Luz María León-Muñoz

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.

Validity and reproducibility of a Spanish dietary history

Objective To assess the validity and reproducibility of food and nutrient intake estimated with the electronic diet history of ENRICA (DH-E), which collects information on numerous aspects of the Spanish diet. Methods The validity of food and nutrient intake was estimated using Pearson correlation coefficients between the DH-E and the mean of seven 24-hour recalls collected every 2 months over the previous year. The reproducibility was estimated using intraclass correlation coefficients between two DH-E made one year apart. Results The correlations coefficients between the DH-E and the mean of seven 24-hour recalls for the main food groups were cereals (r = 0.66), meat (r = 0.66), fish (r = 0.42), vegetables (r = 0.62) and fruits (r = 0.44). The mean correlation coefficient for all 15 food groups considered was 0.53. The correlations for macronutrients were: energy (r = 0.76), proteins (r = 0.58), lipids (r = 0.73), saturated fat (r = 0.73), monounsaturated fat (r = 0.59), polyunsaturated fat (r = 0.57), and carbohydrates (r = 0.66). The mean correlation coefficient for all 41 nutrients studied was 0.55. The intraclass correlation coefficient between the two DH-E was greater than 0.40 for most foods and nutrients. Conclusions The DH-E shows good validity and reproducibility for estimating usual intake of foods and nutrients.

Mortalidad cardiovascular atribuible a la presión arterial elevada en la población española de 50 años o más

Fundamento y objetivo: No se dispone de informacion actual sobre la mortalidad cardiovascular atribuible a la presion arterial elevada en Espana. Pacientes y metodo: Se han estimado, mediante formulas convencionales, los riesgos atribuibles poblacionales y el numero de muertes cardiovasculares relacionadas con cifras elevadas de presion arterial sistolica (

Prevalence and determinants of metabolically healthy obesity in Spain

120 mmHg) en la poblacion de 50-89 anos de Espana. Los datos sobre riesgos relativos proceden del Prospective Studies Collaboration, metaanalisis de 61 estudios de presion arterial y mortalidad, con datos de un millon de personas (30.000 del sur de Europa) sin antecedentes de enfermedad vascular. Las prevalencias de la presion arterial proceden de 2 estudios representativos de la poblacion espanola para personas de 50-59 y 60-89 anos de edad, respectivamente. El numero de muertes de causa cardiovascular ocurridas se ha tomado del Instituto Nacional de Estadistica (ano 2004). Resultados: Anualmente un total de 44.401 muertes de causa cardiovascular son atribuibles a la presion arterial elevada, lo que representa el 54% de la mortalidad cardiovascular en mayores de 50 anos: 17.312 por cardiopatia isquemica, 15.599 por enfermedad cerebrovascular y 11.490 por otras enfermedades cardiovasculares. El mayor numero de muertes atribuibles corresponde a las categorias de hipertension grados 1 y 2 (32.638) y a los mayores de 70 anos (36.345), y las presiones normal y normal-alta explican un 6% de todas las muertes atribuibles. Conclusiones: Una de cada 2 muertes de causa cardiovascular ocurridas anualmente a los individuos mayores de 50 anos son atribuibles a la presion arterial elevada, y el 90% de ellas son atribuibles a la hipertension.

Sleep quality and the metabolic syndrome: the role of sleep duration and lifestyle.

BACKGROUND AND AIMS Obesity is a heterogeneous disorder, so some obese individuals do not have cardiometabolic abnormalities (CA) which mediate the association between obesity and coronary heart disease. This study assessed the prevalence of metabolically healthy obesity and its determinants in Spain. METHODS The data were taken from a cross-sectional study conducted in 2008-2010 among 11,520 individuals representative of the population of Spain aged ≥18 years. Normal-weight was defined as body mass index (BMI) <25 kg/m(2), and obesity as BMI ≥30 kg/m(2). Six CA were considered: elevated blood pressure, low high-density lipoprotein cholesterol, and elevated levels of triglycerides, fasting glucose, homeostasis model assessment of insulin resistance value, and C-reactive protein. Then, two phenotypes were defined: healthy (0-1 CA) and abnormal (≥2 CA). RESULTS The prevalence of metabolically healthy obesity was 6.5% overall (95% confidence interval: 6.0-7.1), and corresponds to 28.9% of obese individuals. Lower age, being female, current smoking, moderate alcohol consumption, and high level of physical activity were independently associated with the healthy phenotype among the obese. The prevalence of normal weight with a metabolically abnormal phenotype was 6.4% overall (95% confidence interval: 5.8-6.9) and corresponds to 16.8% of normal-weight subjects. Factors associated with this phenotype in normal-weight persons were higher age, being male, never smoking, no alcohol consumption and larger waist circumference. CONCLUSION Metabolically healthy obesity represents almost one-third of the obese population in Spain. Since this was a cross-sectional study, the association of metabolic healthy obesity with smoking consumption, alcohol intake and physical activity warrants more research.

Dietary habits of the hypertensive population of Spain: accordance with the DASH diet and the Mediterranean diet.

This study examined the association between sleep quality and the metabolic syndrome and whether if it is independent of sleep duration and if it can be explained by lifestyles linked to sleep quality.

Food sources of sodium, saturated fat and added sugar in the Spanish hypertensive and diabetic population

Objectives: Dietary treatment is appropriate for all patients with hypertension. However, only a few population-based studies have evaluated the diet of hypertensive individuals, and none of them has been conducted in Europe. This study examined accordance with the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet in the hypertensive population of Spain. Methods: A cross-sectional study conducted in 2008–2010 among 12 948 individuals representative of the Spanish population aged at least 18 years. Blood pressure was measured with validated devices under standardized conditions. Habitual food consumption was assessed with a computerized diet history. DASH accordance was defined as at least 4.5 points on a score using nine nutrient targets, and Mediterranean diet accordance as at least 9 points on the Mediterranean Diet Adherence Screener score. Results: Among the diagnosed hypertensive individuals, 17.3% [95% confidence interval (CI) 15.4–19.2%] had a DASH-accordant diet, and 17.2% (95% CI 15.4–19.1%) had a Mediterranean-accordant diet. The frequency of DASH accordance increased with age, was higher among women and hypercholesterolaemic individuals, and lower in current smokers. Similar results were found for Mediterranean diet accordance. Only 60% of the diagnosed hypertensive individuals reported receiving and following a diet prescribed to control hypertension; this group showed a better accordance with the DASH diet [age and sex-adjusted odds ratio (aOR) 1.43; 95% CI 1.08–1.88]. As compared with the 1518 hypertensive individuals unaware of their condition, those who were diagnosed showed a similar frequency of accordance with the DASH diet (aOR 1.08; 95% CI 0.87–1.34) and the Mediterranean diet (aOR 0.98; 95% CI 0.79–1.20). Conclusion: The diet of hypertensive individuals in Spain has a low accordance with the DASH and Mediterranean dietary patterns. The similarity in healthy-diets accordance between the diagnosed and undiagnosed hypertensive individuals suggests that nutritional interventions in hypertensive patients are poor, a problem that should be compellingly addressed.

Obesity‐related eating behaviours in the adult population of Spain, 2008–2010

OBJECTIVES Previous research has shown that the diet of hypertensive and diabetic patients has a low accordance with the main nutritional recommendations, mostly due to the high intake of sodium, saturated fat and added sugars. This is the first study to identify the main food sources of these nutrients in these patients. METHODS Cross-sectional study conducted in 2008-2010 in a representative sample of the Spanish adult population, including 2323 patients with hypertension and 635 with diabetes. The habitual diet was assessed using a validated diet history. The intake of sodium, saturated fat and added sugars was estimated with Spanish food composition tables. RESULTS The hypertensive and diabetic population showed, respectively, an intake of 2.9 and 3.1 g/day of sodium, 26 and 26 g/day of saturated fat, and 33 and 24 g/day of added sugar. In hypertensive and diabetic patients, respectively, most sodium intake came from bread (35%, 34%), raw-cured sausages (15%, 15%), cooked sausages (6%, 7%), and soup (5%, 6%). The main sources of saturated fat were cured cheese (13%, 13%), bakery products (12%, 11%), red meat (10%, 11%), raw-cured sausages (8%, 9%) and whole milk (4%, 4%). The food groups that most contributed to added sugar intake were sugar directly added to coffee and other beverages (27%, 19%), bakery products (15%, 19%), sugary soft drinks (10%, 13%), and whole yogurt (9%, 12%). The main food sources of nutrients were similar in all sex and age groups. CONCLUSIONS In patients with hypertension and diabetes, the intake of sodium, saturated fat and added sugar can be substantially reduced by prioritizing low-salt varieties of bread, reducing the consumption of bakery products and sausages, replacing cured cheese and other whole dairy products by low-fat products, using non-sugary sweeteners, and substituting sugar-free soft drinks, or plain water, for sugary sodas.

Is a specific drinking pattern a consistent feature of the Mediterranean diet in Spain in the XXI century

Knowledge of the socio‐demographic distribution of eating behaviours can aid our understanding of their contribution to the obesity epidemic and help to address healthy eating interventions to those who can benefit most. This cross‐sectional study assessed the frequency of self‐reported eating behaviours among 11,603 individuals representative of the non‐institutionalized Spanish population aged ≥18 years in the period 2008–2010. In the adult population of Spain, 24.3% had lunch and 18.2% had dinner away from home >3 times per month. About three‐fourths of adults did not plan the amount of food to be eaten, and did not choose light foods and/or skim dairy products. Also, 26% did not trim visible fat from meat, and 74.7% usually ate while watching television. Compared with individuals with primary or less education, those with university studies were more likely to remove fat from meat (age‐ and sex‐adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.08–1.44), and to choose light food and/or skim dairy (aOR 1.50; 95% CI 1.30–1.77), and less likely to eat while watching television (aOR 0.54; 95% CI 0.47–0.63). In conclusion, the prevalence of several obesity‐related eating behaviours is high in Spain, which indicates a deficient implementation of dietary guidelines. Socioeconomic inequalities in eating behaviours should also be addressed.

Change in health-related quality of life as a predictor of mortality in the older adults.

BACKGROUND AND AIM Over the last 50 years, people in Spain have increasingly been eating their main meal away from home and are shifting from the typical Mediterranean diet (MD). In addition, wine consumption has decreased whereas beer intake has risen. Consequently, it is uncertain if the Mediterranean drinking pattern (MDP; moderate alcohol intake mainly from wine and during meals) is a habitual feature of the MD today. METHODS AND RESULTS Cross-sectional study conducted from 2008 to 2010 among 8894 individuals representative of the Spanish population aged 18-64 years. Consumption of alcoholic beverages and food was collected with a validated diet history. Accordance with the MD was defined as a score ≥8 on the Mediterranean Diet Adherence Screener (MEDAS) or ≥5 in the Trichopoulou index (after excluding alcohol intake from both indices). Among individuals with MEDAS-based MD accordance, only 17.1% had a MDP. After adjustment for potential confounders, this drinking pattern showed a weak association with higher MD accordance (odds ratio (OR) 1.32; 95% confidence interval (CI) 1.12-1.57). Only 14.7% of those with Trichopoulou-based MD accordance had a MDP; this pattern showed an even weaker association with higher MD accordance (OR 1.17; 95% CI 1.01-1.36). Similar results were obtained when this drinking pattern was redefined to include persons who drank wine with or outside of meals, as well as those who were primarily beer drinkers. CONCLUSIONS The MDP is not a habitual feature of the MD in the early XXI century in Spain.