Canada-United States-Mexico Trilateral Cooperation on Childhood Obesity Initiative.

Childhood obesity is an important public health problem that affects countries in the Americas. In 2014, Pan American Health Organization (PAHO) Member States agreed on a Plan of Action for the Prevention of Obesity in Children and Adolescents in an effort to address the impact of this disorder in the Americas region. The interventions laid out in this regional plan are multi-faceted and require multi-sectoral partnerships. Building on a strong history of successful trilateral collaboration, Canada, Mexico, and the United States formed a partnership to address the growing epidemic of childhood obesity in the North American region. This collaborative effort, known as the Trilateral Cooperation on Childhood Obesity Initiative, is the first initiative in the region to address chronic noncommunicable diseases by bringing together technical and policy experts, with strong leadership and support from the secretaries and ministers of health. The Initiative's goals include increasing levels of physical activity and reducing sedentary behavior through 1) increased social mobilization and citizen engagement, 2) community- based outreach, and 3) changes to the built (man-made) environment. This article describes the background and development process of the Initiative; specific goals, activities, and actions achieved to date; and opportunities and next steps. This information may be useful for those forming other partnerships designed to address childhood obesity or other complex public health challenges in the region.

L'obésité de l'enfant est un problème de santé publique important dans les pays des Amériques. En 2014, les États Membres de l'Organisation Panaméricaine de la Santé (OPS) ont approuvé un Plan d'action pour la prévention de l'obésité chez les enfants et les adolescents pour combattre la prévalence de ce trouble dans la Région des Amériques. Les interventions énoncées dans ce plan régional sont multidimensionnelles et nécessitent des partenariats multisectoriels. S'appuyant sur une riche histoire de collaboration trilatérale fructueuse, le Canada, les États-Unis et le Mexique ont établi un partenariat pour combattre l'épidémie croissante d'obésité chez les enfants dans la région nord-américaine. Cet effort de collaboration, connu sous le nom d'Initiative de Coopération Trilatérale pour Réduire l'Obésité de l'Enfant, est la première initiative de la Région pour lutter contre les maladies chroniques non transmissibles en réunissant des experts techniques et stratégiques, sous le solide leadership et avec le soutien des secrétaires et des ministres de la Santé. Les objectifs de l'initiative visent à accroître les niveaux d'activité physique et réduire les comportements sédentaires grâce à 1) une augmentation de la mobilisation sociale et de la participation des citoyens, 2) une sensibilisation au niveau de la communauté et 3) des modifications de l'environnement bâti (par l'homme). Cet article décrit le contexte et le processus de conception et d'élaboration de l'initiative, les objectifs spécifiques atteints à ce jour, ainsi que les activités et les actions réalisées, les perspectives et les étapes à venir. Cette information peut être utile à ceux qui établissent des partenariats en vue de combattre l'obésité chez les enfants ou de relever d'autres défis difficiles de santé publique dans la Région.

La obesidad infantil es un problema de salud pública importante que afecta a los países de las Américas. En el 2014, los Estados Miembros de la Organización Panamericana de la Salud (OPS) acordaron un Plan de acción para la prevención de la obesidad en la niñez y la adolescencia con el fin de hacer frente a las repercusiones de este trastorno en la Región de las Américas. Las intervenciones que componen este plan regional son multifacéticas y exigen la formación de alianzas multisectoriales. Aprovechando las bases sentadas por una larga tradición de colaboración trilateral, el Canadá, los Estados Unidos y México formaron una alianza para controlar la epidemia creciente de obesidad infantil en la subregión norteamericana. Esta iniciativa colaborativa, que se conoce por Iniciativa de Cooperación Trilateral contra la Obesidad Infantil, es la primera iniciativa en la Región en tratar de hacer frente al problema de las enfermedades crónicas no transmisibles convocando a un grupo de expertos técnicos y de expertos en asuntos normativos, con el liderazgo y respaldo de los secretarios y ministros de salud de los países implicados. La Iniciativa tiene por objetivos aumentar los niveles de actividad física y reducir el sedentarismo mediante a) una mayor movilización social y participación ciudadana, b) medidas de extensión comunitaria y c) modificaciones de las zonas edificadas (construidas por el hombre). En el presente artículo se describen los antecedentes de la Iniciativa y su creación; las metas, actividades y medidas específicas que ha habido hasta ahora; y las oportunidades y los pasos que hay que dar en lo sucesivo. Esta información podría resultar útil para quienes estén formando otras alianzas encaminadas a controlar la obesidad infantil u otros problemas de salud pública complejos en la Región.

Canada-United States-Mexico Trilateral Cooperation on Childhood Obesity Initiative

Childhood obesity is an important public health problem that affects countries in the Americas. In 2014, Pan American Health Organization (PAHO) Member States agreed on a Plan of Action for the Prevention of Obesity in Children and Adolescents in an effort to address the impact of this disorder in the Americas region. The interventions laid out in this regional plan are multi-faceted and require multi-sectoral partnerships. Building on a strong history of successful trilateral collaboration, Canada, Mexico, and the United States formed a partnership to address the growing epidemic of childhood obesity in the North American region. This collaborative effort, known as the Trilateral Cooperation on Childhood Obesity Initiative, is the first initiative in the region to address chronic noncommunicable diseases by bringing together technical and policy experts, with strong leadership and support from the secretaries and ministers of health. The Initiative’s goals include increasing levels of physical activity and reducing sedentary behavior through 1) increased social mobilization and citizen engagement, 2) communitybased outreach, and 3) changes to the built (man-made) environment. This article describes the background and development process of the Initiative; specific goals, activities, and actions achieved to date; and opportunities and next steps. This information may be useful for those forming other partnerships designed to address childhood obesity or other complex public health challenges in the region.

An ecological and theoretical deconstruction of a school-based obesity prevention program in Mexico.

BACKGROUND: Ecological intervention programs are recommended to prevent overweight and obesity in children. The National Institute of Public Health (INSP) in Mexico implemented a successful ecological intervention program to promote healthy lifestyle behaviors in school age children. This study assessed the integration of ecological principles and Social Cognitive Theory (SCT) constructs in this effective school-based obesity prevention program implemented in 15 elementary schools in Mexico City. METHODS: Two coders applied the Intervention Analysis Procedure (IAP) to "map" the program's integration of ecological principles. A checklist gauged the use of SCT theory in program activities. RESULTS: Thirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains. CONCLUSIONS: Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement and were most commonly underpinned by Reciprocal Determinism for both Nutrition and Physical Activity.

Contribution of formative research to design an environmental program for obesity prevention in schools in Mexico City.

OBJECTIVE: This paper describes the methods and key findings of formative research conducted to design a school-based program for obesity prevention. MATERIALS AND METHODS: Formative research was based on the ecological model and the principles of social marketing. A mixed method approach was used. Qualitative (direct observation, indepth interviews, focus group discussions and photo-voice) and quantitative (closed ended surveys, checklists, anthropometry) methods were employed. RESULTS: Formative research key findings, including barriers by levels of the ecological model, were used for designing a program including environmental strategies to discourage the consumption of energy dense foods and sugar beverages. CONCLUSION: Formative research was fundamental to developing a context specific obesity prevention program in schools that seeks environment modification and behavior change.

Contribution of formative research to design an environmental program for obesity prevention in schools in Mexico City / Contribución de la investigación formativa para el diseño de un programa para la prevención de obesidad en escuelas de la Ciudad de México

Objective. This paper describes the methods and key findings of formative research conducted to design a school-based program for obesity prevention. Materials and methods. Formative research was based on the ecological model and the principles of social marketing. A mixed method approach was used. Qualitative (direct observation, indepth interviews, focus group discussions and photo-voice) and quantitative (closed ended surveys, checklists, anthropometry) methods were employed. Results. Formative research key findings, including barriers by levels of the ecological model, were used for designing a program including environmental strategies to discourage the consumption of energy dense foods and sugar beverages. Conclusion. Formative research was fundamental to developing a context specific obesity prevention program in schools that seeks environment modification and behavior change.

Objetivo. Describir los aspectos metodológicos y principales resultados de una investigación formativa realizada para diseñar un programa ambiental para la prevención de obesidad en escuelas. Material y métodos. La investigación formativa se basó en el modelo ecológico y los principios del mercadeo social. Se utilizó un enfoque de métodos mixtos: cualitativos (observación directa, entrevistas en profundidad, grupos de discusión y foto-voz) y cuantitativos (cuestionarios cerrados, inventarios de alimentos y bebidas, antropometría). Resultados. Los principales resultados de la investigación formativa, incluyendo las barreras identificadas en los niveles del modelo ecológico, fueron contemplados para el diseño del programa, que incluyó estrategias ambientales para desincentivar el consumo de alimentos de alta densidad energética y bebidas azucaradas. Conclusión. La investigación formativa fue fundamental para diseñar un programa de prevención de obesidad para la modificación del ambiente y cambios de comportamientos, factible y adaptado al contexto de las escuelas públicas de la Ciudad de México.

Promoting healthful diet and physical activity in the Mexican school system for the prevention of obesity in children.

OBJECTIVE: This paper describes the rationale, design, and methods of a two-year randomized controlled trial conducted to evaluate the effectiveness of an environmental intervention in 27 elementary schools in Mexico City. MATERIALS AND METHODS: There were two units of analysis, school level addressing changes in elementary public part-time schools, and individual-level addressing behavioral changes in students 9 to 11 years of age. Two intensities of an intervention program were implemented (basic and plus), each containing two intervention components: physical activity and nutrition, supported by a communication/education component. Evaluation of the intervention was carried out during the school cycles 2006-2007 and 2007-2008. RESULTS: Primary outcomes were overweight and obesity prevalence and fitness; environmental and behavioural measures were also examined. CONCLUSIONS: This is the first institutional multilevel, multifactorial project, consistent with the best practices available in current literature, carried out in Mexico to prevent childhood obesity in schools.

Impact of a school-based intervention program on obesity risk factors in Mexican children.

OBJECTIVE: To evaluate the impact of an 18-month school obesity prevention intervention on the health behaviors of 4th and 5th grade students based on ecological principles and formative research conducted in Mexico. MATERIALS AND METHODS: A Randomized Control Trial (RCT), design was used to assign 27 schools to one of three conditions: basic or plus interventions and control. School environment measures, children's eating and physical activity behaviors, and body mass index were assessed four times over a 2-year period in a sample of 830 students. RESULTS: In the intervention schools, the availability of healthy foods increased with a concomitant decrease in unhealthy food availability. Food intake showed the same trend. In the intervention schools, children did not engage in more moderate to vigorous physical activity (MVPA) in physical education (PE) class or recess but increased steps taken. Obesity prevalence did not change. CONCLUSION: The intervention improved the school food environment and child healthy behaviors.

Promoting healthful diet and physical activity in the Mexican school system for the prevention of obesity in children / Promoción de actividad física adecuada y alimentación saludable en el sistema educativo mexicano para la prevención de la obesidad infantil

Objective. This paper describes the rationale, design, and methods of a two-year randomized controlled trial conducted to evaluate the effectiveness of an environmental intervention in 27 elementary schools in Mexico City. Materials and methods. There were two units of analysis, school level addressing changes in elementary public part-time schools, and individual-level addressing behavioral changes in students 9 to 11 years of age. Two intensities of an intervention program were implemented (basic and plus), each containing two intervention components: physical activity and nutrition, supported by a communication/education component. Evaluation of the intervention was carried out during the school cycles 2006-2007 and 2007-2008. Results. Primary outcomes were overweight and obesity prevalence and fitness; environmental and behavioural measures were also examined. Conclusions. This is the first institutional multilevel, multifactorial project, consistent with the best practices available in current literature, carried out in Mexico to prevent childhood obesity in schools.

Objetivo. El presente trabajo describe el protocolo, objetivo, el diseño y los métodos de un ensayo controlado aleatorio de dos años realizados para evaluar la efectividad de una intervención ambiental en 27 escuelas primarias de la Ciudad de México. Material y métodos. El protocolo consta de dos unidades de análisis: el nivel escolar donde se evaluaron los cambios en el entorno escolar de escuelas primarias publicas de medio tiempo y el nivel individual que evaluó los cambios de comportamiento en alumnos de 9 a 11 años de edad. Se implementaros dos tipos de intervenciones: nutrición y actividad física apoyadas de una estrategia de educación/comunicación. Las intervenciones tuvieron dos intensidades: básica y plus. La evaluación de la efectividad se llevó a cabo durante los ciclos escolares 2006-2007 y 2007-2008. Resultados. Los resultados iniciales reportan los métodos de evaluación de conducta individual así como la prevalencia de sobrepeso y obesidad. La evaluación ambiental reporta el protocolo de evaluación del entorno escolar. Conclusiones. Este es el primer proyecto de la de intervención escolar con un diseño multinivel, multifactorial, basado en literatura científica disponible y en investigación formativa para prevenir la obesidad infantil en las escuelas de la Ciudad de México.

Impact of a school-based intervention program on obesity risk factors in Mexican children / Impacto de un programa de intervención en escuelas para la prevención de factores de riesgo de la obesidad en niños mexicanos

Objective. To evaluate the impact of an 18-month school obesity prevention intervention on the health behaviors of 4th and 5th grade students based on ecological principles and formative research conducted in Mexico. Materials and methods. A Randomized Control Trial (RCT), design was used to assign 27 schools to one of three conditions: basic or plus interventions and control. School environment measures, children's eating and physical activity behaviors, and body mass index were assessed four times over a 2-year period in a sample of 830 students. Results. In the intervention schools, the availability of healthy foods increased with a concomitant decrease in unhealthy food availability. Food intake showed the same trend. In the intervention schools, children did not engage in more moderate to vigorous physical activity (MVPA) in physical education (PE) class or recess but increased steps taken. Obesity prevalence did not change. Conclusion. The intervention improved the school food environment and child healthy behaviors.

Objetivo. Evaluar el impacto de una intervención de 18 meses para la prevención de obesidad en escolares de 4o y 5o grados basada en el modelo ecológico en conductas saludables en México. Material y métodos. Diseño experimental para asignar 27 escuelas a uno de los tres tratamientos: intervenciones básicas, intervenciones plus y control. Se midió el impacto en el ambiente escolar, la alimentación y la actividad física e índice de masa corporal en niños. La evaluación se llevó a cabo en dos años en 830 estudiantes. Resultados. En las escuelas de intervención, la disponibilidad de alimentos sanos aumentó y la disponibilidad de alimentos poco saludables disminuyó. La ingesta de alimentos en niños no mostraron las mismas tendencias. En las escuelas de intervención, los niños no participaron más en actividad física moderada y vigorosa. La prevalencia de obesidad no se modificó. Conclusión. La intervención mejoró el entorno alimentario escolar y las conductas saludables de alimentación y actividad física.

Effect of a school-based intervention on physical activity: cluster-randomized trial.

PURPOSE: Physical activity in childhood has many health benefits; however, the majority of children in many countries, including Mexico, are insufficiently active. The objective of this investigation was to test the effect of a school-based environmental intervention on the physical activity and physical fitness of students attending public primary schools in Mexico City. METHODS: Twenty-seven schools were randomly assigned to basic or plus intervention or control. The basic and plus groups were exposed to school environment and policy changes to enhance physical activity. Physical activity was evaluated in 699 randomly selected fourth- and fifth-grade students by measuring school-day and all-day (24 h) steps using pedometers worn for 5 d before and after the 6-month intervention. Physical fitness was assessed by measuring the 9-min run, flexibility, and sit-ups. We calculated the average change in school-day and all-day steps and fitness measures from baseline to follow-up. Using linear regression, we tested the effect of intervention on change controlling for baseline measures and covariates and accounting for the design effect of school. Using logistic regression, we tested the effect of intervention on reaching step cutoffs at baseline and follow-up. RESULTS: The plus group significantly (P < 0.05) increased school-day steps relative to control (change = 687 vs -639). Significantly (P < 0.05) more participants in the basic (25.8%) and plus (36.4%) groups reached step cutoffs during school relative to control (12.0%). The basic group significantly (P < 0.05) increased all-day steps relative to control (change = 581 vs -419). The plus group significantly (P = 0.05) increased sit-ups relative to control (change = 0.3 vs -1.7). CONCLUSIONS: A school-based environmental intervention improved student physical activity during school in public schools in Mexico City.

Physical activity during the school day in public primary schools in Mexico City.

OBJECTIVE: To quantify the physical activity (PA) of students and describe the school environment surrounding PA. MATERIAL AND METHODS: Between November 2005 and March 2006, in Mexico City, we conducted quantitative and qualitative observations to describe the PA and the school context. RESULTS: Recess and physical education class (PE) were the only opportunities to participate in PA. PE occurred one time per week with a duration of 39.8+/-10.6 minutes which is less than national and international recommendations. Students participated in moderate-to-vigorous PA 29.2+/-17.8% of PE. The dynamics of PE did not promote the inclusion of all students or PA. During recess there was overcrowding of the school patio and no equipment for PA or organization of PA. DISCUSSION: The PA of students in public schools in Mexico City can be improved by increasing the quantity and quality of PE and increasing opportunities for activity during recess.

Physical activity during the school day in public primary schools in Mexico City / La actividad física durante la jornada escolar en escuelas primarias públicas en la Ciudad de México

OBJECTIVE: To quantify the physical activity (PA) of students and describe the school environment surrounding PA. MATERIAL AND METHODS: Between November 2005 and March 2006, in Mexico City, we conducted quantitative and qualitative observations to describe the PA and the school context. RESULTS: Recess and physical education class (PE) were the only opportunities to participate in PA. PE occurred one time per week with a duration of 39.8±10.6 minutes which is less than national and international recommendations. Students participated in moderate-to-vigorous PA 29.2±17.8 percent of PE. The dynamics of PE did not promote the inclusion of all students or PA. During recess there was overcrowding of the school patio and no equipment for PA or organization of PA. DISCUSSION: The PA of students in public schools in Mexico City can be improved by increasing the quantity and quality of PE and increasing opportunities for activity during recess.

OBJETIVO: Cuantificar la actividad física (AF) en niños escolares y describir el entorno escolar relacionado con la AF. MATERIAL Y MÉTODOS: Entre noviembre de 2005 y marzo de 2006 en la Ciudad de México, se realizó observación directa cuantitativa y cualitativa para describir el nivel de AF y el contexto escolar durante recreo y clases de educación física (CEF). RESULTADOS: El recreo y las CEF fueron los únicos espacios en los que se realizó AF. Las CEF se impartieron una vez a la semana y duraron 39.8±10.6 minutos, lo que está por debajo de las recomendaciones internacionales. Se participó en actividades moderadas-vigorosas 29.2±17.8 por ciento de las CEF. La dinámica de las CEF no favoreció la AF. Durante el recreo se observó saturación del patio y no se realizaron actividades organizadas ni se utilizaron materiales para promover la AF. DISCUSIÓN: Se recomienda incrementar la calidad y la cantidad de las CEF y el tiempo dedicado a jugar durante el recreo.

Overweight and obesity trends in Mexican children 2 to 18 years of age from 1988 to 2006.

OBJECTIVE: To describe prevalences and trends of overweight and obesity/OW&OB in Mexican children from 1988 to 2006 at the national level and by relevant subpopulations. MATERIAL AND METHODS: Prevalences of OW&OB in children aged 2-18 years were estimated using body mass index data from three national surveys conducted in 1988, 1999 and 2006. RESULTS: Prevalences of OW&OB are high in children of all ages, particularly among school-age and adolescent groups disaggregated by regions, socioeconomic status, urban and rural areas, and ethnic groups. The overall prevalence of OW&OB in children 2 to 18 years old in 2006 was 26.3%. Prevalences by age groups were 16.7% in preschool-age, 26.2% in school-age, and 30.9% in adolescents, using the IOTF classification system. CONCLUSIONS: Upward trends were observed in school-age children and adolescents at the national level and in all subpopulations.

Overweight and obesity trends in Mexican children 2 to 18 years of age from 1988 to 2006 / Tendencias de sobrepeso y obesidad en niños mexicanos de 2 a 18 años de edad: 1988 a 2006

OBJECTIVE: To describe prevalences and trends of overweight and obesity/OW&OB in Mexican children from 1988 to 2006 at the national level and by relevant subpopulations. MATERIAL AND METHODS: Prevalences of OW&OB in children aged 2-18 years were estimated using body mass index data from three national surveys conducted in 1988, 1999 and 2006. RESULTS: Prevalences of OW&OB are high in children of all ages, particularly among school-age and adolescent groups disaggregated by regions, socioeconomic status, urban and rural areas, and ethnic groups. The overall prevalence of OW&OB in children 2 to 18 years old in 2006 was 26.3 percent. Prevalences by age groups were 16.7 percent in preschool-age, 26.2 percent in school-age, and 30.9 percent in adolescents, using the IOTF classification system. CONCLUSIONS: Upward trends were observed in school-age children and adolescents at the national level and in all subpopulations.

OBJETIVO: Describir las prevalencias y tendencias de sobrepeso y obesidad (SPyO) en niños mexicanos, de 1988 a 2006, en el ámbito nacional y por subgrupos relevantes de población. MATERIAL Y MÉTODOS: Las prevalencias de SPyO (peso no saludable) se estimaron usando cifras de índice de masa corporal de tres encuestas nacionales realizadas en 1988, 1999 y 2006. RESULTADOS: Las prevalencias de SPyO son altas en niños de todas las edades, particularmente en niños de edad escolar y adolescentes, estratificados por regiones, estado socioeconómico, áreas urbanas, rurales y grupo étnico. La prevalencia de SPyO en 2006 fue de 26.3 por ciento en el grupo de entre 2 a 18 años de edad, 16.7 por ciento en preescolares, 26.2 por ciento en escolares y 30.9 por ciento en adolescentes, usando la clasificación de The International Obesity Task Force (IOTF). CONCLUSIONES: Se observa una tendencia de sobrepeso y obesidad en aumento en niños de edad escolar y adolescentes, para todos los subgrupos de población.

Maternal knowledge and use of a micronutrient supplement was improved with a programmatically feasible intervention in Mexico.

In Mexico, the potential impact on child malnutrition from a nutritional supplement (papilla) delivered through a conditional transfer program (Oportunidades) was attenuated by problems of household utilization. A behavioral change through communication intervention was developed to improve supplement utilization. Our study assessed the efficacy of this intervention through the results of a randomized trial. In 2 states (Veracruz and Chiapas) 2 clusters of communities were randomly assigned to intervention or control groups. Data were obtained from 176-198 mothers in intervention and control communities using a survey questionnaire at preintervention baseline and at a 5-mo follow-up. Concordance between reported and observed behaviors was examined through an observational substudy. The 4 behavioral recommendations were: 1) prepare papilla as a pap; 2) administer the preparation every day; 3) administer it between breakfast and dinner; and 4) administer it only to target children. The intervention resulted in a significant increase (P<0.05) in the prevalence of reported correct behaviors in the intervention group compared with the control for 3 of the behaviors: a mean increase of 42.5% for preparing papilla as pap, 64.4% for daily administration, and 61.5% for giving papilla between breakfast and dinner. Administering to a target child increased significantly in Veracruz (from 51.5% to 90.6%), but not in Chiapas (20.6% to 33.3%). Reported behaviors agreed with observed behaviors in the substudy. With the exception of the target-child administration in Chiapas, adopting the recommendations was culturally acceptable and feasible. The results indicate that improvements in household utilization of the supplement can be achieved with a communication intervention that is potentially feasible for implementation on a large scale within the Oportunidades Program.

Energy and nutrient consumption in Mexican women 12-49 years of age: analysis of the National Nutrition Survey 1999.

OBJECTIVE: To describe the reported energy and nutrient intake and adequacies in Mexican women. MATERIAL AND METHODS: A 24-hour dietary recall was used to obtain nutrient intake in a representative sub-sample of 2,630 women from 12 to 49 years of age from the National Nutrition Survey 1999. Nutrient adequacies were estimated using the Dietary Reference Intakes and stratified according to region, area (urban or rural), socioeconomic status and obesity status (non-obese: BMI < 30 kg/m2, obese: > or = 30 kg/m2). Differences were analyzed using linear regression for complex surveys of log-transformed intake and adequacy, adjusting for multiple comparisons with the Bonferroni test. RESULTS: The median national energy intake was 1,471 kcal. The Risk of Inadequacy (RI) (prevalence of adequacy < 50%) was: vitamin A: 38.3%, vitamin C: 45.5%, and folate: 34.3%. Carbohydrates, folate, iron and calcium intake was significantly higher in rural than in urban areas. The RI was higher in women of the lowest socioeconomic status tertile for all nutrients with the exception of carbohydrates and calcium. Macro-nutrient adequacies were significantly higher in non-obese women. CONCLUSIONS: Differences within the country among regions, rural and urban areas, and socioeconomic status tertile reflect an increasing availability of inexpensive calorie-dense foods in marginal groups. However, total energy, cholesterol, saturated and total fat were consumed in greater quantities by women from the higher socioeconomic status tertile and from urban areas. These patterns could be a contributing factor to the rise of obesity and other non-communicable nutrition-related chronic diseases in Mexico. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Energy and nutrient intake in preschool and school age Mexican children: National Nutrition Survey 1999.

OBJECTIVE: To estimate energy and nutrient intake and adequacy in preschool and school age Mexican children, using the National Nutrition Survey 1999 (NNS-1999). MATERIAL AND METHODS: Twenty four-h dietary recalls from pre-school (n = 1,309) and school (n = 2,611) children obtained from a representative sub-sample of the NNS-1999 were analyzed. Intakes and adequacies were estimated and compared across four regions, socio-economic strata, and between urban and rural areas, and indigenous vs. non-indigenous children. RESULTS: Median energy intake in pre-school children was 949 kcal and in school children 1,377 kcal, with adequacies < 70% for both groups. Protein adequacy was > 150% in both age groups. The North and Mexico City regions had the highest fat intake and the lowest fiber intake. Children in the South region, indigenous children, and those in the lowest socio-economic stratum had higher fiber and carbohydrate intakes and the lowest fat intake. These children also showed the highest risks of inadequacies for vitamin A, vitamin C, folate, iron, zinc and calcium. CONCLUSIONS: Mexico is experiencing a nutrition transition with internal inequalities across regions and socio-economic strata. Food policy must account for these differences in order to optimize resources directed at social programs. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Energy and nutrient consumption in Mexican women 12-49 years of age: analysis of the National Nutrition Survey 1999

OBJETIVO: Describir la ingesta reportada de energía y nutrimentos en mujeres mexicanas. MATERIAL Y MÉTODOS: Se utilizó un recordatorio de 24 horas para obtener la ingesta de energía en una submuestra representativa de 2 630 mujeres de 12 a 49 años de edad de la Encuesta Nacional de Nutrición 1999. Las adecuaciones nutrimentales se estimaron utilizando las Referencias de Ingesta Dietética y fueron estratificadas por región, área urbana o rural, nivel socioeconómico y presencia de obesidad (no-obesas: IMC <30 kg/m2, obesas: >30 kg/m2). Las diferencias se analizaron utilizando modelos de regresión lineal para encuestas complejas del logaritmo de la ingesta y la adecuación, ajustando para comparaciones múltiples con la prueba de Bonferroni. RESULTADOS: La media nacional de ingesta de energía fue de 1 471 kcal. El riesgo de inadecuación (prevalencia de adecuación <50 por ciento) fue vitamina A: 38.3 por ciento, vitamina C: 45.5 por ciento y folato: 34.3 por ciento. La ingesta de carbohidratos, folato, hierro y calcio fue significativamente más alta en áreas rurales que en las urbanas. El riesgo de inadecuación fue mayor en mujeres del nivel socioeconómico más bajo para todos los nutrimentos con excepción de carbohidratos y calcio. Las adecuaciones de macro-nutrimentos fueron significativamente mayores en mujeres no-obesas. CONCLUSIONES: Las diferencias entre las regiones, áreas del país y terciles de nivel socioeconómico reflejan una disponibilidad creciente de alimentos densamente calóricos de bajo costo en grupos marginales. Sin embargo, la energía total, colesterol y la grasa saturada y total se consumieron en mayores cantidades por mujeres del tercil de nivel socioeconómico más alto y áreas urbanas. Estos patrones pueden estar contribuyendo al incremento de la obesidad y otras enfermedades no transmisibles en México.

Energy and nutrient intake in preschool and school age Mexican children: National Nutrition Survey 1999

OBJETIVO: Estimar el consumo de energía y nutrimentos y su adecuación en niños prescolares y escolares mexicanos, usando datos de la Encuesta Nacional de Nutrición 1999 (ENN-1999). MATERIAL Y MÉTODOS: Se analizaron datos de recordatorio de dieta de 24 horas de 1 309 niños prescolares y 2 611 escolares en una sub-muestra representativa de la ENN-1999. Se calcularon la ingesta y la adecuación de energía y nutrimentos, y se hicieron comparaciones por región, área urbana y rural, estado socioeconómico e indigenismo. RESULTADOS: La mediana de ingestión de energía fue de 949 kcal en prescolares y de 1 377 kcal en escolares, con adecuaciones <70 por ciento para ambos grupos de edad. La adecuación de proteína fue >150 por ciento. Las regiones norte y Ciudad de México tuvieron la mayor ingesta de grasa y la menor ingesta de fibra. Los niños de la región sur, los de familias indígenas y los del estrato socioeconómico más pobre tuvieron la mayor ingesta de carbohidratos y fibra y la menor ingesta de grasa. Estos mismos niños tuvieron los mayores riesgos de deficiencias de vitaminas A, C y folato, así como de hierro, cinc y calcio. CONCLUSIONES: México está experimentando una transición nutricional con polarización interna entre regiones y estratos socioeconómicos. Las políticas alimentarias deben tomar estas diferencias en consideración para optimizar los recursos dirigidos a programas sociales.

Epidemiological and nutritional transition in Mexico: rapid increase of non-communicable chronic diseases and obesity.

OBJECTIVE: The objective of this paper is to characterise the epidemiological and nutritional transition and their determinants in Mexico. DESIGN: Age-adjusted standardised mortality rates (SMRs) due to acute myocardial infarction (AMI), diabetes mellitus and hypertension were calculated for 1980-1998. Changes in the prevalences of overweight and obesity in women and children and of dietary intake from 1988 to 1999 were also used in the analysis. Quantities of food groups purchased by adult equivalent (AE) and food expenditures away from home between 1984 and 1989 were used to assess trends. All information was analysed at the national and regional levels, and by urban and rural areas. RESULTS: SMR for diabetes, AMI and hypertension increased dramatically parallel to obesity at the national and regional levels. Fat intake in women and the purchase of refined carbohydrates, including soda, also increased. DISCUSSION: The results suggest that obesity is playing a role in the increased SMRs of diabetes, AMI and hypertension in Mexico. Total energy dietary intake and food purchase data could not explain the rise in the prevalence of obesity. The increases in fat intake and the purchase of refined carbohydrates may be risk factors for increased mortality. Information on physical activity was not available. CONCLUSION: SMRs due to diabetes, hypertension and AMI have increased dramatically in parallel with the prevalence of obesity; therefore actions should be taken for the prevention of obesity. Reliable information about food consumption and physical activity is required to assess their specific roles in the aetiology of obesity.