101
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Tolentino-Mayo L, Rincón-Gallardo Patiño S, Bahena-Espina L, Ríos V, Barquera S. Conocimiento y uso del etiquetado nutrimental de alimentos y bebidas industrializados en México. ACTA ACUST UNITED AC 2018; 60:328-337. [DOI: 10.21149/8825] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 02/16/2018] [Indexed: 11/06/2022]
Abstract
Objetivo. Documentar el conocimiento y uso de la información de las diferentes etiquetas colocadas en los productos industrializados en México. Material y métodos. En una submuestra de la Encuesta Nacional de Salud y Nutrición de Medio Camino 2016, se aplicó un cuestionario semiestructurado, desarrollado por investigadores libres de conflicto de interés, previamente validado y piloteado en población de diferentes estratos socioeconómicos, grupos de edad y regiones del país. Resultados. Se entrevistó a 8 667 adultos ≥20 años de edad. El etiquetado más utilizado para la elección de alimentos y bebidas industrializados fue la “tabla nutrimental” 41.5% (IC95% 36.9-46.3) y el de menor uso el “sello nutrimental” 4.3% (IC95% 3.1-5.7). Conclusiones. Es de suma importancia que las instancias reguladoras, en coordinación con la Secretaría de Salud, implementen un etiquetado frontal rápido de leer y de fácil comprensión con criterios nutrimentales que garanticen el cumplimiento de lo expuesto en los documentos oficiales, así como la estandarización del porcentaje de consumo de azúcar al recomendado por la OMS o a una menor cantidad dada la alerta epidemiológica por diabetes que experimenta el país.
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102
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Barquera S, Hernández-Barrera L, Rothenberg SJ, Cifuentes E. The obesogenic environment around elementary schools: food and beverage marketing to children in two Mexican cities. BMC Public Health 2018; 18:461. [PMID: 29625608 PMCID: PMC5889561 DOI: 10.1186/s12889-018-5374-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/26/2018] [Indexed: 12/02/2022] Open
Abstract
Background Unhealthy environments and food advertisements are major determinants of childhood obesity. Recent regulation has banned unhealthy foods from schools in Mexico. However, currently there is no regulation limiting exposure to food marketing around schools. Thus, our objective was to analyze the characteristics of food advertising practices around 60 elementary schools in two cities and to evaluate compliance with the Pan American Health Organization (PAHO) recommendations and the local food industry self-regulatory marketing code. Methods Data were collected during the period of October 2012 to March 2013. A random sample of elementary schools was selected from two Mexican cities. Using geographic information systems, we drew a 100-m-diameter buffer around each school. Trained personnel obtained photographs to assess the locations and types of food advertisements. Our results were stratified by school type and by indicators of compliance with the PAHO and industry recommendations. We developed a multivariate negative binomial regression model to determine factors predicting the number of advertisements around schools. Results The number of advertisements was significantly higher around public schools than around private schools (6.5 ± 5.6 vs. 2.4 ± 3.5, p < 0.05). Printed posters were the most common type of marketing medium (97%), showing mostly sugar-sweetened beverages, sweet breads, candies, and bottled water. Promotions, such as special prices or gifts, were included on 30% of printed posters. Food advertising practices were often in compliance with industry recommendations (83%) but not with those from the PAHO (32%) (p < 0.001). Conclusion Our results support the importance of monitoring the obesogenic environment and identifying policy tools to protect children from food marketing not only inside schools but also around them, particularly in lower income communities.
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Affiliation(s)
- Simón Barquera
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Lucia Hernández-Barrera
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Stephen J Rothenberg
- Center for Research in Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Enrique Cifuentes
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
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103
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Panton UH, Bagger M, Barquera S. Projected diabetes prevalence and related costs in three North American urban centres (2015–2040). Public Health 2018; 157:43-49. [DOI: 10.1016/j.puhe.2017.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/17/2017] [Accepted: 12/22/2017] [Indexed: 01/04/2023]
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104
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Medina C, Janssen I, Barquera S, Bautista-Arredondo S, González ME, González C. Occupational and leisure time physical inactivity and the risk of type II diabetes and hypertension among Mexican adults: A prospective cohort study. Sci Rep 2018; 8:5399. [PMID: 29599426 PMCID: PMC5876361 DOI: 10.1038/s41598-018-23553-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/14/2018] [Indexed: 01/09/2023] Open
Abstract
There is a lack of longitudinal data linking physical inactivity and chronic diseases among Mexicans. Objective. To examine the relationship between total, leisure and occupational moderate-to-vigorous physical activity (MVPA) and incidence of type II diabetes (T2D) and hypertension in the Mexico City Diabetes Study. Study design and population. A prospective cohort study was conducted from 1989 to 2009 among 2282 men and non-pregnant women residing in six low-income neighborhoods in Mexico City. Main outcome. Incidence of T2D and hypertension. Results. After controlling for confounders, <1 MET/min/week of MVPA during leisure time was associated with higher risk of hypertension (HR 1.29, CI 95% 1.01, 1.66) and T2D (HR 1.31 CI 95% 1.00, 1.74). In addition, accumulating <1 MET/min/week of occupational MVPA was associated with higher risk of hypertension (HR 1.47, CI 95% 1.13, 1.90). Conclusion. The absence of leisure and occupational MVPA was associated with an increased risk of hypertension. However, no associations were found between occupational MVPA and T2D.
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Affiliation(s)
- C Medina
- Mexican National Institute of Public Health, Health and Nutrition Research Center, Cuernavaca, Mexico.,Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - I Janssen
- Queen's University, School of Kinesiology and Health Studies, Kingston, Canada
| | - S Barquera
- Mexican National Institute of Public Health, Health and Nutrition Research Center, Cuernavaca, Mexico
| | - S Bautista-Arredondo
- Mexican National Institute of Public Health, Division of Health Economics, Cuernavaca, Mexico
| | - M E González
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - C González
- Mexican National Institute of Public Health, Unit for Research in Diabetes and Cardiovascular Risk, Cuernavaca, Mexico. .,Centro de Estudios en Diabetes, Mexico City, Mexico.
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105
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Denova-Gutiérrez E, Tucker KL, Salmerón J, Flores M, Barquera S. Relative validity of a food frequency questionnaire to identify dietary patterns in an adult Mexican population. Salud Publica Mex 2018; 58:608-616. [PMID: 28225937 DOI: 10.21149/spm.v58i6.7842] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/12/2016] [Indexed: 11/06/2022] Open
Abstract
Objective: To examine the validity of a semi-quantitative food frequency questionnaire (SFFQ) to identify dietary patterns in an adult Mexican population. Materials and methods: A 140-item SFFQ and two 24-hour dietary recalls (24DRs) were administered. Foods were categorized into 29 food groups used to derive dietary patterns via factor analysis. Pearson and intraclass correlations coefficients between dietary pattern scores identified from the SFFQ and 24DRs were assessed. Results: Pattern 1 was high in snacks, fast food, soft drinks, processed meats and refined grains; pattern 2 was high in fresh vegetables, fresh fruits, and dairy products; and pattern 3 was high in legumes, eggs, sweetened foods and sugars. Pearson correlation coefficients between the SFFQ and the 24DRs for these patterns were 0.66 (P<0.001), 0.41 (P<0.001) and 0.29 (P=0.193) respectively. Conclusions: Our data indicate reasonable validity of the SFFQ, using factor analysis, to derive major dietary patterns in comparison with two 24DR.
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Affiliation(s)
- Edgar Denova-Gutiérrez
- Unidad de Investigacion en Epidemiología Clínica, Hospital Infantil de México. Ciudad de México, México
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell. Lowell, MA, USA
| | - Jorge Salmerón
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México.,Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social. Cuernavaca, México
| | - Mario Flores
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
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106
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Medina C, Tolentino-Mayo L, López-Ridaura R, Barquera S. Evidence of increasing sedentarism in Mexico City during the last decade: Sitting time prevalence, trends, and associations with obesity and diabetes. PLoS One 2017; 12:e0188518. [PMID: 29194458 PMCID: PMC5711014 DOI: 10.1371/journal.pone.0188518] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/08/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Sedentary behaviors such as sitting time are associated with obesity and diabetes independently of total reported physical activity. This study aimed to describe the current sitting time/day prevalence and trends and to examine the association of sitting time with sociodemographic and clinical variables in Mexico City. METHODS Two cross-sectional representative surveys in Mexico City were used for this analysis (2006: n = 1148 and 2015: n = 1329). Sedentary behavior questions from the International Physical Activity Questionnaire included time spent sitting on a weekday in the last week or on a Wednesday. Sitting time /day was divided into deciles, and participants in the highest decile (≥ 420 minutes/day) were classified within the high sitting category; others were classified in the low sitting time category. Multivariate logistic regression was used to evaluate the associations of sitting time with sociodemographic and clinical indicators, controlling for confounders and testing for potential interactions. RESULTS A total of 13.7% (2006) and 14.8% (2015) adults were classified in the highest sitting time category (≥ 420 minutes/day). There was a significant increase in the average sitting time/day between the surveys (216.0 minutes in 2006 vs. 233.3 minutes in 2015, p < 0.001). In 2015, men, those aged 20-49 years, those in low-intensity jobs, students, and those with a high socioeconomic level were more likely to be in the highest sitting time category. Participants with overweight/obesity (OR = 2.37, 95% CI: 1.11, 5.09) and those with high glucose levels (survey finding) (OR = 2.34, 95% CI: 1.04, 5.25) were more likely to report sitting time in the highest category. DISCUSSION Sitting time/day prevalence increased 8%, and average daily sitting minutes significantly increased by 8.2% (18 minutes) in the nine-year study period (2006-2015). Current public health policies should consider strategies not only for increasing physical activity levels, but also for reducing sitting time/day among the population as a measure to fight the growing epidemic of obesity and diabetes in Mexico.
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Affiliation(s)
- Catalina Medina
- Mexican National Institute of Public Health, Cuernavaca, Morelos, México
| | | | - Ruy López-Ridaura
- Mexican National Institute of Public Health, Cuernavaca, Morelos, México
| | - Simón Barquera
- Mexican National Institute of Public Health, Cuernavaca, Morelos, México
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107
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Mendoza-Herrera K, Quezada AD, Pedroza-Tobías A, Hernández-Alcaraz C, Fromow-Guerra J, Barquera S. A Diabetic Retinopathy Screening Tool for Low-Income Adults in Mexico. Prev Chronic Dis 2017; 14:E95. [PMID: 29023230 PMCID: PMC5645201 DOI: 10.5888/pcd14.170157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A national diabetic retinopathy screening program does not exist in Mexico as of 2017. Our objective was to develop a screening tool based on a predictive model for early detection of diabetic retinopathy in a low-income population. METHODS We analyzed biochemical, clinical, anthropometric, and sociodemographic information from 1,000 adults with diabetes in low-income communities in Mexico (from 11,468 adults recruited in 2014-2016). A comprehensive ophthalmologic evaluation was performed. We developed the screening tool through the following stages: 1) development of a theoretical predictive model, 2) performance assessment and validation of the model using cross-validation and the area under the receiver operating characteristic curve (AUC ROC), and 3) optimization of cut points for the classification of diabetic retinopathy. We identified points along the AUC ROC that minimized the misclassification cost function and considered various scenarios of misclassification costs and diabetic retinopathy prevalence. RESULTS Time since diabetes diagnosis, high blood glucose levels, systolic hypertension, and physical inactivity were considered risk factors in our screening tool. The mean AUC ROC of our model was 0.780 (validation data set). The optimized cut point that best represented our study population (z = -0.640) had a sensitivity of 82.9% and a specificity of 61.9%. CONCLUSION We developed a low-cost and easy-to-apply screening tool to detect people at high risk of diabetic retinopathy in Mexico. Although classification performance of our tool was acceptable (AUC ROC > 0.75), error rates (precision) depend on false-negative and false-positive rates. Therefore, confirmatory assessment of all cases is mandatory.
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Affiliation(s)
- Kenny Mendoza-Herrera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, México
| | - Amado D Quezada
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, México
| | - Andrea Pedroza-Tobías
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, México
| | - Cesar Hernández-Alcaraz
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, México
| | - Jans Fromow-Guerra
- Association for the Prevention of Blindness in Mexico, México City, México
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, México.,Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México, Avenida Universidad #655 Col. Sta. Ma. Ahuacatitlán, CP 62100.
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108
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Mindell JS, Moody A, Vecino-Ortiz AI, Alfaro T, Frenz P, Scholes S, Gonzalez SA, Margozzini P, de Oliveira C, Sanchez Romero LM, Alvarado A, Cabrera S, Sarmiento OL, Triana CA, Barquera S. Comparison of Health Examination Survey Methods in Brazil, Chile, Colombia, Mexico, England, Scotland, and the United States. Am J Epidemiol 2017; 186:648-658. [PMID: 28486584 DOI: 10.1093/aje/kwx045] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/14/2016] [Indexed: 11/13/2022] Open
Abstract
Comparability of population surveys across countries is key to appraising trends in population health. Achieving this requires deep understanding of the methods used in these surveys to examine the extent to which the measurements are comparable. In this study, we obtained detailed protocols of 8 nationally representative surveys from 2007-2013 from Brazil, Chile, Colombia, Mexico, the United Kingdom (England and Scotland), and the United States-countries that that differ in economic and inequity indicators. Data were collected on sampling frame, sample selection procedures, recruitment, data collection methods, content of interview and examination modules, and measurement protocols. We also assessed their adherence to the World Health Organization's "STEPwise Approach to Surveillance" framework for population health surveys. The surveys, which included half a million participants, were highly comparable on sampling methodology, survey questions, and anthropometric measurements. Heterogeneity was found for physical activity questionnaires and biological samples collection. The common age range included by the surveys was adults aged 18-64 years. The methods used in these surveys were similar enough to enable comparative analyses of the data across the 7 countries. This comparability is crucial in assessing and comparing national and subgroup population health, and to assisting the transfer of research and policy knowledge across countries.
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109
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Nieto C, Rincon-Gallardo Patiño S, Tolentino-Mayo L, Carriedo A, Barquera S. Characterization of Breakfast Cereals Available in the Mexican Market: Sodium and Sugar Content. Nutrients 2017; 9:nu9080884. [PMID: 28813010 PMCID: PMC5579677 DOI: 10.3390/nu9080884] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 12/31/2022] Open
Abstract
Preschool Mexican children consume 7% of their total energy intake from processed breakfast cereals. This study characterized the nutritional quality and labelling (claims and Guideline Daily Amount (GDA)) of the packaged breakfast cereals available in the Mexican market. Photographs of all breakfast cereals available in the 9 main food retail chains in the country were taken. The nutrition quality of cereals was assessed using the United Kingdom Nutrient Profiling Model (UKNPM). Claims were classified using the International Network for Food and Obesity/non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) taxonomy and the GDA was defined according to the Mexican regulation, NOM-051. Overall, a total of 371 different breakfast cereals were analysed. The nutritional profile showed that 68.7% were classified as “less healthy”. GDAs and claims were displayed more frequently on the “less healthy” cereals. Breakfast cereals within the “less healthy” category had significantly higher content of energy, sugar and sodium (p < 0.001). Most of the claims were displayed in the “less healthy” cereals (n = 313). This study has shown that there is a lack of consistency between the labelling on the front of the pack and the nutritional quality of breakfast cereals.
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Affiliation(s)
- Claudia Nieto
- Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca C.P 62100, Morelos, Mexico.
| | | | - Lizbeth Tolentino-Mayo
- Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca C.P 62100, Morelos, Mexico.
| | - Angela Carriedo
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK.
| | - Simón Barquera
- Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca C.P 62100, Morelos, Mexico.
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110
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Théodore FL, Tolentino-Mayo L, Hernández-Zenil E, Bahena L, Velasco A, Popkin B, Rivera JA, Barquera S. Pitfalls of the self-regulation of advertisements directed at children on Mexican television. Pediatr Obes 2017; 12:312-319. [PMID: 27135300 DOI: 10.1111/ijpo.12144] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/21/2016] [Accepted: 04/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are no academic studies that characterize advertisements directed at children from the companies that signed the self-regulation. OBJECTIVE The aim of this paper was to assess the extent and nature of food advertisements and the persuasive techniques used to market unhealthy food and beverages (UFB) to children, by signatory companies of self-regulation. METHODS From December 2012 to April 2013, 600 h of programming were recorded on the four broadcast public television channels in Mexico with the highest rating nationwide. Marketing aimed at children directly (broadcast on children's programmes or advertisements with a specific appeal to children) or indirectly (aimed at other target audiences with messages or scenes that link children to the product) were considered. RESULTS About 74.9% (2148) of the total food and beverage advertisements tried to influence children directly and indirectly. Companies, which had signed the self-regulation, focused 92.7% of their advertisements on UFB. Of the total number, 23.9% were aimed at children, 7.1% at adolescents, 12.5% at parents and 56.2% at the general public. Most of these advertisements were broadcast on movies (29.8%), cartoons (18%), soap operas (17.6%), entertainment shows (17.2%) and sports programs (6.4%). CONCLUSION Despite the self-regulation of television marketing, children were surrounded by UFB advertisements. Signatory companies influence children indirectly by targeting other audiences and by marketing during family television programs, which are also watched by children.
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Affiliation(s)
- F L Théodore
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - L Tolentino-Mayo
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - E Hernández-Zenil
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - L Bahena
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - A Velasco
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - B Popkin
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J A Rivera
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - S Barquera
- Center for Research in Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
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111
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Romieu I, Dossus L, Barquera S, Blottière HM, Franks PW, Gunter M, Hwalla N, Hursting SD, Leitzmann M, Margetts B, Nishida C, Potischman N, Seidell J, Stepien M, Wang Y, Westerterp K, Winichagoon P, Wiseman M, Willett WC. Energy balance and obesity: what are the main drivers? Cancer Causes Control 2017; 28:247-258. [PMID: 28210884 PMCID: PMC5325830 DOI: 10.1007/s10552-017-0869-z] [Citation(s) in RCA: 360] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/06/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this paper is to review the evidence of the association between energy balance and obesity. METHODS In December 2015, the International Agency for Research on Cancer (IARC), Lyon, France convened a Working Group of international experts to review the evidence regarding energy balance and obesity, with a focus on Low and Middle Income Countries (LMIC). RESULTS The global epidemic of obesity and the double burden, in LMICs, of malnutrition (coexistence of undernutrition and overnutrition) are both related to poor quality diet and unbalanced energy intake. Dietary patterns consistent with a traditional Mediterranean diet and other measures of diet quality can contribute to long-term weight control. Limiting consumption of sugar-sweetened beverages has a particularly important role in weight control. Genetic factors alone cannot explain the global epidemic of obesity. However, genetic, epigenetic factors and the microbiota could influence individual responses to diet and physical activity. CONCLUSION Energy intake that exceeds energy expenditure is the main driver of weight gain. The quality of the diet may exert its effect on energy balance through complex hormonal and neurological pathways that influence satiety and possibly through other mechanisms. The food environment, marketing of unhealthy foods and urbanization, and reduction in sedentary behaviors and physical activity play important roles. Most of the evidence comes from High Income Countries and more research is needed in LMICs.
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Affiliation(s)
- Isabelle Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
| | - Laure Dossus
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Hervé M Blottière
- Micalis Institute, MGP MetagenoPolis, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France
| | - Paul W Franks
- Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, CRC, University hospital Malmö, Malmö, Sweden
| | - Marc Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Nahla Hwalla
- Faculty of Agricultural and Food Science, American University of Beirut, Beirut, Lebanon
| | - Stephen D Hursting
- Department of Nutrition and the Nutrition Research Institute, The University of North Carolina, Chapel Hill, USA
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Barrie Margetts
- Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Chizuru Nishida
- Nutrition Policy and Scientific Advice (NPU), Department of Nutrition for Health and Development (NHD), World Health Organization (WHO), Geneva, Switzerland
| | - Nancy Potischman
- Office of the Associate Director, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Jacob Seidell
- Faculty of Earth and Life Sciences, Department of Health Sciences, University Amsterdam, Amsterdam, The Netherlands
| | - Magdalena Stepien
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Youfa Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, Joint Appointments, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, USA
| | - Klaas Westerterp
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | | | | | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
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112
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Soltero EG, Ortiz Hernández L, Jauregui E, Lévesque L, Lopez Y Taylor J, Barquera S, Lee RE. Characterization of the School Neighborhood Food Environment in Three Mexican Cities. Ecol Food Nutr 2017; 56:139-151. [DOI: 10.1080/03670244.2016.1274261] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Erica G. Soltero
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Luis Ortiz Hernández
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Unidad, Mexico City, México
| | - Edtna Jauregui
- Instituto de Ciencias Aplicadas a la Actividad Física y Deporte, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco Mexico
- Departamento Medicina Preventiva, Secretaria de Salud, Guadalajara, Jalisco, México
| | - Lucie Lévesque
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Juan Lopez Y Taylor
- Instituto de Ciencias Aplicadas a la Actividad Física y Deporte, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco Mexico
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morales, México
| | - Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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113
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Elder JP, Holub CK, Arredondo EM, Sánchez-Romero LM, Moreno-Saracho JE, Barquera S, Rivera J. Promotion of water consumption in elementary school children in San Diego, USA and Tlaltizapan, Mexico. Salud Publica Mex 2016; 56 Suppl 2:s148-56. [PMID: 25629247 DOI: 10.21149/spm.v56s2.5179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 08/27/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Consumption of water may help promote health and prevent obesity in children by decreasing consumption of sugar-sweetened beverages. This study used evidence-based strategies to increase water consumption in Mexican-American and Mexican children. MATERIALS AND METHODS In 2012, two schools in San Diego, USA and two other in Tlaltizapan, Mexico were recruited to Agua para Niños (Water for Kids), a program designed to promote water consumption among elementary grade students. Guided by operant psychology, the intervention focused on school and classroom activities to encourage water consumption. One control and one intervention school in each country were included. RESULTS Agua para Niños resulted in increases in observed water consumption and bottle possession among US and Mexican students. Teacher receptivity to the program was very positive in both countries. CONCLUSIONS Agua para Niños yielded sufficiently positive behavioral changes to be used in a future fully randomized design, and to contribute to school nutrition policy changes.
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Affiliation(s)
- John P Elder
- Institute for Behavioral and Community Health, School of Public Health, San Diego State University, San Diego, California, Estados Unidos de América
| | - Christina K Holub
- Institute for Behavioral and Community Health, School of Public Health, San Diego State University, San Diego, California, Estados Unidos de América
| | - Elva M Arredondo
- Institute for Behavioral and Community Health, School of Public Health, San Diego State University, San Diego, California, Estados Unidos de América
| | | | | | - Simón Barquera
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Juan Rivera
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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114
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Romieu I, Margetts B, Barquera S, Gomes FDS, Gunter M, Hwalla N, Kampman E, Leitzmann M, Potischman N, Slimani N, Vorster E, Willett WC, Winichagoon P, Wiseman M. Strengthening the evidence base for nutrition and cancer in low and middle income countries. J Glob Health 2016; 6:020306. [PMID: 27606056 PMCID: PMC5012230 DOI: 10.7189/jogh.06.020306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Isabelle Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Barrie Margetts
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Fabio da Silva Gomes
- Food, Nutrition and Cancer Division, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Brazil
| | - Marc Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Nahla Hwalla
- Faculty of Agricultural & Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Nancy Potischman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Nadia Slimani
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Este Vorster
- Centre of Excellence for Nutrition (CEN), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Walter C. Willett
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | | | | | - for the International Cancer Research Funders Nutrition Working Group
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Food, Nutrition and Cancer Division, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Brazil
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Faculty of Agricultural & Food Sciences, American University of Beirut, Beirut, Lebanon
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
- Centre of Excellence for Nutrition (CEN), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
- Institute of Nutrition, Mahidol University Salaya, Nakhon Pathom, Thailand
- World Cancer Research Fund International, London, UK
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115
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Sánchez-Romero LM, Penko J, Coxson PG, Fernández A, Mason A, Moran AE, Ávila-Burgos L, Odden M, Barquera S, Bibbins-Domingo K. Projected Impact of Mexico's Sugar-Sweetened Beverage Tax Policy on Diabetes and Cardiovascular Disease: A Modeling Study. PLoS Med 2016; 13:e1002158. [PMID: 27802278 PMCID: PMC5089730 DOI: 10.1371/journal.pmed.1002158] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/16/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rates of diabetes in Mexico are among the highest worldwide. In 2014, Mexico instituted a nationwide tax on sugar-sweetened beverages (SSBs) in order to reduce the high level of SSB consumption, a preventable cause of diabetes and cardiovascular disease (CVD). We used an established computer simulation model of CVD and country-specific data on demographics, epidemiology, SSB consumption, and short-term changes in consumption following the SSB tax in order to project potential long-range health and economic impacts of SSB taxation in Mexico. METHODS AND FINDINGS We used the Cardiovascular Disease Policy Model-Mexico, a state transition model of Mexican adults aged 35-94 y, to project the potential future effects of reduced SSB intake on diabetes incidence, CVD events, direct diabetes healthcare costs, and mortality over 10 y. Model inputs included short-term changes in SSB consumption in response to taxation (price elasticity) and data from government and market research surveys and public healthcare institutions. Two main scenarios were modeled: a 10% reduction in SSB consumption (corresponding to the reduction observed after tax implementation) and a 20% reduction in SSB consumption (possible with increases in taxation levels and/or additional measures to curb consumption). Given uncertainty about the degree to which Mexicans will replace calories from SSBs with calories from other sources, we evaluated a range of values for calorie compensation. We projected that a 10% reduction in SSB consumption with 39% calorie compensation among Mexican adults would result in about 189,300 (95% uncertainty interval [UI] 155,400-218,100) fewer incident type 2 diabetes cases, 20,400 fewer incident strokes and myocardial infarctions, and 18,900 fewer deaths occurring from 2013 to 2022. This scenario predicts that the SSB tax could save Mexico 983 million international dollars (95% UI $769 million-$1,173 million). The largest relative and absolute reductions in diabetes and CVD events occurred in the youngest age group modeled (35-44 y). This study's strengths include the use of an established mathematical model of CVD and use of contemporary Mexican vital statistics, data from health surveys, healthcare costs, and SSB price elasticity estimates as well as probabilistic and deterministic sensitivity analyses to account for uncertainty. The limitations of the study include reliance on US-based studies for certain inputs where Mexico-specific data were lacking (specifically the associations between risk factors and CVD outcomes [from the Framingham Heart Study] and SSB calorie compensation assumptions), limited data on healthcare costs other than those related to diabetes, and lack of information on long-term SSB price elasticity that is specific to geographic and economic subgroups. CONCLUSIONS Mexico's high diabetes prevalence represents a public health crisis. While the long-term impact of Mexico's SSB tax is not yet known, these projections, based on observed consumption reductions, suggest that Mexico's SSB tax may substantially decrease morbidity and mortality from diabetes and CVD while reducing healthcare costs.
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Affiliation(s)
- Luz Maria Sánchez-Romero
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Joanne Penko
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America
| | - Pamela G Coxson
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America
| | - Alicia Fernández
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America
| | - Antoinette Mason
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America
| | - Andrew E Moran
- Division of General Internal Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Leticia Ávila-Burgos
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Michelle Odden
- Department of Epidemiology, Oregon State University, Corvalis, Oregon, United States of America
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America.,Division of General Internal Medicine, Columbia University Medical Center, New York, New York, United States of America.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
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116
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Scholes S, Moody A, Alfaro T, Frenz P, Dominguez A, Sanchez-Romero L, Vecino-Ortiz A, Borges C, Margozzini P, Mindell J, Cabrera S, Barquera S, de Oliveira C. P59 Changes in the body mass index and waist circumference distribution of adults aged 25–64 years in England, Scotland, and the United States, 1998–2012. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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117
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Rincón-Gallardo Patiño S, Tolentino-Mayo L, Flores Monterrubio EA, Harris JL, Vandevijvere S, Rivera JA, Barquera S. Nutritional quality of foods and non-alcoholic beverages advertised on Mexican television according to three nutrient profile models. BMC Public Health 2016; 16:733. [PMID: 27495000 PMCID: PMC4975920 DOI: 10.1186/s12889-016-3298-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 07/13/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Evidence supports that television food advertisements influence children's food preferences and their consumption. However, few studies have examined the extent and nature of food marketing to children in low and middle income countries. This study aims to assess the nutritional quality of foods and beverages advertised on Mexican TV, applying the Mexican, World Health Organization (WHO) European and United Kingdom (UKNPM) nutrient profile models, before the Mexican regulation on food marketing came into effect. METHODS We recorded 600 h on the four national public and free TV channels with the highest national ratings, from December 2012 to April 2013. Recordings were done for 40 randomly selected (week, weekend, school and vacation) days, from 7 am to 10 pm. Nutritional information per 100 g/ml of product was obtained from the product labels or company websites. RESULTS A total of 2,544 food and non-alcoholic beverage advertisements were broadcast, for 275 different products. On average, the foods advertised during cartoon programming had the highest energy (367 kcal) and sugar (30.0 g) content, while foods advertised during sport programming had the highest amount of total fat (9.5 g) and sodium (412 mg) content. More than 60 % of the foods advertised did not meet any nutritional quality standards. 64.3 % of the products did not comply with the Mexican nutritional standards, as compared with 83.1 % and 78.7 % with WHO Europe and UKNPM standards, respectively. The food groups most frequently advertised were beverages (24.6 %), followed by chocolate and confectionery sugar (19.7 %), cakes, sweet biscuits and pastries (12.0 %), savory snacks (9.3 %), breakfast cereals (7.1 %), ready-made food (6.4 %) and dairy products (6.0 %). CONCLUSION The majority of foods and beverages advertised on Mexican TV do not comply with any nutritional quality standards, and thus should not be marketed to children. The nutritional quality standards applied by the Mexican regulation are much weaker than those applied by the WHO Europe and United Kingdom. The Mexican government should improve the nutrition standards in its new regulation, especially the sugar cut off points.
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Affiliation(s)
- Sofía Rincón-Gallardo Patiño
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655, CP 62100 Cuernavaca, Morelos México
| | - Lizbeth Tolentino-Mayo
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655, CP 62100 Cuernavaca, Morelos México
| | - Eric Alejandro Flores Monterrubio
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655, CP 62100 Cuernavaca, Morelos México
| | - Jennifer L Harris
- Rudd Center for Food Policy & Obesity, One Constitution Plaza, Kinsley St, Hartford, CT 06103 USA
| | - Stefanie Vandevijvere
- School of Population Health, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Juan A Rivera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655, CP 62100 Cuernavaca, Morelos México
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655, CP 62100 Cuernavaca, Morelos México
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118
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Kraak VI, Vandevijvere S, Sacks G, Brinsden H, Hawkes C, Barquera S, Lobstein T, Swinburn BA. Progress achieved in restricting the marketing of high-fat, sugary and salty food and beverage products to children. Bull World Health Organ 2016; 94:540-8. [PMID: 27429493 PMCID: PMC4933136 DOI: 10.2471/blt.15.158667] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 12/25/2022] Open
Abstract
In May 2010, 192 Member States endorsed Resolution WHA63.14 to restrict the marketing of food and non-alcoholic beverage products high in saturated fats, trans fatty acids, free sugars and/or salt to children and adolescents globally. We examined the actions taken between 2010 and early 2016 - by civil society groups, the World Health Organization (WHO) and its regional offices, other United Nations (UN) organizations, philanthropic institutions and transnational industries - to help decrease the prevalence of obesity and diet-related noncommunicable diseases among young people. By providing relevant technical and policy guidance and tools to Member States, WHO and other UN organizations have helped protect young people from the marketing of branded food and beverage products that are high in fat, sugar and/or salt. The progress achieved by the other actors we investigated appears variable and generally less robust. We suggest that the progress being made towards the full implementation of Resolution WHA63.14 would be accelerated by further restrictions on the marketing of unhealthy food and beverage products and by investing in the promotion of nutrient-dense products. This should help young people meet government-recommended dietary targets. Any effective strategies and actions should align with the goal of WHO to reduce premature mortality from noncommunicable diseases by 25% by 2025 and the aim of the UN to ensure healthy lives for all by 2030.
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Affiliation(s)
- Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 223 Wallace Hall, 295 West Campus Drive, Blacksburg, Virginia 24061, United States of America
| | | | - Gary Sacks
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Australia
| | | | - Corinna Hawkes
- Centre for Food Policy, City University London, London, England
| | - Simón Barquera
- National Institute of Public Health of México, Cuernavaca, Mexico
| | | | - Boyd A Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
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119
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Hutchens A, Soltero EG, Barquera S, Lévesque L, Jauregui E, López Y Taylor J, Lee RE. Influence of parental perception of school safety and gender on children's physical activity in Mexico: A cross sectional study. Salud Publica Mex 2016; 58:7-15. [PMID: 26879502 DOI: 10.21149/spm.v58i1.7662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/17/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This cross sectional study aims to determine the effects of gender and parental perception of safety at school on children's physical activity (PA) levels. MATERIALS AND METHODS Parents of school aged Mexican children residing in Guadalajara, Mexico City, and Puerto Vallarta, completed surveys about their children's PA measures. The physical activity indicators were evaluated using linear and logistical regression models. RESULTS Analysis did not indicate that gender moderated the relationship between parental perception of safety and PA measures, but significant gender issues exist with girls participating less than boys in the three measures of PA in this study (p<0.001). CONCLUSION Results suggest the need for additional interventions promoting physical activity in girls in Mexico.
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Affiliation(s)
- Amy Hutchens
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, Estados Unidos de América
| | - Erica G Soltero
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, Houston, Texas, Estados Unidos de América
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Lucie Lévesque
- School of Kinesiology & Health Studies, Queen's University, Kingston, Ontario, Canadá
| | - Edtna Jauregui
- Instituto de Ciencias Aplicadas a la Actividad Física y Deporte, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Juan López Y Taylor
- Instituto de Ciencias Aplicadas a la Actividad Física y Deporte, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Rebecca E Lee
- Center of Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, Estados Unidos de América
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120
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Denova-Gutiérrez E, Tucker KL, Flores M, Barquera S, Salmerón J. Dietary Patterns Are Associated with Predicted Cardiovascular Disease Risk in an Urban Mexican Adult Population. J Nutr 2016; 146:90-7. [PMID: 26581684 DOI: 10.3945/jn.115.217539] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/19/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dietary patterns may predict cardiovascular disease (CVD) risk more accurately than does consumption of specific nutrients or foods. OBJECTIVE We evaluated the association between Mexican adults' dietary patterns and development of a >10% risk of 10-y CVD (using the Framingham risk score) over 7 y of follow-up. METHODS This prospective cohort study included 1196 men and women aged 20-80 y with a 10-y predicted risk <10% and without a CVD diagnosis at baseline in 2004-2007. Data on sociodemographic, lifestyle, and medical history factors were collected with a self-administered questionnaire. Dietary intake was evaluated by using a semiquantitative food-frequency questionnaire. The relations between dietary patterns and predicted CVD were analyzed by using pooled logistic regression models. RESULTS With the use of factor analysis, we identified 3 major dietary patterns in participants' dietary data. The "prudent" pattern was characterized by high positive loadings for the consumption of fresh fruit, vegetables, and whole grains. The "meat/fish" pattern showed positive loadings for the consumption of red meat, processed meat, eggs, fats, fish, and poultry. Finally, the "refined foods" pattern featured positive loadings for corn tortillas, refined grains, soft drinks, and alcohol. After adjustment for potential confounders, compared with participants in the lowest quintile of the prudent pattern, those in the highest quintile had a lower RR of 10-y CVD (RR: 0.40; 95% CI: 0.20, 0.79; P-trend = 0.006). In contrast, participants in the highest quintile of the refined-foods pattern had a greater risk of elevated 10-y CVD (RR: 2.98; 95% CI: 1.46, 6.10; P-trend = 0.020) than did those in the lowest quintile. Finally, the meat/fish dietary pattern was not significantly associated with 10-y CVD. CONCLUSION Our data suggest that the prudent pattern is associated with a reduced risk of 10-y CVD, whereas the refined-foods pattern may increase 10-y CVD in Mexican adults.
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Affiliation(s)
- Edgar Denova-Gutiérrez
- Health Services and Epidemiological Investigation Unit, Mexican Institute of Social Security, Cuernavaca, Mexico; Center of Research in Nutrition and Health and Geriatric Epidemiology Research Center, National Institute of Geriatrics, Mexico City, Mexico; and
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA
| | | | | | - Jorge Salmerón
- Health Services and Epidemiological Investigation Unit, Mexican Institute of Social Security, Cuernavaca, Mexico; Population Research Center, National Institute of Public Health, Cuernavaca, Mexico
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121
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Eisenberg CM, Sánchez-Romero LM, Rivera-Dommarco JA, Holub CK, Arredondo EM, Elder JP, Barquera S. Interventions to increase physical activity and healthy eating among overweight and obese children in Mexico. Salud Publica Mex 2015; 55 Suppl 3:441-6. [PMID: 24643494 DOI: 10.21149/spm.v55s3.5146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to conduct a systematic literature review of obesity interventions that focused on increasing physical activity and healthy eating among overweight and obese children in Mexico. MATERIALS AND METHODS Data was taken from a larger literature review focused on obesity interventions for Latinos in Latin America and the United States. Study design suitability, quality of execution, and effect size were assessed for a subset of these articles. RESULTS There were six intervention studies included in the present review. Five studies showed reductions in obesity-related outcomes, while one study reported gains in body mass index (BMI). CONCLUSIONS Physical activity and healthy eating remain constant components in obesity treatment interventions, which highlights the importance of understanding evidence-based strategies to guide future research to reduce childhood obesity in Mexico.
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Affiliation(s)
- Christina M Eisenberg
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, EUA
| | | | | | - Christina K Holub
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, EUA
| | - Elva M Arredondo
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, EUA
| | - John P Elder
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, EUA
| | - Simón Barquera
- Instituto Nacional de Salud Pública, Cuernavaca, Mor., México
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122
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Bauer CCC, Moreno B, González-Santos L, Concha L, Barquera S, Barrios FA. Child overweight and obesity are associated with reduced executive cognitive performance and brain alterations: a magnetic resonance imaging study in Mexican children. Pediatr Obes 2015; 10:196-204. [PMID: 24989945 DOI: 10.1111/ijpo.241] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 02/28/2014] [Accepted: 03/29/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Overweight and obesity in childhood is associated with negative physical and psychological effects. It has been proposed that obesity increase the risk for developing cognitive deficits, dementia and Alzheimer's disease and that it may be associated with marked differences in specific brain structure volumes. OBJECTIVE The purpose of this study was a neurobiopsychological approach to examine the association between overweight and obesity, brain structure and a paediatric neuropsychological assessment in Mexican children between 6 and 8 years of age. METHODS We investigated the relation between the body mass index (BMI), brain volumetric segmentation of subcortical gray and white matter regions obtained with magnetic resonance imaging and the Neuropsychological Assessment of Children standardized for Latin America. Thirty-three healthy Mexican children between 6 and 8 years of age, divided into normal weight (18 children) and overweight/obese (15 children) groups. RESULTS Overweight/obese children showed reduced executive cognitive performance on neuropsychological evaluations (i.e. verbal fluidity, P = 0.03) and presented differences in brain structures related to learning and memory (reduced left hippocampal volumes, P = 0.04) and executive functions (larger white matter volumes in the left cerebellum, P = 0.04 and mid-posterior corpus callosum, P = 0.03). Additionally, we found a positive correlation between BMI and left globulus pallidus (P = 0.012, ρ = 0.43) volume and a negative correlation between BMI and neuropsychological evaluation scores (P = 0.033, ρ = -0.37). CONCLUSIONS The findings contribute to the idea that there is a relationship between BMI, executive cognitive performance and brain structure that may underlie the causal chain that leads to obesity in adulthood.
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Affiliation(s)
- C C C Bauer
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany; Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
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123
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Janssen I, Medina C, Pedroza A, Barquera S. Screen time in Mexican children: findings from the 2012 National Health and Nutrition Survey (ENSANUT 2012). Salud Publica Mex 2015; 55:484-91. [PMID: 24626619 DOI: 10.21149/spm.v55i5.7248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To provide descriptive information on the screen time levels of Mexican children. MATERIALS AND METHODS 5 660 children aged 10-18 years from the 2012 National Health and Nutrition Survey (ENSANUT 2012) were studied. Screen time (watching television, movies, playing video games and using a computer) was self-reported. RESULTS On average, children engaged in 3 hours/day of screen time, irrespective of gender and age. Screen time was higher in obese children, children from the northern and Federal District regions of the country, children living in urban areas, and children in the highest socioeconomic status and education categories. Approximately 33% of 10-14 year olds and 36% of 15-18 year olds met the screen time guideline of ≤ 2 hours/day. CONCLUSIONS 10-18 year old Mexican children accumulate an average of 3 hours/day of screen time. Two thirds of Mexican children exceed the recommended maximal level of time for this activity.
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Affiliation(s)
- Ian Janssen
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Catalina Medina
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Andrea Pedroza
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Simón Barquera
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Hernández-Cordero S, Barquera S, Rodríguez-Ramírez S, Villanueva-Borbolla MA, González de Cossio T, Rivera Dommarco J, Popkin B. Reply to Brown et al. J Nutr 2015; 145:1029-30. [PMID: 26125074 PMCID: PMC4408742 DOI: 10.3945/jn.115.211680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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125
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Hernández-Cordero S, Barquera S, Rodríguez-Ramírez S, Villanueva-Borbolla MA, González de Cossio T, Dommarco JR, Popkin B. 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. J Nutr 2014; 144:1742-52. [PMID: 25332472 PMCID: PMC6457091 DOI: 10.3945/jn.114.193490] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mexico's 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/m(2)) 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.
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Affiliation(s)
- Sonia Hernández-Cordero
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Simón Barquera
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Sonia Rodríguez-Ramírez
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | - Juan Rivera Dommarco
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Barry Popkin
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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126
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Ponce X, Rodríguez-Ramírez S, Mundo-Rosas V, Shamah T, Barquera S, de Cossio TG. Dietary quality indices vary with sociodemographic variables and anthropometric status among Mexican adults: a cross-sectional study. Results from the 2006 National Health and Nutrition Survey. Public Health Nutr 2014; 17:1717-28. [PMID: 24124890 PMCID: PMC10282364 DOI: 10.1017/s1368980013002462] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 06/28/2013] [Accepted: 07/25/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the dietary quality of Mexican adults' diet, we constructed three dietary quality indices: a cardioprotective index (CPI), a micronutrient adequacy index (MAI) and a dietary diversity index (DDI). DESIGN Data were derived from the 2006 National Health and Nutrition Survey, which is a national survey representative of the Mexican population with a stratified, multistage, probabilistic sample design. Dietary intake was assessed from an FFQ with 101 different foods and daily nutrient intakes were computed. The CPI evaluated compliance with seven WHO recommendations for the prevention of CVD, the MAI evaluated the intake of six micronutrients based on the estimated average requirements from the US Institute of Medicine and the DDI was constructed based on the consumption of thirty different food groups. SETTINGS Mexico. SUBJECTS Mexican adults aged 19-59 years old. RESULTS We evaluated the diet of 15 675 males and females. Adjusted means and adjusted proportions by age and sex were computed to predict adherence to dietary recommendations. Rural inhabitants, those living in the South and those from the lowest socio-economic status reported a significantly higher CPI (4·5 (se 0·08), 4·3 (se 0·08) and 4·2 (se 0·09), respectively; P < 0·05), but a significantly lower MAI and DDI, compared with urban inhabitants, those from the North and those of upper socio-economic status (P < 0·05). CONCLUSIONS The constructed diet quality indices identify nutrients and foods whose recommended intakes are not adequately consumed by the population. Given the epidemiological and nutritional transition that Mexico is experiencing, the CPI is the most relevant index and its components should be considered in Mexican dietary guidelines as well as in any food and nutrition programmes developed.
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Affiliation(s)
- Xochitl Ponce
- Research Center on Nutrition and Health, National Institute of Public Health, Av. Universidad 655, Col. Sta María Ahuacatitlán, Cuernavaca, Morelos, México CP 62508
| | - Sonia Rodríguez-Ramírez
- Research Center on Nutrition and Health, National Institute of Public Health, Av. Universidad 655, Col. Sta María Ahuacatitlán, Cuernavaca, Morelos, México CP 62508
| | - Verónica Mundo-Rosas
- Research Center on Nutrition and Health, National Institute of Public Health, Av. Universidad 655, Col. Sta María Ahuacatitlán, Cuernavaca, Morelos, México CP 62508
| | - Teresa Shamah
- Research Center on Nutrition and Health, National Institute of Public Health, Av. Universidad 655, Col. Sta María Ahuacatitlán, Cuernavaca, Morelos, México CP 62508
| | - Simón Barquera
- Research Center on Nutrition and Health, National Institute of Public Health, Av. Universidad 655, Col. Sta María Ahuacatitlán, Cuernavaca, Morelos, México CP 62508
| | - Teresa González de Cossio
- Research Center on Nutrition and Health, National Institute of Public Health, Av. Universidad 655, Col. Sta María Ahuacatitlán, Cuernavaca, Morelos, México CP 62508
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127
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Hernández-Cordero S, González-Castell D, Rodríguez-Ramírez S, Villanueva-Borbolla MÁ, Unar M, Barquera S, González de Cossío T, Rivera-Dommarco J, Popkin BM. Design and challenges of a randomized controlled trial for reducing risk factors of metabolic syndrome in Mexican women through water intake. Salud Publica Mex 2014; 55:595-606. [PMID: 24715012 DOI: 10.21149/spm.v55i6.7305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 09/23/2013] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To describe the design, methods, and challenges encountered during a randomized clinical trial aimed to promote water intake for reducing risks of metabolic syndrome in Mexican women. MATERIALS AND METHODS In a randomized clinical trial in Cuernavaca, Mexico, overweight and obese (body mass index [BMI] ≥ 25 < 39) women, 18 - < 45 years old with an intake of sugar-sweetened beverages ≥ 250 kilocalories per day (kcal/day) were randomly allocated to the water and education provision group (n = 120) or the education provision only group (n = 120). RESULTS We screened 1 756 women. The main difficulties encountered were identifying participants with the recruitment criteria, delivering water to participants, and the time demanded from the study participants. CONCLUSIONS The trial's main challenges were difficulties surrounding recruitment, delivery of the intervention, and the time demanded from the study participants. Modifications were effectively implemented without jeopardizing the original protocol.
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Affiliation(s)
| | - Dinorah González-Castell
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Sonia Rodríguez-Ramírez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | | | - Mishel Unar
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Teresita González de Cossío
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Juan Rivera-Dommarco
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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128
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Rivera J, Barquera S, Colchero A, Barrientos T, Hernández M. Mexico’s fight against obesity: evidence, actions, results, and challenges (630.9). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.630.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Juan Rivera
- Center for Nutrition and Health Research National Institute of Public Health CuernavacaMorelosMexico
| | - Simón Barquera
- Center for Nutrition and Health Research National Institute of Public Health CuernavacaMorelosMexico
| | - Arantxa Colchero
- Center for Health Systems and Economics Research National Institute of Public Health CuernavacaMorelosMexico
| | - Tonatiuh Barrientos
- Center for Research IN Population Health National Institute of Public Health CuernavacaMorelosMexico
| | - Mauricio Hernández
- General Director National Institute of Public Health CuernavacaMorelosMexico
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129
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Monterrubio E, Espinosa J, Sánchez M, Barquera S. Psychometric properties and validation of an instrument to measure perception of well‐being associated with water intake (IPBA) (810.33). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.810.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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130
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Medina C, Janssen I, Campos I, Barquera S. Physical inactivity prevalence and trends among Mexican adults: results from the National Health and Nutrition Survey (ENSANUT) 2006 and 2012. BMC Public Health 2013; 13:1063. [PMID: 24215173 PMCID: PMC3883516 DOI: 10.1186/1471-2458-13-1063] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lifestyles such as unhealthy diets and the lack of physical activity have been contributed to the increased prevalence of obesity. In 2012, the world health organization published the first global recommendation for physical activity and health. People who do not meet at least 150 minutes of moderate-to-vigorous physical activity are considered to be physically inactive. The prevalence of physical inactivity worldwide is 31%, however there is insufficient data from prevalence and trends of physical inactivity in Mexican population. The purposes of this study are to describe the physical inactivity prevalence and recent trends in Mexican adults and to examine the association between physical inactivity with biologic and sociodemographic characteristics. METHODS Representative samples of 17,183 and 10,729 adults (aged 20 to 69 years) who participated in the National Health and Nutrition Survey (ENSANUT) in 2006 and 2012, respectively. Moderate-to-vigorous physical activity (MVPA) was assessed using the short form version of the International Physical Activity Questionnaire (IPAQ), which was administered in face-to-face interviews. Self-reported IPAQ MVPA levels were adjusted using an equation derived from a previous validation study. Participants were considered inactive if they engaged in <150-minutes/week of moderate physical activity or <75 minutes/week of vigorous physical activity according to WHO classification criteria. RESULTS The prevalence of physical inactivity was significantly higher in 2012 (19.4%, 95% CI: 18.1, 20.7) than in 2006 (13.4%, 95% CI: 12.5, 14.5). Adults in the obese category, 60-69 age group, and those in the highest socioeconomic status tertile were more likely to be physically inactive. CONCLUSIONS The proportion of the Mexican adult population who do not meet the minimum WHO physical activity criteria has increased by 6% points between 2006 and 2012. Given the increasing prevalence of obesity, the aging of the population, and the shift in socioeconomic status in Mexico, physical inactivity could continue to increase in the coming years unless effective public health interventions are implemented.
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Affiliation(s)
| | | | | | - Simón Barquera
- Instituto Nacional de Salud Pública, Av, Universidad 655, Col, Sta, María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
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131
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Barquera S, Campos I, Rivera JA. Mexico attempts to tackle obesity: the process, results, push backs and future challenges. Obes Rev 2013; 14 Suppl 2:69-78. [PMID: 24103026 DOI: 10.1111/obr.12096] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
Abstract
Mexico's obesity prevalence is one of the world's highest. In 2006, academics, and federal and state government agencies initiated efforts to design a national policy for obesity prevention. The Ministry of Health (MOH) established an expert panel to develop recommendations on beverage intake for a healthy life in 2008. Subsequently, the MOH, with support from academia, initiated the development of the National Agreement for Healthy Nutrition (ANSA). ANSA was signed by all relevant sectoral actors in 2010 and led to initiatives banning sodas and regulating unhealthy food in schools and the design of other yet to be implemented initiatives, such as a front-of-package labeling system. A main challenge of the ANSA has been the lack of harmonization between industry interests and public health objectives and effective accountability and monitoring mechanisms to assess implementation across government sectors. Bold strategies currently under consideration include taxation of sugar-sweetened beverages, improvement of norms for healthy food in schools, regulation of food and beverage marketing to children and implementation of a national front-of-pack labeling system. Strong civil society organizations have embraced the prevention of obesity as their goal and have used evidence from academia to position obesity prevention in the public debate and in the government agenda.
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Affiliation(s)
- S Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca Morelos, México
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132
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Medina C, Villanueva-Borbolla M, Barquera S. [Development of a didactic questionnaire to measure vegetable and fruit intake during the school recess. Pilot test]. Salud Publica Mex 2013; 54:479-86. [PMID: 23011499 DOI: 10.1590/s0036-36342012000500004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/17/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To develop an open, self-reported questionnaire, focused in understanding intake and intention to increase vegetable and fruit consumption during the Mexican children's lunchtime. MATERIALS AND METHODS After assessing pilot tests, the self-reported questionnaire was applied as a classroom exercise to measure children's consumptions of fruit and vegetables. RESULTS A total of 486 children completed the questionnaire (49.8% males and 50.2% females). The reported food consumption indicates that 24.5% of children do not consume vegetables or fruits, and among consumers the most common portion size is one. Girls consume more vegetables and fruits and they can recognize more benefits. A total of 9.7% of the participants that do not consume VF, expressed less intention of including vegetables or fruits in their lunch. These results were similar to those reported by other authors. CONCLUSION This study is useful to identify strengths and limitations during the design and implementation of this type of instrument to understand children's food habits during school recess.
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Affiliation(s)
- Catalina Medina
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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133
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Brinsden H, Lobstein T, Landon J, Kraak V, Sacks G, Kumanyika S, Swinburn B, Barquera S, Friel S, Hawkes C, Kelly B, L'abbé M, Lee A, Ma J, Macmullen J, Mohan S, Monteiro C, Neal B, Rayner M, Sanders D, Snowdon W, Vandevijvere S, Walker C. Monitoring policy and actions on food environments: rationale and outline of the INFORMAS policy engagement and communication strategies. Obes Rev 2013; 14 Suppl 1:13-23. [PMID: 24074207 DOI: 10.1111/obr.12072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) proposes to collect performance indicators on food policies, actions and environments related to obesity and non-communicable diseases. This paper reviews existing communications strategies used for performance indicators and proposes the approach to be taken for INFORMAS. Twenty-seven scoring and rating tools were identified in various fields of public health including alcohol, tobacco, physical activity, infant feeding and food environments. These were compared based on the types of indicators used and how they were quantified, scoring methods, presentation and the communication and reporting strategies used. There are several implications of these analyses for INFORMAS: the ratings/benchmarking approach is very commonly used, presumably because it is an effective way to communicate progress and stimulate action, although this has not been formally evaluated; the tools used must be trustworthy, pragmatic and policy-relevant; multiple channels of communication will be needed; communications need to be tailored and targeted to decision-makers; data and methods should be freely accessible. The proposed communications strategy for INFORMAS has been built around these lessons to ensure that INFORMAS's outputs have the greatest chance of being used to improve food environments.
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Affiliation(s)
- H Brinsden
- International Association for the Study of Obesity, London, United Kingdom
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134
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Rayner M, Wood A, Lawrence M, Mhurchu CN, Albert J, Barquera S, Friel S, Hawkes C, Kelly B, Kumanyika S, L'abbé M, Lee A, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Sacks G, Sanders D, Snowdon W, Swinburn B, Vandevijvere S, Walker C. Monitoring the health-related labelling of foods and non-alcoholic beverages in retail settings. Obes Rev 2013; 14 Suppl 1:70-81. [PMID: 24074212 DOI: 10.1111/obr.12077] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Food labelling on food packaging has the potential to have both positive and negative effects on diets. Monitoring different aspects of food labelling would help to identify priority policy options to help people make healthier food choices. A taxonomy of the elements of health-related food labelling is proposed. A systematic review of studies that assessed the nature and extent of health-related food labelling has been conducted to identify approaches to monitoring food labelling. A step-wise approach has been developed for independently assessing the nature and extent of health-related food labelling in different countries and over time. Procedures for sampling the food supply, and collecting and analysing data are proposed, as well as quantifiable measurement indicators and benchmarks for health-related food labelling.
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Affiliation(s)
- M Rayner
- British Heart Foundation Health Promotion Research Group, University of Oxford, Oxford, UK
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135
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Kelly B, King L, Baur L, Rayner M, Lobstein T, Monteiro C, Macmullan J, Mohan S, Barquera S, Friel S, Hawkes C, Kumanyika S, L'Abbé M, Lee A, Ma J, Neal B, Sacks G, Sanders D, Snowdon W, Swinburn B, Vandevijvere S, Walker C. Monitoring food and non-alcoholic beverage promotions to children. Obes Rev 2013; 14 Suppl 1:59-69. [PMID: 24074211 DOI: 10.1111/obr.12076] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Food and non-alcoholic beverage marketing is recognized as an important factor influencing food choices related to non-communicable diseases. The monitoring of populations' exposure to food and non-alcoholic beverage promotions, and the content of these promotions, is necessary to generate evidence to understand the extent of the problem, and to determine appropriate and effective policy responses. A review of studies measuring the nature and extent of exposure to food promotions was conducted to identify approaches to monitoring food promotions via dominant media platforms. A step-wise approach, comprising 'minimal', 'expanded' and 'optimal' monitoring activities, was designed. This approach can be used to assess the frequency and level of exposure of population groups (especially children) to food promotions, the persuasive power of techniques used in promotional communications (power of promotions) and the nutritional composition of promoted food products. Detailed procedures for data sampling, data collection and data analysis for a range of media types are presented, as well as quantifiable measurement indicators for assessing exposure to and power of food and non-alcoholic beverage promotions. The proposed framework supports the development of a consistent system for monitoring food and non-alcoholic beverage promotions for comparison between countries and over time.
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Affiliation(s)
- B Kelly
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
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136
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Neal B, Sacks G, Swinburn B, Vandevijvere S, Dunford E, Snowdon W, Webster J, Barquera S, Friel S, Hawkes C, Kelly B, Kumanyika S, L'Abbé M, Lee A, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Rayner M, Sanders D, Walker C. Monitoring the levels of important nutrients in the food supply. Obes Rev 2013; 14 Suppl 1:49-58. [PMID: 24074210 DOI: 10.1111/obr.12075] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A food supply that delivers energy-dense products with high levels of salt, saturated fats and trans fats, in large portion sizes, is a major cause of non-communicable diseases (NCDs). The highly processed foods produced by large food corporations are primary drivers of increases in consumption of these adverse nutrients. The objective of this paper is to present an approach to monitoring food composition that can both document the extent of the problem and underpin novel actions to address it. The monitoring approach seeks to systematically collect information on high-level contextual factors influencing food composition and assess the energy density, salt, saturated fat, trans fats and portion sizes of highly processed foods for sale in retail outlets (with a focus on supermarkets and quick-service restaurants). Regular surveys of food composition are proposed across geographies and over time using a pragmatic, standardized methodology. Surveys have already been undertaken in several high- and middle-income countries, and the trends have been valuable in informing policy approaches. The purpose of collecting data is not to exhaustively document the composition of all foods in the food supply in each country, but rather to provide information to support governments, industry and communities to develop and enact strategies to curb food-related NCDs.
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Affiliation(s)
- B Neal
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
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137
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L'Abbé M, Schermel A, Minaker L, Kelly B, Lee A, Vandevijvere S, Twohig P, Barquera S, Friel S, Hawkes C, Kumanyika S, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Rayner M, Sacks G, Sanders D, Snowdon W, Swinburn B, Walker C. Monitoring foods and beverages provided and sold in public sector settings. Obes Rev 2013; 14 Suppl 1:96-107. [PMID: 24074214 DOI: 10.1111/obr.12079] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper outlines a step-wise framework for monitoring foods and beverages provided or sold in publicly funded institutions. The focus is on foods in schools, but the framework can also be applied to foods provided or sold in other publicly funded institutions. Data collection and evaluation within this monitoring framework will consist of two components. In component I, information on existing food or nutrition policies and/or programmes within settings would be compiled. Currently, nutrition standards and voluntary guidelines associated with such policies/programmes vary widely globally. This paper, which provides a comprehensive review of such standards and guidelines, will facilitate institutional learnings for those jurisdictions that have not yet established them or are undergoing review of existing ones. In component II, the quality of foods provided or sold in public sector settings is evaluated relative to existing national or sub-national nutrition standards or voluntary guidelines. Where there are no (or only poor) standards or guidelines available, the nutritional quality of foods can be evaluated relative to standards of a similar jurisdiction or other appropriate standards. Measurement indicators are proposed (within 'minimal', 'expanded' and 'optimal' approaches) that can be used to monitor progress over time in meeting policy objectives, and facilitate comparisons between countries.
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Affiliation(s)
- M L'Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
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138
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Friel S, Hattersley L, Snowdon W, Thow AM, Lobstein T, Sanders D, Barquera S, Mohan S, Hawkes C, Kelly B, Kumanyika S, L'Abbe M, Lee A, Ma J, Macmullan J, Monteiro C, Neal B, Rayner M, Sacks G, Swinburn B, Vandevijvere S, Walker C. Monitoring the impacts of trade agreements on food environments. Obes Rev 2013; 14 Suppl 1:120-34. [PMID: 24074216 DOI: 10.1111/obr.12081] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The liberalization of international trade and foreign direct investment through multilateral, regional and bilateral agreements has had profound implications for the structure and nature of food systems, and therefore, for the availability, nutritional quality, accessibility, price and promotion of foods in different locations. Public health attention has only relatively recently turned to the links between trade and investment agreements, diets and health, and there is currently no systematic monitoring of this area. This paper reviews the available evidence on the links between trade agreements, food environments and diets from an obesity and non-communicable disease (NCD) perspective. Based on the key issues identified through the review, the paper outlines an approach for monitoring the potential impact of trade agreements on food environments and obesity/NCD risks. The proposed monitoring approach encompasses a set of guiding principles, recommended procedures for data collection and analysis, and quantifiable 'minimal', 'expanded' and 'optimal' measurement indicators to be tailored to national priorities, capacity and resources. Formal risk assessment processes of existing and evolving trade and investment agreements, which focus on their impacts on food environments will help inform the development of healthy trade policy, strengthen domestic nutrition and health policy space and ultimately protect population nutrition.
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Affiliation(s)
- S Friel
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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139
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Swinburn B, Sacks G, Vandevijvere S, Kumanyika S, Lobstein T, Neal B, Barquera S, Friel S, Hawkes C, Kelly B, L'abbé M, Lee A, Ma J, Macmullan J, Mohan S, Monteiro C, Rayner M, Sanders D, Snowdon W, Walker C. INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles. Obes Rev 2013; 14 Suppl 1:1-12. [PMID: 24074206 DOI: 10.1111/obr.12087] [Citation(s) in RCA: 342] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Non-communicable diseases (NCDs) dominate disease burdens globally and poor nutrition increasingly contributes to this global burden. Comprehensive monitoring of food environments, and evaluation of the impact of public and private sector policies on food environments is needed to strengthen accountability systems to reduce NCDs. The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) is a global network of public-interest organizations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities. The INFORMAS framework includes two 'process' modules, that monitor the policies and actions of the public and private sectors, seven 'impact' modules that monitor the key characteristics of food environments and three 'outcome' modules that monitor dietary quality, risk factors and NCD morbidity and mortality. Monitoring frameworks and indicators have been developed for 10 modules to provide consistency, but allowing for stepwise approaches ('minimal', 'expanded', 'optimal') to data collection and analysis. INFORMAS data will enable benchmarking of food environments between countries, and monitoring of progress over time within countries. Through monitoring and benchmarking, INFORMAS will strengthen the accountability systems needed to help reduce the burden of obesity, NCDs and their related inequalities.
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Affiliation(s)
- B Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand; WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
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140
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Swinburn B, Vandevijvere S, Kraak V, Sacks G, Snowdon W, Hawkes C, Barquera S, Friel S, Kelly B, Kumanyika S, L'Abbé M, Lee A, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Rayner M, Sanders D, Walker C. Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed Government Healthy Food Environment Policy Index. Obes Rev 2013; 14 Suppl 1:24-37. [PMID: 24074208 DOI: 10.1111/obr.12073] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Government action is essential to increase the healthiness of food environments and reduce obesity, diet-related non-communicable diseases (NCDs), and their related inequalities. This paper proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food-EPI) was developed, which comprises a 'policy' component with seven domains on specific aspects of food environments, and an 'infrastructure support' component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week-long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food-EPI will be pre-tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.
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Affiliation(s)
- B Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand; WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia
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141
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Sacks G, Swinburn B, Kraak V, Downs S, Walker C, Barquera S, Friel S, Hawkes C, Kelly B, Kumanyika S, L'Abbé M, Lee A, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Rayner M, Sanders D, Snowdon W, Vandevijvere S. A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention. Obes Rev 2013; 14 Suppl 1:38-48. [PMID: 24074209 DOI: 10.1111/obr.12074] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first ('minimal') step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second ('expanded') step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third ('optimal') step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention.
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Affiliation(s)
- G Sacks
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia
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142
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Lee A, Mhurchu CN, Sacks G, Swinburn B, Snowdon W, Vandevijvere S, Hawkes C, L'abbé M, Rayner M, Sanders D, Barquera S, Friel S, Kelly B, Kumanyika S, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Walker C. Monitoring the price and affordability of foods and diets globally. Obes Rev 2013; 14 Suppl 1:82-95. [PMID: 24074213 DOI: 10.1111/obr.12078] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Food prices and food affordability are important determinants of food choices, obesity and non-communicable diseases. As governments around the world consider policies to promote the consumption of healthier foods, data on the relative price and affordability of foods, with a particular focus on the difference between 'less healthy' and 'healthy' foods and diets, are urgently needed. This paper briefly reviews past and current approaches to monitoring food prices, and identifies key issues affecting the development of practical tools and methods for food price data collection, analysis and reporting. A step-wise monitoring framework, including measurement indicators, is proposed. 'Minimal' data collection will assess the differential price of 'healthy' and 'less healthy' foods; 'expanded' monitoring will assess the differential price of 'healthy' and 'less healthy' diets; and the 'optimal' approach will also monitor food affordability, by taking into account household income. The monitoring of the price and affordability of 'healthy' and 'less healthy' foods and diets globally will provide robust data and benchmarks to inform economic and fiscal policy responses. Given the range of methodological, cultural and logistical challenges in this area, it is imperative that all aspects of the proposed monitoring framework are tested rigorously before implementation.
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Affiliation(s)
- A Lee
- School of Public Health and Social Work and School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
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143
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Lobelo F, Garcia de Quevedo I, Holub CK, Nagle BJ, Arredondo EM, Barquera S, Elder JP. School-based programs aimed at the prevention and treatment of obesity: evidence-based interventions for youth in Latin America. J Sch Health 2013; 83:668-677. [PMID: 23879787 DOI: 10.1111/josh.12080] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 11/27/2012] [Accepted: 12/02/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND Rapidly rising childhood obesity rates constitute a public health priority in Latin America which makes it imperative to develop evidence-based strategies. Schools are a promising setting but to date it is unclear how many school-based obesity interventions have been documented in Latin America and what level of evidence can be gathered from such interventions. METHODS We performed a systematic review of papers published between 1965 and December 2010. Interventions were considered eligible if they had a school-based component, were done in Latin America, evaluated an obesity related outcome (body mass index [BMI], weight, %body fat, waist circumference, BMI z-score), and compared youth exposed vs not exposed. RESULTS Ten studies were identified as having a school-based component. Most interventions had a sample of normal and overweight children. The most successful interventions focused on prevention rather than treatment, had longer follow-ups, a multidisciplinary team, and fewer limitations in execution. Three prevention and 2 treatment interventions found sufficient improvements in obesity-related outcomes. CONCLUSIONS We found sufficient evidence to recommend school-based interventions to prevent obesity among youth in Latin America. Evidence-based interventions in the school setting should be promoted as an important component for integrated programs, policies, and monitoring frameworks designed to reverse the childhood obesity in the region.
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Affiliation(s)
- Felipe Lobelo
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, NE, MS K-40 Atlanta, GA 30341, USA.
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144
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Medina C, Barquera S, Janssen I. Validity and reliability of the International Physical Activity Questionnaire among adults in Mexico. Rev Panam Salud Publica 2013; 34:21-28. [PMID: 24006016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/21/2013] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To determine the test-retest reliability and validity of the Spanish version of the short-form International Physical Activity Questionnaire (IPAQ) among adults in Mexico. METHODS This was a cross-sectional study of a convenience sample of 267 adult factory workers in Mexico City. Participants were 19 - 68 years of age; 48% were female. Participants wore an accelerometer for 9 consecutive days and were administered the Spanish version of the short form IPAQ on two occasions (IPAQ1 and IPAQ2, separated by 9 days). The relation and differences between moderate-to-vigorous physical activity (MVPA) measures obtained from IPAQ1, IPAQ2, and the accelerometer were determined using correlations, linear regression, and paired t-tests. RESULTS IPAQ1 and IPAQ2 measures of MVPA were significantly correlated to each other (r = 0.55, P < 0.01). However, MVPA was 44 ± 408 minutes/week lower in IPAQ1 than in IPAQ2, although this difference did not reach statistical significance (P = 0.08). The (min/week) measures from IPAQ1 and IPAQ2 were only modestly correlated with the accelerometer measures (r = 0.26 and r = 0.31, P < 0.01), and by comparison to accelerometer measures, MVPA values were higher when based on IPAQ1 (174 ± 357 min/week, P < 0.01) than for IPAQ2 (135 ± 360 min/week, P < 0.01). The percentage of participants who were classified as physically inactive according to the World Health Organization guidelines was 18.0% in IPAQ1, 25.1% in IPAQ2, and 28.2% based on the accelerometer. CONCLUSIONS Similar to what has been observed in other populations, the short form IPAQ has a modest reliability and poor validity for assessing MVPA among Mexican adults.
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Affiliation(s)
- Catalina Medina
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
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145
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Barquera S. Introduction. Obesity prevention. Salud Publica Mex 2013. [DOI: 10.21149/spm.v55s3.5136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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146
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J Nagle B, K Holub C, Barquera S. Interventions for the treatment of obesity among children and adolescents in Latin America: a systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.21149/spm.v55s3.5145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objetivo. El objetivo de esta revisión sistemática de la literatura fue identificar estrategias basadas en evidencia asociadas con intervenciones en salud efectivas para la prevención y el tratamiento de la obesidad infantil en Latinoamérica. Material y métodos. Se realizó una revisión sistemática por pares de intervenciones relacionadas con la obesidad, que fueron llevadas a cabo en clínicas de atención para la salud. Criterios de inclusión: implementadas en Latinoamérica, dirigidas a niños con obesidad y sobrepeso y evaluación de por lo menos un reultado relacionado con obesidad (ej. índice de masa corporal (IMC), puntaje Z, peso, circunferencia de cintura o grasa corporal). Resultados. Se identificaron cinco intervenciones dirigidas a niños obesos en clínicas de salud en Latinoamérica. Todas las intervenciones mostraron cambios significativos en IMC y la mayoría obtuvo un tamaño del efecto grande a través de la promoción de actividad física y alimentación saludable. Conclusión. A pesar del número limitado de estudios de intervención para tratar la obesidad en clínicas de salud, existe evidencia que las intervenciones en estos lugares pueden ser efectivas en alcanzar cambios antropométricos positivos en los niños con obesidad y sobrepeso.
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147
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Marshall SJ, Simoes EJ, Eisenberg CM, Holub CK, Arredondo EM, Barquera S, Elder JP. Weight-related child behavioral interventions in Brazil: a systematic review. Am J Prev Med 2013; 44:543-9. [PMID: 23597821 DOI: 10.1016/j.amepre.2013.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 01/22/2013] [Accepted: 01/29/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Between 1974 and 1997, the prevalence of overweight increased 300% among Brazilian children and adolescents. A systematic review was conducted between January 2010 and December 2011 of obesity-related interventions targeting Brazilian children and adolescents. EVIDENCE ACQUISITION Manuscripts from 1965 to December 2010 were evaluated based on inclusion criteria including evaluating obesity-related outcomes and at least 50% of participants living in Brazil. Methods were adapted from the CDC's Community Guide. Evidence was based on the number of available studies, study design, execution, quality, and effect size. EVIDENCE SYNTHESIS Sixteen articles were abstracted; five met final inclusion criteria. All intervention samples (range n=14-78; mean n=40.6) included overweight or obese children aged 8-17 years. The intervention duration range was 3-6 months, and dose frequency ranged from two to five times per week. Three of the five interventions included healthy eating and physical activity; two included only physical activity. Two interventions studies were rated as having greatest design suitability. Only one intervention had the greatest design suitability and a large effect size. CONCLUSIONS Intervention approaches that combined physical activity and healthy eating had the strongest effects. However, small sample bias, 95% CIs of primary effects, and poor-to-moderate quality of research designs and implementation suggest the combined evidence is best rated as Insufficient. This prohibits the recommendation of specific strategies or settings. Findings suggest that more well-designed evidence-based childhood obesity interventions in Brazil are needed and that promising, but yet unproven, interventions should be evaluated rigorously.
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Affiliation(s)
- Simon J Marshall
- Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
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148
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Mehta S, Dimsdale J, Nagle B, Holub CK, Woods C, Barquera S, Elder JP. Worksite interventions: improving lifestyle habits among Latin American adults. Am J Prev Med 2013; 44:538-42. [PMID: 23597820 DOI: 10.1016/j.amepre.2013.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 01/22/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Abstract
CONTEXT Worksite-based interventions have been shown to result consistently in significant improvements in weight- and health-related outcomes among the working adult population; however, applicability and effectiveness of studies has often been limited by inadequate reporting of age and ethnicity. This study aimed to examine work-based interventions among Latinos in the U.S. and Latin America. EVIDENCE ACQUISITION Data were abstracted (and analyzed) from "parent" study Guide to Obesity Prevention in Latin American and the U.S. (GOL), between January 2010 and December 2011. Manuscripts from 1965 to 2010 were evaluated according to inclusion criteria for interventions, including a sample population of at least 50% Latinos or results stratified by ethnicity, at least one obesity-related outcome measure evaluated before and after intervention, and worksite setting and comparison of an intervention group to a non-intervention group (including pre-post designs). EVIDENCE SYNTHESIS Of 105 interventions abstracted, five were work-based interventions. The average participant age was 45 years, with an average of 58% women. Four of the five interventions had a pre-post study design that received a fair execution score and lowest design-suitability score, whereas one group RCT intervention had the greatest design suitability and good execution. For two studies, Cohen's d effect sizes ranged from 0.09 to 0.603. Effect sizes could not be calculated for three of the interventions. Three interventions found significant outcomes for BMI, three for weight, two for waist circumference, and one for waist-to-hip ratio. CONCLUSIONS Few studies have focused on work-based interventions specifically aimed at Latinos. This review identified promising strategies for reducing obesity in the workplace.
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Affiliation(s)
- Setoo Mehta
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA 92123, USA
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149
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Holub CK, Elder JP, Arredondo EM, Barquera S, Eisenberg CM, Sánchez Romero LM, Rivera J, Lobelo F, Simoes EJ. Obesity control in Latin American and U.S. Latinos: a systematic review. Am J Prev Med 2013; 44:529-37. [PMID: 23597819 PMCID: PMC4808744 DOI: 10.1016/j.amepre.2013.01.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 01/22/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Abstract
CONTEXT Latinos are the largest and fastest-growing ethnically diverse group in the U.S.; they are also the most overweight. Mexico is now second to the U.S. in experiencing the worst epidemic of obesity in the world. Objectives of this study were to (1) conduct a systematic review of obesity-related interventions targeting Latinos living in the U.S. and Latin America and (2) develop evidence-based recommendations to inform culturally relevant strategies targeting obesity. EVIDENCE ACQUISITION Obesity-related interventions, published between 1965 and 2010, were identified through searches of major electronic databases in 2010-2011. Selection criteria included evaluation of obesity-related measures; intervention conducted in a community setting; and at least 50.0% Latino/Latin American participants, or with stratified results by race/ethnicity. EVIDENCE SYNTHESIS Body of evidence was based on the number of available studies, study design, execution, and effect size. Of 19,758 articles, 105 interventions met final inclusion criteria. Interventions promoting physical activity and/or healthy eating had strong or sufficient evidence for recommending (1) school-based interventions in the U.S. and Latin America; (2) interventions for overweight or obese children in the healthcare context in Latin America; (3) individual-based interventions for overweight or obese adults in the U.S.; (4) individual-based interventions for adults in Latin America; and (5) healthcare-based interventions for overweight or obese adults in Latin America. CONCLUSIONS Most intervention approaches combined physical activity and healthy eating to address both sides of the energy-balance equation. Results can help guide comprehensive evidence-based efforts to tackle the obesity epidemic in the U.S. and Latin America.
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Affiliation(s)
- Christina K Holub
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA 92123, USA
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150
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Perez LG, Arredondo EM, Elder JP, Barquera S, Nagle B, Holub CK. Evidence-based obesity treatment interventions for Latino adults in the U.S.: a systematic review. Am J Prev Med 2013; 44:550-60. [PMID: 23597822 PMCID: PMC6733516 DOI: 10.1016/j.amepre.2013.01.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 10/26/2012] [Accepted: 01/08/2013] [Indexed: 11/28/2022]
Abstract
CONTEXT Latinos have one of the highest prevalences of obesity in the U.S. Efforts to address U.S. Latino health have expanded to include obesity prevention and treatment initiatives. The objectives of this review were to (1) conduct a systematic review of obesity-related treatment interventions targeting U.S. Latino adults and (2) develop evidence-based recommendations to inform culturally relevant strategies for obesity treatment targeting U.S. Latino adults. EVIDENCE ACQUISITION Obesity treatment interventions, published between 1990 and 2010, were identified through a systematic search of electronic databases conducted between January 2010 and December 2011. Details of the screening process and selection/exclusion criteria are reported in the Guide to Obesity Prevention in Latin America and the U.S. (GOL) parent study. EVIDENCE SYNTHESIS Of the 325 studies identified in the GOL parent study, 105 met the inclusion criteria, and 22 involved obesity treatment interventions for Latinos and were included in the present review. The 22 studies were evaluated (between January 2010 and December 2011) for strength of study design and execution; effect sizes were also estimated for treatment effects on obesity-related outcomes. Interventions for physical activity or diet behavioral changes with strong or sufficient evidence included (1) community-based, culturally relevant, RCTs, and non-randomized controlled trials; (2) church-based interventions; and (3) promotora-led interventions. CONCLUSIONS Most interventions targeted physical activity and/or diet behavioral modification in Latinas and were led by bicultural/bilingual professionals. Potential key intervention settings include community clinics/centers and churches. Although there was limited literature on obesity treatment interventions for U.S. Latinos, the review findings provide valuable insight to researchers and practitioners involved in obesity treatment for U.S. Latino adults.
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Affiliation(s)
- Lilian G Perez
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA 92123, USA
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