Caloric beverage consumption patterns in Mexican children

Impact of a School-Based Intervention on Sugar-Sweetened Beverage Intake Substitution by Water in Mexican Scholars

INTRODUCTION

The prevalence of overweight and obesity in children has increased in recent years, associated with substituting plain water intake with sugar-sweetened beverages. The aim of the study was to evaluate the impact of a school-based intervention that aimed to replace sugar-sweetened beverages with water on Mexican scholars.

METHODS

We included 314 children aged 9-11 from three public schools of the State of Hidalgo, Mexico, randomized to intervention (two schools from the municipality of Apan; six classes with 146 participants) or control group (one school from the municipality of Emiliano Zapata; six classes with 168 participants) and followed for 6 months. The intervention consisted of placing drinking fountains at schools and classrooms with nutritional education lessons to increase water consumption and decrease sugar-sweetened beverages. Mixed models for repeated measures were used to assess the impact of the intervention.

RESULTS

At the end of the study, water consumption was higher (200 mL/day, p = 0.005), and flavored milk consumption was lower (94 mL/day, p = 0.044) in the intervention group compared with the control group. There was also a statistically significant reduction in energy (p = 0.016) and sugar intake (p = 0.007).

CONCLUSIONS

The school-based intervention favorably modified the consumption pattern of sugar-sweetened beverages and water in Mexican students.

Prevalence of healthy diet and activity behaviours among U.S. Latino preschool children living in an emerging Latino community

This pilot study provides preliminary insights into whether Latino preschool children living in an emerging Latino community (ELC) are meeting recommendations for healthy diet and activity behaviours and whether those behaviours are associated with sociodemographic or home environment variables. Secondary data analysis was conducted utilising cross-sectional baseline survey data from ANDALE Pittsburgh, a home-based intervention study. Measures included parent-reported information on child dietary intake, screen time and the home environment, and objectively measured physical activity and anthropometry. χ² and Fischer's exact tests were used to determine associations. The study was conducted in an ELC in western Pennsylvania in the US. Fifty-one Latina mothers (age: 33⋅5 ± 6⋅1 years; 63 % Mexican origin; 86 % low acculturation) and their children (age: 3⋅9 ± 1⋅3 years; 55 % male) 2-5 years of age. On average, children consumed 2⋅25 ± 1⋅44 cups of fruits/vegetables, viewed 98⋅7 ± 74⋅2 min of screen time, accumulated 12⋅9 ± 2⋅9 min/h of total physical activity and consumed 15⋅5 ± 26⋅0 kcals of sugar-sweetened beverages per day. Forty-one percent met the fruit/vegetable recommendation, 54 % met the screen time recommendation, 27 % met the physical activity recommendation and 58 % met the sugary drink recommendation. Country of origin (P = 0⋅032) and acculturation (P = 0⋅048) were significantly associated with children meeting sugary drink recommendations. No other relationships were significant. The proportion of children in this sample meeting diet and activity recommendations was mixed. More research with larger sample sizes is needed in ELCs to identify effective intervention strategies for improving health behaviours.

The potential epidemiologic, clinical, and economic impact of requiring schools to offer Physical Education (PE) classes in Mexico City

Background

Many schools have been cutting physical education (PE) classes due to budget constraints, which raises the question of whether policymakers should require schools to offer PE classes. Evidence suggests that PE classes can help address rising physical inactivity and obesity prevalence. However, it would be helpful to determine if requiring PE is cost-effective.

Methods

We developed an agent-based model of youth in Mexico City and the impact of all schools offering PE classes on changes in weight, weight-associated health conditions and the corresponding direct and indirect costs over their lifetime.

Results

If schools offer PE without meeting guidelines and instead followed currently observed class length and time active during class, overweight and obesity prevalence decreased by 1.3% (95% CI: 1.0%-1.6%) and was cost-effective from the third-party payer and societal perspectives ($5,058 per disability-adjusted life year [DALY] averted and $5,786/DALY averted, respectively, assuming PE cost $50.3 million). When all schools offered PE classes meeting international guidelines for PE classes, overweight and obesity prevalence decreased by 3.9% (95% CI: 3.7%-4.3%) in the cohort at the end of five years compared to no PE. Long-term, this averted 3,183 and 1,081 obesity-related health conditions and deaths, respectively and averted ≥$31.5 million in direct medical costs and ≥$39.7 million in societal costs, assuming PE classes cost ≤$50.3 million over the five-year period. PE classes could cost up to $185.5 million and $89.9 million over the course of five years and still remain cost-effective and cost saving respectively, from the societal perspective.

Conclusion

Requiring PE in all schools could be cost-effective when PE class costs, on average, up to $10,340 per school annually. Further, the amount of time students are active during class is a driver of PE classes’ value (e.g., it is cost saving when PE classes meet international guidelines) suggesting the need for specific recommendations.

The Combination of School-Based and Family-Based Interventions Appears Effective in Reducing the Consumption of Sugar-Sweetened Beverages, a Randomized Controlled Trial among Chinese Schoolchildren

To examine whether environmental interventions, student awareness and parents’ model roles are associated with the consumption of sugar-sweetened beverages (SSBs), a randomized controlled trial was conducted among Chinese schoolchildren. A multi-stage cluster random sampling method was applied to select four primary schools, two in urban areas and two in rural areas, in Nanjing, eastern China. Classes of the third grade in the selected four schools were randomly assigned to the intervention group and control group. Among selected students in those classes, aged 9–10 years, those in the intervention group received intervention measures comprising school-based and family-based measures and accepted monthly monitoring along with interventions, for two consecutive semesters, while those in the control group did not receive any specific interventions. After intervention, there was a significant increase in SSB knowledge and an improvement in the family environment with parents in the intervention group. The proportion of frequent consumption (≥4 times/week) of any SSBs in the intervention group was lower than that in the control group (31.5% vs. 56.2%, p < 0.01). Multivariate analysis indicated that parental education level is positively associated with reduced SSB consumption. Interventions showed an average decrease in SSBs consumption by 1.77 units, those living in urban areas decreased by 2.05 units. The combination of school-based and family-based interventions appears effective in reducing SSB consumption among Chinese schoolchildren, especially in urban areas and for those with parents with lower educational levels.

Monounsaturated Fat Intake Was Associated with Lower Abdominal Obesity but Poor Dietary Quality Remains in Elementary School Children from Northwest Mexico

Overweight and obesity in Mexican elementary school children increased ten percentage points in the last 30 years; one of the factors attributed is inadequate dietary quality. The objective of this study was to evaluate the association of monounsaturated fat intake with abdominal obesity and nutrient intake and obesity and overweight with dietary quality of elementary school children from Northwest Mexico. A cross-sectional study was conducted with 218 first grade elementary school children. A socioeconomic survey and two nonconsecutive 24-HR were applied, and anthropometric measurements were taken. Dietary quality was evaluated and classified as: healthy, medium and poor. Children consumed fewer servings of fruits, vegetables, legumes, dairy products and water than recommended by the Mexican food guidelines. A negative association was found among monounsaturated fat intake and abdominal obesity (p = .032). Only 1.4% of the children presented healthy dietary quality, 44.5% showed a medium dietary quality, and 54.1% had poor dietary quality. Poor dietary quality was associated with a lower intake of fiber (p = .002), protein (p = .002), potassium (p = .001) and vitamin E (p = .002). Elementary school children from Northwest Mexico have inadequate dietary quality that compromises their nutritional and health status, while monounsaturated fat intake could be a protective factor for abdominal obesity.

Association Between Breastfeeding and Child Overweight in Mexico

BACKGROUND

Globally, the prevalence of child overweight has increased over the past few decades. The largest burden of child overweight is identified among upper-middle-income countries, such as Mexico. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child overweight.

OBJECTIVE

To examine the association between breastfeeding and child overweight while sequentially controlling for individual, household, and area factors in Mexican children.

METHODS

Secondary data analysis using the 2012 Mexican National Health and Nutrition Survey which included risk factors for overweight on 2089 children aged 6 to 35 months and analyzed data to estimate fixed- and mixed-effects logistic regression models.

RESULTS

Overall, 9.0% of children were overweight and 71.1% of mothers reported any breastfeeding for ≥ 6 months. We found no evidence for a protective effect of any breastfeeding for ≥ 6 months on child overweight when compared to children who were never breastfed in the fully adjusted model and across all models (model 4, adjusted odds ratio [AOR] [95% CI] = 0.76 [0.31-1.86]). We identified risk factors for child overweight at the individual and area levels, with maternal obesity and offspring high birthweight being significant in the fully adjusted model and across all models (model 4, AOR [95% CI] = 2.26 [1.32-3.85] and 2.83 [1.44-5.56], correspondingly).

CONCLUSIONS

Our results suggest shared obesogenic environment influences from which the overweight-obese maternal-child dyads are emerging in Mexican households. More research is needed to better understand these obesogenic environments grounded on the particular contexts among upper-middle-income countries.

Maternal Factors and Their Association with Patterns of Beverage Intake in Mexican Children and Adolescents

Childhood and adolescence represent critical periods where beverage and food consumption behaviors are learned and developed. Mexican mothers' presence and influence are instrumental in shaping such behaviors. The aim of this study was to estimate the prevalence and risk associations of maternal factors for unhealthy patterns of beverage intake. This study analyzed data from a population-based cross-sectional study of healthy children and adolescents from Mexico City. Data of subject's total water intake (TWI) and its' sources were collected using two 24-h recall surveys. Patterns of beverage intake were constructed based on the guidance system of beverage consumption in the US. Maternal factors of interest included age, body mass index (BMI), mother's educational level (MEL), socioeconomic status (SES), and belongingness to the paid workforce (BPW). Data of 1532 subject-mother dyads informed that 47% of subjects did not meet the Institute of Medicine (IOM) recommendations for TWI, and 94.6% showed an unhealthy beverage intake pattern, mainly consisting in a lower intake of water and a higher intake of caloric beverages with some nutrients; and calorically sweetened beverages. The major sources of hydration were caloric beverages with some nutrients (i.e., whole milk, fruit water, and flavored milk). The highest risk association for an unhealthy beverage intake pattern was seen in those subjects with mothers in the cluster with lower SES, lower MEL, lower proportion of BPW, higher BMI, and younger age (OR = 9.3, 95% CI 1.2-72.8, P = 0.03). Thus, there is a remarkably high prevalence of an unhealthy pattern of beverage intake, and specific maternal factors may be implicated as enablers of such behaviors, which is also addressable for future interventions.

Feeding pattern, biochemical, anthropometric and histological effects of prolonged ad libitum access to sucrose, honey and glucose-fructose solutions in Wistar rats

BACKGROUND/OBJECTIVES

The exposure to sucrose in rats has mimic abnormalities attributed to metabolic syndrome (MetS). The effects of honey bee and "free" glucose and fructose, have not been explored in this context. The aim was to expose Wistar rodents to sucrose solution (SS), honey solution (HS) and fructose/glucose solution (GFS) at 30% to assess their effects.

SUBJECTS/METHODS

HS (n = 10), SS (n = 10) and GFS (n = 10) groups were formed. Solutions were ad libitum along 14-weeks.

RESULTS

Between solutions consumptions, honey was significantly 42% higher (P = 0.000), while similar consumption was observed among GFS and SS. The feeding pattern of HS consumption was irregular along experiment; while the food intake pattern showed the similar trend among groups along time. Non statistical differences were obtained in any biochemical and anthropometric measure, however, a higher concentration of leptin (721 ± 507 pg/mL), lower concentration of total cholesterol (TC; 48.87 ± 2.41 mg/100 mL), very low density lipoprotein (VLDL; 16.47 ± 6.55 mg/100 mL) and triglycerides (82.37 ± 32.77 mg/100 mL) was obtained in SS group. For anthropometric values, HS showed less total adipose tissue (AT; average 26 vs. 31-33 g) and adiposity index (average 6.11 vs. 7.6). Due to sugar-sweetened beverages consumption increases the risk for the development of chronic diseases; correlations between fluid intake and anthropometric and biochemical parameters were assessed. A moderate correlation was obtained in groups with the weight of total AT and solution intake; for the weight gain in GFS group and for triglycerides in HS and GFS. The highest hepatic tissue damage was observed in SS group with multiple intracytoplasmic vacuoles, atypia changes, moderate pleomorphism and hepatocellular necrosis.

CONCLUSIONS

In spite of the significantly higher consumption of HS, biochemical, anthropometrical and histological effects were not remarkably different in comparision to other sweeteners.

Contribution of Home and School Environment in Children's Food Choice and Overweight/Obesity Prevalence in African Context: Evidence for Creating Enabling Healthful Food Environment

This review aimed primarily to investigate the current trends of overweight and obesity in school children in the African context, secondly to explore the contribution of home and school environments on the children’s food choices and lastly suggesting measures for creating a healthier food environment. Despite the increase in overweight and obesity among school children, empirical evidence on their determinants in the African context is scarce, thus calls for consideration of home and school environments. A literature search was conducted between October and December 2018 using Medline (PubMed), Directory of Open Access Journals, Google Scholar, manual search and “grey” literature. This review included articles published between the 1st January 2008 and 30th June 2018. Out of 343 articles, 49 were included for the full text reading after meeting the inclusion criteria. Five reports from grey literature were also included. Results show that the prevalence of overweight and obesity among school children in Africa is increasing and ranges from <5% to >40% in the 10-year period in which the review was taken. High socio-economic status, urban residence and female gender predicted higher prevalence of overweight/obesity. Few reviewed articles on the contribution of home and school environments on children’s food choices showed a shred of evidence, thus calls for further research to address this gap. This review found an increasing prevalence of overweight and obesity in school children in Africa. Therefore, further investigation of home and school environment is imperative to curb the increase in the magnitude of overweight and obesity.

Trends in Beverage Consumption and Related Demographic Factors and Obesity among Korean Children and Adolescents

It is well known that reducing consumption of sugar is a global public health priority. Beverages were the primary source of total sugar intake from processed foods. However, there are few studies investigating the trend of beverage consumption among children and adolescents in Korea. We examined the overall trend in beverage consumption among 11,996 participants aged 10-18 years who were enrolled in the Korea National Health and Nutrition Examination Survey (KNHANES) (1998-2018). Further, we examined the effect of beverage types on beverage consumption-related demographic factors and obesity among 6121 participants using the recent 24 h dietary recall data (2010-2018) that captured the consumption of fruit and vegetable juices, soft drinks, milk and milk-based products and alcoholic beverages. Demographic characteristics, including sex, age, body mass index, household income level and residential area, were considered. Consumers' overall beverage intake and the percentage of energy derived from fruit and vegetable juices and soft drinks steadily increased from 1998 to 2016-2018 (p-trend < 0.0001); in contrast, dairy product consumption declined since 2010-2012. The main sources of beverage-based calories were fruit and vegetable juices (107.5 kcal/day), soft drinks (145.2 kcal/day), dairy products (181.8 kcal/day) and alcoholic beverages (103.5 kcal/day). Also, Korean adolescents aged 16-18 years consumed more soft drinks, fewer dairy products and higher alcoholic drinks than other age groups; particularly, boys consumed more energy from beverages (p < 0.0001). The odds ratios of obesity prevalence tended to be higher for soft drink consumption than for other beverages but this was not significant. The consumption of fruit and vegetable juices and milk and milk products showed a marginal association with a reduced risk of obesity prevalence. Since beverage consumption has increased steadily among Korean children and adolescents, appropriate interventions are needed. In the future, data from a larger sample of Korean children and adolescents are necessary to identify significant differences and longitudinal studies are necessary to examine the causalities.

Relationship between different levels of the Mexican food environment and dietary intake: a qualitative systematic review

Objective:

To investigate the possible associations between the food environment and dietary intake in the Mexican population.

Design:

Four databases (PubMed, PsychInfo, Web of Science and SCIelo) were used to retrieve relevant articles using an open timeframe. Articles were reviewed if they contained a systematic measure (i.e. food checklist) of the food environment (e.g. food availability) and dietary intake.

Setting:

Urban and rural communities in Mexico.

Participants:

Population-based studies of Mexican communities.

Results:

Twenty studies that assessed at least one food environment level, and at least one dietary outcome, were reviewed. Findings from these studies showed that changes in the Mexican food environment seem to be associated with higher availability of energy-dense foods. Energy-dense foods can be linked to a high consumption in household, environment and community food environments. When both nutrient-dense and energy-dense foods were present, individuals were more likely to consume foods with added sugars, fats and salt options than nutrient-dense items.

Conclusions:

The various levels of the food environment (i.e. household, school, community) exposed participants to energy-dense foods. Although nutrient-dense foods were present in all three levels, individuals were more likely to consume energy-dense food items. Not all three levels of the food environment are well represented in the urban and rural settings. Most studies on the community food environment were done in rural areas, whereas most studies on the school food environment were done in urban settings. Additional rigorously designed studies are needed to document the relationship between the food environment and dietary intake in the Mexican population.

Drinking water improvements and rates of urinary and gastrointestinal infections in Galápagos, Ecuador: Assessing household and community factors

OBJECTIVES

The Galápagos provides an important setting to investigate the health impacts of a new drinking water treatment plant (DWTP) in a limited resource environment. We examine how household perceptions and practices affect the relationship between water quality and infections before and after DWTP.

METHODS

Ethnographic data and self-reported infections were collected from 121 mothers and 168 children ages 2 to 10 from Isla San Cristóbal. Household tap water samples were tested for levels of fecal contamination. Community level infection rates were estimated using discharge records from the Ministry of Public Health. The effects of the new DWTP and fecal contamination levels on infections were tested using logistic and Poisson models.

RESULTS

Perceptions of water quality and household practices influenced exposures to contaminated tap water. We found minimal change in drinking water sources with 85% of mothers sampled before the DWTP and 83% sampled after using bottled water, while >85% from the pooled sample used tap water for cooking and hygiene practices. The DWTP opening was associated with lower odds of fecal contamination in tap water, reported urinary infections, and community level rates of urinary and gastrointestinal infections. The household practice of recently washing the cistern contributed to higher contamination levels after the DWTP opened.

CONCLUSIONS

To ensure access to clean water, public health works need to consider how household perceptions and practices influence tap water use and quality, in addition to infrastructure improvements. Exposures to contaminated tap water contribute to the burden of infectious disease in environments with inadequate water infrastructure.

Attributable Burden and Expenditure of Cardiovascular Diseases and Associated Risk Factors in Mexico and other Selected Mega-Countries

BACKGROUND

This paper describes the health and economic burden of cardiovascular diseases (CVD) in Mexico and other mega-countries through a review of literature and datasets.

METHODS

Mega-countries with a low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S.A./Japan) human development index were included. The review was focused on prevalence of dyslipidemias and CVD economic impact and conducted according to the PRISMA statement. Public datasets of CVD indicators were explored.

RESULTS

Heterogeneity in economic data and limited information on dyslipidemias were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared with other countries. Higher contribution of dietary risk factors for cardiovascular mortality and greater probability of dying prematurely from CVD were observed in developing countries. From 1990-2016, a greater decrease in cardiovascular mortality in developed countries was registered. In 2015, a CVD expense equivalent to 4% of total health expenditure was reported in Mexico. CVD ranked first in health expenditures in almost all these nations and the economic burden will remain significant for decades to come.

CONCLUSIONS

Resources should be assured to optimize CVD risk monitoring. Educational and medical models must be improved to enhance CVD diagnosis and the prescription and adherence to treatments. Long-term benefits could be attained by modifying the food system.

Effectiveness of behavioral interventions to reduce the intake of sugar-sweetened beverages in children and adolescents: a systematic review and meta-analysis

Context

Consumption of sugar-sweetened beverages (SSBs) among children has been associated with adverse health outcomes. Numerous behavioral interventions aimed at reducing the intake of SSBs among children have been reported, yet evidence of their effectiveness is lacking.

Objective

This systematic review explored the effectiveness of educational and behavioral interventions to reduce SSB intake and to influence health outcomes among children aged 4 to 16 years.

Data Sources

Seven databases were searched for randomized controlled trials published prior to September 2016. Studies identified were screened for eligibility.

Study Selection

Trials were included in the review if they met the PICOS (Population, Intervention, Comparison, Outcome, and Study design) criteria for inclusion of studies.

Data Extraction

Data were extracted by 2 reviewers following Cochrane guidelines and using Review Manager software.

Results

Of the 16 trials included, 12 were school based and 4 were community or home based. Only 3 trials provided data that could be pooled into a meta-analysis for evaluating change in SSB intake. Subgroup analyses showed a trend toward a significant reduction in SSB intake in participants in school-based interventions compared with control groups. Change in body mass index z scores was not statistically significant between groups.

Conclusions

The quality of evidence from included trials was considered moderate, and the effectiveness of educational and behavioral interventions in reducing SSB intake was modest.

Systematic Review Registration

PROSPERO registration number CRD42014004432.

Snacking frequency and dietary intake in toddlers and preschool children

Understanding the relationship between snacking and dietary intake in early life years is one key but understudied area. In this study, we examined snacking patterns in toddlers and preschool children and the associations between snacking frequency and daily energy intake. We analyzed data from children aged 12-72 months (N = 1186) in the Newborn Epigenetic STudy (NEST). We used Bonferroni multiple comparison methods to examine the differences in snacking patterns across subgroups. Linear and quantile regression models were fit to investigate the association between dietary intake and snacking frequency. Our estimates suggest that Non-Hispanic blacks had the highest total daily energy intake from snacks (334 kcal/day) compared to non-Hispanic whites (270 kcal/day) and Hispanics (274 kcal/day) in 12-to-24-month-olds. In 2-to-6-year-olds, mean energy intake from snacks was 296 kcal/day without a significant racial/ethnic difference. Carbohydrate, fat and protein from snacks contributed about 17%, 9% and 4% respectively of the total energy intake in 12-to-24-month-olds while they contributed about 15%, 7% and 2% respectively of the total energy intake in the other age group. Snacking frequency was positively and significantly associated with total daily energy intake in both 12-to-24-month-olds and 2-to-6-year-olds as indicated by regression coefficient estimates of snacking frequency (β = 31.3 kcal/day with P = 0.027 and β = 175.4 kcal/day with P < 0.0001, respectively, indicating a higher snacking frequency was associated with a greater total daily energy intake). In conclusion, snacking frequency was positively associated with daily energy intake. Carbohydrates and fats from snacks are significant energy contributors. Age differentiation was apparent regarding the relationship between snacking frequency and dietary intake. Differentiated interventions that are age-specific and focus on the dietary quality of snacks instead of quantity are needed.

Childhood obesity in Mexico: A critical analysis of the environmental factors, behaviours and discourses contributing to the epidemic

Mexico has the highest prevalence globally for children who are overweight. We conducted a qualitative study to understand childhood obesity in Mexico and the complex factors at play. Data were collected at three elementary schools in a low socio-economic area in Mexico City. Semi-structured interviews were conducted with 60 children, 24 parents and 28 teachers. The children interviewed were between the ages of 8 and 12 years old. Interview texts were analysed using NVivo 9 and 10 and thematic discourse analysis was used. Findings revealed how children’s choices around nutrition and physical activity were constrained by their environment and discursive constructions.

[Food groups consumption and sociodemographic characteristics in Mexican population]

OBJECTIVE

To estimate the recommendable and non-recommendable food groups for usual consumption by sociodemographic characteristics in Mexican population.

MATERIALS AND METHODS

Through a 7-day, semi-quan¬titative food frequency questionnaire used in 2016 National Health and Nutrition Survey, we estimated the proportions of population (preschool and school children, adolescents and adults) who consumed food groups that are relevant for public health by area, region and socioeconomic status (SES).

RESULTS

Less than 50% of population consumed vegetables daily; almost 80% of the population consumed plain water daily and sweetened beverages (3 d/week). Center and Mexico City regions had the highest percentage of fruits and vegetables consumers (p<0.012). High SES had the highest consumer´s percentage of recommendable and non-recommendable food groups.

CONCLUSIONS

A high percentage of the population do not consume fruits, vegetables and plain water daily.

Patterns and trends in the intake distribution of manufactured and homemade sugar-sweetened beverages in pre-tax Mexico, 1999-2012

OBJECTIVE

To describe trends across the intake distribution of total, manufactured and homemade sugar-sweetened beverages (SSB) from 1999 to 2012, focusing on high SSB consumers and on changes by socio-economic status (SES) subgroup.

DESIGN

We analysed data from one 24 h dietary recall from two nationally representative surveys. Quantile regression models at the 50th, 75th and 90th percentiles of energy intake distribution of SSB were used.

SETTING

1999 Mexican National Nutrition Survey and 2012 Mexican National Health and Nutrition Survey.ParticipantsSchool-aged children (5-11 years) and women (20-49 years) for trend analyses (n 7718). Population aged &gt;1 year for 2012 (n 10 096).

RESULTS

Over the 1999-2012 period, there were significant increases in the proportion of total and manufactured SSB consumers (5·7 and 10·7 percentage points), along with an increase in per-consumer SSB energy intake, resulting in significant increases in per-capita total SSB energy intake (142, 247 and 397 kJ/d (34, 59 and 95 kcal/d) in school-aged children and 155, 331 and 456 kJ/d (37, 79 and 109 kcal/d) in women at the 50th, 75th and 90th percentile, respectively). Total and manufactured SSB intakes increased sharply among low-SES children but remained similar among high-SES children during this time span.

CONCLUSIONS

Large increases in SSB consumption were seen between 1999 and 2012 during this pre-tax SSB period, particularly for the highest consumers. Trends observed in school-aged children are a clear example of the nutrition transition experienced in Mexico. Policies to discourage high intake of manufactured SSB should continue, joined with strategies to encourage water and low-calorie beverage consumption.

Beverage Consumption among Adults in the Balearic Islands: Association with Total Water and Energy Intake

The paper seeks to describe beverage consumption and examine the association between beverage consumption and total water intake and total energy intake of the adult population in the Balearic Islands. Beverage consumption, total water intake, and total energy intake were obtained by using two 24-h diet recalls from a cross-sectional nutritional survey carried out in the Balearic Islands (n = 1386). The contribution of beverages to total water intake and total energy intake were also assessed. Beverages accounted for 65–71% of total water intake and 29–35% of it provided by drinking water. Food moisture contributed 31–37% of total water intake. The mean daily total water intake from all sources was around 2.2 L for men and 1.9 L for women and slightly lower than the proposed adequate intake (AI) recommendations of the European Food Safety Authority (EFSA). The mean total energy intake was 2222 kcal/day and beverages contributed 10.3% of total energy intake for men and 9.5% for women. Energy intake from beverages varied with age. In both sexes, milk was the main beverage contributed to total energy intake. The energy contribution of caloric soft drinks was 1.8% for men and 1.2% for women and energy intake from these beverages was significantly higher among younger adults. Water was the main beverage in the diet, followed by milk and hot beverages. Beverages were mainly consumed in the main meal times (breakfast, lunch, and dinner) in both sexes. The main findings of this study indicate that consumption of sugar-sweetened beverages (caloric soft drinks and commercial fruit juice) is higher among young adults, consumption of alcoholic beverages is higher among males aged 26 and older, and TWI (total water intake) is lower than the EFSA recommendations. These findings may be used to develop effective, healthy eating and drinking policies and campaigns.

Does the Mexican sugar-sweetened beverage tax have a signaling effect? ENSANUT 2016

OBJECTIVE

To evaluate the potential signaling effect of the Mexican tax on sugar-sweetened beverages (SSBs) by analyzing the association between awareness of and opinions about its effectiveness with current consumption of taxed SSBs and with a self-reported change in consumption of SSBs since the implementation of the tax. We also examined the association between psychosocial and environmental determinants of SSB consumption with current consumption of taxed SSBs and with a reported change in consumption of SSBs.

METHODS

Cross-sectional analyses of survey and food-frequency questionnaire data from the Mexican National Health and Nutrition Survey 2016. Participants were Mexican adults (20-59 years, N = 6,650). Logistic regression was used to evaluate the probability of a person reporting a decrease in SSB consumption, given their awareness of the tax, opinion about its effectiveness, psychosocial (SSB health-related beliefs, self-efficacy, and liking of SSBs) and environmental (availability of potable water) determinants. Multiple linear regression analysis was utilized to examine the association between the aforementioned factors and current consumption of taxed SSBs.

RESULTS

Compared with adults not aware, adults who were aware of the SSB tax were more likely (OR = 1.30) to report a decrease in SSB consumption (p = .012). In urban areas, adults aware of the tax drank a significantly lower amount of taxed SSBs (-15.7%; p = .023) than those not aware. Self-efficacy and liking of SSBs were significantly associated with a reported decrease in consumption and with current consumption (p < .001), while health beliefs and availability of potable water were not significantly associated with either reported change in SSB consumption or current consumption of taxed SSBs.

CONCLUSIONS

Implementation of an SSB tax accompanied by highly visible campaigns may further influence the impact of taxes on SSBs consumption. Future public health and nutrition education campaigns designed to increase knowledge and enhance motivation should be complemented by programs to assist individuals develop self-efficacy and self-regulation skills.

Obesity and the food system transformation in Latin America

The Latin America and the Caribbean (LAC) region faces a major diet-related health problem accompanied by enormous economic and social costs. The shifts in diet are profound: major shifts in intake of less-healthful low-nutrient-density foods and sugary beverages, changes in away-from-home eating and snacking and rapid shifts towards very high levels of overweight and obesity among all ages along with, in some countries, high burdens of stunting. Diet changes have occurred in parallel to, and in two-way causality with, changes in the broad food system - the set of supply chains from farms, through midstream segments of processing, wholesale and logistics, to downstream segments of retail and food service (restaurants and fast food chains). An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation. These two literatures and debates have been to date largely 'two ships passing in the night'. This review documents in-depth the recent history of rapid growth and transformation of that broad food system in LAC, with the rapid rise of supermarkets, large processors, fast food chains and food logistics firms. The transformation is the story of a 'double-edged sword', showing its links to various negative diet side trends, e.g. the rise of consumption of fast food and highly processed food, as well as in parallel, to various positive trends, e.g. the reduction of the cost of food, de-seasonalization, increase of convenience of food preparation reducing women's time associated with that and increase of availability of some nutritious foods like meat and dairy. We view the transformation of the food system, as well as certain aspects of diet change linked to long-run changes in employment and demographics (e.g. the quest for convenience), as broad parameters that will endure for the next decades without truly major regulatory and fiscal changes. We then focus in on what are the steps that are being and can be taken to curb the negative effects on diet of these changes. We show that countries in LAC are already among the global leaders in initiating demand-related solutions via taxation and marketing controls. But we also show that this is only a small step forward. To shift LAC's food supply towards prices that incentivize consumption of healthier diets and demand away from the less healthy component is not simple and will not happen immediately. We must be cognizant that ultimately, food industry firms must be incentivized to market the components of healthy diets. This will primarily need to be via selective taxes and subsidies, marketing controls, as well as food quality regulations, consumer education and, in the medium term, consumers' desires to combine healthier foods with their ongoing quest for convenience in the face of busy lives. In the end, the food industry in LAC will orient itself towards profitable solutions, ie those demanded by the broad mass of consumers.

Potential Co-exposure to Arsenic and Fluoride and Biomonitoring Equivalents for Mexican Children

BACKGROUND

Mexico is included in the list of countries with concurrent arsenic and fluoride contamination in drinking water. Most of the studies have been carried out in the adult population and very few in the child population. Urinary arsenic and urinary fluoride levels have been accepted as good biomarkers of exposure dose. The Biomonitoring Equivalents (BE) values are useful tools for health assessment using human biomonitoring data in relation to the exposure guidance values, but BE information for children is limited.

METHODS

We conducted a systematic review of the reported levels of arsenic and fluoride in drinking water, urinary quantification of speciated arsenic (inorganic arsenic and its methylated metabolites), and urinary fluoride levels in child populations. For BE values, urinary arsenic and fluoride concentrations reported in Mexican child populations were revised discussing the influence of factors such as diet, use of dental products, sex, and metabolism.

RESULTS

Approximately 0.5 and 6 million Mexican children up to 14 years of age drink water with arsenic levels over 10 μg/L and fluoride over 1.5 mg/L, respectively. Moreover, 40% of localities with arsenic levels higher than 10 μg/L also present concurrent fluoride exposure higher than 1.5 mgF/L. BE values based in urinary arsenic of 15 μg/L and urinary fluoride of 1.2 mg/L for the environmentally exposed child population are suggested.

CONCLUSIONS

An actual risk map of Mexican children exposed to high levels of arsenic, fluoride, and both arsenic and fluoride in drinking water was generated. Mexican normativity for maximum contaminant level for arsenic and fluoride in drinking water should be adjusted and enforced to preserve health. BE should be used in child populations to investigate exposure.

Influence of lifestyle factors on Body Mass Index in preschoolers in Behbahan city, southwest Iran, 2016

Background and aim

The body mass index (BMI) of Iranian preschoolers is noticeably increasing. Thus, studying the factors influencing BMI in preschool children is crucial. The purpose of this study was to identify the effects of lifestyle factors on BMI of preschool children, residing in Behbahan city, southwest Iran, in 2016.

Methods

A total of 120 preschool children, aged 4 to 6 years, participated in this cross-sectional study. Multi-stage random sampling was done. Using researcher-developed questionnaires whose validity and reliability was confirmed, demographic and lifestyle data were obtained, as the questionnaires were completed by the subject's mothers. Lifestyle factors included physical activity, fruit and vegetable consumption, sugar-free beverage intake, and screen time. Multiple logistic regression was conducted to analyze the influence of lifestyle-related behaviors on BMI. Data were analyzed by means of the SPSS 22 software and p<0.05 was resulted as the meaningful level of statistics.

Results

The average BMI values for children was 15.13±1.90 kg/m2. A total of 88.3% of children did not receive 5 cups of fruits and vegetables each day. Also, 12.5% consumed more than one serving of sweetened beverages per day. Only 2.5% engaged in 60 minutes of structured physical activity every day and 40% did not limit screen-time viewing to 2 hours per day or less. The findings indicated that the physical activity and screen time affected the BMI (p<0.05), and the duration of physical activity had inverse relationship with obesity, and screen time was directly related to obesity.

Conclusion

Understanding the factors affecting the BMI of preschool children can inform the development of interventions to impact children's weight-related behavior and it can be used as the basis for future healthy body weight policies. Efforts to lower the obesity rate of preschoolers should be focused on the lifestyle behaviors, especially on the physical activity and screen time.

Effect on the Metabolic Biomarkers in Schoolchildren After a Comprehensive Intervention Using Electronic Media and In-Person Sessions to Change Lifestyles: Community Trial

BACKGROUND

Obesity is a chronic low-intensity state of inflammation with metabolic alterations that, when acquired during childhood, lead to severe illness in adults. Encouraging healthy eating habits and physical activity is the basis for preventing and treating obesity and its complications.

OBJECTIVE

To evaluate how a comprehensive intervention promoting healthy eating habits and physical activities in schools affects children's metabolic biomarkers.

METHODS

Of four Mexico City primary schools in this study, two groups of children that were recruited at their schools were assigned to a 12-month intervention group (IG) and the other two were assigned to control groups (CGs). The intervention had two components: (1) parents/schoolchildren attended in-person educational sessions promoting healthy eating and physical activity habits, and were provided printed information; and (2) parents were able to seek information through a website, and also received brief weekly mobile phone text messages. Anthropometric measurements and fasting blood samples were taken from both groups of children at baseline and again after 12 months.

RESULTS

The study involved 187 children in the IG and 128 in the CG. Regardless of each child's nutritional status at the beginning of the study, the intervention improved metabolic parameters; the IG showed a negative effect on glucose concentrations (-1.83; CI 95% -3.06 to -0.60), low-density lipoprotein-cholesterol (-2.59; CI 95% -5.12 to -0.06), insulin (-0.84; CI 95% -1.31 to -0.37), and homeostasis model to assess the insulin resistance index (HOMA-IR; -0.21; CI 95% -0.32 to -0.09) in comparison to the CG. HOMA-IR improved in children who had higher than baseline body mass index z-scores.

CONCLUSIONS

Intervention through multiple components that promoted healthier eating and physical activity habits improved the metabolic parameters of the children in the study after one year, regardless of their nutritional status.

The Socioeconomic Disparities in Intakes and Purchases of Less-Healthy Foods and Beverages Have Changed over Time in Urban Mexico

Background

To our knowledge, the association between diet and socioeconomic status (SES), using both purchase and intake data, in the Mexican population has not been examined, which is particularly important given the high prevalence of diet-related diseases in Mexico.

Objective

Our objective was to examine the SES-diet relation using household food purchases and individual food intake data.

Methods

We analyzed purchases of packaged food and beverages of 5240 households with the use of the 2012-2014 Nielsen Mexico Consumer Panel Service Dataset, representative of urban areas. Likewise, we examined 9672 individuals over 2 y with food and beverage intake information collected using a single 24-h recall as part of the Mexican National Health and Nutrition Survey 2012. Multivariate linear regression models were conducted to predict per capita daily purchases and intakes of food and beverages classified as healthy and less healthy by SES, and adjusting for sociodemographic variables.

Results

Per capita daily purchases of healthy and less-healthy foods were, on average, 142% and 55% higher in high- than in low-SES households, respectively, from 2012 to 2014 (P < 0.05). Intakes of healthy and less-healthy foods in urban areas were, on average, 7% and 136% higher in high- than in low-SES groups (P < 0.05). Per capita daily purchases of healthy beverages were, on average, 56% higher in high- than in low-SES households from 2012 to 2014 (P < 0.05), whereas purchases of less-healthy beverages were 27% and 17% higher in low- than in high-SES households in 2012 and 2014, respectively (P < 0.05). Per capita daily intake of healthy beverages was 33% higher in high- than in low-SES groups (P < 0.05).

Conclusion

Higher-SES groups from urban areas had greater purchases and intakes of less-healthy foods and healthy beverages. Lower-SES households had greater purchases of less-healthy beverages, but also had the largest reduction in these purchases from 2012 to 2014, which could be associated with the beverage tax implemented in Mexico in 2014.

Do high vs. low purchasers respond differently to a nonessential energy-dense food tax? Two-year evaluation of Mexico's 8% nonessential food tax

It is unclear whether response to a nonessential food tax varies across time or for high vs. low-consuming households. The objective is to examine whether the effect of Mexico's 2014 8% nonessential energy-dense foods tax increased in the second year post-implementation and whether it differentially affected households by pre-tax purchasing pattern. We used longitudinal data on Mexican household food purchases (n=6089 households) from 2012 to 2015. Households were classified based on median pre-tax purchases: low untaxed/low taxed ("low"), low untaxed/high taxed ("unhealthy"), high untaxed/low taxed ("healthy"), and high untaxed/high taxed ("high") purchasers. Fixed effects models tested whether observed post-tax purchases differed from the counterfactual, or what would have been expected based on pre-tax trends. Post-tax declines in the % taxed food purchases increased from -4.8% in year one to -7.4% in year two, yielding a 2-year mean decline of 6.0% beyond the counterfactual (p<0.01). Post-tax change in % taxed food purchases varied by pre-tax purchasing level. Healthy purchasers showed no post-tax change in % taxed food purchases beyond the counterfactual, while unhealthy, low and high purchasers decreased (-12.3%, -5.3% and -4.4%, respectively) (p<0.01). The positive effect of Mexico's junk food tax continued in the second year, and households with greater preferences for taxed foods showed a larger decline in taxed food purchases.

Processed and ultra-processed food consumption among children aged 13 to 35 months and associated factors

Abstract: The aim of this study was to evaluate the consumption of processed and ultra-processed foods among children aged 13-35 months and its associated factors. We studied 1,185 children within the BRISA cohort in São Luís, Maranhão State, Brazil. The food consumption was investigated using a 24-hour recall, and the percentages of daily caloric intake and nutrients were estimated by food groups according to “NOVA” classification. We chose to categorize children belonging to the upper tertile of the distribution as having a high consumption of processed and ultra-processed food products. The Poisson regression model with robust variance estimation using a hierarchical modeling approach was used to calculate the prevalence ratios (PRs) of variables associated with high consumption of processed and ultra-processed food products. The mean energy intake was 1,226Kcal/day. After adjustments, there was a higher proportion of high consumption of processed and ultra-processed food products among children whose mothers had < 12 years of education and among children who were older than 16 months. Mothers with low schooling and children older than 16 months should be the targets of interventions aimed at reducing consumption of these food products and preventing adverse health outcomes in later life.

Trends in Fast-Food and Sugar-Sweetened Beverage Consumption and Their Association with Social Environmental Status in South Korea

BACKGROUND

As South Korea has enjoyed rapid economic development, Koreans' diet, particularly consumption of fast food (FF) and sugar-sweetened beverages (SSBs), has changed.

OBJECTIVE

To examine time trends in FF and SSB consumption and their associations with social environmental status (SEnS) in South Korea.

DESIGN

Korean National Health and Nutrition Examination Surveys (KNHANES) were a series of population-based cross-sectional surveys.

PARTICIPANTS

Data from the KNHANES conducted in 1998, 2001, 2005, and 2007-2009 for 49,826 Koreans aged ≥1 year were used.

MAIN OUTCOME MEASURES

Consumption of FF and SSBs were assessed by a 24-hour recall. We defined two FF categories (Western-style and Korean-style) and one SSB category. Sex, age, household income, and residence regions were investigated.

STATISTICAL ANALYSES PERFORMED

The primary sampling units, strata, and sampling weights were taken into account using SAS survey-related procedures. Logistic regression models were used to test associations between SEnS and FF consumption.

RESULTS

Over an 11-year period, the proportion of participants' who consumed Western FF and SSBs on the surveyed day doubled (P<0.05). Per capita energy contribution from Western FF also increased in adults, men, and low-income groups. SSB consumption doubled (per capita: 32 to 82 kcal/day, only consumers: 123 to 166 kcal/day), but consumption of Korean-style FF decreased (P<0.05). Compared with the low-income rural resident group, the high-income urban resident group was much more likely to consume Western FF (OR=26.7[3.7, 193.4]) and SSBs (odds ratio [OR]=3.1 [2.4, 4.1]) in 1998. However, in recent years, the patterns changed; the high-income urban resident group was more likely to consume Korean-style FF (OR=2.0[1.3, 2.9]) and SSBs (OR=1.7[1.3, 2.1]).

CONCLUSIONS

In South Korea, people who reported consuming Western FF and SSBs on the surveyed day almost doubled during 1998-2009, whereas those who consumed Korean FF decreased. SEnS was related to FF and SSB consumption.

A research agenda to guide progress on childhood obesity prevention in Latin America

Childhood obesity rates in Latin America are among the highest in the world. This paper examines and evaluates the many efforts underway in the region to reduce and prevent further increases in obesity, identifies and discusses unique research challenges and opportunities in Latin America, and proposes a research agenda in Latin America for the prevention of childhood obesity and concomitant non-communicable diseases. Identified research gaps include biological challenges to healthy growth across the life cycle, diet and physical activity dynamics, community interventions promoting healthy child growth, and rigorous evaluation of national food and activity programs and regulatory actions. Addressing these research gaps is critical to advance the evidence-based policy and practice in childhood obesity tailored to the Latin American context that will be effective in addressing obesity.

Nutrition status of children in Latin America

The prevalence of overweight and obesity is rapidly increasing among Latin American children, posing challenges for current healthcare systems and increasing the risk for a wide range of diseases. To understand the factors contributing to childhood obesity in Latin America, this paper reviews the current nutrition status and physical activity situation, the disparities between and within countries and the potential challenges for ensuring adequate nutrition and physical activity. Across the region, children face a dual burden of undernutrition and excess weight. While efforts to address undernutrition have made marked improvements, childhood obesity is on the rise as a result of diets that favour energy-dense, nutrient-poor foods and the adoption of a sedentary lifestyle. Over the last decade, changes in socioeconomic conditions, urbanization, retail foods and public transportation have all contributed to childhood obesity in the region. Additional research and research capacity are needed to address this growing epidemic, particularly with respect to designing, implementing and evaluating the impact of evidence-based obesity prevention interventions.

Food Sources of Energy and Nutrients in Infants, Toddlers, and Young Children from the Mexican National Health and Nutrition Survey 2012

Food sources of nutrients in Mexican children are not well known. To fill the knowledge gap, dietary intake was assessed in 2057 children using a 24-h dietary recall. All reported foods and beverages were assigned to one of 76 food groups. Percent contribution of each food group to nutrient intake was estimated for four age groups: 0–5.9, 6–11.9, 12–23.9, and 24–47.9 months. Breast milk, infant formula, and cow’s milk were the top sources of energy and nutrients, especially in younger groups. Among infants aged 6–11.9 months, the top food sources of energy included soups and stews, cookies, fruit, tortillas, eggs and egg dishes, and traditional beverages. The same foods plus sweetened breads, dried beans, and sandwiches and tortas were consumed as the top sources of energy among toddlers and young children. Milk, soups, and stews were the top contributors for all nutrients and tortillas, eggs, and egg dishes were among the top contributors for iron and zinc. This study showed that low nutrient-dense cookies, sweetened breads, and traditional beverages were among the core foods consumed early in life in Mexico. This compromises the intake of more nutritious foods such as vegetables and fortified cereals and increases the risk of obesity.

Association between Plain Water and Sugar-Sweetened Beverages and Total Energy Intake among Mexican School-Age Children

Water consumption promotes a decrease in total diet energy intake, and one explanation for this fact is the replacement of sugar-sweetened beverages (SSBs) by plain water (PW). The objective of this study was to analyze the association between SSB and PW consumption as a part of the total energy intake. Dietary information was obtained by one 24 h recall of 2536 school-age children who participated in the National Nutrition Survey in Mexico. PW and SSB consumption was measured in mL and servings (240 mL), and consumption was stratified into two levels (<2 and ≥2 servings/day). Linear regression models were used to evaluate the association between PW and SSB consumption in relation to total energy intake. Models were adjusted for age, sex, the proportion of energy obtained from non-beverage food, area of residence, and socioeconomic status (based on information regarding housing conditions and ownership of home appliances). PW consumption at the national level was two servings/day, and was not associated with total energy intake. However, the combination of the high consumption of PW and the low consumption of SSB was associated with less total energy intake (p < 0.05). Promoting higher PW and lower SSB consumption provides a useful public health strategy for reducing total energy intake and preventing overconsumption among Mexican school-age children.

First-Year Evaluation of Mexico's Tax on Nonessential Energy-Dense Foods: An Observational Study

BACKGROUND

In an effort to prevent continued increases in obesity and diabetes, in January 2014, the Mexican government implemented an 8% tax on nonessential foods with energy density ≥275 kcal/100 g and a peso-per-liter tax on sugar-sweetened beverages (SSBs). Limited rigorous evaluations of food taxes exist worldwide. The objective of this study was to examine changes in volume of taxed and untaxed packaged food purchases in response to these taxes in the entire sample and stratified by socioeconomic status (SES).

METHODS AND FINDINGS

This study uses data on household packaged food purchases representative of the Mexican urban population from The Nielsen Company's Mexico Consumer Panel Services (CPS). We included 6,248 households that participated in the Nielsen CPS in at least 2 mo during 2012-2014; average household follow-up was 32.7 mo. We analyzed the volume of purchases of taxed and untaxed foods from January 2012 to December 2014, using a longitudinal, fixed-effects model that adjusted for preexisting trends to test whether the observed post-tax trend was significantly different from the one expected based on the pre-tax trend. We controlled for household characteristics and contextual factors like minimum salary and unemployment rate. The mean volume of purchases of taxed foods in 2014 changed by -25 g (95% confidence interval = -46, -11) per capita per month, or a 5.1% change beyond what would have been expected based on pre-tax (2012-2013) trends, with no corresponding change in purchases of untaxed foods. Low SES households purchased on average 10.2% less taxed foods than expected (-44 [-72, -16] g per capita per month); medium SES households purchased 5.8% less taxed foods than expected (-28 [-46, -11] g per capita per month), whereas high SES households' purchases did not change. The main limitations of our findings are the inability to infer causality because the taxes were implemented at the national level (lack of control group), our sample is only representative of urban areas, we only have 2 y of data prior to the tax, and, as with any consumer panel survey, we did not capture all foods purchased by the household.

CONCLUSIONS

Household purchases of nonessential energy-dense foods declined in the first year after the implementation of Mexico's SSB and nonessential foods taxes. Future studies should evaluate the impact of the taxes on overall energy intake, dietary quality, and food purchase patterns (see S1 Abstract in Spanish).

Snacking Among US Children: Patterns Differ by Time of Day

OBJECTIVE

Evaluate foods and beverages consumed, and energy and nutrient densities that constitute morning, afternoon, and evening snacking periods among children in the US.

DESIGN

Evaluate snacking behavior using the National Health and Nutrition Examination Survey, 2009-2012.

PARTICIPANTS

Children aged 4-8 and 9-13 years (n = 3,647).

VARIABLES MEASURED

Self-reported foods and beverages reported as snacks were aggregated into morning (0:00-12:00 hours), afternoon (12:00-18:00 hours), and evening (18:00-24:00 hour) snacking periods.

ANALYSIS

Intakes and amounts consumed during different snacking periods were analyzed from per capita weighted averages using SAS 9.2 and SUDAAN software. Statistical differences were detected using Student t test for means and chi-square test for prevalence data.

RESULTS

Snacking contributed 25% of daily energy in both age groups, with the morning snacking period contributing the least energy. The most frequently consumed food groups across all snacking periods were water, snacks and sweets, nonalcoholic beverages, milk and dairy, and fruit. Nutrient densities varied among different snacking periods; the morning snack period for 4- to 8-year-olds was the most nutrient dense.

CONCLUSIONS AND IMPLICATIONS

Snacking is an important contributor to energy and nutrients in children's diets, but foods and beverages selected vary by time of day and age. Modifying snacking choices, especially in the afternoon, could improve the nutritional quality of children's diets.

Early introduction and cumulative consumption of sugar-sweetened beverages during the pre-school period and risk of obesity at 8-14 years of age

BACKGROUND

Consumption of sugar-sweetened beverages (SSB) has been associated with risk of obesity, but little evidence exists to evaluate if age of introduction and cumulative SSB consumption increases risk in children.

OBJECTIVES

The objective of the study was to estimate the relationship between age of introduction and cumulative SSB consumption with risk of obesity in 227 Mexican children.

METHODS

SSB intake was measured every 6 months; age of introduction and cumulative consumption during the pre-school period were calculated. Height, weight, waist circumference, SSB intake and other relevant variables were measured at age 8-14 years and obesity defined using standard criteria.

RESULTS

All participants were introduced to SSB before age 24 months and most (73%) before 12 months. Early SSB introduction (≤12 months) was not significantly associated with increased odds of obesity (odds ratio [OR] = 2.00, 95% confidence interval [CI]: 0.87, 4.59). However, children in the highest tertile of cumulative SSB consumption, compared with the lowest, had almost three times the odds of general (OR = 2.99, 95% CI: 1.27, 7.00) and abdominal (OR = 2.70, 95% CI: 1.03, 7.03) obesity at age 8-14 years.

CONCLUSIONS

High SSB consumption increased the likelihood of obesity in 8-14-year-old children. Our results suggest that SSB intake should be delayed and excessive SSB consumption in pre-school period should be avoided.

Obesity-promoting factors in Mexican children and adolescents: challenges and opportunities

BACKGROUND

Mexico is a developing country with one of the highest youth obesity rates worldwide; >34% of children and adolescents between 5 and 19 years of age are overweight or obese.

OBJECTIVES

The current review seeks to compile, describe, and analyze dietary conditions, physical activity, socioeconomic status, and cultural factors that create and exacerbate an obesogenic environment among Mexican youth.

DESIGN

A narrative review was performed using PubMed and the Cochrane Library databases, as well as grey literature data from the Mexican government, academics, and statistical reports from nongovernmental organizations, included in electronic formats.

RESULTS

The recent socioeconomic and nutritional transition has resulted in reduced healthy meal options at public schools, high rates of sedentary lifestyles among adolescents, lack of open spaces and playgrounds, socioeconomic deprivation, false or misunderstood sociocultural traditional beliefs, misconceptions about health, a high percentage of overweight or obese adults, and low rates of maternal breastfeeding. Some of the factors identified are exacerbating the obesity problem in this population. Current evidence also shows that more policies and health programs are needed for prevention of childhood and adolescent obesity. Mexico presents alarming obesity levels, which need to be curtailed and urgently reversed.

CONCLUSIONS

The present narrative review presents an overview of dietary, physical activity, societal and cultural preconceptions that are potentially modifiable obesity-promoting factors in Mexican youth. Measures to control these factors need to be implemented in all similar developing countries by governments, policy makers, stakeholders, and health care professionals to tackle obesity in children and young people.

Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study

STUDY QUESTION

What has been the effect on purchases of beverages from stores in Mexico one year after implementation of the excise tax on sugar sweetened beverages?

METHODS

In this observational study the authors used data on the purchase of beverages in Mexico from January 2012 to December 2014 from an unbalanced panel of 6253 households providing 205 112 observations in 53 cities with more than 50 000 inhabitants. To test whether the post-tax trend in purchases was significantly different from the pretax trend, the authors used a difference in difference fixed effects model, which adjusts for both macroeconomic variables that can affect the purchase of beverages over time, and pre-existing trends. The variables used in the analysis included demographic information on household composition (age and sex of household members) and socioeconomic status (low, middle, and high). The authors compared the predicted volumes (mL/capita/day) of taxed and untaxed beverages purchased in 2014-the observed post-tax period-with the estimated volumes that would have been purchased if the tax had not been implemented (counterfactual) based on pretax trends.

STUDY ANSWER AND LIMITATIONS

Relative to the counterfactual in 2014, purchases of taxed beverages decreased by an average of 6% (-12 mL/capita/day), and decreased at an increasing rate up to a 12% decline by December 2014. All three socioeconomic groups reduced purchases of taxed beverages, but reductions were higher among the households of low socioeconomic status, averaging a 9% decline during 2014, and up to a 17% decrease by December 2014 compared with pretax trends. Purchases of untaxed beverages were 4% (36 mL/capita/day) higher than the counterfactual, mainly driven by an increase in purchases of bottled plain water.

WHAT THIS STUDY ADDS

The tax on sugar sweetened beverages was associated with reductions in purchases of taxed beverages and increases in purchases of untaxed beverages. Continued monitoring is needed to understand purchases longer term, potential substitutions, and health implications.

FUNDING, COMPETING INTERESTS, DATA SHARING

This work was supported by grants from Bloomberg Philanthropies and the Robert Wood Johnson Foundation and by the Instituto Nacional de Salud Pública and the Carolina Population Center. The authors have no competing interests. No additional data are available.

Effects of dietary high fructose corn syrup on regulation of energy intake and leptin gene expression in rats

OBJECTIVE: To evaluate in Wistar rats the effect of chronic use of high fructose corn syrup on serum lipids, body weight, energy intake regulation, and expression of associated genes. METHODS: For 11 weeks, male rats were fed a standard diet with either water (control) or 15% high fructose corn syrup solution, or fed a high-fat diet. The rats' food intake and body weight were measured weekly. Expression of leptin and fatty acid synthase genes was quantified in their brain and adipose tissue upon sacrifice at age 119 days using real-time polymerase chain reaction. RESULTS: The intake of 15% high fructose corn syrup did not affect the rats' weight, only the rats on the high-fat diet gained significant weight. The rats in both diets had lower levels of leptin expression and high levels of fatty acid synthase in the brain, which were associated with high serum triglycerides. CONCLUSION: Fifteen percent high fructose corn syrup intake and the high-fat diet reduced leptin gene expression in the brain of Wistar rats, with differential effects on weight gain.

Determinants of sugar-sweetened beverage consumption in young children: a systematic review

Sugar-sweetened beverage (SSB) consumption is associated with adverse health outcomes. Improved understanding of the determinants will inform effective interventions to reduce SSB consumption. A total of 46,876 papers were identified through searching eight electronic databases. Evidence from intervention (n = 13), prospective (n = 6) and cross-sectional (n = 25) studies on correlates/determinants of SSB consumption was quality assessed and synthesized. Twelve correlates/determinants were associated with higher SSB consumption (child's preference for SSBs, TV viewing/screen time and snack consumption; parents' lower socioeconomic status, lower age, SSB consumption, formula milk feeding, early introduction of solids, using food as rewards, parental-perceived barriers, attending out-of-home care and living near a fast food/convenience store). Five correlates/determinants were associated with lower SSB consumption (parental positive modelling, parents' married/co-habiting, school nutrition policy, staff skills and supermarket nearby). There was equivocal evidence for child's age and knowledge, parental knowledge, skills, rules/restrictions and home SSB availability. Eight intervention studies targeted multi-level (child, parents, childcare/preschool setting) determinants; four were effective. Four intervention studies targeted parental determinants; two were effective. One (effective) intervention targeted the preschool environment. There is consistent evidence to support potentially modifiable correlates/determinants of SSB consumption in young children acting at parental (modelling), child (TV viewing) and environmental (school policy) levels.

Increased Snacking and Eating Occasions Are Associated with Higher Energy Intake among Mexican Children Aged 2-13 Years

BACKGROUND

Little is known about the dietary behaviors of Mexican children with regard to frequency, amount, and quality of foods consumed at eating occasions and their impact on total daily energy intake.

OBJECTIVES

The objectives were to 1) describe foods consumed across eating occasions and 2) examine whether the number or type of total eating occasions was associated with increased total daily energy intake and differed between 2- to 5-y-old and 6- to 13-y-old Mexican children.

METHODS

A nationally representative sample of 5031 children from the 2012 ENSANUT (Encuesta Nacional de Salud y Nutrición) was used to examine the percentage of meals and snacks consumed, mean energy intake from meals and snacks, and the top food groups contributing to meals and snacks. Multivariate linear regression was used to examine the association between meals, snacks, and total eating occasions with daily energy intake for 2- to 5-y-old and 6- to 13-y-old children.

RESULTS

Eating patterns were similar across age groups (per capita mean intake of 3 meals and 1.4-1.6 snacks/d). Each additional snack was associated with greater increases in mean daily energy for older children (+191-289 kcal/d; P < 0.01) relative to younger children (+102-130 kcal/d; P < 0.01). Likewise, each additional eating occasion was associated with greater increases in mean daily energy for older children (+323 kcal/d; P < 0.01) relative to younger children (+166-261 kcal/d; P < 0.01). In both younger and older children, snacking was prevalent (75% and 68%, respectively). Top food contributors to snacks included fruit, salty snacks, candy, sweetened breads, and cookies. Among older children, whole milk as a snack was partially replaced with soda and sweetened fruit drinks.

CONCLUSION

Snacks represent an area for potential improvement in the diets of Mexican children, especially among those aged 6 to 13 y, for whom each additional snack or eating occasion was linked to even greater increases in total daily energy intake.

Comparing a 7-day diary vs. 24 h-recall for estimating fluid consumption in overweight and obese Mexican women

BACKGROUND

High intake of sugar-sweetened beverages (SSB) is linked to increased weight, energy intake, and diabetes. Even though the increasing interest on beverages and water intake, there are few dietary tools carefully validated. The purpose of this paper is to compare a fluid intake 7-day diary against a 24-h recall questionnaire to estimate the fluid consumption in overweight and obese women participating in a randomized controlled trial in Mexico.

METHODS

This cross-sectional study explored the correlation of reported fluid consumption between two methods: 3-day 24-hr recalls and 7-day diary beverage registry in overweight and obese Mexican women aged 18-45 y (n = 190).

RESULTS

There was no difference on median estimated volume (mL/d), nor the median estimated energy (kcal/d) from total beverage consumption registered by the two dietary tools. The crude and rank correlation among the two dietary instruments was high for total fluid consumption in mL/d r = 0.7, p < 0.001 (crude and rank correlation) and for fluid consumption measured as energy intake: r = 0.7; p < 0.001 crude, and r = 0.5; p < 0.001 rank correlation. By type of beverage, the more meaningful rank correlations were for fluid intake in: mL/d, water, alcohol beverages, and SSB; and in kcal/d, alcohol beverages and SSBs (rank correlation ≥ 0.6).

CONCLUSIONS

Overall, the 7-day diary showed high and strong rank correlations with that reported in the 24-h recall, suggesting that the diary method is a valid dietary tool to evaluate total fluid, water and SSB intake in this population.

School-Based Interventions to Reduce Obesity Risk in Children in High- and Middle-Income Countries

School-based interventions are relatively new and were first introduced in the United States in the 1990s. Early programs were mainly education based with many of the findings now embedded in school policy in the form of a healthy eating curriculum. More recent school programs have taken education outside the classroom and attempted to engage parents as well as teachers. Environmental changes such as improving the quality of foods available at lunchtime and at other times during the school day are now common. Reviews of evaluations of school-based programs have demonstrated that they are effective and successfully improve dietary quality such as increasing fruit and vegetable intake and decreasing sweet and savory snacks and sweetened drinks; not just in school but over the whole day and particularly in younger school children. School-based interventions are also effective at reducing obesity if components to increase physical activity and reduce sedentary behaviors are also targeted but not if only dietary behaviors are tackled. Most of the high-quality evaluation studies using randomized controlled trials have been carried out in high-income countries as they are costly to run. However, middle-income countries have benefitted from the information available from these evaluation studies and many are now starting to fund and evaluate school-based programs themselves, resulting in unique problems such as concomitant under- and overnutrition being addressed. Action for the future demands more focus on populations most at risk of poor dietary quality and obesity in order to reduce inequalities in health and on adolescents who have not benefited as much as younger children from school-based interventions. This will involve innovative solutions within schools as well as targeting the food environment outside schools such as reducing the density of fast-food outlets and marketing of sweet and savory snacks and drinks.

Prevalence of caries and malocclusion in an indigenous population in Chiapas, Mexico

OBJECTIVES

To assess the prevalence of caries and malocclusion in Mayan Mexican adolescents, 14-20 years of age, living in Chiapas, Mexico.

METHODS

This was a cross-sectional, population-based, quantitative, epidemiological study. Sites were chosen to capture subjects representative of the state's Mayan population. A total of 354 subjects were recruited. Caries experience was quantified, via visual inspection, using the Decayed, Missing and Filled Surface (DMFS) index. Malocclusion was quantified using the Index of Complexity, Outcome and Need (ICON).

RESULTS

Our data showed that 99% of the population had caries experience, with a median DMFS score of 8. Of the 99% with caries experience, over half had caries affecting more than five tooth surfaces. Thirty-seven per cent of the students had unmet orthodontic treatment need, and 46.46% presented a Class II, and 39.09% a Class III, anterior-posterior relationship.

CONCLUSIONS

Less than 1% of the population had any exposure to orthodontics, demonstrating the lack of access to care. Likewise, only 1% of the population was found to have no caries experience, exhibiting a large unmet treatment need. The median DMFS score of 8 was also high in comparison with the median DMFS in the USA of 6. Our data suggest a correlation between the lack of access to care and high prevalence of caries and malocclusion in Mexican Mayans who inhabit Chiapas, Mexico.

Cross-continental comparison of national food consumption survey methods--a narrative review

Food consumption surveys are performed in many countries. Comparison of results from those surveys across nations is difficult because of differences in methodological approaches. While consensus about the preferred methodology associated with national food consumption surveys is increasing, no inventory of methodological aspects across continents is available. The aims of the present review are (1) to develop a framework of key methodological elements related to national food consumption surveys, (2) to create an inventory of these properties of surveys performed in the continents North-America, South-America, Asia and Australasia, and (3) to discuss and compare these methodological properties cross-continentally. A literature search was performed using a fixed set of search terms in different databases. The inventory was completed with all accessible information from all retrieved publications and corresponding authors were requested to provide additional information where missing. Surveys from ten individual countries, originating from four continents are listed in the inventory. The results are presented according to six major aspects of food consumption surveys. The most common dietary intake assessment method used in food consumption surveys worldwide is the 24-HDR (24 h dietary recall), occasionally administered repeatedly, mostly using interview software. Only three countries have incorporated their national food consumption surveys into continuous national health and nutrition examination surveys.

Impact of interventions to reduce sugar-sweetened beverage intake in children and adults: a protocol for a systematic review and meta-analysis

BACKGROUND

Sugar-sweetened beverages (SSBs) have been stressed as relevant targets of public health interventions considering the negative outcomes derived from their excessive intake. Though the evidence from published literature grows to support a cause-and-effect association of SSBs with obesity and other diseases, little is known on the effectiveness that strategies alone or as part of multi-component programmes have had to influence this particular dietary behaviour across all ages. Therefore, this review and meta-analysis aim to evaluate the effect that interventions have had to decrease their consumption or increase water intake in children and adults so as to guide the design of future programmes and inform policy making.

METHODS

Included studies in this review will be randomised controlled trials and quasi-experimental interventions (with a control group) that have reported baseline and post-intervention intakes of SSBs or water and that have been published from 1990 in any language. A thorough search will be performed in MEDLINE, EMBASE, Scopus, Web of Science, Cochrane's central register of controlled trials, and the Global Health Library. Two independent reviewers will conduct initial screening of potentially included articles and will later extract data to analyse domains of intervention design and delivery (with emphasis on behaviour change techniques used as rationale), as well as results in changes on consumption patterns and behavioural determinants. Internal and external validity of each study will also be appraised. A meta-analysis will be performed if a sufficient number of studies are available, and if not, a narrative review will be conducted instead.

DISCUSSION

The results from this review aim to strengthen public health initiatives tackling obesity through improvements in non-alcoholic drinking patterns. As a subject of growing attention globally, this review will help determine which strategies available are the most effective in different contexts. Knowledge gained from this work will also aid resource allocation in future research and government agendas.

PROSPERO

CRD42014013436 .

Food habits, physical activities and sedentary lifestyles of eutrophic and obese school children: a case-control study

BACKGROUND

Civilization has produced lifestyle changes; currently, people ingest more calories than are expended, resulting in obesity. This study assessed the association between dietary habits, physical activities, and sedentary behaviors and the risk of obesity in schoolchildren in Mexico City.

METHODS

Of 1,441 children (6-12 years old) screened in elementary schools, 202 obese (BMI ≥95(th) pc) and 200 normal-weight children (BMI 25(th)- 75(th) pc), as defined by the 2000 CDC criteria, were included in a case-control study. The children's eating, physical activity and sedentary lifestyle habits were recorded using validated questionnaires. The quantity and quality of the foods were obtained, and the energy that was expended was transformed into METs. Sedentary behavior was assessed in hours. Logistic regression models were used to determine the risks of certain habits and their association with obesity.

RESULTS

Obese children ingested around of 270 Kcal less than eutrophic children. However, compared with the eutrophic children, obese children had significantly worse lifestyle habits; the children with healthy dietary habits (eating breakfast at home, bringing a school lunch, and not bringing money to purchase food) had a lower risk of obesity (OR 0.59, CI 0.46; 0.75). The quality of the eaten food was associated with a risk of obesity. Consuming fruit demonstrated an inverse association with risk of obesity (p Trend = 0.01); consumption of sweetened beverages (p Trend < 0.04) and refined carbohydrates with added fat (p Trend = 0.002) were associated with an increased risk of obesity. Children who were more physically active at school had an OR of 0.37 (CI 0.16; 0.89), those who had 3-4 televisions at home had an OR of 2.13 (CI 1.20; 3.78), and the risk of developing obesity was independent of caloric intake.

CONCLUSIONS

Poorer eating habits as well as less physical activity were associated with the risk of obesity. An obesogenic environment could change if teachers and parents worked together to form healthy food intake and physical activity habits.

[Unhealthy eating, physical inactivity and childhood obesity in Colombia: an urgent call for the state and civil society to undertake effective action]

Resumen

Colombia, al igual que la mayoría de los países de América Latina, ha experimentado una rápida transición nutricional, la cual se ha dado en un contexto caracterizado por altos niveles de pobreza, inequidad y exclusión social; sumado a acelerados procesos de globalización y una creciente influencia política y mediática de las grandes corporaciones de bebidas y alimentos ultra-procesados. Esta situación tiene un impacto potencialmente negativo en la salud infantil, al afectar sus patrones de actividad física y alimentación. Existen acciones poblacionales efectivas para la promoción de la actividad física y la alimentación saludable en niños, niñas y adolescentes, que podrían implementarse en Colombia si se contara con la voluntad política del gobierno y la participación activa de la sociedad civil.

Substituting water for sugar-sweetened beverages reduces circulating triglycerides and the prevalence of metabolic syndrome in obese but not in overweight Mexican women in a randomized controlled trial

BACKGROUND

Mexico's sugar-sweetened beverage (SSB) intake is among the highest globally. Although evidence shows that increases in SSB intake are linked with increased energy intake, weight gain, and cardiometabolic risks, few randomized clinical trials have been conducted in adults.

OBJECTIVE

The aim of this study was to determine if replacing SSBs with water affects plasma triglycerides (TGs) (primary outcome), weight, and other cardiometabolic factors.

METHODS

We selected overweight/obese (BMI ≥ 25 and <39 kg/m(2)) women (18-45 y old) reporting an SSB intake of at least 250 kcal/d living in Cuernavaca, Mexico. Women were randomly allocated to the water and education provision (WEP) group (n = 120) or the education provision (EP)-only group (n = 120). The WEP group received biweekly water deliveries, and both groups received equal monthly nutrition counseling. During nutrition counseling, the WEP group sessions included activities to encourage increased water intake, reduced SSB intake, and substitution of water for SSBs. Repeated 24-h dietary recalls, anthropometric measurements, and fasting blood samples were collected at baseline and at 3, 6, and 9 mo. The Markov-Monte Carlo method was used for multiple imputation; separate mixed-effects models tested each outcome.

RESULTS

An intent-to-treat (ITT) analysis indicated that the WEP group increased water intake and decreased SSB intake significantly over time, but there were no differences in plasma TG concentrations between groups at the end of the intervention (WEP at baseline: 155 ± 2.10 mg/dL; WEP at 9 mo: 149 ± 2.80 mg/dL; EP at baseline: 150 ± 1.90 mg/dL; EP at 9 mo: 161 ± 2.70 mg/dL; P for mean comparisons at 9 mo = 0.10). Secondary analyses showed significant effects on plasma TGs (change from baseline to 9 mo: WEP, -28.9 ± 7.7 mg/dL; EP, 8.5 ± 10.9 mg/dL; P = 0.03) and metabolic syndrome (MetS) prevalence at 9 mo (WEP: 18.1%; EP: 37.7%; P = 0.02) among obese participants.

CONCLUSIONS

Providing water and nutritional counseling was effective in increasing water intake and in partially decreasing SSB intake. We found no effect on plasma TGs, weight, and other cardiometabolic risks in the ITT analysis, although the intervention lowered plasma TGs and MetS prevalence among obese participants. Further studies are warranted. This trial was registered at http://www.clinicaltrials.gov as NCT01245010.