Juan Luis Gutiérrez-Fisac

Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study.

This is the first study to report the prevalence of general obesity and abdominal obesity (AO) in the adult population of Spain based on measurements of weight, height and waist circumference. The data are taken from the ENRICA study, a cross‐sectional study carried out between June 2008 and October 2010 in 12,883 individuals representative of the non‐institutionalized population on Spain aged 18 years and older. Anthropometry was performed under standardized conditions in the households by trained interviewers. Overweight was considered as body mass index (BMI) 25–29.9 kg m−2, and obesity as BMI ≥ 30 kg m−2. AO was defined as waist circumference >102 cm in men and >88 cm in women. The prevalence of obesity was 22.9% (24.4% in men and 21.4% in women). About 36% of adults had AO (32% of men and 39% of women). The frequency of obesity and of AO increased with age and affected, respectively, 35 and 62% of persons aged 65 and over. The frequency of obesity and AO decreased with increasing educational level. For example, 29% of women with primary education or less had obesity vs. only 11% of those with university studies. The prevalence of obesity was very high in the Canary Islands and in the south of Spain.

Justificación y métodos del estudio sobre nutrición y riesgo cardiovascular en España (ENRICA)

INTRODUCTION AND OBJECTIVES The ENRICA study aims to assess the frequency and distribution of the main components of the natural history of cardiovascular disease in Spain, including food consumption and other behavioral risk factors, biological risk factors, early damage of target organs, and diagnosed morbidity. METHODS A cross-sectional survey of 11,991 individuals representative of the non-institutionalized population aged 18 years and older in Spain was conducted from June 2008 to October 2010. Data collection comprised 3 sequential stages: a) computer-assisted telephone interview to obtain information on lifestyle, knowledge and attitudes about cardiovascular disease risk factors, and the signs and symptoms of heart attack and stroke, subjective health, and morbidity; b) first home visit, to collect blood and urine samples for analysis by a central laboratory, and c) second home visit, to measure anthropometric variables and blood pressure and to administer a computer-assisted dietary history; data on functional limitations are also collected from participants aged 65 years and older. DISCUSSION The ENRICA study has shown the feasibility of a large home-based health interview and examination survey in Spain. It will provide valuable information to support and evaluate national strategies against cardiovascular disease and other chronic diseases in Spain. Moreover, a 3-year prospective follow-up of the study participants, including a new physical exam, is planned to start in the second semester of 2011 and will update lifestyle information and biological variables. (ClinicalTrials.gov number, NCT01133093).

Valores de referencia de la versión española del Cuestionario de Salud SF-36 en población adulta de más de 60 años

Fundamento Y Objetivo El Cuestionario de Salud SF-36 es el mas usado en la bibliografia internacionalpara medir la calidad de vida relacionada con la salud. Los valores de referencia del cuestionario sonnecesarios para interpretar sus resultados en estudios clinicos y poblacionales. Un estudio realizadoen 1996 proporciono dichos valores para la poblacion espanola, pero no se desagregaron por edad enlos sujetos de 75 y mas anos, a pesar de que el estado de salud cambia al envejecer en los que, cadadia con mas frecuencia, superan dicha edad. Ademas, el estado de salud de los ancianos de los paisesdesarrollados ha mejorado en los ultimos anos. Por ello, el objetivo de este trabajo ha sido obtenerlos valores de referencia del Cuestionario de Salud SF-36 en el ano 2001 para la poblacion espanolaen grupos quinquenales de edad en el intervalo de 60 a 85 y mas anos. Sujetos Y Metodo Estudio transversal en una muestra de 3.949 personas representativas de la poblacionespanola no institucionalizada de 60 y mas anos de edad. El Cuestionario de Salud SF-36 secompleto mediante entrevista personal en los domicilios. Se calcularon medidas de tendencia centraly de dispersion, y los percentiles de las puntuaciones de las 8 escalas del cuestionario, segun la edady el sexo. Ademas se examino la consistencia o fiabilidad interna de cada escala mediante el coeficientealfa de Cronbach. Resultados Los sujetos refirieron las puntuaciones mas elevadas para las escalas de rol emocional(media [DE]: 84,8 [32,9]), funcion social (79,2 [28,0]) y rol fisico (73,3 [41,1]). Los valores mediosde todas las escalas fueron superiores (mejor salud percibida) en los varones que en las mujeres (p Conclusiones Estos resultados complementan los del estudio de 1996 y favoreceran la interpretacionde los valores del Cuestionario de Salud SF-36 en estudios clinicos y poblacionales en personas de 60y mas anos en Espana. Background and Objective The SF-36 Health Survey questionnaire is the most widely used instrumentto measure health-related quality of life. Reference measures are needed to interpret its results in clinicaland population studies. In 1996, a study provided population-based norms for Spain, but thesewere not disaggregated by age in subjects aged 75 years and over, even though health status changeswith aging among those who overpass such age. Moreover, health status in elderly people from developedcountries has improved over the last years. This study obtains population-based norms for theSpanish version of the SF-36 Health Survey in five-year age-groups for those aged 60 to 85 and over. Subjects and Method Cross-sectional survey on a sample of 3,949 non-institutionalised subjects representativeof the Spanish population aged 60 years and over. Information on the SF-36 Health Survey wasobtained through house-hold personal interviews. Central position and dispersion statistics, as well aspercentiles, were calculated for each of the eight SF-36 scales by age and sex. Cronbachs alpha coefficientswere calculated to assess the internal reliability of each scale. Results Subjects reported higher scores for emotional role (mean [SD] 84.8 [32.9]), social functioning(79.2 [28.0]) and physical role (73.3 [41.1]). For all scales, mean scores were higher (better perceivedhealth) among men than women (p Conclusions These results extend those obtained in 1996 and facilitate the interpretation of the SF-36Health Survey values in clinical and population studies in the Spanish population aged 60 years andolder.

Relationship between obesity, hypertension and diabetes, and health-related quality of life among the elderly.

Background The purpose of this study was to study the cumulative effects of cardiovascular risk factors on all the health-related quality of life dimensions among the elderly in this era of epidemic obesity and diabetes. Design and methods The population-based study covered 3567 participants, representative of the Spanish non-institutionalized population aged 60 years and above. Data were gathered from home-based interviews and from the measurements of blood pressure and other anthropometric variables. Multiple linear regression was used to examine the relationships between health-related quality of life, on each scale of the SF-36 questionnaire, and obesity (waist circumference > 102 cm in men and >88cm in women), hypertension (blood pressure ≥ 140/90 mmHg), and known diabetes, after adjusting for sociodemographic and lifestyle factors. Results Patients with obesity, hypertension, and diabetes, or a combination of these factors were, in general, associated with a worse health-related quality of life, on both the physical and the mental scales, than those without these factors, though statistical significance (P<0.05) was only attained for some relationships. Obesity in women (−2.9 to −6.7 points, according to the scale) and diabetes in men (−6.1 to −16.4 points, according to the scale) were the factors most closely and significantly associated with diminished health-related quality of life. Women who had all three factors showed the maximum decline in health-related quality of life (−10.2 to −17.7 points, according to the scale). Conclusions Obesity in old women and diabetes in old men are the most decisive factors adversely affecting the health-related quality of life. The association with worse health-related quality of life is especially marked (greater than additive) in women with all three factors, thereby rendering them a group that calls for special study and attention.

Eating behaviours and obesity in the adult population of Spain

To examine the association between several eating behaviours and obesity, data were taken from a cross-sectional study conducted with 34,974 individuals aged 25-64 years, representative of the non-institutionalised Spanish population. Obesity was defined as BMI >or= 30 kg/m2. Study associations were summarised with OR obtained from logistic regression, with adjustment for socio-demographic and lifestyle factors. The results showed that those skipping breakfast were more likely to be obese, both in men (OR 1.58; 95 % CI 1.29, 1.93) and women (OR 1.53; 95 % CI 1.15, 2.03). Moreover, obesity was more prevalent in those having only two meals per day than in those having three or four meals in men (OR 1.63; 95 % CI 1.37, 1.95) and women (OR 1.30; 95 % CI 1.05, 1.62). Also, snacking was associated with obesity in women (OR 1.51; 95 % CI 1.17, 1.95). However, no association was observed between obesity and having one or more of the main meals away from home, in either sex. In conclusion, skipping breakfast and eating frequency were associated with obesity. The lack of association between eating away from home and obesity is in contrast to most previous research conducted in Anglo-Saxon countries. Differences in the type of establishment frequented when eating out or in the characteristics of restaurant customers in a Mediterranean population might explain these conflicting results.

Trends in obesity differences by educational level in Spain

Our objective was to study the trend in differences in the frequency of obesity by educational level in the general population 20 to 64 years of age. We used data from two cross-sectional health surveys carried out in 1987 and 1993 in representative samples of the Spanish population. We investigated the relation between obesity and educational level during the periods 1987 and 1993, taking into account the main factors confounding the relation. We used, as setting, the National Health Interview Surveys representative of the whole Spanish population. In both men and women, the highest odds ratios (ORs) for obesity were observed at lower educational levels. These differences increased in women between 1987 and 1993, while they decreased in men during the same period. Evidence of increased educational differences in the frequency of obesity indicates that future studies should focus on the evaluation and monitoring of this trend in the population.

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.

Increased socioeconomic differences in mortality in eight Spanish provinces

In Spain, the study of socioeconomic differences in mortality has been limited by the fact that death certificates often do not include complete information on occupation. In this study, we chose those geographic areas with the highest quality information on occupation of the deceased in order to study socioeconomic differences in mortality from various causes of death. We used information from the death certificates of males who died between 30 and 64 years of age in eight Spanish provinces to compare mortality from the leading causes of death in professionals and managers (group I) and in manual laborers (group II) in 1980-82 and 1988-90. In each period the standardized mortality ratios (SMRs) were higher in group II, except for ischaemic heart disease during the first period, and cancer of the colon and rectum in both, although in the latter case the differences were not statistically significant. The ratio between the SMR from all causes in group II and group I was 1.27 in 1980-82, and 1.72 in 1988-90; for cancer of the colon and rectum the ratio went from 0.98 to 0.84, and for ischaemic heart disease, from 0.80 to 1.31. Except for cancer of the colon and rectum, which resulted in higher mortality in occupational group I, the excess mortality in occupational group II increased between the first and second period. The relation between socioeconomic level and mortality for ischaemic heart disease was reversed, a phenomenon similar to that which took place in the 1960s and 1970s in the developed countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors explaining the geographical differences in Disability Free Life Expectancy in Spain

OBJECTIVE To study the geographical variations in Disability Free Life Expectancy (DFLE) at birth (DFLEb) and at 65 years (DFLE65) in Spain and to identify the main factors that explain these variations. DESIGN Ecological study with the 50 provinces of Spain as the units of analysis. Sullivans method is used to calculate DFLE for each province based on information from the death registry and the survey on disabilities, impairments and handicaps. Information on the independent variables—socioeconomic level, factors related with the health system and risk factors—was taken from various sources. MAIN OUTCOME MEASURE Simple correlation coefficients were obtained between each dependent variable (DFLEb and DLFE65) and the independent variables. Two multiple linear regression models were fit to obtain the best set of factors that explain the geographical distribution of DFLEb and DLFE65. RESULTS Both DFLEb and DLFE65 vary widely among provinces. The multiple linear regression analysis shows that the illiteracy rate, the percentage of the unemployed and the percentage of smokers in the population were the main factors associated with the geographical variation of DFLE. The models explained approximately 40% of the variance for DFLEb and 30% for DLFE65. CONCLUSIONS The results obtained show the influence of education, the unemployment rate and smoking on the geographical differences of DFLE. The DFLE indicators are shown to be valid for use in health policy.

Magnitude and Management of Metabolic Syndrome in Spain in 2008-2010: The ENRICA Study

INTRODUCTION AND OBJECTIVES Few studies in Spain have reported the distribution of metabolic syndrome using the harmonized definition and that of premorbid metabolic syndrome, which consists of metabolic syndrome without diabetes mellitus or cardiovascular disease. Moreover, their regional distributions and clinical management are unknown. The present study examined the distributions and clinical management of both syndromes in Spain. METHODS This cross-sectional study was performed from 2008 to 2010 in 11 149 representative individuals of the Spanish population aged 18 years or older. Data were obtained through standardized physical examination, and analytical measurements were done in a central laboratory. RESULTS The prevalences (95% confidence interval) of metabolic syndrome and premorbid metabolic syndrome were 22.7% (21.7%-23.7%) and 16.9% (16.0%-17.8%), respectively. The frequency of both syndromes increased with age and was higher in men than in women up to 65 years; above this age, the frequency was higher in women. The communities of the south of Spain and the Balearic and Canary islands had the highest prevalence of both syndromes, in some regions reaching double that of the community with the lowest prevalence. About one third of patients with premorbid metabolic syndrome reported that they had not received health recommendations to improve their lifestyles; of those that did receive advice, adherence was low, particularly for reducing weight (31.9%) and salt intake (38.3%). CONCLUSIONS The prevalence of metabolic syndrome is high in Spain and considerable geographical differences exist in its distribution. There is substantial room for improvement in the clinical management of premorbid metabolic syndrome.