Indicators of Dietary Behavior and Physical Activity Change Associated with Metabolic Control of Obesity, Hypertension, and Type 2 Diabetes Mellitus in Mexican Adults: National Nutrition and Health Survey in Mexico, 2016.

Introduction: Obesity (OB), type 2 diabetes mellitus (T2D), and hypertension (HTN) are health issues in Mexico linked to unhealthy behaviors. This study investigates the relationship between behavior change indicators and metabolic control in Mexican adults with OB, T2D, and HTN. Methods: We used data from the 2016 National Health and Nutrition Survey Midway (ENSANUT MC-2016), representing ∼59.5 million Mexican adults aged 20-59 with these conditions. We assessed behavior change indicators, including stages of change, self-efficacy, and perceptions of benefits and barriers. In addition, we conducted descriptive analyses and used statistical tests, such as Pearson's chi-squared test and logistic regression models, adjusted for multiple variables. Results: We found that adults in the action and maintenance stages of physical activity (PA) were four times more likely to have adequate HTN control than those in the precontemplation stage. Self-efficacy for PA was related to better control in T2D and HTN. Self-efficacy for reducing the consumption of sugary beverages was positively associated with control in OB and T2D. No significant association was observed with self-efficacy for consuming fruits and vegetables. Conclusion: Behavior-change indicators are significantly linked to metabolic control in adults with HTN. These results support the importance of these indicators in managing chronic diseases such as HTN and their potential use in public health strategies.

The nature and extent of food marketing on Facebook, Instagram, and YouTube posts in Mexico.

Food and beverage marketing appealing to children and adolescents has an impact on their food preferences, purchases requests, consumption patterns, health outcomes, and obesity. The objective of this study was to assess the nature and extent of food and beverage marketing on Facebook, Instagram, and YouTube posts in Mexico. This was a content analysis that followed the World Health Organization CLICK methodology to comprehend the landscape of digital food marketing campaigns of the top-selling food products and brands and the most popular accounts carried out between September and October 2020. A total of 926 posts from 12 food and beverage products and 8 brands were included. Facebook was the social media platform with the most posts and greatest engagement. The most prevalent marketing techniques were brand logo, image of packaging, image of the product itself, hashtags, and engagement to consume. Fifty percent of the posts were assessed as appealing to children, 66% to adolescents, and 80% to either children or adolescents. Ninety-one percent of products (n = 1250) were classified as unhealthy according to the Mexican warning labels nutrient profile; 93% of the food promoted on posts appealing to either children or adolescents were unhealthy. Hashtags commonly referred to the COVID-19 pandemic. Most of the unhealthy food digital marketing features marketing techniques that appeal to children or adolescents; moreover, the use of the pandemic hashtag reflected brands' responsiveness to the environment at the time of the study. The present data contribute to evidence supporting the strengthening of food marketing regulations in Mexico.

Screen-Based Sedentary Behaviors and Their Association With Metabolic Syndrome Components Among Adults in Mexico.

INTRODUCTION: Approximately 25% of the adult population worldwide and 49.8% of Mexican adults have metabolic syndrome. Metabolic syndrome is the result of unhealthy dietary and sleeping patterns, sedentary behaviors, and physical inactivity. The objective of our study was to evaluate the association between sedentary behaviors as screen-based sedentary time (SBST) and each component of metabolic syndrome among adults who participated in the Mexico National Survey of Health and Nutrition Mid-way 2016. METHODS: We analyzed sociodemographic, clinical, and physical activity data from 3,166 adults aged 20 years or older. The International Physical Activity Questionnaire was used to evaluate sedentary behavior. SBST was obtained by counting minutes per week spent watching television, playing video games, and interacting with computers and smartphones. We used Poisson regression to estimate the prevalence ratio of time in front of screens as a continuous variable and its association with metabolic syndrome. RESULTS: The mean (SD) hours per day of SBST in men was 3.6 (0.4) and in women was 2.8 (0.2). The prevalence of metabolic syndrome was 59.6%. In men, the risk for metabolic syndrome increased 4% (P < .05) for each hour of SBST. Similarly, for each hour of SBST, the risk of abdominal obesity increased by 4% (P < .01). In women, we observed that the risk of hypertension or high-density lipoprotein cholesterol deficiency increased for each hour of SBST, and the risk of abdominal obesity increased for each hour of SBST in those who were inactive. CONCLUSION: Sedentary behavior based on screen time is associated with metabolic syndrome and its components among Mexicans, depending on hours of sleep. Current public health policies should consider strategies for reducing SBST.

Characterizing a two-pronged epidemic in Mexico of non-communicable diseases and SARS-Cov-2: factors associated with increased case-fatality rates.

BACKGROUND: People with a previous diagnosis of non-communicable diseases (NCDs) are more likely to develop serious forms of COVID-19 or die. Mexico is the country with the fourth highest fatality rate from SARS-Cov-2, with high mortality in younger adults. OBJECTIVES: To describe and characterize the association of NCDs with the case-fatality rate (CFR) adjusted by age and sex in Mexican adults with a positive diagnosis for SARS-Cov-2. METHODS: We studied Mexican adults aged ≥20 years who tested positive for SARS-Cov-2 during the period from 28 February to 31 July 2020. The CFR was calculated and associations with history of NCDs (number of diseases and combinations), severity indicators and type of institution that treated the patient were explored. The relative risk (RR) of death was estimated using Poisson models and CFR was adjusted using logistic models. RESULTS: We analysed 406 966 SARS-Cov-2-positive adults. The CFR was 11.2% (13.7% in men and 8.4% in women). The CFR was positively associated with age and number of NCDs (p trend <0.001). The number of NCDs increased the risk of death in younger adults when they presented three or more NCDs compared with those who did not have any NCDs [RR, 46.6; 95% confidence interval (CI), 28.2, 76.9 for women; RR, 16.5; 95% CI, 9.9, 27.3 for men]. Lastly, there was great heterogeneity in the CFR by institution, from 4.6% in private institutions to 18.9% in public institutions. CONCLUSION: In younger adults, higher CFRs were associated with the total number of NCDs and some combinations of type 2 diabetes, chronic kidney disease, chronic obstructive pulmonary disease and cardiovascular disease.

Usual Intake of Added Sugars and Saturated Fats Is High while Dietary Fiber Is Low in the Mexican Population.

BACKGROUND: The Mexican National Health and Nutrition Survey (ENSANUT) was carried out in 2012. Information from the survey is used to design and evaluate food and nutrition policies in Mexico. OBJECTIVE: The objective of this study was to estimate the usual intake of energy and macronutrients in the Mexican population by using the ENSANUT 2012. METHODS: Twenty-four-hour recall interviews were administered to a nationally representative subsample of 10,096 individuals aged ≥1 y from the ENSANUT 2012. Usual intake distributions and the prevalence of inadequate intakes were estimated by using the Iowa State University method. Student's t tests and tests on the equality of proportions were used to compare usual intakes and prevalence of inadequacy across socioeconomic status, area (rural or urban), and region of residence (North, Center, or South). RESULTS: Energy and macronutrient intakes and indicators of dietary adequacy are presented for children (ages 1-4 y and 5-11 y), adolescents (12-19 y), and adults (≥20 y). At the national level, the estimated mean fiber intake was below the Adequate Intake for all population subgroups, suggesting inadequacies. The estimated proportion with a usual added sugars intake of >10% of total energy intake was >64% in all age groups. The proportion with a usual saturated fat intake of >10% of total energy intake was estimated to be >78% in children, >66% in adolescents, and >50% in adults. Overall, fiber intake was lower and intakes of saturated fat and added sugars were higher in urban compared with rural areas, in the North compared with South regions, and among those with high compared with low socioeconomic status (P < 0.05). CONCLUSIONS: Fiber intake is lower and added sugar and saturated fat intakes are higher than recommended for >50% of the Mexican population aged ≥1 y. These results highlight the importance of improving the diets of the overall population to reduce the risk of noncommunicable chronic diseases.

Development and Validation of an Instrument to Evaluate Perceived Wellbeing Associated with the Ingestion of Water: The Water Ingestion-Related Wellbeing Instrument (WIRWI).

BACKGROUND: Ingestion of water has been associated with general wellbeing. When water intake is insufficient, symptoms such as thirst, fatigue and impaired memory result. Currently there are no instruments to assess water consumption associated with wellbeing. The objective of our study was to develop and validate such an instrument in urban, low socioeconomic, adult Mexican population. METHODS: To construct the Water Ingestion-Related Wellbeing Instrument (WIRWI), a qualitative study in which wellbeing related to everyday practices and experiences in water consumption were investigated. To validate the WIRWI a formal, five-process procedure was used. Face and content validation were addressed, consistency was assessed by exploratory and confirmatory psychometric factor analyses, repeatability, reproducibility and concurrent validity were assessed by conducting correlation tests with other measures of wellbeing such as a quality of life instrument, the SF-36, and objective parameters such as urine osmolality, 24-hour urine total volume and others. RESULTS: The final WIRWI is composed of 17 items assessing physical and mental dimensions. Items were selected based on their content and face validity. Exploratory and confirmatory factor analyses yielded Cronbach's alpha of 0.87 and 0.86, respectively. The final confirmatory factor analysis demonstrated that the model estimates were satisfactory for the constructs. Statistically significant correlations with the SF-36, total liquid consumption and simple water consumption were observed. CONCLUSION: The resulting WIRWI is a reliable tool for assessing wellbeing associated with consumption of plain water in Mexican adults and could be useful for similar groups.

Plain water consumption is associated with lower intake of caloric beverage: cross-sectional study in Mexican adults with low socioeconomic status.

BACKGROUND: Plain water (PW) should be the main beverage consumed by the population. However, consumption of caloric beverages (CB) has increased considerably worldwide. The purpose of this paper is to analyze the association between CB and PW intake in Mexican adults with a low socioeconomic status (SES). METHODS: In a cross-sectional design, beverage consumption was evaluated with a 24-h beverages recall using the five-step multiple-pass method recommended by the U.S. Department of Agriculture. Physical activity, anthropometric and sociodemographic information were obtained. CB was defined as those beverages that provide energy, with the exception of low-fat milk and beverages with noncaloric sweeteners. Participants were classified into five groups according to their PW consumption (nondrinkers and four quartiles). Differences between groups were evaluated with ANOVA and Bonferroni tests for multiple comparisons among quartiles. A two-stage Heckman regression model was designed with robust standard errors, adjusting for potential confounders. RESULTS: A total of 1108 adults between 21 and 59 years of age were evaluated. A negative association was noted between PW intake and CB consumption (p <0.001) with the exception of natural juice, which was positive (p <0.01) and sodas that no differences were found between quartiles. Specifically, for every milliliter of PW, the intake of CB was 3.4, 1.3, 0.68 and 0.38 mL in each quartile, respectively (p <0.001). In Heckman's model, PW consumers were 0.5 times less likely to consume CB (p = 0.029). This probability increased to 0.9 for low-fat milk, skim milk and beverages without added sugar (LFM-BWAS) consumers (p <0.001). Also, for every 100 mL of PW consumption, CB intake diminished by 20 mL (p <0.001). In turn, for every 100 mL of LFM-BWAS consumption, a reduction of 47 mL in CB was observed (p <0.001). CONCLUSIONS: Higher PW consumption was associated with lower CB consumption. This association suggests that future studies are warranted to determine if increasing PW intake in a low SES Mexican population can reduce intake of CB.

[Knowledge about consumption of plain water in adults of low socioeconomic status of the city of Cuernavaca, México]. / Conocimiento sobre el consumo de agua simple en adultos de nivel socioeconómico bajo de la ciudad de Cuernavaca, México.

OBJECTIVE: To describe and compare the everyday knowledge about plain water consumption among "small" and "big drinkers". MATERIALS AND METHODS: A qualitative study was conducted between April and August 2010 in Mexico. Eight focus groups with low socioeconomic status adults as key informants were conformed; half of the groups were conducted with men and half with women. Data analysis was conducted with: a) coding and categorization according to hydration literature review b) conceptual mapping, recognizing propositions and affirmations made by the participants. RESULTS: Small and big drinkers have similar everyday knowledge about plain water intake. Both groups use the same epistemological axes to explain its intake: "what the body needs". Both groups have the notion that plain water and other beverages such as soda "may be harmful" if you drink them in excess. CONCLUSIONS: Everyday knowledge about water is related to soda and drinks used to substitute water intake. The characteristics of water and soda intake are constructed based on personal experience and insights on their effect on the body and mind. These representations can be used to assess fluid intake and may constitute barriers to the consumption of plain water.

Conocimiento sobre el consumo de agua simple en adultos de nivel socioeconómico bajo de la ciudad de Cuernavaca, México / Knowledge about consumption of plain water in adults of low socioeconomic status of the city of Cuernavaca, México

Objetivo. Describir los conocimientos cotidianos acerca del consumo de agua simple en adultos "pequeños bebedores" y "grandes bebedores" de agua simple. Material y métodos. Estudio cualitativo realizado entre abril y agosto de 2010 en México. Se conformaron ocho grupos focales con informantes clave adultos de nivel socioeconómico bajo; la mitad de los grupos se conformaron con hombres y la mitad con mujeres. El análisis de datos fue realizado mediante: a) codificación y categorización de acuerdo con literatura revisada acerca de hidratación, y b) mapeo conceptual, reconociendo proposiciones y afirmaciones hechas por los participantes. Resultados. Pequeños y grandes bebedores tienen conocimientos cotidianos similares sobre el agua simple; utilizan los mismos ejes epistemológicos para explicar la ingesta de agua simple en función de lo que "el cuerpo necesite". Ambos grupos tienen la noción de que el agua simple y el refresco "pueden ser dañinos" si se beben en exceso. Conclusiones. El conocimiento cotidiano sobre el agua se relaciona con el refresco, bebida que sirve para comparación y como sustituto. Los conceptos sobre el agua y el refresco se construyen con base en la experiencia personal y en las nociones sobre el efecto de ambos en el cuerpo y en la mente. Estas representaciones se utilizan para valorar la ingesta de líquidos y pueden constituirse como barreras para el consumo de agua simple.

Objective. To describe and compare the everyday knowledge about plain water consumption among "small" and "big drinkers". Materials and methods. A qualitative study was conducted between April and August 2010 in Mexico. Eight focus groups with low socioeconomic status adults as key informants were conformed; half of the groups were conducted with men and half with women. Data analysis was conducted with: a) coding and categorization according to hydration literature review b) conceptual mapping, recognizing propositions and affirmations made by the participants. Results. Small and big drinkers have similar everyday knowledge about plain water intake. Both groups use the same epistemological axes to explain its intake: "what the body needs". Both groups have the notion that plain water and other beverages such as soda "may be harmful" if you drink them in excess. Conclusions. Everyday knowledge about water is related to soda and drinks used to substitute water intake. The characteristics of water and soda intake are constructed based on personal experience and insights on their effect on the body and mind. These representations can be used to assess fluid intake and may constitute barriers to the consumption of plain water.

Energy and nutrient consumption in Mexican women 12-49 years of age: analysis of the National Nutrition Survey 1999.

OBJECTIVE: To describe the reported energy and nutrient intake and adequacies in Mexican women. MATERIAL AND METHODS: A 24-hour dietary recall was used to obtain nutrient intake in a representative sub-sample of 2,630 women from 12 to 49 years of age from the National Nutrition Survey 1999. Nutrient adequacies were estimated using the Dietary Reference Intakes and stratified according to region, area (urban or rural), socioeconomic status and obesity status (non-obese: BMI < 30 kg/m2, obese: > or = 30 kg/m2). Differences were analyzed using linear regression for complex surveys of log-transformed intake and adequacy, adjusting for multiple comparisons with the Bonferroni test. RESULTS: The median national energy intake was 1,471 kcal. The Risk of Inadequacy (RI) (prevalence of adequacy < 50%) was: vitamin A: 38.3%, vitamin C: 45.5%, and folate: 34.3%. Carbohydrates, folate, iron and calcium intake was significantly higher in rural than in urban areas. The RI was higher in women of the lowest socioeconomic status tertile for all nutrients with the exception of carbohydrates and calcium. Macro-nutrient adequacies were significantly higher in non-obese women. CONCLUSIONS: Differences within the country among regions, rural and urban areas, and socioeconomic status tertile reflect an increasing availability of inexpensive calorie-dense foods in marginal groups. However, total energy, cholesterol, saturated and total fat were consumed in greater quantities by women from the higher socioeconomic status tertile and from urban areas. These patterns could be a contributing factor to the rise of obesity and other non-communicable nutrition-related chronic diseases in Mexico. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Energy and nutrient consumption in Mexican women 12-49 years of age: analysis of the National Nutrition Survey 1999

OBJETIVO: Describir la ingesta reportada de energía y nutrimentos en mujeres mexicanas. MATERIAL Y MÉTODOS: Se utilizó un recordatorio de 24 horas para obtener la ingesta de energía en una submuestra representativa de 2 630 mujeres de 12 a 49 años de edad de la Encuesta Nacional de Nutrición 1999. Las adecuaciones nutrimentales se estimaron utilizando las Referencias de Ingesta Dietética y fueron estratificadas por región, área urbana o rural, nivel socioeconómico y presencia de obesidad (no-obesas: IMC <30 kg/m2, obesas: >30 kg/m2). Las diferencias se analizaron utilizando modelos de regresión lineal para encuestas complejas del logaritmo de la ingesta y la adecuación, ajustando para comparaciones múltiples con la prueba de Bonferroni. RESULTADOS: La media nacional de ingesta de energía fue de 1 471 kcal. El riesgo de inadecuación (prevalencia de adecuación <50 por ciento) fue vitamina A: 38.3 por ciento, vitamina C: 45.5 por ciento y folato: 34.3 por ciento. La ingesta de carbohidratos, folato, hierro y calcio fue significativamente más alta en áreas rurales que en las urbanas. El riesgo de inadecuación fue mayor en mujeres del nivel socioeconómico más bajo para todos los nutrimentos con excepción de carbohidratos y calcio. Las adecuaciones de macro-nutrimentos fueron significativamente mayores en mujeres no-obesas. CONCLUSIONES: Las diferencias entre las regiones, áreas del país y terciles de nivel socioeconómico reflejan una disponibilidad creciente de alimentos densamente calóricos de bajo costo en grupos marginales. Sin embargo, la energía total, colesterol y la grasa saturada y total se consumieron en mayores cantidades por mujeres del tercil de nivel socioeconómico más alto y áreas urbanas. Estos patrones pueden estar contribuyendo al incremento de la obesidad y otras enfermedades no transmisibles en México.