Teresita González de Cossío

Childhood and adolescent overweight and obesity in Latin America: a systematic review

The number of children and adolescents who are overweight or obese worldwide is alarming. We did a systematic review to estimate the prevalence of overweight and obesity in children aged 0-19 years in Latin America. We searched specialised databases and seven books for relevant studies that were done in Spanish-speaking and Portuguese-speaking Latin American and Caribbean countries and published in peer-reviewed journals between January 2008, and April 2013. Indicators used were BMI (kg/m(2)) in all age groups and weight-for-height in children younger than 5 years. We identified 692 publications and included 42. Estimated prevalence of overweight in children younger than 5 years in Latin America was 7·1% with the weight-for-height WHO 2006 classification method. National combined prevalences of overweight and obesity with the WHO 2007 classification method ranged from 18·9% to 36·9% in school-age children (5-11 years) and from 16·6% to 35·8% in adolescents (12-19 years). We estimated that 3·8 million children younger than 5 years, 22·2-25·9 million school-age children, and 16·5-21·1 million adolescents were overweight or obese. Overall, between 42·5 and 51·8 million children aged 0-19 years were affected-ie, about 20-25% of the population. Although undernutrition and obesity coexist in the region, policies in most countries favour prevention of undernutrition, and only a few countries have implemented national policies to prevent obesity. In view of the number of children who are overweight or obese, the associated detrimental effects on health, and the cost to health-care systems, implementation of programmes to monitor and prevent unhealthy weight gain in children and adolescents are urgently needed throughout Latin America.

Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in womens life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexicos progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexicos rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

Breastfeeding in Mexico Was Stable, on Average, but Deteriorated among the Poor, whereas Complementary Feeding Improved: Results from the 1999 to 2006 National Health and Nutrition Surveys

We present: 1) indicators of infant and young child feeding practices (IYCFP) and median age of introduction of foods analyzed by geographic and socioeconomic variables for the 2006 national probabilistic Health Nutrition Survey (ENSANUT-2006); and 2) changes in IYCFP indicators between the 1999 national probabilistic Nutrition Survey and ENSANUT-2006, analyzed by the same variables. Participants were women 12-49 y and their <2-y-old children (2953 in 2006 and 3191 in 1999). Indicators were estimated with the status quo method. The median age of introduction of foods was calculated by the Kaplan-Meier method using recall data. The national median duration of breastfeeding was similar in both surveys, 9.7 mo in 1999 and 10.4 mo in 2006, but decreased in the vulnerable population. In 1999 indigenous women breastfed 20.8 mo but did so for only 13.0 mo in 2006. The national percentage of those exclusively breastfeeding <6 mo also remained stable: 20% in 1999 and 22.3% in 2006. Nevertheless, exclusively breastfeeding <6 mo changed within the indigenous population, from 46% in 1999 to 34.5% in 2006. Between surveys, most breastfeeding indicators had lower values in vulnerable populations than in those better-off. Complementary feeding, however, improved overall. Complementary feeding was inadequately timed: median age of introduction of plain water was 3 mo, formula and non-human milk was 5 mo, and cereals, legumes, and animal foods was 5 mo. Late introduction of animal foods occurred among vulnerable indigenous population when 50% consumed these products at 8 mo. Mexican IYCFP indicate that public policy must protect breastfeeding while promoting the timely introduction of complementary feeding.

Does food insecurity compromise maternal dietary Zinc or energy intake in favor of her child, in rural poor Mexican households?

OBJECTIVE To analyze quantitative indicators of food insecurity (FI), and estimate if FI modifies the association between maternal and child Zinc and energy intake as evidence for maternal dietary compromise in favor of her child. MATERIAL AND METHODS Cross-sectional study (n=2 563), data derived from baseline impact evaluation of the Mexican Programa de Apoyo Alimentario. Quantitative indicators of FI were:Household food storage, maize and/or bean production, food expenditure, and spatial access to food markets. We evaluated percentage adequacy of energy (PAE) and Zinc (PAZn) intake. Multiple linear regression model was fitted to estimate the association between maternal and child PAE and PAZn. RESULTS Child PAE and PAZn were positively associated with those of their mothers. None of the FI indicators modified the association between maternal and child PAE and PAZn. CONCLUSIONS No evidence of maternal dietary compromise in favor of her child was observed using four quantitative indicators of FI in central-southern rural Mexican househods.

Sistema de etiquetado frontal de alimentos y bebidas para México: una estrategia para la toma de decisiones saludables

The Mexican Ministry of Health requested the National Institute of Public Health to constitute a group of independent, free of conflict-of-interest academic experts on front-of-pack labelling (FOP). This group was instructed to created a positioning paper to contribute to the development of a FOP system for industrialized products that offers useful information for purchase decision making. This position paper uses the best available scientific evidence, and recommendations from experts of international organizations. The FOP proposal focuses on the contents of energy, nutrients, ingredients and components that if consumed in excess on the diet, can be harmful to peoples health, such as added sugars, sodium, total fat, saturated fat and energy. The academic expert group recommends the implementation of a FOP that provides an easy way to quickly assess the quality of a product. It is essential that this FOP provides direct, simple, visible and easily understandable information.

Riesgo de sobrepeso en niños preescolares beneficiarios de programas de ayuda alimentaria

Objective To review the evidence regarding the potential impact of food programs on the risk of obesity in beneficiary children. Methods The search was conducted in databases using terms in Spanish and English. Those items that included the variable of interest, cross sectional studies, cohort or community trials were selected. Results Food assistance programs could contribute to increased obesity rates in the target population due to the availability and easier access to food with high energy content, either through the delivery of provisions or cash. However, the impact of the programs on this outcome has been little studied and evaluations have been mostly in adults or school-age children. Conclusion This review contributes to knowledge about the possible effect that food programs have on the risk of obesity in beneficiary children. This review may also serve as a reference for the design, implementation and evaluation of food and nutrition programs in countries of low and middle income facing malnutrition.