Sustainable-psycho-nutritional Intervention Program and Its Effects on Water and Carbon Footprint, Metabolic Biomarkers, and Gut Microbiota in Mexican Population: a m-Health Randomized Clinical Trial
Phase: NA
Conditions: Gut Microbiota, Hyperglycemia, Hypercholesterolemia, HDLC, Hypertriglyceridemia, Eating Behavior, Body Composition, Acanthosis Nigricans, Blood Pressure, Food Intake, Physical Activity, Diet Quality
Sponsor: University of Guadalajara

 
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Cover page 
 
Official title:  
Sustainable-psycho-nutritional intervention program and its effects on water and carbon footprint, 
metabolic biomarkers, and gut microbiota in Mexican population: study protocol of a m-Health 
randomized clinical trial 
 
Brief Title:  
Sustainable-psycho-nutritional intervention program and its effects on health outcomes and the 
environment 
 
Date of the document: March 27, 2022 
NCT: not yet available  
Ethics committee number: CUCBA/CEIC/CE/002/2022 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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Mariana Lares-Michel1,2*, Fatima Ezzahra Housni1•, Zyanya Reyes-Castillo1, Jesús Francisco Rodríguez 
Huertas2, Virginia Gabriela Aguilera Cervantes1, Rosa María Michel Nava3 
 
1. Instituto de Investigaciones en Comportamiento Alimentario y Nutrición (IICAN), University Center of the 
South, University of Guadalajara. Address: Av. Enrique Arreola Silva 883, Col. Centro. Zip Code: 49000, Cd. 
Guzmán, Jalisco, México. 
2. Institute of Nutrition and Food Technology “José Mataix Verdú”, Biomedical Research Center, University 
of Granada, Avenida del Conocimiento S/N. Parque Tecnológico de la Salud. Armilla,18071 Granada, Spain  
3. Tecnológico Nacional de México, Campus Ciudad Guzmán. Address: Avenida Tecnológico 100, Col. Centro. 
Zip Code: 49000. Ciudad Guzmán, México. 
 
*This study protocol is the Ph.D. thesis of the student Mariana Lares-Michel, who is currently registered as Ph.D. 
student at the University of Guadalajara and the University of Granada under a double Ph.D. title program. Contact 
e-mail: marianalares@correo.ugr.es, mariana.lmichel@alumnos.udg.mx 
•Responsible researcher on ClinicalTrials.gov: fatima.housni@cusur.udg.mx   
 
Note: This study protocol will be submitted to a scientific journal as a study protocol.  
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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Abstract  
Mexico is going through a major environmental and nutritional crisis, which is related to unsustainable dietary 
behaviors. Sustainable diets could solve both problems together. However, in Mexico and the world, an 
intervention program oriented to promoting sustainable diets has not been designed. This study protocol aims to 
design a 3-stages, 15 weeks, sustainable-psycho-nutritional digital intervention program whose objective is to 
promote the adherence of the Mexican population to a sustainable diet and to evaluate its effects on dietary water 
and carbon footprints, metabolic biomarkers, and gut microbiota of this population. The behavior change wheel 
model and the guide for digital interventions design will be followed. In stage 1, the program will be designed 
using the sustainable diets model, and the behavior change wheel model. A sustainable food guide, sustainable 
recipes, and food plans as well as a mobile application will be developed. In stage 2, the intervention will be 
carried out for 7 weeks, and a follow-up period of 7 weeks, in a sample of Mexican young adults (18 to 35 years) 
randomly divided into an experimental group (n=50) and a control group (n=50). The nutritional care process 
model will be used. Anthropometric, biochemical, clinical, dietary, environmental, socioeconomic level and 
cultural aspects, nutritional-sustainable knowledge, behavioral aspects, and physical activity will be considered. 
Thirteen behavioral objectives will be included using successive approaches in online workshops twice a week. 
The population will be monitored using the mobile application that will include behavioral change techniques. In 
stage 3, the effects of the intervention will be assessed on the dietary water and carbon footprint, lipid profile, 
serum glucose, and gut microbiota composition of the evaluated population. We expected to find improvements 
in health outcomes and a decrease in the dietary water and carbon footprints. With this study, the first theoretical-
methodological approach to the sustainable-psycho-nutrition approach will be generated.  
 
Keywords: Sustainable Diets, Behavior Change, Gut Microbiota, Environmental Impact of Diets, Nutritional and 
Environmental Education, Mexican Population, Water Footprint, Carbon Footprint, Eating Behavior, m-Health.  
 
 
 
 
 
 
 

 
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1. Introduction 
The change from the traditional Mexican diet to a Western diet, generated by the nutritional transition, has not 
only generated prevalence’s of more than 75% of metabolic alterations (obesity, type 2 diabetes, cardiovascular 
diseases, dyslipidemia) (1–3) and in the gut microbiota of the Mexican population (4), but it has also generated 
the water and carbon footprint of their diet to be the highest in the world with more than 8,000 Liters per person 
per day (L p-1d-1) (5) and 6.01 Kg CO2eq p-1d-1 (6), respectively. This is linked to the aggravation of climate 
change, with increases of more than 1.0 ºC in the average atmospheric temperatures (7) and the current water 
crisis that Mexico is going through, which affects 85% of the territory and has been referred to as the worst water 
drought in history, affecting the water supply of millions of Mexicans (1,8).  
One of the proposals for the joint solution of these problems has been the adoption of sustainable and territorial 
diets, which in Mexico could be carried out through the recovery of its traditional diet, both pre-Hispanic and 
colonized, which, prepared with low-fat culinary techniques and low content of animal products, can be 
considered as an appropriate option from a nutritional, cultural, economic and environmental perspective, 
dimensions that must be present for a diet to be considered as sustainable (1,9–12). 
However, to achieve the adoption of a particular diet, it is necessary to modify the eating behavior of the 
population (13–15). To modify both dietary and unsustainable behaviors in a population, there are multiple 
strategies, among which intervention programs have stood out (14,16,17). However, to date and both nationally 
and internationally, no intervention program whose objective is to promote both adequate nutrition to improve 
health and reduce the environmental impact of dietary behaviors, has been reported. This respecting cultural, 
social, economic, and psychological aspects of the population. 
Based on the above, this study protocol aims to design a three-stage 15 weeks intervention program, based on 
the guide to designing interventions of the behavior change wheel model (14), which includes both nutritional and 
sustainability elements, in the sense of considering unsustainable dietary behaviors of the Mexican population, in 
addition to taking into account their social, cultural and economic aspects. In addition to these axes, the basis of 
behavioral modification intervention programs is psychology. Therefore, it is proposed to design a sustainable-
psycho-nutritional intervention program, whose objective is to promote the adherence of the population to 
sustainable diets. But, in addition, it is proposed to evaluate its effects on environmental indicators, metabolic 
biomarkers, and gut microbiota, as well as clinical aspects and body composition in a Mexican population sample. 
Because of the effectiveness of technologies use in nutritional (18,19) and environmental (20,21) interventions, 

 
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the intervention program will be a digital one, for which a mobile application is being designed to evaluate and 
monitor the intervened population. Therefore, this will be a m-Health intervention program.   
We hypothesized that a sustainable-psycho-nutritional intervention digital program can modify the eating 
behavior of a Mexican population group and guide it towards a sustainable diet, generating decreases in glucose 
levels, total cholesterol (TC), LDL cholesterol (LDL-C), and triglycerides (TG), and increases in HDL cholesterol 
(HDL-C) levels. Likewise, we hypothesized that this type of program can modify the composition of the gut 
microbiota of the population, promoting the proliferation of bacteria related to metabolic health; reduce the water 
and carbon footprint of the sample’s diets; maintain adequate body fat levels in the population with an adequate 
body fat percentage or reduce them in the overweight or obese population; maintain blood pressure levels in the 
healthy population and lower them in the population with high blood pressure, and reduce the presence of 
acanthosis nigricans. 
 
2. Methods  
It is proposed to carry out a quasi-experimental longitudinal study of three stages that will be related to each 
other. 
 
2.1 Stage 1: Design of the program  
A sustainable-psycho-nutritional intervention program will be designed based on the characteristics of a 
sustainable diet for the national context of Mexico, adaptable to any regional context. It will include a mobile 
application that is being designed for this project, which will include a sustainable food guide, sustainable-psycho-
nutritional workshops, sustainable recipes and food plans, and behavioral change techniques. The program will 
be designed based on the sustainable diets model (12) and concept (9), the behavior change wheel model (14), the 
guideline for the development and evaluation of digital behavioral interventions in health care (19), and on the 
guide to designing interventions of the behavior change wheel, which incorporate 3 stages and 8 development 
steps (22).  
 
2.1.1 Mobile application design  
A mobile application (app) will be developed in collaboration with software and mobile applications 
developers and will be based on the user-centered methodology (23), and on the guide for the design of digital 
interventions by West and Michie (24). It will contain the following behavioral modification techniques: education 

 
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through workshops videos (13); persuasion by sending messages of risks and benefits (25), encouragement and 
coercion using token economy (13), nudges by messaging (26), self-monitoring by graphical progress viewing 
(27,28), successive approaches by behavioral objectives addressing (13), and guides (14), through a sustainable 
food guide that will be designed by means of linear programming optimization (29,30) using MATLAB®, and 
graphic design programs such as Adobe Illustrator® and BioRender®. This guide will be designed based on the 
recommendations of the FAO for the development of dietary guidelines (31) and on the Mexican Food Equivalent 
System (32). For the token economy system, cut-off points will be established to be charged to the app 
(Supplementary Material 1). Additionally, educational workshops and meal plans will be designed, following the 
model of sustainable diets of Johnston et al. (12), and using the Nutriecology® Nutritional-Ecological software 
and the Nutrimind® Software for diet calculation. Likewise, the guidelines for the prescription of meal plans, 
menu design, and recipes for the Mexican population will be followed (33). Prior to the launch of the mobile 
application, its feasibility, acceptability, quality, and usability will be assessed. Also, it will be evaluated following 
the APEASE criteria, which include evaluating the 1) Affordability, 2) Practicability, 3) Effectiveness, and Cost-
effectiveness, 4) Acceptability, 5) Side-effects/safety, and 6) Equity. 
 
2.1.2 Behavior change intervention design process  
The process of design of the intervention is shown in Table 1. The process of understanding the behavior, 
including the problem definition (1–3,5,6), the selected target behaviors, and what needs to be modified from 
them (12,13,27,34–36) are described. Also, the selected intervention functions (37), as well as the selected policy 
categories from the behavior change wheel model, are presented.  
 
 
 
 
 
 
 
 
 

 
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Table 1. Design of the Sustainable-Psycho-Nutritional intervention program according to the behavior 
change wheel model and guide for interventions design  
 
Stage 1: Understand the behavior 
Step 1: Define the 
problem in 
behavioral terms 
This step will be based on the available scientific evidence on the country's dietary and 
environmental situation, which reveals high prevalence’s of overweight, obesity, and 
associated pathologies such as type 2 diabetes, dyslipidemia, and hypertension (1,2,6). 
Also, the highest values of dietary water and carbon footprints were found (5,6). These 
problems are mainly related to inadequate food consumption (which will be further 
detailed) and lack of physical activity (1).  
 
Step 2: Select target 
behavior 
 
The target behaviors will be lack of physical activity performance, inadequate 
consumption of Mexican foods and dishes, fruits and vegetables, whole grains, 
legumes, seeds and healthy fats, dairy products, eggs, fish and shellfish, chicken, red 
meat (beef and pork, and, in some cases, goat and lamb) and processed, ultra-
processed foods and added and free sugars, as well as foods high in trans and saturated 
fats. 
Step 3: Specify the 
target behavior 
 
Step 4: Identify 
what needs to 
change  
 
Targets behaviors will be established as a goal-setting strategy, which has been reported 
to be one of the most effective methods for modifying dietary behaviors (27). Also, they 
will be addressed as successive approximations toward a sustainable diet, another 
effective behavior change technique (13,33). Targets behaviors will be:   
 
1. Increase physical activity. 
2. Increase the consumption of sustainable Mexican foods and dishes. 
3. Increase the consumption of fruits and vegetables. 
4. Increase the consumption of whole grains. 
5. Increase the consumption of legumes. 
6. Increase the intake of seeds and healthy fats. 
7. Reduce dairy consumption. 
8. Reduce the consumption of eggs. 
9. Reduce consumption of fish and shellfish. 
10. Reduce chicken consumption. 
11. Reduce the consumption of red (beef, pork, goat, and lamb) and processed 
meats.  
12. Reduce the consumption of ultra-processed foods. 
13. Reduce the intake of added and free sugars, as well as foods with a high content 
of trans and saturated fats. 
 
All foods whose consumption will be promoted will be aligned with the sustainability 
characteristics for the Mexican context (12), on the recommendations of a healthy diet 
provided by the WHO (35), and on the model QC7G for food and nutrition education, 
that will specify which foods to select, in which quantities, when to consumed them 
and how to prepare them. In addition to when to perform physical activity, specifying 
type and duration (13).  
Stage 2: Identify intervention options 
Step 5: Intervention 
functions 
 
The intervention functions from the behavior change wheel model will be: education, 
persuasion, incentivization, and coercion. These will be verified in relation to the 
APEASE criterion Michie et al. (36).  
 
 
 
 
 
 
 
 
 

 
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Table 1. Continuation: Design of the Sustainable-Psycho-Nutritional intervention program according to 
the behavior change wheel model and guide for interventions design 
Stage 2: Identify intervention options 
Step 6: Policy 
categories 
 
The policy category of the behavior change wheel model will be the guidelines. 
Therefore, a nutritional-sustainable food guide will be designed, using linear 
programming optimization (29, 30), based on the FAO recommendations for the 
development of dietary guidelines (31), and covering the elements of the sustainable 
diets model (12) as follows: 1) Wellness and Health: ABCD; A: anthropometric and 
body composition data (body weight and height, BMI, percentage of body fat, visceral 
fat, muscle mass, waist, and hip circumference, as well as waist-hip ratio); B: 
biochemical data (serum glucose, lipid profile and gut microbiota); C: clinical data 
(signs of nutrient deficiencies, acanthosis nigricans, and blood pressure). 2) 
Biodiversity, environment, and climate: carbon footprint and gray water footprint. 3) 
Equity and fair trade: food prices and socioeconomic level of the population. 4) “Eco-
friendly”, local, and seasonal foods: green and blue water footprint, locally produced 
and seasonal foods. 5) Cultural heritage and skills: Traditional Mexican diet, Mexican 
Diet Quality Index Adapted (IACDMx), and nutritional education based on a traditional 
diet. 6) Food needs, nutrients, food security, and access: personalized food plan 
according to individual requirements, preferences, and contexts. Figure 1 shows an 
adaptation of the model of sustainable diets of Johnston et al. (12) for this protocol 
characteristics.  
 
Subsequently, this nutritional-sustainable food guide will be accompanied by a system 
of equivalent foods (32) that, in addition to incorporating the food’s nutrients, will 
integrate their environmental impact. The calculation of the environmental impact will 
be made based on the calculation of the total, green, blue, and gray water footprint, 
using the Water Footprint Assessment method for Mexico (5). Likewise, the greenhouse 
gas emissions of foods will be calculated, using the Life Cycle Assessment method for 
food production and processing through pre-quantified databases (55,56,57). The prices 
and cultural characteristics of the main consumed foods in Mexico will be included 
(5,32). Prices will be obtained based on fieldwork in supermarkets, and a review of 
supermarket databases, while cultural aspects will be determined based on a literature 
review of the traditional Mexican diet (1,10). 
 
Once sustainability dimensions are calculated, a sustainable recipe book will be 
developed, including examples of food plans with individualization options. These food 
plans will be made up of a distribution of equivalent food rations (32) and examples of 
menus that meet the nutritional and sustainability characteristics of the Mexican 
population, with adaptations options.  
 
Stage 3: Identify content and implementation options  
Step 7: Behavior 
change techniques 
 
Specific behavior change techniques will be used covering the selected intervention 
functions as follows:  
• 
Education: successive approximations in the workshops addressing the target 
objectives.  
• 
Persuasion: Nudges, risk, and benefits communication.  
• 
Incentivization, coercion, and monitoring: messaging, remainders, and token 
economy through food registers by writing and photos on the mobile 
application.  
• 
Social support: forum in the mobile app where participants can share pictures 
of their foods and their physical activity performance. Also, will be able to like 
the photos of other participants and comment on the photos. Also, a chat for the 
resolution of doubts between user and administrator will be included in the 
mobile application.  
 
Step 8: Mode of 
delivery 
The mode of delivery will be digital since a mobile application is being designed and the 
workshops will be delivered by digital platforms in videos.  

 
9 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 1. Sustainable-Psycho-Nutritional approach for the intervention design, based on the sustainable diets model (12), The behavior change wheel model (14), and the COM-
B model (14). Own elaboration. 

 
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2.2 Stage 2: Application of the sustainable-psycho-nutritional intervention program 
2.2.1 Participants  
Once the intervention program has been designed, it will be applied to a sample of Mexican young adults 
from the south of Jalisco, randomly divided into two groups: an experimental group (n=50) and a control group 
(n=50). This is based on recommendations for group designs in behavior modification programs (38). The sample 
size is according to the minimum suggested for nutritional interventions (39,40), and taking into account the 
possible desertion of the participants during the intervention, which can amount to more than 50% of the initial 
sample (41). We will include a population between 18 and 35 years old, with Body Mass Index (BMI) values 
from 18.5 to 40, with or without risk factors for the development of chronic diseases, but without diagnosis with 
previous pharmacological treatment. The inclusion, exclusion, and elimination criteria are detailed in 
Supplementary Material 2 in Table SM2.1. Also, for being included in the study cut-off points to identify 
inadequate consumption and physical activity were established (Table SM2.2). The population will be invited to 
participate through social networks and posters at strategic points, such as Universities, gyms, and the downtown 
city. Young adults were selected as the population for this study since they are already considered adults who 
make autonomous food decisions, but at the same time, their young age makes them susceptible to behavioral 
modification. In addition, they represent parents or future parents, as well as the active population of Mexico, so 
providing nutritional-sustainable education to these people could generate long-term benefits for their health and 
that of their families (21,42,43).  
 
2.2.2 Procedure   
Participants will be evaluated following the nutritional care process model (44). The first evaluation will 
be performed at the beginning of the intervention at baseline, and according to individual requirements, the 
behavioral objectives will be individually adapted and will be addressed for 7 weeks, considering 2 objectives per 
week, thus providing 2 weekly educational workshops. Also, personalized food plans will be prescribed, according 
to the linear programming optimization (29,30) performed at MATLAB®. 
After 7 weeks of educational and nutritional intervention, at week 8, the experimental population will be 
divided into two sub-groups, where one group will stop being intervened completely (n = 25), and another will 
continue to receive messages through the mobile application (n = 25) for 8 weeks. Finally, at week 15, a final 
evaluation will be carried out. The study design is shown in Figure 2. Participants will be evaluated in the regard 
of Anthropometric, Biochemical, Clinical, Dietetics, Environmental, Socioeconomic level and cultural aspects, 

 
11 
Nutritional-sustainable knowledge, Behavioral aspects, and Physical activity (ABCD-ESNBP). These aspects will 
be evaluated according to the nutritional care process model, thus identifying the problem of the population, 
establishing the etiology, and stating the signs and symptoms (44). 
 
2.2.3 Sustainable-psycho-nutritional indicators  
The ABCD-ESNBP indicators will be included in a complete clinical history that will be uploaded to the 
mobile application (Supplementary Material 3) and will be evaluated as follows: A) Anthropometric: height with 
a Smartmet® stadiometer, weight, and body composition (percentage of body fat, muscle mass, visceral fat) with 
an Omron® bioimpedance scale (HBF-511T-E/HBF-511B-E), BMI = weight/height2, waist and hip 
circumference using a Lufkin® metal tape measure. The assessment will be performed following the validated 
techniques of Suverza and Haua (45). 
B) Biochemical: glucose and lipid profiles (TC, LDL-C, HDL-C, and TG) will be determined through 
blood samples that will be taken from the antecubital vein of each participant, following the protocol from the 
Mexican Health Secretary (46,47). Samples will be taken by specialists, after an overnight fast of 8 to 12 hours 
and will be centrifuged at 3500 rpm for 15 min to separate the serum. Samples will be aliquoted and stored at -
20°C until the day of testing. Tourniquets, alcohol swabs, 10 mL syringes, and blood collection tubes will be 
required. Gut microbiota will also be analyzed, for which fecal samples will be collected in a sterile stool container 
using a sterile kit including gloves and a spatula that will be delivered to the participants. Once collected, the 
samples will be divided into aliquots and will be stored at -80 ºC, following a method used for the Mexican 
population (4,48).  
C) Clinical: a clinical history will be carried out, covering pathologies suffering, pathological family 
history, medicaments, and supplement use (Supplementary Material 3). Clinical signs of insulin resistance 
(acanthosis nigricans) will be evaluated by physical exploration, searching for hyperpigmentation and thickening 
of the skin with velvety, in visible flex areas (axilla, anterior ulnar area, and posterior and lateral region of the 
neck) (49). Signs of nutrient deficiencies or excess will also be evaluated in relation to hair, nails, mouth, tongue, 
edema, and mucous membranes appearance (45). Likewise, blood pressure will be evaluated with a Medstar® 
sphygmomanometer and following the Mexican normativity (50).

 
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Figure 2. Study design for stage 2. Own elaboration.  
 

 
13 
 
D) Dietetics: caloric-nutritional intake will be assessed through 24-hour recalls and dietary records (51), 
and by a validated adapted Food Frequency Questionnaire (CFCA) (5,52). Diet quality will also be analyzed by 
an adapted version of the Mexican Diet Quality Index (ICDMx)  (53). Participants will also be asked about food 
preparation, food shopping places, food allergies and intolerances, food preferences, and about following specific 
diets at the moment of the evaluation.  
E) Environmental: dietary water footprint will be calculated using the Water Footprint Assessment method 
(54) in its version for Mexico’s context (5). The water footprint of each food and food ingredients are going to be 
calculated. Also, water involved in cooking and food washing is going to be evaluated.  Dietary carbon footprint 
is also going to be calculated using the Life Cycle Assessment method (7,55,56). Food system boundaries are 
going to be the impact of food production and processing on greenhouse gas emissions, as carried out by Fresán 
et al. (57). Corrections factors from converting cooked to uncooked food and peeled to unpeeled food are going 
to be applied. Both calculations are going to be performed in the Nutriecology® Software. 
S) Socioeconomic level and cultural aspects: educational level, occupational level, and economic income 
are going to be evaluated according to classifications used for Mexico, which are detailed in Supplementary 
Material 3 (58). For this aspect, food prices are going to be investigated in fieldwork and in supermarket databases, 
in order to promote the consumption of accessible foods. Also, food culture related to celebrations and traditions 
is going to be investigated.  
N) Nutritional-sustainable knowledge: it will be evaluated through a designed questionnaire 
(Supplementary Material 4), based on the psychological capacity presented in the COM-B model. It will include 
a series of questions for the evaluation of nutritional-sustainable knowledge, which will be related to the 
established behavioral objectives and will be based on manuals for the design of nutritional knowledge 
questionnaires and on questions on sustainable food consumption (59–62).  
 B) Behavioral aspects: all dimensions of the COM-B model will be assessed in a designed questionnaire 
based on Brain et al. (63) (Supplementary Material 4). The questions will be related to physical and psychological 
ability, automatic and reflexive motivation, and physical and social opportunity (14). Questions were adapted 
according to the context of sustainable diets (12): (1) Capacity: knowledge of sustainable nutrition, preparation 
skills food and preparation capacity; (2) Opportunity: time to eat and prepare food, access to food, and food 
storage; (3) Motivation: the desire to change eating habits, emotions involved in food consumption and habits that 
participants are willing to change.  

 
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P) Physical activity: the IPAQ questionnaire will be used, which is included in the clinical history shown 
in Supplementary Material 3. Besides the questionnaire, specific questions about physical activity type, frequency, 
intensity, and duration are going to be asked.  
 
2.3 Stage 3: Effects of the sustainable-psycho-nutritional intervention program 
As the last stage of this protocol, the corresponding laboratory analyses, and statistical tests will be carried 
out. 
2.3.1 Metabolic biomarkers analysis  
For the analysis of metabolic biomarkers, colorimetric enzymatic methods will be used using the 
Spinreact® S. A/S A. U (Girona, Spain) laboratory kits, for fasting glucose determination (Cat. No. 1001190), 
TC (Cat. No. 41022), LDL-C (Cat. No. BSIS51-E), HDL-C (Cat. No. BSIS37-E) and TG (Cat. No. 1001313) 
(47). The reference points for glucose values and lipid profiles will be taken from the regulations in force in 
Mexico (64,65).  
 
2.3.2 Gut microbiota analysis  
For the analysis of the gut microbiota, the real-time quantitative polymerase chain reaction (qPCR) method 
will be followed (4,48). First, DNA will be extracted from the collected stool samples, following the protocol for 
rapid purification of genomic DNA from stool samples. The Qiagen brand commercial kit (1066790ES, USA) 
will be used. This procedure integrates two stages: lysis and separation of impurities from stool samples, for which 
Inhibitex Buffer will be used and DNA purification will be carried out by means of centrifugation columns. Once 
the bacterial DNA samples are obtained, they will be stored and labeled in sterile plastic microtubes (Eppendorf 
1.6 mL) at a temperature of -80°C until further analysis. 
Next, the purity of the DNA will be verified, and its concentration will be determined using a NanoDrop 
Lite spectrophotometer (Thermo Scientific, Waltham, MA, USA). 1 µL of the DNA stock of each sample will be 
placed on the lens of the equipment and the sample will be read at a wavelength of 260 nm for DNA quantification 
and at 280 nm for protein quantification. The purity will be determined by calculating the index performed by the 
team, by dividing the reading at 260 nm by the reading at 280 nm and will be considered acceptable in a range of 
1.5 to 2. The concentration of the purified coproDNA sample will be measured by their absorbance ratio of 
260/280 nm using the same spectrophotometer. This analysis corresponds to the absorbance index of nucleic acids 
and provides the final concentration in ng/µL (4,48,66). 

 
15 
Once the previous analyzes have been completed, the identification of the gut microbiota will be carried 
out using the qPCR molecular technique, on the StepOne Applied BioSystems platform, using the SYBR Green 
reagent as DNA detection chemistry. This reagent is considered an agent that intercalates into the DNA double 
helix and fluoresces as the DNA copies are synthesized. Therefore, at a higher concentration of the DNA of 
interest (bacterial), the equipment will record a higher fluorescence signal. In this case, the analysis of interest 
will be carried out in the V3-V4 hypervariable region of the bacterial 16S rRNA gene. For this analysis, specific 
primers, which are detailed in Supplementary Material 5 will be used. The bacterial load and relative abundance 
of the main bacteria present in the intestine (Firmicutes and Bacteroidetes) (4,67,68) will be determined, as well 
as those related to particular types of diets, for example, Lactobacillus and Bifidobacterium that are related to 
healthy, vegetarian and Mediterranean diets (67,69,70), Faecalibacterium prausnitzii that is related to healthy 
diets and an anti-inflammatory effect (41,71–73), as well as Akkermansia muciniphila, which besides of being 
related to anti-inflammatory effects is associated to the consumption of the Mexican pre-Hispanic diet 
(41,70,72,74,75). The presence of Prevotella copri will also be identified, which is one of the bacteria most related 
to plant-based diets and is considered anti-inflammatory and glucose modulator (75,76). The presence of Bilophila 
wadsworthia will also be identified, as it is related to diets with a high content of foods of animal origin, mainly 
dairy and meat (71,77), as well as in westernized diets (67,78). Likewise, the presence of Clostridium coccoides 
will be analyzed, as it is related to obesity (48) and a high fat intake (79). Also, Streptococcus thermophilus will 
be included because it is related to dairy consumption (71,80). The exact procedure to follow regarding the qPCR 
run, as well as the specific conditions and temperatures of the analysis, are presented in the investigation of 
Rodríguez-Lara et al. (48), which will serve as the guide for this research project. 
 
2.3.3 Evaluation of the adherence to the program  
To measure the adherence of the intervened population to the program, an adapted questionnaire will be 
applied based on that of Gila-Díaz et al. (81), which will consist of the contrast of the recommendations provided 
with the performance of the behaviors to promote. For example, questions about the type and intensity of physical 
activity performed and the amount and frequency of consumption of each of the foods included in the behavioral 
objectives will be included. This questionnaire is shown in Supplementary Material 6.  
 
2.3.4 Statistical analyses  

 
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The distribution of the data will be analyzed with the Kolmogorov Smirnov test. Descriptive analysis will 
be performed, including means, standard deviations, and medians. Next, the effects of the program on the selected 
variables will be assessed by comparing them between evaluations and between groups with t-student tests for 
paired and unpaired data, respectively, if a normal distribution is found. For no normally distributed data, the 
Wilcoxon test (repetitive measures) and the U de Mann Whitney test (independent groups) will be used. For no 
categorical variables, the chi-squared test will be used. Correlation analyses will also be performed, considering 
Pearson correlation for normally distributed data and Spearman correlations for no normally distributed data. 
Likewise, simple, and multiple linear regression models will be carried out, as well as binary logistic regression 
analysis, to identify relationships and risks between variables. Statistical analysis will be performed at STATA 
V12® program. 
 
2.4 Ethical and biosafety considerations 
This project has been already evaluated and approved by the Ethics Committee of the Center for Studies 
and Research in Behavior, of the University Center for Biological and Agricultural Sciences (CUCBA) from the 
University of Guadalajara with the number CUCBA/CEIC/CE/002/2022 and by the Technical Research 
Committee of the University Center of the South (CUSUR), with the number 2021D001. This protocol will also 
be registered on Clinical Trials.gov. When performing the intervention, the Declaration of Helsinki (82) and 
biosafety protocols of the Secretary of Health of Mexico (83) will be followed all the time. All participants will 
sign an informed consent (Supplementary Material 7) and their identities will be protected by the Federal Law on 
Protection of Personal Data Held by Private Parties (84). 
Both due to regulations in research with human beings, and due to the situation of the COVID-19 pandemic, 
a strict biosafety protocol will be followed, where mouth covers will be always worn, both by the evaluating staff 
and by the participants. Likewise, the sample collection personnel will wear protective glasses and sterile gloves 
and constant disinfection of the work area will be carried out. In addition, hazardous biological waste will be 
disposed of in a special trash can in accordance with the provisions of the Ministry of Health (85). 
 
3. Discussion   
By developing this program, we would be generating the first bases for the Mexican population (and future 
populations) to achieve a healthy and sustainable diet that can have positive effects on health outcomes and 
decrease the environmental impact of food consumption; thus addressing two of the main problems afflicting the 

 
17 
world population. Also, we are proposing a new concept: The Sustainable-Psycho-Nutrition, which is proposed 
as an approach based on behavioral science that integrates the psychological, social, cultural, economic, 
nutritional, and environmental aspects of eating behavior, whose objective is to generate the necessary bases to 
carry out behavioral change interventions, to guide the eating behavior of the population, towards sustainable 
eating behaviors. Within this term, we also launch the nutritional-ecological education, whose objective is to get 
people to acquire and performed the appropriate behavioral repertoire to determine what, how much, when, and 
how to eat, in relation to when, how much, and how energy is spent to maintain or recover their physical well-
being, considering at all times the environmental impact of their behaviors and selecting the most sustainable 
foods, regarding the environment, culture, economy, preferences, food security, health, nutrition, among other 
factors (13).  
Besides those aspects, the mobile application that we are currently developing is going to be a tool that will 
facilitate the promotion of sustainable diets first at the national level in Mexico, and forward, worldwide. Also, 
we will generate the first sustainable food guide for Mexico’s context that will consider not only sustainability 
aspects but psychological and behavioral aspects. Moreover, the workshops, recipes, and food plans that we are 
creating are going to serve as tools for the health and environmental sector of the country to promote the 
consumption of sustainable diets. Finally, the link between gut microbiota and sustainable diets is a new aspect 
that this study will be characterized for the first time, specifically for the Mexican population. Finally, this project 
intends to bring attention to the importance of considering behavioral interventions and techniques for promoting 
sustainable diets.   
 
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24 
Supplementary Material 
Supplementary Material 1. Token economy system cut-off points 
Table SM1.1. Scores according to the frequency of physical activity according to the type of activity 
Physical activity 
Frequency for obtaining points 
Score 
Cardiovascular exercises (any 
including Walking, Jogging, 
Running, Aerobics, Zumba or 
dance, Cycling, Swimming) 
 
or 
 
Strength or resistance exercises 
(any including Crossfit, Weights, 
Multifunctional 
Focused exercises (for example, 
sit-ups, squats, push-ups) 
Once a week 
1  
2 times a week 
2 
3 times a week 
3 
4 times a week 
4 
5 times a week 
5 
6 times a week 
6 
7 times a week 
7 
< once a week  
0 
Combination of cardio and 
strength exercises 
Once a week 
1  
2 times a week 
2 
3 times a week 
3 
4 times a week 
4 
5 times a week 
5 
6 times a week 
6 
7 times a week 
7 
< once a week  
0 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
25 
 
Table SM1.2. Scores according to duration and intensity according to the type of physical activity 
Type  
Duration  
Intensity  
Score  
Cardiovascular 
exercises (any 
including Walking, 
Jogging, Running, 
Aerobics, Zumba or 
dance, Cycling, 
Swimming) 
 
or 
 
Strength or resistance 
exercises (any 
including Crossfit, 
Weights, 
Multifunctional 
Focused exercises 
(for example, sit-ups, 
squats, push-ups) 
Less than 10 minutes 
Mild 
0.5 
10 to 29 minutes  
Mild 
1 
30 to 59 minutes 
Mild 
2  
60 to 120 minutes 
Mild 
3 
More than 120 minutes, but 
less than 240 minutes 
Mild 
4  
More than 240 minutes 
Mild 
4 points and send a message not 
to exceed the amount of exercise 
Less than 10 minutes 
Moderate 
1  
10 to 29 minutes  
Moderate 
2  
30 to 59 minutes 
Moderate 
4  
60 to 120 minutes 
Moderate 
6  
More than 120 minutes, but 
less than 240 minutes 
Moderate 
8  
More than 240 minutes 
Moderate 
8 points and send a message not 
to exceed the amount of exercise 
Less than 10 minutes 
Intense 
2  
10 to 29 minutes  
Intense 
4 
30 to 59 minutes 
Intense 
8 
60 to 120 minutes 
Intense 
12  
More than 120 minutes, but 
less than 240 minutes 
Intense 
16 
More than 240 minutes 
Intense 
16 points and send a message not 
to exceed the amount of exercise 
Combination of 
cardio and strength 
exercises 
Less than 10 minutes of each 
Mild 
1 
10 to 29 minutes of each 
Mild 
2  
30 to 59 minutes of each 
Mild 
4  
60 to 120 minutes of each 
Mild 
6 
More than 120 minutes, but 
less than 240 minutes of each 
Mild 
8 
More than 240 minutes of 
each 
Mild 
8 points and send a message not 
to exceed the amount of exercise 
Less than 10 minutes of each 
Moderate 
2 
10 to 29 minutes of each 
Moderate 
4 
30 to 59 minutes of each 
Moderate 
6  
60 to 120 minutes of each 
Moderate 
8  
More than 120 minutes, but 
less than 240 minutes of each 
Moderate 
10  
More than 240 minutes of 
each 
Moderate 
8 points and send a message not 
to exceed the amount of exercise 
Less than 10 minutes of each 
Intense 
4 
10 to 29 minutes of each 
Intense 
8  
30 to 59 minutes of each 
Intense 
16  
60 to 120 minutes of each 
Intense 
24  
More than 120 minutes, but 
less than 240 minutes of each 
Intense 
32  
More than 240 minutes of 
each 
Intense 
32 points and send a message not 
to exceed the amount of exercise 
 
 
 
 

 
26 
Table SM1.3. Scores according to the frequency of food consumption by groups 
Food group   
Points for consumption frequency 
Score  
Mexican food and dishes 
Once a week  
1 
2 times a week 
2 
3 times a week 
3 
4 times a week 
4 
5 times a week 
5 
6 times a week 
6 
7 times a week 
7 
< once a week   
0 
Mexican desserts and drinks 
Once a week  
1 
2 times a week 
0 
3 times a week 
0 
4 times a week 
0 
5 times a week 
0 
6 times a week 
0 
7 times a week 
0 
Fruits, vegetables, legumes, dairy, 
seeds and healthy fats, eggs 
Once a week  
1  
2 times a week 
2 
3 times a week 
3 
4 times a week 
4 
5 times a week 
5 
6 times a week 
6 
7 times a week 
7 
< once a week   
0 
Fish and shellfish, chicken and other 
white meats 
Once a week  
3 
2 times a week 
2 
3 times a week 
1 
4 times a week 
0 
5 times a week 
0 
6 times a week 
0 
7 times a week 
0 
Red and processed meats, Ultra-
processed foods, Foods high in sugars, 
trans and saturated fats 
0 times a week   
7 
Once a week  
1 
2 times a week 
0 
3 times a week 
0 
4 times a week 
0 
5 times a week 
0 
6 times a week 
0 
7 times a week 
0 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
27 
Table SM1.4. Scores by frequency of consumption 
Food group  
Consumption quantities 
 
Score  
 
Mexican foods and dishes, 
fruits, vegetables, legumes, 
dairy products, seeds and 
healthy fats, eggs 
< recommended portion or > minimum portion 
1 
Recommended portion 
2 
< recommended maximum or > recommended portion 
1 
> the recommended maximum or < the recommended 
minimum 
0 
Fish and shellfish, chicken 
and other white meats, Red 
and processed meats, Ultra-
processed foods, Foods high 
in sugars, trans and saturated 
fats 
Minimum portion 
3 
< Recommended portion > minimum portion 
2 
> recommended portion < maximum portion 
1 
> Maximum portion 
-1 
 
Note: recommend amount of consumption will be determined by the linear optimization programing. An 
example is shown in Table SM1.5.  
 
 
 
 
 

 
28 
 
Table SM1.5. Examples of recommended amounts of consumption by food groups including the target foods of the intervention  
 
 
 
 
Examples of amounts of consumption 
Consumption 
Group by 
objective 
Food 
Average 
Recommended Serving 
Range  
 
 
 
 
Minimum 
Maximum 
Daily (at least 
1 food from 
the group) 
Mexican food 
and dishes 
Chilaquiles with or without egg and/or chicken 
1 cup (160 g) 
80 g 
240 g 
Mexican style egg (tomato, onion, chili, nopal) 
1 plate (220 g) 
110 g 
330 g 
Quesadilla of corn tortilla (without meat) 
1 piece (60 g) 
30 g 
90 g 
Beans taco  
1 piece (60 g) 
30 g 
90 g 
Panela cheese and beans torta (not meat) 
1 piece (197 g) 
98.5 
295.5 g 
Chicken tamal (no red meat) 
1 piece (200 g) 
100 g 
300 g 
Tamal of ash, chard, or cheese (without red meat) 
1 piece (200 g) 
100 g 
300 g 
Sweet tamal (corn, fruits) 
1 piece (172 g) 
86 g 
258 g 
Mole with chicken 
1 plate (334 g) 
167 g 
501 g 
Chicken or vegetarian (mushroom) pozole 
1 plate (300 g) 
150 g 
450 g 
Chicken or cheese flute (no red meat) 
1 piece (75 g) 
37.5 g 
112.5 g 
Bean or chicken sope (no red meat) 
1 piece (75 g) 
37.5 g 
112.5 g 
Chicken or cheese enchilada (no red meat) 
1 piece (75 g) 
196.5 g 
589.5 g 
Fish or chicken taco (no beef or pork) 
1 piece (75 g) 
37.5 g 
112.5 g 
Bean burrito (no meat) 
1 piece (100 g) 
50 g 
150 g 
Fresh water without sugar 
1 cup (240 ml) 
120 ml 
360 ml 
Toast with beans or chicken 
1 big toast (174 g) 
87 g 
261 g 
1 time per 
week 
Rice pudding 
½ cup (178 g) 
89 g 
267 g 
Flan 
1 piece (120 ml) 
60 ml 
180 ml 
Capirotada 
1 slice (60 g) 
30 g 
90 g 
Sweet bread 
1 piece (63 g) 
31.5 g 
94.5 g 
Atole in water 
1 cup (240 ml) 
120 ml 
360 ml 
Atole in milk or champurrado 
1 cup (240 ml) 
120 ml 
360 ml 
Tejuino 
2 cups (418 ml) 
209 ml 
627 ml 
Tuba 
1 cup (240 ml) 
120 ml 
360 ml 
Tepache or honey water  
1 cup (240 ml) 
120 ml 
360 ml 
 
Note: this table will be updated according to the linear optimization programming.  
 

 
29 
 
Table SM1.5. Continuation: Examples of recommended amounts of consumption by food groups including the target foods of the intervention  
 
 
 
 
Examples of amounts of consumption 
Consumption 
Group by 
objective 
Food 
Average 
Recommended Serving 
Range  
Daily (at least 
1 food from 
the group) 
Fruits  
Papaya 
1 cup (140 g) 
70 g 
210 g 
Tuna 
1 piece (70 g) 
35 g 
105 g 
Pineapple 
1 cup (165 g) 
82.5 g 
247.5 g 
Soursop 
½ piece (175 g) 
87.5 g 
262.5 g 
Guava 
2 pieces (83 g) 
41.5 g 
124.5 g 
Capulín 
1 cup (32 g) 
16 g 
48 g 
Pitaya 
1 piece (50 g) 
25 g 
75 g 
Nance 
5 pieces (15 g) 
7.5 g 
22.5 g 
Creole plum 
2 pieces (105 g) 
52.5 g 
157.5 g 
Daily (at least 
1 food from 
the group) 
Vegetables  
Zucchini 
1 piece (91 g) 
45.5 g 
136.5 g 
Pumpkin 
½ cup (110 g) 
55 g 
165 g 
Onion  
½ cup (58 g) 
29 g 
87 g 
Mushrooms 
1 cup (93 g) 
46.5 g 
139.5 g 
Chayote 
½ cup (80 g) 
40 g 
120 g 
Spicy chili 
1 cup (30 g) 
15 g 
45 g 
Huitlacoche 
1/3 cup (66 g) 
33 g 
99 g 
Tomato  
2 pieces (124 g) 
62 g 
186 g 
Nopales 
2 pieces (134 g) 
67 g 
201 g 
Bell pepper 
1 piece (64 g) 
32 g 
96 g 
Poblano chili 
1/2 piece (32 g) 
16 g 
48 g 
Quelites 
½ cup (66 g) 
33 g 
99 g 
Green tomato 
5 pieces (86 g) 
43 g 
129 g 
Purslane 
1 cup (115 g) 
57.5 g 
172.5 g 
Daily (at least 
1 food from 
the group) 
Whole grains 
Corn tortilla 
1 piece (30 g) 
15 g 
45 g 
Baked corn toast 
2 pieces (20 g) 
10 g 
30 g 
Corn dough 
1 ball (45 g) 
22.5 g 
67.5 g 
Unsweetened amaranth 
¼ cup (16 g) 
8 g 
24 g 
Sweetened amaranth 
¼ cup (16 g) 
8 g 
24 g 
Sweet potato 
1/3 cup (69 g) 
34.5 g 
103.5 g 
 
Note: this table will be updated according to the linear optimization programming. 

 
30 
Table SM1.5. Continuation: Examples of recommended amounts of consumption by food groups including the target foods of the intervention  
 
 
 
 
Examples of amounts of consumption 
Consumption 
Group by 
objective 
Food 
Average 
Recommended Serving 
Range  
Daily (at least 
1 food from 
the group) 
Legumes  
Pot beans 
½ cup (86 g) 
43 g 
129 g 
Fried beans 
1/3 cup (75 g) 
37.5 g 
112.5 g 
Cooked lentils 
½ cup (99 g) 
49.5 g 
148.5 g 
Cooked chickpeas 
½ cup (82 g) 
41 g 
123 g 
Baked beans 
½ cup (85 g) 
42.5 g 
127.5 g 
Daily (at least 
1 food from 
the group) 
Dairy products 
Curd 
3 tablespoons (36 g) 
18 g 
54 g 
Fresh cheese 
1 slice (40 g) 
20 g 
60 g 
Panela cheese 
1 slice (40 g) 
20 g 
60 g 
Natural yogurt 
1 cup (227 g) 
113.5 g 
340.5 
Whole milk 
1 cup (240 ml) 
120 ml 
360 ml 
Semi-skimmed milk 
1 cup (240 ml) 
120 ml 
360 ml 
Skim milk (light) 
1 cup (240 ml) 
120 ml 
360 ml 
Daily (at least 
1 food from 
the group) 
Seeds and 
healthy fats 
Avocado 
1/3 piece (31 g) 
15.5 g 
46.5 g 
Dried beans 
¼ cup (38 g) 
19 g 
57 g 
Pumpkin seeds 
2 tablespoons (15 g) 
7.5 g 
22.5 g 
Chia seeds 
5 teaspoons (12 g) 
6 g 
18 g 
Peanuts 
14 pieces (12 g) 
6 g 
18 g 
Canola oil 
1 teaspoon (5 g) 
5 ml 
15 ml 
Daily (at least 
1 food from 
the group) 
Eggs  
Complete chicken egg 
1 piece (44 g) 
22 g 
66 g 
Egg white 
2 pieces (66 g) 
33 g 
99 g 
0 to 3 times a 
week 
Fish and 
shellfish 
White fish 
1 portion (40 g) 
0 g 
60 g 
Octopus 
1 portion (25 g) 
0 g 
37.5 g 
River prawn 
4 pieces (110 g) 
0 g 
165 g 
0 to 3 times a 
week 
Chicken and 
other white 
meat 
Grilled chicken 
1 portion (29 g) 
0 g 
58 g 
Chicken in piece 
1/3 piece (29 g) 
0 g 
58 g 
Insects (maguey worms, crickets) 
1 portion (35 g) 
0 g 
52.5 g 
 
Note: this table will be updated according to the linear optimization programming. 
 
 
 
 

 
31 
 
Table SM1.5. Continuation: Examples of recommended amounts of consumption by food groups including the target foods of the intervention  
 
 
 
 
Examples of amounts of consumption 
Consumption 
Group by 
objective 
Food 
Average 
Recommended Serving 
Range  
0 to 1 time a 
week 
Red and 
processed meats 
Beef 
1 portion (14 g) 
0 g 
60 g 
Pork Meat 
1 portion (14 g) 
0 g 
60 g 
Rabbit 
1 portion (29 g) 
0 g 
58 g 
Pork or turkey ham 
1 slice (10.5 g) 
0 g 
21 g 
Pork or turkey sausage 
1 slice (14 g) 
0 g 
60 g 
Longaniza, chorizo, pepperoni or salami 
1 portion (14 g) 
0 g 
30 g 
Beef or pork tacos 
1 piece (75 g) 
0 g 
112.5 g 
Quesadilla with meat, gringa or synchronized (with sausages 
or meats) 
1 piece (60 g) 
0 g 
90 g 
Enchilada with beef or pork 
1 piece (75 g) 
0 g 
112.5 g 
Flute with beef or pork 
1 piece (75 g) 
0 g 
112.5 g 
Sope with beef or pork 
1 piece (75 g) 
0 g 
112.5 g 
Pork pozole 
1 plate (300 g) 
0 g 
450 g 
Offal 
1 plate (300 g) 
0 g 
450 g 
Birria 
1 plate (200 g) 
 
 
Meat tamal  
1 piece (200 g) 
0 g 
300 g 
Torta (marinated, meat, drowned) 
1 piece (197 g) 
0 g 
295.5 g 
Beef burrito 
1 piece (100 g) 
0 g 
150 g 
Toast with beef or pork 
1 large piece of toast 
(174 g) 
0 g 
261 g 
0 to 1 time a 
week 
Ultra-processed 
foods 
Soft drink with sugar 
¼ can (92 ml) 
0 ml 
138 ml 
Sugar free soft drink 
¼ can (92 ml) 
0 ml 
138 ml 
Packaged juice 
1/3 cup (80 ml) 
0 ml 
120 ml 
Packaged cookies 
1 piece (10.5 g) 
0 g 
15.75 g 
Box cereals 
½ cup (16 g) 
0 g 
24 g 
Instant soup 
1 piece (64 g) 
0 g 
96 g 
Packaged cupcakes (pingüinos, chocorroles, gansitos) 
1/2 piece (25 g) 
0 g 
37.5 g 
Packaged potato chips or snacks 
6 piece (18 g) 
0 g 
27 g 
 
Note: this table will be updated according to the linear optimization programming. 
 

 
32 
 
 
 
Table SM1.5. Continuation: Examples of recommended amounts of consumption by food groups including the target foods of the intervention  
 
 
 
 
Examples of amounts of consumption 
Consumption 
Group by 
objective 
Food 
Average 
Recommended Serving 
Range  
0 to 1 time a 
week 
Foods high in 
added and free 
sugars, trans and 
saturated fats 
Table sugar to sweeten 
1 teaspoon (4 g) 
0 g 
6 g 
Fresh water with sugar 
1 cup (240 ml) 
0 g 
360 ml 
Industrialized jams 
1 tablespoon (17 g) 
0 g 
25.5 g 
Industrialized syrups and honeys 
1 teaspoon (7 g) 
0 g 
10.5 g 
Cake or pie (thin slice) 
1 slice (28 g) 
0 g 
32 g 
Vegetable oil (not olive or canola) 
1 teaspoon (5 ml) 
0 g 
7.5 ml 
Salt added to already prepared foods 
1 pinch (2 g) 
0 g 
3 g 
Vegetable shortening 
1 teaspoon (5 g) 
0 g 
7.5 g 
Margarine 
1 teaspoon (5 g) 
0 g 
7.5 g 
Lard 
1 teaspoon (5 g) 
0 g 
7.5 g 
Butter 
1 teaspoon (5 g) 
0 g 
7.5 g 
 
Note: this table will be updated according to the linear optimization programming. 
 
 
 
 
 
 
 
 

 
33 
 
Supplementary Material 2. Inclusion, exclusion, and elimination criteria 
Table SM2.1. Inclusion, exclusion, and elimination criteria 
Study Criteria 
Inclusion  
Exclusion  
Elimination  
Being between 18 and 35 
years old 
Not signing the informed consent 
Not completing the questionnaires 
Being Mexican 
Not accepting to donate blood 
and/or stool samples 
Do not allow the extraction of 
blood and / or delivery of stool 
sample 
Reside in the South of Jalisco 
for at least 1 year 
Not being able to stand up to take 
anthropometric data 
Failure to complete the 7-week 
intervention or 7-week follow-up 
Levels of physical activity 
below what is recommended 
and what is established as a 
criterion for inclusion in the 
study (Table SM2) 
Perform levels of physical 
activity above the minimum 
established as criteria for 
inclusion in the study (Table 
SM2) 
 
Consuming amounts of food 
below or above that 
established as criteria for 
inclusion in the study or in a 
lesser or greater frequency 
than recommended, according 
to the type of food (Table 
SM2) 
Consume adequate levels of the 
foods to be promoted in the 
intervention program (Table 
SM2) 
 
Have a Smartphone 
Being pregnant or lactating 
 
Not having consumed 
antibiotics at least 3 months 
before the intervention 
Suffer from a chronic disease 
such as type 2 diabetes mellitus, 
arterial hypertension, 
dyslipidemia, under  medication 
 
Have a BMI between 18.5 and 
40 
Suffering from an autoimmune 
disease such as type 1 diabetes, 
hypo or hyperthyroidism 
 
Not having a medical 
diagnosis of chronic disease 
under pharmacological 
treatment 
Having a gastrointestinal disease 
such as Crohn's disease, 
ulcerative colitis, etc. 
 
Not having a medical 
diagnosis of gastrointestinal 
disease 
Having used antibiotics less than 
3 months ago 
 
 
Taking antidepressant 
medications or corticosteroids 
 
 
Consume probiotics or nutritional 
supplements, except protein 
powder 
 
 
 
 
 
 
 

 
34 
Table SM2.2 Cut-off points to establish inadequate consumption and physical activity, to be included in the 
research 
 
Physical activity 
Inclusion criteria 
Type of physical activity 
Light 
Weekly frequency 
< 3 times per week 
Minutes per day 
< 30 minutes per day 
Food group 
Consumption to be 
included in the study 
Frequency of consumption to 
be included in the study 
Mexican food and dishes 
< 100 g p-1d-1 
< 7 times a week 
Fruits  
< 400 g p-1d-1 
< 7 times a week 
Vegetables  
< 400 g p-1d-1 
< 7 times a week 
Whole cereals   
< 200 g p-1d-1 
< 7 times a week 
Legumes 
< 60 g p-1d-1 
< 7 times a week 
Seeds and healthy fats 
< 80 g p-1d-1 
< 7 times a week 
Dairy products 
> 250 ml p-1d-1 
> 5 times a week 
Eggs  
> 25 g p-1d-1 
> 5 times a week 
Fish and shellfish  
> 28 g p-1d-1 
> 3 times a week 
Chicken 
> 29 g p-1d-1 
> 3 times a week 
Red and processed meats 
> 7 g p-1d-1 
> once a week 
Ultra-processed foods 
> 10 g p-1d-1 
> once a week 
Added and free sugars and foods high in 
trans and saturated fats 
> 31 g p-1d-1 
> once a week 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
35 
Supplementary Material 3. Clinical history which will be uploaded to the mobile application  
Table SM3.1 Initial Assessment Questionnaire  
Clinic history 
General and sociodemographic data 
Last name: 
Middle name:  
Name:  
Cell phone: 
Email: 
Age: 
Date of Birth: 
Sex:  
Country of birth: 
City of residence: 
State of birth: 
Time living there: 
Occupation 
Less than 1 month 
 
Officer, director or boss 
 
1 to 6 months 
 
Professional or technician 
 
6 to 12 months  
 
Auxiliary worker in administrative activities 
 
1 to 3 years 
 
Merchant, sales clerk, or sales agent 
 
3 to 6 years 
 
Workers in personal and surveillance services 
 
6 to 9 years 
 
Worker in agricultural, livestock, forestry, hunting or fishing activities 
 
10 years or more 
 
Craft worker 
 
Lifetime 
 
Industrial machinery operator, assemblers, chauffeur or transport driver 
 
Workers in elementary and support activities 
 
Education   
Student 
 
Did not sudy   
 
Unemployed 
 
Unfinished primary 
 
Retired 
 
Finished elementary school 
 
Other (specify): 
 
Unfinished high school 
 
Days a week that work 
High school finished 
 
1 
 
Unfinished high school 
 
2 
 
School completed 
 
3 
 
Unfinished technical career 
 
4 
 
Technical career finished 
 
5 
 
Undergraduate student 
 
6 
 
Unfinished degree 
 
7 
 
Completed bachelor's degree 
 
Modality 
 
Master's degree 
 
Face-to-face 
 
Doctorate 
 
Online  
 
Specialty 
 
Mixed  
 
Other:  
 
Online until further notice 
 
Individual and family 
monthly income (pesos per 
month MXN) 
Individual expenditure 
on food per month 
(MXN pesos) 
Household expenditure on food 
per month (MXN pesos) 
Feeding 
–0 - 2,699 
 
 
 
 
0 – 500 
Favorite foods 
2,7–0 - 6,799 
 
–0 - 200 
 
 
500 – 1,000 
 
6,8–0 - 11,599 
 
2–0 - 500 
 
 
1,000 – 3,000 
Foods you don't like 
11,6–0 - 34,999 
 
500 – 800 
 
 
3,000 – 6,000 
 
35,000 - 84,999 
 
800 – 1,000 
 
 
6,000 – 9,000 
Food allergies and intolerances 
+ 85,000 
 
1,500- 2,000 
 
 
10,0–0 - 13,000 
Lactose  
 
 
 
2,500 – 3,000 
 
 
13,000 – 16,000 
Seafood 
 
 
 
3,000 – 3,500 
 
 
16,000 – 20,000 
Gluten  
 
 
 
+ 4,000 
 
 
+ 20,000 
Fresas  
 
Diet and physical activity 
Nuts  
 
Main place of food 
purchase 
Who cooks the food you eat? 
Are you currently 
following a specific 
diet? 
Peanuts 
 
Tianguis  
 
Me 
 
Others (specify): 
 
Market  
 
Mother 
 
Yes 
 
Retail supermarket 
(Soriana, Walmart) 
 
Father 
 
To lose weight 
 
Wholesale 
supermarket (Sam's, 
Costco) 
 
Economic Kitchen 
 
To gain weight 
 
Butcher shop 
 
Restaurants 
 
Ketogenic 
 
Creamery 
 
I get it as a gift   
 
Vegetarian (ovo-lacto, ovo or lacto) 
 
Fruit store 
 
Others (specify): 
 
Intermittent fasting 
 
Others (specify): 
 
Vegan 
 
Mediterranean 
 
DASH or diet to stop hypertension 
 
Others (specify): 
 
 
 
 
 

 
36 
Table SM3.1 Continuation: Initial Assessment Questionnaire  
Clinic history 
Physical activity 
Currently doing physical activity 
Type of activity 
 
  
Less than 3 times a week 
 
Walking  
 
3 or more days of vigorous activity of at least 20 minutes per day 
 
Jogging 
 
5 or more days of moderate to vigorous activity or walking at least 30 minutes per day 
 
Run 
 
3 days a week of very vigorous activity for at least 60 minutes a day 
 
Aerobics, Zumba or dance 
 
7 days a week of moderate to vigorous activity or even walking for at least 60 minutes per day 
 
Cycling 
 
Times a week 
Type of activity 
Minutes a day 
Swimming 
 
1 
 
10 
 
Crossfit 
 
2 
 
20 
 
Weightlifting 
 
3 
 
30 
 
Multifunctional 
 
4 
 
40 
 
Focused exercises (write 
which ones, e.g. sit-ups, sit-
ups, push-ups) 
 
5 
 
50 
 
Other:  
 
6 
 
60 
 
 
7 
 
90 
 
Intensity 
120 
 
Mild 
 
150 
 
Moderate 
 
180 
 
Intense 
 
210 
 
240 or more  
 
Other: 
 
Anthropometric data 
Estimated weight for you: 
 
Size in centimeters 
estimated by you: 
 
 
 
Height (centimeters): 
 
Weight (kg): 
 
BMI:  
 
Fat percentage:    
 
Muscle mass: 
 
Body water: 
 
Metabolic age: 
 
Metabolic rate: 
 
Visceral fat: 
 
Waist circumference: 
 
Hip circumference: 
 
Bone mass: 
 
Biochemical indicators 
Clinical indicators 
Fasting glucose 
 
Blood pressure 
 
Glucose 2 hours after eating 
 
Acanthosis nigricans 
 
Triglycerides 
 
Signs and symptoms of nutritional deficiencies 
Total cholesterol 
 
Overall status 
 
LDL cholesterol 
 
Very tired 
 
HDL cholesterol 
 
Dizziness 
 
Gut microbiota   
 
Very thirsty 
 
Gastrointestinal signs and symptoms 
Frequent urination 
 
Abdominal swelling 
 
Very hungry 
 
How often does it happen? 
 
Do your feet or hands swell? 
 
Diarrhea 
 
What time of day does it occur? 
 
How often does it happen? 
 
How often does it happen? 
 
Constipation 
 
How many hours do you spend 
sitting a day? 
 
How often does it happen? 
 
How many hours do you spend 
standing a day? 
 
Reflux 
 
Nose bleed 
 
How often does it happen? 
 
How often does it happen? 
 
Abdominal swelling 
 
Red spots on your skin or bruises 
for no reason 
 
How often does it happen? 
 
How often does it happen? 
 
Nails  
Hair 
Brittle nails 
Hair loss 
 
Have you recently performed any cosmetic treatment on your nails? 
Brittle hair Is your hair dyed or undergoing any cosmetic 
treatment? 
 
 
 
 
 
 
 
 
 
 
 

 
37 
Table SM3.1 Continuation: Initial Assessment Questionnaire  
Clinic history 
Signs and symptoms of nutritional deficiencies 
Mouth 
Sueño 
 
Cuts at the corners of your mouth 
 
How many hours do you sleep a day? 
 
How often does it happen? 
 
Do you rest at night?  
 
Tongue swelling 
 
Do you wake up during the night? 
 
How often does it happen? 
 
How often does it happen? 
 
Gum inflammation 
 
How many hours do you sleep a day? 
 
How often does it happen? 
 
Do you rest at day?   
 
Solar exposition 
How many minutes do you expose yourself to the sun per day? 
Do you cover your skin with long-sleeved clothing, 
pants, a cap or a hat? 
Less than 5 minutes 
 
Always 
 
5 to 10 minutes 
 
Sometimes  
 
10 to 15 minutes 
 
Never  
 
15 to 20 minutes 
 
Do you use sunscreen? 
 
20 to 30 minutes 
 
Yes 
 
30 minutes to 1 hour 
 
No 
 
More than 1 hour 
 
How many days do you expose yourself 
to the sun per week? 
 
Type of delivery 
 
1 
 
You were born for: 
 
2 
 
Vaginal delivery 
 
3 
 
Caesarean section 
 
4 
 
Notes:   
 
5 
 
 
6 
 
 
7 
 
Lactation 
 
Write for how long 
Exclusive breastfeeding 
 
 
Formula feeding (if you received only artificial milk as food) 
 
Observations: 
Mixed breastfeeding (if in addition to breastfeeding you received any artificial 
milk) 
 
Supplemented breastfeeding (if non-dairy solid or liquid foods were received 
in addition to breastfeeding) 
 
Mixed supplemented breastfeeding (if it was a breastfed infant, who also 
received some artificial milk and solid or liquid foods) 
 
Complemented artificial feeding (if when breastfeeding you received artificial 
milk and solid or liquid foods) 
 
Festivities 
Please write the main holidays you celebrate and on the right side write the main foods you eat on these holidays 
Festivity 
Food eaten on the holiday 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hygiene habits 
How often do you take a bath? 
 
How many times do you brush your teeth a day? 
 
Is the street where you live paved? 
 
What type of flooring does your house have? 
 
Do you have pets? What type? 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
38 
Table SM3.1 Continuation: Initial Assessment Questionnaire  
Personal and family history 
Do you suffer from any disease? 
Mark pathology 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Type 2 diabetes 
Arterial hypertension 
Elevated triglycerides 
High cholesterol 
Nervous colitis 
Cancer 
Hypothyroidism 
Hyperthyroidism 
Rheumatoid arthritis 
Chronic renal insufficiency 
Heart disease 
Depression 
Other  
If you selected the other option, specify which or which 
 
Does anyone in your family suffer from any disease? 
Father 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mother 
 
 
 
 
 
 
 
 
 
 
 
 
 
Brother 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sister 
 
 
 
 
 
 
 
 
 
 
 
 
 
Paternal grandfather 
 
 
 
 
 
 
 
 
 
 
 
 
 
Paternal grandmother 
 
 
 
 
 
 
 
 
 
 
 
 
 
Maternal grandfather 
 
 
 
 
 
 
 
 
 
 
 
 
 
Maternal grandmother 
 
 
 
 
 
 
 
 
 
 
 
 
 
Paternal uncle 
 
 
 
 
 
 
 
 
 
 
 
 
 
Paternal aunt 
 
 
 
 
 
 
 
 
 
 
 
 
 
Maternal uncle 
 
 
 
 
 
 
 
 
 
 
 
 
 
Maternal aunt 
 
 
 
 
 
 
 
 
 
 
 
 
 
Other:  
 
Do you currently take any medications and/or supplements? 
Medicines 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ampicillin 
Bezafibrate 
Cephalexin 
Ciprofloxacin 
Clarithromycin 
Fluoxetine 
Insulin 
Levothyroxine 
Losartan 
Metformin 
Omeprazole 
Pravastatin 
Telmisartan 
Other. If you selected the other option, specify which or 
which 
 
Supplements 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Multivitamin 
Vitamin D 
Probiotics 
Prebiotics 
Vitamin C 
Vitamin E 
Iron 
Calcium 
Omega 3 
Protein powder 
Creatine monohydrate 
Other  
 
 
 
 
 
 
 
 
 
 
 

 
39 
Table SM3.1 Continuation: Initial Assessment Questionnaire  
24-hour reminder 
Food time 
Menu / Preparation 
Ingredient / Food 
Quantity 
Breakfast 
 
 
 
 
 
 
 
 
 
Hour: 
Place: 
Morning snack  
 
 
 
 
 
 
 
 
 
Hour: 
Place: 
Meal  
 
 
 
 
 
 
 
 
 
Hour: 
Place: 
Evening snack 
 
 
 
 
 
 
 
 
 
Hour: 
Place: 
Dinner 
 
 
 
 
 
 
 
 
 
Hour: 
Place: 
Milliliters of water consumed throughout the day: 
 
 
 
 
 
 
 
 

 
40 
 
Table SM3.1 Continuation: Initial Assessment Questionnaire  
Food frequency questionnaire 
For each food, indicate how many times per month or per week you consume it. Subsequently, indicate how many times a day you consume it, the day you take it. For example, if you drink 2 cups (480 milliliters) of whole milk 3 
times a week and those 3 days you drink it in the morning and at night, you drink it 3 times a week and 2 times a day, in a quantity of 2 portions. It is also important to consider the summer/winter variation. For example, if you eat ice 
cream 4 times a week during the 3 summer months, your average consumption is 1 time a week. 
Group  
 
 
 
Food  
 
 
 
Portion  
Type, brand, flavor or 
preparation 
Average consumption last year 
*Mark 1 option among these 3 frequencies. 
*If you do not consume it, choose the option never 
and go to the next food. 
When you 
consume it, 
how many 
times a day do 
you do it? 
(Check 1 
option per day) 
Number of servings 
Times a year 
Times a 
month 
Times a week 
Times a day 
(Mark how many servings you 
consume each time you eat it) 
Never 
1-5 
6-11 
1 
2 
3 
1 
2 
3 
4 
5 
6 
7 
1 
2 
3 
4+ 
1/4 
1/2 
1 
2 
3 
4 
5 
6+ 
Dairy  
1. Whole milk 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
2. Semi-skim milk 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
3. Skim milk 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
4. Almond milk 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
5. Soy milk  
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
6. Coconut milk 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
7. Chocolate flavored milk 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
8. Packaged milk shake 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
9. Whole yogurt (sweetened with fruit) 
1 cup (227 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
10. Low-fat yogurt  
1 cup (240 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
11. Fermented milk drink 
1 piece (80 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
12. Bionico cream (evaporated milk with cow cream)  
½ cup (120 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cheeses 
13. Curd 
3 tablespoons (42 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
14. Cottage cheese 
3 tablespoons (48 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
15. Fresh cheese (not in quesadillas)  
1 slice (40 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
15.1 Panela cheese (not in quesadillas) 
1slice (40 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
16. Cured cheeses consumed alone (manchego, oaxaca, asadero, 
mozzarella, cheddar, goat, parmesan, chihuahua), (not in 
quesadillas) 
1 slice (30 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Animal source 
foods 
17. Chicken eggs 
1 piece (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
18. Egg white 
2 pieces (66 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
19. Chicken with skin (chicken pieces except wings) 
1 piece (200 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
20. Chicken without skin in pieces 
1 piece (200 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
20.1 Grilled skinless chicken fillet 
1 ration (90 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
21. Turkey 
1 ration (108 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
21.1 Bunny  
1 ration (90 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
22. Beef steak or steak (stews, griddle) 
1 ration (90 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
41 
23. Ground beef (meatballs, hash) 
1 ration (99 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
24. Pork (stews, grilled) 
1 ration (120 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
25. Sheep meat (al pastor, stews) 
1 ration (111 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
26. Goat meat (birria) 
1 ration (100 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
27. Liver or organ meats of chicken, beef or pork (brains, 
gizzard, heart) 
1 ration (90 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
28. Turkey or pork ham (besides of used in sandwich) 
1 slice (21 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
29. Turkey or pork sausage (other than hot dog) 
1 piece (61 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
30. Processed meats (pepperoni, salami, sausage, chorizo, 
machaca) 
½ cup (20 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
31. Bacon 
1 slice (16 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
32. Pork rinds 
½ cup (24 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
33. White fish (tilapia, sole) 
1 ration (120 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
34. Blue fish (salmon, tuna, red snapper) 
1 ration (120 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
35. Salty fish (cod, dried charales) 
1 ration (90 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
36. Canned fish (tuna, sardine) or shellfish in water 
½ can (55g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
37. Canned fish (tuna, sardine) or shellfish in oil 
½ can (55g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
38. Shellfish (shrimp, prawn) 
10 piece (68 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
38.1 River prawn 
10 piece (68 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
39. Octopus or squid 
1 ration (100 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
40. Oysters, clams, mussels 
4 pieces (58 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
40.1 Insects (maguey worms, crickets) 
1 portion (35 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Vegetables 
 
41. Frozen vegetables 
½ cup (46 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
42. Spinach, chard or purslane 
1/2 cup (30 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
43. Broccoli or cauliflower 
½ cup (108 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
44. Lettuce, cabbage, cabbage or kale 
½ cup (25 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
45. Red tomato raw or in sauce 
1 piece (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
46. Carrot 
½ piece (64g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
47. Zucchini  
1 piece (91 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
48. Pumpkin 
½ cup (110 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
49. Green beans or peas 
½ cup (63 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
50. Cucumber 
1 piece (104 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
51. Celery 
½ cup (45 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
52. Beetroot 
¼ piece (39 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
53. Eggplant 
½ cup (50 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
54. Asparagus 
3 piece (45 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
55. Onion  
¼ cup (29 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
56. Green tomato, raw or in sauce 
4 pieces (69 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
57. Mushrooms 
½ cup (70 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
57.1 Huitlacoche 
1/3 cup (66 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
58. Chayote 
½ cup (80 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
59. Jicama  
½ cup (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
60. Cooked, raw or roasted nopales (cactus)  
½ cup (75g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
61. Bell pepper 
1/2 piece (32 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
42 
62. Poblano Chile 
1/2 piece (32 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
62.1 Quelites  
½ cup (66 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
62.2 Purslane 
1 cup (115 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
63. Hot peppers (jalapeño, serrano, habanero) 
1 piece (30 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
64. Garlic  
¼ piece (1 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
65. Coriander, parsley, oregano, basil, bay leaf 
1 pinch (6 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fruits 
66. Orange (not in juice) 
1 piece (76 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
67. Grapefruit (not in juice) 
1 piece (76 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
68. Tangerines (not in juice) 
1 piece (76 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
69. Lemon 
1 piece (38 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
70. Lime (not in juice) 
1 piece (49 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
71. Banana (not fried) 
1 piece (108 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
72. Apple  
1 piece (106 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
73. Pear  
1 piece (162 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
74. Strawberries 
6 pieces (68 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
75. Blueberry   
½ cup (49 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
76. Raspberry   
½ cup (61 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
77. Blackberry  
½ cup (72 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
78. Creole plum 
2 pieces (105 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
78.1 Capulín  
1 cup (32 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
78.2 Nance  
5 pieces (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
79. Cherries  
4 pieces (18 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
80. Peach   
1 piece (77 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
81. Nectarine  
1 piece (124 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
82. Watermelon  
1 cup (160 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
83. Cantaloupe  
1 cup (160 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
84. Papaya 
1 cup (140 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
85. Kiwi 
1 piece (76 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
86. Grapes  
18 pieces (86 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
87. Mango  
½ piece (110 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
88. Guava  
2 pieces (83 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
89. Tuna 
1 piece (70 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
90. Pitaya 
1 piece (50 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
91. Guanabana  
½ piece (175 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
92. Pineapple  
1 cup (165 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
93. Canned fruit in syrup 
½ cup (124 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
94. Dehydrated fruit (blueberries, raisins, dates, prune) 
10 pieces (20 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Protein oils 
 
95. Almonds 
10 pieces (12 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
96. Raw peanuts 
14 pieces (12 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
96.1 Peanuts (Japanese, enchiladas, with salt) 
14 pieces (12 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
97. Nuts  
7 halvez (10 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
98. Pistachios, hazelnuts, pine nuts 
18 pieces (13 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
98.1 Dried beans 
18 pieces (13 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
99. Sunflower or hemp seeds 
1 tablespoon (10 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
43 
99.1 Pumpkin seeds 
1 tablespoon (10 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
100. Chia seeds 
1 teaspoon (3 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
100.1 Flax 
1 teaspoon (3 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
101. Peanut or almond butter 
1 tablespoon (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Legumes 
102. Cooked beans 
½ cup (99 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
103. Refried beans   
½ cup (99 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
104. Cooked lentils   
½ cup (99 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
105. Cooked chickpeas   
½ cup (82 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
105.1 Baked beans 
½ cup (99 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
106. Chickpea hummus 
4 tablespoon (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
107. Textured soy 
1/2 cup (30 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fat-free cereal 
108. Corn tortilla   
1 piece (30 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
10.8.1 Corn dough 
1 ball (45 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
109. Corn 
1 piece (116 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
110. Baked or boiled potato 
1 piece (136 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
111. Flour tortilla 
1 piece (28 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
112. Wholemeal flour tortilla 
1 piece (28 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
113. Bolillo, birote or telera (not in cake) 
½ piece (30 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
114. White bread or toast white bread (apart from sandwich) 
1 slice (27 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
115. Whole wheat bread or toast whole wheat bread (apart from 
sandwich) 
1 slice (25 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
116. Unsweetened box cereal  
1 cup (25 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
117. Sweetened box cereal  
1 cup (25 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
118. Whole wheat box cereal  
1 cup (25 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
119. Pasta (noodles, macaroni, spaghetti) 
½ cup (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
120. Oatmeal (flaked, cooked in water) 
½ cup (20 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
121. Cooked oatmeal with milk and sugar (drink or solid) 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
122. Cooked white rice or Mexican cooked white rice 
½ cup (94 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
123. Brown or wild rice 
½ cup (94 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
124. Natural puffed rice or puffed rice cake 
½ cup (17 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
125. Unsweetened amaranth 
½ cup (32 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
125.1 Sweetened amaranth or amaranth bar 
½ cup (32 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
126. Cooked sweet potato 
½ cup (103 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
127. Sweet potato cooked with sugar 
½ cup (103 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
128. Quinoa  
½ cup (40 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
129. Marías or animals shape biscuits 
5 pieces (19 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
130. Whole meal or fibre biscuits (sweet or salty type) 
1 sweet or 9 salty (45 
g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
131. Salty biscuits  
4 pieces (16 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
132. Baked Maize toast  
1 piece (10 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fatty 
cereals 
133. Fried Maize toast 
1 piece (12 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
134. Packaged sweet biscuits  
2 piece (21 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
135. Granola bar 
1 piece (35g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
136. Granola with nuts 
3 tablespoons (21 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
44 
137. Hot cake or waffle  
1 piece (50 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
138. Industrialized bread (donuts, shortcakes) 
1 piece (30 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
139. Industrialized bread with chocolate 
1 piece (50 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
140. Sweet bread (conchas, orejas, polvorón) 
1 piece (63 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
141. Cake or pay (thick slice) 
1 slice (56 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
142. Homemade breads or rosca de reyes 
1 slice (56 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
143. Packaged chips  
1 bag (55 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
144. Packaged Maize snack 
1 bag (58 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
145. French fries or home fries 
4 pieces (20 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
146. Wheat churritos 
1 bag (50 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
147. Popcorn (homemade, microwave, cinema) 
½ bag (40 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Protein oils 
148. Oil spray 
5 sprays (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
149. Olive oil 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
150. Avocado oil   
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
151. Maize oil  
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
152. Coconut oil   
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
153. Sunflower oil  
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
154. Soy oil 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
155. Canola oil  
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
156. Safflower oil 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
157. Olives  
8 pieces (24 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
158. Chopped coconut 
1 strip (16 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
159. Avocado or guacamole 
½ pieces (46 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
160. Mayonnaise, dressing or vinaigrette 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
161. Margarine 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
162. Butter   
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
163. Lard 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
164. Vegetable shortening 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
165. Cream cheese 
1 tablespoon (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
166. Cream, nata or jocoque 
1 tablespoon (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sugars with and without fat 
 
167. Sugar  
1 teaspoonful (4 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
168. Honey   
1 teaspoonful (7 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
169. Maple syrup 
1 teaspoonful (7 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
170. Cajeta  
1 tablespoon (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
171. Hazelnut cream  
1 tablespoon (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
172. Condensed milk 
1 tablespoon (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
173. Piloncillo (brown sugar)  
1 portion (10 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
174. Jams 
1 tablespoon (17 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
175. Packaged candy (i.e. popsicles, solid sweets, jelly beans) 
1 - 5 pieces (20 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
176. Chocolates  
1 bar (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
177. Cocoa powder for chocolate milk  
1 tablespoon (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
178. Ice cream or ice cream popsicle 
1 scoop/piece (96 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
179. Water-based ice cream or ice cold water palette 
1 scoop/piece (65 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
180. Tapioca (cooked in caramel or milk) 
½ cup (147 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
45 
181. Gelatin in water or milk  
1 piece (125 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
182. Mexican candy (Ate, cocada, marzipan, palanqueta 
(peanut or walnut), milk candy) 
1 piece (28 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
183. Fried or honeyed bananas 
1 piece (123.5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fast food 
184. Pizza 
1 slice (100 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
185. Burger 
1 piece (235 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
186. Hot dog 
1 piece (156 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
187. Ham sandwich 
1 piece (128 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
188. Instant soup 
1 piece (64 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
189. Sushi  
4 rolls (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
190. Chicken wings 
1 piece (51 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
191. Baguette or panini  
1 piece (208 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
192. Envelope soups and creams 
1 plate (100 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mexican food 
193. Chilaquiles with beef 
1 cup (160 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
193. Chilaquiles with egg and/or chicken but without beef 
1 cup (160 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
193.1 Mexican style egg (tomato, onion, chili, nopal) 
1 plate (220 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
194. Offal 
1 plate (300 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
195. Corn tortilla quesadillas without meats 
1 piece (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
195.1 Corn tortilla quesadillas with meats 
1 piece (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
196. Flour tortilla quesadillas 
1 piece (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
197. Torta (marinated, meat, drowned) 
1 piece (197 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
197.1 Panela cake or beans (not meat) 
1 piece (197 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
198. Meat tamale (beef, pork, chicken) 
1 piece (200 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
198.1 Chicken tamale 
1 piece (200 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
198.2 Cheese tamale 
1 piece (200 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
198.3 Tamale of rajas or ash (beans) 
1 piece (200 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
199. Sweet tamale (corn, fruits) 
1 piece (172 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
200. Mole with chicken 
1 plate (334 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
201. Pork pozole 
1 plate (300 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
201.1 Chicken pozole 
1 plate (300 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
201.2 Vegetarian pozole (mushrooms) 
1 plate (300 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
202. Sopitos with beef or pork 
1 piece (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
202.1 Sopitos of beans or chicken (no red meat) 
1 piece (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
202.1 Enchiladas with beef or pork 
1 piece (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
202.2 Chicken or cheese enchilada (no red meat) 
1 piece (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
202.2 Flautas with beef or pork 
1 piece (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
202.3 Chicken or cheese flautas (no red meat) 
1 piece (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
203. Natural vegetable soups, broths or creams 
1 plate (393 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
204. Beef tacos 
1 piece (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
204.1 Pork tacos (adobado, al pastor) 
1 piece (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
204.2 Beans taco 
1 piece (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
204.3 Chicken or fish tacos 
1 piece (75 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
205. Beef burrito 
1 piece (100 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
205.1 Meatless Bean Burrito 
1 piece (100 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
46 
205.2 Toast with beef or pork 
1 large toast (174g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
205.2 Toast with beans or chicken 
1 large toast (174g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
206. Rice pudding 
½ cup (178 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
207. Flan, jericalla, custard 
1 piece (120 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
208. Capirotada 
1 slice (60 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
209. Stuffed or sugared churros 
1 pice (90 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
210. Corn atole in water 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
211. Corn atole in milk or champurrado 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Condiments 
212. Ketchup or canned tomato puree 
1 tablespoon (15 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
213. Bottled hot sauce 
1 teaspoonful (6 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
214. Mustard 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
215. Salt 
1 pinch (2 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
216. Soy sauce 
1 teaspoonful (5 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
217. Vanilla, pepper, cinnamon, ginger, turmeric, curry, cloves, 
anise 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
218. Coffee creamer 
1 teaspoonful (5 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Beverages 
219. Soft drink or drink with sugar 
1 bottle (600 ml)  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
220. Soft drink or drink without sugar or light 
1 bottle (600 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
221. Fresh fruit water with sugar 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
221.1 Fresh fruit water without sugar 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
222. Natural fruit juice (orange, grapefruit) 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
223. Industrialized fruit juice 
1 bottle (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
224. Sports drink (Gatorade, etc) 
1 bottle (600 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
225. Tejuino  
2 cups (418 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
225.1 Tuba 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
225.2 Raspados 
2 cups (418 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
226. Soluble or American coffee 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
227. Coffee pot 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
228. Cappuccinos or lattes 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
229. Frappuccinos or milk shakes 
2 cups (480 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
230. Chocolate in water 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
231. Milk chocolate 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
232. Tea or cinnamon 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
233. Natural water 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Alcoholic drinks 
234. Red wine 
1 glass (100 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
235. White or rosé wine 
1 glass (100 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
236. Beer 
1 can or bottle (356 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
237. Spirits: whiskey, vodka, gin, cognac, tequila, mezcal, rum, 
brandy 
1 shot (60 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
238. Punch (pomegranate, raspberry) 
1 glass (80 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
239. Rompope  
1 glass (80 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
240. Pulque, tepache or honey water  
1 glass (80 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
O
th
241. Protein supplement 
1 scoop (40 g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
242. Estevia  
1 sachet (3g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
47 
243. Splendaâ or Canderelâ 
1 sachet (3g) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
244. Multivitamin supplements (place mark) 
1 capsule 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fermented foods 
245. Kéfir  
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
246. Kombucha (Fermented tea)  
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
247. Tempeh (Fermented soy) 
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
248. Natto (Fermented soy)  
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
249. Miso (Fermented soybean paste)  
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
250. Kimchi (Fermented vegetables)  
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
251. Sourdough bread (Sourdough bread)  
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
252. Saurkraut (Fermented cabbage)  
1 cup (240 ml) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Note: foods colored blue corresponds to those that will be included in the intervention program and correspond to those presented in Table A6.5, where the frequency and 
quantity of consumption to be promoted are specified. FCFQ adapted from: Lares-Michel, M.; Housni, F. E.; Aguilera Cervantes, V. G.; Michel Nava, R. M. Nutriecology: A 
Mexican web-based nutritional ecologic software for the assessment of diet, dietary pattern, diet quality, and dietary environmental impact. Nutrients (under revision).  
 
 
 
 
 
 
 
 
 
 
 
 
 

 
48 
 
Supplementary Material 4. COM-B questionnaire including nutritional-sustainable knowledge questions  
This questionnaire will be modified based on the issues addressed during the development of the program, as well as based on the execution of the pilot test, where multiple 
options will be established for data analysis. However, the format to be used and the questions determined so far are presented below, which incorporate the elements of the 
COM-B model, which include capacity, opportunity, and motivation (14). Likewise, questions on sustainable food consumption were integrated, according to the questionnaire 
by Verain et al. (62). 
 
Table SM4.1. COM-B questionnaire including nutritional-sustainable knowledge questions  
COM-B questionnaire 
Participant number:   
Date:  
COM-B dimension  
Answer 
Mark your answer 
Explain your answer 
Capability 
Knowledge of general nutrition and sustainability 
Do you know which food groups exist? 
Yes 
 
 
No 
 
If you know, write them down please. 
Do you know what foods contain carbohydrates? 
Yes 
 
 
 
No 
 
If you know, write them down please. 
Do you know what foods contain fat? 
Yes 
 
 
 
No 
 
If you know, write them down please. 
Do you know what foods contain protein? 
Yes 
 
 
 
No 
 
If you know, write them down please. 
Did you know that the food you eat requires high amounts of water during its production? 
Yes 
 
 
No 
 
Explain your answer please 
Did you know that the food you eat generates greenhouse gas emissions during its production, which promote 
climate change? 
Yes 
 
 
 
No 
 

 
49 
Explain your answer please 
What foods do you think use more water during their production? 
Yes 
 
 
 
No 
 
If you know, write them down please. 
What foods do you think generate more greenhouse gas emissions during their production? 
Yes 
 
 
 
No 
 
If you know, write them down please. 
Do you consider that the traditional Mexican diet is healthy? 
Yes 
 
 
 
No 
 
Explain your answer please 
Do you consider that the tortilla is "fattening"? 
Yes 
 
 
 
No 
 
Explain your answer please 
Do you consider that buying food in local markets or markets is frowned upon? 
Yes 
 
 
 
No 
 
Explain your answer please 
Do you consider it a better option to buy your food in supermarkets than in local markets? 
Yes 
 
 
 
No 
 
Explain your answer please 
If you knew all the environmental impacts of your diet, would you change it? 
Yes 
 
 
 
No 
 
Explain your answer please 
Would you be willing to eat less red meat if you knew that it had a high environmental impact? 
Yes 
 
 
 
No 
 
Explain your answer please 
 
Do you know what sustainable diets are? 
Yes 
 
 
 
No 
 
Explain your answer please 
Specific nutrition and sustainability knowledge 
Aspect  
Write your answer please 
Please mention the benefits of physical activity 
 
Mention what is the recommended amount of physical activity to perform per day 
 
Please mention the benefits of consuming a traditional Mexican diet 
 
Mention what is the recommended amount to consume of portions of Mexican food per day 
 
Please mention the benefits of consuming fruits and vegetables 
 
Mention what is the recommended amount to consume of servings of fruits and vegetables per day 
 
Please mention the benefits of consuming whole grains 
 
Mention what is the recommended amount to consume of servings of whole grains per day 
 
Please mention the benefits of consuming legumes 
 
Mention what is the recommended amount to consume portions of legumes per day 
 
Please mention the benefits of consuming seeds and healthy fats 
 
Mention what is the recommended amount to consume of portions of seeds and healthy fats per day 
 
Please mention the benefits of consuming dairy in adequate amounts 
 
Mention what is the recommended amount to consume of dairy portions per day 
 

 
50 
Please mention the benefits of consuming eggs in adequate amounts 
 
Mention what is the recommended amount to consume of servings of eggs per day 
 
Please mention the benefits of consuming fish and shellfish in adequate amounts 
 
Mention what is the recommended amount to consume of portions of fish and shellfish per day 
 
Please mention the benefits of consuming chicken in adequate amounts 
 
Mention what is the recommended amount to consume chicken portions per day 
 
Please mention the benefits of avoiding red and processed meats 
 
Mention what is the recommended amount to consume of portions of red and processed meats 
 
Please mention the benefits of avoiding ultra-processed foods 
 
Mention what is the recommended amount to consume of portions of ultra-processed foods per day 
 
Please mention the benefits of avoiding added sugar, foods high in trans and saturated fats 
 
Mention what is the recommended amount to consume of portions of added sugar, foods high in trans and saturated 
fats 
 
Food preparation skills 
Do you know how to cook? 
Yes     /     No 
If the answer was yes, what foods do you know how to cook? 
 
Preparation capacity 
Does it have a kitchen equipped with a stove? 
Yes     /     No 
Does it have a kitchen equipped with a refrigerator? 
Yes     /     No 
Does it have a kitchen equipped with an oven? 
Yes     /     No 
Opportunity 
Time to eat 
How many minutes a day do you have for breakfast? 
 
How many minutes a day do you have to eat? 
 
How many minutes a day do you have for dinner? 
 
How many minutes a day do you have to consume snacks? 
 
Prepare food 
How many minutes a day do you have to prepare your breakfast? 
 
How many minutes a day do you have to prepare your food? 
 
How many minutes a day do you have to prepare your dinner? 
 
How many minutes a day do you have to prepare your snacks? 
 
Access to food 
Are there places selling fresh food (fruits, vegetables) near your home? 
Yes     /     No     /      I do not know 
Are there non-perishable food outlets near your home (beans, oatmeal, rice, crackers, etc.? 
Yes     /     No     /      I do not know 
Food storage 
Do you have a refrigerator at home? 
Yes     /     No 
Do you have containers to store food (tupers)? 
Yes     /     No 
Motivation 
You want to change your eating habits 
Would you like to improve your eating habits? 
Yes     /     No     /      I do not know 
Would you like to eat healthier? 
Yes     /     No     /      I do not know 
Would you like to be a more physically active person? 
Yes     /     No     /      I do not know 
Emotions involved in your food consumption 

 
51 
Do you eat more food or less food when you are sad, angry, or happy? 
Please specify the emotion and the effect it 
has on your hunger and satiety 
 
Habits you are willing to change 
Please write down the eating habits that you would be willing to change, for example, eat more fruits and 
vegetables, eat less beef, etc. 
 
Reasons for sustainable food consumption 
Please write how important the following aspects are to you when you are going to consume food 
1 is not very important and 5 is very important 
 
Animal welfare 
Produced without animals suffering 
(Not very important)     1    2     3     4     5     (Very important) 
Produced in an animal-friendly way 
(Not very important)     1    2     3     4     5     (Very important) 
It is produced respecting the rights of animals 
(Not very important)     1    2     3     4     5     (Very important) 
Produced with enough space for animals 
(Not very important)     1    2     3     4     5     (Very important) 
It is a free range or free range product 
(Not very important)     1    2     3     4     5     (Very important) 
Ethical concern 
Produced without exploitation 
(Not very important)     1    2     3     4     5     (Very important) 
Produced without child labor 
(Not very important)     1    2     3     4     5     (Very important) 
Traded fairly 
(Not very important)     1    2     3     4     5     (Very important) 
Environmental welfare 
 
Produced in an environmentally friendly way 
(Not very important)     1    2     3     4     5     (Very important) 
It is produced without disturbing the balance of nature 
(Not very important)     1    2     3     4     5     (Very important) 
Produced with minimal CO2 emissions 
(Not very important)     1    2     3     4     5     (Very important) 
It is packaged in an environmentally friendly way 
(Not very important)     1    2     3     4     5     (Very important) 
Local and seasonal 
 
It is a local/regional product 
(Not very important)     1    2     3     4     5     (Very important) 
It is a seasonal product 
(Not very important)     1    2     3     4     5     (Very important) 
It comes from nearby (short transport distance). 
(Not very important)     1    2     3     4     5     (Very important) 
 
 
 
 
 
 
 
 

 
52 
 
Supplementary Material 5. Primers for bacteria identification in the qPCR analysis  
Bacteria 
Name 
Primer 
(5’-3’) 
Number 
of bases 
Sequence 
Notes 
Reference 
Firmicutes 
928F-Firm 
Forward 
21 
5'-TGAAACTCAAAGGAATTGACG-3' 
Y = C or T à C 
(4,68)  
1040FirmR 
Reverse 
17 
5'-ACCATGCACCACCTGTC-3' 
 
Bacteroidetes 
798cfbF 
Forward 
20 
5'-CAAACAGGATTAGATACCCT-3' 
R = A or G à A 
Cfb967R 
Reverse 
19 
5'-GGTAAGGTTCCTCGCGTAT-3' 
 
Universal 
926F 
Forward 
20 
5'-AAACTCAAAGGAATTGACGG-3' 
K = G or T à G 
1062R 
Reverse 
18 
5'-CTCACAACACGAGCTGAC-3' 
R = A or G à A 
Lactobacillus 
 
Forward 
19 
5'-AGCAGTAGGGAATCTTCCA-3' 
 
(70) 
 
Reverse 
17 
5'-CACCGCTACACATGGAG-3' 
 
Bifidobacterium 
 
Forward 
18 
5'-TCGCGTCCGGTGTGAAAG-3' 
C 
 
Reverse 
17 
5'-CCACATCCAGCATCCAC-3' 
A 
Faecalibacterium 
prausnitzii 
FPR-2F 
Forward 
19 
5'-GGAGGAAGAAGGTCTTCGG-3' 
Amplicon 248 
(73) 
Fprau645R 
Reverse 
21 
5'-AATTCCGCCTACCTCTGCACT-3' 
 
Akkermansia 
muciniphila 
 
Forward 
20 
5’-CAGCACGTGAAGGTGGGGAC-3’ 
 
(74) 
 
Reverse 
20 
5’-CCTTGCGGTTGGCTTCAGAT-3’ 
 
Prevotella copri 
 
Forward 
20 
5'-CCGGACTCCTGCCCCTGCAA-3' 
 
(75) 
 
Reverse 
20 
5'-GTTGCGCCAGGCACTGCGAT-3' 
 
Bilophila 
wadsworthia 
 
Forward 
26 
5'-CAACGTCCCCACCATCAAGTTCTCTG-3' 
 
(77) 
 
 
Reverse 
26 
5'-TGAATTCGCGGAAGGAGCGAGAGGTC-3' 
 
Clostridium 
coccoides 
(Eubacterium rectale 
group and 
Lachnospiraceae 
family) 
 
Forward 
19 
5’-CGGTACCTGACTAAGAAGC-3’ 
429 pb 
(48) 
 
Reverse 
19 
5’-AGTTTCATTCTTGCGAACG-3’ 
429 pb 
Streptococcus 
thermophilus 
St1 
Forward 
22 
5'-TTATTTGAAAGGGGCAATTGCT-3' 
Posición: 195–216 
(80) 
St2 
Reverse 
21 
5'-GTGAACTTTCCACTCTCACAC-3' 
Posición: 474–454 
 
Bases 
modified 
according 
to 
“Re: 
What 
are 
Y, 
M, 
W 
and 
D 
in 
primer 
design?”, 
by 
A. 
Gund, 
Nadine, 
2014.  
https://www.researchgate.net/post/What_are_Y_M_W_and_D_in_primer_design/538c1577d11b8ba27a8b45df/citation/download. 

 
53 
Supplementary Material 6. Adherence questionnaire  
This questionnaire will be updated based on the food plans to be designed, so the recommendations provided, 
and the consumption of the population will be contrasted, after the pilot test of this study. However, the format to 
be used and the questions developed so far are presented below. 
 
Table SM6.1. Questionnaire of adherence to the sustainable-psycho-nutritional program 
Questionnaire of adherence to the sustainable-psycho-nutritional program 
Participant number: 
Date:  
Questions about food consumption 
Times per week 
Times per day 
1 
2 
3 
4 
5 
6 
7 
 
How many times a week do you eat foods that include corn? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include 
amaranth? 
 
 
 
 
 
 
 
 
How many times a week do you eat fruit? 
 
 
 
 
 
 
 
 
How many times a week do you eat vegetables? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include beans? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include lentils? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include canola, 
olive, or avocado oil? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include milk? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include cheese? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include yogurt? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include eggs? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include fish or 
shellfish such as shrimp, octopus or crab? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include 
chicken? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include beef or 
red meat such as pork, lamb, and goat? 
 
 
 
 
 
 
 
 
How many times a week do you eat foods that include 
processed meats like ham and sausage? 
 
 
 
 
 
 
 
 
How many times a week do you consume soft drinks? 
 
 
 
 
 
 
 
 
How many times a week do you eat packaged (ultra-
processed) foods? 
 
 
 
 
 
 
 
 
Question about consumption reasons 
Answers  
 
Have you ever preferred to eat a particular food because of its 
environmental impact? 
Yes  
No  
Explain 
your 
answer 
please: 
 
 
 
  
  
 
Have you ever preferred to eat a particular food because of its 
impact on health and nutrition? 
Yes  
No  
Explain 
your 
answer 
please: 
 
 
 
 
  
  
 
From 1 to 10, how much would you say you consumed the 
meal plan that was provided to you? 
Yes  
No  
Explain 
your 
answer 
please: 
 
 
 
 
  
  
 
Was there any food that you did not like and therefore did not 
consume it? 
Yes 
No  
Explain 
your 
answer 
please: 
 
 
 
 
 
 
 
 

 
54 
Informed consent for study participants:  
 
Official title:  
Sustainable-psycho-nutritional intervention program and its effects on water and carbon footprint, metabolic 
biomarkers, and gut microbiota in Mexican population: study protocol of a m-Health randomized clinical trial 
 
Brief Title:  
Sustainable-psycho-nutritional intervention program and its effects on health outcomes and the environment 
                             
Responsible institution:  
Research Institute  in Eating Behavior and Nutrition (Instituto de Investigaciones en Comportamiento 
Alimentario y Nutrición (IICAN), University Center of the South, University of Guadalajara. Address: Av. 
Enrique Arreola Silva 883, Col. Centro. Zip Code: 49000, Cd. Guzmán, Jalisco, México. 
 
Collaborating institutions:  
Institute of Nutrition and Food Technology “José Mataix Verdú”, Biomedical Research Center, University of 
Granada, Avenida del Conocimiento S/N. Parque Tecnológico de la Salud. Armilla,18071 Granada, Spain  
 
National Technological Institute of Mexico (Tecnológico Nacional de México, Campus Ciudad Guzmán) 
Address: Avenida Tecnológico 100, Col. Centro. Zip Code: 49000. Ciudad Guzmán, México. 
 
 
Zapotlán el Grande, Jalisco. Date:________________ 
By means of the present, I ______________________________________________________, I agree to 
participate in the research project entitled: "Sustainable-psycho-nutritional intervention program and its 
effects on water and carbon footprint, metabolic biomarkers, and gut microbiota in Mexican population: 
study protocol of a m-Health randomized clinical trial". I am aware that the objective of this study is to design 
a sustainable-psycho-nutritional intervention program and evaluate its effect on biological and environmental 
indicators in the Mexican population. and that the information collected will be analyzed for non-profit research 
purposes which will lead to publications in scientific journals. In addition, I am aware that at no time will I receive 
financial remuneration for my participation. 
I have been informed that my participation will consist of an evaluation of the following aspects. 
Anthropometric data: weight, height, waist and hip circumference. To do this I must take off my shoes and uncover 
my waist for less than 3 minutes. Biochemical data: blood sample and stool. For this, a specialist will take blood 
from my arm, so I will have to discover it and maintain a 12-hour overnight fast. Likewise, I will be given a sterile 
container to place a 3 cm3 stool sample that I could be asked to preserve at the fridge if I a am not able to deliver 
it to the researcher as soon as I collected it. Clinical data: blood pressure measurement and superficial examination 
(e.g., face, neck, feet, hands), so I will uncover my left arm and allow the specialist to check my eyes, nails, hair, 
neck, and mouth, and, if necessary, the folds of my armpits. Dietary data: completion of dietary records and food 
frequency questionnaire. So, I will report the amounts of food I consume per day and on average per week, month, 
or year. I will be asked to write it down in paper, a mobile application, or a computer. Also, I may be asked to 
send photos of my food intake or uploaded into a mobile application. I am also aware that I will respond to a 
survey where I will provide sociodemographic and socioeconomic data, such as my educational level, my 
employment, a range of monthly income in Mexican pesos, among other data. In addition, I have been informed 
that I will have to use a mobile application that will help me improve my diet, both in relation to my nutrition and 
the environment. I know that the intervention in which I agree to participate will last 15 weeks, in which I will 
allow the extraction of blood and measurement of my weight, waist, and hip circumference on three occasions, as 
well as the visual physical examination and the taking of my blood pressure. I also know that I will deliver stool 
samples on a weekly basis, during the 15 weeks and that within the mobile application that I will use, I will be 
asked to record my food consumption on a daily basis, incorporating photographs and specifying the amounts of 
food consumed. 
Additionally, I know that I may not be involved in the study but only evaluated. In addition, I know that 
the intervention, if it is part of it, will last 7 weeks, and additionally, there will be a 7-week follow-up period 
where I will be told whether or not I will be able to use the mobile application. 
I know that the study will be carried out at the Centro Universitario del Sur, specifically at the Institute for 
Research in Eating Behavior and Nutrition (IICAN), as well as at the Laboratory of Biomedicine and 
Biotechnology for Health. In addition, it has been explained to me that my participation in this study is voluntary 
and I will not receive any financial compensation for it. However, I know that, if I wish, I will be able to obtain a 

 
55 
psycho-nutritional-sustainable diagnosis, and furthermore, with my participation I will benefit from obtaining 
nutritional counseling at the end of the intervention. 
Finally, I confirm that I have been informed that the responsible researchers will maintain the 
confidentiality of my personal data based on the guidelines established by the Federal Law on Protection of 
Personal Data Held by Private Parties. 
Therefore, I declare that: 
1. I have read or had read to me the information provided. 
2. I have had the opportunity to ask and all my doubts and questions have been satisfactorily clarified. 
3. I voluntarily consent to participate in this research. 
4. I understand that I have the right to withdraw at any time I choose without it affecting me in any way. 
5. I have been informed that my refusal to participate will not cause me any problems. 
6. I have been informed that the researchers undertake to answer any questions I may have during and after 
the data collection process. 
7. I am aware that the main investigator will provide me with a diagnosis of my nutritional status and will 
provide me with nutritional guidance, if I wish. 
8. I am aware that measurements will be taken on my waist and hips, so I will have to uncover my abdomen. 
In addition, I know that I will have to remove my shoes, socks and metallic accessories, including the belt, 
earrings, among other artifacts, when the main researcher of the study asked me to do so, before getting on the 
scale to be weighed and before being measured on the stadiometer. 
9. I consent to a blood sample being taken and am aware that I will submit a stool sample on a weekly 
basis. 
10. I agree to allow my blood pressure to be taken, visual examination of my neck, eyes, mouth, hair, nails 
and, if applicable, armpit folds. I also agree to fill in the questionnaires that the main researcher provides me, 
always answering as honestly as possible. 
11. I agree to use a mobile application where I know that I will provide information, which will be 
confidential, but will help me improve my diet, both in relation to my nutrition and the environment. Likewise, 
and if I wish, I will be able to interact with other users within the mobile application and thus provide us with 
support. 
12. I accept that my data will be used in this and future studies, where my identity will always be protected. 
 
If you have doubts or queries regarding participation in this study, you can contact the researcher 
responsible for this study, Mtra. Mariana Lares Michel, who is a doctoral student at the Institute for Research in 
Eating Behavior and Nutrition (IICAN). Her contact details are as follows: Av. Enrique Arreola Silva 883, Centro, 
C.P. 49000, Cd. Guzmán, Jalisco, Mexico, telephone: 3411017629. email: mariana.lmichel@alumnos.udg.mx 
Also, you can contact Dr. Fatima Ezzahra Housni, who is the responsible researcher for this study at 
ClinicalTrials.gov. Her contact details are as follows: Av. Enrique Arreola Silva 883, Centro, C.P. 49000, Cd. 
Guzmán, Jalisco, Mexico, Tel.: (+52) 341 5752222 ext. 46142. email: fatima.housni@cusur.udg.mx  
 
 
Sincerely 
Place and date 
 
_______________________________________________________ 
 
Name and signature of the participant 
 
 
Telephone:__________________________________________________________________________ 
Email:_______________________________________________________________________________ 
 
 
Name and signature of the Witness 1: _______________________________________________________                                      
Address and telephone: ___________________________________________________________________                                     
Type of relationship with the participant: _____________________________________________________          
 
 
 Name and signature of the Witness 2: _______________________________________________________                                     
Address and telephone: ___________________________________________________________________                                     
Type of relationship with the participant: _____________________________________________________          
 

 
56 
I have explained to the participant the objective, justification and procedures of this research, as well as the risks 
and benefits that their participation implies. In turn, I have answered all the questions, doubts and clarifications 
that he has made me. Finally, I declare that I respect the guidelines and regulations corresponding to research on 
human beings. 
 
_____________________________                        _____________________________ 
 
Name and signature of the investigator                           Name and signature of the applicator