Promoting traditional diets could potentially reduce the current high rates of non-communicable diseases (NCDs) globally. While the traditional Mexican diet (TMexD) could be specifically promoted in Mexico, a concise definition of the TMexD and evidence of its association with NCDs are needed before its promotion. To evaluate what constitutes this diet pattern, we aimed to systematically review, for the first time, how the TMexD has been described in the literature to date. A secondary aim was to examine whether the TMexD, as described by available definitions, is associated with NCD outcomes. We searched for records describing a whole TMexD up to July 2019 in 12 electronic databases, reference lists, a relevant journal, and by contacting experts on the topic. We reported the results using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included 61 records for the definition of the diet and six for the association with NCD outcomes. The food groups characterising the TMexD that were consistently mentioned in all the study subgroups were grains and tubers, legumes, and vegetables; specific foods included maize, beans, chile, squash, tomato, and onion. Other groups also mentioned, although with lesser frequency, were maize products, fruits, beverages, fish and seafood, meats, sweets and sweeteners, and herbs and condiments. Only a few studies reported on the frequency of consumption or the amounts in which these foods were consumed in the TMexD. It was not possible to reach strong conclusions for the association between adherence to the TMexD and NCD outcomes. The TMexD was weakly associated with developing breast cancer, not associated with triglyceride levels, and inconsistently associated with obesity and diabetes outcomes. However, results were limited by the small number of studies (n = 6), of which most were of observational nature and evaluated diets using different TMexD definitions. These findings provide systematically identified evidence of the characteristics of the TMexD. More studies are needed to ascertain the exact quantities by which foods were consumed in the TMexD in order to establish whether this dietary pattern is associated with health and should be promoted within the Mexican population.

Objective: Promoting a traditional Mexican diet (TMexD) could potentially reduce high rates of non-communicable diseases (NCDs) and support food sustainability in Mexico. This study aimed to develop an index to assess adherence to the TMexD. Design: A three-round Delphi study was conducted to examine the food groups, specific foods, and food-related habits that would constitute a TMexD index. Participants selected the TMexD items using Likert scales, lists of responses, and yes/no questions. Consensus was determined using percentages of agreement, mean values and/or coefficients of variation. Setting: Online Delphi study. Participants: Seventeen nutrition and food experts in Mexico completed all three rounds. Results: The resulting index (ranging from 0 to 21 points) consisted of 15 food groups, containing 102 individual foods. Food groups included in higher quantities were maize, other grains, legumes, vegetables, fruits, herbs, nuts and seeds, and tubers. Animal foods, vegetable fats and oils, home-made beverages, maize-based dishes, and plain water were also included, but in lower quantities. The food-related habits included were consuming home-made meals, socialising at meals, and buying food in local markets. Consensus was reached for all index items apart from quantities of consumption of six food groups (herbs, nuts, grains, tubers, dairy, and eggs). Conclusions: Although future research could improve the measures for which consensus was not reached, the TMexD index proposed in this study potentially displays a healthy and sustainable dietary pattern and could be used to examine links between the TMexD and health outcomes in Mexican populations.

This study evaluated the association between adherence to a traditional Mexican diet (TMexD) and obesity, diabetes, and cardiovascular (CVD)-related outcomes in secondary data analysis of the cross-sectional Mexican National Health and Nutrition Survey 2018-19. Data from 10,180 Mexican adults were included, collected via visits to randomly selected households by trained personnel. Adherence to the TMexD (characterised by mostly plant-based foods like maize, legumes, vegetables) was measured through an adapted version of a recently developed TMexD index, using food frequency questionnaire data. Outcomes included obesity (anthropometric measurements), diabetes (biomarkers and diagnosis), and CVD (lipid biomarkers, blood pressure, hypertension diagnosis, and CVD-event diagnosis) variables. Percentage differences and odds ratios for presenting non-communicable disease (NCD)-related outcomes (with 95% confidence intervals [CI]) were measured using multiple linear and logistic regression, respectively, adjusted for relevant covariates. Sensitivity analyses were conducted according to sex, excluding people with an NCD diagnosis, and using multiple imputation. In fully adjusted models, high, compared to low, TMexD adherence was associated with lower insulin (-9.8%; 95% CI: -16.0, -3.3), LDL-cholesterol (-4.3%; 95% CI -6.9, -1.5), non-HDL cholesterol (-3.9%; 95% CI: -6.1, -1.7), and total cholesterol (-3.5%; 95% CI: -5.2, -1.8) concentrations. Men and those with no NCD diagnosis had overall stronger associations. Effect sizes were smaller, and associations weakened in multiple imputation models. No other associations were observed. While results may have been limited due to the adaptation of a previously developed index, the results highlight the potential association between the TMexD and lower insulin and cholesterol concentrations in Mexican adults.

Background There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers’ views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies. Methods We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding. Results We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded ‘healthy’ behaviours rather than only penalising ‘unhealthy’ behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone’s needs and use of appropriate channels and messages in policy communication. Conclusions Our findings highlight that members’ of the public and policymakers’ support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.

Objectives To evaluate the association between adherence to the traditional Mexican diet (TMexD) and cardiovascular disease (CVD), obesity, and diabetes-related outcomes. Methods Secondary data analysis of the 2018–19 Mexican National Health and Nutrition Survey, including cross-sectional data from 10,180 adults collected by trained personnel via visits to randomly selected households. Adherence to the TMexD was measured using a validated food frequency questionnaire and an adapted TMexD index, developed by systematically reviewing the literature and consulting expert opinion. Outcomes included CVD biomarkers and diagnosis, hypertension values and diagnosis, anthropometric measurements, and diabetes biomarkers and diagnosis. The percentage differences and odds ratios for presenting non-communicable disease (NCD)-related outcomes (with 95% confidence intervals [CI]), were calculated using multiple linear and logistic regression, adjusting for relevant variables. Sensitivity analyses were conducted using multiple imputation, according to sex, and excluding people with an NCD diagnosis. Results High, compared to low, TMexD adherence was associated with lower total cholesterol (−3.5%; 95% CI: −5.2, −1.8), low-density lipoprotein-cholesterol (−4.3%; 95% CI −6.9, −1.5), non-high-density lipoprotein-cholesterol (−3.9%; 95% CI: −6.1, −1.7), and insulin (−9.8%; 95% CI: −16.0, −3.3) concentrations (p < 0.004) in fully adjusted models. Weaker associations were observed in multiple imputation models, whereas men and adults with no NCD diagnosis had stronger associations. No other associations were observed. Conclusions TMexD adherence was associated with a favorable profile for some NCD-related outcomes, highlighting the potential of the TMexD in reducing the risk of some NCD-related outcomes in Mexican adults. Funding Sources This research was funded by Consejo Nacional de Ciencia y Tecnología (CONACYT). CONACYT had no role in the design, analysis or writing of this abstract.