Mexican National Health Research Articles

Mental health, water, and food: Relationships between water and food insecurity and probable depression amongst adults in Mexico

BackgroundWater and food insecurity often co-occur, and have independently been identified as potential risk factors for poor mental health. Their interlinkages are only just beginning to be explored; even less is known about how the relationships vary by gender. Understanding the independent associations of water and food insecurity with mental health, as well as their joint effects, can help identify which interventions might be most appropriate for improving health. MethodsWe explored how probable depression covaried with water and food insecurity using nationally representative data from the Mexican National Health and Nutrition Survey 2021 (ENSANUT 2021, n = 13,126). Cross-sectional data were collected on household water, food insecurity, and probable depression amongst adults were collected. We used multivariable logistic regression models to examine the association of water and food insecurity with moderate-to-severe probable depression: and we stratified the models by sex. ResultsHousehold water insecurity was associated with higher odds of probable depression amongst women (1.37 OR, CI: 1.13–1.66) and men (1.30 OR, CI: 0.92–1.83). When controlling for household food insecurity, the association between probable depression and water insecurity was no longer important, however, household food insecurity was associated with higher odds of probable depression. Those experiencing joint water and food insecurity had the highest odds of probable depression (2.70 OR, CI: 2.13–3.40). The associations between water insecurity, food insecurity and mental health did not differ by sex. ConclusionConcurrent water and food insecurity increase the likelihood of probable depression amongst both men and women. Strategies to mitigate both resource insecurities could improve mental health.

Adherence to the EAT-Lancet index is associated with lower diet costs in the Mexican population

SummaryBackgroundPoor diet quality contributes to morbidity and mortality and affects environmental sustainability. The EAT-Lancet reference diet offers a healthy and sustainable solution. This study aimed to estimate the association between diet cost and dietary quality, measured with an EAT-Lancet Index.MethodsAn EAT-Lancet index was adapted to assess adherence to this dietary pattern from 24-h recalls data from the 2012 and 2016 Mexican National Health and Nutrition Surveys (n = 14,242). Prices were obtained from the Consumer Price Index. We dichotomized cost at the median (into low- and high-cost) and compared the EAT-Lancet index scores. We also used multivariate linear regression models to explore the association between diet cost and diet quality.ResultsIndividuals consuming a low-cost diet had a higher EAT-Lancet score than those consuming a high-cost diet (20.3 vs. 19.4 from a possible scale of 0 to 42; p < 0.001) due to a lower intake of beef and lamb, pork, poultry, dairy, and added sugars. We found that for each one-point increase in the EAT-Lancet score, there was an average decrease of MXN$0.4 in the diet cost (p < 0.001). This association was only significant among low- and middle-SES individuals.ConclusionsContrary to evidence from high-income countries, this study shows that in Mexico, adhering to the EAT-Lancet reference diet is associated with lower dietar costs, particularly in lower SES groups. These findings suggest the potential for broader implementation of healthier diets without increasing the financial burden.

Sleep duration, overweight status, and the modifying role of food insecurity in a sample of 10- to 14-year-old Mexican early adolescents

ObjectivesShort sleep duration has been associated with an increased risk of childhood overweight and obesity in high-income countries, but data from low- and middle-income countries are scarce. Independently, short sleep and food insecurity may increase the risk of overweight/obesity, but it is unknown whether they concurrently affect it. MethodsWe included 3350 adolescents aged 10-14 from the 2012 and 2016 Mexican National Health and Nutrition Survey. Short sleep was categorized as less than 9 hours for ages 10-12 and less than 8 hours for ages 13-14. Overweight/obesity was assessed via anthropometry. Modified Poisson regression models assessed prevalence ratios between short sleep and overweight, examining effect modification by food security status. Results86% met sleep duration recommendations. Short sleep was associated with an increased prevalence of overweight/obesity (prevalence ratio, 1.16; 95% CI, 1.05, 1.31). Multiplicative interaction was found between low and very low food security status and short sleep: adolescents in low food secure households with short sleep had 1.38 (95% CI: 1.10, 1.75) times the prevalence of overweight/obesity compared to adequate sleepers. Very low food secure households had 1.16 (95% CI: 1.14, 1.31) times the prevalence compared to adequate sleepers. This association was not significant in fully or marginally food secure households. ConclusionsShort sleep is associated with an increased obesity risk among Mexican adolescents 10-14years, particularly in the context of low and very low food security. These findings highlight the importance of addressing both sleep hygiene and food security in strategies to reduce obesity risk.

Municipal-level estimates (2020) of adult obesity in Mexico drawn from a hierarchical Bayesian estimator

Since the beginning of the 21st Century obesity has become a major public health concern in Mexico. Survey data have been key to tracking the evolution of the national and regional prevalence of obesity over time. However, these data are insufficient for policymakers and researchers interested in obesity from a more local and spatial perspective. This paper uses two secondary data sources: the Mexican National Health and Nutrition Survey 2021 and the Mexican National Population Census 2020. This paper implements a Bayesian hierarchical approach to model survey and census data to produce municipal-level estimates for Mexico in 2020. The results indicate that obesity has inter and intra-regional variability. Obesity is more prevalent in the north and in the Yucatan peninsula and tends to be lower in the state of Chiapas. However, within these regions there is some degree of variability in obesity rates. The results provide a more detailed geographical picture of obesity across Mexico and raise the possibility of using the resulting estimates for further statistical and policy-relevant research.

Lead Levels in the Most Consumed Mexican Foods: First Monitoring Effort.

Globally, there is growing concern over the presence of lead (Pb) in foods because it is a heavy metal with several toxic effects on human health. However, monitoring studies have not been conducted in Mexico. In this study, we estimated the concentrations of Pb in the most consumed foods and identified those that exceeded the maximum limits (MLs) for Pb in foods established by the International Standards. Based on the Mexican National Health and Nutrition Survey, 103 foods and beverages were selected and purchased in Mexico City retail stores and markets. Samples were analyzed twice using atomic absorption spectrophotometry. Values above the limit of quantification (0.0025 mg/kg) were considered to be detected. The percentage of detected values was 18%. The highest concentration was found in infant rice cereal (1.005 mg/kg), whole wheat bread (0.447 mg/kg), pre-cooked rice (0.276 mg/kg), black pepper (0.239 mg/kg), and turmeric (0.176 mg/kg). Among the foods with detected Pb, the levels in infant rice cereal, whole wheat bread, pre-cooked rice, and soy infant formula exceeded the MLs. The food groups with the highest percentages of exceeded MLs were baby foods (18%) and cereals (11%). Monitoring the concentration of contaminants in foods is essential for implementing food safety policies and protecting consumer health.

Diabetes subgroups and sociodemographic inequalities in Mexico: a cross-sectional analysis of nationally representative surveys from 2016 to 2022

Differences in the prevalence of four diabetes subgroups have been reported in Mexico compared to other populations, but factors that may contribute to these differences are poorly understood. Here, we estimate the prevalence of diabetes subgroups in Mexico and evaluate their correlates with indicators of social disadvantage using data from national representative surveys. We analyzed serial, cross-sectional Mexican National Health and Nutrition Surveys spanning 2016, 2018, 2020, 2021, and 2022, including 23,354 adults (>20 years). Diabetes subgroups (obesity-related [MOD], severe insulin-deficient [SIDD], severe insulin-resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks based on a previously validated algorithm. We used the density-independent social lag index (DISLI) as a proxy of state-level social disadvantage. We identified 4204 adults (median age: 57, IQR: 47-66, women: 64%) living with diabetes, yielding a pooled prevalence of 16.04% [95% CI: 14.92-17.17]. When stratified by diabetes subgroup, prevalence was 6.62% (5.69-7.55) for SIDD, 5.25% (4.52-5.97) for MOD, 2.39% (1.95-2.83) for MARD, and 1.27% (1.00-1.54) for SIRD. SIDD and MOD clustered in Southern Mexico, whereas MARD and SIRD clustered in Northern Mexico and Mexico City. Each standard deviation increase in DISLI was associated with higher odds of SIDD (OR: 1.12, 95% CI: 1.06-1.12) and lower odds of MOD (OR: 0.93, 0.88-0.99). Speaking an indigenous language was associated with higher odds of SIDD (OR: 1.35, 1.16-1.57) and lower odds of MARD (OR 0.58, 0.45-0.74). Diabetes prevalence in Mexico is rising in the context of regional and sociodemographic inequalities across distinct diabetes subgroups. SIDD is a subgroup of concern that may be associated with inadequate diabetes management, mainly in marginalized states. This research was supported by Instituto Nacional de Geriatría in Mexico.

Association Between Avocado Consumption and Diabetes in Mexican Adults: Results From the 2012, 2016, and 2018 Mexican National Health and Nutrition Surveys

BackgroundAvocado contains numerous vitamins, minerals, and phytochemicals that can contribute to reducing the risk of metabolic syndrome and diabetes. However, limited studies have examined the association between avocados and diabetes risk. ObjectiveThis study aimed to examine the association between avocado consumption and diabetes by sex in Mexican adults. DesignThis was a cross-sectional study. Participants/settingParticipants included a subsample of adults (aged 20 years and older) from the 2012, 2016, and 2018 Mexican National Health and Nutrition Survey. Avocado consumption was assessed using a 7-day, semiquantitative food frequency questionnaire, and participants were classified as avocado consumers (consuming any amount of avocado) or nonconsumers. Main outcome measuresParticipants were considered to have diabetes if they answered “yes” to “Has a doctor ever told that you have diabetes or high blood sugar?” Statistical analyses performedThis analysis assessed the association between avocado intake and diabetes using multivariate logistic models by sex and adjusted for relevant covariates. ResultsOf 28 239 Mexican National Health and Nutrition Survey 2012, 2016, and 2018 participants, 25 640 met the criteria (ie, have diabetes outcome and plausible energy and avocado intakes) for this study. More than half of the participants were women, and approximately 45% were avocado consumers, with an average (SE) avocado consumption of 34.7 (0.9) among men and 29.8 (0.8) g/day among women. Avocado consumers had lower odds of diabetes in both unadjusted (odds ratio [OR] 0.762, 95% CI 0.639 to 0.907) and adjusted (OR 0.792, 95% CI 0.632 to 0.993) models among women but not men (OR 1.192, 95% CI: 0.907 to 1.566 and OR 0.914, 95% CI 0.675 to 1.239 for unadjusted and adjusted models, respectively). ConclusionsAvocado consumption was associated with a lower risk of diabetes, which remained significant even when adjusted for relevant covariates. However, this finding was observed in only women, not men, underscoring the importance of personalized nutrition in diabetes care and prevention.

Knowledge mobilization in Type 2 Diabetes Mellitus (T2DM) researchers: an approach to the Mexican national health system

ABSTRACT The literature on transfer, mobilization, and appropriation of knowledge produced in universities and public research centers yielded results allowing a better understanding of benefits, obstacles, and determining channels of such processes. Emphasis has been on differences between agents, researchers, and institutions, instead of trying to understand epistemic practices that affect Knowledge Mobilization (KMb). Our key question is: what type of obstacles are presented in KMb generated by Mexican researchers at the National Health System of Mexico when focused on Type 2 Diabetes Mellitus (T2DM)? We analyzed obstacles in the mobilization of knowledge generated by Mexican T2DM researchers focused at the National Health System of Mexico. We critically discuss the KMb literature, evaluate its qualitative methodology, and offer a case study with researchers in T2DM from the National Health System of Mexico. Finally, we discuss the findings and approaches from the theory in a series of recommendations to address the problem.

Hypothetical impact of the Mexican front-of-pack labeling on intake of critical nutrients and energy

BackgroundSince 2020 in Mexico, front-of-pack warning labels (FOPWL) have been implemented in processed products. Evidence supports warning labels allow consumers to identify unhealthy products. We aimed to evaluate the hypothetical impact of the FOPWL regulation on the Mexican population’s intake of critical nutrients and energy, based on the replacement of food and beverages using 4 hypothetical scenarios which represented the phases of the regulation.MethodsDietary data were collected using a standardized 24-h dietary recall from the 2016 Mexican National Health and Nutrition Survey (n = 4184). To evaluate the hypothetical impact of FOPWL, the nutritional content of critical nutrients in processed products was evaluated according to the Mexican Official Standard 051 (NOM-051). Then, we replaced products with several warning labels (WL) with those with a fewer number of them or with non-processed food. For the replacement, 4 hypothetical scenarios were established: scenario 1: the current consumption of the Mexican Population, scenario 2: the replacement during the first phase of the norm, scenario 3: the replacement in the second phase and scenario 4: the replacement in the last phase. We estimated the means, confidence intervals (CI 95%), and the mean percentage change of energy, saturated fat, trans-fat, added sugars, and sodium intake during the second, third, and the fourth scenarios.ResultsAccording to the norm, in the second scenario, the majority of the products presented a label for energy (52.6%) whereas in the third (56.4%) and fourth (61.2%) scenarios were for sodium. In contrast, trans-fat was the least labeled nutrient in all the scenarios (from 2.1 to 4.1%). In the fourth scenario, we observed a reduction of the intake of energy intake to 15.4% as well as saturated fat (− 20%, CI 95% − 18.4; − 21.6), trans-fat (− 8.2%, CI 95% − 6.4; − 10.1) and sodium (− 12.7%, CI 95% − 11.3; − 14.1). The most important reduction was observed for added sugars intake (until − 54.1%, CI 95% − 51; − 57.1).ConclusionsFOPWL could be an effective strategy to decrease energy consumption and nutrients of concern. If consumers use the FOPWL, it would be an important change in critical nutrients intake. These results support that FOPWL might help the Mexican population to choose healthier nutrition alternatives.

Food Insecurity is Associated with Low Dietary Diversity in Rural Women in Mexico: Results from the Mexican National Health and Nutrition Survey, ENSANUT 2018

ABSTRACT Rural women suffer greater vulnerability to food insecurity (FI) compared to their urban or male counterparts. We analyzed the association between food security (FS) status and dietary diversity (DD) in rural women through data from the Mexican National Health and Nutrition Survey (ENSANUT) 2018 from 2,099 rural women. DD was measured using a semi-quantitative food frequency questionnaire. FS was measured using the Latin America and Caribbean Food Security Scale (ELCSA). The prevalence of any level of FI was 70.1%. Mean DD score was 3.8. Mild FI was associated with low DD (OR 1.49, 95% CI 1.06, 2.10). Results highlight the need for government strategies targeted to this population sector to improve their diet quality.

Associated substitution and complementation patterns of processed discretionary foods and drinks on total energy and added sugar intake.

Processed discretionary foods and drinks (industrialised sugary drinks, sweet and savoury snacks, and grain-based sweets) are often target of policies aimed at regulating the food environment. We aimed to understand if a lower intake of processed foods or drinks is associated with substitution or complementation patterns and overall intake. We analysed a subsample with two 24-h dietary recalls of the Mexican National Health and Nutrition Survey 2012 (358 children, 253 adolescents and 278 adults). We compared within-person, energy and added sugar intakes between days with and without consumption of each food group with fixed-effects regressions. We estimated the relative change (change in intake when not consumed/average intake when consumed × 100). Processed discretionary foods were not fully substituted, as total energy was 200-400 kcal/day lower when these foods were not consumed. The change in total intake was larger than the intake when consumed (i.e., complemented) for industrialised sugary drinks in adolescents (-136%) and adults (-215%), and sweet, savoury snacks for children (-141%). The change was lower (i.e., partially substituted) for grain-based sweets among children (-78%) and adolescents (-73%). For added sugars, most processed discretionary groups were complemented. Days without intake of processed discretionary foods were associated with lower total energy and lower added sugar intake compared to days when those foods were consumed. This suggests that regulatory policies to reduce the intake of processed foods could have a meaningful impact on improving the overall diet.

Sex differences in the association between diabetes and depressive symptoms: findings from Mexican National Health and Nutrition Survey 2018–2019

AimsWe set out to investigate the potential sex differences in the association between diabetes and depressive symptoms by conducting an interaction analysis, and to investigate whether sex mediates the effect...

Evaluation of effective coverage for type 2 diabetes in Mexican primary care health information systems: a retrospective registry analysis

BackgroundAs the leading cause of disability and the fourth leading cause of premature death in Mexico, type 2 diabetes (T2D) represents a serious public health concern. The incidence of diabetes has increased dramatically in recent years, and data from the Mexican National Health and Nutrition Survey (ENSANUT) indicate that many people remain undiagnosed. Persistent socioeconomic health care barriers exacerbate this situation, as T2D morbidity and mortality are worsened in vulnerable populations, such as those without social security. We evaluated the performance of public primary health centers (PHCs) in T2D medical attention through the measure of effective coverage (EC, a combined measure of health care need, use, and quality) at national, state, health jurisdiction, and municipality levels.MethodsThis retrospective analysis used blinded data recorded during 2017 in the Non-communicable Diseases National Information System (SIC) and T2D prevalence reported in 2018 ENSANUT to evaluate the EC achieved. We included individuals ≥ 20 years old without social security who did not declare the use of private health care services. Each EC component (need, use, and quality) was estimated based on the Shengelia adapted framework. The Kruskal–Wallis test was applied to evaluate the associations among EC quintiles and demographics.ResultsIn 2017, 26.5 million individuals, aged ≥ 20 years, without social security, and without the use of private health care services, were under the care of 12,086 PHCs. The national prevalence of T2D was 10.3%, equivalent to 2.6 million people living with T2D in need of primary health care. Large contrasts were seen among EC components between and within Mexican states. We found that only 37.1% of the above individuals received health services at PHCs and of them, 25.8% improved their metabolic condition. The national EC was 9.3%, and the range (by health jurisdiction) was 0.2%–38.6%, representing a large geographic disparity in EC. We found an evident disconnect among need, utilization, and quality rates across the country.ConclusionsExpansion and improvement of EC are urgently needed to address the growing number of people living with T2D in Mexico, particularly in states with vulnerable populations.

Breakfast Dietary Patterns among Mexican Children Are Related to Total-Day Diet Quality

Background: Mexico has experienced shifts in food availability and consumption patterns over the past few decades from traditional diets to those containing more high-energy density foods, resulting in the development of unhealthful dietary patterns among children and adults. However, to our knowledge it is not known whether breakfast consumption patterns contribute to the overall daily diet of Mexican children.Objective: We examined total-day diet among breakfast consumers compared with breakfast skippers, identified and investigated breakfast dietary patterns in relation to energy and nutrient intakes at breakfast and across the day, and examined these patterns in relation to sociodemographic characteristics.Methods: With the use of nationally representative dietary data (one 24-h recall) from the 2012 Mexican National Health and Nutrition Survey, 3760 children aged 4-13 y were categorized into mutually exclusive breakfast patterns with the use of cluster analysis. The association between breakfast patterns and breakfast skippers with dietary intake at breakfast and for the total day was investigated with the use of multivariate linear regression.Results: Most children (83%) consumed breakfast. Six breakfast dietary patterns were identified (milk and sweetened breads, tortillas and beans, sweetened beverages, sandwiches and quesadillas, eggs, and cereal and milk) and reflected both traditional and more Westernized dietary patterns. Sugar-sweetened beverages were consumed across all patterns. Compared with all breakfast dietary patterns, breakfast skippers had the lowest intake of several nutrients of public health concern. Nutrients to limit that were high at breakfast tended to be high for the total day and vice versa for nutrients to encourage.Conclusions: There was not a single pattern that complied perfectly with the Mexican School Breakfast Guidelines, but changes such as increasing dietary fiber by encouraging more whole grains, fruits, vegetables, and beans and reducing sodium and sugar-sweetened beverages could support compliance with these targets and improve overall diet quality.

Overweight and obesity in women participating in social feeding programs in Mexico: data from vulnerable population groups in the Mexican National Nutrition and Health Survey 2018.

Mexico is a country with a high prevalence of overweight and obesity. However, social feeding programs often target only undernutrition in vulnerable population groups. to estimate the association of overweight and obesity (OW) with participation in a conditional cash transfers (CCT) program and other social feeding programs in women 15-49 years of age within the most economically vulnerable population in Mexico. anthropometric data, as well as information on participation in social feeding programs, household food insecurity and sociodemographic variables, were analyzed for women aged 15-49 living in localities of under 100,000 inhabitants in Mexico. Data was derived from the Mexican National Health and Nutrition Survey 2018. A multiple logistic regression model was applied to estimate the association between OW and participation in social feeding programs, as well as other covariables. the prevalence of OW in women who benefited from CCT was 62 %, while for women who participated in this as well as other programs the prevalence was 72.9 % (p = 0.04). A protective association was observed between the CCT program and OW (OR = 0.72, p = 0.04). Additionally, benefitting from DIF Community Kitchens revealed a risk association with OW (OR = 2.76, p = 0.03). it is critical that the design of public policy and social feeding programs consider the scientific evidence generated through rich experiences in Mexico, such as the program of CCT Prospera. This will allow decision-makers to address the epidemiological health and nutrition problems impacting the Mexican population today.

Trends in overweight and obesity in children under 24 months of age in Mexico (2012-2020): analysis of four national health surveys.

The prevalence of childhood obesity has increased rapidly in Mexico, with significant consequences for the population's health in the future. Little is known about the prevalence of obesity in children under two years of age, even though this life stage is fundamental to prevent this condition. This study aims to determine the magnitude, distribution, and trends of overweight and obesity in children under 24 months of age using the Mexican National Health and Nutrition Surveys (ENSANUT) conducted in the last 10 years. The data presented here are derived from four ENSANUTs, carried out in Mexico in 2012, 2016, 2018, and 2020. They include 6,719 infants under 24 months with complete anthropometric data (weight/height) by age, gender, Indigeneity, area of residence, and socioeconomic status. The risk of overweight levels and overweight + obesity rates were calculated according to World Health Organization guidelines. We identified that infants < 12 months currently have a higher prevalence of overweight + obesity (10.3%) and that those aged 12 to 23 months are generally at a higher risk of overweight (26.1%). The most relevant findings of this study, linking weight trends to sex, region, socioeconomic status, and indigeneity, show that overweight and obesity prevalences vary across the Mexican population, without presenting a specific behavior. There is a high prevalence of overweight and obesity among Mexican infants and a slight trend toward increased obesity in infants < 12 months. Weight monitoring and obesity prevention interventions focused on the first 1,000 days of life are essential.

Chronic kidney disease risk prediction scores assessment and development in Mexican adult population.

Chronic kidney disease (CKD) is a major public health problem, with considerable growth in prevalence and mortality in recent years. Screening of CKD at primary care is crucial for the implementation of prevention strategies. The aims of this study are to assess CKD risk prediction scores and to develop a risk prediction score for the Mexican adult population. Data from the Mexican National Health and Nutrition Survey 2016 was utilized and 3463 participants ≥ 20 years old were included. Reduced renal function with Glomerular filtration rate and/or the presence of albuminuria was defined as CKD. Multiple logistic regression models were performed for the creation of a training and validation model. Additionally, several models were validated in our Mexican population. The developed training model included sex, age, body mass index, fast plasma glucose, systolic blood pressure, and triglycerides, as did the validation model. The area under the curve (AUC) was 0.78 (95% CI: 0.72, 0.79) for training model, and 0.76 (95% CI: 0.71, 0.80) in validation model for Mexican adult population. Age, female gender, presence of diabetes and hypertension, elevated systolic and diastolic blood pressure, serum and urinary creatinine, and higher HbA1c were significantly associated with the prevalent chronic kidney disease. Previous CKD risk predictive models were evaluated with a representative sample of the Mexican adult population, their AUC was between 0.61 and 0.78. The designed CKD risk predictive model satisfactorily predicts using simple and common variables in primary medical care. This model could have multiple benefits; such as, the identification of the population at risk, and prevention of CKD.

Trend of Ultraprocessed Product Intake Is Associated with the Double Burden of Malnutrition in Mexican Children and Adolescents.

Background: Ultraprocessed products (UPPs) have been associated with unfavorable health outcomes; however, until now, they have not been associated with the coexistence of undernutrition and overnutrition, known as the double burden of malnutrition (DBM) at the individual level. Methods: Cross-sectional analyses were performed on data collected from children and adolescents participating in the 2006 and 2016 Mexican National Health and Nutrition Surveys. The food and beverages reported in the food frequency questionnaire (SFFQ) were classified as UPPs as defined by the NOVA classification system. Associations of UPPs with anemia, excess weight, and the DBM were estimated with logistic regression models. A pseudo-panel was generated using the cohorts of children born from 1997 to 2001 to estimate the effect of the UPPs on anemia, excess weight, and the DBM. Results: The consumption of UPPs (% energy) was higher in 2016 (children 30.1% and adolescents 28.3%) than in 2006 (children 27.3% and adolescents 23.0%) in both age-groups. The higher contribution of UPPs was positively associated with excess weight and the DBM in children’s lower tertile of socioeconomic status (SES) and the DBM in higher tertile of SES in adolescents. The pseudo-panel analysis shows the positive association between UPPs and DBM in lower SES. Conclusions: These results provide evidence of the association between the consumption of UPPs and the DBM and excess weight in children and adolescents.

Effective access to health care in Mexico

ObjectivesThis paper assesses the impact of effective access on out-of-pocket health payments and catastrophic health expenditure. Effective access cannot be attained unless both health services and financial risk protection are accessible, affordable, and acceptable. Therefore, it represents a key determinant in the transition from fragmented health systems to universal coverage that many low- and middle-income countries face.MethodsWe use a definition of effective access as the utilization of health insurance when available. We conducted a cross-sectional analysis using the 2018 Mexican National Health Survey (ENSANUT) at the household level. The analysis is performed in two stages. The first stage is a multinomial analysis that captures the factor associated with choosing effective access against the alternative of paying privately. The second stage consists of an impact analysis regarding the decision of not choosing effective access in terms of out-of-pocket (OOP) health payments and catastrophic health expenditures (CHE). The analysis corrects for both the decision to buy insurance and the decision to pay for health care.ResultsWe found that, on average, not choosing effective access increases OOP health payments by around 2300 pesos annually. Medicine payments are the most common factor in this increase. Nevertheless, outpatient and medicines health care are the main drivers of the increase in OOP health payments in all insurance beneficiaries. Not having effective access increases the probability of CHE health expenditures by 2.7 p.p. for the case of Social Security Insurance and 4.0 p.p. for Social Government insurance. Household enrolled in Prospera program for the poor are more likely to choose effective access while having household heads with more education and assets value does the opposite. Diabetes illnesses are associated with a higher probability of effective access.ConclusionImproving effective access is a middle step that cannot be disregarded when seeking universal coverage because OOP health payments and catastrophic outcomes are direct consequences. Public insurance in general, has around 50% effective access which remains a challenge in terms of health services utilization and health public policy design, calling for the need of better coordination across insurance types and pooling mechanisms to increase sustainability of needed health services.

Adherence to a traditional Mexican diet and non-communicable disease-related outcomes: secondary data analysis of the cross-sectional Mexican National Health and Nutrition Survey.

This study evaluated the association between adherence to a traditional Mexican diet (TMexD) and obesity, diabetes and CVD-related outcomes in secondary data analysis of the cross-sectional Mexican National Health and Nutrition Survey 2018-2019. Data from 10180 Mexican adults were included, collected via visits to randomly selected households by trained personnel. Adherence to the TMexD (characterised by mostly plant-based foods like maize, legumes and vegetables) was measured through an adapted version of a recently developed TMexD index, using FFQ data. Outcomes included obesity (anthropometric measurements), diabetes (biomarkers and diagnosis) and CVD (lipid biomarkers, blood pressure, hypertension diagnosis and CVD event diagnosis) variables. Percentage differences and OR for presenting non-communicable disease (NCD)-related outcomes (with 95 % CI) were measured using multiple linear and logistic regression, respectively, adjusted for relevant covariates. Sensitivity analyses were conducted according to sex, excluding people with an NCD diagnosis and using multiple imputation. In fully adjusted models, high, compared with low, TMexD adherence was associated with lower insulin (-9·8 %; 95 % CI (-16·0, -3·3)), LDL-cholesterol (-4·3 %; 95 % CI (-6·9, -1·5)), non-HDL-cholesterol (-3·9 %; 95 % CI (-6·1, -1·7)) and total cholesterol (-3·5 %; 95 % CI (-5·2, -1·8)) concentrations. Men and those with no NCD diagnosis had overall stronger associations. Effect sizes were smaller, and associations weakened in multiple imputation models. No other associations were observed. While results may have been limited due to the adaptation of a previously developed index, the results highlight the potential association between the TMexD and lower insulin and cholesterol concentrations in Mexican adults.