Dalia Stern

Instituto Nacional de Salud Pública

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Martín Lajous

Instituto Nacional de Salud Pública

Ruy López‐Ridaura

Instituto Nacional de Salud Pública

Tonatiuh Barrientos‐Gutiérrez

Instituto Nacional de Salud Pública

Nancy López‐Olmedo

Instituto Nacional de Salud Pública

Carolina Pérez‐Ferrer

Instituto Nacional de Salud Pública

Adrián Cortés-Valencia

Instituto Nacional de Salud Pública

Barry M. Popkin

University of North Carolina at Chapel Hill

Francisco Canto‐Osorio

Instituto Nacional de Salud Pública

M. Arantxa Colchero

Instituto Nacional de Salud Pública

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Juan Á. Rivera

Centers for Disease Control and Prevention

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Instituto Nacional de Salud Pública

116

Harvard University

Drexel University

Universidad de Los Andes

University of North Carolina at Chapel Hill

Universidad Nacional Autónoma de México

National Institute of Public Health

Brigham and Women's Hospital

University of Chile

Medical Research Council

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Low-intensity daily smoking and mortality risk among Mexican women

Tobacco Control (2023)

Daniela S. Gutiérrez‐Torres Marion Brochier Dalia Stern Adrián Cortés-Valencia Juan Eugenio Hernández-Ávila

Objective To examine the association between low-intensity smoking (10 or less cigarettes per day) and all-cause and cause-specific mortality risk among women who smoke and by age at cessation among women who previously smoked. Methods In this study, 104 717 female participants of the Mexican Teachers’ Cohort Study were categorised according to self-reported smoking status at baseline (2006/2008) and were followed for mortality through 2019. We estimated HRs and 95% CIs for all-cause and cause-specific mortality using multivariable Cox proportional hazards regression models with age as the underlying time metric. Results Smoking as few as one to two cigarettes per day was associated with higher mortality risk for all causes (HR: 1.36; 95% CI 1.10 to 1.67) and all cancers (HR: 1.46; 95% CI 1.05 to 2.02), compared with never smoking. Similarly, slightly higher HRs were observed among participants smoking ≥3 cigarettes per day (all causes HR: 1.43; 95% CI 1.19 to 1.70; all cancers HR: 1.48; 95% CI 1.10 to 1.97; cardiovascular disease HR: 1.58; 95% CI 1.09 to 2.28). Conclusions In this large study of Mexican women, low-intensity smoking was associated with higher mortality risk for all causes and all cancers. Interventions are needed to promote cessation among women who smoke at low-intensity in Mexico, regardless of how few cigarettes they smoke per day.

10.1136/tc-2022-057839

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The Beverage Quality Index and Type 2 Diabetes Risk in Women: A Prospective Analysis of the Mexican Teachers’ Cohort

Research Square (Research Square) (2024)

Dalia Stern Maria G. Jacobo Cejudo Adriana Monge Neha Khandpur Trudy Voortman

Abstract BACKGROUND Individual beverages have shown divergent associations with type 2 diabetes. Whether overall beverage quality affects diabetes risk is unknown. Therefore, we estimated the association of a previously developed Beverage Quality Index (BQI) with incidence of diabetes in Mexican women.METHODS We included 77 484 female participants from the Mexican Teachers’ Cohort without diabetes at baseline (2006–2008). At baseline, diet was assessed using a 140-item food-frequency questionnaire. The BQI included 7 components (coffee, milk, juices, sugar-sweetened beverages [SSBs], alcohol, sugar added to beverages, and energy from beverages), with a total theoretical score ranging from 0 to 70. A higher score represents a healthier beverage intake pattern. Data on diabetes incidence were available through 2018 from self-reports or cross-linkage with administrative data. We used multivariable Cox proportional-hazard models adjusted for potential confounders.RESULTS Participants' mean (SD) baseline age was 45.9 (7.2) years, and BQI score was 37.3 (8.6), ranging from 9.8 to 69.3. During a median follow-up of 7.6 years, 4521 participants developed diabetes. After multivariable adjustment, when comparing extreme categories (≥55 vs. <25), a higher BQI was suggestively associated with lower diabetes incidence (HR: 0.87; 95% CI: 0.71, 1.06), but the estimation was imprecise. However, restricted cubic spline analysis showed no association between the BQI and diabetes incidence (p-nonlinearity = 0.20).CONCLUSIONS In a cohort of Mexican women, the BQI for overall beverage quality showed no consistent association with diabetes incidence. Further research on beverage quality indices for Mexican populations, including those with high SSBs intake, is warranted.

10.21203/rs.3.rs-4713212/v1

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Changes in waist circumference relative to body mass index in Chinese adults, 1993–2009

Carolina Digital Repository (University of North Carolina at Chapel Hill) (2014)

Dalia Stern L P Smith B Zhang P Gordon-Larsen Barry M. Popkin

Circumference

Body volume index

Waist-to-height ratio

10.17615/hxjg-6f56

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Improving nutrition science begins with asking better questions

American Journal of Epidemiology (2024)

Dalia Stern Daniel B. Ibsen Conor‐James MacDonald Yu‐Han Chiu Martín Lajous

A priority of nutrition science is to identify dietary determinants of health and disease to inform effective public health policies, guidelines, and clinical interventions. Yet, conflicting findings in synthesizing evidence from randomized trials and observational studies have contributed to confusion and uncertainty. Often, heterogeneity can be explained by the fact that seemingly similar bodies of evidence are asking very different questions. Improving the alignment within and between research domains begins with investigators clearly defining their diet and disease questions; however, nutritional exposures are complex and often require a greater degree of specificity. First, dietary data are compositional, meaning a change in a food may imply a compensatory change of other foods. Second, dietary data are multidimensional; that is, the primary components (ie, foods) comprise subcomponents (eg, nutrients), and subcomponents can be present in multiple primary components. Third, because diet is a lifelong exposure, the composition of a study population's background diet has implications for the interpretation of the exposure and the transportability of effect estimates. Collectively clarifying these key aspects of inherently complex dietary exposures when conducting research will facilitate appropriate evidence synthesis, improve certainty of evidence, and improve the ability of these efforts to inform policy and decision-making.

Scientific evidence

Confusion

Certainty

Evidence-Based Medicine

Empirical evidence

10.1093/aje/kwae110

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A systematic evaluation of seven different scores representing the EAT–Lancet reference diet and mortality, stroke, and greenhouse gas emissions in three cohorts

The Lancet Planetary Health (2024)

Anna Stubbendorff Dalia Stern Ulrika Ericson Emily Sonestedt Elinor Hallström

Stroke

10.1016/s2542-5196(24)00094-9

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Phthalates exposure estimation from personal care products usage in participants of The Mexican Teachers' Cohort.

ISEE Conference Abstracts (2024)

María José Rivero Treviño Astrid Schilmann Halbinger Dalia Stern Jesús Alejandro Estévez García

10.1289/isee.2024.1056

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Adoption of healthy and sustainable diets in Mexico does not imply higher expenditure on food

Nature Food (2021)

Carolina Batis Joaquín Alejandro Marrón-Ponce Dalia Stern Stefanie Vandevijvere Sı́món Barquera

Healthy food

10.1038/s43016-021-00359-w

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Changes in waist circumference relative to body mass index in Chinese adults, 1993–2009

International Journal of Obesity (2014)

Dalia Stern L P Smith Bing Zhang P Gordon-Larsen Barry M. Popkin

Circumference

Waist-to-height ratio

10.1038/ijo.2014.74

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The burden of suboptimal breastfeeding in Mexico: Maternal health outcomes and costs

Maternal and Child Nutrition (2018)

Mishel Unar‐Munguía Dalia Stern M. Arantxa Colchero Teresita González de Cosío

Abstract Longer duration of breastfeeding is associated with a lower risk of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension diseases in women. Mexico has one of the lowest breastfeeding rates worldwide; therefore, estimating the disease and economic burden of such rates is needed to influence public policy. We considered suboptimal breastfeeding when fewer than 95% of parous women breastfeed for less than 24 months per child, according to the World Health Organization recommendations. We quantified the lifetime excess cases of maternal health outcomes, premature death, disability‐adjusted life years, direct costs, and indirect costs attributable to suboptimal breastfeeding practices from Mexico in 2012. We used a static microsimulation model for a hypothetical cohort of 100,000 Mexican women to estimate the lifetime economic cost and disease burden of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension in mothers, due to suboptimal breastfeeding, compared with an optimal scenario of 95% of parous women breastfeeding for 24 months. We expressed cost in 2016 USD. We used a 3% discount rate and tested in sensitivity analysis 0% and 5% discount rates. We found that the 2012 suboptimal scenario was associated with 5,344 more cases of all analysed diseases, 1,681 additional premature deaths, 66,873 disability‐adjusted life years, and 561.94 million USD for direct and indirect costs over the lifetime of a cohort of 1,116 million Mexican women. Findings suggest that investments in strategies to enable more women to optimally breastfeed could result in important health and cost savings.

10.1111/mcn.12661

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Ciclos de trabajo-confinamiento para reducir la transmisión de Covid-19: evidencia y recomendaciones en el contexto de México

Salud Pública de México (2021)

Carolina Pérez‐Ferrer Nancy López‐Olmedo Sergio Bautista‐Arredondo M. Arantxa Colchero Dalia Stern

Este artículo propone intervenciones estructurales dirigidas a la reorganización del trabajo para evitar un repunte de casos de Covid-19, permitiendo la continuidad de la actividad económica. Se resume la evidencia disponible acerca de los ciclos de trabajo-confinamiento y la posible aplicación de ciclos de cuatro días de trabajo por tres de confinamiento (4x3) en el contexto mexicano. También se discuten otras intervenciones como la continuación del teletrabajo en algunos sectores y el escalonamiento de las jornadas de trabajo como medidas complementarias a los ciclos de trabajo-confinamiento. Esta discusión se da en el contexto de alta informalidad y escasos recursos para absorber una pérdida importante de la productividad por las empresas medianas y pequeñas en México. Se considera la necesidad de implementar apoyos para que personas y empresas puedan mitigar pérdidas en salarios y ganancias tanto del sector formal como informal.

10.21149/12105

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