RESUMO
BACKGROUND: The consumption of sugar-sweetened beverages (SSBs) is associated with obesity, metabolic diseases, and incremental healthcare costs. Given their health consequences, the World Health Organization (WHO) recommended that countries implement taxes on SSB. Over the last 10 years, obesity prevalence has almost doubled in Brazil, yet, in 2016, the Brazilian government cut the existing federal SSB taxes to their current 4%. Since 2022, a bill to impose a 20% tax on SSB has been under discussion in the Brazilian Senate. To simulate the potential impact of increasing taxes on SSB in Brazil, we aimed to estimate the price-elasticity of SSB and the potential impact of a new 20% or 30% excise SSB tax on consumption, obesity prevalence, and cost savings. METHODS AND FINDINGS: Using household purchases data from the Brazilian Household Budget Survey (POF) from 2017/2018, we estimated constant elasticity regressions. We used a log-log specification by income level for all beverage categories: (1) sugar-sweetened beverages; (2) alcoholic beverages; (3) unsweetened beverages; and (4) low-calorie or artificially sweetened beverages. We estimated the adult nationwide baseline intake for each beverage category using 24-h dietary recall data collected in 2017/2018. Taking group one as the taxed beverages, we applied the price and cross-price elasticities to the baseline intake data, we obtained changes in caloric intake. The caloric reduction was introduced into an individual dynamic model to estimate changes in weight and obesity prevalence. No benefits on cost savings were modeled during the first 3 years of intervention to account for the time lag in obesity cases to reduce costs. We multiplied the reduction in obesity cases during 7 years by the obesity costs per capita to predict the costs savings attributable to the sweetened beverage tax. SSB price elasticities were higher among the lowest tertile of income (-1.24) than in the highest income tertile (-1.13), and cross-price elasticities suggest SSB were weakly substituted by milk, water, and 100% fruit juices. We estimated a caloric change of -17.3 kcal/day/person under a 20% excise tax and -25.9 kcal/day/person under a 30% tax. Ten years after implementation, a 20% tax is expected to reduce obesity prevalence by 6.7%; 9.1% for a 30% tax. These reductions translate into a -2.8 million and -3.8 million obesity cases for a 20% and 30% tax, respectively, and a reduction of $US 13.3 billion and $US 17.9 billion in obesity costs over 10 years for a 20% and 30% tax, respectively. Study limitations include using a quantile distribution method to adjust self-reported baseline weight and height, which could be insufficient to correct for reporting bias; also, weight, height, and physical activity were assumed to be steady over time. CONCLUSIONS: Adding a 20% to 30% excise tax on top of Brazil's current federal tax could help to reduce the consumption of ultra-processed beverages, empty calories, and body weight while avoiding large health-related costs. Given the recent cuts to SSB taxes in Brazil, a program to revise and implement excise taxes could prove beneficial for the Brazilian population.
Assuntos
Obesidade , Bebidas Adoçadas com Açúcar , Impostos , Humanos , Impostos/economia , Bebidas Adoçadas com Açúcar/economia , Brasil/epidemiologia , Obesidade/epidemiologia , Obesidade/economia , Obesidade/prevenção & controle , Obesidade/etiologia , Prevalência , Adulto , Modelos Econômicos , Feminino , Masculino , Bebidas/economia , Redução de CustosRESUMO
BACKGROUND/OBJECTIVES: Obesity prevalence in Mexican children has increased rapidly and is among the highest in the world. We aimed to estimate the longitudinal association between nonessential energy-dense food (NEDF) consumption and body mass index (BMI) in school-aged children 5 to 11 years, using a cohort study with 6 years of follow-up. SUBJECTS/METHODS: We studied the offspring of women in the Prenatal omega-3 fatty acid supplementation, child growth, and development (POSGRAD) cohort study. NEDF was classified into four main groups: chips and popcorn, sweet bakery products, non-cereal based sweets, and ready-to-eat cereals. We fitted fixed effects models to assess the association between change in NEDF consumption and changes in BMI. RESULTS: Between 5 and 11 years, children increased their consumption of NEDF by 225 kJ/day (53.9 kcal/day). In fully adjusted models, we found that change in total NEDF was not associated with change in children's BMI (0.033 kg/m2, [p = 0.246]). However, BMI increased 0.078 kg/m2 for every 418.6 kJ/day (100 kcal/day) of sweet bakery products (p = 0.035) in fully adjusted models. For chips and popcorn, BMI increased 0.208 kg/m2 (p = 0.035), yet, the association was attenuated after adjustment (p = 0.303). CONCLUSIONS: Changes in total NEDF consumption were not associated with changes in BMI in children. However, increases in the consumption of sweet bakery products were associated with BMI gain. NEDF are widely recognized as providing poor nutrition yet, their impact in Mexican children BMI seems to be heterogeneous.
Assuntos
Índice de Massa Corporal , Ingestão de Energia , Obesidade Infantil , Humanos , Feminino , Criança , México/epidemiologia , Masculino , Estudos Prospectivos , Obesidade Infantil/epidemiologia , Pré-Escolar , Ingestão de Energia/fisiologia , Comportamento Alimentar/fisiologia , Dieta/estatística & dados numéricosRESUMO
BACKGROUND: There are limited population-representative data that describe the potential burden of Post-COVID conditions (PCC) in Mexico. We estimated the prevalence of PCC overall and by sociodemographic characteristics among a representative sample of adults previously diagnosed with COVID-19 in Mexico. We additionally, characterized the PCC symptoms, and estimated the association between diagnosed type-2 diabetes and hypertension with PCC. METHODS: We used data from the 2021 National Health and Nutrition Survey in Mexico, a nationally and regionally representative survey, from August 1st to October 31st, 2021. Using the WHO definition, we estimated the prevalence of PCC by sociodemographics and prevalence of PCC symptoms. We fit multivariable log-binomial regression models to estimate the associations. RESULTS: The prevalence of PCC was 37.0%. The most common persistent symptoms were fatigue (56.8%), myalgia or arthralgia (47.5%), respiratory distress and dyspnea (42.7%), headache (34.0%), and cough (25.7%). The prevalence was higher in older people, women, and individuals with low socioeconomic status. There was no significant association between hypertension and PCC or diabetes and PCC prevalence. CONCLUSIONS: About one-third of the adult Mexican population who had COVID-19 in 2021 had Post-COVID conditions. Our population-based estimates can help assess potential priorities for PCC-related health services, which is critical in light of our weak health system and limited funding.
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COVID-19 , Sobreviventes , Humanos , COVID-19/epidemiologia , México/epidemiologia , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Adulto , Prevalência , Idoso , Sobreviventes/estatística & dados numéricos , Adulto Jovem , Hipertensão/epidemiologia , Adolescente , Diabetes Mellitus Tipo 2/epidemiologia , Fatores Sociodemográficos , SARS-CoV-2RESUMO
Objectives. To describe national and city-level fatal drug overdose trends between 2005 and 2021 in Mexico. Methods. We calculated fatal overdose rates at the city level in 3-year periods from 2005 to 2021 and annually at the national level for people aged 15 to 64 years in Mexico. We calculated rate differences and rate ratios for each city between periods. Results. The national fatal overdose rate was 0.53 overdose deaths per 100 000 population and was almost twice as high in urban than in nonurban areas. The national fatal overdose rate was stable over the period 2005 to 2014 and increased monotonically to a peak in 2021. Fatal overdose rates varied across cities. Cities with the 8 highest fatal overdose rates in the period were all in states along the US-Mexico border. Conclusions. Fatal overdoses have doubled over the past 15 years in Mexico. Overdose rates are particularly high and increasing in cities close to the US-Mexico border. Public Health Implications. There is a need for enhanced overdose surveillance data and coordinated harm reduction strategies, particularly in the northern border region of Mexico. (Am J Public Health. 2024;114(7):705-713. https://doi.org/10.2105/AJPH.2024.307650).
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Cidades , Overdose de Drogas , Humanos , México/epidemiologia , Overdose de Drogas/mortalidade , Overdose de Drogas/epidemiologia , Adulto , Adolescente , Feminino , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Assessing the trends in dietary GHGE considering the social patterning is critical for understanding the role that food systems have played and will play in global emissions in countries of the global south. Our aim is to describe dietary greenhouse gas emissions (GHGE) trends (overall and by food group) using data from household food purchase surveys from 1989 to 2020 in Mexico, overall and by education levels and urbanicity. METHODS: We used cross-sectional data from 16 rounds of Mexico's National Income and Expenditure Survey, a nationally representative survey. The sample size ranged from 11,051 in 1989 to 88,398 in 2020. We estimated the mean total GHGE per adult-equivalent per day (kg CO2-eq/ad-eq/d) for every survey year. Then, we estimated the relative GHGE contribution by food group for each household. These same analyses were conducted stratifying by education and urbanicity. RESULTS: The mean total GHGE increased from 3.70 (95%CI: 3.57, 3.82) to 4.90 (95% CI 4.62, 5.18) kg CO2-eq/ad-eq/d between 1989 and 2014 and stayed stable between 4.63 (95% CI: 4.53, 4.72) and 4.89 (95% CI: 4.81, 4.96) kg CO2-eq/ad-eq/d from 2016 onwards. In 1989, beef (19.89%, 95% CI: 19.18, 20.59), dairy (16.87%, 95% CI: 16.30, 17.42)), corn (9.61%, 95% CI: 9.00, 10.22), legumes (7.03%, 95% CI: 6.59, 7.46), and beverages (6.99%, 95% CI: 6.66, 7.32) had the highest relative contribution to food GHGE; by 2020, beef was the top contributor (17.68%, 95%CI: 17.46, 17.89) followed by fast food (14.17%, 95% CI: 13.90, 14.43), dairy (11.21%, 95%CI: 11.06, 11.36), beverages (10.09%, 95%CI: 9.94, 10.23), and chicken (10.04%, 95%CI: 9.90, 10.17). Households with higher education levels and those in more urbanized areas contributed more to dietary GHGE across the full period. However, households with lower education levels and those in rural areas had the highest increase in these emissions from 1989 to 2020. CONCLUSIONS: Our results provide insights into the food groups in which the 2023 Mexican Dietary Guidelines may require to focus on improving human and planetary health.
Assuntos
Gases de Efeito Estufa , México , Gases de Efeito Estufa/análise , Humanos , Estudos Transversais , Bebidas/estatística & dados numéricos , Dieta/estatística & dados numéricos , Dieta/tendências , Alimentos/estatística & dados numéricos , Efeito Estufa , Características da FamíliaRESUMO
BACKGROUND: Childhood obesity is a growing concern worldwide. School-based interventions have been proposed as effective means to improve nutritional knowledge and prevent obesity. In 2023, Mexico approved a reform to the General Education Law to strengthen the ban of sales and advertising of nonessential energy-dense food and beverages (NEDFBs) in schools and surroundings. We aimed to predict the expected one-year change in total caloric intake and obesity prevalence by introducing the ban of NEDFBs sales in schools, among school-aged children and adolescents (6 to 17 years old) in Mexico. METHODS AND FINDINGS: We used age-specific equations to predict baseline fat-free mass (FFM) and fat mass (FM) and then estimated total energy intake (TEI) per day. The TEI after the intervention was estimated under 4 scenarios: (1) using national data to inform the intervention effect; (2) varying law compliance; (3) using meta-analytic data to inform the intervention effect size on calories; and (4) using national data to inform the intervention effect by sex and socioeconomic status (SES). We used Hall's microsimulation model to estimate the potential impact on body weight and obesity prevalence of children and adolescents 1 year after implementing the intervention in Mexican schools. We found that children could reduce their daily energy intake by 33 kcal/day/person (uncertainty interval, UI, [25, 42] kcal/day/person), reducing on average 0.8 kg/person (UI [0.6, 1.0] kg/person) and 1.5 percentage points (pp) in obesity (UI [1.1, 1.9] pp) 1 year after implementing the law. We showed that compliance will be key to the success of this intervention: considering a 50% compliance the intervention effect could reduce 0.4 kg/person (UI [0.3, 0.5] kg/person). Our sensitivity analysis showed that the ban could reduce body weight by 1.3 kg/person (UI [0.8, 1.8] kg/person) and up to 5.4 kg/person (UI [3.4, 7.5] kg/person) in the best-case scenario. Study limitations include assuming that obesity and the contribution of NEDFBs consumed at school remain constant over time, assuming full compliance, and not considering the potential effect of banning NEDFBs in stores near schools. CONCLUSIONS: Even in the most conservative scenario, banning sales of NEDFBs in schools is expected to significantly reduce obesity, but achieving high compliance will be key to its success. WHY WAS THIS STUDY DONE?: - School-based interventions have been recognized as effective means to improve nutritional knowledge and prevent obesity-related diseases.- In December 2023, the Chamber of Representatives of Mexico approved an amendment that strengthens and updates the General Education Law (Article 75) and nutritional guidelines to ban the sales and advertising of nonessential energy-dense food and beverages (NEDFBs) in schools. WHAT DID THE RESEARCHERS DO AND FIND?: - We used age-specific equations to predict baseline fat-free mass (FFM) and fat mass (FM) and total energy intake (TEI) per day.- We used microsimulation modeling to predict body weight and obesity prevalence of children and adolescents 1 year after implementing the intervention in Mexican schools.- Our modeling study suggests that an important impact on obesity prevalence can be expected if the law is implemented and enforced as intended. WHAT DO THESE FINDINGS MEAN?: - If successful, this law could serve as an example beyond Mexico on how to achieve changes in body weight through school food regulation.- An important limitation of our main scenario is that we assumed full compliance of schools with the law, yet lower compliance will reduce its impact. We also did not consider historical trends on obesity or NEDFBs consumed in schools during our 1 year simulation, and we considered only the ban impact inside schools, excluding effects near and outside schools.
Assuntos
Bebidas , Ingestão de Energia , Obesidade Infantil , Instituições Acadêmicas , Humanos , México/epidemiologia , Adolescente , Criança , Feminino , Masculino , Obesidade Infantil/prevenção & controle , Obesidade Infantil/epidemiologia , Alimentos , Prevalência , Peso CorporalRESUMO
BACKGROUND: Latin American countries are often limited in the availability of food outlet data. There is a need to use online search engines that allow the identification of food outlets and assess their agreement with field observations. We aimed to assess the agreement in the density of food outlets provided by a web collaborative data (Google) against the density obtained from an administrative registry. We also determined whether the agreement differed by type of food outlet and by area-level socioeconomic deprivation. METHODS: In this cross-sectional study, we analyzed 1,693 census tracts from the municipalities of Hermosillo, Leon, Oaxaca de Juarez, and Tlalpan. The Google service was used to develop a tool for the automatic acquisition of food outlet data. To assess agreement, we compared food outlet densities obtained with Google against those registered in the National Statistical Directory of Economic Units (DENUE). Continuous densities were assessed using Bland-Altman plots and concordance correlation coefficient (CCC), while agreement across tertiles of density was estimated using weighted kappa. RESULTS: The CCC indicated a strong correlation between Google and DENUE in the overall sample (0.75); by food outlet, most of the correlations were from negligible (0.08) to moderate (0.58). The CCC showed a weaker correlation as deprivation increased. Weighted kappa indicated substantial agreement between Google and DENUE across all census tracts (0.64). By type of food outlet, the weighted kappa showed substantial agreement for restaurants (0.69) and specialty food stores (0.68); the agreement was moderate for convenience stores/small food retail stores (0.49) and fair for candy/ice cream stores (0.30). Weighted kappa indicated substantial agreement in low-deprivation areas (0.63); in very high-deprivation areas, the agreement was moderate (0.42). CONCLUSIONS: Google could be useful in assessing fixed food outlet densities as a categorical indicator, especially for some establishments, like specialty food stores and restaurants. The data could also be informative of the availability of fixed food outlets, particularly in less deprived areas.
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Abastecimento de Alimentos , Alimentos , Humanos , Estudos Transversais , México , Meio Ambiente , Restaurantes , Comércio , Características de ResidênciaRESUMO
BACKGROUND: The association between environmental temperature and alcohol consumption has not been widely explored despite the potential that increasing temperatures could promote the consumption of alcoholic beverages and the alcohol-related burden of disease. We aimed to explore the association between temperature and binge drinking in Mexican adults from urban cities, overall, and by alcoholic beverage type. METHODS: Data on 10,552 adults ≥ 18 years was obtained from the 2016 National Survey on Drug, Alcohol, and Tobacco Consumption. The mean annual temperature at the municipality was obtained from the Mexican National Weather Service using monthly temperatures from 2015 to 2016. We analyzed binge drinking for all alcoholic beverages in the last year and by type of alcohol as beer, liquor, wine, and coolers. Associations between mean temperature over the past year and binge drinking over the past year among current drinkers were estimated using multilevel Poisson models with robust standard errors adjusted for age, sex, education level, marital status, and household socioeconomic status, with a fixed effect by region. RESULTS: We observed a non-significant increase in the prevalence of binge drinking for every difference of 1 °C between municipalities of the same region. By alcohol type, a 1 °C increase in mean annual temperature across municipalities of the same region increased the prevalence of beer binge drinking in the past year by 0.9% (PR = 1.009, 95%CI 1.005, 1.013) among beer consumers and the prevalence of coolers' binge drinking by 3.0% (PR = 1.030, 95%CI 1.003, 1.057) in coolers consumers. We observed non-significant results for liquor binge drinking (PR = 1.047, 95%CI 0.994, 1.102) and wine binge drinking (PR = 1.047, 95% 0.944, 1.161). CONCLUSION: People living in municipalities with higher temperatures reported a higher beer binge drinking in Mexican cities. This could account for 196,000 cases of beer binge drinking in 2016. The context of each country needs to be considered when generalizing these findings, and they need to be further explored with longitudinal data as there might be implications for climate change. If our findings are confirmed given the forecasted rising temperatures, we could expect an increase in binge drinking and therefore, in the alcohol burden of disease.
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Benzamidas , Consumo Excessivo de Bebidas Alcoólicas , Fenilenodiaminas , Adulto , Humanos , Temperatura , Cidades , Estudos Transversais , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , EtanolRESUMO
OBJECTIVE: Estimate COVID-19 vaccine booster uptake and identify sociodemographic profiles associated with vaccine booster uptake in Mexican adults aged 60 and older. METHODS: Using data from the 2022 National Health and Nutrition Survey, we estimated COVID-19 booster uptake in Mexican adults 60 and older. We conducted a latent class analysis using sociodemographic characteristics and then estimated group-specific booster prevalence. RESULTS: Adults aged 60 and older with a completed vaccination schedule had 80.3% booster coverage. Two groups showed the lowest coverage: 1) unemployed and informal working men with elementary education with low socioeconomic status (73.8% boosted), and 2) female homekeepers with elementary education or less living in rural areas (77.0% boosted). CONCLUSIONS: Our analysis points to the need to reach out to men and women with elementary education or less who live in rural areas to strengthen booster campaigns in the future.