Roxana Torres

Diet Quality, Social Determinants, and Weight Status in Puerto Rican Children Aged 12 Years

Diet quality may be influenced by social determinants and weight status. This has not been studied in Puerto Rico; therefore, our cross-sectional study examined whether diet quality, assessed by the Healthy Eating Index-2005 (HEI-2005), differs by social determinants (sex, school type, and region) and weight status in children in Puerto Rico. As part of an island-wide study to evaluate oral health in 1,550 children aged 12 years, dietary intake was assessed in a representative subset (n=796) using a 24-hour diet recall. Diet quality was evaluated from the diet recall results using the HEI-2005. Overall mean HEI-2005 score was 40.9, out of a total maximum score of 100. Girls had significantly higher scores for whole fruit, total vegetables, whole grains, and sodium but lower scores for total grains and milk compared with boys (P<0.05). Children from public schools had higher scores for total fruit, whole fruit, and dark green and orange vegetables and legumes, but lower scores for whole grains and milk compared with those from private schools (P<0.05). Children from the central mountains had higher scores for the dark green and orange vegetables and legumes and for whole fruit compared with the other regions (P<0.05). Overweight children had significantly higher scores for total vegetables and milk, but lower scores for total fruit and sodium compared with non-overweight children (P<0.01). Some components of diet quality were associated with the social determinants studied and with weight status in our sample. Overall diet quality needs improvement in Puerto Rican children so that it is better aligned with dietary recommendations.

High prevalence of overweight and obesity among a representative sample of Puerto Rican children

BackgroundThe prevalence of childhood overweight and obesity has become a public health problem worldwide. The objectives of the study were: 1) to establish the BMI prevalence in 12-year olds residing in Puerto Rico, and 2) to determine BMI differences by sex, public-private school type, and geographic regions.MethodsData was obtained from an island-wide probabilistic stratified sample of 1,582 twelve-year-olds (53% girls and 47% boys). The BMI was determined using the National Health and Nutrition Examination Survey procedures. Children were categorized as underweight, healthy weight, overweight or obese using the Center for Disease Control and Prevention’s age and gender specific growth charts. A logistic regression model was used to estimate BMI category prevalence. Odds ratios were calculated using a multinomial regression.ResultsIn this study, 18.8% of the children were overweight and 24.3% were obese. A higher prevalence of obesity was observed in boys as compared to girls, 28.2% vs. 20.2%, respectively. The estimated prevalence of overweight and obesity in children from public schools was lower than for those from private schools. After adjusting for type of school and region, boys had a significantly higher risk of being obese (64%) as compared to girls. In public schools, boys had a lower prevalence of being overweight while girls had a higher prevalence compared to children attending private schools. Girls attending private schools had a higher obesity prevalence (27.8%) compared to girls from public schools (19.8%). The prevalence of underweight (2.7%) is slightly lower than in the United States.ConclusionsThe prevalence of overweight and obesity of 12-year-olds residing in PR was 18.8% and 24.3%, respectively; higher than in the U.S. (by groups). Boys were at higher risk of obesity than girls. There is an urgent need to implement public health policies/programs to reduce the prevalence of overweight and obesity in children in PR.

Association between Type, Amount, and Pattern of Carbohydrate Consumption with Dental Caries in 12-Year-Olds in Puerto Rico

Objective: To identify the types, food sources, and pattern of carbohydrates that significantly contribute to dental caries in Puerto Rican children. Methods: As part of an island-wide cross-sectional oral health study in 1,587 twelve-year-olds, diet intake was assessed in a representative subset (n = 801) with a 24-hour dietary recall. Carbohydrate intake was quantified using a computer-based diet analysis program. Caries was assessed using the National Institute of Dental and Craniofacial Research diagnostic criteria. Odds ratios were used to associate carbohydrate intake quartiles with caries, after controlling for important confounders. Results: A total of 723 subjects had complete data. Most were females (54%) and attended public schools (77%). The caries prevalence was 33%. The highest quartile intake for the following sugars significantly increased the odds of caries compared to the lowest quartile: total carbohydrates (OR = 1.93, 95% CI = 1.08-3.46), total sugars (OR = 1.88, 95% CI = 1.01-351), sucrose (OR = 2.05, 95% CI = 1.13-3.70), fructose (OR = 1.95, 95% CI = 1.05-3.62), and inositol (OR = 2.52, 95% CI = 1.38-4.63). The main food sources of these sugars were juices, including natural juices with no added sugars, and sweetened beverages. The odds of caries also increased significantly in children whose 10% of total energy intake was from total sugars (OR = 3.76, 95% CI = 1.03-13.7). Conclusion: After adjusting for important caries risk factors, total carbohydrates, total sugars, ≥10% kilocaloric energy from total sugars, and sucrose, fructose, and inositol intake significantly increased caries risk. Our findings can help raise awareness about the potential caries risk from the main sources of these sugars, natural fruit juices and sweetened beverages, which are consumed in great quantities in many societies.

Micronutrient Intake among Children in Puerto Rico: Dietary and Multivitamin-Multimineral Supplement Sources

BACKGROUND Micronutrients are critical for healthy growth and development of children. Micronutrient intake from dietary sources is inadequate among some children and may be improved by use of multivitamin and multimineral (MVMM) supplements. OBJECTIVE To assess micronutrient intake from dietary and MVMM supplement sources among 12-year-old children in Puerto Rico. METHODS A representative sample of 732 children enrolled in an oral health study in Puerto Rico, who completed dietary and MVMM assessments through one 24-h recall, were included in this analysis. Micronutrient intake sources were described and compared to the Dietary Reference Intakes (DRIs) using the Estimated Average Requirement when available (used Adequate Intake for vitamin K and pantothenic acid). Micronutrient profiles of MVMM users and non-users were compared using t-tests. RESULTS Mean intakes of vitamins A, D, E, and K, pantothenic acid, calcium, and magnesium from food and beverage sources were below the DRIs. From food and beverage sources, MVMM users had higher intakes of riboflavin and folate compared to non-users (p < 0.05). When MVMM supplements were taken into account, users had higher intakes of all nutrients except vitamin K. With the help of MVMM, users increased intake of vitamins E, A, D, and pantothenic acid to IOM-recommended levels but calcium, magnesium, and vitamin K remained below guidelines. CONCLUSION Micronutrient intake from diet was below the IOM-recommended levels in the total sample. MVMM use improved intake of selected micronutrients and facilitated meeting recommendations for some nutrients. Public health measures to improve micronutrient intake among children in Puerto Rico are needed.