Representaciones sociales relacionadas con la alimentación escolar: el caso de las escuelas públicas de la Ciudad de México

México está confrontando una epidemia de sobrepeso/obesidad sin precedentes, en particular entre los niños. El objetivo de este trabajo fue identificar las principales representaciones sociales relacionadas con la alimentación en la escuela, presentes en los discursos de los diferentes actores escolares. Se realizaron 20 entrevistas con actores escolares y 10 grupos de discusión con niños y niñas de 12 escuelas. Se identificaron tres principales concepciones, representaciones en las que estructuran su relación con la alimentación en la escuela, 1) comida "chatarra" versus comida casera, 2) valoración de la fruta desde diferentes perspectivas, 3) función placentera de la comida escolar. Se argumentará la contribución de esta información para entender mejor la oferta y el consumo de los escolares. El estudio permitió identificar algunos elementos que estructuran profundamentela relación de los diferentes actores escolares con la alimentación escolar y que se relacionan con, 1) presencia en los discursos de ideas y conocimientos sobre la alimentación, a veces opuestos y generados por diferentes campos de saberes, que muestran el carácter dinámico y complejo del hecho alimentario, 2) interiorización por parte de los niños de un sistema de jerarquización de los alimentos, 3) carácter identitario de la alimentación

An Iterative Process for Training Design and Implementation Increased Health Workers\u27 Knowledge for Taking Nutrition Behavior Change to Scale

The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. Results: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers\u27 routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. Conclusions: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions

Micronutrient recommendations for vulnerable groups in context of undernutrition, during the COVID-19 pandemic in Latin America

La crisis por COVID-19 (SARS-CoV-2) puede convertirse en una catástrofe alimentaria para Latinoamérica, aumentando las personas que padecen hambre de 135 a 265 millones, especialmente en Venezuela, Guatemala, Honduras, Haití y El Salvador, que ya enfrentaban crisis económicas y sanitarias. Este manuscrito presenta la posición de un grupo de expertos latinoamericanos sobre las recomendaciones de consumo y/o suplementación con vitamina A, C, D, zinc, hierro, folatos y micronutrientes múltiples, en contextos de desnutrición, para grupos vulnerables: mujeres embarazadas y lactantes, niñas y niños menores de 5 años y adultos mayores. Las recomendaciones buscan disminuir el impacto potencial que tendrá COVID-19 en el estado nutricional, durante la pandemia. La posición surge de la discusión de dichos expertos con base a la revisión de evidencia científica actual para estos grupos vulnerables. Está dirigida a tomadores de decisiones, encargados de políticas públicas, personal de salud y organismos de la sociedad civil. Después de la lactancia materna y una dieta suficiente en cantidad y calidad, la suplementación con los micronutrientes presentados, puede contribuir a prevenir y tratar enfermedades virales, reforzar el sistema inmune y reducir complicaciones. La lactancia materna con medidas de higiene respiratoria, el suministro de múltiples micronutrientes en polvo para niños desde los 6 meses hasta los 5 años y el aporte de hierro y folatos o micronutrientes múltiples para la embarazada, son estrategias comprobadas y eficaces que deben seguirse implementando en tiempos de COVID-19. Para los adultos mayores la suplementación con vitamina C, D y zinc puede estar indicada.The COVID-19 crisis (SARS-CoV-2) might transform into a food catastrophe in Latin America and would increase the number of people suffering from hunger from 135 to 265 million, particularly in Venezuela, Guatemala, Honduras, Haiti and El Salvador, already facing economic and health crises. This manuscript presents the position of a group of Latin American experts in nutrition for establishing the recommendations for consumption and / or supplementation with vitamin A, C, D, zinc, iron, folates and multiple micronutrients, in undernutrition contexts, for vulnerable population of pregnant and lactating women, children under 5 years and the elderly. The recommendations seek to decrease the potential impact that COVID-19 will have on nutritional status during the pandemic. The position arises from the discussion of the experts based on the review of current scientific evidence for these vulnerable groups. It aims to reach stakeholders, public policy makers, health personnel and civil society organizations. Only after breastfeeding and a sufficient diet in terms of quantity and quality, a supplementation with the micronutrients mentioned above can help prevent and treat viral diseases, strengthen the immune system and even reduce complications. Breastfeeding with respiratory higiene measures, the provision of multiple micronutrients powders for children from 6 moths to 5 years of age and the supply of iron and folates or multiple micronutrients tablets for pregnant women are proven and effective strategies that must continue to be implemented during COVID-19 pandemic. For older adults, supplementation with vitamin C, D and zinc might be indicated.publishedVersionFil: Bonvecchio Arenas, Anabelle. Instituto Nacional de Salud Pública; México.Fil: Bernal, Jennifer. Universidad Nacional de Colombia. Observatorio de Seguridad Alimentaria; Colombia.Fil: Herrera Cuenca, Marianella. Universidad Central de Venezuela; Venezuela.Fil: Herrera Cuenca, Marianella. Fundación Bengoa para la Alimentación y Nutrición, Venezuela.Fil: Flores Aldana, Mario. Instituto Nacional de Salud Pública; México.Fil: Gutiérrez, Marlén. Global Nutrition Professionals Consultancy; Venezuela.Fil: Irizarry, Laura. Oficina Regional para América Latina y el Caribe. Programa Mundial de Alimentos (WFP); Panamá.Fil: Lay Mendivil, Lina. Universidad Tecnológica de Panamá; Panamá.Fil: López Bautista, Fabiola. Universidad Nacional Autónoma de México; México.Fil: López Reyes, Marisol. Global Nutrition Professionals Consultancy; España.Fil: Mata, Claret. Universidad Central de Venezuela; Venezuela.Fil: Moliterno, Paula. Universidad de la República; Uruguay.Fil: Moyano, Daniela. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Escuela de Nutrición; Argentina.Fil: Moyano, Daniela. Universidad Nacional de Córdoba. Secretaría de Extensión Universitaria; Argentina.Fil: Moyano, Daniela. Universidad Nacional de la Matanza; Argentina.Fil: Murillo, Diana. Oficina Regional para América Latina y el Caribe. Programa Mundial de Alimentos; Panamá.Fil: Pacheco Miranda, Selene. Instituto Nacional de Salud Pública; México.Fil: Palacios, Cristina. Florida International University; United States.Fil: Palomares, Lita. Universidad Peruana Cayetano Heredia; Perú.Fil: Páramo, Kenia. Instituto de Nutrición de Centroamérica y Panamá; Belice y Nicaragua.Fil: Pérez, Analy. Unison Health & Community Services Global Nutrition Professionals Consultancy; Canadá.Fil: Tijerina Walls, María Virginia. Nutrien Nutrición y Salud; México.Fil: Trak-Fellermeier, María Angélica. Florida International University. Global Nutrition Professionals Consultancy; United States.Fil: Venosa López, Mónica. Instituto Nacional de Salud Pública; México

Talla baja y sobrepeso en menores de 5 años que habitan la Sierra Tarahumara, México

La doble carga de la desnutrición y el exceso de peso (o mala nutrición) es uno de los indicadores que mejor ilustra las inequidades en salud que existen en zonas indígenas de México. Por otro lado, existe escasa evidencia del estado de nutrición en población Tarahumara. Objetivo: Estimar indicadores del estado de nutrición y su asociación con factores sociodemográficos en población indígena Tarahumara menor de 5 años. Métodos: Estudio transversal en 21 localidades indígenas de la Sierra Tarahumara en Chihuahua, México, que analizó información sociodemográfica, de salud y antropométrica en población infantil de 6 a 59 meses de edad (n=323). Se estimaron índices antropométricos y su asociación con variables de interés mediante regresión logística múltiple. Un valor de p ≤0,05 fue considerado como estadísticamente significativo. Todos los análisis se realizaron en el paquete estadístico Stata v14.2. Resultados: Se encontraron altas prevalencias de talla baja (44,4%), emaciación (5,3%), bajo peso (11,9%) y sobrepeso (15,2%). El sexo masculino se asoció significativamente con talla baja (Razón de Momios (RM)=2,5; 1,45-4,34), mientras que, ninguna escolaridad de la madre (RM=0,39; 0,15-0,99) y ser beneficiario de un programa local de nutrición por más de 2 años se asoció con sobrepeso (RM=2,97; 1,26 -6,97). Conclusión: Se encontraron indicadores de mala nutrición en la muestra estudiada; éstos hallazgos podrían sugerir la existencia de inequidad y rezago en salud y nutrición de población infantil indígena Tarahumara. Se requieren más estudios que puedan orientar programas y acciones de salud y nutrición para atender a esta población de forma prioritaria.The double burden of malnutrition and excess weight (or poor nutrition) is one of the indicators that best illustrates the health inequities that exist in indigenous areas of Mexico. On the other hand, there is scarce evidence of the nutritional status of the Tarahumara population. Objective: To estimate indicators of the nutritional status and its association with sociodemographic factors in the Tarahumara indigenous population under 5 years of age. Methods: A cross-sectional study in 21 indigenous localities of the Sierra Tarahumara in Chihuahua, Mexico, which analyzed sociodemographic, health and anthropometric information in children from 6 to 59 months of age (n=323). Anthropometric indices and their association with variables of interest was estimated by multiple logistic regression. A value of p ≤0.05 was considered statistically significant. All analyzes were performed using the Stata v14.2 statistical package. Results: It were founded high prevalences of short stature (44.4%), emaciation (5.3%), underweight (11.9%) and overweight (15.2%). Male sex was significantly associated with short stature (Odds Ratio (OR) = 2.5; 1.45-4.34), while no education of the mother (OR = 0.39; 0.15-0.99) and being a beneficiary of a local nutrition program for more than 2 years it was associated with being overweight (OR = 2.97; 1.26-6.97). Conclusion: Indicators of malnutrition and overweight were founded in the sample studied; these findings suggest inequity and delays in health and nutrition of the indigenous Tarahumara child population. More research is required that can guide health and nutrition programs and actions to serve this indigenous population as a priority

Factors associated with changes in movement behaviors in toddlers and preschoolers during the COVID-19 pandemic: A national cross-sectional study in Mexico

Little is known about physical activity, screen time and sleep among Mexican toddlers and preschoolers. The COVID-19 pandemic led to the closure of childcare education centers and restrictions to spend time outdoors. This study aimed to investigate the correlates of changes in movement behaviors from before to during the early stages of the COVID-19 lockdown in a national sample of toddlers and preschoolers in Mexico. A cross-sectional study was conducted using an open online survey completed by caretakers of children aged 1–5 years from April to July 2020. The questionnaire enquired about the time spent in each movement behavior during a regular week before and during lockdown, and family and household characteristics. Factors associated with changes in movement behaviors were explored using adjusted linear regression models. A total of 631 children (3.3y, 95% CI: 3.1, 3.4) were included in the study. During lockdown, physical activity decreased by 25%, screen time doubled, and sleep quality declined in 17% (p \u3c 0.001). Toddlers and preschoolers of older age, attending a childcare education center before the lockdown, with a screen in their bedroom, higher access to electronic devices, and lower socioeconomic level experienced greater changes during this period. Those with limits on the use of electronic devices, who had someone available to play with them, and availability of toys experienced less pronounced changes. Pandemic restrictions have impacted movement behaviors of toddlers and preschoolers, with disproportionate effects among lower socioeconomic levels. Interventions with a multi-level equity-oriented approach are urgently needed to mitigate these effects

Consumption of Micronutrient Powder, Syrup or Fortified Food Significantly Improves Zinc and Iron Status in Young Mexican Children: A Cluster Randomized Trial

The objective of this study was to compare the effect of three micronutrient products on biomarkers of iron and zinc status of Mexican children 6–12 months of age. As part of research to improve the impact of a national program, 54 communities were randomly assigned to receive: (1) fortified food (FF), provided by the program at the time, or (2) micronutrient powders (MNP) or (3) syrup. Each product contained 10 mg each of zinc and iron, plus other micronutrients. Children consumed the product 6 days/week for four months. Primary outcomes were changes in serum zinc, ferritin, soluble transferrin receptor, hemoglobin concentrations, and their deficiencies. Zinc concentration increased significantly from baseline to follow-up in all groups, with the largest change in the syrup group (geometric mean difference: +4.4 µmol/L; 95%CI: 3.2, 5.5), followed by MNP (+2.9 µmol/L; 95%CI: 2.1, 3.6) and FF (+0.9 µmol/L; 95%CI: 0.3, 1.6). There was a significant increase in hemoglobin concentration (+5.5 g/L; 2.5, 8.4) and a significant reduction in anemia prevalence (44.2% to 26.8%, p < 0.01) only in the MNP group. Compliance differed significantly among groups (MNP vs. FF, p = 0.04; MNP vs. syrup, p = 0.04), but may not fully explain the greater improvement in zinc and iron status in the syrup and MNP groups. The food matrix may influence nutrient utilization from supplements

Effect of Added Sugar on the Consumption of A Lipid-Based Nutrient Supplement Among 7–24-Month-Old Children

Small-quantity lipid-based nutrient supplements (SQ-LNS) could help prevent malnutrition. Our primary objective was to examine the acceptability and consumption of sweetened and unsweetened versions of SQ-LNS before and after 14-days of repeated exposure. A total of 78 mother-infant dyads recruited from health centers in Morelos, Mexico, were randomized to two groups of SQ-LNS (sweetened, LNS-S; unsweetened, LNS-U). During the study, infants were fed SQ-LNS (20 g) mixed with 30 g of complementary food of the caregiver’s choice. The amount of supplement-food mixture consumed was measured before, during and after a 14-day home exposure period. We defined acceptability as consumption of at least 50% of the offered food mixture. At initial exposure, LNS-U consumption was on average 44.0% (95% CI: 31.4, 58.5) and LNS-S 34.8% (25.3, 44.0); at final exposure, LNS-U and LNS-S consumption were 38.5% (27.8, 54.0) and 31.5% (21.6, 43.0). The average change in consumption did not differ between the groups (2.2 p.p. (−17.2, 24.4)). We conclude that the acceptability of sweetened and unsweetened SQ-LNS was low in this study population. Since consumption did not differ between supplement versions, we encourage the use of the unsweetened version given the potential effects that added sugar may have on weight gain especially in regions facing the double burden of malnutrition

An Iterative Process for Training Design and Implementation Increased Health Workers’ Knowledge for Taking Nutrition Behavior Change to Scale

The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. Results: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers\u27 routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. Conclusions: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions

Factors affecting anemia among women of reproductive age in Mexico: A mixed-methods country case study

Background: In Mexico, anemia prevalence among women of reproductive age (WRA) decreased from 16.4% in 2006 to 11.6% in 2012, only to increase to 18.3% in 2016. The factors associated with this fluctuation are uncertain.Objective: We conducted a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in Mexico between 2006 and 2018.Methods: Using multivariate stepwise linear regression, we analyzed Mexico\u27s Encuesta Nacional de Salud y Nutrición (ENSANUT) surveys from 2006, 2012, and 2018 to identify determinants of WRA anemia. We also conducted a review of anemia-relevant programs and policies, including financing documents, and conducted in-depth interviews and focus group discussions with key stakeholders in Mexico.Results: Among non-pregnant women (NPW) 15-49 years, mean hemoglobin (Hb) increased from 13.8 g/dL in 2006 to 14.0 g/dL in 2012, decreasing to 13.2 g/dL in 2018 (p\u3c0.001). Inequities by geographical region and household wealth persisted throughout this period, with household wealth, urban residence and gravidity emerging as significant predictors of Hb among NPW. Qualitative analyses generally supported these findings. The most discussed program was Progresa-Oportunidades-Prospera (POP), where most resources for health were invested and most participants acknowledged that its cancellation in 2019 would lead to worsening in health and nutrition among the poor. Financing analyses showed a drop of funding for nutrition-related programs between 2014 and 2018. Cultural norms around gender roles were still prevalent, along with increasing rates of teenage pregnancy.Conclusions: Anemia prevention efforts need to refocus on poverty alleviation, continuity of adequate coverage and financing of nutrition programs, especially with safety nets, and increase in uptake of family planning, especially among adolescent girls