Development of a crowdsourcing- and gamification-based mobile application to collect epidemiological information and promote healthy lifestyles in Mexico

We developed a mobile application to promote healthy lifestyles and collect non-communicable disease (NCD) data in Mexico. Its theoretical foundations are supported by a framework-guided literature review. With design sprints, Scrum, Model-View-Controller, and Representational State Transfer architecture, we operationalized evidence-based nutrition/physical activity information into a crowdsourcing- and gamification-based application. The application was piloted for three months to monitor the response of 520 adults. Potential improvements were characterized, considering benchmarking, expert guidance, and standards. Salud Activa (English: Active Health) has two crowdsourcing modules: Nutritional scanner, scanning products' bar codes, providing nutritional data, and allowing new product registry feeding our databases; Surveys, comprising gradually-released NCD questions. Three intervention modules were generated: Drinks diary, a beverage assessment component to receive hydration recommendations; Step counter, monitoring users' steps via Google Fit/Health-iOS; Metabolic Avatar, interconnecting modules and changing as a function of beverage and step records. The 3-month median of Salud Activa use was seven days (IQR = 3-12), up to 35% of participants completed a Survey section, and 157 food products were registered through Nutritional scanner. Better customization might benefit usability and user engagement. Quantitative and qualitative data will enhance Salud Activa's design, user uptake, and efficacy in interventions delivered through this platform.

Association of sociodemographic and lifestyle factors with dietary patterns among men and women living in Mexico City: A cross-sectional study

Background

Diet is one of the leading risk factors for non-communicable diseases and is related to sociodemographic and lifestyle factors, including sex. These associations vary across populations. We aimed to investigate which factors are associated with dietary patterns among adults living in Mexico City by sex.

Methods

We used data from the Mexico City Diabetes Representative Study, a cross-sectional, multistage, stratified, and cluster-sampled survey in Mexico City (n = 1,142; 413 men and 729 women). Dietary information was collected using a semi-quantitative food frequency questionnaire. Foods and beverages were categorized into 23 food groups to identify dietary patterns by cluster analysis. Sociodemographic and lifestyle variables included were self-reported through standardized questionnaires. We assessed the association of sociodemographic and lifestyle factors with dietary patterns through a multinomial logistic model stratified by sex.

Results

We identified three dietary patterns: basic, prudent, and fast food. Among men and women, higher school attainment was associated with a lower relative probability of having a basic rather than prudent dietary pattern (women: RRR = 0.8, 95% CI: 0.8, 0.9; men: RRR = 0.8, 95% CI: 0.7, 0.9). Divorced or separated men (RRR = 3.8, 95% CI: 1.3, 11.2) and those living with a partner (RRR = 2.6, 95% CI: 1.1, 6.1) had a higher relative probability of consuming a fast food dietary pattern than the prudent one, compared to single men. Men living with a partner (RRR = 3.0, 95% CI: 1.1, 8.6) or working long shifts (RRR = 3.8, 95% CI: 1.3, 11.1) had a higher probability of consuming a basic pattern rather than a prudent one compared to peers. Among women, those with high SES had a lower probability of consuming the "basic" pattern rather than the "prudent" pattern compared to those with low SES. No lifestyle factors were associated to dietary patterns.

Conclusions

Men living in Mexico City with lower education, age, non-single, and working long hours (i.e., more than the established by the law), and women with lower age, education, and socioeconomic level are prone to adhere to unhealthy diets. These associations are likely to be driven by gender roles.

Association between density of convenience and small grocery stores with diet quality in adults living in Mexico City: A cross sectional study

There is evidence of the association between different retail stores and food consumption, yet research is still limited in low- and medium-income countries, where the context of the food retail environment is different from that observed in high-income countries. Specifically, less is known about how convenience and small grocery stores, which offer products with immediate access, are associated with the diet as a whole. The present study assessed the association between density of convenience and small grocery stores and diet quality in adults from the Mexico City Representative Diabetes Survey 2015. A final sample size of 1,023 adults aged 20–69 years was analyzed. The density of stores was measured using Euclidean buffers within 500 meters of each participant's home. The Mexican Alternate Healthy Eating Index (MxAHEI) was used to assess diet quality. Multivariable Poisson models were used to test the association of convenience and small grocery stores densities with the MxAHEI. Although our results were not statistically significant, we observed a lower diet quality score among adults from Mexico City living in areas with a higher density of small grocery and convenience stores. More research is needed on the influence of environmental food retail on food consumption.

Changes Among Mexican Adults in Physical Activity and Screen Time During the COVID-19 Lockdown Period and Association With Symptoms of Depression, Anxiety, and Stress, May 29-July 31, 2020

Introduction

We examined the association between changes in physical activity and leisure screen time and mental health outcomes during the early stages of the recommended COVID-19 stay-at-home period in a national sample of Mexican adults aged 18 years or older.

Methods

A cross-sectional online survey conducted from May 29 through July 31, 2020, among 1,148 participants, reported time spent in physical activity and leisure screen time during a typical week before (retrospectively) and a week during the COVID-19 stay-at-home period. Mental health outcomes during this period were measured with the Depression, Anxiety and Stress Scale (DASS-21). Linear regression models were used to estimate the associations between changes in physical activity and leisure screen time and mental health outcomes by socioeconomic status (SES), adjusting for potential confounders.

Results

Compared with maintaining high levels of physical activity or increasing them, decreasing physical activity was associated with higher stress scores overall, and among people of high SES, with higher scores for DASS-21, depression, and anxiety. Among participants of low and medium SES only, increasing screen time was associated with higher DASS-21, depression, anxiety, and stress scores compared with maintaining low or decreasing leisure screen time.

Conclusion

Results highlight the potential protective effect of physical activity and limited leisure screen time on mental health in the context of COVID-19 stay-at-home restrictions.

[Subsample for the analysis of chronic diseases with biomarkers, National Survey of Health and Nutrition 2016]

OBJECTIVE

To describe the adult subsample for the analysis of biomarkers of chronic diseases, as well as the sample sizes (n) and representativity of the Encuesta Nacional de Salud y Nutrición (Ensanut) 2016.

MATERIALS AND METHODS

An adult subsample with national representativity was calculated to obtain blood, serum and urine samples. The prevalence of variables of interest was compared for each subsample.

RESULTS

The n for at least one serum biomarker and urine samples were 4 000 and 3 782, respectively. The n varied depending on the grouping of biomarkers and fasting time selection. No differences were observed in the distribution of variables between the whole sample, urine and blood biomarkers samples.

CONCLUSIONS

The weighted subsamples of urine, serum and blood biomarkers are comparable to the weighted sample of adults in the survey. The data of the subsample will allow to monitor the distribution of chronic diseases in Mexico, including altered function of liver and kidney, and sodium intake.

Dyslipidemia prevalence, awareness, treatment and control in Mexico: results of the Ensanut 2012

OBJECTIVE

To describe in a national sample 1) the prevalence, awareness, treatment and control of dyslipidemias 2) the prevalence of dyslipidemias through previous national surveys.

MATERIALS AND METHODS

We analyzed data of the National Health and Nutrition Survey 2012, a representative cross-sectional study. Serum samples of 9 566 adults ≥20 years old with fasting ≥8 hours were analyzed for lipid fractions. Age-adjusted prevalences were calculated, by sociodemographic variables. Prevalence of awareness, treatment and control was estimated. A description of the dyslipidemia prevalence reported in previous surveys is reported.

RESULTS

Hypoalphalipoproteinemia and elevated LDL-C are the most prevalent dyslipidemias in Mexican adults. One in four adults had hypercholesterolemia at the moment of the interview without previous diagnosis. Awareness, treatment and control of dyslipidemia were 12.6, 3.7 and 3.1%, respec- tively.

CONCLUSIONS

Dyslipidemias are the most prevalent risk factor for cardiovascular diseases in Mexico. Public policies to increase awareness, access to therapy and sustained control are urgently needed.

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.

Polyunsaturated fatty acids and child neurodevelopment among a population exposed to DDT: a cohort study

BACKGROUND

Child neurodevelopment has been positively linked to maternal intake of polyunsaturated fatty acids (PUFAs) during pregnancy; however, it is unknown if that relationship persists among populations exposed to environmental neurotoxicants.

OBJECTIVE

The aim of this work was to assess whether maternal dietary intake of PUFAs during pregnancy is positively associated with child neurodevelopment, whose mothers were environmentally exposed to 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (DDT).

METHODS

A prospective cohort study with 276 mother-child pairs was performed in Mexico. Neurodevelopment was assessed by Bayley Scales II from children age 1 to 30 months. Dietary PUFAs intake was estimated by Food Frequency Questionnaire at 1st and 3rd trimester of pregnancy. DDE (1,1-dichloro-2,2-bis(p-chlorophenyl) ethylene, the main metabolite of DDT) maternal serum levels were determined by electron capture gas chromatography. Longitudinal multivariate linear mixed-effects analysis, which combines mental (MDI) and motor (PDI) Bayley scales in a single model, were performed.

RESULTS

Our results show that in a sample environmentally exposed to DDT, maternal ingestion of DPA during the first trimester of pregnancy was positively associated with MDI (β = 0.10, 95% CI 0.02, 0.18) in children from 1 to 30 months. Likewise, our results suggest that dietary ALA may be also related to MDI.

CONCLUSION

DPA may benefit neurodevelopment even in populations exposed to DDT. Our results strengthen the importance of PUFAs intake during the prenatal period.

Arsenic methylation capacity in relation to nutrient intake and genetic polymorphisms in one-carbon metabolism

BACKGROUND

Nutrients and genetic polymorphisms participating in one-carbon metabolism may explain interindividual differences in inorganic arsenic (iAs) methylation capacity, which in turn may account for variations in susceptibility to iAs-induced diseases.

OBJECTIVES

1) To evaluate the association between polymorphisms in five one-carbon metabolism genes (FOLH1 c.223 T > C, MTHFD1 c.1958 G > A, MTHFR c.665 C > T, MTR c.2756 A > G, and MTRR c.66 A > G) and iAs methylation capacity; 2) To assess if previously reported associations between nutrient intake and iAs methylation capacity are modified by those polymorphisms.

METHODS

Women (n = 1027) exposed to iAs in Northern Mexico were interviewed. Blood and urine samples were collected. Nutrient dietary intake was estimated using a validated food frequency questionnaire. iAs methylation capacity was calculated from urinary iAs species (iAs, monomethylarsonic acid [MMA] and dimethylarsinic acid [DMA]) measured by high performance liquid chromatography (HPLC-ICP-MS). One polymorphism in each of the five genes evaluated was genotyped by allelic discrimination. Multivariable linear regression models were used to evaluate if genetic polymorphisms modified the associations between iAs methylation capacity parameters and nutrient intake.

RESULTS

The median (min-max) concentration of total arsenic (TAs) was 20.2 (1.3-2776.0) µg/g creatinine in the study population. Significant interactions for iAs metabolism were only found with FOLH1 c.223 T > C polymorphism and vitamin B12 intake, so that CT and CC genotype carriers had significantly lower %iAs, and higher DMA/iAs with an increased vitamin B12 intake, as compared to carriers of wild-type TT.

CONCLUSION

Differences in dietary nutrient intake and genetic variants in one-carbon metabolism may jointly influence iAs methylation capacity. Confirmation of these interactions in other populations is warranted.

Maternal dietary intake of polyunsaturated fatty acids modifies association between prenatal DDT exposure and child neurodevelopment: A cohort study

BACKGROUND

Maternal 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) serum levels during pregnancy have been negatively linked to child neurodevelopment in contrast to intake of omega-3 and -6 (ω-3 and ω-6) fatty acids.

OBJECTIVES

To assess whether maternal dietary intake of ω-3 and ω-6 during pregnancy modifies the association between exposure to DDE and child neurodevelopment from age 42-60 months.

METHODS

Prospective cohort study with 142 mother-child pairs performed in Mexico. DDE serum levels were determined by electron capture gas chromatography. Dietary ω-3 and ω-6 intake was estimated by questionnaire. Child neurodevelopment was assessed by McCarthy Scales.

RESULTS

Docosahexaenoic (DHA) fatty acid intake significantly modified the association between DDE and motor component: increased maternal DDE was associated with lower motor development in children whose mothers had lower DHA intake (β_log2DDE = -1.25; 95% CI: -2.62, 0.12), in contrast to the non-significant increase among children whose mothers had higher DHA intake (β_{log2DDE-motor} = 0.50; 95% CI: 0.55, 1.56). Likewise, arachidonic fatty acid (ARA) intake modified the association between DDE and memory component: increased maternal DDE was associated with a significantly larger reduction in the memory component in children whose mothers had lower ARA intake (β_log2DDE = -1.31; 95% CI: -2.29, -0.32) than children whose mothers had higher ARA intake (β_{log2DDE-memory} = 0.17; 95% CI: -0.78, 1.11).

CONCLUSIONS

Dietary intake of DHA and ARA during pregnancy may protect against child neurodevelopment damage associated with prenatal maternal DDE levels.

Phthalate exposure, flavonoid consumption and breast cancer risk among Mexican women

OBJECTIVE

To evaluate if selected phthalate exposure and flavonoid intake interact on breast cancer (BC) risk.

MATERIAL AND METHODS

Interviews and urine samples were obtained from 233 women with histologically confirmed BC and 221 healthy controls matched by age and place of residence, from various states of northern Mexico. Urinary metabolites concentrations of diethyl phthalate (DEP), butyl benzyl phthalate (BBzP) and dioctyl phthalate (DOP) were determined by solid-phase extraction coupled with high-performance liquid chromatography/isotope dilution/tandem mass spectrometry. Using a semiquantitative food frequency questionnaire, consumption of five types of flavonoids (anthocyanidins, flavan-3-ols, flavanones, flavones and flavonols) was estimated according to three food groups: vegetables, fruits and legumes-oil seeds.

RESULTS

A higher intake of anthocyanidins and flavan-3-ols (from vegetables), synergistically increased the negative association between BBzP and BC. No other significant flavonoid-phthalate multiplicative interactions on the risk for BC were found.

CONCLUSION

The consumption of some flavonoids may interact with exposure to phthalates on the risk of BC. Epidemiological and underlying mechanisms information is still insufficient and requires further investigations.

Dietary micronutrient intake and its relationship with arsenic metabolism in Mexican women

INTRODUCTION

Concentrations of inorganic arsenic (iAs) metabolites in urine present intra- and interindividual variations, which are determined not only by the magnitude of exposure to iAs, but also by differences in genetic, environmental and dietary factors.

OBJECTIVE

To evaluate whether differences in dietary intake of selected micronutrients are associated with the metabolism of iAs.

METHODS

The intake of 21 micronutrients was estimated for 1027 women living in northern Mexico using a food frequency questionnaire. Concentration of urinary metabolites of iAs was determined by high performance liquid chromatography inductively coupled plasma mass spectrometry (HPLC-ICP-MS) and the proportion of iAs metabolites was calculated (%iAs, monomethylarsonic acid [%MMA] and dimethylarsinic acid [%DMA]), as well as ratios corresponding to the first (MMA/iAs), second (DMA/MMA) and total methylation (DMA/iAs).

RESULTS

After adjustment for covariates, it was found that methionine, choline, folate, vitamin B12, Zn, Se and vitamin C favor elimination of iAs mainly by decreasing the %MMA and/or increasing %DMA in urine.

CONCLUSIONS

Our results confirm that diet contributes to the efficiency of iAs elimination. Further studies are needed to assess the feasibility of dietary interventions that modulate the metabolism of iAs and the consequent risk of diseases related to its exposure.