The socioeconomic disparities in intakes and purchases of less-healthy foods and beverages have changed over time in urban Mexico

Background: To our knowledge, the association between diet and socioeconomic status (SES), using both purchase and intake data, in the Mexican population has not been examined, which is particularly important given the high prevalence of diet-related diseases in Mexico. Objective: Our objectivewas to examine the SES-diet relation using household food purchases and individual food intake data. Methods: We analyzed purchases of packaged food and beverages of 5240 households with the use of the 2012- 2014 Nielsen Mexico Consumer Panel Service Dataset, representative of urban areas. Likewise, we examined 9672 individuals over 2 y with food and beverage intake information collected using a single 24-h recall as part of the Mexican National Health and Nutrition Survey 2012. Multivariate linear regression models were conducted to predict per capita daily purchases and intakes of food and beverages classified as healthy and less healthy by SES, and adjusting for sociodemographic variables. Results: Per capita daily purchases of healthy and less-healthy foods were, on average, 142% and 55% higher in highthan in low-SES households, respectively, from 2012 to 2014 (P < 0.05). Intakes of healthy and less-healthy foods in urban areas were, on average, 7% and 136% higher in high- than in low-SES groups (P < 0.05). Per capita daily purchases of healthy beverages were, on average, 56% higher in high- than in low-SES households from 2012 to 2014 (P < 0.05), whereas purchases of less-healthy beverageswere 27% and 17% higher in low- than in high-SES households in 2012 and 2014, respectively (P < 0.05). Per capita daily intake of healthy beverages was 33% higher in high- than in low-SES groups (P < 0.05). Conclusion: Higher-SES groups from urban areas had greater purchases and intakes of less-healthy foods and healthy beverages. Lower-SES households had greater purchases of less-healthy beverages, but also had the largest reduction in these purchases from 2012 to 2014, which could be associated with the beverage tax implemented in Mexico in 2014

Association between socioeconomic status and diet quality in Mexican men and women: A cross-sectional study

Examining the potential differences in diet quality among socioeconomic status (SES) subgroups in Mexican adults may help to explain SES disparities in the burden of non-communicable diseases. We determined the association between SES, gender and diet quality among Mexican adults. We analyzed data from adults participating in the subsample with dietary information from the Mexican National Health and Nutrition Survey 2012 (n = 2,400), and developed the Mexican Diet Quality Index based on the Mexican Dietary Guidelines. We tested the interaction between sex and SES indicators using multivariable linear regression models. Sex was not a modifier; therefore, the analyses were carried out in the overall sample of men and women. The mean age was 42 (SE = 0.4) years, the total diet quality score was 38 (SE = 0.4), and a high percentage of men and women were classified with reading/writing skills or 3-9 years of school. A higher percentage of adults were classified with high versus medium or low assets index. In the multivariable model further adjusted for the assets index, for adults with education in the reading and/or 3-9 years of schooling and those with ≥10 years of school, there was a 3.7 and 5.8 points lower total diet quality score than with adults with no reading/writing skills (p < 0.05). Likewise, in multivariable model further adjusted for educational level, the total diet quality score was 2.5 points and 3.3 points lower in adults classified with medium and high assets index, respectively, versus low assets index (p < 0.05). The difference between individuals with medium and high assets index was not statistically significant. Although there is currently better diet quality among adults with low SES, this needs to continue to be monitored as Mexico progress through the nutrition transition

Do high vs. low purchasers respond differently to a nonessential energy-dense food tax? Two-year evaluation of Mexico's 8% nonessential food tax

It is unclear whether response to a nonessential food tax varies across time or for high vs. low-consuming households. The objective is to examine whether the effect of Mexico's 2014 8% nonessential energy-dense foods tax increased in the second year post-implementation and whether it differentially affected households by pre-tax purchasing pattern. We used longitudinal data on Mexican household food purchases (n = 6089 households) from 2012 to 2015. Households were classified based on median pre-tax purchases: low untaxed/low taxed (“low”), low untaxed/high taxed (“unhealthy”), high untaxed/low taxed (“healthy”), and high untaxed/high taxed (“high”) purchasers. Fixed effects models tested whether observed post-tax purchases differed from the counterfactual, or what would have been expected based on pre-tax trends. Post-tax declines in the % taxed food purchases increased from − 4.8% in year one to − 7.4% in year two, yielding a 2-year mean decline of 6.0% beyond the counterfactual (p < 0.01). Post-tax change in % taxed food purchases varied by pre-tax purchasing level. Healthy purchasers showed no post-tax change in % taxed food purchases beyond the counterfactual, while unhealthy, low and high purchasers decreased (− 12.3%, − 5.3% and − 4.4%, respectively) (p < 0.01). The positive effect of Mexico's junk food tax continued in the second year, and households with greater preferences for taxed foods showed a larger decline in taxed food purchases

The association of overall diet quality with BMI and waist circumference by education level in Mexican men and women

Objective:The present study evaluated the association of two measures of diet quality with BMI and waist circumference (WC), overall and by education level, among Mexican men and women.Design:We constructed two a priori indices of diet quality, the Mexican Diet Quality Index (MxDQI) and the Mexican Alternate Healthy Eating Index (MxAHEI), which we examined relative to BMI and WC. We computed sex-specific multivariable linear regression models for the total sample and by education level.Setting:Mexico.Participants:Mexican men (n 954) and women (n 1356) participating in the Mexican National Health and Nutrition Survey 2012.Results:Total dietary scores were not associated with BMI in men and women, but total MxDQI was inversely associated with WC in men (-0·10, 95 % CI -0·20, -0·004 cm). We also found that some results differed by education level in men. For men with the lowest education level, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean reduction in BMI of 0·11 (95 % CI -0·18, 0·04) and 0·18 (95 % CI -0·25, -0·10) kg/m2, respectively. Likewise, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean change in WC of -0·30 (95 % CI -0·49, -0·11) and -0·53 (95 % CI -0·75, -0·30) cm, respectively, in men with the lowest level of education. In women, the association of diet quality scores with BMI and WC was not different by education level.Conclusions:Our findings suggest that a higher diet quality in men with low but not high education is associated with lower BMI and WC

The caloric and sugar content of beverages purchased at different store-types changed after the sugary drinks taxation in Mexico

Background: Following the 2014 sugary drinks tax implementation in Mexico, promising reduction in the volume of purchases of taxed beverages were observed overall and at different store-types. However, the tax's effects on purchasing patterns of calories and sugar remain unclear. Methods: Using longitudinal data from Mexican households (n = 7038), we examined changes in volume, calories and total sugar of packaged beverages purchased from 2012 to 2016 overall and by store-type. We used fixed effects models to estimate means for volume, calories, and sugar of households. To address the potential selectivity from households shopping at different stores, we calculated inverse probability weights to model the purchases changes over time by store-type. Results: For taxed beverages, the volume of purchases declined by-49 ml and-30 ml in the first year and second year post tax (2014 and 2015, respectively), while purchases leveled off in the third year of the tax (2016). Calories and sugar from taxed beverage purchases decreased over time, with the majority of the declines occurring in the first two years post-tax implementation. The volume of untaxed beverage purchases increased, whereas changes in calories and total sugar of untaxed beverages were minimal. Store level purchases of taxed beverages significantly decreased in the first two years post taxation (2014 and to 2015) only in supermarkets and traditional stores. The steepest declines in purchases of taxed beverages in 2014 were observed at supermarkets (-40 ml or-45%). The volume of purchases of untaxed beverages increased over time in almost all store-types, while calories and sugar minimally decreased over time. Conclusion: Although the Mexican tax on SSBs has lowered the purchases of sugary drinks 3 years after the tax implementation, the tax should be strengthened and store-specific interventions should be implemented to further reduce SSBs purchases in the Mexican population

Cross-sectional association between diet quality and cardiometabolic risk by education level in Mexican adults

Objective: Understanding the association between diet quality and cardiometabolic risk by education level is important for preventing increased cardiometabolic risk in the Mexican population, especially considering pre-existing disparities in diet quality. The present study examined the cross-sectional association of overall diet quality with cardiometabolic risk, overall and by education level, among Mexican men and women.Design: Cardiometabolic risk was defined by using biomarkers and diet quality by the Mexican Diet Quality Index. We computed sex-specific multivariable logistic regression models.Setting: Mexico.Participants: Mexican men (n 634) and women (n 875) participating in the Mexican National Health and Nutrition Survey 2012.Results: We did not find associations of diet quality with cardiometabolic risk factors in the total sample or in men by education level. However, we observed that for each 10-unit increase in the dietary quality score, the odds of diabetes risk in women with no reading/writing skills was 0·47 (95 % CI 0·26, 0·85) relative to the odds in women with ≥10 years of school (referent). Similarly, for each 10-unit increase of the dietary quality score, the odds of having three v. no lipid biomarker level beyond the risk threshold in lower-educated women was 0·27 (95 % CI 0·12, 0·63) relative to the odds in higher-educated women.Conclusions: Diet quality has a stronger protective association with some cardiometabolic disease risk factors for lower- than higher-educated Mexican women, but no association with cardiometabolic disease risk factors among men. Future research will be needed to understand what diet factors could be influencing the cardiometabolic disease risk disparities in this population

Sugar-sweetened beverage intake among chilean preschoolers and adolescents in 2016: A cross-sectional analysis

Background: Chile has the highest sugar-sweetened beverage (SSB) sales of any country and a growing burden of childhood obesity. This study examines SSB intake in Chilean children after a 5% SSB tax increase in 2014 but prior to marketing, labeling, and school policies implemented in 2016. Methods: 24-h recalls were collected in 2016 from two cohorts comprised of preschoolers 3–5 years of age (n = 961) and adolescents 12–14 years of age (n = 770) from low–moderate income neighborhoods. Beverages were categorized as regulated or unregulated according to whether they exceeded nutrient thresholds established by the 2016 policies. Results: Preschoolers consumed mainly beverage calories from regulated dairy beverages and substitutes (109 kcal, SD 30), unregulated dairy beverages (102 kcal, SD 24), and regulated fruit and vegetables drinks (44 kcal, SD 20). For adolescents, the greatest contributions came from regulated sodas (77 kcal, SD 47), regulated dairy beverages and substitutes (41 kcal, SD 16), and unregulated coffee and tea (41 kcal, SD 11). Overall, regulated beverages provided a greater proportion of calories than unregulated for preschoolers (15.0% vs. 11.8%) and for adolescents (9.1% vs. 5.0%). Conclusions: Before major policy implementation, regulated beverages accounted for a higher percentage of energy intake than unregulated beverages among both age groups. Future research will be needed to evaluate the impact of Chile’s new policies on sugary beverage intake in children

Dietary quality and cardiometabolic indicators in the USA: A comparison of the Planetary Health Diet Index, Healthy Eating Index-2015, and Dietary Approaches to Stop Hypertension

Background The Planetary Health Diet Index (PHDI) measures adherence to the sustainable dietary guidance proposed by the EAT-Lancet Commission on Food, Planet, Health. To justify incorporating sustainable dietary guidance such as the PHDI in the US, the index needs to be compared to health-focused dietary recommendations already in use. The objectives of this study were to compare the how the Planetary Health Diet Index (PHDI), the Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to cardiometabolic risk factors. Methods and findings Participants from the National Health and Nutrition Examination Survey (2015–2018) were assigned a score for each dietary index. We examined disparities in dietary quality for each index. We used linear and logistic regression to assess the association of standardized dietary index values with waist circumference, blood pressure, HDL-C, fasting plasma glucose (FPG) and triglycerides (TG). We also dichotomized the cardiometabolic indicators using the cutoffs for the Metabolic Syndrome and used logistic regression to assess the relationship of the standardized dietary index values with binary cardiometabolic risk factors. We observed diet quality disparities for populations that were Black, Hispanic, low-income, and low-education. Higher diet quality was associated with improved continuous and binary cardiometabolic risk factors, although higher PHDI was not associated with high FPG and was the only index associated with lower TG. These patterns remained consistent in sensitivity analyses.; Conclusions Sustainability-focused dietary recommendations such as the PHDI have similar cross-sectional associations with cardiometabolic risk as HEI-2015 or DASH. Health-focused dietary guidelines such as the forthcoming 2025–2030 Dietary Guidelines for Americans can consider the environmental impact of diet and still promote cardiometabolic health

An evaluation of Chile’s law of food labeling and advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study

Background Chile’s Law of Food Labeling and Advertising, implemented in 2016, was the first national regulation to jointly mandate front-of-package warning labels, restrict child-directed marketing, and ban sales in schools of all foods and beverages containing added sugars, sodium, or saturated fats that exceed set nutrient or calorie thresholds. The objective of this study is to evaluate the impact of this package of policies on household beverage purchases. Method and findings In this observational study, monthly longitudinal data on packaged beverage purchases were collected from urban-dwelling households (n = 2,383) participating in the Kantar Word-Panel Chile Survey from January 1, 2015, to December 31, 2017. Beverage purchases were linked to nutritional information at the product level, reviewed by a team of nutritionists, and categorized as “high-in” or “not high-in” according to whether they contained high levels of nutrients of concern (i.e., sugars, sodium, saturated fat, or energy) according to Chilean nutrient thresholds and were thus subject to the law’s warning label, marketing restriction, and school sales ban policies. The majority of high-in beverages were categorized as such because of high sugar content. We used fixed-effects models to compare the observed volume as well as calorie and sugar content of postregulation beverage purchases to a counterfactual based on preregulation trends, overall and by household-head educational attainment. Of households included in the study, 37% of household heads had low education (less than high school), 40% had medium education (graduated high school), and 23% had high education (graduated college), with the sample becoming more educated over the study period. Compared to the counterfactual, the volume of high-in beverage purchases decreased 22.8 mL/capita/day, postregulation (95% confidence interval [CI] −22.9 to −22.7; p 0.001), or 23.7% (95% CI −23.8% to −23.7%). High-educated and low-educated households showed similar absolute reductions in high-in beverage purchases (approximately 27 mL/capita/day; p 0.001), but for high-educated households this amounted to a larger relative decline (−28.7%, 95% CI −28.8% to −28.6%) compared to low-educated households (−21.5%, 95% CI −21.6% to −21.4%), likely because of the high-educated households’ lower level of high-in beverage purchases in the preregulation period. Calories from high-in beverage purchases decreased 11.9 kcal/capita/day (95% CI −12.0 to −11.9; p 0.001) or 27.5% (95% CI −27.6% to −27.5%). Calories purchased from beverages classified as “not high-in” increased 5.7 kcal/capita/day (95% CI 5.7–5.7; p 0.001), or 10.8% (10.8%–10.8%). Calories from total beverage purchases decreased 7.4 kcal/capita/day (95% CI −7.4 to −7.3; p 0.001), or 7.5% (95% CI −7.6% to −7.5%). A key limitation of this study is the inability to assess causality because of its observational nature. We also cannot determine whether observed changes in purchases are due to reformulation or consumer behavioral change, nor can we parse out the effects of the labeling, marketing, and school sales ban policies. Conclusions Purchases of high-in beverages significantly declined following implementation of Chile’s Law of Food Labeling and Advertising; these reductions were larger than those observed from single, standalone policies, including sugar-sweetened-beverage taxes previously implemented in Latin America. Future research should evaluate the effects of Chile’s policies on purchases of high-in foods, dietary intake, and long-term purchasing changes