J.R. Banegas

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.

Epidemiología de la hipertensión arterial en España. Situación actual y perspectivas

Si el control de la hipertension arterial (HTA) y de otros importantes factores de riesgo no mejora, la carga sanitaria y economica de las enfermedades cardiovasculares, renales y neurologicas consiguientes podria incrementarse sustancialmente en las proximas decadas debido al envejecimiento de la poblacion y a la alta prevalencia de estos factores de riesgo. Realmente se ha logrado cierto grado de progreso en el control de la HTA, pero se necesita investigacion adicional y mejoras en las tres areas de conocimiento, tratamiento y control de la HTA. En este articulo se postula que el paradigma de definicion y manejo de la HTA puede estar cambiando hacia el concepto de “esion arterial susceptible de tratamiento” (en funcion de sus cifras y el riesgo cardiovascular). Por ultimo, es preciso no olvidar que para que el sistema sanitario pueda asumir los costes implicados en la carga y el manejo de la HTA deberia potenciarse la prevencion, sobre todo la prevencion primaria, que debe contemplar tambien a la infancia y la adolescencia.

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.

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.

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.

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.

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 problema del control de la hipertensión en España

Es bien conocido por los clinicos que el grado de control de la hipertension arterial (HTA) en Espana y otros paises desarrollados deja mucho que desear. El interesante trabajo de Antonio Coca en este numero de la revista (estudio Controlpres 2001) pone de manifiesto una buena y una mala noticia. La buena es que el control de la HTA ha mejorado en Espana, al parecer de forma notable, en los ultimos pocos anos. La mala es que seguimos en unas cifras de control todavia muy bajas (eufemisticamente, muy mejorables), sobre todo teniendo en cuenta que estas cifras estan calculadas sobre hipertensos atendidos y tratados en Atencion Primaria y no en la poblacion general, donde muchos hipertensos desconocen que lo son. Y no nos consuela saber que en algunos otros paises la situacion es incluso peor. Mas concretamente destacamos tres evidencias y consideraciones del estudio Controlpres 2001. En primer lugar, la magnitud del control de la HTA en la actualidad y el progreso ocurrido en los ultimos anos. Segundo, algunas pistas epidemiologicas sobre las razones del todavia bajo control de la HTA. Por ultimo, las medidas propuestas para avanzar en el grado de control y, por ende, en la reduccion del riesgo cardiovascular.

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.