Reducción de carnes rojas y procesadas en la población española: ¿cuál es su impacto sobre la mortalidad cardiovascular? / Reduction of red and processed meats in the Spanish population: What is its impact on total and cardiovascular mortality?

OBJETIVO: Cuantificar el impacto de reducir el consumo de carnes rojas y procesadas sobre la mortalidad cardiovascular y la mortalidad total de la población adulta española, basado en 5 revisiones publicadas. Participantes y mediciones principales: Se define la exposición como el consumo de ≥ 3 raciones/semana de carnes rojas o procesadas, y se consideran cuatro escenarios de población expuesta (30-60%). Con datos del Instituto Nacional de Estadística, se calcula la mortalidad ponderada en población española de 40-80 años y, utilizando los riesgos relativos (RR) y los intervalos de confianza (IC) al 95% publicados en 5 revisiones (RR = 0,88; IC95%: 0,84-0,93 para mortalidad por todas las causas y RR = 0,92; IC95%: 0,90-0,93 para la mortalidad cardiovascular), se calculó la tasa de mortalidad en expuestos y no expuestos. Multiplicando esas tasas por el número de expuestos, se obtuvo el número de muertes atribuibles. RESULTADOS: Asumiendo un 60% de población española de 40-80años expuesta, el número de muertes anuales de causa cardiovascular que se podrían evitar consumiendo < 3 raciones/semana de carnes rojas o procesadas con un IC95% está entre 2.112 y 3.055. Si la población expuesta fuese un 30% se podrían evitar entre 1.079 y 1.577 muertes. CONCLUSIONES: Incluso bajo el supuesto más conservador, el beneficio poblacional de reducir el consumo de carnes rojas o procesadas sobre la mortalidad cardiovascular y total sería muy importante. Las conclusiones de las revisiones mencionadas contradicen sus propios resultados y contribuyen a un estado de confusión que representa un daño a la salud pública

OBJECTIVE: Quantify the impact of reducing the consumption of red/processed meats on cardiovascular mortality and all-cause mortality of the Spanish adult population based in 5 revisions published. Participants and main measurements: We defined exposure as consumption of ≥ 3 servings/week of red or processed meats and considered four possible scenarios of exposed population (30%-60%). Based on data from the Spanish National Statistics Institute, we calculated the weighted mortality between 40 and 80years. Using the relative risks (RR) and 95% confidence intervals (CI) published by the referred revisions (RR = 0.88; IC95%: 0.84-0.93 for all-cause mortality and RR = 0.92; IC95%: 0.90-0.93 for cardiovascular mortality), we calculated the expected mortality rate in both exposed and unexposed categories. By multiplying these rates by the number of exposed individuals, we estimated the attributable number of yearly deaths. RESULTS: If 60% of the population was exposed, with a 95% CI, the number of cardiovascular deaths that could be averted each year if population consumed < 3 servings/week of red or processed meats was between 2.112 and 3.055. If was exposed that 30%, the difference in the yearly number of potentially averted deaths was between 1.079 and 1.577. CONCLUSIONS: Even under the most conservative assumption, the benefit, at the population level, of reducing red or processed meats consumption < 3 servings/week on cardiovascular mortality is important. The conclusions of the recently published reviews contradicted their own results and contributed to a state of confusion that can create substantial harm for public health

[Reduction of red and processed meats in the Spanish population: What is its impact on total and cardiovascular mortality?] / Reducción de carnes rojas y procesadas en la población española: ¿cuál es su impacto sobre la mortalidad cardiovascular?

OBJECTIVE: Quantify the impact of reducing the consumption of red/processed meats on cardiovascular mortality and all-cause mortality of the Spanish adult population based in 5 revisions published. PARTICIPANTS AND MAIN MEASUREMENTS: We defined exposure as consumption of ≥3 servings/week of red or processed meats and considered four possible scenarios of exposed population (30%-60%). Based on data from the Spanish National Statistics Institute, we calculated the weighted mortality between 40 and 80years. Using the relative risks (RR) and 95% confidence intervals (CI) published by the referred revisions (RR=0.88; IC95%: 0.84-0.93 for all-cause mortality and RR=0.92; IC95%: 0.90-0.93 for cardiovascular mortality), we calculated the expected mortality rate in both exposed and unexposed categories. By multiplying these rates by the number of exposed individuals, we estimated the attributable number of yearly deaths. RESULTS: If 60% of the population was exposed, with a 95%CI, the number of cardiovascular deaths that could be averted each year if population consumed <3 servings/week of red or processed meats was between 2.112 and 3.055. If was exposed that 30%, the difference in the yearly number of potentially averted deaths was between 1.079 and 1.577. CONCLUSIONS: Even under the most conservative assumption, the benefit, at the population level, of reducing red or processed meats consumption <3 servings/week on cardiovascular mortality is important. The conclusions of the recently published reviews contradicted their own results and contributed to a state of confusion that can create substantial harm for public health.

Evaluation of compliance with the self-regulation agreement of the food and drink vending machine sector in primary schools in Madrid, Spain, in 2008 / Evaluación del cumplimiento del convenio de autorregulación del sector de máquinas expendedoras de alimentos y bebidas en las escuelas de primaria de Madrid, España, en 2008

Objectives To evaluate compliance with the self-regulation agreement of the food and drink vending machine sector in primary schools in Madrid, Spain. Methods Cross-sectional study of the prevalence of vending machines in 558 primary schools in 2008. Using the directory of all registered primary schools in Madrid, we identified the presence of machines by telephone interviews and evaluated compliance with the agreement by visiting the schools and assessing accessibility, type of publicity, the products offered and knowledge of the agreement. Results The prevalence of schools with vending machines was 5.8%. None of the schools reported knowledge of the agreement or of its nutritional guidelines, and most machines were accessible to primary school pupils (79.3%) and packed with high-calorie, low-nutrient-dense foods (58.6%).Conclusions Compliance with the self-regulation agreement of the vending machines sector was low. Stricter regulation should receive priority in the battle against the obesity epidemic (AU)

Objetivos Evaluar el cumplimiento del convenio de autorregulación del sector de máquinas expendedoras de alimentos y bebidas en las escuelas de primaria de Madrid. Métodos Estudio de prevalencia de máquinas expendedoras en las 558 escuelas de primaria de Madrid en 2008. A partir del directorio de colegios registrados, se detectó la existencia de máquina mediante entrevista telefónica. El conocimiento y el cumplimiento del acuerdo se evaluaron mediante inspección in situ de las máquinas (accesibilidad, tipo de publicidad, productos ofertados).Resultados La prevalencia de colegios con máquina fue del 5,8%. Ninguna escuela conocía el convenio. La mayoría de las máquinas eran accesibles a estudiantes de primaria (79,3%) y contenían mayoritariamente productos altamente energéticos y bajos en nutrientes (58,6%).Conclusiones Observamos un bajo cumplimiento de los acuerdos del convenio. En la batalla contra la epidemia de la obesidad, debería priorizarse una regulación más estricta de la industria alimentaria (AU)

Evaluation of compliance with the self-regulation agreement of the food and drink vending machine sector in primary schools in Madrid, Spain, in 2008.

OBJECTIVES: To evaluate compliance with the self-regulation agreement of the food and drink vending machine sector in primary schools in Madrid, Spain. METHODS: Cross-sectional study of the prevalence of vending machines in 558 primary schools in 2008. Using the directory of all registered primary schools in Madrid, we identified the presence of machines by telephone interviews and evaluated compliance with the agreement by visiting the schools and assessing accessibility, type of publicity, the products offered and knowledge of the agreement. RESULTS: The prevalence of schools with vending machines was 5.8%. None of the schools reported knowledge of the agreement or of its nutritional guidelines, and most machines were accessible to primary school pupils (79.3%) and packed with high-calorie, low-nutrient-dense foods (58.6%). CONCLUSIONS: Compliance with the self-regulation agreement of the vending machines sector was low. Stricter regulation should receive priority in the battle against the obesity epidemic.

[European Guidelines on Cardiovascular Disease Prevention in Clinical Practice: CEIPC 2008 Spanish adaptation]. / Guía europea de prevención cardiovascular en la práctica clínica: Adaptación española del CEIPC 2008.

We present the Spanish adaptation from the CEIPC of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care medical doctors in promoting a healthy life style, based on increasing physical activity, change dietary habits, and non smoking. The therapeutic goal is to achieve a Blood Pressure <140/90 mmHg, but among patients with diabetes, chronic kidney disease, or definite CVD, the objective is <130/80 mmHg. Serum cholesterol should be <200 mg/dl and cLDL <130 mg/dl, although among patients with CVD or diabetes, the objective is <100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by BMI -body mass index- and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin <7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.