Reliability and validity of the Mexican teachers' physical activity questionnaire (MTPAQ) in a subsample of female Mexican teachers.

BACKGROUND: Reliable and valid instruments are needed to estimate physical activity levels. The purposes of this study were to estimate the reliability and validity of the Physical Activity Questionnaire (MTPAQ) in a subsample of the Mexican Teachers Cohort study. METHODS: We completed telephone interviews and clinical examinations of 82 teachers. Two MTPAQ, five International Physical Activity Questionnaire (IPAQ)-long form, and two accelerometer (AC) measures were used to determine physical activity levels throughout 24 months. Moderate and walking physical activity (MWPA min/week), vigorous physical activity (VPA min/week), and moderate-to-vigorous physical activity minutes per week (MVPA min/week) were estimated for each instrument. Pearson, Intra-class correlations and deattenuated adjustments were used to determine the reliability and validity of MTPAQ. RESULTS: MWPA and MVPA min/week of MTPAQs were moderately correlated (r ≥ 0.54) to min/week of IPAQ-long form. MWPA and MVPA min/week average MTPAQ and MTPAQ1 and average AC, AC1 and AC2 were fairly correlated (r ≥ 0.20). A higher correlation was observed when correlation coefficients were attenuated (r ≥ 0.32). CONCLUSIONS: MTPAQ1 is a reliable and valid tool to measure physical activity levels.

Digital marketing of products with poor nutritional quality: a major threat for children and adolescents.

OBJECTIVES: To identify general characteristics, the use of persuasive techniques, and the nutritional quality of Mexican digital marketing of food and beverages/brand with the greatest number of followers and views (Facebook, Twitter, and YouTube) with specific appeal to children/adolescents. STUDY DESIGN: Cross sectional, quantitative, exploratory, and descriptive study. METHODS: Multistep process to select a sample of 46 products with a Mexican website and major audiences on social networks. The energy and nutrient content of the foods and beverages were analyzed with the Pan American Health Organization Nutrient Profile Model. RESULTS: Cola and soft drinks, sweetened juices were the products with the greatest number of followers on Facebook and Twitter (13,321,274 and 1,020,504). Companies used diverse persuasive techniques combining promotional characters (79.1%), incentives (65.1%), and digital techniques (78.3%). Products with excess critical nutrients were most frequently advertised regardless of the type of social network and the marketing techniques used. CONCLUSION: Digital Marketing represents a major threat for children and adolescents in Mexico, and probably all over the world, because of its persuasive techniques, and it shall be regulated.

Occupational and leisure time physical inactivity and the risk of type II diabetes and hypertension among Mexican adults: A prospective cohort study.

There is a lack of longitudinal data linking physical inactivity and chronic diseases among Mexicans. OBJECTIVE: To examine the relationship between total, leisure and occupational moderate-to-vigorous physical activity (MVPA) and incidence of type II diabetes (T2D) and hypertension in the Mexico City Diabetes Study. Study design and population. A prospective cohort study was conducted from 1989 to 2009 among 2282 men and non-pregnant women residing in six low-income neighborhoods in Mexico City. MAIN OUTCOME: Incidence of T2D and hypertension. RESULTS: After controlling for confounders, <1 MET/min/week of MVPA during leisure time was associated with higher risk of hypertension (HR 1.29, CI 95% 1.01, 1.66) and T2D (HR 1.31 CI 95% 1.00, 1.74). In addition, accumulating <1 MET/min/week of occupational MVPA was associated with higher risk of hypertension (HR 1.47, CI 95% 1.13, 1.90). CONCLUSION: The absence of leisure and occupational MVPA was associated with an increased risk of hypertension. However, no associations were found between occupational MVPA and T2D.

Pitfalls of the self-regulation of advertisements directed at children on Mexican television.

BACKGROUND: There are no academic studies that characterize advertisements directed at children from the companies that signed the self-regulation. OBJECTIVE: The aim of this paper was to assess the extent and nature of food advertisements and the persuasive techniques used to market unhealthy food and beverages (UFB) to children, by signatory companies of self-regulation. METHODS: From December 2012 to April 2013, 600 h of programming were recorded on the four broadcast public television channels in Mexico with the highest rating nationwide. Marketing aimed at children directly (broadcast on children's programmes or advertisements with a specific appeal to children) or indirectly (aimed at other target audiences with messages or scenes that link children to the product) were considered. RESULTS: About 74.9% (2148) of the total food and beverage advertisements tried to influence children directly and indirectly. Companies, which had signed the self-regulation, focused 92.7% of their advertisements on UFB. Of the total number, 23.9% were aimed at children, 7.1% at adolescents, 12.5% at parents and 56.2% at the general public. Most of these advertisements were broadcast on movies (29.8%), cartoons (18%), soap operas (17.6%), entertainment shows (17.2%) and sports programs (6.4%). CONCLUSION: Despite the self-regulation of television marketing, children were surrounded by UFB advertisements. Signatory companies influence children indirectly by targeting other audiences and by marketing during family television programs, which are also watched by children.

Child overweight and obesity are associated with reduced executive cognitive performance and brain alterations: a magnetic resonance imaging study in Mexican children.

BACKGROUND: Overweight and obesity in childhood is associated with negative physical and psychological effects. It has been proposed that obesity increase the risk for developing cognitive deficits, dementia and Alzheimer's disease and that it may be associated with marked differences in specific brain structure volumes. OBJECTIVE: The purpose of this study was a neurobiopsychological approach to examine the association between overweight and obesity, brain structure and a paediatric neuropsychological assessment in Mexican children between 6 and 8 years of age. METHODS: We investigated the relation between the body mass index (BMI), brain volumetric segmentation of subcortical gray and white matter regions obtained with magnetic resonance imaging and the Neuropsychological Assessment of Children standardized for Latin America. Thirty-three healthy Mexican children between 6 and 8 years of age, divided into normal weight (18 children) and overweight/obese (15 children) groups. RESULTS: Overweight/obese children showed reduced executive cognitive performance on neuropsychological evaluations (i.e. verbal fluidity, P = 0.03) and presented differences in brain structures related to learning and memory (reduced left hippocampal volumes, P = 0.04) and executive functions (larger white matter volumes in the left cerebellum, P = 0.04 and mid-posterior corpus callosum, P = 0.03). Additionally, we found a positive correlation between BMI and left globulus pallidus (P = 0.012, ρ = 0.43) volume and a negative correlation between BMI and neuropsychological evaluation scores (P = 0.033, ρ = -0.37). CONCLUSIONS: The findings contribute to the idea that there is a relationship between BMI, executive cognitive performance and brain structure that may underlie the causal chain that leads to obesity in adulthood.

Monitoring policy and actions on food environments: rationale and outline of the INFORMAS policy engagement and communication strategies.

The International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) proposes to collect performance indicators on food policies, actions and environments related to obesity and non-communicable diseases. This paper reviews existing communications strategies used for performance indicators and proposes the approach to be taken for INFORMAS. Twenty-seven scoring and rating tools were identified in various fields of public health including alcohol, tobacco, physical activity, infant feeding and food environments. These were compared based on the types of indicators used and how they were quantified, scoring methods, presentation and the communication and reporting strategies used. There are several implications of these analyses for INFORMAS: the ratings/benchmarking approach is very commonly used, presumably because it is an effective way to communicate progress and stimulate action, although this has not been formally evaluated; the tools used must be trustworthy, pragmatic and policy-relevant; multiple channels of communication will be needed; communications need to be tailored and targeted to decision-makers; data and methods should be freely accessible. The proposed communications strategy for INFORMAS has been built around these lessons to ensure that INFORMAS's outputs have the greatest chance of being used to improve food environments.

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles.

Non-communicable diseases (NCDs) dominate disease burdens globally and poor nutrition increasingly contributes to this global burden. Comprehensive monitoring of food environments, and evaluation of the impact of public and private sector policies on food environments is needed to strengthen accountability systems to reduce NCDs. The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) is a global network of public-interest organizations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities. The INFORMAS framework includes two 'process' modules, that monitor the policies and actions of the public and private sectors, seven 'impact' modules that monitor the key characteristics of food environments and three 'outcome' modules that monitor dietary quality, risk factors and NCD morbidity and mortality. Monitoring frameworks and indicators have been developed for 10 modules to provide consistency, but allowing for stepwise approaches ('minimal', 'expanded', 'optimal') to data collection and analysis. INFORMAS data will enable benchmarking of food environments between countries, and monitoring of progress over time within countries. Through monitoring and benchmarking, INFORMAS will strengthen the accountability systems needed to help reduce the burden of obesity, NCDs and their related inequalities.

Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed Government Healthy Food Environment Policy Index.

Government action is essential to increase the healthiness of food environments and reduce obesity, diet-related non-communicable diseases (NCDs), and their related inequalities. This paper proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food-EPI) was developed, which comprises a 'policy' component with seven domains on specific aspects of food environments, and an 'infrastructure support' component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week-long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food-EPI will be pre-tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.

A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention.

Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first ('minimal') step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second ('expanded') step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third ('optimal') step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention.

Monitoring the levels of important nutrients in the food supply.

A food supply that delivers energy-dense products with high levels of salt, saturated fats and trans fats, in large portion sizes, is a major cause of non-communicable diseases (NCDs). The highly processed foods produced by large food corporations are primary drivers of increases in consumption of these adverse nutrients. The objective of this paper is to present an approach to monitoring food composition that can both document the extent of the problem and underpin novel actions to address it. The monitoring approach seeks to systematically collect information on high-level contextual factors influencing food composition and assess the energy density, salt, saturated fat, trans fats and portion sizes of highly processed foods for sale in retail outlets (with a focus on supermarkets and quick-service restaurants). Regular surveys of food composition are proposed across geographies and over time using a pragmatic, standardized methodology. Surveys have already been undertaken in several high- and middle-income countries, and the trends have been valuable in informing policy approaches. The purpose of collecting data is not to exhaustively document the composition of all foods in the food supply in each country, but rather to provide information to support governments, industry and communities to develop and enact strategies to curb food-related NCDs.

Monitoring food and non-alcoholic beverage promotions to children.

Food and non-alcoholic beverage marketing is recognized as an important factor influencing food choices related to non-communicable diseases. The monitoring of populations' exposure to food and non-alcoholic beverage promotions, and the content of these promotions, is necessary to generate evidence to understand the extent of the problem, and to determine appropriate and effective policy responses. A review of studies measuring the nature and extent of exposure to food promotions was conducted to identify approaches to monitoring food promotions via dominant media platforms. A step-wise approach, comprising 'minimal', 'expanded' and 'optimal' monitoring activities, was designed. This approach can be used to assess the frequency and level of exposure of population groups (especially children) to food promotions, the persuasive power of techniques used in promotional communications (power of promotions) and the nutritional composition of promoted food products. Detailed procedures for data sampling, data collection and data analysis for a range of media types are presented, as well as quantifiable measurement indicators for assessing exposure to and power of food and non-alcoholic beverage promotions. The proposed framework supports the development of a consistent system for monitoring food and non-alcoholic beverage promotions for comparison between countries and over time.

Monitoring the health-related labelling of foods and non-alcoholic beverages in retail settings.

Food labelling on food packaging has the potential to have both positive and negative effects on diets. Monitoring different aspects of food labelling would help to identify priority policy options to help people make healthier food choices. A taxonomy of the elements of health-related food labelling is proposed. A systematic review of studies that assessed the nature and extent of health-related food labelling has been conducted to identify approaches to monitoring food labelling. A step-wise approach has been developed for independently assessing the nature and extent of health-related food labelling in different countries and over time. Procedures for sampling the food supply, and collecting and analysing data are proposed, as well as quantifiable measurement indicators and benchmarks for health-related food labelling.

Monitoring the price and affordability of foods and diets globally.

Food prices and food affordability are important determinants of food choices, obesity and non-communicable diseases. As governments around the world consider policies to promote the consumption of healthier foods, data on the relative price and affordability of foods, with a particular focus on the difference between 'less healthy' and 'healthy' foods and diets, are urgently needed. This paper briefly reviews past and current approaches to monitoring food prices, and identifies key issues affecting the development of practical tools and methods for food price data collection, analysis and reporting. A step-wise monitoring framework, including measurement indicators, is proposed. 'Minimal' data collection will assess the differential price of 'healthy' and 'less healthy' foods; 'expanded' monitoring will assess the differential price of 'healthy' and 'less healthy' diets; and the 'optimal' approach will also monitor food affordability, by taking into account household income. The monitoring of the price and affordability of 'healthy' and 'less healthy' foods and diets globally will provide robust data and benchmarks to inform economic and fiscal policy responses. Given the range of methodological, cultural and logistical challenges in this area, it is imperative that all aspects of the proposed monitoring framework are tested rigorously before implementation.

Monitoring foods and beverages provided and sold in public sector settings.

This paper outlines a step-wise framework for monitoring foods and beverages provided or sold in publicly funded institutions. The focus is on foods in schools, but the framework can also be applied to foods provided or sold in other publicly funded institutions. Data collection and evaluation within this monitoring framework will consist of two components. In component I, information on existing food or nutrition policies and/or programmes within settings would be compiled. Currently, nutrition standards and voluntary guidelines associated with such policies/programmes vary widely globally. This paper, which provides a comprehensive review of such standards and guidelines, will facilitate institutional learnings for those jurisdictions that have not yet established them or are undergoing review of existing ones. In component II, the quality of foods provided or sold in public sector settings is evaluated relative to existing national or sub-national nutrition standards or voluntary guidelines. Where there are no (or only poor) standards or guidelines available, the nutritional quality of foods can be evaluated relative to standards of a similar jurisdiction or other appropriate standards. Measurement indicators are proposed (within 'minimal', 'expanded' and 'optimal' approaches) that can be used to monitor progress over time in meeting policy objectives, and facilitate comparisons between countries.

Monitoring the impacts of trade agreements on food environments.

The liberalization of international trade and foreign direct investment through multilateral, regional and bilateral agreements has had profound implications for the structure and nature of food systems, and therefore, for the availability, nutritional quality, accessibility, price and promotion of foods in different locations. Public health attention has only relatively recently turned to the links between trade and investment agreements, diets and health, and there is currently no systematic monitoring of this area. This paper reviews the available evidence on the links between trade agreements, food environments and diets from an obesity and non-communicable disease (NCD) perspective. Based on the key issues identified through the review, the paper outlines an approach for monitoring the potential impact of trade agreements on food environments and obesity/NCD risks. The proposed monitoring approach encompasses a set of guiding principles, recommended procedures for data collection and analysis, and quantifiable 'minimal', 'expanded' and 'optimal' measurement indicators to be tailored to national priorities, capacity and resources. Formal risk assessment processes of existing and evolving trade and investment agreements, which focus on their impacts on food environments will help inform the development of healthy trade policy, strengthen domestic nutrition and health policy space and ultimately protect population nutrition.

Mexico attempts to tackle obesity: the process, results, push backs and future challenges.

Mexico's obesity prevalence is one of the world's highest. In 2006, academics, and federal and state government agencies initiated efforts to design a national policy for obesity prevention. The Ministry of Health (MOH) established an expert panel to develop recommendations on beverage intake for a healthy life in 2008. Subsequently, the MOH, with support from academia, initiated the development of the National Agreement for Healthy Nutrition (ANSA). ANSA was signed by all relevant sectoral actors in 2010 and led to initiatives banning sodas and regulating unhealthy food in schools and the design of other yet to be implemented initiatives, such as a front-of-package labeling system. A main challenge of the ANSA has been the lack of harmonization between industry interests and public health objectives and effective accountability and monitoring mechanisms to assess implementation across government sectors. Bold strategies currently under consideration include taxation of sugar-sweetened beverages, improvement of norms for healthy food in schools, regulation of food and beverage marketing to children and implementation of a national front-of-pack labeling system. Strong civil society organizations have embraced the prevention of obesity as their goal and have used evidence from academia to position obesity prevention in the public debate and in the government agenda.

Recommendations for healthier hydration: addressing the public health issues of obesity and type 2 diabetes.

Given the rapid increase in the prevalence of overweight, obesity, type 2 diabetes and other obesity-related conditions across the world, despite a plethora of evidence-based guidance for clinicians, innovative campaigns aimed at the general public and widespread government public health initiatives, it is clear that a novel approach is required. The importance of fluid intake has been overlooked in campaigns and guidelines and also in the clinical setting, where the question 'what do you drink?' is often omitted. It is a significant oversight that food pyramids and healthy-eating plates across the world omit fluids from their graphics and advice. While guidelines include recommendations on changes in physical activity and diet, often little or no advice is offered on the importance of healthier hydration practices, neglecting to highlight the contribution of beverages high in sugar, alcohol or additives. An interdisciplinary group of experts in medicine, nutrition, physiology and public health discussed issues surrounding healthy-hydration practices in March 2010 in Paris to create a consensus statement on hydration and gain of body weight and provide recommendations.

Association between diabetes mellitus and hypertension with anthropometric indicators in older adults: results of the Mexican Health Survey, 2000.

OBJECTIVE: To determine the association between anthropometric indicators of adiposity with type 2 diabetes mellitus (T2DM) and hypertension (HTN) in older adults. DESIGN: Cross-sectional study of participants of the Mexican Health Survey 2000 (MHS). SETTING: Mexico, subjects recruited from the general community. PARTICIPANTS: The analytic sample included 7,322 adults who were > or = 60 years of age at the time of the survey. T2DM data were available on 6,994 individuals, who represent 95.5% of the original sample; data on HTN was available on 6,268 subjects, which accounted for 86.5% of the original sample. MEASUREMENTS: Type 2 diabetes mellitus and hypertension, as well as anthropometric indicators including body mass index (BMI), waist circumference (WC), and conicity index (CI). RESULTS: The prevalence of T2DM and HTN in this age group was 34.3% and 73.9%, respectively. After adjusting for other variables, the association between high WC and T2DM (OR = 1.59 95%CI = 1.26-2.01, P < 0.001) was stronger than the association with overweight (OR = 1.26, 95%CI = 1.01-1.58, P = 0.04) and obesity (OR = 1.38, 95%CI = 1.08-1.79, P < 0.01) using BMI, and slightly higher than tertile 2 of the CI (OR = 1.49, 95%CI = 1.20-1.88, P < 0.01), while tertile 3 showed a stronger association with T2DM (OR = 1.60, 95%CI = 1.22-2.08, P < 0.001). However, the association between obesity and HTN measured by BMI (OR = 1.98, 95%CI = 1.48-2.65, P < 0.001) was stronger than what was observed with overweight (OR = 1.42, 95%CI 1.13-1.77, P < 0.01), with high WC (OR = 1.62, 95%CI = 1.25-2.10, P < 0.001) and tertiles 2 and 3 of the CI (OR = 1.23, 95%CI = 0.99-1.55, P = 0.09); (OR = 1.53, 95%CI = 1.16-2.03, P < 0.01) respectively. CONCLUSIONS: BMI and abdominal obesity are significantly and independently associated with an increase in the prevalence of T2DM and HTN among older Mexican adults.

Hypertension in Mexico and among Mexican Americans: prevalence and treatment patterns.

Increased social and economic integration across the US-Mexican borders has led to important new developments in public health. Lower levels of cardiovascular mortality have been observed among Mexican Americans (MAs) although few direct comparisons have been undertaken with Mexico. Using survey data in the respective countries we examined blood pressure (BP) levels, hypertension prevalence and patterns of awareness, treatment and control in Mexico and among MAs. A national representative sample of the adult population from Mexico collected in 2000 (N=49 294), and data on 8688 MA participants in the 1999-2004 National Health and Nutrition Examination survey from the United States were available for analysis. US-born MAs and those born in Mexico were analysed separately in the US data. Lack of direct standardization of methods between surveys necessitated statistical adjustment of BP values. Analyses were based on persons aged 25-64 in each country. Sex- and age-adjusted mean systolic/diastolic BPs were 122/80, 119/71 and 120/73 in Mexicans, immigrant MAs and US-born MAs, respectively. The prevalences of hypertension (BP > or = 140/90 or treatment) were 33, 17 and 22%. Hypertension control rates were 3.7, 32.1 and 37.9%, in the same groups. Awareness and treatment rates were 25 and 13% in Mexico and 54 and 46% among MAs in the United States, respectively. Hypertension appears to be more common in Mexico than among Mexican immigrants to the United States. Despite relatively low access to health insurance in the United States, hypertension control increased over the course of this migration.

The overlap of overweight and anaemia among women in three countries undergoing the nutrition transition.

OBJECTIVE: To compare the odds of anaemia in overweight and obese (OVWT) (body mass index (BMI) > or =25) versus non-overweight (non-OVWT) (BMI<25) women in three countries at different stages of the nutrition transition. DESIGN: Analysis of cross-sectional data. SETTING: Nationally representative data from Mexico (1998 National Nutrition Survey), Peru and Egypt (2000 Demographic and Health Surveys) were analyzed. SUBJECTS: Data from non-pregnant women ages 18-49 years were used. ANALYSIS: Logistic regression was used to test whether the odds of anaemia differed by BMI category, controlling for sociodemographic factors. RESULTS: More than half of the women were OVWT in all three countries and the prevalence of OVWT reached 77% in Egypt. Anaemia prevalence was similar across countries (28, 31 and 23% in Egypt, Peru and Mexico respectively). In Egypt, OVWT women had significantly lower odds of anaemia than non-OVWT women (OR=0.78, 95% CI: 0.68, 0.90). Similar results were found in Peru, but the difference was smaller in magnitude (OR=0.83, 95% CI: 0.71, 0.96). In Mexico, there were no differences in the odds of anaemia by BMI group. CONCLUSIONS: These findings show that the iron needs of OVWT women in developing countries are not necessarily being met. The intakes of other micronutrients might also be insufficient. Diet quality remains an important issue even among women with sufficient energy intakes.