Skip to main content Accessibility help

The association of overall diet quality with BMI and waist circumference by education level in Mexican men and women

  • Nancy López-Olmedo (a1), Barry M Popkin (a1), Michelle A Mendez (a2) and Lindsey Smith Taillie (a1)



The present study evaluated the association of two measures of diet quality with BMI and waist circumference (WC), overall and by education level, among Mexican men and women.


We constructed two a priori indices of diet quality, the Mexican Diet Quality Index (MxDQI) and the Mexican Alternate Healthy Eating Index (MxAHEI), which we examined relative to BMI and WC. We computed sex-specific multivariable linear regression models for the total sample and by education level.




Mexican men (n 954) and women (n 1356) participating in the Mexican National Health and Nutrition Survey 2012.


Total dietary scores were not associated with BMI in men and women, but total MxDQI was inversely associated with WC in men (−0·10, 95 % CI −0·20, −0·004 cm). We also found that some results differed by education level in men. For men with the lowest education level, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean reduction in BMI of 0·11 (95 % CI −0·18, 0·04) and 0·18 (95 % CI −0·25, −0·10) kg/m2, respectively. Likewise, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean change in WC of −0·30 (95 % CI −0·49, −0·11) and −0·53 (95 % CI −0·75, −0·30) cm, respectively, in men with the lowest level of education. In women, the association of diet quality scores with BMI and WC was not different by education level.


Our findings suggest that a higher diet quality in men with low but not high education is associated with lower BMI and WC.


Corresponding author

*Corresponding author: Email


Hide All
1.Kroker-Lobos, MF, Pedroza-Tobias, A, Pedraza, LS et al. (2014) The double burden of undernutrition and excess body weight in Mexico. Am J Clin Nutr 100, issue 6, 1652S1658S.
2.Gómez-Dantés, H, Fullman, N, Lamadrid-Figueroa, H et al. (2016) Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 388, 23862402.
3.Hernández-Ávila, M, Rivera-Domarco, J, Shamah, T et al. (2016) Encuesta Nacional de Salud y Nutrición de Medio Camino 2016. Informe Final de Resultados (National Health and Nutrition Survey 2016. Final Results). Cuernavaca, Mexico: National Institute of Public Health.
4.Lim, SS, Vos, T, Flaxman, AD et al. (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 22242260.
5.Stern, D, Smith, LP, Zhang, B et al. (2014) Changes in waist circumference relative to body mass index in Chinese adults, 1993-2009. Int J Obes (Lond) 38, 15031510.
6.Aburto, TC, Pedraza, LS, Sanchez-Pimienta, TG et al. (2016) Discretionary foods have a high contribution and fruit, vegetables, and legumes have a low contribution to the total energy intake of the Mexican population. J Nutr 146, issue 9, 1881s1887s.
7.Arvaniti, F & Panagiotakos, DB (2008) Healthy indexes in public health practice and research: a review. Crit Rev Food Sci Nutr 48, 317327.
8.Schwingshackl, L & Hoffmann, G (2015) Diet quality as assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension score, and health outcomes: a systematic review and meta-analysis of cohort studies. J Acad Nutr Diet 115, 780800.e5.
9.Kourlaba, G & Panagiotakos, DB (2009) Dietary quality indices and human health: a review. Maturitas 62, 18.
10.George, SM, Ballard-Barbash, R, Manson, JE et al. (2014) Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women’s Health Initiative Observational Study: evidence to inform national dietary guidance. Am J Epidemiol 180, 616625.
11.Harmon, BE, Boushey, CJ, Shvetsov, YB et al. (2015) Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project. Am J Clin Nutr 101, 587597.
12.Sundararajan, K, Campbell, MK, Choi, YH et al. (2014) The relationship between diet quality and adult obesity: evidence from Canada. J Am Coll Nutr 33, 117.
13.Pate, RR, Ross, SET, Liese, AD et al. (2015) Associations among physical activity, diet quality, and weight status in US adults. Med Sci Sports Exerc 47, 743750.
14.Asghari, G, Mirmiran, P, Yuzbashian, E et al. (2017) A systematic review of diet quality indices in relation to obesity. Br J Nutr 117, 10551065.
15.Gregory, CO, McCullough, ML, Ramirez-Zea, M et al. (2009) Diet scores and cardio-metabolic risk factors among Guatemalan young adults. Br J Nutr 101, 18051811.
16.López-Olmedo, N, Carriquiry, AL, Rodríguez-Ramírez, S et al. (2016) Usual intake of added sugars and saturated fats is high while dietary fiber is low in the Mexican population. J Nutr 146, issue 9, 1856S1865S.
17.Pedroza-Tobías, A & Rivera-Dommarco, JA (2013) Prevalencia de obesidad en adultos Mexicanos, ENSANUT 2012 (Prevalence of obesity in Mexican adults, ENSANUT 2012). Salud Publica Mex 55, Suppl. 2, S151S160.
18.Arganini, C, Saba, A, Comitato, R et al. (2012) Gender differences in food choice and dietary intake in modern western societies. In Public Health – Social and Behavioral Health, pp. 83102 [Maddock, J, editor]. Rijeka, Croatia: InTech.
19.Vogel, C, Lewis, D, Ntani, G et al. (2017) The relationship between dietary quality and the local food environment differs according to level of educational attainment: a cross-sectional study. PLoS One 12, e0183700.
20.Lovejoy, JC & Sainsbury, A (2009) Sex differences in obesity and the regulation of energy homeostasis. Obes Rev 10, 154167.
21.Palmer, BF & Clegg, DJ (2015) The sexual dimorphism of obesity. Mol Cell Endocrinol 402, 113119.
22.Whitaker, KM, Choh, AC, Lee, M et al. (2016) Sex differences in the rate of abdominal adipose accrual during adulthood: the Fels Longitudinal Study. Int J Obes (Lond) 40, 12781285.
23.Chiuve, SE, Fung, TT, Rimm, EB et al. (2012) Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 142, 10091018.
24.Gutiérrez, JP, Rivera-Domarco, J, Shamah-Levy, T et al. (2012) Encuesta Nacional de Salud y Nutrición 2012. Resultados Nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública.
25.Conway, JM, Ingwersen, LA, Vinyard, BT et al. (2003) Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women. Am J Clin Nutr 77, 11711178.
26.Blanton, CA, Moshfegh, AJ, Baer, DJ et al. (2006) The USDA Automated Multiple-Pass Method accurately estimates group total energy and nutrient intake. J Nutr 136, 25942599.
27.Agricultural Research Service, Food Surveys Research Group (2010) USDA Food and Nutrient Database for Dietary Studies, 4.1. (accessed January 2017).
28.Ledesma Solano, J, Chávez Villasana, A, Pérez-Gil Romo, F et al. (2010) Composición de Alimentos ‘Miriam Muñoz de Chávez’. Valor Nutritivo de los Alimentos de Mayor Consumo (Food Composition ‘Miriam Muñoz de Chávez’. Nutrition Value of the Most Consumed Foods), 2a ed. México, DF: McGraw-Hill.
29.US Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory (2013) National Nutrient Database for Standard Reference, Release 24. (accessed January 2017).
30.Villalpando, S, Ramírez-Silva, I, Bernal Medina, D et al. (2007) Tablas de Composición de Ácidos Grasos de Alimentos Frecuentes en la Dieta Mexicana (Tables of Fatty Acids Composition of Common Foods in the Mexican Diet). Cuernavaca, Mexico: National Institute of Public Health.
31.World Health Organization (2008) Waist Circumference and Waist–Hip Ratio. Geneva: WHO.
32.Lohman, T, Roche, A & Martorell, R (1988) Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics.
33.Habicht, JP (1974) Standardization of quantitative epidemiological methods in the field. Bol Oficina Sanit Panam 76, 375384.
34.World Health Organization (2000) Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series no. 894. Geneva: WHO.
35.Alberti, K, Eckel, RH, Grundy, SM et al. (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity. Circulation 120, 16401645.
36.Bonvecchio-Arenas, A, Fernández-Gaxiola, AC, Plazas-Belusteguigoitia, M et al. (2015) Guías Alimentarias y de Actividad Física en Contexto de Sobrepeso y Obesidad en la Población Mexicana (Dietary and Physical Activity Guidelines in the Context of Overweight and Obesity in the Mexican Population). México, DF: Academia Nacional de Medicina.
37.Bourges, H, Casanueva, E & Rosado, J (2008) Recomendaciones de Ingestion de Nutrimentos para la Poblacion Mexicana: Bases Fiosiológicas. Tomo 2 (Recommendations of Nutrient Intake for the Mexican Population: Physiological Basis. Vol. 2). México, DF: Editorial Medica Panamericana.
38.World Health Organization (2015) Guideline: Sugars Intake for Adults and Children. Geneva: WHO.
39.World Health Organization & Food and Agriculture Organization of the United Nations (2003) Diet, Nutrition and Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series no. 916. Geneva: WHO.
40.Micha, R, Shulkin, ML, Peñalvo, JL et al. (2017) Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE). PLoS One 12, e0175149.
41.Sánchez-Pimienta, TG, Batis, C, Lutter, CK et al. (2016) Sugar-sweetened beverages are the main sources of added sugar intake in the Mexican population. J Nutrition 146, issue 9, 1888S1896S.
42.Vallejo, M, Colin-Ramirez, E, Rivera Mancia, S et al. (2017) Assessment of sodium and potassium intake by 24 h urinary excretion in a healthy Mexican cohort. Arch Med Res 48, 195202.
43.Pérez-Lizaur, AB (2014) Sistema Mexicano de alimentos equivalentes. In Dietas Normales y Terapéuticas: Los Alimentos en la Salud y la Enfermedad, 6a ed. México, DF: McGraw-Hill.
44.Martínez, R & Fernández, A (2010) Impacto Social y Económico del Analfabetismo: Modelo de Análisis y Estudio Piloto. Santiago: Comisión Económica para América Latina y el Caribe.
45.Robles, JN & Navarro, DM (2013) Analfabetismo en México: una deuda social. Rev Int Estad Geogr 3, 517.
46.Gutiérrez, JP (2008) Clasificación por Niveles Socioeconómicos de los Hogares Entrevistados para la Encuesta Nacional de Salud y Nutrición 2006: Nota Metodológica (Classification of the Interviewed Households by Socioeconomic Levels for the National Health and Nutrition Survey 2006: Methodological Note). Cuernavaca, Mexico: National Institute of Public Health.
47.Medina, C, Janssen, I, Campos, I et al. (2013) Physical inactivity prevalence and trends among Mexican adults: results from the National Health and Nutrition Survey (ENSANUT) 2006 and 2012. BMC Public Health 13, 1063.
48.Medina, C, Barquera, S & Janssen, I (2013) Validity and reliability of the International Physical Activity Questionnaire among adults in Mexico. Rev Panam Salud Publica 34, 2128.
49.Pampel, FC, Krueger, PM & Denney, JT (2010) Socioeconomic disparities in health behaviors. Annu Rev Sociol 36, 349370.
50.Pepper, GV & Nettle, D (2014) Socioeconomic disparities in health behaviour: an evolutionary perspective. In Applied Evolutionary Anthropology: Darwinian Approaches to Contemporary World Issues,, pp. 225243 [Gibson, MA and Lawson, DW, editors]. New York: Springer.
51.Allen, L, Williams, J, Townsend, N et al. (2017) Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. Lancet Glob Health 5, e277e289.
52.Chen, M, Wu, Y, Narimatsu, H et al. (2015) Socioeconomic status and physical activity in Chinese adults: a report from a community-based survey in Jiaxing, China. PLoS One 10, e0132918.
53.Smith, LP, Ng, SW & Popkin, BM (2014) No time for the gym? Housework and other non-labor market time use patterns are associated with meeting physical activity recommendations among adults in full-time, sedentary jobs. Soc Sci Med 120, 126134.
54.Vargas, AS, Merino, ALH & Hernández, IP (2015) La participación laboral femenina y el uso del tiempo en el cuidado del hogar en México. Contaduría y Administración 60, 651662.
55.Dabbagh-Moghadam, A, Mozaffari-Khosravi, H, Nasiri, M et al. (2017) Association of white and red meat consumption with general and abdominal obesity: a cross-sectional study among a population of Iranian military families in 2016. Eat Weight Disord 22, 717724.
56.Tande, DL, Magel, R & Strand, BN (2010) Healthy Eating Index and abdominal obesity. Public Health Nutr 13, 208214.
57.Guo, X, Warden, BA, Paeratakul, S et al. (2004) Healthy Eating Index and obesity. Eur J Clin Nutr 58, 15801586.
58.Carroll, RJ, Midthune, D, Subar, AF et al. (2012) Taking advantage of the strengths of 2 different dietary assessment instruments to improve intake estimates for nutritional epidemiology. Am J Epidemiol 175, 340347.
59.Conrad, J & Nothlings, U (2017) Innovative approaches to estimate individual usual dietary intake in large-scale epidemiological studies. Proc Nutr Soc 76, 213219.
60.Freedman, LS, Midthune, D, Arab, L et al. (2018) Combining a food frequency questionnaire with 24-hour recalls to increase the precision of estimation of usual dietary intakes– evidence from the validation studies pooling project. Am J Epidemiol 187, 22272232.
61.Galobardes, B, Morabia, A & Bernstein, MS (2001) Diet and socioeconomic position: does the use of different indicators matter? Int J Epidemiol 30, 334340.
62.Howe, LD, Galobardes, B, Matijasevich, A et al. (2012) Measuring socio-economic position for epidemiological studies in low-and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol 41, 871886.
63.Rutstein, SO & Johnson, K (2004) The DHS Wealth Index. DHS Comparative Reports no. 6. Calverton, MD: ORC Macro.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

López-Olmedo et al. supplementary material
López-Olmedo et al. supplementary material 1

 Word (44 KB)
44 KB


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed