Sonia Rodríguez-Ramírez

Cash and In-Kind Transfers in Poor Rural Communities in Mexico Increase Household Fruit, Vegetable, and Micronutrient Consumption but Also Lead to Excess Energy Consumption

Conditional transfer programs are increasingly popular, but the impact on household nutrient consumption has not been studied. We evaluated the impact of the Programa de Apoyo Alimentario (PAL), a cash and in-kind transfer program, on the energy and nutrient consumption of poor rural households in Mexico. The program has been shown to reduce poverty. Beneficiary households received either a food basket (including micronutrient-fortified milk) or cash. A random sample of 206 rural communities in Southern Mexico was randomly assigned to 1 of 4 groups: a monthly food basket with or without health and nutrition education, a cash transfer with a cost to the government equivalent to the food basket (14 USD/mo) with education, or control. The impact after 14 mo of exposure was estimated in a panel of 5823 households using a double difference regression model with household fixed effects. PAL was associated with increases (P < 0.01) in the consumption of total energy (5-9%), energy from fruits and vegetables (24-28%), and energy from animal source foods (24-39%). It also affected iron, zinc, and vitamin A and C consumption (P < 0.05). The consumption of energy and all nutrients was greater in the food basket group (P < 0.05). Cash and in-kind transfers in populations that are not energy-deficient should be carefully redesigned to ensure that pulling poor families out of poverty leads to improved micronutrient intake but not to increased energy consumption.

Methodology for the analysis of dietary data from the Mexican National Health and Nutrition Survey 2006

OBJECTIVE To describe the methodology for the analysis of dietary data from the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) carried out in Mexico. MATERIAL AND METHODS Dietary data from the population who participated in the ENSANUT 2006 were collected through a 7-day food-frequency questionnaire. Energy and nutrient intake of each food consumed and adequacy percentage by day were also estimated. Intakes and adequacy percentages > 5 SDs from the energy and nutrient general distribution and observations with energy adequacy percentages < 25% were excluded from the analysis. RESULTS Valid dietary data were obtained from 3552 children aged 1 to 4 years, 8716 children aged 5 to 11 years, 8442 adolescents, 15951 adults, and 3357 older adults. CONCLUSIONS It is important to detail the methodology for the analysis of dietary data to standardize data cleaning criteria and to be able to compare the results of different studies.

Usual Intake of Added Sugars and Saturated Fats Is High while Dietary Fiber Is Low in the Mexican Population

BACKGROUND The Mexican National Health and Nutrition Survey (ENSANUT) was carried out in 2012. Information from the survey is used to design and evaluate food and nutrition policies in Mexico. OBJECTIVE The objective of this study was to estimate the usual intake of energy and macronutrients in the Mexican population by using the ENSANUT 2012. METHODS Twenty-four-hour recall interviews were administered to a nationally representative subsample of 10,096 individuals aged ≥1 y from the ENSANUT 2012. Usual intake distributions and the prevalence of inadequate intakes were estimated by using the Iowa State University method. Students t tests and tests on the equality of proportions were used to compare usual intakes and prevalence of inadequacy across socioeconomic status, area (rural or urban), and region of residence (North, Center, or South). RESULTS Energy and macronutrient intakes and indicators of dietary adequacy are presented for children (ages 1-4 y and 5-11 y), adolescents (12-19 y), and adults (≥20 y). At the national level, the estimated mean fiber intake was below the Adequate Intake for all population subgroups, suggesting inadequacies. The estimated proportion with a usual added sugars intake of >10% of total energy intake was >64% in all age groups. The proportion with a usual saturated fat intake of >10% of total energy intake was estimated to be >78% in children, >66% in adolescents, and >50% in adults. Overall, fiber intake was lower and intakes of saturated fat and added sugars were higher in urban compared with rural areas, in the North compared with South regions, and among those with high compared with low socioeconomic status (P < 0.05). CONCLUSIONS Fiber intake is lower and added sugar and saturated fat intakes are higher than recommended for >50% of the Mexican population aged ≥1 y. These results highlight the importance of improving the diets of the overall population to reduce the risk of noncommunicable chronic diseases.

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.

Energy and nutrient intake in Mexican adolescents: analysis of the Mexican National Health and Nutrition Survey 2006

OBJECTIVE To describe energy and nutrient intake and adequacy percentages in Mexican adolescents included in the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) as well as the proportion of population at risk of dietary inadequacy. MATERIAL AND METHODS Data were analyzed from 7-day food-frequency questionnaires for 8442 male and female adolescents 12-19 years old. Energy and nutrient adequacies as percentage of the Estimated Average Requirement were calculated and comparisons were done by region, residence area, and socioeconomic status (SES). RESULTS Energy intake was 1903 kcal [adequacy percentage (AP=75%)] in boys, and 1 571 kcal (AP=79.2%) in girls. Intake of most nutrients (zinc, iron, vitamin C and A) was lower in subjects of low SES, living in the southern region and in rural areas. CONCLUSIONS The rural area, the southern region, and the lower socioeconomic status show the lowest intakes and percentages of nutrient adequacy for both male and female adolescents, in particular vitamin A, folates, heme iron, zinc, and calcium.

Energy and nutrient intake in Mexican children 1 to 4 years old: results from the Mexican National Health and Nutrition Survey 2006

OBJECTIVE To document the energy and nutrient intake of Mexican preschool children using data from the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006). MATERIAL AND METHODS Dietary data from 3 552 children less than 5 years old collected through a semi-quantitative food frequency questionnaire were analyzed. Energy and nutrient daily intakes and adequacies were calculated. Comparisons were made by geographic region, residence locality, and socioeconomic status. RESULTS The Mexico City region showed the highest energy (103.2%), carbohydrate (109.9%), and fat (110.1%) adequacies. The highest proportion of preschoolers with energy and micronutrients inadequacy (adequacy < 100%) was observed in children of indigenous ethnicity, low socioeconomic status, living in rural localities, and in the south region. CONCLUSIONS This information may help as an indicator of food availability and access in different population strata and as a tool to focus interventions on those who may better benefit from food assistance programs.

High Prevalence of Inadequate Calcium and Iron Intakes by Mexican Population Groups as Assessed by 24-Hour Recalls

BACKGROUND A National Health and Nutrition Survey (ENSANUT) conducted in Mexico in 1999 identified a high prevalence of inadequate mineral intakes in the population by using 24-h recall questionnaires. However, the 1999 survey did not adjust for within-person variance. The 2012 ENSANUT implemented a more up-to-date 24-h recall methodology to estimate usual intake distributions and prevalence of inadequate intakes. OBJECTIVE We examined the distribution of usual intakes and prevalences of inadequate intakes of calcium, iron, magnesium, and zinc in the Mexican population in groups defined according to sex, rural or urban area, geographic region of residence, and socioeconomic status (SES). METHODS We used dietary intake data obtained through the 24-h recall automated multiple-pass method for 10,886 subjects as part of ENSANUT 2012. A second measurement on a nonconsecutive day was obtained for 9% of the sample. Distributions of usual intakes of the 4 minerals were obtained by using the Iowa State University method, and the prevalence of inadequacy was estimated by using the Institute of Medicines Estimated Average Requirement cutoff. RESULTS Calcium inadequacy was 25.6% in children aged 1-4 y and 54.5-88.1% in subjects >5 y old. More than 45% of subjects >5 y old had an inadequate intake of iron. Less than 5% of children aged <12 y and 25-35% of subjects aged >12 y had inadequate intakes of magnesium, whereas zinc inadequacy ranged from <10% in children aged <12 y to 21.6% in men aged ≥20 y. Few differences were found between rural and urban areas, regions, and tertiles of SES. CONCLUSIONS Intakes of calcium, iron, magnesium, and zinc are inadequate in the Mexican population, especially among adolescents and adults. These results suggest a public health concern that must be addressed.

Validity of a food frequency questionnaire to assess food intake in Mexican adolescent and adult population

Objective: To assess the validity of a 140-item semiquantitative food frequency questionnaire (SFFQ), in Mexican adolescents and adults. Materials and methods: Dietary intakes using a SFFQ and two 24-hour dietary recalls (24DRs), in nonconsecutive days during the same week were measured from 178 adolescents and 230 adults participating in the Mexican National Health and Nutrition Survey-2012.Validity was evaluated using correlation coefficients (CC),deattenuated CC, linear regression models, cross-classification analysis, and the Bland-Altman method. Results: In adults, deattenuated correlation coefficients between the SFFQ and the 24DRs ranged from 0.30 for folate to 0.61 for saturated fat. In addition, 63% adults and 62% adolescents were classified in the same and adjacent quartile of nutrient intake when comparing data from SFFQ and 24DRs. Conclusions: The SFFQ had moderate validity for energy, macronutrients and micronutrients. It also had good validity to rank individuals according to their dietary intake of different nutrients.

Methodology for estimating dietary data from the semi-quantitative food frequency questionnaire of the Mexican National Health and Nutrition Survey 2012

Objective: To describe the methodology used to clean up and estimate dietary intake (DI) data from the Semi-Quantitative Food Frequency Questionnaire (SFFQ) of the Mexican National Health and Nutrition Survey 2012. Materials and methods: DI was collected through a shortterm SFFQ regarding 140 foods (from October 2011 to May 2012). Energy and nutrient intake was calculated according to a nutrient database constructed specifically for the SFFQ. Results: A total of 133 nutrients including energy and fiber were generated from SFFQ data. Between 4.8 and 9.6% of the survey sample was excluded as a result of the cleaning process.Valid DI data were obtained regarding energy and nutrients consumed by 1 212 pre-school children, 1 323 school children, 1 961 adolescents, 2 027 adults and 526 older adults. Conclusions: We documented the methodology used to clean up and estimate DI from the SFFQ used in national dietary assessments in Mexico.

Usual Vitamin Intakes by Mexican Populations

BACKGROUND In the past several years, the consumption of high-energy, nutrient-poor foods has increased globally. Dietary intake data collected by the National Health and Nutrition Survey (ENSANUT) 2012 provide information to assess the quality of the Mexican diet and to guide food and nutrition policy. OBJECTIVE The aim was to describe the usual intake and the prevalence of inadequate intakes of vitamins for the overall Mexican population and by subgroups defined by sex, age, region, urban or rural areas, and socioeconomic status (SES). METHODS ENSANUT 2012 is a cross-sectional probabilistic survey representative of the Mexican population. Dietary information was collected by using the 24-h recall automated multiple-pass method (n = 10,096) with a repeated measurement on a subsample (n = 889) to permit adjustment for intraindividual variability with the use of the Iowa State University method. Mean usual intakes and the prevalence of inadequate intakes of thiamin, riboflavin, niacin, folate, and vitamins A, D, E, C, B-6, and B-12 were calculated for children aged 1-4 y (CH1-4y), children aged 5-11 y (CH5-11y), adolescents aged 12-19 y, and adults aged ≥20 y. RESULTS In all of the age groups, prevalences of inadequate intakes of vitamins D and E were the highest (77-99% of adults and adolescents and 53-95% of CH5-11y and CH1-4y) and those of folate and vitamin A were intermediate (47-70% of adults and adolescents, 15-23% of CH5-11y and 8-13% of CH1-4y), whereas those of thiamin, riboflavin, niacin, and vitamins B-6, B-12, and C were the lowest (0-37% of adults, 1-27% of adolescents, and 0-2.4% of CH5-11y and CH1-4y). With few exceptions, the highest prevalences of inadequate intakes for vitamins were observed in the poorest populations (rural South region and the lowest tertile of SES). CONCLUSIONS The intake of vitamins among Mexicans is inadequate overall. Information collected by ENSANUT can help target food assistance programs and develop strategies to prevent vitamin deficiencies.