Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders

BACKGROUND

Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021.

METHODS

We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective.

RESULTS

Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women.

CONCLUSIONS

These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.

Development and validation of a new set of indicators to assess the quality of maternal and child nutritional care at the primary care

Introduction

Maternal and child malnutrition is a worldwide public health problem with short, medium, and long-term adverse consequences for both mother and child. In Mexico, maternal and child malnutrition represents a serious public health problem that must be urgently addressed. In this context, Primary Health Care (PHC) plays an important role in the prevention, detection, monitoring, and treatment of the different forms of maternal and child malnutrition. Assessing the quality of nutritional care offered at this level of care is necessary in order to improve it; however, there are no indicators for the evaluation of this quality. Therefore, this study aimed at developing a set of indicators to assess the quality of maternal and child nutritional care at PHC.

Methods

We developed indicators for different stages of life: preconception, pregnancy, infancy, and preschool age. A systematic review of the literature on clinical guidelines for the prevention, diagnosis, and treatment of the different forms of malnutrition was carried out; the recommendations of the guidelines evaluated with good quality were extracted.

Results

Based on these recommendations, 22 indicators were constructed. A pilot study was carried out to validate the indicators and 16 indicators were selected to assess the maternal and child nutritional care at PHC.

The beneficial effect of a comprehensive diabetes care model on high-risk relatives accompanying patients with type 2 diabetes

AIMS

Assess the effect of a diabetes program on lifestyle, metabolic, and mental health parameters in relatives of patients with T2D, and correlate changes between relatives and patients.

METHODS

Relatives were included in a structured program for patients with T2D. They received individualized interventions or were asked to follow lifestyle modifications indicated to their patient with diabetes. Outcomes were change in BMI, fat loss, patients achieving LDL-c and triglycerides goals, exercise, and mental health indicators at three and twelve months.

RESULTS

We included 200 relatives. Obesity was present in 42 %, hypertension in 8.5 %, hypercholesterolemia in 29.5 %, and hypertriglyceridemia in 46 % of relatives. Relatives lost - 3.7 kg and - 3.0 kg of body fat at three months and one-year evaluations. At least 60 % achieved normal triglycerides and LDL-c, and 40 % exercised at least 150 min/week. Anxiety symptoms dropped from 37 % to 22 % (p = 0.001), and depressive symptoms from 22 % to 12.9 % (p = 0.01) at three months. Correlations were found between the changes in relatives and patients in weight at three months (r = 0.22, p = 0.001), one year (r = 0.3, p < 0.001), and the number of goals achieved at one year.

CONCLUSION

Relatives of patients with diabetes attending a multidisciplinary program for T2D benefit in metabolic, lifestyle, and mental health indicators.

Examining the validity and consistency of the Adult Eating Behaviour Questionnaire-Español (AEBQ-Esp) and its relationship to BMI in a Mexican population

PURPOSE

Appetitive traits in adults and their associations with weight can be measured using the Adult Eating Behaviour Questionnaire (AEBQ). The aim of this study was to confirm the factor structure of the Spanish AEBQ (AEBQ-Esp) in a Mexican sample and explore associations between the eight traits with body mass index (BMI).

METHOD

A sample of 1023 adults, mean age of 36.8 ± 12.8 years, was recruited from Guadalajara, Mexico. Researchers weighed and measured participants, and they completed the AEBQ-Esp either online or in paper format and reported sociodemographic data. To test two alternative factor structures (eight factors including Hunger; seven factors excluding Hunger), confirmatory factor analysis (CFA) was used. Internal reliability was assessed using Cronbach's alpha; test-retest reliability was assessed using intra-class correlation coefficients. Multivariate linear regressions were used to test for associations between the AEBQ subscales and BMI, adjusted for age, sex, format of AEBQ responses, education, marital and employment status.

RESULTS

A seven-factor structure was the best model fit using CFA, excluding the Hunger subscale but similar to the original AEBQ. Internal reliability was good for all subscales (Cronbach's α = 0.70-0.86), and the intra-class correlation coefficient (0.70-0.91) reflected good test-retest reliability. In the fully adjusted models, Satiety Responsiveness [β = - 0.61; (- 1.01, - 0.21)] and Slowness in Eating [β = - 0.70; (- 1.01, - 0.39)] were negatively associated with BMI, and Emotional Over-Eating [β = 0.94; (0.62, 1.27)] was positively associated with BMI.

CONCLUSIONS

The AEBQ-Esp (excluding Hunger) appears to be a valid and reliable psychometric questionnaire for measuring appetitive traits in a Mexican Spanish-speaking population. Some traits appear to be associated with BMI in adulthood and warrant further exploration.

LEVEL OF EVIDENCE

Level III evidence obtained from well-designed cohort or case-control analytic studies. Although this was just an observational study, it was well designed and provided new evidence.

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

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

Perceived Diet Quality, Eating Behaviour, and Lifestyle Changes in a Mexican Population with Internet Access during Confinement for the COVID-19 Pandemic: ESCAN-COVID19Mx Survey

Perceived changes in diet quality, emotional eating, physical activity, and lifestyle were evaluated in a group of Mexican adults before and during COVID-19 confinement. In this study, 8289 adults answered an online questionnaire between April and May 2020. Data about sociodemographic characteristics, self-reported weight and height, diet quality, emotional eating, physical activity, and lifestyle changes were collected. Before and after confinement, differences by sociodemographic characteristics were assessed with Wilcoxon, Anova, and linear regression analyses. Most participants were women (80%) between 18 and 38 years old (70%), with a low degree of marginalisation (82.8%) and a high educational level (84.2%); 53.1% had a normal weight and 31.4% were overweight. Half (46.8%) of the participants perceived a change in the quality of their diet. The Diet Quality Index (DQI) was higher during confinement (it improved by 3 points) in all groups, regardless of education level, marginalisation level, or place of residence (p < 0.001). Lifestyle changes were present among some of the participants, 6.1% stopped smoking, 12.1% stopped consuming alcohol, 53.3% sleep later, 9% became more sedentary, and increased their screen (43%) as well as sitting and lying down time (81.6%). Mexicans with Internet access staying at home during COVID-19 confinement perceived positive changes in the quality of their diet, smoking, and alcohol consumption, but negative changes in the level of physical activity and sleep quality. These results emphasise the relevance of encouraging healthy lifestyle behaviours during and after times of crisis to prevent the risk of complications due to infectious and chronic diseases.

Nutriologia Medica: Medical Nutriology Comprehensive Textbook

Objectives

To know the opinion of users and readers about the application of Nutriología Médica as a textbook and its use as a reference for the practice of nutritional care in Mexico.To know the opinion of users and readers about the application of Nutriología Médica as a textbook and its use as a reference for the practice of nutritional care in Mexico.

Methods

Invitation open to students and health professionals from Mexico to evaluate the content and use of the 3rd and 4th editions of Nutriología Médica through an electronic survey designed on the Google Forms platform.

Results

197 students and 238 health professionals responded. 80% of the teachers considered that Nutriología Médica is a good tool for the learning of their students. 88.5% of the students considered that the text is appropriate for their level of studies. The 4th edition was better evaluated than the 3rd edition in terms of content, information and organization.

Conclusions

Nutriología Médica is a book used and recognized by students and health professionals in medicine and nutrition that has favored the teaching of nutrition in Mexico.

Funding Sources

Universidad Iberoamericana CDMX.

[Nutricia Code: nutrition and conflict of interest in academia]

To combat malnutrition in all its forms, actions must be integrated from society as a whole. The main interest of the actors involved in these actions should be health. However, there are actors with conflict of interest that interfere in the design, planning, implementation and monitoring of public health nutrition policies. In order to mitigate the adverse effect that result from these conflicts, from evidence generation to the design and implementation of policies, this Code is proposed. It invites the nutrition and health community to adopt it, promote it and subscribe it, and to favor the advancement of actions and policies without industry interference to address the problem of malnutrition.

Bioethics in Medical Care Rationing During the Coronavirus Disease-19 Pandemic

BACKGROUND

Coronavirus (CoV) disease (COVID)-19 poses difficult situations in which the ethical course of action is not clear, or choices are made between equally unacceptable responses.

METHODS

A web search was performed using the terms "bioethics; COVID-19; ethics; severe acute respiratory syndrome CoV-2; emergent care; pandemic; and public health emergencies."

RESULTS

Protection from COVID-19 has resulted in the cancellation of necessary medical interventions, lengthened suffering, and potential non-COVID-19 deaths. Prolonged lockdown reduced well-being, triggering or aggravating mental illnesses and violence, and escalated medical risks. Collateral damage includes restrictions on visitations to hospitals, alienation from the deceased relative, or lack of warm caring of patients. Finally, in a public health crisis, public health interest overrides individual rights if it results in severe harm to the community.

CONCLUSION

Balancing ethical dilemmas are one more challenge in the COVID-19 pandemic.

Bioethics in the COVID-19 Pandemic Research: Challenges and Strategies

As all other aspects in times of the coronavirus disease (COVID)-19 pandemic, carrying-out quality clinical research has been challenging. Many well-established paradigms have shifted as a consequence of the rapid demand for new knowledge. New treatments are fast-moving, informed consent forms are difficult to obtain, a competitive invitation from researchers to participate in different studies is common, and non-COVID-19 research protocols are suffering continuity. However, these challenges should not imply taking shortcuts or accepting deficiencies in bioethical standards, but rather enhance the alertness for rigorous ethical approaches despite these less than ideal circumstances. In this manuscript, we point out some interrogates in COVID-19 research and outline possible strategies to overcome the difficult task to continue with high-quality research without violating the ethical principles.

II. THE RESEARCH ETHICS INVOLVING VULNERABLE GROUPS

Vulnerability in research occurs when the participant is incapable of protecting his or her interests and therefore, has an increased probability of being intentionally or unintentionally harmed. This manuscript aims to discuss the conditions that make a group vulnerable and the tools and requirements that can be used to reduce the ethical breaches when including them in research protocols. The vulnerability can be due either to an inability to understand and give informed consent or to unequal power relationships that hinder basic rights. Excluding subjects from research for the only reason of belonging to a vulnerable group is unethical and will bias the results of the investigation. To consider a subject or group as vulnerable depends on the context, and the investigator should evaluate each case individually.

Perímetro de cuello y éxito del tratamiento de pacientes con obesidad: estudio de vida real

Introduction

Evaluation of the patient with obesity is a challenge due to the technical difficulties to carry out measurements.

Objective

To assess the association between neck circumference (NC) and waist circumference (WC) with cardio-metabolic risk markers, as well as treatment success in patients with morbid obesity.

Method

Four-hundred and seventy patients of 39.3 ± 11.4 years of age and with a body mass index (BMI) of 44.1 ± 8.4 were studied; 73.5% were females. Baseline and final BMI, WC, NC, hip circumference and cardio-metabolic markers were assessed. Success was defined as weight loss ≥ 5%.

Results

Significant correlations were found between WC and NC, and between these and cardio-metabolic risk markers, as well as between changes in WC and NC and treatment success. NC predicted success in logistic regression models.

Conclusions

The association of WC and NC with cardio-metabolic risk indicators and the association of NC with treatment success in patients with morbid obesity was documented. Given the simplicity for obtaining it, NC might replace WC in the assessment and follow-up of patients with class III obesity.

Understanding traditional and modern eating: the TEP10 framework

Across the world, there has been a movement from traditional to modern eating, including a movement of traditional eating patterns from their origin culture to new cultures, and the emergence of new foods and eating behaviors. This trend toward modern eating is of particular significance because traditional eating has been related to positive health outcomes and sustainability. Yet, there is no consensus on what constitutes traditional and modern eating. The present study provides a comprehensive compilation of the various facets that seem to make up traditional and modern eating. Specifically, 106 facets were mentioned in the previous literature and expert discussions, combining international and interdisciplinary perspectives. The present study provides a framework (the TEP10 framework) systematizing these 106 facets into two major dimensions, what and how people eat, and 12 subdimensions. Hence, focusing only on single facets of traditional and modern eating is an oversimplification of this complex phenomenon. Instead, the multidimensionality and interplay between different facets should be considered to gain a comprehensive understanding of the trends, consequences, and underlying factors of traditional and modern eating.

Changes in nutrient and calorie intake, adipose mass, triglycerides and TNF-α concentrations after non-caloric sweetener intake: A pilot study

Establishing the safety of non-caloric sweetener consumption in humans is a difficult task, since many contradictory results have been reported. The objective of this study was to compare the effect of frequent intake of sucrose, sucralose or steviol glycosides, on selected anthropometric, biochemical and immunological parameters in healthy, young adults. 38 individuals with normal body mass index were recruited and randomly divided into three experimental groups. After a washout week (where food with added sweeteners was restricted), each group was supplemented with sucrose (8 × 5 g packets/day), sucralose or steviol glycosides (4 × 1 g packets/day each) for 6 weeks. Selected variables were measured before and after treatment in each group and differences within and among groups were assessed. Our results showed that, compared to baseline, there was a modest but significant increase in weight (p = 0.0293) in the sucralose group, while the steviol glycosides group reduced their fat mass (p = 0.0390). No differences were observed in glycaemia; however, there was a significant increase in serum triglycerides (77.8-110.8 mg/dL) and cholesterol (162.0-172.3 mg/dL) in the sucrose group, whereas the steviol glycosides group presented lower triglycerides (104.7-92.8 mg/dL) and TNF-α concentrations (51.1-47.5 pg/mL). Comparison among groups showed differences in serum triglycerides (p = 0.0226), TNF-α (p = 0.0460) and IL-β (p = 0.0008). Our results suggest that, even in a short time span, frequent intake of steviol glycosides may have positive effects on metabolic parameters that may be relevant for human health.

III. THE ROLE OF THE RESEARCH ETHICS COMMITTEES IN THE REGULATION OF PHARMA-SPONSORED STUDIES

Participants of Pharma-sponsored research are exposed to risks, benefits, and uncertainties that do not occur in other forms of clinical studies. Ethics committees represent the subjects' first line of protection. This responsibility begins with the study review and ends after all study subjects finish the intervention. The objective of this paper is to review the most common controversial issues found in Pharma-sponsored studies. Potential solutions are proposed to prevent or resolve the polemical aspects. However, different challenges will be faced in the near future (e.g., when new therapies reach their late stage of development). All parties involved in research should work together to guarantee the protection of participants, the paramount principle on which clinical investigation is based. Pharma-sponsored research is a crucial driver to develop and implement innovative approaches to improve the informed consent process and the execution of the studies.

I. THE ROLE OF RESEARCH ETHICS COMMITTEES IN OBSERVATIONAL STUDIES: EPIDEMIOLOGICAL REGISTRIES, CASE REPORTS, INTERVIEWS, AND RETROSPECTIVE STUDIES

It is often unclear to the clinical investigator whether observational studies should be submitted to a research ethics committee (REC), mostly because, in general, no active or additional interventions are performed. Moreover, obtaining an informed consent under these circumstances may be challenging, either because these are very large epidemiological registries, or the subject may no longer be alive, is too ill to consent, or is impossible to contact after being discharged. Although observational studies do not involve interventions, they entail ethical concerns, including threats such as breaches in confidentiality and autonomy, and respect for basic rights of the research subjects according to the good clinical practices. In this context, in addition to their main function as evaluators from an ethical, methodological, and regulatory point of view, the RECs serve as mediators between the research subjects, looking after their basic rights, and the investigator or institution, safeguarding them from both legal and unethical perils that the investigation could engage, by ensuring that all procedures are performed following the international standards of care for research. The aim of this manuscript is to provide information on each type of study and its risks, along with actions to prevent such risks, and the function of RECs in each type of study.

Ethnic differences in fat and muscle mass and their implication for interpretation of bioelectrical impedance vector analysis

According to the World Health Organization Expert Consultation, current body mass index (BMI) cut-offs should be retained as an international classification. However, there are ethnic differences in BMI-associated health risks that may be caused by differences in body fat or skeletal muscle mass and these may affect the interpretation of phase angle and bioelectrical impedance vector analysis (BIVA). Therefore, the aim of this study was to compare body composition measured by bioelectrical impedance analysis among 1048 German, 1026 Mexican, and 995 Japanese adults encompassing a wide range of ages and BMIs (18–78 years; BMI, 13.9–44.3 kg/m2). Regression analyses between body composition parameters and BMI were used to predict ethnic-specific reference values at the standard BMI cut-offs of 18.5, 25, and 30 kg/m2. German men and women had a higher fat-free mass per fat mass compared with Mexicans. Normal-weight Japanese were similar to Mexicans but approached the German phenotype with increasing BMI. The skeletal muscle index (SMI, kg/m2) was highest in Germans, whereas in BIVA, the Mexican group had the longest vector, and the Japanese group had the lowest phase angle and the highest extracellular/total body water ratio. Ethnic differences in regional partitioning of fat and muscle mass at the trunk and the extremities contribute to differences in BIVA and phase angle. In conclusion, not only the relationship between BMI and adiposity is ethnic specific; in addition, fat distribution, SMI, and muscle mass distribution vary at the same BMI. These results emphasize the need for ethnic-specific normal values in the diagnosis of obesity and sarcopenia.

[A front-of-pack labelling system for food and beverages for Mexico: a strategy of healthy decision-making.]

The Mexican Ministry of Health requested the National Institute of Public Health to constitute a group of independent, free of conflict-of-interest academic experts on front-of-pack labelling (FOP). This group was instructed to created a positioning paper to contribute to the development of a FOP system for industrialized products that offers useful information for purchase decision making. This position paper uses the best available scientific evidence, and recommendations from experts of international organizations. The FOP proposal focuses on the contents of energy, nutrients, ingredients and components that if consumed in excess on the diet, can be harmful to people's health, such as added sugars, sodium, total fat, saturated fat and energy. The academic expert group recommends the implementation of a FOP that provides an easy way to quickly assess the quality of a product. It is essential that this FOP provides direct, simple, visible and easily understandable information.

Weight Loss Success Among Overweight and Obese Women of Mexican-Origin Living in Mexico and the United States: A Comparison of Two National Surveys

We assessed variations in and correlates of weight-loss success (WLS) among overweight/obese women in Mexico (WIMX) and Mexican-American women (MA). We used cross-national data from 2006 ENSANUT (Mexico) and NHANES (2001-2008) to compare 5061 WIMX with 550 MA's without known metabolic conditions. WLS was defined as losing ≥5 % of body weight over 1 year. MA's were more likely to attain WLS (OR 1.31; 95 % CI 1.01-1.70). WLS among WIMX was higher in those with at least high school, a provider screen of overweight and a lower BMI. Among MA's, an incomplete high school versus primary education reduced the odds of WLS. Among women who lost ≥10 lbs, weight-loss strategies such as eating less were higher among MA's. MA women were more likely than WIMX to attain WLS. Understanding these disparities can help design customized public health interventions that curb the obesity epidemic in these women in both countries.

Eating behavior and psychological profile: associations between daughters with distinct eating disorders and their mothers

Background

Associations of eating behaviors and psychological profile between mothers and daughters with eating disorders exist, but it is important to dissect the influence of the mother in each specific disorder since all eating disorders must be seen or treated not as one entity. The aim of the present study was to evaluate the association of eating behavior and psychological profile between mothers and daughters with different eating disorders and a control group.

Methods

The study group included young girls with anorexia nervosa (AN, n = 30), bulimia nervosa (BN, n = 30), binge eating disorder (BED, n = 19), and a control group of women (Non-ED, n = 54) together with their mothers. BMI was calculated for dyads and Eating Disorder Inventory, Beck Depression Inventory, Beck Anxiety Inventory, Toronto Alexithymia Scale and Three-Factor Eating Questionnaire were applied. The differences between dyads were tested by Student’s t test and Pearson’s correlation was used to study the association between BMI, variables of eating behavior and psychological profile in each dyad.

Results

The study found significant inverse correlations between the AN dyad; some correlations between the BN dyad, and the highest positive correlations exist in BED dyad, especially in eating behavior. Finally, between the control dyads, low but significant correlations were found in the majority of cases.

Conclusions

The study concluded that the associations between mothers and daughters with distinct eating disorders varied depending on the specific diagnosis of the daughter, indicating it is necessary to analyze them individually, given that there may be different implications for treatment.

Relationship between Fatty Acid Habitual Intake and Early Inflammation Biomarkers in Individuals with and without Type 2 Diabetes in Mexico

BACKGROUND

Lifestyle changes have led to a high global incidence of type 2 Diabetes mellitus (T2DM). Evidence suggests beneficial effects of the intake of n-3 and n-6 polyunsaturated fatty acids (PUFA) in patients with T2DM.

OBJECTIVE

To investigate the relationship between habitual fatty acid intake and inflammatory biomarkers in Mexican individuals with and without T2DM.

METHODS

A cross-sectional study of 120 adults with and 120 without T2DM; anthropometric assessments (BMI, waist circumference and body fat), blood pressure, PUFA intake, biochemical analyses (glucose and lipid profile) and inflammation biomarkers (IFN-γ, TNF-α, IL-1 β, IL-2, IL-6, IL-8 and IL-13) was undertaken.

RESULTS

Low n-3 intake was found in both groups (0.68 ± 0.55g/day in T2DM vs 0.81 ± 0.53 g/day in non-T2DM). Comparison between groups showed significantly higher concentrations of triacylglcerols (p=.001) and IL-6 (p=.018) in the T2DM group, as well as significant correlations between serum TNF-α and total n-3 fatty acid intake (r=.507, p= .001), EPA (r=.284, p=.002), DHA (r=.404, p=.001), and a weak but significant correlation between serum IL-1β and total PUFA (r=.245, p=.005), total n-3 (r=.214, p=.019) and total n-6 (r=.241, p=.008) intake.

CONCLUSIONS

Patients with T2DM had a tendency for higher pro-inflammatory cytokines than subjects without T2DM. There was an association between PUFA intake and pro-inflammatory biomarkers in patients with T2DM. Further studies of anti-inflammatory nutrients and plasma and cell fatty acid profiles are needed to corroborate the present findings in patients with and without T2DM.

Socioeconomic status and misperception of body mass index among Mexican adults

Objective. To estimate the association between perceived body mass index (BMI) and socioeconomic variables in adults in Mexico. Materials and methods. We studied 32 052 adults from the Mexican National Health and Nutrition Sur­vey of 2006. We estimated BMI misperception by comparing the respondent’s weight perception (as categories of BMI) with the corresponding category according to measured weight and height. Misperception was defined as respondent’s perception of a BMI category different from their actual cat­egory. Socioeconomic status was assessed using household assets. Logistic and multinomial regression models by gender and BMI category were estimated. Results. Adult women and men highly underestimate their BMI category. We found that the probability of a correct classification was lower than the probability of getting a correct result by chance alone. Bet­ter educated and more affluent individuals are more likely to have a correct perception of their weight status, particularly among overweight adults. Conclusions. Given that a correct perception of weight has been associated with an increased search of weight control and that our results show that the studied population underestimated their BMI, interventions providing definitions and consequences of overweight and obesity and encouraging the population to monitor their weight could be beneficial.

Stakeholder perspectives on national policy for regulating the school food environment in Mexico

In Mexico, the school environment has been promoting sale of unhealthy foods. There is little empirical evidence on multi-stakeholder perspectives around national school food policy to regulate this. We studied stakeholders' perspectives on the proposed regulation for school sale of unhealthy foods. Comments about the regulation were available from an open consultation process held in June 2010 before the approval and implementation of the regulation. To examine perspectives, we coded 597 comments for beliefs, expectations and demands in NVivo. We created matrices by actors: academics, parents, citizens, health professionals and food industry. For academics, citizens and health professionals, the primary issue regarding the regulation was obesity, while for parents it was health of children. Academics, citizens, health professionals and parents believed that government was responsible for health of citizens, expected that this regulation would improve eating habits and health (i.e. less obesity and chronic diseases), and demanded that unhealthy foods be removed from schools. Parents demanded immediate action for school food policy that would protect their children. Citizens and health professionals demanded nutrition education and healthy food environment. Food industry opposed the regulation because it would not solve obesity or improve diet and physical activity behaviours. Instead, industry would lose income and jobs. Food industry demanded policy aimed at families that included nutrition education and physical activity. There was substantial consensus in narratives and perspectives for most actor types, with the primary narrative being the food environment followed by shared responsibility. Food industry rejected both these narratives, espousing instead the narrative of personal responsibility. Consensus among most actor groups supports the potential success of implementation of the regulation in Mexican schools. With regard to addressing childhood obesity, sound government policy is needed to balance different perspectives and desired outcomes among societal actors, particularly in Mexico between food industry and other actors.

Weight status of Mexican immigrant women: a comparison with women in Mexico and with US-born Mexican American women

OBJECTIVES

We assessed the association between birthplace, residence, or years in the United States and actual weight (body mass index), perceived weight accuracy, or provider screens for overweight or obesity among Mexican immigrant women.

METHODS

We used linked data from Health and Nutrition Examination Survey waves 2001-2006 and 2006 National Mexican Health and Nutrition Survey to compare 513 immigrants with 9527 women in Mexico and 342 US-born Mexican American women.

RESULTS

Immigrants were more likely than women in Mexico to be obese and to perceive themselves as overweight or obese after adjustment for confounders. Recent immigrants had similar weight-related outcomes as women in Mexico. Immigrants were less likely to be obese than were US-born Mexican Americans. Within the overweight or obese population, reported provider screens were higher among immigrants than among women in Mexico, but lower than among US-born Mexican Americans. US residency of at least 5 years but less than 20 years and reporting insufficient provider screens elevated obesity risk.

CONCLUSIONS

Mexican-origin women in the United States and Mexico are at risk for overweight and obesity. We found no evidence of a "healthy immigrant" effect.

A population-based comparison of weight and weight perceptions among overweight and obese Mexican and Mexican-American men

OBJECTIVE

To examine actual and perceived weight in national cohorts of Mexican-origin adult men in Mexico and the United States (US).

MATERIALS AND METHODS

We used the 2001-06 National Health and Nutrition Examination Survey and the 2006 Mexican National Health and Nutrition Survey.

RESULTS

The prevalence of overweight or obesity (OO) in Mexicans was 65% and in Mexican-Americans was 72%. OO Mexican-American men were more likely than OO Mexican men (56 vs. 49%) to perceive themselves as "overweight". Among OO men from both populations, those who had been screened for OO by a health provider were almost seven times more likely to have accurate weight perceptions. Only 9% of OO men in Mexico and 25% in the US recalled having been screened for weight.

CONCLUSION

Weight misperceptions were common in both populations but more prevalent in Mexico; low screening by providers may contribute to poor weight control in both countries.

Weight perceptions among overweight and obese women: a US-Mexico binational perspective

We examined actual and perceived weight in nationally representative cohorts of adults in Mexico (n = 9,527) and the United States (n = 855) using data from the National Health and Nutrition Examination Survey (waves 2001-2006) and Mexican National Health and Nutrition Survey (2006). Actual weight was assessed by health technicians using BMI and perceived weight was collected through self-report. The prevalence of overweight or obesity (OO) in Mexican women was 72% and in Mexican-American women was 71%. OO Mexican-American women were more likely than OO Mexican women to label themselves as "overweight" (86% vs. 64%, P < 0.001), and this difference was significant while controlling for socio-demographic and weight-related variables. Among OO women from both populations, those who had been told by a health provider that they were OO were much more likely to perceive themselves as such (odds ratio = 5.3; 95% confidence intervals: 3.8-7.3). Significantly fewer OO women in Mexico than in the United States (13% vs. 42%, P < 0.0001) recalled having been screened for obesity by their health care provider. Weight misperceptions were common in both populations but more prevalent in Mexico, and low screening by health providers may be an important contributor to poor weight control in both countries.

[Obesity and metabolic syndrome. A challenge for the Mexican Institutes of Health]

Numerous efforts for the development of basic and clinical research in obesity are being made by the National Institutes of Health and Federal Reference Hospitals in Mexico. However, greater interaction among researchers and stronger efforts towards the dissemination of the results are needed. The document outlines the general ideas and proposals of the Academic Group for the Study, Prevention and Treatment of Obesity and Metabolic Syndrome of the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals (CCINSHAE). This is the first step in developing common objectives, with the aim of understanding the effect of these entities in public health and to establish guidelines to limit and eventually overcome them. We discuss the appropriateness of analyzing obesity and the metabolic syndrome together, and the current management of these entities at the National Institutes of Health in Mexico. The problems that arise in clinical practice lead to the need to generate a new model of medical care, including a new health worker and a new patient. It is imperative to establish permanent lines of communication and education with health personnel and with patients. The group proposes an integrated approach for research in these areas. Finally, a master plan that links the National Institutes of Health, particularly in the areas of research and programs within the institutions, is required as a first step in seeking answers useful in solving the problem. The second step would be linking the first and second levels of care through concrete actions needed to limit and reduce obesity and metabolic syndrome in the population.

Environmental and personal correlates of fruit and vegetable consumption in low income, urban Mexican children

BACKGROUND

Epidemiological evidence suggests that populations with high fruit and vegetable (FV) consumption have a lower risk for childhood obesity, cancer and cardiovascular diseases. There are no studies that address the correlates of FV intake in Mexican children; therefore, the aim of this study was to identify the frequency of FV consumption by children in Mexico City's low income state schools and their personal (preferences, expectancy, knowledge and self-efficacy) and environmental (accessibility and person in charge of cooking at home) correlates.

METHODS

A validated questionnaire to assess accessibility, expectancy, self-efficacy, preference and knowledge; and a 2-day dietary recall were used to assess the FV intake and its correlates in 327 children. Statistical analysis included chi-square and stepwise logistic regression.

RESULTS

Average consumption of FV was once a day with a higher proportion of girls consuming FV 3 or more times per day (15.2% versus 6.7%; P < 0.01). The environmental factors that influenced a higher consumption of FV were the mother being responsible for cooking at home (P < 0.02) and accessibility to FV (P < 0.01); whereas the personal factors were self-efficacy (P < 0.05) and preference (P < 0.03) to vegetables.

CONCLUSION

Correlates of fruit and vegetable consumption in children from Mexico City's State Schools were being female and accessibility to fruits and vegetables. Home and school environments are decisive for the children to increase FV consumption. Creative ways to encourage FV consumption in boys should be explored. These factors should be considered when designing programmes aimed at increasing consumption of fruits and vegetables in children.

Poverty, obesity, and malnutrition: an international perspective recognizing the paradox

In the year 2000, multiple global health agencies and stakeholders convened and established eight tenets that, if followed, would make our world a vastly better place. These tenets are called the Millennium Development Goals. Most of these goals are either directly or indirectly related to nutrition. The United Nations has led an evaluation team to monitor and assess the progress toward achieving these goals until 2015. We are midway between when the goals were set and the year 2015. The first goal is to "eradicate extreme poverty and hunger." Our greatest responsibility as nutrition professionals is to understand the ramifications of poverty, chronic hunger, and food insecurity. Food insecurity is complex, and the paradox is that not only can it lead to undernutrition and recurring hunger, but also to overnutrition, which can lead to overweight and obesity. It is estimated that by the year 2015 noncommunicable diseases associated with overnutrition will surpass undernutrition as the leading causes of death in low-income communities. Therefore, we need to take heed of the double burden of malnutrition caused by poverty, hunger, and food insecurity. Informing current practitioners, educators, and policymakers and passing this information on to future generations of nutrition students is of paramount importance.

[Association of body segments and body composition with blood pressure in young adults]

Skeletal structure and body composition may be altered permanently in response to aggressions during critical periods of growth. This increases propensity to adverse effects in adulthood. The study explored the association of anthropometric variables of body size and proportions and of body composition with systolic (SBP) and diastolic (DBP) blood pressure (BP) in young adults. We studied 166 men and 246 women age 20-34. SBP, DBP, weight, stature, sitting height, circumferences (waist, hip), breadths (biacromial, biiliac) and skinfolds (bicipital, tricipital, subscapular, suprailiac) were assessed. BMI, waist-hip ratio (WHR), waist-stature ratio, and Sigma skinfolds-stature were calculated. Pearson correlations were determined for anthropometric variables with SBP and DBP and linear regression models for SBP and DBP were developed by sex. Correlation coefficients between indicators and BP were significant, except for stature and SBP and DPB, and WHR with DBP in women; and stature with DBP, biiliac breadth and WHR with SBP, and sitting height with SBP and DPB in men. SBP and DPB were explained by weight, BMI, and biiliac breadth in multivariable analysis in women, where 15.4% and 10.8% of variance of SBP and DPB was explained. In men, SBP was explained by weight, Sigma skinfolds and WHR, and DBP by Sigma skinfolds; models explained almost 20% of SBP and DPB variance. No association was found between BP and past malnutrition indicators. Biiliac breadth, weight and BMI in women, and weight, WHR and Sigma skinfolds in men explained BP. The use of biiliac breadth in the assessment of hypertension risk in women should be explored further.

Association between measured BMI and self-perceived body size in Mexican adults

AIM

The study examined the association between perceived body size (through self-selection of Stunkard's body shape silhouettes) and measured body mass index (BMI) in Mexican Mestiso adult men and women, and determined the BMI values that corresponded to each silhouette.

SUBJECTS

A sample of 1092 men and 1247 women, apparently healthy, aged 20-69, was studied.

METHODS

Participants were asked to identify the silhouette that most accurately represented his/her body size. Weight and height were measured in duplicate to calculate BMI. A simple linear regression analysis was used to adjust BMI values to silhouette categories by gender. Areas under the receiver operating characteristic curves (AUC) were calculated to assess accuracy.

RESULTS

Gender-specific BMI values for each silhouette were obtained. Correlation coefficients between silhouette ratings and BMI were 0.702 in males and 0.766 in females. Overweight ranged from silhouette 4 to 6 and obesity from silhouette 6 to 9, in both men and women. In the regression models, 49.3% of BMI variance in males and 58.7% in females were explained statistically by silhouette self-selection. AUC were higher than 0.8 for overweight and obesity in males and females.

CONCLUSIONS

Both male and female models had a good fit, indicating that BMI can be associated with body shape silhouettes. Silhouettes can be useful for defining overweight and obesity in settings such as schools or worksites, or where scales and stadiometers might not be available. They can also be used to provide health advice to the public.

Hypertension, Overweight and Abdominal Adiposity in Women. An Analytical Perspective

BACKGROUND

The aim of our study was to determine in a group of premenopausal (preM) and postmenopausal women with hormone replacement therapy (postM-HRT) or without HRT (postM-noHRT) whether the strength of the association of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with hypertension is affected by the way in which these variables are used (i.e., continuous or dichotomous) in logistic regression modeling, where weight and age are set as continuous variables only.

METHODS

We studied 639 preM, 341 postM-noHRT, and 77 postM-HRT healthy women age 20-69 years. The main outcome variable was hypertension: BP > or =140 or 90 mmHg on two occasions or hypertension treatment. Risk factors were assessed as continuous variables (age, postmenopausal years, weight, stature, BMI, WC, hip circumference, and WHR); and dichotomous variables (overweight: BMI > or =25; high WC: WC > or =88 cm; and high WHR: WHR > or =0.84). Stepwise regression models for hypertension were developed for continuous (model 1) and dichotomous (model 2) variables in each group.

RESULTS

In preM, model 1 included BMI (OR=1.202, CI: 1.115-1.296) and age (OR=1.154, CI: 1.081-1.296); and model 2 included weight (OR=1.070, CI: 1.040-1.100) and age (OR=1.157, CI: 1.084-1.235). In postM-noHRT, both models included age (OR=1.074, CI: 1.035-1.113) and weight (OR=1.025, CI: 1.004-1.046). Overweight and age were associated with hypertension in preM and postM-noHRT; overweight being more relevant in preM, and age in postM-noHRT. No models were found for postM-HRT.

CONCLUSIONS

The strength of the association of risk factors with hypertension depends on how the variables are analyzed. Acknowledging these differential effects and assigning differential risks by age could be useful in intervention programs.

[Harmonization for mesoamerican nutrient-based recommendations: regional unification or national specification?]

Mesoamerica, the area we focus for this paper, is a section of Latin America that extends from Central Mexico to Panama. The deliberations of international committees are the primary bases for their nutrient-based recommendations. To a smaller extent, the unique particularities of the bioavailability for one or another nutrient have been considered. The nutrient recommendations throughout the region are "relatively" uniform and mutually consistent with respect to: iron, iodine and most of the B-complex vitamins. discrepancies exist among the various sets of recommendations for other nutrients. A valid basis of harmonization would not be unification of recommendations across all nationalities, but rather assuring a consistency in the nutrient profile that is recommended provides the nutrient exposures and/or fills the body's reserves as best suits the goals of survival, growth, well-being and function within the ecological niche of the population. That the recommendations for nutrients must be satisfied from foods, foods that are accessible and culturally acceptable, and that approximate the parallel demands of food-based dietary guidelines, add additional constraints onto the process of enunciating the former.

[Evaluation of a breakfast as screening test for the detection of gestational diabetes]

A standard breakfast was evaluated as a screening test (BT) for gestational diabetes in a case-control study. The breakfast had a high carbohydrate content and was designed based on women's preferences in a similar sample. Women were selected with a standard 50 g, 1 hour glucose screening test (GT). Fifteen women had a positive GT and 15 had a negative test. A glucose tolerance test (GTT) and a standard breakfast (719 kcal) were performed to all women. Age, weight, height, tricipital and subscapular skinfold thicknesses were obtained by previously standardized personnel and glucose levels were determined by an automatic technique (oxidase glucose). Ten women had gestational diabetes. Sensitivity and specificity were calculated for the GT and several values of the BT, in order to identify the threshold and optimum time. Concordance of both screening tests with GTT was calculated through Kappa test. For the BT, a sensitivity of 0.90 and specificity of 1.00 with a glucose level > or = 140 mg/L (7.2 mmol/L) at 60 and 90 minutes were found. The 60 minutes timing were preferred due to a shorter waiting time to performed the test. Concordance of GTT with GT and BT was 0.53 and 0.92 respectively, both statistically significant. GT had high frequency of false negative values (6/15) that explain the low kappa value. Standard breakfast can be used as an alternative method for assessing carbohydrate tolerance in pregnancy with a better physiological response in these women.

[Clinical nutrition training in medical schools of Mexico]

OBJECTIVE

To describe the efforts carried out to strengthen nutrition education in Mexican medical schools. Emphasis was placed on the status previous to the program implementation, the design of a new basic curriculum, and the description of the main program strategies implemented.

METHODS

a) Analysis of available medical curricula; b) Application of a questionnaire to the school deans; c) Assessment of knowledge of nutrition of advanced medical students; d) Design of a basic curriculum of clinical nutrition; e) Edition of a textbook; f) Design and implementation of program strategies to strengthen nutrition education.

RESULTS

Clinical nutrition was not a topic included in most curricula analyzed and, when present, it was incorporated to related clinical subjects. Usually, emphasis was placed on basic topics of nutrition while clinical and applied subjects were considered less frequently. Lack of a specialized faculty and weakness of teaching infrastructure were some problems identified. A basic curriculum adaptable to different contexts was designed, and a textbook on clinical nutrition was edited and published. Training and formation of nutrition specialists were among the key programs implemented.