Sex differences in the secular change in waist circumference relative to body mass index in the Americas and England from 1997 to 2020

Objective

To quantify changes over time in waist circumference (WC) relative to body mass index (BMI) by sex in the Americas (United States of America, Mexico, Chile, Peru) and England.

Methods

Data from adults aged 25-64 years between 1997 and 2020 was analysed; US data was stratified by racial-ethnic groups. Sex-specific BMI and WC means, and obesity and abdominal obesity prevalence, were compared between the first and last surveys. Using data from all survey years, secular changes across the BMI and WC distributions were estimated applying quantile regression models. BMI was added as a predictor of WC to estimate secular changes in WC relative to BMI. Interaction terms were included in all models to evaluate differences by sex.

Results

BMI and WC (except Peru) showed larger secular increases at the upper-tails of the distributions in both sexes. Increases at the 50th and 75th WC centiles relative to BMI were more pronounced in women than in men, with larger increases in US non-Hispanic whites and in England. In men, increases in WC independently of BMI were most evident in Mexico.

Conclusions

Disease risk associated with visceral fat, is potentially underestimated by national surveillance efforts that quantify secular changes only in BMI.

Understanding of front of package nutrition labels: Guideline daily amount and warning labels in Mexicans with non-communicable diseases

One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile’s labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants’ number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA.

[Understanding and use of the front-of-pack Guideline Daily Amounts nutritional labeling of industrialized food and beverages in Mexico.]

OBJECTIVE

Evaluate the use, subjective and objective under-standing of the GDA frontal labeling to assist the population towards making healthy decisions regarding the products they consume.

MATERIALS AND METHODS

The use of nu-tritional information contained in products ́ packages (GDA, nutritional information table, and list of ingredients), as well as the subjective and objective comprehension of the GDA.

RESULTS

A total of 43 157 people were interviewed. Amid the labels, the nutritional table was read more frequently (11.1%). 24.6% (IC95%: 23.9-25.3) and 41.2% (IC95%: 40.4-42.1) of the interviewees classified products correctly as not healthy and high in sodium, respectively. These outcomes were smaller between the elderly, lower socioeconomic levels, lower educational levels, and rural areas.

CONCLUSIONS

The results show that the GDA labeling is not useful to support the vulnerable population to make healthy decisions.