Teresita González de Cosío - Academia.edu (original) (raw)
Papers by Teresita González de Cosío
How to cite Complete issue More information about this article Journal's homepage in redalyc.org ... more How to cite Complete issue More information about this article Journal's homepage in redalyc.org Scientific Information System Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Non-profit academic project, developed under the open access initiative Nutrición Hospitalaria
The FASEB Journal, 2015
Objective: To estimate the prevalence of exclusive breastfeeding <6 mo (EBF<6m) by level of... more Objective: To estimate the prevalence of exclusive breastfeeding <6 mo (EBF<6m) by level of obesity in Mexican women who participated in the 2012 National Nutrition Survey. Methods: A representative sample of 477 postpartum women 12-49 y and their <6 mo infants were studied. EBF<6m information obtained by status quo method; EBF<6mo indicator was constructed as recommended by the WHO-2008. Maternal weight and height were measured wearing light clothing - no shoes. Maternal BMI (kg/m2) categorized in non-obese, obese-1 or obese-2+ (BMI<30, 30-< 35 and 35+ respectively). To compare proportions of EBF< 6m per BMI we used Student's t test and the Mann- Kendall test for trend. P < 0.05 was declared statistically significant. Results: Prevalence of EBF<6m was 17.4, 7.1 and 3.2 % in non-obese, obese-1 and obese-2+ women respectively (p< 0.05 for proportions, p=0.012, test for trend). Results are similar when excluding teenage mothers from the analysis. Conclusion: Obesity inhibits breastfeeding through an inadequ...
Supplementary_Material for Can "Becoming Breastfeeding Friendly" Impact Breastfeeding P... more Supplementary_Material for Can "Becoming Breastfeeding Friendly" Impact Breastfeeding Protection, Promotion, and Support in Mexico? A Qualitative Study by Cara Safon, Gabriela Buccini, Isabel Ferré, Teresita González de Cosío, and Rafael Pérez-Escamilla in Food and Nutrition Bulletin
Public Health Nutrition, 2020
Objective:The WHO and UNICEF recommend home visits to improve health outcomes for mothers and new... more Objective:The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women’s knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children.Design:Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews.Setting:Poor rural communities in Mexico; 48 intervention and 29 control.Participants:Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 29...
Maternal & Child Nutrition, 2020
One post-partum behaviour that may be protective against post-partum weight retention and long-te... more One post-partum behaviour that may be protective against post-partum weight retention and long-term weight gain among women of reproductive age is lactation because of its potential role in resetting maternal metabolism after pregnancy. However, most of the evidence focuses on weight retention at 6, 12, or 24 months post-partum, and data beyond 2 years after birth are sparse, and findings are inconclusive. Therefore, our aim was to assess the association of parity and mean duration of lactation per child with long-term weight change in Mexican women. We assessed the association of parity and mean duration of lactation per child with long-term weight change in 75,421 women from the Mexican Teachers' Cohort. Several multivariable regression models were fit to assess these associations. We also examined the non-linear association between duration of lactation and weight change using restricted cubic splines. We found that parous women (≥4 children) gained 2.81 kg more (95% CI [2.52, 3.10]) than did nulliparous women. The association between mean duration of lactation per child and weight change appeared to be non-linear. Women who breastfed on average 3-6 months per child had lower gain weight (−1.10, 95% CI [−1.58, −0.47 kg]) than had women who did not breastfeed. This association was linear up to 6 months of lactation per child. Our findings suggest that parity alters weight-gain trajectory in women and that lactation could reduce this alteration. These findings are important in the prevention of excessive weight gain through reproductive years and their future health implications.
Journal of Nutritional Science, 2020
Little information exists on how to garner political commitment to strengthen large-scale breastf... more Little information exists on how to garner political commitment to strengthen large-scale breastfeeding policies and programmes by targeting key decision makers. The present study aims to map and describe the influence of stakeholders involved in breastfeeding policy and programming and identify opportunities to strengthen the breastfeeding-friendly environment in Mexico. A total of nine key informants from seventeen stakeholder organisations were selected based on their in-depth knowledge of the breastfeeding environment in Mexico and were individually interviewed using Net-Map methodology. This participatory interview technique combines stakeholder mapping, social network analysis and influence mapping to identify relevant stakeholders. Participants identified a total of fifty-five stakeholders shaping breastfeeding programmes and policies through four domains of influence: commands (n32 stakeholders), dissemination (n40), funding (n35) and technical assistance (n37). The Federal ...
Maternal & Child Nutrition, 2019
Media can be a powerful communication tool to promote breastfeeding programs, influence mother... more Media can be a powerful communication tool to promote breastfeeding programs, influence mother's breastfeeding behaviour, and generate support among stakeholders for breastfeeding. Yet, there is little information on how media coverage influences a country's breastfeeding enabling environment. This study addressed this gap by conducting a retrospective content analysis of documents published between January 1, 2017 and January 1, 2018 to analyse the media coverage related to breastfeeding in Mexico. Content analysis was based on the breastfeeding gear model and a strategic planning technique to identify strengths, weaknesses, opportunities, and threats for enabling the national breastfeeding environment. Media coverage of breastfeeding was more frequent in August (36% of all documents). The top three topics commonly covered by the media were advocacy events promoting breastfeeding, promotion campaigns, and changes in breastfeeding legislation and policy. In general, the medi...
Maternal & Child Nutrition, 2019
One postpartum behaviour that may be protective against diabetes is lactation due to its potentia... more One postpartum behaviour that may be protective against diabetes is lactation due to its potential role in resetting maternal metabolism after pregnancy. However, the role of lactation in maternal risk of diabetes has not been investigated in Latin American populations, where rates of breastfeeding are suboptimal and diabetes incidence is increasing. Therefore, our aim was to estimate the association between mean duration of lactation per child and maternal incidence of diabetes. We followed 66,573 women from the Mexican Teachers' Cohort free of diabetes at baseline. Incident diabetes was ascertained through triennial questionnaires and lactation history was asked in baseline questionnaire. We used Cox proportional hazards regression models to estimate the hazard ratio (HR) for diabetes by mean duration of lactation per child. We examined the dose–response association between lactation per child and diabetes with restricted cubic splines. We found that 3,168 incident cases of di...
Nutrients, 2019
Malnutrition and poor diet are the largest risk factors responsible for the global burden of dise... more Malnutrition and poor diet are the largest risk factors responsible for the global burden of disease. Therefore, ending all forms of malnutrition by 2030 is a global priority. To achieve this goal, a key element is to design and implement nutrition policies based on the best available scientific evidence. The demand for evidence-based nutrition policies may originate directly from policymakers or through social actors. In both cases, the role of research institutions is to generate relevant evidence for public policy. The two key objects of analysis for the design of an effective policy are the nutrition conditions of the population and the policies and programs available, including the identification of delivery platforms and competencies required by personnel in charge of the provision of services (social response). In addition, systematic literature reviews about risk factors of malnutrition, as well as the efficacy and effectiveness of policy actions, lead to evidence-based poli...
Food and Nutrition Bulletin, 2018
Background:The Becoming Breastfeeding Friendly (BBF) initiative includes a guide that helps count... more Background:The Becoming Breastfeeding Friendly (BBF) initiative includes a guide that helps countries worldwide assess their readiness to scale up national breastfeeding programs. Country committees of breastfeeding experts across government, academia, and civil society engage with BBF by applying the BBF toolbox that includes (1) the BBF Index (BBFI) to measure and score a country’s breastfeeding environment, (2) case studies that illustrate how countries have created enabling environments for breastfeeding, and (3) a 5-meeting process, during which country committees develop policy recommendations intended to improve breastfeeding outcomes based on the BBFI scores.Objective:This study seeks to understand how the application of the BBF toolbox impacted plans to improve the enabling environment for breastfeeding in Mexico.Methods:Semi-structured interviews were conducted with Mexico’s 11 BBF country committee members about the 5-meeting process between May and June 2017. Audio recor...
Maternal & Child Nutrition, 2018
Longer duration of breastfeeding is associated with a lower risk of type 2 diabetes, breast and o... more Longer duration of breastfeeding is associated with a lower risk of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension diseases in women. Mexico has one of the lowest breastfeeding rates worldwide; therefore, estimating the disease and economic burden of such rates is needed to influence public policy. We considered suboptimal breastfeeding when fewer than 95% of parous women breastfeed for less than 24 months per child, according to the World Health Organization recommendations. We quantified the lifetime excess cases of maternal health outcomes, premature death, disability‐adjusted life years, direct costs, and indirect costs attributable to suboptimal breastfeeding practices from Mexico in 2012. We used a static microsimulation model for a hypothetical cohort of 100,000 Mexican women to estimate the lifetime economic cost and disease burden of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension in mothers, due to su...
Current developments in nutrition, 2018
Given the magnitude of the health and economic burden of inadequate breastfeeding practices in Me... more Given the magnitude of the health and economic burden of inadequate breastfeeding practices in Mexico, there is an urgency to improve breastfeeding practices to increase the health and well-being of children and mothers. The Becoming Breastfeeding Friendly (BBF) Toolbox was recently developed to guide countries in assessing their readiness to and progress with scale-up of breastfeeding protection, promotion, and support and to develop policy recommendations to high-level decision makers. The aim of this study was to document the BBF process in Mexico, which led to evidence-based recommendations for policymakers to improve breastfeeding protection, promotion, and support in the country. We followed the BBF methodology. First, a group of experts, with the use of scientific and gray literature, face-to-face interviews, and their own experience, analyzed and assigned a score to each of the 8 gears from the BBF index and identified scaling-up gaps on the basis of the Breastfeeding Gear M...
Salud Pública de México, 2013
Objetivo. Describir la magnitud, distribución y tendencias de la desnutrición y el sobrepeso en m... more Objetivo. Describir la magnitud, distribución y tendencias de la desnutrición y el sobrepeso en menores de 5 años de 1988 a 2012 y hacer recomendaciones para su erradicación. Material y métodos. Se analizaron indicadores antropométricos en menores de 5 años, de cuatro encuestas nacionales. Resultados. A pesar de haber tenido un notable descenso en el periodo estudiado, la desnutrición crónica persiste como problema de salud pública, con mayores prevalencias en la población indígena, las zonas rurales del sur y el quintil de menores condiciones de bienestar. Conclusiones. Diversas políticas y programas han mostrado efectividad aunque persisten retos de implementación entre la población más pobre, particularmente la indígena. Se recomiendan, por una parte, medidas para aumentar la efectividad de las políticas y programas actuales, sobre todo entre la población indígena y la más pobre, mediante el ajuste de los programas actuales, de acuerdo con los resultados de las evaluaciones y, p...
Journal of Human Lactation, 2017
Background: Breastfeeding reduces women’s risk of breast cancer. Since exclusive breastfeeding ha... more Background: Breastfeeding reduces women’s risk of breast cancer. Since exclusive breastfeeding has a stronger hormonal effect, it could theoretically result in a greater reduction in breast cancer risk than any breastfeeding mode. No meta-analysis has examined breast cancer risk by breastfeeding mode. Research aim: The authors conducted a meta-analysis for breast cancer risk in parous women who breastfed exclusively or in any mode versus parous women who formula fed their infants, and they estimated the summary dose–response association by the accumulated duration of any breastfeeding mode. Methods: A systematic review of studies published between 2005 and 2015 analyzing breastfeeding and breast cancer risk in women was conducted in PubMed and EBSCOhost. A meta-analysis ( n = 65 studies) with fixed effects (or random effects, if heterogeneity existed) was carried out stratified by breastfeeding mode and menopausal and parity status. A summary dose–response association was estimated ...
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...
The Journal of nutrition, Sep 1, 2016
Mexico faces malnutrition problems in the child population. Analysis of food consumption in small... more Mexico faces malnutrition problems in the child population. Analysis of food consumption in small children allows us to identify and propose strategies focused on feeding to improve their nutritional status. We described the consumption of beverages and food groups in Mexican children <24 mo of age. A cross-sectional study was carried out in 926 children aged <24 mo participating in the 2012 ENSANUT (National Health and Nutrition Study). Dietary information was obtained through 24-h recalls. The foods and beverages consumed were divided into 17 groups. Consumption was estimated in grams or milliliters, kilocalories per day, and percentage of energy (PE) per day. The percentage of consumers was calculated for each food group and stratified by age (<6, 6-11, and 12-23 mo) and by breastfeeding status (breastfed or not breastfed). Differences in the consumption of food groups were analyzed by breastfeeding status, area of residence (urban or rural), and socioeconomic status (SE...
The Journal of nutrition, Jan 11, 2015
Inadequate complementary feeding partially explains micronutrient deficiencies in the first 2 y o... more Inadequate complementary feeding partially explains micronutrient deficiencies in the first 2 y of life. To prevent malnutrition, the Mexican government implemented the Programa de Apoyo Alimentario (PAL), which transferred either food baskets containing micronutrient-fortified milk and animal food products or cash to beneficiary families along with educational sessions. This study evaluated the impact of PAL on 2 indicators of complementary feeding: minimum dietary diversity and consumption of iron-rich or iron-fortified foods in children aged 6-23 mo. A secondary analysis of the original PAL evaluation design was conducted through a randomized community trial implemented with 3 intervention groups (food basket with education, food basket without education, and cash transfer with education) and a control. The impact of PAL after 14 mo of exposure was estimated in 2 cross-sectional groups of children aged 6-23 mo at baseline and at follow-up in a panel of 145 communities by using di...
The Journal of Nutrition, 2015
Background: There is minimal information on the impact of replacing sugar-sweetened beverage (SSB... more Background: There is minimal information on the impact of replacing sugar-sweetened beverage (SSB) consumption with water on diet quality from randomized controlled trials.Objective: We evaluated the effect of a water intake intervention on diet quality in overweight Mexican women.Methods: Women with a body mass index ≥25 and <39, 18–45 y old, and a self-reported high intake of SSBs (≥250 kcal/d) were randomly allocated to either the water and education provision (WEP) group (n = 120) or the education provision (EP) only group (n = 120). Each group received monthly nutrition counseling, and the WEP group received biweekly water deliveries for 9 mo. Three 24-h recalls, anthropometry, and demographic information were collected at baseline, and 3, 6, and 9 mo. Energy, macronutrient, sugar, SSB, fruit and vegetable, salty snack, cake and cookie, and fast food intakes were assessed in study completers (n = 189) classified by intervention assignment and by actual water intake at every ...
![Research paper thumbnail of [Infant feeding practices and deterioration of breastfeeding in Mexico]](https://attachments.academia-assets.com/112935700/thumbnails/1.jpg)
](Salud pública de México, 2013
To present data on infant and young child feeding practices (IYCFP) in Mexico from the 2012 Natio... more To present data on infant and young child feeding practices (IYCFP) in Mexico from the 2012 National Health and Nutrition Survey (ENSANUT 2012) to support the development of public policy. Women 12-49y and children <2y. Indicators of IYCFP suggested by WHO were analyzed by geographic, socioeconomic, participation in food programs and health insurance variables. Median duration of breast-feeding: 10.2mo and 14.4% with exclusive breastfeeding (EBF) <6m. Breastfeeding deteriorated in most vulnerable groups. Decline in EBF<6m 2006-2012 was explained by increases in consumption of formula and other milks (4%) and water (4%). Three-quarters (74%) of 6-11mo infants had minimum food diversity, and it was lower in the most vulnerable. Complementary feeding improved but breastfeeding declined in Mexico. Promotion actions must be integral, coordinated, financed and evaluated, with Federal government leadership and should include the participation of various stakeholders.
How to cite Complete issue More information about this article Journal's homepage in redalyc.org ... more How to cite Complete issue More information about this article Journal's homepage in redalyc.org Scientific Information System Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Non-profit academic project, developed under the open access initiative Nutrición Hospitalaria
The FASEB Journal, 2015
Objective: To estimate the prevalence of exclusive breastfeeding <6 mo (EBF<6m) by level of... more Objective: To estimate the prevalence of exclusive breastfeeding <6 mo (EBF<6m) by level of obesity in Mexican women who participated in the 2012 National Nutrition Survey. Methods: A representative sample of 477 postpartum women 12-49 y and their <6 mo infants were studied. EBF<6m information obtained by status quo method; EBF<6mo indicator was constructed as recommended by the WHO-2008. Maternal weight and height were measured wearing light clothing - no shoes. Maternal BMI (kg/m2) categorized in non-obese, obese-1 or obese-2+ (BMI<30, 30-< 35 and 35+ respectively). To compare proportions of EBF< 6m per BMI we used Student's t test and the Mann- Kendall test for trend. P < 0.05 was declared statistically significant. Results: Prevalence of EBF<6m was 17.4, 7.1 and 3.2 % in non-obese, obese-1 and obese-2+ women respectively (p< 0.05 for proportions, p=0.012, test for trend). Results are similar when excluding teenage mothers from the analysis. Conclusion: Obesity inhibits breastfeeding through an inadequ...
Supplementary_Material for Can "Becoming Breastfeeding Friendly" Impact Breastfeeding P... more Supplementary_Material for Can "Becoming Breastfeeding Friendly" Impact Breastfeeding Protection, Promotion, and Support in Mexico? A Qualitative Study by Cara Safon, Gabriela Buccini, Isabel Ferré, Teresita González de Cosío, and Rafael Pérez-Escamilla in Food and Nutrition Bulletin
Public Health Nutrition, 2020
Objective:The WHO and UNICEF recommend home visits to improve health outcomes for mothers and new... more Objective:The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women’s knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children.Design:Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews.Setting:Poor rural communities in Mexico; 48 intervention and 29 control.Participants:Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 29...
Maternal & Child Nutrition, 2020
One post-partum behaviour that may be protective against post-partum weight retention and long-te... more One post-partum behaviour that may be protective against post-partum weight retention and long-term weight gain among women of reproductive age is lactation because of its potential role in resetting maternal metabolism after pregnancy. However, most of the evidence focuses on weight retention at 6, 12, or 24 months post-partum, and data beyond 2 years after birth are sparse, and findings are inconclusive. Therefore, our aim was to assess the association of parity and mean duration of lactation per child with long-term weight change in Mexican women. We assessed the association of parity and mean duration of lactation per child with long-term weight change in 75,421 women from the Mexican Teachers' Cohort. Several multivariable regression models were fit to assess these associations. We also examined the non-linear association between duration of lactation and weight change using restricted cubic splines. We found that parous women (≥4 children) gained 2.81 kg more (95% CI [2.52, 3.10]) than did nulliparous women. The association between mean duration of lactation per child and weight change appeared to be non-linear. Women who breastfed on average 3-6 months per child had lower gain weight (−1.10, 95% CI [−1.58, −0.47 kg]) than had women who did not breastfeed. This association was linear up to 6 months of lactation per child. Our findings suggest that parity alters weight-gain trajectory in women and that lactation could reduce this alteration. These findings are important in the prevention of excessive weight gain through reproductive years and their future health implications.
Journal of Nutritional Science, 2020
Little information exists on how to garner political commitment to strengthen large-scale breastf... more Little information exists on how to garner political commitment to strengthen large-scale breastfeeding policies and programmes by targeting key decision makers. The present study aims to map and describe the influence of stakeholders involved in breastfeeding policy and programming and identify opportunities to strengthen the breastfeeding-friendly environment in Mexico. A total of nine key informants from seventeen stakeholder organisations were selected based on their in-depth knowledge of the breastfeeding environment in Mexico and were individually interviewed using Net-Map methodology. This participatory interview technique combines stakeholder mapping, social network analysis and influence mapping to identify relevant stakeholders. Participants identified a total of fifty-five stakeholders shaping breastfeeding programmes and policies through four domains of influence: commands (n32 stakeholders), dissemination (n40), funding (n35) and technical assistance (n37). The Federal ...
Maternal & Child Nutrition, 2019
Media can be a powerful communication tool to promote breastfeeding programs, influence mother... more Media can be a powerful communication tool to promote breastfeeding programs, influence mother's breastfeeding behaviour, and generate support among stakeholders for breastfeeding. Yet, there is little information on how media coverage influences a country's breastfeeding enabling environment. This study addressed this gap by conducting a retrospective content analysis of documents published between January 1, 2017 and January 1, 2018 to analyse the media coverage related to breastfeeding in Mexico. Content analysis was based on the breastfeeding gear model and a strategic planning technique to identify strengths, weaknesses, opportunities, and threats for enabling the national breastfeeding environment. Media coverage of breastfeeding was more frequent in August (36% of all documents). The top three topics commonly covered by the media were advocacy events promoting breastfeeding, promotion campaigns, and changes in breastfeeding legislation and policy. In general, the medi...
Maternal & Child Nutrition, 2019
One postpartum behaviour that may be protective against diabetes is lactation due to its potentia... more One postpartum behaviour that may be protective against diabetes is lactation due to its potential role in resetting maternal metabolism after pregnancy. However, the role of lactation in maternal risk of diabetes has not been investigated in Latin American populations, where rates of breastfeeding are suboptimal and diabetes incidence is increasing. Therefore, our aim was to estimate the association between mean duration of lactation per child and maternal incidence of diabetes. We followed 66,573 women from the Mexican Teachers' Cohort free of diabetes at baseline. Incident diabetes was ascertained through triennial questionnaires and lactation history was asked in baseline questionnaire. We used Cox proportional hazards regression models to estimate the hazard ratio (HR) for diabetes by mean duration of lactation per child. We examined the dose–response association between lactation per child and diabetes with restricted cubic splines. We found that 3,168 incident cases of di...
Nutrients, 2019
Malnutrition and poor diet are the largest risk factors responsible for the global burden of dise... more Malnutrition and poor diet are the largest risk factors responsible for the global burden of disease. Therefore, ending all forms of malnutrition by 2030 is a global priority. To achieve this goal, a key element is to design and implement nutrition policies based on the best available scientific evidence. The demand for evidence-based nutrition policies may originate directly from policymakers or through social actors. In both cases, the role of research institutions is to generate relevant evidence for public policy. The two key objects of analysis for the design of an effective policy are the nutrition conditions of the population and the policies and programs available, including the identification of delivery platforms and competencies required by personnel in charge of the provision of services (social response). In addition, systematic literature reviews about risk factors of malnutrition, as well as the efficacy and effectiveness of policy actions, lead to evidence-based poli...
Food and Nutrition Bulletin, 2018
Background:The Becoming Breastfeeding Friendly (BBF) initiative includes a guide that helps count... more Background:The Becoming Breastfeeding Friendly (BBF) initiative includes a guide that helps countries worldwide assess their readiness to scale up national breastfeeding programs. Country committees of breastfeeding experts across government, academia, and civil society engage with BBF by applying the BBF toolbox that includes (1) the BBF Index (BBFI) to measure and score a country’s breastfeeding environment, (2) case studies that illustrate how countries have created enabling environments for breastfeeding, and (3) a 5-meeting process, during which country committees develop policy recommendations intended to improve breastfeeding outcomes based on the BBFI scores.Objective:This study seeks to understand how the application of the BBF toolbox impacted plans to improve the enabling environment for breastfeeding in Mexico.Methods:Semi-structured interviews were conducted with Mexico’s 11 BBF country committee members about the 5-meeting process between May and June 2017. Audio recor...
Maternal & Child Nutrition, 2018
Longer duration of breastfeeding is associated with a lower risk of type 2 diabetes, breast and o... more Longer duration of breastfeeding is associated with a lower risk of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension diseases in women. Mexico has one of the lowest breastfeeding rates worldwide; therefore, estimating the disease and economic burden of such rates is needed to influence public policy. We considered suboptimal breastfeeding when fewer than 95% of parous women breastfeed for less than 24 months per child, according to the World Health Organization recommendations. We quantified the lifetime excess cases of maternal health outcomes, premature death, disability‐adjusted life years, direct costs, and indirect costs attributable to suboptimal breastfeeding practices from Mexico in 2012. We used a static microsimulation model for a hypothetical cohort of 100,000 Mexican women to estimate the lifetime economic cost and disease burden of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension in mothers, due to su...
Current developments in nutrition, 2018
Given the magnitude of the health and economic burden of inadequate breastfeeding practices in Me... more Given the magnitude of the health and economic burden of inadequate breastfeeding practices in Mexico, there is an urgency to improve breastfeeding practices to increase the health and well-being of children and mothers. The Becoming Breastfeeding Friendly (BBF) Toolbox was recently developed to guide countries in assessing their readiness to and progress with scale-up of breastfeeding protection, promotion, and support and to develop policy recommendations to high-level decision makers. The aim of this study was to document the BBF process in Mexico, which led to evidence-based recommendations for policymakers to improve breastfeeding protection, promotion, and support in the country. We followed the BBF methodology. First, a group of experts, with the use of scientific and gray literature, face-to-face interviews, and their own experience, analyzed and assigned a score to each of the 8 gears from the BBF index and identified scaling-up gaps on the basis of the Breastfeeding Gear M...
Salud Pública de México, 2013
Objetivo. Describir la magnitud, distribución y tendencias de la desnutrición y el sobrepeso en m... more Objetivo. Describir la magnitud, distribución y tendencias de la desnutrición y el sobrepeso en menores de 5 años de 1988 a 2012 y hacer recomendaciones para su erradicación. Material y métodos. Se analizaron indicadores antropométricos en menores de 5 años, de cuatro encuestas nacionales. Resultados. A pesar de haber tenido un notable descenso en el periodo estudiado, la desnutrición crónica persiste como problema de salud pública, con mayores prevalencias en la población indígena, las zonas rurales del sur y el quintil de menores condiciones de bienestar. Conclusiones. Diversas políticas y programas han mostrado efectividad aunque persisten retos de implementación entre la población más pobre, particularmente la indígena. Se recomiendan, por una parte, medidas para aumentar la efectividad de las políticas y programas actuales, sobre todo entre la población indígena y la más pobre, mediante el ajuste de los programas actuales, de acuerdo con los resultados de las evaluaciones y, p...
Journal of Human Lactation, 2017
Background: Breastfeeding reduces women’s risk of breast cancer. Since exclusive breastfeeding ha... more Background: Breastfeeding reduces women’s risk of breast cancer. Since exclusive breastfeeding has a stronger hormonal effect, it could theoretically result in a greater reduction in breast cancer risk than any breastfeeding mode. No meta-analysis has examined breast cancer risk by breastfeeding mode. Research aim: The authors conducted a meta-analysis for breast cancer risk in parous women who breastfed exclusively or in any mode versus parous women who formula fed their infants, and they estimated the summary dose–response association by the accumulated duration of any breastfeeding mode. Methods: A systematic review of studies published between 2005 and 2015 analyzing breastfeeding and breast cancer risk in women was conducted in PubMed and EBSCOhost. A meta-analysis ( n = 65 studies) with fixed effects (or random effects, if heterogeneity existed) was carried out stratified by breastfeeding mode and menopausal and parity status. A summary dose–response association was estimated ...
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...
The Journal of nutrition, Sep 1, 2016
Mexico faces malnutrition problems in the child population. Analysis of food consumption in small... more Mexico faces malnutrition problems in the child population. Analysis of food consumption in small children allows us to identify and propose strategies focused on feeding to improve their nutritional status. We described the consumption of beverages and food groups in Mexican children <24 mo of age. A cross-sectional study was carried out in 926 children aged <24 mo participating in the 2012 ENSANUT (National Health and Nutrition Study). Dietary information was obtained through 24-h recalls. The foods and beverages consumed were divided into 17 groups. Consumption was estimated in grams or milliliters, kilocalories per day, and percentage of energy (PE) per day. The percentage of consumers was calculated for each food group and stratified by age (<6, 6-11, and 12-23 mo) and by breastfeeding status (breastfed or not breastfed). Differences in the consumption of food groups were analyzed by breastfeeding status, area of residence (urban or rural), and socioeconomic status (SE...
The Journal of nutrition, Jan 11, 2015
Inadequate complementary feeding partially explains micronutrient deficiencies in the first 2 y o... more Inadequate complementary feeding partially explains micronutrient deficiencies in the first 2 y of life. To prevent malnutrition, the Mexican government implemented the Programa de Apoyo Alimentario (PAL), which transferred either food baskets containing micronutrient-fortified milk and animal food products or cash to beneficiary families along with educational sessions. This study evaluated the impact of PAL on 2 indicators of complementary feeding: minimum dietary diversity and consumption of iron-rich or iron-fortified foods in children aged 6-23 mo. A secondary analysis of the original PAL evaluation design was conducted through a randomized community trial implemented with 3 intervention groups (food basket with education, food basket without education, and cash transfer with education) and a control. The impact of PAL after 14 mo of exposure was estimated in 2 cross-sectional groups of children aged 6-23 mo at baseline and at follow-up in a panel of 145 communities by using di...
The Journal of Nutrition, 2015
Background: There is minimal information on the impact of replacing sugar-sweetened beverage (SSB... more Background: There is minimal information on the impact of replacing sugar-sweetened beverage (SSB) consumption with water on diet quality from randomized controlled trials.Objective: We evaluated the effect of a water intake intervention on diet quality in overweight Mexican women.Methods: Women with a body mass index ≥25 and <39, 18–45 y old, and a self-reported high intake of SSBs (≥250 kcal/d) were randomly allocated to either the water and education provision (WEP) group (n = 120) or the education provision (EP) only group (n = 120). Each group received monthly nutrition counseling, and the WEP group received biweekly water deliveries for 9 mo. Three 24-h recalls, anthropometry, and demographic information were collected at baseline, and 3, 6, and 9 mo. Energy, macronutrient, sugar, SSB, fruit and vegetable, salty snack, cake and cookie, and fast food intakes were assessed in study completers (n = 189) classified by intervention assignment and by actual water intake at every ...
Salud pública de México, 2013
To present data on infant and young child feeding practices (IYCFP) in Mexico from the 2012 Natio... more To present data on infant and young child feeding practices (IYCFP) in Mexico from the 2012 National Health and Nutrition Survey (ENSANUT 2012) to support the development of public policy. Women 12-49y and children <2y. Indicators of IYCFP suggested by WHO were analyzed by geographic, socioeconomic, participation in food programs and health insurance variables. Median duration of breast-feeding: 10.2mo and 14.4% with exclusive breastfeeding (EBF) <6m. Breastfeeding deteriorated in most vulnerable groups. Decline in EBF<6m 2006-2012 was explained by increases in consumption of formula and other milks (4%) and water (4%). Three-quarters (74%) of 6-11mo infants had minimum food diversity, and it was lower in the most vulnerable. Complementary feeding improved but breastfeeding declined in Mexico. Promotion actions must be integral, coordinated, financed and evaluated, with Federal government leadership and should include the participation of various stakeholders.