Factores asociados con anemia y deficiencia de micronutrimentos en mujeres mexicanas. Ensanut Continua 2022.

OBJETIVO: Identificar los factores asociados con anemia, deficiencias de hierro (DH) y vitamina B12 (DVB12) en mujeres de 12 a 49 años, participantes en la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022). Material y métodos. La Ensanut es probabilística con representatividad nacional. Se recolectó sangre venosa de 1 141 mujeres para analizar hemoglobina, ferritina y vitamina B12, para estimar deficiencias según la Organización Mundial de la Salud. Se realizaron análisis descriptivos y modelos de regresión logística (módulo SVY/STATA). RESULTADOS: Las prevalencias de anemia, DH y DVB12 fueron 15.7, 41.9 y 17.2%, respectivamente. Se asoció (p<0.5) anemia con agua de garrafón/botella (razón de momios [RM]=2.27; IC95% 0.99,5.17) y DH con no tener agua entubada (RM=2.86; IC95% 1.31, 6.22) y pertenecer al estrato urbano (RM=1.56; IC95% 0.98, 2.45). Conclusión. La anemia, DH y DVB12 fueron altamente prevalentes, por lo tanto se requiere profundizar en el tema del agua para beber y en la derechohabiencia en mujeres con mayores desventajas socioeconómicas.

Estado de micronutrimentos en niños, niñas y mujeres mexicanas: análisis de la Ensanut Continua 2022.

OBJETIVO: Describir las deficiencias de micronutrientes en la población mexicana participante de la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). Material y métodos. La Ensanut 2022 es probabilística y de representatividad nacional. Se recolectó sangre venosa en una submuestra de niños de 1-11 años (48%) y de mujeres de 12-49 años (37%). Se separó el suero in situ para analizar ferritina, vitamina B12, folato y 25[OH]D, definiendo deficiencias según criterios de la Organización Mundial de la Salud. Se realizaron análisis descriptivos en niños/as preescolares, escolares y mujeres (12-49 años), utilizando el diseño de la encuesta. RESULTADOS: Las prevalencias de deficiencia de hierro, niveles bajos de vitamina B12 y deficiencia de vitamina D fueron 30.6, 17.4 y 4.7% en preescolares; 17.2, 20 y 37.1% en escolares; y 39.7, 34.0 y 37.7% en mujeres, respectivamente. Conclusión. La deficiencia de hierro en preescolares y de micronutrientes en mujeres fueron altamente prevalentes. Es necesario un llamado a la acción para realizar intervenciones focalizadas en grupos con mayor desventaja social.

Prevalencia de anemia en la población mexicana: análisis de la Ensanut Continua 2022.

OBJETIVO: Describir la magnitud de la prevalencia de anemia en la población mexicana participante en la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022). Material y métodos. La Ensanut 2022 es probabilística. Mediante sangre venosa y Hemocué (201+) se midió hemoglobina (Hb) y se ajustó por altitud. Se definió anemia según criterios de la Organización Mundial de la Salud (OMS). Considerando el diseño muestral de la encuesta, se obtuvieron prevalencias e IC95%. RESULTADOS: Las prevalencias de anemia fueron 6.8% en niños de 1-4 años, 3.8% en niños de 5-11 años, 10.1% en adolescentes (12-19 años), 15.8% en mujeres (20-49 años) y 10.3% en adultos mayores (≥60 años). CONCLUSIONES: La anemia afectó principalmente a las mujeres adultas. Resulta necesario identificar sus causas para focalizar acciones y evitar el ciclo intergeneracional del riesgo de anemia.

Prevalence of iron deficiency was stable and anemia increased during 12 years (2006-2018) in Mexican women 20-49 years of age.

OBJECTIVE: To compare the prevalence of women 20-49 years of age with iron deficiency anemia (IDA), iron deficiency with no anemia (IDNA), and non-ID anemia (NIDA) in com-parison during 2006, 2012 and 2018, and their association with sociodemographic characteristics and nutritional status. MATERIALS AND METHODS: Ensanut 2006, 2012 and 2018- 19 are comparable for measurements of anemia (hemoglobin) and Iron deficiency (ID, by ferritin). Both measurements combined were compared with year of surveys and other dependent variables using a multinomial regression. RESULTS: In 2006, the total prevalence of anemia was 14.9% and ID 29.0%, the prevalence of IDA was 8.35%, of IDNA 20.5%, and NIDA 6.6%; in 2012, the total prevalence of anemia was 13.3%, ID was 9.6%, IDA 8.6%, IDNA 21.0% y NIDA 4.7%; in 2018 total prevalence of anemia was 21.4%, of ID 25.7%, IDA 10.5%, IDNA 15.2% and NIDA 10.9%. CONCLUSIONS: The total prevalence of anemia increased 6.5 pp between 2006 and 2018, IDNA reduced, IDA had no significant changes, the mayor increase (4.3 pp) occurred in NIDA.

Magnitud y tendencia de la desnutrición y factores asociados con baja talla en niños menores de cinco años en México, Ensanut 2018-19.

Objetivos. Actualizar la prevalencia de desnutrición y sus tendencias en los últimos 30 años e identificar factores asociados con la baja talla en una muestra representativa nacional de niños <5 años en México. Material y méto-dos. Se estimaron prevalencias de desnutrición en <5 años en 2018-19 y se compararon con prevalencias de los últimos 30 años. Se estudiaron asociaciones de factores geográficos, del hogar, maternos e individuales con baja talla, utilizando regresión logística múltiple. Resultados. El 4.8% de los <5 años presentó bajo peso, 14.2% baja talla y 1.4% emaciación. Entre 1988-2012 hubo un descenso en baja talla interrum-pido entre 2012-2018. La baja talla se asoció positivamente con residencia rural, región sur, hogares más pobres, madres indígenas y mayor número de hijos, y negativamente con diversidad dietética. Conclusiones. La desnutrición cró-nica es un problema persistente asociado con factores de vulnerabilidad social, cuya tendencia descendente de 30 años se interrumpió entre 2012-2018. Es imperativo implementar una estrategia nacional de prevención de baja talla.

Sociodemographic factors associated with low intake of bioavailable iron in preschoolers: National Health and Nutrition Survey 2012, Mexico.

BACKGROUND: Children < 5 years of age are at risk of developing an iron deficiency due to a low intake of bioavailable iron (FeBio). Few studies have estimated dietary FeBio in children at a national level in relation to sociodemographic characteristics. This study aimed to estimate FeBio intake and its association with sociodemographic factors among Mexican children aged 12-59 months. METHODS: A cross-sectional study was carried out. Information on serum ferritin and diet was obtained from a national survey and representative sample of 1012 Mexican children aged 12-59 months. We used a 24-h recall to estimate total iron, heme and non-heme iron, vitamin C, phytates, calcium, and meat intake. We calculated FeBio intake using an algorithm. Differences in FeBio intake were analyzed by area of residence (rural/urban), country region (north, center, south), and socioeconomic status (SES), using linear regression models by age subgroups (12-23 and 24-59 months) and total population, while adjusting for study design. RESULTS: Total iron intake was 9.2 ± 6.7 mg/d. The estimated average of total FeBio fluctuated between 0.74-0.81 mg/d, with a bioavailability of 9.15-12.03% of total iron. Children aged 12-23 months residing in rural areas consumed less FeBio than those in urban areas (ß = - 0.276) (p < 0.05). Children aged 24-59 months with high SES consumed more FeBio (ß = 0.158 mg/d) than those of a low SES (p < 0.05). CONCLUSIONS: FeBio is low in Mexican preschoolers. Being from a rural area and having low SES were negatively associated with FeBio intake. These results can benefit interventions seeking to improve iron status.

[Municipal malnutrition in Mexican preschool children population and coverage of the Programa Nacional México Sin Hambre.] / Mala nutrición a nivel municipal en población preescolar mexicana y cobertura del Programa Nacional México Sin Hambre.

OBJECTIVE: To estimate malnutrition prevalence of preschool children at the level of municipality in Mexico, describe prevalence heterogeneity and its relationship with the Programa Nacional México Sin Hambre´s coverage. MATERIALS AND METHODS: Using the 2012 Mexican National Survey of Health and Nutrition, municipal income inequality and marginality, we applied a generalized normal model to obtain municipal distributions of nutrition status indicators from which we estimated malnutrition prevalence. RESULTS: Stunting prevalence ranged from 7.8% (95%CI: 5.9-8.9) to 64.2% (49.2-72.5), low weight prevalence ranged from 0.6% (0.005- 1.7) to 22.2% (13.5-34.9) and overweight-obesity prevalencem ranged from 2.6% (0.2-3.9) to 14.4% (11.9-27.7). A total of 275 out of 554 municipalities with stunting prevalence above 25% were covered by the Programa Nacional México Sin Hambre. CONCLUSIONS: Municipal malnutrition prevalence estimation showed wide differences within Mexico; this knowledge could assist public policy.

OBJETIVO: Estimar las prevalencias municipales de mala nutrición en población preescolar en México, y describir su variabilidad y su relación con la cobertura del Programa Nacional México Sin Hambre. MATERIAL Y MÉTODOS: A partir de datos de la Encuesta Nacional de Salud y Nutrición de 2012, la desigualdad del ingreso y marginación municipal se aplicó un modelo normal generalizado para obtener las distribuciones municipales de los indicadores de nutrición y estimar las prevalencias de mala nutrición. RESULTADOS: Las prevalencias de talla baja variaron de 7.8% (IC95%: 5.9-8.9) a 64.2% (49.2-72.5), las de bajo peso de 0.6% (0.005-1.7) a 22.2% (13.5-34.9) y de sobrepeso u obesidad de 2.6% (0.2- 3.9) a 14.4% (11.9-27.7). De los 554 municipios con prevalencias de talla baja mayor que 25%, 275 fueron cubiertos por el programa México Sin Hambre. CONCLUSIONES: La estimación de prevalencias municipales de mala nutrición evidenció grandes diferencias al interior del país, mismas que podrían asistir la política pública.

Perfil nutricional y estrategias de publicidad en el empaque de alimentos procesados de trigo y maíz en la Ciudad de México.

Objetivo. Evaluar la asociación entre el perfil nutricional y las estrategias de publicidad de alimentos procesados de trigo y maíz (APTM) ofertados en puntos de venta de la Ciudad de México. Material y métodos. Se recolectó información del contenido nutricional y tipos de publicidad para doce categorías de APTM en 58 puntos de venta localizados en zonas de niveles socioeconómicos (NSE) bajo y alto. Resultados. El 8.5 y 10.7% de APTM en NSE bajo y alto fueron saludables, respectivamente. ≤12% de los APTM fueron saludables, excepto harinas (~30%) y pastas (~95%). Entre ambos NSE, de 28.3% a 31.9% de APTM usaron personajes, de 46.5% a 50.1% promociones y de 38.2% a 41.3% claims. Se encontraron asociaciones significativas (p<0.001) en el uso de publicidad de APTM no saludables en ambas zonas de NSE. Conclusiones. La mayoría de los APTM en venta fueron no saludables, y se ofertaron más en el NSE bajo. En ambos NSE la mayoría de APTM no saludables usa estrategias publicitarias para estimular su consumo.

[Behavior and factors associated with anemia inMexican women of childbearing age. Ensanut 2018-19]. / Comportamiento y factores asociados con la anemia en mujeres mexicanas en edad fértil. Ensanut 2018-19.

OBJECTIVE: To study the behavior of anemia in 2006, 2012 and 2018-19, its severity and associated factors in Mexican women between 20 and 49 years of age. MATERIALS AND METHODS: The Ensanut 2006, 2012 and 2018-19 has a methodological design that allows comparisons between them. Capillary hemoglobin (Hb) classified anemia with Hb values <12dL. Pregnant women were excluded. Anemia was associated with individual and sociodemographic factors using a logit regression model. RESULTS: The reduction in anemia from 2006 to 2012 was significant, but not the increase for 2018-19. Anemia was associated with a higher number of pregnancies, and being 35 to 49 years of age. A BMI≥30 (k/m2), tertile 3 of wellness condition, not being indigenous and living in the Center and Mexico City were protective of anemia. CONCLUSIONS: Anemia continues to be a public health problem, especially in women 35 to 49 years of age with more than four pregnancies.

OBJETIVO: Estudiar el comportamiento de la anemia en los años 2006, 2012 y 2018-19, su severidad y factores asociados en mujeres mexicanas de 20 a 49 años de edad. MATERIAL Y MÉTODOS: Las Ensanut 2006, 2012 y 2018-19 tienen un diseño metodológico que permite comparaciones entre ellas. Mediante hemoglobina capilar <12dL se clasificó anemia. Se excluyó a quienes estuvieron embarazadas. Se asoció anemia con factores sociodemográficos mediante regresión logística. RESULTADOS: La reducción de anemia de 2006 a 2012 fue significativa, pero no el incremento para 2018-19. Se asoció anemia con un mayor número de embarazos, y tener de 35 a 49 años de edad. Fueron factores protectores de anemia un IMC≥30(k/m2), tercil 3 de CB, no ser indígena y vivir en Cen-tro y Ciudad de México. CONCLUSIONES: La anemia continúa siendo un problema de salud pública, sobre todo en mujeres de 35 a 49 años de edad con más de cuatro embarazos.

Sociocultural Influences on Poor Nutrition and Program Utilization of Mexico's Conditional Cash Transfer Program.

BACKGROUND: The impact of the Conditional Cash Transfer Program in Mexico was significant but smaller than expected. Several bottlenecks related to program design and implementation have been identified that may have limited its impact; population and other contextual factors may be equally important to analyze. OBJECTIVES: We aimed to explore how sociocultural context contributes to poor nutrition in Mexico and how it shaped the acceptability, fidelity, and penetration of the fortified food and of education sessions provided by the program. METHODS: We carried out qualitative research studies in the central and southern states in urban, rural, and indigenous settings between 2001 and 2014 with different informants and by using interviews, focus group discussions, and nonparticipatory observation. We explored 4 dimensions of the sociocultural context: objective dimension (e.g., food availability and family organization), social norms and symbolic meaning related to child feeding, literacy and communication with the biomedical culture, and knowledge related to child care generally and child feeding. We generated information about the experience of the beneficiaries with fortified food and education sessions. RESULTS: Several sociocultural factors, including patriarchal family organization, high availability of nonnutritious food, social norms promoting the consumption of food in liquid form for young children, sharing of food among family members, traditional knowledge, and communication barriers with the biomedical culture, participated in shaping the poor nutrition situation, the inadequate utilization of fortified foods, and the inappropriateness of the education sessions. CONCLUSIONS: Our studies revealed the importance of local context and culture to understand the acceptance, utilization, and impact of a nutrition program and shed light on infant and child feeding practices. This knowledge is critical to strengthen program designs and ensure adequacy with the diversity of cultural and social contexts in which programs are implemented.

A Fortified Food Can Be Replaced by Micronutrient Supplements for Distribution in a Mexican Social Protection Program Based on Results of a Cluster-Randomized Trial and Costing Analysis.

BACKGROUND: Despite positive nutrition impacts, the prevalence of malnutrition among beneficiaries of Mexico's conditional cash transfer (CCT) program remains high. Greater nutrition impact may have been constrained by the type of nutritional supplements provided. OBJECTIVE: The objective of this study was to inform a potential modification to the supplements distributed to pregnant and lactating women and children. METHODS: Impact was assessed using 2 cluster-randomized trials (pregnant women, children) run simultaneously. Communities (n = 54) were randomly assigned to the fortified foods provided by the program (Nutrivida women, Nutrisano children) or alternatives: tablets (women), syrup (children), or micronutrient powders for women (MNP-W) and children (MNP-C). Each supplement for women/children contained the same micronutrients based on the formulations of Nutrivida and Nutrisano, respectively. Pregnant women (aged >18 y) were recruited before 25 weeks of gestation and followed to 3 mo postpartum. Children aged 6-12 mo were recruited and followed to age 24 mo. Primary outcomes were anemia for women and length growth for children. Statistical analyses appropriate for cluster-randomized designs were used, and structural equation modeling to estimate dose-response effects. Supplement costs per beneficiary (daily dose for 18 mo) were estimated for production and distribution. RESULTS: There was no significant difference in change of anemia prevalence between supplement groups in women, or in length growth between groups in children. One daily dose of any supplement was associated with 0.8 cm greater length growth. From baseline to age 24 mo, the prevalence of anemia in the Nutrisano, syrup, and MNP-C groups decreased by 36.7, 40.8, and 37.9 percentage points, respectively (within-group, P < 0.05; between groups, P > 0.05). Costs per beneficiary ranged from $12.1 (MNP-C) to $94.8 (Nutrivida). CONCLUSIONS: The CCT program could distribute alternative supplements at lower cost per beneficiary without compromising potential for impact. Acceptance among beneficiaries should also be considered in choice of alternatives. This trial was registered at www.clinicaltrials.gov as NCT00531674.

Closing the Nutrition Impact Gap Using Program Impact Pathway Analyses to Inform the Need for Program Modifications in Mexico's Conditional Cash Transfer Program.

BACKGROUND: Mexico's Prospera-Oportunidades-Progresa Conditional Cash Transfer Program (CCT-POP) included the distribution of fortified food supplements (FFS) for pregnant and lactating women and young children. Rigorous evaluations showed significant impacts on nutrition outcomes but also substantial gaps in addressing nutrition problems. OBJECTIVES: To highlight the program design-related and implementation-related gaps and challenges that motivated further research and the eventual design and roll-out of a modified nutrition component for CCT-POP. METHODS: We used a program impact pathway approach to highlight the extent and quality of implementation of CCT-POP, and its impact on nutrition outcomes. We drew on previously published and new primary data, organized into 3 sources: impact evaluations, studies to inform reformulation of the FFS, and a longitudinal follow-up study using qualitative and quantitative methods to document FFS use and the dietary intake of women and children. RESULTS: Despite positive impacts, a high prevalence of malnutrition persisted in the population. Coverage and use of health services improved, but quality of care was lacking. Consumption of FFS among lactating women was irregular. Micronutrient intake improved among children who consumed FFS, but the pattern of use limited frequency and quantity consumed. Substantial diversity in the prevalence of undernutrition was documented, as was an increased risk of overweight and obesity among women. CONCLUSIONS: Three key design and implementation challenges were identified. FFS, although well accepted for children, had limited potential to substantially modify the quality of children's diets because of the pattern of use in the home. The communications strategy was ineffective and ill-suited to its objective of motivating FFS use. Finally, the program with its common design across all regions of Mexico was not well adapted to the special needs of some subgroups, particularly indigenous populations. The studies reviewed in this paper motivated additional research and the eventual redesign of the nutrition component.

An Iterative Process for Training Design and Implementation Increased Health Workers' Knowledge for Taking Nutrition Behavior Change to Scale.

BACKGROUND: The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. OBJECTIVE: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. METHODS: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. RESULTS: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers' routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. CONCLUSIONS: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions.

Translating Evidence-Based Program Recommendations into Action: The Design, Testing, and Scaling Up of the Behavior Change Strategy EsIAN in Mexico.

BACKGROUND: The Integrated Strategy for Attention to Nutrition (EsIAN in Spanish) is a national strategy within Mexico's conditional cash transfer program (initially Progresa, then Oportunidades, then Prospera, CCT-POP) designed to strengthen the health and nutrition component, address the nutrition transition, and improve the health and nutritional status of its beneficiaries, through 3 main components: 1) procurement of functioning equipment to primary health care (PHC) units; 2) providing free micronutrient supplements to beneficiary women and children; 3) implementing a behavior change communication (BCC) strategy and a training system for PHC providers (PHCPs). OBJECTIVE: We aim to describe the iterative process and evidence-based approach used to design and roll-out the EsIAN at scale, by focusing on the BCC component. METHODS: The BCC strategy was developed by following an iterative process through the following phases: situational analysis, formative research and design of the BCC strategy (using the socioecological framework and the social marketing approach), large-scale feasibility study, redesign, and national scale-up. RESULTS: The review and formative research revealed several barriers and issues that limited program coverage, utilization, and acceptance. These included misconceptions about pregnancy and infant feeding, nonalignment of practices with international recommendations, and lack of knowledge on nutrition and related topics, among others. These results were used to identify priority behaviors and elaborate key messages for mothers/caregivers and providers to develop the BCC strategy. The feasibility study resulted in significant improvements in PHCPs' knowledge, counseling (breastfeeding, and supplement use and consumption), and caregivers' complementary feeding behaviors, and highlighted several design and delivery aspects that needed strengthening. Based on these findings, the BCC strategy was adapted prior to a national scale-up. CONCLUSIONS: The theory-based iterative approach resulted in the identification of specific actions to target, and approaches to do so, as part of the design and roll-out of the BCC strategy at scale.

[Anemia, iron and zinc deficiencies, supplements consumption and morbidity in Mexican children aged 1 to 4: analysis of Ensanut 100k.] / Anemia, deficiencias de zinc y hierro, consumo de suplementos y morbilidad en niños mexicanos de 1 a 4 años: resultados de la Ensanut 100k.

OBJECTIVE: To analyze the association between supplements and Liconsa milk intake, with anemia, zinc (ZD) and iron (ID) deficiencies, and morbidity in Mexican children resident of less than 100 000 habitants' localities. MATERIALS AND METHODS: A subsample of 1 516 children aged 1-4 participants of Ensanut 100k was analyzed, carried out in 2018. Anemia was considered if [Hb]<11 g/dL, ZD if [Zn]<65 µg/dL and ID if [ferritin]<12 µg/L. Supplements and Liconsa milk consumption were obtained from a semi-quantitative food frequency; morbidity by self-report of the mother. Multiple logistic regression models were used adjusted by confounders. RESULTS: Medium and high consumption of Liconsa milk was associated to lower odds of ID (OR=0.02, [95%CI 0.002,0.24] and OR=0.07, [95%CI 0.01,0.52]) and anemia (OR=0.13, [95%CI 0.04,0.37] and OR=0.17, [95%CI 0.03,0.87]). A high intake of Liconsa milk (OR=0.09, [95%CI 0.01,0.44]) and Vitaniño (OR=0.05 [95%CI 0.005, 0.46]) were both associated to lower diarrhea risk. CONCLUSIONS: To assure the continuity of the consumption of nutritional supplements is necessary for improving the health and the micronutrients status in vulnerable Mexican children.

OBJETIVO: Analizar la asociación entre el consumo de suplementos o leche Liconsa y anemia, deficiencias de zinc (DZ) y hierro (DH) y morbilidad en niños mexicanos residentes de localidades menores a 100 000 habitantes. MATERIAL Y MÉTODOS: Se analizó información de 1 516 niños de 1 a 4 años de la Encuesta Nacional de Salud y Nutrición en localidades con menos de 100 000 habitantes realizada en el año 2018. Se definió Anemia si [Hb]<11 g/dL, DZ: [Zn]<65 µg/dL y DH: [ferritina]<12 µg/L. El consumo de suplementos y de leche Liconsa se obtuvo del cuestionario de Frecuencia de Consumo de Alimentos y morbilidad por autorreporte de la madre. Se emplearon modelos de regresión logística múltiple para el análisis de las asociaciones, ajustados por confusores. RESULTADOS: El consumo medio y alto de leche Liconsa se asoció con menor momio de DH (RM=0.02 [IC95% 0.002,0.24] y RM=0.07 [IC95% 0.01,0.52]) y anemia (RM=0.13 [IC95% 0.04,0.37] y RM=0.17 [IC95% 0.03,0.87]). Un alto consumo de leche Liconsa (RM=0.09, [IC95% 0.01,0.44]) y de Vitaniño (RM=0.05 [IC95% 0.005, 0.46]) se asoció con menor momio de diarrea. CONCLUSIONES: Es necesario considerar la continuidad del consumo de suplementos nutricionales para mejorar la salud y el estado de micronutrimentos en población infantil mexicana vulnerable.

[High prevalence of anemia in Mexican women in poverty, Ensanut 100k]. / Alta prevalencia de anemia en mujeres mexicanas en pobreza, Ensanut 100k.

OBJECTIVE: To estimate the prevalence and distribution of anemia in Mexican women and their association with sociodemographic factors and diet diversity. MATERIALS AND METHODS: We analyzed information of women in childbearing age. The Ensanut 100k is a probabilistic survey that overrepresents households with less economic capacity. Anemia was estimated using hemoglobin concentration. We collected sociodemographic and health information, food insecurity, and dietary diversity. RESULTS: 34.3% of the women presented anemia, belong to tertile 3 of welfare status is a protective factor for anemia (OR= 0.26, 95%CI 0.16-0.61), and living in a household with food security, as well as high diversity of the diet in rural women (OR= 0.57, 95%CI 0.36-0.92). CONCLUSIONS: It is necessary to implement actions of detection and early attention of the anemia in women in childbearing age, identification of its underlying causes, strengthening and reformulation of strategies to prevent it.

OBJETIVO: Estimar la prevalencia y distribución de anemia en mujeres mexicanas y su asociación con factores sociodemográficos y la diversidad de la dieta. MATERIAL Y MÉTODOS: Se incluyeron mujeres en edad fértil de la encuesta probabilística Ensanut 100k, que representa a los hogares con menos capacidades económicas. Se estimó la prevalencia de anemia mediante concentración de hemoglobina, con información sociodemográfica, de salud, inseguridad alimentaria y diversidad de la dieta. RESULTADOS: El 34.3% de las mujeres presentó anemia; los factores protectores para anemia fueron pertenecer al tercil 3 de condición de bienestar (OR=0.26, IC95% 0.16-0.61), alta diversidad de la dieta en áreas rurales (OR=0.57, IC95%0.36-0.92), así como vivir en un hogar con seguridad alimentaria. CONCLUSIONES: Es necesario implementar acciones de detección y atención temprana de la anemia en las mujeres de edad fértil, así como identificar las causas subyacentes y fortalecer y reformular estrategias para prevenirla.

Fortified food supplementation in children with reduced dietary energy and micronutrients intake in Southern Mexico.

BACKGROUND: Nutritional supplements are an important source of complementary food for young children, since they may either complement or substitute nutrients obtained from other food sources. Assessing how the introduction of different types of supplements modifies the consumption of other food sources may help in designing supplementation programs that aim to improve the nutrition of vulnerable populations. The objetive is to quantify dietary energy and nutrient intake among children aged 6-12 months who received one of three nutritional supplements. METHODS: A cluster-randomized trial was conducted from 2005 to 2007. Urban communities were randomly allocated to one of three intervention groups receiving one of the following: a milk-based fortified food, micronutrient powders, or syrup. Each supplement was fortified with equal amounts of micronutrients. Dietary intake was estimated using a food frequency questionnaire (FFQ) to reflect the average consumption over the month prior to the interview. Children between 6 and 12 months of age were recruited. Median regression was performed with adjusted standard errors for clustered data, and the linear predictors for the median included the study group, study stage and their interaction. Adjusted medians by study group and study stage were obtained as post-estimations. RESULTS: No statistically significant differences between study groups were observed at baseline. After four months of supplementation, the children in the fortified food group had a smaller increase in median dietary energy (183.7 kcal, CI95%: 59.9, 307.5) and dietary protein (6.6 g, CI95%: 2.6, 10.6) intake from their home diet than those in the syrup group (p < 0.05). These differences remained significant after adjusting for group differences at baseline. Regarding covariate-adjusted median changes from baseline to follow-up at 10 months, the children in the fortified food group had a smaller median increase in dietary energy intake than those in the syrup group (698 vs 915 kcal), with a difference of 217.9 kcal (CI95%: 20.4, 415.4). CONCLUSION: Children in the fortified food group consumed less dietary energy, protein, and micronutrients than those in the micronutrient powder and syrup groups. It is possible that absolute nutrient intake may be overestimated by the FFQ, but this possibility does not compromise the ability to compare study groups. Given the observed differences in dietary energy consumption among the three supplemented groups, it can be concluded that supplementation with micronutrient powders is an adequate option for urban children who have met their minimum energy and protein requirements.

Low level aflatoxin exposure associated with greater linear growth in southern Mexico: A longitudinal study.

Aflatoxins are a group of naturally occurring mycotoxins, which can lead to death and are a known cause of hepatocellular carcinoma. AF exposure has been hypothesised to lead to stunted growth in children, but separating the AF effect from other determinants of linear growth retardation is difficult. The study used secondary data from an efficacy trial conducted in young children in southern Mexico to test the comparative efficacy of a milk-based multiple micronutrient-fortified food, a multiple micronutrient syrup, or a multiple micronutrient powder. The effect of serum AFB1 -lysine adduct level on incremental growth was tested using a longitudinal mixed model, controlling for key individual, maternal, and household-level covariates. AFB1 -lysine adduct was detectable in all but 2 of the 347 children in the study (median exposure: 0.82 pg/mg albumin). AF exposure was associated (p < .05) with greater linear growth: an increase equivalent to the sample interquartile range (~0.5 pg AFB1 -lysine/mg albumin) was associated (p < .05) with an increase in the child's height-for-age deficit of 1.5 to 2.0 mm in the 4 months from baseline (average age 8 months) to follow-up (average age 12 months); the magnitude of the difference in the 10-month follow-up was smaller and not statistically significant. This study documents that low-dose AF exposure was associated with greater child linear growth. Given its toxicity and carcinogenicity, our results do not change the urgent need to drastically reduce human AF exposure. Our findings show that the association between AF exposure and linear growth is more complex than previously thought.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

High Prevalence of Inadequate Calcium and Iron Intakes by Mexican Population Groups as Assessed by 24-Hour Recalls.

BACKGROUND: A National Health and Nutrition Survey (ENSANUT) conducted in Mexico in 1999 identified a high prevalence of inadequate mineral intakes in the population by using 24-h recall questionnaires. However, the 1999 survey did not adjust for within-person variance. The 2012 ENSANUT implemented a more up-to-date 24-h recall methodology to estimate usual intake distributions and prevalence of inadequate intakes. OBJECTIVE: We examined the distribution of usual intakes and prevalences of inadequate intakes of calcium, iron, magnesium, and zinc in the Mexican population in groups defined according to sex, rural or urban area, geographic region of residence, and socioeconomic status (SES). METHODS: We used dietary intake data obtained through the 24-h recall automated multiple-pass method for 10,886 subjects as part of ENSANUT 2012. A second measurement on a nonconsecutive day was obtained for 9% of the sample. Distributions of usual intakes of the 4 minerals were obtained by using the Iowa State University method, and the prevalence of inadequacy was estimated by using the Institute of Medicine's Estimated Average Requirement cutoff. RESULTS: Calcium inadequacy was 25.6% in children aged 1-4 y and 54.5-88.1% in subjects >5 y old. More than 45% of subjects >5 y old had an inadequate intake of iron. Less than 5% of children aged <12 y and 25-35% of subjects aged >12 y had inadequate intakes of magnesium, whereas zinc inadequacy ranged from <10% in children aged <12 y to 21.6% in men aged ≥20 y. Few differences were found between rural and urban areas, regions, and tertiles of SES. CONCLUSIONS: Intakes of calcium, iron, magnesium, and zinc are inadequate in the Mexican population, especially among adolescents and adults. These results suggest a public health concern that must be addressed.