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We aimed to assess the efficacy of whole cow's milk fortified with ferrous gluconate and zinc oxide, along with ascorbic acid, in reducing the prevalence of anemia and improving iron status of low income children 10-30 mo of age. Healthy children were randomly assigned to drink 400 mL/d of cow's whole milk, either fortified milk (FM) with 5.8 mg/400 mL of iron as ferrous gluconate, 5.28 mg/400 mL of zinc as zinc oxide, and 48 mg/400 mL of ascorbic acid, or nonfortified milk (NFM) with 0.2 mg iron/400 mL, 1.9 mg zinc/400 mL, and 6.8 mg ascorbic acid/400 mL. Hemoglobin, serum ferritin, soluble transferrin receptors (TfR), and C-reactive protein concentrations were measured at baseline and 6 mo after intervention. The prevalence of anemia declined from 41.4 to 12.1% (P < 0.001), or 29 percentage points, in the FM group; there was no change in the NFM group. Hemoglobin (coefficient = 0.22, P < 0.01) was positively and TfR (coefficient = -0.29, P < 0.001) negatively associated with treatment, controlling for their respective baseline values, age, and gender. Treatment with FM was negatively associated with the likelihood of being anemic (pseudo [R.sup.2] = 0.085, P < 0.03) after 6 mo of intervention. Ferrous gluconate added to whole cow's milk as a fortificant along with ascorbic acid is efficacious in reducing the prevalence of anemia and in improving iron status of Mexican toddlers. The results of this study lead to broadening a subsidized FM distribution program to 4.2 million beneficiary children 1-11 y of age in Mexico.

The fortification of staple foods with zinc may play an important role in achieving adequate zinc intakes in countries at risk of zinc deficiency. However, little is known about the relative bioavailability of different zinc compounds that may be used in food fortification. The objective of this study was to measure and compare fractional zinc absorption from a test meal that included a maize tortilla fortified with zinc oxide, zinc sulfate, zinc oxide + EDTA, or sodium-zinc EDTA. A double isotopic tracer ratio method ([sup.67]Zn as oral tracer and [sup.70]Zn as intravenous tracer) was used to estimate zinc absorption in 42 Mexican women living in a periurban community of Puebla State, Mexico. The test meal consisted of maize tortillas, yellow beans, chili sauce, and milk with instant coffee; it contained 3.3 mg zinc and had a phytate:zinc molar ratio of 17. Fractional zinc absorption did not differ significantly between the test groups (ANOVA; P > 0.05). Percent absorptions were (mean [+ or -] SD) zinc oxide, 10.8 [+ or -] 0.9; zinc sulfate, 10.0 [+ or -] 0.02; zinc oxide + EDTA, 12.7 [+ or -] 1.5; and sodium-zinc EDTA, 11.1 [+ or -] 0.7. We conclude that there was no difference in zinc absorption from ZnO and ZnS[O.sub.4] when added as fortificants to maize tortillas and consumed with beans and milk. The addition of EDTA with zinc oxide or the use of prechelated sodium-zinc EDTA as fortificants did not result in higher zinc absorption from the test meal. KEY WORDS: * zinc * absorption * maize * fortificants * stable isotopes

The purpose of this study was to investigate the usefulness of soluble serum transferrin receptor (TfR) concentration, TfR index and log TfR:ferritin ratio (TfR outcomes) in detecting tissue Fe deficiency among breast-feeding Otomi women residing in Capulhuac, Mexico (2800 m above sea level) and to determine whether folate deficiency modifies the interpretation of these data. Lactating women (n = 68) provided blood samples at 22 [+ or -] 13 d (mean [+ or -] SD) postpartum. Using the 3-index Fe assessment model with and without Hb, 2 women (3%) had Fe-deficient erythropoiesis, 24 (36%) Fe deficiency anemia, and 19 (29%) indeterminate Fe status; 29 (43%) and 5 (7.5%) women had plasma and erythrocyte folate concentrations below normative cutoff values, respectively. Mean values for TfR outcomes were higher among women classified as Fe deficient than those who were Fe sufficient, but did not differ with low or normal blood folate concentrations. Similarly, TfR outcomes did not differ among women with normocytic or macrocytic erythrocytes. Receiver-operating characteristic (ROC) curves generated for TfR outcomes yielded areas under the curve from 0.62 to 0.68, indicating that each of these measures, on its own, is a poor predictor of tissue Fe deficiency in lactating women. In conclusion, low blood folate concentrations or the presence of macrocytosis in Otomi women from Capulhuac, Mexico (moderate altitude) did not influence the utility of TfR outcomes for the detection of Fe deficiency during early lactation. Further, on their own, TfR, TfR index, and TfR:ferritin ratio were poor predictors of tissue Fe deficiency for any given individual. J. Nutr. 135: 144-149, 2005. KEY WORDS: * iron * folate * lactation * transferrin receptor

After 1 y of distributing a milk-based fortified weaning food provided by the Mexican social program PROGRESA, positive effects on physical growth, prevalence of anemia, and several vitamin deficiencies were observed. There was no effect on iron status, which we hypothesized was related to the poor bioavailability of the reduced iron used as a fortificant in PROGRESA. The objective of this study was to compare the iron bioavailability from different iron sources added as fortificants to the weaning food. Children (n 54) aged 2-4 y were randomly assigned to receive 44 g of the weaning food fortified with ferrous sulfate, ferrous fumarate, or reduced iron + [Na.sub.2]EDTA. Iron absorption was measured using an established double-tracer isotopic methodology. Iron absorption from ferrous sulfate (7.9 [+ or -] 9.8%) was greater than from either ferrous fumarate (2.43 [+ or -] 2.3%) or reduced iron + [Na.sub.2]EDTA (1.4 [+ or -] 1.3%) (P < 0.01). The absorption of [log-.sup.58] Fe sulfate given with the iron source correlated with serum ferritin (s-ferritin) concentration (n = 13, r = 0.63, P = 0.01) and [log-.sup.57] Fe absorption (reference dose) (n = 14, r = -0.52, P = 0.02). Absorption from ferrous fumarate and reduced iron + Na2EDTA did not correlate with s-ferritin or absorption of [sup.57] Fe. The recommended daily portion of the fortified complementary food provides an average of 0.256, 0.096, 0.046 mmol (1.44, 0.54, and 0.26 mg) of absorbed iron, if fortified with sulfate, fumarate and reduced iron + [Na.sub.2] EDTA, respectively. Ferrous sulfate was more bioavailable than either ferrous fumarate or reduced iron + [Na.sub.2]EDTA when added to the milk-based fortified food and more readily met the average daily iron requirements for children 2-3 y of age. KEY WORDS: * iron absorption * stable isotopes * fortification

A randomized effectiveness study is conducted to document the short-term nutritional impact of a large-scale, incentive-based development program in Mexico, Progresa (Program for Education, Health and Nutrition), which included a nutritional component. The results indicate that progresa is associated with better growth and lower rates of anemia in low-income, rural infants and children in Mexico.

The impact of iron-only supplements (FE) versus multiple micronutrient supplements containing iron (MM) during pregnancy on iron status was assessed in a subsample (n = 453) of women who participated in a randomized double-blind trial in Mexico. Compliance, monitored by observation, was high (>85%). The two groups were similar at recruitment ( KEY WORDS: * iron * multivitamin-mineral * supplements * pregnancy * anemia

An attenuated severity of infections is among the well-documented benefits of breast-feeding. The degree to which this attenuated severity extends to the amelioration of anorexia is understood incompletely,and possible underlying mechanisms have received limited evaluation. This study was designed to test whether breast-feeding attenuates reductions in energy intake associated with a mild immunologic stimulus and to assess poststimulus relationships among putative reductions in energy intake and serum interleukin (IL)-1[beta], tumor necrosis factor (TNF)-[alpha] and leptin concentrations. A quasi-experimental, hospital-based study was conducted in 23 healthy fully breast- (BF) and formula-fed (FF) infants who received the quadruple diphtheria, pertussis, tetanus and hemophilus influenza (DPTH) immunization as an immunologic challenge. Only FF infants had decreased energy intakes (12[+ or -]2%, P = 0.001) after immunization. Leptin concentrations increased after immunization only in FF infants (30[+ or -]7%, P = 0.03). Correlations between postimmunization increases in IL-[beta]and reductions in energy intake were of borderline significance (r = -0.56, P = 0.08). These findings support the view that breast-feeding protects against anorectic response to mild immunologic stimuli. Increases in leptin are associated with reductions in energy consumption in the postimmunization period in FF infants and postimmunization changes in IL-1[beta]concentrations likely are related to reductions in energy intake in response to immunologic stimuli. Key Words: * breast-feeding * infants * interleukin-1[beta] * tumor necrosis factor-[alpha] * leptin * infections * anorexia

Rats fed a diet with high fat concentration produce larger amounts of milk with a higher lipid concentration than rats fed a lower fat diet. This investigation was designed to study the relationship between dietary fat intake, mammary gland lipid uptake and lipogenesis in rat dams fed, during pregnancy and lactation, one of two purified diets, with equal energy density, containing 2.5 (LL) or 20 g fat/100 g diet (HL). Milk lipid concentration and fatty acid composition were determined at d 14 of lactation. Mammary gland lipogenesis, lipoprotein lipase (LPL) activity and the uptake of [1-14C]triolein by the mammary gland and its transfer to the pups was measured. The intestinal absorption of oral 14C-lipid, 14C[O.sub.2] production and the amount of 14C-lipid transferred to the pups (milk clot + pups carcass) were significantly higher in the HL group than in the LL group (P < 0.05). Mammary gland lipogenesis was 75% lower and LPL activity was 30% higher in the HL group (P < 0.05). Medium-chain fatty acids (C6-C14) excretion was 46% lower and that of long-chain fatty acids was 142% (P < 0.001) higher in the HL group than in the LL group. The higher milk lipid excretion in the rats fed a high-fat diet resulted from a larger uptake of dietary lipid by the mammary gland, indicated by a larger transfer of 14C-lipid to the pups and by a higher LPL activity in the mammary gland. KEY WORDS: mammary gland; lipoprotein lipase; lactation; dietary fat; lipogenesis; rats

It remains unclear whether breast-feeding protects infants against acute respiratory infection (ARI). To determine if breast-feeding protects against ARI as it does against diarrhea, 170 healthy newborns were followed for 6 mo. Feeding mode, incidence and duration of ARI and diarrhea were recorded biweekly. Infants were classified as fully or partially breast-fed, or formula-fed. Incidence and prevalence were computed monthly. The effects of duration of breast-feeding and potential confounders were analyzed by multiple and logistic regression analyses. Incidence and prevalence of ARI were significantly lower in fully breast-fed infants than in formula-fed infants from birth up to 4 mo, as was the mean duration of individual episodes (5.1 [+ or -] 3.5 vs. 6.4 [+ or -] 3.6 d, respectively). Incidence of ARI was negatively associated with duration of breast-feeding and positively associated with the presence of siblings (P < 0.05). The prevalence of ARI was associated only with the duration of breast-feeding (P < 0.05). Infants that were never breast-fed and that had one or more siblings were more likely to have an episode of ARI than those fully breast-fed for at least 1 mo. Incidence, prevalence, and duration of individual episodes of diarrhea were also lower in breast-fed infants. Incidence (r = -0.17, P < 0.02) and prevalence (r = -0.19, P KEY WORDS: * infants * breast-feeding * acute respiratory infection * diarrhea * humans

The relationship between dietary fat content and milk composition, production and litter growth was studied in rats fed during pregnancy and lactation purified diets of equal energy density containing 2.5 or 20 g fat/100 g diet. A subsample of rats (HL-EP group) fed the high lipid (HL) diet but pair-fed on an energy basis with the low lipid (LL) diet group was also studied in a separate experiment. Food intake, dam body weight and litter weight were recorded daily. Rats were milked on d 14 of lactation. Milk lipid, lactose and protein concentration and milk production were measured. Lactating rats fed the HL diet had significantly higher energy intakes (P < 0.01) and milk production (P < 0.05) than rats fed the LL diet. Milk lipid concentration and daily milk volume and lipid production were significantly higher in the HL group. The HL-EP dams had significantly higher milk lipid, protein and lactose concentrations (P < 0.05) and tended to have higher daily lipid and energy outputs (P = 0.08) than LL rats. Birth weights of pups were similar among groups, but from d 6 on, the pups from the HL and HL-EP groups were significantly heavier (P < 0.05) than pups from the LL group. This investigation presents evidence that the milk fat concentration and the daily output of fat, protein and lactose of lactating rats are altered by dietary fat manipulations, which in turn affect growth of the litter. KEY WORDS: * lactation * dietary fat * milk composition * rats * litter growth

To investigate the energy requirements of infants living under unfavorable environmental conditions in rural Mexico, we measured the total energy expenditure (TEE) of 40 Otomi infants at approximately 4 or approximately 6 mo of age. Total energy expenditure was estimated by the doubly labeled water method: 100 mg 2H2O/kg and 250 mg 18O/kg were administered orally, after which urine was collected serially for 7 or 10 d. Isotopic enrichment of urine samples was analyzed by gas-isotope-ratio mass spectrometry. Weight and length were measured monthly from birth to 6 mo. Fat free mass was estimated from 18O dilution spaces. Total energy expenditures (mean + or - SD) were 310 + or - 58 and 318 + or - 29 kJ center dot kg to the -1 center dot d to the -1 at approximately 4 and approximately 6 mo, respectively. Total energy expenditure was higher than that previously observed for breast-fed infants reared under more protected environments (268 + or - 29 kJ center dot kg to the -1 center dot d to the -1). Weight, length and weight gain were 5.9 + or - 0.8 kg, 60 + or - 2 cm and 2.9 + or - 2.4 g center dot kg to the -1 at 4.25 mo and 7.1 + or - 0.8 kg, 65 + or - 2 cm and 1.0 + or - 1.2 g center dot kg to the -1 center dot d to the -1 at 6.27 mo. Growth faltering was evident at 6 mo by clinically significant declines in growth velocities and National Center for Health Statistics Z-scores. Body fat of the Otomi infants averaged 21 + or - 6 and 18 + or - 5 g/100 g at approximately 4 and approximately 6 mo, respectively. Higher rates of TEE narrowed the margin of energy available for growth and thereby contributed to growth faltering in the Otomi infants.

Abstract Background In México, the prevalence of unhealthy weight increased from 24% at 6 y to 33% at 12 y of age, opening a window of opportunity to better understand the pathogenesis of obesity. The objective of this study was to explore the association between time spent on medium, vigorous physical activity (MVPA) and concurrent gains in BMI, fat mass (FM) and fat-free mass (FFM), alternately, in a cohort of Mexican children followed from kindergarten (baseline) to 2nd grade elementary school (endline). Methods The MVPA (5-d accelerometry), BMI, FM and FFM (air displacement plethysmography) were measured at baseline and endline. Associations between gains in BMI, FM and FFM and changes in MVPA were examined using lagged and dynamic regression models, controlling for energy intake and demographic variables. Results A total of 205 children were analyzed. Gender affected the effect of MVPA on FM gain. In girls, a high baseline MVPA predicted a lower FM gain (-0.96 kg, p=0.025) compared to low/medium MVPA. Increasing, decreasing or having a persistently high MVPA predicted a lower FM gain (range -1.6 to -1.03 kg, p Conclusion These results support a protective role of MVPA on FM gain in girls, suggesting that it may play a crucial role in the development of obesity. Further research on the gender effect of MVPA is warranted to better understand its role in the prevention and control of overweight and obesity.

Abstract Background There is growing evidence that quality, rather that quantity of fat is the determinant of cardiovascular risk. The objective of the study is to describe quantitatively the intake and adequacy of fatty acid classes among the Mexican population aged 5-90 years from a probabilistic survey. Methods Dietary intake of individual and classes of fatty acids was computed from the dataset of the 2006 Mexican National Health and Nutrition Survey (ENSANUT2006), collected by a food frequency questionnaire. Adequacy was calculated in reference to authoritative recommendations. Results The mean intake of total fatty acids (TFA ≈ 25%E) fell within WHO recommendations; the intakes of saturated fatty acids (SFA) among all age-groups (45-60%) and of trans fatty acids (TrFA) in 30% of school-age children and adolescents and 20% of adults exceeded international recommendations. The mean intake of polyunsaturated fatty acids (PUFA) and particularly of n6 and n3 PUFAS, was inadequately insufficient in 50% of the sample. Conclusions The main public health concerns are the high intake of SFA and the suboptimal intake of PUFA in Mexican population. The TrFA intake represents a low public health risk.

Abstract Background To estimate the incidence of complications, life expectancy and diabetes related mortality in the Mexican diabetic population over the next two decades using data from a nation-wide, population based survey and the United Kingdom Prospective Diabetes Study (UKPDS) outcome model Methods The cohort included all patients with type 2 diabetes evaluated during the National Health and Nutrition Survey (ENSANut) 2006. ENSANut is a probabilistic multistage stratified survey whose aim was to measure the prevalence of chronic diseases. A total of 47,152 households were visited. Results are shown stratified by gender, time since diagnosis (> or ≤ to 10 years) and age at the time of diagnosis (> or ≤ 40 years). Results The prevalence of diabetes in our cohort was 14.4%. The predicted 20 year-incidence for chronic complications per 1000 individuals are: ischemic heart disease 112, myocardial infarction 260, heart failure 113, stroke 101, and amputation 62. Furthermore, 539 per 1000 patients will have a diabetes-related premature death. The average life expectancy for the diabetic population is 10.9 years (95%CI 10.7-11.2); this decreases to 8.3 years after adjusting for quality of life (CI95% 8.1-8.5). Male sex and cases diagnosed after age 40 have the highest risk for developing at least one major complication during the next 20 years. Conclusions Based on the current clinical profile of Mexican patients with diabetes, the burden of disease related complications will be tremendous over the next two decades.

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