Gemma Salvador

Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study

Background Obesity has become a global public health problem, which also affects children. It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity. Objective To evaluate the efficacy of an intervention on food habits and physical activity in school children. Methods A 2-year cluster-randomised prospective study with two parallel arms was used to evaluate an intervention programme in children in their first year of primary schooling (5–6 years of age) in schools in the city of Granollers. The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation, Vision, Action and Change (IVAC). At the beginning and at the end of the study (2006 and 2008) the weight and height of each child was measured in situ, while the families were given a self-report physical activity questionnaire and the Krece Plus quick test. Results Two years after the beginning of the study, the body mass index of the children in the control group was 0.89 kg/m2 higher than that of the intervention schools. The intervention reduced by 62% the prevalence of overweight children. Similarly, the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group. In the control group, the weekly consumption of fish was reduced. Conclusions The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity.

Trends in energy and nutrient intake and risk of inadequate intakes in Catalonia, Spain (1992-2003).

OBJECTIVES To analyse trends in energy and nutrient intakes and nutritional adequacy from 1992 to 2003. DESIGN Two consecutive cross-sectional studies carried out on random samples of the Catalan population ENCAT 1992-93 and ENCAT 2002-03. Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days. Spanish food consumption tables were used. Energy and nutrient data were adjusted for intraindividual variability, and the Spanish recommend nutrient intakes (RNIs) were used in the analysis. SETTING Catalonia region, North Eastern Spain. SUBJECTS Analysis is based on a total of 4701 individuals; 2641 from ENCAT 1992-93 (1210 men and 1431 women) and 2060 from ENCAT 2002-03 (954 men and 1106 women), aged 10-75 years. RESULTS No relevant changes in energy intake trends were observed, although a decrease was observed in the daily consumption of proteins (-7 g), cholesterol (-56 mg), potassium (-245 mg), vitamin A (-283 RE microg), retinoids (-71 microg), carotenoids (-1520 microg), niacin (-29 mg), folates (-15 microg), vitamin B12 (-1.6 microg) vitamin D (-0.5 microg), fibre and iron, and an increase in the consumption of calcium (+57 mg) and a slight increase in lipids and fatty acids (% energy). In general, the most outstanding trends were those of vitamin A (as a result of the decreased consumption of offal), proteins, vitamin D and B12 (due to the decreased consumption of meat and fish) and calcium (as a consequence of the increased consumption of dairy products). CONCLUSION No changes were observed in the energy intake of males or females; therefore, the obesity changes may possibly be attributed to changes in physical activity patterns. However, an increase in energy sources of a poorer nutritional profile has been identified, especially for between meal snacks.

Trends in dietary habits and food consumption in Catalonia, Spain (1992–2003)

OBJECTIVE To analyse trends in food habits and food consumption from 1992 to 2003. DESIGN Two consecutive cross-sectional nutrition surveys were carried out on random samples of the Catalan population (Evaluation of Nutritional Status in Catalonia (ENCAT) 1992-93 and ENCAT 2002-03). Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days and a food frequency questionnaire was used to ascertain tendencies in the frequency of food consumption. SETTING Catalonia region, Northeastern Spain. SUBJECTS Analysis is based on a total of 4701 individuals: 2641 from ENCAT 1992-93 (1210 men and 1431 women) and 2060 from ENCAT 2002-03 (954 men and 1106 women), aged 10-75 years. RESULTS The trends from 1992 to 2003 showed an increase in eating between meals and outside the home. There was also an upsurge in consumers for fast food, especially among young adults. Notable decreases in fruit consumption (from 301 to 224 g day(-1)) as well as in vegetables, potatoes, meat (red meat and chicken), fish (whitefish and seafood) and offals were observed. In contrast, there was an increase in dairy product consumption, in general (from 255 to 312 g day(-1)), as well as low fat and skim milk derivatives. Fruit juice, nuts and olive oil consumption also increased, the latter being consumed daily by 96% of the population. Little variation was observed for the rest of the food groups in the period studied. Overall, Catalonia is characterised by a model of consumption that is quite favourable, inherent to Mediterranean countries but with important differences according to age. CONCLUSION Based on the food consumption trends observed in Catalonia, an increase in the consumption of fruits and vegetables, as well as whole grain cereals and fish, should be promoted, along with a reduction in the consumption of meat and sausages.

Estado ponderal, hábitos alimentarios y de actividad física en escolares de primer curso de educación primaria: estudio AVall

OBJECTIVE To evaluate weight, dietary patterns and exercise habits in children attending the first year of primary school in the city of Granollers (Spain). METHODS We performed a cross-sectional study of children enrolled in the schools of the city of Granollers. All the children were born in 2000. Data were collected from September to October 2006. Weight and height were measured in each schoolchild. The parents completed a questionnaire on the frequency of food intake and physical activity and the Krece Plus test. The International Obesity Task Force cut-offs for body mass index were used to define overweight and obesity. RESULTS A total of 566 schoolchildren were included. The prevalence of overweight was 19.6% and that of obesity was 8.5%. Only 3.8% of the children had an adequate breakfast and 17.1% ate five portions of fruit and vegetables a day. Some families consumed a low amount of fruit (22%), vegetables (37%), bread/pasta/ rice/cereals (14%), fish (32%), legumes (13%) and nuts (9%). Children who had lunch at school ate more fruits (38% vs 29%), vegetables (35% vs 25%) and fish (82% vs 73%) than those who did not have lunch at school. A total of 82% of the schoolchildren exercised regularly. CONCLUSIONS A quarter of the children who participated in the study were overweight. The schoolchildren who had lunch at school had better dietary patterns. Inappropriate family habits can determine childrens dietary habits.Objetivo: Determinar el estado ponderal y los habitos alimentarios y de actividad fisica de escolares de primer curso de primaria de la ciudad de Granollers.Diseno y poblacion de estudio: Estudio transversal de los ninos censados en todas las escuelas de la ciudad de Granollers, nacidos en el ano 2000. En septiembre-octubre de 2006 se determino el peso y la talla de cada nino, las familias respondieron una encuesta de frecuencia de consumo de alimentos y de actividad fisica y el test rapido Krece Plus. Para definir el sobrepeso y la obesidad se utilizaron los puntos de corte de indice de masa corporal propuestos por la International Obesity Task Force. Resultados: Se estudio a 566 escolares. La prevalencia de sobrepeso fue del 19,6% y la de obesidad, del 8,5%. Solo el 3,9% de los escolares tomaban un desayuno adecuado y el 17,1% comian 5 raciones de fruta y verduras al dia. A escala familiar, destaca el bajo consumo de frutas (22%), verduras (37%), pan/pasta alimenticia/arroz/cereales (14%), pescado (32%), legumbres (13%) y frutos secos (9%). Los alumnos que almorzaban en la escuela tomaban mas fruta (el 38 frente al 29%), verdura (el 35 frente al 25%) y pescado (el 82 frente al 73%). El 82% de los ninos realizaban actividad fisica de manera regular.Conclusiones: Uno de cada 4 escolares de primero de primaria presenta ya problemas de peso. Los ninos que almuerzan en la escuela tienen mejores habitos alimentarios. Los habitos inadecuados de la familia pueden condicionar los habitos del escolar.

Compliance with dietary guidelines in the Catalan population: basis for a nutrition policy at the regional level (the PAAS strategy)

OBJECTIVE To analyse the degree of compliance with the nutrition objectives and population-based food guides and to indicate possible recommendations for their development within the framework of a Nutrition and Health Policy in Catalonia. DESIGN Using data derived from the latest Catalan Nutrition Survey (ENCAT 2002-03) conducted by the Department of Health, compliance was analysed with respect to the recommendations derived as a result of a previously conducted Survey. In addition, compliance to the recommendations elaborated by the Spanish Society of Community Nutrition (SENC) was also evaluated. SETTING Catalonian region located in the Northeast of Spain. SUBJECTS Analysis is based on a total of 2160 individuals (996 males and 1164 females) aged 10-80 years interviewed in 2002-03. RESULTS The analysis of compliance with the recommendations established in 1995 showed: (a) recommendation to maintain and increase consumption of fruits and vegetables was not achieved; (b) continued use of olive oil as the dietary fat of choice was met; (c) incomplete compliance with maintaining the Mediterranean diet traditions, especially in the younger cohorts; (d) compliance with the recommendation to decrease consumption of red meat and sausages, but non-compliance with guidance to maintain or increase fish consumption and (e) compliance with partially substituting whole milk and dairy for low-fat products. Compliance with the SENC Healthy Eating Guide revealed that those food groups with the worst results were meat and sausages (excessive), pulses (below recommendations) and fruits and vegetables (below recommendations). CONCLUSIONS Compliance with dietary guidelines is low in Catalonia, and reflects the need for an effective nutrition policy in the region defined by the Autonomous Government as the Plan for the Promotion of Physical Activity and Healthy Eating (PAAS).

Evaluación a medio plazo de una intervención educativa en hábitos alimentarios y de actividad física en escolares: estudio Avall 2

OBJECTIVE To assess whether the benefits seen in nutrition, physical activity. and body mass index were maintained at 2 years of completion of the educational intervention. MATERIAL AND METHODS An experimental, longitudinal, 4-year, two-arm, parallel study with cluster randomization to assess an intervention program aimed at children in their first year of primary schooling attending schools in the city of Granollers. Intervention consisted of promoting healthy dietary habits and increasing physical activity through the educational pedagogy Investigation, Vision, Action and Change (IVAC), applied over 2 school years (2006-2008). Weight and height of each child wee measured in situ, and families self-completed a physical activity survey and the Krece Plus quick test in 2006, 2008, and 2010. RESULTS A greater increase in body mass index was seen in 2010 in children from the control group (2.84 ± 0.22 vs 1.96 ± 0.163 kg/m(2), <.001). Prevalence of overweight and obesity increased by 8% and 0.5% respectively in schoolchildren in the control group, while the intervention group showed a 5.3% increase in prevalence of overweight and a 3.6%decrease in prevalence of obesity. Prevalence of excess weight therefore increased by 8.5% in the control group and by 1.8% in the intervention group. Reduction in body mass indexincrease was maintained 2 years after completion of educational intervention regardless of sex, origin, maternal obesity, and educational level of parents. CONCLUSIONS These results confirm that school-based interventions may help contain the current increase in childhood obesity.

Cumplimiento de la dieta mediterránea y nivel de actividad física de los usuarios de la web PAFES (Plan de Actividad Física, Deporte y Salud)

Background: The Physical Activity Plan Sport and Health web site (www.pafes.cat) allows users to assess the level of adherence to the Mediterranean Diet (MD) and level of physical activity (PA) by two interactive questionnaires: the MD questionnaire adapted from the study Prevention with Mediterranean Diet (Predimed) and the abbreviated version of the International Physical Activity questionnaire (IPAQ). Methods: A descriptive analysis was performed on the results of both questionnaires during the period 2009 to 2010. Results: Of the 1376 questionnaires analyzed on adherence to the MD, 12.5% of users have a high compliance, 67.2% moderate, and 20.3% low. Almost all (95.8%) used olive oil as the main added fat, 82.2% and 78.4% reported a low intake of butter and derivatives, and sugary drinks, respectively, and 70.9% referred to an adequate intake of vegetables. On the negative side, 82.3% reported a low intake of legumes, 71.6% a high intake of red meat, 67.6% and 25% lower intake of fruit and nuts, respectively. As regards PA, of the 1221 questionnaires analyzed, 79.4% of the population met the PA health recommendations, 36.5% at a high level, and 42.9% moderate. Conclusions: Web questionnaires can be a useful tool in the promotion and dissemination of both habits. As a suggestion for improvement, we propose the inclusion of demographic variables to determine the profile of users who completed the questionnaires.

Validity of a method for the self-screening of cardiovascular risk

Background The validity of a cardiovascular risk self-screening method was assessed. The results obtained for self-measurement of blood pressure, a point-of-care system’s assessment of lipid profile and glycated hemoglobin, and a self-administered questionnaire (sex, age, diabetes, tobacco consumption) were compared with the standard screening (gold standard) conducted by a health professional. Methods Crossover clinical trial on a population-based sample from Girona (north-eastern Spain), aged 35–74, with no cardiovascular disease at recruitment. Participants were randomized to one of the two risk assessment sequences (standard screening followed by self-screening or vice versa). Cardiovascular risk was estimated with the Framingham-REGICOR function. Concordance between methods was estimated with the intraclass correlation coefficient (ICC). Sensitivity, specificity, and positive and negative predictive values were estimated, considering 5% cardiovascular risk as the cutoff point. ClinicalTrials.gov Registration #NCT02373319. Clinical Research Ethic Committee of the Parc de Salut Mar Registration #2014/5815/I. Results The median cardiovascular risk in men was 2.56 (interquartile range: 1.42–4.35) estimated by standard methods and 2.25 (1.28–4.07) by self-screening with ICC=0.92 (95% CI: 0.90–0.93). In women, the cardiovascular risk was 1.14 (0.61–2.10) by standard methods and 1.10 (0.56–2.00) by self-screening, with ICC=0.89 (0.87–0.90). The sensitivity, specificity, and positive and negative predictive values for the self-screening method were 0.74 (0.63–0.82), 0.97 (0.95–0.99), 0.86 (0.77–0.93), and 0.94 (0.91–0.96), respectively, in men. In women, these values were 0.50 (0.30–0.70), 0.99 (0.98–1), 0.81 (0.54–0.96), and 0.97 (0.95–0.99), respectively. Conclusion The self-screening method for assessing cardiovascular risk provided similar results to the standard method. Self-screening had high clinical performance to rule out intermediate or high cardiovascular risk.

Colonias y campamentos de verano para niños y jóvenes con diabetes. La alimentación: cara a cara, teoría y práctica

Resumen Aunque es evidente que la educacion del nino con diabetes debe ser un proceso individualizado y continuado, las colonias de verano estan consideradas como un instrumento muy adecuado (tal y como indica la Organizacion Mundial de la Salud en la Declaracion de St. Vincent de 1989) para realizar una accion educativa, tanto en lo concerniente a las tecnicas de autocontrol como de ayuda psicologica en relacion con la aceptacion de la enfermedad. El hecho de estar alejados del nucleo familiar y tambien del entorno hospitalario, en un ambiente relajado y en convivencia con otros ninos con diabetes, convierte estas actividades de verano en un experiencia muy favorable para aprender a controlar las glucemias, modificar las dosis, tratar las situaciones agudas y las intercurrencias (con frecuencia relacionadas con la coordinacion entre las actividades deportivas, las comidas y la dosificacion de insulina) y seleccionar los alimentos mas adecuados, en definitiva, para conseguir una mejor adaptacion del tratamiento a la actividad cotidiana, siempre de una forma integrada en las actividades diarias. Por otro lado, tambien resulta enriquecedor para el personal sanitario que participa. Durante los 10 dias que suele durar un turno de colonias, los profesionales sanitarios (personal medico, de enfermeria y dietistas-nutricionistas) tienen la oportunidad de convivir con el nino o el adolescente con diabetes en una situacion que no es la que suele darse en una visita o consulta hospitalaria. En el proceso educativo que representan estas convivencias destaca de forma importante el proceso educativo en alimentacion tanto desde la vertiente de la alimentacion saludable apropiada a la infancia y la adolescencia como desde la vertiente del tratamiento de la propia enfermedad.