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

Abstract

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

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

“…To assess diet quality as a potential mediator in the association between PFS and excess weight, we used the Traditional Costa Rican Adolescent Diet Score (TCRAD), which was previously validated [ 59 ]. Briefly, the TCRAD score comprises a possible range of 0 to 14 points that reflect a consumption at or above the sex-specific median of 6 healthy food groups (legumes, vegetables, fruits, vegetable oils, dairy, and tortillas) and an intake below the sex-specific median of 8 detrimental food groups (white rice, red/processed meat, solid fats, desserts, sugary drinks, snacks, fast food, and refined bread) at one point each.…”

“…We replicated the regression-based mediation analysis and stratified by sex because differences in diet quality between Costa Rican boys and girls have been reported [ 59 ]. Sex was not considered a confounder in this segment of the analysis.…”

“…Statistical interactions between sex and PFS, as well as between sex and TCRAD, were tested by including cross-product terms in the analog linear equations pertaining to paths α and β . As an exploration, and based on literature suggesting differences in diet quality by these factors, we also performed stratified analyses by urban vs. rural area of residence and by parent-child dyads (mother–boy, father–boy, mother–girl) [ 59 , 64 , 65 , 66 ]. Statistical significance was set at an α of 0.05, and all the analyses were carried out using SAS ® Studio.…”

Analysis of Minerals in Foods: A Three-year Survey from Costa Rican Market Products

“…Finally, studies have shown that the consumption of Ca in Costa Rica is around 570.3 mg, one of the most consumed minerals, second only to K with 2 172.1 mg (Monge-Rojas et al, 2021).…”

“…In the case of P, in a single meal time, more than 50% of the recommended daily values were consumed, in contrast to the Ca values, which generate a Ca:P ratio below the recommended 1.7 (Gutierrez et al, 2020). However, Ca is the mineral most consumed by the Costa Rican population, in part due to the high consumption of dairy products in Costa Rica (217 kg per capita), as well as the enrichment and fortification programs with this mineral (Monge-Rojas et al, 2021) (National Council of Milk Producers., 2017. P sources, in this case, are primarily of plant origin, so P bioavailability analyses should be carried out.…”