BRIEF REPORT

The Fattening Burden of Type 2 on Mexicans Projections from early growth to adulthood

ARTURO JIMENEZ´ -CRUZ, MD, PHD pathophysiological consequences of MONTSERRAT BACARDI-GASCON, MD catch-up growth, particularly among children from the low socioeconomic population groups undergoing transition from rural to urban areas, where they n , diabetes is the first cause of lifestyle are undoubtedly high risk factors have more access to energy-dense fatty adult nonobstetric hospital admissions that favor the development of and foods. I and hospital mortality and the third diabetes. These above-mentioned conditions cause of mortality nationwide (1). Its Second, pregestational obesity and that predispose Mexicans to type 2 diabe- overall prevalence increased from 8.8% in gestational diabetes, which are associated tes are compounded by an inadequate 1993 to 11.4% in 1999 (2). This was par- with high birth weight and are both risk preventive health care system. At the pre- ticularly marked, rising from 6.6 to factors for later obesity, type 2 diabetes, natal care at primary health care clinics in 14.4% among the southern states of Mex- , and the metabolic syn- Tijuana, tests of glucose tolerance are ico, which have the highest prevalence of drome (8), are also increasing in Mexico rarely conducted. Only 3% of the women undernutrition and the largest population (3,4,9) (Table 1). The fact that 1 in every at the Instituto Mexicano del Seguro So- of Mexican Indians (2). More drastic in- 5 newborns in Mexico are heavier than 4 cial (IMSS) and none of the women seen creases in type 2 diabetes are expected to kg and that 1 in every 10 newborns are at the uninsured clinics, Instituto de Ser- occur over the next decades for the fol- lighter than 2.5 kg (1) suggests that nei- vicios de Salud (ISESALUD), had a 50-g lowing reasons. ther pregestational obesity nor gestational glucose load test. In addition, only 45% of First, obesity, which is a high risk fac- diabetes are adequately controlled in this the women at IMSS and 23% of the tor for type 2 diabetes, is also increasing country, leaving these babies at higher women at ISESALUD had two fasting rapidly in Mexico. In fact, between 1993 risk of becoming obese and developing its blood glucose tests. and 2000 the prevalence of comorbidities later in life. The increasing Greater awareness of the diabetes ep- and obesity increased from 55 to 62% prevalence of obesity in Mexico, where idemic in Mexico will eventually raise the among adults (3,4) and between 1989 58% of women of reproductive age are critical question of how the cost of its and 1998 the prevalence increased from either overweight or obese (6), is there- treatment will be met in this country. The 77.8 to 79.9% among 35- to 64-year-old fore a cause of great concern for public public health care system in Mexico pro- men and women in the low-income Mex- health. vides services for insured and uninsured ico City urban population (5). In addi- The third reason as to why the prev- population, and those who are uninsured tion, in a recent nationwide nutrition alence of diabetes will surge in Mexico is might received care from the “oportu- survey a 27% prevalence of overweight based upon emerging evidence from lon- nidades” (OP) and the “seguro popular” and obesity was found among children gitudinal studies conducted in several (SP) programs. The OP program covers (6). Furthermore, this surge in childhood countries stating that malnutrition early 15–10% of the population, i.e., the ex- obesity has been associated with reduced in life, when followed by catch-up growth tremely poor, and provide some primary physical activity and consumption of during childhood, is a high risk factor for care services including drugs for diabetes foods and drinks that are high in energy the development of obesity, diabetes, and and hypertension. The SP was expected to density (6). It was found that at the na- cardiovascular diseases in adulthood cover 500,000 families by the end of tional level, only 3% of children reported (10–12). Indeed, the available evidence 2003, but by 2010 it will be expected to intense physical activity (6), while in the suggests that catch-up growth per se is a cover 45 million Mexicans (14). There- Mexico-U.S. border state of Baja Califor- state of hyperinsulinemia and that it is Ͼ fore, by the end of 2003, 43 million peo- nia, 90% of children and teenagers re- characterized by a disproportionate re- ple would have to pay for drugs and for ported consumption of a soft drink daily covery of fat rather than lean (muscle) tis- Ͼ most of their health care services. Fur- and 75% had a daily high fat– sue (13). This phenomenon of “catch-up thermore, monitoring supplies and sy- containing snack (7). These patterns of fat” (13) underscores the long-term ringes are not provided by the public ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● health care system. The cost of drugs at From the Medical School, Department of Nutrition, Universidad Autonoma de Baja California, Baja Cali- private pharmacies in the Mexico-U.S. fornia, Tijuana, Mexico. border city of Tijuana in 2003 was $60 Address correspondence and reprint requests to Dr. Arturo Jime´nez-Cruz, Medical School, Nutrition Av. U.S. a month for the treatment and con- Tecnologico 14418, Mesa de Otay, Baja California, Tijuana, Mexico 22390. E-mail: [email protected]. Received for publication 4 February 2004 and accepted in revised form 6 February 2004. trol of diabetes, $60 U.S. for the treatment Abbreviations: OP, oportunidades; SP, seguro popular. of high cholesterol, and $60 U.S. for the © 2004 by the American Diabetes Association. treatment of hypertension. In 2002 at

DIABETES CARE, VOLUME 27, NUMBER 5, MAY 2004 1213 Overweight, obesity, and type 2 diabetes in Mexicans

Table 1—Trends of diabetes, hypertension, overweight, and hyperlipidemia in Mexico

Age-group Prevalence Disorder Source (years) Cutoff (%) Diabetes Fasting blood glucose 1992–1993* 20–69 Ն7 mmol/l 8.5 Any blood glucose Ն11 mmol/l Fasting blood glucose 2000† 20–69 Ն7 mmol/l 10.7 Any blood glucose Ն11 mmol/l Glucose impairment Fasting blood glucose Ն6.1–7 mmol/l 12.7 Any blood glucose Ն7–11 mmol/l ⌬ Cholesterol 1987–1988‡ 20–98 Ն5.17–6.20 mmol/l 22.8 1987–1988‡ 20–98 Ն6.20 mmol/l 10.6 1992–1993* 20–69 Ն5.2–6.3 mmol/l 27 1992–1993* 20–69 Ն6.3 mmol/l 7 HDL cholesterol 1992–1993* 20–69 0.9 mmol/l 48 LDL cholesterol 1992–1993* 20–69 Ն4.2 mmol/l 10 Overweight 1992–1993* 20–69 25–30 kg/m2 35 2000† 20–69 25–30 kg/m2 38 Obesity 1992–1993* 20–69 Ն30 kg/m2 20 2000† 20–69 Ն30 kg/m2 24.4 Overweight and obesity 1992–1993* 20–69 Ն25 kg/m2 55 2000† 20–69 Ն25 kg/m2 62.4 Hypertension Systolic blood pressure 1992–1993* 20–69 Ն140 mm/Hg 31.0 Diastolic blood pressure Ն90 mm/Hg Systolic blood pressure 2000† 20–69 Ն140 mm/Hg 30.5 Diastolic blood pressure Ն90 mm/Hg *Ref. 4, National Survey of Chronic Diseases; †ref. 3, National Health Survey; ‡ref. 9, National Serum Epidemiologic Survey. least 65% of the family income in Mexico vent diabetes and obesity at different 4. Aguilar-Salinas CA, Olaiz G, Valles V, was approximately $250 U.S. a month levels. This would need to include a more Rios-Torres JM, Gomez-Perez FJ, Rull JA, (15). That income will hardly meet the adequate prenatal care for obese and ges- Rojas R, Franco A, Sepulveda J: High need for the treatment of diabetes and hy- tational diabetes, adequate monitoring prevalence of low HDL cholesterol con- pertension for one member of the family. of growth and nutrition during postna- centrations and mixed hyperlipidemia in In fact, at the National Health Survey, it tal period, and intervention programs to a Mexican nationwide survey. J Lipid Res was shown that Ͼ50% of adult popula- promote physical activity and healthy 42:1298–1307, 2001 tion have at least one chronic disease and eating at the preschool and grade- 5. Gonzalez-Villalpando C, Rivera-Martı´nez that Ͼ50% of them have no drug treat- school levels. D, Cisneros-Castolo M, Gonzalez-Villal- ment (3). The above data suggest that nei- pando ME, Simon J, Williams K, Haffner S, Stern M: Seven-year incidence and pro- ther the public health care system nor the gression of obesity: characterization of uninsured population can afford to con- References body fat pattern evolution in low-income 1. SSA: Salud Mexico 2002.Me´xico, Secre- trol the “diabesity” epidemic. This situa- urban population. Arch Med taria de Salud, 2003 tion might be similar in other developing Res 34:348–353, 2003 2. SSA: Programa de Accion para Diabetes. countries where there is no universal 6. Ribera J, Villalpando S, Shamah T: En- health care, including drug provision. Me´xico, Secretaria de Salud, 2001 3. Velazquez-Monroy O, Rosas Peralta M, cuesta Nacional de Nutricio´n 1999. Cuerna- In conclusion, the lack of control of vaca, Mexico, Instituto Nacional de Salud prenatal and postnatal risk factors, as well Lara Esqueda A, Pastelin-Herandez G, Grupo ENSA 2000, Castillo C, Attie F, Publica, 2001 as the high prevalence of obesity/diabetes Tapia-Conyer R: Prevalencia e interrela- 7. Jime´nez-Cruz A, Bacardı´ Gasco´n M, Jones risk behaviors predicts a marked increase cion de enfermedades cronicas no E: Fruit, vegetable, soft drink, and high- in the incidence of the diabesity epidemic transmisibles y factores de riesgo cardio- fat containing snack consumption among in Mexico. An urgent strategy at the na- vascular en Mexico. Arch Cardiol Mex 73: Mexican children. Arch Med Res 33:74– tional level is needed to effectively pre- 62–77, 2003 80, 2002

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8. Dietz WH: Periods of risk in childhood for Catch-up growth in childhood and death 13. Dulloo AG, Jacquet J, Montani JP: Path- the development of adult obesity: what do from coronary heart disease: longitudinal ways from weight fluctuations to meta- we need to learn? J Nutr 127:1884S– study. BMJ 318:427–431, 1999 bolic diseases: focus on maladaptive 1886S, 1997 11. Huxley RR, Shiell AW, Law CM: The role thermogenesis during catch-up fat. Int J 9. Posadas-Romero C, Tapia-Conyer R, Ler- of birth and postnatal catch-up growth in Obes Relat Metab Disord 26 (Suppl. 2): man-Garber I, Zamora-Gonzalez J, Car- determining systolic blood pressure: a S46–S57, 2002 doso-Saldana G, Salvatierra-Izaba B, systematic review of the literature. J Hy- 14. Botvinik J: Economia moral: seguro pop- Sepulveda J: Cholesterol levels and prev- pertens 18:815–831, 2000 ular y oportunidades. Mexico, DF, La Jor- alence of hypercholesterolemia in a Mex- 12. Ong KK, Ahmed ML, Emmett PM, Preece nada, 19 Sept 2003 ican adult population. Atherosclerosis 118: MA, Dunger DB: Association between 15. Instituto Nacional de Estadı´stica Geogra- 275–284, 1995 postnatal catch-up growth and obesity in fı´a e Informa´tica [article online], 2003. 10. Eriksson JG, Forsen T, Tuomilehto J, childhood: prospective cohort study. BMJ Available from http://www.inegi.gob.mx. Winter PD, Osmond C, Barker DJP: 320:967–971, 2000 Accessed 29 August 2003

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