The association of major patterns of physical activity, sedentary behavior and sleep with health-related quality of life: a cohort study.

OBJECTIVE: To examine the prospective association of patterns of physical activity, sedentary behavior and sleep with health-related quality of life (HRQL) in the general population of Spain. METHODS: A cohort study with 4271 individuals aged ≥ 18 years was recruited in 2008-2010 and followed-up prospectively through 2012. Activity patterns were derived from factor analysis. HRQL was assessed with the SF-12 questionnaire, and suboptimal HRQL was defined as a score below the sex-specific sample median. RESULTS: Three main activity patterns were identified. A higher adherence to the pattern named "vigorous activity-seated at the computer" was inversely associated with a suboptimal score in the physical-composite summary (PCS) of the SF-12 (multivariate adjusted odds ratio [aOR] for the highest vs. the lowest quartile 0.71; 95% confidence interval [IC] 0.55-0.90; p-trend=0.003). The "light activity-seated for reading" pattern was inversely associated with a suboptimal score in the mental-composite summary (aOR=0.73; 95% CI=0.61-0.89; p-trend=0.002). However, a higher adherence to the "seated for watching TV-daytime sleeping" pattern was directly associated with suboptimal PCS (aOR=1.35; 95% CI=1.10-1.66; p-trend=0.008). CONCLUSION: Patterns including any physical activity were associated with better physical or mental HRQL. However, a pattern defined by sedentary behavior with diurnal sleep showed worse HRQL and should be a priority target of preventive interventions.

Magnitud y manejo del síndrome metabólico en España en 2008-2010: Estudio ENRICA / Magnitude and Management of Metabolic Syndrome in Spain in 2008-2010: The ENRICA Study

Introducción y objetivos Pocos estudios en España han descrito la distribución del síndrome metabólico según la definición armonizada, y del síndrome metabólico premórbido, que es el síndrome metabólico sin diabetes mellitus o enfermedad cardiovascular. Además, se desconoce la distribución por comunidades autónomas y su manejo clínico. Este trabajo examina la distribución y el manejo clínico de ambos síndromes en España. Métodos Estudio transversal realizado de 2008 a 2010 sobre 11.149 personas representativas de la población española de 18 o más años. La información se obtuvo mediante examen físico estandarizado y las determinaciones analíticas se hicieron en un laboratorio central. Resultados La prevalencia (intervalo de confianza del 95%) de síndrome metabólico fue del 22,7% (21,7-23,7) y la del premórbido, el 16,9% (16,0-17,8). La frecuencia de ambos síndromes aumentó con la edad y fue mayor en varones que en mujeres hasta los 65 años; a partir de esa edad, fue mayor entre las mujeres. Las comunidades del sur de España y las insulares fueron las de mayor prevalencia de ambos síndromes, y en algún caso resultó el doble que la de la comunidad de menor prevalencia. Aproximadamente un tercio de los pacientes con síndrome metabólico premórbido declararon no recibir consejo sanitario para mejorar sus estilos de vida; entre los que recibieron consejo, el seguimiento fue bajo, especialmente para perder peso (31,9%) y reducir la sal (38,3%).Conclusiones La prevalencia de síndrome metabólico es elevada en España. Hay importantes diferencias geográficas en su distribución y sustanciales oportunidades de mejora del manejo clínico del síndrome metabólico premórbido(AU)

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

Magnitude and management of metabolic syndrome in Spain in 2008-2010: the ENRICA study.

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

Trends in obesity and abdominal obesity in the older adult population of Spain (2000-2010).

OBJECTIVE: This work examines the trend in obesity and abdominal obesity in the Spanish population aged 60 years and over during the first decade of the 21st century. METHODS: We analyze data from a representative study of the Spanish population aged 60 years and older conducted in 2000-2001 and from the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA) conducted in 2008-2010. RESULTS: In men, the distribution of BMI did not vary in the period 2000-2010. In contrast, in women there was a reduction in both mean BMI--from 29.3 to 28.8 kg/m2--and the prevalence of obesity--from 40.8 to 36.3%. This decline was greatest in women aged 60-69 years. In men, no significant changes were observed in mean waist circumference (WC) or in the prevalence of abdominal obesity. In contrast, WC decreased by 3.6 cm and abdominal obesity prevalence by 12.7% in women. The decline was greatest in women aged 60-69 years, in whom mean WC decreased by 5.1 cm and abdominal obesity prevalence by 18.6%. CONCLUSION: These findings show that the frequency of obesity has begun to decline in Spanish women aged 60 and over. The causes of this decline are unclear.

Obesity-related eating behaviors are associated with low physical activity and poor diet quality in Spain.

This study examined the association of obesity-related eating behaviors (OREB) with physical activity, sedentariness, and diet quality. Data were taken from a cross-sectional study in 10,791 persons representative of the Spanish population who were ≥18 y of age in 2008-2010. The following self-reported information was collected on 12 OREB: not planning how much to eat before sitting down, not deciding the amount of food on the plate, skipping breakfast, eating precooked/canned food or snacks bought at vending machines or at fast-food restaurants, not choosing low-energy foods, not removing visible fat from meat or skin from chicken, eating while watching television or seated on a sofa or an armchair, and taking a short time for meals. Analyses were performed with linear or logistic regression, as appropriate, and adjusted for the main confounders. In comparison to participants with ≤1 OREB, those with ≥5 OREB performed less physical activity [ß: -2.61 (95% CI: -4.44, -0.78); P-trend < 0.001] and spent more time watching television [ß: 2.17 (95% CI: 1.39, 2.95); P-trend < 0.001]; furthermore, they had greater total energy intake [ß: 160 (95% CI: 115, 210); P-trend < 0.001] and were less likely to follow a Mediterranean diet [OR: 0.55 (95% CI: 0.41, 0.73); P-trend < 0.001]. In conclusion, the association between OREB and obesity is biologically plausible because OREB are associated with energy intake and poor accordance with the Mediterranean diet. Studies on the association between OREB and obesity should control for the confounding effect of physical activity and sedentariness.

Justificación y métodos del estudio sobre nutrición y riesgo cardiovascular en España (ENRICA) / Rationale and methods of the study on nutrition and cardiovascular risk in Spain (ENRICA)

Introducción y objetivos. El estudio ENRICA pretende medir la frecuencia y la distribución de los principales componentes de la historia natural de la enfermedad cardiovascular en España, incluyendo el consumo alimentario y otros factores de riesgo conductuales, factores de riesgo biológicos, daño precoz en órganos diana y morbilidad diagnosticada. Métodos. Estudio transversal realizado de junio de 2008 a octubre de 2010 sobre 11.991 personas representativas de la población no institucionalizada de 18 y más años de edad en España. La recogida de datos se hizo en tres etapas secuenciales: a) entrevista telefónica asistida por ordenador sobre estilos de vida, conocimiento y actitudes sobre factores de riesgo de enfermedad cardiovascular y sobre signos y síntomas de alerta de ataque al corazón e ictus, salud subjetiva y morbilidad; b) primera visita al domicilio, para obtener muestras de sangre y orina que se envían a un laboratorio central para las determinaciones analíticas, y c) segunda visita al domicilio, para realizar antropometría, medir presión arterial y completar historia dietética electrónica. De las personas de 65 y más años, se obtuvo información sobre limitaciones funcionales. Discusión. El estudio ENRICA ha mostrado en España la factibilidad de un gran estudio con entrevista y examen físico en los domicilios. Este estudio proporcionará información valiosa para orientar y evaluar las estrategias nacionales contra la enfermedad cardiovascular y otras enfermedades crónicas. Además, está previsto que en el segundo semestre de 2011 comience el seguimiento durante 3 años de los participantes en el estudio. Con ello se actualizará la información de estilos de vida y sobre variables biológicas obtenidas en un nuevo examen físico (ClinicalTrials.gov number, NCT01133093) (AU)

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

[Rationale and methods of the study on nutrition and cardiovascular risk in Spain (ENRICA)]. / Justificación y métodos del estudio sobre nutrición y riesgo cardiovascular en España (ENRICA).

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

Housing conditions and mortality in older patients hospitalized for heart failure.

BACKGROUND: Although decent housing is recognized as a prerequisite for good health, very few studies in developed countries have examined the influence of housing characteristics on disease prognosis. This work examined whether housing conditions predict mortality in older adults with heart failure (HF). METHODS: This is a cohort study comprising 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals between January 1, 2000, and June 30, 2001. At baseline, patients reported whether their homes lacked an elevator (in an apartment building), hot water, heating, an indoor bathroom, a bathtub or shower, individual bedroom, automatic washing machine, and telephone and whether they frequently felt cold. Analyses included all-cause deaths identified prospectively until January 1, 2005. RESULTS: Among study participants, 165 (38.1%) lived in a home without one of the services considered; and 111 (25.6%) lacked ≥2 services. During follow-up, 260 deaths (60%) occurred. After adjustment for the main confounders, mortality was higher in those who lived in homes without an elevator (hazard ratio [HR] 1.39, 95% CI 1.07-1.80) and in those who frequently felt cold (HR 1.39, 95% CI 1.01-1.92). In comparison with living in a home with all the services considered, mortality was higher for persons living in a home lacking 1 service (HR 1.42, 95% CI 1.10-1.93) or ≥2 services (HR 1.94, 95% CI 1.37-2.74). Patients living in homes lacking any of the services more often had poor functional status, higher comorbidity, lower educational level, and less income. CONCLUSION: Poor housing conditions are associated with higher mortality in HF. Patients living in these homes are especially vulnerable because they have poorer clinical situation and lower socioeconomic position.

Prevalencia de obesidad en inmigrantes en Madrid / Prevalence of obesity in immigrants in Madrid, Spain

Fundamento y objetivo: En España no hay estudios sobre la magnitud de la obesidad en la población adulta inmigrante. El objetivo de este trabajo es presentar la frecuencia y la distribución de la obesidad en los inmigrantes residentes en la ciudad de Madrid. Material y método: Se seleccionaron sujetos de entre 18 y 64 años de edad. El índice de masa corporal se utilizó como estimador de obesidad. El estatus de inmigrante se definió según el país de nacimiento. Los resultados presentan la prevalencia bruta y ajustada de la obesidad para los diferentes grupos de inmigrantes. Resultados: El porcentaje de obesos fue mayor entre los inmigrantes que entre la población española, a excepción del grupo de occidentales. Según sexo, los inmigrantes varones de Europa del Este y Latinoamérica y las mujeres procedentes de África-Asia y Europa del Este fueron los más obesos. Conclusiones: La mayor prevalencia de obesidad entre los inmigrantes también se ha observado en estudios realizados en otros países. Esta alta prevalencia de obesidad entre los inmigrantes podría deberse a una exposición más intensa a factores obesógenos, tanto antes de su llegada como durante su residencia en España (AU)

Background and objective: There are no studies in Spain on the extent of obesity in adult immigrants. The aim of this paper is to present the frequency and distribution of obesity among immigrants living in Madrid. Patients and method: We selected subjects between 18 and 64 years of age. Body Mass Index was used as an estimator of obesity. Immigrant status was defined according to country of birth. The results show the unadjusted and adjusted prevalence of obesity for different immigrant groups. Results: The percentage of obesity was higher in the immigrant population than in the Spanish population, except for the group of immigrants from western countries. According to gender, male immigrants from Eastern Europe and Latin America and women from Asia, Africa and Eastern Europe were the most obese. Conclusion: The highest prevalence of obesity among immigrants has also been observed in studies conducted in other countries. The prevalence of obesity among immigrants may be due to a more intense exposure to obesogenic factors both before arrival and during their residence in Spain (AU)

[Prevalence of obesity in immigrants in Madrid, Spain]. / Prevalencia de obesidad en inmigrantes en Madrid.

BACKGROUND AND OBJECTIVE: There are no studies in Spain on the extent of obesity in adult immigrants. The aim of this paper is to present the frequency and distribution of obesity among immigrants living in Madrid. PATIENTS AND METHOD: We selected subjects between 18 and 64 years of age. Body Mass Index was used as an estimator of obesity. Immigrant status was defined according to country of birth. The results show the unadjusted and adjusted prevalence of obesity for different immigrant groups. RESULTS: The percentage of obesity was higher in the immigrant population than in the Spanish population, except for the group of immigrants from western countries. According to gender, male immigrants from Eastern Europe and Latin America and women from Asia, Africa and Eastern Europe were the most obese. CONCLUSION: The highest prevalence of obesity among immigrants has also been observed in studies conducted in other countries. The prevalence of obesity among immigrants may be due to a more intense exposure to obesogenic factors both before arrival and during their residence in Spain.

Sleep duration and health-related quality of life among older adults: a population-based cohort in Spain.

STUDY OBJECTIVES: The few studies that have addressed the association between sleep duration and health-related quality of life (HRQL) were cross-sectional and small-sized, targeted young and middle-aged persons, and did not adjust for the main confounders. This study sought to examine the cross-sectional and longitudinal relationship between habitual sleep duration and HRQL in older adults. DESIGN: Prospective study conducted from 2001 through 2003. Sleep duration was self-reported in 2001, and HRQL was measured using the SF-36 questionnaire in 2001 and 2003. Analyses were adjusted for the main confounders. SETTING: Community-based study. PARTICIPANTS: A cohort of 3834 persons representative of the non-institutionalized Spanish population aged 60 years and over. INTERVENTION: None. MEASUREMENT AND RESULTS: In comparison with women who slept 7 hours, those with extreme sleep durations (< or = 5 or > or = 10 h) reported worse scores on the SF-36 physical and mental scales in 2001. Among men, sleeping < or = 5 h was associated with a worse score in the role-physical scale in 2001. The magnitude of most of these associations was comparable with the reduction in HRQL associated with aging 10 years. Sleep duration in 2001 failed to predict changes in HRQL between 2001 and 2003. CONCLUSION: Extreme sleep durations are a marker of worse HRQL in the elderly.

[Health-risks associated with Western diet and sedentariness: the obesity epidemia]. / Riesgos asociados a la dieta occidental y al sedentarismo: la epidemia de obesidad.

We describe the magnitude and trends of obesity in Spain and of its main determinants, associated both with the increase in energy intake and the reduction of energy expenditure. Such determinants include factors from the individual subjects and from their environment. We also present the main features of the strategy for the Nutrition, Physical Activity, and the Prevention of Obesity, fostered by the Ministry of Health, as well as plans and activities carried out by the Regional Governments, to control this health disorder. We conclude that effective and sustained implementation of these activities is badly needed. It should be made along with the monitoring of obesity and its determinants in the general population. Research in this field should also be strengthened because social determinants of obesity are not known in depth, and the effectiveness of many of the interventions proposed by the national and regional initiatives is not well established yet. Moreover, in the next future, the effectiveness of intervention models applied to control the smoking epidemic must be assessed to examine its usefulness in the control of obesity. An example of this type of interventions is the limitation of the publicity of nutrient-poor and energy-dense foods addressed to children.

Riesgos asociados a la dieta occidental y al sedentarismo: la epidemia de obesidad / Health-risks associated with western diet and sedentariness: the obesity epidemia

Describimos la magnitud y las tendencias de la obesidad en España, así como sus principales factores determinantes, asociados al aumento de la ingesta energética y a la reducción del gasto calórico. Estos determinantes incluyen tanto factores propios del individuo como de su entorno. También se presentan las principales características de la Estrategia para la Nutrición, Actividad Física y Prevención de la Obesidad (NAOS) promovida por el Ministerio de Sanidad y Consumo, y los planes y actividades de las Comunidades Autónomas, para controlar este problema de salud. Concluimos que es necesaria la implantación efectiva y mantenida en el tiempo de estas actividades. Ello se debe acompañar de la monitorización de la frecuencia de la obesidad y sus determinantes en la población. También debe potenciarse la investigación en este campo, pues los determinantes sociales de la obesidad todavía son insuficientemente comprendidos y, lo que es más importante, el conocimiento de la efectividad de muchas de las medidas propuestas es claramente incompleto. En el futuro deberá evaluarse además la efectividad de modelos de intervención utilizados para controlar la epidemia tabáquica y que se empiezan a plantear, dada la gravedad de la situación, en el caso de la epidemia de obesidad. Un ejemplo de este tipo de intervenciones es la limitación de la publicidad de productos pobres en nutrientes y con gran densidad energética dirigidos a los niños (AU)

We describe the magnitude and trends of obesity in Spain and of its main determinants, associated both with the increase in energy intake and the reduction of energy expenditure. Such determinants include factors from the individual subjects and from their environment. We also present the main features of the strategy for the Nutrition, Physical Activity, and the Prevention of Obesity, fostered by the Ministry of Health, as well as plans and activities carried out by the Regional Governments, to control this health disorder. We conclude that effective and sustained implementation of these activities is badly needed. It should be made along with the monitoring of obesity and its determinants in the general population. Research in this field should also be strengthened because social determinants of obesity are not known in depth, and the effectiveness of many of the interventions proposed by the national and regional initiatives is not well established yet. Moreover, in the next future, the effectiveness of intervention models applied to control the smoking epidemic must be assessed to examine its usefulness in the control of obesity. An example of this type of interventions is the limitation of the publicity of nutrient-poor and energy-dense foods addressed to children (AU)

[The obesity epidemic and related factors: the case of Spain]. / La epidemia de obesidad y sus factores relacionados: el caso de España.

The obesity epidemic is a global phenomenon that does not respect geographic or socio-demographic boundaries. Thus, research on factors related to the obesity epidemic has focused on social and economic characteristics of modern societies. This article discusses obesity in Spain and trends in several associated factors. Together with the increase in the prevalence of obesity, important changes in the population's dietary pattern have been observed, although total energy and fat intake appear to be stable. According to several indirect indicators, sedentary behavior predominates, although the percentage of the population reporting some leisure exercise is increasing. An increase in the amount of leisure time in modern societies is suggested as an explanation for this paradox. Factors related to energy expenditure could be as important as dietary factors in the genesis of the obesity epidemic.

[Population-based reference values for the Spanish version of the SF-36 Health Survey in the elderly]. / Valores de referencia de la versión española del Cuestionario de Salud SF-36 en población adulta de más de 60 años.

BACKGROUND AND OBJECTIVE: The SF-36 Health Survey questionnaire is the most widely used instrument to measure health-related quality of life. Reference measures are needed to interpret its results in clinical and population studies. In 1996, a study provided population-based norms for Spain, but these were not disaggregated by age in subjects aged 75 years and over, even though health status changes with aging among those who overpass such age. Moreover, health status in elderly people from developed countries has improved over the last years. This study obtains population-based norms for the Spanish version of the SF-36 Health Survey in five-year age-groups for those aged 60 to 85 and over. SUBJECTS AND METHOD: Cross-sectional survey on a sample of 3,949 non-institutionalised subjects representative of the Spanish population aged 60 years and over. Information on the SF-36 Health Survey was obtained through house-hold personal interviews. Central position and dispersion statistics, as well as percentiles, were calculated for each of the eight SF-36 scales by age and sex. Cronbach's alpha coefficients were calculated to assess the internal reliability of each scale. RESULTS: Subjects reported higher scores for emotional role (mean [SD] 84.8 [32.9]), social functioning (79.2 [28.0]) and physical role (73.3 [41.1]). For all scales, mean scores were higher (better perceived health) among men than women (p < 0.0001). As age increased, mean scores in all scales decreased (p for linear trend < 0.001) except for mental health (p for linear trend = 0.29 in women, p for lineal trend = 0.14 in men), yet the decrease was greater for physical functioning and physical role. Reliability was very high for all scales (Cronbach's alpha from 0.84 to 0.95). RESULTS were similar to those of the study carried out in 1996. CONCLUSIONS: These results extend those obtained in 1996 and facilitate the interpretation of the SF-36 Health Survey values in clinical and population studies in the Spanish population aged 60 years and older.

Valores de referencia de la versión española del Cuestionario de Salud SF-36 en poblaciónadulta de más de 60 años / Population-based reference values for the Spanish version of the SF-36 Health Survey in the elderly

FUNDAMENTO Y OBJETIVO: El Cuestionario de Salud SF-36 es el más usado en la bibliografía internacional para medir la calidad de vida relacionada con la salud. Los valores de referencia del cuestionario son necesarios para interpretar sus resultados en estudios clínicos y poblacionales. Un estudio realizado en 1996 proporcionó dichos valores para la población española, pero no se desagregaron por edad en los sujetos de 75 y más años, a pesar de que el estado de salud cambia al envejecer en los que, cada día con más frecuencia, superan dicha edad. Además, el estado de salud de los ancianos de los países desarrollados ha mejorado en los últimos años. Por ello, el objetivo de este trabajo ha sido obtener los valores de referencia del Cuestionario de Salud SF-36 en el año 2001 para la población española en grupos quinquenales de edad en el intervalo de 60 a 85 y más años. SUJETOS Y MÉTODO: Estudio transversal en una muestra de 3.949 personas representativas de la población española no institucionalizada de 60 y más años de edad. El Cuestionario de Salud SF-36 se completó mediante entrevista personal en los domicilios. Se calcularon medidas de tendencia central y de dispersión, y los percentiles de las puntuaciones de las 8 escalas del cuestionario, según la edad y el sexo. Además se examinó la consistencia o fiabilidad interna de cada escala mediante el coeficiente alfa de Cronbach. RESULTADOS: Los sujetos refirieron las puntuaciones más elevadas para las escalas de rol emocional (media [DE]: 84,8 [32,9]), función social (79,2 [28,0]) y rol físico (73,3 [41,1]). Los valores medios de todas las escalas fueron superiores (mejor salud percibida) en los varones que en las mujeres (p < 0,0001). Al aumentar la edad disminuía la puntuación media en todas las escalas (p para la tendencia lineal < 0,001) excepto la de salud mental (p para la tendencia lineal = 0,29 en mujeres; p para la tendencia lineal = 0,14 en varones), aunque el descenso fue mayor en las de función física y rol físico. La consistencia interna de todas las escalas fue muy alta (alfa de Cronbach de 0,84 a 0,95). Los resultados fueron similares a los obtenidos en el estudio de 1996. CONCLUSIONES: Estos resultados complementan los del estudio de 1996 y favorecerán la interpretación de los valores del Cuestionario de Salud SF-36 en estudios clínicos y poblacionales en personas de 60 y más años en España (AU)

La epidemia de obesidad y sus factores relacionados: el caso de España / The obesity epidemic and related factors: the case of Spain

La epidemia de obesidad es un fenómeno universal que no parece reconocer límites ni geográficos ni sociodemográficos. Las investigaciones sobre los factores responsables de la epidemia se centran sobre algunas de las condiciones sociales y económicas que imperan en las sociedades actuales. El presente artículo muestra la situación de la obesidad en España y la tendencia de una serie de factores potencialmente relacionados. El incremento en la prevalencia de obesidad se acompañó de importantes cambios en el patrón de alimentación de la población a pesar de una tendencia estabilizada en la ingesta calórica total y de grasas. Diversos indicadores indirectos muestran la tendencia sedentaria de la población, a pesar de que un mayor porcentaje de la población declara realizar ejercicio físico en su tiempo libre. Los factores dependientes del gasto energético parecen tan o más importantes que los derivados del ingreso. Para explicar la situación paradójica de los distintos indicadores de sedentarismo se sugiere la hipótesis de un aumento del "stock de tiempo libre" en las sociedades actuales

[Association of cardiovascular disease with overweight and obesity in Spain]. / Asociación de la enfermedad cardiovascular con el sobrepeso y la obesidad en España.

BACKGROUND: Our purpose was to examine the relationship of overweight and obesity with cardiovascular disorders. PATIENTS AND METHOD: Data from the 1993 Spanish National Health Survey (16,692 subjects with a body mass index [BMI] >= 18.5 kg/m2). RESULTS: After adjustment for age, residence city size and tobacco consumption, we observed a positive dose-response relationship (p linear trend < 0.05) of BMI >= 18.5 kg/m2 with hypertension, hypercholesterolemia and diabetes in both sexes, as well as with heart diseases in women. These associations decreased with age. CONCLUSIONS: Overweight and obesity are associated with a greater frequency of cardiovascular disorders in Spain.

Asociación de la enfermedad cardiovascularcon el sobrepeso y la obesidad en España / Association of cardiovascular disease with overweight and obesity in Spain

FUNDAMENTO: Examinar la relación del exceso de peso con la presencia de trastornos cardiovasculares. PACIENTES Y MÉTODO: Los datos proceden de la Encuesta Nacional de Salud de España de 1993 (16.692 sujetos con índice de masa corporal ([IMC] 18,5 kg/m2). RESULTADOS: Después de ajustar por edad, consumo de tabaco y tamaño del municipio, se observó una relación dosis-respuesta positiva (p para la tendencia lineal < 0,05) del IMC 18,5 kg/m2 con la hipertensión, la hipercolesterolemia y la diabetes en varones y mujeres, y con las enfermedades del corazón en las mujeres. Estas asociaciones disminuían con la edad. CONCLUSIONES: El exceso de peso se asocia a mayor frecuencia de trastornos cardiovasculares en España. (AU)

Changes in the prevalence of overweight and obesity and their risk factors in Spain, 1987-1997.

BACKGROUND: The aim of this study was to examine the relationship of the changes in the prevalence of overweight and obesity with the changes in some of their risk factors in Spain from 1987 to 1997. METHODS: Data were obtained from three interview-based health surveys, covering representative samples of the noninstitutionalized Spanish population aged 16 years and over and undertaken in 1987 (n = 17,434), 1995 (n = 4,736), and 1997 (n = 4,678). To compensate for the different sample sizes, the 1995 and 1997 surveys were combined. Risk factors for obesity and overweight considered in this study were age, educational level, physical activity at work, physical activity during leisure time, tobacco use, alcohol consumption, and civil status. Data analysis was performed with logistic regression. RESULTS: The prevalence of overweight and obesity (body mass index >or= 25 kg/m(2)) rose from 35.6% in 1987 to 40.9% in 1995/1997 among women and from 47.1 to 56.2% among men. In the period 1987-1995/1997, the proportion of persons with secondary or university education increased by 11.3% in women and 10.8% in men. Similarly, the prevalence of intense or regular leisure-time physical activity increased by 5.7 and 6.2% in women and men, respectively. The remaining risk factors for overweight and obesity registered no substantial change in prevalence over the study period. The prevalence of overweight and obesity expected in 1995/1997, had educational level and leisure-time physical activity been the same as in 1987, is higher than the observed figures; for educational level, expected figures are 7.3 and 1.4% higher than those observed among women and men, respectively, while for leisure-time physical activity corresponding values are 2.8 and 1.6%. CONCLUSIONS: The rise in the prevalence of overweight and obesity in Spain from 1987 to 1997 may have been attenuated by an increase in leisure-time physical activity and by an improvement in educational level, particularly among women. The contribution to overweight and obesity trends attributable to physical activity at work or to tobacco and alcohol consumption appears to be small or null.