Metodología de la Encuesta Nacional de Salud y Nutrición 2021

Prevalence of prediabetes in Mexico: a retrospective analysis of nationally representative surveys spanning 2016-2022

Background

Characterizing prediabetes phenotypes may be useful in guiding diabetes prevention efforts; however, heterogeneous criteria to define prediabetes have led to inconsistent prevalence estimates, particularly in low- and middle-income countries. Here, we estimated trends in prediabetes prevalence in Mexico across different prediabetes definitions and their association with prevalent cardiometabolic conditions.

Methods

We conducted a serial cross-sectional analysis of National Health and Nutrition Surveys in Mexico (2016-2022), totalling 22 081 Mexican adults. After excluding individuals with diagnosed or undiagnosed diabetes, we defined prediabetes using ADA (impaired fasting glucose [IFG] 100-125 mg/dL and/or HbA1c 5.7-6.4%), WHO (IFG 110-125 mg/dL), and IEC criteria (HbA1c 6.0-6.4%). Prevalence trends of prediabetes over time were evaluated using weighted Poisson regression and its association with prevalent cardiometabolic conditions with weighted logistic regression.

Findings

The prevalence of prediabetes (either IFG or high HbA1c [ADA]) in Mexico was 20.9% in 2022. Despite an overall downward trend in prediabetes (RR 0.973, 95% CI 0.957-0.988), this was primarily driven by decreases in prediabetes by ADA-IFG (RR 0.898, 95% CI 0.880-0.917) and WHO-IFG criteria (RR 0.919, 95% CI 0.886-0.953), while prediabetes by ADA-HbA1c (RR 1.055, 95% CI 1.033-1.077) and IEC-HbA1C criteria (RR 1.085, 95% CI 1.045-1.126) increased over time. Prediabetes prevalence increased over time in adults >40 years, with central obesity, self-identified as indigenous or living in urban areas. For all definitions, prediabetes was associated with an increased risk of cardiometabolic conditions.

Interpretation

Prediabetes rates in Mexico from 2016 to 2022 varied based on defining criteria but consistently increased for HbA1c-based definitions and high-risk subgroups.

Funding

This research was supported by Instituto Nacional de Geriatría in Mexico. JAS was supported by NIH/NIDDK Grant# K23DK135798.

Self-reported decreases in the purchases of selected unhealthy foods resulting from the implementation of warning labels in Mexican youth and adult population

Background

Front-of-package nutritional warning labels (WLs) are designed to facilitate identification and selection of healthier food choices. We assessed self-reported changes in purchasing different types of unhealthy foods due to WLs in Mexico and the association between the self-reported reductions in purchases of sugary beverages and intake of water and sugar-sweetened beverages.

Methods

Data came from 14-17 year old youth (n=1,696) and adults ≥18 (n=7,775) who participated in the Mexican arm of the 2020-2021 International Food Policy Study, an annual repeat cross-sectional online survey. Participants self-reported whether the WLs had influenced them to purchase less of each of ten unhealthy food categories due to WLs. Among adults, a 23-item Beverage Frequency Questionnaire was used derive past 7-day intake of water and sugary beverages analyzed to determine the relationship between self-reported reductions in purchasing sugary drinks due to the WLs. Multilevel mixed-effects logistic regression models were fitted to estimate the percentage of participants who self-reported reducing purchases within each food group, and overall. Sociodemographic characteristics associated with this reduction were investigated as well.

Results

Overall, 44.8% of adults and 38.7% of youth reported buying less of unhealthy food categories due to the implementation of WL, with the largest proportion reporting decreased purchases of cola, regular and diet soda. A greater impact of WLs on the reported purchase of unhealthy foods was observed among the following socio-demographic characteristics: females, individuals who self-identified as indigenous, those who were overweight, individuals with lower educational levels, those with higher nutrition knowledge, households with children, and those with a significant role in household food purchases. In addition, adults who reported higher water intake and lower consumption of sugary beverages were more likely to report reduced purchases of sugary drinks due to the WLs. Adults who reported greater water intake and lower sugary beverages intake were significantly more likely to report buying fewer sugary drinks due to the WLs.

Conclusion

Our findings suggest that implementation of WLs has reduced purchases of unhealthy foods in Mexico. These results underscore the positive impact of the labeling policy particularly in subpopulations with lower levels of education and among indigenous adults.

Report of the Influenza Vaccination Program in Mexico (2006-2022) and Proposals for Its Improvement

BACKGROUND

Influenza has continued to be an important public health challenge, and the WHO recommends that countries consider vaccination for persons at high risk. Mexico has such a program, and we sought to determine its current situation.

MATERIAL AND METHODS

This study has an ecological, longitudinal, and retrospective design based on secondary information on the acquisition and application of vaccines against influenza from official data from 2006 to 2022.

RESULTS

We found annual variability in the numbers of purchases and application of doses, with coverage of less than 90% of the total population every year; in addition, 17 million vaccines were not used in this period.

DISCUSSION

This study shows the situation of the program at the national level. Two institutions acquired fewer the vaccines, while one purchased more for its target population, but the necessary vaccinations were not acquired. On average, 1.7 million of the vaccines purchased annually were not used, but in some years, more vaccines were applied than were purchased in all of the institutions. We also observed that, between institutions, the vaccine coverage was very different, from 21% to 180%. On average, 6.2 million people were not vaccinated annually, between 16% and 22% of the target population, demonstrating low coverage. When we compared the coverage data that we calculated to the data published by the institutions, a great difference was observed.

CONCLUSIONS

We found inconsistencies in the data, indicating their unreliability and potential disorganization within the program, as the target populations of each institution were not clear. In addition, the application data may have had reporting errors. Adequate coverage was not achieved, and the coverage was different from that reported in the official sources. We propose the implementation of different systems for control, evaluation, and access to the information of the program.

Estimation of vaccination coverage and associated factors in older Mexican adults

National vaccination programmes recommend the influenza vaccine for older adults, but this population group has the greatest morbidity and mortality from other preventable vaccine diseases. The aim of this article is to estimate the vaccine coverage in adults aged 65 years and older and to analyse the factors that could increase or decrease vaccination uptake probability for the three listed vaccines in the national vaccination programme (influenza, tetanus and diphtheria, and pneumococcus) and the full scheme in Mexico. We conducted an analytical cross-sectional study with 2012, 2018, and 2021 rounds from the National Health and Nutrition Survey, in which we calculated the vaccine coverage estimations and performed multivariable logistic regression models to analyse the factors related to vaccine uptake. Tetanus and diphtheria vaccines had the greatest coverage estimation in all years (59-71%), whereas the pneumococcus vaccine had the lowest (32-53%). Full scheme vaccine coverage decreased from 37.80% to 24.77% in 2012 and 2021, respectively. The National Health Card property, morbidity, being a beneficiary of any health system institution, and use of preventive services increased the probability of vaccine uptake. In conclusion, vaccine coverage in older Mexican adults decreased over time, and the Mexican health system plays a strategic role in immunisation.

SARS-CoV-2 seroprevalence and vaccine coverage from August to November 2021: A nationally representative survey in Mexico

We aimed to estimate self-reported vaccine coverage and SARS-CoV-2 anti-N and anti-S seroprevalence in Mexico overall and for five vaccine types. We used a nationally representative survey with 7236 dried blood spot samples for adults 18 years and older collected from August to November 2021. Anti-N and anti-S seroprevalence were estimated adjusting for the sensitivity and specificity of the immunoassay test. A multivariate Poisson regression model was used to estimate seroprevalence by vaccine type and by age group adjusting for confounders and test performance. Vaccination coverage was 74%, being higher in women compared to men, high socioeconomic status (SES) compared to low and middle SES, graduates compared to people with high school, and formal workers compared to other employment statuses. Anti-N seroprevalence was 59.2%, compared to 84.1% anti-S seroprevalence. Anti-S seroprevalence was higher for vaccinated than unvaccinated participants. All vaccines were associated with more than 70% anti-S seroprevalence, with the lowest being observed for CoronaVac and Ad5-nCoV. Fully vaccinated participants over 60 years presented a lower seroprevalence (77.6%) compared to younger adults (91.1%), with larger differences for ChAdOx1 and CoronaVac vaccines. Between August and November 2021, three out of four Mexican adults had been vaccinated. Vaccination was associated with a higher positivity to anti-S antibodies. While antibodies do not reflect immunity, our results suggest that booster doses should be offered to people over 60 years of age and to adults who received Ad5-nCoV or CoronaVac as primary vaccination schemes.

Low prevalence of ideal levels in cardiovascular behavior metrics among Mexican adolescents

BACKGROUND

Lifestyle changes when transitioning from high-school to college expose students to unhealthy behaviors associated with high cardiovascular risk. The study aimed to assess the cardiovascular behavior metrics according to the AHA criteria, in freshman college adolescents from Northwest Mexico.

METHODS

The study was cross-sectional. Demographics and health history were collected by questionnaires. Four behaviors were evaluated: diet quality using a duplicated FFQ, physical activity (PA) using the IPAQ, smoking, and body mass index (BMI) percentile; blood pressure was measured as a biological metric. Intakes were averaged and summed for each food group; sodium and saturated fat were calculated using the Mexican System of Food Equivalents or the USDA Database. Metrics were categorized into ideal, intermediate or poor level according to the AHA criteria. Diet outliers (± 3 SD) were trimmed and data was tested for normality. Mean±SD were calculated for continuous and percentages for categorical variables. Chi-square test compared the prevalence of demographic variables and levels of each cardiovascular metric by sex. Independent T-test evaluated differences in anthropometrics, dietary, and PA by sex, and the prevalence of ideal vs. non-ideal dietary intakes.

RESULTS

Participants were n = 228, 55.6% men, age = 18.5±0.4 y. A higher prevalence of men indicated working, playing sports, and family history hypertriglyceridemia (p < 0.05). Men showed higher weight, height, BMI, waist, blood pressure, and lower PA and body fat (p < 0.05). Concerning diet quality, significant differences by sex were observed in nuts and seeds (1.1±0.6 and 0.9±0.6 oz/week, p = 0.042) and processed meats (749.8±639 and 503.6±300.3 g/week, p = 0.002); only fish and shellfish group reached AHA recommendations (513.1 ± 450.7 vs. 501.7 ± 428 g/week, p = 0.671) for men and women, respectively. Ideal level was reached by 70.9% participants for BMI percentile, 87% for smoking, 67.2% for blood pressure, 25.9% for PA, and 12.2% for diet score. Regarding food groups and nutrients, the lower prevalence in the ideal level was for sugar-sweetened beverages (10%, p = 0.013) and processed meats (4.8%, p = 0.208), and the highest for fish and shellfish (87.8%, p = 0.281) .

CONCLUSIONS

The diet and PA patterns of Northwest Mexican freshman adolescents make them a high-risk group for developing long-term unhealthy habits and cardiovascular complications early in adulthood.

Socioeconomic and geographic inequities in vaccination among children 12 to 59 months in Mexico, 2012 to 2021

Objective

To document the evolution of socioeconomic and geographical inequalities in childhood vaccination in Mexico from 2012 to 2021.

Methods

Repeated cross-sectional analysis using three rounds of National Health and Nutrition Surveys (2012, 2018, and 2021). Dichotomous variables were created to identify the proportion of children who received no dose of each vaccine included in the national immunization schedule (BCG; diphtheria, pertussis, and tetanus-containing; rotavirus; pneumococcal conjugate; and measles, mumps, and rubella [MMR]), and the proportion completely unvaccinated. The distribution of unvaccinated children was analyzed by state, and by socioeconomic status using the concentration index.

Results

The prevalence of completely unvaccinated children in Mexico was low, with 0.3% children in 2012 and 0.8% children in 2021 receiving no vaccines (p = 0.070). Notwithstanding, for each vaccine, an important proportion of children missed receiving any dose. Notably, the prevalence of MMR unvaccinated children was 10.2% (95% CI 9.2-11.1) in 2012, 22.3% (95% CI 20.9-23.8) in 2018, and 29.1% (95% CI 26.3-31.8) in 2021 (p < 0.001 for the difference between 2012 and 2021). The concentration index indicated pro-rich inequalities in non-vaccination for 2 of 5 vaccines in 2012, 3 of 5 vaccines in 2018, and 4 of 5 vaccines in 2021. There were marked subnational variations. The percentage of MMR unvaccinated children ranged from 3.3% to 17.9% in 2012, 5.5% to 36.5% in 2018, and 13.1% to 72.5% in 2021 across the 32 states of Mexico.

Conclusions

Equitable access to basic childhood vaccines in Mexico has deteriorated over the past decade. Vigilant equity monitoring coupled with tailored strategies to reach those left out is urgently required.

Psychometric Assessment of an Online Self-Test Measuring Risky Eating Behavior, Depression, Social Anxiety, and Self-Injury in Mexican Adolescents

The objective of this study was to evaluate the validity and reliability of OTESSED, an online test for the self-detection and prevention of risk factors for eating disorders and related problems, such as depression, social anxiety, and self-injury, in samples of male and female adolescents. Participants formed a non-probability sample of N = 577 high school students. The mean ages of boys and girls were the same (Mage = 15.61; SD = 0.73). Among the main results, scales of depression, self-injury, social anxiety, and risky eating behavior (REB) with construct validity (CFA) were obtained. The first two showed the same structure (two factors per sex), with an appropriate reliability omega value (0.92), and a similar percentage of explained variance (≥50). The REB scale presented two factors for boys and three for girls, with an appropriate omega value (0.88) and explained variance percentage (0.56). The instrument validation process was completed, meeting the discriminant validity criterion for each scale of the OTESSED.

The New SARS-CoV-2 Variants and Their Epidemiological Impact in Mexico

The COVID-19 disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus started its deadly journey into a global pandemic in Wuhan, China, in December 2019, where it was first isolated. Subsequently, multiple variants of the virus have been identified worldwide. In this review, we discuss the overall landscape of the pandemic in Mexico, including its most prevalent variants, their surveillance at a genomic level, and how they impacted the epidemiology of the disease. We also evaluate the heterologous vaccination in Mexico and how it may have influenced group immunity and helped mitigate the pandemic. Finally, we present an integrated view that could help us to understand the pandemic and serve as an example of the situation in Latin America.