Juan Rivera - Academia.edu (original) (raw)
Papers by Juan Rivera
Salud Publica De Mexico, 2011
Describir un plan maestro para el desarrollo de planes nacionales para prevenir la desnutricion m... more Describir un plan maestro para el desarrollo de planes nacionales para prevenir la desnutricion materno-infantil en Mesoamerica en un plazo de cinco anos. Para ello se elaboro un analisis sobre los principales problemas, politicas y programas de nutricion en Mesoamerica. A partir del analisis y de la revision de la literatura sobre las mejores practicas en el combate a la desnutricion, el Grupo Tecnico de Nutricion desarrollo, discutio y valido el plan durante varias reuniones presenciales. Se desarrollo la teoria de cambio que identifica los problemas y barreras, las acciones propuestas, los cambios e impactos esperados. Se propone la implementacion de paquetes de intervenciones para reducir la desnutricion y deficiencia de micronutrientes de utilidad para diversos contextos epidemiologicos. El plan maestro de nutricion constituye un insumo que puede facilitar la elaboracion de propuestas de programas y politicas dirigidos a reducir la desnutricion y promover la toma de decisiones ...
The American Journal of Clinical Nutrition, 2021
Background Dietary recommendations worldwide have focused on promoting healthy diets to prevent d... more Background Dietary recommendations worldwide have focused on promoting healthy diets to prevent diseases. In 2019, the EAT–Lancet Commission presented global scientific targets for healthy diets and sustainable food production and proposed a healthy reference diet (EAT-HRD) that can be adapted to the culture, geography, and demography of the population and individuals in any country. Objectives We aimed to describe the daily energy intake from food groups and subgroups in Mexican adults relative to the EAT-HRD and propose an adaptation of the EAT-HRD to the Mexican context. Methods We analyzed data from the Mexican National Health and Nutrition Surveys in 2012 and 2016. Diet information was obtained using the 5-step multiple-pass 24-h dietary recall method. We estimated the mean energy intake from food groups and subgroups and compared these figures with the midpoint of the EAT-HRD and with the Mexican Dietary Guidelines (MDGs). We also proposed an adaptation of the EAT-HRD to the M...
The American Journal of Clinical Nutrition, 2001
Background: The role of single micronutrient deficiencies in the etiology of growth retardation h... more Background: The role of single micronutrient deficiencies in the etiology of growth retardation has recently gained attention. However, because multiple micronutrient deficiencies are common in children in developing countries, it is possible that more than one micronutrient may limit growth and, hence, the correction of a single deficiency may not be enough to improve growth substantially. Objective: The objective was to evaluate the effect of multiple micronutrient supplementation on the growth of children aged 8-14 mo whose diets were poor in several micronutrients. Design: Children were randomly assigned to 1 of 2 groups. One group received a multiple micronutrient supplement containing the recommended dietary allowance (RDA) or 1.5 times the RDA of vitamins A, D, E, K, C, B-1, B-6, B-12, riboflavin, niacin, biotin, folic acid, and pantothenic acid, and iron, zinc, iodine, copper, manganese, and selenium. The other group received a placebo. Supplements were administered 6 d/wk for an average of 12.2 mo. Body length was measured at baseline and monthly thereafter until the end of supplementation. Results: Supplemented infants initially aged < 12 mo had significantly greater length gains than did the placebo group, with a difference of 8.2 mm (length-forage z score: 0.3) at the end of supplementation. In contrast, differences in length gains between the supplemented and placebo groups initially aged ≥ 12 mo were not significant. Conclusions: Micronutrient deficiencies limited the growth of the Mexican infants studied. Improving micronutrient intakes should be a component of interventions to promote growth in infants living in settings where micronutrient intakes are inadequate.
Salud Pública de México, 2013
Objetivo. Evaluar el impacto de una intervención de 18 meses para la prevención de obesidad en es... more Objetivo. Evaluar el impacto de una intervención de 18 meses para la prevención de obesidad en escolares de 4o y 5o grados basada en el modelo ecológico en conductas saludables en México. Material y métodos. Diseño experimental para asignar 27 escuelas a uno de los tres tratamientos: intervenciones básicas, intervenciones plus y control. Se midió el impacto en el ambiente escolar, la alimentación y la actividad física e índice de masa corporal en niños. La evaluación se llevó a cabo en dos años en 830 estudiantes. Resultados. En las escuelas de intervención, la disponibilidad de alimentos sanos aumentó y la disponibilidad de alimentos poco saludables disminuyó. La ingesta de alimentos en niños no mostraron las mismas tendencias. En las escuelas de intervención, los niños no participaron más en actividad física moderada y vigorosa. La prevalencia de obesidad no se modificó. Conclusión. La intervención mejoró el entorno alimentario escolar y las conductas saludables de alimentación y ...
Salud Pública de México, 2017
Objective. To estimate the dietary contribution of taxed beverages and foods. Materials and metho... more Objective. To estimate the dietary contribution of taxed beverages and foods. Materials and methods. Using 24-hour diet recall data from the Ensanut 2012 (n=10 096), we estimated the contribution of the items which were taxed in 2014 to the total energy, added sugar, and saturated fat intakes in the entire sample and by sociodemographic characteristics. Results. The contributions for energy, added sugar, and saturated fat were found to be 5.5, 38.1, and 0.4%, respectively, for the taxed beverages, and 14.4, 23.8, and 21.4%, respectively, for the taxed foods. Children and adolescents (vs. adults), medium and high socioeconomic status (vs. low), urban area (vs. rural), and North and Center region (vs. South) had higher energy contribution of taxed beverages and foods. The energy contribution was similar between males and females. Conclusions. These taxes covered an important proportion of Mexicans' diet and therefore have the potential to improve it meaningfully.
Preventive medicine, Jan 17, 2017
It is unclear whether response to a nonessential food tax varies across time or for high vs. low-... more It is unclear whether response to a nonessential food tax varies across time or for high vs. low-consuming households. The objective is to examine whether the effect of Mexico's 2014 8% nonessential energy-dense foods tax increased in the second year post-implementation and whether it differentially affected households by pre-tax purchasing pattern. We used longitudinal data on Mexican household food purchases (n=6089 households) from 2012 to 2015. Households were classified based on median pre-tax purchases: low untaxed/low taxed ("low"), low untaxed/high taxed ("unhealthy"), high untaxed/low taxed ("healthy"), and high untaxed/high taxed ("high") purchasers. Fixed effects models tested whether observed post-tax purchases differed from the counterfactual, or what would have been expected based on pre-tax trends. Post-tax declines in the % taxed food purchases increased from -4.8% in year one to -7.4% in year two, yielding a 2-year mean de...
The Journal of nutrition, Sep 1, 2016
Mexico is facing the double burden of malnutrition: stunting and micronutrient deficiencies in yo... more Mexico is facing the double burden of malnutrition: stunting and micronutrient deficiencies in young children, iron deficiency in pregnant women, and widespread obesity across age groups. The aim was to summarize and discuss findings published in this supplement on dietary intakes and the eating habits of the Mexican population. A 24-h recall questionnaire that used the multiple-pass method with a repeated measure in a fraction of the sample was applied in a nationally representative sample. We estimated mean intakes and percentages of inadequacy for macronutrients and micronutrients; mean intakes and percentages of the population who adhere to dietary recommendations for food groups; sources of added sugars; intakes of discretionary foods by mealtime, place, and activity; and mean dietary intakes in children <2 y old. Infant formula was consumed by almost half of infants aged <6 mo and sugar-sweetened beverages were consumed by two-thirds of children aged 12-23 mo. In the dif...
BMC Public Health, 2016
Background: Evidence supports that television food advertisements influence children's food prefe... more 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.
PLoS medicine, 2016
In an effort to prevent continued increases in obesity and diabetes, in January 2014, the Mexican... more In an effort to prevent continued increases in obesity and diabetes, in January 2014, the Mexican government implemented an 8% tax on nonessential foods with energy density ≥275 kcal/100 g and a peso-per-liter tax on sugar-sweetened beverages (SSBs). Limited rigorous evaluations of food taxes exist worldwide. The objective of this study was to examine changes in volume of taxed and untaxed packaged food purchases in response to these taxes in the entire sample and stratified by socioeconomic status (SES). This study uses data on household packaged food purchases representative of the Mexican urban population from The Nielsen Company's Mexico Consumer Panel Services (CPS). We included 6,248 households that participated in the Nielsen CPS in at least 2 mo during 2012-2014; average household follow-up was 32.7 mo. We analyzed the volume of purchases of taxed and untaxed foods from January 2012 to December 2014, using a longitudinal, fixed-effects model that adjusted for preexisting...
The Journal of nutrition, May 6, 2016
Population surveys often collect dietary intake data by using one or two 24-h recalls (24HR), mai... more Population surveys often collect dietary intake data by using one or two 24-h recalls (24HR), mainly to minimize cost and respondent burden. However, in order to increase accuracy in estimating usual intake distributions, a larger number of 24HRs may be advisable. The purpose of this study was to identify whether estimates of the intake and prevalence of nutrient inadequacy based on 3 d are better than those that are based on 1 d of information. We conducted a national survey in 31 cities in Mexico using a sample that included 1073 individuals of both sexes, from birth through 79 y of age. Dietary information was collected by using 3 multiple-pass 24HRs (on nonconsecutive days). We estimated intake, adequacy, and prevalence of energy and nutrient inadequacy using information from 1 d and also from 3 d, adjusted for day-to-day variability, using PC-SIDE software. The prevalence of inadequacy was estimated by using the reference values proposed by the US Institute of Medicine. We foun...
![Research paper thumbnail of [Drink consumption for a healthy life: recommendations for the general population in Mexico]](https://attachments.academia-assets.com/93115848/thumbnails/1.jpg)
](Gaceta médica de México
The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mex... more The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Ministry of Health with the aim of drafting evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has documented that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages in six categories. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage. Ranges included healthier (level 1) to least healthy (level 6) options as follows: Level 1: water; ...
The Journal of nutrition, 2014
Snacking has increased globally, but little is known about how Mexicans consume foods outside mea... more Snacking has increased globally, but little is known about how Mexicans consume foods outside meals. The aim of this study was to examine the prevalence and patterns of snacking behavior among Mexicans. We used data from children and adults (aged ≥ 2 y; n = 9937) from the Mexican National Nutrition Survey 1999 and the Mexican National Health and Nutrition Survey (NHNS) 2012 to examine the prevalence of snacking as well as amount (kcal) and contribution of snacks to total energy intake per day. Snacking was defined as eating outside of the 3 main meals. We calculated per capita (among the total population) and per consumer ("snackers") estimates of the number of snacks per day, kilocalories per snack, kilocalories per day from snacks, and the percentage of energy from snacks. Top foods consumed during snack occasions were also examined for the NHNS 2012. All results were weighted to account for survey design and to be nationally representative. In 2012, an estimated 73% of ...
![Research paper thumbnail of [Preventing maternal and child malnutrition: the nutrition component of the Mesoamerican Health Initiative 2015]](https://attachments.academia-assets.com/93115854/thumbnails/1.jpg)
](Salud pública de México, 2011
To describe the regional master plan of nutrition to address maternal and child malnutrition in a... more To describe the regional master plan of nutrition to address maternal and child malnutrition in a 5- year period developed by the Nutrition Technical Group. The Nutrition Technical Group developed a situation analysis describing the main nutrition problems, policies and programs in Mesoamerica. The situation analysis and a literature review about effective interventions to address malnutrition were conducted to develop a nutrition master plan. The Nutrition Technical Group held various meetings to develop, discuss and validate the master plan. Theory of change identified problems and barriers, the actions to be developed, the changes and impacts expected. A package of interventions is proposed to reduce undernutrition and micronutrient deficiencies useful under different epidemiological contexts. The nutrition master plan provides a guideline of best practices that can be used for evidence-informed decision making and the development of national policies and programs to reduce malnu...
The Journal of Nutrition, 2014
Mexico, with 1 of the highest obesity prevalences in the world, instituted a 10% excise tax for a... more Mexico, with 1 of the highest obesity prevalences in the world, instituted a 10% excise tax for any sugar-sweetened beverage (SSB) starting on 1 January 2014. Understanding the recent patterns and trends in beverage intake and sales in Mexico provides both background and baseline data for the importance of SSBs and other beverages in the Mexican diet. We analyzed a single 24-h dietary recall from 2 nationally representative surveys: the Mexican Nutrition Survey 1999 (n = 6049) and the National Health and Nutrition Survey 2012 (n = 10,343). To describe trends and patterns in beverages, we calculated the volume and energy intake per capita and per consumer and the proportion of consumers of each beverage group in each survey. A commercial sales dataset was used to describe beverage sales trends from 1999 to 2012. From 1999 to 2012, total daily energy from beverages increased among children aged 5-11 y (+45.3 kcal), females aged 12-19 y (+57.3 kcal), and adult females aged 20-49 y (+96.4 kcal) (P < 0.05). Over the same period, intake of beverages with added sugars increased, specifically flavored milk, agua fresca (fruit water made in stalls or at home, usually with added sugars), and fruit drinks among children aged 5-11 y and females aged 12-19 y and caloric coffee/tea, soda, and agua fresca among adult females aged 20-49 y. In 2012, beverages represented 17.5% (325 kcal) and 19.0% (382 kcal) of the total daily energy intake per capita in children aged 1-19 y and adults aged 20y,respectively.In2012,flavoredmilkbeverages,caloricsoda,andhigh−fatmilkwerethetop3majorcontributorstototaldailyenergyintakepercapitainallchildrenaged1−19y.Caloricsoda,caloriccoffee/tea,andaguafrescawerethetop3majorenergycontributorsinadultsaged20 y, respectively. In 2012, flavored milk beverages, caloric soda, and high-fat milk were the top 3 major contributors to total daily energy intake per capita in all children aged 1-19 y. Caloric soda, caloric coffee/tea, and agua fresca were the top 3 major energy contributors in adults aged 20y,respectively.In2012,flavoredmilkbeverages,caloricsoda,andhigh−fatmilkwerethetop3majorcontributorstototaldailyenergyintakepercapitainallchildrenaged1−19y.Caloricsoda,caloriccoffee/tea,andaguafrescawerethetop3majorenergycontributorsinadultsaged20 y. From 1999 to 2012, sales of soda, fruit-flavored drinks, and flavored waters increased. In conclusion, consumption of several beverages with added sugars increased among children and adult females in Mexico. Because caloric soda is currently 1 of the top beverages consumed, a 10% tax on SSBs might help to significantly reduce added sugars intake in Mexico.
Salud Pública de México, 2003
Consumo de energía y nutrimentos en niños mexicanos prescolares y escolares: Encuesta Nacional de... more Consumo de energía y nutrimentos en niños mexicanos prescolares y escolares: Encuesta Nacional de Nutrición 1999. Salud Publica Mex 2003;45 supl 4:S540-S550. El texto completo en inglés de este artículo también está disponible en: http://www.insp.mx/salud/index.html
Salud Pública de México, 2003
Objective. The purpose of this study is to quantify the prevalence and distribution of anemia amo... more 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.
Salud Pública de México, 2003
Consumo de energía y nutrimentos en mujeres mexicanas de entre 12 a 49 años de edad: análisis de ... more Consumo de energía y nutrimentos en mujeres mexicanas de entre 12 a 49 años de edad: análisis de la Encuesta Nacional de Nutrición 1999. Salud Publica Mex 2003;45 supl 4:S530-S539. El texto completo en inglés de este artículo también está disponible en: http://www.insp.mx/salud/index.html Resumen Objetivo. Describir la ingesta reportada de energía y nutrimentos en mujeres mexicanas. Material y métodos. Se utilizó un recordatorio de 24 horas para obtener la ingesta de energía en una submuestra representativa de 2 630 mujeres de 12 a 49 años de edad de la Encuesta Nacional de Nutrición 1999. Las adecuaciones nutrimentales se estimaron utilizando las Referencias de Ingesta Dietética y fueron estratificadas por región, área urbana o rural, nivel socioeconómico y presencia de obesidad (no-obesas: IMC <30 kg/m 2 , obesas: ≥30 kg/m 2). Las diferencias se analizaron utilizando modelos de regresión lineal para encuestas complejas del logaritmo de la ingesta y la adecuación, ajustando para comparaciones múltiples con la prueba de Bonferroni. Resultados. La media nacional de ingesta de energía fue de 1 471 kcal. El riesgo de inadecuación (prevalencia de adecuación <50%) fue vitamina A: 38.3%, vitamina C: 45.5% y folato: 34.3%. La ingesta de carbohidratos, folato, hierro y calcio fue significativamente más alta en áreas rurales que en las urbanas. El riesgo de inadecuación fue mayor en mujeres del nivel socioeconómico más bajo para todos los nutrimentos con excepción de carbohidratos y calcio. Las adecuaciones de macro-nutrimentos fueron significativamente mayores en mujeres no-obesas. Conclusiones. Las diferencias entre las regiones, áreas del país y terciles de nivel socioeconómico reflejan una disponibilidad creciente de alimentos densamente calóricos de bajo costo en grupos marginales. Sin embargo, la energía total, colesterol y la
Salud Pública de México, 2009
Objective. To describe energy and nutrient intake in adults. Material and Methods. The 2006 Mexic... more Objective. To describe energy and nutrient intake in adults. Material and Methods. The 2006 Mexican National Health and Nutrition Survey is a nationally representative cross-sectional household survey. A food frequency questionnaire was administered (n= 16 494 adults). Mean percent of adequacy (PA) and inadequacy (PA < 50%) of total energy and macroand micro-nutrient intake was calculated for all subjects and by sociodemographic characteristics. Results. Significant differences in PA and inadequate macro-and micro-nutrient intakes were found among sex, region, rural/urban area, and socioeconomic status tertile. PA < 50% was higher than 20% for vitamin A (26.2%), fat (24.8%), fiber (23.6%), folic acid (23.5%), vitamin C (21.3%) and calcium (21%). Obese subjects reported a lower energy intake than normal weight subjects. Conclusions. A significant proportion of the population was at risk of excessive carbohydrate and fat intake. Across the country there are significant sociodemographic differences in macro-and micro-nutrient intake and a myriad of micronutrient inadequacies continue to persist in Mexico.
Salud Pública de México, 2009
Results. A total of 33 023 adults ≥ 20 years old were included; 39.7% were found to be overweight... more Results. A total of 33 023 adults ≥ 20 years old were included; 39.7% were found to be overweight and 29.9% were found to be obese; 75.9% of all adults had abdominal obesity. In Mexico between 2000 and 2006, the combined prevalence of overweight and obesity in adults increased approximately 12%. Mexican-Americans showed a higher prevalence of morbid obesity compared to native Mexicans. Conclusions. Mexico has experienced a rapid increase in the number of adults who have experienced excess weight gain between the years 2000 and 2006.
Salud Pública de México, 2007
Objective. To compare dietary intake of women supplemented with multiple micronutrients (MM) or i... more Objective. To compare dietary intake of women supplemented with multiple micronutrients (MM) or iron only during pregnancy. Materials and Methods. Design: Randomized, double-blind, controlled community-based trial. Setting: One semi-urban community in Central Mexico. Subjects: Pregnant women identified before week 13 of pregnancy, willing to provide informed consent. Interventions: Women were randomly assigned to receive daily supplementation with MM or iron only from recruitment until delivery. Supplements were delivered to the participants' home and compliance observed daily. Dietary intake was assessed by repeat 24-hr recall. Data were analyzed using non-parametric tests and multiple regression analysis to determine the impact of MM supplementation on dietary intake of energy and select micronutrients. Results. During the third trimester, women in the MM group consumed more energy and iron from dietary sources than women in the iron only group. After adjustment for differences between the groups at baseline, women in the MM group consumed 111.3 kcal/day more (p<0.05) energy. The difference in iron intake was not significant after adjusting for the increase in energy intake. Conclusions. Women consuming MM supplements during pregnancy increased energy intake from dietary sources without a concurrent increase in micronutrient density. Future studies should include Flores ML, Neufeld LM, González-Cossío T, Rivera J, Martorell R, Ramakrishnan U. Suplementación con micronutrimentos múltiples y consumo de eneregía en mujeres embarazadas.
Salud Publica De Mexico, 2011
Describir un plan maestro para el desarrollo de planes nacionales para prevenir la desnutricion m... more Describir un plan maestro para el desarrollo de planes nacionales para prevenir la desnutricion materno-infantil en Mesoamerica en un plazo de cinco anos. Para ello se elaboro un analisis sobre los principales problemas, politicas y programas de nutricion en Mesoamerica. A partir del analisis y de la revision de la literatura sobre las mejores practicas en el combate a la desnutricion, el Grupo Tecnico de Nutricion desarrollo, discutio y valido el plan durante varias reuniones presenciales. Se desarrollo la teoria de cambio que identifica los problemas y barreras, las acciones propuestas, los cambios e impactos esperados. Se propone la implementacion de paquetes de intervenciones para reducir la desnutricion y deficiencia de micronutrientes de utilidad para diversos contextos epidemiologicos. El plan maestro de nutricion constituye un insumo que puede facilitar la elaboracion de propuestas de programas y politicas dirigidos a reducir la desnutricion y promover la toma de decisiones ...
The American Journal of Clinical Nutrition, 2021
Background Dietary recommendations worldwide have focused on promoting healthy diets to prevent d... more Background Dietary recommendations worldwide have focused on promoting healthy diets to prevent diseases. In 2019, the EAT–Lancet Commission presented global scientific targets for healthy diets and sustainable food production and proposed a healthy reference diet (EAT-HRD) that can be adapted to the culture, geography, and demography of the population and individuals in any country. Objectives We aimed to describe the daily energy intake from food groups and subgroups in Mexican adults relative to the EAT-HRD and propose an adaptation of the EAT-HRD to the Mexican context. Methods We analyzed data from the Mexican National Health and Nutrition Surveys in 2012 and 2016. Diet information was obtained using the 5-step multiple-pass 24-h dietary recall method. We estimated the mean energy intake from food groups and subgroups and compared these figures with the midpoint of the EAT-HRD and with the Mexican Dietary Guidelines (MDGs). We also proposed an adaptation of the EAT-HRD to the M...
The American Journal of Clinical Nutrition, 2001
Background: The role of single micronutrient deficiencies in the etiology of growth retardation h... more Background: The role of single micronutrient deficiencies in the etiology of growth retardation has recently gained attention. However, because multiple micronutrient deficiencies are common in children in developing countries, it is possible that more than one micronutrient may limit growth and, hence, the correction of a single deficiency may not be enough to improve growth substantially. Objective: The objective was to evaluate the effect of multiple micronutrient supplementation on the growth of children aged 8-14 mo whose diets were poor in several micronutrients. Design: Children were randomly assigned to 1 of 2 groups. One group received a multiple micronutrient supplement containing the recommended dietary allowance (RDA) or 1.5 times the RDA of vitamins A, D, E, K, C, B-1, B-6, B-12, riboflavin, niacin, biotin, folic acid, and pantothenic acid, and iron, zinc, iodine, copper, manganese, and selenium. The other group received a placebo. Supplements were administered 6 d/wk for an average of 12.2 mo. Body length was measured at baseline and monthly thereafter until the end of supplementation. Results: Supplemented infants initially aged < 12 mo had significantly greater length gains than did the placebo group, with a difference of 8.2 mm (length-forage z score: 0.3) at the end of supplementation. In contrast, differences in length gains between the supplemented and placebo groups initially aged ≥ 12 mo were not significant. Conclusions: Micronutrient deficiencies limited the growth of the Mexican infants studied. Improving micronutrient intakes should be a component of interventions to promote growth in infants living in settings where micronutrient intakes are inadequate.
Salud Pública de México, 2013
Objetivo. Evaluar el impacto de una intervención de 18 meses para la prevención de obesidad en es... more Objetivo. Evaluar el impacto de una intervención de 18 meses para la prevención de obesidad en escolares de 4o y 5o grados basada en el modelo ecológico en conductas saludables en México. Material y métodos. Diseño experimental para asignar 27 escuelas a uno de los tres tratamientos: intervenciones básicas, intervenciones plus y control. Se midió el impacto en el ambiente escolar, la alimentación y la actividad física e índice de masa corporal en niños. La evaluación se llevó a cabo en dos años en 830 estudiantes. Resultados. En las escuelas de intervención, la disponibilidad de alimentos sanos aumentó y la disponibilidad de alimentos poco saludables disminuyó. La ingesta de alimentos en niños no mostraron las mismas tendencias. En las escuelas de intervención, los niños no participaron más en actividad física moderada y vigorosa. La prevalencia de obesidad no se modificó. Conclusión. La intervención mejoró el entorno alimentario escolar y las conductas saludables de alimentación y ...
Salud Pública de México, 2017
Objective. To estimate the dietary contribution of taxed beverages and foods. Materials and metho... more Objective. To estimate the dietary contribution of taxed beverages and foods. Materials and methods. Using 24-hour diet recall data from the Ensanut 2012 (n=10 096), we estimated the contribution of the items which were taxed in 2014 to the total energy, added sugar, and saturated fat intakes in the entire sample and by sociodemographic characteristics. Results. The contributions for energy, added sugar, and saturated fat were found to be 5.5, 38.1, and 0.4%, respectively, for the taxed beverages, and 14.4, 23.8, and 21.4%, respectively, for the taxed foods. Children and adolescents (vs. adults), medium and high socioeconomic status (vs. low), urban area (vs. rural), and North and Center region (vs. South) had higher energy contribution of taxed beverages and foods. The energy contribution was similar between males and females. Conclusions. These taxes covered an important proportion of Mexicans' diet and therefore have the potential to improve it meaningfully.
Preventive medicine, Jan 17, 2017
It is unclear whether response to a nonessential food tax varies across time or for high vs. low-... more It is unclear whether response to a nonessential food tax varies across time or for high vs. low-consuming households. The objective is to examine whether the effect of Mexico's 2014 8% nonessential energy-dense foods tax increased in the second year post-implementation and whether it differentially affected households by pre-tax purchasing pattern. We used longitudinal data on Mexican household food purchases (n=6089 households) from 2012 to 2015. Households were classified based on median pre-tax purchases: low untaxed/low taxed ("low"), low untaxed/high taxed ("unhealthy"), high untaxed/low taxed ("healthy"), and high untaxed/high taxed ("high") purchasers. Fixed effects models tested whether observed post-tax purchases differed from the counterfactual, or what would have been expected based on pre-tax trends. Post-tax declines in the % taxed food purchases increased from -4.8% in year one to -7.4% in year two, yielding a 2-year mean de...
The Journal of nutrition, Sep 1, 2016
Mexico is facing the double burden of malnutrition: stunting and micronutrient deficiencies in yo... more Mexico is facing the double burden of malnutrition: stunting and micronutrient deficiencies in young children, iron deficiency in pregnant women, and widespread obesity across age groups. The aim was to summarize and discuss findings published in this supplement on dietary intakes and the eating habits of the Mexican population. A 24-h recall questionnaire that used the multiple-pass method with a repeated measure in a fraction of the sample was applied in a nationally representative sample. We estimated mean intakes and percentages of inadequacy for macronutrients and micronutrients; mean intakes and percentages of the population who adhere to dietary recommendations for food groups; sources of added sugars; intakes of discretionary foods by mealtime, place, and activity; and mean dietary intakes in children <2 y old. Infant formula was consumed by almost half of infants aged <6 mo and sugar-sweetened beverages were consumed by two-thirds of children aged 12-23 mo. In the dif...
BMC Public Health, 2016
Background: Evidence supports that television food advertisements influence children's food prefe... more 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.
PLoS medicine, 2016
In an effort to prevent continued increases in obesity and diabetes, in January 2014, the Mexican... more In an effort to prevent continued increases in obesity and diabetes, in January 2014, the Mexican government implemented an 8% tax on nonessential foods with energy density ≥275 kcal/100 g and a peso-per-liter tax on sugar-sweetened beverages (SSBs). Limited rigorous evaluations of food taxes exist worldwide. The objective of this study was to examine changes in volume of taxed and untaxed packaged food purchases in response to these taxes in the entire sample and stratified by socioeconomic status (SES). This study uses data on household packaged food purchases representative of the Mexican urban population from The Nielsen Company's Mexico Consumer Panel Services (CPS). We included 6,248 households that participated in the Nielsen CPS in at least 2 mo during 2012-2014; average household follow-up was 32.7 mo. We analyzed the volume of purchases of taxed and untaxed foods from January 2012 to December 2014, using a longitudinal, fixed-effects model that adjusted for preexisting...
The Journal of nutrition, May 6, 2016
Population surveys often collect dietary intake data by using one or two 24-h recalls (24HR), mai... more Population surveys often collect dietary intake data by using one or two 24-h recalls (24HR), mainly to minimize cost and respondent burden. However, in order to increase accuracy in estimating usual intake distributions, a larger number of 24HRs may be advisable. The purpose of this study was to identify whether estimates of the intake and prevalence of nutrient inadequacy based on 3 d are better than those that are based on 1 d of information. We conducted a national survey in 31 cities in Mexico using a sample that included 1073 individuals of both sexes, from birth through 79 y of age. Dietary information was collected by using 3 multiple-pass 24HRs (on nonconsecutive days). We estimated intake, adequacy, and prevalence of energy and nutrient inadequacy using information from 1 d and also from 3 d, adjusted for day-to-day variability, using PC-SIDE software. The prevalence of inadequacy was estimated by using the reference values proposed by the US Institute of Medicine. We foun...
Gaceta médica de México
The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mex... more The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Ministry of Health with the aim of drafting evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has documented that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages in six categories. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage. Ranges included healthier (level 1) to least healthy (level 6) options as follows: Level 1: water; ...
The Journal of nutrition, 2014
Snacking has increased globally, but little is known about how Mexicans consume foods outside mea... more Snacking has increased globally, but little is known about how Mexicans consume foods outside meals. The aim of this study was to examine the prevalence and patterns of snacking behavior among Mexicans. We used data from children and adults (aged ≥ 2 y; n = 9937) from the Mexican National Nutrition Survey 1999 and the Mexican National Health and Nutrition Survey (NHNS) 2012 to examine the prevalence of snacking as well as amount (kcal) and contribution of snacks to total energy intake per day. Snacking was defined as eating outside of the 3 main meals. We calculated per capita (among the total population) and per consumer ("snackers") estimates of the number of snacks per day, kilocalories per snack, kilocalories per day from snacks, and the percentage of energy from snacks. Top foods consumed during snack occasions were also examined for the NHNS 2012. All results were weighted to account for survey design and to be nationally representative. In 2012, an estimated 73% of ...
Salud pública de México, 2011
To describe the regional master plan of nutrition to address maternal and child malnutrition in a... more To describe the regional master plan of nutrition to address maternal and child malnutrition in a 5- year period developed by the Nutrition Technical Group. The Nutrition Technical Group developed a situation analysis describing the main nutrition problems, policies and programs in Mesoamerica. The situation analysis and a literature review about effective interventions to address malnutrition were conducted to develop a nutrition master plan. The Nutrition Technical Group held various meetings to develop, discuss and validate the master plan. Theory of change identified problems and barriers, the actions to be developed, the changes and impacts expected. A package of interventions is proposed to reduce undernutrition and micronutrient deficiencies useful under different epidemiological contexts. The nutrition master plan provides a guideline of best practices that can be used for evidence-informed decision making and the development of national policies and programs to reduce malnu...
The Journal of Nutrition, 2014
Mexico, with 1 of the highest obesity prevalences in the world, instituted a 10% excise tax for a... more Mexico, with 1 of the highest obesity prevalences in the world, instituted a 10% excise tax for any sugar-sweetened beverage (SSB) starting on 1 January 2014. Understanding the recent patterns and trends in beverage intake and sales in Mexico provides both background and baseline data for the importance of SSBs and other beverages in the Mexican diet. We analyzed a single 24-h dietary recall from 2 nationally representative surveys: the Mexican Nutrition Survey 1999 (n = 6049) and the National Health and Nutrition Survey 2012 (n = 10,343). To describe trends and patterns in beverages, we calculated the volume and energy intake per capita and per consumer and the proportion of consumers of each beverage group in each survey. A commercial sales dataset was used to describe beverage sales trends from 1999 to 2012. From 1999 to 2012, total daily energy from beverages increased among children aged 5-11 y (+45.3 kcal), females aged 12-19 y (+57.3 kcal), and adult females aged 20-49 y (+96.4 kcal) (P < 0.05). Over the same period, intake of beverages with added sugars increased, specifically flavored milk, agua fresca (fruit water made in stalls or at home, usually with added sugars), and fruit drinks among children aged 5-11 y and females aged 12-19 y and caloric coffee/tea, soda, and agua fresca among adult females aged 20-49 y. In 2012, beverages represented 17.5% (325 kcal) and 19.0% (382 kcal) of the total daily energy intake per capita in children aged 1-19 y and adults aged 20y,respectively.In2012,flavoredmilkbeverages,caloricsoda,andhigh−fatmilkwerethetop3majorcontributorstototaldailyenergyintakepercapitainallchildrenaged1−19y.Caloricsoda,caloriccoffee/tea,andaguafrescawerethetop3majorenergycontributorsinadultsaged20 y, respectively. In 2012, flavored milk beverages, caloric soda, and high-fat milk were the top 3 major contributors to total daily energy intake per capita in all children aged 1-19 y. Caloric soda, caloric coffee/tea, and agua fresca were the top 3 major energy contributors in adults aged 20y,respectively.In2012,flavoredmilkbeverages,caloricsoda,andhigh−fatmilkwerethetop3majorcontributorstototaldailyenergyintakepercapitainallchildrenaged1−19y.Caloricsoda,caloriccoffee/tea,andaguafrescawerethetop3majorenergycontributorsinadultsaged20 y. From 1999 to 2012, sales of soda, fruit-flavored drinks, and flavored waters increased. In conclusion, consumption of several beverages with added sugars increased among children and adult females in Mexico. Because caloric soda is currently 1 of the top beverages consumed, a 10% tax on SSBs might help to significantly reduce added sugars intake in Mexico.
Salud Pública de México, 2003
Consumo de energía y nutrimentos en niños mexicanos prescolares y escolares: Encuesta Nacional de... more Consumo de energía y nutrimentos en niños mexicanos prescolares y escolares: Encuesta Nacional de Nutrición 1999. Salud Publica Mex 2003;45 supl 4:S540-S550. El texto completo en inglés de este artículo también está disponible en: http://www.insp.mx/salud/index.html
Salud Pública de México, 2003
Objective. The purpose of this study is to quantify the prevalence and distribution of anemia amo... more 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.
Salud Pública de México, 2003
Consumo de energía y nutrimentos en mujeres mexicanas de entre 12 a 49 años de edad: análisis de ... more Consumo de energía y nutrimentos en mujeres mexicanas de entre 12 a 49 años de edad: análisis de la Encuesta Nacional de Nutrición 1999. Salud Publica Mex 2003;45 supl 4:S530-S539. El texto completo en inglés de este artículo también está disponible en: http://www.insp.mx/salud/index.html Resumen Objetivo. Describir la ingesta reportada de energía y nutrimentos en mujeres mexicanas. Material y métodos. Se utilizó un recordatorio de 24 horas para obtener la ingesta de energía en una submuestra representativa de 2 630 mujeres de 12 a 49 años de edad de la Encuesta Nacional de Nutrición 1999. Las adecuaciones nutrimentales se estimaron utilizando las Referencias de Ingesta Dietética y fueron estratificadas por región, área urbana o rural, nivel socioeconómico y presencia de obesidad (no-obesas: IMC <30 kg/m 2 , obesas: ≥30 kg/m 2). Las diferencias se analizaron utilizando modelos de regresión lineal para encuestas complejas del logaritmo de la ingesta y la adecuación, ajustando para comparaciones múltiples con la prueba de Bonferroni. Resultados. La media nacional de ingesta de energía fue de 1 471 kcal. El riesgo de inadecuación (prevalencia de adecuación <50%) fue vitamina A: 38.3%, vitamina C: 45.5% y folato: 34.3%. La ingesta de carbohidratos, folato, hierro y calcio fue significativamente más alta en áreas rurales que en las urbanas. El riesgo de inadecuación fue mayor en mujeres del nivel socioeconómico más bajo para todos los nutrimentos con excepción de carbohidratos y calcio. Las adecuaciones de macro-nutrimentos fueron significativamente mayores en mujeres no-obesas. Conclusiones. Las diferencias entre las regiones, áreas del país y terciles de nivel socioeconómico reflejan una disponibilidad creciente de alimentos densamente calóricos de bajo costo en grupos marginales. Sin embargo, la energía total, colesterol y la
Salud Pública de México, 2009
Objective. To describe energy and nutrient intake in adults. Material and Methods. The 2006 Mexic... more Objective. To describe energy and nutrient intake in adults. Material and Methods. The 2006 Mexican National Health and Nutrition Survey is a nationally representative cross-sectional household survey. A food frequency questionnaire was administered (n= 16 494 adults). Mean percent of adequacy (PA) and inadequacy (PA < 50%) of total energy and macroand micro-nutrient intake was calculated for all subjects and by sociodemographic characteristics. Results. Significant differences in PA and inadequate macro-and micro-nutrient intakes were found among sex, region, rural/urban area, and socioeconomic status tertile. PA < 50% was higher than 20% for vitamin A (26.2%), fat (24.8%), fiber (23.6%), folic acid (23.5%), vitamin C (21.3%) and calcium (21%). Obese subjects reported a lower energy intake than normal weight subjects. Conclusions. A significant proportion of the population was at risk of excessive carbohydrate and fat intake. Across the country there are significant sociodemographic differences in macro-and micro-nutrient intake and a myriad of micronutrient inadequacies continue to persist in Mexico.
Salud Pública de México, 2009
Results. A total of 33 023 adults ≥ 20 years old were included; 39.7% were found to be overweight... more Results. A total of 33 023 adults ≥ 20 years old were included; 39.7% were found to be overweight and 29.9% were found to be obese; 75.9% of all adults had abdominal obesity. In Mexico between 2000 and 2006, the combined prevalence of overweight and obesity in adults increased approximately 12%. Mexican-Americans showed a higher prevalence of morbid obesity compared to native Mexicans. Conclusions. Mexico has experienced a rapid increase in the number of adults who have experienced excess weight gain between the years 2000 and 2006.
Salud Pública de México, 2007
Objective. To compare dietary intake of women supplemented with multiple micronutrients (MM) or i... more Objective. To compare dietary intake of women supplemented with multiple micronutrients (MM) or iron only during pregnancy. Materials and Methods. Design: Randomized, double-blind, controlled community-based trial. Setting: One semi-urban community in Central Mexico. Subjects: Pregnant women identified before week 13 of pregnancy, willing to provide informed consent. Interventions: Women were randomly assigned to receive daily supplementation with MM or iron only from recruitment until delivery. Supplements were delivered to the participants' home and compliance observed daily. Dietary intake was assessed by repeat 24-hr recall. Data were analyzed using non-parametric tests and multiple regression analysis to determine the impact of MM supplementation on dietary intake of energy and select micronutrients. Results. During the third trimester, women in the MM group consumed more energy and iron from dietary sources than women in the iron only group. After adjustment for differences between the groups at baseline, women in the MM group consumed 111.3 kcal/day more (p<0.05) energy. The difference in iron intake was not significant after adjusting for the increase in energy intake. Conclusions. Women consuming MM supplements during pregnancy increased energy intake from dietary sources without a concurrent increase in micronutrient density. Future studies should include Flores ML, Neufeld LM, González-Cossío T, Rivera J, Martorell R, Ramakrishnan U. Suplementación con micronutrimentos múltiples y consumo de eneregía en mujeres embarazadas.