State-level prevalence of anemia in women of reproductive age. Ensanut 2006, 2012 and 2018-19.

OBJECTIVE: To compare the prevalence of anemia and iron deficiency, at state level in non-pregnant women between 20 and 49 years of age from the Encuesta Nacional de Salud y Nutrición (Ensanut, in Spanish) 2006, 2012 and 2018-19. MATERIALS AND METHODS: The Ensanut 2006, 2012 and 2018-19 have a probabilistic design. Hb in capillary blood was measured by HemoCue Hb201 and ferritin by venous sample. Anemia was diagnosed with Hb<120g/L and iron deficiency with Ferritin<15ng/mL. RESULTS: At the national level, anemia increased 6.1 (p<0.05) percentage points (pp) from 2006 to 2018-19. Baja California Norte, Campeche, Colima, Chiapas, Quintana Roo, Sinaloa and Sonora, went from low prevalence (5 to 19.9%) to moderate (20 to 39.9%); in Yucatán and Tamaulipas it went from low to severe (>40). In Guanajuato, State of Mexico and Querétaro it was reduced from 2006 to 2018-19 (p<0.05). CONCLUSIONS: Anemia continues to be a public health problem that requires actions at the state level, considering level of wellbeing index, food programs and affiliation to medical Services insurance.

Factores asociados con anemia y deficiencia de micronutrimentos en mujeres mexicanas. Ensanut Continua 2022.

OBJETIVO: Identificar los factores asociados con anemia, deficiencias de hierro (DH) y vitamina B12 (DVB12) en mujeres de 12 a 49 años, participantes en la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022). Material y métodos. La Ensanut es probabilística con representatividad nacional. Se recolectó sangre venosa de 1 141 mujeres para analizar hemoglobina, ferritina y vitamina B12, para estimar deficiencias según la Organización Mundial de la Salud. Se realizaron análisis descriptivos y modelos de regresión logística (módulo SVY/STATA). RESULTADOS: Las prevalencias de anemia, DH y DVB12 fueron 15.7, 41.9 y 17.2%, respectivamente. Se asoció (p<0.5) anemia con agua de garrafón/botella (razón de momios [RM]=2.27; IC95% 0.99,5.17) y DH con no tener agua entubada (RM=2.86; IC95% 1.31, 6.22) y pertenecer al estrato urbano (RM=1.56; IC95% 0.98, 2.45). Conclusión. La anemia, DH y DVB12 fueron altamente prevalentes, por lo tanto se requiere profundizar en el tema del agua para beber y en la derechohabiencia en mujeres con mayores desventajas socioeconómicas.

Estado de micronutrimentos en niños, niñas y mujeres mexicanas: análisis de la Ensanut Continua 2022.

OBJETIVO: Describir las deficiencias de micronutrientes en la población mexicana participante de la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). Material y métodos. La Ensanut 2022 es probabilística y de representatividad nacional. Se recolectó sangre venosa en una submuestra de niños de 1-11 años (48%) y de mujeres de 12-49 años (37%). Se separó el suero in situ para analizar ferritina, vitamina B12, folato y 25[OH]D, definiendo deficiencias según criterios de la Organización Mundial de la Salud. Se realizaron análisis descriptivos en niños/as preescolares, escolares y mujeres (12-49 años), utilizando el diseño de la encuesta. RESULTADOS: Las prevalencias de deficiencia de hierro, niveles bajos de vitamina B12 y deficiencia de vitamina D fueron 30.6, 17.4 y 4.7% en preescolares; 17.2, 20 y 37.1% en escolares; y 39.7, 34.0 y 37.7% en mujeres, respectivamente. Conclusión. La deficiencia de hierro en preescolares y de micronutrientes en mujeres fueron altamente prevalentes. Es necesario un llamado a la acción para realizar intervenciones focalizadas en grupos con mayor desventaja social.

Prevalencia de anemia en la población mexicana: análisis de la Ensanut Continua 2022.

OBJETIVO: Describir la magnitud de la prevalencia de anemia en la población mexicana participante en la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022). Material y métodos. La Ensanut 2022 es probabilística. Mediante sangre venosa y Hemocué (201+) se midió hemoglobina (Hb) y se ajustó por altitud. Se definió anemia según criterios de la Organización Mundial de la Salud (OMS). Considerando el diseño muestral de la encuesta, se obtuvieron prevalencias e IC95%. RESULTADOS: Las prevalencias de anemia fueron 6.8% en niños de 1-4 años, 3.8% en niños de 5-11 años, 10.1% en adolescentes (12-19 años), 15.8% en mujeres (20-49 años) y 10.3% en adultos mayores (≥60 años). CONCLUSIONES: La anemia afectó principalmente a las mujeres adultas. Resulta necesario identificar sus causas para focalizar acciones y evitar el ciclo intergeneracional del riesgo de anemia.

Anaemia in adolescent women: A priority for the nutrition agenda in Mexico. A comparison of data from the ENSANUT 2012 and 2018-2019 surveys.

The risk of anaemia in adolescence increases due to accelerated growth. This study aims to: (1) estimate the prevalence of anaemia in 2012 and 2018-2019 (Encuesta Nacional de Salud y Nutricion - ENSANUT [n = 5841 in 2012 and n = 2380 in 2018-2019]) in non-pregnant, Mexican adolescent women aged 12-19 years, and the changes in prevalence over this period according to sociodemographic, health and nutrition characteristics; (2) estimate the associations between anaemia and sociodemographic, health and nutrition characteristics in each year and overall, in non-pregnant Mexican adolescent women. Anaemia was defined as capillary haemoglobin <12 g/dL. The distribution of characteristics and their changes between 2012 and 2018-2019 were described. The covariate-adjusted prevalence of anaemia in 2012 and 2018-2019 and the changes over that period were estimated from a multiple log-binomial regression model and the factors associated with anaemia were assessed in each survey year and in both years combined. The prevalence of anaemia was 7.7% in 2012 and 13.1% in 2018-2019 (69% increase, Prevalence Ratio: PR = 1.69; 95%CI: 1.35, 2.13). The covariate-adjusted prevalence of anaemia increased from 6.9% to 10.5% in the overall population (PR = 1.53, 95%CI: 1.19, 1.96), and increased considerably in the age group 12-14 years (PR = 1.94, 95%CI: 1.36, 2.75), and in the northern region (PR = 3.68, 95%CI: 2.55, 5.32). Those receiving iron supplements or school breakfasts did not register a significant increase. A higher household wellbeing status and older age were associated with a lower prevalence of anaemia. Anaemia in non-pregnant adolescent women continues to be a public health problem. To improve the development and health of adolescent women in Mexico and to pave the way to a healthy pregnancy for the next generation, the causes of anaemia should be identified.

Cambios en el estado de la anemia en una población infantil mexicana: un estudio longitudinal / Changes in anemia status in Mexican children: a longitudinal study

Objetivo: evaluar el cambio longitudinal de la anemia y su asociación con el indigenismo, el nivel socioeconómico (NSE) y la inseguridad alimentaria (IA) en una población infantil mexicana beneficiaria de dos programas sociales. Métodos: estudio longitudinal de 1164 niños menores de 18 meses de localidades rurales, residentes en tres estados de México. Se midió la concentración de hemoglobina en 2008 y 2012, y se determinó el cambio intrasujeto en la condición de anemia. Indigenismo, NSE e IA se obtuvieron en 2008. Su asociación con cuatro categorías de cambio de la anemia se evaluó mediante modelos de regresión logística multinomial ajustados por covariables. Resultados: en 2008, el 40,5 % de los niños padecían anemia. Para 2012, un 85,2 % de ellos ya no la tenían y el 9,8 % de los que no la habían tenido la presentaban. Las distribuciones de las categorías de cambio de estado de la anemia no se asociaron con la IA, mientras que sí se detectaron diferencias estadísticamente significativas en relación con el indigenismo y el NSE. Conclusiones: la alta prevalencia de la anemia que aqueja a la población infantil justifica la implementación de intervenciones basadas en la evidencia y de probada efectividad para su combate. (AU)

Objectives: to evaluate longitudinal change in anemia and its association with indigenous status, socioeconomic status (SES), and food insecurity (FI) in Mexican children. Methods: a longitudinal study in 1164 children under 18 months of age in rural communities. Hemoglobin concentration was measured in 2008 and 2012, and changes in anemia status were determined. Indigenous status, SES and FI were obtained in 2008, and their associations with four categories of change in anemia status were assessed through multinomial logistic regression models including adjustment covariates. Results: in 2008, 40.5 % of children had anemia, and 85.2 % of these did not have anemia in 2012, whereas 9.9 % of those who did not have anemia in 2008 had developed it in 2012. The distributions of the categories of change in anemia status were not associated with FI, while statistically significant differences were detected according to indigenism and NSE. Conclusions: the high prevalence of anemia that affects the child population justifies the implementation of interventions based on evidence, of proven effectiveness to combat it. (AU)

[Changes in anemia status in Mexican children: a longitudinal study]. / Cambios en el estado de la anemia en una población infantil mexicana: un estudio longitudinal.

Introduction: Objectives: to evaluate longitudinal change in anemia and its association with indigenous status, socioeconomic status (SES), and food insecurity (FI) in Mexican children. Methods: a longitudinal study in 1164 children under 18 months of age in rural communities. Hemoglobin concentration was measured in 2008 and 2012, and changes in anemia status were determined. Indigenous status, SES and FI were obtained in 2008, and their associations with four categories of change in anemia status were assessed through multinomial logistic regression models including adjustment covariates. Results: in 2008, 40.5 % of children had anemia, and 85.2 % of these did not have anemia in 2012, whereas 9.9 % of those who did not have anemia in 2008 had developed it in 2012. The distributions of the categories of change in anemia status were not associated with FI, while statistically significant differences were detected according to indigenism and NSE. Conclusions: the high prevalence of anemia that affects the child population justifies the implementation of interventions based on evidence, of proven effectiveness to combat it.

Introducción: Objetivo: evaluar el cambio longitudinal de la anemia y su asociación con el indigenismo, el nivel socioeconómico (NSE) y la inseguridad alimentaria (IA) en una población infantil mexicana beneficiaria de dos programas sociales. Métodos: estudio longitudinal de 1164 niños menores de 18 meses de localidades rurales, residentes en tres estados de México. Se midió la concentración de hemoglobina en 2008 y 2012, y se determinó el cambio intrasujeto en la condición de anemia. Indigenismo, NSE e IA se obtuvieron en 2008. Su asociación con cuatro categorías de cambio de la anemia se evaluó mediante modelos de regresión logística multinomial ajustados por covariables. Resultados: en 2008, el 40,5 % de los niños padecían anemia. Para 2012, un 85,2 % de ellos ya no la tenían y el 9,8 % de los que no la habían tenido la presentaban. Las distribuciones de las categorías de cambio de estado de la anemia no se asociaron con la IA, mientras que sí se detectaron diferencias estadísticamente significativas en relación con el indigenismo y el NSE. Conclusiones: la alta prevalencia de la anemia que aqueja a la población infantil justifica la implementación de intervenciones basadas en la evidencia y de probada efectividad para su combate.

Differential Effects of Three Nutritional Supplements on the Nutrient Intake of Pregnant Women Enrolled in a Conditional Cash Transfer Program in Mexico: A Cluster Randomized Trial.

Supplementation in malnourished pregnant women should not displace natural healthy foods. Objective: To estimate the differential effects of three nutritional supplements on macro- and micronutrient intake of pregnant women beneficiaries of the conditional cash transfer program Prospera (CCT-POP). Methods: Prospective cluster randomized trial. Communities were randomly assigned to receive a fortified beverage (Beverage), micronutrient tablets (Tablets), or micronutrient powder (MNP). Pregnant women (at <25 weeks) were recruited. The food frequency questionnaire was applied at 25 and 37 weeks of pregnancy and at one and three months postpartum (mpp). Differential effects of the three supplements on the median change in nutrient intake from baseline to each follow-up stage were estimated. Results: Median change in protein intake from dietary and supplement sources were significantly lower for MNP and Tablets than for Beverages (baseline to 37 w: −7.80 ± 2.90 and −11.54 ± 3.00, respectively; baseline to 1 mpp: −7.34 ± 2.90 for MNP, p < 0.001). Compared to Beverages, median increases were higher for the MNP for vitamins C (31.2 ± 11.7, p < 0.01), E (1.67 ± 0.81, p < 0.05), and B12 (0.83 ± 0.27, p < 0.01) from baseline to 37 wk; from baseline to 1 mpp, there was a higher median increase in B12 (0.55 ± 0.25, p < 0.05) and folate (63.4 ± 24.3, p < 0.01); and from baseline to 3 mpp, a higher median increase in iron (2.38 ± 1.06, p < 0.05) and folate (94.4 ± 38.1, p < 0.05). Conclusions: Intake of micronutrients was higher for MNP and Tablets, likely due to food displacement among Beverage consumers. Although iron bioavailability and absorption inhibitors were not considered for the present analyses, the distribution of Tablets or MNP had several advantages in this context where micronutrient deficiency remains high among pregnant women, but macronutrient intake is generally adequate or even high.

Talla baja y sobrepeso en menores de 5 años que habitan la Sierra Tarahumara, México / Stunting and overweight in children under 5y who inhabit the Sierra Tarahumara in northern Mexico

La doble carga de la desnutrición y el exceso de peso (o mala nutrición) es uno de los indicadores que mejor ilustra las inequidades en salud que existen en zonas indígenas de México. Por otro lado, existe escasa evidencia del estado de nutrición en población Tarahumara. Objetivo: Estimar indicadores del estado de nutrición y su asociación con factores sociodemográficos en población indígena Tarahumara menor de 5 años. Métodos: Estudio transversal en 21 localidades indígenas de la Sierra Tarahumara en Chihuahua, México, que analizó información sociodemográfica, de salud y antropométrica en población infantil de 6 a 59 meses de edad (n=323). Se estimaron índices antropométricos y su asociación con variables de interés mediante regresión logística múltiple. Un valor de p ≤0,05 fue considerado como estadísticamente significativo. Todos los análisis se realizaron en el paquete estadístico Stata v14.2. Resultados: Se encontraron altas prevalencias de talla baja (44,4%), emaciación (5,3%), bajo peso (11,9%) y sobrepeso (15,2%). El sexo masculino se asoció significativamente con talla baja (Razón de Momios (RM)=2,5; 1,45-4,34), mientras que, ninguna escolaridad de la madre (RM=0,39; 0,15-0,99) y ser beneficiario de un programa local de nutrición por más de 2 años se asoció con sobrepeso (RM=2,97; 1,26 -6,97). Conclusión: Se encontraron indicadores de mala nutrición en la muestra estudiada; éstos hallazgos podrían sugerir la existencia de inequidad y rezago en salud y nutrición de población infantil indígena Tarahumara. Se requieren más estudios que puedan orientar programas y acciones de salud y nutrición para atender a esta población de forma prioritaria(AU)

The double burden of malnutrition and excess weight (or poor nutrition) is one of the indicators that best illustrates the health inequities that exist in indigenous areas of Mexico. On the other hand, there is scarce evidence of the nutritional status of the Tarahumara population. Objective: To estimate indicators of the nutritional status and its association with sociodemographic factors in the Tarahumara indigenous population under 5 years of age. Methods: A cross-sectional study in 21 indigenous localities of the Sierra Tarahumara in Chihuahua, Mexico, which analyzed sociodemographic, health and anthropometric information in children from 6 to 59 months of age (n=323). Anthropometric indices and their association with variables of interest was estimated by multiple logistic regression. A value of p ≤0.05 was considered statistically significant. All analyzes were performed using the Stata v14.2 statistical package. Results: It were founded high prevalences of short stature (44.4%), emaciation (5.3%), underweight (11.9%) and overweight (15.2%). Male sex was significantly associated with short stature (Odds Ratio (OR) = 2.5; 1.45-4.34), while no education of the mother (OR = 0.39; 0.15-0.99) and being a beneficiary of a local nutrition program for more than 2 years it was associated with being overweight (OR = 2.97; 1.26-6.97). Conclusion: Indicators of malnutrition and overweight were founded in the sample studied; these findings suggest inequity and delays in health and nutrition of the indigenous Tarahumara child population. More research is required that can guide health and nutrition programs and actions to serve this indigenous population as a priority(AU)

Association between Predictors of Vitamin D Serum Levels and Risk of Retinoblastoma in Children: A Case-Control Study.

BACKGROUND: vitamin D (VD) may be a protective factor for retinoblastoma, though no temporal association has been reported during pregnancy or the child's first year of life. Serum VD concentrations are determined by both distal (DF) and proximal factors (PF). OBJECTIVE: To identify if DF and PF can predict VD insufficiency (VDI) and VD deficiency (VDD) in women of childbearing age; and to test whether maternal exposure to DF and PF during pregnancy and a child's exposure during the first 11.9 months postpartum are associated with sporadic retinoblastoma (SRb) in children. METHODS: This is a secondary analysis of data from the Epidemiology of SRb in Mexico (EpiRbMx) study and the National Health and Nutrition Survey 2018-2019 (ENSANUT 2018-2019, for its acronym in Spanish). The association of DF and PF with VDD or VDI was estimated using ENSANUT 2018-2019, and the association of DF and PF with SRb using EpiRbMx. All were estimated using logistic regression, with comparable samples selected from ENSANUT 2018-2019 and EpiRbMx. RESULTS: Altitude, latitude and obesity predicted VDI and VDD in ENSANUT women. In EpiRbMx, residence in a rural location during pregnancy increased the risk of SRb. For children, rural residence and latitude increased the risk of SRb, while the number of days exposed to the spring-summer season during months 6 to 11.9 of life was protective. CONCLUSIONS: risk of VDI and VDD in women (ENSANUT 2018-2019) increased with altitude, urban dwelling, overweight and obesity. The child and mother's place of residence, including altitude, latitude and rural classification were important predictors of SRb in EpiRbMx.

Vitamin D status in Mexican women at reproductive age, Ensanut 2018-19 / Estado de vitamina D en mujeres en edad reproductiva, Ensanut 2018-19

Abstract Objective: To describe the prevalence of deficiency (VDD) and insufficiency (VDI) of vitamin D (VD), by sociodemographic factors, obesity and physical activity in a probabilistic sample of Mexican women participating in Ensanut 2018-19. Materials and methods: In 1 262 women aged 20 to 49 years, the prevalence of VDD/IVD was estimated and the factors associated with it were evaluated with a multinomial regression model. Results: The prevalence of VDI was 46.1% and of VDD was 31.6%. The probability of presenting VDI and VDD was higher for residents of urban areas, in tertiles 2 and 3 of socioeconomic status, and with obesity, while was lower in women with moderate physical activity. Conclusión: The prevalence of vitamin D in Mexican women continues to be a public health problem in Mexico despite the high availability of sunlight in the country. It is necessary to promote healthy sun exposure in the population and consider fortifying foods with vitamin D.

Resumen Objetivo: Describir la prevalencia de deficiencia (VDD) e insuficiencia (VDI) de vitamina D (VD) por factores sociodemográficos, obesidad y actividad física, en una muestra probabilística de mujeres mexicanas participantes de la Encuesta Nacional de Salud y Nutrición 2018-19. Material y métodos: En 1 262 mujeres se estimó la prevalencia de VDD y VDI y se evaluaron los factores asociados con ellas con un modelo de regresión multinomial. Resultados: La prevalencia de VDI fue de 46.1% y de VDD fue 31.6%. La probabilidad de presentar VDI y VDD fue mayor en residentes de áreas urbanas, en terciles más altos de nivel socioeconómico y con obesidad, mientras que fue menor en mujeres con actividad física moderada. Conclusión: La prevalencia de VDI y VDD en mujeres mexicanas continúa siendo un problema de salud pública en México a pesar de la alta disponibilidad de luz solar en el país. Es necesario fomentar en la población una saludable exposición solar y considerar la fortificación de alimentos con vitamina D.

La prevalencia de la deficiencia de hierro se mantuvo estable y la anemia aumentó durante 12 años (2006-2018) en mujeres mexicanas de 20 a 49 años / Prevalence of iron deficiency was stable and anemia increased during 12 years (2006-2018) in Mexican women 20-49 years of age

Resumen Objetivo: Comparar la proporción de mujeres de 20 a 49 años con anemia por deficiencia de hierro (ADH), con deficiencia de hierro (DH) con deficiencia de hierro sin anemia (DHSA) y anemia no DH (ANDH) durante 2006, 2012 y 2018, y sus asociaciones con características sociodemográficas y estado nutricional. Material y métodos: Las Encuestas Nacionales de Salud y Nutrición de 2006, 2012 y 2018-19 usan métodos comparables para medir anemia (hemoglobina capilar) y deficiencia de hierro (DH, ferritina sérica). Ambas mediciones combinadas se compararon por año de encuesta y variables de control mediante regresión multinomial. Resultados: En 2006 la prevalencia global de anemia fue de 14.9% y DH de 29.0%, la de ADH de 8.35%, la de DHSA 20.5%, y ANDH 6.6%; en 2012 la prevalencia global de anemia fue de 13.3%, la de DH 29.6%, de ADH 8.6%, DHSA 21.0% y ANDH 4.7%; en 2018 prevalencia global de anemia fue de 21.4%, de DH 25.7%, ADH 10.5%, 15.2% y ANDH 10.9%. Conclusiones: La presencia global de anemia aumentó 6.5 pp entre 2006 y 2018; la de DHSA disminuyó; ADH no tuvo cambios significativos y el aumento mayor fue de ANDH.

Abstract Objective: To compare the prevalence of women 20-49 years of age with iron deficiency anemia (IDA), iron deficiency with no anemia (IDNA), and non-ID anemia (NIDA) in comparison during 2006, 2012 and 2018, and their association with sociodemographic characteristics and nutritional status. Materials and methods: Ensanut 2006, 2012 and 2018-19 are comparable for measurements of anemia (hemoglobin) and Iron deficiency (ID, by ferritin). Both measurements combined were compared with year of surveys and other dependent variables using a multinomial regression. Results: In 2006, the total prevalence of anemia was 14.9% and ID 29.0%, the prevalence of IDA was 8.35%, of IDNA 20.5%, and NIDA 6.6%; in 2012, the total prevalence of anemia was 13.3%, ID was 9.6%, IDA 8.6%, IDNA 21.0% y NIDA 4.7%; in 2018 total prevalence of anemia was 21.4%, of ID 25.7%, IDA 10.5%, IDNA 15.2% and NIDA 10.9%. Conclusions: The total prevalence of anemia increased 6.5 pp between 2006 and 2018, IDNA reduced, IDA had no significant changes, the mayor increase (4.3 pp) occurred in NIDA.

Vitamin D status in Mexican women at reproductive age, Ensanut 2018-19.

OBJECTIVE: To describe the prevalence of deficiency (VDD) and insufficiency (VDI) of vitamin D (VD), by sociodemo-graphic factors, obesity and physical activity in a probabilistic sample of Mexican women participating in Ensanut 2018-19. MATERIALS AND METHODS: In 1 262 women aged 20 to 49 years, the prevalence of VDD/IVD was estimated and the factors associated with it were evaluated with a multinomial regression model. RESULTS: The prevalence of VDI was 46.1% and of VDD was 31.6%. The probability of present-ing VDI and VDD was higher for residents of urban areas, in tertiles 2 and 3 of socioeconomic status, and with obesity, while was lower in women with moderate physical activ-ity. CONCLUSION: The prevalence of vitamin D in Mexican women continues to be a public health problem in Mexico despite the high availability of sunlight in the country. It is necessary to promote healthy sun exposure in the population and consider fortifying foods with vitamin D.

Prevalence of iron deficiency was stable and anemia increased during 12 years (2006-2018) in Mexican women 20-49 years of age.

OBJECTIVE: To compare the prevalence of women 20-49 years of age with iron deficiency anemia (IDA), iron deficiency with no anemia (IDNA), and non-ID anemia (NIDA) in com-parison during 2006, 2012 and 2018, and their association with sociodemographic characteristics and nutritional status. MATERIALS AND METHODS: Ensanut 2006, 2012 and 2018- 19 are comparable for measurements of anemia (hemoglobin) and Iron deficiency (ID, by ferritin). Both measurements combined were compared with year of surveys and other dependent variables using a multinomial regression. RESULTS: In 2006, the total prevalence of anemia was 14.9% and ID 29.0%, the prevalence of IDA was 8.35%, of IDNA 20.5%, and NIDA 6.6%; in 2012, the total prevalence of anemia was 13.3%, ID was 9.6%, IDA 8.6%, IDNA 21.0% y NIDA 4.7%; in 2018 total prevalence of anemia was 21.4%, of ID 25.7%, IDA 10.5%, IDNA 15.2% and NIDA 10.9%. CONCLUSIONS: The total prevalence of anemia increased 6.5 pp between 2006 and 2018, IDNA reduced, IDA had no significant changes, the mayor increase (4.3 pp) occurred in NIDA.

[Behavior and factors associated with anemia inMexican women of childbearing age. Ensanut 2018-19]. / Comportamiento y factores asociados con la anemia en mujeres mexicanas en edad fértil. Ensanut 2018-19.

OBJECTIVE: To study the behavior of anemia in 2006, 2012 and 2018-19, its severity and associated factors in Mexican women between 20 and 49 years of age. MATERIALS AND METHODS: The Ensanut 2006, 2012 and 2018-19 has a methodological design that allows comparisons between them. Capillary hemoglobin (Hb) classified anemia with Hb values <12dL. Pregnant women were excluded. Anemia was associated with individual and sociodemographic factors using a logit regression model. RESULTS: The reduction in anemia from 2006 to 2012 was significant, but not the increase for 2018-19. Anemia was associated with a higher number of pregnancies, and being 35 to 49 years of age. A BMI≥30 (k/m2), tertile 3 of wellness condition, not being indigenous and living in the Center and Mexico City were protective of anemia. CONCLUSIONS: Anemia continues to be a public health problem, especially in women 35 to 49 years of age with more than four pregnancies.

OBJETIVO: Estudiar el comportamiento de la anemia en los años 2006, 2012 y 2018-19, su severidad y factores asociados en mujeres mexicanas de 20 a 49 años de edad. MATERIAL Y MÉTODOS: Las Ensanut 2006, 2012 y 2018-19 tienen un diseño metodológico que permite comparaciones entre ellas. Mediante hemoglobina capilar <12dL se clasificó anemia. Se excluyó a quienes estuvieron embarazadas. Se asoció anemia con factores sociodemográficos mediante regresión logística. RESULTADOS: La reducción de anemia de 2006 a 2012 fue significativa, pero no el incremento para 2018-19. Se asoció anemia con un mayor número de embarazos, y tener de 35 a 49 años de edad. Fueron factores protectores de anemia un IMC≥30(k/m2), tercil 3 de CB, no ser indígena y vivir en Cen-tro y Ciudad de México. CONCLUSIONES: La anemia continúa siendo un problema de salud pública, sobre todo en mujeres de 35 a 49 años de edad con más de cuatro embarazos.

Comportamiento y factores asociados con la anemia en mujeres mexicanas en edad fértil. Ensanut 2018-19 / Behavior and factors associated with anemia in Mexican women of childbearing age. Ensanut 2018-19

Resumen: Objetivo: Estudiar el comportamiento de la anemia en los años 2006, 2012 y 2018-19, su severidad y factores asociados en mujeres mexicanas de 20 a 49 años de edad. Material y métodos: Las Ensanut 2006, 2012 y 2018-19 tienen un diseño metodológico que permite comparaciones entre ellas. Mediante hemoglobina capilar <12dL se clasificó anemia. Se excluyó a quienes estuvieron embarazadas. Se asoció anemia con factores sociodemográficos mediante regresión logística. Resultados: La reducción de anemia de 2006 a 2012 fue significativa, pero no el incremento para 2018-19. Se asoció anemia con un mayor número de embarazos, y tener de 35 a 49 años de edad. Fueron factores protectores de anemia un IMC≥30(k/m2), tercil 3 de CB, no ser indígena y vivir en Centro y Ciudad de México. Conclusiones: La anemia continúa siendo un problema de salud pública, sobre todo en mujeres de 35 a 49 años de edad con más de cuatro embarazos.

Abstract: Objective: To study the behavior of anemia in 2006, 2012 and 2018-19, its severity and associated factors in Mexican women between 20 and 49 years of age. Materials and methods: The Ensanut 2006, 2012 and 2018-19 has a methodological design that allows comparisons between them. Capillary hemoglobin (Hb) classified anemia with Hb values <12dL. Pregnant women were excluded. Anemia was associated with individual and sociodemographic factors using a logit regression model. Results: The reduction in anemia from 2006 to 2012 was significant, but not the increase for 2018-19. Anemia was associated with a higher number of pregnancies, and being 35 to 49 years of age. A BMI≥30 (k/m2), tertile 3 of wellness condition, not being indigenous and living in the Center and Mexico City were protective of anemia. Conclusions: Anemia continues to be a public health problem, especially in women 35 to 49 years of age with more than four pregnancies.

[High prevalence of anemia in Mexican women in poverty, Ensanut 100k]. / Alta prevalencia de anemia en mujeres mexicanas en pobreza, Ensanut 100k.

OBJECTIVE: To estimate the prevalence and distribution of anemia in Mexican women and their association with sociodemographic factors and diet diversity. MATERIALS AND METHODS: We analyzed information of women in childbearing age. The Ensanut 100k is a probabilistic survey that overrepresents households with less economic capacity. Anemia was estimated using hemoglobin concentration. We collected sociodemographic and health information, food insecurity, and dietary diversity. RESULTS: 34.3% of the women presented anemia, belong to tertile 3 of welfare status is a protective factor for anemia (OR= 0.26, 95%CI 0.16-0.61), and living in a household with food security, as well as high diversity of the diet in rural women (OR= 0.57, 95%CI 0.36-0.92). CONCLUSIONS: It is necessary to implement actions of detection and early attention of the anemia in women in childbearing age, identification of its underlying causes, strengthening and reformulation of strategies to prevent it.

OBJETIVO: Estimar la prevalencia y distribución de anemia en mujeres mexicanas y su asociación con factores sociodemográficos y la diversidad de la dieta. MATERIAL Y MÉTODOS: Se incluyeron mujeres en edad fértil de la encuesta probabilística Ensanut 100k, que representa a los hogares con menos capacidades económicas. Se estimó la prevalencia de anemia mediante concentración de hemoglobina, con información sociodemográfica, de salud, inseguridad alimentaria y diversidad de la dieta. RESULTADOS: El 34.3% de las mujeres presentó anemia; los factores protectores para anemia fueron pertenecer al tercil 3 de condición de bienestar (OR=0.26, IC95% 0.16-0.61), alta diversidad de la dieta en áreas rurales (OR=0.57, IC95%0.36-0.92), así como vivir en un hogar con seguridad alimentaria. CONCLUSIONES: Es necesario implementar acciones de detección y atención temprana de la anemia en las mujeres de edad fértil, así como identificar las causas subyacentes y fortalecer y reformular estrategias para prevenirla.

Closing the Nutrition Impact Gap Using Program Impact Pathway Analyses to Inform the Need for Program Modifications in Mexico's Conditional Cash Transfer Program.

BACKGROUND: Mexico's Prospera-Oportunidades-Progresa Conditional Cash Transfer Program (CCT-POP) included the distribution of fortified food supplements (FFS) for pregnant and lactating women and young children. Rigorous evaluations showed significant impacts on nutrition outcomes but also substantial gaps in addressing nutrition problems. OBJECTIVES: To highlight the program design-related and implementation-related gaps and challenges that motivated further research and the eventual design and roll-out of a modified nutrition component for CCT-POP. METHODS: We used a program impact pathway approach to highlight the extent and quality of implementation of CCT-POP, and its impact on nutrition outcomes. We drew on previously published and new primary data, organized into 3 sources: impact evaluations, studies to inform reformulation of the FFS, and a longitudinal follow-up study using qualitative and quantitative methods to document FFS use and the dietary intake of women and children. RESULTS: Despite positive impacts, a high prevalence of malnutrition persisted in the population. Coverage and use of health services improved, but quality of care was lacking. Consumption of FFS among lactating women was irregular. Micronutrient intake improved among children who consumed FFS, but the pattern of use limited frequency and quantity consumed. Substantial diversity in the prevalence of undernutrition was documented, as was an increased risk of overweight and obesity among women. CONCLUSIONS: Three key design and implementation challenges were identified. FFS, although well accepted for children, had limited potential to substantially modify the quality of children's diets because of the pattern of use in the home. The communications strategy was ineffective and ill-suited to its objective of motivating FFS use. Finally, the program with its common design across all regions of Mexico was not well adapted to the special needs of some subgroups, particularly indigenous populations. The studies reviewed in this paper motivated additional research and the eventual redesign of the nutrition component.

Alta prevalencia de anemia en mujeres mexicanas en pobreza, Ensanut 100k / High prevalence of anemia in Mexican women in poverty, Ensanut 100k

Resumen: Objetivo: Estimar la prevalencia y distribución de anemia en mujeres mexicanas y su asociación con factores sociodemográficos y la diversidad de la dieta. Material y métodos: Se incluyeron mujeres en edad fértil de la encuesta probabilística Ensanut 100k, que representa a los hogares con menos capacidades económicas. Se estimó la prevalencia de anemia mediante concentración de hemoglobina, con información sociodemográfica, de salud, inseguridad alimentaria y diversidad de la dieta. Resultados: El 34.3% de las mujeres presentó anemia; los factores protectores para anemia fueron pertenecer al tercil 3 de condición de bienestar (OR=0.26, IC95% 0.16-0.61), alta diversidad de la dieta en áreas rurales (OR=0.57, IC95%0.36-0.92), así como vivir en un hogar con seguridad alimentaria. Conclusiones: Es necesario implementar acciones de detección y atención temprana de la anemia en las mujeres de edad fértil, así como identificar las causas subyacentes y fortalecer y reformular estrategias para prevenirla.

Abstract: Objective: To estimate the prevalence and distribution of anemia in Mexican women and their association with sociodemographic factors and diet diversity. Materials and methods: We analyzed information of women in childbearing age. The Ensanut 100k is a probabilistic survey that over-represents households with less economic capacity. Anemia was estimated using hemoglobin concentration. We collected sociodemographic and health information, food insecurity, and dietary diversity. Results: 34.3% of the women presented anemia, belong to tertile 3 of welfare status is a protective factor for anemia (OR= 0.26, 95%CI 0.16-0.61), and living in a household with food security, as well as high diversity of the diet in rural women (OR= 0.57, 95%CI 0.36-0.92). Conclusions: It is necessary to implement actions of detection and early attention of the anemia in women in childbearing age, identification of its underlying causes, strengthening and reformulation of strategies to prevent it.

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.