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

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          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.

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          Most cited references45

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          Dietary pattern analysis: a new direction in nutritional epidemiology.

          Frank Hu (2002)
          Recently, dietary pattern analysis has emerged as an alternative and complementary approach to examining the relationship between diet and the risk of chronic diseases. Instead of looking at individual nutrients or foods, pattern analysis examines the effects of overall diet. Conceptually, dietary patterns represent a broader picture of food and nutrient consumption, and may thus be more predictive of disease risk than individual foods or nutrients. Several studies have suggested that dietary patterns derived from factor or cluster analysis predict disease risk or mortality. In addition, there is growing interest in using dietary quality indices to evaluate whether adherence to a certain dietary pattern (e.g. Mediterranean pattern) or current dietary guidelines lowers the risk of disease. In this review, we describe the rationale for studying dietary patterns, and discuss quantitative methods for analysing dietary patterns and their reproducibility and validity, and the available evidence regarding the relationship between major dietary patterns and the risk of cardiovascular disease.
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            Adjustment for total energy intake in epidemiologic studies

            In epidemiologic studies, total energy intake is often related to disease risk because of associations between physical activity or body size and the probability of disease. In theory, differences in disease incidence may also be related to metabolic efficiency and therefore to total energy intake. Because intakes of most specific nutrients, particularly macronutrients, are correlated with total energy intake, they may be noncausally associated with disease as a result of confounding by total energy intake. In addition, extraneous variation in nutrient intake resulting from variation in total energy intake that is unrelated to disease risk may weaken associations. Furthermore, individuals or populations must alter their intake of specific nutrients primarily by altering the composition of their diets rather than by changing their total energy intake, unless physical activity or body weight are changed substantially. Thus, adjustment for total energy intake is usually appropriate in epidemiologic studies to control for confounding, reduce extraneous variation, and predict the effect of dietary interventions. Failure to account for total energy intake can obscure associations between nutrient intakes and disease risk or even reverse the direction of association. Several disease-risk models and formulations of these models are available to account for energy intake in epidemiologic analyses, including adjustment of nutrient intakes for total energy intake by regression analysis and addition of total energy to a model with the nutrient density (nutrient divided by energy).
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              Childhood stunting: a global perspective

              Abstract Childhood stunting is the best overall indicator of children's well‐being and an accurate reflection of social inequalities. Stunting is the most prevalent form of child malnutrition with an estimated 161 million children worldwide in 2013 falling below −2 SD from the length‐for‐age/height‐for‐age World Health Organization Child Growth Standards median. Many more millions suffer from some degree of growth faltering as the entire length‐for‐age/height‐for‐age z‐score distribution is shifted to the left indicating that all children, and not only those falling below a specific cutoff, are affected. Despite global consensus on how to define and measure it, stunting often goes unrecognized in communities where short stature is the norm as linear growth is not routinely assessed in primary health care settings and it is difficult to visually recognize it. Growth faltering often begins in utero and continues for at least the first 2 years of post‐natal life. Linear growth failure serves as a marker of multiple pathological disorders associated with increased morbidity and mortality, loss of physical growth potential, reduced neurodevelopmental and cognitive function and an elevated risk of chronic disease in adulthood. The severe irreversible physical and neurocognitive damage that accompanies stunted growth poses a major threat to human development. Increased awareness of stunting's magnitude and devastating consequences has resulted in its being identified as a major global health priority and the focus of international attention at the highest levels with global targets set for 2025 and beyond. The challenge is to prevent linear growth failure while keeping child overweight and obesity at bay.
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                Author and article information

                Journal
                Rev Saude Publica
                Rev Saude Publica
                rsp
                Revista de Saúde Pública
                Faculdade de Saúde Pública da Universidade de São Paulo
                0034-8910
                1518-8787
                06 August 2021
                2021
                : 55
                : 53
                Affiliations
                [I ] orgdiv1Nutrition and Health Research Center orgnameNational Institute of Public Health Cuernavaca México originalNutrition and Health Research Center. National Institute of Public Health. Cuernavaca, México
                [II ] orgdiv1Population Research Center orgnameNational Institute of Public Health Cuernavaca México originalPopulation Research Center. National Institute of Public Health. Cuernavaca, México
                Author notes
                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@ 123456insp.mx ;

                Authors’ Contributions: MEF coordinated statistical analysis. MEF, MRP, LMSZ, SRR, ACM, NM draft manuscript and approved the final version. MRP conceptualized the study, coordinated the group. LMSZ, MRP, NM performed and interpreted statistical analysis. SRR acquired data. MEF, EDG, LMSZ, SRR, MRP, NM critical reviewed final version.

                Conflict of Interests: The authors declare no conflict of interest.

                Author information
                https://orcid.org/0000-0001-5522-6849
                https://orcid.org/0000-0002-1398-8738
                https://orcid.org/0000-0003-2268-9622
                https://orcid.org/0000-0002-4871-3945
                https://orcid.org/0000-0002-5439-4389
                https://orcid.org/0000-0003-1576-5922
                https://orcid.org/0000-0001-9671-9682
                Article
                00245
                10.11606/s1518-8787.2021055002350
                8352562
                e7394d47-e793-4938-a090-198341cc7736

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 January 2020
                : 20 December 2020
                Page count
                Figures: 0, Tables: 5, Equations: 0, References: 36
                Categories
                Original Article

                child, preschool,diet, food, and nutrition,overweight,growth disorders,nutrition surveys

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