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BACKGROUND/OBJECTIVES: Obesity prevalence in Mexican children has increased rapidly and is among the highest in the world. We aimed to estimate the longitudinal association between nonessential energy-dense food (NEDF) consumption and body mass index (BMI) in school-aged children 5 to 11 years, using a cohort study with 6 years of follow-up. SUBJECTS/METHODS: We studied the offspring of women in the Prenatal omega-3 fatty acid supplementation, child growth, and development (POSGRAD) cohort study. NEDF were classified into four main groups: chips and popcorn, sweet bakery products, non-cereal based sweets, and ready-to-eat cereals. We fitted fixed effects models to assess the association between change in 418.6 kJ (100 kcal) of NEDF consumption and changes in BMI. RESULTS: Between 5 and 11 years, children increased their consumption of NEDF by 225 kJ/day (53.9 kcal/day). In fully adjusted models, we found that change in total NEDF was not associated with change in children’s BMI (0.033 kg/m2, [p=0.246]). However, BMI increased 0.078 kg/m2 for every 418.6 kJ/day (100 kcal/day) of sweet bakery products (p=0.035) in fully adjusted models. For chips and popcorn, BMI increased 0.208 kg/m2 (p=0.035), yet, the association was attenuated after adjustment (p=0.303). CONCLUSIONS: Changes in total NEDF consumption were not associated with changes in BMI in children. However, increases in the consumption of sweet bakery products were associated with BMI gain. NEDF are widely recognized as providing poor nutrition yet, their impact in Mexican children BMI seems to be heterogeneous.

Currently, 30% of the total energy intake in the Mexican diet comes from ultra-processed foods. Although its consumption is associated with high intakes of added sugar and saturated fats and low intakes of dietary fibre, there is no evidence regarding its association with dietary diversity and micronutrient intake. The present study evaluated the association between ultra-processed foods consumption with dietary diversity and micronutrient intake in Mexico.Ultra-processed foods items were identified in a 24-h recall from a sample of 10,087 participants aged ≥ 1 year. The minimum dietary diversity (MDD) was established by using the Food and Agriculture Organization 10 food group indicators with unprocessed, minimally processed and processed foods. The study conducted multiple linear regression models to evaluate the association between quintiles of energy contribution of ultra-processed foods with dietary diversity and micronutrient intake.A high consumption of ultra-processed foods was associated with a low dietary diversity and micronutrients intake. The association between ultra-processed foods and MDD was not linear (47.1%, 57.1%, 52.5%, 45.0% and 28.0% of participants achieved the MDD). On the other hand, the association was linear and negatively associated with: niacin, pantothenic acid, pyridoxine, folate, vitamin BThese findings are relevant in the context of the double burden of malnutrition currently faced in Mexico. Increasing dietary diversity and micronutrient intake is essential by discouraging ultra-processed foods consumption. However, other strategies are also needed to promote the dietary diversity and increase the consumption of unprocessed and minimally processed foods.

A predominantly plant-based diet would aid low- and middle- income countries to deviate from the existing negative trends in health and environmental outcomes. Taking Mexico as case study, we assessed the impact of adopting such a diet on multiple food system indicators and identified a menu of fiscal policies to reach the intake targets determined in the EAT-Lancet framework. A macroeconomic model named MAGNET and a Quadratic Almost Ideal Demand System model were employed for the analysis. Two diets were modelled, an adaptation of the EAT diet considering existing intakes in Mexico and a version proposed here based on traditional eating patterns (i.e., Milpa diet). Our results showcased that the magnitude of the changes needed to attain the proposed dietary intakes is such that fiscal policies alone were found implausible. We thus modelled the change to two thirds of the EAT targets by 2040 (the goal was 100% of the EAT targets by 2050). Still, to keep fiscal policies feasible (up to +/-80% ad-valorem tax rates) 75% of the required change in consumption would need to come from other strategies. Substantial environmental gains are expected from the adoption of the EAT diet, and at the same time, foods would be more affordable for all but the poorer households. At the household level, subsidies would improve the intakes of fruits, vegetables and added fats, but the targets would be attained only by the highest income households and possibly by the urban households. Subsidies would be ineffective to reach the intake target for plant-based proteins. Given the projected progress, increased taxes are strongly advised for the foods with targeted intake reductions, particularly for the well-off and urban households. Policy makers should be cautious in the design of taxes to dairy foods, as these could lead to excessive intake reductions among vulnerable populations.

Background We have developed a simple and globally applicable tool, the Global Diet Quality Score (GDQS), to measure diet quality. Objectives To test the utility of the GDQS, we examined the associations of the GDQS with weight change and risk of obesity in US women. Methods Health, lifestyle, and diet information were collected from women (n = 68,336) in the Nurses’ Health Study II (aged 27–44 y in 1991) through repeated questionnaires (1991–2015). The GDQS has 25 food groups (maximum = 49 points) and scoring higher points reflects a healthier diet. The association between GDQS change in 4-y intervals and concurrent weight change was computed with linear models adjusted for confounders. Results Mean ± SD weight gain across 4-y periods was 1.68 ± 6.26 kg. A >5-point improvement in GDQS was associated with −1.13 kg (95% CI: −1.19, −0.77 kg) weight gain compared with a score change of 5-point score decrease was associated with 1.13 kg (95% CI: 1.04, 1.22 kg) more weight gain in women aged 5-point increase and 1.32 (95% CI: 1.26, 1.37) for a >5-point decrease. Risk of obesity did not differ by age. Compared with other diet quality scores, the Alternate Healthy Eating Index-2010 had somewhat stronger associations than the GDQS (P

Background The global diet quality score (GDQS) is a simple, standardized metric appropriate for population-based measurement of diet quality globally. Objectives We aimed to operationalize data collection by modifying the quantity of consumption cutoffs originally developed for the GDQS food groups and to statistically evaluate the performance of the operationalized GDQS relative to the original GDQS against nutrient adequacy and noncommunicable disease (NCD)-related outcomes. Methods The GDQS application uses a 24-h open-recall to collect a full list of all foods consumed during the previous day or night, and automatically classifies them into corresponding GDQS food group. Respondents use a set of 10 cubes in a range of predetermined sizes to determine if the quantity consumed per GDQS food group was below, or equal to or above food group-specific cutoffs established in grams. Because there is only a total of 10 cubes but as many as 54 cutoffs for the GDQS food groups, the operationalized cutoffs differ slightly from the original GDQS cutoffs. Results A secondary analysis using 5 cross-sectional datasets comparing the GDQS with the original and operationalized cutoffs showed that the operationalized GDQS remained strongly correlated with nutrient adequacy and was equally sensitive to anthropometric and other clinical measures of NCD risk. In a secondary analysis of a longitudinal cohort study of Mexican teachers, there were no differences between the 2 modalities with the beta coefficients per 1 SD change in the original and operationalized GDQS scores being nearly identical for weight gain (-0.37 and -0.36, respectively, P

Background The prevalence of type 2 diabetes has increased substantially in India over the past 3 decades. Undiagnosed diabetes presents a public health challenge, especially in rural areas, where access to laboratory testing for diagnosis may not be readily available. Objectives The present work explores the use of several machine learning and statistical methods in the development of a predictive tool to screen for prediabetes using survey data from an FFQ to compute the Global Diet Quality Score (GDQS). Methods The outcome variable prediabetes status (yes/no) used throughout this study was determined based upon a fasting blood glucose measurement ≥100 mg/dL. The algorithms utilized included the generalized linear model (GLM), random forest, least absolute shrinkage and selection operator (LASSO), elastic net (EN), and generalized linear mixed model (GLMM) with family unit as a (cluster) random (intercept) effect to account for intrafamily correlation. Model performance was assessed on held-out test data, and comparisons made with respect to area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Results The GLMM, GLM, LASSO, and random forest modeling techniques each performed quite well (AUCs >0.70) and included the GDQS food groups and age, among other predictors. The fully adjusted GLMM, which included a random intercept for family unit, achieved slightly superior results (AUC of 0.72) in classifying the prediabetes outcome in these cluster-correlated data. Conclusions The models presented in the current work show promise in identifying individuals at risk of developing diabetes, although further studies are necessary to assess other potentially impactful predictors, as well as the consistency and generalizability of model performance. In addition, future studies to examine the utility of the GDQS in screening for other noncommunicable diseases are recommended.

Background Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. Objectives We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. Methods We scored the GDQS, Minimum Dietary Diversity–Women (MDD-W), and Alternative Healthy Eating Index–2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15–49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. Results Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P

Background The double burdens of under- and overnutrition are changing the health of individuals and the economic and disease burdens in China. Poor diet plays an important role; however, a valid and easily operationalized metric that could capture the full range of characteristics of the diet that are relevant to both under- and overnutrition is lacking in China. Objectives We aimed to examine the application of the Global Diet Quality Score (GDQS) to evaluate nutrient inadequacy and metabolic syndrome in different demographic groups of Chinese adults. Methods A total of 35,146 individuals (men 14,978, women 20,168) aged >18 y from the 2010–2012 China National Nutrition and Health Survey were included. We scored the GDQS using average intakes of 25 food groups from 3 d of 24-h dietary recalls. Double burden was defined as coexisting metabolic syndrome and nutrient inadequacy. Results Diet quality assessed by GDQS was significantly higher in urban than in rural residents (20.8 compared with 18.7), and increased with both educational level and household income (P-trends < 0.0001). A higher GDQS score was inversely associated with metabolic syndrome and nutrient inadequacy, or both (P-trends < 0.0001): multivariate adjusted ORs comparing extreme quintiles of GDQS were 0.79 (95% CI: 0.69, 0.91) for metabolic syndrome, 0.17 (95% CI: 0.14, 0.20) for nutrient inadequacy, and 0.59 (95% CI: 0.50, 0.69) for the double burden. These associations were consistent across different household income levels (P-interaction = 0.26), suggestively stronger in younger (

Background Evidence on concurrent changes in overall diet quality and weight and waist circumference in women of reproductive age from low- and middle-income countries is limited. Objectives We examined the associations of changes in the Global Diet Quality Score (GDQS) and each GDQS food group with concurrent weight and waist circumference change in Mexican women. Methods We followed prospectively 8967 nonpregnant nonlactating women aged 25–49 y in the Mexican Teachers’ Cohort between 2006 and 2008. We assessed diet using an FFQ of the previous year and anthropometric measures were self-reported. Regression models were used to examine 2-y changes in the GDQS and each food group (servings/d) with weight and waist circumference changes within the same period, adjusting for demographic and lifestyle factors. Results Compared with those with little change in the GDQS (−2 to 2 points), women with the largest increase in the GDQS (>5 points) had less weight (β: −0.81 kg/2 y; 95% CI: −1.11, −0.51 kg/2 y) and waist circumference gain (β: −1.05 cm/2 y; 95% CI: −1.62, −0.48 cm/2 y); likewise, women with the largest decrease in the GDQS (

Background We have developed a diet quality metric intended for global use. To assess its utility in high-income settings, an evaluation of its ability to predict chronic disease is needed. Objectives We aimed to prospectively examine the ability of the Global Diet Quality Score (GDQS) to predict the risk of type 2 diabetes in the United States, examine potential differences of association by age, and compare the GDQS with other diet quality scores. Methods Health, lifestyle, and diet information was collected from women (n = 88,520) in the Nurses’ Health Study II aged 27–44 y at baseline through repeated questionnaires between 1991 and 2017. The overall GDQS consists of 25 food groups. Points are awarded for higher intake of healthy groups and lower intake of unhealthy groups (maximum of 49 points). Multivariable HRs were computed for confirmed type 2 diabetes using proportional hazards models. We also compared the GDQS with the Minimum Diet Diversity score for Women (MDD-W) and the Alternate Healthy Eating Index-2010 (AHEI-2010). Results We ascertained 6305 incident cases of type 2 diabetes during follow-up. We observed a lower risk of diabetes with higher GDQS; the multivariable HR comparing extreme quintiles of the GDQS was 0.83 (95% CI: 0.76, 0.91; P-trend

Background Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. Objectives We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. Methods Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. Results We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). Conclusions The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application–based 24-h recall system developed as part of this project.

The relative cost of healthy and sustainable diets is key for their adoption in different countries. Using a newly developed modelling tool that generates different diet baskets, we compared the costs of diets following the EAT–Lancet healthy reference diet, the Mexican dietary guidelines and locals’ current food intake. On average, the cost of the EAT–Lancet healthy reference diet baskets was 21% lower than that of the Mexican dietary guidelines baskets, and 40% lower than that of the current intake baskets (29% lower if the comparison was isocaloric). Findings were similar over time (2011–2018) and by geographic region. The higher cost associated with the larger amount of fruits, vegetables, legumes and nuts in healthy and sustainable diets was surpassed by the savings associated with their lower amount of animal protein sources, sugar-sweetened beverages and discretionary foods. We conclude that transitioning to better diets in Mexico is possible without a higher expenditure on food. Costs are often assumed to be a barrier to the adoption of healthier and more sustainable diets. A comparison of the EAT–Lancet healthy reference diet, national dietary guidelines and current food intake in Mexico reveals that better diets do not always imply higher food expenditures.

Background Dietary recommendations worldwide have focused on promoting healthy diets to prevent diseases. In 2019, the EAT-Lancet Commission presented global scientific targets for healthy diets and sustainable food production and proposed a healthy reference diet (EAT-HRD) that can be adapted to the culture, geography, and demography of the population and individuals in any country. Objectives We aimed to describe the daily energy intake from food groups and subgroups in Mexican adults relative to the EAT-HRD and propose an adaptation of the EAT-HRD to the Mexican context. Methods We analyzed data from the Mexican National Health and Nutrition Surveys in 2012 and 2016. Diet information was obtained using the 5-step multiple-pass 24-h dietary recall method. We estimated the mean energy intake from food groups and subgroups and compared these figures with the midpoint of the EAT-HRD and with the Mexican Dietary Guidelines (MDGs). We also proposed an adaptation of the EAT-HRD to the Mexican context based on the mean energy intake and the comparison between the MDGs and the EAT-HRD. Results Mexican adults consume higher than the EAT-HRD for grains (mostly refined), dairy, added sugars, and animal-based proteins (particularly red meat, poultry, eggs, and processed meats); and lower than the EAT-HRD for vegetables, fruits, legumes, nuts, tubers and starchy vegetables, fish, and added fats. Based on these findings, we propose a healthy and sustainable reference diet adapted for the Mexican population. Conclusions Mexican adults have a diet that is far from being healthy and is not sustainable. The adaptation of the EAT-HRD to the Mexican context is a timely input for current government efforts to move to a sustainable and healthy food system, including the update of the current MDGs.

To improve the health of our planet and develop sustainable food policies, it is important to understand the health impact of a diet pattern that considers planetary and population health. We used data from the Mexican Teachers' Cohort (MTC) to estimate the association between the EAT-Lancet healthy reference diet (EAT-HRD) and type 2 diabetes (T2D) incidence. We included 74,671 women aged ≥25 years, free of T2D at baseline. A validated food frequency questionnaire (FFQ) was used to assess dietary intake. We created an EAT-HRD score based on 15 food groups recommended by the EAT-Lancet Commission (range from 0 to 15). T2D cases were identified through self-report and cross-linkage with clinical and administrative databases. We used Cox proportional hazards models to estimate the association between categories of the EAT-HRD score with T2D incidence. During a median follow-up of 2.16 y (IQR 1.8-4.3 y), we identified 3241 T2D incident cases. The median EAT-HRD score was 6 (IQR 5-7). In multivariable analyses, when comparing extreme categories, higher adherence to the EAT-HRD score was associated with lower T2D incidence (HR 0.90; 95% CI 0.75, 1.10), yet, the estimation was imprecise. Compared to those who did not meet the EAT-HRD recommendations, adhering to the red meat, legumes, and fish recommendations was associated with lower T2D incidence. Meeting the recommendation of dairy and added sugars was associated with an increased incidence of T2D. Higher adherence to a diet designed to promote environmental and human health may help prevent T2D incidence among women in a middle-income country.

Background In India, there is a need to monitor population-level trends in changes in diet quality in relation to both undernutrition and noncommunicable diseases. Objectives We conducted a study to validate a novel diet quality score in southern India. Methods We included data from 3041 nonpregnant women of reproductive age (15–49 years) from 2 studies in India. Diet was assessed using a validated food frequency questionnaire (FFQ). The Global Diet Quality Score (GDQS) was calculated from 25 food groups (16 healthy; 9 unhealthy), with points for each group based on the frequency and quantity of items consumed in each group. We used Spearman correlations to examine correlations between the GDQS and several nutrient intakes of concern. We examined associations between the GDQS [overall, healthy (GDQS+), and unhealthy (GDQS−) submetrics] and overall nutrient adequacy, micro- and macronutrients, body mass index (BMI), midupper arm circumference, hemoglobin, blood pressure, high density lipoprotein (HDL), and total cholesterol (TC). Results The mean GDQS was 23 points (SD, 3.6; maximum, 46.5). In energy-adjusted models, positive associations were found between the overall GDQS and GDQS+ and intakes of calcium, fiber, folate, iron, monounsaturated fatty acid (MUFA), protein, polyunsaturated fatty acid (PUFA), saturated fatty acid (SFA), total fat, and zinc (ρ = 0.12–0.39; P

El entorno alimentario es un factor importante que contribuye a las dietas poco saludables en la niñez y, por tanto, a las crecientes tasas de obesidad. Los países de Latinoamérica han recibido el reconocimiento internacional por su liderazgo en la implementación de políticas dirigidas a distintos aspectos del entorno alimentario. Sin embargo, los datos sobre la naturaleza y la gravedad de la exposición de los niños a entornos alimentarios poco saludables en la región latinoamericana y entre los latinos que viven en Estados Unidos son aún insuficientes. El objetivo de esta revisión es utilizar el marco conceptual de la Red Internacional para la Investigación, Monitoreo y Apoyo a la Acción para la Alimentación, Obesidad y Enfermedades No Transmisibles (INFORMAS, por sus siglas en inglés) para crear un entorno alimentario saludable con el que (i) comparar los elementos clave de los entornos alimentarios en relación con la obesidad en Latinoamérica y entre los latinos que viven en Estados Unidos; (ii) describir la evidencia sobre soluciones que podrían contribuir a mejorar los entornos alimentarios relacionados con la obesidad infantil; y (iii) establecer prioridades de investigación que permitan identificar estrategias de lucha contra la obesidad en estas poblaciones. Hemos detectado la necesidad de un amplio conjunto integrado de evidencias que sirva de respaldo para establecer un conjunto adecuado de políticas que mejoren el entorno alimentario al que están expuestos los niños de Latinoamérica y los niños latinos que viven en Estados Unidos y para traducir de forma más eficiente las soluciones políticas, de manera que contribuyan a reducir los crecientes niveles de obesidad infantil en estos países.

IntroductionThe prevalence of childhood obesity has risen dramatically in recent years. A proportion of this burden has been attributed to factors that occur during the first 1000 days of life such as genetic predisposition, breast feeding and complementary feeding. Although the mechanisms by which these factors affect weight and adiposity are less well understood, appetite and satiety regulation may be a key to understanding them. This cohort study aims to investigate the role of appetite and satiety regulation as a mediator in the association between infant feeding practices and genetic polymorphisms with children’s growth, adiposity and metabolic risk factors.Methods and analysis‘MAS-Lactancia’ (the first word means ‘more’ and is also an acronym in Spanish for ‘Appetite and Satiety Mechanisms’, the second word is ‘breastfeeding’) is an open, ongoing, prospective birth cohort that began the enrolment in 2016 of mother–child pairs affiliated to the Mexican Social Security Institute and that live in the city of Cuernavaca, Mexico. Pregnant women between 16-week and 22-week gestation are followed during the second half of their pregnancies, at birth and throughout their infant’s first 48 months of life (at 1 month, 3 months, 6 months, 9 months, 12 months, 18 months, 24 months, 36 months and 48 months) at the clinic and at-home visits that include questionnaires, anthropometric measurements and biospecimen collection. The main exposure variables are infant feeding (breast feeding and complementary feeding) and genetic polymorphisms (fat mass and obesity-associated, leptin and adiponectin genes). Outcome variables include infant’s growth, adiposity and metabolic risk factors. We will conduct longitudinal models and path analyses to identify the potential mediating role of satiety and appetite indicators (leptin, adiponectin, insulin concentrations, appetite and satiety perception).Ethics and disseminationThe study protocol, data collection instruments, consent forms and procedures were approved by the institutional review boards of the National Institute of Public Health and the Mexican Social Security Institute in Mexico. Findings will be disseminated through conferences, peer-reviewed publications and meetings with stakeholders.

Objective. To estimate energy contribution (EC) of food groups in 2016, to compare consumption against Mexican Dietary Guidelines, and to examine changes in EC from 2012 to 2016. Materials and methods. We analyzed 24-hour dietary recalls from the 2012 and 2016 National Health and Nutrition Surveys (Ensanut). Foods and beverages were clas­sified into eight food groups: cereals, legumes, dairy, meats, fruit and vegetables, fats and oils, sugar-sweetened beverages, and high in saturated fat and added sugar (HSFAS) products. Results. Cereals had the highest EC (30.1%), followed by meats (15.9%), HSFAS products (15.5%), and SSBs (10.5%). Fruits and vegetables, and legumes had the lowest contribu­tion with 6.4 and 3.8%, respectively. SSBs, meats, and HSFAS products were 250, 59 and 55% above the recommended intake, respectively. Conclusions. This analysis confirms the need to generate a food environment conducive to a healthier diet.

Summary The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity‐related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity‐related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.

Obesity is clearly associated to kidney disease in adult population; however, there is scarce evidence in children and adolescents. The aim was to compare frequency of renal damage according to the presence of overweight-obesity in children and adolescents, as well as to compare nutritional and biochemical risk factors, according to the presence of kidney alterations.Cross-sectional study; 172 children and adolescents, 6-16 years old, without malnutrition, diabetes mellitus, hypertension and independent comorbid conditions associated to obesity or kidney disease, as well as transitory causes of microalbuminuria (MA) from a Primary Health-Care Unit were included. Clinical, biochemical, anthropometric and dietetic evaluations were measured in all subjects; subsequently they were classified as normal weight, overweight and obesity groups according to sex- and age-adjusted body mass index (BMI). Glomerular filtration rate (GFR, estimated by Schwartz equation) and albuminuria (albumin/creatinine ratio) were determined. Presence of kidney alterations was measured as decreased GFR (90 mL/min/1.73mCompared with controls, subjects with overweight-obesity had significantly (P.05) abdominal obesity (0 vs 69%), hypertension (19 vs 26%), hypertriglyceridemia (11 vs 47%), high low-density lipoprotein cholesterol (2 vs 8%) and low high-density lipoprotein cholesterol (HDL-cholesterol; 2 vs 28%), hyperuricemia (11 vs 28%) and hyperinsulinemia (8 vs 70%). Hyperfiltration and MA were present in 5 and 4 subjects with overweight/obesity, respectively, whereas decreased GFR was present in only 1 subject with obesity. Normal weight subjects had no kidney alterations. In multivariate analysis, kidney alterations were significantly predicted by higher BMI and lower HDL-cholesterol.Kidney alterations were observed only in subjects with overweight (3.6%) and obesity (9.9%), who additionally, displayed cardiometabolic and kidney disease risk factors more frequently than normal weight subjects.

Previous studies have shown that intake of sugary drinks in Mexico has increased, while intake of whole milk has decreased. Yet, in-depth analyses of the changes in solid foods, overall and in specific generations and urban/rural subpopulation, are scarce. We aimed to analyse changes in solid foods intake in Mexican children, adolescent girls and adult women through a single 24-h dietary recall from the Mexican Nutrition Survey 1999 (n 5627) and 2012 (n 6712). Foods were classified into twenty-two healthy and unhealthy food groups without considering beverages. We estimated the crude and adjusted change in the energy contribution of solid foods by age group and birth cohort and tested if the changes differed by urban/rural area. The contribution of fruits, vegetables and unsweetened dairy increased, while sweet bread from bakery decreased. However, the total contribution of healthy food groups (67–70 % kj in 1999) decreased −4·3 and −7·2 percentage points (pp) (P < 0·05) among children and adolescents, respectively, but only −1·7 pp (P > 0·05) among adult women. Likewise, those born in 1980–1984 changed little in comparison with those born in 1993–1997, and there were greater increases in unhealthy foods in urban compared with rural areas. In conclusion, from 1999 to 2012, there were negative changes in the intake of foods, specifically healthy foods, which mainly affected Mexican youth. These findings, along with previous reports on the increased intake of sugary drinks in the same population, that emphasise the need to reinforce strategies aimed at improving dietary intake of the Mexican population need to be reinforced.

Background The Global Diet Quality Score (GDQS) is intended as a simple global diet quality metric feasible in low- and middle-income countries facing the double burden of malnutrition. Objective The aim of this study was to evaluate the performance of the GDQS with markers of nutrient adequacy and chronic disease in nonpregnant nonlactating (NPNL) Mexican women of reproductive age and to compare it with the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Minimum Dietary Diversity for Women (MDD-W). Methods We included NPNL women aged 15 to 49 y from the Mexican National Health and Nutrition Surveys (2012 and 2016) with 24-h recall (n = 2542) or a FFQ (n = 4975) (separate samples). We evaluated the correlation of the GDQS with the energy-adjusted intake of several nutrients and evaluated its association with health parameters using covariate-adjusted linear regression models. Results The GDQS was positively correlated with the intake of calcium, folate, iron, vitamin A, vitamin B-12, zinc, fiber, protein, and total fat (rho = 0.09 to 0.38, P < 0.05) and was inversely correlated with the intake of added sugar (rho = −0.37 and −0.38, P < 0.05) using both instruments, and with total fat, SFA, and MUFA only with 24-h recall data (rho = −0.06 to −0.16, P < 0.05). The GDQS was inversely associated with serum ferritin, BMI, waist circumference, and serum total and LDL cholesterol using FFQ data (P

Background Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. Objectives To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. Methods We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15–49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models. Results In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31–0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44–0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45–0.84), and anemia (OR, 0.59; 95% CI: 0.38–0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12–2.80). For comparison, the Minimum Dietary Diversity–Women (MDD-W) was associated more positively (P

Close economic ties encourage production and trade of meat between Canada, Mexico, and the US. Understanding the patterns of red and processed meat consumption in North America may inform policies designed to reduce meat consumption and bolster environmental and public health efforts across the continent. We used nationally-representative cross-sectional survey data to analyze consumption of unprocessed red meat, processed meat, and total red and processed meat. Generalized linear models were used to separately estimate probability of consumption and adjusted mean intake. Prevalence of total meat consumers was higher in the US (73.6, 95% CI: 72.3&ndash, 74.8%) than in Canada (65.6, 63.9&ndash, 67.2%) or Mexico (62.7, 58.1&ndash, 67.2%). Men were more likely to consume unprocessed red, processed, and total meat, and had larger estimated intakes. In Mexico, high wealth individuals were more likely to consume all three categories of meat. In the US and Canada, those with high education were less likely to consume total and processed meat. Estimated mean intake of unprocessed red, processed, and total meat did not differ across sociodemographic strata. Overall consumption of red and processed meat remains high in North America. Policies to reduce meat consumption are appropriate for all three countries.

Background: Consumption of foods high in energy, sugar, fat, and salt contributes to the increase in body mass index and the prevalence of overweight and obesity in children. Mexico implemented an 8% tax to non-essential energy-dense foods (NEDF) in 2014 as part of a national strategy to reduce obesity.Objective: We modeled the potential effect of the NEDF tax on body mass index and overweight and obesity in Mexican children (6–17 years).Materials and Methods: We used the Dynamic Childhood Growth and Obesity Model calibrated to Mexican children to simulate the potential 1-year effect of the NEDF tax on body weight. Inputs for the model included NEDF consumption, weight, and height, obtained from the 2012 Mexican National Health and Nutrition Survey. To project the potential impact of the tax, we ran a first simulation without intervention and another reducing the caloric intake from NEDF in the proportion observed in the Mexican population after the tax (−5.1%). The tax effect was defined as the absolute difference in body mass index and prevalence of overweight and obesity between both models.Results: The tax on NEDF should lead to a mean reduction of 4.1 g or 17.4 kcal/day of NEDF at the population level. One year after the tax, mean body weight and body mass index should decrease 0.40 kg and 0.19 kg/m2; this translates into −1.7 and −0.4% points in overweight and obesity, respectively.Conclusions: The use of fiscal instruments to discourage the consumption of NEDF could help to reduce the prevalence of overweight and obesity in children.

Cross-sectional nutritional survey data collected in eight countries were used to estimate saturated fatty acid intakes. Our objective was to estimate the proportion of excessive saturated fatty acid intakes (>10 % of total energy intake) that could be avoided if ultra-processed food consumption was reduced to levels observed in the first quintile of each country. Secondary analysis was performed of 24 h dietary recall or food diary/record data collected by the most recently available nationally representative cross-sectional surveys carried out in Brazil (2008–9), Chile (2010), Colombia (2005), Mexico (2012), Australia (2011–12), the UK (2008–16), Canada (2015) and the US (2015–16). Population attributable fractions estimated the impact of reducing ultra-processed food consumption on excessive saturated fatty acid intakes (above 10 % of total energy intake) in each country. Significant relative reductions in the percentage of excessive saturated fatty acid intakes would be observed in all countries if ultra-processed food consumption was reduced to levels observed in the first quintile's consumption. The reductions in excessive intakes ranged from 10⋅0 % (95 % CI 6⋅2–13⋅6 %) in Canada to 35⋅0 % (95 % CI 28⋅7–48⋅0 %) in Mexico. In all eight studied countries, all presenting more than 30 % of intakes with excessive saturated fatty acids, lowering the dietary contribution of ultra-processed foods to attainable, context-specific levels was shown to be a potentially effective way to reduce the percentage of intakes with excessive saturated fatty acids, which may play an important role in the prevention of non-communicable diseases, particularly cardiovascular diseases.

Background Mexicans’ adherence to food group’s dietary recommendations is low and an inaccurate self-perception of dietary quality might perpetuate this low adherence. Our aim was to compare the intake and the adherence to the dietary recommendations for several food groups, subgroups, and to an overall Mexican Diet Quality Index (MxDQI), among those that perceived their diet as healthy vs. those that did not. Methods We analyzed data from 989 subjects 20–59 y old from the nationally representative Mexican National Health and Nutrition Survey 2016. Dietary intake was collected with one 24-h recall and a repeated recall in 82 subjects. Self-perception of dietary quality was evaluated with the following question “Do you consider that your diet is healthy? (yes/no)”. We used the National Cancer Institute method to estimate the usual intake. We compared the mean intake adjusted by sociodemographic variables and the percentage of adherence according to the self-perception of dietary quality among the whole sample and in sociodemographic subpopulations. Results Sixty percent perceived their diet as healthy, and their adherence to recommendations was low [20% for fruits and vegetables, p > 0.05), and the MxDQI score was 40 vs. 37 (out of 100 points). The only food groups and subgroups with a statistically significant difference between those that perceived their diet as healthy vs. unhealthy were fruits [38 g/d (95% CI 3, 73)], fruit juices [27 g/d (95% CI 2, 52)], industrialized SSBs [− 35 kcal/d (− 70, − 1)] and salty snacks [− 40 kcal/d (− 79, − 1)]. Other differences were small or inconsistent across subgroups of the population. Conclusions Those that perceived their diet as healthy only had a slightly healthier diet than the rest of the population, moreover, their adherence to recommendations was very low. Hence, it is necessary to improve their nutrition knowledge.

OBJECTIVES: No tool to measure diet quality on the global scale currently exist. At the same time, type 2 diabetes is a global issue for women, including those under age 50. As part of an effort to develop an instrument to assess diet quality, this analysis the ability of a global diet quality score to predict type 2 diabetes in women in a high-income country. Therefore, the objective of this analysis is to examine prospectively the association between the Global Diet Quality Score (GDQS) and risk of type 2 diabetes, and potential differences in association by age, among U.S. women. METHODS: Health, lifestyle, and diet information was collected from women (n = 88,520) in the Nurses’ Health Study II through repeated questionnaires between 1991 and 2017. The GDQS consisted of 25 food groups and points were awarded for higher intake of healthy groups and lower intake of unhealthy groups (maximum of 49 points). Multivariable hazard ratios (HR) were computed for confirmed type 2 diabetes using Cox proportional hazards models. RESULTS: We ascertained 6319 incident type 2 diabetes during follow-up. The multivariable HR comparing top to bottom quintile of GDQS was 0.83 (95% CI = 0.76–0.91, p trend

OBJECTIVES: Close economic ties have encouraged production and trade of meat between the US, Canada, and Mexico. Understanding the sociodemographic correlates of red and processed meat intake in North America may inform policies designed to reduce greenhouse gas emissions and non-communicable diseases. METHODS: Data were from one day of 24-hour dietary recall in the US National Health and Nutrition Examination Survey (2013–2016), Mexico National Health and Nutrition Survey (2016), and Canadian Community Health Survey (2015). Adult participants were classified as consumers or non-consumers of the following three categories: red meat (mammalian muscle and organ meat); processed meat (all meats processed for preservation and flavor); and any meat (red and/or processed meat). Negative binomial regression accounting for complex survey design was used to model sociodemographic correlates (sex, ten-year age categories, wealth, and education) of being a consumer of red, processed, and any meat. RESULTS: The overall prevalence of any meat consumption in a given day was higher in the US (74%) than in Canada (66%) or Mexico (63%). Age was not associated with meat intake. In the US and Canada, females were less likely to consume all three categories of meat (all P

Although the isolated effects of several specific nutrients have been examined, little is known about the relationship between overall maternal diet during pregnancy and fetal development and growth. This study evaluates the association between maternal diet and low birthweight (LBW) in 660 pregnant women from the Pregnancy Research on Inflammation, Nutrition,& City Environment: Systematic Analyses (PRINCESA) cohort in Mexico City. Using prior day dietary intake reported at multiple prenatal visits, diet was assessed prospectively using a priori (Maternal Diet Quality Score [MDQS]) and a posteriori (dietary patterns extracted by factor analysis) approaches. The association between maternal diet and LBW was investigated by logistic regression, controlling for confounders. Adherence to recommended guidelines (higher MDQS) was associated with a reduced risk of LBW (OR, 0.22; 95% confidence interval [0.06, 0.75], P < .05, N = 49) compared with the lowest adherence category (reference group), controlling for maternal age, education, height, marital status, pre‐pregnancy body mass index, parity, energy intake, gestational weight gain, and preterm versus term birth; a posteriori dietary patterns were not associated with LBW risk. Higher adherence to MDQS was associated with a lower risk of having an LBW baby in this sample. Our results support the role of advocating a healthy overall diet, versus individual foods or nutrients, in preventing LBW.

Background Cost is one of the main drivers of food selection; thus it is important to monitor food prices. Evidence from low- and middle-income countries such as Mexico is limited. Objective The aim of this study was to evaluate the prices and price trends of healthy and less healthy food/beverage groups in Mexico from 2011 to 2018. Design This study used a time series of the prices of foods and beverages classified by 1) healthiness, 2) processing level, and 3) pairs of healthy/less healthy substitutes. Setting Food and beverage prices used to estimate the Consumer Price Index were obtained. Prices were collected weekly from 46 cities (>20,000 habitants) distributed across the country. Main outcome measures Price trend (% change/year) from 2011 to 2018 for all food/beverage groups and price/100 g in 2018 for pairs of healthy/less healthy substitutes were obtained. Statistical analyses Linear regression models were used for each food/beverage group, with the logarithm of deflated price as the dependent variable and time (years) as the independent variable. Results On average, prices for less healthy foods and beverages increased more than prices of healthy foods and beverages (foods: 1.72% vs 0.70% change/year; beverages: 1.61% vs −0.19% change/year). The price change was similar for unprocessed/minimally processed foods and ultraprocessed foods (1.95% vs 1.85% change/year); however, within each processing category, the price of less healthy foods increased more. By pairs of substitutes (within food/beverage groups), the healthier option for bread, sodas, and poultry was more expensive (price/100 g) in 2018, whereas for red meat, cheese, mayonnaise, and milk, the healthier option was cheaper. Conclusions Overall, the food prices of less healthy foods and beverages increased more than the food prices of healthy foods and beverages. However, by processing level there was no difference, and for pairs of healthy/less healthy substitutes results were mixed. Continued monitoring of food prices is warranted, and future research is needed to understand how these price changes affect dietary quality.

It is unclear whether response to a nonessential food tax varies across time or for high vs. low-consuming households. The objective is to examine whether the effect of Mexico's 2014 8% nonessential energy-dense foods tax increased in the second year post-implementation and whether it differentially affected households by pre-tax purchasing pattern. We used longitudinal data on Mexican household food purchases (n=6089 households) from 2012 to 2015. Households were classified based on median pre-tax purchases: low untaxed/low taxed ("low"), low untaxed/high taxed ("unhealthy"), high untaxed/low taxed ("healthy"), and high untaxed/high taxed ("high") purchasers. Fixed effects models tested whether observed post-tax purchases differed from the counterfactual, or what would have been expected based on pre-tax trends. Post-tax declines in the % taxed food purchases increased from -4.8% in year one to -7.4% in year two, yielding a 2-year mean decline of 6.0% beyond the counterfactual (p