Unhealthy food advertising on Costa Rican and Guatemalan television: a comparative study.

This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. The International Network for Food and Obesity Non-Communicable Diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) methodology was applied. In 2016, we recorded 1440 h of video among 10 TV channels. We used the Pan American Health Organization (PAHO) Nutrient Profile (NP) Model to identify 'critical nutrients', whose excessive consumption is associated with NCDs. We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters (e.g. Batman), premium offers (e.g. toys), brand benefit claims (e.g. tasty) and health-related claims (e.g. nutritious). In Guatemala, foods that exceeded one critical nutrient were more likely to use persuasive marketing techniques, and in Costa Rica were those with an excess of ≥2 critical nutrients, compared with foods without any excess in critical nutrients [Guatemala: promotional characters (odds ratio, OR = 16.6, 95% confidence interval, CI: 5.8, 47.3), premium offers (OR = 3.4, 95% CI: 1.4, 8.2) and health-related claims (OR = 3.5, 95% CI: 2.2, 5.7); Costa Rica: health-related claims (OR = 4.2, 95% CI: 2.0, 8.5)]. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing, including on TV and other media.

This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. In 2016, we recorded 1440 h of video among 10 TV channels. We used the PAHO Nutrient Profile Model to identify 'critical nutrients' (e.g. sodium) whose excessive consumption is associated with Non-Communicable Chronic Diseases (e.g. hypertension). We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters, premium offers, brand benefit claims and health-related claims. In Guatemala, foods that exceeded one critical nutrient had a high probability of using promotional characters, premium offers and health-related claims than foods without any excess in critical nutrients. However, in Costa Rica health-related claims had a high probability of appearing with foods that exceeded ≥2 critical nutrients. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing.

Nutritional quality of foods and non-alcoholic beverages advertised on Mexican television according to three nutrient profile models.

BACKGROUND: Evidence supports that television food advertisements influence children's food preferences and their consumption. However, few studies have examined the extent and nature of food marketing to children in low and middle income countries. This study aims to assess the nutritional quality of foods and beverages advertised on Mexican TV, applying the Mexican, World Health Organization (WHO) European and United Kingdom (UKNPM) nutrient profile models, before the Mexican regulation on food marketing came into effect. METHODS: We recorded 600 h on the four national public and free TV channels with the highest national ratings, from December 2012 to April 2013. Recordings were done for 40 randomly selected (week, weekend, school and vacation) days, from 7 am to 10 pm. Nutritional information per 100 g/ml of product was obtained from the product labels or company websites. RESULTS: A total of 2,544 food and non-alcoholic beverage advertisements were broadcast, for 275 different products. On average, the foods advertised during cartoon programming had the highest energy (367 kcal) and sugar (30.0 g) content, while foods advertised during sport programming had the highest amount of total fat (9.5 g) and sodium (412 mg) content. More than 60 % of the foods advertised did not meet any nutritional quality standards. 64.3 % of the products did not comply with the Mexican nutritional standards, as compared with 83.1 % and 78.7 % with WHO Europe and UKNPM standards, respectively. The food groups most frequently advertised were beverages (24.6 %), followed by chocolate and confectionery sugar (19.7 %), cakes, sweet biscuits and pastries (12.0 %), savory snacks (9.3 %), breakfast cereals (7.1 %), ready-made food (6.4 %) and dairy products (6.0 %). CONCLUSION: The majority of foods and beverages advertised on Mexican TV do not comply with any nutritional quality standards, and thus should not be marketed to children. The nutritional quality standards applied by the Mexican regulation are much weaker than those applied by the WHO Europe and United Kingdom. The Mexican government should improve the nutrition standards in its new regulation, especially the sugar cut off points.

Association between migration and physical activity of school-age children left behind in rural Mexico.

OBJECTIVES: The purpose of this study was to explore in rural communities of Mexico, the association between physical activity (PA) in school-age children and exposure to migration. METHODS: We measured PA through a questionnaire validated in school-age children and used in Mexican National Surveys. Migration status was measured as the number of years a family member had been in the US, and the amount of remittances that family member had sent to their household in Mexico. We used multivariable linear regression to measure the association between physical activity and migration. RESULTS: School-age children who had a migrant family member spent less time on PA per day, especially recreation activities, compared to school-age children without the migrating influence. Also, children who belonged to a family that received remittances and their migrant relative lived ≥ 5 years in US were less likely to engage in PA. CONCLUSIONS: Exposure to migration may predict reduction in PA in school-age children left behind in Mexican rural communities from the State of Morelos. These findings call for PA-tailored interventions that consider household migration characteristics.

Effectiveness of a large-scale iron-fortified milk distribution program on anemia and iron deficiency in low-income young children in Mexico.

BACKGROUND: Anemia during infancy impairs neurodevelopment. Little information has been published about the effectiveness of large-scale programs on anemia and iron-deficiency prevention. OBJECTIVE: The objective was to assess the effectiveness of a large-scale program that distributes subsidized iron-fortified milk in Mexico on anemia and iron deficiency in children aged 12-30 mo. DESIGN: A double-blinded, group-randomized effectiveness trial was conducted in 12 milk distribution clusters assigned to consume iron-fortified (FM; n = 7) or nonfortified (NFM; n = 5) milk. A daily portion of FM contained 5.28 mg Fe (ferrous gluconate) and 48 mg sodium ascorbate. RESULTS: Overall treatment effects were documented at 6 and 12 mo for anemia and for iron deficiency assessed by both serum ferritin (SF) and serum soluble transferrin receptor (sTfR) (interaction: P < 0.10). Differential effects at 6 mo (P = 0.004) and 12 mo (P = 0.664) were documented only for sTfR. Estimated prevalences (EPs) of anemia (hemoglobin < 110 g/L) from baseline to 6 and 12 mo decreased from 42.6% to 19.7% and 9.4%, respectively, in the NFM group (n = 210) and from 44.5% to 12.7% and 4.0%, respectively, in the FM group (n = 357). EPs of SF < 12 mug/L from baseline to 6 and 12 mo changed from 36.0% to 41.8% and 17.1%, respectively, in the NFM group (n = 43) and from 29.8% to 18.6% and 5.7%, respectively, in the FM group (n = 144). EPs of sTfR > 3.3 mg/L from baseline to 6 and 12 mo decreased from 16.2% to 8.3% and 2.0%, respectively, in the NFM group (n = 114) and from 15.5% to 0.7% and 1.1%, respectively, in the FM group. CONCLUSION: A large-scale iron-fortified subsidized-milk program was effective at reducing the rates of anemia and iron deficiency in Mexican children during 12 mo of implementation. This trial was registered at clinicaltrials.gov as NCT00508131.

Child malnutrition in Mexico in the last two decades: prevalence using the new WHO 2006 growth standards.

OBJECTIVE: To describe preschool malnutrition prevalence and trends in Mexican children for the 1988, 1999 and 2006 Mexican National Nutrition Surveys using WHO-2006 standards and National Center for Health Statistics/WHO (NCHS/WHO) references. MATERIAL AND METHODS: Prevalence of undernutrition (< minus 2 z-score for weight/age, height/age and weight/height) and overweight (> plus 2 z-score for weight/height) were calculated. RESULTS: Height/age and weight/height have increased over time (p< 0.05). Using WHO-2006 standards, stunting in children less than 5 years years old was 26.9%, 21.5% and 15.5% in 1988, 1999 and 2006, respectively; values for wasting were 6.2%, 2.1% and 2.0%, respectively. Wasting in the very young (< 6 mo) in 2006 is high (4.9%). Overweight increased from 1988 to 1999 (6.1% to 7.5%) and stabilized in 2006 (7.6%). Gaps among ethnic and socioeconomic groups have decreased over time. CONCLUSIONS: Stunting has decreased markedly but continues to be the main malnutrition problem. Overweight has emerged as a public health problem in the young. Lower NCHS/WHO estimates previously published underestimated true prevalence. Length deviations in attained height after 12 months indicate poor infant feeding practices, probably coupled with early infections. Results reinforce the need to improve the quality of nutrition programs and to promote adequate lactation and infant feeding practices in Mexico.

Overweight and obesity trends in Mexican children 2 to 18 years of age from 1988 to 2006.

OBJECTIVE: To describe prevalences and trends of overweight and obesity/OW&OB in Mexican children from 1988 to 2006 at the national level and by relevant subpopulations. MATERIAL AND METHODS: Prevalences of OW&OB in children aged 2-18 years were estimated using body mass index data from three national surveys conducted in 1988, 1999 and 2006. RESULTS: Prevalences of OW&OB are high in children of all ages, particularly among school-age and adolescent groups disaggregated by regions, socioeconomic status, urban and rural areas, and ethnic groups. The overall prevalence of OW&OB in children 2 to 18 years old in 2006 was 26.3%. Prevalences by age groups were 16.7% in preschool-age, 26.2% in school-age, and 30.9% in adolescents, using the IOTF classification system. CONCLUSIONS: Upward trends were observed in school-age children and adolescents at the national level and in all subpopulations.

Overweight and obesity in school children aged 5 to 11 years participating in food assistance programs in Mexico.

OBJECTIVE: To determine the association between overweight and obesity among Mexican school-aged children and participation in the Liconsa milk and the School Breakfast food assistance programs. MATERIAL AND METHODS: Data from 15 003 school-aged children included in the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) were analyzed. Information on body mass index (BMI) and participation in food assistance programs was obtained. Descriptive analyses were conducted and logistic regression models were adjusted. RESULTS: Prevalence of overweight and obesity was 17.3% and 9%, respectively. No significant association between overweight and obesity and participation in Liconsa was found. Among school-aged children in the middle socioeconomic status quintile, those enrolled in the School Breakfast program were more likely to be overweight than those not enrolled (OR= 1.6, 95% CI 1.1, 2.3). CONCLUSIONS: We found no association between the Liconsa and the School Breakfast programs and overweight or obesity in school-aged children.

Child malnutrition in Mexico in the last two decades: prevalence using the new WHO 2006 growth standards / Malnutrición preescolar en México en las últimas dos décadas: prevalencias usando los estándares de la OMS-2006

OBJECTIVE: To describe preschool malnutrition prevalence and trends in Mexican children for the 1988, 1999 and 2006 Mexican National Nutrition Surveys using WHO-2006 standards and National Center for Health Statistics/WHO (NCHS/WHO) references. MATERIAL AND METHODS: Prevalence of undernutrition (< minus 2 z-score for weight/age, height/age and weight/height) and overweight (> plus 2 z-score for weight/height) were calculated. RESULTS: Height/age and weight/height have increased over time (p< 0.05). Using WHO-2006 standards, stunting in children less than 5 years years old was 26.9 percent, 21.5 percent and 15.5 percent in 1988, 1999 and 2006, respectively; values for wasting were 6.2 percent, 2.1 percent and 2.0 percent, respectively. Wasting in the very young (< 6 mo) in 2006 is high (4.9 percent). Overweight increased from 1988 to 1999 (6.1 percent to 7.5 percent) and stabilized in 2006 (7.6 percent). Gaps among ethnic and socioeconomic groups have decreased over time. CONCLUSIONS: Stunting has decreased markedly but continues to be the main malnutrition problem. Overweight has emerged as a public health problem in the young. Lower NCHS/WHO estimates previously published underestimated true prevalence. Length deviations in attained height after 12 months indicate poor infant feeding practices, probably coupled with early infections. Results reinforce the need to improve the quality of nutrition programs and to promote adequate lactation and infant feeding practices in Mexico.

OBJETIVO: Describir las prevalencias y tendencias de malnutrición en preescolares mexicanos, según resultados de las Encuestas Nacionales de Nutrición 1988, 1999 y 2006, usando estándares de la Organización Mundial de la Salud de 2006 y referencias del National Center for Health Statistics/ World Health Organization (NCHS/WHO). MATERIAL Y MÉTODOS: Se calcularon prevalencias de desnutrición (puntaje z < -2 para talla/edad, peso/edad, y peso/talla) y de sobrepeso (> +2z peso/talla). RESULTADOS: La talla/edad y el peso/talla han aumentado con el tiempo (p< 0.05). Usando los estándares de la OMS de 2006, el desmedro en menores de cinco años de edad era de 26.9, 21.5 y 15.5 por ciento en 1988, 1999 y 2006, respectivamente. Los valores de emaciación fueron 6.2, 2.1 y 2.0 por ciento. La emaciación en 2006 en los menores de seis meses de edad fue de 4.9 por ciento. El sobrepeso aumentó de 1988 a 1999 (6.1 a 7.5 por ciento) y se estabilizó en 2006 (7.6 por ciento). Las diferencias entre grupos étnicos y socioeconómicos disminuyeron con el tiempo. CONCLUSIONES: El desmedro disminuyó marcadamente, pero continúa siendo el principal problema de malnutrición. El sobrepeso emergió como problema de salud pública en niños. Las estimaciones de desnutrición en preescolares previamente publicadas usando las referencias del NCHS/WHO subestimaban las verdaderas cifras. Las desviaciones en la talla alcanzada a partir de los 12 meses de edad revelan prácticas de lactancia y alimentación infantil pobres, probablemente aunadas a infecciones tempranas. Estos resultados refuerzan la necesidad de mejorar la calidad de los programas de nutrición y de promover prácticas adecuadas de alimentación infantil en México.

Overweight and obesity trends in Mexican children 2 to 18 years of age from 1988 to 2006 / Tendencias de sobrepeso y obesidad en niños mexicanos de 2 a 18 años de edad: 1988 a 2006

OBJECTIVE: To describe prevalences and trends of overweight and obesity/OW&OB in Mexican children from 1988 to 2006 at the national level and by relevant subpopulations. MATERIAL AND METHODS: Prevalences of OW&OB in children aged 2-18 years were estimated using body mass index data from three national surveys conducted in 1988, 1999 and 2006. RESULTS: Prevalences of OW&OB are high in children of all ages, particularly among school-age and adolescent groups disaggregated by regions, socioeconomic status, urban and rural areas, and ethnic groups. The overall prevalence of OW&OB in children 2 to 18 years old in 2006 was 26.3 percent. Prevalences by age groups were 16.7 percent in preschool-age, 26.2 percent in school-age, and 30.9 percent in adolescents, using the IOTF classification system. CONCLUSIONS: Upward trends were observed in school-age children and adolescents at the national level and in all subpopulations.

OBJETIVO: Describir las prevalencias y tendencias de sobrepeso y obesidad (SPyO) en niños mexicanos, de 1988 a 2006, en el ámbito nacional y por subgrupos relevantes de población. MATERIAL Y MÉTODOS: Las prevalencias de SPyO (peso no saludable) se estimaron usando cifras de índice de masa corporal de tres encuestas nacionales realizadas en 1988, 1999 y 2006. RESULTADOS: Las prevalencias de SPyO son altas en niños de todas las edades, particularmente en niños de edad escolar y adolescentes, estratificados por regiones, estado socioeconómico, áreas urbanas, rurales y grupo étnico. La prevalencia de SPyO en 2006 fue de 26.3 por ciento en el grupo de entre 2 a 18 años de edad, 16.7 por ciento en preescolares, 26.2 por ciento en escolares y 30.9 por ciento en adolescentes, usando la clasificación de The International Obesity Task Force (IOTF). CONCLUSIONES: Se observa una tendencia de sobrepeso y obesidad en aumento en niños de edad escolar y adolescentes, para todos los subgrupos de población.

Overweight and obesity in school children aged 5 to 11 years participating in food assistance programs in Mexico / Sobrepeso y obesidad en niños de 5 a 11 años de edad beneficiarios de programas de ayuda alimentaria en México

OBJECTIVE: To determine the association between overweight and obesity among Mexican school-aged children and participation in the Liconsa milk and the School Breakfast food assistance programs. MATERIAL AND METHODS: Data from 15 003 school-aged children included in the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) were analyzed. Information on body mass index (BMI) and participation in food assistance programs was obtained. Descriptive analyses were conducted and logistic regression models were adjusted. RESULTS: Prevalence of overweight and obesity was 17.3 percent and 9 percent, respectively. No significant association between overweight and obesity and participation in Liconsa was found. Among school-aged children in the middle socioeconomic status quintile, those enrolled in the School Breakfast program were more likely to be overweight than those not enrolled (OR= 1.6, 95 percent CI 1.1, 2.3). CONCLUSIONS: We found no association between the Liconsa and the School Breakfast programs and overweight or obesity in school-aged children.

OBJETIVO: Determinar la asociación entre el sobrepeso y la obesidad en niños de edad escolar y la pertenencia a los programas de asistencia alimentaria Liconsa o Desayunos Escolares en México. MATERIAL Y MÉTODOS: Se analizó la información de 15 003 niños en edad escolar de la Encuesta Nacional de Salud y Nutrición 2006 (ENSANUT 2006). Se obtuvo el índice de masa corporal (IMC) e información sobre participación en programas de asistencia alimentaria. Se realizaron análisis descriptivos y se ajustaron modelos de regresión logística. RESULTADOS: La prevalencia de sobrepeso y obesidad fue de 17.3 y 9 por ciento, respectivamente. No hubo asociación significativa entre el sobrepeso y obesidad y ser beneficiario de Liconsa. En el quintil socioeconómico medio, los beneficiarios de Desayunos Escolares tuvieron mayores posibilidades de presentar sobrepeso que los no beneficiarios (RM= 1.6, IC 95 por ciento 1.1,2.3). CONCLUSIONES: No se encontró asociación entre ser beneficiario de Liconsa o Desayunos Escolares con el sobrepeso y obesidad en este grupo de edad.

Dyslipidemias and obesity in Mexico

OBJECTIVE: To describe in a national sample 1) the mean total cholesterol (TC), HDL-cholesterol (HDLc) and triglyceride (TG) concentrations, 2) the prevalence of the most common lipid abnormalities and 3) the association between obesity and these conditions. MATERIAL AND METHODS: We analyzed the nationally representative, cross-sectional Me-xican Health Survey (2000). The final analytic sample used consisted of 2 351 individuals at fasting state. TC, HDLc and TG were determined. BMI was classified according to the WHO cut-off points. Sex-specific means and 95 percent confidence intervals (95 percentCI) were calculated by age group for TC, HDLc and TG. The prevalence of: a) hypercholesterolemia (HC), b) hypoalphalipoproteinemia (HA), c) hypertriglyceridemia (HT), d) HT with HA and e) HC with HT was calculated adjusting for age. Multivariate logistic regression models were estimated to analyze the association of obesity to the prevalence of dyslipidemias. RESULTS: The mean TC, HDLc, and TG concentrations were: 197.5 mg/dl (95 percent CI= 194.0, 201.1), 38.4 mg/dl (95 percent CI= 37.2, 39.5) and 181.7 mg/dl (95 percent CI= 172.7, 190.6), respectively. HC was present in 40.5 percent of the adult females (95 percent CI=35.5, 45.4) and 44.6 of the adult males (95 percent CI=37.7, 51.4); HA was the most prevalent form of dyslipidemia, present in 64.7 percent (95 percent CI=58.7, 70.8) and 61.4 percent (95 percent CI=54.4, 68.3) of females and males, respectively. Obesity increased ~1.4 times the probability ratio (PR) of having HC among women and 1.9 among men. CONCLUSION: TC concentrations from our study in Mexico were similar to those found for Mexican-Americans and the prevalence of HC was slightly lower than the one reported in the US; however, it increased ~26 percent from 1988 to 2000. HA was the most frequent lipid abnormality followed by HT. Regions showed no significant differences, contrary to what has been previously reported.

OBJETIVO: Describir en una muestra nacional las concentraciones de 1) colesterol total (CT), colesterol-HDL (cHDL) y triglicéridos, 2) la prevalencia de las anomalías lipídicas más comunes y 3) identificar la asociación entre obesidad y estas condiciones. MATERIAL Y MÉTODOS: Se analizó la Encuesta Nacional de Salud (2000), una encuesta representativa y transversal. La muestra analítica final consistió en 2 351 individuos en ayuno. Se determinaron las concentraciones de CT, cHDL y TG. El índice de masa corporal se clasificó de acuerdo con los puntos de corte de la OMS. Se calcularon las medias y el intervalo de confianza del 95 por ciento (IC95 por ciento) estratificado por sexo para CT, cHDL y TG. La prevalencia de a) hipercolesterolemia (HC), b) hipoalfalipoproteinemia (HA), c) hipertrigliceridemia (HT), d) HT con HA y e) HC con HT se calculó ajustando por edad. Se estimaron modelos de regresión logística mul-tivariada para analizar la asociación de la obesidad a la prevalencia de dislipidemias. RESULTADOS: Las medias de CT, cHDL y TG fueron: 197.5 mg/dl (IC95 por ciento= 194.0, 201.1), 38.4 mg/dl (IC95 por ciento= 37.2, 39.5) y 181.7 mg/dl (IC95 por ciento= 172.7, 190.6) respectivamente. La prevalencia de HC fue de 40.5 por ciento en mujeres (IC95 por ciento=35.5, 45.4) y 44.6 en hombres (IC95 por ciento=37.7, 51.4); HA fue la forma más prevalente de dislipidemia, presente en 64.7 por ciento (IC95 por ciento=58.7, 70.8) y 61.4 por ciento (IC95 por ciento=54.4, 68.3) de las mujeres y los hombres respectivamente. La obesidad aumentó ~1.4 veces la razón de probabilidad de tener HC en mujeres y 1.9 en hombres. CONCLUSION: Las concentraciones de CT de nuestro estudio fueron similares a las encontradas en mexicanos residentes en los EUA y la prevalencia de HC fue ligeramente menor que la reportada en dicho país; sin embargo aumentó ~26 por ciento de 1988 a 2000. Las HA fueron la anomalía lipídica más frecuente seguida de HT. Las regiones...

Poor compliance with appropriate feeding practices in children under 2 y in Mexico.

We evaluated breast-feeding and complementary feeding practices in Mexico, using data from a national probabilistic survey carried out in 17,716 households, with regional and urban-rural representation. Mothers of children <2 y old (n = 3,191) reported duration of breast-feeding and the ages of usual introduction of 7 food groups. The Kaplan-Meier method was used to estimate the median time of feeding events. Practices were analyzed by categories of ethnicity, housing condition, and place of residence (geographic region and degree of urbanization). We found that 86% of infants at 1 mo and 39% at 11 mo were breast-fed, whereas 60% at 1 mo and 8% at 6 mo were exclusively breast-fed. Early introduction (<6 mo) of water, nonhuman milk, nonnutritive liquids, and fruits and vegetables was reported for all categories studied. Also, early introduction of nutritive liquids, cereals and legumes, and animal foods other than milk occurred in all categories except rural areas and the indigenous population. Late introduction of solid foods was documented in large proportions of infants in rural areas and in poor families. Poorer, unemployed, and indigenous women, and those bearing males, had a significantly higher probability of feeding their infants as recommended by the WHO. Feeding practices were unrelated to attained growth when the influence of economic and social factors was considered. Results indicate the need to implement actions for the promotion of exclusive breast-feeding during the first 6 mo and of timely introduction of complementary foods thereafter.

Fortifying milk with ferrous gluconate and zinc oxide in a public nutrition program reduced the prevalence of anemia in toddlers.

We aimed to assess the efficacy of whole cow's milk fortified with ferrous gluconate and zinc oxide, along with ascorbic acid, in reducing the prevalence of anemia and improving iron status of low income children 10-30 mo of age. Healthy children were randomly assigned to drink 400 mL/d of cow's whole milk, either fortified milk (FM) with 5.8 mg/400 mL of iron as ferrous gluconate, 5.28 mg/400 mL of zinc as zinc oxide, and 48 mg/400 mL of ascorbic acid, or nonfortified milk (NFM) with 0.2 mg iron/400 mL, 1.9 mg zinc/400 mL, and 6.8 mg ascorbic acid/400 mL. Hemoglobin, serum ferritin, soluble transferrin receptors (TfR), and C-reactive protein concentrations were measured at baseline and 6 mo after intervention. The prevalence of anemia declined from 41.4 to 12.1% (P < 0.001), or 29 percentage points, in the FM group; there was no change in the NFM group. Hemoglobin (coefficient = 0.22, P < 0.01) was positively and TfR (coefficient = -0.29, P < 0.001) negatively associated with treatment, controlling for their respective baseline values, age, and gender. Treatment with FM was negatively associated with the likelihood of being anemic (pseudo R(2) = 0.085, P < 0.03) after 6 mo of intervention. Ferrous gluconate added to whole cow's milk as a fortificant along with ascorbic acid is efficacious in reducing the prevalence of anemia and in improving iron status of Mexican toddlers. The results of this study lead to broadening a subsidized FM distribution program to 4.2 million beneficiary children 1-11 y of age in Mexico.

[Factors associated with physical activity among Mexican women of childbearing age]. / Factores asociados con la actividad fisica en mujeres mexicanas en edad reproductiva.

OBJECTIVE: To document the practice of light and heavy physical activities, especially sports and exercise, among women from 12 to 49 years old in Mexico, and to evaluate the association that that has with some sociodemographic characteristics. METHODS: A sample of 2 367 women 12 to 49 years old living in Mexico in 1999 was studied through secondary analysis of data from Mexico's 1999 National Nutrition Survey (Encuesta Nacional de Nutrición). The Survey used a clustered stratified multistage sampling scheme, with a final sample of 21 000 homes in the entire country. A questionnaire was used to evaluate the time that the women spent on various forms of physical activity, with the activity measured on a scoring scale in terms of metabolic equivalents (METs). The dependent variables in the study were the time spent on heavy physical activities (those that require an energy expenditure of at least 5 METs/hour) and the time devoted to light or sedentary activities (such as sitting while on the job or elsewhere; watching television, a video, a movie, or a theater presentation; or sleeping). The independent variables were age, schooling, parity, region of the country, area of residence (urban or rural), socioeconomic level (measured through an index prepared based on housing conditions and household possessions), and marital status. The association between the independent variables and practicing sports was evaluated, and gross odds ratios (ORs) were calculated, with 95% confidence intervals (CIs). In order to identify the association between practicing sports and the independent variables a logistic regression model was used, adjusted for the effects of possible confounding variables. Adjustments were also made in the probability of a woman's being selected for the sample, using a weighting factor. In addition, adjustments were made to control for the design effect produced by the grouping of the observations in the sample, using the "svy" complex-samples routine of the Stata version 7.0 statistical analysis computer software. RESULTS: The 2 367 women whose information was analyzed spent an average of 0.08 hours per day practicing sports and 1.25 hours per day on heavy physical activities. Only 16% of the women reported that they regularly practiced some sport. After adjusting for all the independent variables, the women older than 30 years had a lower OR of practicing sports in comparison to women who were 20 years of age or less (OR = 0.53; 95% CI: 0.33 to 0.84), as was also true for women 21-30 years old (OR = 0.35; 95% CI: 0.23 to 0.54). Having the highest level of schooling and not having had children were both directly associated with practicing a sport. While the area of residence (urban or rural), marital status, and socioeconomic level showed differences among the groups, such differences were not significant after adjusting for the other study variables. In terms of physical activity measured in METs, the time spent on sports made up 10% of the total for heavy activity and 0.7% of the overall total. In terms of the possibility of being among the 10% of the women who expended the fewest METs per day, that was more likely for women under 21 years of age than it was for women 31 or older, and it was also more likely for women who had a primary level of schooling than for women with a secondary education. CONCLUSIONS: This study showed that practicing sports is not a frequent form of physical activity among women of childbearing age in Mexico, especially those who are over 20 years of age and those with a low level of schooling. This situation could contribute to increases in the prevalence of obesity and chronic diseases.

Factores asociados con la actividad física en mujeres mexicanas en edad reproductiva / Factors associated with physical activity among Mexican women of childbearing age

OBJETIVO: Documentar la práctica de actividades físicas ligeras y pesadas, particularmente de deportes y ejercicios, en mujeres de 12 a 49 años en México, y evaluar su asociación con algunas características sociodemográficas. MÉTODOS: Se estudió una muestra de 2 367 mujeres de 12 a 49 años de edad residentes en México en 1999 mediante el análisis secundario de los datos de la Encuesta Nacional de Nutrición de México, 1999 (ENN-99). En esta encuesta se utilizó un esquema de muestreo polietápico, estratificado, por conglomerados que conformó una muestra final de 21 000 hogares de todo el país. Mediante un cuestionario se evaluó el tiempo dedicado a las distintas formas de actividad física y se midió la actividad en equivalentes metabólicos (MET) según una escala puntual. Las variables dependientes del estudio fueron el tiempo dedicado a actividades físicas pesadas (las que exigen un gasto de energía equivalente a 5 MET/hora) y el dedicado a actividades ligeras o sedentarias (tales como estar sentada en el trabajo o fuera de él, ver televisión, video, cine o teatro y dormir). Las variables independientes fueron la edad, escolaridad, paridad, región del país y área de residencia (urbana o rural), nivel socioeconómico (medido mediante un índice elaborado a partir de las condiciones de la vivienda y la posesión de enseres domésticos) y estado marital. Se evaluó la asociación entre las variables independientes y la práctica de deportes y se calcularon las razones de posibilidades brutas con intervalos de confianza de 95 por ciento. Para identificar la asociación entre la práctica de deportes y las variables independientes se utilizó un modelo de regresión logística ajustado según el efecto de posibles variables de confusión. Se ajustó también mediante un factor de ponderación la probabilidad de que una mujer fuese seleccionada para la muestra, y para controlar el efecto de diseño producido por la agrupación de observaciones en esta muestra se utilizó la rutina de análisis de muestras complejas svy de Stata, versión 7.0. RESULTADOS: Se analizó la información obtenida de 2 367 mujeres. Las mujeres encuestadas dedicaron 0,08 horas diarias, en promedio, a practicar deportes y 1,25 horas diarias a actividades físicas pesadas...

Nutritional status of indigenous children younger than five years of age in Mexico: results of a national probabilistic survey.

OBJECTIVE: To compare the prevalence of undernutrition and anemia in indigenous and non-indigenous children < 5 years of age at the national level, by region and by urban and rural areas, and to evaluate the degree to which the socioeconomic condition of the family predicts the differences. MATERIAL AND METHODS: A national probabilistic survey was conducted in Mexico in 1999. Indigenous families were identified as those in which at least one woman 12-49 years of age in the household spoke a native language. The prevalence of undernutrition (stunting, wasting and underweight) and anemia was compared between indigenous and non-indigenous children. Probability ratios (PR) were used to compare prevalences in indigenous and non-indigenous children adjusting for socioeconomic status (SES) of the family and for other covariates. RESULTS: The prevalences of stunting and underweight were greater in indigenous than in non-indigenous children. At the national level and in urban areas the prevalences were three times greater and in rural areas approximately 2 times greater (p < 0.05). No differences were found in the prevalence of wasting (p > 0.05). The prevalence of anemia in indigenous children was one third greater than in non-indigenous children at the national level (p < 0.05) and was between 30 and 60% greater in urban areas and in the regions studied (p < 0.05) but was not statistically significant (p > 0.05) in rural areas. These differences were reduced to about half when adjusting for SES but remained significantly higher in indigenous children (p < 0.05). CONCLUSIONS: Indigenous children have higher probabilities of stunting and underweight than non-indigenous children. The differences are larger in urban areas and in higher socioeconomic geographic regions and are explained mostly by socioeconomic factors. The overall difference in the probability of anemia is small, is higher only in urban relative to rural areas, and is explained to a lesser degree by socioeconomic factors. Policy and programs should be designed and implemented to reduce the dramatic differences in nutritional status between indigenous and non-indigenous children in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Anemia in Mexican women: a public health problem.

OBJECTIVE: The purpose of this study is to quantify the prevalence and distribution of anemia among women of childbearing age (12 to 49 years) participating in the 1999 National Nutrition Survey (NNS-1999). MATERIAL AND METHODS: The survey had a probabilistic design and was representative at the national level, of urban and rural areas and four regions: North, South, Center, and Mexico City. Hemoglobin concentration was determined in capillary blood samples using a portable photometer (HemoCue), in 17,194 women, 697 of whom were pregnant. RESULTS: The overall prevalence of anemia was 27.8% in pregnant women and 20.8% in non-pregnant women. Higher prevalences were observed in rural as compared to urban areas, both in pregnant (28.0% vs 27.7%) and non-pregnant (22.6% vs 20.0%) women, but the differences were not statistically significant (p > 0.05). Women in the South had the greatest prevalence (23.2%), followed by those in the North (20.9%), Center (20.6%), and Mexico City (16.4%). Non-pregnant indigenous women had a prevalence of 24.8%, while in-non-indigenous women the prevalence was 20.4%. CONCLUSIONS: Anemia in women of childbearing age is a growing public health problem that justifies the implementation of interventions for its prevention and control. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Breast-feeding practices in Mexico: results from the Second National Nutrition Survey 1999.

OBJECTIVE: To assess breast-feeding (BF) practices and determinants of exclusive BF (EBF) < 4 and < 6 months (mo) among women and infants < 23 mo in the NNS-1999. MATERIAL AND METHODS: BF practices from the day and night before the interview were ascertained, and median duration estimated. Determinants of EBF < 4 and < 6 mo were analysed by logistic regression models for complex surveys. RESULTS: Prevalence of EBF < 4 mo was 25.7%, and of < 6 mo 20.3%. The overall rate of continued BF (second year) was 30.9%, median duration of BF 9 mo, and the national proportion of children ever breast-fed 92.3%. The probability (p) of EBF < 4 mo was determined by infant age and sex, by maternal socio-economic level (SEL) and ethnicity, and by the interaction between infant sex and SEL. The pEBF < 6 mo was determined by infant age and length, by maternal ethnicity, and employment. CONCLUSIONS: EBF rates and duration are low in Mexico and have improved only slightly in the last 20 y. Infant and maternal characteristics determine the pEBF. If improvements in infant health are a national priority, aggressive interventions to promote and protect BF are urgently needed in Mexico, as well as formal evaluation of current initiatives. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Energy and nutrient consumption in Mexican women 12-49 years of age: analysis of the National Nutrition Survey 1999.

OBJECTIVE: To describe the reported energy and nutrient intake and adequacies in Mexican women. MATERIAL AND METHODS: A 24-hour dietary recall was used to obtain nutrient intake in a representative sub-sample of 2,630 women from 12 to 49 years of age from the National Nutrition Survey 1999. Nutrient adequacies were estimated using the Dietary Reference Intakes and stratified according to region, area (urban or rural), socioeconomic status and obesity status (non-obese: BMI < 30 kg/m2, obese: > or = 30 kg/m2). Differences were analyzed using linear regression for complex surveys of log-transformed intake and adequacy, adjusting for multiple comparisons with the Bonferroni test. RESULTS: The median national energy intake was 1,471 kcal. The Risk of Inadequacy (RI) (prevalence of adequacy < 50%) was: vitamin A: 38.3%, vitamin C: 45.5%, and folate: 34.3%. Carbohydrates, folate, iron and calcium intake was significantly higher in rural than in urban areas. The RI was higher in women of the lowest socioeconomic status tertile for all nutrients with the exception of carbohydrates and calcium. Macro-nutrient adequacies were significantly higher in non-obese women. CONCLUSIONS: Differences within the country among regions, rural and urban areas, and socioeconomic status tertile reflect an increasing availability of inexpensive calorie-dense foods in marginal groups. However, total energy, cholesterol, saturated and total fat were consumed in greater quantities by women from the higher socioeconomic status tertile and from urban areas. These patterns could be a contributing factor to the rise of obesity and other non-communicable nutrition-related chronic diseases in Mexico. The English version of this paper is available at: http://www.insp.mx/salud/index.html.