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The urban jungle and allergy.

The urban forest is the assemblage of trees, shrubs, and other plants that occupy the urban and suburban zone. In urban areas, the number of potentially allergenic plants has grown rapidly as the diversity of plants increases. The recommended street trees of many cities are allergenic species that are well known to allergy clinicians. Some of the most commonly planted trees in urban zones are known to be the greatest producers of pollen. These trees are situated in close proximity to humans, either at home, at work, or on their travel routes between locations. There are common misconceptions about the plants that do and do not cause allergy. It generally has been considered that insect-pollinated plants with showy flowers are allergy safe; however, when these species are planted in close proximity to people, as they are in urban landscaping, the pollen that leaks from the flowers is often enough to cause an allergic reaction. With increasing emphasis on green space in urban areas, it is advisable to evaluate what is being planted, how much is planted, and the plants' potential for triggering allergy.

Allergens↗

Urban-rural variation in cancer incidence in Denmark 1943-1987.

Urban and rural cancer incidence in Denmark in 1943-1987 was analysed. A consistent urban excess was found for all sites combined for individuals of each sex, irrespective of age at diagnosis. The capital:rural incidence ratio was 1.42 for men and 1.25 for women, and these ratios were not affected to any great extent using another definition of urban areas. Urban:rural ratios were highest for cancers of the respiratory, urinary and upper digestive tracts. The differences cannot be explained by tobacco and alcohol consumption alone. Other risk factors linked to urbanisation may contribute importantly to the "urban factor", and analytical studies of data at an individual level are required to establish their relative importance. Our findings contradict the generally accepted view that there is no urban-rural difference in cancer incidence in the relatively small, homogeneous population of Denmark.

Denmark↗

No evidence of time trends in the urban-rural differences in schizophrenia risk among five million people born in Denmark from 1910 to 1986.

BACKGROUND: There have been conflicting reports on time trends in urban-rural differences in the incidence of schizophrenia. This study explored the potential time trends in these differences with regard to birth cohort and age at onset. METHOD: Linking data from the Danish Civil Registration system with data from the Danish Psychiatric Central Register, a cohort born in Denmark from 1910 to 1986 was established (5.05 million people). Overall, 23051 people were classified with schizophrenia in 1970-2001. RESULTS: Urban-rural differences in schizophrenia risk may have existed for people born in Denmark since 1910, and have existed at a constant level for people born from 1945 to 1986. Males aged <20 years had a risk of 3.90 [95% confidence interval (CI) 3.28-4.65] associated with urban birth while males >or=20 years had a risk of 2.12 (1.98-2.27). Females <20 years had a risk of 2.49 (95% CI 2.01-3.09) associated with urban birth while females >or=20 years had a risk of 1.90 (95% CI 1.74-2.08). At age 46, 1.84% (95% CI 1.76-1.93) of males and 1.05% (95% CI 0.99-1.12) of females born in the capital area had developed schizophrenia, while 0.81% (95% CI 0.75-0.86) of males and 0.56% (95% CI 0.51-0.60) of females born in the rural area had developed schizophrenia. CONCLUSIONS: There was no evidence of time trends in the urban-rural differences in the incidence of schizophrenia in Denmark, suggesting that the cause(s) responsible for these differences were not related to exposures that became more prevalent in urban areas over time. This finding is in contrast to findings from Finland and The Netherlands.

Adolescent↗

Urbanization and risk for schizophrenia: does the effect operate before or around the time of illness onset?

BACKGROUND: Higher level of urbanicity of place of birth and of place of residence at the time of illness onset has been shown to increase the risk for adult schizophrenia. However, because urban birth and urban residence are strongly correlated, no conclusions can be drawn about the timing of the risk-increasing effect. The current study discriminated between any effect of urbanization before and around the time of illness onset. METHODS: All individuals born between 1972 and 1978 were followed up through the Dutch National Psychiatric Case Register for first admission for schizophrenia until 1995 (maximum age 23 years). Exposure status was defined by a combination of place of birth and place of residence at the time of illness onset in the three most densely populated provinces of the Netherlands (the 'Randstad', exposed) or in all other areas (the 'non-Randstad', non-exposed). The risk for schizophrenia was examined in four different exposure groups: non-exposed born and non-exposed resident (NbNr, reference category), non-exposed born and exposed resident (NbEr), exposed born and non-exposed resident (EbNr) and exposed born and exposed resident (EbEr). RESULTS: The greatest risk for schizophrenia was found in the EbNR group, without evidence for any additive effect of urban residence (rate ratio (RR) for narrow schizophrenia in EbNr group, 2.05 (95 % CI 1.18-3-57); in EbEr group, 1.96 (95% CI, 1.55-2.46)). Individuals who were not exposed at birth, but became so later in life, were not at increased risk of developing schizophrenia (RR for narrow schizophrenia in NbEr group, 0.79 (0.46-1.36)). CONCLUSION: The results suggest that environmental factors associated with urbanization increase the risk for schizophrenia before rather than around the time of illness onset.

Adolescent↗

Mood and anxiety disorders among rural, urban, and metropolitan residents in the United States.

OBJECTIVE: To estimate the correlates of mood and anxiety disorders among rural, urban and metropolitan residents in the United States. METHODS: We analyzed the National Co-morbidity Survey (NCS), which yields the distribution and correlates of psychiatric disorders in a probability sample of U.S. population using DSM-III-R for diagnosis. Logistic regressions of mood and anxiety disorders were stratified by geographical area. RESULTS: We found gender differences in mood disorders among urban (O.R. = 1.8, P < 0.0001) and metropolitan (O.R. = 1.6, P < 0.0001) but not among rural residents. Rural (O.R. = 0.2, P < 0.05) and urban (O.R. = 0.5, P < 0.05) African Americans were less likely to report mood disorders compared to rural and urban Whites. Similarly, we found gender differences in anxiety disorders among urban (O.R. = 2.0, P < 0.0001) and metropolitan (O.R. = 1.7, P < 0.0001), but not among rural residents. CONCLUSION: Rural men reported more mood and anxiety disorders than urban men, thus erasing expected rural gender differences in these disorders. Rural male mood and anxiety disorders may be a function of diminishing resources (steady, high paying jobs) or increasing financial strain particularly among Whites, who comprise a majority of rural residents.

Adolescent↗

Prevalence of Actinobacillus actinomycetemcomitans and clinical conditions in children and adolescents from rural and urban areas of central Italy.

BACKGROUND: The aim of this study was to report on the prevalence of Actinobacillus actinomycetemcomitans (Aa) and the periodontal clinical conditions in children and adolescents from a rural area of central Italy compared with the ones from an urban area of the same region. METHOD: The study population consisted of 780 systemically healthy children, aged 6-14 years inhabiting the county of Chieti. 505 children attended 3 primary and 2 secondary schools from a rural area whereas 275 individuals attended 1 primary and 1 secondary school from the city of Chieti. The 2 provincial areas present a great difference in socioeconomic level and cultural background. Clinical examination consisted of recording the % of gingival sites positive for the presence of plaque (P1+), bleeding on probing (BOP+), mean probing depth (PD) from each primary or permanent tooth fully erupted in the oral cavity. Loss of periodontal attachment (AL+) was evaluated only in interproximal sites. AL+ subjects were distinguished in juvenile periodontitis (JP) prepubertal periodontis and early periodontitis (EP) patients. 8 gingival sites were microbiologically sampled in each subject and cultured, after pooling, for the presence of Aa. RESULTS: 30.3% of rural subjects, were positive for the presence of Aa, the difference from urban children (16%) being statistically significant (p=0.01) irrespective of gender and age. Aa showed a significantly (p=0.006) higher mean proportion in subgingival plaque samples from rural children (0.13% versus 0.02%). Loss of periodontal attachment in at least one site was found in 18 rural children (3.56%) (3 JP; 15 EP) and 2 urban girls (0.72%)(1 JP; 1 EP). No significant differences for AL were observed within the rural group according to the gender and age differentiation. In the urban group, both AL+ subjects were Aa+, while among children from rural areas all 3 JP and 13 EP subjects were Aa+. Rural subjects evidenced significantly worse clinical parameters with respect to urban children (% PI+ sites: p=0.000; % BOP+ sites: p=0.010; mean PD: p=0.000.) The relative risk for AL+ sites was significantly greater (2.42) in rural subjects harboring Aa in subgingival plaque. Similarly, the presence of Aa in subgingival plaque was related to a greater risk of more than 50% of BOP+ gingival sites in both rural and urban subjects (1.45 and 8.40, respectively). CONCLUSIONS: Results of this study suggest that Aa colonization in children and adolescents from central Italy is affected by socioeconomic and cultural factors; these factors also affect the periodontal condition of the subjects.

Adolescent↗

Oral hygiene and sugar consumption among urban and rural adolescents in Ghana.

OBJECTIVES: The purpose of this study was to compare categories of self-reported oral health behavior among adolescents raised in urban and rural areas of Ghana. METHODS: Second year students (n=583) aged 14-18 years were selected from the five secondary schools in the Awutu-Effutu Senya district, using a stratified random sampling procedure. A total of 504 (86%) students completed questionnaires under supervision at school. RESULTS: Cross-tabulation analyses revealed that most urban and rural residents (97% and 96%) reported daily tooth brushing, whereas small and moderate proportions reported use of toothpicks and intake of sugared snacks, respectively. Multiple logistic regression analyses, controlling for gender and parents' education, showed that the socio-regional context (urban/rural) was significantly related to intake of cakes/biscuits (odds ratio (OR)=2.6, 95% CI 1.7-4.4), chocolate/sweets (OR=3.5, 95% CI 2.0-6.0) and use of toothpicks (OR=2.6, 95% CI 1.3-5.5), indicating true differences between urban and rural residents. CONCLUSION: As predicted, urban residents were more likely than their rural counterparts to use toothpicks and to consume sugared snacks. Among both urban and rural residents, males and those having less educated parents reported oral hygiene and sugar intake less frequently than did females and the highly educated. Whereas the gender difference with respect to intake of sugared snacks was larger among urban than rural residents, the socio-economic disparity with respect to use of toothpicks was most pronounced among rural residents. The results appear to imply that in addition to targeting specific oral health behaviors, bath individual characteristics and the wider socio-regional context should be addressed when planning oral health intervention among Ghanaian adolescents.

Adolescent↗

Effects of early extra fluid and food intake on breast milk consumption and infant nutritional status at 5 months of age in an urban and a rural area of Burkina Faso.

OBJECTIVE: To assess the effects of early extra fluid and food intake on breast milk consumption and the effects of food intake on 5-month-old infant nutritional status. DESIGN: Cross-sectional surveys. Infants were selected by random choice. SETTINGS: Urban and rural Burkina Faso. SUBJECTS: A total of 97 urban and 69 rural infants were recruited, but 67 and 51, respectively, completed the surveys. Infant selection criteria were: age (5 +/- 0.5-month old), thriving, breastfed, having Burkinabè parents in study area for a year, study conditions accepted by parents. INTERVENTION: Surveys were conducted respectively in January and February 2001 (urban), and 2002 (rural) during the cool season. They were performed by home visit. With the help of health workers and traditional midwives, families were informed of the studies' objectives and gave agreement. Food intakes were estimated by test-weighing for breast milk and precise weighing techniques for other foods. Socioeconomic status of households, anthropometry of infants and mothers were also recorded. Breast milk samples were collected from each mother's breast and analysed for lipid and fatty acid concentrations. RESULTS: Daily breast milk intake did not differ between urban (776 +/- 262 g) and rural areas (835 +/- 265 g). Porridge intake was, respectively, 128 +/- 105 and 96 +/- 49 g. Median extra fluid intake was, respectively, 79 and 122 g. In both areas, porridge and fluid intake had no effect on breast milk consumption. In urban areas, infant nutritional status at 5 months was better than at birth. CONCLUSION: Breast milk intake and nutritional status of predominantly breastfed infants at 5 months of age, living in both urban and rural settings, were not affected by the consumption of extra fluid or food intake.

Adult↗

Asthma, smoking and chronic cough in rural and urban adult communities in The Gambia.

BACKGROUND: Asthma is reported to be rare in traditional rural communities, but is thought to be increasing as lifestyles become more urbanized or 'western'. OBJECTIVES: A community-based survey of non-communicable diseases was conducted from October 1996 to June 1997, and included comparison of the prevalence of asthma, smoking and chronic cough in rural and urban Gambia. METHODS: A cluster sample survey was conducted in a random sample of rural and urban adults (> or = 15 years of age). Subjects were asked about respiratory symptoms using a locally adapted version based on the IULTD questionnaire. Spirometry (basal, methacholine provocation and reversibility with a bronchodilator) and skin prick tests were performed on a randomly selected subsample of all subjects and those who, when interviewed, said they wheezed or had been diagnosed as asthmatic by a doctor. RESULTS: Out of 2166 participants in the urban population, 4.1% reported having had wheezing or whistling in the chest in the previous 12 months, 3.6% reported doctor-diagnosed asthma, and 0.6% chronic cough. In the rural population with 3223 participants these figures were 3.3%, 0.7% and 1.2%, respectively. Wheeze was more common in women, cough for 3 months of the year was more common in the age-groups 45+. Those who reported that they currently smoked accounted for 34% in urban and 42% in rural men. Figures were much lower for women (1.5% and 6.0%). Seven out of 574 randomly selected subjects (1.4%) exhibited bronchial hyper-responsiveness to methacholine challenge. Four of 133 (3.0%) people with self-reported wheeze and 3/69 (4.3%) participants with doctor-diagnosed asthma reacted positively on bronchial provocation with methacholine. There was a remarkably high prevalence of positive skin prick tests to aeroallergens: 38% in participants with a history of wheeze and 27% in those without. CONCLUSION: The prevalence of wheeze (particularly in association with bronchial hyper-responsiveness) was low in both rural and urban Gambia. This is in contrast to the relatively high prevalence of positive skin prick tests to aeroallergens (in both wheezers and non-wheezers), questioning the mechanisms of interaction between allergy and asthma and the presence of protective factors against asthma in this West African population. The high smoking rates justify international concern about tobacco marketing in developing societies.

Adolescent↗

Hospital admission and mortality differentials of asthma between urban and rural populations in New South Wales.

It remains unclear whether there are any differentials in hospital admission and mortality rates of asthma between urban and rural populations. An observational study was conducted, based on patient hospital records, to examine the distribution of asthma admissions and mortality in New South Wales. Data on all reported cases of asthma were obtained from New South Wales hospitals between 1989 and 1994. Information on deaths of asthma was collected between 1983 and 1992. The hospital admission rates of asthma varied from 4.8 per 1000 in 1990 to 5.4 per 1000 in 1992 for rural population, and from 3.0 per 1000 in 1991 to 3.4 per 1000 in 1992 for urban population. The hospital admission rates were 51.2-69.1% higher for rural residents than urban dwellers. The mortality rates of asthma ranged from 4.8 per 100,000 in 1983 to 8.0 per 100,000 in 1985 for rural population, and from 3.8 per 100,000 in 1983 to 6.0 per 100,000 in 1989 for urban population. The mortality rates of asthma were 3.62-42.85% higher for rural residents than urban dwellers. These results indicate that the non-age-adjusted hospital admission and mortality rates of asthma were considerably higher in rural populations than in urban populations in New South Wales.

Age Distribution↗

High prevalence disorders in urban and rural communities.

OBJECTIVE: High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the 'quantity' question to the quality question: how does urban or rural place influence mental health? METHOD: A literature review (Medline and PsychLIT) was carried out using the words 'rural, urban, mental/psychiatric, illness/disorders and prevalence', as well as a review of relevant papers and publications known to the authors. RESULTS: Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a 'one size fits all' definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence. CONCLUSION: Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting.

Anxiety Disorders↗

Differences in body mass index and waist: hip ratios in North Indian rural and urban populations.

Overweight could be a major factor in determining the increasing rates of coronary heart disease in the Indian population, by its influence on blood pressure, diabetes and insulin resistance. We studied the prevalence of overweight in north Indian urban and rural population samples. The urban sample population (n = 3050) was selected using a multistage sampling with stratification for geographical zone and the type of residential colony and cluster sampling of urban blocks in each stratum. The rural sample (n = 2487) was selected by random sampling of villages stratified for population size followed by coverage of all eligible persons in the village. All participating individuals were 35-64 years of age. Women constituted 52.2% (n = 1594) and 57% (n= 1417) of urban and rural samples, respectively. The study reveals that overweight is widely prevalent in the adult urban Delhi population, whereas underweight is a significant problem in the rural population. This was noted across all the age groups in both men and women. We estimated 'comprehensive coronary risk estimates' based on the New Zealand Heart foundation guidelines and noted that the proportion of high and very high risk subjects increased in a continuous manner even within the 'normal' ranges of BMI. This difference in prevalence in the urban population could represent the demographic transition in the Indian population.

Adult↗

Urban-rural differences in a memory disorders clinical population.

OBJECTIVES: To compare patient characteristics and family perceptions of patient function at one urban and one rural memory disorders clinic. DESIGN: Secondary, cross-sectional data analyses of an extant clinical database. SETTING/PARTICIPANTS: First time visits (n = 956) at two memory disorders clinics. MEASUREMENTS: Patient and family-member demographics and assessment results for the Mini-Mental State Examination (MMSE), instrumental activities of daily living (IADLs), activities of daily living (ADLs), the Memory Change and Personality Change components of the Blessed Dementia Rating Scale, and the Revised Memory and Behavior Problems Checklist. RESULTS: In both clinics, patients and family members were more likely female. The typical urban clinic patient was significantly more likely to be living in a facility and more educated than the typical rural patient. Urban and rural patients did not show significant differences in age- and education-adjusted MMSE scores or raw ADL/IADL ratings, but the urban family members reported more memory problems, twice as many personality changes, more-frequent behavior problems, and more adverse reactions to problems. CONCLUSION: Physicians who practice in both urban and rural areas can anticipate differences between patients, and their families, who seek a diagnosis of memory disorders. Our most important finding is that despite similarities in reported functional abilities, urban families appear to be more sensitive to and more distressed by patients' cognitive and behavioral symptoms than rural families. These differences may reflect different underlying needs, and should be explored in further research.

Activities of Daily Living↗

Comparison of dietary intakes of micro- and macronutrients in rural, suburban and urban populations in Costa Rica.

OBJECTIVE: To compare, along with behavioural habits, the potential atherogenicity of diets in rural and urban areas in Costa Rica. DESIGN: Subjects were randomly selected from the general population in Costa Rica. A validated food-frequency questionnaire that inquired about dietary intake in the previous year was administered once to each subject. Each subject provided plasma and an adipose tissue biopsy, which were used as biomarkers for carotenoid, tocopherol and/or fatty acid intakes. Each subject also answered another questionnaire on personal profile and household characteristics. SETTING: A dietitian visited all subjects and conducted the interviews at their homes. SUBJECTS: Adult male and female free-living rural, suburban and urban Costa Ricans without a history of physical or mental disability. RESULTS: Subjects in rural areas were significantly (P < 0.05) more active physically, earned less income and had a higher intake of dietary fibre than urban dwellers. Urban residents reported a significantly (P < 0.05) higher consumption of total fat, specifically unsaturated fat mostly from soyabean oil, and had higher plasma and adipose tissue tocopherol and lycopene concentrations. Interestingly, no differences in body mass index were observed. CONCLUSIONS: These data show differences in cardiovascular disease (CVD) risk factors of rural and urban populations in Costa Rica. In rural areas, low socio-economic status and low intake of unsaturated fatty acids appear to be the prevalent CVD risk factors, while in urban areas they were low physical activity, high trans-fatty acids in the diet and adipose tissue, and low dietary fibre intake.

Cardiovascular Diseases↗

Knowledge, attitude and practice of modern contraception among single women in a rural and urban community in southeast Nigeria.

The contraceptive information and services offered to single women in most developing countries is compromised by stigma attached to premarital sex. This study was to ascertain the knowledge, attitude and practice of contraception among single women in a rural and urban community in southeast Nigeria, using a cross-sectional survey of 279 and 295 single women in Ngwo (rural) and Enugu (urban) community. The mean age of the population was 21.3 years. Contraceptive awareness was more among the urban than rural respondents (90.2% vs 34.1%). The major sources of contraceptive knowledge were mass media (68%) and peer groups (86.3%) for the urban and rural respondents, respectively. Most respondents in both groups had positive attitude towards contraception. More urban than rural respondents (68.3% vs 12.5%) began sexual activity during adolescence and the level of contraceptive use during first coitus were 48.4% and 13.7%, respectively. Of the currently sexually active respondents, 32.5% (rural) and 59.7% (urban) were using a form of modern contraception. Condoms, followed by oral pills were the most popular contraceptive method because they can easily procure them over the counter. Poor contraceptive information, highly critical behavior of family planning providers towards unmarried women seeking contraception and attitude of male partners militate against contraceptive practice. There is need to promote information and education on contraception among single women, their male partners and family planning providers.

Adolescent↗

Rural and urban similarities and differences in private substance abuse treatment centers.

Although previous research has considered the unique treatment needs of rural residents, little research has investigated the potential differences in the availability of treatment services in rural and urban areas. Using three waves of longitudinal data from a nationally representative sample of privately-funded substance abuse treatment centers, this research compared rural and urban treatment centers with regard to the availability of clinical levels of care, the offering of specialty treatment tracks, the adoption of treatment innovations, and the average costs of care. Results indicate that rural and urban centers were similar in their increasing provision of inpatient psychiatric levels of care and their decreasing offering of more intensive levels of chemical dependency services between 1995 and 2001. Rural and urban centers were increasingly likely to offer specialty treatment tracks for women, adolescents, clients with HIV/AIDS, and relapsing clients over time, but rural centers were less likely to offer a treatment track tailored to substance-abusing women. The use of treatment innovations was similar at rural and urban treatment centers with the exception of lesser use of acupuncture at rural centers. Rural and urban centers did not differ in their average charges for treatment services.

Adolescent↗

Body composition of rural and urban children from the central region of Spain.

Body composition components are considered in a cross-sectional sample of 2564 children (age range 6-14 years) from Central Spain. The sample was divided depending on rural or urban residence. Weight, and skinfold at the triceps, biceps, subscapular and suprailiac site were measured. Body composition was represented by percentage fat (%F), lean body mass (LBM), fat mass (FM) and sum of skinfolds (SSK). Sex differences were found to be highly significant for all variables and rural-urban differences were small. Rural boys show slightly larger fat content, in %F, FM and SSK, than their urban peers, but significant (p < 0.05) differences appear only for SSK. No statistically significant environmental effect was found for LBM. The improvement of living conditions, the urban influence on the rural area and the degree of urbanization of the urban settlement are suggested as the main determinants influencing obtained results.

Adolescent↗

Saturated and cis- and trans-unsaturated fatty acids intake in rural and urban Costa Rican adolescents.

OBJECTIVE: The purpose of this study is to determine whether intake of saturated fatty acids and cis- and trans-unsaturated fatty acids is associated with an urban compared to a rural lifestyle, and whether these associations are responsible for differences in plasma lipid concentrations. METHODS: Two hundred seventy-five adolescents, aged 12 to 19 years, living in rural and urban areas of San José, Costa Rica, were included in the study. All participants completed three-day food records, provided a fasting blood sample, and carried out a modified Harvard Step Test. RESULTS: Compared to rural, urban adolescents reported higher intakes of energy-adjusted individual and total saturated fatty acids, total n-3, total n-6 (p < 0.05). Compared to rural, urban adolescents had higher intake of 18:1 (3.65 vs. 3.25, p = 0.0001) and 18:2 (0.62 vs. 0.80, p = 0.001) trans fatty acids, as well as lower intake of carbohydrate (p < 0.05). Palm shortening was the main source of saturated fat (32%), and partially hydrogenated soybean oil used for cooking was the main source of n-3 fatty acids (33%), n-6 fatty acids (33%) and trans fatty acids (34%). Compared to rural, urban adolescents had lower systolic and diastolic blood pressure and higher plasma HDL cholesterol concentration (44 vs. 40 mg/dL, p < 0.0001), but were more likely to be sedentary (68% vs. 57%, p < 0.0001). Among environmental factors, higher carbohydrate intake was a significant determinant of a lower HDL cholesterol (beta coeff = -1.45, p = 0.04), while lauric and myristic fatty acids correlated with increased LDL cholesterol (beta coeff = 3.6, 1.7, p < 0.05). CONCLUSIONS: A diet containing less carbohydrate and less saturated fatty acids contributes to a more beneficial lipid profile in Costa Rican adolescents, but a trend towards high trans fatty acids intake, particularly in the urban area, is worrisome given the well-known adverse effects of trans fatty acids.

Adolescent↗