Sonia Hernández-Cordero

Substituting Water for Sugar-Sweetened Beverages Reduces Circulating Triglycerides and the Prevalence of Metabolic Syndrome in Obese but Not in Overweight Mexican Women in a Randomized Controlled Trial

Abstract Background: Mexicos sugar-sweetened beverage (SSB) intake is among the highest globally. Although evidence shows that increases in SSB intake are linked with increased energy intake, weight gain, and cardiometabolic risks, few randomized clinical trials have been conducted in adults. Objective: The aim of this study was to determine if replacing SSBs with water affects plasma triglycerides (TGs) (primary outcome), weight, and other cardiometabolic factors. Methods: We selected overweight/obese (BMI ≥25 and <39 kg/m2) women (18–45 y old) reporting an SSB intake of at least 250 kcal/d living in Cuernavaca, Mexico. Women were randomly allocated to the water and education provision (WEP) group (n = 120) or the education provision (EP)–only group (n = 120). The WEP group received biweekly water deliveries, and both groups received equal monthly nutrition counseling. During nutrition counseling, the WEP group sessions included activities to encourage increased water intake, reduced SSB intake, and substitution of water for SSBs. Repeated 24-h dietary recalls, anthropometric measurements, and fasting blood samples were collected at baseline and at 3, 6, and 9 mo. The Markov–Monte Carlo method was used for multiple imputation; separate mixed-effects models tested each outcome. Results: An intent-to-treat (ITT) analysis indicated that the WEP group increased water intake and decreased SSB intake significantly over time, but there were no differences in plasma TG concentrations between groups at the end of the intervention (WEP at baseline: 155 ± 2.10 mg/dL; WEP at 9 mo: 149 ± 2.80 mg/dL; EP at baseline: 150 ± 1.90 mg/dL; EP at 9 mo: 161 ± 2.70 mg/dL; P for mean comparisons at 9 mo = 0.10). Secondary analyses showed significant effects on plasma TGs (change from baseline to 9 mo: WEP, −28.9 ± 7.7 mg/dL; EP, 8.5 ± 10.9 mg/dL; P = 0.03) and metabolic syndrome (MetS) prevalence at 9 mo (WEP: 18.1%; EP: 37.7%; P = 0.02) among obese participants. Conclusions: Providing water and nutritional counseling was effective in increasing water intake and in partially decreasing SSB intake. We found no effect on plasma TGs, weight, and other cardiometabolic risks in the ITT analysis, although the intervention lowered plasma TGs and MetS prevalence among obese participants. Further studies are warranted. This trial was registered at http://www.clinicaltrials.gov as NCT01245010.

A Water and Education Provision Intervention Modifies the Diet in Overweight Mexican Women in a Randomized Controlled Trial

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 time point (low <1200 vs. high ≥1200 mL/d). RESULTS The WEP group reported greater decreases in SSB intake than the EP group (from 20.9% to 10.3% of energy/d vs. from 20.1% to 17.8%). Thirty-eight percent of the EP group and 84.3% of the WEP group reported attaining a water intake ≥1200 mL/d. Reductions in energy intake and food groups were similar across intervention groups. However, the high actual water intake group reported greater increases vs. the lower intake group in intake of fruits and vegetables (117 vs. 47 g/d), as well as larger reductions in salty snacks (4.6 vs. 0.7 g/d) and cakes and cookies (31.7 vs. 14.7 g/d). CONCLUSIONS Other than SSBs, improvements in food group intake did not differ by intervention group in overweight Mexican women. However, post hoc analyses suggested that achieving a high actual water intake was associated with additional beneficial changes in food group intake. This trial was registered at clinicaltrials.gov as NCT01245010.

Recomendaciones para una política nacional de promoción de la lactancia materna en México: postura de la Academia Nacional de Medicina

Para mejorar las practicas de lactancia materna es necesario fortalecer acciones de promocion, proteccion y apoyo, y establecer una politica nacional multisectorial que incluya elementos indispensables de diseno, implementacion, monitoreo y evaluacion de programas y politicas publicas, financiamiento para acciones e investigacion, desarrollo de abogacia y voluntad politica, y promocion de la lactancia materna, todo coordinado por un nivel central. Recientemente, Mexico ha iniciado un proceso de reformas conducentes a la conformacion de una Estrategia Nacional de Lactancia Materna (ENLM). Esta estrategia es el resultado de la disponibilidad de evidencia cientifica sobre los beneficios de la lactancia materna en la salud de la poblacion y el desarrollo de capital humano asi como de los datos alarmantes de su deterioro. La implementacion integral de una ENLM que incluya el establecimiento de un Comite Nacional Operativo, coordinacion intra e intersectorial de acciones, establecimiento de metas claras, monitoreo y penalizacion de las violaciones al Codigo Internacional de Comercializacion de Sucedaneos de la Leche Materna, y financiamiento de estas acciones es la gran responsabilidad pendiente de la agenda de salud publica del pais.

Impact of a Water Intervention on Sugar-Sweetened Beverage Intake Substitution by Water: A Clinical Trial in Overweight and Obese Mexican Women.

Background/Aims: Intense marketing for sugar-sweetened beverages (SSB) along with the human innate preference for sweet taste contributes to the increase in consumption of SSB. It is important to understand the intricacies of dietary intake and global changes to the food supply to understand the complexities facing any intervention promoting water intake. We describe challenges to promote and achieve an increase in water intake and present key findings from a clinical trial examining the effects of substituting water for SSB on triglyceride levels, weight and other cardiometabolic factors in overweight/obese Mexican women. Methods: A randomized trial was conducted in Cuernavaca, Mexico selecting overweight/obese (BMI ≥25 and <39 kg/m2) women (18-45 years old), reporting an intake of SSB of at least 250 kcal/day. Women were randomly allocated to the water and education provision (WEP) group (n = 120) or to the education provision (EP) group (n = 120). Repeated 24 h dietary recall questionnaires, anthropometry, and fasting blood levels were collected at baseline and 3, 6, and 9 months following the intervention. Results: There was no effect of the intervention on triglyceride concentration or on any of the studied outcomes. Post-hoc analyses according to weight at baseline show that triglyceride concentration decreased in obese women. Prevalence of metabolic syndrome after the intervention was lower in obese women from the WEP group. Conclusion: Water intake was increased but insufficient to achieve complete substitution of SSB, without effects on triglyceride concentration. Post-hoc analyses suggested that interventions lowered triglyceride concentration. Further studies are needed.

Patrones dietéticos y síndrome metabólico en mujeres con exceso de peso de 18 a 45 años de edad

Resumen: Objetivo: Analizar la asociacion de patrones dieteticos y componentes del sindrome metabolico (SM) en mujeres adultas con exceso de peso. Material y metodos: Estudio transversal que incluye datos antropometricos, dieteticos, bioquimicos y de presion arterial. Se identificaron patrones dieteticos mediante analisis de factores y se emplearon modelos de regresion logistica multiple, para analizar asociaciones. Resultados: Las prevalencias fueron: glucosa alterada 14.6%, hipertrigliceridemia 40.4%, lipoproteinas de alta densidad (HDLc) bajas 45.0%, hipertension 4.6% y SM de 30%. El patron con alto consumo de tortilla de maiz, carnes y leguminosas se asocio con menor posibilidad de hiperglucemia (OR= 0.62; IC95% 0.39-0.98). El patron con alto consumo de botanas dulces y saladas, leche, arroz, sopas y pastas, se asocio inversamente con la posibilidad de baja concentracion de HDLc (OR= 0.76; IC95% 0.60-0.97). Conclusiones: Un patron dietetico con mayor consumo de leguminosas, carne y tortilla de maiz se asocio con menor posibilidad de tener hiperglucemia.

Comparing a 7-day diary vs. 24 h-recall for estimating fluid consumption in overweight and obese Mexican women

BackgroundHigh intake of sugar-sweetened beverages (SSB) is linked to increased weight, energy intake, and diabetes. Even though the increasing interest on beverages and water intake, there are few dietary tools carefully validated. The purpose of this paper is to compare a fluid intake 7-day diary against a 24-h recall questionnaire to estimate the fluid consumption in overweight and obese women participating in a randomized controlled trial in Mexico.MethodsThis cross-sectional study explored the correlation of reported fluid consumption between two methods: 3-day 24-hr recalls and 7-day diary beverage registry in overweight and obese Mexican women aged 18–45 y (n = 190).ResultsThere was no difference on median estimated volume (mL/d), nor the median estimated energy (kcal/d) from total beverage consumption registered by the two dietary tools. The crude and rank correlation among the two dietary instruments was high for total fluid consumption in mL/d r = 0.7, p < 0.001 (crude and rank correlation) and for fluid consumption measured as energy intake: r = 0.7; p < 0.001 crude, and r = 0.5; p < 0.001 rank correlation. By type of beverage, the more meaningful rank correlations were for fluid intake in: mL/d, water, alcohol beverages, and SSB; and in kcal/d, alcohol beverages and SSBs (rank correlation ≥ 0.6).ConclusionsOverall, the 7-day diary showed high and strong rank correlations with that reported in the 24-h recall, suggesting that the diary method is a valid dietary tool to evaluate total fluid, water and SSB intake in this population.

Tendencias de la mala nutrición en menores de cinco años en México, 1988-2016: análisis de cinco encuestas nacionales

Resumen: Objetivo: Estudiar la magnitud, distribucion y tendencias de la desnutricion y el peso excesivo en menores de cinco anos entre 1988 y 2016. Material y metodos: Se calcularon prevalencias de bajo peso, emaciacion, desnutricion cronica y sobrepeso, en el ambito nacional, en cuatro regiones y localidades urbanas/rurales, en menores de cinco anos obtenidas en encuestas nacionales probabilisticas en 1988, 1999, 2006, 2012 y 2016. Resultados: Actualmente 3.9% de la muestra tiene bajo peso, 1.9% emaciacion y 10% desnutricion cronica. Hubo un descenso en la desnutricion cronica de 1988 a 2016 (26.9 vs 10.0%), en localidades rurales (43.1 vs 12.6%) y urbanas (22.5 vs 9.1%) y en el sur (38.6 vs 13.4%), centro (29.2 vs 8.4%) y Ciudad de Mexico (13.6 vs 4.7%). En el Norte el descenso fue menor (13.3 vs 11.4%). El sobrepeso disminuyo de 9.7% a 5.8%, entre 2012-2016. Conclusiones: La desnutricion cronica continua a la baja en Mexico, pero persisten prevalencias elevadas en grupos vulnerables. El sobrepeso presento una disminucion inesperada entre 2012-2016.