公共政策对墨西哥儿童高 BMI 趋势的影响：一项中断时间序列分析。

The effect of public policy on high BMI trends of Mexican children: an interrupted time series analysis.

机构信息

Escuela de Gobierno y Transformación Pública, Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico City, Mexico.

Escuela de Gobierno y Transformación Pública, Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico City, Mexico; Institute for Obesity Research, Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico City, Mexico.

出版信息

Lancet Glob Health. 2023 Mar;11 Suppl 1:S21. doi: 10.1016/S2214-109X(23)00104-3.

DOI:10.1016/S2214-109X(23)00104-3

PMID:36866479

Abstract

BACKGROUND

Mexico declared an obesity epidemic in 2000, and in response, became an early adopter of public policies in the form of natural experiments, which have not been evaluated for their effect on high BMI. We focus on children younger than 5 years due to the long-term outcomes of childhood obesity.

METHODS

We used the Global Burden of Disease data to evaluate time trends in high BMI, defined as being overweight or obese based on the International Obesity Task Force standards, between 1990 and 2019. Marginalisation and poverty estimates from Mexico's Government were used to identify differences in socioeconomic groups. The time variable reflects the introduction of policies between 2006 and 2011. Our hypothesis was that poverty and marginalisation modify the effects of public policies. We tested for the change in prevalence of high BMI over time using Wald-type tests, correcting for the effect of repeated measures. We stratified the sample by gender, marginalisation index, and households under the poverty line. Ethics approval was not required.

FINDINGS

Between 1990 and 2019, high BMI in children younger than 5 years increased from 23·5% (95% uncertainty interval 38·6-14·3) to 30·2% (46·0-20·4). After a period of sustained increase to 28·7% (44·8-18·6) in 2005, high BMI decreased to 27·3% (42·4-17·4; p<0·001) in 2011. Afterwards, high BMI increased constantly. We found an average gender gap of 12·2%, with a higher rate in males, in 2006, which remained constant. With respect to marginalisation and poverty, we observed a reduction in high BMI across all strata, except for the uppermost quintile of marginalisation in which high BMI remained flat.

INTERPRETATION

The epidemic affected groups across different socioeconomic levels, thus weakening economic explanations for the decrease in high BMI, while gender gaps point to behavioural explanations of consumption. The observed patterns warrant investigation through more granular data and structural models to isolate the effect of the policy from secular trends in the population, including other age groups.

FUNDING

Tecnológico de Monterrey Challenge-Based Research Funding Program.

摘要

背景

墨西哥于 2000 年宣布肥胖症流行，并因此成为公共政策的早期采用者，以自然实验的形式出现，这些政策尚未针对其对高 BMI 的影响进行评估。我们关注的是 5 岁以下的儿童，因为儿童肥胖的长期后果。

方法

我们使用全球疾病负担数据评估了 1990 年至 2019 年期间，根据国际肥胖工作组标准超重或肥胖定义的高 BMI（超重或肥胖）的时间趋势。使用墨西哥政府的边缘化和贫困估计数来确定社会经济群体之间的差异。时间变量反映了 2006 年至 2011 年期间政策的引入。我们的假设是，贫困和边缘化会改变公共政策的影响。我们使用 Wald 型检验测试了随着时间的推移高 BMI 患病率的变化，同时校正了重复测量的影响。我们按性别、边缘化指数和贫困线以下家庭对样本进行分层。不需要伦理批准。

结果

1990 年至 2019 年间，5 岁以下儿童的高 BMI 从 23.5%（95%置信区间 38.6-14.3）增加到 30.2%（46.0-20.4）。2005 年，高 BMI 持续增加至 28.7%（44.8-18.6）后，高 BMI 于 2011 年下降至 27.3%（42.4-17.4；p<0.001）。此后，高 BMI 持续增加。我们发现 2006 年男性的平均性别差距为 12.2%，男性的比例更高，这一差距一直保持不变。关于边缘化和贫困，我们观察到除了最高五分位数的边缘化水平保持不变外，所有阶层的高 BMI 都有所下降。