[A front-of-pack labelling system for food and beverages for Mexico: a strategy of healthy decision-making.] / Sistema de etiquetado frontal de alimentos y bebidas para México: una estrategia para la toma de decisiones saludables.

The Mexican Ministry of Health requested the National Institute of Public Health to constitute a group of independent, free of conflict-of-interest academic experts on front-of-pack labelling (FOP). This group was instructed to created a positioning paper to contribute to the development of a FOP system for industrialized products that offers useful information for purchase decision making. This position paper uses the best available scientific evidence, and recommendations from experts of international organizations. The FOP proposal focuses on the contents of energy, nutrients, ingredients and components that if consumed in excess on the diet, can be harmful to people's health, such as added sugars, sodium, total fat, saturated fat and energy. The academic expert group recommends the implementation of a FOP that provides an easy way to quickly assess the quality of a product. It is essential that this FOP provides direct, simple, visible and easily understandable information.

La Secretaría de Salud solicitó al Instituto Nacional de Salud Pública la conformación de un grupo de expertos académicos en etiquetado de alimentos y bebidas, independientes y libres de conflictos de interés, que tuvieran la encomienda de emitir una postura para contribuir al desarrollo de un sistema de etiquetado frontal para productos industrializados que proporcione información útil para facilitar la decisión de compra. La postura utiliza la mejor evidencia científica disponible y recomendaciones de expertos convocados por organismos internacionales. Así, la propuesta de etiquetado frontal se centra en el contenido de energía, nutrimentos, ingredientes y componentes cuyo exceso en la dieta puede ser perjudicial para la salud, como azúcares añadidos, sodio, grasas totales, grasas saturadas y energía. El grupo recomienda implementar un etiquetado frontal que, de forma sencilla, permita evaluar de manera rápida la calidad de un producto al momento de realizar una compra; por ello, es indispensable que éste proporcione información directa, sencilla, visible y fácil de entender.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

Riesgo de sobrepeso en niños preescolares beneficiarios de programas de ayuda alimentaria / Obesity risk in preschoolers beneficiaries of food aid programs

Objetivo Revisar la evidencia sobre el posible efecto de los programas alimentarios en el riesgo de sobrepeso de los niños beneficiarios. Métodos Se realizó la búsqueda de artículos en bases de datos usando términos en español y en inglés. Se incluyeron artículos con variables de interés, estudios de corte transversal, cohorte o ensayos comunitarios. Resultados Los programas alimentarios de transferencias podrían contribuir al aumento del sobrepeso en su población beneficiaria a través de una mayor disponibilidad y acceso a alimentos con alto contenido de energía, ya sea por medio de la entrega de despensas o de dinero en efectivo. Sin embargo, el impacto de los programas en este desenlace ha sido poco estudiado y las evaluaciones que se han realizado han sido, en su mayoría, en población adulta o en edad escolar. Conclusiones Esta revisión puede servir de referencia para el diseño, implementación y evaluación de programas de alimentación y nutrición en países de ingresos bajos y medios que enfrentan la doble carga de la mala nutrición.(AU)

Objective To review the evidence regarding the potential impact of food programs on the risk of obesity in beneficiary children. Methods The search was conducted in databases using terms in Spanish and English. Those items that included the variable of interest, cross sectional studies, cohort or community trials were selected. Results Food assistance programs could contribute to increased obesity rates in the target population due to the availability and easier access to food with high energy content, either through the delivery of provisions or cash. However, the impact of the programs on this outcome has been little studied and evaluations have been mostly in adults or school-age children. Conclusion This review contributes to knowledge about the possible effect that food programs have on the risk of obesity in beneficiary children. This review may also serve as a reference for the design, implementation and evaluation of food and nutrition programs in countries of low and middle income facing malnutrition.(AU)

[Obesity risk in preschoolers beneficiaries of food aid programs]. / Riesgo de sobrepeso en niños preescolares beneficiarios de programas de ayuda alimentaria.

Objective To review the evidence regarding the potential impact of food programs on the risk of obesity in beneficiary children. Methods The search was conducted in databases using terms in Spanish and English. Those items that included the variable of interest, cross sectional studies, cohort or community trials were selected. Results Food assistance programs could contribute to increased obesity rates in the target population due to the availability and easier access to food with high energy content, either through the delivery of provisions or cash. However, the impact of the programs on this outcome has been little studied and evaluations have been mostly in adults or school-age children. Conclusion This review contributes to knowledge about the possible effect that food programs have on the risk of obesity in beneficiary children. This review may also serve as a reference for the design, implementation and evaluation of food and nutrition programs in countries of low and middle income facing malnutrition.

Childhood and adolescent overweight and obesity in Latin America: a systematic review.

The number of children and adolescents who are overweight or obese worldwide is alarming. We did a systematic review to estimate the prevalence of overweight and obesity in children aged 0-19 years in Latin America. We searched specialised databases and seven books for relevant studies that were done in Spanish-speaking and Portuguese-speaking Latin American and Caribbean countries and published in peer-reviewed journals between January 2008, and April 2013. Indicators used were BMI (kg/m(2)) in all age groups and weight-for-height in children younger than 5 years. We identified 692 publications and included 42. Estimated prevalence of overweight in children younger than 5 years in Latin America was 7·1% with the weight-for-height WHO 2006 classification method. National combined prevalences of overweight and obesity with the WHO 2007 classification method ranged from 18·9% to 36·9% in school-age children (5-11 years) and from 16·6% to 35·8% in adolescents (12-19 years). We estimated that 3·8 million children younger than 5 years, 22·2-25·9 million school-age children, and 16·5-21·1 million adolescents were overweight or obese. Overall, between 42·5 and 51·8 million children aged 0-19 years were affected-ie, about 20-25% of the population. Although undernutrition and obesity coexist in the region, policies in most countries favour prevention of undernutrition, and only a few countries have implemented national policies to prevent obesity. In view of the number of children who are overweight or obese, the associated detrimental effects on health, and the cost to health-care systems, implementation of programmes to monitor and prevent unhealthy weight gain in children and adolescents are urgently needed throughout Latin America.

[Exclusive breastfeeding in <6mo is associated to a better weight for length in households with food insecurity in Mexico]. / La lactancia materna exclusiva en menores de seis meses se asocia con un mejor peso para la longitud en hogares con inseguridad alimentaria en México.

OBJECTIVE: To evaluate the effect of exclusive breastfeeding in <6mo (EBF<6mo) on the relationship between food insecurity (FI) and nutritional status, in Mexican infants. MATERIALS AND METHODS: We analyzed the sample of 12-49y women and their children <2y from the national survey ENSANUT 2012 (n = 4 022). Breastfeeding indicators from WHO-2008 were calculated. We estimated the effect modifier EBF<6mo of the relationship between FI and weight length (Z W/L) and length for age (Z L/A) Z score. RESULTS: The EBF<6mo was lower in households (hh) with moderate and severe FI than in those with food security (FS) or mild FI hh. Only EBF<6mo infants from hh with moderate and severe FI showed greater Z W/L (0.44) than those without EBF<6mo (p= 0.038, one-tailed). Score Z W/L of infants from hh FS did not vary according to EBF<6mo. CONCLUSION: EBF<6mo in Mexican infants is associated with better weight for length in households with moderate and severe FI. Breastfeeding promotion, protection and support must be targeted mainly at the most vulnerable, food insecure families.

La lactancia materna exclusiva en menores de seis meses se asocia con un mejor peso para la longitud en hogares con inseguridad alimentaria en México / Exclusive breastfeeding in <6mo is associated to a better weight for length in households with food insecurity in Mexico

Objetivo. Evaluar el efecto modificador de la lactancia materna (LM) exclusiva en menores de seis meses (LME<6m) en la relación entre inseguridad alimentaria (IA) y estado de nutrición infantil. Material y métodos. Análisis de mujeres de 12-49 años y sus hijos menores de dos años de la ENSANUT 2012 (n=4 022). Se calcularon los indicadores de la Organización Mundial de la Salud para LM. Se estimó la media del puntaje Z de peso para la longitud (Z P/L) y Z de longitud para la edad (Z L/E) de niños, por IA y LME<6m. Resultados. La LME<6m fue inferior en hogares con ISA moderada y severa comparada con hogares con seguridad alimentaria (SA) o IA leve. En hogares con IA moderada y severa, niños con LME<6m mostraron mayor Z P/L (0.44) vs. niños sin LME<6m (p=0.038, una cola), sin diferencias en hogares con SA. Conclusión. En México, la LME<6m se asocia con un mejor P/L en hogares con IA moderada y severa, no así en hogares con SA. Urge focalizar políticas públicas para abatir la desnutrición y mejorar las prácticas de lactancia en estos grupos.

Objective. To evaluate the effect of exclusive breastfeeding in <6mo (EBF<6mo) on the relationship between food insecurity (FI) and nutritional status, in Mexican infants. Materials and methods. We analyzed the sample of 12-49y women and their children <2y from the national survey ENSANUT 2012 (n = 4 022). Breastfeeding indicators from WHO-2008 were calculated. We estimated the effect modifier EBF<6mo of the relationship between FI and weight length (Z W/L) and length for age (Z L/A) Z score. Results. The EBF<6mo was lower in households (hh) with moderate and severe FI than in those with food security (FS) or mild FI hh. Only EBF<6mo infants from hh with moderate and severe FI showed greater Z W/L (0.44) than those without EBF<6mo (p= 0.038, one-tailed). Score Z W/L of infants from hh FS did not vary according to EBF<6mo. Conclusion. EBF<6mo in Mexican infants is associated with better weight for length in households with moderate and severe FI. Breastfeeding promotion, protection and support must be targeted mainly at the most vulnerable, food insecure families.

Design and challenges of a randomized controlled trial for reducing risk factors of metabolic syndrome in Mexican women through water intake / Diseño y retos de un ensayo clínico aleatorizado para reducir el riesgo de síndrome metabólico en mujeres mexicanas mediante consumo de agua

Objective. To describe the design, methods, and challenges encountered during a randomized clinical trial aimed to promote water intake for reducing risks of metabolic syndrome in Mexican women. Materials and methods. In a randomized clinical trial in Cuernavaca, Mexico, overweight and obese (body mass index [BMI] ≥ 25 < 39) women, 18 - < 45 years old with an intake of sugar-sweetened beverages ≥ 250 kilocalories per day (kcal/day) were randomly allocated to the water and education provision group (n = 120) or the education provision only group (n = 120). Results. We screened 1 756 women. The main difficulties encountered were identifying participants with the recruitment criteria, delivering water to participants, and the time demanded from the study participants. Conclusions. The trial's main challenges were difficulties surrounding recruitment, delivery of the intervention, and the time demanded from the study participants. Modifications were effectively implemented without jeopardizing the original protocol.

Objetivo. Describir el diseño, métodos y dificultades logísticas enfrentadas durante un ensayo clínico aleatorizado con el objetivo de promover el aumento en el consumo de agua para reducir el riesgo metabólico en mujeres obesas. Material y métodos. Ensayo clínico aleatorizado, desarrollado en Cuernavaca, México. Mujeres con IMC ≥ 25 y < 39, entre 18 y < 45 años, con consumo de bebidas azucaradas ≥ 250 kcal/día, se asignaron aleatoriamente a a) grupo de agua y educación nutricional (n = 120), o b) educación nutricional únicamente (n = 120). Resultados. Se realizaron pruebas de tamizaje a 1 756 mujeres. Las principales dificultades para el desarrollo del estudio fueron identificar participantes que cumplieran criterios del estudio, entrega de agua y tiempo invertido por las participantes en actividades del proyecto. Conclusiones. Los retos del proyecto estuvieron relacionados con el reclutamiento, entrega de la intervención y demanda de tiempo a las participantes. Se implementaron modificaciones sin afectar la validez del estudio.

Breastfeeding in Mexico was stable, on average, but deteriorated among the poor, whereas complementary feeding improved: results from the 1999 to 2006 National Health and Nutrition Surveys.

We present: 1) indicators of infant and young child feeding practices (IYCFP) and median age of introduction of foods analyzed by geographic and socioeconomic variables for the 2006 national probabilistic Health Nutrition Survey (ENSANUT-2006); and 2) changes in IYCFP indicators between the 1999 national probabilistic Nutrition Survey and ENSANUT-2006, analyzed by the same variables. Participants were women 12-49 y and their <2-y-old children (2953 in 2006 and 3191 in 1999). Indicators were estimated with the status quo method. The median age of introduction of foods was calculated by the Kaplan-Meier method using recall data. The national median duration of breastfeeding was similar in both surveys, 9.7 mo in 1999 and 10.4 mo in 2006, but decreased in the vulnerable population. In 1999 indigenous women breastfed 20.8 mo but did so for only 13.0 mo in 2006. The national percentage of those exclusively breastfeeding <6 mo also remained stable: 20% in 1999 and 22.3% in 2006. Nevertheless, exclusively breastfeeding <6 mo changed within the indigenous population, from 46% in 1999 to 34.5% in 2006. Between surveys, most breastfeeding indicators had lower values in vulnerable populations than in those better-off. Complementary feeding, however, improved overall. Complementary feeding was inadequately timed: median age of introduction of plain water was 3 mo, formula and non-human milk was 5 mo, and cereals, legumes, and animal foods was 5 mo. Late introduction of animal foods occurred among vulnerable indigenous population when 50% consumed these products at 8 mo. Mexican IYCFP indicate that public policy must protect breastfeeding while promoting the timely introduction of complementary feeding.

Design and challenges of a randomized controlled trial for reducing risk factors of metabolic syndrome in Mexican women through water intake.

OBJECTIVE: To describe the design, methods, and challenges encountered during a randomized clinical trial aimed to promote water intake for reducing risks of metabolic syndrome in Mexican women. MATERIALS AND METHODS: In a randomized clinical trial in Cuernavaca, Mexico, overweight and obese (body mass index [BMI] ≥ 25 < 39) women, 18 - < 45 years old with an intake of sugar-sweetened beverages ≥ 250 kilocalories per day (kcal/day) were randomly allocated to the water and education provision group (n = 120) or the education provision only group (n = 120). RESULTS: We screened 1 756 women. The main difficulties encountered were identifying participants with the recruitment criteria, delivering water to participants, and the time demanded from the study participants. CONCLUSIONS: The trial's main challenges were difficulties surrounding recruitment, delivery of the intervention, and the time demanded from the study participants. Modifications were effectively implemented without jeopardizing the original protocol.

Does food insecurity compromise maternal dietary zinc or energy intake in favor of her child, in rural poor Mexican households?

OBJECTIVE: To analyze quantitative indicators of food insecurity (FI), and estimate if FI modifies the association between maternal and child Zinc and energy intake as evidence for maternal dietary compromise in favor of her child. MATERIAL AND METHODS: Cross-sectional study (n=2 563), data derived from baseline impact evaluation of the Mexican Programa de Apoyo Alimentario. Quantitative indicators of FI were:Household food storage, maize and/or bean production, food expenditure, and spatial access to food markets. We evaluated percentage adequacy of energy (PAE) and Zinc (PAZn) intake. Multiple linear regression model was fitted to estimate the association between maternal and child PAE and PAZn. RESULTS: Child PAE and PAZn were positively associated with those of their mothers. None of the FI indicators modified the association between maternal and child PAE and PAZn. CONCLUSIONS: No evidence of maternal dietary compromise in favor of her child was observed using four quantitative indicators of FI in central-southern rural Mexican househods.

Does food insecurity compromise maternal dietary Zinc or energy intake in favor of her child, in rural poor Mexican households? / ¿En hogares rurales pobres de México, la inseguridad alimentaria compromete el consumo de zinc y energía de las madres en favor de sus hijos?

OBJECTIVE: To analyze quantitative indicators of food insecurity (FI), and estimate if FI modifies the association between maternal and child Zinc and energy intake as evidence for maternal dietary compromise in favor of her child. MATERIAL AND METHODS: Cross-sectional study (n=2 563), data derived from baseline impact evaluation of the Mexican Programa de Apoyo Alimentario. Quantitative indicators of FI were:Household food storage, maize and/or bean production, food expenditure, and spatial access to food markets. We evaluated percentage adequacy of energy (PAE) and Zinc (PAZn) intake. Multiple linear regression model was fitted to estimate the association between maternal and child PAE and PAZn. RESULTS: Child PAE and PAZn were positively associated with those of their mothers. None of the FI indicators modified the association between maternal and child PAE and PAZn. CONCLUSIONS: No evidence of maternal dietary compromise in favor of her child was observed using four quantitative indicators of FI in central-southern rural Mexican househods.

OBJETIVO: Analizar indicadores cuantitativos de inseguridad alimentaria (IA) y estimar si IA modifica la asociación del consumo de energía y zinc en madres e hijos como evidencia del compromiso de la dieta materna a favor de su hijo. MATERIAL Y MÉTODOS: Estudio transversal,información basal de la evaluación de impacto del Programa de Apoyo Alimentario. Indicadores de IA: reserva de alimentos en hogar, autoproducción maíz y/o frijol, porcentaje del gasto en alimentos y acceso físico a mercados de alimentos.Se calculó el porcentaje de adecuación del consumo energético (PAE) y Zinc (PAZn) (n=2 563 pares). Se estimó un modelo de regresión lineal ajustado por covariables. RESULTADOS: El PAE y PAZn de madres e hijos se asoció positivamente. Ningún indicador de IA modificó la asociación entre PAE y PAZn materno con respecto a sus hijos. CONCLUSIONES: Los indicadores de IA estudiados no modifican la relación entre la dieta de madres-hijos en hogares rurales de México.

Association of Helicobacter pylori infection and height of Mexican children of low socioeconomic level attending boarding schools.

This study evaluated the association between Helicobacter pylori infection and height in a population of schoolchildren of a low socioeconomic level regarding growth-related micronutrient status. It was a cross-sectional study of 685 children 5-13 years of age. Height and weight were recorded, a (13)C urea breath test was performed for detection of H. pylori, and a blood sample was obtained for determination of micronutrient status. Helicobacter pylori infection was found to be associated with the height of children. Children with H. pylori infection are, on average, 1.32 cm lower (95% confidence interval [CI] = -2.22 to -0.42) in height than children without infection. There was an effect modification by age: for every one-year increase in age, height was 0.66 cm less (95% CI = -1.17 to -0.15) in children with H. pylori infection. This finding suggests that H. pylori infection has a negative effect on the growth of children.

Pronóstico rehabilitatorio integral del paciente con labio y paladar hendido / Prognostic and evaluation of rehabilitation in patients with cleft lip and palate

Se propone una escala de evaluación para el estudio y pronostico rehabilitario integral de los pacientes con labio y paladar hendido (LPH), basada en reportes de los servicios de otorrinolaringología, de foniatría, de odontología, de psicología y de terapia de lenguaje. Las menores calificaciones corresponden a los mejores pacientes y las más altas a los daños más severos. Se estudiaron 50 pacientes, 38 hombres (76 por ciento) y 12 mujeres (24 por ciento), con edad promedio de 6.7 años. El 80 por ciento de la muestra presento LPH unilateral completo, 6 por ciento solo paladar hendido con insuficiencia velofaríngea y 14 por ciento LPH bilateral. El 94 por ciento tenía alteraciones morfológicas importantes en la nariz y la cara. Los valores en la escala propuesta, de 0 a 10, se suman de cada especialidad. El promedio de todos los pacientes fué de 5.53 puntos, siendo el máximo de 10 puntos en 3 pacientes y el mínimo de 2 puntos en 5 pacientes. La escala de evaluación puede ser una herramienta útil para todos los que integran el equipo de atención al paciente con LPH pues permite realizar una evaluación pronóstica del paciente en cualquiera de las fases del tratamiento