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 / 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...

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.

Prevalence of overweight and obesity among Costa Rican elementary school children

OBJECTIVE: Given that excessive body weight during childhood influences the development of several chronic diseases in adulthood, this study was conducted to determine the prevalence of overweight and obesity in urban and rural Costa Rican elementary school children. METHODS: The study was carried out from July 2000 to April 2001. A total of 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

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.

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

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

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

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

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

Adverse levels of serum lipids tend to persist over time into adolescence and young adulthood, underlying the progression of Coronary Artery Disease (CAD). Therefore, the lipid profile of Costa Rican adolescents and its relationship with dietary intake, physical activity and Body Mass Index (BMI) was evaluated in a total of 322 adolescents ages 13-18 years from urban and rural areas of San 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.

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

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

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

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