Development of a crowdsourcing- and gamification-based mobile application to collect epidemiological information and promote healthy lifestyles in Mexico.

We developed a mobile application to promote healthy lifestyles and collect non-communicable disease (NCD) data in Mexico. Its theoretical foundations are supported by a framework-guided literature review. With design sprints, Scrum, Model-View-Controller, and Representational State Transfer architecture, we operationalized evidence-based nutrition/physical activity information into a crowdsourcing- and gamification-based application. The application was piloted for three months to monitor the response of 520 adults. Potential improvements were characterized, considering benchmarking, expert guidance, and standards. Salud Activa (English: Active Health) has two crowdsourcing modules: Nutritional scanner, scanning products' bar codes, providing nutritional data, and allowing new product registry feeding our databases; Surveys, comprising gradually-released NCD questions. Three intervention modules were generated: Drinks diary, a beverage assessment component to receive hydration recommendations; Step counter, monitoring users' steps via Google Fit/Health-iOS; Metabolic Avatar, interconnecting modules and changing as a function of beverage and step records. The 3-month median of Salud Activa use was seven days (IQR = 3-12), up to 35% of participants completed a Survey section, and 157 food products were registered through Nutritional scanner. Better customization might benefit usability and user engagement. Quantitative and qualitative data will enhance Salud Activa's design, user uptake, and efficacy in interventions delivered through this platform.

Depression, Anxiety, and Stress Scale: Factor validation during the first COVID-19 lockdown in Mexico

Introduction: Globally, mental health problems have affected nearly 1 billion people and approximately 1 in 10 Mexicans. The detection and surveillance of depression, anxiety, and stress in Mexico requires more reliable and valid instruments. Objective: To determine the factor validity and internal consistency of the Depression, Anxiety, and Stress Scale-21 items (DASS-21) in a non-probabilistic national sample of Mexican adults. Method: Cross-sectional study by means of an online survey of 1 613 Mexican adults aged 18 years and older. The Spanish version of the DASS-21 was used, which evaluates the presence of depressive symptoms, anxiety, and stress. Factor validity was determined by comparing different confirmatory factor analysis models: one-dimensional, three factors (correlated and non-correlated), second order, and bifactor. Results: The application of the bifactor model to the DASS 21, supports its validity for identifying the presence of symptoms of depression, anxiety, and stress, as well as an altered general emotional state in a sample of Mexican adults. Conclusions: The DASS-21 is a theoretically robust instrument useful for research and clinical practice.

Introducción: A nivel global los problemas de salud mental han alcanzado a cerca de 1 billón de personas y aproximadamente a uno de cada diez mexicanos. La detección y vigilancia de depresión, ansiedad y estrés en México demandan instrumentos más confiables y válidos. Objetivo: Determinar la validez factorial y consistencia interna de la Escala de Depresión, Ansiedad y Estrés (DASS-21) en una muestra nacional no probabilística de adultos mexicanos. Método: Estudio transversal por medio de una encuesta en línea entre 1 613 adultos me-xicanos de 18 años o más. Se utilizó la versión en español del DASS-21 que evalúa la presencia de síntomas depresivos, ansiedad y estrés. La validez factorial se determinó mediante la comparación de distintos modelos del análisis factorial confirmatorio: unidimensional; tres factores (correlacionados y no), de segundo orden, y bifactor. Resultados: La aplicación del modelo bifactor al DASS-21 sustenta su validez para identificar la presencia de síntomas de depresión, ansiedad y estrés, así como de un estado general emocional alterado en una muestra de adultos mexicanos. Conclusiones: El DASS-21 es un instrumento teóricamente robusto útil para la investigación y la práctica clínica.

Hacia el diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México.

OBJETIVO: Describir el proceso de diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México. Material y métodos. Se conformó un equipo de trabajo entre especialistas en salud y la Secretaría de Educación Pública. Se establecieron las bases científicas de Vida Saludable, se seleccionaron y evaluaron materiales para Vida Saludable, y se revisaron contenidos vigentes de salud incluidos en otras asignaturas. RESULTADOS: Alimentación, actividad física e higiene y limpieza fueron definidos como los tres ejes temáticos para Vida Saludable. Se aprobaron 3 de 228 insumos para usarse en Vida Saludable y 71.7% de los con-tenidos vigentes en educación básica sobre salud requieren ediciones. CONCLUSIONES: Vida Saludable es un parteaguas hacia la alfabetización en materia de salud en educación básica en México, que se alinea con la agenda global para preservar la salud humana y planetaria.

Chronic kidney disease risk prediction scores assessment and development in Mexican adult population.

Background: Chronic kidney disease (CKD) is a major public health problem, with considerable growth in prevalence and mortality in recent years. Screening of CKD at primary care is crucial for the implementation of prevention strategies. The aims of this study are to assess CKD risk prediction scores and to develop a risk prediction score for the Mexican adult population. Methods: Data from the Mexican National Health and Nutrition Survey 2016 was utilized and 3463 participants ≥ 20 years old were included. Reduced renal function with Glomerular filtration rate and/or the presence of albuminuria was defined as CKD. Multiple logistic regression models were performed for the creation of a training and validation model. Additionally, several models were validated in our Mexican population. Results: The developed training model included sex, age, body mass index, fast plasma glucose, systolic blood pressure, and triglycerides, as did the validation model. The area under the curve (AUC) was 0.78 (95% CI: 0.72, 0.79) for training model, and 0.76 (95% CI: 0.71, 0.80) in validation model for Mexican adult population. Age, female gender, presence of diabetes and hypertension, elevated systolic and diastolic blood pressure, serum and urinary creatinine, and higher HbA1c were significantly associated with the prevalent chronic kidney disease. Previous CKD risk predictive models were evaluated with a representative sample of the Mexican adult population, their AUC was between 0.61 and 0.78. Conclusion: The designed CKD risk predictive model satisfactorily predicts using simple and common variables in primary medical care. This model could have multiple benefits; such as, the identification of the population at risk, and prevention of CKD.

Association of sociodemographic and lifestyle factors with dietary patterns among men and women living in Mexico City: A cross-sectional study.

Background: Diet is one of the leading risk factors for non-communicable diseases and is related to sociodemographic and lifestyle factors, including sex. These associations vary across populations. We aimed to investigate which factors are associated with dietary patterns among adults living in Mexico City by sex. Methods: We used data from the Mexico City Diabetes Representative Study, a cross-sectional, multistage, stratified, and cluster-sampled survey in Mexico City (n = 1,142; 413 men and 729 women). Dietary information was collected using a semi-quantitative food frequency questionnaire. Foods and beverages were categorized into 23 food groups to identify dietary patterns by cluster analysis. Sociodemographic and lifestyle variables included were self-reported through standardized questionnaires. We assessed the association of sociodemographic and lifestyle factors with dietary patterns through a multinomial logistic model stratified by sex. Results: We identified three dietary patterns: basic, prudent, and fast food. Among men and women, higher school attainment was associated with a lower relative probability of having a basic rather than prudent dietary pattern (women: RRR = 0.8, 95% CI: 0.8, 0.9; men: RRR = 0.8, 95% CI: 0.7, 0.9). Divorced or separated men (RRR = 3.8, 95% CI: 1.3, 11.2) and those living with a partner (RRR = 2.6, 95% CI: 1.1, 6.1) had a higher relative probability of consuming a fast food dietary pattern than the prudent one, compared to single men. Men living with a partner (RRR = 3.0, 95% CI: 1.1, 8.6) or working long shifts (RRR = 3.8, 95% CI: 1.3, 11.1) had a higher probability of consuming a basic pattern rather than a prudent one compared to peers. Among women, those with high SES had a lower probability of consuming the "basic" pattern rather than the "prudent" pattern compared to those with low SES. No lifestyle factors were associated to dietary patterns. Conclusions: Men living in Mexico City with lower education, age, non-single, and working long hours (i.e., more than the established by the law), and women with lower age, education, and socioeconomic level are prone to adhere to unhealthy diets. These associations are likely to be driven by gender roles.

Association between density of convenience and small grocery stores with diet quality in adults living in Mexico City: A cross sectional study.

There is evidence of the association between different retail stores and food consumption, yet research is still limited in low- and medium-income countries, where the context of the food retail environment is different from that observed in high-income countries. Specifically, less is known about how convenience and small grocery stores, which offer products with immediate access, are associated with the diet as a whole. The present study assessed the association between density of convenience and small grocery stores and diet quality in adults from the Mexico City Representative Diabetes Survey 2015. A final sample size of 1,023 adults aged 20-69 years was analyzed. The density of stores was measured using Euclidean buffers within 500 meters of each participant's home. The Mexican Alternate Healthy Eating Index (MxAHEI) was used to assess diet quality. Multivariable Poisson models were used to test the association of convenience and small grocery stores densities with the MxAHEI. Although our results were not statistically significant, we observed a lower diet quality score among adults from Mexico City living in areas with a higher density of small grocery and convenience stores. More research is needed on the influence of environmental food retail on food consumption.

Metabolic Syndrome and Prostate Cancer Risk: A Population Case-control Study.

BACKGROUND: Metabolic syndrome (MS) with mixed dyslipidemia and prostate cancer (PC) are relevant health problems among Mexican men. However, there is no information regarding the association between MS and PC for this population. AIM OF THE STUDY: To evaluate this association in a population case-control study in Mexico City. METHODS: We analyzed the information from 394 incident PC-cases and 793 population age-matched (± 5 years) controls, identified in Mexico City (2011-2014). For cases, Gleason score at diagnosis was available. We defined MS history based on the self-report of hypertension, hypercholesterolemia, hypertriglyceridemia, and diabetes; obesity was evaluated using weight-change trajectories throughout life. In addition, the four MS-typologies described for Mexican population were used. The association between MS with PC and histological PC differentiation was evaluated using independent multivariate logistic regression models. RESULTS: MS history was associated with a high PC probability (OR 1.94; 95% CI 1.37-2.75). Lipid alterations, arterial hypertension, and a marked weight increase throughout life were associated with increased PC probability; however, only the marked weight increase was associated with more poorly differentiated PC (Gleason ≥8) (OR 2.79; 95% CI 1.50-5.17). CONCLUSION: Like other populations, in this Mexican study, MS and some of its components were identified as potential PC risk factors. MS-lipid alteration typology seems to be relevant; however, the novelty of this approach together with the retrospective nature of this study, indicate that a prospective evaluation of the MS typologies and PC association must be performed.

Changes Among Mexican Adults in Physical Activity and Screen Time During the COVID-19 Lockdown Period and Association With Symptoms of Depression, Anxiety, and Stress, May 29-July 31, 2020.

INTRODUCTION: We examined the association between changes in physical activity and leisure screen time and mental health outcomes during the early stages of the recommended COVID-19 stay-at-home period in a national sample of Mexican adults aged 18 years or older. METHODS: A cross-sectional online survey conducted from May 29 through July 31, 2020, among 1,148 participants, reported time spent in physical activity and leisure screen time during a typical week before (retrospectively) and a week during the COVID-19 stay-at-home period. Mental health outcomes during this period were measured with the Depression, Anxiety and Stress Scale (DASS-21). Linear regression models were used to estimate the associations between changes in physical activity and leisure screen time and mental health outcomes by socioeconomic status (SES), adjusting for potential confounders. RESULTS: Compared with maintaining high levels of physical activity or increasing them, decreasing physical activity was associated with higher stress scores overall, and among people of high SES, with higher scores for DASS-21, depression, and anxiety. Among participants of low and medium SES only, increasing screen time was associated with higher DASS-21, depression, anxiety, and stress scores compared with maintaining low or decreasing leisure screen time. CONCLUSION: Results highlight the potential protective effect of physical activity and limited leisure screen time on mental health in the context of COVID-19 stay-at-home restrictions.

Prevalence and predictors of elevated liver enzyme levels in Mexico: The Mexican National Health and Nutrition Survey, 2016.

INTRODUCTION AND OBJECTIVE: To determine the prevalence of elevated liver enzyme levels and the fatty liver index according to specific sociodemographic, clinical, anthropometric, and metabolic risk factors in Mexican adult population. MATERIAL AND METHODS: The present analysis was conducted using data from the Mexican National Health and Nutrition Survey 2016. For the present study, 3,490 adults with complete information on liver enzymes, sociodemographic, lifestyle, and metabolic factors were analyzed. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) levels were determined from blood samples. We computed the fatty liver Index (FLI), as a surrogate marker of non-alcoholic fatty liver disease. The associations are reported as adjusted odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: At the national level, the prevalence of high serum levels of ALT, AST, and GGT were 7.9%, 13.5, and 12.9 respectively. We observed that men had higher prevalences of altered ALT, GGT and FLI compared to women. Additionally, we observe that individuals with obesity, metabolic syndrome and insulin resistance are significantly more likely to present elevated concentrations of AST, ALT, GGT and FLI. Finally, we found that the subjects of the lowest socioeconomic level and indigenous population were more likely to present elevated levels of AST, ALT, GGT, and FLI. CONCLUSION: In Mexico, non-alcoholic fatty liver disease affect people with obesity, diabetes, and metabolic syndrome as well as men, subjects of low socioeconomic status, subjects who live in rural areas and indigenous population. Interventions to reduce this condition should be a public health priority.

Environmental and Nutritional Determinants of Macular Pigment in a Mexican Population.

Purpose: The carotenoids lutein (L), zeaxanthin (Z), and meso-zeaxanthin deposit at the macula as macular pigment (MP) and provide visual benefits and protection against macular diseases. The present study investigated MP, its nutritional and environmental determinants, and its constituent carotenoids in serum from a Mexican sample, in healthy participants and with metabolic diseases. Additionally, we compared these variables with an Irish sample. Methods: MP was measured in 215 subjects from a rural community in Mexico with dual-wavelength autofluorescence imaging reported as MP optical volume (MPOV). Dietary intake and serum concentrations of L and Z were evaluated. Results: The mean MPOV was 8429 (95% confidence interval, 8060-8797); range. 1171-15,976. The mean L and Z serum concentrations were 0.25 ± 0.15 µmol/L and 0.09 ± 0.04 µmol/L, respectively. The MPOV was positively correlated with L and Z serum concentrations (r = 0.347; P < 0.001 and r = 0.311; P < 0.001, respectively), but not with L + Z dietary estimates. Subjects with daily sunlight exposure of more than 50% were found to have significantly higher MPOV than those with less than 50% (P = 0.005). MPOV and serum concentrations of L and Z were significantly higher in the Mexican sample compared with the Irish sample, but this difference was not reflected in dietary analysis. Conclusions: These new data from a Mexican sample provide evidence of the multifactorial interactions and environmental determinants of MP such as sunlight exposure and dietary patterns. These findings will be essential for future studies in Mexico for eye health, visual function, and ocular pathology.

[Subsample for the analysis of chronic diseases with biomarkers, National Survey of Health and Nutrition 2016]. / Submuestra para el análisis de enfermedades crónicas con biomarcadores, Encuesta Nacional de Salud y Nutrición 2016.

OBJECTIVE: To describe the adult subsample for the analysis of biomarkers of chronic diseases, as well as the sample sizes (n) and representativity of the Encuesta Nacional de Salud y Nutrición (Ensanut) 2016. MATERIALS AND METHODS: An adult subsample with national representativity was calculated to obtain blood, serum and urine samples. The prevalence of variables of interest was compared for each subsample. RESULTS: The n for at least one serum biomarker and urine samples were 4 000 and 3 782, respectively. The n varied depending on the grouping of biomarkers and fasting time selection. No differences were observed in the distribution of variables between the whole sample, urine and blood biomarkers samples. CONCLUSIONS: The weighted subsamples of urine, serum and blood biomarkers are comparable to the weighted sample of adults in the survey. The data of the subsample will allow to monitor the distribution of chronic diseases in Mexico, including altered function of liver and kidney, and sodium intake.

OBJETIVO: Describir la submuestra de adultos para el análisis de biomarcadores de enfermedades crónicas, así como los tamaños de muestra (n) y la representatividad de las mismas en la Encuesta Nacional de Salud y Nutrición 2016. MATERIAL Y MÉTODOS: Se calculó una submuestra con representati-vidad nacional para la obtención de sangre, suero y orina en adultos. Se comparó la prevalencia de variables de interés para las submuestras. RESULTADOS: Las n obtenidas de suero y orina fueron de 4 000 y 3 782 adultos con al menos un valor en algún marcador bioquímico sérico y marcadores de orina, respectivamente. Esta n varió con el agrupamiento de marcadores y selección por horas de ayuno. No se observa-ron diferencias en la distribución de las variables de interés entre las muestras de hogar, sangre y orina. CONCLUSIONES: Los datos ponderados de las submuestras de marcadores en orina, suero y sangre son comparables con la muestra total de adultos de la encuesta. Los datos de las submuestras permiti-rán monitorear la distribución de enfermedades crónicas en México, incluidas las alteraciones en función hepática, renal, y consumo de sodio.

Submuestra para el análisis de enfermedades crónicas con biomarcadores, Encuesta Nacional de Salud y Nutrición 2016 / Subsample for the analysis of chronic diseases with biomarkers, National Survey of Health and Nutrition 2016

Resumen Objetivo: Describir la submuestra de adultos para el análisis de biomarcadores de enfermedades crónicas, así como los tamaños de muestra (n) y la representatividad de las mismas en la Encuesta Nacional de Salud y Nutrición 2016. Material y métodos: Se calculó una submuestra con representatividad nacional para la obtención de sangre, suero y orina en adultos. Se comparó la prevalencia de variables de interés para las submuestras. Resultados: Las n obtenidas de suero y orina fueron de 4 000 y 3 782 adultos con al menos un valor en algún marcador bioquímico sérico y marcadores de orina, respectivamente. Esta n varió con el agrupamiento de marcadores y selección por horas de ayuno. No se observaron diferencias en la distribución de las variables de interés entre las muestras de hogar, sangre y orina. Conclusión: Los datos ponderados de las submuestras de marcadores en orina, suero y sangre son comparables con la muestra total de adultos de la encuesta. Los datos de las submuestras permitirán monitorear la distribución de enfermedades crónicas en México, incluidas las alteraciones en función hepática, renal, y consumo de sodio.

Abstract Objective: To describe the adult subsample for the analysis of biomarkers of chronic diseases, as well as the sample sizes (n) and representativity of the Encuesta Nacional de Salud y Nutrición (Ensanut) 2016. Materials and methods: An adult subsample with national representativity was calculated to obtain blood, serum and urine samples. The prevalence of variables of interest was compared for each subsample. Results: The n for at least one serum biomarker and urine samples were 4 000 and 3 782, respectively. The n varied depending on the grouping of biomarkers and fasting time selection. No differences were observed in the distribution of variables between the whole sample, urine and blood biomarkers samples. Conclusion: The weighted subsamples of urine, serum and blood biomarkers are comparable to the weighted sample of adults in the survey. The data of the subsample will allow to monitor the distribution of chronic diseases in Mexico, including altered function of liver and kidney, and sodium intake.

Dyslipidemia prevalence, awareness, treatment and control in Mexico: results of the Ensanut 2012.

OBJECTIVE: To describe in a national sample 1) the prevalence, awareness, treatment and control of dyslipidemias 2) the prevalence of dyslipidemias through previous national surveys. MATERIALS AND METHODS: We analyzed data of the National Health and Nutrition Survey 2012, a representative cross-sectional study. Serum samples of 9 566 adults ≥20 years old with fasting ≥8 hours were analyzed for lipid fractions. Age-adjusted prevalences were calculated, by sociodemographic variables. Prevalence of awareness, treatment and control was estimated. A description of the dyslipidemia prevalence reported in previous surveys is reported. RESULTS: Hypoalphalipoproteinemia and elevated LDL-C are the most prevalent dyslipidemias in Mexican adults. One in four adults had hypercholesterolemia at the moment of the interview without previous diagnosis. Awareness, treatment and control of dyslipidemia were 12.6, 3.7 and 3.1%, respec- tively. CONCLUSIONS: Dyslipidemias are the most prevalent risk factor for cardiovascular diseases in Mexico. Public policies to increase awareness, access to therapy and sustained control are urgently needed.

OBJETIVO: Describir en una muestra nacional 1) la prevalencia de dislipidemias, su diagnóstico previo, tratamiento y control, y 2) la prevalencia de dislipidemias en las encuestas previas. MATERIAL Y MÉTODOS: Se analizaron datos de la Encuesta Nacional de Salud y Nutrición 2012 con representatividad nacional. Se analizaron fracciones de lípidos séricos de 9 566 adultos ≥20 años con ayuno ≥8 horas. Se estimaron las prevalencias de dislipidemias, diagnóstico previo (DP), tratamiento y control, ajustadas por edad. Se presenta un análisis comparativo de las prevalencias de dislipidemias reportadas previamente. RESULTADOS: Las dislipidemias más prevalentes en adultos mexicanos fueron hipoalfalipoprotei- nemia y LDL-C elevado. Uno de cada cuatro adultos tenía hipercolesterolemia al momento de la entrevista, sin DP. El DP, tratamiento y control de dislipidemias fue de 12.6, 3.7 y 3.1%, respectivamente. CONCLUSIONES: Las dislipidemias son el factor de riesgo para enfermedades cardiovasculares más prevalente en adultos mexicanos. Se necesitan políticas públicas para incrementar el diagnóstico, acceso a terapia y control.

Dyslipidemia prevalence, awareness, treatment and control in Mexico: results of the Ensanut 2012 / Prevalencia de dislipidemias, diagnóstico previo, tratamiento y control: resultados de la Ensanut 2012

Abstract: Objective: To describe in a national sample 1) the prevalence, awareness, treatment and control of dyslipidemias 2) the prevalence of dyslipidemias through previous national surveys. Materials and methods: We analyzed data of the National Health and Nutrition Survey 2012, a representative cross-sectional study. Serum samples of 9 566 adults ≥20 years old with fasting ≥8 hours were analyzed for lipid fractions. Age-adjusted prevalences were calculated, by sociodemographic variables. Prevalence of awareness, treatment and control was estimated. A description of the dyslipidemia prevalence reported in previous surveys is reported. Results: Hypoalphalipoproteinemia and elevated LDL-C are the most prevalent dyslipidemias in Mexican adults. One in four adults had hypercholesterolemia at the moment of the interview without previous diagnosis. Awareness, treatment and control of dyslipidemia were 12.6, 3.7 and 3.1%, respectively. Conclusions: Dyslipidemias are the most prevalent risk factor for cardiovascular diseases in Mexico. Public policies to increase awareness, access to therapy and sustained control are urgently needed.

Resumen: Objetivo: Describir en una muestra nacional 1) la prevalencia de dislipidemias, su diagnóstico previo, tratamiento y control, y 2) la prevalencia de dislipidemias en las encuestas previas. Material y métodos: Se analizaron datos de la Encuesta Nacional de Salud y Nutrición 2012 con representatividad nacional. Se analizaron fracciones de lípidos séricos de 9 566 adultos ≥20 años con ayuno ≥8 horas. Se estimaron las prevalencias de dislipidemias, diagnóstico previo (DP), tratamiento y control, ajustadas por edad. Se presenta un análisis comparativo de las prevalencias de dislipidemias reportadas previamente. Resultados: Las dislipidemias más prevalentes en adultos mexicanos fueron hipoalfalipoproteinemia y LDL-C elevado. Uno de cada cuatro adultos tenía hipercolesterolemia al momento de la entrevista, sin DP. El DP, tratamiento y control de dislipidemias fue de 12.6, 3.7 y 3.1%, respectivamente. Conclusiones: Las dislipidemias son el factor de riesgo para enfermedades cardiovasculares más prevalente en adultos mexicanos. Se necesitan políticas públicas para incrementar el diagnóstico, acceso a terapia y control.

Attributable Burden and Expenditure of Cardiovascular Diseases and Associated Risk Factors in Mexico and other Selected Mega-Countries.

BACKGROUND: This paper describes the health and economic burden of cardiovascular diseases (CVD) in Mexico and other mega-countries through a review of literature and datasets. METHODS: Mega-countries with a low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S.A./Japan) human development index were included. The review was focused on prevalence of dyslipidemias and CVD economic impact and conducted according to the PRISMA statement. Public datasets of CVD indicators were explored. RESULTS: Heterogeneity in economic data and limited information on dyslipidemias were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared with other countries. Higher contribution of dietary risk factors for cardiovascular mortality and greater probability of dying prematurely from CVD were observed in developing countries. From 1990-2016, a greater decrease in cardiovascular mortality in developed countries was registered. In 2015, a CVD expense equivalent to 4% of total health expenditure was reported in Mexico. CVD ranked first in health expenditures in almost all these nations and the economic burden will remain significant for decades to come. CONCLUSIONS: Resources should be assured to optimize CVD risk monitoring. Educational and medical models must be improved to enhance CVD diagnosis and the prescription and adherence to treatments. Long-term benefits could be attained by modifying the food system.

Polyunsaturated fatty acids and child neurodevelopment among a population exposed to DDT: a cohort study.

BACKGROUND: Child neurodevelopment has been positively linked to maternal intake of polyunsaturated fatty acids (PUFAs) during pregnancy; however, it is unknown if that relationship persists among populations exposed to environmental neurotoxicants. OBJECTIVE: The aim of this work was to assess whether maternal dietary intake of PUFAs during pregnancy is positively associated with child neurodevelopment, whose mothers were environmentally exposed to 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (DDT). METHODS: A prospective cohort study with 276 mother-child pairs was performed in Mexico. Neurodevelopment was assessed by Bayley Scales II from children age 1 to 30 months. Dietary PUFAs intake was estimated by Food Frequency Questionnaire at 1st and 3rd trimester of pregnancy. DDE (1,1-dichloro-2,2-bis(p-chlorophenyl) ethylene, the main metabolite of DDT) maternal serum levels were determined by electron capture gas chromatography. Longitudinal multivariate linear mixed-effects analysis, which combines mental (MDI) and motor (PDI) Bayley scales in a single model, were performed. RESULTS: Our results show that in a sample environmentally exposed to DDT, maternal ingestion of DPA during the first trimester of pregnancy was positively associated with MDI (ß = 0.10, 95% CI 0.02, 0.18) in children from 1 to 30 months. Likewise, our results suggest that dietary ALA may be also related to MDI. CONCLUSION: DPA may benefit neurodevelopment even in populations exposed to DDT. Our results strengthen the importance of PUFAs intake during the prenatal period.

Collaborative research and actions on both sides of the US-Mexico border to counteract type 2 diabetes in people of Mexican origin.

BACKGROUND: Type 2 Diabetes (T2D) is now a massive epidemic in both California and Mexico, with serious consequences for social and economic well-being. A large proportion of these populations share common ethnic backgrounds. Yet diverse environmental and social conditions across regions create unique opportunities to explore the ways that T2D risk, incidence, management and outcomes manifest. MAIN TEXT: An action-oriented research consortium headed up by the University of California and Universidad Nacional Autónoma de Mexico was constituted to set priorities for bi-national translational research, in an attempt to implement and evaluate clinical, public health and policy actions to decrease the burden of T2D for people of Mexican origin. In this paper, we describe the epidemiology of T2D in Mexico and California, review current efforts to combat the epidemic, highlight gaps in knowledge and identify urgent areas of opportunity for collaboration. The group has developed a common research agenda and funding has been obtained to evaluate biological samples from the 2016 Mexican Health Survey, collaborate in a telemedicine-based retinopathy project, implement interventions in food banks, promote a communications campaign, and design a large-scale diabetes prevention effectiveness trial. CONCLUSIONS: T2D has caused a state of emergency in Mexico and is a major health problem among Mexican populations on both sides of the border. Understanding the commonalities and differences between California and Mexico for those of Mexican origin with respect to T2D, when combined with a sharing of knowledge and advances, can produce a bi-national translational research agenda to inform relevant policy and practice. Amidst economic and political uncertainty and limited healthcare budgets, this collaboration can contribute to the development of scientific evidence to inform policies and interventions. This may provide a promising collaborative model that could be expanded to other health conditions and regions of the world.

Maternal dietary intake of polyunsaturated fatty acids modifies association between prenatal DDT exposure and child neurodevelopment: A cohort study.

BACKGROUND: Maternal 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) serum levels during pregnancy have been negatively linked to child neurodevelopment in contrast to intake of omega-3 and -6 (ω-3 and ω-6) fatty acids. OBJECTIVES: To assess whether maternal dietary intake of ω-3 and ω-6 during pregnancy modifies the association between exposure to DDE and child neurodevelopment from age 42-60 months. METHODS: Prospective cohort study with 142 mother-child pairs performed in Mexico. DDE serum levels were determined by electron capture gas chromatography. Dietary ω-3 and ω-6 intake was estimated by questionnaire. Child neurodevelopment was assessed by McCarthy Scales. RESULTS: Docosahexaenoic (DHA) fatty acid intake significantly modified the association between DDE and motor component: increased maternal DDE was associated with lower motor development in children whose mothers had lower DHA intake (ßlog2DDE = -1.25; 95% CI: -2.62, 0.12), in contrast to the non-significant increase among children whose mothers had higher DHA intake (ßlog2DDE-motor = 0.50; 95% CI: 0.55, 1.56). Likewise, arachidonic fatty acid (ARA) intake modified the association between DDE and memory component: increased maternal DDE was associated with a significantly larger reduction in the memory component in children whose mothers had lower ARA intake (ßlog2DDE = -1.31; 95% CI: -2.29, -0.32) than children whose mothers had higher ARA intake (ßlog2DDE-memory = 0.17; 95% CI: -0.78, 1.11). CONCLUSIONS: Dietary intake of DHA and ARA during pregnancy may protect against child neurodevelopment damage associated with prenatal maternal DDE levels.

Arsenic methylation capacity in relation to nutrient intake and genetic polymorphisms in one-carbon metabolism.

BACKGROUND: Nutrients and genetic polymorphisms participating in one-carbon metabolism may explain interindividual differences in inorganic arsenic (iAs) methylation capacity, which in turn may account for variations in susceptibility to iAs-induced diseases. OBJECTIVES: 1) To evaluate the association between polymorphisms in five one-carbon metabolism genes (FOLH1 c.223 T > C, MTHFD1 c.1958 G > A, MTHFR c.665 C > T, MTR c.2756 A > G, and MTRR c.66 A > G) and iAs methylation capacity; 2) To assess if previously reported associations between nutrient intake and iAs methylation capacity are modified by those polymorphisms. METHODS: Women (n = 1027) exposed to iAs in Northern Mexico were interviewed. Blood and urine samples were collected. Nutrient dietary intake was estimated using a validated food frequency questionnaire. iAs methylation capacity was calculated from urinary iAs species (iAs, monomethylarsonic acid [MMA] and dimethylarsinic acid [DMA]) measured by high performance liquid chromatography (HPLC-ICP-MS). One polymorphism in each of the five genes evaluated was genotyped by allelic discrimination. Multivariable linear regression models were used to evaluate if genetic polymorphisms modified the associations between iAs methylation capacity parameters and nutrient intake. RESULTS: The median (min-max) concentration of total arsenic (TAs) was 20.2 (1.3-2776.0) µg/g creatinine in the study population. Significant interactions for iAs metabolism were only found with FOLH1 c.223 T > C polymorphism and vitamin B12 intake, so that CT and CC genotype carriers had significantly lower %iAs, and higher DMA/iAs with an increased vitamin B12 intake, as compared to carriers of wild-type TT. CONCLUSION: Differences in dietary nutrient intake and genetic variants in one-carbon metabolism may jointly influence iAs methylation capacity. Confirmation of these interactions in other populations is warranted.

A Diabetic Retinopathy Screening Tool for Low-Income Adults in Mexico.

INTRODUCTION: A national diabetic retinopathy screening program does not exist in Mexico as of 2017. Our objective was to develop a screening tool based on a predictive model for early detection of diabetic retinopathy in a low-income population. METHODS: We analyzed biochemical, clinical, anthropometric, and sociodemographic information from 1,000 adults with diabetes in low-income communities in Mexico (from 11,468 adults recruited in 2014-2016). A comprehensive ophthalmologic evaluation was performed. We developed the screening tool through the following stages: 1) development of a theoretical predictive model, 2) performance assessment and validation of the model using cross-validation and the area under the receiver operating characteristic curve (AUC ROC), and 3) optimization of cut points for the classification of diabetic retinopathy. We identified points along the AUC ROC that minimized the misclassification cost function and considered various scenarios of misclassification costs and diabetic retinopathy prevalence. RESULTS: Time since diabetes diagnosis, high blood glucose levels, systolic hypertension, and physical inactivity were considered risk factors in our screening tool. The mean AUC ROC of our model was 0.780 (validation data set). The optimized cut point that best represented our study population (z = -0.640) had a sensitivity of 82.9% and a specificity of 61.9%. CONCLUSION: We developed a low-cost and easy-to-apply screening tool to detect people at high risk of diabetic retinopathy in Mexico. Although classification performance of our tool was acceptable (AUC ROC > 0.75), error rates (precision) depend on false-negative and false-positive rates. Therefore, confirmatory assessment of all cases is mandatory.