Perspective: Mexico's Experience in Building a Toolkit for Obesity and Noncommunicable Diseases Prevention.

Noncommunicable diseases (NCDs) are a leading cause of death and disability worldwide, with a higher risk of death in low- and middle-income countries. Diet and excess weight are risk factors for NCDs. In Mexico, the prevalence of overweight and obesity increased dramatically in the last 30 y and is among the highest in the world. To address this public health problem, governments and public health professionals have several policy instruments available. In this study, we present the policy instruments currently approved in Mexico, which include fiscal, informational, and authoritative tools that aim to improve the food environment and promote healthy behaviors (taxes, school food guidelines, front-of-pack labeling, marketing regulations, and dietary guidelines). These types of interventions are important in regions like Latin America, where social inequities and poor access to information are common, and individual healthy choices are often limited. These interventions target the environments in which individuals live, study, work, and seek entertainment, while limiting access to unhealthy choices and offering information to promote healthy alternatives. The Mexican experience in design, implementation, and evaluation of policies to improve the food environment can be useful for other low- and middle-income countries facing similar challenges.

Breastfeeding is associated with the intelligence of school-age children in Mexico.

Breastfeeding has been consistently associated with higher intelligence since childhood. However, this relation could be confounded due to maternal selection bias. We estimated the association between predominant breastfeeding and intelligence in school-age children considering potential selection bias and we simulated the intelligence gap reduction between low versus higher socioeconomic status children by increasing breastfeeding. We analysed predominant breastfeeding practices (breastmilk and water-based liquids) of children 0-3 years included in the Mexican Family Life Survey (MxFLS-1). Intelligence was estimated as the z-score of the abbreviated Raven score, measured at 6-12 years in the MxFLS-2 or MxFLS-3. We predicted breastfeeding duration among children with censored data with a Poisson model. We used the Heckman selection model to assess the association between breastfeeding and intelligence, correcting for selection bias and stratified by socioeconomic status. Results show after controlling for selection bias, a 1-month increase in predominant breastfeeding duration was associated with a 0.02 SD increase in the Raven z-score (p < 0.05). The children who were predominantly breastfed for 4-6 months versus <1 month had 0.16 SD higher Raven z-score (p < 0.05). No associations were found using multiple linear regression models. Among low socioeconomic status children, increasing predominantly breastfeeding duration to 6 months would increase their mean Raven z-score from -0.14 to -0.07 SD and reduce by 12.5% the intelligence gap with high socioeconomic status children. In conclusion, predominant breastfeeding duration was significantly associated with childhood intelligence after controlling for maternal selection bias. Increased breastfeeding duration may reduce poverty-driven intelligence inequities.

The burden of suboptimal breastfeeding in Mexico: Maternal health outcomes and costs.

Longer duration of breastfeeding is associated with a lower risk of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension diseases in women. Mexico has one of the lowest breastfeeding rates worldwide; therefore, estimating the disease and economic burden of such rates is needed to influence public policy. We considered suboptimal breastfeeding when fewer than 95% of parous women breastfeed for less than 24 months per child, according to the World Health Organization recommendations. We quantified the lifetime excess cases of maternal health outcomes, premature death, disability-adjusted life years, direct costs, and indirect costs attributable to suboptimal breastfeeding practices from Mexico in 2012. We used a static microsimulation model for a hypothetical cohort of 100,000 Mexican women to estimate the lifetime economic cost and disease burden of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension in mothers, due to suboptimal breastfeeding, compared with an optimal scenario of 95% of parous women breastfeeding for 24 months. We expressed cost in 2016 USD. We used a 3% discount rate and tested in sensitivity analysis 0% and 5% discount rates. We found that the 2012 suboptimal scenario was associated with 5,344 more cases of all analysed diseases, 1,681 additional premature deaths, 66,873 disability-adjusted life years, and 561.94 million USD for direct and indirect costs over the lifetime of a cohort of 1,116 million Mexican women. Findings suggest that investments in strategies to enable more women to optimally breastfeed could result in important health and cost savings.