Factores con mayor influencia sobre la elección de alimentos en la población española

Fundamentos: Encuesta poblacional dirigida a conocer los factores que influyen en la elección de los alimentos de la población española. Métodos: Análisis de una muestra de todo el territorio español compuesta por 1009 individuos y seleccionada por un procedimiento aleatorio multietápico. Este estudio corresponde a la participación española en un estudio europeo sobre las actitudes de la población frente a la alimentación, nutrición y salud dirigido por el Instituto Europeo de Estudios Nutricionales de Dublín. Se determinó el porcentaje de individuos que situó a alguno de los cinco factores mencionados con más frecuencia (calidad, precio, dieta sana, condicionantes españoles, sabor) entre las tres primeras influencias en la elección de alimentos. Se ajustó un modelo multivariante para identificar los factores asociados a la elección de una dieta sana como una de las tres primeras influencias en la alimentación.Resultados: El precio influía más en los individuos de mayor edad, en niveles socioeconómicos más bajos y en individuos con menor nivel educativo. Fue mayor el impacto del precio en las mujeres de la zona Norte, Noreste y Noroeste. El sexo, la distribución geográfica, la edad y el nivel educativo presentaron un efecto independiente y significativo sobre la importancia concedida por la población a la elección de una dieta sana. Conclusiones: Los resultados sugieren la necesidad de una mayor educación sobre dieta y salud especialmente en hombre jóvenes, personas con menor nivel educativo y mujeres del Noroeste del país

Distribution and determinants of sedentary lifestyles in the European Union

Background Many studies have shown the health burden of a sedentary lifestyle. The main goal of this study was to determine the prevalence of sedentary lifestyles in the 15 Member States of the European Union (EU) and to identify the main correlates of a sedentary lifestyle. Methods Nationally representative samples (n ≈ 1000 subjects in each country; >15 years) completed a questionnaire concerning attitudes to physical activity, body weight, and health; in total 15 239 subjects. Sedentary people were defined in two ways: (1) those expending less than 10% of their leisure time expenditure in activities involving ≥4 metabolic equivalents (MET). (2) Those who did not practice any leisure-time physical activity and who also were above the median in the number of hours spent sitting down during leisure time. Logistic regression models were fitted to analyse the association between sedentary lifestyles and gender, age, body mass index (BMI), educational level, weight change in the last 6 months, and marital and smoking status. Results Percentages of sedentary lifestyles across European countries ranged between 43.3% (Sweden) and 87.8% (Portugal) according to the first definition. According to both definitions, a lower prevalence of sedentary lifestyle was found in Northern countries (especially Scandinavian countries) as compared with Mediterranean countries, whereas the prevalence was higher among older, obese, less educated, widowed/divorced individuals, and current smokers. Similar relative differences between countries and socio-demographic groups were found independently of the method used to define a sedentary lifestyle. Conclusion Prevalence of sedentary lifestyle in the EU is high, especially among inhabitants of some Mediterranean countries, obese subjects, less-educated people, and current smokers. This high prevalence involves important public health burdens and preventive strategies are urgently needed

Perception of body image as indicator of weight status in the European union

Objective To identify the factors associated with an adequate perception of body image in relation to body weight. Material and methods An observational, cross-sectional study was conducted in a representative sample of the European Union (7155 men and 8077 women). Body Mass Index (BMI) was grouped into four categories, perceived body image was assessed using the nine silhouettes drawing scheme. A multivariable logistic regression model for each sex was used to adjust for potentially confounding variables. Results Underweight men and women classi®ed themselves better than other groups (92.9% of correct answers among men and 79.3% among women). Overall, women classi®ed themselves better than men (57.6% vs. 32.7%). Discussion Perceived body image as a method of assessment for body weight has different validity depending on sociodemographic or attitudinal categories. Perceived body image as an estimate of the nutritional status has a limited individualized application. Thus, perhaps it could be applied as a proxy measure of adiposity among slim males and among slim and overweight females, but not among the other groups

Prevalence of physical activity during leisure time in the European Union

PURPOSE: To estimate the prevalence of physical activity during leisure time in adults from the 15 member states of the European Union and the relationship with sociodemographic variables. METHODS: A representative sample, with approximately 1000 adults, aged 15 and upward, was selected from each member state to complete a questionnaire on attitudes to physical activity, body weight, and health by a face-to-face interview, summing a total of 15,239 subjects. The amount of leisure-time physical activity was quantified by assigning metabolic equivalents (METs) to each activity. Multiple linear regression models with MET-h.wk(-1) as the dependent variable were fitted. RESULTS: Northern European countries showed higher levels of physical activity than southern ones. The highest prevalence (91.9%) was found in Finland, and the lowest (40.7%) in Portugal. A higher percentage of men practiced any leisure-time physical activity and also showed higher mean of MET-h.wk(-1). In both genders, the multivariate models showed a significant trend to higher leisure time activity in participants with higher educational levels and in nonsmokers. Also, an inverse association between body mass index and leisure-time physical activity was found. CONCLUSION: The prevalence of any physical activity during leisure time in the adult European population was similar to the U.S. estimates. Nevertheless, the amount of activity is low, and a wide disparity between countries exists. To our knowledge, this is the first study determining the prevalence and amount of leisure-time physical activity, which is the first step to define strategies to persuade populations to increase their physical activity

Percepción de la imagen corporal como aproximación cualitativa al estado de nutrición

Objetivo. Comparar la percepción de la imagen corporal con el índice de masa corporal (IMC) calculado a partir del peso y la talla declarados por los sujetos y valorar su capacidad para clasificar el estado de nutrición. Material y métodos. Se eligió una muestra representativa de la población de España, integrada por 517 hombres y 483 mujeres mayores de 15 años. Las variables fueron sexo, edad, nivel educativo, IMC e imagen corporal percibida. Las diferencias entre grupos se estimaron con la prueba de c2. La capacidad de clasificación de la imagen corporal se comparó con el IMC empleando la sensibilidad y la especificidad. Resultados. El estado nutricional para ambos indicadores mostró mayor sobrepeso en hombres y mayor obesidad en mujeres. Se observó que el sobrepeso y la obesidad se incrementan conforme aumenta la edad, y con mayor educación disminuyen. La percepción de la imagen corporal fue distinta entre sexos, así como por edad y nivel educativo (p<0.01). La comparación entre el IMC y la imagen corporal notificó valores superiores a 0.90 para sensibilidad y especificidad, así como para los valores predictivos positivos y negativos en sujetos que presentaron un estado nutricional que alcanzaba los rangos extremos. La precisión fue mayor para la sensibilidad que para la especificidad. La capacidad de clasificación fue mejor en mujeres que en hombres. La correlación de Spearman fue mayor en mujeres que en hombres (p<0.001) y la concordancia W de Kendall notificó valores altos para ambos sexos. Conclusiones. La percepción de la imagen corporal permitió identificar a los sujetos que presentaban nutrición normal y deficiente o excesiva; por tal motivo, este indicador puede resultar útil en estudios epidemiológicos, aunque tiene algunas limitaciones para diagnósticos individuales

Sources of information on healthy eating in a mediterranean country and the level of trust in them: a national sample in a pan-european survey

Objetivos: Determinar las fuentes de información y el nivel de confianza en las fuentes de información sobre dieta sana en la población española, para facilitar la promoción de hábitos dietéticos sanos. Pacientes y métodos: Análisis de una muestra representativa española de adultos mayores de 15 años compuesta por 1009 individuos y seleccionada por un procedimiento aleatorio multietápico. Este estudio corresponde a la participación española en un estudio europeo multicéntrico coordinado por el Instituto Europeo de Estudios Nutricionales (IEFS) de Dublín. Se preguntó a cada individuo por las fuentes de las que procedía su información sobre dieta sana y su nivel de confianza en ellas. Se analizaron las cinco fuentes más frecuentemente mencionadas. Resultados: La fuente de información más citada y de mayor confianza fueron los "profesionales sanitarios". Aproximadamente, el 26% de los encuestados mencionaron a los "profesionales sanitarios" como su fuente de información acerca de la dieta sana. Sin embargo, la "radio/TV" (25,7%) fue casi tan seleccionada como los "profesionales sanitarios". Alrededor del 17,4% de los individuos declaró que no obtenía información sobre dieta sana. Los individuos con nivel de estudios universitarios citó con mayor frecuencia a los "profesionales sanitarios", mientras que los sujetos de nivel socio-económico elevado prefirieron la "radio/TV". El grado de confianza fue mayor para los mensajes obtenidos de los "profesionales sanitarios" (89,9%) y del "Departamento de Sanidad" (78,7%) y menor en el caso de la información obtenida de los "periódicos" (34,2%) y de los "anuncios publicitarios" (17,6%). Conclusión: Los profesionales sanitarios deben promover las guías dietéticas a través de los canales adecuados para lograr que lleguen a los diferentes grupos de individuos.Objeclive: To know the sources of information and the level of trust in these sources in a population to facilitate the promotion of healthy dietary habits. Palienls and methods: A national survey was carried out according to an established protocol on a representative sample of 1009 Spanish subjects over 15 years of age selected by a random multietapic procedure. This study belongs to the Spanish partnership in a pan-European Survey about sources of information on healthy eating and their level of trust The analysis was focussed on the evaluation of the 5 most frequently chosen sources. Results: There was a trend towards a greater use and trust in "Health professionals" !han other sources. Thus, about 26% of the respondents mentioning "health professionals" as the source of information on healthy eating_ However, "TV/radio" (25.7%) was almos! so often selected as "Health professionals". About 17.4% of subjects declared that they obtained no information at all on healthy eating. Subjects with university level of studies exhibited a greater mention of "Health professionals", while individuals belonging to higher socio-economic levels preferred "TV/radio". The degree of trust was higher for messages obtained from "Health professionals" (89.9%) and the "Department of Health" (78.7%) and lower for information obtained from "newspaper" (34.2%) and "advertising" (17.6%). Conclusion: Nutrition and health educators must pro-J mote dietary guidelines through the appropriate channels for communicating messages to difieren! targets groups

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

Burden of diarrhea in the eastern mediterranean region, 1990-2013: Findings from the global burden of disease study 2013

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6 of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low-and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95 uncertainty interval UI = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden. Copyright © 2016 by The American Society of Tropical Medicine and Hygiene

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14�294 geography�year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61·7 years (95 uncertainty interval 61·4�61·9) in 1980 to 71·8 years (71·5�72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7�17·4), to 62·6 years (56·5�70·2). Total deaths increased by 4·1 (2·6�5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0 (15·8�18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1 (12·6�16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1 (11·9�14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1, 39·1�44·6), malaria (43·1, 34·7�51·8), neonatal preterm birth complications (29·8, 24·8�34·9), and maternal disorders (29·1, 19·3�37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146�000 deaths, 118�000�183�000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393�000 deaths, 228�000�532�000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost YLLs) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licens