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Tortillas and beans have high contents of phytic acid and other food components that inhibit iron absorption, so percentage iron adequacies are not useful predictors of iron intakes without accounting for bioavailability. Owing to the underreporting of intakes in MNS-2, it is likely that the changes in nutrient intakes and adequacy were underestimated.

It was found that the density of iron was also lower in MNS-2 than in MNS-1, which could be attributable either to differences in the iron content of some key foods in the food composition tables used in each of the surveys, or to the increased energy density of the diet, as suggested by the greater percentage of energy derived from fats in MNS Vitamin A and folate showed large increases in total intake, and higher densities of these nutrients were also found in MNS-2, despite the underreporting and the increased energy density of the diet.

This is difficult to interpret, as biochemical data for overt folate deficiency do not suggest that such a trend exists Shamah-Levy et al. Although large quantities of resources are being directed to programmes to prevent micronutrient deficiencies among the poorest populations e. The fortification of maize flour with iron and folate is mandatory in Mexico, but only about half the population consumes maize products made from flour. The other half derives maize products from a nixtamalized maize dough, which is currently not fortified because of technological and logistic difficulties.

One possible public health measure would be to encourage industry to fortify additional basic foods with micronutrients in order to reach the entire population. Prevalence of child stunting, which is a result of chronic undernutrition early in life, showed a substantial decrease 23 percent between the two surveys.

This change was not homogeneous, however, and prevalence was as high as 38 percent in the South region, Stunting therefore continues to be a main public health and nutrition challenge. Mexico has a higher prevalence of stunting than the average for Latin American countries Rivera et al. This problem coexists with another common form of malnutrition - overweight and obesity, which is present in high prevalence in not only developed regions but also in rural locations and the South.

Overall, This represents relative increases of Diabetes mellitus, which is commonly associated with overweight and obesity, has also doubled in recent years Barquera, Rivera Dommarco and Gasca-Garcia, Although the collection and interpretation of data on nutritional and health status may have become more standardized, there is a great need to adapt and improve methods of data collection on dietary habits. The important impact of underreporting on the interpretation of dietary intake data is of concern, and efforts should be made to develop innovative methods of quantifying food consumption, both inside and outside the home.

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This is of great concern because underreporting appears to be intimately linked with degree of overweight. Trends in the quality of food consumed outside the home may be of special concern, but these cannot be assessed with the data that are available at present; food consumption outside the home may be underestimated in the food intake surveys, and the types of foods consumed outside the home are not captured by food expenditure studies. Although food expenditure data may reflect consumption in urban areas fairly accurately, they are less reliable among rural populations, where domestic agricultural production contributes more to total intakes.

Surveys combining food intake data for both inside and outside the home, expenditure data and food production data would be useful for monitoring dietary trends and informing the design of dietary and food policy interventions. Although this analysis used cross-sectional surveys that lack the conditions necessary to establish causal relationships, the information obtained can be used to identify opportunities for action and research aimed at reducing and controlling nutrition-related diseases. Anaemia and other micronutrient deficiencies coexist with rising levels of obesity, type-2 diabetes, high blood pressure and dislipidaemias.

Clearly, nutritional recommendations must be developed to avoid collateral negative effects, but this is not a simple task. For example, there is a need for interventions that promote higher energy intakes, particularly among schoolchildren from marginal communities and among vulnerable groups.

This situation needs to be addressed through targeted interventions with educational messages promoting adequate calorie intakes that include the consumption of a variety of fruits and vegetables, and not only energy-dense foods as these can be a factor in the development of future nutrition-related chronic diseases. Funds for the prevention and control of obesity in children and adults should become a health expenditure priority in order to avoid the higher costs generated by cardiovascular risk factors associated with excess body fat and adiposity.

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In Mexico, the diet is changing rapidly and becoming more homogeneous across regions, locations and socio-economic groups. The same is happening with morbidity and mortality patterns. Increasing urbanization and modernization could reduce, for better or worse, the polarization currently observed in the country. The national food fortification policy i. Overweight, obesity and other diet-related non-communicable diseases are currently the main nutrition and public health problem. It is now necessary to adapt the health systems to face a relatively new type of disease, which can only be prevented and controlled by organized responses involving not only policy planners, but also communities, families and people interacting with the health and education sectors to regulate, promote and inform about diseases.

The coexistence of obesity and undernutrition has been documented in diverse Latin American countries Garret and Ruel, ; Popkin, Richards and Montiero, ; Sawaya et al. In Mexico, an estimated 6. This fact, together with the high prevalence of obesity in adults, suggests that programmes aimed at improving nutrition should always consider the high risk of obesity. Thus, nutrition programmes must address the double burden of disease, and focus on comprehensive integrated approaches - including the promotion of adequate nutrition through education and environmental changes - rather than trying to solve the problem though one-dimensional interventions such as the use of supplements or food coupons.

The health sector, which for a long time was concerned exclusively with infections and other acute health problems, must now pay attention to nutrition-related chronic diseases, which are a very different type of health problem. Thus, health professionals require training so that they can encourage appropriate behavioural change in the population WHO, Among the topics that should be addressed through integrated nutrition programmes are general education on health and nutrition in order to foster a culture where healthy eating practices are promoted, increasing the consumption of fruits and vegetables, and implementing regulatory measures focused on food and nutrition in public schools Kennedy, Nantel and Shetty, Studies need to be carried out in order to identify cost-effective policies aimed at preventing, reducing and controlling nutrition-related diseases, including behavioural change and environmental modifications.

Such interventions could use the experiences and data from previous studies mostly conducted in developed countries as a reference. However, given the unique characteristics of Mexico - in terms of heterogeneous socio-economic development, infrastructure and cultural background - it will be necessary to evaluate the feasibility and impact of these. Improved methods of data collection for evaluation and monitoring purposes should also be emphasized. Various institutions, universities and government bodies are implementing a wide range of research projects in Mexico to improve the understanding of and to prevent nutrition-related and other emerging diseases.

The results of these studies will contribute to ameliorating and controlling these health challenges Fernald, Gertler and Olaiz, ; Fernald et al. Fourth Report of the World Nutrition Situation. No date. The world nutrition situation.

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Nutrition life cycle. Barquera, S. The nutrition and epidemiologic transition in Mexico: analysis of three national surveys. Article 3: Coexistence of maternal central adiposity and child stunting in Mexico. Policies and programs of food and nutrition in Mexico. Salud Publica Mex. Bautista, S. Mexico City, Ministry of Social Development. Becerra, C. Prevalencia de anemia en gestantes.

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Hospital Regio. Salud Publica, 3 5 : Behrman, J.

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An evaluation of the impact of Progresa on pre-school child height. Bobadilla, J. The epidemiologic transition and health priorities. Jamison, ed.

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Disease control priorities in developing countries. New York, Oxford University Press. Campirano, F. Estimation of energy under-reporting in obese and non-obese Mexican women using different equations: Analysis of the Mexican Nutrition Survey. Cole, T. Establishing a standard definition for child overweight and obesity worldwide: international survey.

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BMJ, Diallo, M. Anemia and pregnancy. Epidemiologic, clinical and prognostic study at the university clinic of the Ignace Deen Hospital, Conakry Guinea. Report on the diagnosis and classification of diabetes mellitus. Diabetes Care, 26 suppl. Excecutive summary of the third report of the national cholesterol education program NCEP expert panel on detection, evaluation and treatment of high blood cholesterol in adults adult treatment panel III.

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JAMA, Fernald, L. Hernandez, ed. High prevalence of obesity among the poor in Mexico. JAMA, 21 : Flores, M. Frenk, J. Elements for a theory of transition in health. Frith-Terhune, A. Iron deficiency anemia: higher prevalence in Mexican American than in non-Hispanic white females in the third National Health and Nutrition Examination Survey, Garret, J. Stunted children-overweight mother pairs: an emerging policy concern?