Dietary Intake and Its Determinants Among Adults Living in the Metropolitan Area of Puerto Rico

Abstract

There is scarce information regarding the dietary intake of adults living in Puerto Rico (PR). We aimed to assess intake of nutrients and foods, adherence to recommended intake of nutrients and diet quality, and sociodemographic and lifestyle factors correlated with diet quality among adults in the San Juan metropolitan area of PR. Data were obtained from participants of the cross-sectional convenience-sample Puerto Rico Assessment of Diet, Lifestyle, and Diseases (n = 248; ages 30–75 years). Diet quality was defined using the Alternate Healthy Eating Index 2010 (AHEI; range 0–110 indicating lower–higher quality). Linear regression models were used to relate AHEI to sociodemographic and lifestyle factors. Most participants met the Estimated Average Requirement (EAR) for iron, folate, and vitamins B12 and B6; 61% met the EAR for magnesium and 56% for calcium. Only 4% met the EAR for vitamin D, and 7% met the adequate intake for potassium. The main contributors to total energy intake were sugary beverages (11.8%), sweets/desserts (10.2%), dairy (8.5%), mixed dishes (7.6%), starches (6.3%), fast foods (5.5%), and rice (4.9%). The mean (SD) AHEI score was 59.8 (11.0). The lowest AHEI components for which recommended servings were met were red/processed meats, fruit, sodium, sugary beverages, and polyunsaturated fats, and the highest were nuts/legumes, omega-3 fats, and whole grains. Significantly higher AHEI scores were noted for older adults, other ethnicities (vs. Puerto Rican), being single, having some college or higher education, and never/formerly smoking. Adults living in PR report healthy and unhealthy dietary intakes, providing an opportunity to improve diet at the population level.

Association of a Single-Item Self-Rated Diet Construct With Diet Quality Measured With the Alternate Healthy Eating Index

“…Nevertheless, our study is one of the first to evaluate and characterize perceptions of diet quality in relation to dietary intake patterns in adults living in PR—with striking disparities related to diet access and health, especially with regard to cardiovascular health ( 8 , 10 ). As many as 20% of health center patients have been reported to exhibit poor diet quality in PR ( 10 ).…”

“…As many as 20% of health center patients have been reported to exhibit poor diet quality in PR ( 10 ). Differences in diet quality have been observed between residents of PR vs. those of the contiguous US, with those in PR exhibiting significantly lower average overall, as well as lower component scores ( 8 , 10 ). This serves as impetus for future research on the relationship between food environment, culture, and diet quality.…”

“…Responding to this gap in the literature, our study aimed to evaluate the construct validity of a single-item SRD question and its association with measured diet quality among adults in Puerto Rico (PR). This setting is especially important as Puerto Ricans exhibit documented suboptimal dietary intake and associated risk of cardiometabolic diseases (8)(9)(10). We hypothesized that higher SRD would be associated with significantly higher measured diet quality.…”

Strategies for Healthy Eating Promotion and Behavioral Change Perceived as Effective by Nutrition Professionals: A Mixed-Methods Study

“…The foods that were mentioned as difficult to eliminate from the diet have all been reported as frequently consumed in PR, especially sugary beverages, sweets and desserts, fats and fried foods, and white rice ( 6 , 7 , 9 , 10 ). Other populations have also expressed a high preference for white rice, a staple food in the Latino culture, over potential substitutes such as brown rice, despite a willingness to reduce its intake ( 27 , 28 ).…”

“…Despite these efforts, following a healthy diet continues to be challenging, as evidenced by the low diet quality reported for most residents of the United States, with well-documented disparities for low socioeconomic and racial/ethnic minority groups ( 2 – 4 ). Specifically, the population of Puerto Rico (PR) has inequitable health-related behaviors, including low diet quality and poor nutritional intake ( 5 – 10 ), as well as the high prevalence of multiple chronic diseases that may be prevented by following a healthy lifestyle ( 11 ). It is thus important to understand which strategies for healthy eating may be appropriate for a population, especially underserved individuals with inequitable health.…”