The Nutrition Transition in Rural Guatemala: 12 Year Changes in Diet of Adults
Authors: Ford Nicole D. , Martorell Reynaldo , Ramirez‐Zea Manuel , Stein Aryeh D. 
Published: November 2023

ObjectiveLatin America is undergoing a nutrition transition marked by shifts from traditional to high‐fat, high‐sugar, processed foods. Despite documented changes to the food environment, including proliferation of supermarkets in urban areas, the extent to which rural Guatemalans have adopted Western diets is unclear. Our study explored 12y changes in diet in a cohort of rural Guatemalan adults.MethodsStudy participants were born in eastern Guatemala from 1962–1977 and are members of the INCAP Nutrition Supplementation Trial Longitudinal Cohort. Data on typical dietary intake were collected using a previously‐validated, semi‐quantitative 52‐item food frequency questionnaire (FFQ) in 2002/04 and in 2015/16. We included in this analysis all non‐pregnant/lactating participants with complete dietary data in both study waves (n=511 women and 299 men). We categorized food intake into 19 mutually exclusive food groups and compared dietary composition change over 12 years using paired t‐tests.ResultsIn 2004, the top contributors to diet as a percentage of total calories were corn tortillas (50.6%), refined grains (e.g. French bread, sweet rolls, pastries) (12.6%), and sugar‐sweetened beverages (SSB) (4.9%). In 2015, participants consumed fewer corn tortillas (46.1% of total calories) and traditional foods (tamales and tacos) (2.0% of total calories vs. 2.4% in 2002/04). Participants' diets diversified through small but significant increases in baked/roasted meat and fish (from 4.0% to 5.0%), fried/processed meats (from 3.0% to 4.0%), and starchy and non‐starchy vegetables (from 2.4% to 3.4%). SSB had the largest change of any food group with intake nearly doubling from 4.9% of total caloric intake in 2002/04 to 7.2% in 2015/16. Consumption trends over the 12y study period were similar by gender; however, men reduced consumption of fruit (from 3.8% to 2.7% of caloric intake) and fried starches (from 2.5% to 2.1%). Foods with high sugar content (e.g. SSB, sugar added to coffee, candy, pastries) accounted for approximately 14.6% of caloric intake in 2002/04 and 16.1% of intake in 2015/16. The macronutrient composition of the diet changed significantly over the 12y period: carbohydrate as a percentage of total caloric intake decreased from 69.6% to 67.8% while fat and protein increased from 18.3% to 19.2% and from 12.0% to 12.9%, respectively. Finally, total caloric intake did not change significantly over the study period.ConclusionOur findings suggest that, while diets remained largely reliant on starches and disaccharides at both time points, there was evidence of diet diversification characterized by decreased consumption of corn tortillas and traditional foods and by increased consumption of both healthy (e.g. vegetables and baked/roasted meats and fish) and less healthy food groups (e.g. fried/processed meats and SSB). To help mitigate risks associated with nutrition‐related non‐communicable disease, further research should explore approaches to encourage adoption of healthier foods while minimizing the addition of energy‐dense, nutrient‐poor foods.Support or Funding InformationFunding for this study was provided by the Laney Graduate School at Emory University and the National Institutes of Health (grant numbers HD‐075784 and TW‐005598).