age = 15.39 (SD = 1.43), 52% women) at three measurement points. First, a confirmatory factor analysis measurement model was used to examine the study variables across measurement points. Next, a cross-lagged panel model was used to test directionality between variables.

RESULTS

After adequate fit of the measurement model was confirmed, a mechanism integrating self-regulation with behavior and automaticity was examined. The hypothesized directionality between variables was verified overall by cross-lagged analysis. However, for the intention-action plan association, the inverse relationship was found: plans were associated with subsequent intentions, but intentions did not predict plans. Moreover, automaticity was not associated with subsequent physical activity behavior.

CONCLUSIONS

In general, our findings supported the hypothesized longitudinal direction of the associations, confirming that self-regulation may lead to behavior performance and automaticity. Unexpected findings and implications for intervention and future research are discussed.

Changes in Dietary Intake of Major Nutrients and Food Sources among Costa Rican Adolescents in the Last 20 Years

BACKGROUND

Adolescence offers a window of opportunity to prevent adult obesity and noncommunicable disease risk factors. With the rising prevalence of adolescent obesity over the last 20 y, identifying any changes in dietary risk factors is crucial.

OBJECTIVES

We aimed to assess the dietary intake of major nutrients and their food sources in Costa Rican adolescents from 1996 to 2017.

METHODS

Means from 3-d food records from adolescents (ages 13-18 y) living in San José (the province with the highest concentration of adolescents in Costa Rica) were obtained in 1996 (n = 276), 2006 (n = 133), and 2017 (n = 818). Differences in consumption of major nutrients and selected food groups by sex and survey period were tested using age- and area-adjusted ANOVAs.

RESULTS

In 2017, adolescents consumed significantly (P < 0.05) less saturated and trans fats [saturated: -3.2% of total energy (TE); trans: -1.4% TE], vegetables (-24 g/d), beans (-42 g/d), and white rice (22 g/d) than in 1996. The 2017 adolescents also reported significantly higher consumption of unsaturated fatty acids (MUFAs: up from 8.2% to 15.3% TE; PUFAs: up from 5.5% to 9.5% TE; P < 0.05), sugary drinks (+134 g/d), pastries/desserts (+55 g/d), other refined starchy foods (+36 g/d), and snacks/fast foods (+26 g/d) than their 1996 counterparts. In 1996 and 2006, the main source of calories was white rice, whereas in 2017, it was sugary drinks (12% TE and 15% TE, respectively; P < 0.05). The intake ratio of beans to white rice was significantly higher in 1996 (1:1.6) than in 2017 (1:3.5).

CONCLUSIONS

The changes in the intake of major nutrients and food sources of Costa Rican adolescents present new public health challenges for cardiometabolic risk prevention. Costa Rica should prioritize the design of comprehensive strategies that target added sugar intake while simultaneously increasing access to and promotion of healthful items.

Gender-based food intake stereotype scale (GBFISS) for adolescents: development and psychometric evaluation

Objective. The study aimed to develop and test the validity and reliability of a gender-based food intake stereotype scale (GBFISS) to further the understanding of gender stereotype influences on food intake. Design. Two cross-sectional studies were conducted among adolescents. In the first one (n = 611), exploratory and confirmatory factor analyses were performed on subsamples to identify and cross-validate the scale's structure. Evidence of concurrent validity (correlation with sexism) was also examined. In the second study (n = 813), confirmatory factor analysis was conducted to confirm the scale's dimensionality on a different sample. Further evidence of construct validity (correlations with food intake and social desirability) was examined. Invariance was tested for different features as well. Main outcome. The Gender-Based Food Intake Stereotype Scale. Results. Factor analyses on the first and second studies helped identify and confirm the GBFISS as a three-dimensional scale. The studies also provided evidence of construct validity. Support for invariance by gender and age was found, and reliability was acceptable. Conclusion. The evidence suggests that the GBFISS is valid and reliable. Further research is recommended. The contribution of gender stereotypes, as measured by the GBFISS, to well-established health behavior models should be examined.

Re-evaluating the self-report habit index: the cases of physical activity and snacking habits

Objectives: The Self-Report Habit Index (SRHI) was originally reported as one-dimensional; however, habit has been described as characterised by several features. Moreover, one-dimensional models for the SRHI have demonstrated poor fit. Therefore, we aimed to compare multidimensional models with a one-dimensional model in both snacking and physical activity habits, besides examining further instrument characteristics. Design: A cross-sectional study was conducted with high school and university students (n = 555). Main outcome measure: The SRHI adapted for physical activity and for snaking habits was applied at one time point. Results: Nested models with one factor, two factors and three factors were compared. Next, a hierarchical second-order model was tested, and further validity issues, as well as invariance between habits, were examined. Three-dimensional models represented a better fit for both habits. However, fit was still inadequate in the snacking version. In addition, discriminant validity concerns emerged for the physical activity SRHI. Moreover, invariance between the snacking and the physical activity versions was not confirmed. Conclusions: Considering the SRHI as composed by the dimensions of 'lack of awareness', 'lack of control' and 'history of behavioural repetition' seems to be more accurate. Nevertheless, our findings suggest that further research is needed.

The influence of gender stereotypes on eating habits among Costa Rican adolescents

PURPOSE

To identify the influence of gender stereotypes on eating habits among Costa Rican adolescents.

DESIGN

Qualitative, descriptive research was used in this study.

SETTING

Adolescents and parents were recruited from socioeconomically diverse populations in rural and urban areas of San José, Costa Rica.

SUBJECTS

Subjects were 92 adolescents (14 to 17 years old) and 48 parents.

METHODS

Focus group data were transcribed and entered into the qualitative data analysis software Atlas.ti version 5.0. Analyses were grounded on the social cognitive theory.

RESULTS

Five themes emerged from the focus group discussions: (1) Costa Rican adolescents associate the consumption of moderate quantities of healthy foods with femininity and male homosexuality. (2) The consumption of hearty portions of nonhealthy foods was associated with masculinity and male heterosexuality. (3) There is an emerging view that it is acceptable for heterosexual male adolescents to take care of their bodies through healthy eating. (4) Body care among female adolescents is an element of femininity and body image. (5) Parents reinforce their daughters' persistent concern with weight control because they perceive it as feminine behavior.

CONCLUSION

Health promoters should be aware of the existing and changing food stereotypes around gender as an avenue for the promotion of healthy eating.

Socio-demographic, behavioral, and health correlates of nutrition transition dietary indicators in San Juan, Puerto Rico

OBJECTIVE

To identify socio-demographic, behavioral, and health-related correlates of food preferences in Puerto Rico that will help determine Caribbean-region populations vulnerable to nutrition transition.

METHODS

Data from a cross-sectional study of a representative sample of 858 adults residing in the San Juan Metropolitan Area of Puerto Rico were analyzed. Multivariable ordinal logistic regressions were used to model the frequency of consumption of 1) fruits and vegetables, 2) tubers/starchy root vegetables, 3) fried foods, and 4) Western-style fast foods as a function of socio-demographic, behavioral, and health-related characteristics.

RESULTS

Higher frequency of consumption of fruits and vegetables was associated with being physically active and older and having a medium to high level of education, whereas intake of tubers was associated with being older, having a low income, not using government insurance, and having elevated levels of triglycerides. Frequency of consumption of fast food was associated with younger age, higher income, 12-15 years of formal education, and a higher body mass index (BMI), whereas frequency of consumption of fried food was associated with being younger and male, not being a smoker, and having elevated levels of fasting blood glucose.

CONCLUSIONS

The results indicate a nutrition transition in Puerto Rico with health consequences for the Caribbean region. The characteristics of this nutrition transition seem to be determined by income, education, and age, but may also be dictated by access to various food groups. These results set the stage for needed investigation of environmental and individual-level factors that could shape patterns in food consumption.

Changes in dietary intake and food sources of saturated and cis and trans unsaturated fatty acids in Costa Rican adolescents: 1996 versus 2006

OBJECTIVE

To identify how dietary intake and food sources of saturated (SFA) and cis (PUFA) and trans (TFA) unsaturated fatty acids in the diet of Costa Rican adolescents changed from 1996 to 2006--a period with several public health nutrition changes.

METHODS

Cross-sectional comparisons used data from measured food records of 133 adolescents (ages 12-17 y) surveyed in 1996 and a similar group of adolescents surveyed in 2006. Values obtained in 1996 and 2006 were compared with the current World Health Organization guidelines for chronic disease prevention.

RESULTS

Adolescents surveyed in 2006 reported a significantly higher mean daily energy intake from linoleic acid (LA) and alpha-linolenic acid (ALA) (0.9% and 7.8%, respectively) compared with the 1996 cohort, whereas SFA and TFA were significantly lower (9.5% and 1.3%, respectively). Food sources of fat also changed. In 2006, 2% of SFA in the diet came from palm shortening (compared with 34% in 1996); 39% of TFA came from ruminant-derived foods (in 1996, soybean oil was the main contributor of TFA, 34%), and bakery products (mainly pre-packaged cookies) provided 25% of the source of TFA, compared with only 11% in 1996. Dietary fatty intake of Costa Rican adolescents in 2006 is closer to WHO guidelines compared with 1996.

CONCLUSIONS

After public health initiatives that changed fatty acid profile of most foods, intakes of TFA, SFA, and food sources of fatty acids in adolescents' diets improved. Public health nutrition efforts should continue to strengthen diets that are low in SFA and TFA and higher in ALA content among Costa Rican adolescents.

Voluntary reduction of trans-fatty acids in Latin America and the Caribbean: current situation

As part of the Pan American Health Organization/World Health Organization Trans-Fat-Free Americas initiative, 12 representatives from food industries in Latin America and the Caribbean signed a declaration stating their intention to voluntarily eliminate industrially produced trans-fatty acids (TFA) from the Americas. A year later, in order to document the extent of the voluntary reduction, each declarant was asked to describe all reformulations and reductions in the TFA content of their products. After up to six requests for data, only three declarants provided such information in detail, and three others offered an overall summary of their reformulations. Additionally, three declarants reported the barriers that limit this process: availability of oil substitutes, cost, and consumers' sensory acceptance. The content of TFA and saturated fat in the food supply in the Americas should be regulated and strictly monitored in order to adequately evaluate a reduction of TFA in the region.

Components of the Metabolic Syndrome among a Sample of Overweight and Obese Costa Rican Schoolchildren

Background

The term “pediatric metabolic syndrome” includes a cluster of cardiovascular risk factors such as insulin resistance, dyslipidemia (including increased triglycerides and decreased HDL cholesterol), hypertension, and obesity in children. No studies have been performed on this syndrome in a pediatric population in Costa Rica.

Objective

To establish the prevalence of metabolic syndrome and its components in 8- to 10-year old prepuberal overweight and obese schoolchildren.

Methods

This cross-sectional survey was conducted in 214 overweight and obese boys and girls, aged 8 to 10 years, who were selected from six urban schools from San José, Costa Rica. Anthropometric measurements and determinations of blood glucose, insulin, triglycerides, total cholesterol, HDL cholesterol, and high-sensitivity C-reactive protein (hs-CRP) were performed. The home-ostasis model assessment of insulin resistance (HOMA-IR) index and the Castelli index were calculated to assess insulin resistance and cardiovascular risk, respectively. Social and lifestyle variables were obtained through validated questionnaires.

Results

A total of 110 boys and 104 girls participated in this study; 37.9% of them were overweight and 62.1% were obese. Compared with boys, girls were more sedentary and had higher insulin levels (16.05 ± 10.45 μIU/mL vs. 12.72 ± 7.63 μIU/mL, p = .008), body fat (36.5% vs. 30.9%, p < .001), and HOMA-IR indexes (3.5 ± 2.4 vs. 2.8 ± 1.7, p = .014) but lower HDL cholesterol (0.99 ± 0.23 mmol/L vs. 1.08 ± 0.27 mmol/L, p = .009). Obese children had significantly higher mean serum concentrations of insulin, hs-CRP, and triglycerides and higher insulin resistance (estimated by HOMA-IR) than overweight children, but lower mean serum levels of HDL cholesterol. The prevalence of metabolic syndrome in the study population was 5.6%. Other risk factors for developing cardiovascular disease and type 2 diabetes had high prevalence rates among the children: sedentarism (40.6%), family history of type 2 diabetes (73.3%), high LDL cholesterol levels (≥ 2.84 mmol/L) (57.0%), hyperinsulinemia (> 10.5 μIU/mL) (59.8%), insulin resistance (estimated by HOMA-IR ≥ 2.4) (55.1%), and total cholesterol (> 4.39 mmol/L) (60.7%). Children with metabolic syndrome had significantly higher body mass indexes, glucose levels, and triglyceride levels and lower HDL cholesterol levels than children without metabolic syndrome. Insulin had a very strong positive correlation with HOMA-IR values ( r = 0.982), and hs-CRP had a mild positive correlation with body mass index ( r = 0.296) and body fat ( r = 0.320).

Conclusions

This study reported a prevalence of 5.6% of metabolic syndrome among a sample of Costa Rican overweight and obese prepuberal children. Lifestyle interventions focusing on weight reduction and increasing physical activities should be promoted by education and health authorities in order to avoid the early development and onset of type 2 diabetes and atherosclerosis in childhood.

Barriers to and suggestions for a healthful, active lifestyle as perceived by rural and urban Costa Rican adolescents

OBJECTIVE

To assess the perceptions of rural and urban Costa Rican adolescents regarding which barriers and motivators affect their adoption of an active lifestyle.

DESIGN

Data were collected in focus group discussions.

PARTICIPANTS

108 male and female adolescents aged 12 to 18 from the 7th to 11th grades.

SETTING

Two urban and 1 rural high school in San José, Costa Rica.

PHENOMENA OF INTEREST

Active lifestyle; barriers and motivators for active life.

ANALYSIS

Data were reviewed for emerging themes, and themes were coded using content analysis procedures.

RESULTS

Major barriers: (a) physical education curriculum was focused on competitive sports; (b) lack of facilities in the school and community environments; (c) family did not provide good role models and reinforced the socially expected gender roles. Key motivators: (a) changed the physical education curriculum to focus on leisure and recreational activities; (b) increased the availability of facilities both in the school and in the community; and (c) provided a strong social support network.

CONCLUSIONS AND IMPLICATIONS

The school, community, and family environments are potential targets for physical activity interventions for adolescents. Future studies should explore in depth the influence of adolescent socialization patterns (particularly for females) in the establishment of an active lifestyle.

Insulin resistance and impaired glucose tolerance in overweight and obese Costa Rican schoolchildren

BACKGROUND

Worldwide obesity has become an unprecedented public health challenge. In addition, a notable increase in the risk of insulin resistance and type 2 diabetes mellitus has emerged. In Costa Rica, there are no epidemiological data to establish the prevalence of type 2 diabetes in the pediatric population. However, information from the Endocrinology Department of the Children's National Hospital indicates an increased number of cases in the last 2 to 3 years.

OBJECTIVE

To determine the prevalence of insulin resistance and impaired glucose tolerance in overweight and obese schoolchildren.

METHODS

This cross-sectional study was conducted among 214 healthy 8- to 10-year-old children from urban schools of San José, Costa Rica. Anthropometric measurements and blood determinations of glucose, insulin, proinsulin, glycosylated hemoglobin, C-peptide, and leptin were performed. Indexes were calculated to assess insulin resistance. Information on social and lifestyle variables was obtained from questionnaires, and acanthosis nigricans was certified by a physician. Statistical analysis was performed with SPSS software for Windows, version 10.0.

RESULTS

The prevalence of type 2 diabetes mellitus was very low (0.5%) in the studied population. However, hyperinsulinemia and impaired glucose tolerance were present in 20.6% and 6.5% of the subjects, respectively. On the basis of the Fasting Glucose-to-Insulin Resistance Ratio (FGIR), 46.7% of the children showed insulin resistance. Girls and obese children (body mass index > or = 95th percentile) were more likely to have higher serum insulin levels and insulin resistance than boys and overweight children (BMI > or = 85th percentile). Compared with the lowest quintile, children in the highest quintile of body-fat tissue had higher insulin resistance but had similar serum concentrations of glucose, C-peptide, and proinsulin. Positive family histories of type 2 diabetes mellitus and sedentarism (73.7% and 40.7%, respectively) were highly prevalent among overweight and obese children.

CONCLUSIONS

The prevalence of impaired glucose tolerance and insulin resistance in obese children indicates a worrisome trend in the incidence of type 2 diabetes in Costa Rica. Strategies for weight reduction, obesity prevention, and promotion of healthy lifestyles are necessary to prevent the onset of type 2 diabetes during childhood and adolescence.

Translating research into action: a case study on trans fatty acid research and nutrition policy in Costa Rica

Mounting epidemiologic evidence worldwide has fostered policy regulation of industrially made trans fatty acids (TFA) in several developed countries. Despite country-specific evidence about the effects of TFA on cardiovascular disease in Costa Rica, policy regulation has yet to occur. This qualitative study uses a conceptual framework to identify factors that may impede or promote the process of translation of scientific evidence about TFA into policy in the specific context of Costa Rica. We used single case-study methodology to integrate two sources of data: review of relevant internal documents and in-depth, semi-structured interviews with 21 respondents purposively sampled from three sectors: the cooking oil and food industries, research and academia, and government entities. Content analysis, guided by a conceptual framework of research utilization, revealed 68 emergent themes divided across four categories of analysis. In brief, study participants perceived the political context suitable for discussing policies related to healthy fats. Nevertheless, TFA regulation was not part of the Costa Rican political agenda. Barriers perceived by respondents that impede knowledge translation included: (1) lack of awareness of in-country scientific studies on health effects of TFA; (2) lack of consensus or information about policy options (nutrition labelling, dietary guidelines, legislative mandates); (3) perceived distrust and disparate attitudes between sectors, believed by study participants to result in (4) limited collaboration across sectors. Commissioned task forces and other mechanisms to foster research engagement and facilitate sustained interaction and systematic collaboration among government, food industry and researcher sectors appear crucial in the consideration and adoption of nutrition policy in Costa Rica and other emerging economies.

[Serum total homocysteine and lipoproteins levels in young adults from urban and rural areas of Costa Rica]

Serum total homocysteine and lipoproteins levels in young adults from urban and rural areas of Costa Rica. This study evaluated the lipid profile and the serum levels of total homocysteine of 400 adults aged 20 to 40 years, residents of rural and urban areas of the central valley of Costa Rica. The results showed that the proportion of subjects from urban areas with high levels of LDL-C (= 4.13 mmol/L) was 11% higher than the proportion of adults from rural areas (29.2% and 18.0%, p = 0.045). On the contrary, the proportion of rural subjects with low HDL-C levels (< 1.03 mmol/ L) was higher 19% than the proportion of urban adults (56.0% and 75.3%, p = 0.001). Rural residents also showed higher serum levels of triglycerides and total homocysteine than the urban residents, although the differences were not significant (TG: 1.94 mmol/L and 2.02 mmol/L, p = 0.529; TH: 9.33 micromol/L and 9.84 micromol/L, p = 0.145). The prevalences of hyperhomocysteinemia (>15 micromol/L), hypercholesterolemia (= 5.17 mmol/L) and hypertriglyceridemia (= 1.69 mmol/L) in the studied population were 5.8%, 53.6% and 50.1% respectively. 82% of the studied population had LDL-C levels above 2.58 mmol/L and approximately 61% of the adults had HDL-C levels lower than 1.03 mmol/L. Our data suggest that the studied costarrican population has a very high cardiovascular risk. The prevalence of low levels of HDL-C (< 1.03 mmol/L), marginal levels of total homocysteine and a tendency to have high levels of triglycerides were the most outstanding cardiovascular risk factors found in this population, specially in rural subjects, which could be associated with the quality of the diet of these habitants. It is necessary to develop effective intervention strategies to promote healthy lifestyles in the population in order to reduce the cardiovascular mortality rates in Costa Rica.

Saturated and cis- and trans-unsaturated fatty acids intake in rural and urban Costa Rican adolescents

OBJECTIVE

The purpose of this study is to determine whether intake of saturated fatty acids and cis- and trans-unsaturated fatty acids is associated with an urban compared to a rural lifestyle, and whether these associations are responsible for differences in plasma lipid concentrations.

METHODS

Two hundred seventy-five adolescents, aged 12 to 19 years, living in rural and urban areas of San José, Costa Rica, were included in the study. All participants completed three-day food records, provided a fasting blood sample, and carried out a modified Harvard Step Test.

RESULTS

Compared to rural, urban adolescents reported higher intakes of energy-adjusted individual and total saturated fatty acids, total n-3, total n-6 (p < 0.05). Compared to rural, urban adolescents had higher intake of 18:1 (3.65 vs. 3.25, p = 0.0001) and 18:2 (0.62 vs. 0.80, p = 0.001) trans fatty acids, as well as lower intake of carbohydrate (p < 0.05). Palm shortening was the main source of saturated fat (32%), and partially hydrogenated soybean oil used for cooking was the main source of n-3 fatty acids (33%), n-6 fatty acids (33%) and trans fatty acids (34%). Compared to rural, urban adolescents had lower systolic and diastolic blood pressure and higher plasma HDL cholesterol concentration (44 vs. 40 mg/dL, p < 0.0001), but were more likely to be sedentary (68% vs. 57%, p < 0.0001). Among environmental factors, higher carbohydrate intake was a significant determinant of a lower HDL cholesterol (beta coeff = -1.45, p = 0.04), while lauric and myristic fatty acids correlated with increased LDL cholesterol (beta coeff = 3.6, 1.7, p < 0.05).

CONCLUSIONS

A diet containing less carbohydrate and less saturated fatty acids contributes to a more beneficial lipid profile in Costa Rican adolescents, but a trend towards high trans fatty acids intake, particularly in the urban area, is worrisome given the well-known adverse effects of trans fatty acids.

Genetic, dietary, and other lifestyle determinants of serum homocysteine levels in young adults in Costa Rica

OBJECTIVE

Elevated serum total homocysteine (tHcy) is considered an independent risk factor for cardiovascular disease. The objective of this study was to develop the first-ever information on the prevalence of hyperhomocysteinemia and its determinants in a population in Costa Rica.

METHODS

A cross-sectional study was conducted to determine serum levels of tHcy, vitamin B(12), folate, and creatinine, as well as the presence of the genotype TT for the methylenetetrahydrofolate reductase (MTHFR) enzyme. Additionally, dietary vitamin intakes and other lifestyle risk factors were assessed. A total of 399 Costa Rican adults from the central valley of the country (where the capital city, San José, is located), aged 20 to 40 years, participated in this study in the year 2000. Analyses of variance were performed for continuous variables, and the chi-square test was used for categorical data. Spearman correlation tests were calculated to determine associations between variables. Three linear regression analyses and one binary logistic model were developed in order to determine the predictors for homocysteine levels in the population studied.

RESULTS

The overall prevalence of hyperhomocysteinemia (>15 micromol/L) in the population was 6%, 31% of the population were in the range of 10 to 15 micromol/L, 29% had the genotype TT for the enzyme MTHFR, 18% presented a vitamin B(12) deficiency (<165 pmol/L), and none of the persons had low serum folate levels (<7.0 nmol/L). No significant associations were found between tHcy and age, smoking, consuming alcohol, or dietary vitamin intake.

CONCLUSIONS

Only serum vitamin B(12) levels and the genotype TT of the enzyme MTHFR were considered significant predictors of high serum tHcy levels in the Costa Rica population studied.

Biochemical Indicators of Nutritional Status and Dietary Intake in Costa Rican Cabécar Indian Adolescents

The purpose of this study was to determine the blood levels of selected nutritional status indicators and the dietary intake of Costa Rican Cabécar Indians aged 10 to 16 years. The results showed that 65% of the adolescents had an adequate body mass index (BMI) for their age, and 32% had a BMI < 5th percentile. Likewise, the study revealed a high prevalence of anemia (57%), deficient serum folate levels (54%), deficient vitamin B12 levels (31%), and subclinical vitamin A deficiency (10%). Additionally, the youngsters had elevated prevalences of high triglyceride levels (77%), borderline high-density lipoprotein (HDL) cholesterol levels (46%), homocysteine levels > 10 μmol/L (29%), and homozygous mutation of methylenetetrahydrofolate reductase (MTHFR) (49%). The diet was poor, being high in saturated fat and low in polyunsaturated fat, fiber, and several micronutrients. The dietary intakes of more than 55% of the adolescents did not meet 50% of the estimated average requirements (EAR) for zinc, vitamin A, vitamin C, vitamin B12, vitamin B2, and folate. Furthermore, a high prevalence of parasitosis was found (68%). Our results show an adolescent Cabécar population with a mosaic of nutritional deficiencies and cardiovascular risk factors.

Barriers to and motivators for healthful eating as perceived by rural and urban Costa Rican adolescents

OBJECTIVE

To assess the perceptions of rural and urban Costa Rican adolescents about their diet and the factors they consider significant to healthful eating.

DESIGN

Data were collected in focus group discussions.

PARTICIPANTS

The study sample included 108 male and female adolescents aged 12 to 18 years. Adolescents were recruited among 7th to 11th grade students interested in taking part in the study.

SETTING

Two urban and one rural high school in San José, Costa Rica.

PHENOMENA OF INTEREST

Diet perceptions and barriers to and motivators for healthful eating.

ANALYSIS

Data were reviewed for emerging themes, and themes were coded applying content analysis procedures. The conceptual model for understanding adolescent eating behavior, proposed by Story and colleagues, served as the framework for this study.

RESULTS

Factors perceived as barriers to adopting healthful eating practices included unavailability of healthful food in the school environment, inadequate food choices within the family diet, and the peer-group notion among males and females that healthful eating by males is effeminate. Factors perceived as motivators included improving the nutritional quality of foods available at school, adoption of healthful eating practices by the entire family, and healthful eating becoming a peer-group social norm.

CONCLUSIONS AND IMPLICATIONS

This study suggests that the family, peer group, and school environment are potential targets for nutrition interventions for Costa Rican adolescents, but further studies are needed to confirm this conclusion. Future studies should explore in depth the factors associated with the family's eating pattern and the influence of adolescent socialization patterns (particularly male) in the establishment of a healthful diet.

[Vitamin A deficiency among preschool children: a re-emerging problem in Costa Rica?]

Based on the 1996 National Nutrition Survey, this study shows the prevalence of Vitamin A deficiency (VAD) among 567 Costa Rican urban and rural 12-83 months old-children. In overall, the prevalence of VAD (plasma retinol < or = 20 micrograms/dl) was 8.8%. No difference was found even when data were analyzed by area and gender. Around 30% of preschool children were at risk of VAD (plasma retinol between 20.1-30 micrograms/dl). The proportion of children at risk for retinol deficiency was significantly higher in rural area in comparison with urban area (38.9% and 28.0% respectively, p < 0.05). Lineal regression analysis showed that plasma retinol levels were negatively related to the number of family members and positively related to mother's schooling. Our results suggest a possible impairment in vitamin A status of preschool children.

La violencia física, psicológica, emocional y sexual durante el embarazo: riesgo reproductivo predictor de bajo peso al nacer en Costa Rica

OBJECTIVE

To determine the prevalence of physical, psychological, emotional, and sexual violence during pregnancy and the association that that violence has with low birthweight.

METHODS

For 118 women who gave birth between September 1998 and November 1999 we explored the violence that they had suffered during their pregnancy. All the women were residents of Finca San Juan, a low-income urban settlement in the Rincón Grande de Pavas section of San José, Costa Rica. We used a previously validated questionnaire with closed questions. A multiple linear regression model was used to adjust the average weights of the newborns according to the characteristics of the mother: age, years of schooling, marital status, desire for the pregnancy, harmful habits (smoking, drinking alcohol), number of previous pregnancies and childbirths, birth interval, physical stature, total increase in weight during the pregnancy, and illnesses during the gestation. A logistic regression model was used to measure the direct effect of violence on low birthweight, and a nonparametric method was used to calculate the attributable fraction among the exposed women.

RESULTS

The newborns of the mothers who suffered acts of violence weighed on average 449.4 g less that the newborns of the women who had not been exposed to acts of violence (P < 0.001). The mothers who suffered acts of violence were three times as likely to have a newborn with low birthweight (95% confidence interval: 1.39 to 8.10). The variables that were most closely associated with low birthweight were violence suffered by the mother (direct association) and the mother's weight gain during pregnancy (inverse relation).

CONCLUSIONS

Our results indicate the need to investigate this subject more deeply, to train health workers concerning violence toward women as a reproductive-risk factor, and to form groups of experts on this subject to develop specialized protocols for the early identification of pregnant women subject to violence.

Comparison of serum concentration and dietary intake of alpha-tocopherol in a sample of urban and rural Costa Rican adolescents

Results from several studies have suggested that vitamin E intake could inhibit the progression of atherosclerotic lesions. Therefore, this study was designed to evaluate Costa Rican adolescents' serum alpha-tocopherol levels and their correlation with Body Mass Index (BMI) and the dietary intake of vitamin E and saturated and polyunsaturated fat. Ninety-five healthy, non-smoking adolescents and non-vitamin supplement users (aged 13-18) from urban and rural areas in San José, Costa Rica, were included in this study. Serum levels of lipid adjusted alpha-tocopherol were significantly higher in rural adolescents compared with urban youngsters (4.192 mumol/mmol +/- 0.831 and 3.486 mumol/mmol +/- 0.996, respectively). Likewise, reported mean daily 1000 kcal adjusted-vitamin E intake was higher in rural adolescents than in urban youngsters (9.2 +/- 3.7 mg. 16.0 +/- 8.7 mg). An important correlation was observed between intake of energy from saturated fat and adjusted-alpha-tocopherol serum levels (r = 0.430). Contrariwise, they correlated poorly with dietary alpha-tocopherol (r = 0.273), suggesting that serum is not a good biomarket of intake for alpha-tocopherol. Additionally, our results showed a negative relationship between BMI and adjusted-serum vitamin E levels (beta = 0.189; CI 95% -0.153, -0.013). The analysis of vitamin E intake showed that over 25% of adolescents have inadequate intake of the nutrient. This study suggests that nutritionists and pediatricians should encourage alpha-tocopherol intake and monitor the food sources of the nutrient and the adolescents' body weight as part of the strategies aimed at developing a healthy lifestyle.

Prevalence of overweight and obesity among Costa Rican elementary school children

OBJECTIVE

Given that excessive body weight during childhood influences the development of several chronic diseases in adulthood, this study was conducted to determine the prevalence of overweight and obesity in urban and rural Costa Rican elementary school children.

METHODS

The study was carried out from July 2000 to April 2001. A total of 1 718 students ages 7-12 were selected from 34 schools in the capital city of San José and in other nearby urban and rural areas. Both younger children (ones aged 7 through 9 years) and older children (ones aged 10 through 12 years) with a body mass index (BMI) at or above the sex-specific 85th percentile were considered overweight. The younger children were classified as being obese if their triceps skinfold was greater than or equal to the 85th percentile for age and sex using the percentiles by age for children in the United States of America as normative standards. The older children were considered obese if they had a BMI at or above the sex-specific 85th percentile and both the triceps and subscapular skinfold thickness at or above the 90th percentile.

RESULTS

The prevalence of overweight was 34.5%. Children aged 7-9, boys, children from urban areas, and children of a higher socioeconomic status had a higher prevalence of overweight. The prevalence of obesity was 26.2%. A higher prevalence of obesity was found among children aged 7-9, boys, children from urban areas, and children of middle socioeconomic status.

CONCLUSIONS

Given the high prevalence of obesity that we found in the Costa Rican children, primary and secondary prevention measures are needed in order to reduce the proportion of deaths due to chronic nontransmissible diseases among Costa Rican adults in the coming decades.

[Lipid and lipoprotein profile of Chinese immigrants living in Costa Rica]

The lipid profile and food pattern of 50 Chinese immigrants living in San José, Costa Rica were studied during 1999. The results showed that 35% of the immigrants had high levels of total cholesterol (> or = 5.16 mmol/L) and 51% had high concentrations of LDL-Cholesterol (> or = 2.84 mmol/L). Moreover, 36% of them had high levels of triglycerides (> 1.69 mmol/L) and only the 15% had low concentrations of HDL-cholesterol (< or = 0.90 mmol/L). The ratio of men with high levels of total cholesterol, LDL-cholesterol and triglycerides and low levels of HDL-cholesterol was larger that the one in women; although this difference was not significant. 41% of the studied population presented Castelli's Indexes (TC/HDL-C) above 4.5. In general, around 80% of the Chinese immigrants consume vegetables 5-6 times/week and 50% consume fruits with the same frequency. A high percentage of the immigrants eat food with animal protein more than 3 times/week and around 23% eat frequently snacks and fast foods. Our data suggest that the Chinese immigrants still keep some characteristics of their nutritional culture. Nevertheless, they have changed their food pattern to a more atherogenic one. It's important that nutritionists and other health professionals evaluate in detail the factors associated with the change in the food pattern of the immigrants, in order to avoid an increase in the rates of morbi-mortality of coronary disease in this group of population.

Psychosocial aspects of Costa Rican adolescents' eating and physical activity patterns

PURPOSE

To determine the importance of some psychosocial aspects on the eating and physical activity patterns of Costa Rican adolescents.

METHODS

A total of 1200 adolescents were included in the study. Data were collected using a self-administered instrument containing the following elements: questions to elicit demographic information and five sections with several items (stated as positive or negative behaviors) to study the influence of peers, parents, social environment, body image, and self-efficacy on five target behaviors, intake of foods rich in saturated fats, calcium, and iron, along with consumption of fruits and vegetables and physical activity practices. Data were analyzed using a factor analysis with main component extraction and varimax rotation, along with multiple regression analyses.

RESULTS

Social environment and peer influence were the major factors that predict behaviors associated with the intake of foods rich in saturated fat. Meanwhile, parental and social environment influences were the main factors in explaining the fruit and vegetable intake-related behaviors. Self-efficacy was a significant predictor of behaviors associated with physical activity. Body image influence was an important variable associated with all the behaviors analyzed. Multiple regression analyses suggest that the fathers' educational level, the adolescents' age, being female, and living in a rural area may have positive influence on the behaviors studied; however, the overall R(2) for all regression models was quite small (<.03).

CONCLUSIONS

Most of the variability in adolescents' food intake and physical activity-related behaviors remained unexplained by the demographic variables included in the study. Nevertheless, the results suggest that promotion of health programs built on the influence of social environment, peers and family members, and self-efficacy may have a positive impact on the adolescents' food and physical activity patterns. However, the clear definition of which psychosocial aspect(s) strongly influence the behavior to be modified, is essential for designing an intervention that is properly directed at the correct target.

Total dietary fiber in urban and rural Costa Rican adolescents' diets

Dietary fiber has important health benefits in adolescence, especially in promoting normal laxation and reducing the future risk of some chronic diseases. The purpose of this survey was to examine the dietary fiber intake among Costa Rican adolescents. Prospective 3-d diet records were used for dietary fiber data collection. The "age + 5 rule" was used as criterion for adequate fiber intake. Mean daily reported fiber intake was 23.8 +/- 12.6 grams. Mean fiber intake was higher in rural areas than in urban areas either for direct intake data or for values adjusted per 1,000 Kcal (13.6 +/- 7.7 and 8.2 +/- 2.9 respectively, p < 0.001). On the contrary, no differences were found among males and females when mean fiber intake was adjusted per 1,000 kcal. On average, only 45% of the total adolescents studied showed an adequate fiber intake. This percentage was higher in rural areas than urban areas. Adolescents who met the "age + 5 rule" have healthier diets than those with inadequate fiber intake. This study suggests that nutritionists working with adolescents should focus their efforts on promoting the consumption of fiber-rich foods, especially legumes, fruit and vegetables, in order to reduce the risk of diet-related chronic diseases during adulthood.

Growth and survival of Escherichia coli O157: H7 in meat, poultry and vegetables mixed with different concentrations of mayonnaise

In the last 20 years Escherichia coli O157: H7 has emerged as a new pathogen, causing worldwide disease, death and economic loss. Different studies have revealed important survival characteristics of this pathogen, although there are divergent criteria about its ability to survive in various mayonnaise formulations. We studied the effect of different mayonnaise concentrations (0%, 18%, 37% and 56%) (weight/weight) over the survival of the bacterium in common foods from a neotropical environment (Costa Rica). High [10(7)-10(8) Colony Forming Units (CFU)/ml] and low E. coli populations (10(4)-10(6) CFU/ml) were inoculated, (three replicates) in meat, chopped cabbage and poultry, and mixed with commercial mayonnaise to obtain the concentrations specified. They were incubated at 12 degrees C for 24, 48 and 72 hr. The E. coli O157: H7 enumeration was done according to a standard methodology. Populations of E. coli O157: H7 showed an increasing trend during the first incubation period (48 hr), in all the preparations, regardless of the fat concentration used. Our data indicate that E. coli O157: H7 is capable of surviving and growing in meat, cabbage and poultry mixed with mayonnaise, independently of its concentration.

Serum lipids and lipoprotein levels in Costa Rican 13-18 year-old teenagers

Adverse levels of serum lipids tend to persist over time into adolescence and young adulthood, underlying the progression of Coronary Artery Disease (CAD). Therefore, the lipid profile of Costa Rican adolescents and its relationship with dietary intake, physical activity and Body Mass Index (BMI) was evaluated in a total of 322 adolescents ages 13-18 years from urban and rural areas of San José, Costa Rica. Levels of Total Cholesterol (TC) and HDL-C (High-Density Lipoprotein Cholesterol) were significantly higher in urban adolescents than in rural youngsters. No differences were found between LDL-C (Low-Density Lipoprotein Cholesterol) and triglyceride levels among urban and rural adolescents. TC, HDL-C and LDL-C levels were higher in females than in males. The mean LDL/HDL ratio was 2.3 with no differences between gender and area. Over 20% of adolescents showed borderline TC levels (4.42-5.17 mmol/L) and 10% borderline LDL-C levels (2.86-3.35 mmol/L). The proportion of females with borderline TC and LDL-C was higher than the proportion of males. No differences were found between areas. Around 50% of adolescents showed borderline HDL-C levels (0.91-1.17 mmol/L) and over 55% presented borderline triglyceride level (1.02-1.46 mmol/L). The prevalence of borderline and high triglyceride levels (> or = 1.47 mmol/L) between urban and rural adolescents was similar. However the prevalence of high triglyceride levels was higher in females (22%) than in males (14%). An independent positive relationship was found between LDL-C, triglyceride, the cardiovascular fitness score and BMI. Likewise a negative relationship was found between cardiovascular fitness, BMI, gender and HDL-C. This study suggests that primary prevention programs are required to decrease the prevalence of cardiovascular risk factors among Costa Rican adolescents.

Effect of storage temperatures on growth and survival of Escherichia coli O157: H7 inoculated in foods from a neotropical environment

Escherichia coli O157: H7 has emerged as a new pathogen and is found worldwide. We studied the effect of several storage temperatures on the survival of this bacterium in common foods from a neotropical environment (Costa Rica) because at least seven clinical cases have been reported from the country, and no epidemiological link or probable food association has been described. High (10(6)-10(8) CFU/ml) and low (10(4)-10(6) CFU/ml) populations of E. coli were inoculated (three replications) in ground meat, chopped cabbage, chicken giblets and pasteurized milk and incubated at 0, 6 and 12 degrees C for 24, 48 and 72 h. Vegetables and milk were also stored at 22 degrees C for the same periods. The E. coli O157: H7 enumeration was done according to the methodology described in the Bacteriological Analytical Manual. Populations of E. coli O157: H7 showed either an increasing or decreasing trend, according to temperature, time or food base. Our data indicate that E. coli O157: H7 is capable of surviving and growing in meat, cabbage, milk and chicken giblets; food items commonly consumed by Costa Ricans.

Dietary calcium intake by a group of 13 18-year-old Costa Rican teenagers

Calcium intake is one of the most important predictors of the amount of bone mass gained during growth. Therefore, this study was designed to estimate the dietary calcium intake of Costa Rican urban and rural adolescents ages 13-18 years old. Calcium dietary intake was determined using prospective 3-d diet records. Two-thirds (or 66.7%) or less of the Adequate Intake (AI) was used as the criterion for inadequate calcium intake as suggested by several authors. Reported mean daily calcium intake was 573 mg +/- 290. On average 82% of the adolescents did not meet two-thirds of the Al for calcium. A higher percentage of rural than urban youngsters reported inadequate calcium intake (92% and 75% respectively, p = 0.000). Likewise a higher percentage of girls (91%) than boys (77%) reported marginal calcium intake. This study shows evidence that nutritional interventions and educational strategies are urgent for increasing calcium consumption among adolescents in order to reduce the future burden of osteoporosis in old age.

Dietary intake as a cardiovascular risk factor in Costa Rican adolescents

PURPOSE

To evaluate Costa Rican adolescents' dietary intake as a cardiovascular disease (CVD) risk factor.

METHODS

Dietary intake was determined using 3-day food records; nutrient content of fast foods prepared in school cafeteria was calculated by the weighted records.

RESULTS

Around 30% of adolescents exceed the American Heart Association dietary recommendation for total fat and saturated fat. About 50% reported a cholesterol intake higher than 100 mg/1000 kcal. On average, 45% of adolescents do not meet the dietary fiber recommendation of 10 g/1000 kcal, the 66% of the recommended daily allowance for vitamins E and B(6), or around 25% for folic acid. A higher proportion of urban adolescents do not satisfy the established dietary recommendation to prevent CVD.

CONCLUSIONS

To avoid further increases in the Costa Rican CVD mortality rate, it is necessary to develop primary prevention programs, oriented to modify adolescent's nutrition habits. Schools have the potential to carry out such programs, as at least 60% of all adolescents in Costa Rica are enrolled in high schools.