Reduction of sugar, salt and fat content in foods over the period 2016-2021 in Spain: the National Food Reformulation Plan.

BACKGROUND/OBJECTIVES: Population´s dietary intake of saturated fat, sodium, and sugars is higher than the current recommendations in Spain and most European countries. Nationwide food reformulation strategies have the potential to improve nutritional quality; however, evaluations are only available in a few countries and are difficult to compare. This study shows the degree of compliance with the nutrient reduction objectives included in a 4-year (2016-2020) Spanish food reformulation initiative. METHODS: In 2016, baseline median nutrient content was established for 57 food subcategories. Agreed reduction (%) expressed as the median content to be reached by 2020 was set as the objective. In 2021, Spanish Food Safety and Nutrition Agency (AESAN) collected mandatory nutritional information from 3118 products belonging to the food subcategories included in the PLAN. Median nutrient content was calculated and compared with baseline data established in 2016 and PLAN objectives. RESULTS: Median nutrient content reduction was observed in all food subcategories. Relative reductions (%) ranged from 0.6 to 60% for added sugars, 4.8 to 33.3% for salt, 4.5 to 78.3% for saturated fat, and 24.9 to 36% for total fat. PLAN objectives were achieved in all subcategories except for one. The number of products involved, belonging to the highly consumed food categories, shows the potential of national reformulation strategies to improve the nutritional quality of the diet. CONCLUSION: Compliance with nutrient reduction agreements was 99%; however, the variability of nutrient content within subcategories shows that there is room for further reduction in selected nutrients and food subcategories.

A nation-wide analysis of socioeconomic and geographical disparities in the prevalence of obesity and excess weight in children and adolescents in Spain: Results from the ENE-COVID study.

OBJECTIVE: To estimate national and provincial prevalence of obesity and excess weight in the child and adolescent population in Spain by sex and sociodemographic characteristics, and to explore sources of inequalities in their distribution, and their geographical patterns. METHODS: ENE-COVID is a nationwide representative seroepidemiological survey (68 287 participants) stratified by province and municipality size (April-June 2020). Participants answered a questionnaire which collected self-reported weight and height, that allowed estimating crude and model-based standardized prevalences of obesity and excess weight in the 10 543 child and adolescent participants aged 2-17 years. RESULTS: Crude prevalences (WHO growth reference) were higher in boys than in girls (obesity: 13.4% vs. 7.9%; excess weight: 33.7% vs. 26.0%; severe obesity: 2.9% vs. 1.2%). These prevalences varied with age, increased with the presence of any adult with excess weight in the household, while they decreased with higher adult educational and census tract average income levels. Obesity by province ranged 1.8%-30.5% in boys and 0%-17.6% in girls; excess weight ranged 15.2%-49.9% in boys and 10.8%-40.8% in girls. The lowest prevalences of obesity and excess weight were found in provinces in the northern half of Spain. Sociodemographic characteristics only partially explained the observed geographical variability (33.6% obesity; 44.2% excess weight). CONCLUSIONS: Childhood and adolescent obesity and excess weight are highly prevalent in Spain, with relevant sex, sociodemographic and geographical differences. The geographic variability explained by sociodemographic variables indicates that there are other potentially modifiable factors on which to focus interventions at different geographic levels to fight this problem.

Socio-geographical disparities of obesity and excess weight in adults in Spain: insights from the ENE-COVID study.

Background: In Spain, differences in the prevalence of obesity and excess weight according to sex and sociodemographic factors have been described at the national level, although current data do not allow to delve into geographical differences for these conditions. The aim was to estimate national and regional prevalences of adult obesity and excess weight in Spain by sex and sociodemographic characteristics, and to explore difference sources of inequalities in its distribution, as well as its geographical pattern. Method: ENE-COVID study was a nationwide representative seroepidemiological survey with 57,131 participants. Residents in 35,893 households were selected from municipal rolls using a two-stage random sampling stratified by province and municipality size (April-June 2020). Participants (77.0% of contacted individuals) answered a questionnaire which collected self-reported weight and height, as well as different socioeconomic variables, that allowed estimating crude and standardized prevalences of adult obesity and excess weight. Results: Crude prevalences of obesity and excess weight were higher in men (obesity: 19.3% vs. 18.0%; excess weight: 63.7% vs. 48.4%), while severe obesity was more prevalent in women (4.5% vs. 5.3%). These prevalences increased with age and disability, and decreased with education, census tract income and municipality size. Differences by educational level, relative census income, nationality or disability were clearly higher among women. Obesity by province ranged 13.3-27.4% in men and 11.4-28.1% in women; excess weight ranged 57.2-76.0% in men and 38.9-59.5% in women. The highest prevalences were located in the southern half of the country and some north-western provinces. Sociodemographic characteristics only explained a small part of the observed geographical variability (25.2% obesity). Conclusion: Obesity and overweight have a high prevalence in Spain, with notable geographical and sex differences. Socioeconomic inequalities are stronger among women. The observed geographical variability suggests the need to implement regional and local interventions to effectively address this public health problem.

[Qualitative study on food perceptions, dietary practices and healthy lifestyles in the adolescent population.] / Estudio cualitativo sobre las percepciones en alimentación, prácticas alimentarias y hábitos de vida saludables en población adolescente.

OBJECTIVE: Child and adolescent obesity is a biggest public health challenge. Adolescence is a critical stage for growth and development. The objective of the research was to explore and understand the perceptions of the adolescent population about eating and healthy lifestyle habits, and the identification of barriers and facilitators. METHODS: A multicenter qualitative research was made, in schoolchildren from twelve to fourteen years old, from four Secondary Schools, distributed in four municipalities. During the first quarter of the 2021-2022 school year, ten Discussion Groups were conducted, with 7-11 participants per group, and two ninety-minute work sessions per group. The proceedings were followed by two deliberative sessions. The Atlas.ti version 8 software was used for data content analysis, following the methodological recommendations of Mayring and Cáceres, and the open coding technique was used. RESULTS: A relationship was observed between the foods most consumed in the family home and the ones that teenagers liked most. Also the extracurricular sports activity was highlighted as the main source of physical activity as well as the connection between mental health and healthy practices, and the emphasis about the variety of foods, the importance given to sustainability and the relationship of an unhealthy diet with excess intake of sugar, sweets, soft drinks, fast food and fats. The family was revealed as one of the most influential factors, followed by professionals, the media and high schools. Among the perceived barriers were the socioeconomic level, lack of time, food supply in canteens and social pressure. CONCLUSIONS: The main barriers and motivations linked to the food environment, socioeconomic level, body image and emotional well-being are identified. Adolescents express interest in participating in public policies.

OBJETIVO: La obesidad infanto-juvenil supone un verdadero reto de Salud Pública. La adolescencia es una etapa crítica para el crecimiento y el desarrollo. El objetivo del estudio fue explorar y comprender las percepciones de la población adolescente sobre alimentación y hábitos de vida saludables, así como la identificación de barreras y elementos facilitadores. METODOS: Se realizó un estudio cualitativo multicéntrico, en escolares de doce a catorce años, de cuatro Institutos de Educación Secundaria, distribuidos en cuatro municipios. Durante el primer trimestre del curso escolar 2021-2022 se realizaron diez grupos de discusión, con siete-once participantes por grupo, y dos sesiones de trabajo de noventa minutos de duración, por grupo. Fueron seguidos de dos sesiones deliberativas. Para el análisis del contenido de los datos se utilizó el software Atlas.ti versión 8, siguiendo las recomendaciones metodológicas de Mayring y Cáceres, y se empleó la técnica de codificación abierta. RESULTADOS: Se observó una relación entre los alimentos más consumidos en la vivienda familiar y los que más les gustaban, destacó la actividad extracurricular deportiva como la principal fuente de actividad física y la conexión entre la salud mental y las prácticas saludables, así como el énfasis que pusieron en la variedad de alimentos, la importancia concedida a la sostenibilidad y la relación de una alimentación no saludable con el exceso de azúcar, chucherías, refrescos, comida rápida y grasas. La familia se presentó como uno de los factores más influyentes, seguido de los profesionales, los medios de comunicación y el instituto. Entre las barreras percibidas destacaron: nivel socioeconómico, falta de tiempo, oferta de la cafetería del instituto y presión social. CONCLUSIONES: Se identifican las principales barreras y elementos facilitadores vinculados al entorno alimentario, nivel socioeconómico, imagen corporal y bienestar emocional. Los adolescentes expresan interés en participar en políticas públicas.

Estudio cualitativo sobre las percepciones en alimentación, prácticas alimentarias y hábitos de vida saludables en población adolescente / Qualitative study on food perceptions, dietary practices and healthy lifestyles in the adolescent population

Fundamentos: La obesidad infanto-juvenil supone un verdadero reto de Salud Pública. La adolescencia es una etapa crítica parael crecimiento y el desarrollo. El objetivo del estudio fue explorar y comprender las percepciones de la población adolescente sobrealimentación y hábitos de vida saludables, así como la identificación de barreras y elementos facilitadores.Métodos: Se realizó un estudio cualitativo multicéntrico, en escolares de doce a catorce años, de cuatro Institutos de EducaciónSecundaria, distribuidos en cuatro municipios. Durante el primer trimestre del curso escolar 2021-2022 se realizaron diez grupos dediscusión, con siete-once participantes por grupo, y dos sesiones de trabajo de noventa minutos de duración, por grupo. Fueronseguidos de dos sesiones deliberativas. Para el análisis del contenido de los datos se utilizó el software Atlas.ti versión 8, siguiendolas recomendaciones metodológicas de Mayring y Cáceres, y se empleó la técnica de codificación abierta.Resultados: Se observó una relación entre los alimentos más consumidos en la vivienda familiar y los que más les gustaban,destacó la actividad extracurricular deportiva como la principal fuente de actividad física y la conexión entre la salud mental y lasprácticas saludables, así como el énfasis que pusieron en la variedad de alimentos, la importancia concedida a la sostenibilidad yla relación de una alimentación no saludable con el exceso de azúcar, chucherías, refrescos, comida rápida y grasas. La familia sepresentó como uno de los factores más influyentes, seguido de los profesionales, los medios de comunicación y el instituto. Entre lasbarreras percibidas destacaron: nivel socioeconómico, falta de tiempo, oferta de la cafetería del instituto y presión social.Conclusiones: Se identifican las principales barreras y elementos facilitadores vinculados al entorno alimentario...(AU)

Background: Child and adolescent obesity is a biggest public health challenge. Adolescence is a critical stage for growth anddevelopment. The objective of the research was to explore and understand the perceptions of the adolescent population about eatingand healthy lifestyle habits, and the identification of barriers and facilitators.Methods: A multicenter qualitative research was made, in schoolchildren from twelve to fourteen years old, from four SecondarySchools, distributed in four municipalities. During the first quarter of the 2021-2022 school year, ten Discussion Groups were conducted,with 7-11 participants per group, and two ninety-minute work sessions per group. The proceedings were followed by two deliberativesessions. The Atlas.ti version 8 software was used for data content analysis, following the methodological recommendations of Mayringand Cáceres, and the open coding technique was used.Results: A relationship was observed between the foods most consumed in the family home and the ones that teenagersliked most. Also the extracurricular sports activity was highlighted as the main source of physical activity as well as the connectionbetween mental health and healthy practices, and the emphasis about the variety of foods, the importance given to sustainabilityand the relationship of an unhealthy diet with excess intake of sugar, sweets, soft drinks, fast food and fats. The family was revealedas one of the most influential factors, followed by professionals, the media and high schools. Among the perceived barriers were thesocioeconomic level, lack of time, food supply in canteens and social pressure.Conclusions: The main barriers and motivations linked to the food environment, socioeconomic level, body image and emotio-nal well-being are identified. Adolescents express interest in participating in public policies.(AU)

Resumption of endoscopy in the Galician colorectal cancer screening programme after the COVID-19 lock down: patient safety results.

The COVID-19 pandemic meant that the population-based colorectal cancer (CRC) screening programs had to be suspended. Modifications were made to the organization in order to reduce SARS-CoV-2 transmission. We report the experience of the Galician CRC screening program and patient safety results. Endoscopy was suspended between 13/03/2020 and 11/05/2020. After resumption, a total of 3,310 colonoscopies were performed (1,702 positive fecal occult blood tests and 1,608 endoscopy monitoring) and no SARS-CoV-2 infections were detected in the subsequent two weeks. Thus, resumption of activity associated with population screening was safe.

Measles risk groups in Spain: implications for the European measles-elimination target.

The European Region has set itself the goal of eliminating measles by 2010. Incidence has increased in recent years. This study sought to investigate outbreaks in Spain in the period 2005-2007, in order to identify measles-vulnerable groups and compare Spain to other European countries which have also had measles outbreaks. The pattern observed for Spain proved different to that of other European countries, i.e., whereas young adults and infants aged under 15 months were affected in Spain, children aged under 9 years comprised the predominant group in other European countries. Measles cases in Spain reflect low coverage when vaccination began, a pattern that could be repeated in neighbouring countries. Vaccination efforts should thus be targeted at vulnerable groups, namely: young adults; health professionals; travelling communities; and adopted infants and foreigners from countries with important pockets of susceptibles.

[Epidemiology of varicella in spain pre-and post-vaccination periods]. / Epidemiología de la varicela en España en los períodos pre y post vacunación.

BACKGROUND: Varicella virus can cause two different diseases: chickenpox and herpes zoster. In 2005 varicella vaccine has been introduced in the Spanish national vaccination schedule for 10-14 years old non-immune people, in order to reduce the severity of the disease. In 2007 a new surveillance protocol with aggregate data for chickenpox and herpes zoster was approved in order to detect any change in age distribution, severity and complications of the chickenpox and herpes zoster cases. The aim of this study is to know the burden of diseases (in the last ten years). METHODS: Number of cases, hospitalization and incidence for chickenpox and herpes zoster were study for two periods 1997-2003 and 2005-2007. Analysis for 1996-2007 fatal cases was done too. We decided to remove year 2004 because the extremely high chickenpox incidence registered. SOURCES OF DATA: RENAVE (Spanish Surveillance Network), Spanish hospital surveillance system (CMBD), and mortality registries. RESULTS: Chickenpox incidence decreased since 2005, but an increasing trend was detected in hospitalisation with an average of 1,311 hospitalizations every year. For the 32%-36% of hospitalized cases, the main diagnosis was not chickenpox. 4-14 deaths per year have been detected; 80% of them were older than 14 years. Annual rate of herpes zoster hospitalization was 2.5 per 100,000 inhabitants, similar in both sexes. Case fatality rate per year was 0.31 per million inhabitants. No significant changes were detected in age and sex in complicated cases between the two periods. 88% of chickenpox cases were younger than 15 years old and 64% of herpes zoster older than 50 years in 2007. CONCLUSIONS: Chickenpox has been decreasing during 2005-2007 in Spain. The impact of vaccination is difficult to asses, because of a peak registered in 2004 but also because the lack of vaccination coverage information for this period and the case-data information is available only for the last year.

[Cost-effectiveness of varicella vaccination in Spanish adolescents]. / Coste-efectividad de la vacunación contra la varicela en adolescentes en España.

INTRODUCTION: Varicella is a highly contagious disease. In Spain, in 1996, 91% of the population aged 13 years old had been infected. The complications of varicella are more frequent in adults. Herpes zoster infection can be reactivated after the initial infection in 15%. A vaccine against varicella has recently been authorized in Spain for use in individuals aged more than 13 years old with negative serology. OBJECTIVE: To determine the cost-effectiveness of vaccination of the cohort aged 13 years old in 2001 and to perform a sensitivity analysis of the parameters that are affected. MATERIAL AND METHOD: Tree decision: Decision Analysis by Tree-Age program. Probabilities and costs were calculated using Microsoft Excel. Population size was obtained from the 2001 Census of the National Institute of Statistics to which we applied the percentage of susceptibility from the seroepidemiological study in Spain. Probabilities were calculated by the Bayes Theorem, using the incidence rates by age of a country in the northern hemisphere. Hospital-related data were obtained from the minimum data set. We used the effectiveness of the vaccine licensed in the USA, with a total effectiveness of 71% and a partial effectiveness of 24%, represented by milder varicella in vaccinated individuals (breakthrough varicella). Only direct costs were considered. Costs were obtained by direct consultation of different sources. A discount rate of 3% was used. RESULTS: Varicella vaccination could prevent 27,278 cases of the disease. Prevention of one case would cost the public health system 131 Euros. DISCUSSION: This study constitutes an approach to the cost of introducing varicella vaccination in the Spanish vaccination schedule, from the payer's perspective. However, to take a decision, some unknown factors, such as the effect of vaccination on the incidence of herpes zoster, should be assessed. With currently available data, the introduction of vaccination in adolescence would seem to be the best strategy, but further studies are needed.

[Disease burden due to vaccinable diseases in the Spanish population aged less than 15 years old]. / Carga de enfermedad atribuible a las afecciones inmunoprevenibles en la población infantojuvenil española.

OBJECTIVES: To estimate the burden of disease due to vaccinable diseases and the relative importance of these diseases in the health of the Spanish population aged less than 15 years old. METHODS: Disease burden was measured in disability-adjusted life years (DALYs). DALYs were computed by adding years of life lost (YLL) to years lived with disability (YLD). The DALYs of the Spanish population aged less than 15 years old were estimated for 1999 and were stratified by diseases according to the classification system of the Global Burden of Disease (adapted to the aim of the study), age group and gender. Diseases included in the childhood vaccination schedule, varicella, and pneumococcal disease were targeted for this study. The sources used were: the national mortality register to compute YLL, the Epidemiologic Surveillance National Network, hospital discharge data (CMBD) and the scientific literature to compute YLD due to vaccinable diseases, and World Health Organization estimates (Euro-A) or, when these were lacking, morbidity hospital data (Hospital Morbidity Survey) to compute the YLD due to non-vaccinable diseases. RESULTS: The burden of disease due to vaccinable diseases was 1.2% of global DALYS (the overall DALYs rate was 46,57/1,000 habitants): excluding meningococcal disease (0.5% to 3.3%), diseases included in the vaccination schedule represented 0.00% to 0.03%, depending on age groups, except meningococcal infection (between 0.5% and 3.3%). Pneumococcal meningitis represented 0.06% to 0.65% and varicella 0.00% to 0.15%, also depending on age groups. CONCLUSIONS: Disease burden due to vaccinable diseases is a good indicator of the health of the young population in Spain. This measure summarizes and combines information on mortality, morbidity and disability caused by diseases. The DALYs attributable to diseases included in the vaccination schedule demonstrate that immunization programs have achieved their goals.