High-quality intake of carbohydrates is associated with lower prevalence of subclinical atherosclerosis in femoral arteries: The AWHS study.

BACKGROUND AND AIMS: High-quality of the carbohydrates consumed, apart from their total amount, appear to protect from cardiovascular disease (CVD). However, the relationship between the quality of carbohydrates and the early appearance of atherosclerosis has not yet been described. Our objective was to estimate the association between the quality of dietary carbohydrates and subclinical atherosclerosis in femoral and carotid arteries. METHODS: Cross-sectional study of femoral and carotid atherosclerosis assessed using ultrasounds of 2074 middle-aged males, 50.9 (SD 3.9) years old, with no previous CVD, and pertaining to the Aragon Workers' Health Study (AWHS) cohort. Food frequency questionnaires were used to calculate a carbohydrate quality index (CQI) defined as: consumption of dietary fiber, a lower glycemic index, the ratio of whole grains/total grains, and the ratio of solid carbohydrates/total carbohydrates. The presence of plaques across four CQI intervals was studied using adjusted logistic regression models. RESULTS: The CQI showed a direct inverse association with subclinical atherosclerosis in femoral territories. Participants with a higher consumption of high-quality carbohydrates (13-15 points) were less likely to have femoral plaques when compared with participants in the lowest index interval (4-6 points) (OR = 0.59; 95% CI = 0.39, 0.89; p = 0.005). No association was found between the CQI and the presence of subclinical atherosclerosis in carotid territories. A lower consumption of high-quality carbohydrates tended to be associated with a greater atherosclerosis extension, considered as the odds for having more affected territories (p = 0.011). CONCLUSIONS: Among middle-aged males, a high-quality intake of carbohydrates is associated with a lower prevalence of femoral artery subclinical atherosclerosis when compared with a lower consumption. Thus, indicating an early relationship between the quality of carbohydrates and the development of CVD.

Patterns of alcohol consumption and risk of falls in older adults: a prospective cohort study.

Falls are a major health problem in older adults, but their relationship with alcohol consumption in this population remains unclear. In a cohort with 2170 older adults followed up for 3.3 years, both moderate drinking and the Mediterranean drinking pattern were associated with a lower risk of falls and injurious falls. INTRODUCTION: This study aims to examine the association between certain patterns of alcohol consumption, including the Mediterranean drinking pattern (MDP), and the risk of falls in older adults. METHODS: A prospective cohort with 2170 community-dwelling individuals aged ≥60 years was recruited in Spain in 2008-2010 and followed up through 2012. At baseline, participants reported alcohol consumption and, at the end of follow-up, their falls during the previous year. The MDP was defined as moderate alcohol consumption (threshold between moderate and heavy intake was 40 g/day for men and 24 g/day for women) with preference for wine and drinking only with meals. Analyses were conducted with negative binomial or logistic regression, as appropriate, and adjusted for the main confounders. RESULTS: Compared with never drinkers, the number of falls was lower in moderate drinkers (incidence rate ratio (95% confidence interval), 0.79 (0.63-0.99)) and drinkers with MDP (0.73 (0.56-0.96)). Also, moderate drinkers and those with MDP showed a lower risk of ≥2 falls (odds ratio (95% confidence interval), 0.58 (0.38-0.88) and 0.56 (0.34-0.93), respectively) and of falls requiring medical care (0.67 (0.46-0.96) and 0.61 (0.39-0.96), respectively). CONCLUSION: Both moderate drinking and the MDP were associated with a lower risk of falls and injurious falls in older adults. However, sound advice on alcohol consumption should balance risks and benefits.

Metabolically healthy obesity and health-related quality of life: A prospective cohort study.

BACKGROUND: Metabolically healthy obesity (MHO) has been associated with lower risk of diabetes than obesity with cardiometabolic abnormalities (CA). However, the effect of MHO on other health outcomes is unknown. OBJECTIVE: To examine the association of metabolic status across categories of body mass index (BMI) with health-related quality of life (HRQL). METHODS: Prospective cohort with 4397 individuals aged ≥18 years, recruited in 2008-2010 and followed-up to 2012 in Spain. Normal weight was defined as BMI <25, overweight as BMI 25-29.9, and obesity as BMI ≥30 kg/m2. Two metabolic statuses were defined: healthy (0-1 CA) and unhealthy (≥2 CA). HRQL was measured with the physical component summary (PCS) and the mental component summary (MCS) of the SF-12 questionnaire. The association of joint categories of BMI and metabolic status at baseline with HRQL at 2012 was examined using linear regression, and adjusted for the main confounders. RESULTS: Compared to healthy normal-weight subjects, the unhealthy normal-weight and the healthy overweight individuals had a similar PCS score; however, the PCS was lower (worse) among those with unhealthy overweight (-1.79; 95% confidence interval [CI]: -2.66 to -0.94), with MHO (-1.45; 95% CI: -2.67 to -0.24) and unhealthy obesity (-1.97; 95% CI: -2.88 to -1.05). Being overweight or obese was not associated with the MCS score regardless of metabolic status. CONCLUSION: Metabolically unhealthy overweight, as well as obesity regardless of metabolic status, showed a worse physical HRQL. These results suggest that both obesity and CA should be addressed to improve HRQL.

Physical Activity, Sitting Time and Mortality in Older Adults with Diabetes.

The purpose of this study was to examine the independent and combined association of physical activity (PA) and sitting time (ST) with all-cause mortality in older adults with diabetes. A total of 611 individuals representative of the Spanish diabetic population aged ≥ 60 years. Participants were selected in 2000/2001 and were prospectively followed-up through 2011. PA and ST were self-reported at baseline. Study associations were summarized as hazard ratios (HR) and their 95% confidence interval (CI). During a mean follow-up of 8.3 years, 282 deaths occurred. The HR (95% CI) of mortality for very/moderately active individuals compared to those who were inactive/less active was 0.59 (0.45, 0.78). The association between ST and mortality was non-linear (P<0.001 in spline analysis), and mortality was increased only among individuals who reported a ST>8 h/day (HR=1.77, 95% CI 1.25, 2.52). The HR (95% CI) of mortality was 0.50 (0.32, 0.77) in participants who either were very/moderately active or had ST≤8 h/day, and 0.32 (0.20, 0.50) in those with both health behaviors, compared to those with none of these behaviors. In conclusion, among older adults with diabetes, high PA and less ST are independently and jointly associated with lower risk of all-cause mortality.

Association of the duration of residence with obesity-related eating habits and dietary patterns among Latin-American immigrants in Spain.

The dietary patterns of immigrants usually change with the duration of residence and progressively resemble those of the host country. However, very few studies have investigated individuals migrating to countries with a high-quality diet, such as the Mediterranean diet (MD), and none has yet focused on Latin-American immigrants. The present study examined the association of the duration of residence with obesity-related eating habits and dietary patterns among Latin-American immigrants residing in Spain. A cross-sectional study was conducted in 2008-10 in a representative sample of the adult population residing in Spain. Adherence to the MD was defined as a MD Adherence Screener score ≥ 9. Analyses were conducted by including 419 individuals aged 18-64 years born in Latin-American countries. Compared with immigrants residing in Spain for < 5 years, those residing for ≥ 10 years accounted for a lower percentage of individuals who habitually ate at fast-food restaurants and never trimmed visible fat from meat. Moreover, these immigrants were found to have a lower intake of sugary beverages and a higher intake of Na, saturated fat, fibre, olive oil, vegetables and fish and to more frequently strictly adhere to the MD. A longer duration of residence in Spain was found to be associated with both healthy and unhealthy changes in some eating habits and dietary patterns among Latin-American immigrants. Some of the healthy changes observed contrasted the 'Westernisation' of the diet reported in studies conducted in other Western countries. The results of the present study support the role of the food environment of the host country in the modification of the dietary patterns of immigrants.

Is a specific drinking pattern a consistent feature of the Mediterranean diet in Spain in the XXI century?

BACKGROUND AND AIM: Over the last 50 years, people in Spain have increasingly been eating their main meal away from home and are shifting from the typical Mediterranean diet (MD). In addition, wine consumption has decreased whereas beer intake has risen. Consequently, it is uncertain if the Mediterranean drinking pattern (MDP; moderate alcohol intake mainly from wine and during meals) is a habitual feature of the MD today. METHODS AND RESULTS: Cross-sectional study conducted from 2008 to 2010 among 8894 individuals representative of the Spanish population aged 18-64 years. Consumption of alcoholic beverages and food was collected with a validated diet history. Accordance with the MD was defined as a score ≥8 on the Mediterranean Diet Adherence Screener (MEDAS) or ≥5 in the Trichopoulou index (after excluding alcohol intake from both indices). Among individuals with MEDAS-based MD accordance, only 17.1% had a MDP. After adjustment for potential confounders, this drinking pattern showed a weak association with higher MD accordance (odds ratio (OR) 1.32; 95% confidence interval (CI) 1.12-1.57). Only 14.7% of those with Trichopoulou-based MD accordance had a MDP; this pattern showed an even weaker association with higher MD accordance (OR 1.17; 95% CI 1.01-1.36). Similar results were obtained when this drinking pattern was redefined to include persons who drank wine with or outside of meals, as well as those who were primarily beer drinkers. CONCLUSIONS: The MDP is not a habitual feature of the MD in the early XXI century in Spain.

Alcohol drinking patterns and biomarkers of coronary risk in the Spanish population.

BACKGROUND AND AIMS: To estimate the association between patterns of alcohol consumption and biomarkers of coronary heart disease (CHD) risk. METHODS AND RESULTS: Cross-sectional study among 10,793 individuals representative of the Spanish population aged ≥ 18 years. The threshold between moderate and heavy drinking was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of ≥ 80 g of alcohol in men and ≥ 60 g in women at any drinking occasion in the preceding 30 days. Analyses were performed with generalized linear models with adjustment for the main confounders, and results were expressed as the percentage change in the geometric mean (PCGM). Compared to non-drinkers, moderate and heavy drinkers had progressively higher serum HDL-cholesterol, with a PCGM ranging from 4.8% (95% CI: 3.7-6.0%) in moderate drinkers without binge drinking (MNB) to 9.6% (5.1-14.2%) in heavy drinkers with binge drinking (HB). Fibrinogen decreased progressively with alcohol intake, from -2.2% (-3.1 to -1.3%) in MNB to -5.8% (-9.4 to -2.0%) in HB. Leptin, glycated hemoglobin and the HOMA-index also decreased with increasing alcohol intake, and particularly with binge drinking. CONCLUSIONS: Moderate alcohol intake is associated with improved HDL-cholesterol, fibrinogen and markers of glucose metabolism, which is consistent with the reduced CHD risk of moderate drinkers in many studies. Heavy and binge drinking were also associated with favorable levels of CHD biomarkers; since these drinking patterns produce substantial health harms, our results should not be used to promote alcohol consumption.

Prevalence and determinants of metabolically healthy obesity in Spain.

BACKGROUND AND AIMS: Obesity is a heterogeneous disorder, so some obese individuals do not have cardiometabolic abnormalities (CA) which mediate the association between obesity and coronary heart disease. This study assessed the prevalence of metabolically healthy obesity and its determinants in Spain. METHODS: The data were taken from a cross-sectional study conducted in 2008-2010 among 11,520 individuals representative of the population of Spain aged ≥18 years. Normal-weight was defined as body mass index (BMI) <25 kg/m(2), and obesity as BMI ≥30 kg/m(2). Six CA were considered: elevated blood pressure, low high-density lipoprotein cholesterol, and elevated levels of triglycerides, fasting glucose, homeostasis model assessment of insulin resistance value, and C-reactive protein. Then, two phenotypes were defined: healthy (0-1 CA) and abnormal (≥2 CA). RESULTS: The prevalence of metabolically healthy obesity was 6.5% overall (95% confidence interval: 6.0-7.1), and corresponds to 28.9% of obese individuals. Lower age, being female, current smoking, moderate alcohol consumption, and high level of physical activity were independently associated with the healthy phenotype among the obese. The prevalence of normal weight with a metabolically abnormal phenotype was 6.4% overall (95% confidence interval: 5.8-6.9) and corresponds to 16.8% of normal-weight subjects. Factors associated with this phenotype in normal-weight persons were higher age, being male, never smoking, no alcohol consumption and larger waist circumference. CONCLUSION: Metabolically healthy obesity represents almost one-third of the obese population in Spain. Since this was a cross-sectional study, the association of metabolic healthy obesity with smoking consumption, alcohol intake and physical activity warrants more research.

Consumption of fried foods and weight gain in a Mediterranean cohort: the SUN project.

BACKGROUND AND AIMS: The consumption of fried foods is believed to be linked with obesity and higher weight gain, however, the evidence from long-term randomized trials or prospective epidemiological studies is scarce. Therefore, the aim of our study was to prospectively evaluate the association between the consumption of fried foods and weight change and the incidence of overweight/obesity in a Mediterranean cohort. METHODS AND RESULTS: Prospective cohort study of 9850 men and women with a mean age of 38.1 years (SD 11.4) were followed-up for a median of 6.1 years to assess average yearly change in body weight, and incidence of overweight/obesity. The consumption of fried foods was associated with higher weight gain, but the differences were of small magnitude and statistically non-significant. The incidence of overweight/obesity during follow-up was also assessed in the subset of 6821 participants with initial body mass index <25 kg/m(2) (initially free of overweight/obesity), after adjusting for potential confounders, the odds ratio for developing overweight/obesity among participants who consumed fried foods >4 times/week was 1.37 (95% confidence interval: 1.08 to 1.73) in comparison with those who consumed fried foods <2 times/week (p for trend = 0.02). CONCLUSION: In this Mediterranean prospective cohort, a more frequent consumption of fried foods at baseline was associated with a higher risk of subsequently developing overweight/obesity during follow-up.

Obesity-related eating behaviours in the adult population of Spain, 2008-2010.

Knowledge of the socio-demographic distribution of eating behaviours can aid our understanding of their contribution to the obesity epidemic and help to address healthy eating interventions to those who can benefit most. This cross-sectional study assessed the frequency of self-reported eating behaviours among 11,603 individuals representative of the non-institutionalized Spanish population aged ≥ 18 years in the period 2008-2010. In the adult population of Spain, 24.3% had lunch and 18.2% had dinner away from home >3 times per month. About three-fourths of adults did not plan the amount of food to be eaten, and did not choose light foods and/or skim dairy products. Also, 26% did not trim visible fat from meat, and 74.7% usually ate while watching television. Compared with individuals with primary or less education, those with university studies were more likely to remove fat from meat (age- and sex-adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.08-1.44), and to choose light food and/or skim dairy (aOR 1.50; 95% CI 1.30-1.77), and less likely to eat while watching television (aOR 0.54; 95% CI 0.47-0.63). In conclusion, the prevalence of several obesity-related eating behaviours is high in Spain, which indicates a deficient implementation of dietary guidelines. Socioeconomic inequalities in eating behaviours should also be addressed.

Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: the EPIC-Spain cohort study.

BACKGROUND AND AIM: No previous study has assessed the association between major dietary patterns and the risk of coronary heart disease (CHD) in a large cohort from a Mediterranean country. METHODS AND RESULTS: We studied prospectively 40,757 persons, aged 29-69 years, participating in the Spanish cohort of the EPIC study. Food consumption was collected between 1992 and 1996 with a validated history method. Individuals were followed-up until 2004 through record linkage with hospital discharge registers, population-based registers of myocardial infarction, and mortality registers to ascertain CHD events (fatal and non-fatal acute myocardial infarction or angina requiring revascularization). Two major dietary patterns were identified from factor analysis. The first pattern was labeled as Westernized, because of the frequent consumption of refined cereals and red meat; the second was called the evolved Mediterranean pattern, because of the frequent intake of plant-based foods and olive oil. During a median follow-up of 11 years, 606 CHD events were ascertained. No association was found between the Westernized pattern and CHD risk. In contrast, the score for the evolved Mediterranean pattern was inversely associated with CHD risk (p for trend = 0.0013); when compared with the lowest quintile of the evolved Mediterranean pattern score, the multivariable hazard ratios for CHD were 0.77 (95% confidence interval 0.61-0.98) for the second quintile, 0.64 (95% CI 0.50-0.83) for the third quintile, 0.56 (95% CI 0.43-0.73) for the fourth quintile, and 0.73 (95% CI 0.57-0.94) for the fifth quintile. CONCLUSION: A Mediterranean diet, as consumed in this study population, was associated with a lower risk of CHD.

Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study.

This is the first study to report the prevalence of general obesity and abdominal obesity (AO) in the adult population of Spain based on measurements of weight, height and waist circumference. The data are taken from the ENRICA study, a cross-sectional study carried out between June 2008 and October 2010 in 12,883 individuals representative of the non-institutionalized population on Spain aged 18 years and older. Anthropometry was performed under standardized conditions in the households by trained interviewers. Overweight was considered as body mass index (BMI) 25-29.9 kg m(-2) , and obesity as BMI ≥ 30 kg m(-2) . AO was defined as waist circumference >102 cm in men and >88 cm in women. The prevalence of obesity was 22.9% (24.4% in men and 21.4% in women). About 36% of adults had AO (32% of men and 39% of women). The frequency of obesity and of AO increased with age and affected, respectively, 35 and 62% of persons aged 65 and over. The frequency of obesity and AO decreased with increasing educational level. For example, 29% of women with primary education or less had obesity vs. only 11% of those with university studies. The prevalence of obesity was very high in the Canary Islands and in the south of Spain.

Trends in overweight and misperceived overweight in Spain from 1987 to 2007.

OBJECTIVE: To examine trends in overweight and misperceived overweight in adults (≥ 20 years) and children (5-15 years) of Spain from 1987 to 2007. METHODS: Data were obtained from five cross-sectional studies, representative of the population of Spain in 1987, 1995, 1997, 2001 and 2006/2007. Self-reported weight and height were used to obtain the body mass index (BMI). Overweight was defined in adults as BMI of ≥ 25 kg m⁻², and in children using age- and sex-specific BMI cutoffs proposed by the International Obesity Task Force. People with overweight were considered to have misperceived overweight when adults considered their weight or their child's weight to be normal or less than normal. RESULTS: From 1987 to 2006/2007, the prevalence of overweight increased in absolute terms by 14.1% in men and 10.3% in women. Concurrently, the frequency of misperceived overweight remained relatively stable, approximately 35% in men, but rose from 16.5 to 20.8% in women. From 1995/1997 to 2006/2007, the prevalence of overweight increased in absolute terms by 3.2% in boys and 4.6% in girls. Over the same period, there was an absolute 8% increase in misperception of overweight among children of both sexes. As a result, during 2006/2007, approximately 60% of parents did not correctly perceive the weight status of their overweight children. Moreover, misperceived overweight was highest for younger children, and for those whose parents had a higher education. CONCLUSIONS: The obesity epidemic in Spain has been accompanied by an increased misperception of overweight in women and children of both sexes. Our results warn of the low family's readiness to modify the environment and lifestyle needed to control overweight.

[Self-care behavior and patients' knowledge about self-care predict rehospitalization among older adults with heart failure]. / El autocuidado y el conocimiento del manejo de la enfermedad predicen la rehospitalización en ancianos con insuficiencia cardíaca.

INTRODUCTION: This study examined the association of self-care behavior and patients' knowledge about self-care with rehospitalization among older adults with heart failure (HF). METHODS: Case-control comparison (116 cases and 209 controls) nested in a prospective cohort of patients aged 65 years and older admitted for HF at 4 Spanish hospitals. Cases were patients experiencing a first emergency rehospitalization in the 6 months following the index hospital admission. Controls were patients who did not undergo a rehospitalization during such time-period. RESULTS: The number of self-care behaviors was inversely associated with the frequency of readmission (p for linear trend: 0.006). Compared with patients showing the appropriate self-care behavior, hospital readmission was more frequent among those who did no go for a walk daily or did not engage in any daily physical activity (hazard ratio [HR] 1.55; 95% confidence limits [CL] 1.04-2.29), and among those who did not keep their medical appointments (HR 1.82; 95% CL 1.10-3.02). Hospital readmission was also more frequent among patients who: failed to take their medication at the scheduled time (HR 2.07; 95% CL 1.15-3.72); stopped taking their medication when it disagreed with them (HR 1.76; 95% CL 1.08-2.85); and failed to adhere to their drug treatment (HR 1.96; 95% CL 1.29-2.98). Furthermore, the fewer the number of behaviors which patients knew to be required for self-care, the greater the frequency of rehospitalization (p for linear trend:0.029). CONCLUSIONS: A lower degree of self-care and of patients' knowledge about self-care predicted a higher risk of hospital readmission.

El autocuidado y el conocimiento del manejo de la enfermedad predicen la rehospitalización en ancianos con insuficiencia cardíaca / Self-care behavior and patients’ knowledge about self-care predict rehospitalization among older adults with heart failure

Introducción. Este trabajo examinó la asociacióndel autocuidado y del conocimiento de los pacientesacerca del autocuidado con la rehospitalizaciónen adultos mayores con insuficiencia cardíaca (IC).Métodos. Análisis de casos y controles (116 casos y209 controles) alojado en una cohorte prospectivade pacientes de 65 y más años de edad ingresadospor IC en 4 hospitales españoles. Los casoseran pacientes rehospitalizados de urgencia en los6 meses siguientes a la hospitalización índice.Los controles fueron pacientes que no serehospitalizaron durante esos 6 meses. Resultados. El número de actividades de autocuidado se asoció de forma inversa con la frecuencia de reingreso (p tendencia lineal: 0,006). En comparación con los pacientes que realizaron el autocuidado apropiado, el reingreso hospitalario fue más frecuente entre los que no paseaban ni realizaban actividad física a diario (hazard ratio [HR] 1,55; límites de confianza [LC] 95% 1,04-2,29), y entre los que se saltaban la visita al médico en la fecha programada (HR 1,82; LC 95% 1,10-3,02). El reingreso hospitalario también fue más frecuente entre los pacientes que no tomaban la medicación a su hora (HR 2,07; LC 95% 1,15-3,72), los quedejaban de tomarla cuando les sentaba mal (HR1,76; LC 95% 1,08-2,85), y los que no mostraronadherencia al tratamiento farmacológico (HR 1,96;LC 95% 1,29-2,98). Además, a menor número de actividades de manejo de la IC que se conocía que debían realizarse, mayor fue la frecuencia de rehospitalización (p tendencia lineal: 0,029).Conclusión. A menor autocuidado y menor conocimiento del manejo de la IC, mayor riesgo de reingreso hospitalario

Introduction. This study examined the associationof self-care behavior and patients’ knowledge aboutself-care with rehospitalization among older adultswith heart failure (HF).Methods. Case-control comparison (116 cases and209 controls) nested in a prospective cohort ofpatients aged 65 years and older admitted for HF at4 Spanish hospitals. Cases were patientsexperiencing a first emergency rehospitalization inthe 6 months following the index hospital admission.Controls were patients who did not undergo arehospitalization during such time-period.Results. The number of self-care behaviors wasinversely associated with the frequency of readmission (p for linear trend: 0.006). Compared with patients showing the appropriate self-care behavior, hospital readmission was more frequent among those who did no go for a walk daily or did not engage in any daily physical activity (hazard ratio [HR] 1.55; 95% confidence limits [CL] 1.04-2.29), and among those who did not keep their medical appointments (HR 1.82; 95% CL 1.10-3.02).Hospital readmission was also more frequent amongpatients who: failed to take their medication at thescheduled time (HR 2.07; 95% CL 1.15-3.72);stopped taking their medication when it disagreedwith them (HR 1.76; 95% CL 1.08-2.85); andfailed to adhere to their drug treatment (HR 1.96;95% CL 1.29-2.98). Furthermore, the fewer thenumber of behaviors which patients knew to berequired for self-care, the greater the frequencyof rehospitalization (p for linear trend:0.029).Conclusions. A lower degree of self-care and ofpatients’ knowledge about self-care predicted ahigher risk of hospital readmission

Eating behaviours and obesity in the adult population of Spain.

To examine the association between several eating behaviours and obesity, data were taken from a cross-sectional study conducted with 34,974 individuals aged 25-64 years, representative of the non-institutionalised Spanish population. Obesity was defined as BMI >or= 30 kg/m2. Study associations were summarised with OR obtained from logistic regression, with adjustment for socio-demographic and lifestyle factors. The results showed that those skipping breakfast were more likely to be obese, both in men (OR 1.58; 95 % CI 1.29, 1.93) and women (OR 1.53; 95 % CI 1.15, 2.03). Moreover, obesity was more prevalent in those having only two meals per day than in those having three or four meals in men (OR 1.63; 95 % CI 1.37, 1.95) and women (OR 1.30; 95 % CI 1.05, 1.62). Also, snacking was associated with obesity in women (OR 1.51; 95 % CI 1.17, 1.95). However, no association was observed between obesity and having one or more of the main meals away from home, in either sex. In conclusion, skipping breakfast and eating frequency were associated with obesity. The lack of association between eating away from home and obesity is in contrast to most previous research conducted in Anglo-Saxon countries. Differences in the type of establishment frequented when eating out or in the characteristics of restaurant customers in a Mediterranean population might explain these conflicting results.

Factores asociados con el conocimiento de la hipertensión en españoles mayores de 60 años / Factors associated awareness of hypertension among older Spaniards, over 60 years of age

Objetivo. Identificar los factores asociados al conocimiento de padecer hipertensión en varones y mujeres españoles mayores de 60 años. Material y métodos. Estudio poblacional de 4.009 sujetos a partir de los datos del estudio: “Hipertensión arterial y otros factores de riesgo en la población de 60 años y más de España”. Entrevista en el domicilio que recoge información sobre el conocimiento de padecer hipertensión arterial, además de variables sociodemográficas, estilo de vida, uso de servicios de salud y calidad de vida relacionada con la salud. Resultados. Las mujeres conocen más la condición de ser hipertensas que los varones (69,2 % frente a 60,2%; p80 años (OR: 0,57). A medida que dejan de acudir a la consulta médica desconocen más, presentan cifras altas de presión arterial sistólica (OR: 0,98) y peor calidad de vida en el índice sumarial físico (OR: 0,98). Las obesas conocen que son hipertensas (OR: 1,52). Conclusiones. El conocimiento se relaciona con diferencias de género, regional, en el estilo de vida y en la calidad de vida. Es recomendable diseñar estrategias diferenciadas por las anteriores variables a fin de incrementar el conocimiento de la hipertensión arterial

Objective. To identify factors associated with the awareness of hypertension among man and women Spaniards age 60 years and older. Material and methods. The data of the study: “Arterial hypertension and other factors of risk in the elderly (?60 years) Spanish population”. This was a population-based survey of 4,009 older Spaniards. Information for this survey was obtained thorough household personal interviews to evaluate the awareness of hypertension and associated factors socio-demographic variables, the use of health system, lifestyles and the quality of life related to health. Results. The women more awareness of hypertension that men (69.2% versus 60.2 %). In men, aged ? 80 years the unawareness to hypertension (OR: 0,61). The less being counseled more knowledge their condition (p trends <0,0001). The awareness associated who having had a previous hospitalization (OR: 1,46) having drunk alcoholic products moderately (OR: 1,63). In women ?80 years of age, unawareness of hypertension (OR: 0,57). The reason is that in according to stop attending medical appointments (OR: 0,98), the systolic pressure will increase 1 mmHg (OR: 0,98) and likewise the physical summary index of life quality will do, but in one point (OR: 0,98). However who know more their situation of hypertension they are the obese ones (OR: 1,52). Conclusions. There are regional differences, gender, lifestyles and to measure health-related quality of life. This demonstrates poor awareness about high blood pressure, so the strategy should be directed toward in these variables mentioned

Changes in body weight and health-related quality-of-life in the older adult population.

BACKGROUND: No other study has ascertained the short-term impact of weight change on health-related quality-of-life (HRQL) on a national sample of older adults. OBJECTIVE: To examine the relationship between change in body weight and HRQL among the older adult population. METHODS: We carried out a prospective study from 2001 to 2003 of a cohort of 2364 persons, representative of the noninstitutionalized Spanish population aged 60 y and over. Weight changes during the period 2001-2003 were self-reported, and HRQL in 2003 was measured with the SF-36 questionnaire. Analyses adjusted for the principal confounders. RESULTS: Among nonobese women (body mass index (BMI) 18.5-29.9 kg/m(2)), and compared to those who underwent no important weight change, weight loss was associated with a clinically significant worsening in the role-physical, vitality, and social functioning SF-36 scales. Among obese women (BMI> or =30 kg/m(2)), weight gain led to a reduction in HRQL for four of the eight SF-36 scales, while weight loss was associated with worse scores in role-emotional and mental health scales. Results were usually similar for men, though of lower magnitude. In both sexes, weight change was associated with a reduction of over 5 points on several physical and mental scales of the SF-36, which indicates a clinically relevant worsening in HRQL. CONCLUSION: Weight change is associated with worse HRQL among the older adults, principally women. From the stance of HRQL, it is desirable to prevent weight gain, especially among the obese, and weight loss, especially among the nonobese.

One year effectiveness of an individualised smoking cessation intervention at the workplace: a randomised controlled trial.

AIMS: To assess the effectiveness of a smoking cessation intervention at the workplace. The intervention was adapted to smokers' tobacco dependence, and included minimal structured counselling at the first visit (5-8 minutes), nicotine patches for three months, and three sessions of counselling for reinforcement of abstinence (2-3 minutes) over a three month period. METHODS: Open randomised trial with two groups: the intervention group, and the control group which was subjected to standard clinical practice, consisting of short (30 seconds to one minute) sporadic sessions of unstructured medical antismoking advice. The trial was carried out among 217 smokers of both sexes, aged 20-63 years, motivated to quit smoking and without contraindications for nicotine patches, who were employees at a public transport company and at two worksites of an electric company. The main outcome measure was self reported tobacco abstinence confirmed by carbon monoxide in expired air

A simple estimate of mortality attributable to excess weight in the European Union.

OBJECTIVE: To estimate the current burden of mortality attributable to excess weight in the European Union (EU). METHODS: Prevalence of overweight (body mass index, BMI 25-29.9 kg/m(2)) and obesity (BMI >or=30 kg/m(2)) were based on self-reported data from a survey with samples representative of the 15 EU Member States in 1997. Primary source of relative risk (RR) of death by BMI was the first American Cancer Prevention Study (CPS I). Additional calculations were performed to account for effect of smoking (using CPS I data for non- or never-smokers), for pre-existing illness (using the second CPS, CPS II, data for healthy never-smokers) and using RRs derived from European rather than US data (using data from a meta-analysis of prospective studies). Mortality attributable to excess weight was calculated by combining the prevalences of overweight and obesity, the RRs, and the number of deaths in the EU countries. RESULTS: Annual deaths attributable to overweight and obesity totalled approximately 279 000 when RRs for all subjects were used. When RRs for nonsmokers only were applied to the entire population, about 304 000 deaths were attributable to excess weight. In analyses using RRs which controlled for both smoking and history of disease, the number of deaths attributable to excess weight was estimated at about 337 000 based on European data and at about 401 000 based on US data. In the EU, therefore, a minimum of 279 000 deaths were attributable to excess weight (7.7% of all deaths, varying from 5.8% for France through 8.7% for the UK). More attributable deaths occurred among the obese (175 000) than among the overweight (104 000). Around 70% were cardiovascular disease deaths (195 000) and 20% cancer deaths (53 000). CONCLUSION: Mortality attributable to excess weight is a major public health problem in the EU. At least one in 13 annual deaths in the EU are likely to be related to excess weight.