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.

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.

Plain language titleDescription of the Vitamin and Mineral Consumption Status in Urban Cities of Latin America: Results of the Latin American Health and Nutrition Study.Plain language summaryVitamins and minerals are essential for maintaining good health. However, traditional Latin American diets are changing to include foods that have a lot of sugar and fat but fewer vitamins and minerals. This study was designed to analyze the consumption of these nutrients in urban cities of 8 Latin American countries. We collected food consumption information from September 2014 to August 2015 from 9216 men and women between 15 and 65 years old using a method called 24-hour recall. To find out if participants were consuming the necessary daily amounts of vitamins and minerals, intakes were compared with the daily recommended amounts suggested by the Institutes of Medicine of the United States. We found that Latin American urban populations consume fewer vitamins and minerals than recommended. In some cases, few people do not consume the required amounts of vitamins and minerals, but in other cases, many do not. For example, few do not consume enough thiamine, riboflavin, niacin, folate, cobalamin, iron, phosphorus, copper, and selenium. However an intermediate number of people do not consume enough pyridoxine and zinc, a high number consume little vitamin C and vitamin A, and many people consume very little magnesium, calcium, and vitamin D. We found that the people who consume fewer vitamins and minerals are mostly males, overweight/obese, have lower education and varies according to their financial resources. A deficient intake of vitamins and minerals showed up in most age groups, from adolescence to adulthood. To improve vitamins and minerals intake, it is important that some foods that are frequently eaten are fortified or that the price of foods that are high in vitamins and minerals is lowered.

Energy imbalance gap was associated with body mass index and sex in Latin American adolescents-results from the ELANS study.

Introduction: Energy imbalance gap (EIG) is defined as the average daily difference between energy intake (EI) and energy expenditure (EE). This study aimed to examine the associations between EIG and sociodemographic and anthropometric variables in the adolescent population of eight Latin America countries. Methods: A total of 680 adolescents aged 15 to 18 were included in this study. The estimation of EI was based on two non-consecutive 24-h dietary recalls. EE was predicted from Schofield equations using physical activity level obtained through the long version of the International Physical Activity Questionnaire. Sociodemographic data and anthropometric measurements were also obtained. A descriptive analysis and multilevel linear regression models were used to examine associations between variables. Results: The mean EI, EE, and EIG were 2091.3 kcal, 2067.8 kcal, and 23.5 kcal, respectively. Argentina had the highest EI and EIG, whereas Chile had the lowest EI and EIG. Males had a higher EI (2262.4 kcal) and EE (2172.2 kcal) than females (1930.1 kcal and 2084.5 kcal), respectively (p < 0.05). Overweight subjects had a lower EIG than did underweight and normal-weight subjects (p < 0.05). Subjects with low socioeconomic status (SES) had a lower EE (2047.0 kcal) than those with a high SES (2164.2 kcal) (p < 0.05). Conclusion: Sex and BMI were associated with EIG in adolescents from Latin America.

Exploring the FAO Minimum Dietary Diversity Indicator as a Suitable Proxy of Micronutrient Adequacy in Men and Women Across Reproductive and Non-reproductive Ages in 8 Latin American Countries.

BACKGROUND: Women's Dietary Diversity Score (WDDS) is an indicator of dietary diversity, a key component of diet quality in women of reproductive age (WRA). Limited information is available regarding its applicability in other population groups. OBJECTIVE: To examine the ability of the Minimum Dietary Diversity for Women (MDD-W) of 5-food groups cutoff to predict micronutrient adequacy in men and women 15 to 65 years old from 8 Latin American countries. METHODS: We used a 24-hour recall from 9216 participants in the Latin American Study on Nutrition and Health (ELANS) to determine Dietary Diversity Score (DDS) based on the consumption of 10 food groups. The Mean Probability of Adequacy (MPA) was associated with DDS for the overall sample, for men, WRA, and women of nonreproductive age (WNRA). Sensitivity and specificity analyses were performed to determine if the 5-food groups cutoff point for MDD can be used to correctly identify men, WRA, and WNRA with adequate micronutrient adequacy (MPA ≥ 0.70). RESULTS: We found a mean DDS of 4.78 ± 1.33 and an MPA of 0.64 ± 0.16, with 59% of participants showing a diverse diet (DDS ≥ 5). The 5-food groups-cutoff point showed a better balance between sensitivity and specificity predicting an MPA ≥0.70 in men, WRA, and WNRA. MPA was significantly associated with DDS in WRA and for men and WNRA, as well. CONCLUSION: The 5-food group MDD, originally intended to be used in WRA, performed equally well in predicting MPA ≥0.70 in men, WRA, and WNRA, and can be used as a proxy of micronutrient adequacy in Latin American population.

Plain language titleAssessment of the FAO Minimum Dietary Diversity Index to Estimate Micronutrients Intake in Urban Cities of 8 Latin America CountriesPlain language summaryThe Women's Dietary Diversity Score (WDDS) proposed by the Food and Agriculture Organization is an indicator that measures the variety of foods consumed by women of reproductive age (WRA), and it has been reported in several studies that the more diverse the diet, the greater the probability of meeting micronutrients requirements. This indicator has not been validated in other population, but few studies have been conducted in the Latin American region. So, we aimed to investigate whether the Minimum Dietary Diversity for Women (MDD-W) established for WRA could also predict sufficient micronutrient intake in men and women aged 15 to 65 years in the Latin American population. To accomplish this objective, we used data from the Latin American Study of Nutrition and Health (Estudio Latino Americano de Nutrición y Salud­ELANS) that collected dietary data from 24-h recalls from 9216 participants and analyzed the association between DDS and the Mean Probability of Adequacy (MPA). Additionally, we determined if the MDD cutoff point could correctly identify individuals with appropriate vitamin and mineral intake. We found that the overall mean DDS was 4.78 ± 1.33, the MPA was 0.64 ± 0.16, and approximately 59% of participants had a diverse diet. The MDD of 5-food groups cutoff point was demonstrated to be useful in predicting sufficient micronutrient intake for men, WRA, and women over 50 years. Respondents with a DDS ≥5 had higher micronutrient adequacy. These findings suggest that DDS can serve as a proxy for assessing micronutrient adequacy in urban populations beyond WRA. The effect of promoting diverse diets on micronutrient adequacy as part of intervention programs can be captured by the DDS in urban Latin American populations.

Perfil antropométrico y prevalencia de sobrepeso y obesidad en la población urbana de Costa Rica entre los 20 y 65 años agrupados por sexo: resultados del Estudio Latino Americano de Nutrición y Salud / Anthropometric profile and prevalence of overweight and obesity in Costa Rican urban population (aged 20-65 years old) by sex group: results from the Latin American Study of Nutrition and Health

INTRODUCCIÓN: la obesidad es una enfermedad que afecta en gran medida a la región de las Américas. Esta condición implica un aumento de la morbimortalidad y el riesgo de enfermedades crónicas, como las enfermedades cardiovasculares, diabetes tipo 2 y algunos tipos de cáncer. La prevalencia de exceso de peso en Costa Rica fue del 59,7 % y del 77,3 % en mujeres de 20 a 44 años y de 45 a 65 años, respectivamente, y del 62,4 % en hombres de 20-65 años en el periodo 2008-2009; sin embargo, se desconoce cómo ha evolucionado esta condición en la última década. OBJETIVO: describir el perfil antropométrico y la prevalencia de sobrepeso y obesidad en la población urbana costarricense según características sociodemográficas y nivel de actividad física. MÉTODOS: entre noviembre de 2014 y mayo de 2015 se seleccionó una muestra representativa de la población urbana, conformada por 677 personas entre 20 y 65 años de edad. Se realizaron mediciones de talla, peso, circunferencia de cintura y cuello y se determinó la prevalencia de obesidad y la obesidad abdominal y cervical, según los puntos de corte establecidos para los respectivos indicadores. RESULTADOS: se encontró una prevalencia de exceso de peso (sobrepeso y obesidad) del 68,5 % en la población urbana costarricense, mayor en las mujeres que en los hombres (73,8 %), y en las personas mayores de 35 años (82,2 %). Además, el 70,3 % de la población presentó obesidad abdominal y el 46,8 % presentó una circunferencia de cuello aumentada. CONCLUSIONES: en Costa Rica, la prevalencia de obesidad encontrada es notablemente superior respecto a otras regiones del mundo y se ha incrementado en relación a la Encuesta Nacional de Nutrición 2008-2009, por lo que su abordaje se hace prioritario con el fin de prevenir la incidencia y prevalencia de enfermedades cardiovasculares y metabólicas y así disminuir su impacto, tanto para la salud del individuo como en los costes implicados en su atención

INTRODUCTION: obesity is a disease that greatly affects the region of the Americas. This condition implies an increase risk of developing serious health outcomes such as cardiometabolic disease, type 2 diabetes and some cancers. The prevalence of excess weight in Costa Rica was 59.7 % and 77.3 % in women aged 20 to 44 years old and 45 to 65 years old respectively, and 62,4 % in men aged 20-65 years old, in the period of 2008-2009, however, it is unknown how this condition was evolved. OBJECTIVE: to describe the anthropometric profile and the prevalence of overweight and obesity in the Costa Rican urban population according to sociodemographic characteristics and level of physical activity. MATERIALS AND METHODS: a representative sample of the urban population was selected between November 2014 and May 2015, comprising 677 people between 20 and 65 years old. Measures of height, weight, and waist and neck circumference were measured and the prevalence of obesity, abdominal and cervical obesity was determined, according to the cut-off points established for each indicator. RESULTS: the prevalence of excess weight (overweight and obesity) was 68.5 % among urban Costa Rican population, being higher for women (73.8 %), and for those participants over 35 years old (82.2 %). A 70.3 % of the population presented abdominal obesity and 46,8 % cervical obesity. CONCLUSIONS: in Costa Rica, the prevalence of obesity found is high compared to other regions of the world and has increased in relation to the National Nutrition Survey 2008-2009. The approach to obesity must be prioritized in order to prevent the development of cardiovascular and metabolic diseases and thus reduce the impact of these diseases on the health of the individual and the economic costs of health care

Socio-demographic, behavioral, and health correlates of nutrition transition dietary indicators in San Juan, Puerto Rico / Correlatos sociodemográficos, conductuales y de salud de los indicadores alimentarios de transición nutricional en 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.

OBJETIVO: Determinar los correlatos sociodemográficos, conductuales y relacionados con la salud de las preferencias alimentarias en Puerto Rico a fin de ayudar a determinar las poblaciones vulnerables con respecto a la transición nutricional en el Caribe. MÉTODOS: Se analizaron datos procedentes de un estudio transversal de una muestra representativa de 858 adultos que residen en el área metropolitana de San Juan, en Puerto Rico. Se usaron regresiones logísticas ordinales con múltiples variables para modelar la frecuencia de consumo de 1) frutas y verduras, 2) tubérculos feculentos, 3) alimentos fritos y 4) comida rápida de estilo occidental, como una función de las características sociodemográficas, conductuales y relacionadas con la salud. RESULTADOS: Se asoció una mayor frecuencia de consumo de frutas y verduras con un comportamiento físicamente activo y mayor edad, al igual que un nivel de escolaridad de medio a alto, mientras que la ingesta de tubérculos se asoció a una edad mayor, ingresos bajos, no usar el seguro del gobierno y niveles elevados de triglicéridos. La frecuencia de consumo de comida rápida se asoció con una edad menor, ingresos más altos, de 12 a 15 años de educación formal y un índice de masa corporal mayor, mientras que la frecuencia del consumo de alimentos fritos se asoció con una edad más joven y el sexo masculino, no fumar y niveles elevados de glucemia en ayunas. CONCLUSIONES: Los resultados indican una transición nutricional en Puerto Rico con consecuencias para la salud en el Caribe. Las características de esta transición nutricional parecen estar determinadas por los ingresos, la escolaridad y la edad, pero también podrían estar determinadas por el acceso a diversos grupos alimentarios. Estos resultados establecen las condiciones necesarias para la investigación de los factores ambientales e individuales que podrían configurar los modelos de consumo de alimentos.

Voluntary reduction of trans-fatty acids in Latin America and the Caribbean: current situation / Disminución voluntaria del contenido de ácidos grasos trans en América Latina y el Caribe: situación actual

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.

Como parte de la iniciativa "Las Américas sin grasas trans" de la Organización Panamericana de la Salud/Organización Mundial de la Salud, 12 representantes de empresas alimentarias de América Latina y el Caribe firmaron una declaración en la que se comprometieron a eliminar voluntariamente los ácidos grasos trans (AGT) de los alimentos producidos industrialmente. Un año después, a fin de verificar el progreso en este sentido, se solicitó a cada firmante que describiera todas las reformulaciones y la disminución del contenido de AGT de sus productos. Después de solicitar los datos hasta seis veces en algunos casos, solo tres de las empresas firmantes suministraron información detallada y otras tres ofrecieron un resumen general de las distintas reformulaciones incorporadas. Además, tres proporcionaron información acerca de los obstáculos que dificultan este proceso: la disponibilidad de sucedáneos del aceite, el costo y la aceptación de los consumidores. Es preciso reglamentar y vigilar con rigurosidad el contenido de AGT y grasas saturadas de los alimentos comercializados en la Región de las Américas con el fin de efectuar un seguimiento adecuado de la disminución de los AGT.

Prevalence of mild serum vitamin B12 deficiency in rural and urban Costa Rican young adults.

OBJECTIVE: Recent studies have shown an increase of mild serum cobalamin (vitamin B12) deficiency in some Latin American countries; however, no data are available from Costa Rica. The purpose of this work was to establish the prevalence of serum vitamin B12 deficiency among Costa Rican young adults and to study some factors that may help explain the serum cobalamin concentrations. METHODS: A cross-sectional survey was conducted among 400 adults aged 20 to 40 years old from urban and rural areas of the central valley of Costa Rica to determine serum vitamin B12 levels. Additionally, cobalamin dietary intake and the detection of Helicobacter pylori IgG antibodies were studied as possible determinants of the serum vitamin B12 concentrations. RESULTS: The mean serum concentration of vitamin B12 was 268 ± 125 pmol/L, and no significant differences were found by gender or area. Study data indicate an overall prevalence of inadequate serum cobalamin levels of 42.4% (11.2% deficient and 31.2% marginal); more than 50% but less than 75% of individuals had an intake of vitamin B12 below the U.S. Estimated Average Requirement (EAR) and 61.2% had IgG antibodies to H. pylori. CONCLUSIONS: The prevalence of mild serum vitamin B12 deficiency in young Costa Rican subjects is as high as in other Latin American countries. More investigation should be done to elucidate the etiological factors that are generating deficient and marginal serum cobalamin levels in Costa Rican adults in order to define appropriate public health actions.

Prevalence of mild serum vitamin B12 deficiency in rural and urban Costa Rican young adults / Prevalencia de la deficiencia moderada de vitamina B12 sérica en jóvenes adultos de zonas rurales y urbanas de Costa Rica

OBJECTIVE: Recent studies have shown an increase of mild serum cobalamin (vitamin B12) deficiency in some Latin American countries; however, no data are available from Costa Rica. The purpose of this work was to establish the prevalence of serum vitamin B12 deficiency among Costa Rican young adults and to study some factors that may help explain the serum cobalamin concentrations. METHODS: A cross-sectional survey was conducted among 400 adults aged 20 to 40 years old from urban and rural areas of the central valley of Costa Rica to determine serum vitamin B12 levels. Additionally, cobalamin dietary intake and the detection of Helicobacter pylori IgG antibodies were studied as possible determinants of the serum vitamin B12 concentrations. RESULTS: The mean serum concentration of vitamin B12 was 268 ± 125 pmol/L, and no significant differences were found by gender or area. Study data indicate an overall prevalence of inadequate serum cobalamin levels of 42.4 percent (11.2 percent deficient and 31.2 percent marginal); more than 50 percent but less than 75 percent of individuals had an intake of vitamin B12 below the U.S. Estimated Average Requirement (EAR) and 61.2 percent had IgG antibodies to H. pylori. CONCLUSIONS: The prevalence of mild serum vitamin B12 deficiency in young Costa Rican subjects is as high as in other Latin American countries. More investigation should be done to elucidate the etiological factors that are generating deficient and marginal serum cobalamin levels in Costa Rican adults in order to define appropriate public health actions.

OBJETIVO: Aunque estudios recientes han demostrado un incremento en el déficit moderado de cobalamina (vitamina B12) sérica en algunos países de América Latina, no hay datos de Costa Rica. El propósito de este trabajo fue determinar la prevalencia de la deficiencia de vitamina B12 sérica en jóvenes adultos de Costa Rica y estudiar algunos factores que pueden ayudar a explicar las concentraciones séricas de cobalamina. MÉTODOS: Se realizó un estudio transversal para determinar los niveles de vitamina B12 en el suero de 400 adultos de 20 a 40 años de edad de zonas urbanas y rurales del valle central de Costa Rica. Adicionalmente, se estudió la ingesta de cobalamina en la dieta y la presencia de anticuerpos IgG contra Helicobacter pylori, como posibles factores determinantes de las concentraciones séricas de vitamina B12. RESULTADOS: La concentración media de vitamina B12 en el suero fue de 268 ± 125 pmol/L; no se encontraron diferencias significativas entre los sexos ni entre las áreas de residencia. Estos datos demostraron una prevalencia general de niveles insuficientes de cobalamina sérica de 42,4 por ciento (11,2 por ciento con déficit y 31,2 por ciento con concentraciones marginales); de las personas estudiadas más de 50 por ciento -aunque menos de 75 por ciento- tenían una ingesta de vitamina B12 por debajo del valor de las necesidades promedio estimadas para los Estados Unidos de América y 61,2 por ciento tenía anticuerpos contra H. pylori. CONCLUSIONES: La prevalencia de deficiencia moderada de vitamina B12 sérica en jóvenes costarricenses es tan elevada como en otros países latinoamericanos. Se necesitan más investigaciones para aclarar los factores etiológicos que producen niveles insuficientes y marginales de cobalamina sérica en los adultos de Costa Rica para poder definir intervenciones sanitarias apropiadas.

Niveles séricos de homocisteína total y lipoproteínas en adultos jóvenes de áreas rurales y urbanas de Costa Rica / Serum total homocysteine and lipoproteins levels in young adults from urban and rural areas of Costa Rica

Se estudió el perfil de lípidos y los niveles séricos de homocisteína total de una población de 400 adultos con edades entre 20 y 40 años residentes de áreas rurales y urbanas del valle central de Costa Rica. Los resultados indican que la proporción de sujetos de zona urbana con niveles elevados de LDL-C (= 4,13 mmol/L) fue un 11 por ciento mayor que la proporción de individuos de zona rural (29,2 por ciento y 18,0 por ciento, p=0,045). Por el contrario, la proporción de individuos de zona rural con niveles de HDL-C bajos (< 1,03 mmol/L) fue superior en un 19 por ciento que los sujetos de la zona urbana (56,0 por ciento y 75,3 por ciento, p=0,001). Los adultos rurales también mostraron niveles séricos más altos de triglicéridos y homocisteína total que las personas de origen urbano, aunque las diferencias no mostraron ser significativas (TG: 1,94 mmol/L y 2,02 mmol/L, p=0,529; HT: 9,33 µmol/L y 9,84 µmol/L, p=0,145). La prevalencia total de hiperhomocisteinemia (>15 mmol/L), hipercolesterolemia (= 5,17 mmol/L) e hipertrigliceridemia (= 1,69 mmol/L) en la población estudiada fue 5,8 por ciento; 53,6 por ciento y 50,1 por ciento respectivamente. El 82 por ciento de la población estudiada presentó valores de LDL-C = 2,58 mmol/L y un 61 por ciento aproximadamente de los adultos tenían las HDL-C en niveles inferiores a 1,03 mmol/L. Los datos indican que la población costarricense estudiada presenta un alto riesgo cardiovascular. La prevalencia de niveles bajos de HDL-C (< 1,03 mmol/L), niveles marginales de homocisteína total y una tendencia a presentar niveles altos de triglicéridos fueron los factores de riesgo cardiovascular más característicos encontrados en esta población, principalmente en los individuos de áreas rurales, lo cual podría estar asociado a la calidad de la dieta de los habitantes de estas áreas. Es necesario desarrollar intervenciones efectivas orientadas a promover los estilos de vida saludables en la población con el fin de reducir las...

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 JosÚ, 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.

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.

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.

Perfil de lípidos y lipoproteínas en inmigrantes chinos residentes en Costa Rica / Lipid and lipoprotein profile of Chinese immigrants living in Costa Rica

The lipid profile and food pattern of 50 Chinese immigrants living in San JosÚ, 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.

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.

Prevalence of overweight and obesity among Costa Rican elementary school children / Prevalencia del sobrepeso y la obesidad entre escolares de nivel primario en Costa Rica

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 1718 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 percent. 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 percent. 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

La violencia física, psicológica, emocional y sexual durante el embarazo: riesgo reproductivo predictor de bajo peso al nacer en Costa Rica / Physical, psychological, emotional, and sexual violence during pregnancy as a reproductive-risk predictor of low birthweight in Costa Rica

OBJETIVO: Determinar la prevalencia de la violencia física, psicológica, emocional y sexual durante el embarazo y su asociación con el bajo peso al nacer. MÉTODOS: Se exploró la violencia sufrida por 118 embarazadas de la comunidad urbana marginal Finca San Juan, de Rincón Grande de Pavas, San José, Costa Rica, que dieron a luz entre septiembre de 1998 y noviembre de 1999. Se utilizó un cuestionario de preguntas cerradas previamente validado. Mediante un modelo de regresión lineal múltiple se ajustaron las diferencias entre las medias del peso de los recién nacidos según las características de la madre (edad, años de estudio, condición conyugal, deseo del embarazo, hábitos nocivos, número de embarazos y partos previos, intervalo intergenésico, estatura, aumento total de peso durante el embarazo y enfermedades durante la gestación). Se utilizó un modelo de regresión logística para medir el efecto directo de la violencia sobre el bajo peso al nacer, así como un método no paramétrico para calcular la fracción atribuible en las mujeres expuestas. RESULTADOS: Los niños de madres que sufrieron actos de violencia pesaron como promedio 449,4 g menos (P 0,001) que los de las mujeres que no habían estado expuestas a actos de violencia. Las primeras presentaron un riesgo tres veces mayor de tener hijos con bajo peso al nacer que las segundas (IC95 por ciento: 1,39 a 8,10). Las variables que se asociaron más estrechamente con el bajo peso al nacer fueron la violencia sufrida por la madre (asociación directa) y el aumento de peso de la madre durante la gestación (relación inversa). CONCLUSIONES: Los resultados obtenidos indican la necesidad de investigar el tema más profundamente, instruir al personal de salud sobre la violencia hacia las mujeres como factor de riesgo reproductivo y conformar grupos de expertos en este tema con el fin de desarrollar protocolos especializados para la identificación temprana de embarazadas sometidas a algún tipo de agresión.

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