Marco González-Unzaga

Prevalence of anemia and deficiency of iron, folic acid, and zinc in children younger than 2 years of age who use the health services provided by the Mexican Social Security Institute

BackgroundIn Mexico, as in other developing countries, micronutrient deficiencies are common in infants between 6 and 24 months of age and are an important public health problem. The objective of this study was to determine the prevalence of anemia and of iron, folic acid, and zinc deficiencies in Mexican children under 2 years of age who use the health care services provided by the Mexican Institute for Social Security (IMSS).MethodsA nationwide survey was conducted with a representative sample of children younger than 2 years of age, beneficiaries, and users of health care services provided by IMSS through its regular regimen (located in urban populations) and its Oportunidades program (services offered in rural areas). A subsample of 4,955 clinically healthy children was studied to determine their micronutrient status. A venous blood sample was drawn to determine hemoglobin, serum ferritin, percent of transferrin saturation, zinc, and folic acid. Descriptive statistics include point estimates and 95% confidence intervals for the sample and projections for the larger population from which the sample was drawn.ResultsTwenty percent of children younger than 2 years of age had anemia, and 27.8% (rural) to 32.6% (urban) had iron deficiency; more than 50% of anemia was not associated with low ferritin concentrations. Iron stores were more depleted as age increased. Low serum zinc and folic acid deficiencies were 28% and 10%, respectively, in the urban areas, and 13% and 8%, respectively, in rural areas. The prevalence of simultaneous iron and zinc deficiencies was 9.2% and 2.7% in urban and rural areas. Children with anemia have higher percentages of folic acid deficiency than children with normal iron status.ConclusionIron and zinc deficiencies constitute the principal micronutrient deficiencies in Mexican children younger than 2 years old who use the health care services provided by IMSS. Anemia not associated with low ferritin values was more prevalent than iron-deficiency anemia. The presence of micronutrient deficiencies at this early age calls for effective preventive public nutrition programs to address them.

Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City.

BackgroundMexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics.MethodsWe randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children’s height and weight and parents reported children’s diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values.Results93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program.ConclusionsAlthough satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI.Trial registrationClinicalTrials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.

Necesidades de salud en áreas urbanas marginadas de México

OBJETIVO: Evaluar las necesidades de salud de la poblacion residente en areas urbanas marginadas de Mexico. METODOS: Encuesta poblacional a familias residentes en colonias urbanas pobres de cinco regiones geograficas de Mexico (Norte, Centro, Sur, Sureste y Ciudad de Mexico), seleccionadas mediante un muestreo polietapico. Se realizaron entrevistas y mediciones antropometricas en sus domicilios a todos los integrantes de las familias seleccionadas y se analizaron las caracteristicas de salud positiva, nutricion, salud reproductiva, danos a la salud y salud mental por grupos de analisis formados por edad y sexo. RESULTADOS: Participaron 24 707 personas. En los entrevistados se observo una baja escolaridad (6 anos o menos) y solo 46,8% tuvo cobertura de servicios de salud, ya fuera en instituciones publicas o privadas. De los ninos, 19,8% presentaba desmedro y el sobrepeso predomino a partir de la adolescencia. En los adolescentes de 12 a 19 anos, 15,7% tenia vida sexual activa, pero solo 57,7% de los hombres y 41,9% de las mujeres de ese grupo de edad usaban algun metodo anticonceptivo. De los adultos, 5,9% padecia diabetes y 11,5% hipertension arterial. En la muestra de adolescentes, adultos y adultos mayores, el tabaquismo fue de 21,2%, el consumo de alcohol de 36,0%, el uso de drogas de 9,5% y la depresion de 20,2%. CONCLUSIONES: La vulnerabilidad sanitaria de las personas que viven en las areas urbanas marginadas de Mexico se manifiesta en la existencia de una poblacion joven, con pocas redes de apoyo familiar y de servicios de salud, que sufre trastornos y enfermedades, como la desnutricion infantil, el alto riesgo reproductivo y las adicciones en adolescentes y adultos, producto del rezago en el desarrollo social. La prevalencia de enfermedades cronicas fue similar a la de la poblacion mexicana no marginada.

Efecto de una intervención basada en guarderías para reducir conductas de riesgo de obesidad en niños preescolares

BACKGROUND Preschool age is a critical stage for health promotion and prevention of obesity, which is an emerging public health problem in children. The aim of this study was to design and evaluate the effect of a multifaceted intervention based on child-care centers to reduce risk behaviors for obesity among preschool children. METHODS A 12-month cluster-randomized community trial was conducted in 16 Mexican Institute of Social Security child-care centers in Mexico City. Children between 2 and 4 years of age enrolled in the selected child-care centers participated in the study. Intervention comprised 12 weekly curriculum sessions for the children, and six family workshops. Changes in childrens dietary and physical activity, food availability at home, and maternal feeding styles were determined after 6 and 12 months. Changes within groups among stages, and between groups by stage were analyzed through χ2 test. RESULTS The intervention showed decrease of home availability for some non-recommended foods and increase in physical activity in the intervention group compared to the usual care group. CONCLUSIONS Improvement in physical activity can be effective in the long term; innovative strategies aimed to modify family dietary risk behaviors are required.

The Social Construction of Anemia in School Shelters for Indigenous Children in Mexico

Indigenous children in school shelters in Mexico suffer from anemia in spite of food that is subsidized, prepared, and served to them. Economically and biomedically centered strategies to reduce anemia have achieved only partial and short-term success. An interdisciplinary team investigated the food security system of the school shelters and collected data through interviews and participant observation. The analysis revealed that the childrens nutrition depends on a frail chain of events in which a single links failure can lead to nutritional insecurity. The authors conclude that the social actors involved in the process are mainly considering the economic aspects of nutrition, but anemia persists as a social construction of the faulty relationship between the institution that runs the shelters and the indigenous culture. The authors make suggestions for an intervention that empowers the community by involving it actively in solving the problem.

Effect of an intervention based on child-care centers to reduce risk behaviors for obesity in preschool children

Abstract Background Preschool age is a critical stage for health promotion and prevention of obesity, which is an emerging public health problem in children. The aim of this study was to design and evaluate the effect of a multifaceted intervention based on child-care centers to reduce risk behaviors for obesity among preschool children. Methods A 12-month cluster-randomized community trial was conducted in 16 Mexican Institute of Social Security child-care centers in Mexico City. Children between 2 and 4 years of age enrolled in the selected child-care centers participated in the study. Intervention comprised 12 weekly curriculum sessions for the children, and six family workshops. Changes in children’s dietary and physical activity, food availability at home, and maternal feeding styles were determined after 6 and 12 months. Changes within groups among stages, and between groups by stage were analyzed through X2 test. Results The intervention showed a decrease of home availability for some non-recommended foods and an increase in physical activity in the intervention group compared to the control group. Conclusions Improvement in physical activity can be effective in the long term; innovative strategies aimed to modify family dietary risk behaviors are required.

Preferencias alimentarias y estado de nutrición en niños escolares de la Ciudad de México

BACKGROUND Childhood is a basic period for the development of habits and their continuation during the course of life. The objective of this study was to identify food preferences and their variations according to the nutritional status in school-age children living in Mexico City. METHODS A cross-sectional study was carried out including 1465 school-age children attending eight public elementary schools in Mexico City. Children were asked to complete a questionnaire regarding their preferences to 70 selected different foods. Anthropometric measurements were also carried out. Parents of the children provided sociodemographic information. For each food, the preference was evaluated using a Likert scale. Frequencies were calculated for the total sample and for different nutritional status levels. RESULTS Median age of children was 9 years old. Forty-eight percent of the children were overweight or obese. The most preferred foods were fruits, pizzas, flavored milk, and French fries. The least preferred foods were vegetables, whole-grain cereals, fish, meat, and panela cheese. Plain water (72%) and sugar-sweetened beverages (71%) had a high level of preference. There was no preference variation according to nutritional status. CONCLUSIONS Food preference patterns of school-age children are a risk for unhealthy food consumption as well as for the increase in obesity prevalence in this population. Interventions focused on the promotion of a healthy food environment are necessary, aimed at improving food preferences from early childhood.

Food preferences and nutritional status in school-age children living in Mexico City

BACKGROUND Childhood is a basic period for the development of habits and their continuation during the course of life. The objective of this study was to identify food preferences and their variations according to the nutritional status in school-age children living in Mexico City. METHODS A cross-sectional study was carried out including 1465 school-age children attending eight public elementary schools in Mexico City. Children were asked to complete a questionnaire regarding their preferences to 70 selected different foods. Anthropometric measurements were also carried out. Parents of the children provided sociodemographic information. For each food, the preference was evaluated using a Likert scale. Frequencies were calculated for the total sample and for different nutritional status levels. RESULTS Median age of children was 9 years old. Forty-eight percent of the children were overweight or obese. The most preferred foods were fruits, pizzas, flavored milk, and French fries. The least preferred foods were vegetables, whole-grain cereals, fish, meat, and panela cheese. Plain water (72%) and sugar-sweetened beverages (71%) had a high level of preference. There was no preference variation according to nutritional status. CONCLUSIONS Food preference patterns of school-age children are a risk for unhealthy food consumption as well as for the increase in obesity prevalence in this population. Interventions focused on the promotion of a healthy food environment are necessary, aimed at improving food preferences from early childhood.

Artículo de investigaciónPreferencias alimentarias y estado de nutrición en niños escolares de la Ciudad de MéxicoFood preferences and nutritional status in school-age children living in Mexico City

BACKGROUND Childhood is a basic period for the development of habits and their continuation during the course of life. The objective of this study was to identify food preferences and their variations according to the nutritional status in school-age children living in Mexico City. METHODS A cross-sectional study was carried out including 1465 school-age children attending eight public elementary schools in Mexico City. Children were asked to complete a questionnaire regarding their preferences to 70 selected different foods. Anthropometric measurements were also carried out. Parents of the children provided sociodemographic information. For each food, the preference was evaluated using a Likert scale. Frequencies were calculated for the total sample and for different nutritional status levels. RESULTS Median age of children was 9 years old. Forty-eight percent of the children were overweight or obese. The most preferred foods were fruits, pizzas, flavored milk, and French fries. The least preferred foods were vegetables, whole-grain cereals, fish, meat, and panela cheese. Plain water (72%) and sugar-sweetened beverages (71%) had a high level of preference. There was no preference variation according to nutritional status. CONCLUSIONS Food preference patterns of school-age children are a risk for unhealthy food consumption as well as for the increase in obesity prevalence in this population. Interventions focused on the promotion of a healthy food environment are necessary, aimed at improving food preferences from early childhood.