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BackgroundPromoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. ObjectiveThis study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. MethodsNUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children’s age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants’ experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. ResultsOf the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was “good,” “useful,” and “helpful” for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. ConclusionsWhile NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. Trial RegistrationClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896

Introducción: En individuos con talla baja se ha reportado mayor morbilidad y mortalidad relacionada con diabetes y enfermedades cardiovasculares. En México se desconoce la prevalencia de talla baja y de obesidad en personas con talla baja de acuerdo con criterios nacionales. Objetivo: Estimar, en mexicanos de 20 a 59 años, la prevalencia de talla baja y de obesidad en individuos con talla baja según la NOM-008- SSA3-2017. Métodos: Es un estudio que analiza los datos de las Encuestas Nacionales de Salud y Nutrición (ENSANUT) de 2006, 2012 y 2018. Las mujeres < 150 cm y los hombres < 160 cm se clasificaron con talla baja, se estableció obesidad cuando presentaron índice de masa corporal ≥ 25 kg/m2. La prevalencia nacional de talla baja fue del 27.3, 22.9 y 22.9%, mientras que la de obesidad en individuos con talla baja fue del 73.5, 75.0 y 78.4% en 2006, 2012 y 2018, respectivamente. De 2006 a 2018, la prevalencia de talla baja se redujo un 16.1%, mientras que la de obesidad incrementó un 6.7% en personas con talla baja. Conclusión: Durante el periodo referido se tuvo una reducción en la prevalencia de talla baja, aunque sigue siendo alta. Por otro lado, la prevalencia de obesidad ha incrementado en este grupo poblacional.

Abstract Background Early childhood development (ECD) is essential in human capacity building and a critical element in the intergenerational process of human development. In some countries, social programs targeted at improving ECD have proven to be successful. Oaxaca is one of the States with the greatest social inequities in Mexico. Therefore, children in Oaxaca are at a high risk of suboptimal ECD. In 2014, the non-governmental organization (NGO) Un Kilo de Ayuda started to implement the Neurological and Psycho-affective Early Childhood Development Program in eighty marginalized communities of Oaxaca. In this article, we present the impact evaluation design to estimate the effect of this program on ECD. Methods We will use a cluster randomized stepped-wedge design with an allocation ratio of 1:1. Communities will be randomly assigned to each study group: four groups of twenty communities each. We expect that children from intervened communities will show better ECD outcomes. Discussion This study is one of the few rigorous assessments of the effect of an ECD program on the neurodevelopment of Mexican children recruited in their first 3 years of life from communities of high social vulnerability. Our study design is recommended when the way in which outcomes are measured and assessed depends on age, self-selection is present, and assignment is performed at an aggregate level. Implementation research will be conducted prior to study launch and quality control measures will be in place to maximize the fidelity of study design implementation. Trial registration ClinicalTrials.gov NCT04210362

La doble carga de la desnutrición y el exceso de peso (o mala nutrición) es uno de los indicadores que mejor ilustra las inequidades en salud que existen en zonas indígenas de México. Por otro lado, existe escasa evidencia del estado de nutrición en población Tarahumara. Objetivo: Estimar indicadores del estado de nutrición y su asociación con factores sociodemográficos en población indígena Tarahumara menor de 5 años. Métodos: Estudio transversal en 21 localidades indígenas de la Sierra Tarahumara en Chihuahua, México, que analizó información sociodemográfica, de salud y antropométrica en población infantil de 6 a 59 meses de edad (n=323). Se estimaron índices antropométricos y su asociación con variables de interés mediante regresión logística múltiple. Un valor de p ≤0,05 fue considerado como estadísticamente significativo. Todos los análisis se realizaron en el paquete estadístico Stata v14.2. Resultados: Se encontraron altas prevalencias de talla baja (44,4%), emaciación (5,3%), bajo peso (11,9%) y sobrepeso (15,2%). El sexo masculino se asoció significativamente con talla baja (Razón de Momios (RM)=2,5; 1,45-4,34), mientras que, ninguna escolaridad de la madre (RM=0,39; 0,15-0,99) y ser beneficiario de un programa local de nutrición por más de 2 años se asoció con sobrepeso (RM=2,97; 1,26 -6,97). Conclusión: Se encontraron indicadores de mala nutrición en la muestra estudiada; éstos hallazgos podrían sugerir la existencia de inequidad y rezago en salud y nutrición de población infantil indígena Tarahumara. Se requieren más estudios que puedan orientar programas y acciones de salud y nutrición para atender a esta población de forma prioritaria.

Vitamin D (VD) deficiency (serum 25(OH)D < 50 nmol/L) affects 27.3% of preschool children in Mexico. The purpose of this study was to assess the effect of vitamin D supplementation at different doses on serum 25(OH)D concentrations in preschool children. In a randomized control trial, 222 children 12–30 months old were randomly assigned to one of four treatment groups: (1) Vitamin D2 (Ergocalciferol) 400 IU/day (n = 56); (2) Vitamin D2 (Ergocalciferol) 800 IU/day (n = 55); (3) Vitamin D3 (Cholecalciferol) 1000 IU/day (n = 56); or (4) multiple micronutrients (MM) non-VD (n = 55). Supplements were given five days/wk for three months. Serum 25(OH)D was measured at baseline and after three months. At baseline, mean serum 25(OH)D was 58.9 ± 12.6 nmol/L and 23.4% were VD-deficient. There was a statistically significant increase in serum concentrations of 25(OH)D (range across groups: +8.2 to +17.3 nmol/L). Additionally, the prevalence of vitamin D deficiency decreased after three months: for D2 400 IU, −9.0%; for D2 800 IU, −11.0%; for D3 1000 IU, −18.0%; and for MM non-VD, −2.8% (p < 0.05). No adverse effects were observed. VD supplementation for three months was effective for increasing serum 25(OH)D concentrations and for reducing VD deficiency in preschool children. The highest efficacy was observed by giving 1000 IU D3/d.

Objetivos. Actualizar la prevalencia de desnutrición y sus tendencias en los últimos 30 años e identificar factores asociados con la baja talla en una muestra representativa nacional de niños

Objective. To compare the prevalence of women 20-49 years of age with iron deficiency anemia (IDA), iron deficiency with no anemia (IDNA), and non-ID anemia (NIDA) in com­parison during 2006, 2012 and 2018, and their association with sociodemographic characteristics and nutritional status. Materials and methods. Ensanut 2006, 2012 and 2018- 19 are comparable for measurements of anemia (hemoglobin) and Iron deficiency (ID, by ferritin). Both measurements combined were compared with year of surveys and other dependent variables using a multinomial regression. Results. In 2006, the total prevalence of anemia was 14.9% and ID 29.0%, the prevalence of IDA was 8.35%, of IDNA 20.5%, and NIDA 6.6%; in 2012, the total prevalence of anemia was 13.3%, ID was 9.6%, IDA 8.6%, IDNA 21.0% y NIDA 4.7%; in 2018 total prevalence of anemia was 21.4%, of ID 25.7%, IDA 10.5%, IDNA 15.2% and NIDA 10.9%. Conclusions. The total prevalence of anemia increased 6.5 pp between 2006 and 2018, IDNA reduced, IDA had no significant changes, the mayor increase (4.3 pp) occurred in NIDA.

A massive incorporation of ultra-processed products into young children’s diets worldwide and in Mexico has been documented. The aim of this study is to understand the role of sociocultural factors in principal caregivers’ decisions to give a type of ultra-processed food to children under age five, called ‘comida chatarra’ (‘junk food’ in English), usually includes sugar-sweetened beverages, sweet and salty snacks, and sweet breakfast cereals. We conducted a descriptive, observational qualitative study. The research was conducted in urban and rural communities in two Mexican states. Twenty-four principal caregivers were equally distributed between the two states and types of communities. They were interviewed in person. Phenomenology underpinned this study. Results highlight the preponderant role of culture in food choices and feeding practices with junk food. Local culture influences child-feeding with ultra-processed products through social norms, knowledge, or socially constructed attitudes. These social norms, built in the context of abundant ultra-processed products and omnipresent marketing, ‘justify’ children’s consumption of junk food. They acquire these products from the principal caregivers, family members, and neighbors, among others, who reward and pamper them. These actors also define what amount (small amounts) and when (after meals as snacks) children are given these products. Cultural factors must be considered in the development of effective public policies and programs that aim to change the culture around ultra-processed products among children and avoid their consumption.

Objetivo. Evaluar la asociación entre el perfil nutricional y las estrategias de publicidad de alimentos procesados de trigo y maíz (APTM) ofertados en puntos de venta de la Ciudad de México. Material y métodos. Se recolectó información del contenido nutricional y tipos de publicidad para doce categorías de APTM en 58 puntos de venta localizados en zonas de niveles socioeconómicos (NSE) bajo y alto. Resultados. El 8.5 y 10.7% de APTM en NSE bajo y alto fueron saludables, respectivamente. ≤12% de los APTM fueron saludables, excepto harinas (~30%) y pastas (~95%). Entre ambos NSE, de 28.3% a 31.9% de APTM usaron personajes, de 46.5% a 50.1% promociones y de 38.2% a 41.3% claims. Se encontraron asociaciones significativas (p

Objetivo. Estudiar el comportamiento de la anemia en los años 2006, 2012 y 2018-19, su severidad y factores asociados en mujeres mexicanas de 20 a 49 años de edad. Material y métodos. Las Ensanut 2006, 2012 y 2018-19 tienen un diseño metodológico que permite comparaciones entre ellas. Mediante hemoglobina capilar

Abstract Background Children

Objetivo. Estimar las prevalencias municipales de mala nutrición en población preescolar en México, y describir su variabilidad y su relación con la cobertura del Programa Nacional México Sin Hambre. Material y métodos. A partir de datos de la Encuesta Nacional de Salud y Nutrición de 2012, la desigualdad del ingreso y marginación municipal se aplicó un modelo normal generalizado para obtener las distribuciones municipales de los indicadores de nutrición y estimar las prevalencias de mala nutrición. Resultados. Las prevalencias de talla baja variaron de 7.8% (IC95%: 5.9-8.9) a 64.2% (49.2-72.5), las de bajo peso de 0.6% (0.005-1.7) a 22.2% (13.5-34.9) y de sobrepeso u obesidad de 2.6% (0.2- 3.9) a 14.4% (11.9-27.7). De los 554 municipios con prevalencias de talla baja mayor que 25%, 275 fueron cubiertos por el programa México Sin Hambre. Conclusiones. La estimación de prevalencias municipales de mala nutrición evidenció grandes diferencias al interior del país, mismas que podrían asistir la política pública.

Objective. To estimate the prevalence and distribution of anemia in Mexican women and their association with sociodemographic factors and diet diversity. Materials and methods. We analyzed information of women in childbearing age. The Ensanut 100k is a probabilistic survey that overrepresents households with less economic capacity. Anemia was estimated using hemoglobin concentration. We collected sociodemographic and health information, food insecurity, and dietary diversity. Results. 34.3% of the women presented anemia, belong to tertile 3 of welfare status is a protective factor for anemia (OR= 0.26, 95%CI 0.16-0.61), and living in a household with food security, as well as high diversity of the diet in rural women (OR= 0.57, 95%CI 0.36-0.92). Conclusions. It is necessary to implement actions of detection and early attention of the anemia in women in childbearing age, identification of its underlying causes, strengthening and reformulation of strategies to prevent it.

Objective. To analyze the association between supplements and Liconsa milk intake, with anemia, zinc (ZD) and iron (ID) deficiencies, and morbidity in Mexican children resident of less than 100 000 habitants’ localities. Materials and methods. A subsample of 1 516 children aged 1-4 participants of Ensanut 100k was analyzed, carried out in 2018. Anemia was considered if [Hb]

Supplementation in malnourished pregnant women should not displace natural healthy foods. Objective: To estimate the differential effects of three nutritional supplements on macro- and micronutrient intake of pregnant women beneficiaries of the conditional cash transfer program Prospera (CCT-POP). Methods: Prospective cluster randomized trial. Communities were randomly assigned to receive a fortified beverage (Beverage), micronutrient tablets (Tablets), or micronutrient powder (MNP). Pregnant women (at p < 0.001). Compared to Beverages, median increases were higher for the MNP for vitamins C (31.2 ± 11.7, p < 0.01), E (1.67 ± 0.81, p < 0.05), and B12 (0.83 ± 0.27, p < 0.01) from baseline to 37 wk; from baseline to 1 mpp, there was a higher median increase in B12 (0.55 ± 0.25, p < 0.05) and folate (63.4 ± 24.3, p < 0.01); and from baseline to 3 mpp, a higher median increase in iron (2.38 ± 1.06, p < 0.05) and folate (94.4 ± 38.1, p < 0.05). Conclusions: Intake of micronutrients was higher for MNP and Tablets, likely due to food displacement among Beverage consumers. Although iron bioavailability and absorption inhibitors were not considered for the present analyses, the distribution of Tablets or MNP had several advantages in this context where micronutrient deficiency remains high among pregnant women, but macronutrient intake is generally adequate or even high.

The objective of this study was to compare the effect of three micronutrient products on biomarkers of iron and zinc status of Mexican children 6–12 months of age. As part of research to improve the impact of a national program, 54 communities were randomly assigned to receive: (1) fortified food (FF), provided by the program at the time, or (2) micronutrient powders (MNP) or (3) syrup. Each product contained 10 mg each of zinc and iron, plus other micronutrients. Children consumed the product 6 days/week for four months. Primary outcomes were changes in serum zinc, ferritin, soluble transferrin receptor, hemoglobin concentrations, and their deficiencies. Zinc concentration increased significantly from baseline to follow-up in all groups, with the largest change in the syrup group (geometric mean difference: +4.4 µmol/L; 95%CI: 3.2, 5.5), followed by MNP (+2.9 µmol/L; 95%CI: 2.1, 3.6) and FF (+0.9 µmol/L; 95%CI: 0.3, 1.6). There was a significant increase in hemoglobin concentration (+5.5 g/L; 2.5, 8.4) and a significant reduction in anemia prevalence (44.2% to 26.8%, p < 0.01) only in the MNP group. Compliance differed significantly among groups (MNP vs. FF, p = 0.04; MNP vs. syrup, p = 0.04), but may not fully explain the greater improvement in zinc and iron status in the syrup and MNP groups. The food matrix may influence nutrient utilization from supplements.

The contributions of processed foods to the overweight and obesity problem in Latin America are well known. Engagement with the private and public sectors on possible solutions requires deeper insights into where and how these products are sold and the related implications for diet quality. This article characterizes the diversity of wheat and maize processed foods (WMPFs) available to consumers in Mexico City. Data were gathered across nine product categories at different points of sale (supermarkets, small grocery stores, convenience stores) in high and low socioeconomic (SE) areas. We assessed WMPFs based on Nutri-Score profile, price, and health and nutrition claims. Roughly 17.4% of the WMPFs were considered healthy, of which 62.2% were pastas and breads. Availability of healthy WMPFs was scarce in most stores, particularly in convenience stores Compared to supermarkets in the low SE area, those in the high SE area exhibited greater variety in access to healthy WMPFs across all product categories. In the low SE area, healthy WMPFs were priced 16–69% lower than unhealthy WMPFs across product categories. The extensive variety of unhealthy WMPFs, the limited stock of healthy WMPFs in most retail outlets, and the confusing health and nutrition claims on packaging make it difficult for urban consumers to find and choose healthy WMPFs.

Abstract Background Nutritional supplements are an important source of complementary food for young children, since they may either complement or substitute nutrients obtained from other food sources. Assessing how the introduction of different types of supplements modifies the consumption of other food sources may help in designing supplementation programs that aim to improve the nutrition of vulnerable populations. The objetive is to quantify dietary energy and nutrient intake among children aged 6–12 months who received one of three nutritional supplements. Methods A cluster-randomized trial was conducted from 2005 to 2007. Urban communities were randomly allocated to one of three intervention groups receiving one of the following: a milk-based fortified food, micronutrient powders, or syrup. Each supplement was fortified with equal amounts of micronutrients. Dietary intake was estimated using a food frequency questionnaire (FFQ) to reflect the average consumption over the month prior to the interview. Children between 6 and 12 months of age were recruited. Median regression was performed with adjusted standard errors for clustered data, and the linear predictors for the median included the study group, study stage and their interaction. Adjusted medians by study group and study stage were obtained as post-estimations. Results No statistically significant differences between study groups were observed at baseline. After four months of supplementation, the children in the fortified food group had a smaller increase in median dietary energy (183.7 kcal, CI95%: 59.9, 307.5) and dietary protein (6.6 g, CI95%: 2.6, 10.6) intake from their home diet than those in the syrup group (p

Background: Polyunsaturated fatty acids (PUFAs) are essential to child growth and development. Objective: To assess the effect of PUFAs-fortified infant formula on lipid profile, growth and micronutrient status in children 12 to 30 months old. Methods: This study is a double-blind randomized controlled clinical trial. Two study groups were assessed: (a) milk-based infant formula with micronutrients and PUFAs (PUFAs) and (b) milk-based infant formula with micronutrients, no PUFAs added (Non-PUFAs). Children received prepared formula (240 mL) twice a day, according to the color-code assigned to each infant. Anthropometric measurements and venous blood samples were taken at each day-care center at baseline, and again after four months. Total serum lipid extraction was 0.5 mL. Samples were treated and modified by the Folch method and analyzed with gas chromatography. Results: Changes in serum lipid profile (expressed as % FA) between baseline and four months showed a statistically significant increase in docosahexaenoic acid (DHA) (0.22 vs. −0.07, p < 0.05) and Alpha-Linoleic acid (0.08 vs. 0.02, p < 0.05) in infants who consumed PUFAs-fortified formula compared to Non-PUFAs-fortified formula. Infants increased their length/height-for-age Z-score: median change for the PUFAs group was 0.16 (95% CI = 0.08, 0.28) and 0.23 (95% CI = 0.14, 0.33) for Non-PUFAs, with no differences between groups. Median folate level was significantly higher among the PUFAs group compared to Non-PUFAs: −0.87 (95% CI = −1.38, −0.44) and −3.83 (95% CI = −4.65, −3.03) respectively. Consumption of both supplements was adequate and stable during the intervention. Conclusion: A significant improvement was observed in the lipid profile of children who received the PUFAs-fortified milk-based formula.

Objective.To assess the performance of a simple correction method for nutritional status estimates in children under five years of age when exact age is not available from the data. Materials and methods. The proposed method was ba- sed on the assumption of symmetry of age distributions within a given month of age and validated in a large population-based survey sample of Mexican preschool children. Results. The main distributional assumption was consistent with the data. All prevalence estimates derived from the correction method showed no statistically significant bias. In contrast, failing to correct attained age resulted in an underestimation of stunting in general and an overestimation of overweight or obesity among the youngest. Conclusions. The proposed method performed remarkably well in terms of bias correction of estimates and could be easily applied in situations in which either birth or interview dates are not available from the data.

Objetivo: Estimar la edad promedio de inicio de las relaciones sexuales con penetración (IRSP) y los factores familiares e individuales asociados en chicos y chicas de 14-19 años escolarizados en centros públicos de las 32 entidades de México, en 2007. Métodos: Estudio transversal realizado en una muestra representativa de 9893 estudiantes de 14-19 años de edad. La información se recolectó utilizando un cuestionario autoadministrado, anónimo y voluntario. Se estimaron modelos de regresión logística para obtener odds ratio (OR) e intervalos de confianza del 95% (IC95%) por categorías: sin IRSP, IRSP a los 10-15 años años e IRSP a los 16-19 años. Resultados: El promedio de edad nacional para el IRSP fue de 16 años (IC95%: 15,5-16,1). En los chicos, la media de edad al IRSP fue de 15 años (IC95%: 15,88-16,11), y en las chicas fue de 16 años (IC95%: 15,26-15,42). Factores asociados a IRSP en chicos: nivel socioeconómico desfavorecido (OR = 0,66; IC95%: 0,46-0,94), vivir con los padres (OR = 0,65; IC95%: 0,56-0,75), comunicación ofensiva menor entre padres/madres e hijos/as (OR = 0,66; IC95%: 0,57-0,77)¸ autoestima social alta (OR = 1,68; IC95%: 1,35-1,77). Factores asociados a IRSP en chicas: creencias de género tradicionales (OR = 0,49; IC95%: 0,32-0,74), sintomatología depresiva alta (OR = 1,88; IC95%: 1,19-2,99), autoestima familiar alta (OR = 0,50; IC95%: 0,38-0,65). Conclusiones: En México, el IRSP se presenta a edad más temprana en los chicos. Además, los hallazgos del presente estudio demuestran que la edad de IRSP y los factores asociados son diferentes en los chicos y las chicas. Las creencias de género y socioculturales influyen de manera importante en la edad de IRSP.

Objective. To describe the prevalence of serum iron and zinc deficiencies and low serum concentrations (LSC) of copper and magnesium in Mexican adults. Materials and methods. Blood samples from subjects (≥20 years, both genders) participating in the 2006 National Health and Nutrition Survey were used to measure the serum concentrations of s-ferritin, soluble-transferrin-receptor (s-TfR), zinc, copper, and magnesium. Results. The prevalence of s-ferritin≤12ug/L was 18.1 and 3.6% while s-TfR mayor que 6mg/L was 9.5 and 4.4%, for females and males, respectively. The prevalence of zinc deficiency was 33.8% females and 42.6% males; LSC of copper were 16.8 and 18.2%, and 36.3 and 31.0% for magnesium, for females and males, respectively. Conclusions. The prevalence of deficiencies in iron (in females), and zinc are still high in the adult population. LSC of copper and magnesium are published for the first time and show significant prevalence of deficiencies. Corrective actions are necessary in order to diminish these nutritional deficits in the Mexican population.

OBJECTIVE: To identify associated factors to compliance for multiple micronutrient (MM) or iron and vitamin A (IVITA) supplementation, in children (3 to 24 months old). MATERIALS AND METHODS: A database (n=465 children) from a randomized, controlled, clinical trial, carried out in a semi-rural setting in Mexico, was analyzed. The compliance rate of MM and IVITA supplements was calculated. Adequate compliance rate (AC>80%), and its association with children and households characteristics, was determined. RESULTS: The compliance mean was high (MM:78.2%, IVITA:80.1%; pOBJETIVO: Identificar factores asociados con el cumplimiento del consumo de suplementos con micronutrimentos múltiples (MM) o con hierro y vitamina A (FEVITA) en niños (80%) y su asociación con varias características. RESULTADOS: El cumplimiento fue alto (MM: 78.2%, FEVITA: 80.1%; p

OBJECTIVE: To describe the micronutrient nutritional status of a national sample of 1-11 year old Mexican children surveyed in 2006 in National Health and Nutrition Survey (ENSANUT 2006) and their association with dietary and sociodemographic factors. MATERIALS AND METHODS: Serum samples were used (n=5 060) to measure the concentrations of ferritin, transferrin receptor, zinc, copper and magnesium. RESULTS: Prevalence of deficiencies in 1-4 and 5-11y old children were for iron (using low ferritin) 26.0 and 13.0%; zinc, 28.1 and 25.8%, respectively; and copper, ≈30% in both age groups. Magnesium low serum concentrations (MLSC), were found in 12.0% and 28.4% of the children, respectively. Being beneficiary of Liconsa (OR=0.32; C.I.95%, 0.17-0.61) or belonging to higher socioeconomic status (OR=0.63; C.I.95%, 0.41-0.97) were protective against iron deficiency. Increasing age (OR=0.59; C.I.95%, 1.19-1.32) and living in the Central Region (OR=0.59; C.I.95%, 0.36-0.97) were protective against MLSC. CONCLUSIONS: Deficiencies of iron and zinc are serious public health problems in Mexican children.OBJETIVO: Describir el estado nutricio de micronutrimentos en niños de 1-11 años de edad de la Encuesta Nacional de Salud y Nutrición 2006 y su asociación con factores dietéticos y sociodemográficos. MATERIAL Y MÉTODOS: Se usaron muestras séricas (n=5060) para medir las concentraciones de ferritina, receptor de transferrina, zinc, cobre y magnesio. RESULTADOS: La prevalencias de deficiencias en niños de 1-4 y de 5 a 11 años fueron para ferritina, 26.0 y 13%; zinc, 28.1 y 25.8% respectivamente y cobre ≈30% en ambos grupos. Las concentraciones bajas de magnesio (CBM) fueron 12.0 y 28.4%, respectivamente. Ser beneficiario de Liconsa (RM=0.32; IC 95%: 0.17-0.61) y pertenecer al nivel socioeconómico alto (RM=0.63; IC, 95%: 0.41-0.97) fueron protectores para deficiencia de hierro. La edad (RM=1.26; IC, 95%: 1.19-1.32) y vivir en la región Centro (RM=0.59; IC, 95%: 0.36-0.97) fueron protectores para CBM. CONCLUSIONES: Las deficiencias de hierro y zinc son serios problemas de salud pública en niños mexicanos.

OBJECTIVE: The objective of this analysis was to test the impact of daily supplementation with multiple micronutrients (MM) during pregnancy on Zn, vitamin A and folate status compared to iron only (Fe). MATERIAL AND METHODS: The study was carried out during 1997-2000 in a semi-urban community in Morelos state, Mexico. Women were randomly assigned to MM (n= 249) or Fe (n= 258) and received supplements daily (6 d/wk) under supervision by the field team from recruitment (approximately 9 weeks pregnancy) until delivery. Blood samples were collected on a sub-sample of women at baseline, 32 weeks pregnancy and one month postpartum (1PP) and assessed for serum zinc, retinol and whole blood folate (baseline and 1PP only). A breast milk sample was extracted at 1PP and assessed for retinol content. RESULT: At baseline there was no significant difference between supplementation groups in mean Zn, retinol or folate concentrations or the prevalence of deficiencies (Zn 12.2%, vitamin A 2.8%, folate 5.3%). Mean change in Zn and retinol concentrations from baseline to 32 weeks pregnancy did not differ between groups or between baseline and 1PP for Zn, retinol or folate. At 1PP, there was a tendency (p= 0.09) towards a lower prevalence of folate deficiency/depletion in the MM group (10.0%) than the Fe group (18.5%). CONCLUSIONS: MM supplementation during pregnancy did not improve zinc or vitamin A status compared to Fe only. There is some indication that folate status may have improved with MM supplementation despite low prevalence of deficiency. While lack of response in serum retinol may be explained by generally adequate status, the lack of impact on zinc status requires further exploration.OBJETIVO: Evaluar el efecto de la suplementación diaria con múltiples micronutrimentos (MM) durante el embarazo en el estado de zinc, vitamina A y folato comparado con la suplementación sólo con hierro (Fe). MATERIAL Y MÉTODOS: El estudio se realizó en una comunidad semiurbana en el estado de Morelos, México, entre 1997 y 2000. Las mujeres fueron asignadas aleatoriamente a recibir un suplemento de MM (n= 249) o Fe (n= 258) diariamente (6 días/semana), cuyo consumo fue supervisado por personal de campo, desde la evaluación basal (aproximadamente 9 semanas de gestación) hasta el parto. En una submuestra de mujeres participantes, se tomaron muestras de sangre venosa, a las 9 y 32 semanas de embarazo y al mes posparto (1PP). Se midieron las concentraciones séricas de zinc y retinol y la concentración de folato en sangre total, esta última sólo en la evaluación basal y al 1PP. Además se colectó una muestra de leche materna al 1PP, en donde se midió la concentración de retinol. RESULTADOS: En la evaluación basal no hubo diferencias significativas entre grupos en las concentraciones promedio de zinc y retinol, ni en la concentración de folato o en la prevalencia de deficiencias (Zn 12.2%, vitamina A 2.8%, folato 5.3%). El cambio promedio en zinc y retinol de la evaluación basal a la semana 32 de embarazo, no fue diferente entre grupos, tampoco entre la evaluación basal y al 1PP en zinc, retinol o folato. Al 1PP hubo una tendencia (p= 0.09) a menor prevalencia de deficiencia/depleción de folato en el grupo de MM (10.0%) que en el grupo Fe (18.5%). CONCLUSIONES: La suplementación con MM durante el embarazo no mejoró el estado de zinc y vitamina A comparada con la suplementación sólo con Fe. Sin embargo, el estado de folato puede haber mejorado con la suplementación con MM, a pesar de la baja prevalencia de deficiencia de folato. La falta de efecto en vitamina A podría ser explicada por el adecuado estado de la misma en las mujeres estudiadas y la falta de efecto en el estado de zinc requiere futura exploración.

Los objetivos de este análisis son: caracterizar los suplementos alimenticios (SA) de mayor consumo, así como explorar la asociación del consumo SA con características sociodemográficas, antropométricas, y anemia, en una muestra representativa de mujeres, entre 12 a 49 años de edad (n=15,936), incluidas en la Encuesta Nacional de Nutrición, de 1999, en México. Se usó un modelo de regresión logística múltiple para calcular probabilidades (P) de consumo de SA, según características a nivel individual y del hogar, incluyendo términos de interacción ajustando por diseño de la Encuesta. Los SA más consumidos fueron el grupo de vitaminas con minerales (36.7%) y el de vitaminas (34.3%). La mayor probabilidad estadísticamente significativa (pFactors associated with nutritional supplement consumption in Mexican women aged 12 to 49 years. The objectives of this analysis are to identify the types of nutritional supplements (NS) commonly used and explore the associations between NS consumption and socio-demographic characteristics, nutritional status, measured as BMI, and anemia in a nationally representative sample Mexican women aged 12 to 49 years (n=15,936) who participated in the Mexican National Nutrition Survey in 1999. Data on NS consumption and the other characteristics of interest were collected. We calculated the probability (P) of supplement consumption using logistic regression. For the statistical analysis characteristics at the individual and household level were included in the statistical models, and adjusted for the study design. Interaction effects were also explored. Multiple mixed vitamin and mineral supplements were the most commonly consumed (36.7%) followed by vitamins only (34.3%). Married women were significantly (p

OBJECTIVE: To describe the epidemiology of Vitamin A and C and folic acid deficiencies and their association with sociodemographic and dietary factors in a national probabilistic sample of Mexican women and children. MATERIAL AND METHODS: This is a probabilistic sample from the National Nutrition Survey 1999 (ENN-99) including 1 966 children and 920 women. Vitamins A and C were measured in serum by high-performance liquid chromatography, and folic acid in total blood by a microbiological method. Determinants for such deficiencies were explored by multiple regression models. RESULTS: Vitamin A deficiency (retinol 10 and OBJETIVO: Describir la epidemiología de las deficiencias de las vitaminas A y C y del ácido fólico, y analizar su asociación con factores sociodemográficos y dietéticos en una muestra probabilística nacional de mujeres y niños mexicanos. Informar acerca del estado nutricio de estas vitaminas en una muestra probabilística nacional en México. MATERIAL Y MÉTODOS: Esta muestra probabilística de la Encuesta Nacional de Nutrición 1999 incluyó 1 966 niños y 920 mujeres. Las concentraciones séricas de las vitaminas A y C fueron medidas por cromatografía líquida de alta resolución HPLC (por sus siglas en inglés) y las de ácido fólico en sangre total por un método microbiológico. Se exploraron los posibles determinantes de la deficiencia de tales nutrimentos mediante modelos de regresión logística. RESULTADOS: La deficiencia de vitamina A (retinol 10

OBJECTIVE: To describe the epidemiology of iron, zinc and iodide deficiencies in a probabilistic sample of Mexican women and children and explore its association with some dietary and socio-demographic variables. MATERIAL AND METHODS: We carried out in 1999 an epidemiological description of iron (percent transferrin saturation, PTS, OBJETIVO: Describir la epidemiología de las deficiencias de hierro, zinc y yodo en una muestra probabilística de mujeres y niños mexicanos y analizar algunas asociaciones con factores dietéticos y sociodemográficos. MATERIAL Y MÉTODOS: Descripción epidemiológica de las deficiencias de hierro (Porcentaje de saturación de transferrina

OBJECTIVE: To compare the prevalence of undernutrition and anemia in indigenous and non-indigenous children 0.05). The prevalence of anemia in indigenous children was one third greater than in non-indigenous children at the national level (p0.05) in rural areas. These differences were reduced to about half when adjusting for SES but remained significantly higher in indigenous children (pOBJETIVO: Comparar las prevalencias de desnutrición y anemia en niños indígenas y no indígenas menores de cinco años de edad en el ámbito nacional, por región, por zonas urbanas y rurales, y evaluar en qué medida la condición socioeconómica de la familia predice las diferencias. MATERIAL Y MÉTODOS: Se realizó una encuesta nacional probabilística en 1999 en México. Las familias indígenas fueron identificadas como aquellas en las cuales al menos una mujer entre 12 y 49 años de edad en el hogar hablara una lengua indígena. Las prevalencias de desnutrición (baja talla, emaciación y bajo peso) y anemia fueron comparadas entre niños indígenas y no indígenas. Se utilizaron razones de probabilidad para comparar prevalencias ajustando por las condiciones socioeconómicas de la familia y por otras variables. RESULTADOS: Las prevalencias de baja talla y de bajo peso fueron mayores en indígenas que en no indígenas. En el ámbito nacional y en zonas urbanas las prevalencias fueron casi tres veces mayores, mientras que en zonas rurales fueron ~2 veces mayores (p0.05). La prevalencia de anemia en indígenas fue un tercio mayor que en no indígenas en el ámbito nacional (p 0.05). Estas diferencias se redujeron aproximadamente a la mitad al ajustar por las condiciones socioeconómicas, pero continuaron siendo significativamente superiores en niños indígenas (p

Objective. To assess the comparability of hemoglobin concentration (Hb) in venous and capillary blood measured by Hemocue and an automated spectrophotometer (Celldyn) and to document the influence of type of blood (capillary or venous) and analysis method on anemia prevalence estimates. Material and Methods. Between February and May 2000, capillary and venous samples were collected from 72 adults and children at Hospital del Niño Morelense (Morelos State Children's Hospital) in Cuernavaca, Morelos, Mexico, and assessed for Hb using the Hemocue and Celldyn methods. Estimated Hb levels were compared using the concordance correlation coefficient and Student's t test for paired data. The sensitivity and specificity for anemia diagnosis were estimated and compared between type of blood and method of assessment. Results. Capillary blood had higher Hb (+0.5g/dl) than venous blood in adults and children, as did samples assessed by Celldyn compared to Hemocue (+0.3g/dl). Specificity to detect anemia was adequate (>0.90) but sensitivity was low for capillary blood assessed by Hemocue (Objetivo. Evaluar la comparabilidad de la concentración de hemoglobina (Hb) en sangre venosa y capilar medida por Hemocue y por espectrofotómetro automatizado (Celldyn), así como documentar la influencia del tipo de sangre (capilar o venosa) y del método de análisis sobre la prevalencia de anemia. Material y métodos. De febrero a mayo de 2000, se recolectaron muestras de sangre capilar y venosa en 72 adultos y niños en el Hospital del Niño Morelense, Cuernavaca, Morelos, México. Se determinaron los niveles de Hb con los métodos Hemocue y Celldyn. Las cifras de Hb estimadas se compararon con el coeficiente de concordancia y la prueba pareada de t de Student. También se comparó la sensibilidad y especificidad para el diagnóstico de anemia, utilizando sangre de los dos tipos y métodos de análisis. Resultados. La Hb fue mayor en sangre capilar comparada con sangre venosa (+0.5g/dl) en adultos y niños, y en las determinaciones por Celldyn comparadas con las de Hemocue (+0.3 g/dl). La especificidad para el diagnóstico de anemia fue adecuada (>0.90), mientras que la sensibilidad fue baja para las muestras capilares medidas por Hemocue (

OBJECTIVE: To describe the prevalence of anemia in Mexican women and analyze its trends with information from the last two national nutrition surveys. MATERIAL AND METHODS: The prevalence of anemia in women was analyzed. Anemia was adjusted by socioeconomic profile and by potentially explanatory variables. RESULTS: The overall prevalence of anemia for pregnant women was 20.2% (95% CI 15.9, 26.2%) and 15.5% for non-pregnant women (95% CI 14.7, 16.4%). The prevalence of anemia in women decreased from 1999 to 2006 in all socioeconomic profiles. Adolescent women living in the northern and in the southern regions had a greater risk of anemia than those in Mexico City (p= 0.05). Significant risk was found among low socioeconomic level (p< 0.06). Greater parity was a significant risk factor (p< 0.05) for being anemic. CONCLUSIONS: Although anemia in reproductive age women in Mexico decreased, it continues to be a public health problem.OBJETIVO: Describir la prevalencia de anemia en mujeres y analizar su tendencia a través de las dos últimas encuestas nacionales de nutrición. MATERIAL Y MÉTODOS: Se analizó la prevalencia de anemia en mujeres. La prevalencia de anemia se ajustó por perfil socioeconómico y por posibles variables que la expliquen. RESULTADOS: La prevalencia global de anemia fue de 20.2% (IC95% 15.9, 26.2%) para mujeres embarazadas y de 15.5% (IC95% 14.7, 16.4%) para mujeres no embarazadas. La prevalencia de anemia en mujeres disminuyó de 1999 a 2006 en todos los niveles socioeconómicos. Las mujeres adolescentes que viven en las regiones norte y sur tuvieron mayor riesgo de anemia que las que viven en la Ciudad de México (p= 0.05). Se encontró un riesgo significativo asociado con el nivel socioeconómico bajo (p< 0.06). La mayor paridad resultó ser un factor de riesgo significativo (p< 0.05). CONCLUSIONES: Aun cuando la presencia de anemia en mujeres en edad reproductiva en México ha disminuido, continúa siendo un problema de salud pública.

OBJECTIVE: To estimate energy, nutrient intake and diet adequacy in school-aged children based on the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006). MATERIAL AND METHODS: Food intake data from food frequency questionnaires was analyzed for 8 716 children aged 5 to 11 years. Energy and nutrients intake and adequacy were obtained. Comparisons were made at regional, urban/rural areas, socioeconomic status (SES) and nutrition status (body mass index and height/age). RESULTS: Median energy intake was 1501 kcal/d (percent adequacy: 88.0). Overweight and obesity prevalence was 25.5%. Stunting prevalence was 10%. Children at lowest SES, indigenous and from rural communities showed the highest inadequacies for vitamin A, folate, zinc, and calcium. Overweight children and those highest SES had higher risk of excessive intakes. CONCLUSIONS: Coexistence of over and undernutrition reflects a polarized model of nutrition transition among Mexican children.OBJETIVO: Estimar el consumo y adecuación de energía y nutrimentos en niños escolares mexicanos que participaron en la Encuesta Nacional de Salud y Nutrición 2006 (ENSANUT 2006). MATERIAL Y MÉTODOS: Se analizaron datos de frecuencia de consumo de alimentos en 8 716 niños de entre 5 y 11 años de edad. Se calcularon la ingesta y la adecuación de energía y nutrimentos. Se hicieron comparaciones por región, área urbana/rural, nivel socioeconómico (NSE) y estado nutricio (índice de masa corporal y talla/edad). RESULTADOS: La mediana de ingestión de energía fue 1 501 kcal/día (% adecuación 88.0); 25.5% de los niños tuvieron sobrepeso u obesidad; 10%, retardo en talla. Los niños con menor NSE, los indígenas y los de comunidades rurales mostraron mayores inadecuaciones dietarias de vitamina A, folato, zinc y calcio. Los niños con sobrepeso y los de mayor NSE presentaron más riesgo de ingestiones excesivas. CONCLUSIONES: La coexistencia de malnutrición por exceso y por deficiencia evidencia una transición nutricional polarizada en niños mexicanos.

OBJECTIVE: To compare the distribution of anemia in children, based on information from Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) and Mexican National Nutrition Survey 1999 (ENN-99), and examine the association of anemia with potentially explanatory variables. MATERIAL AND METHODS: Adjusted prevalence and means as well as associations with potentially explanatory variables were assessed by multiple linear and logistic regression models for complex samples. RESULTS: From 1999 to 2006, the prevalence of anemia decreased 13.8 percentage points (pp) in toddlers and 7.8 pp in children 24-35 months of age; it also decreased 0.7 pp/year in urban and rural populations, 1.8 pp/year in indigenous and 0.61 pp/year in non-indigenous toddlers, 1.5 pp/year in children 5-8 years of age and 0.78 pp/year in children 9-11 years of age. In toddlers served by Oportunidades, Hb was inversely associated with indigenous ethnicity (p=0.1) and they had a lower risk of anemia (OR=0.002). In school-age children, age (OR=0.98), affiliation to Liconsa (OR=0.42) and living in the central region (OR=0.56) were protective factors for anemia. CONCLUSIONS: The national prevalence of anemia in Mexico has decreased in the past seven years, especially in toddlers. Being a beneficiary of Liconsa or Oportunidades was protective for anemia.OBJETIVO: Comparar la distribución de la anemia en niños con base en la información de la Encuesta Nacional de Nutrición 2006 (ENSANUT 2006) y la Encuesta Nacional de Nutrición 1999 (ENN99). Asimismo, examinar la asociación de la anemia con variables potencialmente explicativas. MATERIAL Y MÉTODOS: Se calcularon las prevalencias y las medias ajustadas, así como las asociaciones mediante modelos de regresión múltiple lineal y logística para muestras complejas. RESULTADOS: Entre 1999 y 2006 la anemia disminuyó 13.8 puntos porcentuales (pp) en lactantes de 12-23 meses de edad y 7.8 pp en los de 24-35; 0.7 pp/año en prescolares urbanos y rurales, 1.8 pp/año en indígenas y 0.61 pp/año en no indígenas; 1.5 pp/año en niños de 5-8 años y 0.78 pp/año en los de 9-11 años. En preescolares beneficiarios de Oportunidades la Hb se asoció negativamente con indigenismo (p=0.1) y tuvieron un riesgo menor para anemia (OR=0.002). En niños escolares la edad (OR=0.98), ser beneficiario de Liconsa (OR=0.42) y vivir en la región centro (OR=0.56) resultaron ser factores protectores contra la anemia. CONCLUSIONES: La prevalencia de anemia disminuyó en México durante los pasados siete años, especialmente en lactantes. Ser beneficiario de Oportunidades y de Liconsa fue protector para el riesgo de anemia.

In Mexico, about one third of school-age population is overweight or obese and the diet is one of the main determinants. The purpose of this study was to identify the dietary patterns of Mexican school-age children and to determine their association with the risk of overweight/obesity. This study included 8252 school-age children who participated in the 2006 National Health and Nutrition Survey (ENSANUT-2006). Dietary data were collected using a 7-day Food Frequency Questionnaire (FFQ). Foods were classified into 25 groups and dietary patterns were defined by cluster analysis. Body Mass Index and prevalence of overweight/obesity were calculated. Logistic regression models were used to evaluate the association between dietary patterns and overweight/obesity. Five dietary patterns were identified: Rural dietary pattern (high intake of tortilla and legumes), sweet cereal and corn dishes pattern (high intake of sugary cereals, tortilla, and maize products); diverse pattern (intake of several food groups); western pattern (high intake of sweetened beverages, fried snacks, industrial snack cakes, and sugary cereals), and whole milk and sweet pattern (high intake of whole milk and sweets). We found that children with sweet cereal and corn dishes and western dietary patterns showed an association with overweight and obesity (prevalence ratio 1.29 and 1.35, respectively, using as reference the rural dietary pattern). Patterns characterized by high intakes of sugary cereals, sweetened beverages, industrial snack, cakes, whole milk, and sweets were associated with a higher risk of overweight/ obesity among in Mexican school-age children.

Los objetivos de este análisis son: caracterizar los suplementos alimenticios (SA) de mayor consumo, así como explorar la asociación del consumo SA con características sociodemográficas, antropométricas, y anemia, en una muestra representativa de mujeres, entre 12 a 49 años de edad (n=15,936), incluidas en la Encuesta Nacional de Nutrición, de 1999, en México. Se usó un modelo de regresión logística múltiple para calcular probabilidades (P) de consumo de SA, según características a nivel individual y del hogar, incluyendo términos de interacción ajustando por diseño de la Encuesta. Los SA más consumidos fueron el grupo de vitaminas con minerales (36.7%) y el de vitaminas (34.3%). La mayor probabilidad estadísticamente significativa (p