Patterns of alcohol consumption and risk of falls in older adults: a prospective cohort study.

Falls are a major health problem in older adults, but their relationship with alcohol consumption in this population remains unclear. In a cohort with 2170 older adults followed up for 3.3 years, both moderate drinking and the Mediterranean drinking pattern were associated with a lower risk of falls and injurious falls. INTRODUCTION: This study aims to examine the association between certain patterns of alcohol consumption, including the Mediterranean drinking pattern (MDP), and the risk of falls in older adults. METHODS: A prospective cohort with 2170 community-dwelling individuals aged ≥60 years was recruited in Spain in 2008-2010 and followed up through 2012. At baseline, participants reported alcohol consumption and, at the end of follow-up, their falls during the previous year. The MDP was defined as moderate alcohol consumption (threshold between moderate and heavy intake was 40 g/day for men and 24 g/day for women) with preference for wine and drinking only with meals. Analyses were conducted with negative binomial or logistic regression, as appropriate, and adjusted for the main confounders. RESULTS: Compared with never drinkers, the number of falls was lower in moderate drinkers (incidence rate ratio (95% confidence interval), 0.79 (0.63-0.99)) and drinkers with MDP (0.73 (0.56-0.96)). Also, moderate drinkers and those with MDP showed a lower risk of ≥2 falls (odds ratio (95% confidence interval), 0.58 (0.38-0.88) and 0.56 (0.34-0.93), respectively) and of falls requiring medical care (0.67 (0.46-0.96) and 0.61 (0.39-0.96), respectively). CONCLUSION: Both moderate drinking and the MDP were associated with a lower risk of falls and injurious falls in older adults. However, sound advice on alcohol consumption should balance risks and benefits.

Association between REM sleep behaviour disorder and impulse control disorder in patients with Parkinson's disease. / Relación entre el trastorno de conducta del sueño REM y el trastorno de control de impulsos en pacientes con enfermedad de Parkinson.

INTRODUCTION: The relationship between impulse control disorder (ICD) and REM sleep behaviour disorder (RBD) has not yet been clarified, and the literature reports contradictory results. Our purpose is to analyse the association between these 2 disorders and their presence in patients under dopaminergic treatment. METHODS: A total of 73 patients diagnosed with Parkinson's disease and treated with a single dopamine agonist were included in the study after undergoing clinical assessment and completing the single-question screen for REM sleep behaviour disorder and the short version of the questionnaire for impulsive-compulsive behaviours in Parkinson's disease. RESULTS: Mean age was 68.88 ± 7.758 years. Twenty-six patients (35.6%) were classified as probable-RBD. This group showed a significant association with ICD (P=.001) and had a higher prevalence of non-tremor akinetic rigid syndrome and longer duration of treatment with levodopa and dopamine agonists than the group without probable-RBD. We found a significant correlation between the use of oral dopamine agonists and ICD. Likewise, patients treated with oral dopamine agonists demonstrated a greater tendency toward presenting probable-RBD than patients taking dopamine agonists by other routes; the difference was non-significant. CONCLUSIONS: The present study confirms the association between RBD and a higher risk of developing symptoms of ICD in Parkinson's disease.

Physical Activity, Sitting Time and Mortality in Older Adults with Diabetes.

The purpose of this study was to examine the independent and combined association of physical activity (PA) and sitting time (ST) with all-cause mortality in older adults with diabetes. A total of 611 individuals representative of the Spanish diabetic population aged ≥ 60 years. Participants were selected in 2000/2001 and were prospectively followed-up through 2011. PA and ST were self-reported at baseline. Study associations were summarized as hazard ratios (HR) and their 95% confidence interval (CI). During a mean follow-up of 8.3 years, 282 deaths occurred. The HR (95% CI) of mortality for very/moderately active individuals compared to those who were inactive/less active was 0.59 (0.45, 0.78). The association between ST and mortality was non-linear (P<0.001 in spline analysis), and mortality was increased only among individuals who reported a ST>8 h/day (HR=1.77, 95% CI 1.25, 2.52). The HR (95% CI) of mortality was 0.50 (0.32, 0.77) in participants who either were very/moderately active or had ST≤8 h/day, and 0.32 (0.20, 0.50) in those with both health behaviors, compared to those with none of these behaviors. In conclusion, among older adults with diabetes, high PA and less ST are independently and jointly associated with lower risk of all-cause mortality.

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

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.

Nut Consumption and Depression: Cross-Sectional and Longitudinal Analyses in Two Cohorts of Older Adults.

OBJECTIVES: To assess the cross-sectional and longitudinal associations between nut consumption and depression in two cohorts of older adults. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: The first cohort (Seniors-ENRICA-I or SE-I) included a representative sample of Spanish noninstitutionalized adults aged ≥65 years interviewed in 2010 and 2013. The second cohort (SE-II) included individuals from the Madrid region, Spain, aged ≥65 years interviewed in 2017 and in 2019. Nut consumption was estimated with a validated computer-based diet history. Depression was defined as self-reported physician-diagnosed depression or the use of antidepressants. Logistic regression models were adjusted for the main confounders. The DerSimonian and Laird random-effect method was used to meta-analyze the results from both studies. A participant-level pooled analysis was conducted to examine the robustness of our analyses. RESULTS: The SE-I included 2278 individuals (233 prevalent cases) in the cross-sectional analysis and 1534 (108 incident cases) in the longitudinal analysis; the corresponding figures for SE-II were 2726 (407 prevalent cases) and 1566 (74 incident cases). In the meta-analysis of cross-sectional results from the two studies, compared to consuming <1 serving (30 g) of nuts/week, the odds ratio (95% confidence interval) for depression was 0.90 (0.64, 1.16) for consuming 1 to <3 servings/week and 0.92 (0.70, 1.13) for consuming ≥3 servings/week; the corresponding figures for the longitudinal results were 0.90 (0.41, 1.38) and 0.66 (0.35, 0.97). CONCLUSION: Nut consumption was associated with a lower risk of depression in a pooled longitudinal analysis using data from two cohorts of older adults. Nuts should be recommended as part of a healthy diet in older adults.

Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: the EPIC-Spain cohort study.

BACKGROUND AND AIM: No previous study has assessed the association between major dietary patterns and the risk of coronary heart disease (CHD) in a large cohort from a Mediterranean country. METHODS AND RESULTS: We studied prospectively 40,757 persons, aged 29-69 years, participating in the Spanish cohort of the EPIC study. Food consumption was collected between 1992 and 1996 with a validated history method. Individuals were followed-up until 2004 through record linkage with hospital discharge registers, population-based registers of myocardial infarction, and mortality registers to ascertain CHD events (fatal and non-fatal acute myocardial infarction or angina requiring revascularization). Two major dietary patterns were identified from factor analysis. The first pattern was labeled as Westernized, because of the frequent consumption of refined cereals and red meat; the second was called the evolved Mediterranean pattern, because of the frequent intake of plant-based foods and olive oil. During a median follow-up of 11 years, 606 CHD events were ascertained. No association was found between the Westernized pattern and CHD risk. In contrast, the score for the evolved Mediterranean pattern was inversely associated with CHD risk (p for trend = 0.0013); when compared with the lowest quintile of the evolved Mediterranean pattern score, the multivariable hazard ratios for CHD were 0.77 (95% confidence interval 0.61-0.98) for the second quintile, 0.64 (95% CI 0.50-0.83) for the third quintile, 0.56 (95% CI 0.43-0.73) for the fourth quintile, and 0.73 (95% CI 0.57-0.94) for the fifth quintile. CONCLUSION: A Mediterranean diet, as consumed in this study population, was associated with a lower risk of CHD.

Numerical Assessment of a Safety System to Minimize Injuries during a Cyclist Run-Over.

BACKGROUND: The World Health Organization has reported that 1.35 million people die on the roads every year due to road traffic accidents. This paper focuses on exploring a passive safety system that reduces lesions in the overtaking run-over scenario. METHODS: Head Injury Criterion (HIC) and Combined Thoracic Index (CTI) were evaluated through numerical simulations using LS-Dyna®; in order to compare the computed results, three different speed scenarios were carried out (velocity of running over 40, 50, 60 km/h). RESULTS: The computed results were divided into groups, A for the run-over test without a passive security system and B for the run-over test with a passive security system. For case A.1, the HIC15 was 3325. For case A.2, the HIC15 was 1510, and for case A.3, the HIC 15 was 1208. For case B.1, the HIC15 2605, for case B.2, the HIC15 was 1282, and for case B.3, the HIC was 730. CONCLUSION: The comparative results show that the passive safety system installed on the bicycle has an increased benefit impact on the severity of the injury on vulnerable road users, decreasing the probability of cranioencephalic lesions in all study cases. In addition, the thorax injuries are cut down only in the impact scenario at a speed of 40 km/h.

Health-related quality of life in individuals with metabolic syndrome: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. METHOD: A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55-75 years with overweight/obesity (body mass index ≥27 and ≤40kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. RESULTS: Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4-86.4) and emotional role scales (mean 86.8, 95% CI; 86.0-87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0-66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4-55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70-75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. CONCLUSIONS: Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected.

Coffee consumption and risk of cardiovascular events and all-cause mortality among women with type 2 diabetes.

AIMS/HYPOTHESIS: Coffee has been linked to both beneficial and harmful health effects, but data on its relationship with cardiovascular disease and mortality in patients with type 2 diabetes are sparse. METHODS: This was a prospective cohort study including 7,170 women with diagnosed type 2 diabetes but free of cardiovascular disease or cancer at baseline. Coffee consumption was assessed in 1980 and then every 2-4 years using validated questionnaires. A total of 658 incident cardiovascular events (434 coronary heart disease and 224 stroke) and 734 deaths from all causes were documented between 1980 and 2004. RESULTS: After adjustment for age, smoking and other cardiovascular risk factors, the relative risks were 0.76 (95% CI 0.50-1.14) for cardiovascular diseases (p trend = 0.09) and 0.80 (95% CI 0.55-1.14) for all-cause mortality (p trend = 0.05) for the consumption of >or=4 cups/day of caffeinated coffee compared with non-drinkers. Similarly, multivariable RRs were 0.96 (95% CI 0.66-1.38) for cardiovascular diseases (p trend = 0.84) and 0.76 (95% CI 0.54-1.07) for all-cause mortality (p trend = 0.08) for the consumption of >or=2 cups/day of decaffeinated coffee compared with non-drinkers. Higher decaffeinated coffee consumption was associated with lower concentrations of HbA(1c) (6.2% for >or=2 cups/day versus 6.7% for <1 cup/month; p trend = 0.02). CONCLUSIONS: These data provide evidence that habitual coffee consumption is not associated with increased risk of cardiovascular diseases or premature mortality among diabetic women.

Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial.

OBJECTIVE: To assess the impact of a physical activity program on obesity in primary school children. DESIGN: Cluster-randomized controlled trial with 10 intervention and 10 control schools. PARTICIPANTS: A total of 1044 children, mean age 9.4 years (s.d.=0.7) at baseline, of the Province of Cuenca, Spain. INTERVENTION: Recreational, non-competitive physical activity program conducted after school hours on school premises. The program consisted of three 90-min sessions per week, for 24 weeks. MAIN OUTCOME MEASURES: Body mass index (BMI), triceps skin-fold thickness (TST) and percentage body fat. Secondary measures were blood lipids and blood pressure. Measurements were made at the beginning (September 2004) and at the end of the program (June 2005). Since schools rather than children were randomized, mixed regression models were used to adjust for individual-level covariates under cluster randomization. RESULTS: There were no differences in BMI between the intervention and control groups. Compared with controls, intervention children showed a decrease in TST in both boys (-1.14 mm; 95% confidence interval (CI) -1.71 to -057; P<0.001) and girls (-1.55 mm; 95% CI -2.38 to -0.73; P<0.001), as well as a reduction in the percentage of body fat in girls (-0.58%; 95% CI -1.04 to -0.11; P=0.02). Furthermore, the intervention boys exhibited a decrease in apolipoprotein (apo) B levels (-4.59; 95% CI -8.81 to -0.37; P=0.03) and an increase in apo A-I levels (13.57; 95% CI 7.95-19.20; P<0.001). Blood lipid results in girls were very similar. No changes in total cholesterol, triglycerides or blood pressure were associated with the intervention in either sex, except for an increase in diastolic blood pressure (1.55 mm Hg; 95% CI 0.19-2.91; P=0.03) in the intervention versus control boys. CONCLUSION: An after-school program of recreational physical activity reduced adiposity, increased apo A-I and decreased apo B in primary school children.

[Laryngeal dystonia: novel forms of therapeutic administration of botulinum toxin by direct routes]. / Distonia laringea: nuevas formas de administracion terapeutica de toxina botulinica por via directa.

AIM: To describe our experience in the treatment of laryngeal dystonia (in abduction and adduction), with special emphasis given to the technical aspects (approach procedure, dosage and type of botulinum toxin type A used), as well as treatment response and possible side effects. PATIENTS AND METHODS: We conducted a cross-sectional descriptive study of a sample of patients with laryngeal dystonia treated by means of transoral administration of onabotulinumtoxinA or incobotulinumtoxinA over a period of 10 years (2007-2017). Data collected include demographic and clinical variables, treatment response (based on a self-rating scale), the duration of treatment and the appearance of side effects. SAMPLE SIZE: 15 patients (11 women; mean age: 44.06 years) with laryngeal dystonia (mean time since onset of 40 months; 12 patients with dystonia in adduction) and 174 administrations (92% incobotulinumtoxinA; average dosage of 5 U in each vocal cord). The procedure took an average of 11.7 minutes to perform. Response was good in 31% of the procedures and very good in 57.5%. Side effects were recorded in 14.4% of the procedures, although always mild and transitory, with a predominance of dysphagia and dysphonia. CONCLUSION: In our experience, transoral administration of botulinum toxin type A to treat laryngeal dystonia has proved to be a simple, quick, effective and safe technique.

TITLE: Distonia laringea: nuevas formas de administracion terapeutica de toxina botulinica por via directa.Objetivo. Describir nuestra experiencia en el tratamiento de la distonia laringea (en abduccion y aduccion), destacando los aspectos tecnicos (procedimiento de abordaje, dosis y tipo de toxina botulinica de tipo A utilizada), asi como la respuesta al tratamiento y los posibles efectos adversos. Pacientes y metodos. Estudio descriptivo transversal de una muestra de pacientes con distonia laringea tratados mediante administracion transoral de onabotulinumtoxina o incobotulinumtoxina A durante un periodo de 10 años (2007-2017). Se recogen las variables demograficas y clinicas, la respuesta al tratamiento (a partir de una escala de autoevaluacion), la duracion de este y la aparicion de efectos adversos. Resultados. Tamaño muestral: 15 pacientes (11 mujeres; edad media: 44,06 años) con distonia laringea (tiempo medio de evolucion de 40 meses; 12 pacientes con distonia en aduccion) y 174 administraciones (92% incobotulinumtoxina A; dosis media de 5 U en cada cuerda vocal). La duracion media del procedimiento fue de 11,7 minutos. La respuesta fue notable en el 31% de los procedimientos y alta en el 57,5%. Se registraron efectos adversos en el 14,4% de los procedimientos, siempre de caracter leve y transitorio, con predominio de la disfagia y la disfonia. Conclusion. En nuestra experiencia, la administracion transoral de toxina botulinica de tipo A como tratamiento de la distonia laringea ha demostrado ser una tecnica sencilla, rapida, eficaz y segura.

Metabolically healthy obesity and health-related quality of life: A prospective cohort study.

BACKGROUND: Metabolically healthy obesity (MHO) has been associated with lower risk of diabetes than obesity with cardiometabolic abnormalities (CA). However, the effect of MHO on other health outcomes is unknown. OBJECTIVE: To examine the association of metabolic status across categories of body mass index (BMI) with health-related quality of life (HRQL). METHODS: Prospective cohort with 4397 individuals aged ≥18 years, recruited in 2008-2010 and followed-up to 2012 in Spain. Normal weight was defined as BMI <25, overweight as BMI 25-29.9, and obesity as BMI ≥30 kg/m2. Two metabolic statuses were defined: healthy (0-1 CA) and unhealthy (≥2 CA). HRQL was measured with the physical component summary (PCS) and the mental component summary (MCS) of the SF-12 questionnaire. The association of joint categories of BMI and metabolic status at baseline with HRQL at 2012 was examined using linear regression, and adjusted for the main confounders. RESULTS: Compared to healthy normal-weight subjects, the unhealthy normal-weight and the healthy overweight individuals had a similar PCS score; however, the PCS was lower (worse) among those with unhealthy overweight (-1.79; 95% confidence interval [CI]: -2.66 to -0.94), with MHO (-1.45; 95% CI: -2.67 to -0.24) and unhealthy obesity (-1.97; 95% CI: -2.88 to -1.05). Being overweight or obese was not associated with the MCS score regardless of metabolic status. CONCLUSION: Metabolically unhealthy overweight, as well as obesity regardless of metabolic status, showed a worse physical HRQL. These results suggest that both obesity and CA should be addressed to improve HRQL.

Adsorbent phases with nanomaterials for in-tube solid-phase microextraction coupled on-line to liquid nanochromatography.

Following the present trends in miniaturization, a methodology that combines on-line In-Tube Solid-Phase Microextraction (IT-SPME) with Liquid Nanochromatography (nano-LC) and UV-vis diode array detection (DAD) was developed. This coupling was achieved by using two interconnected valves (i.e. conventional and micro-automatic valves) in the system of injection. As for IT-SPME, different materials, containing in some cases nanostructures or nanoparticles and in other cases polymeric adsorbent phases immobilized on capillary columns, were tested in order to improve extraction efficiencies of organic compounds; diclofenac was selected as the target analyte. Additionally, the transfer time of the sample between the two injection valves, as well as the lengths and the internal diameters of the capillary columns, was optimized. Under the selected conditions, the resulting IT-SPME-nano-LC-DAD method showed great potential to become a powerful analytical tool as it was successfully applied to the determination of diclofenac in pharmaceutical and water samples. For comparison purposes, IT-SPME coupled to Capillary Liquid Chromatography (Cap-LC) was used. The extraction yield of diclofenac reached near 80%, a high value for techniques that involve IT-SPME. Good accuracy (recoveries near 100%) and precision (4% RSD) were obtained.

Consumption of soft drinks and health-related quality of life in the adult population.

BACKGROUND/OBJECTIVES: Despite the accumulated evidence on the health risks associated with sugar-sweetened beverages (SSB), the industry has funded mass communication strategies promoting the idea that soft drinks, including SSB, may represent a source of well-being. This study assessed the association between consumption of soft drinks and health-related quality of life (HRQL), as a proxy of well-being, in the adult population of Spain. SUBJECTS/METHODS: The cohort was established in 2008-2010 with 8417 individuals representative of the Spanish population aged 18-60 years. Habitual soft drink consumption was assessed with a validated diet history at baseline. HRQL was measured using the SF-12 questionnaire at baseline and in a subsample of 2132 study participants in 2012. The analyses were performed using linear regression and adjusted for the main confounders. RESULTS: In cross-sectional analyses at baseline, those who drank ⩾1 serving/day of SSB had a lower (worse) score on the physical composite summary (PCS) of the SF-12 (adjusted linear regression coefficient: -1.08; 95% confidence interval (CI): -1.60 to -0.54) than those who drank <1 serving/week. Results were similar among individuals younger than 35 years (-1.06; 95% CI: -1.79 to -0.32), those who were not dieting (-1.21; 95% CI: -1.80 to -0.62), those who did not lose >5 kg in the previous 4 years (-0.79; 95% CI: -1.87 to 0.29), and in those without morbidity (-1.18; 95% CI: -1.91 to -0.46). Neither SSBs nor artificially sweetened beverages (ASBs) showed an association with the mental composite summary (MCS) of the SF-12. In the prospective analyses, no association was observed between baseline consumption of SSBs or ASBs and the changes in the PCS and MCS score from 2008/2010 to 2012. CONCLUSIONS: No evidence was found that soft drink consumption has a beneficial effect on either the physical or mental dimensions of HRQL.

El análisis de aguas residuales con fines epidemiológicos: presente y futuro en España / Wastewater-based epidemiology: present and future in Spain

El análisis de aguas residuales con fines epidemiológicos es actualmente una herramienta fiable y complementaria a las metodologías basadas en indicadores tradicionales para el control de diferentes sustancias entre las que cabe destacar las drogas. Si bien varios países europeos la utilizan como herramienta de trabajo para la monitorización de drogas de abuso, en España su uso se limita principalmente a estudios realizados por diferentes grupos de investigación, tal y como se describe en el caso práctico puesto de ejemplo en el artículo. Sin embargo, el potencial de la metodología ha quedado evidenciado en los estudios científicos llevados a cabo tanto a nivel español como internacional y, aunque son necesarios más estudios para llegar a conocer todo su potencial, se prevé pueda ser incorporada como herramienta de trabajo complementaria a las que habitualmente se utilizan. En este sentido, la Red Española de Análisis de Aguas Residuales (ESAR-Net), creada en 2017 y formada por diferentes grupos de investigación españoles, pretende contribuir al conocimiento y aplicación de esta metodología en España a través de actividades científicas y de divulgación

Wastewater-Based Epidemiology is currently a reliable and complementary tool to methodologies based on traditional indicators for the control of various substances such as drugs. Although several European countries use it as a working tool for the monitoring of drugs of abuse, in Spain its use is mainly limited to studies carried out by different research groups, as described in the case study used as an example in the article. However, the potential of the methodology has been demonstrated in the scientific studies carried out both at the Spanish and international level and, although more studies are necessary to get to know its full potential, it is expected that it could be incorporated as a complementary work tool to those that are usually used. In this sense, the Red Española de Análisis de Aguas Residuales (ESAR-Net), created in 2017 and formed by different Spanish research groups, aims to contribute to the knowledge and application of this methodology in Spain through scientific and outreach activities

Obesity and socioeconomic position measured at three stages of the life course in the elderly.

OBJECTIVE: To investigate the association between socioeconomic position, measured at three stages of the life course, and obesity in the elderly. DESIGN: Cross-sectional study carried out in 2000-2001. SUBJECTS: In total, 4009 subjects aged 60 y and older, representative of the Spanish noninstitutionalised population. RESEARCH METHODS AND PROCEDURES: We estimated body mass index (BMI) and waist circumference (WC) by social class in childhood, by educational level and by adult social class, as well as the association between these two obesity measures and each socioeconomic characteristic after adjusting for the other two. RESULTS: In men, no relation was found between the two measures of obesity studied and socioeconomic circumstances throughout the life course. Nor was any relation found in women between social class in childhood and the two measures of obesity after adjusting for the other two socioeconomic variables. In contrast, BMI and WC in women showed a statistically significant inverse gradient with educational level and with adult social class after adjusting for age and the rest of the socioeconomic variables. CONCLUSIONS: In general, these results support the small amount of existing evidence on the association between obesity and abdominal obesity and socioeconomic position by educational level and adult social class. The results for social class in childhood do not support the existing evidence, and suggest that this association may depend on specific historic and cultural circumstances.

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 25-29.9 kg/m(2)) and obesity (BMI >or=30 kg/m(2)) 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 279 000 when RRs for all subjects were used. When RRs for nonsmokers only were applied to the entire population, about 304 000 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 337 000 based on European data and at about 401 000 based on US data. In the EU, therefore, a minimum of 279 000 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 (175 000) than among the overweight (104 000). Around 70% were cardiovascular disease deaths (195 000) and 20% cancer deaths (53 000). 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.

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) >or=25 kg/m(2). 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/m(2) 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.

Dietary patterns among children aged 6-7 y in four Spanish cities with widely differing cardiovascular mortality.

OBJECTIVE: Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6-7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. DESIGN AND SETTING: Cross-sectional anthropometric and dietary survey in four cities in Spain. SUBJECTS: A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. OUTCOME MEASURES: Body mass index (BMI), overweight (BMI>17.6 kg/m(2)), obesity (BMI>20.1 kg/m(2)) and intake of food and nutrients. RESULTS: Children in the four cities showed a high prevalence of overweight (range across cities, 28.9-34.5%) and obesity (8.5-15.7%). They also had a moderately hypercaloric diet (range, 2078-2218 kcal/day), marked by an excessive intake of lipids (45.0-47.3% kcal), particularly saturated fats (16.6-16.9% kcal), proteins (17.0-17.3% kcal), sugars (20.0-21.9% kcal) and cholesterol (161.6-182.9 mg/1000 kcal/day), and a low intake of complex carbohydrates (17.5-18.1% kcal) and fibre (19.6-19.9 g/day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg/m(2); P=0.0001) and ponderal index (0.58 kg/m(3); P=0.0001) and a higher intake of energy (104 kcal/day; P=0.007), cholesterol (16.00 mg/1000 kcal/day; P=0.0001) and sodium (321 mg/day; P=0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. CONCLUSIONS: Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences. SPONSORSHIP: This study was partly funded by grants from the International Olive Oil Board (Consejo Oleícola Internacional), Comunidad Autónoma de Madrid, Fundación Pedro Barrié de la Maza, and Fundación Eugenio Rodríguez Pascual.