Early consumption of liquids different to breast milk in Mexican infants under 1 year: results of the probabilistic National Health and Nutrition Survey 2012

Introduction: Studies on infant dietary intake do not generally focus on the types of liquids consumed. Objective: To document by age and breastfeeding status, the types of liquids present in the diet of Mexican children under 1 year of age (< 1 y) who participated in the National Health and Nutrition Survey 2012 (ENSANUT-2012). Methods: Analysis of the infant < 1 y feeding practices from the ENSANUT-2012 survey in non-breastfed (non-BF) and breastfed (BF) infants by status quo for the consumption of liquids grouped in: water, formula, fortified LICONSA milk, nutritive liquids (NL; thin cereal-based gruel with water or milk and coffee with milk) and non-nutritive liquids (non-NL) as sugared water, water-based drinks, tea, beans or chicken broth, aguamieland coffee. In this infants < 1 y we analyzed the not grouped consumption of liquids in the first three days of life (newborns) from the mother's recall. Percentage and confidence intervals (95% CI) were calculated adjusting for survey design. Statistical differences were analyzed by Z test. Results: We observed a high consumption of human milk followed by formula (56.7%) and water (51.1%) in infants under 6 months of age (< 6 mo). The proportion of non-BF infants consuming non-NL was higher than for BF infants (p < 0.05). More than 60% of older infants (6 mo and < 1 y) consumed formula and were non-BF. In newborns formula consumption was predominant, followed by tea or infusion and water. Conclusions: Non-breast milk liquids are present undesirably in Mexican infants' diet and non-NL are consumed earlier than NL, revealing inadequate early dietary practices.

Early consumption of liquids different to breast milk in Mexican infants under 1 year: results of the probabilistic National Health and Nutrition Survey 2012 / Consumo temprano de líquidos diferentes a leche materna en niños mexicanos menores de 1 año: resultados de la Encuesta Nacional de Salud y Nutrición 2012

Introduction: Studies on infant dietary intake do not generally focus on the types of liquids consumed. Objective: To document by age and breastfeeding status, the types of liquids present in the diet of Mexican children under 1 year of age (< 1 y) who participated in the National Health and Nutrition Survey 2012 (ENSANUT-2012). Methods: Analysis of the infant < 1 y feeding practices from the ENSANUT-2012 survey in non-breastfed (non-BF) and breastfed (BF) infants by status quo for the consumption of liquids grouped in: water, formula, fortified LICONSA milk, nutritive liquids (NL; thin cereal-based gruel with water or milk and coffee with milk) and non-nutritive liquids (non-NL) as sugared water, water-based drinks, tea, beans or chicken broth, aguamiel and coffee. In this infants < 1 y we analyzed the not grouped consumption of liquids in the first three days of life (newborns) from the mother’s recall. Percentage and confidence intervals (95% CI) were calculated adjusting for survey design. Statistical differences were analyzed by Z test. Results: We observed a high consumption of human milk followed by formula (56.7%) and water (51.1%) in infants under 6 months of age (< 0.05). More than 60% of older infants (6 mo and < 1 y) consumed formula and were non-BF. In newborns formula consumption was predominant, followed by tea or infusion and water. Conclusions: Non-breast milk liquids are present undesirably in Mexican infants’ diet and non-NL are consumed earlier than NL, revealing inadequate early dietary practices (AU)

Introducción: los estudios en consumo dietético infantil no se enfocan generalmente al tipo de líquidos consumidos. Objetivo: documentar los líquidos presentes en la dieta de infantes mexicanos < 1 año, participantes en la Encuesta Nacional de Salud y Nutrición 2012 (ENSANUT-2012) de acuerdo a su edad y lactancia. Métodos: se analizaron las prácticas de alimentación de infantes < 1 año de la ENSANUT-2012 en niños no amamantados (no-A) y amamantados (A) determinado por status quo para el consumo de líquidos agrupados en: agua, fórmula, leche fortificada LICONSA, líquidos nutritivos (LN; atole con agua o leche y café con leche) y líquidos no-nutritivos (Lno-N): agua endulzada, bebidas a base de agua, tes, caldos de frijol o pollo, aguamiel y café con agua. A partir del recuerdo de la madre en los tres primeros días de nacidos (recién nacidos) de los infantes < 1 año, analizamos el consumo de líquidos sin agrupar. Calculamos porcentajes e intervalos de confianza (IC 95%) ajustados por diseño de encuesta. Las diferencias estadísticas se analizaron a través de la prueba Z con un valor p < 0,05. Resultados: en infantes < 6 meses se observó un alto consumo de leche materna seguido por fórmula (56,7%) y agua (51,1%). Fue más alta la proporción del consumo Lno-N en infantes no-A que en amamantados (p < 0,05). Más del 60% de infantes entre 6 meses y 1 año consumieron fórmula y no eran amamantados. En recién nacidos predominó el consumo de fórmula seguido por té o infusión. Conclusiones: los líquidos diferentes a la leche materna se encuentran indeseablemente en la alimentación de infantes mexicanos y los líquidos no nutritivos son consumidos antes que los nutritivos, resaltando negativas prácticas dietéticas tempranamente (AU)

Breastfeeding and maternal employment: results from three national nutritional surveys in Mexico.

To evaluate the association between maternal employment and breastfeeding (both duration and status) in Mexican mothers using data from three National Health and Nutrition Surveys conducted in 1999, 2006 and 2012. We analyzed data from the 1999 National Nutrition Survey, the 2006 National Nutrition and Health Survey, and the 2012 National Nutrition and Health Survey (NNS-1999, NHNS-2006 and NHNS-2012) on 5,385 mothers aged 12-49 years, with infants under 1 year. Multivariate logistic regression models were used to analyze the association between breastfeeding and maternal employment adjusted for maternal and infant's socio-demographic covariates. Maternal formal employment was negatively associated with breastfeeding in Mexican mothers with infants under 1 year. Formally employed mothers were 20 % less likely to breastfeed compared to non-formally employed mothers and 27 % less likely to breastfeed compared to unemployed mothers. Difference in median duration of breastfeeding between formally employed and unemployed mothers was 5.7 months for NNS-1999, 4.7 months for NNHS-2006 and 6.7 months for NNHS-2012 respectively (p < 0.05). In NHNS-2006 and NHNS-2012, health care access was associated with longer breastfeeding duration. Maternal employment has been negatively associated with breastfeeding in Mexican mothers of <1 year infants at least for the last 15 years. For Mexicans involved in policy design, implementation or modification, these data might offer robust evidence on this negative association, and can be used confidently as basis for conceiving a more just legislation for working lactating women.

[Exclusive breastfeeding in <6mo is associated to a better weight for length in households with food insecurity in Mexico]. / La lactancia materna exclusiva en menores de seis meses se asocia con un mejor peso para la longitud en hogares con inseguridad alimentaria en México.

OBJECTIVE: To evaluate the effect of exclusive breastfeeding in <6mo (EBF<6mo) on the relationship between food insecurity (FI) and nutritional status, in Mexican infants. MATERIALS AND METHODS: We analyzed the sample of 12-49y women and their children <2y from the national survey ENSANUT 2012 (n = 4 022). Breastfeeding indicators from WHO-2008 were calculated. We estimated the effect modifier EBF<6mo of the relationship between FI and weight length (Z W/L) and length for age (Z L/A) Z score. RESULTS: The EBF<6mo was lower in households (hh) with moderate and severe FI than in those with food security (FS) or mild FI hh. Only EBF<6mo infants from hh with moderate and severe FI showed greater Z W/L (0.44) than those without EBF<6mo (p= 0.038, one-tailed). Score Z W/L of infants from hh FS did not vary according to EBF<6mo. CONCLUSION: EBF<6mo in Mexican infants is associated with better weight for length in households with moderate and severe FI. Breastfeeding promotion, protection and support must be targeted mainly at the most vulnerable, food insecure families.

La lactancia materna exclusiva en menores de seis meses se asocia con un mejor peso para la longitud en hogares con inseguridad alimentaria en México / Exclusive breastfeeding in <6mo is associated to a better weight for length in households with food insecurity in Mexico

Objetivo. Evaluar el efecto modificador de la lactancia materna (LM) exclusiva en menores de seis meses (LME<6m) en la relación entre inseguridad alimentaria (IA) y estado de nutrición infantil. Material y métodos. Análisis de mujeres de 12-49 años y sus hijos menores de dos años de la ENSANUT 2012 (n=4 022). Se calcularon los indicadores de la Organización Mundial de la Salud para LM. Se estimó la media del puntaje Z de peso para la longitud (Z P/L) y Z de longitud para la edad (Z L/E) de niños, por IA y LME<6m. Resultados. La LME<6m fue inferior en hogares con ISA moderada y severa comparada con hogares con seguridad alimentaria (SA) o IA leve. En hogares con IA moderada y severa, niños con LME<6m mostraron mayor Z P/L (0.44) vs. niños sin LME<6m (p=0.038, una cola), sin diferencias en hogares con SA. Conclusión. En México, la LME<6m se asocia con un mejor P/L en hogares con IA moderada y severa, no así en hogares con SA. Urge focalizar políticas públicas para abatir la desnutrición y mejorar las prácticas de lactancia en estos grupos.

Objective. To evaluate the effect of exclusive breastfeeding in <6mo (EBF<6mo) on the relationship between food insecurity (FI) and nutritional status, in Mexican infants. Materials and methods. We analyzed the sample of 12-49y women and their children <2y from the national survey ENSANUT 2012 (n = 4 022). Breastfeeding indicators from WHO-2008 were calculated. We estimated the effect modifier EBF<6mo of the relationship between FI and weight length (Z W/L) and length for age (Z L/A) Z score. Results. The EBF<6mo was lower in households (hh) with moderate and severe FI than in those with food security (FS) or mild FI hh. Only EBF<6mo infants from hh with moderate and severe FI showed greater Z W/L (0.44) than those without EBF<6mo (p= 0.038, one-tailed). Score Z W/L of infants from hh FS did not vary according to EBF<6mo. Conclusion. EBF<6mo in Mexican infants is associated with better weight for length in households with moderate and severe FI. Breastfeeding promotion, protection and support must be targeted mainly at the most vulnerable, food insecure families.

Breastfeeding in Mexico was stable, on average, but deteriorated among the poor, whereas complementary feeding improved: results from the 1999 to 2006 National Health and Nutrition Surveys.

We present: 1) indicators of infant and young child feeding practices (IYCFP) and median age of introduction of foods analyzed by geographic and socioeconomic variables for the 2006 national probabilistic Health Nutrition Survey (ENSANUT-2006); and 2) changes in IYCFP indicators between the 1999 national probabilistic Nutrition Survey and ENSANUT-2006, analyzed by the same variables. Participants were women 12-49 y and their <2-y-old children (2953 in 2006 and 3191 in 1999). Indicators were estimated with the status quo method. The median age of introduction of foods was calculated by the Kaplan-Meier method using recall data. The national median duration of breastfeeding was similar in both surveys, 9.7 mo in 1999 and 10.4 mo in 2006, but decreased in the vulnerable population. In 1999 indigenous women breastfed 20.8 mo but did so for only 13.0 mo in 2006. The national percentage of those exclusively breastfeeding <6 mo also remained stable: 20% in 1999 and 22.3% in 2006. Nevertheless, exclusively breastfeeding <6 mo changed within the indigenous population, from 46% in 1999 to 34.5% in 2006. Between surveys, most breastfeeding indicators had lower values in vulnerable populations than in those better-off. Complementary feeding, however, improved overall. Complementary feeding was inadequately timed: median age of introduction of plain water was 3 mo, formula and non-human milk was 5 mo, and cereals, legumes, and animal foods was 5 mo. Late introduction of animal foods occurred among vulnerable indigenous population when 50% consumed these products at 8 mo. Mexican IYCFP indicate that public policy must protect breastfeeding while promoting the timely introduction of complementary feeding.

[Infant feeding practices and deterioration of breastfeeding in Mexico]. / Prácticas de alimentación infantil y deterioro de la lactancia materna en México.

OBJECTIVE: To present data on infant and young child feeding practices (IYCFP) in Mexico from the 2012 National Health and Nutrition Survey (ENSANUT 2012) to support the development of public policy. POPULATION: Women 12-49y and children <2y. Indicators of IYCFP suggested by WHO were analyzed by geographic, socioeconomic, participation in food programs and health insurance variables. RESULTS: Median duration of breast-feeding: 10.2mo and 14.4% with exclusive breastfeeding (EBF) <6m. Breastfeeding deteriorated in most vulnerable groups. Decline in EBF<6m 2006-2012 was explained by increases in consumption of formula and other milks (4%) and water (4%). Three-quarters (74%) of 6-11mo infants had minimum food diversity, and it was lower in the most vulnerable. CONCLUSIONS: Complementary feeding improved but breastfeeding declined in Mexico. Promotion actions must be integral, coordinated, financed and evaluated, with Federal government leadership and should include the participation of various stakeholders.

Prácticas de alimentación infantil y deterioro de la lactancia materna en México / Infant feeding practices and deterioration of breastfeeding in Mexico

Objetivo. Presentar prácticas de alimentación infantil (PAI) en México de la Encuesta Nacional Salud y Nutrición (ENSANUT 2012) y ofrecer información para el desarrollo de políticas públicas. Material y métodos. Encuesta con diseño probabilístico. Población: Mujeres de 12 a 49 años e hijos menores de 3 años. Cálculo de indicadores propuestos por OMS, por factores geográficos, socioeconómicos, pertenencia a programas y servicios de salud. Resultados. Mediana de duración lactancia de 10.2 meses y 14.4% con lactancia materna exclusiva (LME) en menores de 6 meses. Las PAI se deterioraron en grupos más vulnerables. El descenso de LME en menores de 6 meses entre 2006 y 2012 se explica por el aumento en consumo de fórmulas y otras leches (4%) y agua (4%). El 74% de niños de 6 a 11 meses tuvo diversidad mínima alimentaria, menor (<60%) en grupos más vulnerables. Conclusiones. En México, la alimentación complementaria mejoró pero la lactancia se deterioró. Su promoción, protección y apoyo deben ser integrales, coordinados, financiados y evaluados con liderazgo del Gobierno Federal y participación de diversos actores.

Objective. To present data on infant and young child feeding practices (IYCFP) in Mexico from the 2012 National Health and Nutrition Survey (ENSANUT 2012) to support the development of public policy. Materials and methods. Population: Women 12-49y and children <2y. Indicators of IYCFP suggested by WHO were analyzed by geographic, socioeconomic, participation in food programs and health insurance variables. Results. Median duration of breast-feeding: 10.2mo and 14.4% with exclusive breastfeeding (EBF) <6m. Breastfeeding deteriorated in most vulnerable groups. Decline in EBF<6m 2006-2012 was explained by increases in consumption of formula and other milks (4%) and water (4%). Three-quarters (74%) of 6-11mo infants had minimum food diversity, and it was lower in the most vulnerable. Conclusions. Complementary feeding improved but breastfeeding declined in Mexico. Promotion actions must be integral, coordinated, financed and evaluated, with Federal government leadership and should include the participation of various stakeholders.