F. Rodríguez Artalejo

Increasing prevalence of overweight and obesity among Spanish adults, 1987–1997

OBJECTIVE: To study the trend in the prevalence of obesity and overweight in Spanish men and women 25–64 y of age between 1987 and 1997.DESIGN: Cross-sectional surveys of representative samples of the non-institutionalized population in Spain in 1987, 1995 and 1997.SUBJECTS: 14,676 and 7004 adults aged 25–64 who were representative of the Spanish population in 1987 and 1995/1997.MEASURES: Body mass index (BMI) calculated from self-reported weight and height. Overweight is defined as BMI=27–29.9 kg/m2 and obesity as BMI≥30 kg/m2.RESULTS: Between 1987 and 1995/97, the prevalence of overweight in the Spanish population aged 25–64 increased by 2.2% (P<0.01); the increase was greater in men (3.8%; P<0.01) than in women (0.6%; P>0.05). The largest increases in the prevalence of overweight were seen in men (5.2%; P<0.01) and women (2.3%; P<0.05) aged 25–34. During the same period, the prevalence of obesity increased by 3.9% (P<0.01), 4.6% in men (P<0.01) and 3.2% in women (P<0.01). The largest increases were seen in men aged 45–54 (6.5%, P<0.01) and in women aged 25–34 (2.2%, P<0.05). By educational level, the prevalence of overweight increased significantly in men with fewer than 12 y of education (4.7%, P<0.01). Obesity increased by 4.6% (P<0.01) and by 4.9% (P<0.01) in men and women with fewer than 12 y of education, respectively.CONCLUSIONS: The prevalence of overweight and obesity is increasing in Spain, the same as it is in other developed countries. The increase, which is found in most age and sex groups in the population, especially affects middle-aged men, young women and persons with lower educational level. The causes of the increase in the prevalence of overweight and obesity are likely to be multifactorial.

Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial

Objective:To assess the impact of a physical activity program on obesity in primary school children.Design:Cluster-randomized controlled trial with 10 intervention and 10 control schools.Participants:A total of 1044 children, mean age 9.4 years (s.d.=0.7) at baseline, of the Province of Cuenca, Spain.Intervention:Recreational, non-competitive physical activity program conducted after school hours on school premises. The program consisted of three 90-min sessions per week, for 24 weeks.Main outcome measures:Body mass index (BMI), triceps skin-fold thickness (TST) and percentage body fat. Secondary measures were blood lipids and blood pressure. Measurements were made at the beginning (September 2004) and at the end of the program (June 2005). Since schools rather than children were randomized, mixed regression models were used to adjust for individual-level covariates under cluster randomization.Results:There were no differences in BMI between the intervention and control groups. Compared with controls, intervention children showed a decrease in TST in both boys (−1.14 mm; 95% confidence interval (CI) −1.71 to −057; P<0.001) and girls (−1.55 mm; 95% CI −2.38 to −0.73; P<0.001), as well as a reduction in the percentage of body fat in girls (−0.58%; 95% CI −1.04 to −0.11; P=0.02). Furthermore, the intervention boys exhibited a decrease in apolipoprotein (apo) B levels (−4.59; 95% CI −8.81 to −0.37; P=0.03) and an increase in apo A-I levels (13.57; 95% CI 7.95–19.20; P<0.001). Blood lipid results in girls were very similar. No changes in total cholesterol, triglycerides or blood pressure were associated with the intervention in either sex, except for an increase in diastolic blood pressure (1.55 mm Hg; 95% CI 0.19–2.91; P=0.03) in the intervention versus control boys.Conclusion:An after-school program of recreational physical activity reduced adiposity, increased apo A-I and decreased apo B in primary school children.

The size of obesity differences associated with educational level in Spain, 1987 and 1995/97

Objective: To determine the size of obesity differences associated with educational level in the adult population in Spain. Design: Three cross sectional studies representative of the adult population in Spain were carried out in 1987, 1995, and 1997. Setting: The general population in Spain. Participants: 11 461 men and 10 219 women aged 25 to 64 years. Main results: For both men and women the obesity prevalence was highest in those with elementary education. In 1987 the obesity prevalence proportion associated with less than third level education (PA) was 24.5% (95% CI 6.0 to 42.8) and 47.9% (15.7 to 71.8) in men and women, respectively. The PAs in 1995/97 were 19.8% (0.2 to 40.2) and 55.1% (21.3 to 72.8). Conclusions: In 1995/97 the burden of obesity associated with less than third level education was 20% in men and 55% in women aged 25 to 64 years. Between 1987 and 1997 the obesity prevalence proportion associated with less than third level education increased in women and decreased in men.

Determinants of geographical variations in body mass index (BMI) and obesity in Spain.

OBJECTIVE:To identify the factors associated with geographic variations in Body Mass Index (BMI) and obesity in Spain.DESIGN:Cross-sectional, ecological analysis using data on illiteracy rate (per 1000 population), energy intake (kcal//person/-4/d), sedentary population (%), smoking population (%), alcohol consumption (g/person/d), and percentage of population aged 65 y or over, for Spain’s 50 provinces.SUBJECTS:Non-institutionalized population aged 16 y or over.MEASUREMENTS:Median BMI and percentage of population with obesity, defined as BMI>30 kg/m2.RESULTS:There was a clear geographical pattern, with some areas in the south and north-west of the country registering the highest BMI and prevalence of obesity and a north–south pattern on illiteracy per 1000 population. Multivariate regression analysis showed that illiteracy, sedentary lifestyle and energy intake explain 35% and 14% of the variation in BMI and obesity, respectively. Illiteracy proved to be the variable most associated with both BMI (regression coefficient (β=0.01; P=0.005) and obesity (β0.05; P=0.013). Sedentary lifestyle showed a statistically significant relationship with BMI (β=0.01; P=0.03), but not with obesity (β=0.03; P=0.581). Energy intake exhibited a relationship with BMI (β<0.01 P=0.03) that lost statistical significance when adjusted for age.CONCLUSION: Geographical variations in BMI in Spain are partly explained by illiteracy, sedentary lifestyle and, to a lesser extent, energy intake, whereas regional variations in obesity are related only to the educational level of the population.

The relationship of overweight and obesity with subjective health and use of health-care services among Spanish women

OBJECTIVE: To examine the relationship of overweight and obesity with subjective health and use of health-care services among women in Spain.METHODS: Data were drawn from the 1993 Spanish National Health Survey, covering a 13 244-woman sample representative of the non-institutionalised Spanish population aged 16 y and over. Information was collected through home-based interviews. Multiple logistic regression models were used to calculate odds ratios for suboptimal health (fair, poor or very poor) and utilisation of health-care services by women with normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2) and obesity (BMI≥30 kg/m2). Analyses were adjusted for age, education level, occupation, civil status, social support, tobacco use, alcohol consumption, physical activity at work and during leisure time, job status and town of residence.RESULTS: Frequency of suboptimal health was higher in women with overweight (OR 1.7; 95% CI 1.5–1.9) and obesity (OR 2.1; 95% CI 1.8–2.5) than in those with normal weight. Overweight and obese women visited the physician, used hospital emergency services and took medication with greater frequency than did women of normal weight. There was a positive dose–response relationship (P<0.05) of BMI≥18.5 kg/m2 with suboptimal health and utilisation of health-care services. These associations were not wholly explained by BMI-related risk factors and chronic diseases, since their statistical significance remained unchanged and their magnitude was only slightly reduced after adjustment for those factors. The association of overweight and obesity with the use of health-care services did not vary with age, educational level or presence of chronic disease.CONCLUSION: Overweight and obese women have worse subjective health and make greater use of health-care services. This finding is an additional argument for implementing weight-control programmes in Spain.

Impact of gastroesophageal reflux symptoms on health resource usage and work absenteeism in Spain

OBJECTIVES To estimate the impact of gastroesophageal reflux (GER) symptoms on the utilization of healthcare services and work absenteeism in Spain. METHODS A cross-sectional study on 2,500 subjects representative of the Spanish population from 40 to 79 years of age. Data were collected via a telephone interview in January 2002 using Locke s questionnaire after its cross-cultural adaptation and validation for telephone use in Spain. RESULTS GER is responsible for 296.8 doctor consultations (95% CI: 245.3-348.7) per 1,000 inhabitants per year, for 24 esophagogastrointestinal radiographic studies per 1,000 inhabitants per year (95% CI: 18-30), for 32.4 (95% CI: 25.5-39.3) high digestive endoscopies per 1,000 inhabitants per year, and for the loss of 201 (95% CI: 0-411.1) working days per 1,000 employed inhabitants with GER per year. In relation to medication intake, GER resulted in 4,092 (95% CI: 3,300-5,133) treatment days with H2 antagonists per 1,000 inhabitants per year, 9,030 (95% CI: 7,846-10,332) treatment days with proton pump inhibitors per 1,000 inhabitants per year, and 1,082 (95% CI: 519-1,549) treatment days with prokinetics per 1,000 inhabitants per year. CONCLUSIONS GER has a large impact on the utilization of healthcare resources and work absenteeism in Spain, in contrast to the widespread belief that it is an illness of little importance.

Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular

El documento «Control de la colesterolemia en Espana, 2000: un instrumento para la prevencion cardiovascular» revisa la evidencia existente en el campo de la prevencion cardiovascular y los avances terapeuticos producidos en los ultimos anos con el objetivo de ayudar a tomar decisiones clinicas basadas en el riesgo cardiovascular. Las enfermedades cardiovasculares son la primera causa de muerte en Espana. Su impacto demografico, sanitario y social esta aumentando y va a continuar haciendolo en las proximas decadas. El adecuado tratamiento de la hipercolesterolemia y del resto de los factores de riesgo es fundamental para prevenir las enfermedades cardiovasculares. La estratificacion del riesgo de las personas es esencial, por cuanto condiciona la periodicidad del seguimiento y la indicacion e intensidad del tratamiento. Basandose en dicha estratificacion se han establecido unas prioridades de control de la colesterolemia y del riesgo cardiovascular derivado de la misma. En prevencion primaria en los pacientes de riesgo alto el objetivo terapeutico se establece en un c-LDL inferior a 130 mg/dl. En prevencion secundaria el tratamiento farmacologico se instaurara con un c-LDL ≥ 130 mg/dl y el objetivo terapeutico sera c-LDL Las estatinas son los farmacos de primera eleccion en el tratamiento de la hipercolesterolemia. Cuando exista hipertrigliceridemia moderada-grave y c-HDL bajo se emplearan los fibratos. En el sindrome coronario agudo el tratamiento hipolipidemiante, cuando este indicado, debe iniciarse precozmente. Los pacientes con cardiopatia isquemica se deben incluir en programas de prevencion secundaria que aseguren, de forma continuada, un buen control clinico y de los factores de riesgo.

El autocuidado y el conocimiento del manejo de la enfermedad predicen la rehospitalización en ancianos con insuficiencia cardiaca

Introduccion Este trabajo examino la asociacion del autocuidado y del conocimiento de los pacientes acerca del autocuidado con la rehospitalizacion en adultos mayores con insuficiencia cardiaca (IC). Metodos Analisis de casos y controles (116 casos y209 controles) alojado en una cohorte prospective de pacientes de 65 y mas anos de edad ingresados por IC en 4 hospitales espanoles. Los casos eran pacientes rehospitalizados de urgencia en los 6 meses siguientes a la hospitalizacion indice. Los controles fueron pacientes que no se rehospitalizaron durante esos 6 meses. Resultados El numero de actividades de autocuidado se asocio de forma inversa con la frecuencia de reingreso (p tendencia lineal: 0,006). En comparacion con los pacientes que realizaron el autocuidado apropiado, el reingreso hospitalario fue mas frecuente entre los que no paseaban ni realizaban actividad fisica a diario (hazard ratio [HR] 1,55; limites de confianza [LC] 95% 1,04-2,29), y entre los que se saltaban la visita al medico en la fecha programada (HR 1,82; LC 95% 1,10-3,02). El reingreso hospitalario tambien fue mas frecuente entre los pacientes que no tomaban la medicacion a su hora (HR 2,07; LC 95% 1,15-3,72), los que dejaban de tomarla cuando les sentaba mal (HR 1,76; LC 95% 1,08-2,85), y los que no mostraron adherencia al tratamiento farmacologico (HR 1,96; LC 95% 1,29-2,98). Ademas, a menor numero de actividades de manejo de la IC que se conocia que debian realizarse, mayor fue la frecuencia de rehospitalizacion (p tendencia lineal: 0,029). Conclusion A menor autocuidado y menor conocimiento del manejo de la IC, mayor riesgo de reingreso hospitalario.

Prevalencia de infección tuberculosa y su relación con la clase social en niños de la Comunidad de Madrid

Introduccion La frecuencia de infeccion tuberculosa, sobre todo en poblacion infantil, indica la magnitud del reservorio de la enfermedad. El objetivo de este trabajo fue medir la prevalencia de infeccion tuberculosa en ninos de la Comunidad de Madrid y su asociacion con la clase social de pertenencia. Material y metodos Se realizo un estudio transversal de los ninos de 6 anos escolarizados y residentes en la Comunidad de Madrid, seleccionados mediante muestreo probabilistico. Entre septiembre y junio de 2000, se obtuvo informacion sobre estrato de residencia, resultado de la prueba de la tuberculina (umbral de positividad de 5 mm), clase social (en 5 categorias) estimada por la ocupacion del sustentador principal del hogar, y los estudios realizados por el padre y por la madre. Se realizaron estimaciones al 95 % de confianza (IC 95 %) a partir de una distribucion de Poisson. Resultados Se han estudiado 2.721 ninos. La prevalencia de infeccion tuberculosa en el total de la poblacion de estudio fue 0,62 % (IC 95 %: 0,29-0,95). Por clase social, la prevalencia ha sido 0,42 % (IC 95 %: 0,00-0,85) en la clase I (la mas alta), 0,00 % (IC 95 %: 0,00-1,17) en la clase II, 0,77 % (IC 95 %: 0,00-1,86) en la clase III, 0,62 % (IC 95 %: 0,00-1,32) en la clase IV, y 1,57 % (IC 95 %: 0,00-3,40) en la clase V (la mas baja). En los padres y madres, la prevalencia de infeccion tuberculosa mas elevada correspondio al grupo que ha completado el bachiller elemental/EGB. Conclusiones La prevalencia de infeccion tuberculosa en la Comunidad de Madrid es similar a la observada en otras zonas de Espana. Los resultados son consistentes con una menor prevalencia en los grupos con nivel socioeconomico mas elevado.

La distribución geográfica de la razón varón/mujer de la mortalidad cardiovascular en España

Resumen Objetivos Describir la distribucion geografica de la razon varon/mujer (RVM) de mortalidad por enfermedad isquemica del corazon (EIC) y enfermedad cerebrovascular (ECV) en 1991-1995 en Espana, y examinar si puede explicarse por las diferencias de exposicion a factores de riesgo cardiovascular entre varones y mujeres. Metodos Los datos de mortalidad proceden de las Estadisticas Vitales Nacionales. Se calcularon tasas, ajustadas por edad por el metodo directo, de mortalidad por EIC y ECV en la poblacion de 40 a 79 anos en el periodo 1991-1995. Los datos de consumo de tabaco y alcohol, hipertension arterial, hipercolesterolemia, diabetes, obesidad, sedentarismo y uso de servicios sanitarios son de la Encuesta Nacional de Salud de 1993, y los de variables socioeconomicas del Censo de Poblacion de 1991. El analisis se realizo usando la correlacion de Pearson y la regresion de Poisson. Resultados Las RVM de mortalidad por EIC y ECV son mayores en las provincias del norte de Espana, y se correlacionan negativamente con la mortalidad por EIC y ECV. Esta asociacion negativa es mas fuerte con la mortalidad de las mujeres que de los varones. Entre los factores de riesgo estudiados solo la RVM del consumo de alcohol se asocio de forma estadisticamente significativa (p Conclusiones Las provincias del norte de Espana, que son las de menor mortalidad cardiovascular, presentan la mayor sobremortalidad masculina por EIC y ECV, debido principalmente a una menor mortalidad cardiovascular en las mujeres. Segun se deriva de la relacion dosis-respuesta de la RVM de mortalidad por EIC y ECV con la RVM del consumo de alcohol, un mayor consumo de alcohol en los varones puede contribuir a su mayor mortalidad cardiovascular en relacion a las mujeres en algunas provincias espanolas.