Diet cost and quality using the Healthy Eating Index-2015 in adults from urban and rural areas of Mexico.

OBJECTIVE: To assess the association between diet cost and quality by place of residence. DESIGN: We analysed cross-sectional data of the National Health and Nutrition Survey-2012. Diet cost was estimated by linking dietary data, obtained from a 7-d SFFQ, with municipality food prices, which were derived from a national expenditure survey. Diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015). Association between quintiles of diet cost and HEI-2015 was assessed using linear regression analysis. SETTINGS: Mexico. PARTICIPANTS: 2438 adults (18-59 years). RESULTS: Diet cost was positively associated with diet quality (HEI-2015) in urban but not in rural areas. Compared with quintile (Q1) of cost, the increment in diet quality score was 1·17 (95 % CI -0·06, 4·33) for Q2, 2·14 (95 % CI -0·06, 4·33) for Q3, 4·70 (95 % CI 2·62, 6·79) for Q4 and 6·34 (95 % CI 4·20, 8·49) for Q5 (P-trend < 0·001). Individuals in rural v. urban areas on average have higher quality diets at lower cost with higher intakes of whole grains and beans and lower intakes of Na, added sugars and saturated fats. Living in the South, being indigenous and having low socio-economic status were also associated with higher quality diets. CONCLUSIONS: Diet cost was positively associated with diet quality, but only in urban areas. Further studies are needed to understand the relation between diet cost and quality in rural areas. To improve overall diet quality in Mexico, strategies that aim to reduce the cost of high-quality diets should consider the heterogeneity by place of residence.

There's an App for That: Development of an Application to Operationalize the Global Diet Quality Score.

BACKGROUND: The global diet quality score (GDQS) is a simple, standardized metric appropriate for population-based measurement of diet quality globally. OBJECTIVES: We aimed to operationalize data collection by modifying the quantity of consumption cutoffs originally developed for the GDQS food groups and to statistically evaluate the performance of the operationalized GDQS relative to the original GDQS against nutrient adequacy and noncommunicable disease (NCD)-related outcomes. METHODS: The GDQS application uses a 24-h open-recall to collect a full list of all foods consumed during the previous day or night, and automatically classifies them into corresponding GDQS food group. Respondents use a set of 10 cubes in a range of predetermined sizes to determine if the quantity consumed per GDQS food group was below, or equal to or above food group-specific cutoffs established in grams. Because there is only a total of 10 cubes but as many as 54 cutoffs for the GDQS food groups, the operationalized cutoffs differ slightly from the original GDQS cutoffs. RESULTS: A secondary analysis using 5 cross-sectional datasets comparing the GDQS with the original and operationalized cutoffs showed that the operationalized GDQS remained strongly correlated with nutrient adequacy and was equally sensitive to anthropometric and other clinical measures of NCD risk. In a secondary analysis of a longitudinal cohort study of Mexican teachers, there were no differences between the 2 modalities with the beta coefficients per 1 SD change in the original and operationalized GDQS scores being nearly identical for weight gain (-0.37 and -0.36, respectively, P < 0.001 for linear trend for both models) and of the same clinical order of magnitude for waist circumference (-0.52 and -0.44, respectively, P < 0.001 for linear trend for both models). CONCLUSION: The operationalized GDQS cutoffs did not change the performance of the GDQS and therefore are recommended for use to collect GDQS data in the future.

Changes in the Global Diet Quality Score, Weight, and Waist Circumference in Mexican Women.

BACKGROUND: Evidence on concurrent changes in overall diet quality and weight and waist circumference in women of reproductive age from low- and middle-income countries is limited. OBJECTIVES: We examined the associations of changes in the Global Diet Quality Score (GDQS) and each GDQS food group with concurrent weight and waist circumference change in Mexican women. METHODS: We followed prospectively 8967 nonpregnant nonlactating women aged 25-49 y in the Mexican Teachers' Cohort between 2006 and 2008. We assessed diet using an FFQ of the previous year and anthropometric measures were self-reported. Regression models were used to examine 2-y changes in the GDQS and each food group (servings/d) with weight and waist circumference changes within the same period, adjusting for demographic and lifestyle factors. RESULTS: Compared with those with little change in the GDQS (-2 to 2 points), women with the largest increase in the GDQS (>5 points) had less weight (ß: -0.81 kg/2 y; 95% CI: -1.11, -0.51 kg/2 y) and waist circumference gain (ß: -1.05 cm/2 y; 95% CI: -1.62, -0.48 cm/2 y); likewise, women with the largest decrease in the GDQS (<-5 points) had more weight (ß: 0.36 kg/2 y; 95% CI: 0.06, 0.66 kg/2 y) and waist circumference gain (ß: 0.71 cm/2 y; 95% CI: 0.09, 1.32 cm/2 y). Increased intake of dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, citrus fruits, and fish and shellfish was associated with less weight gain. In addition, deep orange vegetables, low fat and high fat dairy, whole grains, and fish were associated with less waist circumference gain within the 2-y period. CONCLUSIONS: Improvements in diet quality over a 2-y period reflected by an increase in the GDQS and changes in consumption of specific components of the GDQS were associated with less weight and waist circumference gain in Mexican women.

Challenges and opportunities in establishing a collaborative multisite observational study of chronic diseases and lifestyle factors among adults in Puerto Rico.

BACKGROUND: Prevalence of chronic diseases and unhealthy lifestyle behaviors among the adult population of Puerto Rico (PR) is high; however, few epidemiological studies have been conducted to address these. We aimed to document the methods and operation of establishing a multisite cross-sectional study of chronic diseases and risk factors in PR, in partnership with academic, community, clinical, and research institutions. METHODS: The Puerto Rico Assessment of Diet, Lifestyle and Diseases (PRADLAD) documented lifestyle and health characteristics of adults living in PR, with the goal of informing future epidemiological and intervention projects, as well as public health, policy, and clinical efforts to help improve the population's health. The study was conducted in three primary care clinics in the San Juan, PR metropolitan area. Eligible volunteers were 30-75y, living in PR for at least 10 months of the previous year, and able to answer interviewer-administered questionnaires without assistance. Questions were recorded electronically by trained interviewers, and included socio-demographic characteristics, lifestyle behaviors, self-reported medically-diagnosed diseases, and psychosocial factors. Waist and hip circumferences were measured following standardized protocols. A subset of participants answered a validated food frequency questionnaire, a legumes questionnaire, and had medical record data abstracted. Process and outcome evaluation indicators were assessed. RESULTS: The study screened 403 participants in 5 months. Of these, 396 (98%) were eligible and 380 (94%) had reliable and complete information. A subset of 242 participants had valid dietary data, and 236 had medical record data. The mean time to complete an interview was 1.5 h. Participants were generally cooperative and research collaborators were fully engaged. Having multiple sites helped enhance recruitment and sociodemographic representation. Diagnosed conditions were prevalent across sites. Challenges in data monitoring, interviewer training, and scheduling were identified and corrected, and should be addressed in future studies. CONCLUSIONS: Epidemiological studies in PR can be successfully implemented in partnership with multiple institutions. Effective recruitment and implementation requires concerted planning and continued involvement from partners, frequent quality control, brief interviews, reasonable incentives, and thorough training/re-training of culturally-sensitive interviewers. Further studies are feasible and needed to help address highly prevalent chronic conditions in PR.

Diet Quality and Its Association with Cardiometabolic Risk Factors Vary by Hispanic and Latino Ethnic Background in the Hispanic Community Health Study/Study of Latinos.

BACKGROUND: Healthful diet quality has been associated with a lower risk of metabolic syndrome (MetS) in several populations, but reports on Hispanic and Latino cohorts, grouped or by ethnic background, have been limited and inconsistent. OBJECTIVE: We aimed to examine diet quality by using the 2010 Alternate Healthy Eating Index [(AHEI) range: 0-110, lowest to highest quality] and its cross-sectional association with MetS and its cardiometabolic components across 6 Hispanic and Latino backgrounds. METHODS: We studied 12,406 US Hispanics and Latinos, aged 18-74 y and free of diabetes, from the multicenter, population-based Hispanic Community Health Study/Study of Latinos cohort. Food and nutrients were assessed from two 24-h recalls. MetS was defined by using the 2009 harmonized guidelines. Complex survey procedures were used in multivariable-adjusted linear regression models to test the association of the AHEI with continuous markers and in logistic regression models with MetS as an outcome. RESULTS: The prevalence of MetS was 24.2%. Overall, Hispanics and Latinos had low scores for intakes of sugar-sweetened beverages and fruit juices, whole grains, and fruit and favorable scores for trans fats and nuts and legumes, according to AHEI criteria. Adjusted mean AHEI and its individual components differed by ethnic background (P < 0.001), ranging from 43.0 for Puerto Ricans to 52.6 for Mexicans. Overall, adjusted odds (95% CIs) of having MetS were 22% (9%, 33%) lower for each 10-unit increase in AHEI. This association was modified by ethnic background (P-interaction = 0.03), with significantly lower odds observed only for Mexicans (30%; 95% CIs: 13%, 44%) and Central Americans (42%; 95% CIs: 9%, 64%) for each 10-unit increase in AHEI. AHEI was inversely associated with waist circumference, blood pressure, and glucose among Mexicans and Puerto Ricans and with triglycerides among Mexicans only, and positively associated with HDL cholesterol among Puerto Ricans and Central Americans (all P < 0.05). CONCLUSIONS: Diet quality differed by Hispanic or Latino background. Although healthier diet quality was associated with lower odds of MetS in the overall Hispanic and Latino cohort, the association of AHEI and cardiometabolic factors varied by ethnic background. Nutrition-related research and interventions among ethnically diverse groups should consider individual ethnic backgrounds to optimally address diet quality and cardiometabolic health. This trial was registered at clinicaltrials.gov as NCT02060344.

FTO genotype, vitamin D status, and weight gain during childhood.

Previous evidence suggests that variants in the fat mass and obesity-associated gene (FTO) affect adiposity in an age-dependent fashion in children, and nutritional factors may modify genotype effects. We assessed the effect of FTO rs9939609 on BMI and BMI-for-age Z score changes during childhood in a population-based longitudinal study in the Brazilian Amazon and investigated whether these effects were modified by vitamin D status, an important nutritional factor related to adiposity. At baseline, 1,088 children aged <10 years had complete genotypic and anthropometric data; 796 were followed up over a median 4.6 years. Baseline vitamin D insufficiency was defined as <75 nmol/L. We observed a 0.07 kg/m(2)/year increase in BMI and a 0.03 Z/year increase in BMI-for-age Z score per rs9939609 risk allele over follow-up (P = 0.01). Vitamin D status significantly modified FTO effects (P for interaction = 0.02). The rs9939609 risk allele was associated with a 0.05 Z/year increase in BMI-for-age Z score among vitamin D-insufficient children (P = 0.003), while no significant genetic effects were observed among vitamin D-sufficient children. Our data suggest that FTO rs9939609 affects child weight gain, and genotype effects are more pronounced among children with insufficient vitamin D levels.

Sociodemographic and lifestyle characteristics in relation to dietary patterns among young Brazilian adults.

OBJECTIVE: To identify dietary patterns among young adults and the relationships with socio-economic, demographic and lifestyle characteristics. DESIGN: Population-based, cross-sectional analysis of a cohort study. Food intake was assessed by a frequency questionnaire, and dietary patterns were identified using principal components analysis. SETTING: Southern Brazil. SUBJECTS: A total of 4202 men and women aged 23 years, who participated in the 1982 Pelotas Birth Cohort Study. RESULTS: Five dietary patterns were identified: common Brazilian, processed food, vegetable/fruit, dairy/dessert and tubers/pasta. Subjects who had low own or maternal educational levels, low social position or who were always poor throughout life had high adherence to the common Brazilian dietary pattern. In contrast, the processed food pattern was more likely to be followed by those belonging to middle and high social position and who were never poor. Men and smokers showed high adherence to the processed food and common Brazilian dietary patterns. Vegetable/fruit pattern was more likely to be followed by women and subjects engaged in physical activity. Women also showed high adherence to the dairy/dessert pattern. CONCLUSIONS: Our study among young Brazilian adults has identified distinct dietary patterns that are clearly influenced by socio-economic and lifestyle characteristics, which have important policy implications in a country with marked social and economic inequalities.

Dietary recommendations: comparing dietary guidelines from Brazil and the United States.

The Brazilian dietary guidelines are based in part on mainstream United States' recommendations, in spite of the criticisms and shortcomings of the American guidelines. In this paper, Brazilian food guidelines are summarized and discussed in comparison with the USA recommendations. American and Brazilian dietary recommendations are quite similar in many aspects, particularly those related to variety in the diet, the importance of physical activity and weight management. Different to American guidelines, those from Brazil advise people to choose fresh foods, to prefer healthier types of fat, to limit trans fat intake and to eat good sources of protein, but does not recommend the consumption of whole grains. Besides the challenges related to their implementation, indicators for the evaluation of the effectiveness of these guidelines should be established from the beginning, particularly those related to changes in dietary habits and the prevalence of obesity.

Dietary recommendations: comparing dietary guidelines from Brazil and the United States / Recomendações dietéticas: comparação entre os guias alimentares brasileiro e americano

The Brazilian dietary guidelines are based in part on mainstream United States' recommendations, in spite of the criticisms and shortcomings of the American guidelines. In this paper, Brazilian food guidelines are summarized and discussed in comparison with the USA recommendations. American and Brazilian dietary recommendations are quite similar in many aspects, particularly those related to variety in the diet, the importance of physical activity and weight management. Different to American guidelines, those from Brazil advise people to choose fresh foods, to prefer healthier types of fat, to limit trans fat intake and to eat good sources of protein, but does not recommend the consumption of whole grains. Besides the challenges related to their implementation, indicators for the evaluation of the effectiveness of these guidelines should be established from the beginning, particularly those related to changes in dietary habits and the prevalence of obesity.

O guia alimentar brasileiro é baseado parcialmente nas recomendações americanas a despeito das críticas e problemas identificados no documento dos Estados Unidos. Neste artigo, as recomendações alimentares para o Brasil são resumidas e discutidas em comparação com as recomendações estadunidenses. Os guias alimentares brasileiro e americano são bastante similares em diversos aspectos, particularmente aqueles relacionados com a variação da dieta, a importância da atividade física e o gerenciamento do peso. Diferentemente dos Estados Unidos, o guia brasileiro estimula o consumo de alimentos frescos, aconselha o uso de fontes saudáveis de gorduras, a limitação do consumo de gordura trans, o consumo de boas fontes de proteínas, mas não indica o consumo de grãos integrais. Além dos desafios relacionados com a sua implantação, os indicadores para a avaliação da eficácia dos guias alimentares devem ser estabelecidos desde sua implantação, particularmente, os relacionados a mudanças nos hábitos alimentares e à prevalência da obesidade.

Vitamin D deficiency and anthropometric indicators of adiposity in school-age children: a prospective study.

BACKGROUND: Cross-sectional studies have indicated that vitamin D serostatus is inversely associated with adiposity. It is unknown whether vitamin D deficiency is a risk factor for the development of adiposity in children. OBJECTIVE: We investigated the associations between vitamin D serostatus and changes in body mass index (BMI; in kg/m²), skinfold-thickness ratio (subscapular-to-triceps), waist circumference, and height in a longitudinal study in children from Bogota, Colombia. DESIGN: We quantified plasma 25-hydroxyvitamin D [25(OH)D] concentrations in baseline samples of a randomly selected group of 479 schoolchildren aged 5-12 y and classified vitamin D status as deficient [25(OH)D concentrations < 50 nmol/L], insufficient [25(OH)D concentrations ≥ 50 and < 75 nmol/L], or sufficient [25(OH)D concentrations ≥ 75 nmol/L]. We measured anthropometric variables annually for a median of 30 mo. We estimated the average change in each anthropometric indicator according to baseline vitamin D status by using multivariate mixed linear regression models. RESULTS: Vitamin D-deficient children had an adjusted 0.1/y greater change in BMI than did vitamin D-sufficient children (P for trend = 0.05). Similarly, vitamin D-deficient children had a 0.03/y (95% CI: 0.01, 0.05/y) greater change in subscapular-to-triceps skinfold-thickness ratio and a 0.8 cm/y (95% CI: 0.1, 1.6 cm/y) greater change in waist circumference than did vitamin D-sufficient children. Vitamin D deficiency was related to slower linear growth in girls (-0.6 cm/y, P = 0.04) but not in boys (0.3 cm/y, P = 0.34); however, an interaction with sex was not statistically significant. CONCLUSION: Vitamin D serostatus was inversely associated with the development of adiposity in school-age children.

Dietary patterns are associated with metabolic syndrome in an urban Mexican population.

The role that diet plays in the origin of metabolic syndrome (MetS) is not completely understood. Certain foods and nutrients have been established as dietary risk factors for MetS. However, the dietary patterns associated with MetS risk have been minimally studied with factor analysis. Our objective in this study was to use exploratory factor analysis to examine whether particular dietary patterns are related to risk of MetS in Mexican adults. We characterized the dietary patterns among 5240 men and women aged 20-70 y in the Health Workers Cohort Study. Information on participants' sociodemographic conditions and physical activity was collected via self-administered questionnaires. We also obtained anthropometric and clinical measurements and fasting blood samples for biochemical analyses. In a cross-sectional analysis, we examined dietary patterns in relation to MetS, defined using criteria from the Adult Treatment Panel III. Factor analysis revealed 3 major dietary patterns: prudent, Western, and high protein/fat. The prevalence of MetS was 26.6%. After adjustment for potential confounders, compared with participants in the lowest tertile of the Western pattern, those in the highest tertile had higher odds ratios (OR) for high fasting glucose (OR, 1.67; 95% CI: 1.36-2.06), low serum HDL cholesterol (OR, 1.55; 95% CI: 1.31-1.83), and MetS (OR, 1.56; 95% CI, 1.31-1.88). However, we found no significant associations between other patterns and MetS. In summary, a diet high in soft drinks, refined grains, corn tortillas, pastries, seafood, and whole grains was associated with MetS risk. This result emphasizes the importance of preventive nutrition interventions.

A randomized clinical trial of home-based exercise combined with a slight caloric restriction on obesity prevention among women.

OBJECTIVE: The study investigated the effectiveness of home-based exercise combined with a slight caloric restriction on weight change during 12 months in non-obese women. METHODS: A randomized clinical trial with a factorial design was conducted from 2003 to 2005. Two hundred three middle-aged women (Rio de Janeiro/Brazil), 25-45 years, were randomly assigned to one of two groups: control (CG) and home-based exercise (HB). The HB group received a booklet on aerobic exercise that could be practiced at home (3 times/week-40 min/session), in low-moderate intensity, during 12 months. Both groups received dietary counseling aimed at a slight energy restriction of 100-300 calories per day. RESULTS: The HB experienced a greater weight loss in the first 6 months (-1.4 vs. -0.8 kg; p=0.04), but after 12 months there was no differences between groups (-1.1 vs. -1.0; p=0.20). Of the serum biochemical markers, HDL cholesterol showed major change, with an increase at month 12 of 18.3mg/dl in the HB compared to 9.5 in the CG (p<0.01). CONCLUSION: Home-based exercise promoted greater weight reduction during the first 6 months after which no further benefits are observed. Continuous favorable changes in HDL cholesterol after 1 year suggest that home-based exercise promote health benefits.

[Drink consumption for a healthy life: recommendations for the general population in Mexico]. / Consumo de bebidas para una vida saludable: recomendaciones para la población mexicana.

The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Ministry of Health with the aim of drafting evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has documented that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages in six categories. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage. Ranges included healthier (level 1) to least healthy (level 6) options as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category together with healthy consumption patterns for men and women.

Consumo de bebidas para una vida saludable: recomendaciones para la población mexicana / Drink consumption for a healthy life: recommendations for the general population in Mexico

El Secretario de Salud convocó al Comité de Expertos para la elaboración de las “Recomendaciones sobre el consumo de bebidas para la población mexicana”; la finalidad fue desarrollar lineamientos basados en evidencia científica para los consumidores, los profesionales de la salud y el sector gubernamental. Las prevalencias de sobrepeso, obesidad y diabetes han aumentado con rapidez en México y las bebidas representan la quinta parte de la energía que consumen los mexicanos. La evidencia señala que las bebidas con aporte energético incrementan el riesgo de obesidad. Considerando los beneficios y riesgos para la salud y nutrición, así como el patrón de consumo de las bebidas en México, el Comité clasificó las bebidas en seis categorías de acuerdo con su contenido energético, valor nutricio y riesgos a la salud, en una escala que clasifica las bebidas de la más (nivel 1) a la menos (nivel 6) saludable. Nivel 1: agua potable; nivel 2: leche baja en grasa (1%) y sin grasa y bebidas de soya sin azúcar; nivel 3: café y té sin azúcar; nivel 4: bebidas no calóricas con edulcorantes artificiales; nivel 5: bebidas con alto valor calórico y beneficios a la salud limitados (jugos de fruta, leche entera, licuados de fruta con azúcar o miel, bebidas alcohólicas y bebidas deportivas); y nivel 6: bebidas con azúcar y bajo contenido de nutrimentos (refrescos y otras bebidas con altas cantidades de azúcares agregadas como jugos, aguas frescas, café y té). El Comité recomienda el consumo de agua en primer lugar, seguido de bebidas sin o con bajo aporte energético y leche descremada. Éstas deben tener prioridad sobre las de mayor aporte energético o endulzadas, incluso con edulcorantes artificiales. Se presentan cantidades recomendadas para cada categoría de bebidas y se ilustran patrones de consumo saludable para adultos de ambos sexos.

The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Ministry of Health with the aim of drafting evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has documented that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages in six categories. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage. Ranges included healthier (level 1) to least healthy (level 6) options as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category together with healthy consumption patterns for men and women.

[Beverage consumption for a healthy life: recommendations for the Mexican population]. / Consumo de bebidas para una vida saludable: recomendaciones para la población mexicana.

The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.

Alpha-linolenic acid and risk of nonfatal acute myocardial infarction.

BACKGROUND: Intake of long-chain n-3 fatty acids found in fish is low in many countries worldwide. alpha-Linolenic acid could be a viable cardioprotective alternative to these fatty acids in these countries. METHODS AND RESULTS: Cases (n=1819) with a first nonfatal acute myocardial infarction and population-based controls (n=1819) living in Costa Rica matched for age, sex, and area of residence were studied. Fatty acids were assessed by gas chromatography in adipose tissue samples and by a validated food frequency questionnaire specifically designed for this population. Odds ratios and 95% confidence intervals were calculated from multivariate conditional logistic regression models. alpha-Linolenic acid in adipose tissue ranged from 0.36% in the lowest decile to 1.04% in the highest decile. The corresponding median levels of intake were 0.42% and 0.86% energy. Greater alpha-linolenic acid (assessed either in adipose or by questionnaire) was associated with lower risk of myocardial infarction. The odds ratios for nonfatal myocardial infarction for the highest compared with the lowest deciles were 0.41 (95% confidence interval, 0.25 to 0.67) for alpha-linolenic acid in adipose tissue and 0.61 (95% confidence interval, 0.42 to 0.88) for dietary alpha-linolenic acid. The relationship between alpha-linolenic acid and myocardial infarction was nonlinear; risk did not decrease with intakes > approximately 0.65% energy (1.79 g/d). Fish or eicosapentaenoic acid and docosahexaenoic acid intake at the levels found in this population did not modify the observed association. CONCLUSIONS: Consumption of vegetable oils rich in alpha-linolenic acid could confer important cardiovascular protection. The apparent protective effect of alpha-linolenic acid is most evident among subjects with low intakes.

Consumo de bebidas para una vida saludable: recomendaciones para la población mexicana / Beverage consumption for a healthy life: recommendations for the Mexican population

El Secretario de Salud convocó al Comité de Expertos para la elaboración de las ''Recomendaciones sobre el consumo de bebidas para la población mexicana''; la finalidad fue desarrollar lineamientos basados en evidencia científica para los consumidores, los profesionales de la salud y el sector gubernamental. Las prevalencias de sobrepeso, obesidad y diabetes han aumentado con rapidez en México y las bebidas representan la quinta parte de la energía que consumen los mexicanos. La evidencia señala que las bebidas con aporte energético incrementan el riesgo de obesidad. Considerando los beneficios y riesgos para la salud y nutrición, así como el patrón de consumo de las bebidas en México, el Comité clasificó las bebidas en seis categorías de acuerdo con su contenido energético, valor nutricio y riesgos a la salud en una escala que clasifica las bebidas de lamas (nivel 1) a la menos (nivel 6) saludable. Nivel 1: agua potable; nivel 2: leche baja en grasa (1%) y sin grasa y bebidas de soya sin azúcar; nivel 3: café y té sin azúcar; nivel 4: bebidas no calóricas con edulcorantes artificiales; nivel 5: bebidas con alto valor calórico y beneficios a la salud limitados (jugos de fruta, leche entera, licuados de fruta con azúcar o miel, bebidas alcohólicas y bebidas deportivas); y nivel 6: bebidas con azúcar y bajo contenido de nutrimentos (refrescos y otras bebidas con altas cantidades de azúcares agregadas como jugos, aguas frescas, café y té). El Comité recomienda el consumo de agua en primer lugar, seguido de bebidas sin o con bajo aporte energético y leche descremada. Éstas deben tener prioridad sobre las de mayor aporte energético o endulzadas, incluso con edulcorantes artificiales. Se presentan cantidades recomendadas para cada categoría de bebidas y se ilustran patrones de consumo saludable para adultos de ambos sexos.

The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of over-weight, obesity and diabetes have dramatically increased in México; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in México, the committee classified beverages into 6 levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.