Abstract Objective: to evaluate the impact of a group program of nutrition education implemented by community workers on food consumption, physical activity and cardiometabolic risk. Material and methods: a randomized trial by conglomerates was performed. The intervention group (n = 246) participated in a program of nine group sessions of nutrition education delivered by community workers and focused on giving healthy habits options and evocation of motivations. The control group (n = 183) received printed information on healthy eating and physical activity. At the beginning of the study and after one year of follow-up, anthropometric measurements of blood pressure, heart rate, lipid profile and glucose were assessed. A questionnaire was applied to collect sociodemographic data, food consumption and physical activity. Results: in multilevel regression models it was observed that the intervention group reported an increase in the frequency of consumption of fruits, vegetables and legumes, increased body mass index and its probability of increasing recreational physical activity was higher; in addition, it reduced its consumption of sweetened cereals, and decreased the probability of hyperglycemia compared to the control group. Resting heart rate increased in both groups, but the increase was lower in the intervention group. Conclusions: nutrition education guided by community workers can have positive effects on cardiometabolic risk, so it would be an alternative to traditional education focused on providing information.

Resumen Objetivo: evaluar el impacto de un programa grupal de orientación alimentaria implementado por trabajadores comunitarios sobre el consumo de alimentos, actividad física y riesgo cardiometabólico. Material y métodos: se realizó un ensayo aleatorizado por conglomerados. El grupo de intervención (n = 246) participó en un programa de nueve sesiones grupales de orientación alimentaria impartido por trabajadores comunitarios y centrado en dar opciones de hábitos saludables y en la evocación de motivaciones. El grupo control (n = 183) recibió información impresa sobre alimentación saludable y actividad física. Al inicio del estudio y después de un año de seguimiento se realizaron mediciones antropométricas, de presión arterial, frecuencia cardiaca, perfil de lípidos y glucosa; además se aplicó un cuestionario que recabó información sociodemográfica, consumo de alimentos y actividad física. Resultados: en modelos de regresión multinivel se observó que el grupo de intervención reportó aumento en la frecuencia de consumo de frutas, verduras y leguminosas, aumentó el índice de masa corporal y su probabilidad de incrementar la actividad física recreativa fue mayor; además, redujo su consumo de cereales altos en azúcar y grasa, y disminuyó la probabilidad de hiperglucemia comparado con el grupo control. La frecuencia cardiaca aumentó en ambos grupos, pero el aumento fue menor en el grupo de intervención. Conclusiones: la orientación alimentaria guiada por trabajadores comunitarios puede tener efectos positivos en el riesgo cardiometabólico, por lo cual sería una alternativa a la educación en salud enfocada a dar información.

Resumen El objetivo del estudio fue conocer la relación de las experiencias de homofobia con la adherencia al tratamiento anti-retroviral (TAR) en hombres que tienen sexo con hombres (HSH). Para ello, se realizó una encuesta transversal con una muestra por conveniencia de HSH que vivían con VIH (n=340) atendidos en dos instituciones públicas de salud de la Ciudad de México. La información sobre la adherencia al TAR en el mes previo de los participantes y sus experiencias de violencia, discriminación y homofobia internalizada se recopiló mediante un cuestionario. Entre 14% y 33% de los HSH reportaron alguna experiencia de discriminación y entre 41% y 60% experimentaron violencia. Cuando los HSH habían experimentado ambos tipos de estresores, el riesgo de baja adherencia TAR fue mayor (RP=6.49 para mes previo) que cuando habían experimentado sólo una de ellas (RP=4.36 para violencia y RP=5.67 para discriminación). Los profesionales de la salud deben ser sensibles a cómo el ambiente sociocultural puede afectar las prácticas de autocuidado de HSH, incluyendo la adherencia al TAR.

Abstract The aim of the study was to know the relationship of homophobic experiences with adherence to antiretroviral treatment (ART) in men who have sex with men (MSM) in Mexico City (CDMX). A cross-sectional study was conducted with a convenience sampling of MSM who lived with HIV, treated at two public health institutions at Mexico City (n=340). A questionnaire was applied to record information related to the adherence to ART of the participants and their experiences of violence and discrimination associated with homophobia and internalized homophobia. Between 14% and 33% of MSM reported experiences of discrimination and between 41% and 60% experienced violence. When participants had jointly experienced both types of stressors, the risk of low adherence to ART in the previous month was higher (RP=6.49) than when they had experienced only one of them (RP=4.36 for violence and RP=5.67 for discrimination). Health professionals must be sensitive to how the sociocultural environment can affect self-care among MSM including ART adherence.

Abstract The aim of the study was to know the relationship of homophobic experiences with adherence to antiretroviral treatment (ART) in men who have sex with men (MSM) in Mexico City (CDMX). A cross-sectional study was conducted with a convenience sampling of MSM who lived with HIV, treated at two public health institutions at Mexico City (n=340). A questionnaire was applied to record information related to the adherence to ART of the participants and their experiences of violence and discrimination associated with homophobia and internalized homophobia. Between 14% and 33% of MSM reported experiences of discrimination and between 41% and 60% experienced violence. When participants had jointly experienced both types of stressors, the risk of low adherence to ART in the previous month was higher (RP=6.49) than when they had experienced only one of them (RP=4.36 for violence and RP=5.67 for discrimination). Health professionals must be sensitive to how the sociocultural environment can affect self-care among MSM including ART adherence.

Resumen El objetivo del estudio fue conocer la relación de las experiencias de homofobia con la adherencia al tratamiento anti-retroviral (TAR) en hombres que tienen sexo con hombres (HSH). Para ello, se realizó una encuesta transversal con una muestra por conveniencia de HSH que vivían con VIH (n=340) atendidos en dos instituciones públicas de salud de la Ciudad de México. La información sobre la adherencia al TAR en el mes previo de los participantes y sus experiencias de violencia, discriminación y homofobia internalizada se recopiló mediante un cuestionario. Entre 14% y 33% de los HSH reportaron alguna experiencia de discriminación y entre 41% y 60% experimentaron violencia. Cuando los HSH habían experimentado ambos tipos de estresores, el riesgo de baja adherencia TAR fue mayor (RP=6.49 para mes previo) que cuando habían experimentado sólo una de ellas (RP=4.36 para violencia y RP=5.67 para discriminación). Los profesionales de la salud deben ser sensibles a cómo el ambiente sociocultural puede afectar las prácticas de autocuidado de HSH, incluyendo la adherencia al TAR.

Abstract: This article documents the differences in socioeconomic position, discrimination experiences and self-perception according to skin color among Mexican adults, considering that the last is a proxy of the phenotype symbolically associated with geographic ancestry (i. e., African, indigenous, or European). The analysis is based on the premise that in Mexican society prevailing an ideology that associates European characteristics with positive traits (i. e., “white privilege”), while African and indigenous characteristics are negatively valued (which results in racist practices). To achieve the objective the National Survey on Discrimination in Mexico was analyzed. The results indicate that, with exceptions, whites have more access to education, better jobs, and higher wages; with less frequency experience discrimination and like their skin. As the skin is darker the opposite trend is verified.

Resumen: Este artículo documenta las diferencias en posición socioeconómica, experiencias de discriminación y autopercepción de acuerdo al color de piel en adultos mexicanos, considerando que esta última es un reflejo del fenotipo simbólicamente vinculado al ancestro geográfico (i. e., indígena, africano o europeo). La premisa es que en la sociedad mexicana prevalece una asociación de lo europeo con rasgos positivos (i. e., “privilegio blanco”) y lo africano e indígena con aspectos negativos, lo cual deriva en prácticas racistas. Con ese fin se analizó la Encuesta Nacional sobre Discriminación en México. Los resultados indican que, con excepciones, los blancos acceden más a la educación, se ubican en mejores ocupaciones, tienen salarios mayores, con menos frecuencia han experimentado discriminación y les gusta más su piel. Conforme la piel es más oscura, la situación es opuesta.

Resumo Objetivo: Desenvolver e validar equações para estimar o percentual de gordura corporal (%GC) de crianças e adolescentes do México com medidas antropométricas. Métodos: Foi feito um estudo transversal com 601 crianças e adolescentes do México cinco e 19 anos. Os participantes foram divididos aleatoriamente nos seguintes dois grupos: a amostra de desenvolvimento (n = 398) e a amostra de validação (n = 203). A validade das equações publicadas anteriormente (por exemplo, Slaughter) também foi avaliada. O %GC foi estimado por absorciometria de dupla energia de raios X (raios X de dupla energia [DXA]). As medidas antropométricas incluíram estatura, altura sentado, peso, circunferências da cintura e do braço, dobras cutâneas (tríceps, bíceps, subescapular, suprailíaca e panturrilha) e larguras do cotovelo e bitrocantérica. Os modelos de regressão linear foram estimados com o %GC, a variável dependente e as medidas antropométricas como as variáveis independentes. Resultados: As equações foram criadas com base nas combinações de seis a nove variáveis antropométricas e apresentaram coeficientes de determinação (r2) iguais ou superiores a 92,4% para meninos e 85,8% para meninas. Na amostra de validação, as equações desenvolvidas apresentaram altos valores de r2 (≥ 85,6% em meninos e ≥ 78,1% em meninas) em todos os grupos, baixo nível de erros padrão (EP ≤ 3,05% em meninos e ≤ 3,52% em meninas) e os interceptos não foram diferentes da origem (p > 0,050). Com as equações publicadas anteriormente, os coeficientes de determinação foram menores e/ou os interceptos foram diferentes da origem. Conclusões: As equações desenvolvidas neste estudo podem ser usadas para avaliar o %GC das crianças em idade escolar e adolescentes mexicanos, pois têm uma maior validade e menor erro em comparação com as equações publicadas anteriormente.

Abstract Objective: To develop and validate equations to estimate the percentage of body fat of children and adolescents from Mexico using anthropometric measurements. Methods: A cross-sectional study was carried out with 601 children and adolescents from Mexico aged 5-19 years. The participants were randomly divided into the following two groups: the development sample (n = 398) and the validation sample (n = 203). The validity of previously published equations (e.g., Slaughter) was also assessed. The percentage of body fat was estimated by dual-energy X-ray absorptiometry. The anthropometric measurements included height, sitting height, weight, waist and arm circumferences, skinfolds (triceps, biceps, subscapular, supra-iliac, and calf), and elbow and bitrochanteric breadth. Linear regression models were estimated with the percentage of body fat as the dependent variable and the anthropometric measurements as the independent variables. Results: Equations were created based on combinations of six to nine anthropometric variables and had coefficients of determination (r2) equal to or higher than 92.4% for boys and 85.8% for girls. In the validation sample, the developed equations had high r2 values (≥85.6% in boys and ≥78.1% in girls) in all age groups, low standard errors (SE ≤ 3.05% in boys and ≤3.52% in girls), and the intercepts were not different from the origin (p > 0.050). Using the previously published equations, the coefficients of determination were lower, and/or the intercepts were different from the origin. Conclusions: The equations developed in this study can be used to assess the percentage of body fat of Mexican schoolchildren and adolescents, as they demonstrate greater validity and lower error compared with previously published equations.

Abstract The aims of this study are: 1) To analyze the relationship between food insecurity (FI) and adherence to antiretroviral therapy (ART) among people with HIV. 2) To evaluate the contribution of four possible mediators (lack of time due to work and family responsibilities, lack of resources to satisfy needs, psychological distress and side effects of ART) to differences in adherence according to the level of FI. A cross-sectional survey with a convenience sample (n = 557) of people with HIV attending two public institutions in Mexico City was conducted. Variables were assessed by a questionnaire. Logistic regression models were estimated. People with moderate FI were more likely to skip a dose (RM = 2.10) and reported low adherence during the last month (RM = 3.35). Poor adherence among people with FI was explained by the side effects of ART (14.9%), unsatisfied needs (12.5%), lack of time (4.8%) and psychological distress (2%). FI may curtail the benefits of universal access policies because it is associated with lower adherence to ART. An adjustment of health services to reduce the negative effects of FI on adherence to ART is required.

Resumen Los objetivos del artículo son: 1) Analizar la relación entre inseguridad alimentaria (IA) y adherencia al tratamiento antiretroviral (TAR) en personas con VIH/SIDA. 2) Evaluar la contribución de cuatro posibles mediadores (responsabilidades laborales y familiares, falta de recursos para cubrir necesidades, distrés psicológico y efectos secundarios del TAR) a dicha asociación. Estudio transversal con una muestra (n = 557) de personas con VIH atendidas en dos instituciones públicas de la ciudad de México. Las variables fueron indagadas mediante un cuestionario. Mediante modelos de regresión logística se evaluó si los mediadores explicaban la asociación entre IA y adherencia al TAR. Las personas con IA moderada tuvieron mayor probabilidad de omisión en el mes previo (OR = 2.10) y baja adherencia (OR = 3.35). La baja adherencia en las personas con IA fue explicada por los efectos secundarios (14.9%), las necesidades insatisfechas (12.5%), las responsabilidades (4.8%) y el distrés psicológico (2.0%). La IA puede limitar los beneficios de las políticas de acceso universal al TAR pues puede estar asociada con menor adherencia a ésta. Se requiere adecuar los servicios de salud para reducir el efecto de la IA.

Abstract The aims of this study are: 1) To analyze the relationship between food insecurity (FI) and adherence to antiretroviral therapy (ART) among people with HIV. 2) To evaluate the contribution of four possible mediators (lack of time due to work and family responsibilities, lack of resources to satisfy needs, psychological distress and side effects of ART) to differences in adherence according to the level of FI. A cross-sectional survey with a convenience sample (n = 557) of people with HIV attending two public institutions in Mexico City was conducted. Variables were assessed by a questionnaire. Logistic regression models were estimated. People with moderate FI were more likely to skip a dose (RM = 2.10) and reported low adherence during the last month (RM = 3.35). Poor adherence among people with FI was explained by the side effects of ART (14.9%), unsatisfied needs (12.5%), lack of time (4.8%) and psychological distress (2%). FI may curtail the benefits of universal access policies because it is associated with lower adherence to ART. An adjustment of health services to reduce the negative effects of FI on adherence to ART is required.

Resumen Los objetivos del artículo son: 1) Analizar la relación entre inseguridad alimentaria (IA) y adherencia al tratamiento antiretroviral (TAR) en personas con VIH/SIDA. 2) Evaluar la contribución de cuatro posibles mediadores (responsabilidades laborales y familiares, falta de recursos para cubrir necesidades, distrés psicológico y efectos secundarios del TAR) a dicha asociación. Estudio transversal con una muestra (n = 557) de personas con VIH atendidas en dos instituciones públicas de la ciudad de México. Las variables fueron indagadas mediante un cuestionario. Mediante modelos de regresión logística se evaluó si los mediadores explicaban la asociación entre IA y adherencia al TAR. Las personas con IA moderada tuvieron mayor probabilidad de omisión en el mes previo (OR = 2.10) y baja adherencia (OR = 3.35). La baja adherencia en las personas con IA fue explicada por los efectos secundarios (14.9%), las necesidades insatisfechas (12.5%), las responsabilidades (4.8%) y el distrés psicológico (2.0%). La IA puede limitar los beneficios de las políticas de acceso universal al TAR pues puede estar asociada con menor adherencia a ésta. Se requiere adecuar los servicios de salud para reducir el efecto de la IA.

Objetivo: evaluar la satisfacción de personas con VIH con la atención que reciben en los servicios de salud. Material y métodos: se evaluó la satisfacción del usuario y las características sociodemográficas de personas con VIH/SIDA atendidas en dos instituciones públicas de la ciudad de México (n = 557). Para conocer si existían diferencias se estimaron modelos de regresión logística. Resultados: los hombres homosexuales tuvieron mayor probabilidad de insatisfacción con la relación médico-paciente y con el funcionamiento del servicio. Las personas con seguridad social tuvieron mayor probabilidad de insatisfacción con el funcionamiento del servicio y con la atención de las diferentes áreas de la clínica. Los hombres, las personas solteras y quienes tenían mayor escolaridad presentaron mayor insatisfacción con los aspectos administrativos. Conclusiones: se identificaron aspectos de los servicios públicos que pueden ser mejorados, lo cual podría modificar la opinión que las personas con VIH tuvieron sobre ellos.

Objectives: To evaluate the satisfaction of people with HIV/AIDS with the care received from public health services. Material and methods: The user satisfaction and socio-demographic characteristics of people with HIV/AIDS who were treated at two public institutions in Mexico City (n = 557) were assessed. To know whether there were any differences, logistic regression models were estimated. Results: Homosexual males were more likely to be dissatisfied with physician-patient relationship and with services operation. People with social security had higher probability of dissatisfaction with service operation and with the attention received from different areas. Dissatisfaction with administrative aspects was more frequent among men, single people and those who had higher education higher. Conclusions: There were aspects of public services that can be improved, which could result in the improvement of the opinion that people with HIV had of them.

Objetivo: avaliar a satisfação de pessoas com o VIH, atendidos em serviços de saúde. Material e métodos: avaliou-se a satisfação do utente e as características sociodemográficas do pessoal com o VIH/SIDA atendidas em duas instituições públicas da cidade de México (n = 557). Para conhecer se existiam diferenças foram estimados modelos de regressão logística. Resultados: os homes homossexuais tiveram maior probabilidade de insatisfação na relação médico-paciente e com o funcionamento do serviço. As pessoas com previdência social tiveram maior probabilidade de insatisfação com o funcionamento do serviço e a atenção das diferentes áreas da clínica. Os homes, as pessoas solteiras e quem teve maior escolaridade apresentou maior insatisfação com os aspetos administrativos. Conclusões: identificaram-se aspectos dos serviços públicos que podem se melhorar, o qual poderia modificar a opinião das pessoas com VIH.

OBJECTIVE: To evaluate food advertisements on broadcast television channels in Mexico City. MATERIAL AND METHODS: Between July and October, 2007 programming by the 11 broadcast channels (N=11) in Mexico City was recorded during one weekday and one weekend day. The length of advertisements (N = 9178), types of products, and nutritional content of foods advertised were analyzed. RESULTS: The time devoted to food products advertising was greater during children's television than during programming targeted to the general audience (25.8 vs. 15.4%). The foods more frequently advertised were sweetened beverages, sweets and cereals with added sugar. Calorie, carbohydrate and fat contents were higher in foods advertised during children's shows. The two most common marketing strategies were to offer some kind of gift and to link the item to positive emotions. CONCLUSION: The findings of this research indicate the need for an effective system to regulate advertising directed towards children and adolescents.

OBJETIVOS: Evaluar la publicidad relacionada con alimentos transmitida en los canales gratuitos de televisión de la Ciudad de México. MATERIAL Y MÉTODOS: Se grabó la transmisión, un día entre semana y uno en fin de semana, de los 11 canales gratuitos de televisión de la Ciudad de México, entre julio y octubre de 2007. Se analizó la duración de los comerciales (N= 9178), los productos anunciados, el valor nutrimental de los alimentos anunciados, así como las estrategias publicitarias utilizadas. RESULTADOS: La publicidad de alimentos fue mayor durante los programas infantiles que durante la programación dirigida a la audiencia general (25.8 vs. 15.4%). Los alimentos anunciados con mayor frecuencia fueron bebidas con azúcar añadida y dulces, así como cereales con azúcar añadida. Los alimentos anunciados en programas infantiles tuvieron mayor contenido de calorías, grasa y carbohidratos. Las estrategias publicitarias más utilizadas fueron las promociones y asociar productos con emociones positivas. CONCLUSIÓN: Esta investigación ofrece evidencia sobre la necesidad de contar con un sistema de regulación efectiva de la publicidad dirigida a niños y adolescentes.

OBJECTIVE: To evaluate food advertisements on broadcast television channels in Mexico City. MATERIAL AND METHODS: Between July and October, 2007 programming by the 11 broadcast channels (N=11) in Mexico City was recorded during one weekday and one weekend day. The length of advertisements (N = 9178), types of products, and nutritional content of foods advertised were analyzed. RESULTS: The time devoted to food products advertising was greater during children's television than during programming targeted to the general audience (25.8 vs. 15.4%). The foods more frequently advertised were sweetened beverages, sweets and cereals with added sugar. Calorie, carbohydrate and fat contents were higher in foods advertised during children's shows. The two most common marketing strategies were to offer some kind of gift and to link the item to positive emotions. CONCLUSION: The findings of this research indicate the need for an effective system to regulate advertising directed towards children and adolescents.

OBJETIVOS: Evaluar la publicidad relacionada con alimentos transmitida en los canales gratuitos de televisión de la Ciudad de México. MATERIAL Y MÉTODOS: Se grabó la transmisión, un día entre semana y uno en fin de semana, de los 11 canales gratuitos de televisión de la Ciudad de México, entre julio y octubre de 2007. Se analizó la duración de los comerciales (N= 9178), los productos anunciados, el valor nutrimental de los alimentos anunciados, así como las estrategias publicitarias utilizadas. RESULTADOS: La publicidad de alimentos fue mayor durante los programas infantiles que durante la programación dirigida a la audiencia general (25.8 vs. 15.4%). Los alimentos anunciados con mayor frecuencia fueron bebidas con azúcar añadida y dulces, así como cereales con azúcar añadida. Los alimentos anunciados en programas infantiles tuvieron mayor contenido de calorías, grasa y carbohidratos. Las estrategias publicitarias más utilizadas fueron las promociones y asociar productos con emociones positivas. CONCLUSIÓN: Esta investigación ofrece evidencia sobre la necesidad de contar con un sistema de regulación efectiva de la publicidad dirigida a niños y adolescentes.

Background. In México, overweight and obesity have become a public health problem. Anthropometric measurements are generally used to diagnose these illnesses. However, in some situations or places there is no equipment available to measure these anthropometric indicators. The aim of the present study is to validate the body silhouette to assess the nutritional status of school-age children and adolescents. Methods. A cross-sectional study was carried out with 6- to 18-year-old subjects from México City (n =1862). Two types of body silhouettes (Stunkard and KEDS) were validated. Body mass index for age estimated by mean height and weight was used as standard. To assess the accuracy of the diagnosis with the body silhouette, ROC curve (receiver operating characteristic) method was used. The area under the curve (AUC) and optimal cut-off (OC) were estimated. Results. The most accurate assessment for diagnosing obesity was obtained by the interviewers who used the Stunkard silhouettes (AUC = 0.94). The fifth silhouette was the OC. Conclusions. When necessary equipment for measuring weight and height are unavailable, the Stunkard silhouettes can be used as a proxy indicator of the nutritional status of school-age children and adolescents.

Introducción. En México, el sobrepeso y la obesidad se han convertido en un problema de salud pública. Para diagnosticar estas enfermedades por lo regular se recurre a indicadores antropométricos. Sin embargo, en algunas situaciones o lugares no se dispone del equipo que se requiere para medir las dimensiones antropométricas. El objetivo de este estudio fue validar la utilización de siluetas corporales para evaluar el estado de nutrición en escolares y adolescentes mexicanos de zonas urbanas. Métodos. Se realizó un estudio transversal con sujetos de 6 a 18 años de edad de la Ciudad de México (n =1862). Fueron validadas 2 tipos de siluetas corporales (Stunkard y KEDS) tomando como estándar el índice de masa corporal para edad estimado a partir del peso y la talla medidos. Se utilizó la metodología de la curva ROC (receiver operating characteristic) para evaluar la exactitud de los diagnósticos derivados de las siluetas, estimándose el área bajo la curva (ABC) y el mejor punto de corte (MPC) para cada tipo de silueta. Resultados. La mayor exactitud para diagnosticar obesidad se obtuvo con la evaluación realizada por las entrevistadoras utilizando las siluetas de Stunkard (ABC =0.94), con las cuales se puede considerar que existe obesidad cuando las personas se ubican de la silueta V en adelante. Conclusiones. Cuando no se dispone de recursos para medir el peso y la estatura, es posible utilizar las siluetas de Stunkard para tener una aproximación al estado de nutrición de escolares y adolescentes.