Socioeconomic determinants of sarcopenic obesity and frail obesity in community-dwelling older adults: The Seniors-ENRICA Study.

Information on the association between socioeconomic status (SES) throughout life and sarcopenic obesity is scarce, whereas no study has been focused on the association between SES and frail obesity. This analysis estimated the prevalence of sarcopenic obesity and frail obesity, and their associations with SES in older adults. Data were collected in 2012 from 1,765 non-institutionalized individuals aged ≥65 participating in the Seniors-ENRICA study in Spain, by using standardized techniques and equipment. SES throughout life was evaluated with the father's occupation, participant's educational level, former own occupation, and current poor housing condition. Overall, 17.2% of participants had sarcopenic obesity, and 4.0% frail obesity. No association was found between SES and sarcopenic obesity. In contrast, the prevalence of frail obesity was higher in those with lower education, having worked in manual job, and currently having poor housing condition. Having ≥1 social disadvantages throughout life was associated with higher prevalence of frail obesity. The prevalence of this disorder increased by 1.49 (95% CI: 1.21-1.85) times for each social disadvantage added. The OR (95% CI) of frail obesity was 3.13 (1.71-5.7) for those having 3 or 4 vs. 0 or 1 social disadvantages, implying a more complex process beginning early in life.

Metabolic syndrome and insulin resistance are associated with frailty in older adults: a prospective cohort study.

Background: diabetes increases the risk of frailty that is a leading cause of disability and premature mortality in older people. Metabolic syndrome (MS) and insulin resistance (IR) are strong risk factors for diabetes and could, thus, lead to frailty. However, the association between MS or IR and frailty has barely been investigated. Methods: data were obtained from a cohort of 1,499 community-dwelling individuals aged ≥60, who were free of diabetes at 2008-10 and were followed up for 3.5 years. At baseline, MS was ascertained according to the harmonised definition, and IR with the Homoeostatic Model Assessment for IR index (HOMA-IR). Frailty was defined as having three or more of the Fried's criteria: exhaustion, low physical activity, slow walking, unintentional weight loss and low grip strength. Statistical analyses were performed with logistic regression, and adjusted for the main confounders. Results: in 2012, 84 cases of incident frailty were identified. Compared with subjects without MS, those with MS showed increased risk of frailty (multivariate odds ratio [OR]: 1.85; 95% confidence interval [CI] 1.12-3.05). The association persisted after further adjustment for fibrinogen and C-reactive protein. When the frailty criteria were considered individually, low grip strength was the criterion that showed a stronger association with MS (OR: 1.67; 95% CI: 1.25-2.21). Higher HOMA-IR values were also associated with higher risk of frailty. Conclusion: MS and IR were associated with increased risk of frailty. This work extends the spectrum of harmful consequences of MS, and suggests that preventing or controlling MS may serve to delay frailty.

Association of the duration of residence with obesity-related eating habits and dietary patterns among Latin-American immigrants in Spain.

The dietary patterns of immigrants usually change with the duration of residence and progressively resemble those of the host country. However, very few studies have investigated individuals migrating to countries with a high-quality diet, such as the Mediterranean diet (MD), and none has yet focused on Latin-American immigrants. The present study examined the association of the duration of residence with obesity-related eating habits and dietary patterns among Latin-American immigrants residing in Spain. A cross-sectional study was conducted in 2008-10 in a representative sample of the adult population residing in Spain. Adherence to the MD was defined as a MD Adherence Screener score ≥ 9. Analyses were conducted by including 419 individuals aged 18-64 years born in Latin-American countries. Compared with immigrants residing in Spain for < 5 years, those residing for ≥ 10 years accounted for a lower percentage of individuals who habitually ate at fast-food restaurants and never trimmed visible fat from meat. Moreover, these immigrants were found to have a lower intake of sugary beverages and a higher intake of Na, saturated fat, fibre, olive oil, vegetables and fish and to more frequently strictly adhere to the MD. A longer duration of residence in Spain was found to be associated with both healthy and unhealthy changes in some eating habits and dietary patterns among Latin-American immigrants. Some of the healthy changes observed contrasted the 'Westernisation' of the diet reported in studies conducted in other Western countries. The results of the present study support the role of the food environment of the host country in the modification of the dietary patterns of immigrants.

Contribution of lifestyle factors to educational differences in abdominal obesity among the adult population.

BACKGROUND & AIMS: This is the first study to systematically examine the behavioral factors that may explain the inverse association between education and abdominal obesity in adults. METHODS: Cross-sectional study conducted among 3541 men and 3564 women representative of the population aged 25-64 years in Spain. Abdominal obesity was defined as waist circumference >102 cm in men and >88 cm in women. Analyzes were performed with logistic regression, with progressive adjustment for obesity-related behaviors. RESULTS: The age-, sex- and town size-adjusted odds ratios for abdominal obesity were 1.69 in men and 1.85 in women among individuals with lowest versus highest education. After adjustment for all the studied behaviors, the odds ratio was reduced to 1.49 in men and to 1.45 in women. The factors with the largest contribution to the higher prevalence of abdominal obesity in individuals with lowest versus highest education were more time spent watching TV and less time spent in exercising, as well as a higher energy intake in women. Tobacco and alcohol consumption, physical activity at home, leisure walking, sedentary behaviors other than TV watching, and sleep duration did not explain the educational gradient in abdominal obesity. CONCLUSION: Watching TV, physical exercise and energy intake explain a substantial part of the inverse association between education and abdominal obesity.

Socioeconomic variation in the magnitude of the association between self-rated health and mortality.

PURPOSE: To assess socioeconomic variation in the association between self-rated health (SRH) and mortality and to determine whether socioeconomic inequalities in SRH and socioeconomic inequalities in mortality differ in magnitude. METHODS: We used data from a cohort of Spanish people 60 years of age and older with an 8-year follow-up of mortality. The association between SRH at baseline and mortality was estimated by the age-adjusted relative risk of mortality in people with low, medium, and high education. The measures of health inequalities were the prevalence ratio of poor SRH and the age-adjusted relative risk of mortality according to educational level. The validity of SRH to reflect life-threatening and non-life-threatening health conditions was summarized with the likelihood ratio for poor SRH in each educational category. RESULTS: The relative risk of mortality according to SRH in subjects with high and low education was 3.24 and 1.62 in men and 2.25 and 1.50 in women, respectively. Inequalities in poor self-rated health were larger than inequalities in mortality: -1.63 versus 1.07 in men and 1.45 versus 1.30 in women. The highest likelihood ratio for SRH was seen in persons with high education in the case of life-threatening conditions, and for those with low education, in the case of non-life-threatening conditions. CONCLUSIONS: Socioeconomic variation in the validity of SRH to reflect life-threatening and non-life-threatening conditions could explain the greater ability of SRH to predict mortality in persons with high education and why inequalities in poor SRH are larger than inequalities in mortality.

Length of residence and obesity among immigrants in Spain.

OBJECTIVE: Various studies in the USA and Canada have consistently shown a positive association between length of residence of immigrants and obesity. Studies in European countries have obtained less consistent results. The present work assesses the influence of length of residence on the frequency of obesity in immigrants in the city of Madrid, Spain. DESIGN: We studied a sample of 7155 persons aged 18 years and over residing in the city of Madrid, who were was surveyed between November 2004 and May 2005. Information was collected on immigrant status (country of birth), length of residence in Spain, obesity, sociodemographic characteristics and lifestyle. RESULTS: Compared with the Spanish population, the odds for obesity in the immigrant population by length of residence was less than one in all groups, becoming closer to one with increasing time of residence (OR = 0.67, 0.73 and 0.81 for immigrants with less than 2, 2-4 and 5-9 years of residence in Spain, respectively), up to 10 or more years of residence, when it declined (OR = 0.69). The magnitude of this association was considerably reduced after adjusting for sociodemographic variables and for perceived health, but was not further modified after adjusting for lifestyle variables. CONCLUSIONS: Length of residence of immigrants in the city of Madrid is not associated with the frequency of obesity. It is possible that the circumstances immigrants encounter after arriving in Spain do not involve an overexposure to factors favouring obesity, relative to those they bring with them.

BMI, waist circumference, and mortality according to health status in the older adult population of Spain.

Among the explanations proposed for the weak and inconsistent association between BMI and mortality in the elderly are the lack of adjustment for waist circumference (WC) and that the association varies with health status. This work examines the independent association of BMI and WC with mortality in older adults, and the influence of health status on this association. A cohort of 3,536 persons representative of the Spanish population aged >or=60 years was selected in 2000 and 2001, and followed prospectively until 2007. The analyses were performed with Cox models and adjusted for the main confounders. During follow-up, 659 persons died (18.6% of the cohort). Before adjusting for WC, mortality in the upper quartile of BMI was 15% lower than in the lower quartile (hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.66-1.08; P for linear trend = 0.076). After adjusting for WC, the association was even stronger, so that mortality in the upper quartile of BMI was 37% lower than in the lower quartile (HR: 0.63; 95% CI: 0.45-0.88; P for linear trend < 0.003). Before adjusting for BMI, no association was observed between WC and mortality. After adjusting for BMI, WC was positively associated with mortality (HR for upper vs. lower quartile of WC: 1.48; 95% CI: 1.07-2.05; P for linear trend = 0.008). These associations were mainly observed in those with limitations in mobility and agility. BMI has an inverse, and WC has a direct, independent association with mortality in older adults, particularly in those with worse health status.

Increasing the price of tobacco: economically regressive today and probably ineffective tomorrow.

The tobacco price increase during the fourth stage of the smoking epidemic has coincided with a decrease in smoking prevalence, less marked in the lower socio-economic groups. In countries that are at the third stage of the epidemic, smoking prevalence in poor and less educated women has not changed or has increased at the same time as tobacco prices have increased. It is assumed, however, that people with low incomes and those with less education in developed countries are more responsive to price changes. The inconsistent results with regard to the price elasticity of tobacco in different socio-economic groups and the conflicting trends in smoking prevalence between socio-economic groups during periods of increased tobacco prices do not support that consensus. Evidence suggests that increasing tobacco taxation is a regressive measure today and will probably achieve only a moderate reduction in tobacco use in the future, as smoking is becoming a phenomenon associated with poorer and less-educated people.

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 >88 cm 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.

The role of the public health official in communicating public health information.

The prevailing views on the role of public health professionals refer to professionals in the academic world, without taking into account the fact that many public health professionals are government employees. For example, the American Public Health Association states that public health professionals play an active role in communicating public health information to nonscientific audiences, such as the general population or the mass media. We propose that public health officials have an important responsibility to promote the practice of public health. However, they must do so within the bureaucracy. Any actions that public health officials wish to take as advocates of particular public health activities should be carried out independent of their role as government officials.

[Life socioeconomic circumstances, physical inactivity and obesity influences on metabolic syndrome]. / Influencia a lo largo de la vida de las circunstancias socioeconómicas, de la inactividad fisica y de la obesidad sobre la presencia de síndrome metabólico.

BACKGROUND: Majority of the studies have evaluated the independent effect of each risk factor on several component of metabolic syndrome. This study investigates the influence of accumulation of risk factor through life course (socioeconomic circumstances, physical activity and obesity) on the risk of metabolic syndrome and their components in older population in Spain. METHOD: We have studied 4009 subjects representative of the Spanish non-institutionalised population aged 60 years and older. We have elaborated a measure of exposure through life course exposure after combining five risk indicators: low childhood social class, low education, low adult social class, physical inactivity and general obesity. The indicator has six categories of risk from the most favourable (0 risk factors) to the least favourable exposure (5 risk factors). Study participants were considered to have metabolic syndrome if they simultaneously had abdominal obesity, raised blood pressure and diabetes mellitus. RESULTS: The prevalence of abdominal obesity fluctuated between 74.2% and 95.8% in men and between 87.8% and 99.1% en women, prevalence of raised blood pressure did between 77.5% and 85.0% in men and 75.7% and 88.0% in women, and prevalence of diabetes mellitus did between 13.0% and 34.8% in men and 7.6% y 25.4% in women. Except for raised blood pressure and diabetes mellitus in men, increase was gradual with the number of risk factors. The absolute difference in the prevalence of metabolic syndrome between people that had the risk indicator profile least favourable and people that had the risk indicator profile most favourable through life course was 22% in men and 17% in women. CONCLUSIONS: The risk of metabolic syndrome is influenced in a cumulative fashion by socioeconomic exposures and risk behavioural to health acting throughout the life course. The prevalences of abdominal obesity, of raised blood pressure, and of diabetes mellitus show an ascending gradient from the most favourable categories of risk to the least favourable categories of risk, except for raised blood pressure and diabetes mellitus in men

Influencia a lo largo de la vida de las circunstancias socioeconómicas, de la inactividad física y de la obesidad sobre la presencia de síndrome metabólico / Life socioeconomic circumstances, physical inactivity and obesity influences on metabolic syndrome

Fundamento: La mayoría de los estudios han evaluado el efecto independiente de cada factor de riesgo sobre los distintos componentes del síndrome metabólico. Este estudio examina la influencia de la acumulación de factores de riesgo a lo largo de la vida (circunstancias socioeconómicas, actividad física y obesidad general) sobre el riesgo de síndrome metabólico y sus componentes en la población adulta mayor de España. Método. Se han estudiado 4.009 personas representativas de la población española de 60 y más años no institucionalizada. Se ha obtenido una medida de la exposición a lo largo de la vida mediante la combinación de cinco indicadores de riesgo: clase social baja en la infancia baja, nivel de estudios bajo, clase social baja de adulto, inactividad física y obesidad general en la vida adulta. El indicador tiene seis categorías desde la más favorable (0 factores de riesgo) a la más desfavorable (5 factores de riesgo presentes). En este trabajo se consideró que síndrome metabólico fue la presentación simultánea de obesidad abdominal, presión arterial elevada y diabetes mellitus tipo 2. Resultados. La prevalencia de obesidad abdominal osciló entre 74,2% y 95,8% en hombres y entre 87,8% y 99,1% en mujeres, la de presión arterial elevada osciló entre 77,5% y 85,0% en hombres y 75,7% y 88,0% en mujeres, y la de diabetes mellitus tipo 2 varió entre 13,0% y 34,8% en hombres y 7,6% y 25,4% en mujeres. Excepto en la presión arterial elevada y en la diabetes mellitus tipo 2 en hombres, el incremento fue gradual con el aumento de factores de riesgo. La diferencia absoluta en la prevalencia de síndrome metabólico en los sujetos con el perfil de riesgo más desfavorable a lo largo de su vida, con respecto a la prevalencia en los sujetos con el perfil de riesgo más favorable, fue 22% en hombres y 17% en mujeres. Conclusiones: El riesgo de síndrome metabólico está influenciado por la acumulación de exposiciones socioeconómicas y de conductas de riesgo para la salud a lo largo de la vida. Las prevalencias de obesidad abdominal, de presión arterial elevada y de diabetes mellitus tipo 2 aumentaron progresivamente desde la categoría de riesgo más favorable a la menos favorable, excepto en la presión arterial elevada y en la diabetes mellitus tipo 2 en hombres

Background: Majority of the studies have evaluated the independent effect of each risk factor on several component of metabolic syndrome. This study investigates the influence of accumulation of risk factor through life course (socioeconomic circumstances, physical activity and obesity) on the risk of metabolic syndrome and their components in older population in Spain. Method: We have studied 4009 subjects representative of the Spanish non-institutionalised population aged 60 years and older. We have elaborated a measure of exposure through life course exposure after combining five risk indicators: low childhood social class, low education, low adult social class, physical inactivity and general obesity. The indicator has six categories of risk from the most favourable (0 risk factors) to the least favourable exposure (5 risk factors). Study participants were considered to have metabolic syndrome if they simultaneously had abdominal obesity, raised blood pressure and diabetes mellitus. Results: The prevalence of abdominal obesity fluctuated between 74.2% and 95.8% in men and between 87.8% and 99.1% en women, prevalence of raised blood pressure did between 77.5% and 85.0% in men and 75.7% and 88.0% in women, and prevalence of diabetes mellitus did between 13.0% and 34.8% in men and 7.6% y 25.4% in women. Except for raised blood pressure and diabetes mellitus in men, increase was gradual with the number of risk factors. The absolute difference in the prevalence of metabolic syndrome between people that had the risk indicator profile least favourable and people that had the risk indicator profile most favourable through life course was 22% in men and 17% in women. Conclusions: The risk of metabolic syndrome is influenced in a cumulative fashion by socioeconomic exposures and risk behavioural to health acting throughout the life course. The prevalences of abdominal obesity, of raised blood pressure, and of diabetes mellitus show an ascending gradient from the most favourable categories of risk to the least favourable categories of risk, except for raised blood pressure and diabetes mellitus in men

Association of adult socioeconomic position with hypertension in older people.

OBJECTIVE: To determine the role of obesity, adult behavioural risk factors, and markers of specific childhood exposures in the association between adult socioeconomic position and hypertension in a cohort of people aged 60 years and older. DESIGN: Cross sectional study. SETTING: Spain. PARTICIPANTS: 4009 subjects representative of the Spanish non-institutionalised population aged 60 years and older. MAIN OUTCOME MEASURE: Prevalence of hyperteMarinhonsion according to education and social class, and proportion of excess difference in hypertension prevalence in lower socioeconomic groups explained by different risk factors for hypertension. RESULTS: The highest prevalence of hypertension was seen in subjects with less education and in those belonging to a low social class. In men, the hypertension risk factors analysed did not explain the difference in prevalence by education, but they explained almost half of the difference by social class. In women, these risk factors explained the differences in hypertension prevalence by education and a substantial part of the differences by social class. Central and general obesity, and physical inactivity were the risk factors that were the most important in this association in women. CONCLUSIONS: In women, socioeconomic position has no direct effect on hypertension in the case of education and only a small effect in the case of social class. In contrast, most of the effect of education and half of the effect of social class on hypertension in men is direct or, at least, is not explained by the risk factors analysed. The mechanisms that can explain the association between socioeconomic position and hypertension in older men remain to be established.

[Sociodemographic factors and lifestyle habits associated with weight change in the elderly in Spain]. / Factores sociodemográficos y de hábitos de vida asociados al cambio de peso en la población adulta de mayor edad en España.

BACKGROUND AND OBJECTIVE: Our purpose was to examine sociodemographic factors and lifestyle customs associated with weight change in the older adult population of Spain. SUBJECTS AND METHOD: Prospective cohort study conducted from 2001 to 2003 among a cohort of 2,384 people representative of the non-institutionalized Spanish population aged 60 years and over. Data were collected through home interviews, and main statistical analysis was performed through polytomous logistic regression. RESULTS: Over the 2-year follow-up, 27.9% of men and 27.3% of women lost > or = 3 kg, and 18.2% of men and 16.9% of women gained > or = 3 kg. Among men, a loss of > or = 3 kg was more likely among former smokers (odds ratio [OR] = 1.58; 95% confidence interval [CI], 1.13-2.23) and among those with higher body mass index (BMI) (p for linear trend < 0.0001). A weight gain of > or = 3 kg was also more frequent in former smokers (OR = 1.93; 95% IC, 1.28-2.90). In addition, the risk of gaining > or = 3 kg decreased progressively with the increase in the frequency of physical activity at leisure time (p for linear trend < 0.0001). Among women, results were similar to those in men, though in former smokers there was no association with weight changes. CONCLUSIONS: In the older adult population, BMI, physical activity at leisure time, and a former smoker status are associated with weight change in the short term. Intervention on physical activity should be a priority, because it is the main modifiable factor, is associated with health-related quality of life, and it could contribute to avoid excess weight.

Bienestar material de la provincia de residencia e inactividad física / Material well-being of the province of residence and leisure-time physical inactivity

Objetivo: Estimar la asociación entre el bienestar material de la provincia de residencia y la inactividad física durante el tiempo libre en la población española mayor de 15 años. Métodos: Los datos proceden de la encuesta de Discapacidades, Deficiencias y Estado de Salud, realizada por el Instituto Nacional de Estadística en 1999. Se analizaron los datos de 24.561 mujeres y 21.133 varones. Se consideró un sujeto inactivo cuando declaraba no realizar ningún tipo de actividad física durante el tiempo libre. La medida de bienestar material fue la renta per cápita de la provincia agrupada en cuartiles. La medida de asociación entre la renta per cápita y la inactividad física fue la odds ratio (OR) estimada mediante modelos logit multinivel. Resultados: En los individuos ≥ 45 años de edad se encontró una asociación entre la renta per cápita y la inactividad física. Las provincias con mayor renta per cápita presentaron la menor prevalencia de inactividad física. No obstante, la OR de mayor magnitud se encontró en el cuartil 2 de renta per cápita, no observándose diferencias estadísticamente significativas entre el cuartil más rico y el cuartil más pobre. Al ajustar por características socioeconómicas y otras variables individuales, esa asociación persistió en las mujeres y desapareció en los varones. En las mujeres la asociación fue mayor en el grupo de ingresos personales más bajos. Conclusiones: Los resultados sugieren que en las mujeres mayores de 45 años la inactividad física podría estar relacionada no sólo con las características individuales, sino también con el contexto socioeconómico del área de residencia

Objective: To estimate the association between material wellbeing of the province of residence and leisure-time physical inactivity in the Spanish population aged 16 years and older.Methods: We used data from the Survey on Disabilities, Impairments and Health Status carried out by the Statistical National Institute in 1999. We analyse 24,561 women and 21,133 men. Respondents were classified as inactive if they reported no leisure-time physical activity. The measure of material wellbeing was the per capita income of the province of residence grouped in quartiles. The measure of the association between per capita income and physical inactivity was the odds ratio (OR) estimated from logit multilevel models. Results: Association between per capita income and physical inactivity was observed in people aged 45 years and older. The lower prevalence of physical inactivity was observed in provinces with the higher per capita income. However the higher OR was found in quartile 2 of per capita income, because no significant difference was observed between quartile 4 (richest) and quartile 1 (poorest). After adjusting for socioeconomic characteristics and other individual variables, association remained significant in women and disappeared in men. In women, association between per capita income and physical inactivity was higher in the population group with lower personal income. Conclusions: Results suggest that physical inactivity in women aged 45 years and older could be related not only with individual characteristics but with the socioeconomic context of the area of residence

Factores sociodemográficos y de hábitos de vida asociados al cambio de peso en la población adulta de mayor edad en España / Sociodemographic factors and lifestyle habits associated with weight change in the elderly in Spain

Fundamento y objetivo: Estudiar los factores sociodemográficos y de hábitos de vida asociados al cambio de peso corporal en la población adulta de mayor edad de España. Sujetos y método: Estudio de seguimiento prospectivo durante 2 años de una cohorte de 2.384 personas representativas de la población española no institucionalizada de 60 años de edad o mayor. Los datos se obtuvieron mediante entrevista en los domicilios y los análisis principales se realizaron con regresión logística politómica. Resultados: El 27,9% de los varones y el 27,3% de las mujeres perdieron 3 kg o más respecto al peso basal, mientras que el 18,2% de los varones y el 16,9% de las mujeres aumentaron en igual cuantía su peso. En los varones, la pérdida de 3 kg de peso o más fue más frecuente en los ex fumadores (odds ratio [OR] = 1,58; intervalo de confianza [IC] del 95%, 1,13-2,23) y en los de mayor índice de masa corporal basal (p de tendencia lineal < 0,0001). La ganancia de 3 kg de peso o más también resultó más frecuente entre los ex fumadores (OR = 1,93; IC del 95%, 1,28-2,90). Además, el riesgo de ganar 3 kg de peso o más diminuyó progresivamente al aumentar la frecuencia de la actividad física en el tiempo libre (p de tendencia lineal < 0,0001). En las mujeres, los resultados fueron similares a los obtenidos en los varones, aunque en ellas el hecho de ser ex fumadora no se asoció de forma significativa a los cambios de peso. Conclusiones: En la población adulta mayor, el índice de masa corporal, la actividad física en el tiempo libre y ser ex fumador se asocian a los cambios de peso a corto plazo. La intervención sobre la actividad física es prioritaria, por ser el principal factor modificable, porque se asocia a mejor calidad de vida y porque puede contribuir a evitar el exceso de peso

Background and objective: Our purpose was to examine sociodemographic factors and lifestyle customs associated with weight change in the older adult population of Spain. Subjects and method: Prospective cohort study conducted from 2001 to 2003 among a cohort of 2,384 people representative of the non-institutionalized Spanish population aged 60 years and over. Data were collected through home interviews, and main statistical analysis was performed through polytomous logistic regression. Results: Over the 2-year follow-up, 27.9% of men and 27.3% of women lost >= 3 kg, and 18.2% of men and 16.9% of women gained >= 3 kg. Among men, a loss of >= 3 kg was more likely among former smokers (odds ratio [OR] = 1.58; 95% confidence interval [CI], 1.13-2.23) and among those with higher body mass index (BMI) (p for linear trend = 3 kg was also more frequent in former smokers (OR = 1.93; 95% IC, 1.28-2.90). In addition, the risk of gaining >= 3 kg decreased progressively with the increase in the frequency of physical activity at leisure time (p for linear trend < 0.0001). Among women, results were similar to those in men, though in former smokers there was no association with weight changes. Conclusions: In the older adult population, BMI, physical activity at leisure time, and a former smoker status are associated with weight change in the short term. Intervention on physical activity should be a priority, because it is the main modifiable factor, is associated with health-related quality of life, and it could contribute to avoid excess weight

Relationship of BMI, waist circumference, and weight change with use of health services by older adults.

OBJECTIVE: To examine the relationship of BMI, waist circumference (WC), and weight change with use of health care services by older adults. RESEARCH METHODS AND PROCEDURES: This was a prospective cohort study conducted from 2001 to 2003 among 2919 persons representative of the non-institutionalized Spanish population > or =60 years of age. Analyses were performed using logistic regression, with adjustment for age, educational level, size of place of residence, tobacco use, alcohol consumption, and presence of chronic disease. RESULTS: Obesity (BMI > or = 30 kg/m(2)) and abdominal obesity (WC >102 cm in men and >88 cm in women) in 2001 were associated with greater use of certain health care services among men and women in the period 2001-2003. Compared with women with WC < or = 88 cm, women with abdominal obesity were more likely to visit primary care physicians [odds ratio (OR): 1.36; 95% confidence limit (CL): 1.06-1.73] and receive influenza vaccination (OR: 1.30; 95% CL: 1.03-1.63). Weight gain was not associated with greater health service use by either sex, regardless of baseline BMI. Weight loss was associated with greater health service use by obese and non-obese subjects of both sexes. In comparison with those who reported no important weight change, non-obese women who lost weight were more likely to visit hospital specialists (OR: 1.45; 95% CL: 1.02-2.06), receive home medical visits (OR: 1.61; 95% CL: 1.06-2.45), be hospitalized (OR: 1.88; 95% CL: 1.29-2.74), and have more than one hospital admission (OR: 2.31; 95% CL: 1.19-4.47). DISCUSSION: Obesity and weight loss are associated with greater health service use among the elderly.

Prevalencia de obesidad en la población adulta española: 14 años de incremento continuado / Prevalence of obesity in Spanish adult population: 14 years of continous increase

No disponible

[Material well-being of the province of residence and leisure-time physical inactivity]. / Bienestar material de la provincia de residencia e inactividad física.

OBJECTIVE: To estimate the association between material wellbeing of the province of residence and leisure-time physical inactivity in the Spanish population aged 16 years and older. METHODS: We used data from the Survey on Disabilities, Impairments and Health Status carried out by the Statistical National Institute in 1999. We analyse 24,561 women and 21,133 men. Respondents were classified as inactive if they reported no leisure-time physical activity. The measure of material wellbeing was the per capita income of the province of residence grouped in quartiles. The measure of the association between per capita income and physical inactivity was the odds ratio (OR) estimated from logit multilevel models. RESULTS: Association between per capita income and physical inactivity was observed in people aged 45 years and older. The lower prevalence of physical inactivity was observed in provinces with the higher per capita income. However the higher OR was found in quartile 2 of per capita income, because no significant difference was observed between quartile 4 (richest) and quartile 1 (poorest). After adjusting for socioeconomic characteristics and other individual variables, association remained significant in women and disappeared in men. In women, association between per capita income and physical inactivity was higher in the population group with lower personal income. CONCLUSIONS: Results suggest that physical inactivity in women aged 45 years and older could be related not only with individual characteristics but with the socioeconomic context of the area of residence.