Dietary patterns in Mexican preschool children are associated with stunting and overweight

Flores, Mario E.; Rivera-Pasquel, Marta; Macías, Nayeli; Sánchez-Zamorano, Luisa María; Rodríguez-Ramírez, Sonia; Contreras-Manzano, Alejandra; Denova-Gutiérrez, Edgar

doi:10.11606/s1518-8787.2021055002350

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055002350 copy

Dietary patterns in Mexican preschool children are associated with stunting and overweight

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To evaluate the association between dietary patterns, stunting, and overweight among Mexican preschoolers.

METHODS

This study was conducted with anthropometric (weight, height/length), sociodemographic (age, gender, education level of household head, socioeconomic status, country region and area, ethnicity, and beneficiary of social programs), and dietary data (Semiquantitative-food frequency questionnaire) on children aged from 1 to 4 years collected from the Mexican National Health and Nutrition Survey-2012. Dietary patterns were derived by principal components analysis. The association between dietary patterns, stunting, and overweight was assessed by prevalence ratios (PR), estimated by Poisson regression.

RESULTS

In total, 1,112 preschoolers (mean age 3.06 years, SD = 1.08 years; 48.8% females) were included in the study; 11.9% of whom presented stunting, and 6.7% overweight. We identified four dietary patterns: Fruits and Vegetables [F&V], Western [W], Traditional [T], and Milk and Liquids [M&L]. Considering the lowest tertile of each dietary pattern as reference, the prevalence of stunting was 2.04 times higher [95%CI: 1.17–3.56] among children in the highest tertile of the “F&V” pattern. The prevalence of stunting was lower among children in the highest tertile of the “W” pattern [PR = 0.48; 95%CI: 0.27–0.85]. Overweight was negatively associated with the “F&V” dietary pattern [PR = 0.37; 95%CI: 0.16–0.85 for its highest tertile], and children whose consumption was mostly equivalent to the “T” pattern showed higher prevalence of stunting [PR = 1.74; 95%CI: 1.01–3.00].

CONCLUSIONS

The prevalence of stunting and overweight in a nationwide sample of Mexican preschoolers was associated with dietary patterns.

Child, Preschool; Diet, Food, and Nutrition; Overweight; Growth Disorders; Nutrition Surveys

Food group	Example of foods
Fruits	Papaya, pineapple, strawberry, grapes, mango, peach, jicama, grapefruit, orange/tangerine, apple or pear, cantaloupe or watermelon, guava, banana, and dried fruits.
Vegetables	Carrot, cucumber, green beans, broccoli/cauliflower, nopal, squash, red tomato, dark green leaves (quelites, spinach, chard), green tomato, onion, chayote, zucchini, cabbage, lettuce, avocado, poblano pepper, corn, and canned vegetables (peas, carrots, mushrooms, and green beans).
Meat, poultry and fish	Beef, dried beef, pork, chicken, sausages, ham, tuna and sardine (tomato, water, or oil), fresh fish, dried fish (cod), seafood (shrimp).
Stew	Meat (chicken, beef) and vegetables prepared with other ingredients.
Corn tortilla	Corn tortilla.
Beans	Beans, lentils, chickpeas, yellow beans.
Eggs	Eggs.
Mexican Antojitos	Tacos, quesadilla, sopes, tostadas, tamal, pozole, atole.
Bread	White and whole wheat bread.
Cookies	Oreo, chocolate chips, and all kinds of sweet and salty cookies.
Milk	Whole milk.
Milk	Low-fat milk.
Dairy	Yogurt and fresh cheese, mature cheese, Danone and Yakult’s products.
Soups	Vegetable soup, noodle soup, chicken soup, cream vegetable, and instant soups.
Oils and fat	Oils, margarine, butter, lard, mayonnaise, cream.
Fast food	Sandwich, pizza, hamburger, hot dog, pie.
Snacks	Potato chips, Doritos, salted pumpkin seeds, peanuts.
Sweets	Candies, donuts, cake, jellies, marshmallow, lollipops.
Desserts	Flan, Jell-O gelatin, pudding, ice-cream.
Ready to-eat-cereals	Branded cereals.
Water	Plain water – no sugar added.
Sugar-sweetened beverages	Sodas, Kool-aid, and sugar-sweetened fruit juices, flavored water, and tea.
Sugar-free beverages	Coffee and tea without sugar, diet soft drinks.

Variable	Mean (SD)^a	n sample^b	%
*Age (y)*	3.06 (1.08)	1,112	---
Weight (kg)	14.1 (3.1)	1,112	---
Height (cm)	92.6 (9.5)	1,112	---
Age (y)
1−2		539	48.3
3−4		573	51.7
Gender
Female		587	48.8
Male		525	51.2
Nutritional status ^c
Adequate		864	80.6
Overweight		88	6.7
Stunting		149	11.9
Household head education level ^d
Higher education		245	25.5
High school		339	30.7
Up to elementary school		528	43.9
HWI ^e
High		378	39.4
Middle		363	32.9
Low		371	27.7
Region
North		212	19.2
Center and Mexico City		461	47.3
South		439	33.5
Area
Urban		671	70.3
Rural		441	29.7
Indigenous ethnicity
No		978	90.4
Yes		134	9.6
Beneficiary of social welfare programs ^f
No		604	32.3
Yes		325	50.6
No information		183	17.1

Food groups	Factor Loading^b

	Fruits and vegetables	Western	Traditional	Milk/Liquids
Fruits	0.3857	_	_	_
Vegetables	0.4241	_	_	_
Meat, poultry, fish	_	0.3232	_	_
Stew	_	_	_	_
Corn Tortilla	_	_	0.4541	_
Beans	_	_	0.5066	_
Eggs	_	_	0.2981	_
Mexican antojitos	_	0.2650	0.2003	_
Bread	_	_	_	_
Cookies	_	0.3115	_	_
Milk	_	_	_	0.2532
Dairy	0.2178	_	_	_
Soups	0.2273	_	_	0.2209
Oils and fat	_	0.2326	_	_
Fast Food	_	0.3248	_	_
Snacks	_	0.2455	_	_
Sweets	_	0.4178	_	_
Desserts	_	_	_	_
Ready-to-eat cereals	_	_	_	_
Water	_	_	_	_
Sugar-sweetened beverages	_	0.3919	_	_
Sugar-free beverages	_	_	_	0.2884

Dietary patterns	Fruits and vegetables		Western		Traditional		Milk/Liquids

Variables	T1	T3	T1	T3	T1	T3	T1	T3
Age (m)	35.5	36.3^a	33.1	39.5^a	35.2	37.9^a	36.9	36.9
Weight ( kg)	14.1	13.7	13.1	14.8^a	14.2	14.0	14.1	14.2
Height ( cm)	91.8	91.5^a	89.0	94.7^a	92.0	92.3	92.2	92.5
Age, years (%)
1 – 2	50.5	50.6	59.3	39.7^a	53.9	44.4	46.7	48.0
3 – 4	49.4	49.4	40.7	60.3^a	46.1	55.6	53.3	52.0
Gender %
Female	48.4	49.8	47.1	44.8	50.0	47.4^b	49.6	55.0^c
Male	51.6	50.1	52.9	55.2	50.0	52.6^b	50.3	45.0^c
Nutritional status ^e (%)
Adequate	82.9	76.9^a,b	76.1	83.7^a	84.5	75.5^a	79.3	78.5
Overweight	9.3	2.9^a,b,d	4.8	8.2^a	7.8	4.3	7.1	6.9
Stunting	7.5	18.8^a,b,d	17.9	8.1^a	6.9	19.5^a	13.6	12.7
Household head education level ^f (%)
Higher education	28.9	23.0^a	19.9	28.4^b	36.9	13.3^a,b,c	20.7	30.0
High school	32.9	22.3^a	27.7	31.1	29.1	31.6^a	31.1	31.0
Up to elementary school	38.1	54.5^a	52.4	40.5^b	34.0	55.1^a	48.2	39.0^d
HWI ^g (%)
High	44.5	31.6^a	30.0	37.6^a,b	54.1	19.2^a,b	34.0	40.1^b,c,d
Middle	32.6	34.6^a	38.0	36.2^a,b	32.4	35.1^a,c	32.7	38.0^d
Low	22.9	33.6^a	32.1	26.1^a	13.3	45.6^a,b,c	33.2	22.0
Region (%)
North	24.8	15.9^a	12.9	27.4^a,b	17.9	17.1^a,c	23.0	16.0^d
Center and Mexico City	47.4	44.6^a	49.4	40.1^a,d	58.0	37.0^a,d	41.9	52.0^b,d
South	27.7	39.4^a	37.6	24.1^b,c	24.1	45.9^a,c	35.1	32.0^c
Area (%)
Urban	73.4	63.9^a	64.1	70.7^a,b	82.1	56.5^a,b,c	68.3	70.0^c
Rural	26.5	36.0^a	35.9	29.3^a,b,c	17.9	43.5^a,b,c	31.6	30.0
Indigenous Ethnicity (%)
No	95.1	78.9^a,b,c	87.5	92.1	95.1	79.0^a,c	89.4	90.3^b
Yes	4.9	21.1^a,b,c	12.5	7.9	4.9	21.1^a,c	10.6	9.7^b
Beneficiary of social welfare programs ^h (%)
No	32.7	28.8	38.0	41.9^c	42.8	32.6^b,c	34.9	48.1^a
Yes	50.2	48.7	62.0	58.1^c	57.2	67.4^b,c	65.1	51.9^a

Dietary patterns^a	Unadjusted						Adjusted

	Stunting^b			Overweight^b			Stunting^b,c			Overweight^b,c

	PR	95%CI	p	PR	95%CI	p	PR	95%CI	p	PR	95%CI	p
Fruits and vegetables
Tertile 1	1.00			1.00			1.00			1.00
Tertile 2	1.14	0.64–2.03	0.655	0.94	0.51–1.73	0.844	1.15	0.66–2.04	0.618	1.06	0.56–2.03	0.855
Tertile 3	2.36	1.45–3.85	0.001	0.32	0.15–0.70	0.004	2.04	1.17–3.56	0.012	0.37	0.16–0.85	0.019
Western
Tertile 1	1.00			1.00			1.00			1.00
Tertile 2	0.60	0.37–0.98	0.043	1.57	0.84–2.95	0.161	0.68	0.43–1.05	0.080	1.56	0.82–2.97	0.178
Tertile 3	0.41	0.25–0.67	0.001	1.97	1.03–3.77	0.040	0.48	0.27–0.85	0.012	1.77	0.95–3.30	0.073
Traditional
Tertile 1	1.00			1.00			1.00			1.00
Tertile 2	1.46	0.79–2.70	0.232	0.98	0.53–1.83	0.954	1.29	0.70–2.38	0.421	1.01	0.54–1.87	0.985
Tertile 3	2.60	1.63–4.13	0.001	0.59	0.28–1.25	0.169	1.74	1.01–3.00	0.047	0.61	0.27–1.39	0.241
Milk/Liquids
Tertile 1	1.00			1.00			1.00			1.00
Tertile 2	0.85	0.56–1.28	0.434	0.84	0.44–1.60	0.597	0.89	0.59–1.35	0.588	0.78	0.40–1.50	0.455
Tertile 3	1.05	0.69–1.60	0.804	0.92	0.48–1.74	0.796	1.11	0.75–1.65	0.602	0.90	0.46–1.78	0.762

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Marta Rivera-Pasquel Instituto Nacional de Salud Pública Centro de Investigación en Nutrición y Salud Av. Universidad 655, Col. Santa María Ahuacatitlán 62100 Cuernavaca, Morelos, México E-mail: mrivera@insp.mx ;