Objetivo. Actualizar las prevalencias de desnutrición infantil y de sobrepeso más obesidad en menores de cinco años de México, en el ámbito nacional y por grupos de edad y su distribución por variables sociodemográficas. Material y métodos. Se analizó la información de 1 684 menores de cinco años de la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). Se estimaron prevalencias con IC95%, ajustadas por el diseño del estudio, de bajo peso, baja talla, emaciación y sobrepeso más obesidad y su distribución por variables sociodemográficas: tipo de localidad y región de residencia. Resultados. Actualmente, 4.1% tienen bajo peso, 12.8% baja talla y 0.8% emaciación. El sobrepeso más obesidad es de 7.7%. En el Pacífico-Sur y la Península, la baja talla es de 20%. Conclusión. La baja talla es el principal problema de nutrición entre los preescolares, notablemente en los mayores de 24 meses y en los estados del sur. En 12 años se ha estancado la desnutrición crónica en México. La Ensanut 2022 contribuye con información actualizada que permite la focalización de las estrategias hacia las zonas y grupos más vulnerables en México.

Despite 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. The objective of this study was to inform a potential modification to the supplements distributed to pregnant and lactating women and children. Impact 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. There 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). The 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.

Objetivos. Actualizar la prevalencia de desnutrición y sus tendencias en los últimos 30 años e identificar factores asociados con la baja talla en una muestra representativa nacional de niños <5 años en México. Material y méto­dos. Se estimaron prevalencias de desnutrición en <5 años en 2018-19 y se compararon con prevalencias de los últimos 30 años. Se estudiaron asociaciones de factores geográficos, del hogar, maternos e individuales con baja talla, utilizando regresión logística múltiple. Resultados. El 4.8% de los <5 años presentó bajo peso, 14.2% baja talla y 1.4% emaciación. Entre 1988-2012 hubo un descenso en baja talla interrum­pido entre 2012-2018. La baja talla se asoció positivamente con residencia rural, región sur, hogares más pobres, madres indígenas y mayor número de hijos, y negativamente con diversidad dietética. Conclusiones. La desnutrición cró­nica es un problema persistente asociado con factores de vulnerabilidad social, cuya tendencia descendente de 30 años se interrumpió entre 2012-2018. Es imperativo implementar una estrategia nacional de prevención de baja talla.

Mexico's Prospera-Oportunidades-Progresa Conditional Cash Transfer Program (CCT-POP) included the distribution of fortified food supplements (FFS) for pregnant and lactating women and young children. Rigorous evaluations showed significant impacts on nutrition outcomes but also substantial gaps in addressing nutrition problems. To highlight the program design-related and implementation-related gaps and challenges that motivated further research and the eventual design and roll-out of a modified nutrition component for CCT-POP. We used a program impact pathway approach to highlight the extent and quality of implementation of CCT-POP, and its impact on nutrition outcomes. We drew on previously published and new primary data, organized into 3 sources: impact evaluations, studies to inform reformulation of the FFS, and a longitudinal follow-up study using qualitative and quantitative methods to document FFS use and the dietary intake of women and children. Despite positive impacts, a high prevalence of malnutrition persisted in the population. Coverage and use of health services improved, but quality of care was lacking. Consumption of FFS among lactating women was irregular. Micronutrient intake improved among children who consumed FFS, but the pattern of use limited frequency and quantity consumed. Substantial diversity in the prevalence of undernutrition was documented, as was an increased risk of overweight and obesity among women. Three key design and implementation challenges were identified. FFS, although well accepted for children, had limited potential to substantially modify the quality of children's diets because of the pattern of use in the home. The communications strategy was ineffective and ill-suited to its objective of motivating FFS use. Finally, the program with its common design across all regions of Mexico was not well adapted to the special needs of some subgroups, particularly indigenous populations. The studies reviewed in this paper motivated additional research and the eventual redesign of the nutrition component.

Childhood obesity continues to be a global health problem. Previous research suggests that linear growth retardation or stunting during early childhood increases the risk of obesity, but others have reported that rapid linear growth poses a greater concern than early nutritional status. The objective of this study was to determine if growth trajectories are associated with body composition at age 8–10 y. Study participants consisted of 255 girls and 281 boys who participated in a follow-up of the Prenatal Omega-3 Fatty Acid Supplementation and Child Growth and Development (POSGRAD) Study. Sex-specific latent height class (LHC) trajectories were derived from 11 measures of height from birth to 5 y of age and used to calculate 3 distinct growth classes for boys (low, intermediate, and high) and 2 distinct classes for girls (low and high). Body composition at age 8–10 y was estimated using bioelectrical impedance analysis. Multivariable linear regression analysis was used to determine the relationship between growth trajectory classes and fat mass (FM) and fat-free mass (FFM) in late childhood, controlling for confounding factors. In girls, there were no significant associations between LHC and FM or FFM. In boys, relative to the intermediate LHC, the low LHC had higher FM (β = 0.69 kg; 95% CI: 0.26−1.11 kg) and the high LHC had lower FM (β = −0.40 kg; 95% CI: −0.76 to −0.05 kg). Boys in the low LHC had significantly less FFM (β = −0.69 kg; 95% CI: −1.11 to −0.26 kg), and boys in the high LHC had more FFM (β = 0.40 kg; 95% CI: 0.05−0.76 kg) compared with the intermediate LHC. Gain in height among boys, but not girls, in early childhood was associated with lower adiposity in late childhood compared with children with a slower rate of growth. Clinical trial registration number: NCT00646360

Objetivo. Analizar las tendencias y distribución de la mala nutrición en menores de cinco años en México de 1988 a 2023 y discutir las posibles causas. Material y métodos. Se analizó información sobre estado de nutrición y características sociodemográficas de 5 987 menores de cinco años de la Encuesta Nacional de Salud y Nutrición 2020, 2021, 2022 y 2023; la información se comparó con resultados de las encuestas previas. Resultados. Las prevalencias en el periodo 2020-2023 fueron: bajo peso 3.9%, baja talla 13.9%, emaciación 1.2% y sobrepeso 7.7%. Los mayores porcentajes de baja talla se observan en hogares indígenas vs. no indígenas (27.4%) (p>0.10), con inseguridad alimentaria severa vs. seguridad alimentaria (20.7%) (p=0.079), en los quintiles de condiciones de bienestar bajo vs. alto (20.8%) y localidades rurales vs. urbanas (16.9%) (p>0.10). Sólo 37.4% de los hogares con menores de cinco años fueron beneficiarios de uno o más programas sociales. Conclusiones. La desnutrición se estancó a partir de 2012 y el sobrepeso ha aumentado. Los factores que posiblemente explican lo anterior es la situación de pobreza, el aumento de la complejidad de Prospera y la reducción en el financiamiento por beneficiario entre 2012-2018 y, a partir de 2018, la falta de programas focalizados y de transferencias específicas, y el aumento en la carencia de servicios básicos de salud, entre otros.