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Ancira-Moreno M, Hernández-Cordero S. Letter to the editor: will it be possible to achieve the global nutrition targets in Mexico by 2030? Int J Equity Health 2024; 23:60. [PMID: 38500124 PMCID: PMC10946168 DOI: 10.1186/s12939-024-02111-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/16/2024] [Indexed: 03/20/2024] Open
Abstract
In May 2012, the 65th World Health Assembly (WHA) approved six global nutrition targets by 2025 aimed to reduce stunting in children under five by 40%, maintain childhood wasting below 5%, halt obesity, cut anemia in women by 50%, lower low birth weight prevalence by 30%, and increase exclusive breastfeeding (EBF) within the first 6 months to 50%. These targets were extended to 2030, with all of them remaining as originally planned, but the EBF one (increased to 70%), wasting and overweight (both objectives set to eliminate them to negligible concern). Mexico is projected to achieve only one of the six nutrition targets (wasting) by 2025, falling far short of the stunting, low birth weight, anemia, and exclusive breastfeeding for the updated goals by 2030. This letter to the editor describes the most recent prevalence of malnutrition among mothers and children in Mexico. It discusses the challenges pregnant women and children under five years of age face exercising their right to good food, nutrition, and development. The authors reflect on the urgent need to make structural changes to achieve the global nutrition targets by 2030, highlighting the paramount importance of addressing the profound structural obstacles in Mexico and how Mexico's government must prioritize poverty reduction, reduce the marked inequalities, enhance the quality of nutritional care and healthcare infrastructure, and implement climate-resilient agricultural practices to address this pressing issue.
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Affiliation(s)
- Mónica Ancira-Moreno
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, México
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
| | - Sonia Hernández-Cordero
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México.
- Instituto de Investigaciones para el Desarrollo con Equidad, Universidad Iberoamericana, Ciudad de México, México.
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Hoyos-Loya E, Pérez Navarro C, Burrola-Méndez S, Hernández-Cordero S, Omaña-Guzmán I, Sachse Aguilera M, Ancira-Moreno M. Barriers to promoting breastfeeding in primary health care in Mexico: a qualitative perspective. Front Nutr 2024; 10:1278280. [PMID: 38264191 PMCID: PMC10803647 DOI: 10.3389/fnut.2023.1278280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Objective This article aimed to identify the main barriers related to promoting and counseling breastfeeding (BF) at the Primary Health Care (PHC) in Mexico. Methodology A qualitative study with a phenomenological approach was carried out in 88 health centers of the Ministry of Health in the states of Chihuahua, Oaxaca, Chiapas, Veracruz, Mexico, and Yucatan. From September to November 2021, we interviewed 88 key health professionals (HPs) (physicians, nurses, nutritionists, and others) from the PHC of the Ministry of Health in Mexico and 80 parents of children under 5 years old. In addition, nine focus groups were conducted with parents and caregivers. The data obtained were triangulated with information from focus groups and semi-structured interviews. Results Of the total interviews, 43.2% (n = 38) were nurses, 29.5% (n = 26) were physicians, 19.3% (n = 17) were nutritionists, and the rest were other health professionals. In the group of users, 97.6% (n = 121) were women. We identified contextual barriers, such as the lack of well-trained health professionals and the scarcest nutrition professionals, as material resources in the health units, without mentioning the low user attendance at their control consultations. Furthermore, we identified barriers related to the orientation and promotion of breastfeeding in health units, including a lack of specific strategies, ineffective communication, and the recommendations of commercial milk formulas. Conclusion The results presented reflect the reality of Mexico in relation to BF, making it urgent to take immediate action to improve the quality of nutritional care related to the promotion and orientation of BF at the PHC.
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Affiliation(s)
- Elizabeth Hoyos-Loya
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Cecilia Pérez Navarro
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Isabel Omaña-Guzmán
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | | | - Mónica Ancira-Moreno
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
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Hernández-Cordero S, Vilar-Compte M, Tomori C, Lara-Mejía V, Rovelo-Velázquez N, Hayes K, Pérez-Escamilla R. Healthcare professionals and commercial milk formula recommendations in the urban Mexican context. Front Public Health 2023; 11:1260222. [PMID: 38045970 PMCID: PMC10693414 DOI: 10.3389/fpubh.2023.1260222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/16/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Breastfeeding (BF) is considered an essential component of optimal care for child health and development. In the past two decades, global data have shown improvements in some, but not all, BF indicators. Despite these positive changes sales and per capita intake of commercial milk formula (CMF) have increased globally. The CMF industry invests millions of dollars in marketing, which targets families and healthcare professionals (HCP). In Mexico, more than half of the mothers (53%) who feed their infants with CMF chose their Brand on the recommendation of HCP. Understanding the reasons behind the current recommendations for the use of CMF by HCP is important for the design of BF interventions. The primary objective of this study was to explore Mexican HCP' beliefs, attitudes, perceptions, and practices about early infant feeding practices, and reasons for recommending CMF. The secondary objective was to explore pregnant women and mother's perceptions of the infant feeding recommendations they received from HCP, and of the factors that influenced their infant feeding decisions. Methods The study was based on a secondary qualitative data analysis of a WHO/UNICEF multi-country study. We analyzed focus group discussions (FGDs) and in-depth interviews (IDIs) from Mexico. Data were collected through convenience sampling in Mexico City and Guadalajara. HCP (n = 34) analysis was based on IDIs, and pregnant women or mothers of children 0-18 months (n = 74) on FGDs and IDIs. Results Through a thematic analysis, we identified the socioecology of BF and triangulated HCP and women's accounts. HCP, pregnant women, and mothers recognized that several factors might have influenced their infant feeding decisions including healthcare facilities' policies and maternal work conditions. Although HCP believed that BF is the best way to feed newborns and young children, they routinely recommended CMF. On the other hand, pregnant women and mothers had a strong belief that BF is the best way to feed their babies. However, when women sought support from HCP, the latter often recommended switching to CMF. Discussion This study highlights the discordance between HCP perceptions and mothers' experiences of HCP recommendations about infant feeding. Our findings support a national call for policy actions.
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Affiliation(s)
- Sonia Hernández-Cordero
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Cecília Tomori
- Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Vania Lara-Mejía
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Natalia Rovelo-Velázquez
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States
| | - Keily Hayes
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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Litwan K, Lara-Mejía V, Chahine T, Hernández-Cordero S, Vilar-Compte M, Pérez-Escamilla R. An analysis of actors participating in the design and implementation of workplace breastfeeding interventions in Mexico using the NetMap analysis approach. Front Public Health 2023; 11:1192600. [PMID: 38026332 PMCID: PMC10663280 DOI: 10.3389/fpubh.2023.1192600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction While breastfeeding is recognized as providing optimal nutrition for infants and toddlers, maternal employment is a commonly mentioned barrier to breastfeeding. The goal was to (a) identify key actors participating in the design and implementation of workplace breastfeeding interventions in Mexico, (b) understand the complexity of interactions between the actors, and (c) map the connections and influence between the actors when looking into networks of Advice, Command, Funding, and Information. Method Following the NetMap methodology, a total of 11 semi-structured interviews with 12 interview partners from 10 organizations were conducted. Interview data were analyzed, and networks were analyzed and visualized, using a social network mapping software. Results A total of 83 actors from five different actor groups were identified. Four networks were constructed along the four types of connections: Advice, Command, Funding, and Information. The actors were connected by 580 connections with 446 unique links. Based on various network statistics, the Mexican Institute of Social Security, the Mexican Secretary of Labor and Social Welfare, UNICEF, and the Mexican Secretary of Health were identified to be key actors. Conclusion To increase the likelihood of success of workplace breastfeeding interventions, the role of the actors "Employers" and "Women" needs to expand. They should be actively involved in the decision-making process, together with the identified key actors. It is further recommended to re-introduce a national breastfeeding strategy for Mexico that includes policies for workplace breastfeeding interventions.
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Affiliation(s)
- Kathrin Litwan
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Vania Lara-Mejía
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Teresa Chahine
- Yale School of Management, Yale University, New Haven, CT, United States
| | - Sonia Hernández-Cordero
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
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Ancira-Moreno M, Burrola-Méndez S, Muñoz-Manrique C, Omaña-Guzmán I, Hoyos-Loya E, Trejo-Domínguez A, Hernández-Cordero S, Mazariegos M, Smith N, Tavano-Colaizzi L, Mier-Cabrera J, Avendaño-Álvarez F, Espino y Sosa S, Muciño-Sandoval K, Ibarra-González L, Medina-Avilés C. A scoping review and critical evaluation of the methodological quality of clinical practice guidelines on nutrition in the preconception. Front Nutr 2023; 10:1122289. [PMID: 37927499 PMCID: PMC10621738 DOI: 10.3389/fnut.2023.1122289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Clinical practice guidelines (CPGs) contain recommendations for specific clinical circumstances, including maternal malnutrition. This study aimed to identify the CPGs that provide recommendations for preventing, diagnosing, and treating women's malnutrition. Additionally, we sought to assess the methodological quality using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Methods An online search for CPGs was performed, looking for those that contained lifestyle and nutritional recommendations to prevent, diagnose and treat malnutrition in women during the preconception period using PubMed and different websites. The reviewers utilized the AGREE II instrument to appraise the quality of the CPGs. We defined high-quality guidelines with a final score of > 70%. Results The titles and abstracts from 30 guidelines were screened for inclusion, of which 20 guidelines were fully reviewed for quality assessment. The overall quality assessment of CPGs was 73%, and only 55% reached a high-quality classification. The domains in the guidelines classified as high-quality had the highest scores in "Scope and Purpose" and "Clarity of Presentation" with a median of 98.5 and 93%, respectively. Discussion Further assessment is needed to improve the quality of the guidelines, which is an opportunity to strengthen them, especially in the domains with the lowest scores.
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Affiliation(s)
- Mónica Ancira-Moreno
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Cinthya Muñoz-Manrique
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Coordination of Nutrition and Bioprogramming, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Isabel Omaña-Guzmán
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Elizabeth Hoyos-Loya
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Alejandra Trejo-Domínguez
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Mónica Mazariegos
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Natalia Smith
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | | | - Jennifer Mier-Cabrera
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Fermín Avendaño-Álvarez
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Salvador Espino y Sosa
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Karla Muciño-Sandoval
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Lizeth Ibarra-González
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Nutrition and Dietetics Service, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Cristina Medina-Avilés
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Sub-Direction of Gynecology and Obstetrics Instituto Nacional de Perinatología, Mexico City, Mexico
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Pérez-Escamilla R, Tomori C, Hernández-Cordero S, Baker P, Barros AJD, Bégin F, Chapman DJ, Grummer-Strawn LM, McCoy D, Menon P, Ribeiro Neves PA, Piwoz E, Rollins N, Victora CG, Richter L. Breastfeeding: crucially important, but increasingly challenged in a market-driven world. Lancet 2023; 401:472-485. [PMID: 36764313 DOI: 10.1016/s0140-6736(22)01932-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 02/10/2023]
Abstract
In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding. About one in three neonates in low-income and middle-income countries receive prelacteal feeds, and only one in two neonates are put to the breast within the first hour of life. Prelacteal feeds are strongly associated with delayed initiation of breastfeeding. Self-reported insufficient milk continues to be one of the most common reasons for introducing commercial milk formula (CMF) and stopping breastfeeding. Parents and health professionals frequently misinterpret typical, unsettled baby behaviours as signs of milk insufficiency or inadequacy. In our market-driven world and in violation of the WHO International Code for Marketing of Breast-milk Substitutes, the CMF industry exploits concerns of parents about these behaviours with unfounded product claims and advertising messages. A synthesis of reviews between 2016 and 2021 and country-based case studies indicate that breastfeeding practices at a population level can be improved rapidly through multilevel and multicomponent interventions across the socioecological model and settings. Breastfeeding is not the sole responsibility of women and requires collective societal approaches that take gender inequities into consideration.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Cecília Tomori
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Sonia Hernández-Cordero
- Research Center for Equitable Development (EQUIDE), Universidad Iberoamericana, Mexico City, Mexico
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Purnima Menon
- International Food Policy Research Institute, New Delhi, India
| | | | | | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Linda Richter
- Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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Lutter CK, Hernández-Cordero S, Grummer-Strawn L, Lara-Mejía V, Lozada-Tequeanes AL. Violations of the International Code of Marketing of Breast-milk Substitutes: a multi-country analysis. BMC Public Health 2022; 22:2336. [PMID: 36514038 PMCID: PMC9749209 DOI: 10.1186/s12889-022-14503-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
The marketing of formula milk as a substitute for breast milk continues to be ubiquitous and multifaceted despite passage by the World Health Assembly of the International Code of Marketing of Breast-milk Substitutes (the Code) in 1981. In this paper, we summarized reports of the Code violations from eight studies using the WHO/UNICEF NetCode protocol. Among 3,124 pregnant women and mothers with young children, in eight countries, 64% reported exposure to promotion of products covered under the Code in the previous 6 months, primarily from advertisements seen outside of health facilities (62%). Nearly 20% of mothers with an infant < 6 months reported that a health care provider had advised them to feed their child food or drink other than breast milk, and 21% of providers reported contact with a representative of a formula company in the previous 6 months to distribute promotional materials, samples, or free supplies (range 2%-53%). Of the 389 retail stores and pharmacies surveyed, promotions were observed in 63% (range 0-100%), and of 1,206 labels and inserts of products reviewed, nearly half included health and/or nutrition claims (range 0-100%). A strong, though non-significant, linear relationship between the composite violations score and quality of Code legislation was found; countries with the lowest percentage of violations had the strongest Code legislation. In Latin America, over 50% of health care providers reported no knowledge of the Code, and 50% reported no knowledge of national legislation. Our study highlights three key facts: 1) the marketing of BMS is ubiquitous and multifaceted, 2) the high variability of promotion across countries generally reflects the comprehensiveness of Code legislation, and 3) health care providers have poor knowledge of the Code and national legislation.
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Affiliation(s)
- C. K. Lutter
- grid.62562.350000000100301493International Development Group, Food Security and Agriculture, RTI International, 701 13Th Street NW, Suite 750, Washington, DC 20005-3967 USA
| | - S. Hernández-Cordero
- grid.441047.20000 0001 2156 4794Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de La Reforma 880, Lomas de Santa Fe, 01219 Mexico City, Mexico
| | - L. Grummer-Strawn
- grid.3575.40000000121633745Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - V. Lara-Mejía
- grid.441047.20000 0001 2156 4794Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de La Reforma 880, Lomas de Santa Fe, 01219 Mexico City, Mexico
| | - A. L. Lozada-Tequeanes
- grid.415771.10000 0004 1773 4764Nutrition and Health Research Center, National Institute of Public Health, Santa Maria Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
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Muñoz-Manrique C, Trejo-Valdivia B, Hernández-Cordero S, Cantoral A, Deierlein AL, Colicino E, Niedzwiecki MM, Wright RO, Baccarelli AA, Téllez-Rojo MM. Weight gain trajectories patterns from pregnancy to early postpartum: identifying women at risk and timing to prevent weight regain. BMC Pregnancy Childbirth 2022; 22:811. [PMID: 36333677 PMCID: PMC9635073 DOI: 10.1186/s12884-022-05154-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background Woman's weight changes during pregnancy and postpartum contribute to obesity and health outcomes later in life. This study aimed to identify and characterize weight change trajectories from pregnancy to one year postpartum among adult women. Methods We used data from an ongoing cohort of healthy adult women (n = 819) with singleton pregnancies from 2007 – 2011. Sociodemographic data, pre-pregnancy body weight, and sedentary and breastfeeding practices were collected using questionaries applied by trained professionals. We applied a group-based trajectory modeling to distinguish weight change measured in the second and third trimesters of pregnancy and at one month, six, and 12 months postpartum. Multinomial regression models were run to characterize each trajectory. Results We identified six weight change trajectories with the main difference in the patterns followed after one month of delivery. One in three women (36.7%) was classified in some of the three postpartum weight gain trajectories and regained weight from the second trimester of the first year postpartum. Women who followed some of these trajectories were more likely to have higher age, obesity before pregnancy, < 10 years of schooling, and partner, compared with women (10.7%, n = 87) in a postpartum sustained-fast-lost-weight trajectory (p < 0.05). Conclusions Women with obesity before pregnancy have higher odds of regaining gestational weight after delivery without reaching their pre-pregnancy weight. The first six months postpartum are crucial to establishing obesity prevention strategies. Further research is needed to evaluate the effect of the interventions that prevent substantial weight gain through reproductive years in high-risk women.
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Tomori C, Hernández-Cordero S, Busath N, Menon P, Pérez-Escamilla R. What works to protect, promote and support breastfeeding on a large scale: A review of reviews. Matern Child Nutr 2022; 18 Suppl 3:e13344. [PMID: 35315573 PMCID: PMC9113479 DOI: 10.1111/mcn.13344] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023]
Abstract
Globally women continue to face substantial barriers to breastfeeding. The 2016 Lancet Breastfeeding Series identified key barriers and reviewed effective interventions that address them. The present study updates the evidence base since 2016 using a review of reviews approach. Searches were implemented using the Epistomenikos database. One hundred and fifteen reviews of interventions were identified and assessed for quality and risk of bias. Over half of reviews (53%) were high- or moderate quality, with the remaining low or critically low quality due to weaknesses in assessment of bias. A large portion of studies addressed high-income and upper-middle income settings, (41%), and a majority (63%) addressed health systems, followed by community and family settings (39%). Findings from reviews continue to strengthen the evidence base for effective interventions that improve breastfeeding outcomes across all levels of the social-ecological model, including supportive workplace policies; implementation of the Baby-Friendly Hospital Initiative, skin to skin care, kangaroo mother care, and cup feeding in health settings; and the importance of continuity of care and support in community and family settings, via home visits delivered by CHWs, supported by fathers', grandmothers' and community involvement. Studies disproportionately focus on health systems in high income and upper-middle income settings. There is insufficient attention to policy and structural interventions, the workplace and there is a need for rigorous assessment of multilevel interventions. Evidence from the past 5 years demonstrates the need to build on well-established knowledge to scale up breastfeeding protection, promotion and support programmes.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA.,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Natalie Busath
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Purnima Menon
- International Food Policy Research Institute, Delhi, India
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Rhode Island, USA
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Hernández-Cordero S, Vilar-Compte M, Castañeda-Márquez AC, Rollins N, Kingston G, Pérez-Escamilla R. Exposure to marketing of breastmilk substitutes in Mexican women: Sources and scope. Int Breastfeed J 2022; 17:16. [PMID: 35236370 PMCID: PMC8889386 DOI: 10.1186/s13006-022-00455-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/05/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Aggressive and unregulated marketing of breastmilk substitutes (BMS) results in increased child morbidity and mortality. Unregulated BMS marketing is a major public health concern because it encourages formula consumption at the expense of breastfeeding. This study aimed to identify the sources and characterize the nature of exposure to marketing of BMS among Mexican mothers of children under 18 months of age. As a secondary objective we explored potential association between exposure to BMS marketing and infant feeding practices. METHODS Cross-sectional study, comprising a pre-piloted survey, was conducted between February 2020 to February 2021 with Mexican mothers of children under 18 months of age (n = 754), in two major cities in Mexico. Mothers were selected according to their current infant feeding practices (Breastfeeding only vs. Mixed feeding). We characterized the different BMS marketing sources and scope, and related them with infant feeding practices. In addition, we used logistic regression models to estimate the odds ratio for infant feeding practices by BMS marketing exposure or recommendation. RESULTS Mothers reported different sources of exposure to BMS promotion, including BMS advertisements in diverse media channels (41.6%), recommendation by a healthcare professional and/or relative (76.2%), and receiving a BMS sample at a hospital (18.6%). By contrast, only 36.5% recalled hearing or seeing breastfeeding information the previous year. The odds of mixed feeding were substantially higher, compared to breastfeeding, when mothers were recommended to use a BMS by doctors/pediatricians (OR: 3.96, 95% CI: 2.00, 7.83). Having seen or heard breastfeeding information in the previous year was associated with a lower risk of mixed feeding compared to breastfeeding only (OR: 0.59, 95% CI: 0.35, 0.99). CONCLUSIONS Mexican mothers of young children in the metropolitan areas studied were highly exposed to BMS marketing and through different mass media channels and inter-personal sources. Health care professionals, particularly doctors/pediatricians, are a source of BMS promotion that are likely to have a strong influence on maternal decisions about infant feeding practices. There is an urgent need to protect mothers and their families against unregulated BMS promotion through mass media channels and directly by influential individuals, including health care providers.
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Affiliation(s)
- Sonia Hernández-Cordero
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico.
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, 1 Normal Avenue, Montclair, NJ, 07043, USA
| | - Ana Cristina Castañeda-Márquez
- School of Public Health of Mexico, National Institute of Public Health, Av. Universidad 655, Cuernavaca, Morelos, México
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1202, Geneve, Switzerland
| | - Gillian Kingston
- Executive Fellow, School of Business, Kings College London, London, England
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, 06510, CT, USA
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11
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Barquera S, Véjar-Rentería LS, Aguilar-Salinas C, Garibay-Nieto N, García-García E, Bovecchio A, Perichart O, Torres-Tamayo M, Esquivias-Zavala H, Villalpando-Carrión S, García-Méndez RC, Apolinar-Jiménez E, Kaufer-Horwitz M, Martínez-Montañez OG, Fajardo Niquete I, Aguirre Crespo A, Gómez-Álvarez E, Hernández-Jiménez SC, Denova-Gutiérrez E, Batis C, Elías-López D, Palos-Lucio AG, Vásquez Garibay EM, Romero-Velarde E, Ortiz-Rodríguez MA, Almendra-Pegueros R, Contreras A, Nieto C, Hernández-Cordero S, Munguía A, Rojas-Russell M, Sánchez-Escobedo S, Delgado-Amézquita E, Aranda-González I, Cruz-Casarrubias C, Campos-Nonato I, García-Espino F, Martínez-Vázquez S, Arellano-Gómez LP, Caballero-Cantú I, Hunot Alexande C, Valero-Morales I, González-González L, Ríos-Cortázar V, Medina-García C, Argumedo G, Calleja Enríquez CR, Robles Macías E, Nava-González EJ, Lara-Riegos J, Sánchez-Plascencia AK, Hernández-Fernández M, Rodríguez Nuñez JL, Rangel-Quillo S, Cancino-Marentes ME, Hernández-Viana MJ, Saldivar-Frausto M, Alvarez-Ramirez M, Sandoval-Salazar C, Silva-Tinoco RO, Moreno-Villanueva M, Villarreal-Arce ME, Barriguete JA, White M, Jauregui A, Tolentino-Mayo L, López-Ridaura R, Rivera-Dommarco J. Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud. Salud Publica Mex 2022; 64:225-229. [DOI: 10.21149/13679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022] Open
Abstract
La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.
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12
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Ancira-Moreno M, Monterrubio-Flores E, Hernández-Cordero S, Omaña-Guzmán I, Soloaga I, Torres F, Reyes M, Burrola-Mendez Y, Morales-López A. Incidence of low birth weight in Mexico: A descriptive retrospective study from 2008-2017. PLoS One 2021; 16:e0256518. [PMID: 34506506 PMCID: PMC8432805 DOI: 10.1371/journal.pone.0256518] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 08/09/2021] [Indexed: 11/18/2022] Open
Abstract
According to the WHO, low birth weight (LBW) affects 15-20% of newborns worldwide. In Mexico, there are no national, state, nor municipal estimates that inform the country's situation over time. The purpose of this study was to estimate the incidence of LBW at the national, state, and municipal levels from 2008 to 2017, and to estimate the LBW incidence based on maternal sociodemographic characteristics, prenatal care and marginalization indexes at the national level using open national data. We used spatial data analysis to georeferenced LBW incidence at the three levels of geographical disaggregation studied. At the national level, the incidence of LBW increased progressively from 6.2% (2008) to 7.1% (2017), and the country's capital represented the area with the highest incidence. Southeastern and central states reported the highest LBW regional incidence. At the municipal level, the number of municipalities with an incidence of LBW ≥8% increased in both male and female newborns. The incidence of LBW was higher as the marginalization indexes increases. The results from this study may assist in the identification of vulnerable groups and the development of public health programs and policies with an intersectoral approach that improves maternal and child nutrition.
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Affiliation(s)
- Mónica Ancira-Moreno
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, México
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
| | - Eric Monterrubio-Flores
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Sonia Hernández-Cordero
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, México
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, México
| | - Isabel Omaña-Guzmán
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City, México
| | - Isidro Soloaga
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Departamento de Economía y GEOLab-IBERO, Universidad Iberoamericana, Ciudad de México, México
| | - Fabián Torres
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Centro de Estudios en Computación Avanzada, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Moisés Reyes
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Departamento de Economía y GEOLab-IBERO, Universidad Iberoamericana, Ciudad de México, México
- GEOLab-IBERO, Universidad Iberoamericana, Ciudad de México, México
| | - Yohali Burrola-Mendez
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Ariana Morales-López
- Maestría en Nutrición Aplicada, Universidad Iberoamericana, Ciudad de México, México
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13
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Vilar-Compte M, Hernández-Cordero S, Ancira-Moreno M, Burrola-Méndez S, Ferre-Eguiluz I, Omaña I, Pérez Navarro C. Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women. Int J Equity Health 2021; 20:110. [PMID: 33926471 PMCID: PMC8082937 DOI: 10.1186/s12939-021-01432-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background Breastfeeding can be affected by maternal employment. This is important considering that in 2019, 47.1% of women globally participated in the labor force. The aim of this study was to review workplace interventions to promote, protect and support breastfeeding practices among working mothers globally. Methods A systematic review was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational, experimental and qualitative peer-reviewed studies in English and Spanish, published between 2008 and 2019 were included. The review focused on working women who were pregnant, breastfeeding or who recently had a child, and women’s working environments. The outcomes of interest included breastfeeding intentions, initiation, exclusivity and duration, confidence in breastfeeding or breastmilk extraction, and perceived support at workplace. Quality was assessed according to National Institute for Health and Care Excellence (NICE) checklist for systematic reviews. It was registered on PROSPERO (#140624). Results Data was extracted from 28 quantitative and 9 qualitative studies. The most common interventions were designated spaces for breastfeeding or breastmilk extraction (n = 24), and the support from co-workers (n = 20). The least common interventions were providing breast pumps (n = 4) and giving mothers the flexibility to work from home (n = 3). Studies explored how interventions affected different breastfeeding outcomes including breastfeeding duration, breastfeeding exclusivity, confidence in breastmilk expression, and breastfeeding support. The evidence suggests that workplace interventions help increase the duration of breastfeeding and prevent early introduction of breastmilk substitutes. Having a lactation space, breastmilk extraction breaks, and organizational policies are key strategies. However, to achieve equitable working conditions for breastfeeding mothers, organizational and interpersonal changes need to occur as well. Conclusions The systematic review revealed that interventions at the workplace are important in protecting, promoting and supporting breastfeeding among working mothers. To achieve equitable work environments and fair nutritional opportunities for infants of working mothers, interventions should focus at the three ecological layers – individual, interpersonal, and organizational. The quality of studies can be improved. There is a need for studies assessing impacts of workplace interventions on infant feeding practices, mothers’ self-esteem and outcomes such productivity and abstentionism.
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Affiliation(s)
- Mireya Vilar-Compte
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico.
| | - Mónica Ancira-Moreno
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Isabel Ferre-Eguiluz
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Isabel Omaña
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Cecilia Pérez Navarro
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico.,Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
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14
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Hernández-Cordero S, Lozada-Tequeanes AL, Fernández-Gaxiola AC, Shamah-Levy T, Sachse M, Veliz P, Cosío-Barroso I. Barriers and facilitators to breastfeeding during the immediate and one month postpartum periods, among Mexican women: a mixed methods approach. Int Breastfeed J 2020; 15:87. [PMID: 33059706 PMCID: PMC7559131 DOI: 10.1186/s13006-020-00327-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence suggests that inadequate hospital practices, as well as sociocultural and community factors have detrimental effects on timely initiation as the first breastfeed within first hour after birth, and exclusive breastfeeding. The purpose of the study was to examine the factors that influence timely initiation of breastfeeding and exclusive breastfeeding at birth and 1 month postpartum in Mexican women delivering in public and private hospitals. METHODS Mixed methods were conducted between May and July 2017, including surveys (n = 543) and semi-structured interviews (n = 60) in the immediate (7 h) and intermediate (30 days) postpartum periods. Participants were women aged 15-49 years, in public and private hospitals, of urban and rural municipalities of Chihuahua and Puebla, Mexico. RESULTS Timely initiation was reported by 49.4% of mothers, and 34.7% reported that their children received infant formula at the hospital. Only 44.8% of women reported exclusive breastfeeding at 1 month postpartum. Timely initiation of breastfeeding was higher in women with vaginal delivery (62.1 vs 35.5%; p < 0.05) and those who received information during pregnancy (OR 1.07; p = 0.018). Exclusive breastfeeding at 1 month postpartum was related to older maternal age (OR 1.05; p < 0.001) and the fact that the mothers had received more information about breastfeeding during pregnancy (OR 1.13; p = 0.0001). Infant formula use was less associated with timely initiation (OR 0.46; p = 0.001). Participants in qualitative data identified the emotional, physical and economic benefits of breastfeeding, however, the perception about insufficient production of human milk, and the belief that infant formula is recommended, persists. CONCLUSIONS Modification of hospital practices, such as decreasing the number of cesarean and the use of infant formula, as well as the support of the initiation and continuation of exclusive breastfeeding by health personnel and family members, could help increase breastfeeding practices in Mexican women.
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Affiliation(s)
| | | | | | - Teresa Shamah-Levy
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Matthias Sachse
- Fondo de las Naciones Unidas para la Infancia, Ciudad de México, Mexico
| | - Paula Veliz
- Fondo de las Naciones Unidas para la Infancia, Ciudad de México, Mexico
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15
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Lozada-Tequeanes AL, Hernández-Cordero S, Shamah-Levy T. Marketing of breast milk substitutes on the internet and television in Mexico. J Paediatr Child Health 2020; 56:1438-1447. [PMID: 32790214 DOI: 10.1111/jpc.14968] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/24/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Abstract
AIM We aimed to examine the advertising and marketing of breast milk substitutes (BMS) through the internet, social media and television in Mexico. METHODS We recorded the programming of four main TV channels at peak times to identify BMS advertisements. In addition, we identified the main BMS products and companies present on the internet, as well as related home pages and social networks (Facebook, Twitter and YouTube). After that, we examined current BMS' marketing practices using the International Code of Marketing of Breast-milk Substitutes ('the Code') as a framework for ethical marketing. Qualitative and statistical analyses are presented. RESULTS BMS manufacturers have a presence on television, social media and the internet. Violations of the Code, as well as promotional practices unforeseen by the Code, were identified in all the studied media. These include text and images idealising the use of BMS, as well as mechanisms for boosting sales and making contact with consumers. CONCLUSIONS The Mexican population is exposed to BMS advertisements that breach the Code on the internet, on social networks and on television. Emerging challenges related to the use of electronic means to market BMS may call for new strategies for monitoring and enforcing the Code through local regulations.
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Affiliation(s)
| | | | - Teresa Shamah-Levy
- Evaluation and Surveys Research Center, National Public Health Institute, Cuernavaca, Mexico
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16
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Zárate-Ortiz AG, Melse-Boonstra A, Rodríguez-Ramírez S, Hernández-Cordero S, Feskens EJM. Dietary Patterns and the Double Burden of Malnutrition in Mexican Adolescents: Results from ENSANUT-2006. Nutrients 2019; 11:E2753. [PMID: 31766194 PMCID: PMC6893405 DOI: 10.3390/nu11112753] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 09/26/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022] Open
Abstract
Mexico is facing the double burden of malnutrition, and adolescents are not an exception. Diet plays an important role, both in causing overweight and undernutrition. This study aimed to describe the dietary patterns (DPs) of Mexican adolescents and to examine its association with nutritional status using data from adolescents aged 12-19 years (n = 7380) from the National Survey of Health and Nutrition (ENSANUT-2006). Principal component analysis was used to derivate the DPs. Associations between DP and nutritional status were determined by prevalence ratio (PR). Four DPs were identified: nontraditional and breakfast-type, Western, plant-based, and protein-rich. The prevalence of overweight and obesity was higher in adolescents who scored high on the Western pattern (PR: 1.15, 95% CI: 1.08-1.21) or on the plant-based pattern (PR: 1.09, 95% CI: 1.03-1.17). The Western pattern was positively associated with anemia in girls (PR: 1.18, 95% CI: 1.03-1.35), while the nontraditional and breakfast-type pattern was inversely associated with anemia in adolescents aged 12-15 years (PR: 0.87, 95% CI: 0.76-0.99) and in girls (PR: 0.84, 95% CI: 0.75-0.97). The Western and plant-based patterns were simultaneously associated with overweight-obesity and at least one indicator of undernutrition. In the context of the double burden of malnutrition, dietary advice must consider malnutrition in all its forms.
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Affiliation(s)
- Arli Guadalupe Zárate-Ortiz
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen 6708WE, The Netherlands; (A.G.Z.-O.)
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen 6708WE, The Netherlands; (A.G.Z.-O.)
| | - Sonia Rodríguez-Ramírez
- Research Center of Nutrition and Health, National Institute for Public Health, Cuernavaca 62100, Mexico
| | | | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen 6708WE, The Netherlands; (A.G.Z.-O.)
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17
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Hernández-Cordero S, Lozada-Tequeanes AL, Shamah-Levy T, Lutter C, González de Cosío T, Saturno-Hernández P, Rivera Dommarco J, Grummer-Strawn L. Violations of the International Code of Marketing of Breast-milk Substitutes in Mexico. Matern Child Nutr 2018; 15:e12682. [PMID: 30168899 DOI: 10.1111/mcn.12682] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/10/2018] [Accepted: 08/14/2018] [Indexed: 01/15/2023]
Abstract
This study estimated the prevalence of violations of the International Code of Marketing of Breast-milk Substitutes (BMS) and subsequent resolutions of the World Health Assembly (Code) at health facilities, points of sale (POS), and on BMS labelling and media in Mexico. We carried out a cross-sectional survey among 693 mothers with children aged less than 24 months and 48 health providers at public and private health facilities in two states of Mexico. Observational assessment at 20 POS and the health facilities was conducted as well as an analysis of labels on BMS products for sale. Women attending public and private health facilities reported receiving free BMS samples in the previous 6 months (11.1%), and about 80% reported seeing BMS promotion in the mass media. Health providers reported contact with BMS manufacturer representatives in the previous 6 months (15.5%), and only 41.6% of the health providers had knowledge of the Code. BMS promotions were identified at nearly all POS. Analysis of 190 BMS labels showed that 30% included pictures/text idealizing the use of BMS, and all labels incorporated health and nutrition claims. Violations of the Code are prevalent within the health services, POS, and labelling of BMS products. The high percentage of health providers with no knowledge of the Code calls for action at national level to better disseminate and comply with the Code. A transparent, free from commercial influence, and continual monitoring system for Code compliance is needed, including a follow-up component on sanctions for contraventions of the Code.
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Affiliation(s)
- Sonia Hernández-Cordero
- Health Department, Universidad Iberoamericana, Mexico City, Mexico.,Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Teresa Shamah-Levy
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Chessa Lutter
- RTI International, Washington, DC.,School of Public Health, University of Maryland, College Park, Maryland
| | | | - Pedro Saturno-Hernández
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Juan Rivera Dommarco
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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18
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Hernández-Ruiz Z, Rodríguez-Ramírez S, Hernández-Cordero S, Monterrubio-Flores E. [Dietary patterns and metabolic syndrome components in women with excess weight 18 to 45 years old]. Salud Publica Mex 2018; 60:158-165. [PMID: 29738655 DOI: 10.21149/8847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/05/2017] [Accepted: 12/07/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To analyze the association between dietary patterns and metabolic syndrome (MS) components in adult women with excess weight. MATERIAL AND METHODS Cross-sectional study with anthropometric, dietary, biochemical and blood pressure data. Dietary patterns were identified by factor analysis and multiple logistic regression models were used to analyze associations. RESULTS The prevalence of altered glucose was 14.6%, of hypertriglyceridemia 40.4%, of altered concentration of high density lipoprotein cholesterol(HDLc) 45.0%, hypertension 4.6% and MS 30%. The pattern with high consumption of corn tortillas, meats and legumes, was associated with less possibility of hyperglycemia (OR= 0.62; 95%CI 0.39-0.98). The pattern with high consumption of sweet and salty snacks, milk, rice, soaps and pasta, was inversely associated with the possibility of low HDLc concentration (OR= 0.76; 95%CI 0.60-0.97). CONCLUSIONS A dietary pattern with greater consumption of legumes, meats and corn tortillas was associated with less possibility of having hyperglycemia.
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Affiliation(s)
- Zugey Hernández-Ruiz
- Departamento de Vigilancia de la Nutrición, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Sonia Rodríguez-Ramírez
- Departamento de Nutrición de Comunidades, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Sonia Hernández-Cordero
- Departamento de Vigilancia de la Nutrición, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Eric Monterrubio-Flores
- Departamento de Procesamiento y Análisis de Datos, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
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Hernández-Cordero S, Cuevas-Nasu L, Morales-Ruán MC, Humarán IMG, Ávila-Arcos MA, Rivera-Dommarco JA. Overweight and obesity in Mexican children and adolescents during the last 25 years. Nutr Diabetes 2017; 7:e280. [PMID: 28581504 PMCID: PMC5519188 DOI: 10.1038/nutd.2017.29] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This corrects the article DOI: 10.1038/nutd.2016.52.
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Hernández-Cordero S, Cuevas-Nasu L, Morán-Ruán MC, Méndez-Gómez Humarán I, Ávila-Arcos MA, Rivera-Dommarco JA. Overweight and obesity in Mexican children and adolescents during the last 25 years. Nutr Diabetes 2017; 7:e247. [PMID: 28287630 PMCID: PMC5380891 DOI: 10.1038/nutd.2016.52] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/11/2016] [Accepted: 11/01/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/OBJECTIVE The objective of the study was to provide current estimates of the prevalence and trends of overweight and obesity (OW+OB) in Mexican children and adolescents. SUBJECTS/METHODS Body mass index objectively measured was analyzed for 37 147 children and adolescents aged 0-19 years obtained in 2012 as part of the National Health and Nutrition Survey (ENSANUT-2012), a nationally representative sample of the Mexican population. In addition, data from previous National Nutrition Surveys obtained in 1988, 1999 and 2006 were compared with analyze trends over a 24-year period (1988-2012) for children <5 years of age and adolescents and over a 13-year period (1999-2012) for school-age children. World Health Organization Child Growth Standard was used to define OW+OB. RESULTS In 2012, 33.5% of children <5 years of age (both sexes) were at risk of overweight or were overweight (OW); 32% and 36.9% of girls and boys 5-11 years of age were OW+OB, respectively, and 35.8% and 34.1% of female and male adolescents were OW+OB, respectively. Statistically significant trends were documented for all age groups during the study period. Overall change in the combined prevalence in preschool children was 6.3±1.0 percentage points (pp; P<0.001; 0.26 pp per year) in the last 24 years, showing the highest increase between 1988 and 1999, whereas for school-age girls (from 1999 to 2012) and adolescent females (from 1988 to 2012), OW+OB increased across all periods at a declining trend, with an overall change of 0.5 and 1.0 pp per year, respectively. Changes in the prevalence of OW+OB were highest among children and adolescents in the lowest quintile of the household living condition index. CONCLUSIONS Prevalence of OW+OB among children and adolescents increased significantly during the last 13-24 years. The rate of increase has declined in the last 6 years in all age groups. Changes in prevalence of OW+OB presented here suggest that, in Mexico, the burden of obesity is shifting toward the groups with lower socioeconomic level.
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Affiliation(s)
- S Hernández-Cordero
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - L Cuevas-Nasu
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - M C Morán-Ruán
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - I Méndez-Gómez Humarán
- Centro de Investigación en Matemáticas A.C., Unidad Aguascalientes, Aguascalientes, México
| | - M A Ávila-Arcos
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - J A Rivera-Dommarco
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
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González de Cosío-Martínez T, Hernández-Cordero S, Rivera-Dommarco J, Hernández-Ávila M. Recomendaciones para una política nacional de promoción de la lactancia materna en México: postura de la Academia Nacional de Medicina. ACTA ACUST UNITED AC 2017; 59:106-113. [DOI: 10.21149/8102] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/22/2016] [Indexed: 11/06/2022]
Abstract
Para mejorar las prácticas de lactancia materna es necesario fortalecer acciones de promoción, protección y apoyo, y establecer una política nacional multisectorial que incluya elementos indispensables de diseño, implementación, monitoreo y evaluación de programas y políticas públicas, financiamiento para acciones e investigación, desarrollo de abogacía y voluntad política, y promoción de la lactancia materna, todo coordinado por un nivel central. Recientemente, México ha iniciado un proceso de reformas conducentes a la conformación de una Estrategia Nacional de Lactancia Materna (ENLM). Esta estrategia es el resultado de la disponibilidad de evidencia científica sobre los beneficios de la lactancia materna en la salud de la población y el desarrollo de capital humano así como de los datos alarmantes de su deterioro. La implementación integral de una ENLM que incluya el establecimiento de un Comité Nacional Operativo, coordinación intra e intersectorial de acciones, establecimiento de metas claras, monitoreo y penalización de las violaciones al Código Internacional de Comercialización de Sucedáneos de la Leche Materna, y financiamiento de estas acciones es la gran responsabilidad pendiente de la agenda de salud pública del país.
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López-Olmedo N, Hernández-Cordero S, Neufeld LM, García-Guerra A, Mejía-Rodríguez F, Méndez Gómez-Humarán I. The Associations of Maternal Weight Change with Breastfeeding, Diet and Physical Activity During the Postpartum Period. Matern Child Health J 2016; 20:270-80. [PMID: 26525558 DOI: 10.1007/s10995-015-1826-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the association between breastfeeding practices, diet and physical activity and maternal postpartum weight. METHODS This was a secondary data analysis of a randomized community trial on beneficiaries of the Programa de Desarrollo Humano Oportunidades, recently renamed Prospera (n = 314 pregnant women), without any diseases that could affect body weight. Generalized estimating equations were used to determine the association between postpartum weight change and changes in diet, physical activity and type of breastfeeding. RESULTS The mean postpartum weight change from the first to the third month was 0.6 ± 2.2 kg. Women who breastfed exclusively for 3 months had a 4.1 (SE = 1.9) kg weight reduction in comparison with women who did not provide exclusive breastfeeding or who discontinued breastfeeding before 3 months (p = 0.04). There was no association between postpartum weight change and physical activity (p = 0.24) or energy intake (p = 0.06). CONCLUSIONS Exclusive breastfeeding was associated with maternal postpartum weight reduction. These results reinforce the World Health Organization recommendation of exclusive breastfeeding during the first 6 months of life in order to reduce the risk of weight retention or weight gain in postpartum women. It has been well established that exclusive breastfeeding is beneficial for both infants and mothers, but promoting breastfeeding as a strategy to promote postpartum weight loss is of paramount importance, especially in countries like Mexico where excessive weight in women of reproductive age is a public health problem.
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Affiliation(s)
- Nancy López-Olmedo
- Nutrition and Health Research Center, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
| | - Sonia Hernández-Cordero
- Nutrition and Health Research Center, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
| | - Lynnette M Neufeld
- Global Alliance for Improved Nutrition (GAIN), Rue de Vermont 37-39, 1202, Geneva, Switzerland.
| | - Armando García-Guerra
- Nutrition and Health Research Center, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
| | - Fabiola Mejía-Rodríguez
- Nutrition and Health Research Center, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
| | - Ignacio Méndez Gómez-Humarán
- Centro de Investigación en Matemáticas A.C., Unidad Aguascalientes, Fray Bartolomé de las Casas 314, Barrio de la Estación, C.P. 20259, Aguascalientes, Aguascalientes, Mexico.
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Hernández-Cordero S, López-Olmedo N, Rodríguez-Ramírez S, Barquera-Cervera S, Rivera-Dommarco J, Popkin B. Comparing a 7-day diary vs. 24 h-recall for estimating fluid consumption in overweight and obese Mexican women. BMC Public Health 2015; 15:1031. [PMID: 26446676 PMCID: PMC4597614 DOI: 10.1186/s12889-015-2367-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/16/2014] [Accepted: 09/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High intake of sugar-sweetened beverages (SSB) is linked to increased weight, energy intake, and diabetes. Even though the increasing interest on beverages and water intake, there are few dietary tools carefully validated. The purpose of this paper is to compare a fluid intake 7-day diary against a 24-h recall questionnaire to estimate the fluid consumption in overweight and obese women participating in a randomized controlled trial in Mexico. METHODS This cross-sectional study explored the correlation of reported fluid consumption between two methods: 3-day 24-hr recalls and 7-day diary beverage registry in overweight and obese Mexican women aged 18-45 y (n = 190). RESULTS There was no difference on median estimated volume (mL/d), nor the median estimated energy (kcal/d) from total beverage consumption registered by the two dietary tools. The crude and rank correlation among the two dietary instruments was high for total fluid consumption in mL/d r = 0.7, p < 0.001 (crude and rank correlation) and for fluid consumption measured as energy intake: r = 0.7; p < 0.001 crude, and r = 0.5; p < 0.001 rank correlation. By type of beverage, the more meaningful rank correlations were for fluid intake in: mL/d, water, alcohol beverages, and SSB; and in kcal/d, alcohol beverages and SSBs (rank correlation ≥ 0.6). CONCLUSIONS Overall, the 7-day diary showed high and strong rank correlations with that reported in the 24-h recall, suggesting that the diary method is a valid dietary tool to evaluate total fluid, water and SSB intake in this population.
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Affiliation(s)
- Sonia Hernández-Cordero
- Center of Research in Nutrition and Health, National Institute of Public Health, Av. Universidad 655 Col. Sta. Maria Ahuacatitlán, Cuernavaca, Morelos, CP 62100, Mexico.
| | - Nancy López-Olmedo
- Center of Research in Nutrition and Health, National Institute of Public Health, Av. Universidad 655 Col. Sta. Maria Ahuacatitlán, Cuernavaca, Morelos, CP 62100, Mexico.
| | - Sonia Rodríguez-Ramírez
- Center of Research in Nutrition and Health, National Institute of Public Health, Av. Universidad 655 Col. Sta. Maria Ahuacatitlán, Cuernavaca, Morelos, CP 62100, Mexico.
| | - Simón Barquera-Cervera
- Center of Research in Nutrition and Health, National Institute of Public Health, Av. Universidad 655 Col. Sta. Maria Ahuacatitlán, Cuernavaca, Morelos, CP 62100, Mexico.
| | - Juan Rivera-Dommarco
- Center of Research in Nutrition and Health, National Institute of Public Health, Av. Universidad 655 Col. Sta. Maria Ahuacatitlán, Cuernavaca, Morelos, CP 62100, Mexico.
| | - Barry Popkin
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA.
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Rodríguez-Ramírez S, González de Cosío T, Mendez MA, Tucker KL, Méndez-Ramírez I, Hernández-Cordero S, Popkin BM. A Water and Education Provision Intervention Modifies the Diet in Overweight Mexican Women in a Randomized Controlled Trial. J Nutr 2015; 145:1892-9. [PMID: 26136584 PMCID: PMC6681834 DOI: 10.3945/jn.115.212852] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is minimal information on the impact of replacing sugar-sweetened beverage (SSB) consumption with water on diet quality from randomized controlled trials. OBJECTIVE We evaluated the effect of a water intake intervention on diet quality in overweight Mexican women. METHODS Women with a body mass index ≥25 and <39, 18-45 y old, and a self-reported high intake of SSBs (≥250 kcal/d) were randomly allocated to either the water and education provision (WEP) group (n = 120) or the education provision (EP) only group (n = 120). Each group received monthly nutrition counseling, and the WEP group received biweekly water deliveries for 9 mo. Three 24-h recalls, anthropometry, and demographic information were collected at baseline, and 3, 6, and 9 mo. Energy, macronutrient, sugar, SSB, fruit and vegetable, salty snack, cake and cookie, and fast food intakes were assessed in study completers (n = 189) classified by intervention assignment and by actual water intake at every time point (low <1200 vs. high ≥1200 mL/d). RESULTS The WEP group reported greater decreases in SSB intake than the EP group (from 20.9% to 10.3% of energy/d vs. from 20.1% to 17.8%). Thirty-eight percent of the EP group and 84.3% of the WEP group reported attaining a water intake ≥1200 mL/d. Reductions in energy intake and food groups were similar across intervention groups. However, the high actual water intake group reported greater increases vs. the lower intake group in intake of fruits and vegetables (117 vs. 47 g/d), as well as larger reductions in salty snacks (4.6 vs. 0.7 g/d) and cakes and cookies (31.7 vs. 14.7 g/d). CONCLUSIONS Other than SSBs, improvements in food group intake did not differ by intervention group in overweight Mexican women. However, post hoc analyses suggested that achieving a high actual water intake was associated with additional beneficial changes in food group intake. This trial was registered at clinicaltrials.gov as NCT01245010.
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Affiliation(s)
- Sonia Rodríguez-Ramírez
- Center of Research in Nutrition and Health, National Institute of Public
Health, Cuernavaca, Morelos, Mexico
| | - Teresa González de Cosío
- Center of Research in Nutrition and Health, National Institute of Public
Health, Cuernavaca, Morelos, Mexico
| | - Michelle A Mendez
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel
Hill, NC
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, College of
Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Ignacio Méndez-Ramírez
- Department of Probability and Statistics, Institute of Research in Applied
Mathematics and Systems, National University of Mexico, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Center of Research in Nutrition and Health, National Institute of Public
Health, Cuernavaca, Morelos, Mexico
| | - Barry M Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC;
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Hernández-Cordero S, Popkin BM. Impact of a Water Intervention on Sugar-Sweetened Beverage Intake Substitution by Water: A Clinical Trial in Overweight and Obese Mexican Women. Ann Nutr Metab 2015; 66 Suppl 3:22-5. [PMID: 26088043 DOI: 10.1159/000381242] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Intense marketing for sugar-sweetened beverages (SSB) along with the human innate preference for sweet taste contributes to the increase in consumption of SSB. It is important to understand the intricacies of dietary intake and global changes to the food supply to understand the complexities facing any intervention promoting water intake. We describe challenges to promote and achieve an increase in water intake and present key findings from a clinical trial examining the effects of substituting water for SSB on triglyceride levels, weight and other cardiometabolic factors in overweight/obese Mexican women. METHODS A randomized trial was conducted in Cuernavaca, Mexico selecting overweight/obese (BMI ≥25 and <39 kg/m(2)) women (18-45 years old), reporting an intake of SSB of at least 250 kcal/day. Women were randomly allocated to the water and education provision (WEP) group (n = 120) or to the education provision (EP) group (n = 120). Repeated 24 h dietary recall questionnaires, anthropometry, and fasting blood levels were collected at baseline and 3, 6, and 9 months following the intervention. RESULTS There was no effect of the intervention on triglyceride concentration or on any of the studied outcomes. Post-hoc analyses according to weight at baseline show that triglyceride concentration decreased in obese women. Prevalence of metabolic syndrome after the intervention was lower in obese women from the WEP group. CONCLUSION Water intake was increased but insufficient to achieve complete substitution of SSB, without effects on triglyceride concentration. Post-hoc analyses suggested that interventions lowered triglyceride concentration. Further studies are needed.
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Affiliation(s)
- Sonia Hernández-Cordero
- Center of Research in Nutrition and Health, National Institute of Public Health, Mexico City, Mexico
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Safdie M, Lévesque L, González-Casanova I, Salvo D, Islas A, Hernández-Cordero S, Bonvecchio A, Rivera JA. Promoting healthful diet and physical activity in the Mexican school system for the prevention of obesity in children. Salud Publica Mex 2015; 55 Suppl 3:357-73. [PMID: 24643485 DOI: 10.21149/spm.v55s3.5137] [Citation(s) in RCA: 12] [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] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This paper describes the rationale, design, and methods of a two-year randomized controlled trial conducted to evaluate the effectiveness of an environmental intervention in 27 elementary schools in Mexico City. MATERIALS AND METHODS There were two units of analysis, school level addressing changes in elementary public part-time schools, and individual-level addressing behavioral changes in students 9 to 11 years of age. Two intensities of an intervention program were implemented (basic and plus), each containing two intervention components: physical activity and nutrition, supported by a communication/education component. Evaluation of the intervention was carried out during the school cycles 2006-2007 and 2007-2008. RESULTS Primary outcomes were overweight and obesity prevalence and fitness; environmental and behavioural measures were also examined. CONCLUSIONS This is the first institutional multilevel, multifactorial project, consistent with the best practices available in current literature, carried out in Mexico to prevent childhood obesity in schools.
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Affiliation(s)
- Margarita Safdie
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Lucie Lévesque
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | | | | | - Ana Islas
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Sonia Hernández-Cordero
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Anabelle Bonvecchio
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Juan A Rivera
- Centro de Investigación en Nutrición y Salud, 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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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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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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Bonvecchio-Arenas A, Theodore F, Hernández-Cordero S, Campirano-Núñez F, Islas A, Safdie M, Rivera-Dommarco J. La escuela como alternativa en la prevención de la obesidad: la experiencia en el sistema escolar mexicano. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1135-3074(10)70005-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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García-Guerra A, Neufeld LM, Hernández-Cordero S, Rivera J, Martorell R, Ramakrishnan U. Prenatal multiple micronutrient supplementation impact on biochemical indicators during pregnancy and postpartum. Salud pública Méx 2009; 51:327-35. [DOI: 10.1590/s0036-36342009000400010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 04/22/2009] [Indexed: 11/22/2022] Open
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Neufeld LM, Hernández-Cordero S, Fernald LC, Ramakrishnan U. Overweight and obesity doubled over a 6-year period in young women living in poverty in Mexico. Obesity (Silver Spring) 2008; 16:714-7. [PMID: 18239585 DOI: 10.1038/oby.2007.119] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To document the changes in BMI and the prevalence of overweight and obesity in young women living in poverty in a semi-urban community in Mexico. METHODS AND PROCEDURES Women who had previously participated in a longitudinal research study (1997-2000) were re-assessed in 2005. Anthropometric measurements were obtained using standard procedures, and socio-demographic questionnaires were administered. Total and annual rate of change in BMI and change in the prevalence of overweight and obesity (BMI > or = 25.0 and > or =30.0) were estimated. RESULTS Mean age in 2005 was 30.0 +/- 5.7 years (n = 683) and time between recruitment and follow-up was 6.4 +/- 1.0 years. Mean change in BMI was +3.6 +/- 2.7 (range -8.2 to +14.6). In 2005, 500 (73.2%) women were overweight, up from 263 (38.5%) in the original assessment. The prevalence of obesity tripled over the follow-up period (from 9.8% to 30.3%). The mean annual rate of change in BMI was +0.6 (+/-0.4). After adjustment for age and parity at baseline, an annual rate of change of BMI above the sample median (>0.5) was associated with lower levels of formal education. DISCUSSION The annual increase in the prevalence of overweight and obesity in this sample is double that which was reported at a national level in Mexico. An understanding of the determinants of this rapid increase among the women living in poverty in Mexico is urgently needed.
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Affiliation(s)
- Lynnette M Neufeld
- Division of Nutri tional Epidemiology, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
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