No abstract

Mexico is going through an environmental and nutritional crisis related to unsustainable dietary behaviors. Sustainable diets could solve both problems together. This study protocol aims to develop a 3-stages, 15 weeks mHealth randomized controlled trial (RCT) of a sustainable-psycho-nutritional intervention program to promote Mexican population adherence to a sustainable diet and to evaluate its effects on health and environmental outcomes. In stage 1, the program will be designed using the sustainable diets, behavior change wheel, and COM-B models. A sustainable food guide, recipes, meal plans, and a mobile application will be developed. In stage 2, the intervention will be implemented for seven weeks, and a 7-weeks follow-up period in a young Mexican adults (18 to 35 years) sample, randomly divided (1:1 ratio) into a control group (n=50) and an experimental group (n=50), that will be divided in two arms at week 8. Outcomes will include health, nutrition, environment, behavior, and nutritional-sustainable knowledge. Additionally, socioeconomics and culture will be considered. Thirteen behavioral objectives will be included using successive approaches in online workshops twice a week. The population will be monitored using the mobile application consisting of behavioral change techniques. In stage 3, the effects of the intervention will be assessed using mixed-effect models on dietary intake and quality, nutritional status, physical activity, metabolic biomarkers (serum glucose and lipid profile), gut microbiota composition, and dietary water and carbon footprints of the evaluated population. Improvements in health outcomes and a decrease in dietary water and carbon footprints are expected.

Water scarcity and excess adiposity are two of the main problems worldwide and in Mexico, which is the most obese country in the world and suffers from water scarcity. Food production represents 90% of a person's water footprint (WF), and healthy diets can lead to less WF than do unhealthy diets related to obesity. We calculated the WF of the diet and caloric intake of adults in Mexico and analyzed its relationship with adiposity. Also, the risk of water expenditure due to adiposity and adherence to dietary recommendations regarding WF of international healthy diets were examined. A Food Consumption Frequency Questionnaire (FCFQ) was applied to 395 adults. Body mass index (BMI), associated with adiposity indicators, was used as a reference for grouping a sample into adiposity levels. The WF was calculated according to the WF Assessment Method, considering correction factors and accounting for water involved in cooking and food washing. Our results showed that the Mexican diet spends 6,056 liters per person per day (L p−1d−1) and is 55% higher than international healthy diets WF. Consumption of beef, milk, fruits, chicken, and fatty cereals represented 56% of total WF. Strong relations appeared between hypercaloric diets and high WF. Diets of people with excess adiposity generated statistically higher WF with extra expenses of 729 L p−1d−1 compared with the normal adiposity population. Following nutritional recommendations offers a protective factor in water care, whereas not adhering to these represents a risk up to 93 times greater of water expenditure regarding international healthy diets. Therefore, both for the general population and to regulate obesity, adequate diets can help mitigate the problem of water scarcity.

Nutritional tools for dietary assessment are crucial elements for nutritional and diet-related study methodologies. Environmental indexes such as water footprint (WF) are essential for assessing diets' environmental impact. Currently, no available software in Mexico and the world simultaneously allows the evaluation of diet and its environmental impact. This study aimed to design and develop a Mexican online nutritional ecologic software for dietary assessment, automatic diet quality calculation, and diet's environmental impact. The software was developed using the waterfall life cycle methodology. A multi-stage process was followed. The program includes diet evaluation through a 24-hour recall and a validated and adapted Food Consumption Frequency Questionnaire (FFQ). The software also integrates automatic calculation of diet quality through an adaptation of The Mexican Diet Quality Index (ICDMx): the Alternate Mexican Diet Quality Index (IACDMx). An automatic WF assessment for Mexico’s context was also included. The assessment accounts for multi and single-ingredient foods WF, cooking, food-washing water, and applying correction factors. We created Nutriecology®, a novel technology for assessing diet aspects and WF simultaneously, making data collection and analysis time efficient in transversal and longitudinal studies. Further environmental impact indices, clinic history, and socioeconomic elements will be added to the software in future actualizations.

In Zapotlán el Grande (ZEG) the production of berries has increased drastically, while traditional crops has decreased. The availability of these new foods may change eating habits (EH) of the population. The objective of this study was to assess the frequency and amount of berry consumption in the adult population of Ciudad Guzmán (ZEG, Jalisco, Mexico), and to identify if these have become part of their EH. A total of 384 adults, from 18 to 65 years old, residents of Ciudad Guzmán, were surveyed with an adapted version of a food consumption frequency questionnaire. 34% of participants reported never consuming blueberries, raspberries or blackberries, while 39% eat them occasionally. On average, none of the berries was consumed in the amount proposed by the Mexican System of Equivalent Foods (SMAE), and only accounted 18% of the ration suggested by the World Health Organization (WHO). It is concluded that although the amount of berries consumed is less than the recommended by the WHO or SMAE, a quarter of the population assessed has incorporated berries into their usual diet, which shows that their availability is generating a change in the EH of the population. Resumen En Zapotlán el Grande (ZEG) la producción de berries ha aumentado drásticamente, mientras que la de cultivos tradicionales ha disminuido. La disponibilidad de estos nuevos alimentos puede generar cambios en los hábitos alimentarios (HA) de la población. El objetivo del presente estudio fue evaluar la frecuencia y la cantidad de consumo de berries en población adulta de Ciudad Guzmán (ZEG, Jalisco, México), e identificar si estos han pasado a formar parte de sus HA. Participaron 384 adultos, de 18 a 65 años, residentes de Ciudad Guzmán, quienes fueron encuestados por medio de una versión adaptada de un cuestionario de frecuencia de consumo de alimentos. El 34% de los participantes refirió nunca consumir arándanos, frambuesas o zarzamoras, mientras que 39% los ingieren ocasionalmente. En promedio, ninguno de los berries fue consumido en la ración propuesta en el Sistema Mexicano de Alimentos Equivalentes (SMAE), y solo representó 18% de la ración sugerida por la Organización Mundial de la Salud (OMS). Se concluye que aunque en cantidad inferior a la recomendada por la OMS o el SMAE, una cuarta parte de la población evaluada ha incorporado los berries a su dieta habitual, lo que demuestra que su disponibilidad está generando una modificación en los HA de la población.