Role of Residence Area on Diet Diversity and Micronutrient Intake Adequacy in Urban and Rural Costa Rican Adolescents

Abstract

Dietary diversity might be essential to meet nutritional demands during adolescence. Diet diversity among 818 urban and rural Costa Rican adolescents aged 13–18 years was studied using the Minimum Dietary Diversity Score for Women. The Nutrient Adequacy Ratio (NAR) was calculated for 11 nutrients to estimate the nutrient adequacy of the diet. A NAR < 0.7 was considered inadequate for micronutrient intake. The optimal Diet Diversity Score (DDS) cut-off point for this study was 4, established using receiver-operating characteristic curves. The mean DDS for the overall sample was 4.17 ± 1.43, although DDS was significantly higher in adolescents from rural vs. urban areas (4.33 ± 1.43 vs. 4.00 ± 1.42, p-value = 0.001). The odds of having a diverse diet were 62% higher in rural vs. urban adolescents. Overall, 80–95% of adolescents reached a NAR ≥ 0.70 for 8 nutrients except for calcium, zinc, and vitamin A. The residence area plays a key role in adolescent dietary diversity. Although overall DDS was low, foods that make up the rural adolescent diet were nutritionally dense enough to satisfy the EAR for most micronutrients. A high DDS is not necessarily required for the diet to meet most micronutrient demands in adolescence. Improved dietary adequacy of vitamin A, zinc, and calcium is required due to the importance of these micronutrients in maintaining optimal health.

Minimum Dietary Diversity for Adolescents: Multicountry Analysis to Define Food Group Thresholds Predicting Micronutrient Adequacy among Girls and Boys Aged 10–19 Years

“…Similarly, MDD-W (i.e., ≥5 food groups) showed the best predictive capacity for an MPA > 0.60 among children (2–9 y) in China, whereas ≥6 food groups performed more adequately among adolescents, women, men, and the elderly (≥10 y) [ 22 ]. Lastly, among adolescents (13–18 y) in Costa Rica, ≥4 food group threshold best predicted a MAR of ≥0.70 [ 23 ].…”

Exploring Differences in Dietary Diversity and Micronutrient Adequacy between Costa Rican and Mexican Adolescents

“…A diverse diet becomes especially relevant during adolescence since, at this stage of life, nutrient requirements are notably high due to physical growth and biological maturation [1]. Various studies have shown that adolescents living in low-and middleincome countries have low dietary diversity and poor consumption of micronutrient-dense foods, leading to a high prevalence of inadequate intakes of vitamin A, iron, calcium, zinc, and folates [2][3][4][5][6][7], as well as a high prevalence of vitamin B12 deficiency, low serum zinc, and anemia [3].…”

“…Dietary diversity scores have been identified as promising measurement tools due to their simplicity of implementation compared to other complex and expensive methods used to monitor micronutrient intake [15]. Although it was validated and intended to be used as a proxy for micronutrient adequacy in women of reproductive age, the Minimum Dietary Diversity for Women (MDD-W) has shown its applicability in other population groups, including adolescents [5,6,18,19]. To simplify the use of the MDD-W, dichotomous versions of it have been proposed.…”

Reducing dietary intake of added sugars could affect the nutritional adequacy of vitamin A in adolescents: the Costa Rica case

“…However, considering the high prevalence of overweight/obesity among adolescents, the high consumption of added sugars, and the potentially significant amount of vit-A that added sugars could provide, a paradox arises for Costa Rican public health to reduce or prevent obesity during adolescence. Lowering the added sugar intake to less than 10% TEI could lead to a markedly inadequate vit-A intake in adolescents, especially since adolescents are poor consumers of animal food sources of vit-A and vit-A-rich fruits and vegetables [ 12 ].…”