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Introduction: Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6–9 years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics. Methodology: The analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6–9 years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization and the International Obesity Task Force) and of central obesity, in addition to associated demographic and socioeconomic variables. Results: Between 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8 years (by −5.4%, −5.7% and −5.3%, respectively) and boys whose parents had a higher educational attainment (by −5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable. Conclusions: The prevalence of overweight and the prevalence of obesity in schoolchildren aged 6–9 years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6–8 years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable. Resumen: Introducción: El exceso de peso infantil es un problema de salud pública creciente. El objetivo del trabajo es estudiar la evolución de la prevalencia de sobrepeso, obesidad y obesidad central en escolares de 6 a 9 años en España entre 2011 y 2019 según características demográficas y socioeconómicas. Metodología: Se incluyeron las rondas 2011, 2015 y 2019 del estudio observacional, descriptivo y transversal ALADINO en escolares de ambos sexos de 6 a 9 años. Se realizó un análisis descriptivo de la evolución de la prevalencia de sobrepeso y obesidad según los criterios de la Organización Mundial de la Salud (OMS) y la International Obesity Task Force (IOTF), así como obesidad central, y las variables demográficas y socioeconómicas asociadas. Resultados: Entre 2011 y 2019 se redujo la prevalencia de sobrepeso (critrerios OMS) en niños de 6, 7 y 8 años (−5,4, −5,7 y −5,3 puntos porcentuales respectivamente) y niños cuyos progenitores tenían estudios superiores (−5,3 puntos porcentuales). Por renta, el sobrepeso en niños se redujo en todos los niveles de ingresos. Sin embargo, entre 2011 y 2019, se mantuvieron estables tanto la prevalencia de sobrepeso en niñas como la prevalencia de obesidad según las referencias OMS e IOTF y la de obesidad central en ambos sexos. Conclusiones: Las prevalencias de sobrepeso y obesidad en escolares de 6 a 9 años en España siguen siendo altas. Entre 2011 y 2019 disminuyó la prevalencia de sobrepeso en niños de 6 a 8 años y aquellos cuyos progenitores tienen estudios universitarios, mientras que la obesidad en niños, el sobrepeso y la obesidad en niñas, y la obesidad central en ambos sexos han permanecido estables.

Introduction: Childhood obesity is inversely associated with household socioeconomic status in high-income countries. Our aim was to explore the association between childhood weight status and household socioeconomic status in Spain in relation to family characteristics, perceptions and lifestyle habits and the school environment. Methods: We performed a descriptive analysis of child weight status according to family socioeconomic factors and mediating variables based on data from the ALADINO 2019 study in a sample of 16,665 schoolchildren representative of the population aged 6–9 years in Spain. Results: The prevalence of childhood obesity in households with low socioeconomic status (26.8% boys; 20.4% girls) was, in both sexes, twice as high as in those with higher socioeconomic status (12.1% boys; 8.7% girls). Unhealthy eating habits, sedentary lifestyles (mainly in girls) and the presence of screens in the bedroom (more prevalent in boys) were more frequent in school-aged children from low-income households. On the other hand, in the most disadvantaged households, a history of breastfeeding and physical activity (especially in girls) were less frequent. Similarly, schools attended by children from low-income households were less likely to have their own kitchens and indoor gymnasiums or offer sports activities. Conclusion: A lower household socioeconomic status was associated with poorer dietary and physical activity habits and certain characteristics of the family and school environments that mediate the inverse association between household socioeconomic status and the prevalence of childhood obesity. Girls were less physically active and reported more sedentary lifestyles, while boys had greater access to screens. Interventions to combat childhood obesity should address the identified inequalities. Resumen: Introducción: La obesidad infantil se asocia inversamente con el nivel socioeconómico familiar en países desarrollados. El objetivo es evaluar la asociación entre la situación ponderal infantil y el nivel socioeconómico familiar, según características familiares, percepciones, hábitos de vida y entorno escolar. Metodología: Análisis descriptivo de la situación ponderal infantil según factores socioeconómicos familiares y variables mediadoras en el estudio ALADINO 2019, en una muestra de 16.665 escolares representativa de la población escolar de 6 a 9 años en España. Resultados: La prevalencia de obesidad infantil en hogares de bajo nivel socioeconómico (26,8% niños; 20,4% niñas) era, en ambos sexos, el doble de la de los de mayor nivel (12,1% niños; 8,7% niñas). En escolares de familias de baja renta eran más frecuentes hábitos alimentarios poco saludables, el sedentarismo (principalmente en niñas) y la presencia de pantallas en la habitación (más en niños). Por el contrario, en hogares más desfavorecidos eran menos frecuentes el antecedente de lactancia materna y la práctica de actividad física (especialmente en niñas). La disponibilidad de cocina propia, actividades deportivas y gimnasio cubierto en los centros era también menos habitual para los escolares de familias de menor renta. Conclusiones: Un menor nivel socioeconómico del hogar se asocia con peores hábitos alimentarios y de actividad física y ciertas características del entorno familiar y el escolar, que a su vez median la asociación inversa que existe entre el nivel socioeconómico y la prevalencia de obesidad infantil. Las niñas realizan menos actividad física y presentan más sedentarismo mientras que los niños tienen más acceso a pantallas. Las intervenciones para combatir la obesidad infantil deben contemplar las desigualdades identificadas.

Background: Toenails are commonly used as biomarkers of exposure to zinc (Zn), but there is scarce information about their relationship with sources of exposure to Zn. Objectives: To investigate the main determinants of toenail Zn, including selected sources of environmental exposure to Zn and individual genetic variability in Zn metabolism. Methods: We determined toenail Zn by inductively coupled plasma mass spectrometry in 3,448 general population controls from the MultiCase-Control study MCC-Spain. We assessed dietary and supplement Zn intake using food frequency questionnaires, residential proximity to Zn-emitting industries and residential topsoil Zn levels through interpolation methods. We constructed a polygenic score of genetic variability based on 81 single nucleotide polymorphisms in genes involved in Zn metabolism. Geometric mean ratios of toenail Zn across categories of each determinant were estimated from multivariate linear regression models on log-transformed toenail Zn. Results: Geometric mean toenail Zn was 104.1 µg/g in men and 100.3 µg/g in women. Geometric mean toenail Zn levels were 7 % lower (95 % confidence interval 1–13 %) in men older than 69 years and those in the upper tertile of fibre intake, and 9 % higher (3–16 %) in smoking men. Women residing within 3 km from Zn-emitting industries had 4 % higher geometric mean toenail Zn levels (0–9 %). Dietary Zn intake and polygenic score were unrelated to toenail Zn. Overall, the available determinants only explained 9.3 % of toenail Zn variability in men and 4.8 % in women. Discussion: Sociodemographic factors, lifestyle, diet, and environmental exposure explained little of the individual variability of toenail Zn in the study population. The available genetic variants related to Zn metabolism were not associated with toenail Zn.

Introduction: Overweight and obesity in childhood and adolescence has grown alarmingly in the last twenty years or so in many countries of Europe, including Spain. This study presents the prevalences of overweight and obesity in 6–9 year-old schoolchildren in 2015, and their associated characteristics. Methodology: ALADINO (Its initials in Spanish for Diet, physical activity, child development and obesity) is a cross-sectional study of a representative sample of 6–9 year-old schoolchildren in Spain, in line with the Childhood Obesity Surveillance Initiative (COSI) of the World Health Organisation (WHO). The height and weight of the participants, defining the weight status according to WHO standards, and a questionnaire was given to the parents on lifestyle and sociodemographic characteristics. Results: Anthropometric measurements were taken on 10,899 schoolchildren for 168 primary education centres. Excess weight was observed in 41.3% (95% CI: 40.0−42.6), overweight in 23.2% (95% CI: 22.1−24.3) and obesity in 18.1% (95% CI: 17.2−19.1), with obesity being more prevalent in boys, overweight in girls. The prevalence of abdominal obesity was 23.2% (95% CI: 21.8−24.6). The prevalence of overweight and obesity increased with age. Excess weight decreased by 3.2% compared to 2011, mainly due to the decrease in overweight in boys, while that of obesity remained stable. Excess weight was more prevalent in schoolchildren from families with a lower socioeconomic level. Conclusions: The prevalence of excess weight in 6–9 year-old schoolchildren in Spain has decreased by 3.2% since 2011, due to the decrease in overweight, whilst obesity remained stable. Action must be taken in the obesogenic environment, by promoting healthy eating habits and physical activity, bearing in mind the inequalities in health. Resumen: Introducción: El sobrepeso y la obesidad en la infancia y en la adolescencia han crecido alarmantemente en las últimas décadas en muchos países de Europa, incluido España. Este estudio presenta las prevalencias de sobrepeso y obesidad en escolares de 6 a 9 años en 2015 y sus características asociadas. Metodología: ALADINO es un estudio transversal de una muestra representativa de escolares de 6 a 9 años en España, alineado con la iniciativa COSI de la OMS. Se talló y pesó a los participantes, definiendo la situación ponderal según los estándares de la OMS, y se pasó un cuestionario a los progenitores sobre el estilo de vida y las características sociodemográficas. Resultados: Se tomaron medidas antropométricas a 10.899 escolares de 168 centros de educación primaria. El 41,3% (IC 95%: 40,0-42,6) presentaba exceso de peso, el 23,2% sobrepeso (IC 95%: 22,1-24,3) y el 18,1% obesidad (IC 95%: 17,2-19,1), siendo la obesidad más prevalente en niños y el sobrepeso en niñas. La prevalencia de obesidad abdominal era del 23,2% (IC 95%: 21,8-24,6). La prevalencia de sobrepeso y obesidad aumentaba con la edad. El exceso de peso disminuyó un 3,2% respecto a 2011, principalmente por la disminución del sobrepeso en niños, mientras que la obesidad permaneció estable. El exceso de peso era más prevalente en los escolares de familias con menor nivel socioeconómico. Conclusiones: La prevalencia de exceso de peso entre los escolares de 6 a 9 años en España ha disminuido un 3,2% desde 2011 por la disminución del sobrepeso, mientras que la obesidad permanece estable. Se debe intervenir en el entorno obesogénico, promocionando hábitos alimentarios saludables y la actividad física, incidiendo en las desigualdades en salud.

Background: Identifying risk factors for complications or death associated with influenza remains crucial to target preventive interventions. Scores like the Charlson comorbidity index (CCI) may be of help. The aims of this study were to assess the effect of vaccination and comorbidities on severe influenza disease and influenza-related death among hospitalized patients during the season 2016/17; and to evaluate the validity of the CCI to predict death among these patients. Methods: Data from adult patients (≥18 years old) with influenza infection admitted to La Paz University Hospital (LPUH) were recorded during the 2016/17 epidemic. The effect of influenza vaccine to prevent severe influenza or death was evaluated using multivariate logistic regression models. The area under the curve of the CCI and the age-adjusted CCI were compared to assess the predictive effect on mortality. Results: A total of 342 adult patients with influenza infection were admitted, of which 83 developed severe influenza and 25 died during hospitalization. There were no differences between patients who survived and those who died concerning the CCI, but the age-adjusted CCI was higher in fatal cases (p-value = 0.005). Influenza vaccine had no statistically significant effect on the risk of mortality (p-value = 0.162) while age (OR: 1.12, p-value