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Overview of obesity research in Mexico (La vista general de investigación de obesidad en México) Ian Janssen, PhD;1,2 Juan Antonio Jiménez Alvarado, MS;3 Citlali González Álvarez;1 Gabriela

Ibarguchi; MSc,1,4 Mariane Héroux; MSc,1 Juan López Taylor; MD3

1. School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, Canada

2. Department of Community Health and Epidemiology, Queen’s University, Kingston,

ON, Canada

3. Instituto de Ciencias Aplicadas a la Actividad Física y el Deporte; Departamento de

Ciencias del Movimiento Humano, Educación, Deporte, Recreación y Danza;

Universidad de Guadalajara, Jalisco, México

4. Department of Biology, Queen’s University, Kingston, ON, Canada

Correspondence Address:

Ian Janssen, PhD

School of Kinesiology and Health Studies

Queen’s University

28 Division St., Kingston, ON, Canada, K7L 3N6

T: +1(613)533-6000 extension 78631

Fax: +1(613)533-2009

Email: ian.janssen@queensu.ca

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ABSTRACT

Objective: The objectives were to identify published obesity research from Mexico, topic areas

and population groups studied in this field, research gaps, and areas of the country where

research capacity building efforts are warranted.

Materials and Methods: Literature searches were performed in several databases to identify

obesity-related peer reviewed publications from Mexico published from 2000-2007. The

following was gathered from each publication: language; type of research; species studied; sex,

age, ethnicity, and geography of participants; and research institution.

Results: 227 publications (~28 per year) were identified. Only 38.3% of these were in Spanish.

Most publications studied humans (96.9%), both sexes (76.2%), adults (64.7%), and non-

indigenous populations (56.8%) from urban areas (58.6%). The primary author for 56.8% of the

publications worked in the Mexico City area.

Conclusion: Information from this review will allow Mexican researchers and funding agencies

to better align their research programs to areas of most need.

Key Words: obesity, Mexico, citation databases

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INTRODUCTION

Obesity is a leading public health problem and an obvious research priority. While the

problem of obesity used to be limited to developed countries, this is no longer the case as the

obesity epidemic is now a global phenomenon (1, 2). Mexico is a middle income country in the

midst of a nutrition transition, in which the prevalence of overweight and obesity has increased at

a tremendous rate over the past two decades. The most recent nationally representative statistics

from 2006 indicate that 69.3% of young adults and 30.8% of adolescents in Mexico are

overweight or obese; these represent increases from 34.5% and 8.9%, respectively, in 1988 (3).

While nutrition research and public health policies in developing countries such as Mexico have

historically focused on malnutrition and infectious diseases, there has been a shift to

accommodate issues related to obesity and chronic diseases (3, 4).

In light of the issues noted above, we were interested in knowing what obesity research

has been conducted in Mexico in recent years. We were also interested in knowing where this

research has been conducted, what population groups have been studied, what type of research

has been performed, and the rate at which obesity research has increased over time. Thus, the

purpose of this review was to assess the current state and trends in obesity research within

Mexico. It is anticipated that the findings of this review will: (i) allow researchers to better align

their research programs to areas of need, (ii) allow funding agencies to better align their research

priorities to understudied areas and population groups, and (iii) identify regions within Mexico

that have the greatest capacity to conduct obesity research, and at the same time identify regions

of the country where there is a need for capacity building in obesity research.

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METHODS

Literature Search

To identify published research on obesity within Mexico, we conducted electronic

database literature searches using MEDLINE, PsychINFO, SportDiscus, Web of Science, the

Cochrane Library, Academic Search Premier, SocIndex, CAB Abstracts, Fuente Académica,

ERIC, PAIS, Scopus, Biblioteca Virtual de Ciencias Sociales de América Latina y el Caribe,

SCIELO (Scientific Electronic Library Online), and LILACS (Literatura Latinoamericana y del

Caribe en Ciencias Sociales) .

Search terms used within the predominately English language databases consisted of

[“Mex*”] combined with [“body mass index” “BMI” or “overweight” or “obes*” or “morbid

obesity” or “waist to hip ratio” or “waist circumference” or “skinfold thickness” or “adiposity”

or “adipose tissue” or “abdominal fat” or “subcutaneous fat” or “nutrition transition”].

Equivalent terms in Spanish were used to search the predominately Spanish language databases:

[“Mex*” or “Mex$”] combined with [“IMC” or “indice de masa corporal” or “sobrepeso” or

“obesidad” or obes$ or obes* or“obesidad morbida” or “indice cintura cadera” or “ICC” or

“circunferencia de cintura” or “medicion del paniculo adiposo” or “medicion del pliegue

cutaneo” or “plicometria” or “adiposidad” or “tejido adiposo” or “grasa corporal” or “grasa

abdominal” or “grasa subcutanea” or “transicion nutricional” or “modificacion nutrimental” or

“transicion de la nutricion”. The publication dates within each database were limited to papers

published between the years 2000 to 2007. This timeframe limit was established to enable

thorough systematic searches to be conducted.

After the titles and abstracts of potentially relevant publications were retrieved, they were

checked for repetition across the different databases. The title and abstract of each unique

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publication were then examined by English and Spanish speaking co-authors to determine if they

met the following inclusion criteria: (i) any research related to obesity conducted in a Mexico

population (regardless of where the researchers lived) or any animal-based research related to

obesity done by a researcher working out of a Mexican institution; and (ii) peer-reviewed

publications, defined as articles that have been reviewed by other experts in the field for their

quality and pertinence before being published. Obesity could have been the primary focus,

secondary influence, or a measure within the study. If the title and abstract did not provide

sufficient information to determine if the publication should be included or excluded, a copy of

the full publication was obtained. Copies of the full publications were also obtained for those

papers that met the inclusion criteria based on the title and abstract. After the full publications

were obtained, the reference lists were examined to identify potential publications that were not

retrieved in the electronic database searches.

Data Abstraction

The following information was gathered from each publication to provide information on

the research performed: (i) language of publication, (ii) type of publication (original study or

literature review), (iii) role of obesity in the article (primary or secondary), (iv) species studied

(human or animal), (v) sex of participants (males, females, both), (vi) age of participants

(children or adolescents, adults, all ages), (vii) ethnicity of participants (indigenous, non-

indigenous, mixed), (viii) the type of research performed (biomedical, clinical, health services

and policy, and population and public health), (ix) residential geography of participants (urban,

rural, mixed), (x) the region of Mexico where the participants were located (north, central,

Mexico City, west, south-southeast, entire country), and (xi) the region of Mexico where the

institution of the primary author was located.

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Obesity was defined as the primary focus of the publication if it had a central role in the

study (i.e., the research question would not have been addressed without obesity). The type of

research was categorized according to the four pillars encompassing health research, as identified

by the Canadian Institutes of Health Research and used in similar reviews of this nature (5).

Biomedical research is aimed at understanding normal and abnormal functioning at the

molecular, cellular, organ system, and whole body levels. Clinical research focuses towards

improving the diagnosis and treatment of disease and injury and improving the health and quality

of life of individuals. Included in this category is research on animal models of human disease,

clinical trials, and other therapeutic interventions. Health services and policy research has the

goal of improving the efficiency and effectiveness of health professionals and the health care

system through changes to practice and policy. Population and public health research includes

surveillance studies and the way in which our social and physical environment impacts our

health. If more than one type of research applied to the publication, the best fit was selected.

The five regions of Mexico, which share common geographic and socioeconomic characteristics,

are illustrated in Figure 1 and were made up of the following states: (i) north: Baja California,

Southern Baja California, Chihuahua, Coahuila, Nuevo Leon, Sonora, Sinaloa, and Tamaulipas,

(ii) west: Aguascalientes, Colima, Durango, Guanajuato, Jalisco, Michoacan, Nayarit, San Luis

Potosí and Zaatecas, (iii) Mexico City (Federal District) and adjacent metropolitan areas of

Estado de Mexico, (iv) central: Estado de Mexico, Hidalgo, Morelos, Puebla, Queretaro,

Tlaxcala, and (v) south-southeast: Campeche, Chiapas, Guerrero, Oaxaca, Quintana Roo,

Tabasco, Veracruz, and Yucatan. This regionalization is commonly used in surveillance studies

of obesity and other health outcomes within Mexico (3, 4).

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To illustrate the relation between the number of publications in different regions of

Mexico with the population size and regional prevalence of obesity, we created maps of the

country which pinpointed the number of obesity publications that came out of different

institutions. The states in these maps were color coded according to the population size or the

prevalence of obesity. The population size in each state was based on the 2005 census (6). The

prevalence of obesity in each state was based on the 2006 National Health and Nutrition Survey

(4). States were ranked separately according to the prevalence of obesity in adult men, adult

women, adolescent boys, and adolescent girls. The rankings were then averaged to create a

summary ranking score, with the 31 states and the Federal District (Mexico City) being ranked

from the least obese to the most obese.

Additional Analyses

We were also interested in determining the proportion of global obesity research being

conducted in Mexico, and trends in such research (from 1990 to 2010) that dated back to the start

of the global increase in the prevalence of obesity. The global search was performed using the

search term “obes*”. The Mexican search was performed using the search terms “obes*” and

“Mex*”. Finally, we were interested in comparing the amount of obesity research within Mexico

in the last decade (2000-2009) to other medical conditions and lifestyle behaviors such as

hypertension (search terms = hyperten*), diabetes (search term = diabet*), malnutrition (search

terms = malnu*), smoking (search terms = cigarette or smoking), and alcohol consumption

(search terms = alcohol* or drinking). For practical reasons, these additional analyses were

limited to the Medline database, and we did not examine the title and abstracts of these papers to

verify their applicability.

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RESULTS

Description of Mexican Obesity Research, 2000-2007

The electronic literature searches identified a total of 1677 abstracts. Forty five of these

were identified in more than one database and were removed, leaving 1632. A review of the

title, abstract, and at times full papers of the 1632 studies indicated that only 207 met the study

inclusion criteria. An additional 20 papers were identified by cross-referencing the reference

lists of these 207 publications, resulting in a final number of 227 publications. A complete list of

the 227 publications is provided in Appendix 1.

A description of the 227 obesity research publications from Mexico between 2000 and

2007 is provided in Table 1. Of these, 61.2% were published in English and 38.3% were

published in Spanish. Obesity was the primary focus in 69.6% of the publications. Most of the

publications were original research articles (86.8%), studied human populations (96.9%),

included both male and female participants (76.2%), were limited to adult participants (64.7%),

and studied non-indigenous populations (56.8%) from urban areas (58.6%). The majority of

publications (65.6%) were in the population and public health research discipline. No

publications were from the health services and policy discipline. More than one third (37.3%) of

the publications were limited to participants from Mexico City and approximately one quarter

(24.7%) were national in scope.

The primary author for 56.8% of the 227 publications was located at an institution in

Mexico City, which was more than all other areas of Mexico combined (30.0%) and institutions

from other countries (13.2%). The centralization of obesity research within the Mexico City area

is further illustrated in Figures 2 and 3. The dots on these figures indicate the locations of

institutions where at least one obesity publication was generated (as first author); larger dots

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indicate a higher number of publications. The states in Figure 2 are color coded according to the

state population; darker colors indicate more people. The states in Figure 3 are color coded

according to the prevalence of obesity; darker colors indicate a higher prevalence. Figure 2

illustrates that more published obesity research was generated from more heavily populated

states. Figure 3 illustrates that no published obesity research was generated from institutions

from the states with the lowest prevalence of obesity (e.g., Guerrero, Oaxaca, Chiapas), but that

some of the states with a relatively high prevalence of obesity (e.g., Campeche, Southern Baja

California) also generated no published obesity research from their institutions.

Secular Trends and International Comparisons, 1990-2009

The simple Medline search covering the two decade period extending from 1990 to 2009

identified a total of 106,937 global abstracts, of which 500 (0.47%) were Mexican. As illustrated

in Figure 4, over the past 20 years there has been a constant increase in the number of global

obesity abstracts, with an increase from 1991 abstracts in 1990 to 13,173 in 2009. The secular

trend in obesity research in Mexico was similar to that observed globally, with an increase from

13 abstracts in 1990 to 60 abstracts in 2009. However, the sudden increase in obesity research

observed globally around 1997 was not observed until around 2003 in Mexico (i.e., there was a

sharp increase from 18 abstracts in 2002 to 30 abstracts in 2003). The percentage of global

obesity abstracts that were of Mexican origin was relatively stable over time (0.59% from 1990-

1994 versus 0.51% from 2005-2009).

Comparison to Other Research Topics, 2000-2009

The simple Medline search covering the last decade identified a total of 378 Mexican

abstracts in the area of obesity. This was far more than the number of malnutrition abstracts

identified in the same time frame (n=75). The number of obesity abstracts also compared

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favorably with other behavioral risk factors such as smoking (n=280) and alcohol consumption

(n=177) as well as chronic conditions such as hypertension (n=230) and diabetes (n=452).

DISCUSSION

The purpose of this paper was to assess the state of obesity research in Mexico, trends

over time in such research, and to identify population groups, field areas, and regions of the

country that were over or under represented. The results suggest that 227 peer-reviewed

publications in the field of obesity were published between 2000 and 2007 (~28 articles per

year). Most of this research was conducted in the population and public health research

discipline by researchers from the Mexico City area. Over the past 20 years productivity in

obesity research in Mexico has increased in a similar fashion to the rest of the world; however,

research from Mexico has only accounted for ~0.5% of global obesity research.

An average of 28 peer reviewed publications in obesity from Mexico between 2000 and

2007 indicates that obesity research is underdeveloped in the country as a whole. There are

several institutions and even individual researchers from other countries that surpass the number

of papers generated in the entire country of Mexico. For example, in a literature search for the

year 2007 we identified 285 publications from the Pennington Biomedical Research Center, an

obesity focused research center located in Baton Rouge (Louisiana, USA), with an impressive 31

publications from the center’s executive director, Dr. Claude Bouchard.

Approximately 66% of the published obesity research that was conducted in Mexico

between 2000 and 2007 was in the population and public health research discipline and another

27% was in the clinical discipline. Only 17 articles were classified as biomedical and not a

single article was classified as being in the health services discipline. This is much different than

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the situation in Canada where there has been a far greater emphasis on biomedical obesity

research than on obesity research within the other disciplines (7). Although limited, the focus on

population and public health obesity research in Mexico reflects the research discipline of the

regions and institutions within Mexico where most of the obesity research is being conducted.

For example, based on the institution of the primary author, the Institutio Nacional de Salud

Pública (National Institute of Public Health), the Instituto Nacional de Ciencias Médicas y

Nutrición “Salvador Zubirán” (National institute of Medical Sciences and Nutrition), and the

Instituto Mexicano del Seguro Social (National Institute of Social Security) accounted for 5%,

14%, and 18%, respectively, of the total 227 publications (data not shown).

Since Mexico City and its adjacent metropolitan areas accounts for ~18% of the total

Mexican population, and many of the national research institutes are located in and around the

federal district, it comes as no surprise that the 56.8% of the 227 publications had primary

author’s whose institution was located in this part of the country. The publication map in

Figures 2 and 3 helps to illustrate areas of Mexico where obesity research appears to be the most

developed. Areas with larger populations and higher obesity prevalence rates tended to have

more obesity-related publications between 2000 and 2007. While obesity research in the country

as a whole was limited, there are many states and regions of the country that did not even

generate a single obesity publication.

The simple Medline searches provided us with an indication of worldwide activity in

obesity research and Mexico’s contribution to that research. The secular increase in obesity

research in Mexico between 1990 and 2009 was similar to that observed globally. However, the

sharp increase in obesity research observed globally around 1997 was delayed by about 6 years

in Mexico. Throughout the past two decades, about 0.5% of the global obesity research was

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from Mexico. Because Mexico accounts for 1.6% of the global population (8), obesity research

appears to be underdeveloped in Mexico relative to the rest of the world.

A similar review conducted for Canada suggests that Canada accounts for 3.8% of all

global obesity research (7) despite the fact that it only accounts for 0.5% of the global population

(8). Clearly, high income countries such as Canada have more resources to support research and

research training in obesity and other discipline than middle income countries such as Mexico.

For instance, data from the 2005 Mexican census indicated that 42,425 people, or 0.041% of the

total population, were undertaking a graduate degree (6). Similar data from the 2006 Canadian

census indicated that 130,710 people, or 0.42% of the total population, were undertaking a

graduate degree (9). This research disparity between developed and developing countries is well

recognized, and the Teasdale-Corti Global Health Research Partnership Program within Canada,

the funder of this particular study, is an example of a capacity building initiative that is brining

together researchers from Canada and developing countries (10). Through their Team Grant

initiative, the Teasdale-Corti program has funded the CAMBIO (Canadá – México Combatiendo

la Obesidad Infantil) project, whose primary objective is to enhance research capacity in the field

of childhood obesity in Mexico (http://www.cambio-red.net/). This study will provide a baseline

that CABMIO can use to assess the effectiveness if its program.

The simple Medline searches also provided us with an indication of whether the amount

of obesity research conducted within Mexico compares favorably to research conducted on other

medical conditions and behavioral risk factors. While the amount of obesity research conducted

in Mexico is low in comparison to high income countries, it is encouraging to see that within

Mexico itself the amount of obesity research was comparable or higher than the amount of

research being conducted on malnutrition, hypertension, diabetes, smoking, and alcohol

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consumption. A similar analysis at the global level for the years 2000-2003 suggested that there

was approximately three times the amount of research being conducted on hypertension and

diabetes than obesity (7), despite the fact that obesity is a leading risk factor for both of these

medical conditions (11-14).

There are some notable limitations to this study that warrant recognition. This study was

limited to peer-reviewed papers in scientific journals. Research that is conducted by government

and other agencies is often published as reports and therefore would therefore not have been

captured by our review. For practical reasons, the results for the global obesity comparisons and

comparisons to other diseases and risk factors within Mexico were limited to searches on the

Medline database and the abstracts and publications from these searchers were not reviewed.

Thus, these results included many papers that would have not been applicable. We assume that

this error was similar in the proportion of both the global and Mexican counts, and the proportion

of obesity and other disease counts within Mexico. Therefore, the relative proportions and trends

should not be affected.

In conclusion, while the volume of obesity research in Mexico has increased over the past

two decades, it is still underdeveloped. Between 2000 and 2007, there was an average of 28

obesity-related peer reviewed publications per year. The majority of this research was in the

population and public health or clinical disciplines, with little to no biomedical or health services

research. Most of this research was being led by investigators from Mexico City and other

central regions of the country, implying that capacity building efforts need to focus more on

institutions from other regions. There is an obvious leadership role for some of the more

accomplished research institutes and groups from central Mexico in these capacity building

efforts.

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ACKNOWLEDGEMENTS

The study was supported by the CAMBIO Program (Principal Investigators: Juan López

Taylor and Ian Janssen) which is funded through a Teasdale-Corti Team Grant by the

International Development Research Centre, on behalf of the Global Health Research Initiative.

Ian Janssen was supported by researcher awards from the Ontario Ministry of Research and

Innovation and the Canadian Institutes of Health Research. The authors wish to thank Donna

Ivimey for her assistance developing research protocols and gathering data for review, Alison

Young for reviewing and classifying articles, Andrei Rosu for providing GIS support, and Mario

Franco Bicet for translation support.

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4. Shamah-Levy T, Villalpando-Hernández S, Rivera-Dommarco J. Resultados de Nutrición

de la ENSANUT 2006. Cuernavaca: Instituto Nacional de Salud Pública, 2007.

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Tecnología, Recursos Humanos (www.inegi.org.mx)

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7. Sokar-Todd HB, Sharma AM. Obesity research in Canada: literature overview of the last

3 decades. Obes Res 2004;12:1547-53.

8. World Bank. World Development Indicators. September 2010.

9. Statistics Canada. Data on population, CANSIM 2005-2006 (Table 477-0013). Ottawa,

ON, 2006.

10. International Development Research Centre. The Teasdale-Corti Global Health Research

Partnership Program. Ottawa, ON.

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11. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution,

and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961-9.

12. Wilson PW, D'Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity

as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med

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13. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for

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14. Witteman JC, Willett WC, Stampfer MJ, et al. A prospective study of nutritional factors

and hypertension among US women. Circulation 1989;80:1320-7.

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Table 1. Descriptive information on published obesity research within Mexico,

2000-2007.

Number of Articles

(N=227) % of Total

Language of Publication English 139 61.2 Spanish 87 38.3 Other 1 0.4

Article Type Original 197 86.8 Literature review 30 13.2

Role of Obesity Primary 158 69.6 Secondary 66 29.1 No data 3 1.3

Species Studied Human 220 96.9 Animal 7 3.1

Sex Studied Male 11 4.8 Female 39 17.2 Both sexes 173 76.2 No data 4 1.8

Age Group Studied Child or adolescent 52 22.9 Adult 147 64.7 All ages 24 10.6 No data 4 1.8

Ethnicity Studied Indigenous 20 8.8 Non-indigenous 129 56.8 Mixed 26 11.5 No data 52 22.9

Geography Studied Urban 133 58.6 Rural 19 8.4 Mixed 42 18.5 No data 33 14.5

(continued on next page)

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(Table 1, continued from previous page)

Research Discipline

Biomedical 17 7.5 Clinical 61 26.9 Health services 0 0.0 Population health 149 65.6

Region of Mexico of Participants

North 26 11.5 Central 13 5.7 Mexico City 85 37.4 South-Southeast 10 4.4 West 17 7.5 Whole country 56 24.7 Mexico + other country 15 6.6 Unknown 5 2.2

Region of Mexico of Primary Author North 24 10.6 Central 16 7.0 Mexico City 129 56.8 South-Southeast 4 1.8 West 24 10.6 Other countries 30 13.2

19

FIGURE LEGENDS

Figure 1: Regions of Mexico that were examined in this review as made up by the following

states: (i) north: Baja California, Southern Baja California, Chihuahua, Coahuila, Nuevo Leon,

Sonora, Sinaloa, and Tamaulipas, (ii) west: Aguascalientes, Colima, Durango, Guanajuato,

Jalisco, Michoacan, Nayarit, San Luis Potosí and Zaatecas, (iii) Mexico City (Federal District)

and adjacent metropolitan areas of Estado de Mexico, (iv) central: Estado de Mexico, Hidalgo,

Morelos, Puebla, Queretaro, Tlaxcala, and (v) south-southeast: Campeche, Chiapas, Guerrero,

Oaxaca, Quintana Roo, Tabasco, Veracruz, and Yucatan.

Figure 2: Location of institutions where obesity publications were generated relative to

population size. The dots indicate the locations of institutions where at least one obesity

publication was generated (as first author); larger dots indicate a higher number of publications.

The states are color coded according to the state population; darker colors indicate more people.

Figure 3: Location of institutions where obesity publications were generated relative to the

prevalence of obesity. The dots indicate the locations of institutions where at least one obesity

publication was generated (as first author); larger dots indicate a higher number of publications.

The states are color coded according to the prevalence of obesity; darker colors indicate a higher

prevalence.

Figure 4: The number of obesity abstracts identified within Medline for Mexico (circular

symbols, axis on left side of figure) and globally (square symbols, axis on right side of figure)

from 1990 to 2009.

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Appendix 1. List of the 227 Mexican peer-reviewed obesity publications, 2000-2007.

1. Aguilar-Salinas C, Reyes-Rodríguez E, Ordoñes-Sánchez ML, et al. Early-onset type 2 diabetes: Metabolic and genetic characterization in the Mexican population. Journal of Clinical Endocrinology and Metabolism. 2001;86(1):220-6.

2. Aguilar-Salinas CA, Canizales-Quinteros S, Rojas-Martinez R, et al. Successful collaborations between three Mexican institutions in the study of dyslipidemia, obesity and diabetes. [Spanish]. Gaceta Medica de Mexico. 2007;Academia Nacional de Medicina. 143(5):355-64.

3. Aguilar-Salinas CA, Olaiz G, Valles V, et al. High prevalence of low HDL cholesterol concentrations and mixed hyperlipidemia in a Mexican nationwide survey. Journal of Lipid Research. 2001 Aug;42(8):1298-307.

4. Aguilar-Salinas CA, Rojas R, Gomez-Perez F, et al. Characteristics of mixed hyperlipidemia cases in a population-based study: Results from the Mexican National Survey of Chronic Diseases. Salud Publica De Mexico. 2002 Nov-Dec;44(6):546-53.

5. Aguilar-Salinas CA, Rojas R, Gomez-Perez FJ, et al. Prevalence and characteristics of early-onset type 2 diabetes in Mexico. American Journal of Medicine. 2002 Nov;113(7):569-74.

6. Aguilar-Salinas CA, Rojas R, Gomez-Perez FJ, et al. High prevalence of metabolic syndrome in Mexico. Archives of Medical Research. 2004 Jan-Feb;35(1):76-81.

7. Aguilar-Salinas CA, Vazquez-Chavez C, Gamboa-Marrufo R, et al. Obesity, diabetes, hypertension, and tobacco consumption in an urban adult Mexican population. Archives of Medical Research. 2001 Sep-Oct;32(5):446-53.

8. Aguilar-Zinser JV, Irigoyen-Camacho ME, Ruiz-Garcia-Rubio V, et al. Prevalence of overweight and obesity in Mexican professional bus drivers. [Spanish]. Gaceta Medica de Mexico. 2007;Academia Nacional de Medicina. 143(1):21-5.

9. Alarcon-Aguilar FJ, Zamilpa A, Perez-Garcia MD, et al. Effect of Hibiscus sabdariffia on obesity in MSG mice. Journal of Ethnopharmacology. 2007 Oct;114(1):66-71.

10. Alves de Moraes S, Beltran Rosas J, Mondini L, Martins de Freitas IC. [Prevalence of overweight and obesity, and associated factors in school children from urban area in Chilpancingo, Guerrero, Mexico, 2004]. Cadernos de Saude Publica. 2006 Jun;22(6):1289-301.

11. Amador N, Espinoza G, Guizar JM, Gonzalez M, Alpizar M. Comparison of HOMA-IR with minmod for measure insulin sensitivity in polycystic ovary syndrome. Revista De Investigacion Clinica. 2001 Sep-Oct;53(5):407-12.

12. Angeles-Llerenas A, Carbajal-Sanchez N, Allen B, Zamora-Munoz S, Lazcano-Ponce E. Gender, body mass index and socio-demographic variables associated with knowledge about type 2 diabetes mellitus among 13,293 Mexican students. Acta Diabetologica. 2005 Mar;42(1):36-45.

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