Un programa informático en la web para la evaluación dietética en Costa Rica / A web-based software for dietary assessment in Costa Rica

Introducción. La medición del consumo de alimentos es un importante indicador del estado nutricional de las personas; sin embargo, el proceso no es fácil y puede tener un nivel de error inaceptable. La incorporación de nuevas tecnologías pueden facilitar el proceso y minimizar el error. Objetivo. Desarrollar un programa informático en la web para nutricionistas que permita el ingreso de datos de consumo de alimentos con un recordatorio de 24 horas o de los 7 días anteriores, el análisis de la ingesta de energía y nutrientes y su comparación con las ingestas recomendadas; con el fin de minimizar el error en la recopilación y análisis de los datos. Materiales y métodos. Primero, se determinaron las características importantes que debe tener el programa, el cual fue elaborado posteriormente con los lenguajes de programación de Python y Javascript y con un patrón de diseño modelo-vista-controlador. Simultáneamente se crearon tres bases de datos, uno con el valor nutritivo de los alimentos, otro con datos de tamaños de porción de los mismos y otro con las recomendaciones nutricionales. Una vez elaborado, el programa fue sometido a una serie de pruebas para evaluar tanto su facilidad de uso como la exactitud de los cálculos. Resultados. Se describen las 9 etapas del programa y se justifica su diseño con evidencias de la literatura científica. Conclusiones. Se desarrolló el programa en la web, 'Dietnóstico', que permite la recolección y análisis de datos de consumo de alimentos. Una vez validado, el programa estará disponible para nutricionistas a usar en la atención nutricional y la investigación(AU)

Introduction. Assessment of food consumption is an important indicator of a person's nutritional status; however, it is not a simple process and can involve an unacceptable level of error. The application of new technologies in this process can lead to improvements and the minimization of error. Objective. To develop a computer program in the web, for nutritionists that allows the input of food consumption data using a 24- hour recall or a recall of food consumption during the 7 previous days, the analysis of energy and nutrient intake and its comparison with recommended intakes with the aim of minimizing the error involved in the collection and analysis of food consumption data. Materials and methods. The first stage was to define important characteristics to include in the programme which was developed using the programming languages of Python and Javascript and using a model-view-controller design pattern. At the same time, three databases were created: one with the nutritional value of foods, another with portion sizes of the foods and a third with the nutritional recommendations. Once created, several trials were conducted on the programme to test the operations from a user point of view, and the accuracy of the calculations. Results. The 9 stages of the software are described and its design is justified with evidence from the scientific literature. Conclusions. The program 'Dietnóstico' for use in the web, allows the collection and analysis of food consumption data. Once validated, it will be available for nutritionists involved in nutrition counselling and research(AU)

Calidad de los Carbohidratos en la dieta de la población urbana costarricense / Carbohydrate Quality in the diet of the Costa Rican urban population

Introducción. La calidad de los carbohidratos consumidos juega un papel importante en la prevención de las enfermedades crónicas no transmisibles (ECNT). Objetivo. Analizar el índice de calidad de los carbohidratos (ICC) en la población urbana costarricense y su relación con las variables sociodemográficas, antropométricas y la calidad y la diversidad de la dieta. Materiales y métodos. Los datos provienen del Estudio Latinoamericano de Nutrición y Salud, en una muestra representativa de 798 personas entre 15 y 65 años que residen en zonas urbanas de Costa Rica (2014- 2015). En una visita domiciliaria se administró un cuestionario para recolectar los datos sociodemográficos y se pesó y midió a los participantes. El consumo dietético se obtuvo mediante dos recordatorios de 24 horas en días no consecutivos. El ICC se calculó mediante el consumo de fibra, el índice glicémico, la relación carbohidratos sólidos/líquidos y la relación granos enteros/granos totales. Se comparó el ICC según el sexo, el grupo de edad, el nivel socioeconómico, el estado nutricional, la circunferencia de cintura y la calidad y diversidad de la dieta de los participantes. Resultados. El ICC se asoció positivamente con un mayor consumo de energía, carbohidratos totales, proteínas, grasas, colesterol, frutas, vegetales y leguminosas (p<0,001). Un mayor ICC se asoció positivamente con un mayor porcentaje de adecuación de micronutrientes y mayor índice de diversidad y calidad de la dieta (p<0,001), así como con un menor índice de masa corporal y una menor circunferencia de cintura al ajustar por sexo y edad (p<0,005). Conclusiones. El presente estudio demostró que un mayor ICC se asocia significativamente con mejores indicadores dietéticos e índice de masa corporal, por lo que resulta fundamental establecer en Costa Rica pautas dietéticas que permitan aumentar la calidad de los carbohidratos de la dieta con el fin de contribuir en la prevención de las ECNT(AU)

Introduction. The carbohydrate quality index (CQI) plays an important role in the prevention of chronic non-communicable diseases (NCD) and adequate macro and micronutrient intake. Objective. To analyze the carbohydrate quality index (CCI) in the Costa Rican urban population and its relationship with sociodemographic and anthropometric variables and the quality and diversity of the diet. Materials and methods. Data come from the Latin American Nutrition and Health Study (ELANS), in a representative sample of 798 people between 15 and 65 years of age who reside in urban areas of Costa Rica (2014-2015). During a home visit, a questionnaire was administered to collect sociodemographic data, and participants were measured and weighed. Dietary intake was obtained through two 24-hour recalls in non- consecutive days. The CQI was calculated using fiber intake, glycemic index, liquid/solid carbohydrate ratio, and whole grain/total grains. CCI was then compared according to sex, age-group, socioeconomic level, nutritional status and diet quality and diet diversity. Results. The CQI was positively associated with energy intake, total carbohydrates, proteins, fats, cholesterol, fruits, vegetables, and legumes (p<0,001). Also, CQI was associated with a higher percentage of micronutrient adequacy and diet quality and diversity (p<0,001), as well as with a lower body mass index and lower waist circumference when adjusting for sex and age (p<0,005). Conclusions. The present study showed that higher CQI is associated with better dietary and body mass index, which shows that it is essential to establish dietary guidelines for public health in Costa Rica that allows increasing the quality of carbohydrates in the diet to contribute to the prevention of chronic NCD(AU)

Association between obesity and mortality in the Costa Rican elderly: a cohort study.

BACKGROUND: Costa Rica, along with other Latin American countries, is undergoing population aging, with an increase in the prevalence of chronic conditions, many of them resulting from a growing prevalence of obesity. As a result of the demographic and epidemiological transitions, the causes of morbidity and mortality have changed from communicable to non-communicable diseases. An increase in overweight and obesity is hypothesized to be related to premature mortality. This study assesses the association between obesity and both all-cause and cardiovascular mortality in a Costa Rican elderly population. METHODS: This is a secondary data analysis of the Costa Rican Longevity and Healthy Aging Study (CRELES, for its Spanish acronym), a longitudinal nationally representative cohort study of health and life-course experiences of the Costa Rican elderly. A baseline (n = 2827) and two subsequent 2-year follow-up interviews were conducted. Data analyses include descriptive statistics and survival models. Cox and Gompertz distributions were used to model general mortality and cardiovascular mortality as a function of obesity and controlling for confounders. Anthropometric measures used were Body Mass Index (BMI) and Waist Circumference (WC). RESULTS: Each one-unit increment in BMI was significantly associated to a 3,1% (p < 0.001) and 2,6% (p = 0.021) increment in general and cardiovascular mortality respectively. Each one-unit increment in WC was significantly associated with a 0,8% (p = 0.006) increment in general mortality, whereas WC was not significantly associated with cardiovascular mortality. CONCLUSIONS: Obesity is associated with mortality in the Costa Rican elderly. This association is strongest between obesity and all-cause mortality. As general obesity increases, all-cause and cardiovascular mortality also increase in this population. Similarly, as central obesity increases, all-cause mortality increases. Policies aimed at preventing obesity and chronic conditions are warranted for a better survival in this population.

Dietary Intake and Sources of Added Sugars in Various Food Environments in Costa Rican Adolescents.

Consumption of added sugars, especially from sugar-sweetened beverages (SSBs), has been associated with several negative health outcomes during adolescence. This study aimed to identify dietary intake and food sources of added sugars in the home, school, and neighborhood environments of Costa Rican adolescents. Dietary intake of added sugars was determined using 3-day food records in a cross-sectional study of 818 adolescents aged 12 to 19 and enrolled in rural and urban schools in the province of San José. On average, 90% of adolescents consumed more than 10% of their total energy intake from added sugars. Furthermore, 74.0% of added sugars were provided at home, 17.4% at school, and 8.6% in the neighborhood. Added sugars were primarily provided by frescos (29.4%), fruit-flavored still drinks (22.9%), and sugar-sweetened carbonated beverages (12.3%), for a total contribution of 64.6%. Our findings suggest that Costa Rican adolescents have a plethora of added sugar sources in all food environments where they socialize. However, it is relevant for public health to consider the home and school environments as fundamental units of interventions aimed at reducing added sugars in the adolescent diet. Frescos prepared at home and school and fruit-flavored still drinks must be the focus of these interventions.

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) (ß = 0·20, P < 0·05), unhealthy foods (fast food (FF)) (ß = -0·24, P < 0·01) and ultra-processed foods (ß = -0·15, P < 0·05) among urban girls; intake of legumes among rural girls (ß = 0·16, P < 0·05) and intake of sugar-sweetened beverages (SSB) among rural boys (ß = 0·22, P < 0·05). Family meal atmosphere was associated with legume intake (ß = 0·19, P <·05) among rural girls. Authoritative parenting style was associated with FV intake (ß = 0·23, P < 0·05) among urban boys and FF intake (ß = 0·17, P < 0·05) among urban girls. Authoritarian parenting style was associated with FV consumption (ß = 0·19, P < 0·05) among rural boys, and with SSB and FF consumption (ß = 0·21, P < 0·05; ß = 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.

Consumo de frutas y vegetales en la población urbana costarricense: Resultados del Estudio Latino Americano de Nutrición y Salud (ELANS)-Costa Rica / Fruits and vegetables intake among Costa Rican urban population: results from the Latin American Study of Nutrition and Health: ELANS-Costa Rica

Resumen: Introducción: El consumo suficiente de frutas y vegetales ha sido ampliamente asociado con diversos beneficios para la salud, entre ellos, el actuar como factor protector contra el desarrollo de enfermedades crónicas no transmisibles, cáncer y enfermedades mentales. La Organización Mundial de la Salud (OMS) recomienda un consumo diario de 400 gramos entre frutas y vegetales. Este estudio tuvo como objetivo la caracterización del consumo de frutas y vegetales, según variables sociodemográficas en la población costarricense y el cumplimiento de la recomendación de la OMS. Metodología: Los datos se obtuvieron del Estudio Latino Americano de Nutrición y Salud (ELANS)-Costa Rica. Se reclutaron 798 sujetos de 15 a 65 años, residentes en zonas urbanas del país, y se evaluó el consumo de alimentos mediante dos recordatorios de 24 horas. El consumo de frutas y vegetales se analizó según el sexo, el grupo de edad y el nivel socioeconómico. Resultados: Se encontró un consumo promedio de frutas y vegetales de 220g/d/p; el cual incrementó con la edad (p=0.035 entre el grupo de 15 a 19 años y el grupo de 50 a 65 años) y con el nivel socioeconómico (p=0.004 entre el NSE bajo y medio). Sin asociación con el sexo y al nivel educativo (p>0.05). Solamente el 12.0 % de la población urbana costarricense cumple con la recomendación de la OMS. Conclusiones: Los datos obtenidos ponen en evidencia la necesidad de la implementación de programas e intervenciones adaptados a las características y preferencias de la población costarricense para la promoción del aumento en el consumo de frutas y vegetales. Es necesario extender estos estudios a la población rural de Costa Rica, pues el consumo y los factores asociados a este, podría ser diferente entre regiones.

Abstract: Introduction: Consumption of fruit and vegetables has been widely associated with different health benefits such as protection against non-transmissible chronic diseases, cancer and mental disorders. Due to these benefits, the World Health Organization (WHO) recommends daily consumption of 400 grams of fruit and vegetables. This study is aimed at characterize fruit and vegetable consumption according to socioeconomic variables, among the Costa Rican population and the degree to which this meets the WHO recommended intake. Methods: Data were obtained from the Latin American Nutrition and Health Study (ELANS)-Costa Rica. 798 subjects aged 15-65 years, living in urban areas were interviewed and their food consumption assessed by two 24-hour Recalls. Fruit and vegetable consumption were analyzed by gender, age group and socioeconomic status. Results: Average daily consumption of fruit and vegetables was 220g/p/d and increased with age (p=0.035 between with 15-19 and 50-65 years old) and socioeconomic status (p=0.004 between low and middle). No association was found with gender or education level (p>0.05). Only 12.0 % of the urban Costa Rican population met the WHO recommendation. Conclusions: The results provide evidence for the need for programs and interventions adapted to the characteristics and preferences of the Costa Rican population, to promote an increase of the consumption of fruits and vegetables. Similar studies are needed in the rural areas of Costa Rica as food habits and factors associated with them may differ

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.

Comparación de tres métodos cortos contra un método estándar para analizar la composición nutricional de reportes de consumo de alimentos de adultos costarricenses / Comparison of three short methods against a standard method to analyze the nutritional composition of food consumption surveys of Costa Rican adults

RESUMEN Objetivo: comparar tres métodos cortos de análisis de datos de consumo de alimentos contra un método estándar en un grupo de adultos costarricenses. Metodología: se realizó un análisis de la composición nutricional de los alimentos incluidos en 100 recordatorios de 24 horas del Estudio Latinoamericano de Nutrición y Salud. Se utilizaron tres métodos cortos de análisis de dieta (listas de intercambio de la Asociación Dietética Norteamericana, listas colombianas y un nuevo sistema de grupos de alimentos propuesto por las investigadoras), así como un método estándar basado en tablas de composición de alimentos. Los valores obtenidos se compararon mediante la Prueba de Rangos de Wilcoxon, correlaciones de Spearman y gráficos de Bland-Altman. Resultados: se comprueba que el sistema de grupos de alimentos es el método corto de análisis de dieta cuyos resultados son más similares a los obtenidos por el método estándar en cuanto a energía, macro y micronutrientes. En el caso de las listas de intercambio de la ADA los carbohidratos se subestiman (-19.2 %) y las grasas se sobreestiman (53.8 %). En cuanto a las listas colombianas se observan diferencias significativas y menores coeficientes de correlación para el sodio (0.692) y los ácidos grasos (0.758). Conclusión: se encontró que el sistema de grupos de alimentos es el método que presenta los resultados más semejantes al método estándar para el análisis de dieta y se considera más fácil de utilizar en la práctica clínica.

ABSTRACT Objective: comparison of three short methods for analysis of food consumption data from a group of Costa Rican adults. Methodology: 100 questionnaires from 24-hour recalls were obtained from the Latin American Study of Nutrition and Health. Three short methods for dietary analysis based on two different exchange lists and a new food group system proposed by the researchers) were compared to a standard method based on food composition tables. The values ​​obtained were compared using the Wilcoxon signed-rank test, Spearman´s rank correlation coefficient and the Bland-Altman plot. Results: the food group system is the short method of diet whose results are more similar to the standard method in terms of energy, macro and micronutrients. In the ADA exchange lists, carbohydrates are underestimated (-19.2%) and fats are overestimated (53.8%). The Colombian exchange lists resulted in significant differences and lower correlation coefficients for sodium (0.692) and fatty acids (0.758). Conclusion: the food group system is the method that presents results which are more similar to the standard method for dietary analysis and is considered easier to use in clinical practice.

Hábitos alimentarios de la población urbana costarricense / Food habits of urban Costa Rican population

Resumen Objetivo: Es sabido que los malos hábitos alimentarios contribuyen a la aparición de enfermedades crónicas, como la obesidad y la diabetes mellitus, sin embargo, no existe información actualizada respecto a la alimentación de la población urbana en Costa Rica. El objetivo de este estudio fue analizar los hábitos alimentarios de la población costarricense incluida en el Estudio Latinoamericano de Nutrición y Salud (ELANS). Métodos: Se incluyó una muestra de 798 participantes entre 15 y 65 años del área urbana de Costa Rica. Se determinó el consumo diario promedio de alimentos y la frecuencia por tiempo de comida de acuerdo al sexo, el grupo de edad y el nivel socioeconómico. Resultados: Los grupos de alimentos más consumidos en el desayuno fueron café y panes, en la merienda de la mañana frutas, en la merienda de la tarde café y panes y en el almuerzo y la cena arroz blanco, bebidas con azúcar y leguminosas. Se determinaron algunas diferencias en los alimentos incluidos en los diferentes tiempos de comida entre hombres y mujeres, según el grupo de edad y el nivel socioeconómico de los participantes. Conclusión: Los hábitos alimentarios de la población costarricense se caracterizaron por ser poco variados, y poseer un alto consumo de café, panes, arroz blanco y bebidas con azúcar y un consumo insuficiente de leguminosas, frutas, vegetales no harinosos y pescado. Esta información puede ser utilizada para la implementación de programas nutricionales tendientes a mejor los hábitos de alimentación en el país.

Abstract Objective: It is known that poor eating habits contribute to the onset of chronic diseases, such as obesity and diabetes mellitus, among others, however there is no recent information regarding the diet of the urban population in Costa Rica. The objective of this study was to analyze the dietary habits of the Costa Rican population included in the Latin American Nutrition and Health Study (ELANS). Methods: A sample of 798 participants between 15 and 65 years of urban areas of Costa Rica was included. The average daily consumption of food and the frequency per meal time were determined according to sex, age group and socioeconomic level. Results: The most consumed food groups at breakfast were coffee and bread, in the morning snack fruits, in the afternoon snack coffee and bread and at lunch and dinner white rice, sweetened beverages and legumes. Some differences were determined in the foods included in the different meal times between according to sex, age group and socioeconomic status of the participants. Conclusion: The dietary habits of the Costa Rican population were characterized by having little variety, a high consumption of coffee, bread, white rice and sweetened beverages and insufficient consumption of legumes, fruits, non-starchy vegetables and fish. This information can be used for the implementation of nutritional programs aimed at improving eating habits in the country.

Prevalencia de ingesta inadecuada de micronutrientes en la población urbana de Costa Rica / Micronutrients inadequacy in urban population of Costa Rica

La inadecuación de micronutrientes es frecuente en los países en vías de desarrollo. En Costa Rica existe poca información acerca de la ingesta de micronutrientes y del impacto de los programas de fortificación obligatoria de alimentos. El objetivo de este estudio fue evaluar la ingesta de vitaminas y minerales y el aporte de la fortificación de alimentos a la ingesta total de micronutrientes en la población urbana costarricense. Se analizó el consumo de alimentos en una muestra de la población urbana costarricense, participantes del Estudio Latinoamericano de Nutrición y Salud (ELANS). El riesgo de ingesta inadecuada se estimó según sexo y grupo de edad, utilizando el método de punto de corte del Requerimiento Medio Estimado (EAR). Para el hierro, se utilizó el método de aproximación probabilística. Más del 85% de la muestra presentó riesgo de ingesta inadecuada para vitamina E, calcio y vitamina D. Una menor prevalencia de riesgo de ingesta inadecuada se presentó para la niacina, tiamina, folatos, hierro y selenio. La fortificación de alimentos tiene un efecto notorio en la ingesta de micronutrientes, especialmente de hierro, niacina, tiamina y folatos. La ingesta de calcio, vitamina D y vitamina E es preocupantemente inadecuada, siendo las mujeres y las personas mayores de 50 años los grupos más afectados. Resulta fundamental el establecimiento de programas y políticas públicas para asegurar el cumplimiento del requerimiento establecido para los diferentes micronutrientes(AU)

Micronutrient deficiencies are still very common in developing countries. In Costa Rica there is little information on micronutrients intake and the impact of food fortification.This study aimed to determine the contribution of food fortification to the total intake, and to estimate the risk of inadequate intake of vitamins and minerals in an urban Costa Rican population. As a part of the Latin American Nutrition and Health Study, we analyzed data from a nationally representative sample of 798 urban residents from Costa Rica (15-65 years old) whom provided two 24-h dietary recalls. The prevalence of inadequate micronutrient intake was estimated according to the EAR cut-point method. Iron was analyze using the probability approach. We observed a 100% of the sample are at risk of inadequate intake of vitamin D, and similar percentages were obtained for calcium and vitamin E, ranging from 92.9 to 100% and 85.5 to 99.2% respectively. A lower risk of inadequate intake was observed for niacin, thiamin, folate, iron and selenium. Food fortificationmakes an important contribution to folate, thiamin, iron and niacin intake. Despite the efforts that have been made to ensure adequate micronutrient intake in Costa Rica, the intake of calcium, vitamin D and vitamin E is still very low, especially among women and people over 50 are the most affected. Based on the above, it is recommended to promote a healthy diet through nutritional education as part of public health policies, in order to facilitates compliance to nutritional requirement(AU)

Consumo de azúcar añadido en la población urbana costarricense: estudio latinoamericano de nutrición y salud ELANS-Costa Rica / Added sugar intake in a Costa Rican urban population: Latin American nutrition and health study ELANS-Costa Rica

Resumen Objetivo : El objetivo del estudio fue analizar el consumo de azúcares añadidos por la población urbana costarricense y los factores asociados a este. Método: Estudio transversal donde se analizan los datos de 798 participantes del Estudio ELANS-Costa Rica, que constituyen una muestra representativa de la población urbana costarricense, (con edades entre 15 y 65 años). Para conocer el consumo de azúcares añadidos, se realizan dos recordatorios de 24 horas, en días no consecutivos. Se recolectan variables sociodemográficas, cantidad, lugar y momento del consumo. Resultados: El consumo de azúcares añadidos representa el 14,7% de la energía consumida por la población urbana costarricense, siendo este porcentaje mayor en las mujeres y en las personas más jóvenes. La mayor cantidad de azúcares añadidos se consume en el hogar y durante las meriendas. Las bebidas azucaradas constituyen la principal fuente de azúcares añadidos en la dieta costarricense, y las bebidas gaseosas son la fuente más importante en el quintil de mayor consumo. Conclusión: La ingesta de energía obtenida de los azúcares añadidos supera la recomendación máxima establecida por la Organización Mundial de la Salud, por lo tanto, es necesario establecer políticas públicas dirigidas a reducir su consumo y a la modificación de conductas asociadas a la preparación e ingesta de alimentos fuente de azúcares añadidos.

Abstract Aim: High consumption of added sugars has been associated with a greater risk of chronic diseases, appearance of caries and weight gain, which implies a lower quality of life for the population and an increase in costs for the health system. The aim of this study was to evaluate the intake of added sugar and its related factors in urban Costa Rican population. Methods : This was a cross-sectional study conducted in a representative sample of the Costa Rican urban population (798 participants aged between 15 and 65 years). To determine the consumption of added sugars, two 24 hours recalls were conducted, in non-consecutive days. Sociodemographic variables, quantity of food consumed, place and time of consumption were collected. Results: The consumption of added sugars represents 14.7% of total energy intake for the Costa Rican urban population. This consumption is higher among women and younger people. The greater amount of added sugars was consumed in the home and during snacks. Sugar-sweetened beverages were the main source of this added sugar in the Costa Rican diet and soft drinks were the most important source in the highest consumption quintile. Conclusions: The intake of energy obtained from the added sugars exceeds the máximum recommendation established by the World Health Organization, therefore it is necessary to establish public policies aimed at reducing consumption and modifying behaviors associated with the preparation and intake of food source of added sugars.

Diet Quality and Diet Diversity in Eight Latin American Countries: Results from the Latin American Study of Nutrition and Health (ELANS).

This study aimed to assess diet quality score (DQS), considering healthy and unhealthy foods and nutrients, and diet diversity score (DDS) as indicators of risk of noncommunicable diseases in eight Latin American countries, and to verify the possible differences considering country, sex, age, socioeconomic, and nutritional status. A multicenter household population-based cross-sectional survey was conducted with 9218 individuals (age range 15-65 years). Sociodemographic and anthropometric data were collected. Dietary intake was measured using two non-consecutive 24-h recalls and diet quality and diversity were assessed. In the whole sample, scores were observed from 63.0% ± 9.3% to total DQS, 65.0% ± 13.6% to healthy dietary items and 60.2% ± 13.6% to unhealthy items, and 5.6 ± 1.1 out of 9 points to DDS. Women presented lower DDS compared to men (5.5 ± 1.1 vs. 5.6 ± 1.1, p < 0.001). Healthy DQS was higher as the socio-economic level increased, and unhealthy DQS was the opposite (p < 0.05). Total DQS was significantly lower only at the low socio-economic level (p < 0.05). Chile and Venezuela showed the lowest healthy (62.2 ± 15.2 and 61.9 ± 11.7, p < 0.05) and total DQS (61.4 ± 10.3, 61.2 ± 8.7, p < 0.05). No effects were observed when considering the age and anthropometric measurements. Promoting consumption of a diverse and high-quality diet is an essential challenge to accomplish.

Prevalencia de malnutrición según grupos de edad en diferentes comunidades de Costa Rica entre 1997 y 2014 / Prevalence of malnutrition according to age groups in different communities of Costa Rica between 1997 and 2014

Resumen Objetivo: analizar la prevalencia de problemas en el estado nutricional de los miembros de la familia, según grupos de edad en diferentes comunidades de Costa Rica entre 1997 y 2014. Métodos: se realizó un análisis de información recolectada por estudiantes de la Escuela de Nutrición de la Universidad de Costa Rica entre 1997 y 2014. De las familias seleccionadas en cada comunidad, se tomaron los datos de peso y talla de todos los miembros. Para el análisis de los datos se utilizaron los estándares de crecimiento y puntos de corte recomendados por la Organización Mundial de Salud. Resultados: se presenta la información de 25 encuestas realizadas durante un periodo de 17 años. Con el paso de los años, se observa en los grupos de menor de edad (< 20 años) una reducción en los problemas de déficit en peso y talla, y un aumento en porcentaje de individuos con exceso o riesgo de exceso de peso. En la población de adultos, se observa el mismo fenómeno de aumento en exceso de peso; y en las personas adultos mayores, una disminución en el porcentaje con déficit de peso. Discusión: se compara la información presentada con otras publicaciones que reportan resultados similares y se comenta sobre las causas y consecuencias del problema de exceso de peso. Conclusión: durante el periodo, se encontró una reducción en la prevalencia de déficit en peso y talla en los grupos de menor de edad; y, en peso en personas adultos mayores; además, un aumento en la prevalencia de exceso de peso en todos los grupos de edad.

Abstract Objective : to analyze the prevalence of problems in nutritional status of family members, according to age groups from different communities in Costa Rica between 1997 and 2014. Methods: an analysis of data collected by nutrition students of the University of Costa Rica between 1997 and 2014 is presented. All members of the selected families were weighed and their height measured. Growth references and cut-off points of World Health Organization were used in the analysis. Results: information for 25 studies collected during 17 years is presented. Among the under-20 age groups, with the passage of time, a reduction can be seen in prevalence of low weight and height and an increase in prevalence of excess weight or risk of excess weight. An increasing prevalence of excess weight can also be observed in the adults and amongst the elderly, there was a reduction in the prevalence of weight deficit. Discussion: the information presented is compared to other publications which report similar results and the causes and consequences of excess weight are discussed. Conclusion: with the passage of time, a reduction was observed in the prevalence of low weight and height in the under-20 age groups and in the prevalence of low weight in the elderly. There was an increase in the prevalence of excess weight in all the age groups.

Auto-reporte de problemas de salud relacionados con nutrición en Costa Rica / Reported morbidity related to nutrition in Costa Rican

Objetivo: Analizar la prevalencia de problemas de salud relacionados con nutrición auto reportados en diferentes comunidades de Costa Rica entre 1994 y 2012. Métodos: se analiza datos recolectados entre 1994 y 2012 por estudiantes de la Escuela de Nutrición, Universidad de Costa Rica. Las familias encuestadas fueron seleccionadas por muestra probabilística de tipo aleatorio simple y por medio de entrevistas a las madres u otro adulto de la familia, se recolectó datos sobre 12 problemas de salud relacionados con nutrición. En caso de obtener una respuesta afirmativa, se preguntó por el tipo de diagnóstico y si la persona seguía algún tipo de control o tratamiento. Se calculó la frecuencia del reporte de cada problema por comunidad en total y de cada grupo de edad. Resultados: En todas las comunidades encuestadas a partir de 2006, más de 90% de las familias reportan tener en uno o más de sus miembros, por lo menos uno de los problemas de salud y a partir de 1997, de las 22 comunidades con datos disponibles, en 17 más del 50% de las personas pertenecientes a las familias encuestadas, reportan uno o más de los 12 problemas de salud. Los problemas de salud reportado por más de 10 % de la población encuestada en la mayoría de las comunidades fueron: gastritis, caries dental, exceso de peso e hipertensión arterial. Conclusión: se encontró una alta prevalencia de problemas de salud relacionados con nutrición y reportados en las comunidades encuestadas.

Objective: To analyze the prevalence of health problems related to nutrition through self-reports in families of different communities in Costa Rica between 1994 and 2012. Methods: Data collected by nutrition students of the Nutrition School, University of Costa Rica between 1994 and 2012 was analyzed. Families were selected by simple random sampling and interviews were conducted on housewives or other adult family members asking about the presence of 12 different health problems related to nutrition. In cases of an affirmative reply, type of diagnosis and treatment was also asked. The frequency of reported presence of each problem was calculated for each community in total and for each age group. Results: In all the communities studied since 2006, more than 90% of the families report the presence in at least one member of one or more of the health problems. Since 1997, in 17 of the 22 community surveys, more than 50% of the family members are reported as having one or more of the health problems. The following problems were reported in more than 10% of the survey population: gastritis, dental caries, overweight or obesity and arterial hypertension. Conclusion: Ahigh prevalence of health problems related to nutrition was reported among the families in surveyed in the communities.

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.

Validación del método de registro estimado para medir consumo de alimentos en preescolares en Costa

Original El objetivo fue validar el instrumento de registro estimado para medir el consumo de alimentos en 30 preescolares costarricenses. Se trabajó con preescolares de las comunidades de Aserrí y Desamparados. Inicialmente se aplicó el Registro Estimado de Tres Días (método bajo prueba) y una semana después, se administró el método de Registro Diario de Tres Días como método de comparación. Para los valores estimados en el registro estimado y diario se utilizó comparación de promedios (prueba de Tstudent y prueba de Wilcoxon) y pruebas de asociación (correlación Pearson y correlación Spearman) El registro estimado no presenta diferencias estadísticamente significativas con respecto al registro diario en la ingesta promedio de energía y nutrientes, excepto el calcio y la vitamina A. Únicamente en el caso de la fibra dietética, hierro, vitamina A, riboflavina, vitamina B12, ácido fólico y niacina se encontró una correlación entre ambos métodos. En cuanto al consumo de grupos de alimentos, no se encontraron diferencias significativas en el caso de la mayoría de los grupos. El registro estimado se puede usar en lugar del registro diario para estimar la ingesta promedio de energía y nutrientes en niños preescolares en grupo, no así para estimar la ingesta del individuo.

Validación del método de registro estimado para medir consumo de alimentos en Preescolares en Costa Rica / Validation of record method to measure food consumption in preschool children, Costa Rica

Objetivo: Validar el instrumento de Registro Estimado para medir el consumo de alimentos en 30 preescolares costarricenses. Metodología: Se trabajó con preescolares de Aserrí y Desamparados. Inicialmente se aplicó el Registro Estimado de tres días (método bajo prueba), y una semana después, se administró el método de Registro Diario de tres días como método de comparación. Para los valores estimados en el Registro Estimado y Diario se se utilizó comparación de promedios (Prueba de T-student y Prueba de Wilcoxon) y pruebas de asociación (Correlación Pearson y Correlación Spearman) Resultados: El Registro Estimado no presenta diferencias estadísticamente significativas con respecto al Registro Diario en la ingesta promedio de energía y nutrientes a excepción del calcio y la vitamina A. Únicamente en el caso de la fibra dietética, hierro, vitamina A, riboflavina, vitamina B12, ácido fólico y niacina se encontró una correlación entre ambos métodos. En cuanto al consumo de grupos de alimentos, no se encontraron diferencias significativas en el caso de la mayoría de los grupos. Conclusión: El Registro Estimado se puede usar en lugar del Registro Diario para estimar la ingesta promedio de energía y nutrientes en niños preescolares a nivel grupal; no así para estimar la ingesta a nivel del individuo.

Objective: To validate an instrument for measuring estimated food consumption in 30 Costa Rican preschool children. Materials and methods: The work was done with preschool children from Aserri and Desamparados. The Estimated Record (method under test) was applied during three days, and one week later the Daily Record was applied during three more days as a method of comparison. For the analysis of the results of both methods were used the comparison of means (T-student test and the Wilcoxon test) and tests of association (Pearson correlation and Spearman Correlation). Results: The Registry Dear no statistically significant differences with respect to the Daily Record in the average intake of energy and nutrients except for calcium and vitamin A. Only in the case of dietary fiber, iron, vitamin A, riboflavin, vitamin B12, folic acid and niacin found a correlation between both methods. On the consumption of food groups, no significant differences were found for most groups. Conclusion: Dear record can be used instead of the Daily Record to estimate the average intake of energy and nutrients in preschool children at the group level, not for estimating the intake at the individual level. Discussion: Dear Registry can be used instead of the Daily Record to estimate the average intake of energy and nutrients in preschool children at the group level, not for estimating the intake at the individual level.

Development of a food frequency questionnaire and a comparison with food records / Desarrollo de un cuestionario de frecuencia de consumo de alimentos y su comparación con registros de alimentos

Objective: Develop a food frequency questionnaire (FFQ) and assess its ability to rank a group of adults according to nutrient intake by a comparison with food records. Methods: This study consisted of 2 stages. A) Development of FFQ. Analysis of a food consumption database from a group of 60 adults from communities in the Central Valley of Costa Rica led to the identification of 10 food groups which contributed to most of between-person variance in energy and nutrient intake. A quantitative FFQ containing 111 foods from the 10 groups and covering 7 days was developed. B) Data was collected using the FFQ and a 4-day food record from a group of 52 adult inhabitants of an urban community in San José. Energy and nutrient intake as estimated by both methods were compared using Pearson's correlation coefficients and Student's t-test. Results: Pearson's correlation coefficients were above 0,4 for 18 of the 22 crude nutrient intakes. The degree of association was lower for energy-adjusted intakes, reflecting underestimation of energy intakes by the FFQ. Conclusions: When compared with the food record, the FFQ was able to rank the individuals according to crude nutrient intake. However, due to underestimation of total energy intake by the FFQ, the correlations for the energy-adjusted values were poorer. The FFQ requires some modifications in its design and its reproducibility and validity must be demonstrated before being used in epidemiological studies in Costa Rica.

Objetivo: desarrollar un cuestionario de frecuencia de consumo de alimentos (CFCA) y evaluar su habilidad para ordenar un grupo de adultos según su ingesta de nutrientes por medio de una comparación con registros de alimentos. Materiales y metódos:el estudio consistió en dos etapas. A) Elaboración de un CFCA. Un análisis de una base de datos de consumo de 60 adultos de comunidades del Valle Central de Costa Rica, identificó 10 grupos de alimentos que contribuyeron a la mayor parte de variación entre individuos en la ingesta de energía y nutrientes. Se elaboró un CFCA cuantitativo con 111 alimentos pertenecientes a los 10 grupos y que cubría 7 días. B) Se recolectaron datos por medio del CFCA y registros de 4 días en 52 adultos de una comunidad urbana de San José. Se compararon las ingestas de energía y nutrientes estimados por ambos métodos por medio de coeficientes de correlación de Pearson y la prueba t de Student. Resultados: las coeficientes de correlación de Pearson para 18 de los 22 nutrientes crudos fueron mayores a 0,4. El grado de asociación para las ingestas ajustadas por energía fue menor, debido a subestimación en la ingesta de energía por el CFCA. Conclusiones:en comparación con el registro, el CFCA logró ordenar los adultos según su ingesta de nutrientes no ajustados por energía. Sin embargo, debido a una subestimación en la ingesta total de energía por el CFCA, las correlaciones para los valores ajustados por energía fueron más pobres. El CFCA requiere algunas modificaciones y su reproducibilidad y validez debe ser demostrado antes de poder utilizarlo en estudios epidemiológicos en Costa Rica.

Parental feeding styles and adolescents' healthy eating habits. Structure and correlates of a Costa Rican questionnaire.

This study designed and validated a questionnaire aimed at examining parental feeding styles to encourage healthy eating habits among Costa Rican adolescents. Adolescents (n=133; mean age 15.4 years), and their parents, participated in the study. The parents completed a parental feeding style questionnaire, and the adolescents completed 3-day food records. Confirmatory factor analyses suggest four distinct parental feeding styles, (a) verbal encouragement of healthy eating behaviors; (b) use of verbal sanctions to indirectly control the intake of healthy food; (c) direct control of access to and intake of food; and (d) use of food to regulate emotions and behavior. There were no correlations between dietary intake and the verbal encouragement of healthy eating behaviors, but there were significant negative correlations between (1) "the use of verbal sanctions to indirectly control the intake of healthy food", and the consumption of fruit and vegetable, of calcium, iron, vitamin B6 and folic acid intake, and (2) between the "direct control of access to and intake of food" and fast food consumption and total carbohydrates intake. The use of food to regulate emotions and behavior was positively correlated with high energy-dense food consumption. Stratification of the data shows significant differences by gender in the correlations between parental feeding style and dietary intake. Understanding parental feeding styles in a Latin American context is a first step in helping researchers develops culturally-appropriate parenting intervention/prevention strategies to encourage healthy eating behaviors during adolescence.

Validation of a diet history questionnaire for use with Costa Rican adults.

OBJECTIVE: To validate a diet history questionnaire (DHQ) using a weighed food record (WFR) as the standard method in the estimation of food consumption and nutrient intake in a group of adults. DESIGN: WFR: all foods consumed by subjects during 7 consecutive days were weighed and recorded by nutrition students. Two DHQ interviews were carried out on days 1 (first diet history questionnaire, DHQ1) and 28 (second diet history questionnaire, DHQ2). SETTING: Costa Rica. SUBJECTS: Sixty adults: 30 men and 30 women; 30 living in urban and 30 in rural areas. RESULTS: In comparison to the WFR, the DHQ1 gave statistically significant higher estimates of the mean intake of 19 nutrients for men and of three nutrients for women. The uncorrected correlation coefficients for nutrient intake according to both methods ranged from 0.40 to 0.83 for males and from 0.22 to 0.62 for females. Percentage of subjects classified in the same quartiles of nutrient intake according to each method ranged from 33.3% to 63.3% for males and from 23.3% to 53.3% for females. Misclassification in extreme quartiles ranged from 0% to 13.3% for both sexes. The mean food group consumption, according to the DHQ1, when compared with the WFR, gave statistically significant differences for three of the 18 food groups for men and for two groups in the case of women. The two applications of the DHQ gave similar results. CONCLUSION: Validation of a DHQ using a WFR as the standard method gave results that compare favourably with those reported by other authors. This study found important differences in the response of men and women to the DHQ: among men, the estimates of mean nutrient intake from DHQ1 were significantly greater than those of the WFR, while in the case of women, the mean nutrient intake estimates from both methods were not significantly different. There was a higher degree of correlation between the DHQ1 and the WFR mean nutrient intakes among men than among women. The DHQ showed good reproducibility.