Universidad Hispanoamericana
  • San José, Costa Rica
Recent publications
Published studies report inconsistent associations of polyunsaturated fatty acid (PUFA) intake with non-Hodgkin lymphoma (NHL) risk. We conducted a nested case-control study in Nurses' Health Study and Health Professionals Follow-Up Study participants to evaluate a hypothesis of inverse association of pre-diagnosis red blood cell (RBC) membrane PUFA levels with risk of NHL endpoints. We confirmed 583 NHL cases and matched 583 controls by cohort/sex, age, race and blood draw date/time. We estimated odds ratios (OR) and 95% confidence intervals (CI) for risk of NHL endpoints using logistic regression. RBC PUFA levels were not associated with all NHL risk; cis 20:2n-6 was associated with follicular lymphoma risk (OR [95% CI] per one standard deviation increase: 1.35 [1.03-1.77]), and the omega-6/omega-3 PUFA ratio was associated with diffuse large B-cell lymphoma risk (2.33 [1.23-4.43]). Overall, PUFA did not demonstrate a role in NHL etiology; the two unexpected positive associations lack clear biologic explanations.
Post-exercise rehydration has been widely studied, with particular emphasis on retention of ingested fluid; comparatively little research has been conducted on why we drink more or less. To identify physiological values corresponding to voluntary drinking cessation (VDC), nine males exercised intermittently at 70–80% HRmax in the heat (WBGT = 28.1 ± 0.7 °C) to achieve a dehydration of approximately 4.0% body mass (BM). After exercise, participants were instructed to drink water as long and as much as they needed. Urine color (Ucolor), specific gravity (USG), osmolality (Uosm), plasma osmolality (Posm), fullness, BM, and thirst perception (TP) were measured pre- and post-exercise and at VDC. Each variable was compared for the three points in time with a one-way ANOVA. Participants reached dehydration of −3.6 ± 0.3% BM. Pre-exercise USG (1.022 ± 0.004) was lower than at VDC (1.029 ± 0.004, p = 0.022), Uosm did not change over time (p = 0.217), and Ucolor was lower pre-exercise (3.4 ± 0.7) vs. post-exercise (5.5 ± 1.23, p = 0.0008) and vs. VDC (6.3 ± 1.1, p < 0.0001). Posm showed a difference between pre-exercise (289.5 ± 2.3) and post-exercise (297.8 ± 3.9, p = 0.0006) and between post-exercise and VDC (287.3 ± 5.4, p < 0.0001). TP post-exercise (96.4 ± 4.34) was significantly higher than pre-exercise (36.2 ± 19.1) and VDC (25.0 ± 18.2, p < 0.0001). At VDC, participants had recovered 58.7 ± 12.1% of BM loss. At the point of voluntary drinking cessation, Posm and thirst perception had returned to their pre-exercise values, while rehydration relative to initial BM was still incomplete.
The project is developed for Industrial Engineering Schools in the Latin American context, developing two critical aspects of higher education centers: the employability of students after their training and the role of the University in establishing the facilities to achieve it. The main objective of this study is to characterize the current situation of the employability of Industrial Engineering graduates through the measurement of the current working conditions for the improvement of services and processes that this study demands. Although the study is carried out on high school and undergraduate graduates of industrial engineering, the improvements of services and processes, established as a result of the study, will influence all students of the participating universities and the employability study itself will serve as a basis for future studies extended to the other careers of the institutions. The research proceeds through a quantitative approach, descriptive correlational scope, and a non-experimental transectional correlational design; in which the program curriculum and employability are evaluated by means of a content analysis and questionnaires to graduates. The solutions refer to the establishment of strategic activities towards the integral strengthening of the career, which show the interest of the career with the commitment to academic excellence, through the process of continuous improvement applied in an institution of higher education.
To test the diagnostic ability of two combined practical markers for elevated urine osmolality (underhydration) in free-living adults and children. One hundred and one healthy adults (females n = 52, 40 ± 14 y, 1.70 ± 0.95 m, 76.7 ± 17.4 kg, 26.5 ± 5.5 kg/m²) and 210 children (females = 105, 1.49 ± 0.13 m, 43.4 ± 12.6 kg, 19.2 ± 3.2 kg m⁻²) collected urine for 24-h. Urine was analyzed for urine osmolality (UOsm), color (UC), while the number of voids (void) was also recorded. Receiver Operating Characteristic (ROC) analysis was performed for UC, void, and combination of UC and void, to determine markers’ diagnostic ability for detecting underhydration based on elevated UOsm (UOsm ≥ 800 mmol kg⁻¹). Linear regression analysis revealed that UC was significantly associated with UOsm in both adults (R² = 0.38; P < 0.001) and children (R² = 0.45; P < 0.001). Void was significantly associated with UOsm in both adults (R² = 0.13; P < 0.001) and children (R² = 0.15; P < 0.001). In adults, when UC > 3 and void <7 were combined, the overall diagnostic ability for underhydration was 97% with sensitivity and specificity of 100% and 88%, respectively. In children, UC > 3 and void <5 had an overall diagnostic ability for underhydration of 89% with sensitivity and specificity of 100% and 62%, respectively. Urine color alone and the combination of urine color with void number can a valid and simple field-measure to detect underhydration based on elevated urine osmolality.
The purpose of this investigation was to assess the validity and reliability of a seven-day water frequency questionnaire (TWI-FQ) to estimate daily total water intake (TWI) in comparison to a water turnover objective reference value via deuterium oxide (D 2 O). Data collection occurred over 3 weeks, with a wash-out period during week two. Healthy adults ( n = 98; 52% female; 41 ± 14 y; BMI, 26.4 ± 5.5 kg·m ⁻² ) retrospectively self-reported consumption frequencies of 17 liquids and 35 foods with specified volumes/amounts for weeks one and three via TWI-FQ. Standard water content values were utilized to determine the volume of water consumed from each liquid and food for calculation of mean daily TWI for each week. Diet records were completed daily during week two to estimate metabolic water production. To assess validity of the TWI-FQ, participants consumed D 2 O at the start of each week and provided urine samples immediately before ingestion, the following day, and at the end of the week to calculate water turnover. Metabolic water was subtracted from water turnover to estimate TWI. TWI-FQ validity was assessed via Bland-Altman plot for multiple observations. Reliability was assessed via intraclass correlation and Pearson's correlation between weeks. TWI-FQ significantly underestimated D 2 O TWI by −350 ± 1,431 mL·d ⁻¹ (95% confidence interval (CI): −551, −149 mL·d ⁻¹ ). TWI-FQ TWI was significantly correlated ( r = 0.707, P <0.01) and not different (198 ± 1,180 mL·d ⁻¹ , 95% CI: −38, 435 mL·d ⁻¹ ) between weeks. TWI-FQ intraclass correlation = 0.706 was significant [95% CI: 0.591, 0.793; F (97, 98) = 5.799], indicating moderate test-retest reliability. While this tool would not be suitable for individual TWI assessment, the magnitude of bias may be acceptable for assessment at the sample-level.
Background: The gap between the nutrition education provided to medical students and the nutritional competencies and attitudes needed for physicians to provide adequate nutritional care is a global concern. There is no universally accepted benchmark on nutrition competencies for doctors. The objective of this study was to establish, by expert consensus, the objectives of undergraduate nutrition medial education, the nutrition core competencies, and strategies for curriculum development in medical nutrition education. Methods: We administered a Delphi survey to systematically gather the opinion of a panel of Latin-American experts in nutrition. The survey questionnaire was constructed considering scientific literature using a five-point Linkert scale. Consensus was defined as a higher than 70% agreement on the importance of an item (Likert scale 4 and 5). Results: A four-round Delphi survey was conducted for this research. In the second, third and fourth rounds, we validated by consensus a total of 130 competences, which were distributed into four different thematic areas: 1) Basic nutrition concepts, 2) Public nutrition and nutritional prevention throughout the life cycle, 3) Nutritional status and disease, and 4) Nutritional care process. Conclusion: The curricula for general physician education in medical school must include health promotion, prevention, and treatment of diseases related to nutrition. This goal can be reached by integrating at least 130 competencies into four different fundamental areas. This article is protected by copyright. All rights reserved.
Only a few studies primarily examined the associations between starchy vegetables (other than potatoes) and metabolic syndrome (MetS). We aimed to evaluate the association between starchy vegetables consumption and MetS in a population-based sample of Costa Rican adults. We hypothesized that a higher overall intake of starchy vegetables would not be associated with higher MetS prevalence. In this cross-sectional study, log-binomial regression models were used to estimate prevalence ratios (PRs) of MetS across quintiles of total, unhealthy, healthy starchy vegetables, and individual starchy vegetables (potatoes, purple sweet potatoes, etc.), among 1881 Costa Rican adults. Least square means and 95% confidence intervals (CIs) from linear regression models were estimated for each MetS component by categories of starchy vegetable variables. Higher intakes of starchy vegetables were associated with a higher prevalence of MetS in crude models, but no significant trends were observed after adjusting for confounders. A significant inverse association was observed between total starchy and healthy starchy vegetables consumption and fasting blood glucose. In this population, starchy vegetables might be part of a healthy dietary pattern.
Rationale: The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective and efficient nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools, and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final year medical students. Methods: Eighty-five public and private medical schools from 17 Latin American and Caribbean countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. Results: A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0-150). 1,530 of 1,630 (94%) students from 12 countries responded. Students´ average age was 25±3 years, and 59% were female. Most students agreed that improving patients' health through nutrition (91%) is important and that nutritional counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. Conclusions: Positive attitude and interest in nutrition among final year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition. This article is protected by copyright. All rights reserved.
Background Food timing affects circadian rhythms involved in weight control. Regular consumption of breakfast may affect body weight. Objective We examined the relation between breakfast frequency with weight change in middle-age women over a 3-y period. Methods We used data from 65,099 nonpregnant women aged >20 y participating in the Mexican Teachers’ Cohort (MTC) who at baseline (2006–2008) were cancer free and for whom self-reported breakfast frequency at baseline was available. We analyzed body weight change between baseline and the first follow-up (2011) according to breakfast frequency. Participants were classified according to baseline breakfast frequency 0, 1–3, 4–6, or 7 d/wk and meal frequency 1–2, 3–4, or ≥5 meals/d. We used linear and modified Poisson regression to analyze body weight change as a continuous variable and for weight gain ≥5 kg (yes/no), respectively. Models were adjusted for sociodemographic and lifestyle confounders. Results At baseline, 25% of participants were daily breakfast consumers and 18.4% of women increased ≥5 kg between 2008 and 2011. The prevalence of weight gain ≥5 kg among daily breakfast consumers was 7% lower than among those who skipped breakfast (prevalence ratio: 0.93; 95% CI: 0.89, 0.97; P-trend = 0.02). The association was stronger among normal-weight women at baseline with a corresponding estimate of 0.87 (95% CI: 0.79, 0.97; P-trend = 0.02). Conclusion Daily breakfast consumption was inversely associated with weight gain ≥5 kg over 3 y in middle-aged Mexican women. Regular breakfast may be an important dietary factor for body weight change.
Background: Trans fatty acid (TFA) intake persists in much of the world, posing ongoing threats to public health that warrant further elucidation. Published evidence suggests a positive association of self-reported TFA intake with non-Hodgkin lymphoma (NHL) risk. Objectives: To confirm those reports, we conducted a prospective study of prediagnosis RBC membrane TFA levels and risk of NHL and common NHL histologic subtypes. Methods: We conducted a nested case-control study in Nurses' Health Study and Health Professionals Follow-Up Study participants with archived RBC specimens and no history of cancer at blood draw (1989-1090 and 1994-1995, respectively). We confirmed 583 incident NHL cases (332 women and 251 men) and individually matched 583 controls on cohort (sex), age, race, and blood draw date/time. We analyzed RBC membrane TFA using GLC (in 2013-2014) and expressed individual TFA levels as a percentage of total fatty acids. We used unconditional logistic regression adjusted for the matching factors to estimate ORs and 95% CIs for overall NHL risk per 1 SD increase in TFA level and assessed histologic subtype-specific associations with multivariable polytomous logistic regression. Results: Total and individual TFA levels were not associated with risk of all NHL or most subtypes. We observed a positive association of total TFA levels with diffuse large B cell lymphoma (DLBCL) risk [n = 98 cases; OR (95% CI) per 1 SD increase: 1.30 (1.05, 1.61); P = 0.015], driven by trans 18:1n-9(ω-9)/elaidic acid [OR (95% CI): 1.34 (1.08, 1.66); P = 0.007], trans 18:1n-7/vaccenic acid [OR (95% CI): 1.28 (1.04, 1.58); P = 0.023], and trans 18:2n-6t,t [OR (95% CI): 1.26 (1.01, 1.57); P = 0.037]. Conclusions: Our findings extended evidence for TFA intake and DLBCL risk but not for other NHL subtypes. Reduced TFA consumption through dietary choices or health policy measures may support prevention of DLBCL, an aggressive NHL subtype.
Purpose Several epidemiologic investigations have found associations between the consumption of red meat and the metabolic syndrome (MetS). Very few studies have looked at populations undergoing the nutrition transition with smaller levels of red meat consumption than those in Westernized countries. In this population-based cross-sectional study, we examined the association between red meat consumption and MetS in Costa Rican adults, a population with comparably lower consumption of red meat. Methods Prevalence ratios (PRs) of MetS across quintiles of total, unprocessed, and processed red meat consumption were estimated with log-binomial regression models among 2058 adults from the Costa Rican Heart Study. Least-squares mean values of individual components of MetS across quintiles of red meat consumption were estimated with linear regression models. Results We observed a significant positive association between total red meat consumption and MetS (PR for highest compared to lowest quintile: 1.21; 95% CI: 1.03, 1.42; P for trend = 0.0113) but not for unprocessed or processed red meat consumption when analyzed separately after mutual adjustments. We additionally observed a significant positive association between total, unprocessed, and processed red meat consumption and abdominal obesity. Conclusion In this Hispanic population undergoing the nutrition transition, total red meat intake may have an impact on MetS. Based on the relatively low consumption of red meat in Costa Rica compared to other Westernized countries, we hypothesize that a “threshold effect” may exist for unprocessed and processed red meat.
Objetivo: analizar las principales características epidemiológicas de la mortalidad por infarto del miocardio en Costa Rica de 1970 al 2014. Métodos: los datos del número de muertos por IAM para todas las edades y de la población del país se obtuvieron consultando anuarios y bases de datos del Instituto Nacional de Estadística y del Centro de Población de la Universidad de Costa Rica (UCR). Con ellos se obtuvieron las tasas brutas y estandarizadas, “suavizadas” por promedios móviles y quinquenales, así como la relación porcentual con la mortalidad general. Posteriormente, se calcularon las tasas estandarizadas de mortalidad por IAM para el grupo de 35 a 74 años, por sexo y provincia. Resultados: la tendencia permite distinguir dos épocas definidas. Una de ascenso que ocurre desde 1970 hasta finales de la década de los años noventa. La otra en los primeros años del siglo XXI con inclinación hacia el descenso. Esto se observa con las tasas de promedios móviles y quinquenales, especialmente en el grupo de 35 a 74 años (hombres, r=0.99, r2=094, betha=-6.67, p=0.00, mujeres r=0.97, r2=0.94, betha= -6.67, p=0.01, ambos sexos r=0.97, r2=0.94, betha=-7.42, p=0.01). Conclusiones: pese a una leve tendencia a la disminución de la mortalidad por IAM en estos últimos quince años, el IAM continuará siendo un grave problema de salud en Costa Rica y para revertir la situación, tendrá el gobierno nacional que continuar esforzándose en disminuir la prevalencia de los principales factores de riesgo de las ECNT y en mejorar la atención del paciente que tiene la enfermedad.
Objective: To update some important aspects of the descriptive epidemiology of ischemic heart (EIC) disease in Costa Rica during the period 1970-2014. Methods: EIC death rates were obtained in two periods: from 1930 to 1969 and then, for a more specific analysis, from 1970 to 2014, using moving and five-year averages, based on data from the Instituto Nacional de Estadística and the Centro Centroamericano de Población, to analyze them according to age, sex, geographical location and percentage contribution to the general mortality. Information was also obtained to determine the burden of the disease, in this case through Years of Adjusted Life for Disability, Years of Life Lost and Years of Life lost due to Disability. Results: There was a rise in rates in the general population, with greater momentum in the population from 35 to 74 years, up to the five-year period 1995-1999, after which a decline began that apparently stopped during the five-year period 2010-2014 (both sexes: r = 0.9964, r2 = 0.9928, β = -2.4950, p 0.04; men: r = 0.9994, r2 = 0.9988, β = -2.770, p = 0.02; women: r = 0.9896, r2 = 0.9793, β = -2.4950, p = 0.07). The highest rates occur in the provinces of the center of the country. It predominates during the whole period in the male sex and represents on average 14% of the general mortality. Conclusions: Mortality due to EIC is in a phase of decline but the increase in obesity and overweight in the country threatens to slow down this trend, at least during the last five years.
Background: Proper hydration is vital for both exercise and general health. Although various methods for hydration assessment exist, many are not valid for either use or never tested. Introduction: The purpose of this study was to determine whether the uChek© smart phone application can be used to diagnose underhydration based on elevated urine specific gravity (USG) assessed by refractometry. Methods: One hundred forty-seven (n = 147) fresh human urine samples from young and middle-age adults were analyzed for USG with a refractometer and the uChek© application by reading the Siemens Multistix 10G urine reagent strip. Results: Bland-Altman analysis showed agreement of the two methods of assessment. Overall diagnostic ability of the uChek© to identify underhydration was fair (area under the curve 79%). However, the sensitivity to correctly identify underhydration was poor (60%) as well as the specificity of correctly identifying euhydration (53%). Conclusion: The uChek© application does not accurately detect underhydration.
Objective: To update some important aspects of the descriptive epidemiology of ischemic heart (EIC) disease in Costa Rica during the period 1970-2014. Methods: EIC death rates were obtained in two periods: from 1930 to 1969 and then, for a more specific analysis, from 1970 to 2014, using moving and five-year averages, based on data from the Instituto Nacional de Estadística and the Centro Centroamericano de Población, to analyze them according to age, sex, geographical location and percentage contribution to the general mortality. Information was also obtained to determine the burden of the disease, in this case through Years of Adjusted Life for Disability, Years of Life Lost and Years of Life lost due to Disability. Results: There was a rise in rates in the general population, with greater momentum in the population from 35 to 74 years, up to the five-year period 1995-1999, after which a decline began that apparently stopped during the five-year period 2010-2014 (both sexes: r = 0.9964, r² = 0.9928, β = -2.4950, p 0.04; men: r = 0.9994, r² = 0.9988, β = -2.770, p = 0.02; women: r = 0.9896, r² = 0.9793, β = -2.4950, p = 0.07). The highest rates occur in the provinces of the center of the country. It predominates during the whole period in the male sex and represents on average 14% of the general mortality. Conclusions: Mortality due to EIC is in a phase of decline but the increase in obesity and overweight in the country threatens to slow down this trend, at least during the last five years.
Background: Epidemiological evidence supports an association between sugar-sweetened soda consumption and diabetes. However, evidence regarding this association is limited in countries that have recently undergone a nutritional transition. Objective: We estimated the association between sugar-sweetened soda consumption and incident diabetes. We also determined if the association between sugar-sweetened soda and diabetes differs as a result of early life factors and potential genetic susceptibility. Methods: We used data from the Mexican Teachers’ Cohort including 72,667 women aged ≥25 y, free of diabetes, cardiovascular disease, and cancer at baseline. We assessed sugar-sweetened soda consumption using a validated food frequency questionnaire (FFQ) at baseline. Diabetes was self-reported. We used Cox proportional hazard regression models to estimate the association between quintiles of sugar-sweetend soda and diabetes. We also estimated the associaiton by increasing one serving per day (355 mL) of sugar-sweetened soda. We conducted prespecified subgroup analysis by potential effect modifiers, namely markers of energy balance of early life factors, family history of diabetes, and Amerindian admixture. Results: During a median follow-up of 2.16 y (IQR 0.75–4.50) we identified 3,155 incident cases of diabetes. The median consumption of sugar-sweetened soda was 1.17 servings per day (IQR 0.47– 4.00). In multivariable analyses, comparing extreme quintiles showed that higher sugar-sweetened soda consumption was associated with diabetes incidence (HR = 1.32; 95% CI: 1.17, 1.49), and each additional serving per day of sugar-sweetened soda was associated with an increase of 27% in diabetes incidence (HR = 1.27; 95% CI: 1.16, 1.38). The soda–diabetes association was stronger among women who experienced intrauterine and childhood over-nutrition (high birth weight, no short stature, higher adiposity in premenarche, and higher adiposity at age 18–20 y old). Conclusion: Sugar-sweetened soda consumption is associated with an increased risk of diabetes among Mexican women in a magnitude similar to that reported in other populations. The stronger association among individuals with markers of early life over-nutrition reinforce the need for early life interventions.
Institution pages aggregate content on ResearchGate related to an institution. The members listed on this page have self-identified as being affiliated with this institution. Publications listed on this page were identified by our algorithms as relating to this institution. This page was not created or approved by the institution. If you represent an institution and have questions about these pages or wish to report inaccurate content, you can contact us here.
Information
Address
San José, Costa Rica