Defining the traditional Mexican diet and evaluating its role in non-communicable disease outcomes

Abstract

Background: Promoting the traditional Mexican diet (TMexD) could potentially reduce the
current high rates of non-communicable diseases (NCDs) and support food sustainability in
Mexico. However, a concise definition of the TMexD and evidence of its association with
NCDs are needed before its promotion. Objective: The aim of this thesis was to: 1) define the
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association with obesity, diabetes, and cardiovascular diseases (CVDs). Methods: Sixty-one
records describing a whole TMexD were systematically reviewed. Then, the systematic review
results were used to reach consensus (via a three-round Delphi study with 17 food and nutrition
experts) on the food groups, specific foods, and food-related habits constituting a TMexD
index. Finally, the association between the developed TMexD index and NCD-related
outcomes was evaluated in 10,180 adults from the Mexican National Health and Nutrition
Survey 2018-19. Results: The TMexD represents mostly a plant-based diet, characterised by
grains, legumes, and vegetables. Other foods recommended include fruits, herbs and
condiments, grains, tubers, nuts and seeds, vegetable fats and oils, and plain water; the TMexD
also contains moderate amounts of meats, eggs, dairy, calorific beverages, and maize-based
dishes. The food-related habits mostly characterising the TMexD were consuming home-made
meals, socialising at meals, and buying foods locally. In fully adjusted models, high, compared
to low, TMexD adherence was associated (p<0.004) with lower insulin (-9.8%; 95%
confidence interval [CI]: -16.0, -3.3), 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 total cholesterol
(-3.5%; 95% CI: -5.2, -1.8) concentrations. No other associations were observed. Conclusions:
This thesis presents the first comprehensive index measuring adherence to the TMexD, and
found that adhering to the TMexD is associated with reduced risk of some NCD-related
outcomes in Mexican adults.

Date of Award	12 May 2022
Original language	English
Awarding Institution	University of Bristol
Supervisor	Angeliki Papadaki (Supervisor) & Miranda E G Armstrong (Supervisor)