[Breastfeeding duration, mixed feeding and health risk in Costa Rican children and adolescents]. / Duración de la lactancia materna, alimentación combinada y riesgo para la salud en jóvenes costarricenses.

OBJECTIVE: to analyze the associations between breastfeeding duration and mixed feeding (breast milk and formula) with obesity, cardiometabolic risk (WHtR), body fat, and dietary and physical activity risk behaviors in children and adolescents. SUBJECTS AND METHOD: cross-sectional study carried out with 1,467 students in Costa Rica. An interview was conducted with parents and children to gather information on socioeconomic status, education, dietary and physical activity risk behaviors of the youth, including breastfeeding duration and mixed feeding. Body mass index, waist circumference, and body fat were assessed by bioelectrical impedance analysis and cardiometabolic risk was mea sured with the waist-to-height ratio (WHtR ≥ 0.5) by trained personnel. Descriptive statistics and logistic regression models were applied. RESULTS: the average age was 11.4 ± 2.6 years and 50.9% were male. 55.5% of the population was middle class; 60% were sedentary, and 16% presented obesity. Around 20% were breastfed without the introduction of formula before 6 months, 13% were never breastfed, and more than 60% were breastfed for ≥ 6 months. Those children who were fed only with breast milk or in combination with formula for ≥ 6 months presented a lower percentage of obesity than those who received formula feeding only (60.8 vs 39.2; p < 0.005). Children with cardiometa bolic risk (WHtR ≥ 0.50), unhealthy diet, sedentary lifestyle, and who were fed only with formula are at higher risk of developing obesity (OR = 18.8, 95% CI 13.2-26.0). CONCLUSIONS: these results are consistent with other studies and reinforce the evident protection of breastfeeding against the development of obesity.

[Basal state of the nutritional information declared in labels of foods products marketed in Costa Rica]. / Situación basal de la información nutricional declarada en las etiquetas de los alimentos comercializados en Costa Rica.

The nutritional labeling regulations for prepackaged foods based on the Codex Alimentarius legislation enacted in 2002 in Costa Rica. In the same year, a research was conducted in order to describe the baseline of nutritional labeling. The declared information on the labels of all prepackaged foods was collected, except for alcoholic beverages. Six variables were analyzed using SPSS. 2,910 labels of foods were reviewed and classified in 19 food categories. 58.4% (n = 1698) included nutritional information, proportion that varied by country of origin and food category. Of the labels that included nutritional information, 68.1% had nutritional panel, 1.2% nutrient claims and 27.4%, both. 95% of the nutritional components declared on the labels included energy and macronutrients data. At least 100 different nutritional and health claims were identified. Most frequently used claims were content (74.7%), followed by addition (16.9%). The components most frequently mentioned were vitamins and minerals, vitamins (alone), carbohydrates, total fat, cholesterol and energy. Food groups who reported these descriptors were: cereals and by products, baby foods, milks, beverages, foods for special dietary uses and substitutes. One to five descriptors were used in a label. In a decade the proportion of prepackaged foods with nutritional labeling tripled in the metropolitan area of Costa Rica. It is concluded that the tendency of nutrition information declaration is up, sustained and represents an accessible tool for health promotion, if the information provided is reliable and secure.

Situación basal de la información nutricional declarada en las etiquetas de los alimentos comercializados en Costa Rica

El reglamento de etiquetado nutricional para alimentos preenvasados de Costa Rica basado en la normativa del Codex Alimentarius entró en vigencia en el 2002. En este mismo año, se realizó una investigación con el propósito de describir la situación basal del etiquetado nutricional en estos alimentos. En un supermercado representativo del área metropolitana de Costa Rica se recolectó la información declarada en las etiquetas de todos los alimentos preenvasados, excepto de las bebidas alcohólicas. Se analizaron seis variables mediante el programa SPSS. Se revisaron 2.910 etiquetas de alimentos clasificados en 19 categorías. El 58,4% (n=1698) incluyó información nutricional, dato que varió según país de origen y categoría del alimento. De las etiquetas con información nutricional, 68,1% declararon el contenido nutricional, 1,2% descriptores nutricionales y 27,4% ambos. En el 95% del etiquetado nutricional se declaró el contenido de energía y macronutrientes. Se identificaron al menos 100 descriptores nutricionales y saludables diferentes, con mayor frecuencia se empleó el de contenido (74,7%), seguido por el de adición (16,9%). Los componentes referidos con mayor frecuencia fueron vitaminas y minerales, vitaminas, carbohidratos, grasa total, colesterol y energía; y los grupos de alimentos que los declararon fueron: cereales y derivados, alimentos infantiles, leches, bebidas, alimentos para regímenes especiales y sustitutos. En una misma etiqueta fueron declarados entre uno y cinco descriptores. En una década en Costa Rica se triplicó la proporción de alimentos preenvasados con etiquetado nutricional, por lo se concluye que la tendencia de su declaración es ascendente, sostenida y representa una herramienta accesible para la promoción de la salud en la población, siempre y cuando la información sea confiable y segura.

The nutritional labeling regulations for prepackaged foods based on the Codex Alimentarius legislation enacted in 2002 in Costa Rica. In the same year, a research was conducted in order to describe the baseline of nutritional labeling. The declared information on the labels of all prepackaged foods was collected, except for alcoholic beverages. Six variables were analyzed using SPSS. 2,910 labels of foods were reviewed and classified in 19 food categories. 58.4% (n= 1698) included nutritional information, proportion that varied by country of origin and food category. Of the labels that included nutritional information, 68.1% had nutritional panel, 1.2% nutrient claims and 27.4%, both. 95% of the nutritional components declared on the labels included energy and macronutrients data. At least 100 different nutritional and health claims were identified. Most frequently used claims were content (74.7%), followed by addition (16.9%). The components most frequently mentioned were vitamins and minerals, vitamins (alone), carbohydrates, total fat, cholesterol and energy. Food groups who reported these descriptors were: cereals and by products, baby foods, milks, beverages, foods for special dietary uses and substitutes. One to five descriptors were used in a label. In a decade the proportion of prepackaged foods with nutritional labeling tripled in the metropolitan area of Costa Rica. It is concluded that the tendency of nutrition information declaration is up, sustained and represents an accessible tool for health promotion, if the information provided is reliable and secure.

Percepción del peso corporal y estrategias utilizadas para controlarlo, en adultos costarricenses / Body weight perception and strategies used to control body weight among Costa Rican adults

Justificación: La obesidad se considera un problema de salud pública. La encuesta directa es el método más utilizado para generar información al respecto, pero su alto costo económico limita obtener datos periódicos. Se han experimentado otros métodos de recolección de información; entre ellos la encuesta telefónica se concibe como una opción válida de costo menor. Objetivo: Explorar la percepción del peso corporal de adultos costarricenses y las estrategias utilizadas para controlarlo, mediante el análisis de la información obtenida en la primera Encuesta Telefónica de Salud del IDESPO. Métodos: Estudio descriptivo, transversal. Se elaboraron preguntas abiertas sobre conocimiento, percepción y estrategias sobre peso corporal, que se incorporaron en la primera Encuesta Telefónica de Salud del IDESPO. Resultados: El 50,3 por ciento y 42 por ciento de los sujetos se percibieron con peso normal y peso alto o muy alto, respectivamente. Las principales estrategias para perder el peso: hacer ejercicio, 29,4 por ciento, cambios en la alimentación; 42 por ciento de los hombres y 44 por ciento de las mujeres reportaron "no hacer nada". Al contrastar la percepción del peso con el IMC estimado, más del 25 por ciento de mujeres y 34 por ciento de hombres que se percibieron con peso normal presentaron sobrepeso. Conclusiones: La metodología de encuesta telefónica introduce una subestimación en la percepción del exceso de peso conforme avanza la edad. La encuesta telefónica no sustituye las encuestas directas, pero se visualiza como alternativa para generar información sobre factores de riesgo cardiovascular. El reto próximo será validarla en nuestro contexto.

Rationale: Obesity is considered a public-health problem. A direct survey is the method most-frequently used to generate relevant information but its high economic cost doesn´t allow obtaining periodic data. Other methods of collecting information have been tried and, among these, the telephone survey is seen as a valid option at lower cost.Objective: To explore the perception of body-weight among Costa Rican adults as well as the strategies used to control this variable by analyzing information obtained in the First Telephone Health Survey conducted by IDESPO (The Institute for Social Studies in Populations.) Methods: a cross-sectional, descriptive study was carried out. Open questions were developed having to do with knowledge, perception and strategies to deal with body-weight. These were incorporated into the Health Survey mentioned above.Results: 50.3 % and 42% of the subjects, respectively, had a self-perception of normal weight or of high - very high weight. The main weight-loss strategies were: doing exercise (29.4%), changes in diet and no special strategy (the latter as admitted by 42% of men and 44% of women). When comparison of self-perception of weight with estimated BMI was done, more than 25% of females and more than 34% of males of those thinking they had normal weight were actually overweight. Conclusions: a telephone-survey methodology introduces an underestimate in the self-perception of overweight according to age. While telephone surveys do not substitute direct surveys, they can be seen an an alternative to generate information about cardiovascular risk factors. The next challenge will to validate these surveys in Costa Rica.

[Atherogenic factors in the diet of the Costa Rican population, 1991]. / Factores aterogénicos de la dieta de la población costarricense, 1991.

The present study analyzes the aterogenic factors of the diet of the Costa Rican population in various population and geographic groups. Data utilized was obtained from the Second National Survey on Apparent Food Consumption, 1991. Results found that on the national level consumption of fats, in relation to total caloric intake was higher than recommended levels. Likewise, the percentage of saturated fats exceed the established recommendations for prevention cardiovascular disease, and the intake of polyunsaturated fats was inferior to recommended levels. P/S ratio was 0.3, a value within the range considered to be aterogenic. Cholesterol intake is considered to be adequate. Cholesterol-Saturated-Index (CSI) of the majority of the diets studied was high, as reported in similar situation in other countries where cardiovascular disease is likewise the first cause of death. Dietary fiber was found to be in the lower levels of the daily recommendations. Also, the intake of vitamin C and E shows normal values, while intake of vitamin A is deficient. The principal source of three types of fat in the diet, as well as vitamin E, was shortening made from palm oil, which in spite of no being a rich source of unsaturated fatty acid, the consumption of it is high. Egg is the main source of cholesterol and dietary fiber is primarily obtained from beans. In conclusion, the Costa Rican diet presents a nutritional imbalance which can be considered an atherogenic risk factor for cardiovascular disease.