The Modernized Traditional Diet: A Major Risk Factor for Hypertension and Multimorbidity in Belize's Multiethnic Population

ABSTRACT Belize faces a severe epidemic of noncommunicable diseases (NCDs), yet the role of its evolving food culture remains unclear. This study investigated how contemporary dietary patterns, rooted in tradition but altered by modernization, are associated with hypertension and NCD multimorbidity. A national, cross‐sectional study of 289 adults was conducted in 2025. Data were collected via a comprehensive electronic questionnaire, including a culturally tailored food frequency questionnaire. Principal component analysis (PCA) was used to derive dietary patterns. Multiple logistic, linear, and Poisson regression models assessed associations with hypertension and NCD burden, adjusting for key confounders. Two major dietary patterns were identified: a “Modernized Traditional Staple” pattern (high in refined carbohydrates like white rice and corn tortillas, low in fruits and vegetables) and a “Prudent/Healthy” pattern (high in fruits, vegetables, nuts, and fish). High prevalence rates of hypertension (35.7%) and obesity (39.1%) were observed. After multivariate adjustment, each unit increase in the “Traditional Staple” pattern score was associated with a 40% increase in the odds of hypertension (aOR: 1.40, 95% CI: 1.10–1.80) and a higher burden of comorbid NCDs. The “Prudent/Healthy” pattern showed a protective association. Significant socioeconomic and ethnic disparities were also observed. Contrary to the assumption that traditional diets are inherently protective, the modernized traditional diet—high in refined staples and low in diversity—is a significant, independent driver of hypertension and NCD multimorbidity in Belize. Public health strategies must urgently promote the transformation of traditional dietary patterns by advocating for portion control of refined staples, increased dietary diversity, and the reinstatement of protective whole foods.