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Background Nutritional supplements are an important source of complementary food for young children, since they may either complement or substitute nutrients obtained from other food sources. Assessing how the introduction of different types of supplements modifies the consumption of other food sources may help in designing supplementation programs that aim to improve the nutrition of vulnerable populations. The objetive is to quantify dietary energy and nutrient intake among children aged 6–12 months who received one of three nutritional supplements. Methods A cluster-randomized trial was conducted from 2005 to 2007. Urban communities were randomly allocated to one of three intervention groups receiving one of the following: a milk-based fortified food, micronutrient powders, or syrup. Each supplement was fortified with equal amounts of micronutrients. Dietary intake was estimated using a food frequency questionnaire (FFQ) to reflect the average consumption over the month prior to the interview. Children between 6 and 12 months of age were recruited. Median regression was performed with adjusted standard errors for clustered data, and the linear predictors for the median included the study group, study stage and their interaction. Adjusted medians by study group and study stage were obtained as post-estimations. Results No statistically significant differences between study groups were observed at baseline. After four months of supplementation, the children in the fortified food group had a smaller increase in median dietary energy (183.7 kcal, CI95%: 59.9, 307.5) and dietary protein (6.6 g, CI95%: 2.6, 10.6) intake from their home diet than those in the syrup group ( p  < 0.05). These differences remained significant after adjusting for group differences at baseline. Regarding covariate-adjusted median changes from baseline to follow-up at 10 months, the children in the fortified food group had a smaller median increase in dietary energy intake than those in the syrup group (698 vs 915 kcal), with a difference of 217.9 kcal (CI95%: 20.4, 415.4). Conclusion Children in the fortified food group consumed less dietary energy, protein, and micronutrients than those in the micronutrient powder and syrup groups. It is possible that absolute nutrient intake may be overestimated by the FFQ, but this possibility does not compromise the ability to compare study groups. Given the observed differences in dietary energy consumption among the three supplemented groups, it can be concluded that supplementation with micronutrient powders is an adequate option for urban children who have met their minimum energy and protein requirements.

Case control studies evaluating the relationship between dietary intake of specific nutrients and risk of congenital, neonatal or early childhood disease require the ability to rank relative maternal dietary intake during pregnancy. Such studies are limited by the lack of validated instruments for assessing gestational dietary intake several years post-partum. This study aims to validate a semi-quantitative interview-administered food frequency questionnaire (FFQ) for retrospectively estimating nutrient intake at two critical time points during pregnancy. The FFQ was administered to women (N = 84), who 4–6 years earlier had participated in a prospective study to evaluate dietary intake during pregnancy. The FFQ queried participants about intake during the previous month (FFQ-month). This was then used as a reference point to estimate consumption by trimester (FFQ-pregnancy). The resulting data were compared to data collected during the original study from two 24-h recalls (24 h-original) using Spearman correlation and Wilcoxon sign-rank-test. Total energy intake as estimated by the retrospective and original instruments did not differ and was only weakly correlated in the trimesters (1st and 3rd) as a whole (r = 0.18–32), though more strongly correlated when restricted to the first half of the 1st trimester (r = 0.32) and later half of the 3rd trimester (r = 0.87). After energy adjustment, correlation between the 24hR-original and FFQ-pregnancy in the 3rd trimester were r = 0.25 ( P  < 0.05) for dietary intake of vitamin A, and r = 0.26 ( P  < 0.05) for folate, and r = 0.23–0.77 ( P  < 0.005) for folate, and vitamins A, B6 and B12 in the 1st and 3rd trimester after including vitamin supplement intake. The FFQ-pregnancy provides a consistent estimate of maternal intake of key micronutrients during pregnancy and permits accurate ranking of intake 4–6 years post-partum.

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.

Background: vitamin D (VD) may be a protective factor for retinoblastoma, though no temporal association has been reported during pregnancy or the child’s first year of life. Serum VD concentrations are determined by both distal (DF) and proximal factors (PF). Objective: To identify if DF and PF can predict VD insufficiency (VDI) and VD deficiency (VDD) in women of childbearing age; and to test whether maternal exposure to DF and PF during pregnancy and a child’s exposure during the first 11.9 months postpartum are associated with sporadic retinoblastoma (SRb) in children. Methods: This is a secondary analysis of data from the Epidemiology of SRb in Mexico (EpiRbMx) study and the National Health and Nutrition Survey 2018–2019 (ENSANUT 2018–2019, for its acronym in Spanish). The association of DF and PF with VDD or VDI was estimated using ENSANUT 2018–2019, and the association of DF and PF with SRb using EpiRbMx. All were estimated using logistic regression, with comparable samples selected from ENSANUT 2018–2019 and EpiRbMx. Results: Altitude, latitude and obesity predicted VDI and VDD in ENSANUT women. In EpiRbMx, residence in a rural location during pregnancy increased the risk of SRb. For children, rural residence and latitude increased the risk of SRb, while the number of days exposed to the spring–summer season during months 6 to 11.9 of life was protective. Conclusions: risk of VDI and VDD in women (ENSANUT 2018–2019) increased with altitude, urban dwelling, overweight and obesity. The child and mother’s place of residence, including altitude, latitude and rural classification were important predictors of SRb in EpiRbMx.

Supplementation in malnourished pregnant women should not displace natural healthy foods. Objective: To estimate the differential effects of three nutritional supplements on macro- and micronutrient intake of pregnant women beneficiaries of the conditional cash transfer program Prospera (CCT-POP). Methods: Prospective cluster randomized trial. Communities were randomly assigned to receive a fortified beverage (Beverage), micronutrient tablets (Tablets), or micronutrient powder (MNP). Pregnant women (at <25 weeks) were recruited. The food frequency questionnaire was applied at 25 and 37 weeks of pregnancy and at one and three months postpartum (mpp). Differential effects of the three supplements on the median change in nutrient intake from baseline to each follow-up stage were estimated. Results: Median change in protein intake from dietary and supplement sources were significantly lower for MNP and Tablets than for Beverages (baseline to 37 w: −7.80 ± 2.90 and −11.54 ± 3.00, respectively; baseline to 1 mpp: −7.34 ± 2.90 for MNP, p < 0.001). Compared to Beverages, median increases were higher for the MNP for vitamins C (31.2 ± 11.7, p < 0.01), E (1.67 ± 0.81, p < 0.05), and B12 (0.83 ± 0.27, p < 0.01) from baseline to 37 wk; from baseline to 1 mpp, there was a higher median increase in B12 (0.55 ± 0.25, p < 0.05) and folate (63.4 ± 24.3, p < 0.01); and from baseline to 3 mpp, a higher median increase in iron (2.38 ± 1.06, p < 0.05) and folate (94.4 ± 38.1, p < 0.05). Conclusions: Intake of micronutrients was higher for MNP and Tablets, likely due to food displacement among Beverage consumers. Although iron bioavailability and absorption inhibitors were not considered for the present analyses, the distribution of Tablets or MNP had several advantages in this context where micronutrient deficiency remains high among pregnant women, but macronutrient intake is generally adequate or even high.

Background Prior ecologic studies suggest that UV exposure through sunlight to the retina might contribute to increased retinoblastoma incidence. Aims Our study objectives were (1) to examine the relationship between exposure to sunlight during postnatal retinal development (prior to diagnosis of sporadic disease) and the risk of retinoblastoma, and (2) to examine the relationship between sun exposure during postnatal retinal development, and the extent of disease among children with unilateral and bilateral retinoblastoma. Methods and results We interviewed 511 mothers in the EpiRbMx case‐control study about their child's exposure to sunlight during postnatal retinal cell division by examining three time periods prior to Rtb diagnosis coinciding with developmental stages in which outdoor activities vary. Weekly sun exposure was compared by age period, between unilateral (n = 259), bilateral (n = 120), and control (n = 132) children, accounting for two factors affecting UV exposure: residential elevation and reported use of coverings to shield eyes. For cases, association between sunlight exposure and clinical stage was examined by laterality at each age period. After adjusting for maternal education and elevation, sun exposure was lower in cases than controls in all three age periods especially during the first 6 months, and in children 12–23 months whose mothers did not cover their eyes when outdoors. In children diagnosed after 12 months of age, sun exposure during the second year of life (age 12–23 months) appeared inversely correlated (r = −0.25) with more advanced intraocular disease in bilateral Rtb children after adjusting for maternal education, residential elevation, and age of diagnosis (p < .09) consistent with effects of Vitamin D exposure on intraocular spread in earlier transgenic murine models of retinoblastoma, and suggesting potential chemopreventive strategies. Conclusion Sun exposure in early childhood is protective for retinoblastoma and may decrease degree of intraocular spread in children with bilateral Rtb.

This study aims to validate a Food Frequency Questionnaire (FFQ), specifically designed to retrospectively estimate dietary intake and supplement consumption during the first 2 years of life in children from resource poor households in semi-rural Mexico. The FFQ querying about diet during the first 2 years of life was administered to mothers of children ( N  = 84), who participated in a prospective study 3–5 years earlier, in which complementary feeding practice questionnaires and 24-h recall (24hrR) were collected at several time points during the first 2 years of life to evaluate dietary and vitamin supplement intake. The resulting FFQ data were compared to intake data collected during the original study using Spearman correlations, deattenuated correlations and Wilcoxon signed-rank tests. Total energy intake, as estimated by the retrospective and original instruments, did not differ in the second year (Yr2); correlations between the measures were significant ( r  = 0.40, p  < 0.001). The 24hrR and FFQ-Yr2 were significantly correlated for dietary intake of vitamins B6, B12 ( p  < 0.001) and folate ( p  < 0.01); however, after including vitamin supplement intake, the two dietary instruments were correlated only for vitamins A and B12 ( p  < 0.05). The FFQ provides a reasonable estimate of a child’s dietary intake of energy and key micronutrients during the second year of life, and permits accurate ranking of intake 3–5 years after birth.

Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1–3·8), from 72·1 years (71·8–72·3) to 75·5 years (75·3–75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9–14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6–23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

The objectives of this analysis are to identify the types of nutritional supplements (NS) commonly used and explore the associations between NS consumption and socio-demographic characteristics, nutritional status, measured as BMI, and anemia in a nationally representative sample Mexican women aged 12 to 49 years (n = 15,936) who participated in the Mexican National Nutrition Survey in 1999. Data on NS consumption and the other characteristics of interest were collected. We calculated the probability (P) of supplement consumption using logistic regression. For the statistical analysis characteristics at the individual and household level were included in the statistical models, and adjusted for the study design. Interaction effects were also explored. Multiple mixed vitamin and mineral supplements were the most commonly consumed (36.7%) followed by vitamins only (34.3%). Married women were significantly (p < 0.05) more likely (P = 0.16; p < 0.001) to consume NS compared to unmarried women, as were those with more access to public and private health care (P = 0.18; p = 0.010), with higher education level (P = 0.20; p = 0.004) and living in the South region (P = 0.20; p = 0.003). Anemia modified the association between supplement consumption and socioeconomic status (SES) (p = 0.016), non anemic women having greater probabilities of NS consumption. These results suggest that NS use among Mexican women is associated with better living conditions. On the other hand, we also found that women living in the South region, the poorest region of the country, had higher probability of NS consumption compared to the North region. This could be related to participation in food assistance programs; however we were unable to explore this potential explanation. This information will be used to further study trends, risks and health benefits in this population of the use of nutritional supplements.

Iron, zinc, copper and magnesium deficiencies in Mexican adults from the National Health and Nutrition Survey 2006. Brabin BJ, Hakimi M, Pelletier D. An analysis of anemia and pregnancy-related maternal mortality. International Life Sciences Institute.