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Qasrawi R, Sgahir S, Nemer M, Halaikah M, Badrasawi M, Amro M, Vicuna Polo S, Abu Al-Halawa D, Mujahed D, Nasreddine L, Elmadfa I, Atari S, Al-Jawaldeh A. Investigating the Association between Nutrient Intake and Food Insecurity among Children and Adolescents in Palestine Using Machine Learning Techniques. CHILDREN (BASEL, SWITZERLAND) 2024; 11:625. [PMID: 38929205 PMCID: PMC11202236 DOI: 10.3390/children11060625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 06/28/2024]
Abstract
Food insecurity is a public health concern that affects children worldwide, yet it represents a particular burden for low- and middle-income countries. This study aims to utilize machine learning to identify the associations between food insecurity and nutrient intake among children aged 5 to 18 years. The study's sample encompassed 1040 participants selected from a 2022 food insecurity household conducted in the West Bank, Palestine. The results indicated that food insecurity was significantly associated with dietary nutrient intake and sociodemographic factors, such as age, gender, income, and location. Indeed, 18.2% of the children were found to be food-insecure. A significant correlation was evidenced between inadequate consumption of various nutrients below the recommended dietary allowance and food insecurity. Specifically, insufficient protein, vitamin C, fiber, vitamin B12, vitamin B5, vitamin A, vitamin B1, manganese, and copper intake were found to have the highest rates of food insecurity. In addition, children residing in refugee camps experienced significantly higher rates of food insecurity. The findings emphasize the multilayered nature of food insecurity and its impact on children, emphasizing the need for personalized interventions addressing nutrient deficiencies and socioeconomic factors to improve children's health and well-being.
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Affiliation(s)
- Radwan Qasrawi
- Department of Computer Sciences, Al-Quds University, Jerusalem P.O. Box 20002, Palestine
- Department of Computer Engineering, Istinye University, Istanbul 34010, Turkey
| | - Sabri Sgahir
- Department of Nutrition and Food Technology, College of Agriculture, Hebron University, Hebron P.O. Box 40, Palestine
| | - Maysaa Nemer
- Institute of Community and Public Health, Birzeit University, Ramallah P.O. Box 14, Palestine
| | - Mousa Halaikah
- Nutrition Department, Ministry of Health, Ramallah P.O. Box 4284, Palestine
| | - Manal Badrasawi
- Nutrition and Food Technology Department, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus P.O. Box 7, Palestine
| | - Malak Amro
- Department of Computer Sciences, Al-Quds University, Jerusalem P.O. Box 20002, Palestine
| | - Stephanny Vicuna Polo
- Department of Computer Sciences, Al-Quds University, Jerusalem P.O. Box 20002, Palestine
| | - Diala Abu Al-Halawa
- Faculty of Medicine, Al-Quds University, Jerusalem P.O. Box 20002, Palestine
| | - Doa’a Mujahed
- Department of Nutrition and Food Technology, College of Agriculture, Hebron University, Hebron P.O. Box 40, Palestine
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Ibrahim Elmadfa
- Department of Nutrition, Faculty of Life Sciences, University of Vienna, 1090 Vienna, Austria
| | - Siham Atari
- Department of Computer Sciences, Al-Quds University, Jerusalem P.O. Box 20002, Palestine
| | - Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo 7608, Egypt
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Barrero JA, Duarte-Zambrano F, Mockus I. The socioeconomic gradient in overweight and obesity among Colombian adult and pediatric populations: A scoping review. Nutr Health 2024:2601060241248307. [PMID: 38651331 DOI: 10.1177/02601060241248307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Background: The imminent increase in overweight and obesity prevalence constitutes a pervasive concern for the adult and pediatric Colombian population. Nonetheless, the unequal distribution across distinct social groups limits the implementation of public health policies targeting these escalating rates. Aim: This study aimed to compile existing evidence regarding the prevalence of overweight and obesity in relation to the socioeconomic status (SES) of the Colombian population. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews parameters in MEDLINE (PubMed), EMBASE, and LILACS databases for inclusion of investigations published up to January 2024. Results: Twenty-two cross-sectional studies were included. A higher prevalence of overweight and obesity was documented in adults with lower SES defined by social stratum and monetary income, while in particular for nonpregnant adult women, the prevalence of excess weight was higher in the medium-low socioeconomic stratum. In the pediatric population, higher SES defined by social stratum was directly related to an increased prevalence and risk of overweight and obesity. The ownership of household assets, however, was positively related to the risk of overweight in both adult and pediatric populations. Conclusion: The findings of this investigation disclose a socioeconomic gradient in overweight and obesity in Colombia that resembles the epidemiological distribution in high-income countries for adults, though similar to low-income countries for the pediatric population. Further intersectoral interventions aimed at the most vulnerable groups are imperative to mitigate the inequalities that condition their predisposition to overweight and obesity.
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Affiliation(s)
- Jorge A Barrero
- Departamento de Ciencias Fisiológicas, División de Lípidos y Diabetes, Facultad de Medicina, Universidad Nacional de Colombia, Sede Bogotá, Bogotá, Colombia
| | - Felipe Duarte-Zambrano
- Departamento de Ciencias Fisiológicas, División de Lípidos y Diabetes, Facultad de Medicina, Universidad Nacional de Colombia, Sede Bogotá, Bogotá, Colombia
| | - Ismena Mockus
- Departamento de Ciencias Fisiológicas, División de Lípidos y Diabetes, Facultad de Medicina, Universidad Nacional de Colombia, Sede Bogotá, Bogotá, Colombia
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Trilok‐Kumar G, Malik A, Gusain Y, Millerot E, Pathak R, Filteau S. Dietary patterns of Indian school-aged children and associations with markers of chronic disease risk. Food Sci Nutr 2023; 11:7070-7079. [PMID: 37970425 PMCID: PMC10630838 DOI: 10.1002/fsn3.3631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 11/17/2023] Open
Abstract
There is an increasing burden of noncommunicable diseases (NCDs) in India which may be related to changing dietary patterns. We aimed to assess dietary patterns in children since they have time to change unhealthy patterns before NCDs develop. Participants were 665 children, 9-12 years old, born with low birth weight and 77 similarly aged normal birth weight controls. We collected data on sociodemography, anthropometry, body composition, and markers of risk for NCDs: grip strength, long jump, hemoglobin A1c (HbA1c). A food frequency questionnaire was used to collect dietary data from which dietary patterns were derived using principal component analysis (PCA). Fourteen food groups were included in the PCA analysis, resulting in three components: 'fruits and vegetables', 'protein', and 'sugar and fat'. Higher socioeconomic status and maternal education were associated with lower adherence to the fruit and vegetable pattern and higher adherence to the protein and sugar and fat patterns. Adherence to the fruits and vegetables pattern was associated with lower height-for-age, whereas the fat and sugar pattern was associated with higher indicators of body fat. In linear regression analyses adjusted for age, sex, religion, socioeconomic status, maternal education, and season of data collection, adherence to the 'fruits and vegetables' pattern was associated with lower grip strength, shorter long jump, and lower HbA1c. Adherence to the other patterns was not associated with NCD risk factors. Higher consumption of fruits and vegetables, achievable even by poorer families in the cohort, may lower HbA1c, a risk factor for diabetes.
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Affiliation(s)
| | - Anku Malik
- Institute of Home Economics, University of DelhiNew DelhiIndia
| | - Yamini Gusain
- Institute of Home Economics, University of DelhiNew DelhiIndia
| | - Eve Millerot
- London School of Hygiene and Tropical MedicineLondonUK
| | - Renuka Pathak
- Institute of Home Economics, University of DelhiNew DelhiIndia
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de Menezes LRD, E Souza RCV, Cardoso PC, Dos Santos LC. Factors Associated with Dietary Patterns of Schoolchildren: A Systematic Review. Nutrients 2023; 15:nu15112450. [PMID: 37299412 DOI: 10.3390/nu15112450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
The evaluation of food consumption in childhood is essential to help understand the effect of food choices on health. The objective of this study was to conduct a systematic review of studies that identified the dietary patterns in schoolchildren (7-10 years old) and their associated factors. Observational studies published in the last ten years were searched in the databases BVS (Virtual Health Library), Embase, PubMed, Scopus, and Web of Science. The Newcastle Ottawa Scale was adopted to evaluate the articles' quality. The studies covered schoolchildren, children, and adolescents as part of the sample. We selected 16 studies, 75% of which were considered good/very good and seven mentioned three food patterns. A dietary pattern considered unhealthy was identified in 93.75% of the studies, having as associated factors to its consumption: higher screen time, low bone mass, gain of weight and fat in children, and meal skipping. The children who usually had breakfast showed greater adherence to the dietary pattern consisting of healthier foods. The children's dietary patterns were related to their behavior, nutritional status, and family environment habits. Food and nutrition education's effective actions, as well as the regularization of the marketing of ultra-processed foods, must be stimulated and inserted in public policies as a way to promote and protect children's health.
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Affiliation(s)
| | | | - Pollyanna Costa Cardoso
- Nutrition Department, Universidade Federal de Juiz de Fora, Governador Valadares 35010-180, MG, Brazil
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Maldonado-González M, Hernández-Nazara ZH, Torres-Castillo N, Martínez-López E, de la Cruz-Color L, Ruíz-Madrigal B. Association between the rs3812316 Single Nucleotide Variant of the MLXIPL Gene and Alpha-Linolenic Acid Intake with Triglycerides in Mexican Mestizo Women. Nutrients 2022; 14:nu14224726. [PMID: 36432414 PMCID: PMC9692638 DOI: 10.3390/nu14224726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
The carbohydrate response element binding protein (ChREBP) is a key transcription factor to understand the gene−diet−nutrient relationship that leads to metabolic diseases. We aimed to analyze the association between the rs17145750 and rs3812316 SNVs (single nucleotide variants) of the MLXIPL gene with dietary, anthropometric, and biochemical variables in Mexican Mestizo subjects. This is a cross-sectional study of 587 individuals. Genotyping was performed by allelic discrimination. In addition, liver and adipose tissue biopsies were obtained from a subgroup of 24 subjects to analyze the expression of the MLXIPL gene. An in silico test of the protein stability and allelic imbalance showed that rs17145750 and rs3812316 showed a high rate of joint heritability in a highly conserved area. The G allele of rs3812316 was associated with lower triglyceride levels (OR = −0.070 ± 0.027, p < 0.011, 95% CI = −0.124 to −0.016), the production of an unstable protein (ΔΔG −0.83 kcal/mol), and probably lower tissue mRNA levels. In addition, we found independent factors that also influence triglyceride levels, such as insulin resistance, HDL-c, and dietary protein intake in women. Our data showed that the association of rs3812316 on triglycerides was only observed in patients with an inadequate alpha-linolenic acid intake (1.97 ± 0.03 vs. 2.11 ± 0.01 log mg/dL, p < 0.001).
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Affiliation(s)
- Montserrat Maldonado-González
- Laboratorio de Investigación en Microbiología, Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Zamira H. Hernández-Nazara
- Instituto de Investigación en Enfermedades Crónicas Degenerativas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Nathaly Torres-Castillo
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44100, Jalisco, Mexico
| | - Erika Martínez-López
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44100, Jalisco, Mexico
| | - Lucia de la Cruz-Color
- Centro de Investigación en Biotecnología Microbiana y Alimentaria, División de Desarrollo Biotecnológico, Centro Universitario de la Ciénega, Universidad de Guadalajara, Guadalajara 47820, Jalisco, Mexico
| | - Bertha Ruíz-Madrigal
- Laboratorio de Investigación en Microbiología, Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
- Correspondence: ; Tel.: +52-(33)10585200
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Flores-Moreno BJ, Martínez-Andrade G, Klünder-Klünder M, Miranda-Lora AL, Beristain-Lujano B, Flores-Huerta S, Mendoza E, Mayorga-Lima A, Duque X, Vilchis-Gil J. Evidence of Unhealthy Dietary Patterns in the School Lunch Sent from Home for Children in Mexico City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11650. [PMID: 36141913 PMCID: PMC9517523 DOI: 10.3390/ijerph191811650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
The identification and characterization of dietary patterns are tools that are used to assess associations between diet and health or disease conditions. In Mexico, studies have examined dietary patterns in children for breakfast or for the whole day, but not specifically for their school lunch. The aim was to describe dietary patterns identified in school lunch and their association with the nutritional status and metabolic parameters of schoolchildren. In this cross-sectional study on schoolchildren from four elementary schools of Mexico City, we recorded anthropometry measurements, a fasting blood sample was collected, and metabolic parameters were determined. We obtained information on the foods and beverages that children brought for their school lunch; estimated the caloric and nutritional content; and created food groups to obtain dietary patterns from the energy provided by those groups. Among the 350 schoolchildren (mean age, 7.9 ± 1.2 years) included, 24.9% and 21.7% presented having overweight and obesity, respectively. A total of 89.4% of schoolchildren brought the school lunch from home. Using the K-means method, the following four dietary patterns were identified: (1) sandwiches, tortas, and sweetened dairy products were consumed by 13.1% (n = 46) of the schoolchildren; (2) sweet snacks were consumed by 50.3% (n = 176); (3) sweetened dairy products were brought by 15.1% of the children (n = 53); and (4) sandwiches and tortas were brought by 21.4% (n = 75). These four patterns showed significant differences in terms of the caloric and nutritional contents (p < 0.001). Energy sources in the identified patterns were primarily sugars (15.8-40%). No association was found between the anthropometric and metabolic parameters of children and the dietary patterns. No dietary pattern obtained from the school lunch could be considered as healthy, since all of them had high energy content, and a high percentage of the energy was from sugars from ultra-processed foods and beverages.
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Affiliation(s)
- Brenda Jazmín Flores-Moreno
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gomez, Ministry of Health (SSA), Mexico City 06720, Mexico
| | - Gloria Martínez-Andrade
- Academic Area of Nutrition, Institute of Health Sciences, Autonomous University of the State of Hidalgo, Pachuca Hidalgo 42000, Mexico
| | - Miguel Klünder-Klünder
- Research Division, Mexico Children’s Hospital Federico Gómez, Mexico City 06720, Mexico
- Research Committee, Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN), Mexico City 06720, Mexico
| | - América Liliana Miranda-Lora
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gomez, Ministry of Health (SSA), Mexico City 06720, Mexico
| | - Brenda Beristain-Lujano
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gomez, Ministry of Health (SSA), Mexico City 06720, Mexico
| | - Samuel Flores-Huerta
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gomez, Ministry of Health (SSA), Mexico City 06720, Mexico
| | - Eugenia Mendoza
- Infectious Diseases Research Unit, Pediatric Hospital, Mexican Institute of Social Security, Mexico City 06600, Mexico
| | - Ariana Mayorga-Lima
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gomez, Ministry of Health (SSA), Mexico City 06720, Mexico
| | - Ximena Duque
- Infectious Diseases Research Unit, Pediatric Hospital, Mexican Institute of Social Security, Mexico City 06600, Mexico
| | - Jenny Vilchis-Gil
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gomez, Ministry of Health (SSA), Mexico City 06720, Mexico
- Medicine Faculty, National Autonomous University of Mexico, Mexico City 06320, Mexico
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Gračner T, Marquez-Padilla F, Hernandez-Cortes D. Changes in Weight-Related Outcomes Among Adolescents Following Consumer Price Increases of Taxed Sugar-Sweetened Beverages. JAMA Pediatr 2022; 176:150-158. [PMID: 34902003 PMCID: PMC8669601 DOI: 10.1001/jamapediatrics.2021.5044] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Following the implementation of a tax on sugar-sweetened beverages (SSBs) in Mexico in 2014, SSB prices increased by about 10% on average, but differently across cities. It remains unclear how observed SSB price changes are associated with adolescent weight-related outcomes. OBJECTIVE To compare weight-related outcomes among adolescents living in cities with differential SSB price changes before and after the SSB tax was implemented in Mexico. DESIGN, SETTING, AND PARTICIPANTS Associations between differential SSB price changes and changes in weight-related outcomes were examined overall and by sex among 12 654 adolescents aged 10 to 18 years born between 1999 and 2002 living in 39 cities in Mexico. Multivariate regressions with individual fixed effects were applied on longitudinal individual-level yearly clinical data (height and weight) from 2012 to 2017 collected by the Instituto Mexicano del Seguro Social (IMSS) and merged with city-level SSB price data from 2011 to 2016 collected by the National Institute of Statistics and Geography (INEGI). Data were analyzed from July 2018 to July 2021. EXPOSURES Yearly city-level changes in SSB prices between 2011 and 2016. MAIN OUTCOMES AND MEASURES Age- and sex-specific body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) percentile and indicator for overweight or obesity if BMI was at or above the 85th percentile. RESULTS Before 2014, 46% of 12 654 adolescents (6850 girls and 5804 boys) included in this study had obesity or overweight. The mean (SD) age was 11.38 (1.08) years. Among girls, a 10% SSB price increase was associated with a 1.3 percentage point absolute decrease (95% CI, -2.19 to -0.36; P = .008) or a 3% relative decrease in overweight or obesity prevalence within 2 years of a price change. For girls with BMI at or above the 75th percentile pretax, this price increase was associated with a 0.59 lower BMI percentile (95% CI, -1.08 to -0.10; P = .02) or a 0.67% relative decrease. Improved outcomes for girls were observed in cities where price increases were greater than 10% after the tax. No such associations were observed for boys. CONCLUSIONS AND RELEVANCE In this study, increased SSB prices were associated with decreased overweight or obesity prevalence among girls but not among boys. Improvements in outcomes were small, and mostly observed for girls with heavier weight and in cities where price increases after the tax were greater than 10%.
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Clark P, Mendoza-Gutiérrez CF, Montiel-Ojeda D, Denova-Gutiérrez E, López-González D, Moreno-Altamirano L, Reyes A. A Healthy Diet Is Not More Expensive than Less Healthy Options: Cost-Analysis of Different Dietary Patterns in Mexican Children and Adolescents. Nutrients 2021; 13:3871. [PMID: 34836126 PMCID: PMC8624608 DOI: 10.3390/nu13113871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 01/10/2023] Open
Abstract
Unhealthy diets are recognized as a major risk factor for many diseases. The decrease in costs of industrialized products, as well as the possible misinformation about a healthy diet, has led to new behaviors in the dietary patterns of the pediatric population. The costs of dietary patterns have not been estimated in our population, so the objective of this study was to determine the cost associated with dietary patterns in Mexican children and adolescents, hypothesizing that a healthy diet is not necessarily more economically expensive. This study analyzed data from a population-based cross-sectional study of healthy children and adolescents in Mexico City. Data were collected from a food frequency questionnaire and the meal cost of habitual food shopping. Eating patterns were obtained by using principal component analysis. A micro-costing technique was performed to obtain the direct costs of each pattern. When comparing the healthy pattern with the transition and non-healthy patterns, it was observed that there were no statistically significant differences between the dietary patterns (p = 0.8293). The cost of the healthy pattern only takes up 16.6% of the total biweekly income of a salaried Mexican. In this study, no differences were observed between the costs of a healthy and a less healthy diet.
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Affiliation(s)
- Patricia Clark
- Clinical Epidemiology Research Unit, Children’s Hospital of Mexico Federico Gomez-Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 06720, Mexico; (P.C.); (D.M.-O.); (D.L.-G.)
| | - Carlos F. Mendoza-Gutiérrez
- Clinical Epidemiology Research Unit, Children’s Hospital of Mexico Federico Gomez-Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 06720, Mexico; (P.C.); (D.M.-O.); (D.L.-G.)
| | - Diana Montiel-Ojeda
- Clinical Epidemiology Research Unit, Children’s Hospital of Mexico Federico Gomez-Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 06720, Mexico; (P.C.); (D.M.-O.); (D.L.-G.)
| | - Edgar Denova-Gutiérrez
- Nutrition and Health Research Center, Public Health National Institute, Cuernavaca 62000, Mexico;
| | - Desirée López-González
- Clinical Epidemiology Research Unit, Children’s Hospital of Mexico Federico Gomez-Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 06720, Mexico; (P.C.); (D.M.-O.); (D.L.-G.)
| | - Laura Moreno-Altamirano
- Department of Public Health, Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 04510, Mexico;
| | - Alfonso Reyes
- Center for Economic and Social Studies in Health, Children’s Hospital of Mexico Federico Gomez, Mexico City 06720, Mexico;
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