Nutrition Status of Children, Teenagers, and Adults From National Health and Nutrition Surveys in Mexico From 2006 to 2020

Background: Population-level health and nutrition surveys provide critical anthropometric data used to monitor trends of the prevalence of under nutrition and overweight in children under 5 years old, and overweight and obesity in the population over 5 years of age.Objective: Analyze the children malnutrition and overweight and obesity in children, teenagers and adults through the National Health and Nutrition Surveys information available from public databases.Materials and Methods: Comparable anthropometric data was gathered by five Mexican National Health and Nutrition Surveys (in Spanish, ENSANUT). In pre-school-age children, under nutrition status was identified through underweight (Z-score below −2 in weight-for-age), stunting (chronic malnutrition) (Z-score below −2 for length/height-for-age), or wasting (Z-score below −2, for weight-for-length/height); overweight status was defined as a body mass index (BMI, kg/m2) for age over +2. For school-age children and adolescents, a Z-score BMI between +1 and +2 deviations was defined as overweight, and between +2 and +5.5 as obesity. In adults (≥20 years of age), overweight status was classified as a BMI between 25.0 and 29.9, and obesity as ≥30.Results: The anthropometric data presented derives from the databases of five survey years of the Mexican National Health and Nutrition Survey: 2006, 2012, 2016, 2018, and 2020. They include a total of 210,915 subjects with complete anthropometric data (weight, length/height) distributed on five survey moments; subjects were categorized by age group: pre-school-age children (n = 25,968), school-age children (n = 42,255), adolescents (n = 39,275), and adults (n = 103,417). Prevalence of malnutrition by indicator was calculated: in pre-school-age children: low height- and weight-for-age, low weight-for-height, and overweight; and in school-age children, adolescents, and adults, the indicators calculated were overweight and obesity.Conclusions: Results demonstrate the importance of maintaining systematic, reliable, and timely national anthropometric data in the population, in order to detect and track trends and to form the basis of nutrition-related public policy.

How to Estimate Food Prices and Diet Costs in Population-Based Studies?

Health and nutrition surveys usually comprise detailed information on health characteristics and food consumption of certain population groups; however, the lack of data collection on the food prices may pose challenges for the estimation of the diet costs for the comprehensive analysis of food demand. The Household Budget Survey (HBS) represents an opportunity to obtain the data on the food prices for the nutrition surveys in the diverse countries worldwide. Although the HBS and the health and nutrition surveys may correspond to different periods, the application of the appropriate Consumer Price Index (CPI) allows to address the changes in the relative prices to perform the linkage between the data of food consumption with information on the food prices. Therefore, the aim of this study was to present the methods for the extraction and linkage of the food prices data from the Brazilian HBS (2002–2003 and 2008–2009) by using the pairing features related to the household characteristics to match the Health Survey of São Paulo [Inquérito de Saúde de São Paulo (ISA-Capital)] conducted in 2003, 2008, and 2015. Data referring to the household characteristics and food prices acquired by the household members living in São Paulo municipality were selected from the HBS datasets for integration with the ISA-Capital dataset. Specific deflators referring to the food items surveyed in São Paulo were obtained from the datasets of the Brazilian Broad Consumer Price Index (BCPI). Therefore, the pairing criteria referring to time, location, and household characteristics were adopted to allow linking foods consumed by the individuals in the ISA-Capital with the prices from the foods acquired by household members interviewed in the HBS. Matching data on the key pairing criteria (location/year/household income per capita/number of residents/family profile) resulted in the linkage of 94.4% (2003), 92.6% (2008), and 81.2% of the cases (2015). Following the data linkage, it was possible to estimate diet costs per gram and per calorie including application of cooking and conversion factors. Data were presented in the International Monetary Unit under the purchasing power parity (PPP) to allow the comparison at the international level. The mean diet costs identified in the population of São Paulo municipality were $8.45 (dp = 0.38) per capita per day in 2003, $8.72 (dp = 0.24) per capita per day in 2008, and $9.62 (dp = 0.23) per capita per day in 2015. Thus, it was possible to estimate the diet costs based on the prices of food items through pairing linkage of information from the household surveys, such as the Brazilian HBS, with the health and nutrition surveys lacking information on the expenditures or prices such as the ISA-Capital. Similar procedures may be used in the diverse countries with availability of the datasets of the household expenditures and health and nutrition surveys, allowing the researchers worldwide to associate the diet quality with food demand.

Are the Eatwell Guide and Nutrient Profiling Models Consistent in the UK?

A nutrient profiling model (NPM) was developed in 2005 in the UK to regulate the marketing of foods to children. It was revised in 2018, but the new version has not been finalised. The Eatwell Guide (EWG) is the UK’s official food-based dietary guidelines. The aim of this study was to evaluate the agreement between the 2005 and 2018 versions of the NPM and the EWG. Using recent National Diet and Nutrition Surveys, we estimated the healthiness of individual diets based on an EWG dietary score and a NPM dietary index. We then compared the percentage of agreement and Cohen’s kappa for each combination of the EWG score and NPM index across the range of observed values for the 2005 and 2018 versions. A total of 3028 individual diets were assessed. Individuals with a higher (i.e., healthier) EWG score consumed a diet with, on average, a lower (i.e., healthier) NPM index both for the 2005 and 2018 versions. Overall, there was good agreement between the EWG score and the NPM dietary index at assessing the healthiness of representative diets of the UK population, when a low cut-off for the NPM dietary index was used, irrespective of the version. This suggests that dietary advice to the public is broadly aligned with NPM-based food policies and vice-versa.

Nutrition Surveillance in Thailand-Myanmar Border Refugee Camps - Trends in Wasting and Stunting Over 8 Years

Objectives Biennial nutrition surveys are conducted in the 9 refugee camps situated along the Thailand-Myanmar border to examine trends in acute and chronic malnutrition; food consumption patterns; and household hunger. Methods TBC and health agency partners conducted nutrition surveys of children 6–59 months (n = 3,780) in these camps May-November 2019. Random sampling was used to select households with children using TBC's Total Population Database. TBC trained and supervised health agencies and ethnic health departments in survey implementation. The WHO Growth Standards were used to analyze anthropometric data which were presented by prevalence. The Food Consumption, Nutritional Quality and Household Hunger Scale were used to determine diet diversity, quality and food deprivation. Results 2.2% of children surveyed were wasted (global acute malnutrition), considered “very low” (WHO). Wasting has remained unchanged since 2011. Although stunting prevalence was “high” (WHO) at 25.8% (range 13.6%-36.6%), there has been significant progress with a 15.0% reduction since 2011. Food Consumption Score was measure with 98.5% of households reporting an acceptable diet. While most households reported daily intake of protein and vitamin-rich foods, iron (heme) food sources were only consumed daily by about 1 in 3 households. Finally, 96.1%, 3.5% and 0.3% reported little to no hunger, moderate, and severe household hunger, respectively, similar to 2017 (97.7%, 2.2% and 0.1% reported little to no hunger, moderate hunger and severe hunger, respectively). Conclusions Stunting negatively impacts not only individuals but entire nations, currently affecting 162 million children under the age of 5 years. While stunting remains a challenge in the 9 Thailand-Myanmar border refugee camps, a continued downward trend indicates significant progress since 2011, with a 15% reduction. Therefore, supporting recommended maternal and infant and young child feeding practices, including emphasis on diet quality, particularly for heme iron-rich foods for women of reproductive age and protein-rich foods for children, in innovative ways remains a priority. Funding Sources The Border Consortium.

Effective coverage of medical treatment for hypertension, diabetes and dyslipidaemia in Japan: An analysis of National Health and Nutrition Surveys 2003–2017

Objective To examine trends in effective medical treatment coverage for hypertension, diabetes and dyslipidaemia in Japan, using a metric to assess effective coverage of health interventions derived from a health system performance assessment framework. Methods We obtained cross-sectional data for 96,863 individuals aged 40–74 years from the 15 annual Japanese National Health and Nutrition Surveys (2003–2017). We defined treatment need for hypertension, diabetes and dyslipidaemia as biomarkers equal to or greater than diagnostic thresholds or medication use. For individuals needing treatment, we conducted nearest-neighbour matching to estimate treatment effects and effective coverage, defined as the fraction of potential reductions in biomarkers actually achieved in treated individuals by medications. Results The age-standardized prevalence of treatment need for hypertension, diabetes and dyslipidaemia remained around 40%, 7% and 33%, respectively, in 2003–2017. Average treatment effects for those treated in 2013–2017 were 14.8 mmHg (95% confidence interval: 14.2–15.4) for systolic blood pressure, 1.2 percentage points (0.8–1.6) for haemoglobin A1c and 57.9 mg/dl (56.6–59.2) for non-high-density lipoprotein cholesterol. Effective coverage significantly increased between 2003–2007 (hypertension: 48.4% [44.7–52.0], diabetes: 43.8% [35.7–51.8], dyslipidaemia: 86.3% [83.1–89.5]) and 2013–2017 (hypertension: 76.2% [74.2–78.2], diabetes: 74.7% [71.0–78.5], dyslipidaemia: 94.6% [93.3–95.9]). Conclusions Effective coverage of medical treatment for metabolic risk factors has increased. Most of the potential reductions in non-high-density lipoprotein cholesterol have been achieved by statins. Further efforts are necessary to improve the effectiveness of antihypertensive and antidiabetic drugs.

The burden of anaemia among displaced women and children in refugee settings worldwide, 2013–2016

IntroductionDisplaced persons have a unique risk for developing anaemia due to often limited diets, overcrowding, new infections and inadequate sanitation and hygiene. The lack of anaemia prevalence estimates among the displaced inhibit global planning for anaemia reduction.MethodsWe analysed population representative, cross-sectional nutrition surveys from 2013 to 2016 conducted by the United Nations High Commissioner for Refugees and partner agencies. Included surveys measured haemoglobin concentration among children 6–59 months, non-pregnant women 15–49 years, or both groups. For each survey, we calculated mean haemoglobin and prevalence of total anaemia (<110 g/L in children, <120 g/L in women), and classified public health severity following WHO guidelines. Pearson correlations between indicators from women and children surveys were calculated where both subpopulations were measured.ResultsAnalysis included 196 surveys among children and 184 surveys among women from 121 unique refugee settings in 24 countries. The median prevalence of total anaemia in children and women was 44% and 28%, respectively. Sixty-one per cent of child surveys indicated a problem of severe public health importance compared with 25% of surveys in women. The prevalence of total anaemia in children and women was strongly correlated (ρ=0.80). Median prevalence of total anaemia was approximately 55% greater and mean haemoglobin was 6 g/L lower among children age 6–23 months compared with children 24–59 months. West and Central Africa region had the highest median prevalence of anaemia both in women and children.ConclusionWhile the burden of anaemia is high among the displaced, it mirrors that of the general population. Haemoglobin should continue to be measured in nutrition surveys in refugee settings. Sustained, multisectoral efforts to reduce anaemia are needed, with specific focus on children under 2 years of age and refugee settings in the West and Central Africa region.