Overview of Trends in Anemia and Iron Deficiency in the Mexican Population From 1999 to 2018-19.

BACKGROUND: Despite the emergence of diverse programs in Mexico to address anemia and micronutrient deficiencies in disadvantaged groups, progress on reducing their prevalence has stagnated. In Mexico, anemia surveillance at the population level is conducted through the National Health and Nutrition Survey ENSANUT (for its acronym in Spanish). OBJECTIVE: To overview the trends in anemia and iron deficiency (ID) from 1999 to 2018-19 in the Mexican population before COVID-19 pandemic. METHODS: Data from five nationwide surveys in Mexico were used. Where available, data on anemia, ID, and ID anemia (IDA) were extracted from ENSANUTs 1999, 2006, 2012, 2016, and 2018-19 in participants from 1 to 99 years old. Blood sample collection methods were similar across surveys (1999-2018) where capillary drop blood was used to estimate Hb using a HemoCue and serum blood samples to measure ferritin and C-reactive protein concentration. RESULTS: The trend in anemia prevalence shows a U-shape from 1999 to 2018-19 in <60 years old. In older adults (≥60 years), an increasing trend was observed. Anemia declined progressively from 1999 to 2012 but increased from 2016 to 2018-19 in comparison with 2012. In contrast, ID declined from 2006 to 2018-19, mainly in children, while IDA did not change over this period. In older adults, ID prevalence remained constant over time. CONCLUSIONS: The shifting trend in anemia prevalence across ENSANUTs 1999 through 2018-19 did not mimic the decreasing trend of ID over the same period of time. Other noncausal factors seem to play an important role in the variability of hemoglobin measurements.

Plain language titleOverview of Trends in the Prevalence of Anemia and Iron Deficiency in the Mexican Population From 1999 to 2018-19Plain language summaryIn Mexico, anemia surveillance has been monitored through the National Health and Nutrition Survey since 1999. Nonetheless, progress on reducing their prevalence seems to be stagnated despite the emergence of diverse social programs in Mexico to tackle micronutrient deficiencies in children and women. The main cause of anemia in children and women is iron deficiency (ID). Any progress in tackling ID should be reflected in anemia prevalence. To investigate the prevalence trend, we used information about anemia (based on hemoglobin concentration) and ID (based on serum ferritin levels) where available, from 5 nationwide surveys in Mexico among participants from 1 to 99 years old, to discuss some of the potential factors behind anemia and ID trends. From 1999 to 2018-19, we observed an ¨U" shape in the prevalence of anemia in all age groups <60 years old, contrasting with the prevalence of ID, which trend is in decline. No major changes in terms of social programs can explain the trend in anemia. In fact, other nutritional indicators seem to have improved in Mexican children. A major difference in the measurement of anemia and ID is that hemoglobin was measured in situ using drop of capillary blood in HemoCue, a portable photometer, while ferritin was measured in venous blood in the central laboratory. While many external factors might influence the hemoglobin measurement in the field setting, it seems that the technique of finger prick capillary introduces more errors to the measurement of hemoglobin than other techniques (e.g., pool capillary or venous blood using HemoCue). This difference, in turn, affects anemia diagnosis. Since the drop of capillary blood has been widely acceptable, we did not perform any validation of hemoglobin measurement in those past surveys, so we cannot role out the contribution of other factors that affected hemoglobin measurement. Future studies should use venous blood to improve anemia classification; otherwise, validation studies should be carried out to improve hemoglobin measurement when using capillary blood.

Prospective changes in anemia are associated with the incidence and persistence of sarcopenia among older Mexican adults.

Background: Low hemoglobin levels are a significant biomarker in the prognosis of sarcopenia. Anemia and sarcopenia are frequent and disabling conditions in the older adult population, but little is known about the role of anemia in the onset and progression of sarcopenia. This study aimed to determine whether prospective changes in anemia are associated with the incidence and persistence of sarcopenia. Methods: Data come from the second and third waves (2014, 2017) of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) in Mexico. SAGE-Mexico is a dynamic cohort with national representativeness, including a follow-up sample and new enrollments. For this study, 1,500 older adults (aged 50 or above) with measurements in both waves were included. Sarcopenia was defined as having low muscle quantity and either/both slow gait speed and weak handgrip strength. Anemia was defined according to hemoglobin concentrations, adjusted for altitude, as recommended by the WHO, <120 g/L for women and <130 g/L for men. Multinomial logistic regression was used to estimate the association between anemia and prospective changes in sarcopenia. Results: The baseline prevalence of anemia was 17.4%, and that of sarcopenia was 12.1%. The incidence and persistence of anemia were 10.6% (95% CI: 7.3-15.0%) and 6.9% (95% CI: 4.7-9.8%), respectively, and for sarcopenia, they were 5.3% (95% CI: 3.7-7.7%) and 9.2% (95% CI: 6.4-13.0%), respectively. Incident anemia was associated with incident (RRR = 3.64, 95% CI: 1.18-11.19) but not with persistent (RRR = 0.75, 95% CI: 0.18-3.20) sarcopenia. Persistent anemia was significantly associated with persistent (RRR = 3.59, 95% CI: 1.14-11.27) but not incident (RRR = 1.17, 95% CI: 0.30-4.54) sarcopenia. Conclusion: Changes in anemia are significantly associated with incident and persistent sarcopenia. Primary actions to promote a healthy diet rich in antioxidants, high-quality proteins, and micronutrients, as well as moderate physical activity and maintaining a healthy weight, are crucial for the aging population to delay the deleterious effects of anemia and sarcopenia.

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.

Validation of hemoglobin measurement in venous blood using HemoCue for the Ensanut 2022.

OBJECTIVE: To validate hemoglobin (Hb) concentration in venous blood (VB) using the HemoCue 201+ in a subsample of children and women from the Mexican National Health and Nutrition Survey 2022. MATERIALS AND METHODS: Prior to field work 50 HemoCue 201+ devices were verified using venous blood. During the field work 57 children (aged 1-11) and 62 women (aged 12-49) donated 3 mL of VB each. Hb was measured in each device of HemoCue 201+ and in a hematologic autoanalyzer for the validation. RESULTS: No significant bias was found in most of the devices. An adjustment criterion was used for 22 devices. Hb mean difference results were -0.049±0.578 g/dL in children and -0.098±0.628 g/dL in women. CONCLUSIONS: The HemoCue 201+ is a valid tool for estimating Hb concentration to produce reliable estimates of anemia prevalence when using venous blood.

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.

Micronutrient Deficiencies in Older Adults in Latin-America: A Narrative Review.

BACKGROUND: The population in Latin America and Caribbean (LAC) has experienced a major demographic transition with increased numbers of older adults (OA). This change brings opportunities in the public health sector to implement health prevention interventions and delay the onset of geriatric syndromes. Micronutrients play an important role in the maintenance of biological function which contributes to longevity. Micronutrient deficiencies (MD) in OA increase the risk for onset of chronic comorbidities and geriatric syndromes. AIM: To review and summarize the existing data on micronutrient status in OA in the LAC region and discuss the gaps and challenges in public health approaches to address deficiencies. METHODS: Literature review in Medline for records describing nutritional biomarkers in older adults (≥ 60y) from community dwelling and population-based studies in LAC. RESULTS: Few countries (including Chile, Ecuador, Costa Rica, Brazil, and Mexico) have documented one or more nutritional deficiencies for OA in national health surveys, however across the entire region, evidence of micronutrient levels is scarce. Some surveys have documented a high prevalence and large heterogeneity in the prevalence of vitamin D followed by B12 deficiency, being the 2 MDs most studied due their effects on cognition, frailty, and bone mineral density in the OA population. Other MD including C, E, A, copper, zinc, iron, and selenium have also been reported. CONCLUSION: Information on the micronutrient status in OA from LAC is poorly documented. Research and capacity building initiatives in the region are crucial to develop tailored strategies that address the specific nutritional needs and challenges faced by the ageing population in Latin-America.

Plain language titleMicronutrients Deficiencies in Older Adults in Latin AmericanPlain language summaryFor the first time, there are more older adults (OA) than children worldwide. In the Latin America and Caribbean (LAC) region, OA represents 13.2% of the population, and it is projected to increase to 30% (220 millions) by 2030. This demographic shift represents an opportunity in the public health sector to implement health prevention strategies and public health policies to delay the onset of geriatric syndromes in the younger generation. Vitamins and minerals (micronutrients) are necessary in our body to maintain biological function. Deficiencies in older ages have been associated with the onset of geriatric syndromes (such as sarcopenia, frailty, cognitive impairment, and falls, among others). Therefore, it is relevant to understand the magnitude and distribution of micronutrient deficiencies in OA in the LAC region. This will help to inform decision-makers to further implement early actions to maintain good nutrition and health status in the population. In this narrative review, we highlight that few countries in the LAC region documented one or more nutritional deficiencies for OA in their national health surveys. Across the entire region, evidence of micronutrient levels in OA is scarce. Vitamin D and vitamin B12 are the 2 most reported micronutrients in the OA population. Research and capacity-building in the region are crucial to develop tailored strategies to address specific nutritional needs and challenges faced by the aging population in Latin America.

Unveiling the Burden of Miscoding and Misclassification in Stroke Mortality: Analysis of Multiple Cause-of-Death Data in Mexico.

BACKGROUND: The prevalence of risk factors for cerebrovascular diseases in Mexico is increasing although stroke mortality declined from 1990 to 2010, without meaningful changes afterward. While improving access to adequate prevention and care could explain this trend, miscoding and misclassification in death certificates need to be assessed to unveil the true burden of stroke in Mexico. Practices in death certification along with the presence of multi-morbidity could contribute to this distortion. Analyses of multiple causes of death could reveal ill-defined stroke deaths, providing a glimpse of this bias. METHODS: Cause-of-death information from 4,262,666 death certificates in Mexico from 2009 to 2015, was examined to determine the extent of miscoding and misclassification on the true burden of stroke. Age-standardized mortality rates per 100,000 inhabitants (ASMR) were calculated for stroke as underlying and multiple causes of death, by sex and state. Deaths were classified following international standards as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and unspecified, which were kept as an independent category to measure miscoding. To approximate misclassification, we compared ASMR under three misclassification scenarios: (1) current (the status quo); (2) moderate, which includes deaths from selected causes mentioning stroke; and (3) high which includes all deaths mentioning stroke. National and subnational data were analyzed to search for geographical patterns. RESULTS: The burden of stroke in Mexico is underreported due to miscoding and misclassification. Miscoding is an important issue since almost 60% of all stroke deaths are registered as unspecified. Multiple cause analysis indicates that stroke ASMR could increase 39.9%-52.9% of the current ASMR under moderate and high misclassification scenarios, respectively. Both problems indicate the need to improve death codification procedures and cause-of-death classification. CONCLUSIONS: Miscoding and misclassification lead to underestimation of the burden of stroke in Mexico. Stroke deaths are underreported when other important causes coexist, being diabetes the most frequent.

Hope for brain health: impacting the life course and society.

Hope is a cognitive process by which an individual can identify their personal goals and develop actionable steps to achieve results. It has the potential to positively impact people's lives by building resilience, and can be meaningfully experienced at both the individual and group level. Despite this significance, there are sizable gaps in our understanding of the neurobiology of hope. In this perspective paper, the authors discuss why further research is needed on hope and its potency to be harnessed in society as a "tool" to promote brain health across healthy and patient populations. Avenues for future research in hope and the brain are proposed. The authors conclude by identifying strategies for the possible applications of hope in brain health promotion within the areas of technology, arts, media, and education.

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.

Drops of Capillary Blood Are Not Appropriate for Hemoglobin Measurement with Point-of-Care Devices: A Comparative Study Using Drop Capillary, Pooled Capillary, and Venous Blood Samples.

Population-based surveys matched by time but using different methodologies for determining hemoglobin (Hb) concentration have shown inconsistencies in estimating anemia prevalence. This study aimed to estimate measurement errors in Hb quantification in HemoCue 201+ using venous blood (VB) and capillary blood both drops (DCB) and pools (PCB), and compare the results against those of a reference method (VB analyzed in hematology analyzers based on the cyanmethemoglobin method). Children (n = 49), adult females (n = 50), and older adults (n = 50) were randomly allocated to donate VB (4 mL) and either DCB (three drops) or PCB (350 µL). Results in HemoCue were analyzed through Bland Altman and Lyn's concordance against Hb concentration by the reference method. A positive average bias (systematic error) was found for the HemoCue (0.31 g/dL) using the same VB samples. This value was then subtracted from all readings carried out in the device. After this adjustment, DCB still produced a positive bias (0.42 ± 0.81 g/dL), and the variation of single results was ±1.6 g/dL (95% CI). PCB and VB performed similarly; the average bias was negligible (-0.02 ± 0.36 and 0.00 ± 0.33 g/dL, respectively) and the variation of the results (95% CI) was ±0.7 g/dL or lower. Lyn's concordance values were 0.86, 0.96, and 0.98 for DCB, PCB, and VB, respectively. Random variation using DCB is too large to approximate the true Hb values, and therefore DCB should be discontinued for diagnosing anemia both in individuals and in populations.

Serum retinol levels are associated with cognitive function among community-dwelling older Mexican adults.

BACKGROUND: Vitamin A (VA) provides neuroprotection against oxidative stress and brain inflammation. VA deficiency (VAD) increases the risk of neurodegeneration in animal models, but results are inconclusive in humans: particularly in the older adult (OA) population which is at higher risk for micronutrient deficiencies and cognitive impairment. OBJECTIVE: To estimate the association between serum retinol levels and cognitive function (CF) in older Mexican adults. METHODS: Cross-sectional study with 803 adults aged ≥60 years with fasting blood sample from the southern region of Mexico, collected in summer of 2015. Low serum retinol (LSR) was defined if serum retinol ≤20 µg/dl. CF was evaluated using Semantic Verbal Fluency Test (SVFT). Mild cognitive impairment (MCI) was defined using normative values for SVFT. Linear and logistic regression models were used to estimate the association of LSR with CF and MCI, respectively. RESULTS: Prevalence of MCI was 9.35% and LSR 3.36%. OA with LSR evoked less words in the SVFT (ß = -2.8, CI95% -4.6, -0.9) and had higher probability of MCI (OR = 2.7, CI95% 0.9, 7.7). Associations remained significant when considered IL-6. CONCLUSION: Frequency of LSR in older Mexican adults was low, but strongly associated with MCI. This result suggests that VA plays a role in maintaining CF in the elderly population. Since VAD is a reversible condition, further studies are needed in order to identify the main causes of LSR and prevent MCI in populations which are at higher risk for malnutrition.Trial registration: ClinicalTrials.gov identifier: NCT04820465.

Etiology of Anemia in Older Mexican Adults: The Role of Hepcidin, Vitamin A and Vitamin D.

Anemia in older adults is a growing public health issue in Mexico; however, its etiology remains largely unknown. Vitamin A deficiency (VAD) and vitamin D deficiency (VDD) have been implicated in the development of anemia, though by different mechanisms. The aim of this study is to analyze the etiology of anemia and anemia-related factors in older Mexican adults. This is a cross-sectional study of 803 older adults from the southern region of Mexico in 2015. The anemia etiologies analyzed were chronic kidney disease (CKD), nutritional deficiencies (ND), anemia of inflammation (AI), anemia of multiple causes (AMC) and unexplained anemia (UEA). VAD was considered to be s-retinol ≤ 20 µg/dL, and VDD if 25(OH)D < 50 nmol/L. IL-6 and hepcidin were also measured. Multinomial regression models were generated and adjusted for confounders. Anemia was present in 35.7% of OA, independent of sex. UEA, CKD, AI and ND were confirmed in 45%, 29.3%, 14.6% and 7% of older adults with anemia, respectively. Hepcidin and log IL-6 were associated with AI (p < 0.05) and CKD (p < 0.001). VAD was associated with AI (p < 0.001), and VDD with ND and AMC (p < 0.05). Log-IL6 was associated with UEA (p < 0.001). In conclusion, anemia in older adults has an inflammatory component. VAD was associated to AI and VDD with ND and AMC.

Vitamin D status in Mexican children 1 to 11 years of age: an update from the Ensanut 2018-19.

OBJECTIVE: To evaluate vitamin D status and deficiency in Mexican children and related factors, with updated data from a representative national survey. MATERIALS AND METHODS: Data and serum samples of child participants were collected in the Ensanut 2018-19. The measurement 25-(OH)-D was obtained through chemiluminescence. Height and weight, as well as dietary information, were measured using a semi-quan-titative food frequency questionnaire and sociodemographic information. RESULTS: Data of 4 691 children aged 1-11 years were analyzed. Vitamin D deficiency (25-OH-D<50 nmol/L) was found in 27.3% of pre-school-age children and 17.2% of school-age children, and was positively associated with the body mass index (BMI). Main dietary sources were milk, eggs and dairy products, which in combination provided >70% of vitamin D intake. CONCLUSIONS: Vitamin D deficiency is important in Mexican children. Actions and programs to fight this deficiency are required.

Nutritional status of iron, vitamin B12, vitamin A and anemia in Mexican children: results from the Ensanut 2018-19.

OBJECTIVE: To describe the current status of micronutrient deficiencies (MD) and anemia in Mexican children. MATERIALS AND METHODS: Serum data from 1 382 pre-school-age chil-dren (1-4 years) and 3 590 school-age children (5-11 years) Ensanut 2018-19 participants were analyzed. Iron deficiency (ID), vitamin B12 deficiency (B12D), vitamin A depletion (VADp), and anemia were identified. Logistic regression models were used to identify associations between socio-demographic characteristics of children and MD. RESULTS: Anemia was present in 28.9 and 19.2% of the children aged 1-4 and 5-11, respectively; in ID 10 and 5.1%; B12D, in 5.1 and 4.8%, and VADp, in 4.7 and 4.3%. 18.5% of the preschool-age children and 13% of the school-age children had at least one MD associated to anemia. CONCLUSIONS: MD and anemia affect the younger children in larger proportion. Fortification and supplementation programs should be reinforced to avoid the long-term consequences of MD.

A decreasing trend in zinc deficiency in Mexican children aged 1-4: analysis of three national health and nutrition surveys in 1999, 2006 and 2018-19.

OBJECTIVE: To describe trends in zinc deficiency (ZD) prevalence among preschool-age Mexican children, and explore differences in this trend among beneficiaries of the conditional cash transfer program Progresa/Oportunidades/ Prospera (CCT-POP). MATERIALS AND METHODS: The serum zinc information of children aged 1-4 who participa-ted in the ENN 1999, Ensanut 2006 and Ensanut 2018-19 was analyzed. ZD was categorized according to IZiNCG cutoff values. Logistic regression models were used to iden-tify personal participant characteristics associated with ZD trends, and tests for interactions between survey CCT-POP beneficiaries were applied. RESULTS: ZD decreased by 22.3 percentage points (pp) between ENN 1999 and Ensanut 2018-19; among CCT-POP beneficiaries, the decrease was 58.6 pp. Overweight was associated with higher odds of ZD (OR=2.18, p=0.023). CONCLUSIONS: In the last 19 years, ZD declined significantly among preschool-age Mexican children. Child beneficiaries of the social program CCT-POP showed the largest reduction of ZD.

Iron deficiency is not the main contributor to anemia in older Mexican adults: results from the National Health and Nutrition Survey 2018-19.

OBJECTIVE: To describe the current status of anemia and iron deficiency (ID), as well as associated sociodemographic characteristics, in older adults (OA). Materials and meth-ods. Serum and capillary blood samples from a sample of OA participants (n=2 902) from the Ensanut 2018-19 were analyzed. ID was defined as s-ferritin<15 µg/L, and anemia was defined according to World Health Organization stan-dards. Logistic regression models were used to associate the characteristics of OA with anemia and ID. RESULTS: Of the OA analyzed, anemia was present in 28.4%, ID in 5% and iron deficiency anemia in 2.07%. Diabetes (OR=2.14), renal insuf-ficiency (OR=10.4), higher age, and urban dwelling (OR=1.35) were conditions associated with higher odds for anemia (p<0.05). Belonging to the 70-79 year age group was the only condition associated with higher odds for ID (OR=1.86, p<0.05). CONCLUSIONS: Anemia affects a high proportion of OA, and ID is not the main contributor to anemia. Chronic comorbidities help explain the anemia problem in OA.

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.

Prevalence of diabetes and glycemic control in Mexico: national results from 2018 and 2020.

OBJECTIVE: To estimate the prevalence of diabetes (diagnosed and undiagnosed), glycemic control in Mexico, and its associated factors. MATERIALS AND METHODS: We used data from Ensanut 2018 (n=12 648) and 2020 (n=2 309). We defined diabetes as fasting glucose ≥126 mg/dl or HbA1c≥6.5% or previously diagnosed; glycemic control was defined as HbA1c<7%. We fitted Poisson regression models to assess the association between diabetes, glycemic control, and potential associated factors. RESULTS: The total prevalence of diabetes was 16.8% in 2018 and 15.7% in 2020. In 2018, 38% of adults with diabetes were unaware of their disease, while in 2020 this figure was 29%. Glycemic control was observed in 42% of participants in 2018 and 39% in 2020. Longer disease duration was associated with lower glycemic control, while older age, having a diet, and being affiliated to IMSS, Pemex, Sedena, or private healthcare were associated with better control. CONCLUSION: Mexico is among the countries with the highest diabetes prevalence. A high proportion of adults with diabetes did not have a previous diagnosis, and the proportion with glycemic control is low. Strengthening screening to achieve a timely diagnosis, and improving glycemic control, should be key actions in the management of diabetes.

[Prevalence of diabetes and poor glycemic control in Mexico: results from Ensanut 2016.] / Prevalencia de diabetes y descontrol glucémico en México: resultados de la Ensanut 2016.

OBJECTIVE: To estimate the prevalence of total, diagnosed and undiagnosed diabetes, and the prevalence of poor glycemic control in Mexico, and its associated factors. MATERIALS AND METHODS: Data from 3 700 adult participants were analysed in the 2016 National Health and Nutrition Survey. Diabetes prevalences were estimated with population weights, and the factors associated with total diabetes and poor glycemic control with Poisson regression models. RESULTS: The total prevalence of diabetes was 13.7% (9.5% diagnosed, 4.1% undiagnosed); 68.2% of people with diagnosed diabetes presented poor glycemic control. Longer disease duration, living in the centre or south of the country and being treated in pharmacies were associated with poor glycemic control. Being treated in a social security system was associated with better glycemic control. CONCLUSIONS: Multisectoral efforts are needed to strengthen screening, timely diagnosis and disease control, considering differences by region and type of health service.

OBJETIVO: Estimar la prevalencia de diabetes (total, diagnosticada y no diagnosticada), de descontrol glucémico en México y sus factores asociados. MATERIAL Y MÉTODOS: Se analizaron 3 700 adultos participantes en la Encuesta Nacional de Salud y Nutrición de 2016. Se estimaron las prevalencias con ponderadores poblacionales y los factores asociados con diabetes total y descontrol glucémico con modelos de regresión de Poisson. RESULTADOS: La prevalencia total de diabetes fue de 13.7% (9.5% diagnosticada, 4.1% no diagnosticada); 68.2% de los diagnosticados presentó descontrol glucémico. Mayor tiempo de diagnóstico, vivir en el centro/sur del país y ser atendido en farmacias se asoció con descontrol glucémico, mientras que ser atendido en los servicios de seguridad social se asoció con mejor control glucémico. CONCLUSIONES: Se requieren esfuerzos multisectoriales para fortalecer el tamizaje, diagnóstico oportuno y control de la enfermedad, considerando las diferencias por región y tipo de servicio de salud.