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.
Highlights
During the last 20 years, the diet quality of Costa Rican adolescents has deteriorated
Few studies— in Latin America—have analyzed the diets of adolescents living in rural vs. urban areas or belonging to different socioeconomic strata. These studies generally show that adolescents from rural areas tend to have a healthier diet, as we have shown in Costa Rica, a middle-income country [29, 30], results from other countries have been mixed [31,32,33,34]
Using the Traditional Costa Rican Adolescents Diet (TCRAD) score revealed that only about 40% of Costa Rican adolescents had a closer adherence to a more-traditional Costa Rican adolescent dietary pattern
Summary
During the last 20 years, the diet quality of Costa Rican adolescents has deteriorated. Traditional diet scores have been developed in Mediterranean countries [10], Japan [11], Mexico [12, 13], and Sweden [14] to assess and guide an individual’s dietary intake that align with cultural preferences. The use of international populationspecific diet quality scores has been recommended because their components reflect staple traditional food groups [15]. One solution is to use culturally appropriate food and nutrient components to define a traditional diet quality score adapted to the specific food culture of a population group, as it has been done in Mexico, Japan and Sweden [11,12,13,14]
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