P Guallar-Castillón

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 25–29.9u2005kg/m2) and obesity (BMI ≥30u2005kg/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 279u2005000 when RRs for all subjects were used. When RRs for nonsmokers only were applied to the entire population, about 304u2005000 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 337u2005000 based on European data and at about 401u2005000 based on US data. In the EU, therefore, a minimum of 279u2005000 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 (175u2005000) than among the overweight (104u2005000). Around 70% were cardiovascular disease deaths (195u2005000) and 20% cancer deaths (53u2005000).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.

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 ⩾25u2009kgu2009m–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.

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 65u2005y or over, for Spain’s 50 provinces.SUBJECTS:Non-institutionalized population aged 16u2005y or over.MEASUREMENTS:Median BMI and percentage of population with obesity, defined as BMI>30u2005kg/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 13u2005244-woman sample representative of the non-institutionalised Spanish population aged 16u2005y 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 18.5–24.9u2005kg/m2), overweight (BMI 25.0–29.9u2005kg/m2) and obesity (BMI≥30u2005kg/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≥18.5u2005kg/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.

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 60u2009y 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) 18.5–29.9u2009kg/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≥30u2009kg/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.

One year effectiveness of an individualised smoking cessation intervention at the workplace: a randomised controlled trial

Aims: To assess the effectiveness of a smoking cessation intervention at the workplace. The intervention was adapted to smokers‘ tobacco dependence, and included minimal structured counselling at the first visit (5–8 minutes), nicotine patches for three months, and three sessions of counselling for reinforcement of abstinence (2–3 minutes) over a three month period. Methods: Open randomised trial with two groups: the intervention group, and the control group which was subjected to standard clinical practice, consisting of short (30 seconds to one minute) sporadic sessions of unstructured medical antismoking advice. The trial was carried out among 217 smokers of both sexes, aged 20–63 years, motivated to quit smoking and without contraindications for nicotine patches, who were employees at a public transport company and at two worksites of an electric company. The main outcome measure was self reported tobacco abstinence confirmed by carbon monoxide in expired air ≤10 ppm. Analysis was performed according to intention-to-treat. Results: The rate of continuous abstinence at 12 months was 20.2% for the intervention versus 8.7% for the control group (OR: 2.58; 95% CI: 1.13 to 5.90; p = 0.025). In subgroup analyses, effectiveness of the intervention did not vary substantially with age, tobacco dependence, number of cigarettes smoked per day, number of years of tobacco consumption, degree of desire to quit smoking, time spent with smokers, subjective health, and presence of tobacco related symptoms. Weight gain at 12 months was similar for both groups (1.69 kg in the intervention v 2.01 kg in the control group; p = 0.21). Conclusions: A simple and easily generalisable intervention at the workplace is effective to achieve long term smoking cessation. In a setting similar to ours, nine subjects would have to be treated for three months for one to achieve continuous abstinence for 12 months.

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 20u2005y and over.Subjects and interventions: A total of 11u2009496 men and women aged 20u2005y and over with a body mass index (BMI) ≥25u2005kg/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 64u2005y 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 25–26.9u2005kg/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.

Prevalence of Depression and Associated Medical and Psychosocial Factors in Elderly Hospitalized Patients With Heart Failure in Spain

INTRODUCTION AND OBJECTIVESnThis study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain.nnnMETHODSnThe study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale.nnnRESULTSnIn total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for > or =3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17).nnnCONCLUSIONSnDepression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients.

Prevalencia de depresión, y factores biomédicos y psicosociales asociados, en ancianos hospitalizados con insuficiencia cardiaca en España

Introduccion y objetivos En este trabajo se estima la prevalencia de depresion y se identifican los factores biomedicos y psicosociales asociados en ancianos hospitalizados con insuficiencia cardiaca en Espana. Metodos Se estudio a 433 pacientes ≥ 65 anos ingresados de urgencia en 4 hospitales espanoles desde enero de 2000 hasta junio de 2001, con diagnostico principal o secundario de insuficiencia cardiaca. Se considero que habia depresion ante la presencia de 3 sintomas en la Escala de Depresion Geriatrica de 10 items. Resultados Del total de pacientes estudiados, 210 (48,5%) presentaron depresion. Las cifras correspondientes fueron 71 (37,6%) en varones y 139 (57,0%) en mujeres. La depresion fue mas frecuente en los pacientes con las siguientes caracteristicas: grado funcional III-IV de la NYHA (odds ratio ajustada [ORa] = 2,00; intervalo de confianza [IC] del 95%, 1,23-3,24); peor puntuacion en los aspectos fisicos de la calidad vida (ORa = 3,14; IC del 95%,1,98-4,99); dependencia en 1 o 2 actividades basicas de la vida diaria (ABVD) (ORa = 2,52; IC del 95%, 1,41-4,51); dependencia en 3 o mas ABVD (ORa = 2,47; IC del 95%, 1,20-5,07); limitacion en alguna actividad instrumental de la vida diaria (ORa = 2,20; IC del 95%, 1,28-3,79); hospitalizacion previa por insuficiencia cardiaca (ORa = 1,71; IC del 95%, 1,93-5,45); estaban solos en casa mas de 2 h al dia (ORa = 3,24; IC del 95%, 1,93-5,45); menor satisfaccion con el medico de atencion primaria (ORa = 1,90; IC del 95%, 1,14-3,17). Conclusiones La depresion es muy frecuente en los ancianos hospitalizados con insuficiencia cardiaca, y se asocia con varios factores biomedicos y psicosociales. Esta elevada frecuencia, el peor pronostico de la insuficiencia cardiaca en presencia de sintomas depresivos y la existencia de instrumentos diagnosticos sencillos y un tratamiento eficaz apoyan el cribado sistematico de la depression en estos pacientes.

Changes in Sitting Time and Cardiovascular Mortality in Older Adults

INTRODUCTIONnProlonged sitting time has demonstrated consistent associations with increased risk of cardiovascular disease and mortality, but most previous studies have analyzed these associations assessing sitting time at one single point and providing scarce evidence on causal links. The main objective of this study was to analyze the association of 2-year changes in sitting time with subsequent long-term cardiovascular disease mortality in older adults.nnnMETHODSnThe analyses were conducted with 2,657 individuals with complete data. Sitting time and physical activity were assessed by questionnaire. Changes in sitting time were classified into consistently sedentary (high sitting time in 2001 and 2003); newly sedentary (low sitting time in 2001 and high sitting time in 2003); formerly sedentary (high sitting time in 2001 and low sitting time in 2003); and consistently nonsedentary (low sitting time in 2001 and 2003). The associations between change in sitting time and cardiovascular disease mortality were summarized with hazard ratios and their 95% CIs obtained from Cox regression. The combined effect of changes in sitting time and physical activity on cardiovascular disease mortality was also examined.nnnRESULTSnCompared with consistently sedentary participants, those who were consistently nonsedentary had a 33% (hazard ratio=0.67, 95% CI=0.46, 0.96) lower risk of cardiovascular disease death. In combined analyses, consistent nonsedentariness was associated with reduced cardiovascular disease mortality in participants with physical activity less than the median (hazard ratio=0.62, 95% CI=0.39, 1.00) and greater than or equal to the median (hazard ratio=0.49, 95% CI=0.31, 0.79). Formerly sedentary participants with physical activity greater than or equal to the median had a 48% lower cardiovascular disease mortality.nnnCONCLUSIONSnAmong older adults, maintaining low sitting time should be promoted to reduce cardiovascular disease mortality.