Policy action initiatives against obesity in Colombia: a literature review using the NOURISHING framework methodology Colombian policy actions against obesity / Iniciativas de acción de política contra la obesidad en Colombia: una revisión de la literatura a partir de la metodología del marco NOURISHING

Abstract Introduction: In Colombia, obesity is a public health problem that must be addressed by the government through policy action initiatives (PAIs), that is, governmental actions that may or may not be implemented. Objective: To identify PAIs and policy action evaluations (PAEs) against obesity formulated in Colombia since 2005 using the NOURISHING framework methodology. Materials and methods: The search for evidence was conducted between March and August 2019 (with an update in August 2020) as follows: PAIs in government and civil society organization websites. and PAEs in PubMed, SciELO and the Sinergia repository. PAIs were classified according to NOURISHING policy areas. Results: A total of 42 PAIs with 82 lines of action were found: 16 (24 lines) implemented, 17 (37 lines) not implemented, and 9 (21 lines) with insufficient information to determine their implementation (21 lines). These PAIs encompassed all the NOURISHING framework policy areas. The implemented PAIs have more lines of action in the "Harness food supply chain and actions across sectors" area (8/24), while those that have not been implemented have more lines in the "Restrict food and beverage advertising" area (10/37). There were 13 PAEs, and most of them were about food security PAIs focused on food supply (4/13). Conclusions: Colombia has PAIs against obesity that address all the policy areas of the NOURISHING framework. Implemented PAIs focus on food supply, while non-implemented PAIs focus on regulatory measures. A greater government commitment is required in the implementation of PAIs that allow improving the dietary habits of the Colombian population, which will help reduce obesity rates in the country in the medium and long term.

Resumen Introducción. En Colombia, la obesidad es un problema de salud pública que el gobierno debe abordar mediante iniciativas de acción de política (IAP), es decir, acciones gubernamentales que pueden estar implementadas o no. Objetivo. Identificar, mediante la metodología del marco NOURISHING, las IAP y las evaluaciones de acción de política (EAP) contra la obesidad formuladas en Colombia desde 2005. Materiales y métodos. La búsqueda de la evidencia se realizó entre marzo y agosto de 2019 (con una actualización en agosto de 2020) de la siguiente manera: IAP: en sitios web del gobierno y de organizaciones de la sociedad civil; EAP: en PubMed, SciELO y el repositorio Sinergia. Las IAP se clasificaron en las áreas de política del marco NOURISHING. Resultados. Se encontraron 42 IAP con 82 líneas de actuación: 16 (24 líneas) implementadas, 17 (37 líneas) no implementadas, y 9 (21 líneas) sin información suficiente para determinar su implementación (21 líneas). Las IAP abordan todas las áreas de política del marco NOURISHING. Las IAP implementadas tienen más líneas en el área "Habilitar acciones multisectoriales y de suministro de alimentos" (8/24), mientras que las no implementadas, en "Restringir la publicidad de alimentos y bebidas" (10/37). Se identificaron 13 EAP, donde la mayoría fueron sobre IAP en seguridad alimentaria orientadas al suministro de alimentos (4/13). Conclusiones. Colombia tiene IAP contra la obesidad que abarcan todas las áreas de política del marco NOURISHING. Las IAP implementadas se enfocan en el suministro de alimentos y las no implementadas, en medidas regulatorias. Se requiere un mayor compromiso del gobierno en la implementación de IAP sobre medidas regulatorias que permitan mejorar los hábitos alimentarios de la población colombiana, lo que, en el mediano y largo plazo, ayudará a reducir las tasas de obesidad en el país en el mediano y largo plazo.

Individualised prognosis for risk of developing abdominal obesity in the paediatric population.

AIMS: To develop and validate risk scores for predicting abdominal obesity in South American children and adolescents based on extrinsic and intrinsic variables. METHODS: Children (n = 358) and adolescents (n = 369) from seven South American cities from the South American Youth Cardiovascular and Environmental (SAYCARE) Study. The primary outcome was abdominal obesity. Potential predictors were based on sociodemographic, maternal, environmental, and behavioural factors and nutritional status. In multilevel logistic models, associated variables were tested to build the scores, which were internally validated. RESULTS: We identified 120 children and 98 adolescents who were abdominally obese. We found at least five variables associated with the outcome in children with unacceptable predictive capacity. However, in adolescents, we found that biological sex, age, maternal body mass index (BMI), active commuting by bike, soft drink consumption (for risk score A), and weight (for score B) can predict abdominal obesity. Both scores, A and B, showed acceptable performance in the ROC curve [areas under curve: 0.70 (95% CI: 0.56-0.82) and 0.95 (95% CI: 0.89-1.00), respectively]. CONCLUSION: The SAYCARE risk scores present accurate, individualised estimates for identifying adolescents who are at risk of developing abdominal obesity. However, these have not been externally validated.

Enfermedades cardiometabólicas y la mortalidad por el COVID-19 en el inicio de la pandemia en Colombia / Cardiometabolic Diseases and Mortality due to COVID-19 During the Pandemic's Onset in Colombia / Doenças cardiometabólicas e mortalidade por COVID-19 no início da pandemia na Colômbia

Resumen: el escenario de la pandemia actual derivada del COVID-19, infección causada por el virus denominado SARS-CoV-2, ha permitido develar la interacción entre enfermedades infecciosas y enfermedades crónicas no transmisibles, de manera que ha aportado hallazgos que sugieren un aumento en las tasas de mortalidad por COVID-19. El objetivo de este artículo es describir las características sociodemográficas y de morbilidad en los fallecimientos ocurridos en Colombia por COVID-19 al 19 de mayo del 2020. Es un estudio descriptivo a partir de reportes del Instituto Nacional de Salud, sobre fallecimientos de casos positivos por COVID-19, del 6 de marzo al 19 de mayo del 2020. La información sobre factores preexistentes se obtuvo de reportes del periódico El Tiempo en notas de prensa publicadas al respecto. Se realizó análisis descriptivo en Excel y SPSS v25. Se identificaron 613 fallecimientos en el periodo. El mayor número de muertes ocurrió en Bogotá D. C. (35,0 %), seguida de Valle de Cauca (10,4 %), Cartagena (8,6 %), Amazonas (7,2 %) y Meta (5,6 %). La edad promedio de las defunciones fue 67,26 ± 16,28 años, siendo el grupo de edad de 60-79 años en el que más muertes se presentaron, con el 50,7 % de los casos. El 60,8 % de las defunciones ocurrió en personas de sexo masculino, y un 80,1 % tenían alguna morbilidad: 36,2 % padecía hipertensión, 19,2 % diabetes mellitus, 17,1 % EPOC, 16,5 % alguna enfermedad cardiovascular, 11,1 % obesidad y un 16,2 % padecía otro tipo de enfermedad sin especificar. El antecedente de morbilidad por patologías cardiometabólicas asociadas con factores alimentarios y nutricionales favorece la mortalidad en personas infectadas por COVID-19 en Colombia.

Abstract: the current scenario derived from the COVID-19 Infection caused by the virus denominated SARS-CoV-2 has uncovered the interaction between infectious diseases and chronic non-communicable diseases, thus providing findings that suggest an increase in covid-19 mortality rates. The objective of this article is to describe the sociodemographic and morbidity characteristics of deaths occurring In Colombia due to COVID-19 as at May 19,2020. This Is a descriptive study based on reports from the National Institute of Health, on deaths of positive cases due to COVID-19, from March 6 to May 19, 2020. Information on pre-existing factors was obtained from reports on the newspaper El Tiempo in press releases published on the subject. Descriptive analysis was performed in Excel and SPSS v25. 613 deaths were Identified In the period. The highest number of deaths occurred in Bogota D. C. (35.0%), followed by Valle de Cauca (10.4%), Cartagena (8.6%), Amazonas (7.2%) and Meta (5.6%). The average age of the deaths was 67.26 ± 16.28 years, with the 60-79 age group accounting for 50.7 % of the deaths. A total of 60.8 % of the deaths occurred In males, and 80.1 % had some form of morbidity: 36.2% suffered from hypertension, 19.2% from diabetes mellitus, 17.1 % EPOC, 16.5% some cardiovascular disease, 11.1 % obesity and 16.2% other type of unspecified disease. The history of morbidity due to cardiometabolic pathologies associated with dietary and nutritional factors favors mortality In persons infected by COVID-19 in Colombia.

Resumo: o cenário da atual pandemia decorrente da COVID-19, Infecção causada pelo virus chamado SARS-CoV-2, revelou a interação entre doenças Infecciosas e doenças crónicas não transmissíveis, de modo que tem fornecido achados que sugerem um aumento nas taxas de mortalidade por COVID-19. O objetivo deste artigo é descrever as características sociodemográficas e de comorbidade das mortes na Colombia por COVID-19 até o día 19 de maio de 2020. Trata-se de um estudo descritivo baseado em relatórios do Instituto Nacional de Saúde, sobre mortes de casos positivos para COVID-19, de 6 de março a 19 de maio de 2020. Informações sobre fatores pré-existentes foram obtidas de reportagens do jornal El Tiempo em comunicados à imprensa sobre o assunto. A análise descritiva foi realizada no Excel e no SPSS v25. Foram identificadas 613 mortes no período. O maior número de mortes ocorreu na cidade de Bogotá D. C. (35,0 %), seguida por Valle de Cauca (10,4 %), Cartagena (8,6 %), Amazonas (7,2 %) e Meta (5,6 %). A média de idade dos óbitos foi de 67,26 ± 16,28 anos, em que a faixa etária de 60 a 79 anos teve mais óbitos, com 50,7 % dos casos. 60,8 % dos óbitos ocorreram no sexo masculino, e 80,1 % apresentaram alguma comorbidade: 36,2 % sofriam de hipertensão, 19,2 % diabetes mellitus, 17,1 % DPOC, 16,5 % doenças cardiovasculares, 11,1 % obesos e 16,2 % tinham outra doença não especificada. A história de comorbidade por patologias cardiometabólicas associadas a fatores alimentares e nutricionais favorece a mortalidade em pessoas infectadas com COVID-19 na Colômbia.

Inequalities in food consumption the Colombian households: Results from the National Survey of Nutritional Status / Desigualdades en el consumo de alimentos en hogares colombianos: Resultados de la Encuesta Nacional de Situación Nutricional / Desigualdades no consumo de alimentos em lares colombianos: Resultados da Enquete Nacional de Situação Nutricional

Abstract Introduction: adverse socioeconomic conditions may cause food intake characterized by inequality that derives in malnutrition increases. Objective. To identify inequalities in food consumption among the Colombian population according to socioeconomic status and the food security classification for households. Methods. The data were obtained from the 2005 National Survey of Nutritional Status, and the analysis used the first 24-hour recall n=39,413 Colombians. The statistical analysis took into account descriptive statistics and 95% confidence intervals. A multivariate analysis was performed through multinomial logistic regression models, with each of the food groups as a dependent variable. Finally, a latent class analysis was performed to understand the heterogeneity of the inequalities in food consumption in the households. Results. Low-socioeconomic status households showed higher consumption of cereals, tubers and plantains, non-alcoholic beverages, and fats. I contrast, higher socioeconomic status households showed higher consumption of dairy products, fruit, vegetables, and sugars/sweets. The food security classification found that food-secure households had a higher consumption of meat, dairy, vegetables, fruit, and sugars/sweets. Households classified as food-insecure showed a higher consumption of cereals, tubers and plantains, and non-alcoholic beverages. The consumption of tubers and plantains showed a clear social gradient, in higher socioeconomic status there was lower consumption probability of those products. Conclusion. There are inequalities in food consumption in Colombia according to socioeconomic status and the food security classification; therefore, people and families with the most unfavorable socioeconomic status have diets with less nutritional value.

Resumen Objetivo: Identificar las inequidades en el consumo de alimentos según nivel socioeconómico y clasificación de seguridad alimentaria de los hogares colombianos. Métodos: Los datos provienen de la Encuesta Nacional de la Situación Nutricional de 2005, y se utilizó el primer recordatorio de 24 horas n=39,413 colombianos. El análisis estadístico tuvo en cuenta estadística descriptiva e intervalos de confianza del 95%. Se realizó un análisis de regresión logística multinomial, con cada uno de los grupos de alimentos como una variable dependiente. Finalmente, se realizó un análisis de clases latentes para capturar la heterogeneidad de las inequidades en el consumo de alimentos en los hogares. Resultados: Los hogares clasificados con un nivel socioeconómico bajo mostraron un mayor consumo de cereales, tubérculos/plátanos, bebidas no alcohólicas y grasas. Por otro lado, se observó que un nivel socioeconómico alto conllevó un mayor consumo de lácteos, frutas, verduras y azúcares/postres. Según clasificación de seguridad alimentaria, los hogares considerados en seguridad tenían un mayor consumo de carne, lácteos, verduras, frutas y azúcares/postres. Los hogares clasificados en inseguridad alimentaria mostraron mayor consumo de cereales, tubérculos/plátanos, y bebidas no alcohólicas. El consumo de tubérculos y plátanos mostró un gradiente social, con menor probabilidad de consumo a mayor nivel socioeconómico. Conclusión: Existen inequidades en el consumo de alimentos en Colombia según nivel socioeconómico y clasificación de seguridad alimentaria, por tanto, las personas y familias en estado socioeconómico más desfavorable tienen dietas con menor valor nutricional.

Resumo Objetivo: Identificar as desigualdades no consumo de alimentos segundo o nível socioeconômico e classificação de segurança alimentar dos lares colombianos. Métodos: Os dados provêm da Enquete Nacional da Situação Nutricional de 2005, e se utilizou o primeiro lembrete de 24 horas n=39,413 colombianos. A análise estatístico levando em conta Estatísticas descritiva e intervalos de confiança de 95%. Realizou-se uma análise de regressão logística multinominal, com cada um dos grupos de alimentos como uma variável dependente. Finalmente, realizou-se uma análise de classes latentes para capturar a heterogeneidade das desigualdades no consumo de alimentos nos lares. Resultados: Os lares classificados com um nível socioeconómico baixo amostraram um maior consumo de cereais, tubérculos/ banana da terra, bebidas não alcoólicas e gorduras. Por outro lado, observou-se que um nível socioeconómico alto tem um maior consumo de lácteos, frutas, verduras e açúcares/sobremesas. Segundo a clasificação de segurança alimentar, os lares considerados em segurança tinham um maior consumo de carne, lácteos, verduras, frutas e açúcares/sobremesas. Os lares classificados em insegurança alimentar evidenciaram maior consumo de cereais, tubérculos/banana da terra, e bebidas não alcoólicas. O consumo de tubérculos e banana da terra evidenciou uma desigualdade social, com menor probabilidade de consumo no nível socioeconômico mais alto. Conclusão: Existem desigualdades no consumo de alimentos na Colômbia de acordo com o nível socioeconômico e classificação de segurança alimentar. Deste modo, as pessoas e famílias em condições socioeconômicos mais desfavoráveis têm dietas com menor valor nutricional.

Reliability and validity of an FFQ for South American children and adolescents from the SAYCARE study.

OBJECTIVE: The purpose of this study was to analyse the reliability and validity of a semi-quantitative FFQ to assess food group consumption in South American children and adolescents. DESIGN: The SAYCARE (South American Youth/Child cARdiovascular and Environmental) study is an observational, multicentre, feasibility study performed in a sample of 3- to 18-year-old children and adolescents attending private and public schools from six South American countries. Participants answered the FFQ twice with a two-week interval and three 24-h dietary recalls. Intraclass and Spearman's correlations, weighted Cohen's kappa (κw), percentage of agreement and energy-adjusted Pearson's correlation coefficients were calculated. SETTING: Seven cities in South America (Buenos Aires, Lima, Medelin, Montevideo, Santiago, Sao Paulo and Teresina). SUBJECTS: A sample of 200 children and 244 adolescents for reliability analyses and 252 children and 244 adolescents for validity analyses were included. RESULTS: Depending on the food group, for children and adolescents, reliability analyses resulted in Spearman's coefficients from 0·47 to 0·73, intraclass correlation coefficients from 0·66 to 0·99, κw coefficients from 0·35 to 0·63, and percentage of agreement between 72·75 and 83·52 %. In the same way, validity analyses resulted in Spearman's coefficients from 0·17 to 0·37, energy-adjusted Pearson's coefficients from 0·17 to 0·61, κw coefficients from 0·09 to 0·24, and percentages of agreement between 45·79 and 67·06 %. CONCLUSION: The SAYCARE FFQ achieved reasonable reliability and slight-moderate validity for almost all food groups intakes. Accordingly, it can be used for the purpose of ranking the intake of individuals within a population.

Measuring Socioeconomic Status and Environmental Factors in the SAYCARE Study in South America: Reliability of the Methods.

OBJECTIVE: This paper aimed to test the reliability of two questionnaires in studies involving children and adolescents (aged 3-18 years) in seven South American cities. One assesses socioeconomic status (SES) and the other measures environmental factors. METHODS: The SES questionnaire was composed of 14 questions, which included the presence of several consumer goods, domestic services, family income, parental education level, and current parental occupation status. The environmental questionnaire was composed of 15 questions to measure the social and infrastructure characteristics of the area of residence. Parents or guardians completed the questionnaires on behalf of their children. Adolescents answered the questions themselves for environmental factors, while those related to SES factors were answered by their parents or guardians. We analyzed the reliability of the questionnaires through kappa coefficient determination. Multilevel linear regression models were applied to calculate the correlation between the total household scores, the household income, and parents' education level. RESULTS: The environmental questionnaire showed good reproducibility in both age groups (k = 0.132-0.612 in children and k = 0.392-0.746 in adolescents). The SES questionnaire showed strong reliability in both age groups for all indicators (k = 0.52-1.00 in children and k = 0.296-0.964 in adolescents). CONCLUSIONS: Our multiple indicator questionnaires focused on environmental factors and SES in pediatric health surveys provided useful and easily applicable additional indicators to measure these important determinants of cardiovascular health.

Design and Objectives of the South American Youth/Child Cardiovascular and Environmental (SAYCARE) Study.

OBJECTIVE: The purpose of this paper is to introduce the overarching study design of the South American Youth/Child Cardiovascular and Environmental (SAYCARE) study, which is an observational multicenter feasibility study held in seven South American cities: Buenos Aires (Argentina), Lima (Peru), Medellin (Colombia), Montevideo (Uruguay), Santiago (Chile), and São Paulo and Teresina (Brazil). Children and adolescents (3-17 years of age) were studied. METHODS: The data management systems, quality assurance monitoring activities, standardized operating procedure manuals, and training and study management are addressed in this paper. Various quality controls to ensure the collection of valid and reliable data are also discussed. RESULTS AND CONCLUSIONS: Data were obtained from 237 preschoolers and schoolchildren and 258 adolescents during the validation phase measurements. The results of the SAYCARE study are expected to provide higher accuracy in the assessment of cardiovascular disease risk factors, including eating behaviors, body composition, physical activity, sedentary behaviors, lipid profiles and cardiovascular health biomarkers, oral health, social conditions, environmental factors and home environment, and their determinants in children and adolescents from ages 3 to 17 in seven South American cities.

Gaceta Sanitaria se suma a la iniciativa REWARD para mejorar la investigación biomédica y reducir el desperdicio en ciencia / Gaceta Sanitaria joins the REWARD initiative to improve biomedical research and reduce waste in science

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Gaceta Sanitaria en 2016. Una nueva etapa, fortalecimiento de eGaceta e internacionalización / Gaceta Sanitaria in 2016. A new stage; the strengthening of e-Gaceta and its internationalisation

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Abordaje periodístico de la obesidad en la prensa colombiana durante los años 2008 - 2013 / Journalistic approach of obesity in the Colombian press during the years 2008 - 2013

Introducción: Una de las funciones de los medios de comunicación masiva es movilizar la sociedad y la agenda política en torno a problemáticas públicas como por ejemplo la obesidad. Objetivo: Describir el abordaje dado al tema obesidad en dos periódicos colombianos durante los años 2008-2013. Materiales y metodos: Estudio transversal, se seleccionaron 163 noticias, 48 del periódico El Espectador y 115 de El Colombiano. Se realizó análisis deductivo, posteriormente el análisis descriptivo mediante pruebas X2 para establecer la relación entre las variables. α=0,05. SPSS v.18. Resultados: Se evidenció un aumento gradual de las noticias relacionadas con la obesidad en el periodo estudiado. Las fuentes de información más consultadas para construir las noticias fueron científicas-académicas (42,3%). Se encontró asociación entre los artículos que tratan la magnitud de la obesidad, sus estrategias para afrontarla y cuando se empleó como fuente a los políticos (p<0.05). En la población infantil, los temas publicidad (16,4%) y comidas rápidas (26,9%) tuvieron una mayor cobertura (p<0.05). Conclusión: La cobertura del tema obesidad creció en Colombia, al mismo tiempo que se empezaron a implementar estrategias para su prevención y control. Esta situación puede favorecer la movilización pública y política frente a nuevas estrategias que propendan por la solución de esta problemática.

Introduction: One of the functions of the mass media is to mobilize society and the political agenda around public issues such as obesity. Objective: To describe the approach given to obesity in two Colombian newspapers during the years 2008-2013. Materials and methods: A cross-sectional study was conducted were 163 news were selected from two newspapers; 48 from El Espectador newspaper and 115 from El Colombiano. First a deductive analysis of the news was performed and then a descriptive analysis using X2 tests to establish the relationship between the variables. α<0.05. SPSS v.18. Results: An increase in obesity-related news was found. The sources of information most frequently consulted to build the news were scientific-academic ones (42.3%). It was found an association between the articles dealing with the magnitude of the obesity, the strategies to confront it and when it was used a politician source (p <0.05). In the pediatric population, issues related with advertising (16.4%) and fast food (26.9%) had greater coverage (p <0.05). Conclusion: The mass media news related with obesity increased in Colombia, at the same time the implementation of strategies for prevention and control of this disease started. This situation can foster public and political mobilization that promote new strategies that contribute to the solution of the obesity problem.

[Excess weight and economic, political, and social factors: an international ecological analysis]. / Exceso de peso, aspectos económicos, políticos y sociales en el mundo: un análisis ecológico.

This study analyzed prevalence rates for excess weight in adults based on body mass index (BMI) and the association with various demographic, socioeconomic, and political variables (democracy index). An ecological design was used, including a total of 105 countries, with BMI data from 2000 to 2006. Other variables were obtained by proximity to the year of nutritional status. The study used the World Health Organization (WHO) classification for BMI. Spearman correlation coefficients and multiple logistic regression models were used. In both genders, overweight and obesity were correlated with calorie availability and the human development index (HDI) and its component variables. As for the variables related to democracy, there was an inverse correlation with weight, stronger in men than women. In conclusion, better living conditions in countries were directly associated with higher rates of excess weight in the population, with different patterns according to gender.

Exceso de peso, aspectos económicos, políticos y sociales en el mundo: un análisis ecológico / Excess weight and economic, political, and social factors: an international ecological analysis

Se analizaron las prevalencias de exceso de peso, según índice de masa corporal (IMC), en adultos y su asociación con algunas variables demográficas, socioeconómicas e índice de democracia. Se realizó un diseño ecológico que consideró un total de 105 países, con datos de IMC de 2000 a 2006. Las demás variables se obtuvieron en correspondencia con el año del dato de estado nutricional, o su referente más cercano. Se utilizaron los puntos de corte de la Organización Mundial de la Salud (OMS) para IMC. Se calcularon correlaciones de Spearman y modelos de regresión múltiple. El sobrepeso y la obesidad se correlacionaron en ambos sexos con la disponibilidad energética y con el Índice de Desarrollo Humano (IDH) y sus variables constitutivas. En cuanto a las variables relacionadas con democracia, la correlación fue inversa y más fuerte con el nivel ponderal de los hombres. En conclusión, indicadores de condiciones de vida más favorables en los países se asociaron de forma directa con mayores prevalencias de exceso de peso poblacional, con comportamientos diferentes en función del género.

This study analyzed prevalence rates for excess weight in adults based on body mass index (BMI) and the association with various demographic, socioeconomic, and political variables (democracy index). An ecological design was used, including a total of 105 countries, with BMI data from 2000 to 2006. Other variables were obtained by proximity to the year of nutritional status. The study used the World Health Organization (WHO) classification for BMI. Spearman correlation coefficients and multiple logistic regression models were used. In both genders, overweight and obesity were correlated with calorie availability and the human development index (HDI) and its component variables. As for the variables related to democracy, there was an inverse correlation with weight, stronger in men than women. In conclusion, better living conditions in countries were directly associated with higher rates of excess weight in the population, with different patterns according to gender.

[Factors related to birth weight: a comparison of related factors between newborns of Spanish and Colombian immigrant women in Spain]. / Peso al nacer: una comparación de sus factores relacionados entre los recién nacidos de madres españolas y madres colombianas residentes en España.

The objective of this study is to establish differentials in birth weight (BW) and related factors, in term newborns (NB) of Spanish (SP) and Colombian (CO) immigrant mothers living in Spain, between 2001-2005. Data on the NB population of SP and CO mothers was retrieved from the National Statistical Bulletin of Birth in Spain. We analysed the association with BW (Low birth weight -LBW- insufficient weight -IW- macrosomia), by the nationality of the mother; taking into account variables such as the intergenesic interval, maternal age, number of live children, maternal occupation and sex of NB. The analysis was based on frequencies and the estimation of simple and adjusted odds ratios (OR) by means of logistic regression with 95% confidence intervals (95% CI). A higher prevalence of LBW was found in SP mothers (3.4%) than in their CO counterparts (2.1%). In SP mothers a higher risk of LBW (aOR 1.89, 950% CI 1.65- 2.16) and IW (aOR 1.49, 95% CI 1.51- 1.57) was observed. In CO mothers a higher percentage of macrosomia was found (8.0%). Also, a higher percentage of LBW was observed in female new borns (SP4.1%; CO 2.7%) as well as IW (PI (SP 25.6%; CO 19.6%) (p < 0.001). Mothers aged > 40 years and having 4 or more children were associated with LBW in both nationalities. As a conclusion, NB of Colombian mothers presented a lower prevalence of LBW and IW, which could be explained by the healthy migrant effect.

Peso al nacer: una comparación de sus factores relacionados entre los recién nacidos de madres españolas y madres colombianas residentes en España / Factors related to birth weight: a comparison of related factors between newborns of Spanish and Colombian immigrant women in Spain

El objetivo del estudio fue establecer diferencias en el peso al nacer (PN) y sus factores relacionados, en recién nacidos (RN) a término de mujeres españolas (Esp) y colombianas (Col) residentes en España, en el periodo 2001-2005. Para ello, se incluyó el total de RN de madres españolas y colombianas a partir del Boletín Estadístico de Nacimientos de España. Según la nacionalidad materna se estimó la asociación del PN (bajo peso -BP-, peso insuficiente -PI- y macrosomía), con variables como intervalo intergenésico, edad materna, número de hijos nacidos vivos, profesión de la madre y sexo del RN. El análisis se basó en el cálculo de frecuencias y la estimación de Odds ratios (OR) simples y ajustadas con intervalos de confianza del 95 por ciento (IC95 por ciento). Se encontró mayor prevalencia de BP en RN de mujeres españolas (3,4 por ciento) que en colombianas (2,1 por ciento). Las madres españolas presentaron mayor riesgo de BP (ORa 1,89; IC95 por ciento 1,65-2,16) y PI (ORa 1,49; IC95 por ciento 1,41-1,57). En las madres colombianas se observó mayor porcentaje de macrosomía (8,0 por ciento). En las niñas de madres españolas se observó mayor porcentaje de BP (Esp 4,1 por ciento; Col 2,7 por ciento) y PI (Esp. 25,6 por ciento; Col. 19,6 por ciento) (p<0,001). Madres con edades >40 años y tener 4 ó más hijos se asoció con el BP para Españolas y Colombianas. Se concluye que los recién nacidos de las madres colombianas presentan menor prevalencia de BP y PI, lo que es compatible con el efecto del inmigrante sano.

The objective of this study is to establish differentials in birth weight (BW) and related factors, in term newborns (NB) of Spanish (SP) and Colombian (CO) immigrant mothers living in Spain, between 2001-2005. Data on the NB population of SP and CO mothers was retrieved from the National Statistical Bulletin of Birth in Spain. We analysed the association with BW (Low birth weight -LBW- insufficient weight -IW- macrosomia), by the nationality of the mother; taking into account variables such as the intergenesic interval, maternal age, number of live children, maternal occupation and sex of NB. The analysis was based on frequencies and the estimation of simple and adjusted odds ratios (OR) by means of logistic regression with 95 percent confidence intervals (95 percent CI). A higher prevalence of LBW was found in SP mothers (3.4 percent) than in their CO counterparts (2.1 percent). In SP mothers a higher risk of LBW (aOR 1.89, 95 percentCI 1.65- 2.16) and IW (aOR 1.49, 95 percentCI 1.51- 1.57) was observed. In CO mothers a higher percentage of macrosomia was found (8.0 percent). Also, a higher percentage of LBW was observed in female new borns (SP 4.1 percent; CO 2.7 percent) as well as IW (PI (SP 25.6 percent; CO 19.6 percent)(p<0.001). Mothers aged >40 years and having 4 or more children were associated with LBW in both nationalities. As a conclusion, NB of Colombian mothers presented a lower prevalence of LBW and IW, which could be explained by the healthy migrant effect.

The potential role of taxes and subsidies on food in the prevention of obesity in Europe.

BACKGROUND: Obesity implies costs not only for the individual but also for society. The authors explore the opinions of stakeholders on the potential of taxes or subsidies, as measures for tackling obesity in Europe. METHODS: Structured interviews were conducted using Multicriteria Mapping, a computer-based, decision-support tool, with 189 interviewees drawn from 21 different stakeholder categories across nine members of the EU interviews, to appraise 20 predefined policy options aimed at reducing obesity, including 'taxing obesity-promoting foods' and 'subsidising healthy foods.' A four-step approach involved selecting options, defining criteria, scoring options quantitatively and weighting criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data. RESULTS: Compared with other policy options appraised, taxation and subsidies were not favourably received, mainly because they were considered difficult to implement. Overall, trade unions rated both options more favourably than all other stakeholder groups. As anticipated, both options received their lowest scores from representatives of the farming, food processing and advertising industries. Nutritional/obesity advisory experts and public sector caterers gave the most positive ratings to subsidies overall. Along with public health professionals, large commercial retailers were most in favour of taxation. CONCLUSIONS: Taxation and subsidies were poorly appraised compared with other policy measures, with stakeholders expressing reservations mainly focussed on the practicalities and cost of introducing such measures. Although applying taxes/subsidies could be useful to combat obesity, the study suggests that most stakeholders still need to be convinced of their viability and acceptability when compared with other measures.

[Famine in the Spanish civil war and mortality from coronary heart disease: a perspective from Barker's hypothesis]. / El hambre en la Guerra Civil española y la mortalidad por cardiopatía isquémica: una perspectiva desde la hipótesis de Barker.

OBJECTIVE: To determine whether the famine experienced during the Spanish civil war and immediate postwar period influenced mortality from coronary heart disease (CHD) in persons born in this period, following the lines of Barker's hypothesis on fetal programming of chronic diseases in adult life. METHODS: Using CHD mortality data by age and sex for 1990-2002, annual and age-adjusted rates were calculated by the direct method. Poisson regressions were used to estimate period, age and cohort effects by year of birth (1918-1957). RESULTS: During the study period, CHD mortality fell by a yearly average of -2.3% in both sexes and in all ages yearly. This trend was influenced by both cohort and period effects (p<0.001); an increased risk was observed for both sexes and in all ages in the deaths corresponding to persons born during the war and postwar years when the famine was most intense (1937, 1940, 1943 and 1945). CONCLUSIONS: The results obtained by studying yearly CHD mortality are compatible with those expected by Barker's hypothesis of the effect of nutritional stress during pregnancy. In addition to its human, economic and political costs, the Spanish civil war could also have had negative consequences for the health of persons born in this period.

El hambre en la Guerra Civil española y la mortalidad por cardiopatía isquémica: una perspectiva desde la hipótesis de Barker / Famine in the Spanish civil war and mortality from coronary heart disease: a perspective from Baker's hypothesis

Objetivo: Analizar si el hambre durante la Guerra Civil española y la inmediata posguerra influyó sobre la mortalidad por cardiopatía isquémica de las personas que nacieron en este período, según lo planteado en la hipótesis de Barker acerca de la posible programación fetal de enfermedades de la edad adulta. Métodos: Con los datos de mortalidad por edad y sexo por cardiopatía isquémica en el período 1990-2002, se calcularon las tasas anuales de mortalidad específicas y las tasas ajustadas por edad, por el método directo. Mediante análisis de regresión de Poisson se analizó el efecto de la edad, el período y la cohorte anual de nacimiento (1918-1957). Resultados: Durante el período de estudio, la mortalidad por cardiopatía isquémica ha disminuido un promedio anual de ­2,3% en ambos sexos y para todas las edades. En el descenso de mortalidad están presentes los efectos cohorte y período (p < 0,001); se observa un incremento del riesgo para todas las edades y ambos sexos en las muertes correspondientes a personas nacidas durante los años reconocidos como de mayor escasez alimentaria de la Guerra Civil y la inmediata posguerra (1937, 1940, 1943 y 1945). Conclusiones: Los resultados obtenidos al estudiar anualmente la mortalidad por cardiopatía isquémica son compatibles con la hipótesis de Barker sobre el efecto del estrés alimentario durante el embarazo en la génesis de diversas enfermedades en el adulto. La Guerra Civil española, además de costes humanos, económicos y políticos, puede haber tenido consecuencias negativas para la salud de los nacidos en esas cohortes

Objective: To determine whether the famine experienced during the Spanish civil war and immediate postwar period influenced mortality from coronary heart disease (CHD) in persons born in this period, following the lines of Barker's hypothesis on fetal programming of chronic diseases in adult life. Methods: Using CHD mortality data by age and sex for 1990-2002, annual and age-adjusted rates were calculated by the direct method. Poisson regressions were used to estimate period, age and cohort effects by year of birth (1918-1957). Results: During the study period, CHD mortality fell by a yearly average of ­2.3% in both sexes and in all ages yearly. This trend was influenced by both cohort and period effects (p < 0.001); an increased risk was observed for both sexes and in all ages in the deaths corresponding to persons born during the war and postwar years when the famine was most intense (1937, 1940, 1943 and 1945). Conclusions: The results obtained by studying yearly CHD mortality are compatible with those expected by Barker's hypothesis of the effect of nutritional stress during pregnancy. In addition to its human, economic and political costs, the Spanish civil war could also have had negative consequences for the health of persons born in this period