Modelling the impact of sodium intake on cardiovascular disease mortality in Mexico.

BACKGROUND: Cardiovascular diseases (CVD) represent the main cause of death in Mexico, while high blood pressure is suffered by about half of the adult population. Sodium intake is one of the main risk factors for these diseases. The Mexican adult population consumes about 3.1 g/day, an amount that exceeds what is recommended by the World Health Organization (WHO) < 2 g sodium/day. The objective of this study was to estimate the impact of reducing sodium intake on CVD mortality in Mexico using a scenario simulation model. METHODS: The Integrated Model of Preventable Risk (PRIME) was used to estimate the number of deaths prevented or postponed (DPP) due to CVD in the Mexican adult population following the following sodium intake reduction scenarios: (a) according to the WHO recommendations; (b) an "optimistic" reduction of 30%; and (c) an "intermediate" reduction of 10%. RESULTS: The results show that a total of 27,700 CVD deaths could be prevented or postponed for scenario A, 13,900 deaths for scenario B, and 5,800 for scenario C. For all scenarios, the highest percentages of DPP by type of CVD are related to ischemic heart disease, hypertensive disease, and stroke. CONCLUSIONS: The results show that if Mexico considers implementing policies with greater impact to reduce sodium/salt consumption, a significant number of deaths from CVD could be prevented or postponed.

Prevalencia de obesidad y factores de riesgo asociados en adultos mexicanos: resultados de la Ensanut 2022.

OBJETIVO: Describir la prevalencia de obesidad en adultos, medida a través del índice de masa corporal (IMC) y la circunferencia de cintura (CC), estratificando por factores de riesgo y comorbilidades. Material y métodos. Se analizó la información de 8 563 participantes en la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). Se clasificó la obesidad por IMC y por CC. Se calcularon razones de momios (RM) para asociar la obesidad con factores de riesgo y diagnóstico de comorbilidades. RESULTADOS: La prevalencia de sobrepeso fue 38.3%, obesidad 36.9% y obesidad abdominal (OA) 81.0%. Las mujeres tuvieron una mayor RM (1.4) de tener obesidad y OA (2.5). Los adultos con obesidad tenían una mayor posibilidad de tener diagnóstico de diabetes (RM 1.7), hipertensión (3.6) y dislipidemia (RM 2.3) que los adultos con IMC normal. CONCLUSIONES: La prevalencia de obesidad en adultos mexicanos es una de las más altas a nivel mundial y está asociada con los factores de riesgo y enfermedades crónicas más frecuentes. Se requieren políticas públicas multisectoriales para prevenir y controlar la obesidad.

Prevalencia, tratamiento y control de la hipertensión arterial en adultos mexicanos: resultados de la Ensanut 2022.

OBJETIVO: Describir la prevalencia de hipertensión arterial (HTA), las características del tratamiento y la proporción de adultos mexicanos que tiene tensión arterial (TA) controlada. Material y métodos. Se midió la TA a 8 647 adultos en la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). Se consideró que un participante tenía HTA o TA controlada cuando cumplía los criterios de la American College of Cardiology y la American Heart Association (ACC/AHA) o la Eighth Joint National Committee (JNC-8). RESULTADOS: La prevalencia de HTA en adultos fue 47.8% (según criterio del ACC/AHA). De éstos, 65.5% desconocía su diagnóstico. En adultos con diagnóstico previo de HTA, 33.7% tuvo TA controlada. Según la clasificación JNC-8, 29.4% de los adultos tenía HTA y 43.9% ignoraba su diagnóstico. Conclusión. En la Ensanut 2022 la mitad de los adultos tenía HTA y de ellos, tres de cada cinco no habían sido diagnosticados. El sistema de salud debe mejorar sus mecanismos de detección de HTA porque el subdiagnóstico y el mal control de la TA ocasiona discapacidad, mala calidad de vida y mortalidad prematura.

Espacios cardioprotegidos en México: acciones para prevenir la muerte súbita cardiaca. Una postura de profesionales de la salud.

La muerte súbita cardiaca es un problema de salud pública a nivel mundial. Aunque su incidencia no es conocida, se estima que causa hasta 50% de la mortalidad de origen cardíaco y hasta 20% de la mortalidad total en los adultos. En México, estimaciones previas sugieren que causa en promedio 33 000 muertes al año; sin embargo, los datos no son precisos. La  mitad de los eventos por muerte súbita cardiaca se deben a un paro cardiaco súbito extrahospitalario que, de no ser atendido oportunamente, deriva en una muerte súbita cardiaca. Por tanto, la capacidad de responder pronta y adecuadamente a estos eventos con las maniobras y equipos necesarios mejora la sobrevida de las víctimas. Para atender este problema, en algunos estados del país se han creado espacios cardioprotegidos que permiten realizar maniobras de reanimación cardiopulmonar y desfibrilación cardiaca de acceso público oportunamente. Como objetivo, los profesionales de la salud establecen la importancia de implementar espacios cardioprotegidos y crear políticas públicas al respecto en todo el país.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud.

La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.

Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016.

BACKGROUND: The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS: We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS: The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS: In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).

Screen-Based Sedentary Behaviors and Their Association With Metabolic Syndrome Components Among Adults in Mexico.

INTRODUCTION: Approximately 25% of the adult population worldwide and 49.8% of Mexican adults have metabolic syndrome. Metabolic syndrome is the result of unhealthy dietary and sleeping patterns, sedentary behaviors, and physical inactivity. The objective of our study was to evaluate the association between sedentary behaviors as screen-based sedentary time (SBST) and each component of metabolic syndrome among adults who participated in the Mexico National Survey of Health and Nutrition Mid-way 2016. METHODS: We analyzed sociodemographic, clinical, and physical activity data from 3,166 adults aged 20 years or older. The International Physical Activity Questionnaire was used to evaluate sedentary behavior. SBST was obtained by counting minutes per week spent watching television, playing video games, and interacting with computers and smartphones. We used Poisson regression to estimate the prevalence ratio of time in front of screens as a continuous variable and its association with metabolic syndrome. RESULTS: The mean (SD) hours per day of SBST in men was 3.6 (0.4) and in women was 2.8 (0.2). The prevalence of metabolic syndrome was 59.6%. In men, the risk for metabolic syndrome increased 4% (P < .05) for each hour of SBST. Similarly, for each hour of SBST, the risk of abdominal obesity increased by 4% (P < .01). In women, we observed that the risk of hypertension or high-density lipoprotein cholesterol deficiency increased for each hour of SBST, and the risk of abdominal obesity increased for each hour of SBST in those who were inactive. CONCLUSION: Sedentary behavior based on screen time is associated with metabolic syndrome and its components among Mexicans, depending on hours of sleep. Current public health policies should consider strategies for reducing SBST.

Epidemiología de la hipertensión arterial en adultos mexicanos: diagnóstico, control y tendencias. Ensanut 2020.

Objetivo. Describir la prevalencia de hipertensión arterial (HTA) en adultos mexicanos, la proporción que tiene tensión arterial (TA) controlada y la tendencia en el periodo 2018-2020. Material y métodos. Se midió la TA a 9 844 adultos en la Encuesta Nacional de Salud y Nutrición (Ensanut) 2020. Se consideró que tenían HTA o TA controlada cuando cumplían los criterios del Seventh Joint National Committee (JNC-7) o American Heart Association (AHA). Resultados. La prevalencia de HTA fue 49.4% (según AHA), de los cuales 70% desconocía su diagnóstico. Según la clasificación JNC-7, 30.2% de los adultos tenía HTA y 51.0% ignoraba su diagnóstico. Entre adultos con diagnóstico previo de HTA, 54.9% tuvo TA controlada. Entre el periodo 2018-2020 no se observaron cambios en las prevalencias. Conclusiones. Al menos un tercio de los adultos mexicanos tiene HTA y de ellos al menos la mitad no habían sido diagnosticados. Debe evaluarse la pertinencia de los actuales programas de diagnóstico de HTA porque el subdiagnóstico y mal control pueden ocasionar complicaciones y la muerte.

Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

BACKGROUND: Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS: We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS: In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS: The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. (Funded by the Bill and Melinda Gates Foundation.).

Unintentional injuries in Mexico, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: To date, the burden of injury in Mexico has not been comprehensively assessed using recent advances in population health research, including those in the Global Burden of Disease Study 2017 (GBD 2017). METHODS: We used GBD 2017 for burden of unintentional injury estimates, including transport injuries, for Mexico and each state in Mexico from 1990 to 2017. We examined subnational variation, age patterns, sex differences and time trends for all injury burden metrics. RESULTS: Unintentional injury deaths in Mexico decreased from 45 363 deaths (44 662 to 46 038) in 1990 to 42 702 (41 439 to 43 745) in 2017, while age-standardised mortality rates decreased from 65.2 (64.4 to 66.1) in 1990 to 35.1 (34.1 to 36.0) per 100 000 in 2017. In terms of non-fatal outcomes, there were 3 120 211 (2 879 993 to 3 377 945) new injury cases in 1990, which increased to 5 234 214 (4 812 615 to 5 701 669) new cases of injury in 2017. We estimated 2 761 957 (2 676 267 to 2 859 777) disability-adjusted life years (DALYs) due to injuries in Mexico in 1990 compared with 2 376 952 (2 224 588 to 2 551 004) DALYs in 2017. We found subnational variation in health loss across Mexico's states, including concentrated burden in Tabasco, Chihuahua and Zacatecas. CONCLUSIONS: In Mexico, from 1990 to 2017, mortality due to unintentional injuries has decreased, while non-fatal incident cases have increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary by state, age, sex and year. Future research should focus on targeted interventions to decrease injury burden in high-risk populations.

[Obesity in Mexico, prevalence andtrends in adults. Ensanut 2018-19.] / Obesidad en México, prevalencia y tendencias en adultos. Ensanut 2018-19.

OBJECTIVE: To describe the prevalence of obesity in Mexican adults stratifying by physical and sociodemographic conditions and to analyze trends. MATERIALS AND METHODS: The data of 16 256 adults who participated in Ensanut 2018-19 was analyzed. Obesity (WHO), abdominal adiposity (IFD) and short stature (NOM-008-SSA3-2017) were classified. Logistic regression models were performed to analyze the association between obesity and risk factors. ENSA-2000 and Ensanut (2006, 2012, 2018-19) were used to assess trends. RESULTS: The prevalence of overweight was 39.1%, obesity 36.1%, and abdominal adiposity 81.6%. Adults >40-50y and women had the highest prevalence. There was no difference by socio-economic level. Between 2000-2018, the prevalence of obesity increased 42.2% and morbid obesity 96.5%. Women with short stature had a higher risk (RM=1.84) of being obese than women without this condition, while in men the risk was lower (RM=0.79). CONCLUSIONS: In Mexico the prevalence of obesity continues to increase regardless of socio-economic level, region or locality.

OBJETIVO: Describir la prevalencia de obesidad en adultos mexicanos estratificando por condiciones físicas y sociode-mográficas, y analizar tendencias. MATERIAL Y MÉTODOS: Análisis de 16 256 adultos de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19. Se clasificó obesidad (OMS), adi-posidad abdominal (IDF) y talla baja (NOM-008-SSA3-2017). Se realizaron modelos de regresión logística para asociar obesidad y factores de riesgo. Para evaluar tendencias se analizaron Encuesta Nacional de Salud 2000 y Ensanut (2006, 2012, 2018-19). RESULTADOS: La prevalencia de sobrepeso fue 39.1%, obesidad 36.1% y adiposidad abdominal 81.6%. Se presentaron las prevalencias más altas en >40-50 años y en las mujeres. No hubo diferencia por nivel socioeconómico. En el periodo 2000-2018 aumentó la prevalencia de obesidad 42.2% y de obesidad mórbida 96.5%. Las mujeres con talla baja tuvieron mayor riesgo (RM=1.84) de tener obesidad que las mujeres sin esta condición, mientras que en hombres el riesgo fue menor (RM=0.79). CONCLUSIONES: En México, la prevalencia de obesidad sigue aumentando sin importar nivel socioeconómico, región o localidad.

[Prevalence, diagnosis and control of hypertension in Mexican adults with vulnerable condition. Results of the Ensanut 100k]. / Prevalencia, diagnóstico y control de hipertensión arterial en adultos mexicanos en condición de vulnerabilidad. Resultados de la Ensanut 100k.

OBJECTIVE: To describe the prevalence of hypertension (HBP) in adults with vulnerability, the percentage of them with previous diagnosis and the proportion that had adequate control. MATERIALS AND METHODS: Blood pressure was measured in 7 838 adults who participated in the Ensanut 100k. Those who self-reported the diagnosis of HBP or had systolic blood pressure (SBP) ≥130mmHg or diastolic blood pressure (DBP) ≥80mmHg were classified as hypertensive. Controlled blood pressure was considered when SBP was <130mmHg and TAD <80mmHg. RESULTS: The prevalence of hypertension in adults with a vulnerability condition was 49.2%, of which 54.7% did not know had hypertension. Of the hypertensive patients who received pharmacological treatment (69.0%), 66.8% of them had blood pressure under control. CONCLUSIONS: Almost half of Mexican adults in vulnerable condition have HBP and of these more than half do not know that they have this disease. One third of hypertensive adults have inadequate control.

OBJETIVO: Describir la prevalencia de hipertensión arterial (HTA) en adultos en condición de vulnerabilidad, el porcentaje de ellos con diagnóstico previo y la proporción con control adecuado. MATERIAL Y MÉTODOS: Se midió la tensión arterial a 7 838 adultos participantes en la Ensanut 100k. Se clasificó como hipertensos a quienes autorreportaron el diagnóstico de HTA o presentaban tensión arterial sistólica (TAS) ≥130mmHg o tensión arterial diastólica (TAD) ≥80mmHg. Se consideró tensión arterial controlada cuando la TAS fue <130mmHg y la TAD <80mmHg. RESULTADOS: La prevalencia de HTA en adultos en condición de vulnerabilidad fue de 49.2%, de los cuales 54.7% desconocía tener HTA. De los hipertensos que recibían tratamiento farmacológico (69.0%), el 66.8% tuvo tensión arterial controlada. CONCLUSIONES: Casi la mitad de los adultos mexicanos en condición de vulnerabilidad tiene HTA y de ellos, más de la mitad desconoce que tiene esta enfermedad. Asimismo, un tercio de los adultos hipertensos tiene un inadecuado control de su enfermedad.

[Overweight and obesity in Mexican vulnerable population. Results of Ensanut 100k]. / Sobrepeso y obesidad en población mexicana en condición de vulnerabilidad. Resultados de la Ensanut 100k.

OBJECTIVE: Describe the prevalences and trends of overweight and obesity in population with social vulnerability and resident of localities with <100 thousand inhabitants. MATERIALS AND METHODS: In preschoolers, schoolchildren, adolescents and adults participants of the Ensanut 100k and Ensanut 2012, sociodemographic information and anthropometry was analyzed to stimate the prevalence and trends of overweight+obesity (Ow+O), obesity and abdominal obesity. RESULTS: In preschool children the prevalence of Ow+O was 6%. In school children, adolescents and adults the prevalence of obesity was 15.3, 14.2 and 33.6%, respectively. In preschools with severe food insecurity, the prevalence of Ow+O decreased 35% between 2012-2018. In schoolchildren without program food aid, the prevalence of obesity increase 97% between 2012-2018. In adolescents without program food aid, the prevalence of obesity increase 60% between 2012-2018. In adults with moderate food insecurity, abdominal obesity increased 10% between 2012-2018. CONCLUSIONS: There is a high prevalence of obesity in Mexican population with social limitations and seems to reach the rest of the population quickly but with significant structural disadvantage.

OBJETIVO: Describir las prevalencias y tendencias de sobrepeso y obesidad en población con mayor vulnerabilidad social, residente en localidades con menos de 100 000 habitantes. MATERIAL Y MÉTODOS: En preescolares, escolares, adolescentes y adultos de la Ensanut 100k y Ensanut 2012 se analizó la información sociodemográfica y de antropometría para calcular prevalencias y tendencias de sobrepeso+obesidad (SP+O), obesidad y obesidad abdomina. RESULTADOS: La prevalencia de SP+O fue 6% en preescolares. La prevalencia de obesidad fue 15.3% en escolares, 14.2% en adolescentes y 33.6% en adultos. En comparación con el año 2012, el SP+O disminuyó 35% en 2018 entre los preescolares con inseguridad alimentaria severa. En escolares, la obesidad aumentó 97% entre 2012 y 2018 en quienes no tenían ayuda alimentaria. En adolescentes sin programas de ayuda alimentaria, la obesidad aumentó 60% entre 2012 y 2018. En adultos, entre 2012-2018 incrementó 10% la obesidad abdominal en quienes tenían inseguridad alimentaria moderada. CONCLUSIONES: Existe una alta prevalencia de obesidad en la población mexicana con vulnerabilidad social y parece alcanzar al resto de la población de forma rápida pero con importantes desventajas estructurales.

[Prevalence and trends of physical activity in children and adolescents: results of the Ensanut 2012 and Ensanut MC 2016]. / Prevalencia y tendencias de actividad física en niños y adolescentes: resultados de Ensanut 2012 y Ensanut MC 2016.

OBJECTIVE: To describe the prevalence and trends of physical activity (PA) in children and adolescents from Ensanut 2012 and Ensanut MC 2016. MATERIALS AND METHODS: Physical activity levels were obtained from the Health Behaviour in School-aged Children (HBSC) and the International Physical Activity (IPAQ) questionnaires for children and adolescents respectively. RESULTS: More than 80% of the children and 35% of the adolescents in Mexico do not meet the PA recom¬mendations. From 2012-2016, girls and schoolchildren in the rural area showed an increase in participation in organized activities and sports. CONCLUSIONS: The prevalence of PA is low in children and adolescents and the trend has not improved in the last six years.

OBJETIVO: Describir la prevalencia y tendencias de actividad física (AF) en niños y adolescentes de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012 y Encuesta Nacional de Salud y Nutrición de Medio Camino (Ensanut MC) 2016. MATERIAL Y MÉTODOS: Se recolectó información sobre AF a partir del cuestionario de comportamientos en salud para niños en edad escolar (HBSC) en niños y el Cuestionamiento Internacional de Actividad Física (IPAQ) en adolescentes. RESULTADOS: Más de 80% de los niños y 35% de los ado­lescentes en México no cumple con las recomendaciones de AF. En el periodo 2012-2016, las niñas y escolares de la zona rural mostraron un aumento en la participación en actividades organizadas y deportes. CONCLUSIONES: La prevalencia de AF es baja en niños y adolescentes y la tendencia no ha mejorado en los últimos seis años.

[Hypertension in Mexican adults: prevalence, diagnosis and type of treatment. Ensanut MC 2016.] / Hipertensión arterial en adultos mexicanos: prevalencia, diagnóstico y tipo de tratamiento. Ensanut MC 2016.

OBJECTIVE: To describe the prevalence, awareness and proportion of adults with an adequate control of hypertension. MATERIALS AND METHODS: Blood pressure was measured at 8 352 adults who participated in the Ensanut MC 2016. The adults who reported having diagnosis of hypertension or had systolic blood pressure values (TAS) ≥140mmHg or diastolic blood pressure (TAD) ≥90mmHg were classified as hypertensive. Hypertension was considered controlled when blood pressure was TAS <140mmHg and TAD <90mmHg. RESULTS: The prevalence of hypertension was 25.5%. Of these, 40.0% were unaware of having high blood pressure. Of the hypertensive adults who had previous diagnosis of hypertension and receiving drug treatment (79.3%), 45.6% had blood pressure under control. CONCLUSIONS: A high percentage of adults are unaware of having hypertension and nearly half have inadequate control. The relevance of current programmes for diagnosing hypertension should be assessed, as well as the effectiveness of their control strategies.

OBJETIVO: Describir la prevalencia de hipertensión arterial (HTA) en adultos, el porcentaje de ellos con diagnóstico previo y la proporción que tuvo un control adecuado. MATERIAL Y MÉTODOS: Se midió la tensión arterial a 8 352 adultos que participaron en la Ensanut MC 2016. Se clasificó como hipertensos a quienes reportaron haber recibido previamente el diagnóstico de HTA, o presentaban cifras de tensión arterial sistólica (TAS) ≥140mmHg o tensión arterial diastólica (TAD) ≥90mmHg. Se consideró tensión arterial controlada cuando la TAS <140mmHg y la TAD <90mmHg. RESULTADOS: La prevalencia de HTA en adultos fue de 25.5%, de los cuales, 40.0% desconocían tener HTA. De los hipertensos que tenían diagnóstico previo de HTA y que recibían tratamiento farmacológico (79.3%), 45.6% tuvo tensión arterial bajo control. CONCLUSIONES: Un alto porcentaje de adultos desconocen tener HTA y de ellos casi la mitad tiene un control inadecuado. Debería evaluarse la pertinencia de los actuales programas de diagnóstico de HTA y la efectividad de sus estrategias de control.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

Indicators of Dietary Behavior and Physical Activity Change Associated with Metabolic Control of Obesity, Hypertension, and Type 2 Diabetes Mellitus in Mexican Adults: National Nutrition and Health Survey in Mexico, 2016.

Introduction: Obesity (OB), type 2 diabetes mellitus (T2D), and hypertension (HTN) are health issues in Mexico linked to unhealthy behaviors. This study investigates the relationship between behavior change indicators and metabolic control in Mexican adults with OB, T2D, and HTN. Methods: We used data from the 2016 National Health and Nutrition Survey Midway (ENSANUT MC-2016), representing ∼59.5 million Mexican adults aged 20-59 with these conditions. We assessed behavior change indicators, including stages of change, self-efficacy, and perceptions of benefits and barriers. In addition, we conducted descriptive analyses and used statistical tests, such as Pearson's chi-squared test and logistic regression models, adjusted for multiple variables. Results: We found that adults in the action and maintenance stages of physical activity (PA) were four times more likely to have adequate HTN control than those in the precontemplation stage. Self-efficacy for PA was related to better control in T2D and HTN. Self-efficacy for reducing the consumption of sugary beverages was positively associated with control in OB and T2D. No significant association was observed with self-efficacy for consuming fruits and vegetables. Conclusion: Behavior-change indicators are significantly linked to metabolic control in adults with HTN. These results support the importance of these indicators in managing chronic diseases such as HTN and their potential use in public health strategies.

Sodium and potassium excretion and its association with cardiovascular disorders in Mexican adults.

Worldwide, as well as in Mexico, the leading cause of death is cardiovascular disease (CVD). Hypertension is the main risk factor for CVD; about 50% of the adult population suffers from this condition. High sodium (Na) intake combined with low potassium (K) intake can trigger cardiovascular disorders such as high blood pressure (BP). The aim of this study was to estimate the mean excretion of Na and K in Mexican adults using a spot urine sample, and its association with cardiovascular disorders. Information on 2,778 adults, 20-59 years of age, who participated in ENSANUT-2016 was analyzed. Na and K were estimated using Tanaka formulae. Biomarkers such as glucose, total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol, and anthropometry were measured. Mean Na was 3,354 mg/day (95%CI: 3,278, 3,429), 1,440 mg/day of K (95%CI: 1,412, 1,469), and the Na-K ratio was 2.4. The excretion of Na was greater in adults with high BP (3,542 mg/day) compared to those with normal BP (3,296 mg/day). In adults with hypertension, excretion of K was 10% greater (1,534 mg/day) than in adults with normal BP (1,357 mg/day). In adults with moderate reduction of renal function, Na excretion was 22% less (2,772 mg/day) than in adults with normal kidney function (3,382 mg/day). The results of this study show that the cardiovascular health of Mexican adults is at risk, as they showed high Na excretion and low K excretion.

Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy.

BACKGROUND: Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy. METHOD: We review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field. RESULTS: There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country. CONCLUSIONS: The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future.