Household Cooking and Eating out: Food Practices and Perceptions of Salt/Sodium Consumption in Costa Rica
2. Materials and Methods
2.1. Study Design
2.2. Research Techniques and Data Collection
2.3. Location of the Study
- Location according to geographical region: the selection of locations for data collection was based on the regionalization proposed by the Ministry of National Planning and Economic Policy (MIDEPLAN), considering the dimensions of the economy, social participation, health, and education. The country consists of seven provinces divided into six regions: Central, Brunca, Chorotega, Huetar—Atlantic, Huetar—North, and Central Pacific. Most of the population (62%) resides in the Central Region, which was thus subdivided into four subregions: Central North (Heredia), Central East (Alajuela), Central West (San José), and Central South (Cartago) .
- Statistics on cardiovascular mortality were provided by the Directorate of Health Surveillance of the Ministry of Health of Costa Rica . Key communities were selected based on those with the highest prevalence of stroke mortality due to close association with salt intake . See the list of communities and description of the geographical and sociocultural characteristics of the regions of MIDEPLAN in Appendix A.
2.5. Interviews and Workshops
2.6. Data Analysis
2.7. Ethical Considerations
3.1. Population Characteristics
3.2. Food and Cooking in the Different Regions and Cultural Groups of Costa Rica
3.3. Preparing and Consuming Food at Home
3.3.1. The Acquisition and Preparation of Food
“Do you cook every day at home? Who cooks?
Yes, we cook every day. Women are the ones who cook, and, on special occasions, men feel probably ashamed, sorry, men get involved. Hahaha”(Woman, Bagaces)
“Look, here it is, this is the rice with chicken that we are going to prepare, we are going to add all kinds of condiments, vegetables..., we are going to add bell pepper, celery, cilantro and condiments, and a little salt. And then, here are the mayonnaises; the dressings that also have a little salt for taste and a few condiments, also to add a little flavor, we can add mustard. And here are the condiments that we are adding. It can be a few bouillon cubes, that’s what the lady says, we can add a little bit of Lizano® sauce, mustard, we can add… what else can we add, it can be complete with Lizano® sauce.”(Woman, Alajuela)
“Because I add condiment, bouillon… Lizano® sauce, all that—haha—I try it for salt with the tip of the spoon. If it’s salty I do not add any more, but I do if it needs a little. As I was saying, I only calculate it myself, a half teaspoon, a pinch, a teaspoon.”(Woman, Cartago)
“You taste it, you never know (…), add a little first and, then taste it. If you feel like you almost don’t taste salt, you add a little more, and so on, you continue tasting it.”(Woman, Liberia)
The Use of Discretional Salt and Other Salts
“It was Naty who, when we were preparing hash for an event, told me to please get her the sea salt, and since then, I only buy that. Then I bought sea salt and this one. It is more expensive, but for me, it salts more with less quantity.”(Woman, San José)
“Well, I try to buy this sea salt from a friend who goes to Lepanto, Puntarenas to bring salt, she brings this one and another one a little thicker, but it’s not as thin as common salt, it is not a specific brand. And if I don’t have this one, I buy SalSol.”
“I always look for... this one... I don’t know! I think this is the best one, coarser, well, let’s say it like that, it has like bigger grains. I believe the more refined the salt, the more harmful, you know, how they process it and all that. So, I think this is the best one... I always go to the supermarket and look for the one with bigger grains.”
“I generally use the coarse salt for meats, either broiled or baked. It is usually very used for that.”(Man, Heredia)
“Then, it depends on how it is done. My husband learned how to cook pork rinds from my sister’s husband, who in turned learned the recipe from Puriscal residents, and his pork rinds are delicious without being too salty. Another fact is that people from Puriscal and Mora use pink salt, they use it on the pork rinds to give them that color and taste that you cannot find elsewhere. My husband has even had one glass of that salt, bought from the butcheries in Puriscal. It is like salt contraband because it is what they use and it is one of Puriscal pork rind’s secrets. You can go eat pork rinds anywhere else and they will never taste like pork rinds from there.”(Woman, San Jose)
The Use of Seasonings and Condiments
“Condiments, all of them, or seasonings better said and a little oyster sauce. And I do not add salt because it (oyster sauce) is salted already.”(Woman, Palmar Norte)
“(…) mostly when they eat fried chicken, they put it on the fries and the one I use is oyster sauce.”(Woman, Palmar Norte)
“I cook lots of fried rice. I boil it first, because rice needs to be boiled in order to be fried. Boiled rice without salt in it. I do not use salt when I am frying it; I put Chinese sauce in it. Chinese sauce is salty; therefore, no salt is required. Well, before I would put a little “ajinomoto” (local common name used for monosodium glutamate) in it. I no longer buy it for anything, but the Chinese sauce will salt it.”(Woman, Limon)
“(…) it gives food a very original taste, delicious.”(Investigative workshop, Guanacaste, man)
“Those BBQ ribs; take the ribs and the wings and wash them well and put them to… (pauses) pour oil in a pan and put them in the oven. When they are almost done, before taking them out, pour the BBQ sauce. Then the BBQ sauce will give them flavor and you do not need to put anything else on them.”(Woman, Liberia)
“For everything! Lizano® sauce is used in all dishes here, it is almost indispensable, and I know it must have lots of sodium because it is pure condiment, right? It is used in “pinto”, in eggs…well not in white rice and beans, but certainly when recipes are prepared: “picadillo” (hash) or like the soup I am currently preparing, I will put a little Lizano® sauce in it shortly. But yes, generally almost everything has Lizano® sauce in it; well…it is English sauce…”(Man, Alajuela)
“Well, I do not know, I always buy Maggi® because that is what my mom used to buy. I have never tried a different one, I always buy that one, let’s say bouillon powders…”(Woman, Alajuela)
“Many people do not know that if they work with spices, food is really good without putting bouillon powders on them; that is what salt is for. Nevertheless, people do not realize it. People think that if they do not use bouillon powder, their food will not taste good.”(Woman, Guanacaste)
“It would be hypocritical to say that I do not buy, when I like to make rice with chicken and put some in it, I buy canned sweet corn. Because it comes ready, so it is better. To avoid chopping, maybe and reduce effort, to avoid being in a rush.”(Woman, Palmar Norte)
3.3.2. Intent to Reduce the Consumption of Common Salt and Condiments
“His wife prepares him a healthy snack because she loves him and does not want to be widowed early, and it turns out that at the office the guy takes out the healthy food she prepared, opens his desk drawer and pulls out the salt shaker…”(Woman, San Jose)
“As a consumer, what do you need in order to buy products that are low on salt? I think what I am missing is to read a little more because normally almost all products have details of the composition. Well, the fact that everything is labeled makes shopping easier, to know the quantities and as I was saying, it is good to go to lectures where you are told about the good stuff and the right amounts. At least about sugars, she told us mostly about sugar not so much about salt. She told us that one spoon a day is what the body needs to fall into excess.”(Woman, San José)
3.4. Eating Outside the Home
“(…) and if is outside and it is dinner, it is a triple sin. I categorized it in two scenarios. One goes out to eat or one is invited to dinner at someone else’s house. Then, if one goes out to eat, maybe the healthiest choice is ordering sushi…a miso soup, a salad or a roll. Otherwise, it is probably going to be pizza, but it depends of the quantity. Depends on the quantity and personal finance. Nowadays life is hard, even if I have strong cravings, I cannot treat myself, at least not me…because you know, you need money…dammit…things are tough.”(Woman, Heredia)
“Fried chicken, the shops are everywhere, on every corner. In Heredia, chicken is sold all over the place. Chicken is sold everywhere. Chicken is always sold with lots of condiments. Lots of condiments. Since it is sold very cheap, it is sold a lot.”(Woman, Heredia)
Strengths and Limitations
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
|Community||Province||Regions of the Ministry of National Planning and Economic Policy of Costa Rica|
|Guadalupe, Tibás, and Mora||San Jose||Central||Located in the central region of the country and known as the Greater Metropolitan Area. At the time of the study, it agglomerated 62% of the population of Costa Rica, characterized by its multiculturalism. It offers the widest range and diversity of foods (natural, processed, and fast food) and food establishments.|
|Heredia (Centro), San Joaquín de Flores, and San Josecito de San Isidro||Heredia|
|Alajuela (Centro), San Pedro de Poás and Villa Hermosa||Alajuela|
|Cartago (Centro), El Guarco and Aguas Calientes||Cartago|
|Bagaces (Centro)||Guanacaste||Chorotega||Located in the northwest of the country and bordering Nicaragua. Descendants of the Chorotega culture, an ethnic group of Mesoamerican culture. It is known for agriculture, cattle ranching, and tourism. It is a region that associates a sense of identity and folklore with food traditions, especially with products derived from corn (tortilla, “tamal mudo”, “arroz de maiz”, and chicha) and cow’s milk (fresh cheese called “cuajada”). The gastronomy is influenced by Nicaraguan and Chinese immigrants.|
|Limón||Huetar Caribe||Located along the coast of the Caribbean Sea (Atlantic Ocean). Extends from the northeast to the southeast of the country. Predominantly an Afro-Caribbean region. Gastronomy is characterized by the Caribbean cultural heritage and the availability of new culinary ingredients, mostly processed foods that have influenced the modification of recipes and taste preferences. It is characterized by its link with maritime culture and tourism.|
|San Jose||Brunca||Located in the southwest of the country. It is characterized by a population with great sociocultural diversity. Its inhabitants are descendants of indigenous cultures, influenced gastronomically by Italian immigrants.|
|Muelle||Alajuela||Huetar Norte||Located in the northeast of the country and borders with Nicaragua. It is characterized as being made up of populations descended from aboriginal groups from the Central and Chorotega regions and Nicaragua. It is known for agriculture, dairy farming, and tourism. The latter has brought with it trends in the consumption of other foods outside the food tradition, such as fast food.|
|Puntarenas||Pacífico Central||Located on the central coast of the Pacific Ocean of Costa Rica. Their ancestors were indigenous to the Chorotega and Huetar cultures. It has a strong presence of Chinese immigrants. It is characterized by its link with maritime culture and tourism.|
|Do you cook at home?|
Who prepares food/meals at home?
When do you usually prepare food?
What is the use of salt in the kitchen?
When cooking: how do you flavor foods? Do you measure the salt added to food? What do you use for seasoning meals or as a condiment?
Do you add salt, any sauce, dressing, or other ingredients to the dish of served foods? Which one? Why?
What do you think about the use of salt shakers on the table? Do you usually have it at home?
Do you use salt with less sodium? Any other salt?
Who decides on the purchase of food and where buy it?
When you organize a celebration like a prayer meeting or a birthday, what foods and drinks do you offer?
Do you eat out? How often? What kind of food do you choose? What restaurants or establishments do you prefer?
|What do you consider salt to be?|
What is the proper amount of salt to cook with? What is a lot? What is a little?
What do you think about reducing salt intake? Can it be replaced? With what?
Could you cook without salt? How would you do it?
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|Source of Emotions Associated with Food||Feeling Identified in the Study|
|Sensorial properties||Tastes like mom’s food|
Has a pleasant look and taste
I use Lizano® sauce and margarine to give taste
Salt is the flavor
|Experiential consequences||Eating gives me a sensation of pleasure|
|Associated consequences||You eat with little salt to prevent high blood pressure|
You try to eat as naturally as possible to have good health
|Personal consequences or personal significance||To prepare food this way reminds me of family|
Using a condiment or processed seasoning reminds me of my mother/grandmother
|Behavior of involved agents||If food has good taste, they feel happy|
If food lacks salt (taste), the family resents that I cook with little salt due to medical recommendations
|Over 35 Years||Young Adults||Teenagers and Children|
|Physical accessibility||Widely available low-cost fried chicken options. Constitutes a viable option for families for any meal.||Diversity of restaurants located close to the workplace. Going out to eat in groups is an everyday social practice. Trying something new is a temptation.||Frequent fast-food establishments close to school, with refill service and low-cost menus (combos with hamburger, French fries with ketchup, and soft drinks).|
|Tastes and preferences||Prefer typical food or seafood restaurants. Like establishments located in the local markets.|
Buy commercial Chinese food often (chow mein and chop suey with soy sauce), mainly on the weekends.
|Like trying different food, mainly on the weekends and celebrations. Enjoy the experience of eating in Japanese, vegetarian, vegan, and international restaurants, as they are considered innovative.||Seek fast food establishments (food courts in malls, smoothie, ice cream, or beverage shops), even if it implies traveling longer distances.|
Buy fruits seasoned with salt, lemon, vinegar, and Lizano® sauce from street vendors. Children prefer fast food for the food, onsite playgrounds, and kids’ meal toys.
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Blanco-Metzler, A.; Núñez-Rivas, H.; Vega-Solano, J.; Montero-Campos, M.A.; Benavides-Aguilar, K.; Cubillo-Rodríguez, N. Household Cooking and Eating out: Food Practices and Perceptions of Salt/Sodium Consumption in Costa Rica. Int. J. Environ. Res. Public Health 2021, 18, 1208. https://doi.org/10.3390/ijerph18031208
Blanco-Metzler A, Núñez-Rivas H, Vega-Solano J, Montero-Campos MA, Benavides-Aguilar K, Cubillo-Rodríguez N. Household Cooking and Eating out: Food Practices and Perceptions of Salt/Sodium Consumption in Costa Rica. International Journal of Environmental Research and Public Health. 2021; 18(3):1208. https://doi.org/10.3390/ijerph18031208Chicago/Turabian Style
Blanco-Metzler, Adriana, Hilda Núñez-Rivas, Jaritza Vega-Solano, María A. Montero-Campos, Karla Benavides-Aguilar, and Nazareth Cubillo-Rodríguez. 2021. "Household Cooking and Eating out: Food Practices and Perceptions of Salt/Sodium Consumption in Costa Rica" International Journal of Environmental Research and Public Health 18, no. 3: 1208. https://doi.org/10.3390/ijerph18031208