Interventions to improve calcium intake through foods in populations with low intake.

Calcium intake remains inadequate in many low- and middle-income countries, especially in Africa and South Asia, where average intakes can be below 400 mg/day. Given the vital role of calcium in bone health, metabolism, and cell signaling, countries with low calcium intake may want to consider food-based approaches to improve calcium consumption and bioavailability within their population. This is especially true for those with low calcium intake who would benefit the most, including pregnant women (by reducing the risk of preeclampsia) and children (by reducing calcium-deficiency rickets). Specifically, some animal-source foods that are naturally high in bioavailable calcium and plant foods that can contribute to calcium intake could be promoted either through policies or educational materials. Some food processing techniques can improve the calcium content in food or increase calcium bioavailability. Staple-food fortification with calcium can also be a cost-effective method to increase intake with minimal behavior change required. Lastly, biofortification is currently being investigated to improve calcium content, either through genetic screening and breeding of high-calcium varieties or through the application of calcium-rich fertilizers. These mechanisms can be used alone or in combination based on the local context to improve calcium intake within a population.

Nutritional status of iron, vitamin B12, vitamin A and anemia in Mexican children: results from the Ensanut 2018-19 / Estado de nutrición de hierro, vitamina B12, vitamina A y anemia en niños mexicanos: resultados de la Ensanut 2018-19

Abstract Objective: To describe the current status of micronutrient deficiencies (MD) and anemia in Mexican children. Materials and methods: Serum data from 1 382 pre-school-age children (1-4 years) and 3 590 school-age children (5-11 years) Ensanut 2018-19 participants were analyzed. Iron deficiency (ID), vitamin B12 deficiency (B12D), vitamin A depletion (VADp), and anemia were identified. Logistic regression models were used to identify associations between sociodemographic characteristics of children and MD. Results: Anemia was present in 28.9 and 19.2% of the children aged 1-4 and 5-11, respectively; in ID 10 and 5.1%; B12D, in 5.1 and 4.8%, and VADp, in 4.7 and 4.3%. 18.5% of the preschool-age children and 13% of the school-age children had at least one MD associated to anemia. Conclusions: MD and anemia affect the younger children in larger proportion. Fortification and supplementation programs should be reinforced to avoid the long-term consequences of MD.

Resumen Objetivo: Describir la situación actual de deficiencias de micronutrimentos (DM) y anemia en niños mexicanos. Material y métodos: Se analizó información sérica de 1 382 niños de 1-4 años y de 3 590 niños de 5-11 años participantes de la Ensanut 2018-19. Se categorizó la deficiencia de hierro (DH), B12 (DB12), depleción de vitamina A (DepVA) y anemia. Se emplearon modelos de regresión logística para identificar las características asociadas con la DM. Resultados: La anemia afectó al 28.9 y 19.2%, DH al 10 y 5.1%, DB12 al 5.1y 4.8% y DepVA al 4.7 y 4.3% de los niños preescolares y escolares respectivamente. El 18.5 y 13% de los niños tuvo al menos una DM asociada con anemia. Conclusiones: Los niños más jóvenes tuvieron las prevalencias más altas de DM y anemia. Es necesario el refuerzo en los programas de fortificación y suplementación para evitar las consecuencias a largo plazo asociadas con las DM.

Nutritional status of iron, vitamin B12, vitamin A and anemia in Mexican children: results from the Ensanut 2018-19.

OBJECTIVE: To describe the current status of micronutrient deficiencies (MD) and anemia in Mexican children. MATERIALS AND METHODS: Serum data from 1 382 pre-school-age chil-dren (1-4 years) and 3 590 school-age children (5-11 years) Ensanut 2018-19 participants were analyzed. Iron deficiency (ID), vitamin B12 deficiency (B12D), vitamin A depletion (VADp), and anemia were identified. Logistic regression models were used to identify associations between socio-demographic characteristics of children and MD. RESULTS: Anemia was present in 28.9 and 19.2% of the children aged 1-4 and 5-11, respectively; in ID 10 and 5.1%; B12D, in 5.1 and 4.8%, and VADp, in 4.7 and 4.3%. 18.5% of the preschool-age children and 13% of the school-age children had at least one MD associated to anemia. CONCLUSIONS: MD and anemia affect the younger children in larger proportion. Fortification and supplementation programs should be reinforced to avoid the long-term consequences of MD.

[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.

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

Resumen: 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.

Abstract: 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.

Fortification of bakery and corn masa-based foods in Mexico and dietary intake of folic acid and folate in Mexican national survey data.

BACKGROUND: In Mexico, wheat and corn flour fortification with folic acid (FA) was implemented in 2001 and mandated in 2008, but without direct enforcement. Current Mexican nutrient-content tables do not account for FA contained in bakery bread and corn masa-based foods, which are dietary staples in Mexico. OBJECTIVE: The objective of this study was to examine the impact of FA fortification of dietary staples on the proportion of the population consuming below the Estimated Average Requirement (EAR) for folate or above the Tolerable Upper Intake Level (UL) for FA. METHODS: We measured FA and folate content in dietary staples (bakery bread and tortillas) using microbial assays and MS, and we recalculated FA intake from 24-h recall dietary intake data collected in the 2012 Mexican National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición) utilizing estimates from our food measurements, using nutrient concentrations from tortillas to approximate nutrient content of other corn masa-derived foods. The revised FA intake estimates were used to examine population-level intake of FA and dietary folate equivalent (DFE) accounting for geographic differences in FA content with statistical models. RESULTS: FA content in dietary staples was variable, whereas use of FA-fortified flour in corn masa tortillas increased with population size in place of residence. Accounting for dietary staples' FA fortification increased population estimates for FA and DFE intake, resulting in a lower proportion with intake below the EAR and a higher proportion with intake above the UL. Despite accounting for FA-fortified staple foods, 9-33% of women of childbearing age still have intake below the EAR, whereas up to 12% of younger children have intake above the UL. CONCLUSIONS: Unregulated FA fortification of dietary staples leads to unpredictable total folate intake without adequately impacting the intended target. Our findings suggest that monitoring, evaluation, and enforcement of mandatory fortification policies are needed. Without these, alternate strategies may be needed in order to reach women of childbearing age while avoiding overexposing children.

A Randomized Feeding Trial of Iron-Biofortified Beans on School Children in Mexico.

Iron deficiency is a major public health problem worldwide, with the highest burden among children. The objective of this randomized efficacy feeding trial was to determine the effects of consuming iron-biofortified beans (Fe-Beans) on the iron status in children, compared to control beans (Control-Beans). A cluster-randomized trial of biofortified beans (Phaseolus vulgaris L), bred to enhance iron content, was conducted over 6 months. The participants were school-aged children (n = 574; 5⁻12 years), attending 20 rural public boarding schools in the Mexican state of Oaxaca. Double-blind randomization was conducted at the school level; 20 schools were randomized to receive either Fe-Beans (n = 10 schools, n = 304 students) or Control-Beans (n = 10 schools, n = 366 students). School administrators, children, and research and laboratory staff were blinded to the intervention group. Iron status (hemoglobin (Hb), serum ferritin (SF), soluble transferrin receptor (sTfR), total body iron (TBI), inflammatory biomarkers C-reactive protein (CRP) and -1-acid glycoprotein (AGP)), and anthropometric indices for individuals were evaluated at the enrollment and at the end of the trial. The hemoglobin concentrations were adjusted for altitude, and anemia was defined in accordance with age-specific World Health Organization (WHO) criteria (i.e., Hb <115 g/L for <12 years and Hb <120 g/L for 12 years). Serum ferritin concentrations were adjusted for inflammation using BRINDA methods, and iron deficiency was defined as serum ferritin at less than 15.0 µg/L. Total body iron was calculated using Cook's equation. Mixed models were used to examine the effects of Fe-Beans on hematological outcomes, compared to Control-Beans, adjusting for the baseline indicator, with school as a random effect. An analysis was conducted in 10 schools (n = 269 students) in the Fe-Beans group and in 10 schools (n = 305 students) in the Control-Beans group that completed the follow-up. At baseline, 17.8% of the children were anemic and 11.3% were iron deficient (15.9%, BRINDA-adjusted). A total of 6.3% of children had elevated CRP (>5.0 mg/L), and 11.6% had elevated AGP (>1.0 g/L) concentrations at baseline. During the 104 days when feeding was monitored, the total mean individual iron intake from the study beans (Fe-bean group) was 504 mg (IQR: 352, 616) over 68 mean feeding days, and 295 mg (IQR: 197, 341) over 67 mean feeding days in the control group (p < 0.01). During the cluster-randomized efficacy trial, indicators of iron status, including hemoglobin, serum ferritin, soluble transferrin receptor, and total body iron concentrations improved from the baseline to endline (6 months) in both the intervention and control groups. However, Fe-Beans did not significantly improve the iron status indicators, compared to Control-Beans. Similarly, there were no significant effects of Fe-Beans on dichotomous outcomes, including anemia and iron deficiency, compared to Control-Beans. In this 6-month cluster-randomized efficacy trial of iron-biofortified beans in school children in Mexico, indicators of iron status improved in both the intervention and control groups. However, there were no significant effects of Fe-Beans on iron biomarkers, compared to Control-Beans. This trial was registered at clinicaltrials.gov as NCT03835377.

Vitamin D status by sociodemographic factors and body mass index in Mexican women at reproductive age.

OBJECTIVE: To describe the prevalence of Vitamin D deficiency (VDD) and insufficiency (VDI), and the main dietary sources of vitamin D (VD) in a probabilistic sample of Mexican women at reproductive age participating in Ensanut 2012, stratified by sociodemographic factors and body mass index (BMI) categories. MATERIALS AND METHODS: Serum concentrations of 25-hydroxyvitamin-D(25-OH-D) were determined using an ELISA technique in 4162 women participants of Ensanut 2012 and classified as VDD, VDI or optimal VD status. Sociodemographic, anthropometric and dietary data were also collected. The association between VDD/VDI and sociodemographic and anthropometry factors was assessed adjusting for potential confounders through an estimation of a multinomial logistic regression model. RESULTS: The prevalence of VDD was 36.8%, and that of VDI was 49.8%. The mean dietary intake of VD was 2.56 µg/d. The relative risk ratio (RRR) of VDD or VDI was calculated by a multinomial logistic regression model in 4162 women. The RRR of VDD or VDI were significantly higher in women with overweight (RRR: 1.85 and 1.44, p<0.05), obesity (RRR: 2.94 and 1.93, p<0.001), urban dwelling (RRR:1.68 and 1.31, p<0.06), belonging to the 3rd tertile of income (RRR: 5.32 and 2.22, p<0.001), or of indigenous ethnicity (RRR: 2.86 and 1.70, p<0.05), respectively. CONCLUSION: The high prevalence of VDD/VDI in Mexican women calls for stronger actions from the health authorities, strengthtening the actual policy of food supplementation and recommending a reasonable amount of sun exposure.

Vitamin D status by sociodemographic factors and body mass index in Mexican women at reproductive age / Estado de la vitamina D por factores sociodemográficos e índice de masa corporal en mujeres mexicanas en edad reproductiva

Abstract: Objective: To describe the prevalence of Vitamin D deficiency (VDD) and insufficiency (VDI), and the main dietary sources of vitamin D (VD) in a probabilistic sample of Mexican women at reproductive age participating in Ensanut 2012, stratified by sociodemographic factors and body mass index (BMI) categories. Materials and methods: Serum concentrations of 25-hydroxyvitamin-D(25-OH-D) were determined using an ELISA technique in 4162 women participants of Ensanut 2012 and classified as VDD, VDI or optimal VD status. Sociodemographic, anthropometric and dietary data were also collected. The association between VDD/VDI and sociodemographic and anthropometry factors was assessed adjusting for potential confounders through an estimation of a multinomial logistic regression model. Results: The prevalence of VDD was 36.8%, and that of VDI was 49.8%. The mean dietary intake of VD was 2.56 μg/d. The relative risk ratio (RRR) of VDD or VDI was calculated by a multinomial logistic regression model in 4162 women. The RRR of VDD or VDI were significantly higher in women with overweight (RRR: 1.85 and 1.44, p<0.05), obesity (RRR: 2.94 and 1.93, p<0.001), urban dwelling (RRR:1.68 and 1.31, p<0.06), belonging to the 3rd tertile of income (RRR: 5.32 and 2.22, p<0.001), or of indigenous ethnicity (RRR: 2.86 and 1.70, p<0.05), respectively. Conclusion: The high prevalence of VDD/VDI in Mexican women calls for stronger actions from the health authorities, strengthtening the actual policy of food supplementation and recommending a reasonable amount of sun exposure.

Resumen: Objetivo: Describir la prevalencia de deficiencia (DVD) e insuficiencia (IVD) de vitamina D (VD), y las principales fuentes dietéticas de VD en una muestra probabilística de mujeres mexicanas en edad reproductiva participantes de la Ensanut 2012, estratificando por factores sociodemográficos y categorías de IMC. Material y métodos: Las concentraciones séricas de 25-hidroxivitamina-D (25-OH-D) se midieron utilizando la técnica ELISA en 4162 mujeres participantes de la Ensanut 2012, que fueron clasificadas con DVD, IVD u óptimos niveles de VD. Se recolectaron datos sociodemográficos, antropometría y dieta, y se evaluó su asociación con DVD/IVD por medio de un modelo de regresión logística multinomial. Resultados: 36.8% de las mujeres presentaron DVD y 49.8% IVD. La media de ingesta de VD fue 2.56 μg/d. La probabilidad de presentar DVD o IVD fue mayor en las mujeres con sobrepeso (RRR: 1.85 y 1.44, p<0.05), obesidad (RRR: 2.94 y 1.93, p<0.001), residentes del área urbana (RRR: 1.68 y 1.31, p<0.06), del tercil 3 de nivel socioeconómico (RRR: 5.32 y 2.22, p<0.001) o indígenas (RRR: 2.86 y 1.70, p<0.05) respectivamente. Conclusiones: La alta prevalencia de DVD/IVD en mujeres mexicanas es un llamado a las autoridades de salud para implementar una política de suplementación de alimentos más fuerte y hacer recomendaciones para una razonable exposición al sol.

Food assistance programmes are indirectly associated with anaemia status in children <5 years old in Mexico.

Anaemia in children is a public health concern in Mexico; Federal food assistance programmes are being implemented to prevent it. We undertook this research to investigate the indirect association between food assistance programmes (FAP) and anaemia through dietary and socio-economic conditions of beneficiary children. A structural equation model (SEM) was constructed to assess associations among FAP, dietary and socio-economic conditions, as well as anaemia. A cross-sectional comparative study was conducted based on a sample of 1214 households with children <5 years old, beneficiaries of two FAP: Prospera and rescue from malnutrition with amaranth (RMA) and a comparison group in San Luis Potosí, Mexico. The SEM and a decomposition effect analysis revealed the existence of a significant indirect association of FAP on the prevalence of anaemia via dietary and socio-economic conditions in children under 5 years old. The Prospera assistance programme showed a significant indirect positive association with the prevalence of anaemia (standard coefficient=0·027, P<0·031), and the RMA programme showed a significant indirect negative association with the prevalence of anaemia (standard coefficient=-0·029, P=0·047). There was a direct association between FAP and dietary and socio-economic conditions. FAP could indirectly modify the prevalence of anaemia in young children with a direct improvement on dietary and socio-economic conditions. The unexpected finding of the association between RMA, dietary and socio-economic conditions and the prevalence of anaemia reflects differences in the focus of the programmes.

Maternal single nucleotide polymorphisms in the fatty acid desaturase 1 and 2 coding regions modify the impact of prenatal supplementation with DHA on birth weight.

BACKGROUND: Specific single nucleotide polymorphisms (SNPs) in the fatty acid desaturase (FADS) gene affect the activity and efficiency of enzymes that are responsible for the conversion of polyunsaturated fatty acids (PUFAs) into their long-chain active form. A high prevalence of SNPs that are associated with slow PUFA conversion has been described in Hispanic populations. OBJECTIVE: We assessed the heterogeneity of the effect of prenatal supplementation with docosahexaenoic acid (DHA) on birth weight across selected FADS SNPs in a sample of Mexican women and their offspring. DESIGN: We obtained information on the maternal genotype from stored blood samples of 654 women who received supplementation with 400 mg DHA/d or a placebo from weeks 18 to 22 of gestation through delivery as part of a randomized controlled trial conducted in Cuernavaca, Mexico. We selected 4 tag SNPs (rs174455, rs174556, rs174602, and rs498793) in the FADS region for analysis. We used an ANOVA to test for the heterogeneity of the effect on birth weight across each of the 4 SNPs. RESULTS: The mean ± SD birth weight was 3210 ± 470 g, and the weight-for-age z score (WAZ) was -0.24 ± 1.00. There were no intention-to-treat differences in birth weights. We showed significant heterogeneity by SNP rs174602 (P= 0.02); offspring of carriers of alleles TT and TC in the intervention group were heavier than those in the placebo group (WAZ: -0.13 ± 0.14 and -0.20 ± 0.08 compared with -0.55 ± 0.15 and -0.39 ± 0.09, respectively); there were no significant differences in offspring of rs174602 CC homozygotes (WAZ: -0.26 ± 0.09 in the intervention group compared with -0.04 ± 0.09 in the placebo group). We showed no significant heterogeneity across the other 3 FADS SNPs. CONCLUSION: Differential responses to prenatal DHA supplementation on the basis of the genetic makeup of target populations could explain the mixed evidence of the impact of DHA supplementation on birth weight. This trial was registered at clinicaltrials.gov as NCT00646360.

Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012).

BACKGROUND: The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. METHODS: We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. RESULTS: Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. CONCLUSIONS: Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.

Sensory evaluation of dairy supplements enriched with reduced iron, ferrous sulfate or ferrous fumarate / Evaluación sensorial de suplementos lácteos enriquecidos con hierro reducido, sulfato ferroso o fumarato ferroso

Objective. To determine the degree of liking of the Oportunidades programme dietary supplements (DS) -purees and beverages- added with different iron salts (IS): reduced iron (RI), ferrous sulphate (FS) or ferrous fumarate (FF) during 24 weeks of storage. Materials and methods. The DS were evaluated through a hedonic scale for aroma, flavour and colour attributes; at time zero and every eight weeks, each panel member evaluated three DS with same flavour and presentation but different IS. Seventy women participated as panel members. Results. The chocolate and banana DS exhibited a change in preference by colour and flavour due to storage. DS with FS or RI showed the least preference by flavour and colour in the context of the three IS considered. The chocolate and neutral DS enriched with FS changed their colour and flavour. Conclusion. DS were, in general, well-liked; nonetheless, for purees enriched with FS and for beverages enriched with RI, the less-liked attributes were colour and flavour.

Objetivo. Determinar el nivel de agrado de los suplementos alimenticios (SA) (papillas y bebidas) del Programa Oportunidades, adicionados con diferentes sales de hierro (SH): hierro reducido (HR), sulfato ferroso (SF) o fumarato ferroso (FF), durante 24 semanas de almacenamiento. Material y métodos. Se evaluaron mediante una escala hedónica los atributos olor, sabor y color; a tiempo cero y cada ocho semanas, cada juez evaluó tres suplementos, mismo sabor, presentación y diferente SH. Participaron 70 mujeres. Resultados. Los SA sabor chocolate y plátano presentaron modificación del agrado por color y sabor durante el almacenamiento. Los SA con SF o HR presentaron el menor agrado para sabor y olor por efecto de las SH. En los SA sabor chocolate y natural adicionados con SF se afectó el color y el sabor. Conclusión. Los SA en general presentaron agrado; sin embargo, en las papillas adicionadas con SF y las bebidas con HR los atributos limitantes fueron color y sabor.

Sensory evaluation of dairy supplements enriched with reduced iron, ferrous sulfate or ferrous fumarate.

OBJECTIVE: To determine the degree of liking of the Oportunidades programme dietary supplements (DS)--purees and beverages--added with different iron salts (IS): reduced iron (RI), ferrous sulphate (FS) or ferrous fumarate (FF) during 24 weeks of storage. MATERIALS AND METHODS: The DS were evaluated through a hedonic scale for aroma, flavour and colour attributes; at time zero and every eight weeks, each panel member evaluated three DS with same flavour and presentation but different IS. Seventy women participated as panel members. RESULTS: The chocolate and banana DS exhibited a change in preference by colour and flavour due to storage. DS with FS or RI showed the least preference by flavour and colour in the context of the three IS considered. The chocolate and neutral DS enriched with FS changed their colour and flavour. CONCLUSION: DS were, in general, well-liked; nonetheless, for purees enriched with FS and for beverages enriched with RI, the less-liked attributes were colour and flavour.

Model for estimating nutrient addition contents to staple foods fortified simultaneously: Mexico and Kampala data.

The objective of this work was to present a generic model for estimating fortification contents when several food vehicles are being considered simultaneously. It is based on approximating the magnitude of the nutritional inadequacy of the population (nutrient gap), the optimal use of the combination of food vehicles (fortifiable food energy, FFE), and the upper intake level to decrease the possibility that individuals with the highest combined intake of all food vehicles will exceed it. The model is intended to be used when only per capita food and micronutrient intake information, not detailed food intake data, are available. Food consumption survey data from Mexico and Kampala (Uganda) were analyzed for adult women, assuming that their intake may be similar to general per capita values. General adjustment factors for estimating the lowest and highest FFE and micronutrient intake for satisfying the requirements of other family members were calculated. These factors were used to estimate the additional effective content and the maximum allowable content, and then the recommended nutrient contents at the consumers' level were chosen on the basis of technological compatibility and cost. The method should be used in other contexts to test its validity as well as its application to nonstaple foods.

Associations among dietary zinc intakes and biomarkers of zinc status before and after a zinc supplementation program in Guatemalan schoolchildren.

BACKGROUND: The associations among dietary zinc intakes and biomarkers of zinc status are unknown in apparently healthy children at high risk for zinc deficiency. OBJECTIVE: To assess associations among zinc-related parameters in a sample of Guatemalan school-aged children. METHODS: We assessed total dietary intakes and biomarkers of zinc status before and after receiving 6 months of zinc supplementation or placebo in 691 Guatemalan schoolchildren aged 6 to 11 years. Most of the children also received zinc-fortified milk from a government program that started shortly after the trial began. We assessed associations between zinc intakes and serum zinc, alkaline phosphatase (ALP), and albumin. RESULTS: At baseline, the prevalence of serum zinc < 65 microg/dL and dietary zinc intake below Estimated Average Requirements (EAR) (< 4 and < 7 mg/day for children < 9 and > or = 9 years, respectively) were 21.6% and 39.4%, respectively. Pearson correlations between serum zinc concentration and dietary zinc intake, serum ALP, and serum albumin were r = 0.07, 0.15, and 0.07, respectively. At the 6-month follow-up, low serum zinc and low total (diet plus fortified milk) zinc intakes were observed in 1.2% and 0.0% of children in the zinc-supplemented group and 4.0% and 34.1% in the placebo group, respectively. Pearson correlations between serum zinc concentration and total zinc intake, serum ALP, and serum albumin were 0.10, 0.06, and -0.11 in the zinc-supplemented group and -0.04, 0.05, and 0.01 in the placebo group, respectively. CONCLUSIONS: Zinc intake was inconsistently associated with markers of serum zinc concentration. Zinc fortification or supplementation attenuated the associations.

Health significance of fat quality in the diet.

This paper summarizes three presentations on the global and Latin American perspectives on the health significance of fat quality in the diet given at the 16th Congress of the Society of Latin American Nutrition in Havana, Cuba, November 11-16, 2012. Dietary fat quality contributes to the risk of the leading chronic diseases and is more important than fat quantity in reducing the risk of chronic disease mortality, especially from cardiovascular disease (CVD). In many countries, the consumption of saturated fats exceeds the recommended limit of 10% energy (%E) and intakes of polyunsaturated fats (PUFAs) are often below the recommended range of 6-11%E. Consumption of long-chain ω-3 PUFAs is especially low. In many Latin American countries, high consumption of carbohydrates, especially sugars, contributes to obesity, diabetes, hypertension and CVD, while intakes of total fat and PUFAs may be low. Thus, dietary fat recommendations must consider the dietary fat patterns of each country. Nutrition counseling can be effective in teaching individuals and families to modify their food intake patterns and control the major risk factors for chronic disease.

[Prevalence of anemia in Mexican children and adolescents: Results from three national surveys]. / Prevalencia de anemia en niños y adolescentes mexicanos: comparativo de tres encuestas nacionales.

OBJECTIVE: To describe the prevalence of anemia in Mexican children and adolescents from ENSANUT 2012. MATERIALS AND METHODS: Data had the power to make distinctions at the national, regional and rural/urban dwelling. Hemoglobin was measured by Hemocue. Descriptions were made by adjusted frequencies and 95%CI. Confounders were tested in a logistic regression models. RESULTS: The prevalence of anemia in 2012 was: in children 1-4 y, 23.3%; 5-11y, 10.1%, and 12-19 y, 5.6%. The prevalence in female adolescents was 7.7% and 3.6% in males. Reductions in the prevalence of anemia from 1999 was 8.3pp in <5y, 5.1pp in children 5-11y and 3.6pp from 2006 in adolescents. CONCLUSIONS: Despite the decrease in the prevalence of anemia in children 1-4 y in the last 13 years, it still is of great concern. There is a need of awareness among social and medical communities about this, to extend the distribution of micronutrient supplements in children <3y, and to promote nutritional education to incentive mothers to provide foods rich in iron.

Prevalencia de anemia en niños y adolescentes mexicanos: comparativo de tres encuestas nacionales / Prevalence of anemia in Mexican children and adolescents: Results from three national surveys

Objetivo. Describir la prevalencia de anemia en niños y adolescentes mexicanos de la Encuesta Nacional de Salud y Nutrición 2012. Material y métodos. Los datos se distinguen por nivel nacional, regional y rural/urbano. La hemoglobina (Hb) fue medida por Hemocue. Las descripciones se hicieron con frecuencias ajustadas y los confusores se probaron en un modelo de regresión logística. Resultados. La prevalencia de anemia en niños en 2012 fue de 23.3% en los de 1 a 4 años, 10.1% en los de 5 a 11 años, y 5.6% en los de 12 a 19 años. En mujeres adolescentes de 7.7% y en hombres de 3.6%. Entre 1999 y 2012 se redujo la prevalencia de anemia en niños de 8.3 puntos porcentuales (pp) en menores de cinco años, 5.1pp en los de 5 a 11años y 3.6 pp en adolescentes. Conclusiones. A pesar de la reducción de la anemia en niños de 1 a 4 años en los últimos 13 años, ésta es aún preocupante. Es necesario concientizar a las comunidades social y médica acerca de ella, así como ampliar la distribución de suplementos de micronutrientes en niños menores de 3 años, además de promover la educación nutricional e incentivar la ingesta de alimentos ricos en hierro.

Objective. To describe the prevalence of anemia in Mexican children and adolescents from ENSANUT 2012. Materials and methods. Data had the power to make distinctions at the national, regional and rural/urban dwelling. Hemoglobin was measured by Hemocue. Descriptions were made by adjusted frequencies and 95%CI. Confounders were tested in a logistic regression models. Results. The prevalence of anemia in 2012 was: in children 1-4 y, 23.3%; 5-11y, 10.1%, and 12-19 y, 5.6%. The prevalence in female adolescents was 7.7% and 3.6% in males. Reductions in the prevalence of anemia from 1999 was 8.3pp in <5y, 5.1pp in children 5-11y and 3.6pp from 2006 in adolescents. Conclusions. Despite the decrease in the prevalence of anemia in children 1-4 y in the last 13 years, it still is of great concern. There is a need of awareness among social and medical communities about this, to extend the distribution of micronutrient supplements in children <3y, and to promote nutritional education to incentive mothers to provide foods rich in iron.

Docosahexaenoic acid supplementation from mid-pregnancy to parturition influenced breast milk fatty acid concentrations at 1 month postpartum in Mexican women.

(n-3) PUFA, including DHA, are essential for neural development and accumulate extensively in the fetal and infant brain. (n-3) PUFA concentrations in breast milk, which are largely dependent on maternal diet and tissue stores, are correlated with infant PUFA status. We investigated the effect of prenatal DHA supplementation on PUFA concentrations in breast milk at 1 mo postpartum. In a double-blind, randomized, controlled trial conducted in Mexico, pregnant women were supplemented daily with 400 mg DHA or placebo from 18-22 wk gestation to parturition. Fatty acid concentrations in breast milk obtained from 174 women at 1 mo postpartum were determined using GLC and were expressed as % by weight of total detected fatty acids. Breast milk DHA concentrations in the DHA and placebo groups were (mean ± SD) 0.20 ± 0.06 and 0.17 ± 0.07 (P < 0.01), respectively, and those of α-linolenic acid (ALA) were 1.38 ± 0.47 and 1.24 ± 0.46 (P = 0.01), respectively. Concentrations of EPA and arachidonic acid did not differ between groups (P > 0.05). Maternal plasma DHA concentrations at 1 mo postpartum correlated positively with breast milk DHA at 1 mo postpartum in both the placebo and DHA groups (r = 0.4; P < 0.01 for both treatment groups). Prenatal DHA supplementation from 18-22 wk gestation to parturition increased concentrations of DHA and ALA in breast milk at 1 mo postpartum, providing a mechanism through which breast-fed infants could benefit.