Article - Micro- and Macronutrient Intake in Elderly Costa Ricans: The Costa Rican Longevity and Healthy Aging Study (CRELES).

Plain Language Summary

Life expectancy in Costa Rica, a middle-income country, is similar to that of high-income countries, with diet being a possible factor. The aim of this study was to compare the macro- and micronutrient intake of urban and rural Costa Ricans aged 60 years or more, using data from a nationally representative longitudinal survey of health and life course experiences in 3000 participants, the Costa Rican Longevity and Healthy Aging Study (CRELES). Compared to urban dwellers, rural Costa Ricans consumed on average more carbohydrates, but with an overall lower glycaemic index, more fibre, more palm oil, iron, and saturated fat but less soya oil, alcohol, calcium, total fat, mono- and poly-unsaturated fats, and total calories. Rural Costa Ricans had on average a lower body mass index and total cholesterol, and were less likely to smoke, whilst their education standard was lower. There were no differences in exercise levels, HDL and LDL cholesterol, triglycerides or prevalence of hypertension and diabetes between rural and urban dwellers.

Expert Review

Reviewer: Karin Elgar

13th Nov 2024

Conflict of interest

None

Take home message

Adherence to traditional Costa Rican diets may support longevity.
Such dietary patterns may include high intake of carbohydrates with a low glycaemic index and high fibre content, low alcohol consumption, low overall fat consumption but higher intake of saturated fats.

Evidence category

C: Non-randomized trials, observational studies, narrative reviews

Summary review

Introduction

Costa Rica is a middle-income country but has a life-expectancy similar to high-income countries which is attributed, at least in part, to dietary factors.
The aim of this study was to characterise and compare the diets of rural and urban elderly Costa Ricans using data from the nationally representative Costa Rican Longevity and Healthy Aging Study (CRELES).

Methods

CRELES is a longitudinal survey of health and life course experiences of 2819 elderly Costa Ricans aged 60 and older which includes a validated 27 item food frequency questionnaire.
The survey was conducted with household interviews and gathered information on health status, living conditions, medical history and socioeconomic status.
Statistical analysis was conducted to examine the rural and urban differences, as well as gender differences in food and nutrient intakes.

Results

Total caloric intake was lower in rural versus urban areas because rural elderly women had lower energy consumption compared to urban elderly women, whereas men consumed similar calories.
Compared to their urban counterparts, rural Costa Ricans were less likely to be high-school graduates and alcohol drinkers, more likely to be smokers and had lower body mass index (BMI) and total cholesterol levels.
Elderly rural residents had a lower intake of total, mono- and omega-3 and 6 poly-unsaturated fats than urban residents but had a higher intake of palm oil and consumed less soybean oil.
Rural Costa Ricans had lower average alcohol and calcium intakes, a higher dietary fibre and iron intake and were less likely to use multivitamin supplements.
Rural elderly Costa Ricans also had a higher overall carbohydrate intake but a lower mean glycaemic index and a higher fibre intake compared to urban dwellers.

Conclusion

The authors conclude that the traditional rural dietary pattern may explain the lower mortality seen in older Costa Ricans in certain rural areas compared to urban residents.

Clinical practice applications

The adoption of traditional dietary patterns in Costa Rica may be recommended to support longevity.
Such dietary patterns may include high intake of carbohydrates with a low glycaemic index and high fibre content, low alcohol consumption, low overall fat consumption but higher intake of saturated fats.

Considerations for future research

Research into other traditional dietary patterns across the globe could be carried out and compared to identify whether there are universal aspects with regards to macro- and micronutrient intakes as well as specific food groups which are associated with better health outcomes.

Expert reviews are written by nutrition professionals and academics with advanced qualifications to provide a critical appraisal of the article and implications for practice. Each review is peer-reviewed by a member of the NED Editorial Board. Find out more about our NED Expert Reviewers here.

Abstract

Costa Rica, a middle-income country in Central America, has a life expectancy similar or even higher than richer countries. This survival advantage is more evident among the elderly, who have one of the lowest mortality rates in the world. Dietary factors may play a role in this extended longevity. We have shown that a traditional rural diet is associated with longer leukocyte telomere length-a biomarker of aging-among elderly Costa Ricans. In the present study, we used data from the Costa Rican Longevity and Healthy Aging Study (CRELES) to characterize further rural and urban diets of the elderly (60+ years). A validated food frequency questionnaire was used to assess usual diet. We used energy-adjusted regression models to compare the intake of micro- and macronutrients between rural and urban regions of the country. Elderly rural residents had a higher consumption of carbohydrates (but lower glycemic index), fiber, dietary iron, and used more palm oil for cooking than elderly urban dwellers. On the other hand, elderly subjects living in urban areas had a higher intake of total fat, mono and polyunsaturated fat, alcohol and dietary calcium compared to elderly rural residents. Our results are similar to earlier reports of middle-aged Costa Ricans and add to the characterization of diet differences in rural and urban regions of the country.