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Objective:The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women’s knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children.Design:Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews.Setting:Poor rural communities in Mexico; 48 intervention and 29 control.Participants:Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 294 intervention).Results:The intervention increased reports of exclusive breast-feeding in the first 6 months by 24·4 percentage points (pp) (95 % CI: 13·4, 35·4), mothers’ knowledge of obstetric warning signs by 23·4 pp (95 % CI: 9·2, 37·5) and neonatal warning signs by 26·2 pp (95 % CI: 15·2, 37·2) compared to the control group. A non-linear dose–response relation with the number of home visits was found. Diarrhoea and respiratory diseases among children decreased in the intervention v. control group but were not statistically significant.Conclusions:Home visits should be implemented as a complementary strategy to the provision of prenatal and postnatal care in rural communities due to their potential positive effects on the health of mothers and their children.

Objective:To estimate the effects of the social inclusion programme PROSPERA on food insecurity (FI) in Mexican households during 2012 and 2016.Design:Quasi-experimental study using cross-sectional data from 2012 to 2016 National Household Income and Expenditure Survey – Socioeconomic Conditions Module (in Spanish, ENIGH-MCS).Setting:Data were used from a 2012 sample of 56 888 Mexican households (representative of 31 206 819 households) and a 2016 sample of 70 263 Mexican households (representative of 33 445 353 households). Severity of FI was estimated with the Mexican Food Security Scale (in Spanish, EMSA). The statistical analysis estimated a differences in differences (DD) model weighted by propensity score to compare program beneficiary and non-beneficiary households in 2012 than in 2016. We estimated the effect on households with and without children (< 18 years of age). We also compared this model to a DD model without propensity score weighting.Participants:Mexican households.Results:FI among all beneficiary households decreased 8·0pp as compared to non-beneficiary households over the study period. In beneficiary households with children, this decrease was 6·0pp and for beneficiary households without children, this decrease was 12·9pp (for all, P-value < 0·001).Conclusions:The PROSPERA program had a positive effect on FI reduction at the household level through increasing food access, which usually improves nutritional outcomes in vulnerable Mexican populations.

BackgroundThere is little evidence of the association between digital marketing of formula and baby food and infant and young child feeding (IYCF) practices.ObjectiveAssess parents’ exposure to digital marketing of formula and baby food for children MethodsParents ≥18 years recruited from a market research panel completed an online survey (n=1074) and capture-on-screen (n=95) between December 2020 and January 2021. Logistic regressions were used to estimate the association between exposure to digital marketing of formula and baby foods with its purchase, motivation, consumption and IYCF practices.ResultsDigital marketing of formula and baby food was self-reported by 93.9% of parents in the online survey and observed by 93.7% in the capture-on-screen. Recorded ads did not comply with the International Code of Marketing of Breast-milk Substitutes. Parents who self-reported seeing a higher versus lower number of ads were less likely to exclusive breast feed (OR=0.38; 95% CI: 0.19 to 0.78), and more likely to give mixed feeding (OR=2.59; 95% CI: 1.28 to 5.21), formula (OR=1.84; 95% CI: 1.34 to 2.53), processed foods (OR=2.31; 95% CI: 1.59 to 3.32) and sugary drinks (OR=1.66; 95% CI: 1.09 to 2.54). Higher exposure to ads was associated with a higher chance of purchasing products motivated by nutritional (OR=2.1; 95% CI: 1.32 to 3.28) and organic claims (OR=2.1; 95% CI: 1.21 to 3.72).ConclusionsDigital marketing of formula and baby food may negatively influence IYCF and should be regulated to ensure children’s nutrition and health.

The consumption of sugar and sweeteners have been associated with obesity and diabetes, which are public health problems in Mexico. Since 1994, imports of sweeteners for the elaboration of ultra-processed food and beverages increased in the country. This increase in imports may have increased the apparent consumption of sweeteners which could be associated with the implementation of the NAFTA that gradually eliminated tariffs on sugars. However, no study has estimated trends in apparent consumption by type of sugar, and its association with NAFTA in Mexico. Therefore, we analyzed trends in apparent consumption of sugar and sweeteners, and its contribution to energy from 1961 to 2013. We assessed if the gradual implementation of NAFTA in 1994, 1998, 2003 and 2008 was associated with changes in the consumption of sugar and sweeteners in Mexico using the Food Balance Sheet data from the Food and Agriculture Organization of the United Nations. We estimated an interrupted time series analysis with synthetic controls using OECD countries, to assess the association between NAFTA and changes in the type of sugar consumed. We found that between 1961 and 2013, the contribution of sugars to daily energy increased from 243 to 456 (243 to 456 kcal/capita/day). Until 1993, the consumption of sweeteners was 0.20 kg/capita/year and in 2013 reached 12.9 kg/capita/year, representing 20% of total sugar consumption. The consumption of sweeteners increased 2.93 kcal/capita/day after the NAFTA was implemented in 1994. However, there was a reduction in apparent consumption of −2.95 kcal/capita/day between 1998 and 2002, concurrent with the implementation of a 12.5% ad valorem compensatory duty to high fructose corn syrup imports from the US. Consumption increased again 7.7 kcal/capita/day between 2003 and 2007 and up to 10.4 kcal/capita/day after 2008 when the NAFTA was fully implemented. We found a significant increase in the apparent consumption of sweeteners associated with NAFTA but we did not find a conclusive evidence when we estimates total sugars and sweeteners together because we lacked an adequate control group. Sweeteners are mainly used for producing beverages and processed food, so its consumption should be discouraged by improving the existing package of interventions in Mexico, including a 20–30% increase to current taxes that have proven to be effective to reduce sugar sweetened beverages and nonessential energy dense food but whose existing rates are relatively small; improving front of package labelling, monitoring compliance in school regulations for food and beverages sold and improving marketing regulations directed to children.

Although actions have been taken to improve breastfeeding in Mexico, trends over the last decade and their associated factors have not been analysed. We estimated trends in breastfeeding practices at the national, rural/urban, and regional level indigenous ethnicity and socio‐economic level, and their associated factors using the National Demographic Dynamics Survey (2006, 2009, 2014 and 2018). We assessed breastfeeding indicators of women with children

To update the prevalence of infant and young child feeding indicators (IYCFI) in children under 24 months in Mexico.Ensanut 2018-19 national representative survey with probabilistic design. Popu-lation: Women 12-59 years and their children24 months. The indicators proposed by the World Health Organization were assessed by sociodemographic variables of the mothers using the sample design. Wald's test was used to compare between categories.The prevalence of exclusive breastfeeding in children under six months was 28.3%, 42.9% of children under 12 months consumed infant formula and 29% continued breastfeeding at two years. Around 30% of children between 6 and 11 months did not meet the recom-mended minimum dietary diversity and only 49.4% consumed iron-rich foods.There are improvements in breastfeeding practices in Mexico, although the figures are low. The coordinated contribution from all sectors of society is required to improve infant feeding practices.Actualizar prevalencias de indicadores de prác-ticas de lactancia materna y alimentación complementaria (PLMAC) en menores de 24 meses en México.Análisis de la Encuesta Nacional de Salud y Nutrición (Ensanut 2018-19) con diseño probabilístico. Po-blación: Mujeres 12-59 años y sus hijos24 meses. Cálculo de indicadores propuestos por la Organización Mundial de la Salud (OMS) por variables sociodemográficas utilizando el diseño muestral. Se usó la prueba de Wald para comparar entre categorías.El 28.3% de los niños6 meses recibió lactancia materna exclusiva (LME), 42.9% de los niños12 meses consumió fórmula infantil y 29% continuó lactando a los dos años. Sólo 49.4% de los niños de 6-11 meses consumió alimentos ricos en hierro.Existen mejoras en las prácticas de lactancia materna, aunque las cifras siguen siendo bajas. Se requiere de la contribución de todos los sectores de la sociedad para mejorar las prácticas de alimentación infantil.

Exclusive breastfeeding and longer breastfeeding reduce women’s breast cancer risk but Mexico has one of the lowest breastfeeding rates worldwide. We estimated the lifetime economic and disease burden of breast cancer in Mexico if 95% of parous women breastfeed each child exclusively for 6 months and continue breastfeeding for over a year. We used a static microsimulation model with a cost-of-illness approach to simulate a cohort of Mexican women. We estimated breast cancer incidence, premature mortality, disability-adjusted life years (DALYs), medical costs, and income losses due to breast cancer and extrapolated the results to 1.116 million Mexican women of age 15 in 2012. Costs were expressed in 2015 US dollars and discounted at a 3% annual rate. We estimated that 2,186 premature deaths (95% CI 2,123–2,248), 9,936 breast cancer cases (95% CI 9,651–10,220), 45,109 DALYs (95% CI 43,000–47,217), and $245 million USD (95% CI 234–256) in medical costs and income losses owing to breast cancer could be saved over a cohort’s lifetime. Medical costs account for 80% of the economic burden; income losses and opportunity costs for caregivers account for 15 and 5%, respectively. In Mexico, the burden of breast cancer due to suboptimal breastfeeding in women is high in terms of morbidity, premature mortality, and the economic costs for the health sector and society.

Background: Breastfeeding reduces women’s risk of breast cancer. Since exclusive breastfeeding has a stronger hormonal effect, it could theoretically result in a greater reduction in breast cancer risk than any breastfeeding mode. No meta-analysis has examined breast cancer risk by breastfeeding mode. Research aim: The authors conducted a meta-analysis for breast cancer risk in parous women who breastfed exclusively or in any mode versus parous women who formula fed their infants, and they estimated the summary dose–response association by the accumulated duration of any breastfeeding mode. Methods: A systematic review of studies published between 2005 and 2015 analyzing breastfeeding and breast cancer risk in women was conducted in PubMed and EBSCOhost. A meta-analysis ( n = 65 studies) with fixed effects (or random effects, if heterogeneity existed) was carried out stratified by breastfeeding mode and menopausal and parity status. A summary dose–response association was estimated using the generalized least-squares method. Results: The summary relative risk (SRR) for breast cancer in parous women who breastfed exclusively was 0.72, 95% confidence interval (CI) [0.58, 0.90], versus parous women who had never breastfed. For parous women who breastfed in any mode, the SRR was lower in both premenopausal women (0.86, 95% CI [0.80, 0.93]) and postmenopausal women (0.89, 95% CI [0.83, 0.95]). There was no heterogeneity or publication bias. There is weak evidence of a difference between exclusive and any breastfeeding mode ( p = .08). The summary dose–response curve was nonlinear ( p < .001). Conclusion: Exclusive breastfeeding among parous women reduces the risk of breast cancer compared with parous women who do not breastfeed exclusively.

We estimated the affordability of food and beverages by energy density and nutrient quality in Mexico and tested for differential trends in affordability over time and by income quintile. We used the National Income and Expenditures Survey from 1994 to 2016, and information on the caloric and nutrient content of food and beverages from Mexican food composition tables. We estimated food energy density (kcal/kg) and nutrient quality of food and beverages using the nutrient-rich food index (NRFI). Affordability of food and beverages was defined as household monthly income needed to purchase 1000 kcal. The affordability index was expressed by quintiles of energy density and quintiles of the NRFI and by income quintile over time. We found that more energy-dense foods and food and beverages with lower nutrient quality were more affordable compared to healthier food and beverages. Food categories with lower energy density and a higher NRFI became less affordable over time for most income groups, but the burden was higher for lower-income households. A comprehensive national strategy should be implemented to make healthier options more affordable and discretional foods and beverages with lower nutrient quality less affordable.

BACKGROUND: Inadequate complementary feeding partially explains micronutrient deficiencies in the first 2 y of life. To prevent malnutrition the Mexican government implemented the Programa de Apoyo Alimentario (PAL) which transferred either food baskets containing micronutrient-fortified milk and animal food products or cash to beneficiary families along with educational sessions. OBJECTIVE: This study evaluated the impact of PAL on 2 indicators of complementary feeding: minimum dietary diversity and consumption of iron-rich or iron-fortified foods in children aged 6-23 mo. METHODS: A secondary analysis of the original PAL evaluation design was conducted through a randomized community trial implemented with 3 intervention groups (food basket with education food basket without education and cash transfer with education) and a control. The impact of PAL after 14 mo of exposure was estimated in 2 cross-sectional groups of children aged 6-23 mo at baseline and at follow-up in a panel of 145 communities by using difference-in-difference models. Only children who lived in households and communities that were similar between treatment groups at baseline were included in the analysis. These children were identified by using a propensity score. RESULTS: Of the 3 intervention groups when compared with the control only the food basket without education group component increased the consumption of iron-rich or iron-fortified foods by 31.2 percentage points (PP) (P < 0.01) and the prevalence of minimum dietary diversity by 21.6 PP (P < 0.01). CONCLUSION: These findings suggest that in order to improve dietary quality in children food baskets that include fortified complementary foods may be more effective than cash transfers. The fact that the 2 food basket groups differed in the observed impact does not allow for more convincing conclusions to be made about the education component of the program. This trial was registered at clinicaltrials.gov as NCT01304888. (c) 2016 American Society for Nutrition.

Objective. To assess changes in the magnitude of food insecurity (FI) in Mexican households in poverty from 2012 to 2018 and to analyze the association of FI with the access, availability and consumption of food. Materials and methods . Data on 4 464 households were drawn from the Encuesta Nacional de Salud y Nutricion in Mexican localities under 100 000 inhabitants (Ensanut 100k). We measured FI according to the Latin American and Caribbean Food Security Scale and analyzed food access and availability on the basis of food expenditures while consumption through dietary diversity among women. Using multiple logistic regression models, we estimated: the association between FI and expenditures for food groups, and the association between FI and dietary diversity. Results . Moderate and severe FI remained stable at 43% from 2012 to 2018. Larger expenditures on sugar, oil and on eating out as well as meat and dairy products consumption were associated with a lower possibility of FI. Conclusions . It is important to integrate different dimensions of FI in order to reinforce its measurement and monitoring

Longer duration of breastfeeding is associated with a lower risk of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension diseases in women. Mexico has one of the lowest breastfeeding rates worldwide; therefore, estimating the disease and economic burden of such rates is needed to influence public policy. We considered suboptimal breastfeeding when fewer than 95% of parous women breastfeed for less than 24 months per child, according to the World Health Organization recommendations. We quantified the lifetime excess cases of maternal health outcomes, premature death, disability-adjusted life years, direct costs, and indirect costs attributable to suboptimal breastfeeding practices from Mexico in 2012. We used a static microsimulation model for a hypothetical cohort of 100,000 Mexican women to estimate the lifetime economic cost and disease burden of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension in mothers, due to suboptimal breastfeeding, compared with an optimal scenario of 95% of parous women breastfeeding for 24 months. We expressed cost in 2016 USD. We used a 3% discount rate and tested in sensitivity analysis 0% and 5% discount rates. We found that the 2012 suboptimal scenario was associated with 5,344 more cases of all analysed diseases, 1,681 additional premature deaths, 66,873 disability-adjusted life years, and 561.94 million USD for direct and indirect costs over the lifetime of a cohort of 1,116 million Mexican women. Findings suggest that investments in strategies to enable more women to optimally breastfeed could result in important health and cost savings.

Background Chile is the second world’s largest per capita consumer of caloric beverages. Caloric beverages are associated with overweight, obesity and other chronic diseases. The objective of this study is to estimate the price elasticity of demand for soft drinks, other sugar-sweetened beverages and high-energy dense foods in urban areas in Chile in order to evaluate the potential response of households’ consumption to changes in prices. Methods We used microdata from the VII Family Budget Survey 2012–2013, which collects information on expenditures made by Chilean urban households on items such as beverages and foods. We estimated a Linear Approximation of an Almost Ideal Demand System Model to derive own and cross price elasticities of milk, coffee, tea and other infusions, plain water, soft drinks, other flavored beverages, sweet snacks, sugar and honey, and desserts. We considered the censored nature of the data and included the Inverse Mills Ratio in each equation of the demand system. We estimated a Quadratic Almost Ideal Demand System and a two-part model as sensitivity analysis. Results We found an own price-elasticity of −1.37 for soft drinks. This implies that a price increase of 10% is associated with a reduction in consumption of 13.7%. We found that the rest of food and beverages included in the demand system behave as substitutes for soft drinks. For instance, plain water showed a cross-price elasticity of 0.63: a 10% increase in price of soft drinks could lead to an increase of 6.3% of plain water. Own and cross price elasticities were similar between models. Conclusions The demand of soft drinks is price sensitive among Chilean households. An incentive system such as subsidies to non-sweetened beverages and tax to soft drinks could lead to increases in the substitutions for other healthier beverages.

Abstract 79 Purpose Women who have breastfed have a lower risk of breast and ovarian cancer and other chronic diseases. Currently, breast cancer has become the leading cause of death from cancer in Mexican women. In Mexico, exclusive breastfeeding rates have declined one third in the last decade, and only 35% of women breastfed at least 1 year, which provides a unique scenario in which to analyze breastfeeding and mortality. The aim of the current study was to estimate the impact of lifetime breastfeeding duration on the risk of all-cause and breast cancer mortality in Mexican women. Methods We analyzed parous women who were enrolled in a Mexican Teachers’ Cohort since 2006 and observed over 10 years. Months of breastfeeding per pregnancy were self-reported at baseline. We categorized participants according to the accumulated duration of any mode of breastfeeding (never, < 6 months, 6 to 11 months, 12 to 23 months, and ≥ 24 months). Deaths were identified using the employer’s database and next of kin reports, and the date and cause of death were obtained from national mortality databases. We used Cox proportional hazards regression models adjusted for baseline age, parity (one, two, three, and four or more children), age at first birth (< 20, 20 to 24, 25 to 29, and ≥ 30 years), BMI at age 18 years (≤ 25 or > 25), socioeconomic level (tertiles), and smoking (current, past, and never) to estimate hazard ratios (HRs). Results Mean age at baseline was 43 ± 7 years. Over 767,600 person-years of follow-up, 952 all-cause deaths and 92 breast cancer deaths occurred among 92,794 parous women. Mean age at death was 57 ± 7 years. The incidence rate per 1,000 person-years of all-cause mortality was 1.8 for women who did not breastfeed, 1.18 (< 6 months), 1.21 (6 to 11 months), 1.01 (12 to 23 months), and 1.26 (≥ 24 months). HRs for all-cause mortality among parous women with lifetime breastfeeding of < 6 months was 0.79 (95% CI, 0.63 to 0.97), 0.85 (95% CI, 0.70 to 1.05) for 6 to 11 months, 0.78 (95% CI, 0.64 to 0.94) for 12-23 months, and 0.88 (95% CI, 0.69 to 1.10) for > 24 months compared with parous women who never breastfed. No dose-response relationship was found when comparing HRs of the different categories of breastfeeding. HR for breast cancer mortality for women who ever breastfed compared with parous women who never breastfed was 0.75 (95% CI, 0.45 to 1.33). Conclusion Breastfeeding among parous Mexican women was associated with lower all-cause mortality. Breastfeeding could potentially reduce premature deaths in women. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

In 2014 an excise tax to non-alcoholic sweetened beverages (SSB) was implemented in Mexico. The objective of this paper is to study whether and to what degree these taxes passed-through onto SSB prices in urban areas overall and by region, type of beverage and package size. Prices were obtained from the National Institute of Statistics and Geography from 2011 to 2014. We applied a pre-post quasi-experimental approach using fixed effects models. In sensitivity analysis we applied other model specifications to test the robustness of the findings and we also present weighted estimations based on household purchases. The dependent variables are real prices of a specific beverage category; the main independent variables are dummies for each month of 2014, and the models adjust for time trends and seasonality. Results suggest that the SSB tax passed along to consumers for all SSBs and we found overshifting for the carbonated SSBs. A greater effect is seen among the small package sizes, and we see heterogeneous effects by region. Estimating the effect of the tax on prices is important to understand the potential effect on consumption.

A large and growing body of scientific evidence demonstrates that sugar drinks are harmful to health. Intake of sugar-sweetened beverages (SSB) is a risk factor for obesity and type 2 diabetes. Mexico has one of the largest per capita consumption of soft drinks worldwide and high rates of obesity and diabetes. Fiscal approaches such as taxation have been recommended as a public health policy to reduce SSB consumption. We estimated an almost ideal demand system with linear approximation for beverages and high-energy food by simultaneous equations and derived the own and cross price elasticities for soft drinks and for all SSB (soft drinks, fruit juices, fruit drinks, flavored water and energy drinks). Models were stratified by income quintile and marginality index at the municipality level. Price elasticity for soft drinks was −1.06 and −1.16 for SSB, i.e., a 10% price increase was associated with a decrease in quantity consumed of soft drinks by 10.6% and 11.6% for SSB. A price increase in soft drinks is associated with larger quantity consumed of water, milk, snacks and sugar and a decrease in the consumption of other SSB, candies and traditional snacks. The same was found for SSB except that an increase in price of SSB was associated with a decrease in snacks. Higher elasticities were found among households living in rural areas (for soft drinks), in more marginalized areas and with lower income. Implementation of a tax to soft drinks or to SSB could decrease consumption particularly among the poor. Substitutions and complementarities with other food and beverages should be evaluated to assess the potential impact on total calories consumed.