Westernized and Diverse Dietary Patterns Are Associated With Overweight-Obesity and Abdominal Obesity in Mexican Adult Men.

Introduction: The prevalence of overweight and obesity in Mexican adults is very high. To identify the dietary characteristics related with this disorder is necessary to design intervention. The objective was to analyze the association between dietary patterns and obesity in Mexican adults. Materials and Methods: This is a cross-sectional study carried out in Mexican adults (20-59 years old) participating in the Halfway National Health and Nutrition Survey 2016. Participants (n = 5,735) were classified as having normal weight, overweight-obesity and by their abdominal circumference as having abdominal obesity or not. With information from a 7-day food frequency questionnaire, we used a K-means cluster analysis to derive dietary patterns and calculated a healthy diet indicator to evaluate quality. The association between dietary patterns and overweight-obesity and abdominal obesity was assessed with Poisson regression models adjusted by some characteristics. Results: We identified a Rural pattern characterized by tortilla, legumes and egg consumption; a Diverse pattern, characterized by fruits, meat and poultry, vegetables, and dairy beverages, and desserts; and a Westernized pattern, characterized by sweetened non-dairy beverages, fast food, bakery and cookies, candies and salty snacks. In men, Westernized pattern was associated with overweight-obesity (PR = 1.11, 95% CI 0.97-1.27), and abdominal obesity (PR = 1.15, 95% CI 1.00-1.33), the Diverse pattern was associated with overweight-obesity (PR = 1.18, 95% CI 1.00-1.38), and abdominal obesity (PR = 1.27, 95% CI 1.07-1.50), compared with the Rural pattern. In women, these dietary patterns were not associated with obesity. Discussion: Westernized and Diverse patterns are associated with overweight and obesity and abdominal obesity in men. Gender-specific recommendations and surveillance are necessary in the Mexican adult population.

Breastfeeding practices in Mexico: Results from the National Demographic Dynamic Survey 2006-2018.

Although actions have been taken to improve breastfeeding in Mexico, trends over the last decade and their associated factors have not been analysed. We estimated trends in breastfeeding practices at the national, rural/urban, and regional level indigenous ethnicity and socio-economic level, and their associated factors using the National Demographic Dynamics Survey (2006, 2009, 2014 and 2018). We assessed breastfeeding indicators of women with children <24 months according to The World Health Organization recommendations. Logistic regressions models of pooled data were used to estimate trends and associations with biological and sociodemographic characteristics. Between 2006 and 2018, the prevalence of ever breastfed increased from 91.8% to 94.2% (p < 0.001), whereas early initiation of breastfeeding increased from 40.8% to 59.7% (p < 0.001), with similar increments by urban/rural level. Between 2009 and 2018, the prevalence of exclusive breastfeeding in children <6 months increased from 13.0% to 20.7% (p < 0.001). The largest increase was seen in Mexico City, in nonindigenous women and those with a high socio-economic status, whereas indigenous women and those from the South had the lowest or no improvements. Breastfeeding education during pregnancy [odds ratio (OR) 1.3; 95% confidence interval (CI) 1.1-1.5] was positively associated with exclusive breastfeeding, whereas being employed (OR 0.8; 95% CI 0.6-0.9) was negatively associated. Breastfeeding practices improved but are still far from recommendations. Implementing strategies like breastfeeding counselling and programmes and policies that promote and support breastfeeding for poor, indigenous, single and working mothers should be a priority for the government to ensure that all children have the best start in life.

Dietary intake and adequacy in Mexican preschool children: National Health and Nutrition Survey 2012.

OBJECTIVE: to estimate energy, nutrient intake and diet adequacy in preschool-aged children based on data from the Mexican National Health and Nutrition Survey 2012. MATERIAL AND METHODS: dietary data in children < 5 years (n = 1,212) collected through a Semi-quantitative Food Frequency Questionnaire (SFFQ) were analyzed. Energy and daily nutrient intakes and adequacies were calculated comparing by sociodemographic characteristics. RESULTS: median daily energy intake was 1,252 kcal (adequacy 104%). Adequacies above 100% were observed for calcium, zinc, vitamin C, folate, vitamin B12, vitamin A and median of saturated fat. Low percent adequacies were observed for fiber, iron, polyunsaturated fat and vitamin D. Intakes were lower in the southern region compared to other regions. Most intakes and adequacies were higher in urban compared to rural areas, but fiber had the opposite trend. Indigenous children had low intakes and percent adequacies. CONCLUSIONS: risks of dietary deficiencies and excess are present in Mexican preschool-aged children, with marked differences across sociodemographicstrata.

Mexican Children under 2 Years of Age Consume Food Groups High in Energy and Low in Micronutrients.

BACKGROUND: Mexico faces malnutrition problems in the child population. Analysis of food consumption in small children allows us to identify and propose strategies focused on feeding to improve their nutritional status. OBJECTIVE: We described the consumption of beverages and food groups in Mexican children <24 mo of age. METHODS: A cross-sectional study was carried out in 926 children aged <24 mo participating in the 2012 ENSANUT (National Health and Nutrition Study). Dietary information was obtained through 24-h recalls. The foods and beverages consumed were divided into 17 groups. Consumption was estimated in grams or milliliters, kilocalories per day, and percentage of energy (PE) per day. The percentage of consumers was calculated for each food group and stratified by age (<6, 6-11, and 12-23 mo) and by breastfeeding status (breastfed or not breastfed). Differences in the consumption of food groups were analyzed by breastfeeding status, area of residence (urban or rural), and socioeconomic status (SES) by using linear regression adjusted for age, breastfeeding status, and survey design. RESULTS: Only 35% of the children consumed breast milk. Infant formula was consumed by 48% in children aged <6 mo and by 33% in children 6-11 mo old. More than 35% of the children aged 6-11 and 12-23 mo and 12% of children <6 mo old consumed nondairy sugar-sweetened beverages. Legumes and seeds and maize-based preparations contributed a higher PE in rural areas (3.4% and 1.9%, respectively) than in urban areas (11.1% and 6.4%, respectively) (P < 0.05). Children from the lowest SES category consumed less PE from cereals other than maize (2.4%) and more from maize-based preparations (10.2%) than did the middle (4.9% from other cereals and 8.0% from maize) and high (6.0% from other cereals and 4.5% from maize) SES categories (P < 0.05). CONCLUSION: Mexican children <24 mo of age do not consume a diet that meets recommendations, which is consistent with the high prevalence of malnutrition in Mexico.

Early consumption of liquids different to breast milk in Mexican infants under 1 year: results of the probabilistic National Health and Nutrition Survey 2012

Introduction: Studies on infant dietary intake do not generally focus on the types of liquids consumed. Objective: To document by age and breastfeeding status, the types of liquids present in the diet of Mexican children under 1 year of age (< 1 y) who participated in the National Health and Nutrition Survey 2012 (ENSANUT-2012). Methods: Analysis of the infant < 1 y feeding practices from the ENSANUT-2012 survey in non-breastfed (non-BF) and breastfed (BF) infants by status quo for the consumption of liquids grouped in: water, formula, fortified LICONSA milk, nutritive liquids (NL; thin cereal-based gruel with water or milk and coffee with milk) and non-nutritive liquids (non-NL) as sugared water, water-based drinks, tea, beans or chicken broth, aguamieland coffee. In this infants < 1 y we analyzed the not grouped consumption of liquids in the first three days of life (newborns) from the mother's recall. Percentage and confidence intervals (95% CI) were calculated adjusting for survey design. Statistical differences were analyzed by Z test. Results: We observed a high consumption of human milk followed by formula (56.7%) and water (51.1%) in infants under 6 months of age (< 6 mo). The proportion of non-BF infants consuming non-NL was higher than for BF infants (p < 0.05). More than 60% of older infants (6 mo and < 1 y) consumed formula and were non-BF. In newborns formula consumption was predominant, followed by tea or infusion and water. Conclusions: Non-breast milk liquids are present undesirably in Mexican infants' diet and non-NL are consumed earlier than NL, revealing inadequate early dietary practices.

[Exclusive breastfeeding in <6mo is associated to a better weight for length in households with food insecurity in Mexico]. / La lactancia materna exclusiva en menores de seis meses se asocia con un mejor peso para la longitud en hogares con inseguridad alimentaria en México.

OBJECTIVE: To evaluate the effect of exclusive breastfeeding in <6mo (EBF<6mo) on the relationship between food insecurity (FI) and nutritional status, in Mexican infants. MATERIALS AND METHODS: We analyzed the sample of 12-49y women and their children <2y from the national survey ENSANUT 2012 (n = 4 022). Breastfeeding indicators from WHO-2008 were calculated. We estimated the effect modifier EBF<6mo of the relationship between FI and weight length (Z W/L) and length for age (Z L/A) Z score. RESULTS: The EBF<6mo was lower in households (hh) with moderate and severe FI than in those with food security (FS) or mild FI hh. Only EBF<6mo infants from hh with moderate and severe FI showed greater Z W/L (0.44) than those without EBF<6mo (p= 0.038, one-tailed). Score Z W/L of infants from hh FS did not vary according to EBF<6mo. CONCLUSION: EBF<6mo in Mexican infants is associated with better weight for length in households with moderate and severe FI. Breastfeeding promotion, protection and support must be targeted mainly at the most vulnerable, food insecure families.

La lactancia materna exclusiva en menores de seis meses se asocia con un mejor peso para la longitud en hogares con inseguridad alimentaria en México / Exclusive breastfeeding in <6mo is associated to a better weight for length in households with food insecurity in Mexico

Objetivo. Evaluar el efecto modificador de la lactancia materna (LM) exclusiva en menores de seis meses (LME<6m) en la relación entre inseguridad alimentaria (IA) y estado de nutrición infantil. Material y métodos. Análisis de mujeres de 12-49 años y sus hijos menores de dos años de la ENSANUT 2012 (n=4 022). Se calcularon los indicadores de la Organización Mundial de la Salud para LM. Se estimó la media del puntaje Z de peso para la longitud (Z P/L) y Z de longitud para la edad (Z L/E) de niños, por IA y LME<6m. Resultados. La LME<6m fue inferior en hogares con ISA moderada y severa comparada con hogares con seguridad alimentaria (SA) o IA leve. En hogares con IA moderada y severa, niños con LME<6m mostraron mayor Z P/L (0.44) vs. niños sin LME<6m (p=0.038, una cola), sin diferencias en hogares con SA. Conclusión. En México, la LME<6m se asocia con un mejor P/L en hogares con IA moderada y severa, no así en hogares con SA. Urge focalizar políticas públicas para abatir la desnutrición y mejorar las prácticas de lactancia en estos grupos.

Objective. To evaluate the effect of exclusive breastfeeding in <6mo (EBF<6mo) on the relationship between food insecurity (FI) and nutritional status, in Mexican infants. Materials and methods. We analyzed the sample of 12-49y women and their children <2y from the national survey ENSANUT 2012 (n = 4 022). Breastfeeding indicators from WHO-2008 were calculated. We estimated the effect modifier EBF<6mo of the relationship between FI and weight length (Z W/L) and length for age (Z L/A) Z score. Results. The EBF<6mo was lower in households (hh) with moderate and severe FI than in those with food security (FS) or mild FI hh. Only EBF<6mo infants from hh with moderate and severe FI showed greater Z W/L (0.44) than those without EBF<6mo (p= 0.038, one-tailed). Score Z W/L of infants from hh FS did not vary according to EBF<6mo. Conclusion. EBF<6mo in Mexican infants is associated with better weight for length in households with moderate and severe FI. Breastfeeding promotion, protection and support must be targeted mainly at the most vulnerable, food insecure families.

Design and challenges of a randomized controlled trial for reducing risk factors of metabolic syndrome in Mexican women through water intake / Diseño y retos de un ensayo clínico aleatorizado para reducir el riesgo de síndrome metabólico en mujeres mexicanas mediante consumo de agua

Objective. To describe the design, methods, and challenges encountered during a randomized clinical trial aimed to promote water intake for reducing risks of metabolic syndrome in Mexican women. Materials and methods. In a randomized clinical trial in Cuernavaca, Mexico, overweight and obese (body mass index [BMI] ≥ 25 < 39) women, 18 - < 45 years old with an intake of sugar-sweetened beverages ≥ 250 kilocalories per day (kcal/day) were randomly allocated to the water and education provision group (n = 120) or the education provision only group (n = 120). Results. We screened 1 756 women. The main difficulties encountered were identifying participants with the recruitment criteria, delivering water to participants, and the time demanded from the study participants. Conclusions. The trial's main challenges were difficulties surrounding recruitment, delivery of the intervention, and the time demanded from the study participants. Modifications were effectively implemented without jeopardizing the original protocol.

Objetivo. Describir el diseño, métodos y dificultades logísticas enfrentadas durante un ensayo clínico aleatorizado con el objetivo de promover el aumento en el consumo de agua para reducir el riesgo metabólico en mujeres obesas. Material y métodos. Ensayo clínico aleatorizado, desarrollado en Cuernavaca, México. Mujeres con IMC ≥ 25 y < 39, entre 18 y < 45 años, con consumo de bebidas azucaradas ≥ 250 kcal/día, se asignaron aleatoriamente a a) grupo de agua y educación nutricional (n = 120), o b) educación nutricional únicamente (n = 120). Resultados. Se realizaron pruebas de tamizaje a 1 756 mujeres. Las principales dificultades para el desarrollo del estudio fueron identificar participantes que cumplieran criterios del estudio, entrega de agua y tiempo invertido por las participantes en actividades del proyecto. Conclusiones. Los retos del proyecto estuvieron relacionados con el reclutamiento, entrega de la intervención y demanda de tiempo a las participantes. Se implementaron modificaciones sin afectar la validez del estudio.

Breastfeeding in Mexico was stable, on average, but deteriorated among the poor, whereas complementary feeding improved: results from the 1999 to 2006 National Health and Nutrition Surveys.

We present: 1) indicators of infant and young child feeding practices (IYCFP) and median age of introduction of foods analyzed by geographic and socioeconomic variables for the 2006 national probabilistic Health Nutrition Survey (ENSANUT-2006); and 2) changes in IYCFP indicators between the 1999 national probabilistic Nutrition Survey and ENSANUT-2006, analyzed by the same variables. Participants were women 12-49 y and their <2-y-old children (2953 in 2006 and 3191 in 1999). Indicators were estimated with the status quo method. The median age of introduction of foods was calculated by the Kaplan-Meier method using recall data. The national median duration of breastfeeding was similar in both surveys, 9.7 mo in 1999 and 10.4 mo in 2006, but decreased in the vulnerable population. In 1999 indigenous women breastfed 20.8 mo but did so for only 13.0 mo in 2006. The national percentage of those exclusively breastfeeding <6 mo also remained stable: 20% in 1999 and 22.3% in 2006. Nevertheless, exclusively breastfeeding <6 mo changed within the indigenous population, from 46% in 1999 to 34.5% in 2006. Between surveys, most breastfeeding indicators had lower values in vulnerable populations than in those better-off. Complementary feeding, however, improved overall. Complementary feeding was inadequately timed: median age of introduction of plain water was 3 mo, formula and non-human milk was 5 mo, and cereals, legumes, and animal foods was 5 mo. Late introduction of animal foods occurred among vulnerable indigenous population when 50% consumed these products at 8 mo. Mexican IYCFP indicate that public policy must protect breastfeeding while promoting the timely introduction of complementary feeding.

Design and challenges of a randomized controlled trial for reducing risk factors of metabolic syndrome in Mexican women through water intake.

OBJECTIVE: To describe the design, methods, and challenges encountered during a randomized clinical trial aimed to promote water intake for reducing risks of metabolic syndrome in Mexican women. MATERIALS AND METHODS: In a randomized clinical trial in Cuernavaca, Mexico, overweight and obese (body mass index [BMI] ≥ 25 < 39) women, 18 - < 45 years old with an intake of sugar-sweetened beverages ≥ 250 kilocalories per day (kcal/day) were randomly allocated to the water and education provision group (n = 120) or the education provision only group (n = 120). RESULTS: We screened 1 756 women. The main difficulties encountered were identifying participants with the recruitment criteria, delivering water to participants, and the time demanded from the study participants. CONCLUSIONS: The trial's main challenges were difficulties surrounding recruitment, delivery of the intervention, and the time demanded from the study participants. Modifications were effectively implemented without jeopardizing the original protocol.

Child malnutrition in Mexico in the last two decades: prevalence using the new WHO 2006 growth standards.

OBJECTIVE: To describe preschool malnutrition prevalence and trends in Mexican children for the 1988, 1999 and 2006 Mexican National Nutrition Surveys using WHO-2006 standards and National Center for Health Statistics/WHO (NCHS/WHO) references. MATERIAL AND METHODS: Prevalence of undernutrition (< minus 2 z-score for weight/age, height/age and weight/height) and overweight (> plus 2 z-score for weight/height) were calculated. RESULTS: Height/age and weight/height have increased over time (p< 0.05). Using WHO-2006 standards, stunting in children less than 5 years years old was 26.9%, 21.5% and 15.5% in 1988, 1999 and 2006, respectively; values for wasting were 6.2%, 2.1% and 2.0%, respectively. Wasting in the very young (< 6 mo) in 2006 is high (4.9%). Overweight increased from 1988 to 1999 (6.1% to 7.5%) and stabilized in 2006 (7.6%). Gaps among ethnic and socioeconomic groups have decreased over time. CONCLUSIONS: Stunting has decreased markedly but continues to be the main malnutrition problem. Overweight has emerged as a public health problem in the young. Lower NCHS/WHO estimates previously published underestimated true prevalence. Length deviations in attained height after 12 months indicate poor infant feeding practices, probably coupled with early infections. Results reinforce the need to improve the quality of nutrition programs and to promote adequate lactation and infant feeding practices in Mexico.

Child malnutrition in Mexico in the last two decades: prevalence using the new WHO 2006 growth standards / Malnutrición preescolar en México en las últimas dos décadas: prevalencias usando los estándares de la OMS-2006

OBJECTIVE: To describe preschool malnutrition prevalence and trends in Mexican children for the 1988, 1999 and 2006 Mexican National Nutrition Surveys using WHO-2006 standards and National Center for Health Statistics/WHO (NCHS/WHO) references. MATERIAL AND METHODS: Prevalence of undernutrition (< minus 2 z-score for weight/age, height/age and weight/height) and overweight (> plus 2 z-score for weight/height) were calculated. RESULTS: Height/age and weight/height have increased over time (p< 0.05). Using WHO-2006 standards, stunting in children less than 5 years years old was 26.9 percent, 21.5 percent and 15.5 percent in 1988, 1999 and 2006, respectively; values for wasting were 6.2 percent, 2.1 percent and 2.0 percent, respectively. Wasting in the very young (< 6 mo) in 2006 is high (4.9 percent). Overweight increased from 1988 to 1999 (6.1 percent to 7.5 percent) and stabilized in 2006 (7.6 percent). Gaps among ethnic and socioeconomic groups have decreased over time. CONCLUSIONS: Stunting has decreased markedly but continues to be the main malnutrition problem. Overweight has emerged as a public health problem in the young. Lower NCHS/WHO estimates previously published underestimated true prevalence. Length deviations in attained height after 12 months indicate poor infant feeding practices, probably coupled with early infections. Results reinforce the need to improve the quality of nutrition programs and to promote adequate lactation and infant feeding practices in Mexico.

OBJETIVO: Describir las prevalencias y tendencias de malnutrición en preescolares mexicanos, según resultados de las Encuestas Nacionales de Nutrición 1988, 1999 y 2006, usando estándares de la Organización Mundial de la Salud de 2006 y referencias del National Center for Health Statistics/ World Health Organization (NCHS/WHO). MATERIAL Y MÉTODOS: Se calcularon prevalencias de desnutrición (puntaje z < -2 para talla/edad, peso/edad, y peso/talla) y de sobrepeso (> +2z peso/talla). RESULTADOS: La talla/edad y el peso/talla han aumentado con el tiempo (p< 0.05). Usando los estándares de la OMS de 2006, el desmedro en menores de cinco años de edad era de 26.9, 21.5 y 15.5 por ciento en 1988, 1999 y 2006, respectivamente. Los valores de emaciación fueron 6.2, 2.1 y 2.0 por ciento. La emaciación en 2006 en los menores de seis meses de edad fue de 4.9 por ciento. El sobrepeso aumentó de 1988 a 1999 (6.1 a 7.5 por ciento) y se estabilizó en 2006 (7.6 por ciento). Las diferencias entre grupos étnicos y socioeconómicos disminuyeron con el tiempo. CONCLUSIONES: El desmedro disminuyó marcadamente, pero continúa siendo el principal problema de malnutrición. El sobrepeso emergió como problema de salud pública en niños. Las estimaciones de desnutrición en preescolares previamente publicadas usando las referencias del NCHS/WHO subestimaban las verdaderas cifras. Las desviaciones en la talla alcanzada a partir de los 12 meses de edad revelan prácticas de lactancia y alimentación infantil pobres, probablemente aunadas a infecciones tempranas. Estos resultados refuerzan la necesidad de mejorar la calidad de los programas de nutrición y de promover prácticas adecuadas de alimentación infantil en México.

[Contribution of processed foods to the energy, macronutrient and fiber intakes of Mexican children aged 1 to 4 years]. / Alimentos industrializados en la dieta de los preescolares mexicanos.

OBJECTIVE: To classify the foods consumed by Mexican children 1-4 years in three food categories according to the preparation process and temporality: a) Processed Modern Foods (PMF), b) Processed Traditional Foods (PTF) and c) Non-Processed Foods. MATERIAL AND METHODS: Twenty-four-hour dietary recalls were collected from the National Nutrition Survey 1999 in children 1-4 years (n =1070). The contribution of each food category to the total energy, macronutrient and fiber intakes was analyzed. RESULTS: The contribution of PMF and PTF was as follows, respectively: Energy: 17%, 31%; total protein: 14%, 25%; non-animal protein: 10%, 10%; animal protein: 17%, 34%; carbohydrates: 18%, 26%; fiber: 4%, 5%; total fat 15%, 41%; saturated fat 16%, 52%; and cholesterol 7%, 7%. CONCLUSIONS: The contribution of PF to the diets of Mexican children accounts for >39% of energy, total protein, animal protein, carbohydrates and fat. The authors recommend the participation of food industry to prevent malnutrition in children.

Alimentos industrializados en la dieta de los preescolares mexicanos / Contribution of processed foods to the energy, macronutrient and fiber intakes of Mexican children aged 1 to 4 years

OBJETIVOS: Clasificar los alimentos consumidos por preescolares mexicanos, en relación con su proceso de elaboración y temporalidad: a) industrializados modernos (IM), b) industrializados tradicionales (IT) y c) no industrializados (NI). MATERIAL Y MÉTODOS: Con base en información del recordatorio de 24 horas de la Encuesta Nacional de Nutrición 1999 en niños de 1-4 años (n=1 070) se analizó la contribución de cada categoría de alimentos en energía, macronutrimentos y fibra. RESULTADOS: La contribución de energía a partir de IM e IT, respectivamente, fue: energía, 17 y 31 por ciento; proteína total, 14 y 25 por ciento; proteína vegetal, 10 y 10 por ciento; proteína animal, 17 y 34 por ciento; carbohidratos, 18 y 26 por ciento; fibra, 4 y 5 por ciento; grasa total, 15 y 41 por ciento; grasa saturada, 16 y 52 por ciento; y colesterol, 7 y 7 por ciento. CONCLUSIONES: Los alimentos industrializados aportan más de 39 por ciento de la energía, proteína animal, carbohidratos y grasas a la dieta de los preescolares mexicanos. Se recomienda la participación de la industria alimentaria para prevenir la mala nutrición infantil en México.

OBJECTIVE: To classify the foods consumed by Mexican children 1-4 years in three food categories according to the preparation process and temporality: a) Processed Modern Foods (PMF), b) Processed Traditional Foods (PTF) and c) Non-Processed Foods. MATERIAL AND METHODS: Twenty-four-hour dietary recalls were collected from the National Nutrition Survey 1999 in children 1-4 years (n =1070). The contribution of each food category to the total energy, macronutrient and fiber intakes was analyzed. RESULTS: The contribution of PMF and PTF was as follows, respectively: Energy: 17 percent, 31 percent; total protein: 14 percent, 25 percent; non-animal protein: 10 percent, 10 percent; animal protein: 17 percent, 34 percent; carbohydrates: 18 percent, 26 percent; fiber: 4 percent, 5 percent; total fat 15 percent, 41 percent; saturated fat 16 percent, 52 percent; and cholesterol 7 percent, 7 percent. CONCLUSIONS: The contribution of PF to the diets of Mexican children accounts for >39 percent of energy, total protein, animal protein, carbohydrates and fat. The authors recommend the participation of food industry to prevent malnutrition in children.