Obesity: Rivera JA

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC, Anonymous00019. · Instituto Nacional de Salud Pública, Cuemrnavaca, Morelos, México. · Gac Med Mex. · Pubmed #19043956 No free full text.

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Ministry of Health with the aim of drafting evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has documented that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages in six categories. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage. Ranges included healthier (level 1) to least healthy (level 6) options as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category together with healthy consumption patterns for men and women.

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC, Anonymous00004. · Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. · Salud Publica Mex. · Pubmed #18372998 links to  free full text

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.

Rivera JA, Barquera S, González-Cossío T, Olaiz G, Sepúlveda J. · Instituto Nacional de SaIud Pública, Cuernavaca, Morelos, México. · Nutr Rev. · Pubmed #15387482 No free full text.

Abstract: Mexico and other Latin American countries are currently undergoing important demographic, epidemiologic and nutrition transitions. Noncommunicable chronic diseases such as obesity, type 2 diabetes mellitus, and high blood pressure are becoming public health problems as the population experiences an important reduction in physical activity and an increase in energy-dense diets. In contrast, the prevalence of undernutrition is declining in most countries, although several decades will be needed before the prevalence drops to acceptable values. The objective of this article is to discuss the characteristics of the nutrition transition with emphasis in data from Mexico, Brazil, and Chile.

Coitinho DC, Rivera JA, Uauy R, Ding ZY, Ruel MT, Svensson PG. · Reach, Inter-Agency Team on Child Hunger and Undernutrition, World Food Programme, World Health Organization, Rome, Italy. · World Hosp Health Serv. · Pubmed #19181025 No free full text.

Abstract: On 19 May, 2008, Mexico's Secretary of Health, Dr José Angel Córdova Villalobos, hosted an event entitled Emerging Nutrition Challenges: Policies to Tackle Under-nutrition, Obesity and Chronic Diseases. Held in conjunction with the World Health Assembly (WHA) in Geneva, nearly 100 delegates from over 30 countries attended. The International Association of Infant Food Manufacturers and the International Hospital Federation supported Mexico in its sponsorship of this event. Dr Villalobos provided opening remarks including an overview of Mexico's public policies to prevent obesity and chronic diseases. Dr. Mauricio Hernández, Mexico's Undersecretary of Health, moderated as six experts from around the world spoke on issues relating to the nutrition "double burden" (i.e. malnourishment and obesity), successful interventions and policy opportunities for improving nutrition, preventing obesity and enhancing health outcomes. Following are abstracts from their presentations.

Barquera S, Hernandez-Barrera L, Tolentino ML, Espinosa J, Ng SW, Rivera JA, Popkin BM. · Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico. · J Nutr. · Pubmed #19022972 No free full text.

Abstract: Little is understood about the patterns and trends in adolescent and adult beverage intake in Mexico or most other countries. Here, we used nationally representative dietary intake, income, and food expenditure surveys, which included 416 adolescents (aged 12-18 y) and 2180 adults (aged >or=19 y) from the 1999 Mexican Nutrition Survey and 7464 adolescents and 21,113 adults from the 2006 Mexican Health and Nutrition Survey. We measured the volume and energy per day contributed by all beverages consumed by the sample subjects. In 2006, Mexican adolescents and adults obtained 20.1 and 22.3%, respectively, of their energy intake from energy-containing beverages. Whole milk, carbonated and noncarbonated sugar-sweetened beverages, fruit juice with various sugar and water combinations added, and alcohol represented the 4 major categories of beverage intake. The trends from the dietary intake surveys showed very large increases in the intake of energy-containing beverages among adolescents and adults between 1999 and 2006. Income elasticities showed a high likelihood that intakes will increase as Mexican incomes continue to rise. Whereas the own-price elasticities for whole milk and sodas were both modest, intakes of these were increasing and higher than those for all other food groups. Energy intake trends and current levels of beverage intakes in Mexico are the highest recorded in a nationally representative survey and present major challenges for public health authorities.

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC. · Instituto Nacional de Salud Pública, Cuernavaca, Mor. · Rev Invest Clin. · Pubmed #18637573 No free full text.

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.

Stevens G, Dias RH, Thomas KJ, Rivera JA, Carvalho N, Barquera S, Hill K, Ezzati M. · Harvard School of Public Health, Boston, Massachusetts, United States of America. · PLoS Med. · Pubmed #18563960 links to  free full text

Abstract: BACKGROUND: Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities. METHODS AND FINDINGS: We estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries). CONCLUSIONS: Mexico is at an advanced stage in the epidemiologic transition, with the majority of the disease and injury burden from noncommunicable diseases. A unique characteristic of the epidemiological transition in Mexico is that overweight and obesity, high blood glucose, and alcohol use are responsible for larger burden of disease than other noncommunicable disease risks such as tobacco smoking. The Southern region is least advanced in the epidemiological transition and suffers from the largest burden of ill health in all disease and injury groups.

Llanos A, Oyarzún MT, Bonvecchio A, Rivera JA, Uauy R. · Institute of Nutrition and Food Technology (INTA), Santiago, Chile. · Public Health Nutr. · Pubmed #17711613 No free full text.

Abstract: OBJECTIVE: Concordance of nutritional research priorities with the related burden of disease is essential to develop cost-effective interventions to address the nutritional problems of populations. The present study aimed to evaluate whether nutrition research priorities are in agreement with the population's nutritional problems in Latin America. DESIGN: The epidemiological profile was contrasted with the research priorities and research produced by academic institutions for each country. Qualitative analysis of research production by type of contribution to problem solving was also conducted. SETTINGS: Nine Latin American countries. RESULTS: Obesity (high body mass index (BMI)) and micronutrient deficiencies (anaemia) emerged as key problems, followed by stunting, breast-feeding/lactation and low birth weight. Wasting in children and women (low BMI) was uncommon. Concordance of ranked research priorities with the epidemiological profile of the country was generally good for nutrition-related chronic diseases, micronutrients and low birth weight, but not for undernutrition, stunting and breast-feeding. Studies on the efficacy and effectiveness of interventions were uncommon. CONCLUSIONS: The present research agenda insufficiently supports the goal of public health nutrition, which is to ensure the implementation of cost-effective nutrition programmes and policies. A more rational approach to define research priorities is needed.

Rivera JA, Sepúlveda Amor J. · Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad No 655, colonia Santa María Ahuacatitlan, 62508 Cuernavaca Morelos, México. · Salud Publica Mex. · Pubmed #14746051 No free full text.

Abstract: OBJECTIVE: This article presents and overview of the main results and conclusions from the Mexican National Nutrition Survey 1999 (NNS-1999) and the principal nutrition policy implications of the findings. MATERIAL AND METHODS: The NNS-1999 was conducted on a national probabilistic sample of almost 18,000 households, representative of the national, regional, as well as urban and rural levels in Mexico. Subjects included were children < 12 years and women 12-49 years. Anthropometry, blood specimens, diet and socioeconomic information of the family were collected. RESULTS: The principal public nutrition problems are stunting in children < 5 years of age; anemia, iron and zinc deficiency, and low serum vitamin C concentrations at all ages; and vitamin A deficiency in children. Undernutrition (stunting and micronutrient deficiencies) was generally more prevalent in the lower socioeconomic groups, in rural areas, in the south and in Indigenous population. Overweight and obesity are serious public health problems in women and are already a concern in school-age children. CONCLUSIONS: A number of programs aimed at preventing undernutrition are currently in progress; several of them were designed or modified as a result of the NNS-1999 findings. Most of them have an evaluation component that will inform adjustments or modifications of their design and implementation. However, little is being done for the prevention and control of overweight and obesity and there is limited experience on effective interventions. The design and evaluation of prevention strategies for controlling obesity in the population, based on existing evidence, is urgently needed and success stories should be brought to scale quickly to maximize impact. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Hernández B, Cuevas-Nasu L, Shamah-Levy T, Monterrubio EA, Ramírez-Silva CI, García-Feregrino R, Rivera JA, Sepúlveda-Amor J. · Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad 655, colonia Santa María Ahuacatitlán 62508 Cuernavaca, Morelos, México. · Salud Publica Mex. · Pubmed #14746049 No free full text.

Abstract: OBJECTIVE: The objective of the study was to measure the prevalence of overweight and obesity in Mexican school-age children (5-11 years) in the National Nutrition Survey 1999 (NNS-1999). MATERIAL AND METHODS: Overweight and obesity (defined as an excess of adipose tissue in the body) were evaluated through the Body Mass Index (BMI) in 10,901 children, using the standard proposed by the International Obesity Task Force. Sociodemographic variables were obtained using a questionnaire administered to the children's mothers. RESULTS: The national prevalence of overweight and obesity was reported to be 19.5%. The highest prevalence figures were found in Mexico City (26.6%) and the North region (25.6%). When adjusting by region, rural or urban area, sex, maternal schooling, socioeconomic status, indigenous ethnicity and age, the highest prevalences of overweight and obesity were found among girls. The risks of overweight and obesity were positively associated with maternal schooling, children's age and socioeconomic status. CONCLUSIONS: Overweight and obesity are prevalent health problems in Mexican school-age children, particularly among girls, and positively associated with socioeconomic status, age, and maternal schooling. This is a major public health problem requiring preventive interventions to avoid future health consequences. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Barquera S, Rivera JA, Espinosa-Montero J, Safdie M, Campirano F, Monterrubio EA. · Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad 655, colonia Santa María Ahuacatitlán 62508 Cuernavaca, Morelos, México. · Salud Publica Mex. · Pubmed #14746047 No free full text.

Abstract: OBJECTIVE: To describe the reported energy and nutrient intake and adequacies in Mexican women. MATERIAL AND METHODS: A 24-hour dietary recall was used to obtain nutrient intake in a representative sub-sample of 2,630 women from 12 to 49 years of age from the National Nutrition Survey 1999. Nutrient adequacies were estimated using the Dietary Reference Intakes and stratified according to region, area (urban or rural), socioeconomic status and obesity status (non-obese: BMI < 30 kg/m2, obese: > or = 30 kg/m2). Differences were analyzed using linear regression for complex surveys of log-transformed intake and adequacy, adjusting for multiple comparisons with the Bonferroni test. RESULTS: The median national energy intake was 1,471 kcal. The Risk of Inadequacy (RI) (prevalence of adequacy < 50%) was: vitamin A: 38.3%, vitamin C: 45.5%, and folate: 34.3%. Carbohydrates, folate, iron and calcium intake was significantly higher in rural than in urban areas. The RI was higher in women of the lowest socioeconomic status tertile for all nutrients with the exception of carbohydrates and calcium. Macro-nutrient adequacies were significantly higher in non-obese women. CONCLUSIONS: Differences within the country among regions, rural and urban areas, and socioeconomic status tertile reflect an increasing availability of inexpensive calorie-dense foods in marginal groups. However, total energy, cholesterol, saturated and total fat were consumed in greater quantities by women from the higher socioeconomic status tertile and from urban areas. These patterns could be a contributing factor to the rise of obesity and other non-communicable nutrition-related chronic diseases in Mexico. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Rivera JA, Barquera S, Campirano F, Campos I, Safdie M, Tovar V. · Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico. · Public Health Nutr. · Pubmed #12027273 No free full text.

Abstract: OBJECTIVE: The objective of this paper is to characterise the epidemiological and nutritional transition and their determinants in Mexico. DESIGN: Age-adjusted standardised mortality rates (SMRs) due to acute myocardial infarction (AMI), diabetes mellitus and hypertension were calculated for 1980-1998. Changes in the prevalences of overweight and obesity in women and children and of dietary intake from 1988 to 1999 were also used in the analysis. Quantities of food groups purchased by adult equivalent (AE) and food expenditures away from home between 1984 and 1989 were used to assess trends. All information was analysed at the national and regional levels, and by urban and rural areas. RESULTS: SMR for diabetes, AMI and hypertension increased dramatically parallel to obesity at the national and regional levels. Fat intake in women and the purchase of refined carbohydrates, including soda, also increased. DISCUSSION: The results suggest that obesity is playing a role in the increased SMRs of diabetes, AMI and hypertension in Mexico. Total energy dietary intake and food purchase data could not explain the rise in the prevalence of obesity. The increases in fat intake and the purchase of refined carbohydrates may be risk factors for increased mortality. Information on physical activity was not available. CONCLUSION: SMRs due to diabetes, hypertension and AMI have increased dramatically in parallel with the prevalence of obesity; therefore actions should be taken for the prevention of obesity. Reliable information about food consumption and physical activity is required to assess their specific roles in the aetiology of obesity.