[Continuum of risky eating behaviors in Mexican adolescents]. / Continuo de conductas alimentarias de riesgo en adolescentes de México.

OBJECTIVE: Determine the relationship between the variables of self-esteem (SE), body dissatisfaction (BD), and body mass index (BMI) in a continuum of risky eating behaviors (REB) that ranges from normal behavior to the risk of eating disorders (ED), thus facilitating early detection of adolescents with ED symptomatology and the degree to which such variables have an influence. METHODS: A total of 1 982 young women aged 15-19 were selected through stratified random sampling. Self-esteem (Pope, McHale, and Craighead scale), body dissatisfaction (Stunkard's Figure Rating Scale), and body mass index were measured. A brief REB questionnaire was administered. Three categories of REB were defined: no risk, moderate risk, and high risk. A multiple regression analysis was performed. RESULTS: A direct relationship was found between risk of REB and BD, with significant differences between the groups (P < 0.001): no risk (83.6% of sample), 54.1% had BD; moderate risk (11.9% of sample), 84.8% had BD; and high risk (4.5% of sample), 89.9% had BD. There were significant differences in SE and BMI only between the group with no risk and each of the risk groups. Self-esteem played a role in predicting REB in all the regression models evaluated, whereas BMI did not. CONCLUSIONS: It is essential to identify adolescents at moderate risk of REB who have prodromic features of ED such as low SE and BD. When these features occur simultaneously, they can mediate a negative effect of BMI on REB.

Validation of a Spanish-Language Questionnaire on Adolescent Eating Behavior Based on Social Cognitive Theory.

OBJECTIVE: To validate a Spanish-language questionnaire on adolescent eating behavior based on Social Cognitive Theory. DESIGN: The validity (reliability and construct validity) of a self-administered questionnaire containing 28 questions with Likert scale-type response options was evaluated. SETTING: School located in Tonala, Jalisco, Mexico (a peri-urban area) with approximately 1,400 students enrolled. PARTICIPANTS: One hundred fifty-two adolescents enrolled in the second year of a middle school in Tonalá, Jalisco, Mexico (mean age, 13.7 years; SD, 0.5 years; 64% female). The retest was completed by 70 adolescents chosen at random. OUTCOME MEASURES AND ANALYSIS: The questionnaire's reliability was measured through internal consistency (Cronbach α) and reproducibility (intraclass correlation coefficient [ICC]). Construct validity was assessed using exploratory factor analysis. RESULTS: Five questions were eliminated from the questionnaire because of a lack of temporal stability (ICC ≤0.4). The exploratory factor analysis was satisfactory for 3 factors (41.89% of variance): environmental facilitators and social support, self-efficacy and self-regulation, and outcome expectations and outcome expectations value. The questionnaire had good internal consistency (α = 0.824) and excellent temporal stability (ICC = 0.849). CONCLUSIONS AND IMPLICATIONS: The results substantiate the reliability and construct validity of this questionnaire. The questionnaire has the potential to use the assessment of Social Cognitive Theory constructs in clinical practice or in nutrition interventions aimed at modifying the eating habits of Spanish-speaking adolescents.

Second Version of a Mini-Survey to Evaluate Food Intake Quality (Mini-ECCA v.2): Reproducibility and Ability to Identify Dietary Patterns in University Students.

Evaluation of food intake quality using validated tools makes it possible to give individuals or populations recommendations for improving their diet. This study's objective was to evaluate the reproducibility and ability to identify dietary patterns of the second version of the Mini Food Intake Quality Survey (Mini-ECCA v.2). The survey was administered using a remote voting system on two occasions with four-week intervals between administrations to 276 health science students (average age = 20.1 ± 3.1 years; 68% women). We then performed a per-question weighted kappa calculation, a cluster analysis, an ANOVA test by questionnaire item and between identified clusters, and a discriminant analysis. Moderate to excellent agreement was observed (weighted κ = 0.422-0.662). The cluster analysis identified three groups, and the discriminant analysis obtained three classification functions (85.9% of cases were correctly classified): group 1 (19.9%) was characterized by higher intake of water, vegetables, fruit, fats, oilseeds/avocado, meat and legumes (healthy food intake); group 2 (47.1%) frequently consumed both fish and unhealthy fats (habits in need of improvement); group 3 (33%) frequently consumed sweetened beverages, foods not prepared at home, processed foods, refined cereals and alcohol (unhealthy food intake). In conclusion, the Mini-ECCA v.2 has moderate to excellent agreement, and it is able to identify dietary patterns in university students.

Design and Reproducibility of a Mini-Survey to Evaluate the Quality of Food Intake (Mini-ECCA) in a Mexican Population.

Evaluating food intake quality may contribute to the development of nutrition programs. In Mexico, there are no screening tools that can be administered quickly for the evaluation of this variable. The aim was to determine the reproducibility of a mini-survey designed to evaluate the quality of food intake (Mini-ECCA) in a Mexican population. Mini-ECCA consists of 12 questions that are based on Mexican and international recommendations for food and non-alcoholic beverage intake, with the support of photographs for food quantity estimation. Each question scores as 0 (unhealthy) or 1 (healthy), and the final score undergoes a classification procedure. Through the framework of a nutritional study, 152 employees of the municipal water company in Guadalajara, Mexico (April⁻August 2016), were invited to participate. The survey was administered in two rounds (test and retest) with a 15-day interval between them. We calculated the Spearman correlation coefficient, the intra-class correlation coefficient (ICC), and weighted kappa for score classification agreement (SPSS versus 14 p < 0.05 was considered statistically significant). The survey obtained a “good” reproducibility (ρ = 0.713, p < 0.001), and an excellent concordance (ICC = 0.841 Confidence Interval 95% 0.779, 0.885). It can thus be said that the Mini-ECCA displayed acceptable reproducibility and is suitable for the purpose of dietary assessment and guidance.

A REVIEW OF GRAPHICAL REPRESENTATIONS USED IN THE DIETARY GUIDELINES OF SELECTED COUNTRIES IN THE AMERICAS, EUROPE AND ASIA.

INTRODUCTION: Food-Based Dietary Guidelines (FBDGs) are an initiative by the United Nations Food and Agriculture Organization (FAO) and the World Health Organization (WHO) designed to help countries establish their own nutrition education principles. Such principles should be expressed through clear and specific messages that provide guidance and promote good health among populations. Many of these guidelines contain graphical representations (GRs) as visual aids for dietary guidance. OBJECTIVES: to analyze the characteristics of GRs used in various countries on four continents to identify international trends in these graphical messages and assess their usefulness as educational tools for their target populations. METHODS: a review of GRs used in the FBDGs of countries in the Americas, Europe and Asia for which data were available in Spanish or English. RESULTS AND DISCUSSION: the models most used are the food circle and pyramid. The GRs (n = 37) depict the following recommendations: food groups (37), physical activity (21), water intake (17), low salt intake (7), family meals (1) and relaxation (1). In addition, 10 quantitative recommendations were detected. The GRs of Greece and the United States do not show images of food. The aspects considered in the GRs vary by the regions, cultures and epidemiological characteristics of each country. A tendency to use the food circle and to include lifestyle recommendations in illustrations was observed in the United States, Spain and Mexico. Quantitative recommendations may help to clarify information provided during the educational process.

Introducción: las Guías Alimentarias Basadas en Alimentos "Food-Based Dietary Guidelines" (FBDG) son una propuesta de la Food and Agriculture Organization of the United Nations (FAO) y la World Health Organization (WHO) para que cada país plantee sus principios de educación nutricional de manera clara y concreta con el fin de orientar y promover la buena salud en la población. Muchas de estas guías incluyen una representación gráfica (GR) como ayuda visual en el proceso de orientación alimentaria. Objetivos: analizar las características de las GR de países de tres continentes, para conocer las tendencias internacionales de los mensajes gráficos y para facilitar su transmisión durante el proceso educativo a la población a la que van dirigidos. Métodos: revisión de las GR de las FBDG de países de América, Europa y Asia, cuya información estuviera accesible, en español o en inglés. Resultados y discusión: las figuras más utilizadas son el círculo y la pirámide. Las GR ilustran las siguientes recomendaciones: todas (n = 37) grupos de alimentos, 21 actividad física, 17 consumo de agua, 7 restricción de sal, 1 convivencia familiar, 1 relajación y 10 recomendaciones cuantitativas. Las GR de Grecia y Estados Unidos no muestran imágenes de alimentos. Los aspectos considerados en las GR dependen de la región, la cultura y algunas características epidemiológicas de cada país. Se observa una tendencia al uso de la figura del círculo en países como Estados Unidos, España y México, además de incluir recomendaciones sobre el estilo de vida en la ilustración. Las recomendaciones cuantitativas pueden clarificar la información en el proceso educativo.

[Association between food behavior and hypercholesterolemia-LDL in university students]. / ASOCIACIÓN ENTRE COMPORTAMIENTO ALIMENTARIO E HIPERCOLESTEROLEMIA-LDL EN JÓVENES UNIVERSITARIOS.

INTRODUCTION: Hypercholesterolemia-LDL (H-LDL) is associated with increased risk of cardiovascular disease. The association between H-LDL and feeding has focused on nutritional aspects. The study of the association between eating behavior (EB) and H-LDL in university students, could provide nutritional elements for correction and/or prevention in this population. OBJECTIVE: To assess the association between EB and H-LDL in university students. METHODS: A cross-sectional study was carried out in a sample of 167 students from the Autonomous University of Guerrero, Mexico. LDL cholesterol in serum was measured and a concentration ≥100 mg/dL was considered hypercholesterolemia. The EB was assessed using a previously validated questionnaire. The association between EB and H-LDL was determined with a bivariate logistic regression, adjusting for sex, age, socioeconomic status, smoking, energy intake, physical activity, presence or absence of obesity and family history. RESULTS: Eating lunch (morning snack) was related with 63% lower risk of H-LDL (OR 0.37; 95% CI 0.15, 0.90). Take food away from home once or twice a week was associated with a fourfold increased risk of H-LDL (R 5.14; 95% CI 1.12, 23.62). Subjects who reported consuming excess food (1 or 2, and 3 or more times/week) had higher risk of H-LDL (OR 3.26; 95% CI 1.10, 9.64 and OR 10.52; 95% CI 2.66, 41.60 respectively). CONCLUSIONS: Some usual EB of the university students (Guerrero, Mexico) involve greater risk of H-LDL. To encourage actions corrective and/or preventive focused on these EB, could improve the health of this population.

Introducción: la hipercolesterolemia-LDL (H-LDL) se asocia a mayor riesgo de enfermedad cardiovascular. La asociacion entre H-LDL y alimentacion se ha centrado en aspectos nutrimentales. El estudio de la asociacion entre el comportamiento alimentario (CA) y la H-LDL en estudiantes universitarios podria brindar elementos de correccion y/o prevencion nutricional en esta poblacion. Objetivo: evaluar la asociacion entre CA e H-LDL en estudiantes universitarios. Métodos: estudio transversal realizado en una muestra de 167 estudiantes de la Universidad Autonoma de Guerrero, Mexico. Se midio el colesterol-LDL serico, considerandose hipercolesterolemia una concentracion ≥100 mg/dL. El CA se evaluo mediante un cuestionario previamente validado. La asociacion entre CA e H-LDL se determino con una regresion logistica bivariada, ajustando por sexo, edad, nivel socioeconomico, tabaquismo, ingesta de energia, actividad fisica, presencia o no de obesidad y antecedentes familiares. Resultados: consumir el almuerzo (colacion matutina) se asocio con un 63% de menos riesgo de H-LDL (OR 0,37; 95% IC 0,15, 0,90). Ingerir alimentos fuera de casa una o dos veces a la semana, se asocio con cuatro veces mas riesgo de H-LDL (R 5,14; 95% IC 1,12, 23,62). Los sujetos que referian consumir alimentos en exceso (1 o 2, y 3 o mas veces/semana) tuvieron mayor riesgo de H-LDL (OR 3,26; 95% IC 1,10, 9,64 y OR 10,52; 95% IC 2,66, 41,60, respectivamente). Conclusiones: algunos CA habituales de los estudiantes universitarios de Guerrero implican mayor riesgo de H-LDL. Por ello, promover acciones correctivas y/o preventivas centradas en estos CA podria mejorar la salud de esta poblacion.

Diseño y validación de la Guía de Salud Integral como una representación gráfica alternativa para las guías alimentarias mexicanas

bjetivo: diseñar y validar una Representación Gráfica (RG) de guía alimentaria mexicana, como alternativa al Plato del Bien Comer" (PBC).Métodos: la nueva RG se diseñó considerando: la revisión de RG internacionales; el análisis, en el ámbito internacional y en México, de la situación epidemiológica y las recomendaciones nutricionales; la identificación de las áreas de oportunidad del PBC. Validación en dos fases: 1) Análisis de contenido sobre la apreciación de los mensajes transmitidos por la Guía de Salud Integral (GSI) entre 19 alumnos universitarios y 41 pacientes de consulta externa. 2) Comparativo de la percepción de los mensajes transmitidos entre GSI y PBC en 28 padres de familia de alumnos de primaria.Resultados: se generó una RG denominada GSI incluyó cuatro grupos dentro del círculo: frutas, verduras, cereales integrales y proteínas saludables. Además, incorporó grasas saludables, agua natural, actividad física y convivencia familiar. La validación muestra que 59,3 % (fase 1) y 60 % (fase 2), identifica que la GSI representa alimentos saludables; 25,4 % (fase 1) y 40 % (fase 2) percibe que la GSI incluye estilos de vida saludables, datos independientes del tipo de población. La GSI obtuvo datos similares al PBC e incluso más favorables en la inclusión de frutas, grasas y agua natural al elaborar un menú ejemplo.Conclusión: la GSI puede ser utilizada como una RG alternativa para facilitar el proceso educativo, la adopción de hábitos alimentarios saludables y de estilo de vida. Puede ser empleada por profesionales de la salud para impactar de manera positiva en la población.

bjective: To design and validate a Graphic Representation (RG) of mexican food guide, as an alternative to "Healthy eating plate" (PBC).Methods: The new RG was designed considering: the revision of international RG; the analysis, at the international level and in Mexico, of the epidemiological status and nutritional recommendations; the identification of the aspects to improve the PBC. Validation in two phases: 1) Content analysis on the evaluation of the messages transmitted by the Full Health Guide (GSI) among 19 university students and 41 outpatients. 2) Comparison of the perception of messages transmitted between GSI and in 28 parents of elementary school students.Results: An RG denominated , was generated; included four groups within the circle: fruits, vegetables, whole grains and healthy proteins. In addition, it incorporated healthy fats, natural water, physical activity and share time with family. Validation shows that 59.3% (phase 1), and 60% (phase 2), identifies GSI as healthy food; 25.4% (phase 1) and 40% (phase 2) perceived that the GSI included healthy lifestyles, data independent of population type. The GSI obtained data similar to the PBC, and even more favorable, in the inclusion of fruits, fats and natural water when elaborating an example menu.Conclusion: GSI can be used as an alternative RG to facilitate the educational process, adoption of healthy eating habits, and lifestyle. It can be used, by health professionals, to positively influence the population.

A review of graphical representations used in the dietary guidelines of selected countries in the Americas, Europe and Asia / Una revisión de las representaciones gráficas utilizadas en las guías alimentarias de países seleccionados de América, Europa Y Asia

Introduction: Food-Based Dietary Guidelines (FBDGs) are an initiative by the United Nations Food and Agriculture Organization (FAO) and the World Health Organization (WHO) designed to help countries establish their own nutrition education principles. Such principles should be expressed through clear and specific messages that provide guidance and promote good health among populations. Many of these guidelines contain graphical representations (GRs) as visual aids for dietary guidance. Objectives: to analyze the characteristics of GRs used in various countries on four continents to identify international trends in these graphical messages and assess their usefulness as educational tools for their target populations. Methods: a review of GRs used in the FBDGs of countries in the Americas, Europe and Asia for which data were available in Spanish or English. Results and discussion: the models most used are the food circle and pyramid. The GRs (n=37) depict the following recommendations: food groups (37), physical activity (21), water intake (17), low salt intake (7), family meals (1) and relaxation (1). In addition, 10 quantitative recommendations were detected. The GRs of Greece and the United States do not show images of food. The aspects considered in the GRs vary by the regions, cultures and epidemiological characteristics of each country. A tendency to use the food circle and to include lifestyle recommendations in illustrations was observed in the United States, Spain and Mexico. Quantitative recommendations may help to clarify information provided during the educational process (AU)

Introducción: las Guías Alimentarias Basadas en Alimentos 'Food-Based Dietary Guidelines' (FBDG) son una propuesta de la Food and Agriculture Organization of the United Nations (FAO) y la World Health Organization (WHO) para que cada país plantee sus principios de educación nutricional de manera clara y concreta con el fin de orientar y promover la buena salud en la población. Muchas de estas guías incluyen una representación gráfica (GR) como ayuda visual en el proceso de orientación alimentaria. Objetivos: analizar las características de las GR de países de tres continentes, para conocer las tendencias internacionales de los mensajes gráficos y para facilitar su transmisión durante el proceso educativo a la población a la que van dirigidos. Métodos: revisión de las GR de las FBDG de países de América, Europa y Asia, cuya información estuviera accesible, en español o en inglés. Resultados y discusión: las figuras más utilizadas son el círculo y la pirámide. Las GR ilustran las siguientes recomendaciones: todas (n=37) grupos de alimentos, 21 actividad física, 17 consumo de agua, 7 restricción de sal, 1 convivencia familiar, 1 relajación y 10 recomendaciones cuantitativas. Las GR de Grecia y Estados Unidos no muestran imágenes de alimentos. Los aspectos considerados en las GR dependen de la región, la cultura y algunas características epidemiológicas de cada país. Se observa una tendencia al uso de la figura del círculo en países como Estados Unidos, España y México, además de incluir recomendaciones sobre el estilo de vida en la ilustración. Las recomendaciones cuantitativas pueden clarificar la información en el proceso educativo (AU)

Asociación entre comportamiento alimentario e hipercolesterolemia-LDL en jóvenes universitarios / Association between food behavior and hypercholesterolemia- ldl in university students

Introducción: la hipercolesterolemia-LDL (H-LDL) se asocia a mayor riesgo de enfermedad cardiovascular. La asociación entre H-LDL y alimentación se ha centrado en aspectos nutrimentales. El estudio de la asociación entre el comportamiento alimentario (CA) y la H-LDL en estudiantes universitarios podría brindar elementos de corrección y/o prevención nutricional en esta población. Objetivo: evaluar la asociación entre CA e H-LDL en estudiantes universitarios. Métodos: estudio transversal realizado en una muestra de 167 estudiantes de la Universidad Autónoma de Guerrero, México. Se midió el colesterol-LDL sérico, considerándose hipercolesterolemia una concentración más o igual a 100 mg/dL. El CA se evaluó mediante un cuestionario previamente validado. La asociación entre CA e H-LDL se determinó con una regresión logística bivariada, ajustando por sexo, edad, nivel socioeconómico, tabaquismo, ingesta de energía, actividad física, presencia o no de obesidad y antecedentes familiares. Resultados: consumir el almuerzo (colación matutina) se asoció con un 63% de menos riesgo de H-LDL (OR 0,37; 95% IC 0,15, 0,90). Ingerir alimentos fuera de casa una o dos veces a la semana, se asoció con cuatro veces más riesgo de H-LDL (R 5,14; 95% IC 1,12, 23,62). Los sujetos que referían consumir alimentos en exceso (1 o 2, y 3 o más veces/semana) tuvieron mayor riesgo de H-LDL (OR 3,26; 95% IC 1,10, 9,64 y OR 10,52; 95% IC 2,66, 41,60, respectivamente). Conclusiones: algunos CA habituales de los estudiantes universitarios de Guerrero implican mayor riesgo de H-LDL. Por ello, promover acciones correctivas y/o preventivas centradas en estos CA podría mejorar la salud de esta población (AU)

Introduction: hypercholesterolemia-LDL (H-LDL) is associated with increased risk of cardiovascular disease. The association between H-LDL and feeding has focused on nutritional aspects. The study of the association between eating behavior (EB) and H-LDL in university students, could provide nutritional elements for correction and/or prevention in this population. Objective: to assess the association between EB and H-LDL in university students. Methods: a cross-sectional study was carried out in a sample of 167 students from the Autonomous University of Guerrero, Mexico. LDL cholesterol in serum was measured and a concentration greater than or equal to 100 mg / dL was considered hypercholesterolemia. The EB was assessed using a previously validated questionnaire. The association between EB and H-LDL was determined with a bivariate logistic regression, adjusting for sex, age, socioeconomic status, smoking, energy intake, physical activity, presence or absence of obesity and family history. Results: eating lunch (morning snack) was related with 63% lower risk of H-LDL (OR 0.37; 95% CI 0.15, 0.90). Take food away from home once or twice a week was associated with a fourfold increased risk of H-LDL (R 5.14; 95% CI 1.12, 23.62). Subjects who reported consuming excess food (1 or 2, and 3 or more times/week) had higher risk of H-LDL (OR 3.26; 95% CI 1.10, 9.64 and OR 10.52; 95% CI 2.66, 41.60 respectively). Conclusions: some usual EB of the university students (Guerrero, Mexico) involve greater risk of H-LDL. To encourage actions corrective and/or preventive focused on these EB, could improve the health of this population (AU)