Thinness, overweight, and obesity in 6- to 9-year-old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative-COSI 2015-2017.

In 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6-9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.

[Weight status in the 6- to 9-year-old school population in Spain: results of the ALADINO 2019 Study]. / Situación ponderal de la población escolar de 6 a 9 años en España: resultados del estudio ALADINO 2019.

INTRODUCTION: Introduction: childhood obesity is a public health problem whose prevalence has grown steadily in recent decades. Objective: to describe the weight status of schoolchildren aged 6 to 9 years in Spain in 2019, and their associated factors. Methods: ALADINO is a cross-sectional study in schoolchildren aged 6 to 9 years, representative of the Spanish population, and aligned with the Child Obesity Surveillance Initative of the WHO Regional Office for Europe. Participants' weight, height, and abdominal circumference were measured, defining weight status according to different standards (WHO, IOTF, and Orbegozo). A questionnaire on lifestyle and socio-demographic characteristics was administered to parents. Results: a total of 16,665 schoolchildren from 276 schools were measured. Excess weight was observed in 40.6 %: 23.3 % overweight and 17.3 % obesity, with obesity being more prevalent in boys and overweight in girls, both increasing with age. The prevalence of abdominal obesity was 22.6 %. Excess weight decreased by 3.9 percentage points since 2011, mainly due to overweight in boys. Obesity remained stable. Excess weight was more prevalent in schoolchildren with less healthy eating and physical activity habits, and in families with a lower socioeconomic status. Conclusions: the prevalence of excess weight is high, although it has declined since 2011 and remains stable since 2015 among schoolchildren aged 6-9 years in Spain, this reduction being mainly due to a decrease in overweight in children. It is necessary to continue promoting healthy habits from the earliest stages of life, thus reducing health inequalities.

INTRODUCCIÓN: Introducción: la obesidad infantil es un problema de salud pública cuya prevalencia no ha dejado de crecer en las últimas décadas. Objetivo: describir la situación ponderal de los escolares de 6 a 9 años en España en 2019, y sus factores asociados. Métodos: ALADINO es un estudio transversal en escolares de 6 a 9 años, representativo de la población española, aplicando la metodología de la Child Obesity Surveillance Initative de la Oficina Regional para Europa de la OMS. Se midieron el peso, la talla y el perímetro abdominal de los participantes, definiendo la situación ponderal según diferentes estándares (OMS, IOTF y Orbegozo). Se pasó a los progenitores un cuestionario sobre estilo de vida y características sociodemográficas. Resultados: se midieron 16.665 escolares de 276 colegios. El 40,6 % presentaban exceso de peso ­23,3 % sobrepeso y 17,3 % obesidad­, siendo la obesidad más prevalente en los niños y el sobrepeso en las niñas, y aumentando ambos con la edad. La prevalencia de la obesidad abdominal era del 22,6 %. El exceso de peso disminuyó 3,9 puntos porcentuales desde 2011, principalmente el sobrepeso de los niños. La obesidad permaneció estable. El exceso de peso fue más prevalente en los escolares con hábitos menos saludables de alimentación y actividad física, y en las familias con menor nivel socioeconómico. Conclusiones: la prevalencia del exceso de peso es elevada, aunque ha descendido desde 2011 y permanece estable desde 2015 entre los escolares de 6 a 9 años en España, debiéndose esta reducción fundamentalmente al descenso del sobrepeso en los niños. Es necesario seguir fomentando hábitos saludables desde las etapas más tempranas, reduciendo las desigualdades en salud.

Weight status in the 6 to 9 year-old school population in Spain: Results of the ALADINO 2015 study.

INTRODUCTION: Overweight and obesity in childhood and adolescence has grown alarmingly in the last twenty years or so in many countries of Europe, including Spain. This study presents the prevalences of overweight and obesity in 6-9 year-old schoolchildren in 2015, and their associated characteristics. METHODOLOGY: ALADINO (Its initials in Spanish for Diet, physical activity, child development and obesity) is a cross-sectional study of a representative sample of 6-9 year-old schoolchildren in Spain, in line with the Childhood Obesity Surveillance Initiative (COSI) of the World Health Organisation (WHO). The height and weight of the participants, defining the weight status according to WHO standards, and a questionnaire was given to the parents on lifestyle and sociodemographic characteristics. RESULTS: Anthropometric measurements were taken on 10,899 schoolchildren for 168 primary education centres. Excess weight was observed in 41.3% (95% CI: 40.0-42.6), overweight in 23.2% (95% CI: 22.1-24.3) and obesity in 18.1% (95% CI: 17.2-19.1), with obesity being more prevalent in boys, overweight in girls. The prevalence of abdominal obesity was 23.2% (95% CI: 21.8-24.6). The prevalence of overweight and obesity increased with age. Excess weight decreased by 3.2% compared to 2011, mainly due to the decrease in overweight in boys, while that of obesity remained stable. Excess weight was more prevalent in schoolchildren from families with a lower socioeconomic level. CONCLUSIONS: The prevalence of excess weight in 6-9 year-old schoolchildren in Spain has decreased by 3.2% since 2011, due to the decrease in overweight, whilst obesity remained stable. Action must be taken in the obesogenic environment, by promoting healthy eating habits and physical activity, bearing in mind the inequalities in health.

Situación ponderal de la población escolar de 6 a 9 años en España: resultados del estudio ALADINO 2015 / Weight status in the 6 to 9 year-old school population in Spain: Results of the ALADINO 2015 Study

Introducción: El sobrepeso y la obesidad en la infancia y en la adolescencia han crecido alarmantemente en las últimas décadas en muchos países de Europa, incluido España. Este estudio presenta las prevalencias de sobrepeso y obesidad en escolares de 6 a 9 años en 2015 y sus características asociadas. Metodología: ALADINO es un estudio transversal de una muestra representativa de escolares de 6 a 9 años en España, alineado con la iniciativa COSI de la OMS. Se talló y pesó a los participantes, definiendo la situación ponderal según los estándares de la OMS, y se pasó un cuestionario a los progenitores sobre el estilo de vida y las características sociodemográficas. Resultados: Se tomaron medidas antropométricas a 10.899 escolares de 168 centros de educación primaria. El 41,3% (IC 95%: 40,0-42,6) presentaba exceso de peso, el 23,2% sobrepeso (IC 95%: 22,1-24,3) y el 18,1% obesidad (IC 95%: 17,2-19,1), siendo la obesidad más prevalente en niños y el sobrepeso en niñas. La prevalencia de obesidad abdominal era del 23,2% (IC 95%: 21,8-24,6). La prevalencia de sobrepeso y obesidad aumentaba con la edad. El exceso de peso disminuyó un 3,2% respecto a 2011, principalmente por la disminución del sobrepeso en niños, mientras que la obesidad permaneció estable. El exceso de peso era más prevalente en los escolares de familias con menor nivel socioeconómico. Conclusiones: La prevalencia de exceso de peso entre los escolares de 6 a 9 años en España ha disminuido un 3,2% desde 2011 por la disminución del sobrepeso, mientras que la obesidad permanece estable. Se debe intervenir en el entorno obesogénico, promocionando hábitos alimentarios saludables y la actividad física, incidiendo en las desigualdades en salud. (AU)

Introduction: Overweight and obesity in childhood and adolescence has grown alarmingly in the last twenty years or so in many countries of Europe, including Spain. This study presents the prevalences of overweight and obesity in 6 to 9 year-old schoolchildren in 2015, and their associated characteristics. Methodology: ALADINO (Its initials in Spanish for Diet, physical activity, child development and obesity) is a cross-sectional study of a representative sample of 6 to 9 year-old schoolchildren in Spain, in line with the Childhood Obesity Surveillance Initiative (COSI) of the World Health Organisation (WHO). The height and weight of the participants, defining the weight status according to WHO standards, and a questionnaire was given to the parents on lifestyle and sociodemographic characteristics. Results: Anthropometric measurements were taken on 10,899 schoolchildren for 168 primary education centres. Excess weight was observed in 41.3% (95% CI: 40.0-42.6), overweight in 23.2% (95% CI: 22.1-24.3) and obesity in 18.1% (95% CI: 17.2-19.1), with obesity being more prevalent in boys, overweight in girls. The prevalence of abdominal obesity was 23.2% (95% CI: 21.8-24.6). The prevalence of overweight and obesity increased with age. Excess weight decreased by 3.2% compared to 2011, mainly due to the decrease in overweight in boys, while that of obesity remained stable. Excess weight was more prevalent in schoolchildren from families with a lower socioeconomic level. Conclusions: The prevalence of excess weight in 6 to 9 year-old schoolchildren in Spain has decreased by 3.2% since 2011, due to the decrease in overweight, whilst obesity remained stable. Action must be taken in the obesogenic environment, by promoting healthy eating habits and physical activity, bearing in mind the inequalities in health. (AU)

Sugar Content in Processed Foods in Spain and a Comparison of Mandatory Nutrition Labelling and Laboratory Values.

To reduce the sugar content of processed foods through reformulation, the first step is to determine the content of the largest sources of sugars in each country's diet. The aim of this work was to describe the sugar content in the most commonly consumed processed foods in Spain and to compare that sugar's labelling and laboratory analysis values (LVs and AVs, respectively) to confirm its adequacy. A sample of the 1173 most commonly consumed processed foods in Spain (28 groups; 77 subcategories) was collected. For each product, the total sugar content was compared according to its AV and LV. The median (25th -75th percentiles, interquartile range) sugar content by group was calculated for the total sample, and the groups were classified as "high sugar content" when this value was above 22.5 g/100g of product. The adequacy of the LV, according to the European Union (EU) tolerance requirements, was then evaluated, and each subcategory median was compared with the AV to determine its appropriateness via a median test for independent samples (p < 0.05). In total, 10 out of 28 groups presented high sugar content. Moreover, 98.4% of the products met the EU tolerance ranges. Finally, only one subcategory ("cured ham") presented significant differences between the AV and LV median values (0.4 g vs. 0.1 g sugar/100g, p < 0.05). The groups of food products whose sugar content reduction could have the greatest impact on public health were identified. In addition, our study showed the high adequacy of LV with the EU labeling tolerance requirements, as well as the LV's appropriateness as a tool to implement actions aimed at reducing sugar consumption.

The relationship between hours of sleep, screen time and frequency of food and drink consumption in Spain in the 2011 and 2013 ALADINO: a cross-sectional study.

BACKGROUND: The frequency of intake of food and beverages depends on a number of ill-defined behaviour patterns. The objectives of this study were to evaluate the effects of screen time and sleep duration on food consumption frequency, and to describe frequencies and types of food consumption according to BMI category and parents' level of education. METHODS: We studied 6287 and 2806 children drawn from the 2011 and 2013 cross-sectional ALADINO studies respectively. Data were collected on number of hours of sleep, screen time, and weekly frequency of consumption of 17 food groups. Weight status was measured, and information was also collected on parents' educational level. Average food consumption frequencies were calculated by reference to hours of sleep and hours of screen time, and were defined as ≥4 times or <4 times per week (once per week for soft drinks and diet soft drinks). Differences in frequency were evaluated for screen times of more and less than 2 h per day, and for sleep durations longer or shorter than the daily average. We fitted logistic regression models to evaluate the independent association between screen exposure and hours of sleep on the one hand, and food consumption frequency on the other. RESULTS: Consumption of fruit and vegetables was lower among children who had parents with no formal or only primary school education. High levels of screen time were associated with a greater frequency of consumption of energy-dense, micronutrient-poor products and a lower frequency of consumption of fruit and vegetables. Sleeping a sufficient number of hours was associated with a higher consumption of fruit and vegetables. The results for 2011 were concordant with those for 2013. CONCLUSIONS: If efforts to ensure healthier eating habits among children are to be at all successful, they should focus on promoting a sufficient amount of sleep for children, limiting the time they spend watching television and/or playing with computers or video games, and educating parents accordingly.

Trans-fatty acid content of food products in Spain in 2015 / Contenido de ácidos grasos trans en los alimentos en España en 2015

Objective: To ascertain the content of trans-fatty acids (TFA) in food products in Spain in 2015 and assess trends in TFA content since 2010. Methods: We analysed the fat content of 277 food products purchased in Spanish supermarkets in 2015 and calculated both the total fat and TFA content and the proportion of TFA to total fats. The results obtained in 2015 were compared to those yielded by a similar study in 2010. Results: In 2015, the majority of food products studied had a TFA content of less than 0.2g/100g product, and a TFA/total fat ratio of less than 2%. No significant increases were found compared to 2010. Food groups with a higher TFA content were dairy products of possible natural origin. Conclusions: TFA content in Spain is low and has significantly fallen since 2010 (AU)

Objetivo: Conocer el contenido de ácidos grasos trans en los alimentos en España en 2015 y evaluar la tendencia desde 2010. Métodos: Se analizó la composición grasa de 277 alimentos adquiridos en supermercados en España en 2015. Se calcularon el contenido en ácidos grasos trans y en grasas totales, y el porcentaje de ácidos grasos trans respecto de la grasa total. Se compararon los resultados con los de un estudio similar realizado en 2010. Resultados: En 2015 la mayoría de los alimentos estudiados tenían menos de 0,2g de ácidos grasostrans por 100g de producto, y menos del 2% de ácidos grasos trans respecto a las grasas totales. No se hallaron aumentos significativos desde 2010. Los grupos con contenidos más altos de ácidos grasos trans eran derivados lácteos, con posible origen natural. Conclusiones: El contenido de ácidos grasos trans en España es bajo y se ha reducido significativamente desde 2010 (AU)

Trans-fatty acid content of food products in Spain in 2015.

OBJECTIVE: To ascertain the content of trans-fatty acids (TFA) in food products in Spain in 2015 and assess trends in TFA content since 2010. METHODS: We analysed the fat content of 277 food products purchased in Spanish supermarkets in 2015 and calculated both the total fat and TFA content and the proportion of TFA to total fats. The results obtained in 2015 were compared to those yielded by a similar study in 2010. RESULTS: In 2015, the majority of food products studied had a TFA content of less than 0.2g/100g product, and a TFA/total fat ratio of less than 2%. No significant increases were found compared to 2010. Food groups with a higher TFA content were dairy products of possible natural origin. CONCLUSIONS: TFA content in Spain is low and has significantly fallen since 2010.

Determinantes sociales de sobrepeso y obesidad en España 2006 / Social determinants of overweight and obesity in Spain in 2006

Fundamento y objetivo: La obesidad en la población adulta española prácticamente se dobló entre 1987 y 2003. El objetivo de este estudio es actualizar la prevalencia de sobrepeso y obesidad, y reevaluar sus principales determinantes sociales a partir de la Encuesta Nacional de Salud (ENS) de 2006.Pacientes y método: Estudio transversal basado en la ENS-2006. Muestra de 29.478 adultos que respondieron preguntas sobre peso y talla autodeclarados. Se calculó el índice de masa corporal y la sobrecarga ponderal (clasificación de la OMS) como variable dependiente. Se usaron como variables independientes sociodemográficas: edad, sexo, estado civil, nivel de estudios, clase social (manual, no-manual) e ingresos mensuales. Se realizó un estudio descriptivo y diferentes modelos de regresión logística.Resultados: En 2006, la prevalencia de sobrepeso fue mayor en varones (43,9%) que en mujeres (28,9%), pero para la prevalencia de obesidad (15,0%) no se observaron diferencias por sexos. El análisis de regresión logística multinomial muestra asociación significativa entre obesidad-estar casada(o), con una odds ratio (OR) de 1,69 (intervalo de confianza del 95% [IC 95%] 1,51-1,89) y viuda(o), OR de 1,77 (IC 95% 1,45-2,16); sin estudios, OR de 2,77 (IC 95% 2,34-3,28) e ingresos < 600 €, OR de 1,50 (IC 95% 1,18-1,91). Se encontró una interacción estadísticamente significativa (p<0,001) entre sexo y clase social. Las mujeres de clase social manual presentan un 49% más riesgo de tener sobrepeso y un 96% más riesgo de obesidad que las mujeres de clase social no-manual. Mientras, los varones de clase social manual presentan menos riesgo de sobrepeso (18%) y obesidad (12%) frente a los de clase social manual.Conclusiones: El género y la clase social son determinantes sociales relevantes de la obesidad en España. Las actividades preventivas que se desarrollen deben considerar ambas condiciones sociales

Background and objective: Obesity in the Spanish adult population has almost doubled from 1987 to 2003. The aim is to update the prevalence of overweight and obesity, and reassess its main social determinants using the National Health Household Survey (ENS) from 2006. Patients and methods: Cross sectional study based on the ENS-2006. Sample of 29,478 adults who answered questions on self-reported weight and height. We calculated the body mass index (WHO classification) for the dependent variable. Sociodemographic independent variables used were age, sex, marriage status, educational level, social class (manual, non-manual), and monthly income. A descriptive study was conducted as well as different logistic regression models.Results: In 2006, the prevalence of overweight is higher in men (43.9%) than women (28.9%). Sex differences were not observed in the prevalence of obesity (15.0%). The multinomial logistic regression analysis shows significant associations between obesity and marriage status: married OR=1.69 (1.51-1.89), widower OR=1.77 (1.45-2.16); population without education: OR=2.77 (2.34-3.28) and income below 600 €: OR=1.50 (1.18-1.91). There was a statistically significant interaction (p<0.001) between sex and social class. Women from manual social class have 49% more chances to be overweight and 96% greater risk of obesity compared to non-manual social class women. In addition, men of manual social class have less risk of overweight (18%) and obesity (12%) than non-manual social class men. Conclusions: Gender and socioeconomic status are key social determinants for obesity in Spain and, consequently, this needs to be addressed when developing preventive activities

[Social determinants of overweight and obesity in Spain in 2006]. / Determinantes sociales de sobrepeso y obesidad en España 2006.

BACKGROUND AND OBJECTIVE: Obesity in the Spanish adult population has almost doubled from 1987 to 2003. The aim is to update the prevalence of overweight and obesity, and reassess its main social determinants using the National Health Household Survey (ENS) from 2006. PATIENTS AND METHODS: Cross sectional study based on the ENS-2006. Sample of 29,478 adults who answered questions on self-reported weight and height. We calculated the body mass index (WHO classification) for the dependent variable. Sociodemographic independent variables used were age, sex, marriage status, educational level, social class (manual, non-manual), and monthly income. A descriptive study was conducted as well as different logistic regression models. RESULTS: In 2006, the prevalence of overweight is higher in men (43.9%) than women (28.9%). Sex differences were not observed in the prevalence of obesity (15.0%). The multinomial logistic regression analysis shows significant associations between obesity and marriage status: married OR=1.69 (1.51-1.89), widower OR=1.77 (1.45-2.16); population without education: OR=2.77 (2.34-3.28) and income below 600 €: OR=1.50 (1.18-1.91). There was a statistically significant interaction (p<0.001) between sex and social class. Women from manual social class have 49% more chances to be overweight and 96% greater risk of obesity compared to non-manual social class women. In addition, men of manual social class have less risk of overweight (18%) and obesity (12%) than non-manual social class men. CONCLUSIONS: Gender and socioeconomic status are key social determinants for obesity in Spain and, consequently, this needs to be addressed when developing preventive activities.