F Rodríguez-Artalejo

A simple estimate of mortality attributable to excess weight in the European Union

Objective: To estimate the current burden of mortality attributable to excess weight in the European Union (EU).Methods: Prevalence of overweight (body mass index, BMI 25–29.9 kg/m2) and obesity (BMI ≥30 kg/m2) were based on self-reported data from a survey with samples representative of the 15 EU Member States in 1997. Primary source of relative risk (RR) of death by BMI was the first American Cancer Prevention Study (CPS I). Additional calculations were performed to account for effect of smoking (using CPS I data for non- or never-smokers), for pre-existing illness (using the second CPS, CPS II, data for healthy never-smokers) and using RRs derived from European rather than US data (using data from a meta-analysis of prospective studies). Mortality attributable to excess weight was calculated by combining the prevalences of overweight and obesity, the RRs, and the number of deaths in the EU countries.Results: Annual deaths attributable to overweight and obesity totalled approximately 279 000 when RRs for all subjects were used. When RRs for nonsmokers only were applied to the entire population, about 304 000 deaths were attributable to excess weight. In analyses using RRs which controlled for both smoking and history of disease, the number of deaths attributable to excess weight was estimated at about 337 000 based on European data and at about 401 000 based on US data. In the EU, therefore, a minimum of 279 000 deaths were attributable to excess weight (7.7% of all deaths, varying from 5.8% for France through 8.7% for the UK). More attributable deaths occurred among the obese (175 000) than among the overweight (104 000). Around 70% were cardiovascular disease deaths (195 000) and 20% cancer deaths (53 000).Conclusion: Mortality attributable to excess weight is a major public health problem in the EU. At least one in 13 annual deaths in the EU are likely to be related to excess weight.Sponsorship: This study has been partially funded by Madrid Regional Authority (Comunidad de Madrid) grant no. 08.4/0011/2000.

Relation between body weight and health-related quality of life among the elderly in Spain

OBJECTIVE: This study examines the relation between body weight and the physical and mental components of health-related quality of life (HRQL) in the population aged 60 y and over in Spain.RESEARCH METHODS AND PROCEDURES: Cross-sectional study covering 3605 subjects, representative of the noninstitutionalised Spanish population aged 60 y and over. Information was collected through home-based personal interview and measurement of blood pressure and anthropometric variables. Logistic regression was used to examine the relation of suboptimal HRQL (score<100) on each SF-36 questionnaire scale with body mass index (BMI) and waist circumference. Separate regression models were constructed for each sex and adjusted for sociodemographic variables, tobacco and alcohol consumption, physical activity, arterial hypertension and diagnosed chronic disease.RESULTS: Mean age of the study population was 70.9 y for men and 72.2 y for women. The percentage of overweight subjects was 48.5% in men and 39.8% in women, and of obese subjects, 31.9 and 41.1% respectively. Men registered a better HRQL than women on most of the SF-36 scales. Compared to normal-weight subjects (BMI: 18.5–24.9 kg/m2), frequency of suboptimal physical functioning was higher among obese subjects (BMI≥30 kg/m2), both male (OR: 1.91; 95% CI: 1.22–3.00) and female (OR: 2.58; 95% CI: 1.59–4.19). The aspects of physical functioning most affected were bending, kneeling or stooping, climbing stairs and strenuous effort. Male, though not female, obesity was nonetheless associated with a better HRQL on the SF-36 mental scales. Frequencies of suboptimal scores for overweight persons (BMI: 25–29.9 kg/m2) were similar to those for normal-weight subjects on most of the SF-36 scales. Results proved similar for subjects in both the 60–74 and 75-and-over age groups, and also when waist circumference was used as the measure of obesity (>102 cm in men and >88 cm in women).CONCLUSIONS: Obese men and women showed worse physical functioning than normal-weight persons. This occurred irrespective of whether subjects were over or under 74 y of age, or whether obesity was measured by BMI or waist circumference, and was not explained by unhealthy lifestyles or obesity-related chronic disease.

Trends in overweight and misperceived overweight in Spain from 1987 to 2007.

Objective:To examine trends in overweight and misperceived overweight in adults (⩾20 years) and children (5–15 years) of Spain from 1987 to 2007.Methods:Data were obtained from five cross-sectional studies, representative of the population of Spain in 1987, 1995, 1997, 2001 and 2006/2007. Self-reported weight and height were used to obtain the body mass index (BMI). Overweight was defined in adults as BMI of ⩾25 kg m–2, and in children using age- and sex-specific BMI cutoffs proposed by the International Obesity Task Force. People with overweight were considered to have misperceived overweight when adults considered their weight or their childs weight to be normal or less than normal.Results:From 1987 to 2006/2007, the prevalence of overweight increased in absolute terms by 14.1% in men and 10.3% in women. Concurrently, the frequency of misperceived overweight remained relatively stable, approximately 35% in men, but rose from 16.5 to 20.8% in women. From 1995/1997 to 2006/2007, the prevalence of overweight increased in absolute terms by 3.2% in boys and 4.6% in girls. Over the same period, there was an absolute 8% increase in misperception of overweight among children of both sexes. As a result, during 2006/2007, approximately 60% of parents did not correctly perceive the weight status of their overweight children. Moreover, misperceived overweight was highest for younger children, and for those whose parents had a higher education.Conclusions:The obesity epidemic in Spain has been accompanied by an increased misperception of overweight in women and children of both sexes. Our results warn of the low familys readiness to modify the environment and lifestyle needed to control overweight.

Consumption of alcoholic beverages and subjective health in Spain

STUDY OBJECTIVE To examine the relation between alcohol and main alcoholic beverage consumption and subjective health in Spain. DESIGN Logistic regression analysis using a cross sectional survey based on self reported data on alcohol and alcoholic beverage consumption, subjective health and the principal confounding factors (age, sex, civil status, educational level, job status, social support, region of residence, size of town or city, tobacco consumption, physical activity during leisure time and work hours, and chronic disease). SETTING The 1993 Spanish National Health Survey. PARTICIPANTS A 19 573 person sample, representative of the non-institutionalised Spanish population aged 16 years and over. MAIN RESULTS Among Spaniards, 31.4% reported their health as suboptimal (fair, poor or very poor) and 56.9% consumed alcohol regularly, with the majority having a preference for wine. Light (1–2 drinks per day) or moderate consumption (3–4 drinks per day) was the most frequent pattern. After adjusting for confounding factors, a negative dose-response relation was observed between consumption of total alcohol, wine and beer, and prevalence of suboptimal health (linear trend: p<0.001 for total alcohol, p=0.023 for wine, and p=0.030 for beer). In contrast, for consumption of spirits the prevalence of ill health in moderate drinkers was lower than in non-drinkers, with no clear relation at higher consumption. While persons reporting a preference for wine had a lower frequency of suboptimal health than did abstainers, they showed no difference in frequency of subjective ill health with respect to persons with preference for other types of drink or no preference whatsoever. CONCLUSIONS The higher the consumption of total alcohol, wine and beer, the lower the prevalence of suboptimal health. These results differ from those obtained in several Nordic countries, where a “J shaped” relation has been observed for total alcohol and wine, and suggest that the relation between alcohol consumption and subjective health may be different in Mediterranean countries.

Changes in body weight and health-related quality-of-life in the older adult population.

BACKGROUND:No other study has ascertained the short-term impact of weight change on health-related quality-of-life (HRQL) on a national sample of older adults.OBJECTIVE:To examine the relationship between change in body weight and HRQL among the older adult population.METHODS:We carried out a prospective study from 2001 to 2003 of a cohort of 2364 persons, representative of the noninstitutionalised Spanish population aged 60 y and over. Weight changes during the period 2001–2003 were self-reported, and HRQL in 2003 was measured with the SF-36 questionnaire. Analyses adjusted for the principal confounders.RESULTS:Among nonobese women (body mass index (BMI) 18.5–29.9 kg/m2), and compared to those who underwent no important weight change, weight loss was associated with a clinically significant worsening in the role-physical, vitality, and social functioning SF-36 scales. Among obese women (BMI≥30 kg/m2), weight gain led to a reduction in HRQL for four of the eight SF-36 scales, while weight loss was associated with worse scores in role-emotional and mental health scales. Results were usually similar for men, though of lower magnitude. In both sexes, weight change was associated with a reduction of over 5 points on several physical and mental scales of the SF-36, which indicates a clinically relevant worsening in HRQL.CONCLUSION:Weight change is associated with worse HRQL among the older adults, principally women. From the stance of HRQL, it is desirable to prevent weight gain, especially among the obese, and weight loss, especially among the nonobese.

Obesity and socioeconomic position measured at three stages of the life course in the elderly

Objective: To investigate the association between socioeconomic position, measured at three stages of the life course, and obesity in the elderly.Design: Cross-sectional study carried out in 2000–2001.Subjects: In total, 4009 subjects aged 60 y and older, representative of the Spanish noninstitutionalised population.Research Methods and Procedures: We estimated body mass index (BMI) and waist circumference (WC) by social class in childhood, by educational level and by adult social class, as well as the association between these two obesity measures and each socioeconomic characteristic after adjusting for the other two.Results: In men, no relation was found between the two measures of obesity studied and socioeconomic circumstances throughout the life course. Nor was any relation found in women between social class in childhood and the two measures of obesity after adjusting for the other two socioeconomic variables. In contrast, BMI and WC in women showed a statistically significant inverse gradient with educational level and with adult social class after adjusting for age and the rest of the socioeconomic variables.Conclusions: In general, these results support the small amount of existing evidence on the association between obesity and abdominal obesity and socioeconomic position by educational level and adult social class. The results for social class in childhood do not support the existing evidence, and suggest that this association may depend on specific historic and cultural circumstances.

Self-perception of being overweight in Spanish adults

Objective: To describe the frequency, distribution and trend in misperceived overweight and obesity.Design: Three independent cross-sectional studies carried out in 1987, 1995 and 1997 over representative samples of Spanish adult population.Setting: Spanish adult population aged 20 y and over.Subjects and interventions: A total of 11 496 men and women aged 20 y and over with a body mass index (BMI) ≥25 kg/m2.Main outcome measures: Prevalence and time trend of misperceived overweight and obesity based on self-perceived weight and height.Results: Some 28.4% of the population did not perceive themselves to be overweight or obese in 1987 (26.9% in 1995/97). Overweight was more frequently misperceived among men, persons over 64 y of age, those residing in rural areas and those with an elementary educational level. The largest percentages of misperceived overweight were in the more moderate levels of BMI: 50% of men and 30% of women with a BMI of 25–26.9 kg/m2 in 1995/1997 did not perceive themselves to be overweight.Conclusions: Misperceived overweight and obesity is frequent in the adult population in Spain. Some social and cultural factors may explain its higher frequency in men, older individuals and those with elementary level of education. The fact that most of those who do not perceive themselves to be overweight are in the moderate levels of overweight should be taken into account when designing strategies for the prevention and control of overweight and obesity in the general population.

La transición de la cardiopatía isquémica aguda a la crónica en España, 1980-1994

Objetivos El gran aumento de las hospitalizaciones por insuficiencia cardiaca en Espana en los ultimos anos puede resultar paradojico porque coincide con una disminucion de la mortalidad por cardiopatia isquemica, la causa mas importante de la insuficiencia cardiaca. Una posible explicacion es el aumento de la supervivencia de la cardiopatia isquemica producida por los ultimos avances terapeuticos, que se traduciria en un aumento de las formas cronicas de la enfermedad. Por ello se estudia las tendencias en la mortalidad y en las hospitalizaciones por cardiopatia isquemica aguda y cronica en el periodo 1980–1994 en Espana. Metodos Estudio poblacional de tendencias temporales con datos de diagnostico primario de cardiopatia isquemica aguda (CIE-9: 410–411) y cronica (CIE-9: 412–414) obtenidos de las Estadisticas Vitales Nacionales y de la Encuesta Nacional de Morbilidad Hospitalaria. Resultados El numero de muertes por cardiopatia isquemica aguda ha aumentado un 8,3%, pasando de 18.559 en 1980 a 20.101 en 1994. Las muertes por cardiopatia isquemica cronica aumentaron un 49,3%, pasando de 4.703 en 1980 a 7.020 en 1994. Como consecuencia, las formas cronicas produjeron el 20,2% de todas las muertes por cardiopatia isquemica en 1980 y el 25,8% en 1994. Las tasas de mortalidad ajustadas por edad por cardiopatia isquemica aguda han descendido un 20,1%, mientras que las de la cronica han aumentando un 14,6%. El numero y las tasas de hospitalizacion ajustadas por edad han crecido de forma muy importante para la cardiopatia isquemica aguda y cronica. Sin embargo, el crecimiento de la cronica ha sido mayor y ha pasado de representar el 39,4% de todas las hospitalizaciones por cardiopatia isquemica en 1980 al 58,4% en 1994. La cronificacion de la cardiopatia isquemica es mayor en los varones y entre los mas jovenes. Conclusion Se esta produciendo una transicion de la cardiopatia isquemica aguda a la cronica en Espana. Ello explica, en parte, el aumento de las necesidades de asistencia hospitalaria por enfermedades del corazon, en especial la cardiopatia isquemica y la insuficiencia cardiaca.

The relationship of different socioeconomic variables and alcohol consumption with nighttime fatal traffic crashes in Spain: 1978–1993

This paper identifies the variables associated with alcohol-related fatal traffic crashes (AFTC) in Spain. In addition, and for the first time in this country, these variables are used to describe the trend in AFTC, and to study the relationship between AFTC and alcohol consumption over the period 1976–1993. To this end, official data were obtained from the Traffic Department (Dirección General de Tráfico), the National Statistics Institute (Instituto Nacional de Estadística), and from international publications on trends in alcohol consumption. Nighttime fatal crashes (NFC) and male-driver single-vehicle nighttime fatal crashes (MNFC) were strongly associated with AFTC rates in Spain. A further finding was the decrease in NFC and MNFC rates during the period 1978–1993, though this decrease proved of a lower magnitude than that observed for daytime crashes. No relationship was observed between alcohol consumption at the population level and NFC or MNFC rates. The fatal crash rate, particularly the daytime rate, showed a rise with wealth level, as measured by gross domestic product and national private consumption, and an inverse relationship with the unemployment rate. The relationship between the fatal crash rate and economic variables was due, in most part, to changes in vehicle-km travelled.