Objetivo. Describir la magnitud, distribución y tendencias de la desnutrición y el sobrepeso en menores de 5 años de 1988 a 2012 y hacer recomendaciones para su erradicación. Material y métodos. Se analizaron indicadores antropométricos en menores de 5 años, de cuatro encuestas nacionales. Resultados. A pesar de haber tenido un notable descenso en el periodo estudiado, la desnutrición crónica persiste como problema de salud pública, con mayores prevalencias en la población indígena, las zonas rurales del sur y el quintil de menores condiciones de bienestar. Conclusiones. Diversas políticas y programas han mostrado efectividad aunque persisten retos de implementación entre la población más pobre, particularmente la indígena. Se recomiendan, por una parte, medidas para aumentar la efectividad de las políticas y programas actuales, sobre todo entre la población indígena y la más pobre, mediante el ajuste de los programas actuales, de acuerdo con los resultados de las evaluaciones y, por la otra, políticas de desarrollo social que atiendan los determinantes sociales de la desnutrición.
BackgroundDespite positive nutrition impacts, the prevalence of malnutrition among beneficiaries of Mexico's conditional cash transfer (CCT) program remains high. Greater nutrition impact may have been constrained by the type of nutritional supplements provided.ObjectiveThe objective of this study was to inform a potential modification to the supplements distributed to pregnant and lactating women and children.MethodsImpact was assessed using 2 cluster-randomized trials (pregnant women, children) run simultaneously. Communities (n = 54) were randomly assigned to the fortified foods provided by the program (Nutrivida women, Nutrisano children) or alternatives: tablets (women), syrup (children), or micronutrient powders for women (MNP-W) and children (MNP-C). Each supplement for women/children contained the same micronutrients based on the formulations of Nutrivida and Nutrisano, respectively. Pregnant women (aged >18 y) were recruited before 25 weeks of gestation and followed to 3 mo postpartum. Children aged 6–12 mo were recruited and followed to age 24 mo. Primary outcomes were anemia for women and length growth for children. Statistical analyses appropriate for cluster-randomized designs were used, and structural equation modeling to estimate dose-response effects. Supplement costs per beneficiary (daily dose for 18 mo) were estimated for production and distribution.ResultsThere was no significant difference in change of anemia prevalence between supplement groups in women, or in length growth between groups in children. One daily dose of any supplement was associated with 0.8 cm greater length growth. From baseline to age 24 mo, the prevalence of anemia in the Nutrisano, syrup, and MNP-C groups decreased by 36.7, 40.8, and 37.9 percentage points, respectively (within-group, P < 0.05; between groups, P > 0.05). Costs per beneficiary ranged from $12.1 (MNP-C) to $94.8 (Nutrivida).ConclusionsThe CCT program could distribute alternative supplements at lower cost per beneficiary without compromising potential for impact. Acceptance among beneficiaries should also be considered in choice of alternatives. This trial was registered at www.clinicaltrials.gov as NCT00531674.
S466salud To compare the prevalence of undernutrition and anemia in indigenous and non-indigenous children <5 years of age at the national level, by region and by urban and rural areas, and to evaluate the degree to which the socioeconomic condition of the family predicts the differences. Material and Methods. A national probabilistic survey was conducted in Mexico in 1999. Indigenous families were identified as those in which at least one woman 12-49 years of age in the household spoke a native language. The prevalence of undernutrition (stunting, wasting and underweight) and anemia was compared between indigenous and nonindigenous children. Probability ratios (PR) were used to compare prevalences in indigenous and non-indigenous children adjusting for socioeconomic status (SES) of the family and for other covariates. Results. The prevalences of stunting and underweight were greater in indigenous than in nonindigenous children. At the national level and in urban areas the prevalences were three times greater and in rural areas 2 times greater (p<0.05). No differences were found in the prevalence of wasting (p>0.05). The prevalence of anemia in indigenous children was one third greater than in non-indigenous children at the national level (p<0.05) and was between 30 and 60% greater in urban areas and in the regions studied (p<0.05) but was not statistically significant (p>0.05) in rural areas. These differences were reduced to about half when adjusting for SES but remained significantly
Prenatal DHA supplementation did not affect height, weight, or BMI through 60 mo of age. This trial was registered at clinicaltrials.gov as NCT00646360.
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