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.

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.

Contribución de los alimentos a la ingesta total de energía en la dieta de los mexicanos mayores de cinco años / Food contribution to total daily energy intake in the Mexican population older than five years

Resumen: Objetivo: Identificar la contribución a la ingesta de energía (CIE) de alimentos consumidos en mayores de cinco años y por características sociodemográficas, en la población mexicana. Material y métodos: Se analizó información del recordatorio de 24 horas de 7 983 sujetos ≥5 años incluidos en la Encuesta Nacional de Salud y Nutrición 2012 (Ensanut 2012). Se estimó la CIE de 50 alimentos clasificados en ocho grupos de alimentos en el ámbito nacional, estratificando por edad, área de residencia, región y nivel socioeconómico. Resultados: Siete alimentos contribuyeron con 50% de la ingesta energética total: tortilla y productos de maíz (20.6%), pan dulce (6.6%), aceites vegetales (4.9%), pan blanco y derivados de trigo (4.9%), bebidas azucaradas carbonatadas (4.6%), carnes rojas (4.0%) y leche entera (4.0%). Otros alimentos, cuyo consumo es recomendable aumentar por sus efectos positivos en salud, mostraron contribuciones menores a 1.0%, con excepción del frijol (3.3%). Se observó gran heterogeneidad en el consumo entre subgrupos de población. Conclusión: La identificación de los alimentos individuales y su CIE, tanto en grupos de alimentos cuyo consumo se recomienda aumentar, como en aquéllos que se recomienda reducir, puede ser de utilidad para el diseño de acciones regulatorias y estrategias educativas dirigidas a disminuir la carga de enfermedad relacionada con la dieta.

Abstract: Objetive: To identifiy the energy contribution (EC) of the food consumed in those older than five years and by sociodemographic characteristics in Mexican population. Materials and methods: We analyzed data from 24-hour recalls from 7 983 subjects ≥5 years included in the Encuesta Nacional de Salud y Nutrición2012 (Ensanut 2012). The EC to total daily energy intake of 50 foods allocated to eight food groups at national level and stratified by age, area of residence, region and socioeconomic level was estimated. Results: Seven foods contributed 50% of total energy intake: tortilla and corn products (20.6%), sweet bread (6.6%), vegetable oils (4.9%), white bread and wheat products (4.9%), carbonated sugary drinks (4.6%), red meat (4.0%) and whole milk (4.0%). Other foods, which its consumption is recommended to increase due to its positive effects on health, showed minor contributions (less than 1.0%), with the exception of beans (3.3%). Great heterogeneity in intakes was observed between subgroups of the population. Conclusions: The identification of individual foods and their EC for both, food groups whose consumption should be increased as well as those that should be reduced can be useful for the design of regulatory actions and educational strategies aimed at reducing the diet related burden of disease.

Nutrition Label Use Is Related to Chronic Conditions among Mexicans: Data from the Mexican National Health and Nutrition Survey 2016.

BACKGROUND: Non-communicable diseases, such as obesity, diabetes, and hypertension, can be prevented and treated through a balanced nutrient-rich diet. Nutrition labels have been recognized as crucial to preventing obesity and non-communicable diseases through a healthier diet. OBJECTIVE: Our aim was to examine the association between nutrition label use and chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension) among an adult Mexican population. DESIGN: This was a cross-sectional study that used data from the Mexican National Health and Nutrition Survey of 2016 (ENSANUT MC 2016). PARTICIPANTS/SETTING: The participants were 5,013 adults aged 20 to 70 years old. Older adults (>70 years), illiterate participants, pregnant women, and participants with implausible blood pressure data were excluded from the sample. The survey was conducted from May to August 2016 in the participants' households. MAIN OUTCOME MEASURES: We measured chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension). STATISTICAL ANALYSES PERFORMED: Pearson χ2 test was used to examine the associations among the use of nutrition labels and sociodemographic characteristics and chronic conditions. Multiple logistic regression was used to determine the association between nutrition label use and chronic conditions adjusting for the effect of confounding variables like sex, age, body mass index, education level, marital status, ethnicity, residence area, region, and socioeconomic status. RESULTS: From the total sample, 40.9% (95% CI 38.4% to 43.8%) reported using nutrition labeling. Respondents with overweight or obesity were less likely to use nutrition labels (odds ratio 0.74; P<0.05). Participants who self-reported diabetes had significantly lower odds of nutrition label use than participants who did not report to have diabetes (odds ratio 0.66; P<0.05). Participants having 3 chronic conditions had lower odds of nutrition label use (odds ratio 0.34; P<0.01) relative to having zero chronic conditions. CONCLUSIONS: This study suggests an association between nutrition label use and chronic conditions (obesity and diabetes). These findings demonstrate that people with obesity, diabetes, and a combination of chronic conditions were less likely to use nutrition labels than people without these conditions.

[Dietary patterns and metabolic syndrome components in women with excess weight 18 to 45 years old]. / Patrones dietéticos y síndrome metabólico en mujeres con exceso de peso de 18 a 45 años de edad.

OBJECTIVE: To analyze the association between dietary patterns and metabolic syndrome (MS) components in adult women with excess weight. MATERIAL AND METHODS: Cross-sectional study with anthropometric, dietary, biochemical and blood pressure data. Dietary patterns were identified by factor analysis and multiple logistic regression models were used to analyze associations. RESULTS: The prevalence of altered glucose was 14.6%, of hypertriglyceridemia 40.4%, of altered concentration of high density lipoprotein cholesterol(HDLc) 45.0%, hypertension 4.6% and MS 30%. The pattern with high consumption of corn tortillas, meats and legumes, was associated with less possibility of hyperglycemia (OR= 0.62; 95%CI 0.39-0.98). The pattern with high consumption of sweet and salty snacks, milk, rice, soaps and pasta, was inversely associated with the possibility of low HDLc concentration (OR= 0.76; 95%CI 0.60-0.97). CONCLUSIONS: A dietary pattern with greater consumption of legumes, meats and corn tortillas was associated with less possibility of having hyperglycemia.

OBJETIVO: Analizar la asociación de patrones dietéticos y componentes del síndrome metabólico (SM) en mujeres adultas con exceso de peso. MATERIAL Y MÉTODOS: Estudio transversal que incluye datos antropométricos, dietéticos, bioquímicos y de presión arterial. Se identificaron patrones dietéticos mediante análisis de factores y se emplearon modelos de regresión logística múltiple, para analizar asociaciones. RESULTADOS: Las prevalencias fueron: glucosa alterada 14.6%, hipertrigliceridemía 40.4%, lipoproteínas de alta densidad (HDLc) bajas 45.0%, hipertensión 4.6% y SM de 30%. El patrón con alto consumo de tortilla de maíz, carnes y leguminosas se asoció con menor posibilidad de hiperglucemia (OR= 0.62; IC95% 0.39-0.98). El patrón con alto consumo de botanas dulces y saladas, leche, arroz, sopas y pastas, se asoció inversamente con la posibilidad de baja concentración de HDLc (OR= 0.76; IC95% 0.60-0.97). CONCLUSIONES: Un patrón dietético con mayor consumo de leguminosas, carne y tortilla de maíz se asoció con menor posibilidad de tener hiperglucemia.

Development and validation of a Screening Questionnaire of Family Mistreatment against Older Adults for use in primary care settings in Mexico.

The abuse of older adults is a serious public health issue that can be difficult to identify at the first level of care. Medical and nursing personnel are sometimes unable to identify older adults who suffer family mistreatment. This can occur when victims feel shame or as a result of cultural factors. In the light of this, healthcare personnel require a screening tool that can be used to identify signs of mistreatment. The aim of this study was to develop and validate a screening tool for detecting the familial mistreatment of older adults in primary care settings. A mixed method cross-sectional study was carried out in three phases between 2009 and 2012 in Mexico. The formative phase involved using a qualitative methodology to identify terms that older adults use to identify practices defined as forms of mistreatment. On this basis, the second phase involved the design of a screening tool through the formation of items in collaboration with a panel of experts. These items were tested on older adults to ensure their intelligibility. Finally, validity and reliability levels were evaluated through the application of the screening tool to a sample of older adults at a primary care facility and at a legal centre. These findings were discussed with gerontologists, and the data were analysed through an exploratory factor analysis with orthogonal rotation and Cronbach's alpha using STATA v13. From the results, we generated a screening tool that is culturally and socially tailored to older adults in Mexico. The tool has a Cronbach's alpha of 0.89, a sensitivity value of 86% (p < .05) and a specificity value of 90% (p < .05) for positive answers to the tool's 15 items. Applying this tool at the first level of care could limit damage to older adults' health and could lower the frequency of emergency room use in hospitals.

Cigarette Smoking, Alcohol Consumption and Overweight in Multiple Sclerosis: Disability Progression.

BACKGROUND: The rate at which disability progresses in multiple sclerosis (MS), and its severity, have been associated with modifiable lifestyle habits. OBJECTIVE: To investigate the risk of disability progression in MS patients according to tobacco and alcohol consumption and to the presence of overweight. METHODS: This was a follow-up of MS cases from a concluded case-control study (National Institute of Neurology and Neurosurgery, Mexico 2010-2013). The evolution in EDSS (Expanded Disability Scale Score) units was followed through a medical record review. Kaplan Meier statistics and multivariate Cox regression analysis were performed. RESULTS: Of 181 cases, 63.5% were women and 82.5% had relapsing remitting MS. Study duration was 19.95 ± 15.24 months. The disease progressed faster in daily smokers than in non-smokers (p = 0.0168). In overweight patients, disability progressed faster than in normal weight patients (p = 0.0249). Ex-consumers of alcohol had lower risk of progression than current consumers (HR = 0.33 CI 95% = 0.14-0.83, p = 0.019) and both daily and ex-smokers presented higher risk of progression than non-smokers (HR = 2.32 CI 95% = 1.14-4.72, p = 0.020 and HR = 3.56, CI 95% = 1.21-10.46, p = 0.021). Stratifying by gender, the effects of smoking and overweight were only found in men. CONCLUSIONS: Smoking is associated with rapid disability progression in MS. Our results suggest that cessation of tobacco and alcohol consumption could be clinically beneficial. Although there is association between overweight and disability progression in men, a further exploration of gender differences is necessary to corroborate this finding.

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.

Factores asociados al uso de suplementos alimenticios en mujeres mexicanas de 12 a 49 años de edad

Los objetivos de este análisis son: caracterizar los suplementos alimenticios (SA) de mayor consumo, así como explorar la asociación del consumo SA con características sociodemográficas, antropométricas, y anemia, en una muestra representativa de mujeres, entre 12 a 49 años de edad (n=15,936), incluidas en la Encuesta Nacional de Nutrición, de 1999, en México. Se usó un modelo de regresión logística múltiple para calcular probabilidades (P) de consumo de SA, según características a nivel individual y del hogar, incluyendo términos de interacción ajustando por diseño de la Encuesta. Los SA más consumidos fueron el grupo de vitaminas con minerales (36.7%) y el de vitaminas (34.3%). La mayor probabilidad estadísticamente significativa (p<0.05) de consumo de SA se encontró con estar casada (P=0.16; p<0.001), ser derechohabiente de servicios de salud (P=0.18; p=0.010), tener un nivel de educación superior (P=0.20; p=0.004) y vivir en la región sur del país (P=0.20; p=0.003). La anemia modificó la relación entre consumo de SA y nivel socioeconómico (p=0.016). Estos resultados sugieren que el consumo de SA está relacionado con mejores condiciones de vida en mujeres mexicanas. Por otro lado, en la región sur hubo más probabilidad de uso de SA comparada con región Norte, lo cual podría estar relacionado con recibir suplementos por medio de programas de ayuda alimentaria. En el presente análisis no pudimos explorar esta posibilidad. Esta información podría servir de base para evaluar tendencias, así como riesgos y beneficios en la salud en esta población del uso de suplementos alimenticios.

Factors associated with nutritional supplement consumption in Mexican women aged 12 to 49 years. The objectives of this analysis are to identify the types of nutritional supplements (NS) commonly used and explore the associations between NS consumption and socio-demographic characteristics, nutritional status, measured as BMI, and anemia in a nationally representative sample Mexican women aged 12 to 49 years (n=15,936) who participated in the Mexican National Nutrition Survey in 1999. Data on NS consumption and the other characteristics of interest were collected. We calculated the probability (P) of supplement consumption using logistic regression. For the statistical analysis characteristics at the individual and household level were included in the statistical models, and adjusted for the study design. Interaction effects were also explored. Multiple mixed vitamin and mineral supplements were the most commonly consumed (36.7%) followed by vitamins only (34.3%). Married women were significantly (p<0.05) more likely (P=0.16; p <0.001) to consume NS compared to unmarried women, as were those with more access to public and private health care (P=0.18; p=0.010), with higher education level (P=0.20; p=0.004) and living in the South region (P=0.20; p=0.003). Anemia modified the association between supplement consumption and socioeconomic status (SES) (p=0.016), non anemic women having greater probabilities of NS consumption. These results suggest that NS use among Mexican women is associated with better living conditions. On the other hand, we also found that women living in the South region, the poorest region of the country, had higher probability of NS consumption compared to the North region. This could be related to participation in food assistance programs; however we were unable to explore this potential explanation. This information will be used to further study trends, risks and health benefits in this population of the use of nutritional supplements.