Bases metodológicas de la medición de desarrollo infantil temprano en la Ensanut 100k / Methodological bases of the measurement of early childhood development in the Ensanut 100k survey

Resumen Objetivo: Presentar los métodos realizados para la inclusión del módulo de Desarrollo Infantil Temprano (DIT) en la Ensanut 100k. Material y métodos: Con dicho módulo y el cuestionario de menores de cinco años, se obtuvieron indicadores del estado de salud, desarrollo y bienestar de niñas/os en los primeros cinco años de vida. De noviembre a diciembre de 2017, se definió el diseño de la muestra, instrumentos y manuales, y se realizó una prueba piloto. Se capacitó y estandarizó al personal de campo. El levantamiento de información se realizó entre enero y junio de 2018. Resultados: Se estudió en el módulo DIT de la encuesta a 3 892 niños/as de 0 a 59 meses de edad. Conclusiones: La capacitación y estandarización del personal de campo, por parte de personal capacitado y estandarizado, minimiza los sesgos de información.

Abstract Objective: The methods that were carried out for the inclusion of the early childhood development module in the Ensanut 100k are presented. Materials and methods: With this module and the questionnaire for children under five years-old, indicators of the state of health, development and well-being of children in the first five years of life are obtained. From November to December 2017, the sample design, instruments and manuals were defined and a test was carried out. Field staff were trained and standardized. The information was collected between January and June 2018. Results: 3 892 children from 0 to 59 months of age were studied in the DIT Module of the Survey. Conclusions: Training and standardization of field personnel, by trained and standardized personnel, minimizes information biases.

[Obesity in Mexico, prevalence andtrends in adults. Ensanut 2018-19.] / Obesidad en México, prevalencia y tendencias en adultos. Ensanut 2018-19.

OBJECTIVE: To describe the prevalence of obesity in Mexican adults stratifying by physical and sociodemographic conditions and to analyze trends. MATERIALS AND METHODS: The data of 16 256 adults who participated in Ensanut 2018-19 was analyzed. Obesity (WHO), abdominal adiposity (IFD) and short stature (NOM-008-SSA3-2017) were classified. Logistic regression models were performed to analyze the association between obesity and risk factors. ENSA-2000 and Ensanut (2006, 2012, 2018-19) were used to assess trends. RESULTS: The prevalence of overweight was 39.1%, obesity 36.1%, and abdominal adiposity 81.6%. Adults >40-50y and women had the highest prevalence. There was no difference by socio-economic level. Between 2000-2018, the prevalence of obesity increased 42.2% and morbid obesity 96.5%. Women with short stature had a higher risk (RM=1.84) of being obese than women without this condition, while in men the risk was lower (RM=0.79). CONCLUSIONS: In Mexico the prevalence of obesity continues to increase regardless of socio-economic level, region or locality.

OBJETIVO: Describir la prevalencia de obesidad en adultos mexicanos estratificando por condiciones físicas y sociode-mográficas, y analizar tendencias. MATERIAL Y MÉTODOS: Análisis de 16 256 adultos de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19. Se clasificó obesidad (OMS), adi-posidad abdominal (IDF) y talla baja (NOM-008-SSA3-2017). Se realizaron modelos de regresión logística para asociar obesidad y factores de riesgo. Para evaluar tendencias se analizaron Encuesta Nacional de Salud 2000 y Ensanut (2006, 2012, 2018-19). RESULTADOS: La prevalencia de sobrepeso fue 39.1%, obesidad 36.1% y adiposidad abdominal 81.6%. Se presentaron las prevalencias más altas en >40-50 años y en las mujeres. No hubo diferencia por nivel socioeconómico. En el periodo 2000-2018 aumentó la prevalencia de obesidad 42.2% y de obesidad mórbida 96.5%. Las mujeres con talla baja tuvieron mayor riesgo (RM=1.84) de tener obesidad que las mujeres sin esta condición, mientras que en hombres el riesgo fue menor (RM=0.79). CONCLUSIONES: En México, la prevalencia de obesidad sigue aumentando sin importar nivel socioeconómico, región o localidad.

Obesidad en México, prevalencia y tendencias en adultos. Ensanut 2018-19 / Obesity in Mexico, prevalence and trends in adults. Ensanut 2018-19

Resumen: Objetivo: Describir la prevalencia de obesidad en adultos mexicanos estratificando por condiciones físicas y sociodemográficas, y analizar tendencias. Material y métodos: Análisis de 16 256 adultos de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19. Se clasificó obesidad (OMS), adiposidad abdominal (IDF) y talla baja (NOM-008-SSA3-2017). Se realizaron modelos de regresión logística para asociar obesidad y factores de riesgo. Para evaluar tendencias se analizaron Encuesta Nacional de Salud 2000 y Ensanut (2006, 2012, 2018-19). Resultados: La prevalencia de sobrepeso fue 39.1%, obesidad 36.1% y adiposidad abdominal 81.6%. Se presentaron las prevalencias más altas en >40-50 años y en las mujeres. No hubo diferencia por nivel socioeconómico. En el periodo 2000-2018 aumentó la prevalencia de obesidad 42.2% y de obesidad mórbida 96.5%. Las mujeres con talla baja tuvieron mayor riesgo (RM=1.84) de tener obesidad que las mujeres sin esta condición, mientras que en hombres el riesgo fue menor (RM=0.79). Conclusiones: En México, la prevalencia de obesidad sigue aumentando sin importar nivel socioeconómico, región o localidad.

Abstract: Objective: To describe the prevalence of obesity in Mexican adults stratifying by physical and sociodemographic conditions and to analyze trends. Materials and methods: The data of 16 256 adults who participated in Ensanut 2018-19 was analyzed. Obesity (WHO), abdominal adiposity (IFD) and short stature (NOM-008-SSA3-2017) were classified. Logistic regression models were performed to analyze the association between obesity and risk factors. ENSA-2000 and Ensanut (2006, 2012, 2018-19) were used to assess trends. Results: The prevalence of overweight was 39.1%, obesity 36.1%, and abdominal adiposity 81.6%. Adults >40-50y and women had the highest prevalence. There was no difference by socio-economic level. Between 2000-2018, the prevalence of obesity increased 42.2% and morbid obesity 96.5%. Women with short stature had a higher risk (RM=1.84) of being obese than women without this condition, while in men the risk was lower (RM=0.79). Conclusions: In Mexico the prevalence of obesity continues to increase regardless of socio-economic level, region or locality.

Effectiveness of a large-scale iron-fortified milk distribution program on anemia and iron deficiency in low-income young children in Mexico.

BACKGROUND: Anemia during infancy impairs neurodevelopment. Little information has been published about the effectiveness of large-scale programs on anemia and iron-deficiency prevention. OBJECTIVE: The objective was to assess the effectiveness of a large-scale program that distributes subsidized iron-fortified milk in Mexico on anemia and iron deficiency in children aged 12-30 mo. DESIGN: A double-blinded, group-randomized effectiveness trial was conducted in 12 milk distribution clusters assigned to consume iron-fortified (FM; n = 7) or nonfortified (NFM; n = 5) milk. A daily portion of FM contained 5.28 mg Fe (ferrous gluconate) and 48 mg sodium ascorbate. RESULTS: Overall treatment effects were documented at 6 and 12 mo for anemia and for iron deficiency assessed by both serum ferritin (SF) and serum soluble transferrin receptor (sTfR) (interaction: P < 0.10). Differential effects at 6 mo (P = 0.004) and 12 mo (P = 0.664) were documented only for sTfR. Estimated prevalences (EPs) of anemia (hemoglobin < 110 g/L) from baseline to 6 and 12 mo decreased from 42.6% to 19.7% and 9.4%, respectively, in the NFM group (n = 210) and from 44.5% to 12.7% and 4.0%, respectively, in the FM group (n = 357). EPs of SF < 12 mug/L from baseline to 6 and 12 mo changed from 36.0% to 41.8% and 17.1%, respectively, in the NFM group (n = 43) and from 29.8% to 18.6% and 5.7%, respectively, in the FM group (n = 144). EPs of sTfR > 3.3 mg/L from baseline to 6 and 12 mo decreased from 16.2% to 8.3% and 2.0%, respectively, in the NFM group (n = 114) and from 15.5% to 0.7% and 1.1%, respectively, in the FM group. CONCLUSION: A large-scale iron-fortified subsidized-milk program was effective at reducing the rates of anemia and iron deficiency in Mexican children during 12 mo of implementation. This trial was registered at clinicaltrials.gov as NCT00508131.

Prevalence of abnormal eating behaviors in adolescents in Mexico: Mexican National Health and Nutrition Survey 2006 / Prevalencia de conductas alimentarias anormales de adolescentes en México: Encuesta Nacional de Salud y Nutrición ENSANUT 2006

OBJECTIVE: To describe the prevalence of abnormal eating behaviors in a population-based nationwide survey. MATERIAL AND METHODS: A stratified, probabilistic, multistage design sampling process was used. The Brief Questionnaire for Risky Eating Behaviors was included in the Mexican Health and Nutrition Survey 2006 (ENSANUT 2006) and administered to participants 10-19 years old (n= 25 166). The study had the power to describe nationwide characteristics by age, regions and urban/rural settings. RESULTS: A high risk for having an eating disorder was found in 0.8 percent of the total participants (0.4 percent male adolescents and 1.0 percent female). Inhabitants in large cities showed higher risk for having an abnormal eating behavior compared to subjects living in other settings. The highest prevalences were found in males > 15 years old and females > 13 years old for all evaluated behaviors. CONCLUSIONS: Results show less prevalence of risky eating behaviors among adolescents in comparison to other populations. The female/male ratio was 3:1, far different from the 9:1 shown in a previous study in Mexico City, but similar to results from the US national eating disorders screening.

OBJETIVOS: Describir la prevalencia de conductas alimentarias anormales en una encuesta nacional de base poblacional. MATERIAL Y MÉTODOS: Diseño muestral probabilístico, polietápico, por conglomerados y estratificado. Se utilizó el Cuestionario Breve de de Conductas Alimentarias de Riesgo de la ENSANUT 2006, en adolescentes entre 10 y 19 años de edad (n= 25 166) de ambos sexos, con resultado nacional, por región y tipo de localidad. RESULTADOS: En 0.8 por ciento de los participantes se encontró alto riesgo de desarrollar un trastorno de conducta alimentaria (0.4 por ciento hombres y 1.0 por ciento mujeres). La edad de mayor riesgo fue > 15 años en hombres y > 13 en mujeres. Los habitantes de áreas metropolitanas presentan un riesgo mayor que la población rural y urbana. CONCLUSIONES: La prevalencia de conductas alimentarias de riesgo en adolescentes es menor en comparación con otras poblaciones. La relación mujer/hombre resultó de 3:1, muy diferente del 9:1 encontrado en población estudiantil de la Ciudad de México, pero similar a lo reportado en la encuesta nacional de trastornos alimentarios en EUA.

Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and young children: a randomized effectiveness study.

CONTEXT: Malnutrition causes death and impaired health in millions of children. Existing interventions are effective under controlled conditions; however, little information is available on their effectiveness in large-scale programs. OBJECTIVE: To document the short-term nutritional impact of a large-scale, incentive-based development program in Mexico (Progresa), which included a nutritional component. DESIGN, SETTING, AND PARTICIPANTS: A randomized effectiveness study of 347 communities randomly assigned to immediate incorporation to the program in 1998 (intervention group; n = 205) or to incorporation in 1999 (crossover intervention group; n = 142). A random sample of children in those communities was surveyed at baseline and at 1 and 2 years afterward. Participants were from low-income households in poor rural communities in 6 central Mexican states. Children (N = 650) 12 months of age or younger (n = 373 intervention group; n = 277 crossover intervention group) were included in the analyses. INTERVENTION: Children and pregnant and lactating women in participating households received fortified nutrition supplements, and the families received nutrition education, health care, and cash transfers. MAIN OUTCOME MEASURES: Two-year height increments and anemia rates as measured by blood hemoglobin levels in participating children. RESULTS: Progresa was associated with better growth in height among the poorest and younger infants. Age- and length-adjusted height was greater by 1.1 cm (26.4 cm in the intervention group vs 25.3 cm in the crossover intervention group) among infants younger than 6 months at baseline and who lived in the poorest households. After 1 year, mean hemoglobin values were higher in the intervention group (11.12 g/dL; 95% confidence interval [CI], 10.9-11.3 g/dL) than in the crossover intervention group (10.75 g/dL; 95% CI, 10.5-11.0 g/dL) who had not yet received the benefits of the intervention (P =.01). There were no differences in hemoglobin levels between the 2 groups at year 2 after both groups were receiving the intervention. The age-adjusted rate of anemia (hemoglobin level <11 g/dL) in 1999 was higher in the crossover intervention group than in the intervention group (54.9% vs 44.3%; P =.03), whereas in 2000 the difference was not significant (23.0% vs 25.8%, respectively; P =.40). CONCLUSION: Progresa, a large-scale, incentive-based development program with a nutritional intervention, is associated with better growth and lower rates of anemia in low-income, rural infants and children in Mexico.

[Factors associated with physical activity among Mexican women of childbearing age]. / Factores asociados con la actividad fisica en mujeres mexicanas en edad reproductiva.

OBJECTIVE: To document the practice of light and heavy physical activities, especially sports and exercise, among women from 12 to 49 years old in Mexico, and to evaluate the association that that has with some sociodemographic characteristics. METHODS: A sample of 2 367 women 12 to 49 years old living in Mexico in 1999 was studied through secondary analysis of data from Mexico's 1999 National Nutrition Survey (Encuesta Nacional de Nutrición). The Survey used a clustered stratified multistage sampling scheme, with a final sample of 21 000 homes in the entire country. A questionnaire was used to evaluate the time that the women spent on various forms of physical activity, with the activity measured on a scoring scale in terms of metabolic equivalents (METs). The dependent variables in the study were the time spent on heavy physical activities (those that require an energy expenditure of at least 5 METs/hour) and the time devoted to light or sedentary activities (such as sitting while on the job or elsewhere; watching television, a video, a movie, or a theater presentation; or sleeping). The independent variables were age, schooling, parity, region of the country, area of residence (urban or rural), socioeconomic level (measured through an index prepared based on housing conditions and household possessions), and marital status. The association between the independent variables and practicing sports was evaluated, and gross odds ratios (ORs) were calculated, with 95% confidence intervals (CIs). In order to identify the association between practicing sports and the independent variables a logistic regression model was used, adjusted for the effects of possible confounding variables. Adjustments were also made in the probability of a woman's being selected for the sample, using a weighting factor. In addition, adjustments were made to control for the design effect produced by the grouping of the observations in the sample, using the "svy" complex-samples routine of the Stata version 7.0 statistical analysis computer software. RESULTS: The 2 367 women whose information was analyzed spent an average of 0.08 hours per day practicing sports and 1.25 hours per day on heavy physical activities. Only 16% of the women reported that they regularly practiced some sport. After adjusting for all the independent variables, the women older than 30 years had a lower OR of practicing sports in comparison to women who were 20 years of age or less (OR = 0.53; 95% CI: 0.33 to 0.84), as was also true for women 21-30 years old (OR = 0.35; 95% CI: 0.23 to 0.54). Having the highest level of schooling and not having had children were both directly associated with practicing a sport. While the area of residence (urban or rural), marital status, and socioeconomic level showed differences among the groups, such differences were not significant after adjusting for the other study variables. In terms of physical activity measured in METs, the time spent on sports made up 10% of the total for heavy activity and 0.7% of the overall total. In terms of the possibility of being among the 10% of the women who expended the fewest METs per day, that was more likely for women under 21 years of age than it was for women 31 or older, and it was also more likely for women who had a primary level of schooling than for women with a secondary education. CONCLUSIONS: This study showed that practicing sports is not a frequent form of physical activity among women of childbearing age in Mexico, especially those who are over 20 years of age and those with a low level of schooling. This situation could contribute to increases in the prevalence of obesity and chronic diseases.

Factores asociados con la actividad física en mujeres mexicanas en edad reproductiva / Factors associated with physical activity among Mexican women of childbearing age

OBJETIVO: Documentar la práctica de actividades físicas ligeras y pesadas, particularmente de deportes y ejercicios, en mujeres de 12 a 49 años en México, y evaluar su asociación con algunas características sociodemográficas. MÉTODOS: Se estudió una muestra de 2 367 mujeres de 12 a 49 años de edad residentes en México en 1999 mediante el análisis secundario de los datos de la Encuesta Nacional de Nutrición de México, 1999 (ENN-99). En esta encuesta se utilizó un esquema de muestreo polietápico, estratificado, por conglomerados que conformó una muestra final de 21 000 hogares de todo el país. Mediante un cuestionario se evaluó el tiempo dedicado a las distintas formas de actividad física y se midió la actividad en equivalentes metabólicos (MET) según una escala puntual. Las variables dependientes del estudio fueron el tiempo dedicado a actividades físicas pesadas (las que exigen un gasto de energía equivalente a 5 MET/hora) y el dedicado a actividades ligeras o sedentarias (tales como estar sentada en el trabajo o fuera de él, ver televisión, video, cine o teatro y dormir). Las variables independientes fueron la edad, escolaridad, paridad, región del país y área de residencia (urbana o rural), nivel socioeconómico (medido mediante un índice elaborado a partir de las condiciones de la vivienda y la posesión de enseres domésticos) y estado marital. Se evaluó la asociación entre las variables independientes y la práctica de deportes y se calcularon las razones de posibilidades brutas con intervalos de confianza de 95 por ciento. Para identificar la asociación entre la práctica de deportes y las variables independientes se utilizó un modelo de regresión logística ajustado según el efecto de posibles variables de confusión. Se ajustó también mediante un factor de ponderación la probabilidad de que una mujer fuese seleccionada para la muestra, y para controlar el efecto de diseño producido por la agrupación de observaciones en esta muestra se utilizó la rutina de análisis de muestras complejas svy de Stata, versión 7.0. RESULTADOS: Se analizó la información obtenida de 2 367 mujeres. Las mujeres encuestadas dedicaron 0,08 horas diarias, en promedio, a practicar deportes y 1,25 horas diarias a actividades físicas pesadas...