Increasing prevalence of overweight and obesity among Spanish adults, 1987-1997.

OBJECTIVE: To study the trend in the prevalence of obesity and overweight in Spanish men and women 25-64 y of age between 1987 and 1997. DESIGN: Cross-sectional surveys of representative samples of the non-institutionalized population in Spain in 1987, 1995 and 1997. SUBJECTS: 14,676 and 7004 adults aged 25-64 who were representative of the Spanish population in 1987 and 1995/1997. MEASURES: Body mass index (BMI) calculated from self-reported weight and height. Overweight is defined as BMI = 27-29.9 kg/m2 and obesity as BMI > or = 30 kg/m2. RESULTS: Between 1987 and 1995/97, the prevalence of overweight in the Spanish population aged 25-64 increased by 2.2% (P < 0.01); the increase was greater in men (3.8%; P < 0.01) than in women (0.6%; P > 0.05). The largest increases in the prevalence of overweight were seen in men (5.2%; P < 0.01) and women (2.3%; P < 0.05) aged 25-34. During the same period, the prevalence of obesity increased by 3.9% (P < 0.01), 4.6% in men (P < 0.01) and 3.2% in women (P < 0.01). The largest increases were seen in men aged 45-54 (6.5%, P < 0.01) and in women aged 25-34 (2.2%, P < 0.05). By educational level, the prevalence of overweight increased significantly in men with fewer than 12 y of education (4.7%, P < 0.01). Obesity increased by 4.6% (P < 0.01) and by 4.9% (P < 0.01) in men and women with fewer than 12 y of education, respectively. CONCLUSIONS: The prevalence of overweight and obesity is increasing in Spain, the same as it is in other developed countries. The increase, which is found in most age and sex groups in the population, especially affects middle-aged men, young women and persons with lower educational level. The causes of the increase in the prevalence of overweight and obesity are likely to be multifactorial.

Methodology, results and quality of clinical trials of tacrine in the treatment of Alzheimer's disease: a systematic review of the literature.

OBJECTIVE: To review systematically the methodology, results and quality of clinical trials of tacrine in the treatment of Alzheimer's disease (AD). METHODS: Trials included were those conducted on AD patients, aged 40 years or over, assigned to tacrine- or placebo-based treatment. Studies were identified via the Cochrane Collaboration and MEDLINE databases. Trial-selection and data-extraction were carried out separately by two reviewers working independently. Any differences of opinion that arose were resolved by discussion. RESULTS: We identified 49 trials published in the period 1 January 1981 - 1 May 1997. Of these, 21 were randomized controlled trials, eight parallel-group and 13 cross-over type. In the random trials, tacrine dosage ranged from 25 to 200 mg/day, with a duration of 3-36 weeks. In all, 3555 patients with mild to moderate AD started treatment and 1149 failed to complete the course (mean 33.4% patients per trial). Over 80% of patient withdrawals were tacrine-related. Adverse events affected a mean of 59% patients per trial (range 34-90%), mainly in the form of cholinergic manifestations (mean 30.2%, range 5-62%) and transaminase elevations (mean 28.6%, range 0-53%). Adverse events were more frequent at doses of > or = 100 mg/day and disappeared on discontinuation of tacrine treatment. Just over 20% of patients given tacrine experienced improvements in cognitive function (3-4 points in Alzheimer's Disease Assessment Scale cognitive subscale and 2-3 points in Mini-Mental State Examination) and in functional ability at 3-6 months of treatment. No study gave a description of concealment of the randomization sequence or the success of the double-blind procedure. CONCLUSIONS: Tacrine shows a modest degree of efficacy among a small proportion of patients with mild to moderate AD, yet has important adverse effects which limit its clinical usefulness. It is not known which AD patient subgroup could benefit from the treatment. Information on the long-term effects of tacrine (over periods exceeding 7 months) and its effects on quality of life, patient institutionalization and mortality and patient burden on caregivers is inadequate.

[The relationship between obesity, smoking habit and physical activity during leisure time in the 20- to 64-year-old Spanish population]. / Relación entre obesidad, hábito tabáquico y actividad física en el tiempo libre en la población española de 20 a 64 años.

BACKGROUND: Obesity is an important health problem. Its frequency, however, is potentially reducible through health care education influencing daily habits. Therefore, the relationship between obesity, smoking habit and physical activity during leisure time, all modifiable daily habits influencing both obesity and health in general, were studied in a Spanish adult population. METHODS: Information on the study variables of both sexes from 20 to 64 years of age were obtained from the National Health Care Survey undertaken in 1987. The presence of obesity was approximated from the Quetelet index defined as weight (in kg) divided by height (in m2). The data were analyzed by non conditional logistic regression taking the main confusion factors into account. RESULTS: A statistically significant inverse relationship (odds ratio less than 1) (p < 0.05) was observed in both males and females in most of the categories of exposure variables, from obesity with cigarette consumption and with physical activity. An U-shaped dose/response relationship was observed in both sexes. The relationship between obesity and physical activity during free time was lineal and statistically significant (p < 0.0001) among males. CONCLUSIONS: The results were consistent with previous studies and provide additional arguments for the inclusion of physical activity during leisure time within educative actions for health care. Likewise, the modest inverse association seen between smoking and obesity should not be used to counteract the efforts undertaken against this habit.

Odd man out: a graphical approach to meta-analysis.

The areas of overlap of confidence intervals from several studies can be used to create summary confidence regions. These summary regions lend themselves to graphical display, have readily derivable statistical properties, and can carry information about the influence both of available studies and of hypothetical future investigations. The case of a region covered by at least N-1 out of N confidence intervals is presented in some detail.