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1. Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011–2019 period by sex, age and socioeconomic level: results of the ALADINO study

Author: Enrique Gutiérrez-González, Blanca Andreu-Ivorra, Almudena Rollán-Gordo, Laura Tejedor-Romero, Francisco Sánchez-Arenas, and Marta García-Solano
Subjects: Obesidad, Sobrepeso, Niño, Pobreza infantil, Desigualdades socioeconómicas en salud, Determinantes sociales de la salud, Pediatrics, RJ1-570
Abstract: 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.
Published: 2024
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2. Socioeconomic and gender inequalities in childhood obesity in Spain

Author: Enrique Gutiérrez-González, Francisco Sánchez Arenas, Ana María López-Sobaler, Blanca Andreu Ivorra, Almudena Rollán Gordo, and Marta García-Solano
Subjects: Obesidad, Sobrepeso, Infantil, Pobreza infantil, Desigualdades socioeconómicas en salud, Determinantes sociales de la salud, Pediatrics, RJ1-570
Abstract: 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.
Published: 2023
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3. Socio-geographical disparities of obesity and excess weight in adults in Spain: insights from the ENE-COVID study

Author: Enrique Gutiérrez-González, Marta García-Solano, Roberto Pastor-Barriuso, Nerea Fernández de Larrea-Baz, Almudena Rollán-Gordo, Belén Peñalver-Argüeso, Isabel Peña-Rey, Marina Pollán, Beatriz Pérez-Gómez, and the ENE-COVID Study Group
Subjects: obesity, adults, Spain, geographical factors, sociodemographic factors, Public aspects of medicine, RA1-1270
Abstract: BackgroundIn 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.MethodENE-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.ResultsCrude 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).ConclusionObesity 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.
Published: 2023
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4. Parental Perceptions of Children’s Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017

Author: Ximena Ramos Salas, Marta Buoncristiano, Julianne Williams, Maryam Kebbe, Angela Spinelli, Paola Nardone, Ana Rito, Vesselka Duleva, Sanja Musić Milanović, Marie Kunesova, Radka Taxová Braunerová, Tatjana Hejgaard, Mette Rasmussen, Lela Shengelia, Shynar Abdrakhmanova, Akbota Abildina, Zhamyila Usuopva, Jolanda Hyska, Genc Burazeri, Aušra Petrauskiene, Iveta Pudule, Victoria Farrugia Sant’Angelo, Enisa Kujundzic, Anna Fijałkowska, Alexandra Cucu, Lacramioara Aurelia Brinduse, Valentina Peterkova, Elena Bogova, Andrea Gualtieri, Marta García Solano, Enrique Gutiérrez-González, Sanavbar Rakhmatullaeva, Maya Tanrygulyyeva, Nazan Yardim, Daniel Weghuber, Päivi Mäki, Kenisha Russell Jonsson, Gregor Starc, Petur Benedikt Juliusson, Mirjam M. Heinen, Cecily Kelleher, Sergej Ostojic, Stevo Popovic, Viktoria Anna Kovacs, Dilorom Akhmedova, Nathalie J. Farpour-Lambert, Harry Rutter, Bai Li, Khadichamo Boymatova, Ivo Rakovac, Kremlin Wickramasinghe, and Joao Breda
Subjects: childhood obesity, parental perceptions, weight, world health organization/europe, childhood obesity surveillance initiative, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract: Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child’s weight status. The purpose of this study was to measure parental perceptions of their child’s weight status and to identify predictors of potential parental misperceptions. Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children’s weight status as “underweight,” “normal weight,” “a little overweight,” or “extremely overweight.” We categorized children’s (6–9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child’s weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1. Results: Overall, 64.1% of parents categorized their child’s weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child’s weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child’s weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28–1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26–1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98–1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99–1.24). Overall, parents’ BMI was not strongly associated with the underestimation of children’s weight status, but there was a stronger association in some countries. Discussion/Conclusion: Our study supplements the current literature on factors that influence parental perceptions of their child’s weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents’ knowledge and perceptions, as well as the sociocultural contexts in which children and families live.
Published: 2021
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5. Intervención grupal de promoción de hábitos saludables en el ámbito laboral: Programa IPHASAL

Author: Marta García-Solano, Enrique Gutiérrez-González, Sara Santos-Sanz, Mª José Yusta-Boyo, Carmen Villar-Villalba, and Mª Ángeles Dal Re-Saavedra
Subjects: riesgo cardiovascular, hábitos saludables, salud laboral, promoción de la salud, apoyo entre iguales, Medicine, Internal medicine, RC31-1245, Industrial medicine. Industrial hygiene, RC963-969
Abstract: Resumen Introducción: Las enfermedades cardiovasculares constituyen un grave problema de salud pública. El ámbito laboral es óptimo para intervenir sobre los factores de riesgo cardiovascular. El objetivo es evaluar una intervención grupal de promoción de hábitos saludables (programa IPHASAL) mediante apoyo entre iguales en el ámbito laboral. Método: En el programa participaron 325 trabajadores de 13 empresas con factores de riesgo cardiovascular (hipertensión, tabaquismo, exceso de peso, inactividad física). Antes y después del programa se midió peso y altura, tensión arterial y se pasó un cuestionario sobre hábitos de salud. El programa consistía en asistir a talleres formativos y sesiones grupales en las que los participantes compartían experiencias, conocimientos y progresos sobre hábitos saludables. El resultado se midió con el Índice Fuster BEWAT (IFB), calculado con la puntuación de 5 variables: tensión arterial, ejercicio, peso, alimentación y tabaco. Resultados: Los participantes sin criterios de exclusión en el proyecto fueron 273. El 79% asistió a 3 o más talleres y el 73,9% acudió a 3 o más sesiones. Todos los parámetros del IFB mejoraron significativamente tras el programa, siendo el mayor incremento en la actividad física y el menor en el tabaquismo. El IFB total aumentó un 17,4% (1,5 puntos), siendo superior el aumento en mujeres (19,6%) que en hombres (14,0%) y en el grupo más joven (21,6%). Conclusiones: La intervención grupal IPHASAL es aplicable al ámbito laboral y contribuye a mejorar el perfil de riesgo cardiovascular, ayudando a los trabajadores a potenciar el cambio hacia estilos de vida saludables.
Published: 2021
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6. Toenail zinc as a biomarker: Relationship with sources of environmental exposure and with genetic variability in MCC-Spain study

Author: Enrique Gutiérrez-González, Pablo Fernández-Navarro, Roberto Pastor-Barriuso, Javier García-Pérez, Gemma Castaño-Vinyals, Vicente Martín-Sánchez, Pilar Amiano, Inés Gómez-Acebo, Marcela Guevara, Guillermo Fernández-Tardón, Inmaculada Salcedo-Bellido, Victor Moreno, Marina Pinto-Carbó, Juan Alguacil, Rafael Marcos-Gragera, Jesús Humberto Gómez-Gómez, José Luis Gómez-Ariza, Tamara García-Barrera, Elena Varea-Jiménez, Olivier Núñez, Ana Espinosa, Antonio J. Molina de la Torre, Amaia Aizpurua-Atxega, Jessica Alonso-Molero, María Ederra-Sanz, Thalia Belmonte, Nuria Aragonés, Manolis Kogevinas, Marina Pollán, and Beatriz Pérez-Gómez
Subjects: Toenail, Environmental exposure, Biomarker, Zinc, Single nucleotide polymorphism, Polygenic score, Environmental sciences, GE1-350
Abstract: 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.
Published: 2022
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7. Weight status in the 6 to 9 year-old school population in Spain: Results of the ALADINO 2015 study

Author: Marta García-Solano, Enrique Gutiérrez-González, Ana María López-Sobaler, María Ángeles Dal Re Saavedra, Teresa Robledo de Dios, Carmen Villar-Villalba, María José Yusta-Boyo, and Napoleón Pérez-Farinós
Subjects: Obesidad, Sobrepeso, Prevalencia, Escolares, Índice de masa corporal, España, Pediatrics, RJ1-570
Abstract: 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.
Published: 2021
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8. Physical Activity, Screen Time, and Sleep Duration of Children Aged 6–9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015–2017

Author: Stephen Whiting, Marta Buoncristiano, Peter Gelius, Karim Abu-Omar, Mary Pattison, Jolanda Hyska, Vesselka Duleva, Sanja Musić Milanović, Hana Zamrazilová, Tatjana Hejgaard, Mette Rasmussen, Eha Nurk, Lela Shengelia, Cecily C. Kelleher, Mirjam M. Heinen, Angela Spinelli, Paola Nardone, Akbota Abildina, Shynar Abdrakhmanova, Gulmira Aitmurzaeva, Zhamyila Usuopva, Iveta Pudule, Aušra Petrauskiene, Victoria Farrugia Sant’Angelo, Enisa Kujundzic, Stevo Popovic, Anne-Siri Fismen, Ingunn Holden Bergh, Anna Fijalkowska, Ana Isabel Rito, Alexandra Cucu, Lacramioara Aurelia Brinduse, Valentina Peterkova, Andrea Gualtieri, Marta García-Solano, Enrique Gutiérrez-González, Zulfinissio Abdurrahmonova, Khadichamo Boymatova, Nazan Yardim, Maya Tanrygulyyeva, Daniel Weghuber, Karin Schindler, Dragana Stojisavljević, Aida Filipović Hadžiomeragić,, Eliza Markidou Ionnaidu, Wolfgang Ahrens, Maria Hassapidou, Viktoria Anna Kovacs, Sergej M. Ostojic, Lubica Ticha, Gregor Starc, Kenisha Russell Jonsson, Igor Spiroski, Harry Rutter, Romeu Mendes, Julianne Williams, Ivo Rakovac, and João Breda
Subjects: physical inactivity, surveillance, sedentary behaviour, active transport, active play, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract: Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6–9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). Method: The fourth COSI data collection round was conducted in 2015–2017, using a standardized protocol that included a family form completed by parents with specific questions about their children’s PA, screen time, and sleep duration. Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for 1 h/day, 8.2–85.6% were not members of a sport or dancing club, 17.7–94.0% walked or cycled to school each day, 32.3–80.0% engaged in screen time for
Published: 2020
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9. Effect of vaccination, comorbidities and age on mortality and severe disease associated with influenza during the season 2016–2017 in a Spanish tertiary hospital

Author: Enrique Gutiérrez-González, José M. Cantero-Escribano, Lidia Redondo-Bravo, Isabel San Juan-Sanz, Ana Robustillo-Rodela, Emilio Cendejas-Bueno, and Influenza Working Group
Subjects: Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract: 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
Published: 2019
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10. A Snapshot of European Children’s Eating Habits: Results from the Fourth Round of the WHO European Childhood Obesity Surveillance Initiative (COSI)

Author: Julianne Williams, Marta Buoncristiano, Paola Nardone, Ana Isabel Rito, Angela Spinelli, Tatjana Hejgaard, Lene Kierkegaard, Eha Nurk, Marie Kunešová, Sanja Musić Milanović, Marta García-Solano, Enrique Gutiérrez-González, Lacramioara Aurelia Brinduse, Alexandra Cucu, Anna Fijałkowska, Victoria Farrugia Sant’Angelo, Shynar Abdrakhmanova, Iveta Pudule, Vesselka Duleva, Nazan Yardim, Andrea Gualtieri, Mirjam Heinen, Silvia Bel-Serrat, Zhamyla Usupova, Valentina Peterkova, Lela Shengelia, Jolanda Hyska, Maya Tanrygulyyeva, Ausra Petrauskiene, Sanavbar Rakhmatullaeva, Enisa Kujundzic, Sergej M. Ostojic, Daniel Weghuber, Marina Melkumova, Igor Spiroski, Gregor Starc, Harry Rutter, Giulia Rathmes, Anne Charlotte Bunge, Ivo Rakovac, Khadichamo Boymatova, Martin Weber, and João Breda
Subjects: nutrition, child, obesity, surveillance, health, noncommunicable diseases, Nutrition. Foods and food supply, TX341-641
Abstract: Consuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015–2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children’s parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks “every day”, “most days (four to six days per week)”, “some days (one to three days per week)”, or “never or less than once a week”. We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consumed sweet snacks or soft drinks (10.3% and 9.4%, respectively); however, there were large between-country differences. This paper highlights an urgent need to create healthier food and drink environments, reinforce health systems to promote healthy diets, and continue to support child nutrition and obesity surveillance.
Published: 2020
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11. Dietary Zinc and Risk of Prostate Cancer in Spain: MCC-Spain Study

Author: Enrique Gutiérrez-González, Adela Castelló, Pablo Fernández-Navarro, Gemma Castaño-Vinyals, Javier Llorca, Dolores Salas-Trejo, Inmaculada Salcedo-Bellido, Nuria Aragonés, Guillermo Fernández-Tardón, Juan Alguacil, Esther Gracia-Lavedan, Esther García-Esquinas, Inés Gómez-Acebo, Pilar Amiano, Dora Romaguera, Manolis Kogevinas, Marina Pollán, and Beatriz Pérez-Gómez
Subjects: dietary zinc, prostate cancer, diet, genetic susceptibility, Nutrition. Foods and food supply, TX341-641
Abstract: Zinc is a key trace element in normal prostate cell metabolism, and is decreased in neoplastic cells. However, the association between dietary zinc and prostate cancer (PC) in epidemiologic studies is a conflicting one. Our aim was to explore this association in an MCC-Spain case-control study, considering tumor aggressiveness and extension, as well as genetic susceptibility to PC. 733 incident cases and 1228 population-based controls were included for this study. Dietary zinc was assessed using a food frequency questionnaire, and genetic susceptibility was assessed with a single nucleotide polymorphisms (SNP)-based polygenic risk score (PRS). The association between zinc intake and PC was evaluated with mixed logistic and multinomial regression models. They showed an increased risk of PC in those with higher intake of zinc (Odds Ratio (OR) tertile 3vs1: 1.39; 95% Confidence interval (CI):1.00⁻1.95). This association was mainly observed in low grade PC (Gleason = 6 RRR tertile 3vs1: 1.76; 95% CI:1.18⁻2.63) as well as in localized tumors (cT1-cT2a RRR tertile 3vs1: 1.40; 95% CI:1.00⁻1.95) and among those with higher PRS (OR tertile 3vs1: 1.50; 95% CI:0.89⁻2.53). In conclusion, a higher dietary zinc intake could increase the risk of low grade and localized tumors. Men with higher genetic susceptibility might also have a higher risk of PC associated with this nutrient intake.
Published: 2018
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12. S02-1 Physical activity and sedentary behaviour of children aged 6-9 in Europe: an analysis within the Childhood Obesity Surveillance Initiative (COSI)

Author: Stephen Whiting, Marta Buoncristiano, Peter Gelius, Karim Abu-Omar, Mary Pattison, Jolanda Hyska, Vesselka Duleva, Sanja Musić Milanović, Hana Zamrazilová, Tatjana Hejgaard, Mette Rasmussen, Eha Nurk, Lela Shengelia, Cecily C Kelleher, Mirjam M Heinen, Angela Spinelli, Paola Nardone, Akbota Abildina, Shynar Abdrakhmanova, Gulmira Aitmurzaeva, Zhamyila Usuopva, Iveta Pudule, Aušra Petrauskiene, Victoria Farrugia Sant’ Angelo, Enisa Kujundzic, Stevo Popovic, Anne-Siri Fismen, Ingunn Holden Bergh, Anna Fijalkowska, Ana Isabel Rito, Alexandra Cucu, Lacramioara Aurelia Brinduse, Valentina Peterkova, Andrea Gualtieri, Marta García-Solano, Enrique Gutiérrez-González, Zulfinissio Abdurrahmonova, Khadichamo Boymatova, Nazan Yardim, Maya Tanrygulyyeva, Daniel Weghuber, Karin Schindler, Dragana Stojisavljević, Aida Filipović Hadžiomeragić, Eliza Markidou Ionnaidu, Wolfgang Ahrens, Maria Hassapidou, Viktoria Anna Kovacs, Sergej M Ostojic, Lubica Ticha, Gregor Starc, Kenisha Russell Jonsson, Igor Spiroski, Harry Rutter, Romeu Mendes, Julianne Williams, Ivo Rakovac, and João Breda
Subjects: Public Health, Environmental and Occupational Health
Abstract: Background Children are becoming less physically active for a variety of interrelated reasons. The availability of opportunities for safe active playgrounds, recreational activities and active transport has decreased, while time spend on sedentary screen-based activities has increased. This study aimed to evaluate physical activity (PA), sedentary and sleep behaviours of children aged 6-9 years in Europe using data from the WHO Childhood Obesity Surveillance Initiative (COSI). Methods The fourth COSI data collection round was conducted in 36 countries from 2015-2018 using a standardized protocol including a family form completed by parents with specific questions about diet and physical activity-related behaviours. Results Nationally representative data from the 24 countries, who filled in the non-mandatory family record form, were included. Information on PA, screen-time and sleep behaviours of 137,807 children were analysed. Pooled analysis showed that: one in two children walked or cycled to school every day; one in two children were members of a sport or dancing club; around 40 % of children spent at least two hours per day watching TV or using electronic devices; around four in five children were actively or vigorously playing each day; around 88 % of children slept for at least nine hours per night. Country specific analyses showed pronounced differences in prevalence estimates between countries. Conclusions While the severity of the problem varies between countries, physical inactivity and sedentary behaviours are common across the European Region. Policy makers across the Region must do more in order to increase opportunities for young people to participate in daily activities. Furthermore, they should explore solutions to reduce the amount of time spend on sedentary activities, in order to halt the rise in overweight and obesity.
Published: 2022

13. S02-2 Socioeconomic determinants of physical activity, sleep and screen time among children aged 6-9 years of age in Europe

Author: Sanja Music Milanovic, Marta Buoncristiano, Helena Križan, Giulia Rathmes, Julianne Williams, Jolanda Hyska, Vesselka Duleva, Hana Zamrazilová, Tatjana Hejgaard, Maja Bæksgaard Jørgensen, Benoît Salanave, Lela Shengelia, Cecily C Kelleher, Angela Spinelli, Paola Nardone, Shynar Abdrakhmanova, Zhamilya Usupova, Iveta Pudule, Ausra Petrauskiene, Victoria Farrugia Sant'Angelo, Enisa Kujundžic, Anna Fijałkowska, Ana Isabel Rito, Alexandra Cucu, Lacramioara Aurelia Brinduse, Valentina Peterkova, Andrea Gualtieri, Marta García-Solano, Enrique Gutiérrez-González, Khadichamo Boymatova, Mahmut S Yardim, Maya Tanrygulyyeva, Marina Melkumova, Daniel Weghuber, Eha Nurk, Päivi Mäki, Ingunn Holden Bergh, Sergej M Ostojic, Kenisha Russell Jonsson, Igor Spiroski, Harry Rutter, Wolfgang Ahrens, Ivo Rakovac, Stephen Whiting, and João Breda
Subjects: Public Health, Environmental and Occupational Health
Abstract: Background Physical activity is key for preventing obesity and development of noncommunicable diseases later in life. Previous research suggests that socioeconomic factors, such as parental education or income, may influence a child’s risk of obesity. However, previous research on this has provided heterogeneity in results. Our aim was to investigate the socioeconomic disparities between physical activity, sedentary behaviour and sleep patterns in school-aged children aged 6 to 9 years in 24 European countries, using a large nationally-representative sample of children from 24 countries (Albania, Bulgaria, Croatia, Czechia, Denmark, France, Georgia, Ireland, Italy, Kazakhstan, Kyrgyzstan, Lithuania, Latvia, Malta, Montenegro, Poland, Portugal, Romania, Russian Federation – only Moscow, San Marino Republic, Spain, Tajikistan, Türkiye and Turkmenistan). Methods COSI collected information on physical activity patterns of children, sedentary behaviour and sleep duration through a questionnaire filled by parents. Among these, the paper focused on the following behaviours: Transportation to and from schools, Time spent on practising sports, Time spent on actively/vigorously playing, Time spent watching TV or using electronic devices and Hours of sleep per night. For the paper purpose, countries were grouped in 4 macro-regions according to United Nations “Standard Country or Area Codes for Statistical Use”. Results Findings indicated that a high prevalence of motorized school transport among children of employed parents in Southern Europe. The highest prevalence of insufficient sports and active play was among families from West-Central Asia who meet the end of the month with troubles, the highest prevalence of excessive screen time is among families from Eastern Europe, where both parents have a low level of education and the highest prevalence of insufficient sleep is among families from West-Central Asia where both parents have a high level of education. Conclusions There are important differences in the socioeconomic determinants of PA, sleep and screen related behaviours both between countries and sub-regions across the WHO European Region. This analysis of results from the COSI survey provides important insights that can help guide policy makers to take action to address the childhood obesity epidemic.
Published: 2022

14. Situación ponderal de la población escolar de 6 a 9 años en España: resultados del estudio ALADINO 2015

Author: Marta García-Solano, María José Yusta-Boyo, Napoleón Pérez-Farinós, Carmen Villar-Villalba, Enrique Gutiérrez-González, Teresa Robledo de Dios, Ana M. López-Sobaler, and María Ángeles Dal Re Saavedra
Subjects: 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Pediatrics, Perinatology and Child Health
Abstract: Resumen Introduccion El sobrepeso y la obesidad en la infancia y en la adolescencia han crecido alarmantemente en las ultimas decadas en muchos paises de Europa, incluido Espana. Este estudio presenta las prevalencias de sobrepeso y obesidad en escolares de 6 a 9 anos en 2015 y sus caracteristicas asociadas. Metodologia ALADINO es un estudio transversal de una muestra representativa de escolares de 6 a 9 anos en Espana, alineado con la iniciativa COSI de la OMS. Se tallo y peso a los participantes, definiendo la situacion ponderal segun los estandares de la OMS, y se paso un cuestionario a los progenitores sobre el estilo de vida y las caracteristicas sociodemograficas. Resultados Se tomaron medidas antropometricas a 10.899 escolares de 168 centros de educacion 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 mas prevalente en ninos y el sobrepeso en ninas. 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 disminuyo un 3,2% respecto a 2011, principalmente por la disminucion del sobrepeso en ninos, mientras que la obesidad permanecio estable. El exceso de peso era mas prevalente en los escolares de familias con menor nivel socioeconomico. Conclusiones La prevalencia de exceso de peso entre los escolares de 6 a 9 anos en Espana ha disminuido un 3,2% desde 2011 por la disminucion del sobrepeso, mientras que la obesidad permanece estable. Se debe intervenir en el entorno obesogenico, promocionando habitos alimentarios saludables y la actividad fisica, incidiendo en las desigualdades en salud.
Published: 2021

15. Weight status in the 6 to 9 year-old school population in Spain: Results of the ALADINO 2015 study

Author: Carmen Villar-Villalba, Ana M. López-Sobaler, Enrique Gutiérrez-González, Teresa Robledo de Dios, María Ángeles Dal Re Saavedra, María José Yusta-Boyo, Napoleón Pérez-Farinós, and Marta García-Solano
Subjects: Male, Pediatric Obesity, Adolescent, Population, España, Obesidad, Overweight, Índice de masa corporal, Pediatrics, Childhood obesity, RJ1-570, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Management of Technology and Innovation, medicine, Humans, education, Child, Socioeconomic status, Abdominal obesity, education.field_of_study, Schools, business.industry, Anthropometry, medicine.disease, Obesity, Cross-Sectional Studies, Spain, Sobrepeso, Escolares, Female, medicine.symptom, business, Prevalencia, Body mass index, Demography
Abstract: 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.
Published: 2021

16. Socioeconomic differences in food habits among 6- to 9-year-old children from 23 countries—WHO European Childhood Obesity Surveillance Initiative (COSI 2015/2017)

Author: Anne‐Siri Fismen, Marta Buoncristiano, Julianne Williams, Arnfinn Helleve, Shynar Abdrakhmanova, Márta Bakacs, Ingunn Holden Bergh, Khadichamo Boymatova, Vesselka Duleva, Anna Fijałkowska, Marta García‐Solano, Andrea Gualtieri, Enrique Gutiérrez‐González, Tatjana Hejgaard, Constanta Huidumac‐Petrescu, Jolanda Hyska, Cecily C. Kelleher, Lene Kierkegaard, Enisa Kujundžić, Marie Kunešová, Sanja Musić Milanović, Paola Nardone, Eha Nurk, Sergej M. Ostojic, Lütfiye Hilal Ozcebe, Valentina Peterkova, Ausra Petrauskiene, Iveta Pudule, Sanavbar Rakhmatulleoeva, Ivo Rakovac, Ana Isabel Rito, Harry Rutter, Elena Sacchini, Dragana Stojisavljević, Victoria Farrugia Sant'Angelo, Lela Shengelia, Angela Spinelli, Igor Spiroski, Maya Tanrygulyyeva, Zhamilya Usupova, Daniel Weghuber, and João Breda
Subjects: Parents, medicine.medical_specialty, Pediatric Obesity, Endocrinology, Diabetes and Metabolism, Psychological intervention, Food habits, 030209 endocrinology & metabolism, food habits, World Health Organization, Saúde Pública, Childhood obesity, 03 medical and health sciences, 0302 clinical medicine, Childhood Obesity Surveillance Initiative, children, Environmental health, Surveys and Questionnaires, medicine, Humans, Social inequality, 030212 general & internal medicine, Child, Socioeconomic status, Socioeconomic differences, food haits, social inequalities, socioeconomic differences, 2. Zero hunger, Consumption (economics), Portugal, Public health, 1. No poverty, Public Health, Environmental and Occupational Health, Feeding Behavior, medicine.disease, 3. Good health, Diet, Europe, Cross-Sectional Studies, Socioeconomic Factors, COSI, Psychology, Estilos de Vida e Impacto na Saúde
Abstract: Background: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. Methods: The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. Results: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. Conclusion: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets. The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding from Albania: WHO through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry of Health, National Center of Public Health and Analyses, WHO Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe; Czechia: Ministry of Health of the Czech Republic, grant nr. AZV MZČR 17-31670 A and MZČ–VO EÚ 00023761; Denmark: Danish Ministry of Health; Georgia: WHO; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Kazakhstan: Ministry of Health of the Republic of Kazakhstan and WHO Country Office; Kyrgyzstan: World Health Organization; Latvia: Ministry of Health, Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO; Malta: Ministry of Health; Montenegro: WHO and Institute of Public Health of Montenegro; Norway: Ministry of Health and Norwegian Institute of Public Health; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Romania: Ministry of Health; Russian Federation: WHO; San Marino: Health Ministry, Educational Ministry; Serbia: This study was supported by the World Health Organization (Ref. File 2015-540940); Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection; Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health; Turkey: Turkish Ministry of Health and World Bank. The CO-CREATE project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 774210. info:eu-repo/semantics/publishedVersion
Published: 2021

17. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. Tulloch-Reid, Seppo Koskinen, James E. Bennett, Marcela González-Gross, Virginija Dulskiene, Idris Guessous, Assembekov Batyrbek, Kamarul Imran Musa, Jeannette Lee, Josep Redon, Bihungum Bista, Luisa M Macieira, Johan Sundström, Andres Metspalu, Lariane M Ono, Flora A. Ukoli, Salar Rahimikazerooni, Andrea Gualtieri, Trevor S. Ferguson, Félicité Tchibindat, Eliza Cinteza, Ha Tp Do, Tajana Zeljkovic Vrkic, Tuyen D Le, Alison J. Hayes, Abdul Basit, Chandini Nekkantti, Teresa Norat, Eunice Ugel, Gulmira Aitmurzaeva, Mariachiara Di Cesare, Abdul Hamid Zargar, Vincenzo Solfrizzi, Garry L. Jennings, Aline Meirhaeghe, Kaare Christensen, Päivi Mäki, Xu Lin, Ali Esmaeili, Joanna Baran, Aneta Grajda, Renata Cifkova, Alexandre C. Pereira, Martin Bobak, Iuliia A Rusakova, Keiu Nelis, Damian K Francis, Guansheng Ma, Axel C. Carlsson, Alejandro Diaz, Alireza Ansari-Moghaddam, N Capkova, Zumin Shi, Maria Turley, Imelda A. Agdeppa, Helena I. S. Nogueira, Marcia Scazufca, Katharina Maruszczak, Natascia Rinaldo, Paulo A. Lotufo, Nuno Lunet, Thor Aspelund, Caroline H.D. Fall, Antonio Cabrera de León, Ahmad Faudzi Yusoff, Holger Theobald, Beatriz D'Agord Schaan, Pedro Marques-Vidal, William A. Neal, Mihai Gafencu, Tandi E. Matsha, Ana B. Crujeiras, Ahmad Reza Dorosty, Alain Morejon, Weili Yan, Dominique Hange, Bekbolat Zholdin, Frédéric Gottrand, Jorge Mota, Jana Námešná, Stevo Popovic, Louise Eriksen, Line Lund Kårhus, Cihangir Erem, Juergen Breckenkamp, Mathilde Kersting, Yi Song, Martin McKee, Aleksandra Gomula, Rafaela Rosário, Enzo Manzato, S. Goya Wannamethee, Sounnia Mediene Benchekor, Azim Nejatizadeh, Krishna Kumar Aryal, Juan P. González-Rivas, Vedrana Sember, Stephen T. McGarvey, Jukka T. Salonen, Patrick Pasquet, Patricia Varona-Pérez, Amelia C. Crampin, Ramin Heshmat, Violeta Iotova, Juvenal Soares Dias-da-Costa, Oye Gureje, Aletta E. Schutte, João Luiz Bastos, Anelise Reis Gaya, Konrad Jamrozik, Dalia Luksiene, Amina Barkat, Maria Paula Santos, José Camolas, Azli Baharudin, Diego Vanuzzo, Doris Stöckl, Rosalynn Siantar, Jouko Saramies, Albertino Damasceno, Davood Khalili, Simona Bo, Martina Müller-Nurasyid, Dominique Cottel, Markku Peltonen, Fikru Tullu, Ana Isabel Rito, Angélica Ochoa-Avilés, Annette J. Dobson, Christopher T. Cowell, Charumathi Sabanayagam, Rildo de Souza Wanderley Júnior, Oanh T. H. Trinh, Farahnaz Joukar, Mostafa K. Mohamed, Mostafa Qorbani, Jeongseon Kim, Helmut Schröder, Machi Suka, Natasja M. van Schoor, Jussi Kauhanen, Teresa Haugsgjerd, Goodarz Danaei, M. Fernanda Lima-Costa, Yong Tao, Elisabetta L. Romeo, Grazyna Jasienska, Victor Guillermo Sequera, Kazem Mohammad, Yanina Zócalo, Fernanda Cunha Soares, Jianfeng Wu, Mohammad Esmaeel Motlagh, María Elena Díaz-Sánchez, Monika Zuziak, Eldridge Ferrer, Anette Varbo, Leila Beltrami Moreira, Jeremy M. 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Mini, Viktoria Anna Kovacs, Rosemarie Martin, Nahla Hwalla, Wei Zheng, Hoang Van Minh, Edward D Janus, Laetitia Huiart, Farhad Pourfarzi, Sudha Ramachandra Rao, Fred Paccaud, Marcia Makdisse, Aye Aye Sein, Enrique Gutiérrez-González, Yang Yang, Anneke Blokstra, Henrike Galenkamp, Jaume Marrugat, Nazan Yardim, Wan Nazaimoon Wan Mohamud, Jesús Ibarluzea, Julio Zuñiga Cisneros, Laura Lauria, Argyro Karakosta, Dragana P Jovic, Jun Hata, Elio Riboli, Piotr Bandosz, Xun Tang, Parvina Mukhtorova, Jean Dallongeville, Jean-Bernard Ruidavets, Anne Tjønneland, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Aleksandra Piwońska, Dusan Grafnetter, Mette Rasmussen, Daniel Weghuber, Sherali Rakhmatulloev, Martine Vrijheid, Johann Willeit, Motahareh Kheradmand, Małgorzata Mossakowska, Lechaba Tshepo, Dongfeng Gu, Hyeon Chang Kim, Vilmundur Gudnason, Maria Forsner, Peter Bjerregaard, Leon A. Simons, Rachael McLean, Japhet Killewo, Ramón Suárez-Medina, Y Nikitin, Eng Joo Tan, Jean Claude Mbanya, Aroor Bhagyalaxmi, Renata Kuciene, Kairat Davletov, Jose Eugenio Lozano, Afshin Ostovar, Niloofar Peykari, Guy De Backer, Soheir H Ahmed, Nicholas J. Wareham, Sai Yin Ho, Constanta Huidumac Petrescu, Maria Hassapidou, Iris Pigeot, Myriam Galfo, Susana Cararo Confortin, Blanca Sandra Ruiz-Betancourt, W. M. Monique Verschuren, Catterina Ferreccio, Fabio Galvano, Leila Houti, Daniel Bia, Annika Rosengren, Marcin Rutkowski, Biruta Velika, Joana Araújo, Fernando Rigo, Angela Spinelli, Scott B. McLean, Shirin Djalalinia, Marie Kunešová, Boban Mugoša, Sania Nishtar, Mangesh S. Pednekar, Shahla AlDhukair, Helle-Mai Loit, Antonis Zampelas, Altan Onat, Maciej Banach, Shohreh Naderimagham, Hajer Aounallah-Skhiri, Maja Bæksgaard Jørgensen, Yin Guo, Ewelina Czenczek-Lewandowska, Parasmani Dasgupta, Elvis Oa Wambiya, Inge Huybrechts, Raimund Erbel, Jari Jokelainen, Ana P. Ortiz, Stefan Kiechl, Emmanuel Cohen, Caleb Ochimana, Shynar Abdrakhmanova, Laura Censi, Iqbal Bata, Geetha R Menon, Snehalatha Chamukuttan, Pedro Plans-Rubio, Domenico Palli, Ana Azevedo, Slawomir Koziel, Benoît Salanave, Parinaz Mehdipour, Shu Ti Chiou, Lela Sturua, Lubica Ticha, Felipe Vogt Cureau, Jin Soo Moon, Ming-Hui Zhao, Urho M. Kujala, Nathalie Michels, Ertugrul Celikcan, Jaakko Tuomilehto, Judith Benedics, Tobias F. Rinke de Wit, Agnès Le Port, Reza Homayounfar, Andrea Rodriguez-Martinez, Tai Hing Lam, Yn-Tz Sung, Jürgen König, Kodavanti Mallikharjuna Rao, Hazzaa M. Al-Hazzaa, Karen Morgan, Bogdan Wojtyniak, Cynthia M. Pérez, Ilse Khouw, Manoli Garcia-de-la-Hera, Dong Wook Shin, Genc Burazeri, Ausra Petrauskiene, Charles Sossa Jérome, Kenisha Russell Jonsson, José Boggia, Daniela Galeone, Alice Bonilla-Vargas, Han Cg Kemper, Rahman Shiri, Stefaan Demarest, Else Karin Grøholt, San-Lin You, Adelheid Weber, Juha Auvinen, Aida Pilav, Sibel Gogen, Suzanne N Morin, Wan Mohamad Wan Bebakar, Viviane Cunha Cardoso, Kavumpurathu Raman Thankappan, Hana Zamrazilová, Frank Claessens, Karien Stronks, Helen Gonçalves, Tahir Aris, Luis Revilla, Sérgio Viana Peixoto, Zhamilya Battakova, Jing Liu, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Priscilla Duboz, Sandjaja, Tiina Laatikainen, Rafel Ramos, Sareh Eghtesad, Judith Simons, Orn Olafsson, E. Shyong Tai, Louise A. Baur, Nihal Thomas, Aung Soe Htet, Bente Sparboe-Nilsen, Paul Elliott, Soon-Woo Park, Angel R. 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Eriksson, Margarita Samoutian, Andreia N. Pizarro, Mohammed Rasoul Tarawneh, Jean Woo, Kaspar Staub, Maria Teresa Menzano, Mojtaba Farjam, Adroaldo Cesar Araujo Gaya, Mohammad El-khateeb, Zulfiqar A Bhutta, Mukharram M. Bikbov, Hsien-Ho Lin, Oscar Noboa, Thomas Waldhör, Garry Brian, Simona Costanzo, Frank Tanser, Nor Azwany Yaacob, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ioannis Pagkalos, Ivan Pećin, Carlo M. Barbagallo, Abla M. Sibai, Yuna He, Matsuda Fumihiko, Bharathi Viswanathan, Ali Reza Safarpour, Wei Cheng Lo, Abdullatif Husseini, Jiang He, Liv Elin Torheim, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Davide Noto, Panayiotis K. Yiallouros, Kelias P. Msyamboza, William R. Tebar, Yingfeng Zheng, Eha Nurk, Bhawesh Koirala, Ana Jelakovic, Suhad Bahijri, Freja B Kampmann, Qi Sheng You, Marika Ferrari, María-Elena González-Villalpando, Aline Wagner, Olfa Saidi, Anwar Batieha, Eduardo Capuano, Coimbatore Subramaniam Shanthirani, Dong Wook Kim, Albina A Fakhretdinova, Tom Wilsgaard, Maria Avdicova, Moesijanti Soekatri, Chiara Donfrancesco, Salim Mohanna, Paola Russo, Uruwan Yamborisut, Rafael dos Santos Henrique, Martin Nankap, Allan Linneberg, Khairil Si-Ramlee, Kirsten Mehlig, Christina Mavrogianni, Raluca Pop, Lèlita Santos, Graziella Bruno, Valentina Peterkova, Iná S. Santos, Georg Lappas, Alberto Palloni, Malay K. Mridha, Andrzej Pajak, Marta García-Solano, Stefaan De Henauw, Daniel Ferrante, Rute Santos, Anders Grøntved, Lucjan Szponar, Mihaela Vladulescu, Chien-An Sun, Jan A. Staessen, Paula Duarte de Oliveira, Norazizah Ibrahim Wong, Maria Nordendahl, Elaine M. Dennison, Jeonghee Lee, Diego Salmerón, Ida Maria Schmidt, Gao Pei, Noushin Mohammadifard, Igor Spiroski, Fernando Rodríguez-Artalejo, Xu Ma, Elin Pettersen Sørgjerd, Valéria Regecová, Cláudia S. Minderico, Johanna A. Otero, Jamila Abubakar Garba, Vesselka Duleva, Rui Ornelas, Ilpo Huhtaniemi, Cesar G. Victora, Lijuan Liu, Rody G. Sy, Mahmood Moosazadeh, Ali Ahmadi, Antonio Pedro Graça, Natalia Nowak-Szczepanska, Miao Li Chee, Michael Sjöström, Charles Agyemang, Shiqi Zhen, Xiu-Hua Guo, Pawel Kurjata, Jardena J. Puder, Mehrdad Azmin, Neil Murphy, Kaosar Afsana, Alireza Sadjadi, Johanna M. Geleijnse, Prashant Mathur, Elysée Claude Bika Lele, Raphael Mendes Ritti-Dias, Yannis Manios, Majid Shirani, Rosemary B. Duda, Liis Nelis, Jurate Klumbiene, Zhengming Chen, Wichai Aekplakorn, Alun Evans, Andrzej Wiecek, Lars Lind, Denise Eldemire-Shearer, Bernardo L. Horta, Macia Enguerran, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Kumiko Ohara, Ursula Kiechl-Kohlendorfer, Hermann Brenner, Przemyslaw Slusarczyk, Espen Bjertness, Jutta Stieber, Augusto Di Castelnuovo, Joel G. R. Roy, Aryeh D. Stein, Ruth Frikke-Schmidt, Vera Musil, Amaneh Shayanrad, Marcel Goldberg, Ramon O. Jimenez, Mohammad Reza Fattahi, Jolanda Hyska, Amir Houshang Mehrparvar, Elin Kolle, Mohamed Bamoshmoosh, Michelle Holdsworth, Felipe F. Casanueva, Børge G. Nordestgaard, Niels Wedderkopp, Eva Corpeleijn, Elias F. Gudmundsson, Antonio Mistretta, Daniel Lemogoum, Larissa Pruner Marques, Slavica Sović, Olli T. Raitakari, Marco Aurélio Peres, Alexandra Cucu, Gregorio Varela-Moreiras, Janine Clarke, Andrea Gazzinelli, Mieczysław Litwin, Sara Schramm, Xenophon Theodoridis, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Dimitrios Papandreou, Peter T. Katzmarzyk, Benjamin Acosta-Cazares, Ben Schöttker, Prabhdeep Kaur, Norlaila Mustafa, Shariq Rashid Masoodi, Sadaf G. Sepanlou, Adolfo Rubinstein, Francis Delpeuch, Julianne Williams, Abbas Dehghan, Leanne M. Riley, Heloisa Bettiol, Gabriele Nagel, Ellisiv B. Mathiesen, Ekaterina Stoyanova, Alisha N. Wade, Zhamyila Usupova, Arnaud Chiolero, Oonagh Markey, Jacqueline Ramke, Elena Bogova, Niveen M E Abu-Rmeileh, Nguyen D Nguyen, Tomasz Zdrojewski, Marjo-Riitta Järvelin, Jose Sanchez-Abanto, Rômulo Araújo Fernandes, Lourdes Ribas-Barba, Nalan Uysal, Mohamad Hasnan Ahmad, Krista Fischer, Maria Wany Louzada Strufaldi, Ramiro Guerrero, Farnam Mohebi, Tran Quoc Bao, Flávio Danni Fuchs, Salim Berkinbayev, Enisa Kujundzic, Sari Voutilainen, Farzad Hadaegh, Robert Lundqvist, Saeid Safiri, Iraj Mohebbi, George Luiz Lins Machado-Coelho, Annette Peters, Gonzalo Valdivia, Magdalena Korzycka, Rajiv T Erasmus, Masanori Iwasaki, Charmaine A. Duante, Sheikh Mohammed Shariful Islam, Quang Ngoc La, Ricky Eddie, Petra Rust, Daniela Rodrigues, Dirk De Bacquer, Karen Sparrenberger, Agneta Sjöberg, Thet Thet Mu, Katarzyna Dereń, Cora L. Craig, Jorge Motta, Janina Petkeviciene, Boyd Swinburn, Paibul Suriyawongpaisal, Visnja Djordjic, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Daan Kromhout, Marius B. Bjertness, Stefano Marventano, Juel Jarani, Alireza Khosravi, Eva Martos, David De Ridder, Lizzy M. Brewster, Nico Dragano, Liam Smeeth, Kenji Shibuya, Emma Ruiz Moreno, Hashem Jaddou, Grzegorz Sobek, Dimitrios Trichopoulos, Marvin Cervantes-Loaiza, Abu Am Hanif, Elaine M. Murtagh, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Kyungwon Oh, Heiner Boeing, Regina Heidinger-Felso, André Luiz Sena Guimarães, Balkish M. Naidu, Avula Laxmaiah, Ana M. B. Menezes, Marie Eliasen, Francesco Pistelli, Yuan He, Dusko Bjelica, José A. Casajús, Guang Ning, Lutgart Braeckman, Dirk Vanderschueren, Jochanan Stessman, Ivana Radic, Yi Zeng, Hans Concin, Damaskini Valvi, Sari Hantunen, Catherine Kyobutungi, Diego Augusto Santos Silva, Wenhua Zhao, Sok King Ong, Anne W. Taylor, Iraj Nabipour, Justyna Godos, Cyrus Cooper, Mattias Johansson, Samuel C. Dumith, Magdalena Muc, Sabine Schipf, Idowu O Senbanjo, Jim Mann, Rajaa Al-Raddadi, Yih Chung Tham, Kay-Tee Khaw, Joseph Cacciottolo, Ana Henriques, Sahar Saeedi Moghaddam, Reza Mohammadpourhodki, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Camilla T. Damsgaard, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Constance Schultsz, Santiago F. Gomez, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Pierre Traissac, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Eleonora d'Orsi, Irene G. M. van Valkengoed, Anna Fijałkowska, Wen-Harn Pan, Gregor Starc, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Abdullah Alkandari, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Saeed Dastgiri, Lien Braeckevelt, Nasheeta Peer, Radka Taxová Braunerová, Mohamed M. Ali, Steiner Krokstad, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Silvana Donoso, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paola Nardone, Alberto Barceló, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Miquel Porta, Vesna Jureša, Alexander D. Deev, David Faeh, Antonio Bernabe-Ortiz, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Anjani Kumar Jha, Thamara Hubler Figueiró, Jana Kratenova, Claudia M. Hormiga, Maria Tsigga, Zivka Dika, Indrapal I. Meshram, Ei Ei K. Nang, Ian Rouse, Rusidah Selamat, Paul Korrovits, Grethe S. Tell, Julie Taylor, Anabela Mota-Pinto, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Frank J Rühli, Shelly R. McFarlane, Sara Santos Sanz, Edyta Łuszczki, Maria G. Stathopoulou, Tara Coppinger, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. Fuchs, Muhammad Islam, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Maria Ruiz-Castell, Daniela Pierannunzio, Cristina Taddei, Gowri Mahasampath, Gustavo Velasquez-Melendez, Hanna Tolonen, Sudhir Kowlessur, Bagher Larijani, Laura Torres-Collado, Susi Kriemler, Ali Akbar Shayesteh, Cynthia Robitaille, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Line Tang Møllehave, Vincent Jr DeGennaro, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Kodanda R Kanala, Gert B. M. Mensink, Abhijit Sen, Sergej M. Ostojic, Hanan F. Abdul Rahim, Hélène Delisle, Francisco J. Félix-Redondo, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Bethlehem D. Solomon, Erik Lykke Mortensen, Nikhil D. Patel, Reynaldo Martorell, Ching-Yu Cheng, Stine Schramm, Hana Shimizu-Furusawa, Jacek Jóźwiak, Radwan Qasrawi, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Son Thai Pham, Simona Giampaoli, Dong Zhao, Indah Suci Widyahening, Merete Osler, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, Giota Touloumi, Janice Luisa Lukrafka, Adela Chirita-Emandi, Maryam Kavousi, Sanja Musić Milanović, Jean-Michel Gaspoz, Jalila El Ati, Sauli Herrala, Liang Xu, Pilar Guallar-Castillón, Bee Koon Poh, Luis Serra-Majem, Jonathan E. Shaw, Belong Cho, Daphne Mirkopoulou, Salvador Villalpando, Yuki Fujita, Tiffany K. Gill, Nish Chaturvedi, Erkin M. Mirrakhimov, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Deepak Amarapurkar, Deepa Weerasekera, Diana A. Santos, Marjeta Majer, Herman Schargrodsky, Bruna Gonçalves Cordeiro da Silva, Ebrahim Eftekhar, Jesús Vioque, Marisa K. Sophiea, Teresa Shamah-Levy, María Dolores Chirlaque, Mohd Azahadi Omar, Stefan Söderberg, Isabel O. Oliveira, Joanne Katz, Xingwang Ye, Christophe Tzourio, Marie Zins, Aneta Weres, Ulrich Keil, Haiquan Xu, Akihiro Yoshihara, Rachel Dankner, Gabriella Gruden, Maroje Sorić, Hanspeter Stamm, Kim Overvad, Yanping Li, Carsten Oliver Schmidt, Christa L. Lilly, Veikko Salomaa, Gilad Twig, Senthil K Vasan, Qian Wang, Liufu Cui, Andrzej Galbarczyk, Sylvain Sebert, Wilma M. Hopman, Karl-Heinz Jöckel, Ari Voutilainen, Peter Schnohr, Jerzy Chudek, Katia Vergetti Bloch, Vincenzo Capuano, Jyh Eiin Wong, Torben Jørgensen, Anja Schienkiewitz, Nader Saki, Carolina Tarqui-Mamani, Maria Cecília Formoso Assunção, Kazi M. Jamil, Juraci Almeida Cesar, Pedro J Ortiz, Delphine De Smedt, Luciana Zaccagni, Lynne M. Boddy, Jie Hao, David Alejandro González-Chica, Romana Roccaldo, Sara Magnacca, Peter Stehle, Victoria Farrugia Sant'Angelo, Gry Skodje, Maryam Keramati, Tabara Yasuharu, Ali Ghanbari, Gyulli M. Kazakbaeva, Takuro Furusawa, Felicia Cañete, Kari Kuulasmaa, Justina Vaitkeviciute, (NCD-RisC), NCD Risk Factor Collaboration, Imperial College London, Harvard T.H. Chan School of Public Health, Middlesex University [London], Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Montpellier Interdisciplinary center on Sustainable Agri-food systems (Social and nutritional sciences) (UMR MoISA), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Wellcome TrustEuropean Commission, Clinical Developmental Psychology, APH - Mental Health, Sociology, The Social Context of Aging (SoCA), Nutrition and Health, Iurilli, Maria LC [0000-0003-0409-1635], Zhou, Bin [0000-0002-1741-8628], Ezzati, Majid [0000-0002-2109-8081], Apollo - University of Cambridge Repository, Epidemiology and Data Science, APH - Aging & Later Life, APH - Societal Participation & Health, Public and occupational health, APH - Health Behaviors & Chronic Diseases, VU University medical center, APH 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Ltd, Orebro University, University of London, Universitas Indonesia, Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs, Children’s Hospital of Fudan University, University of Cyprus, Niigata University, International Medical University, Iran University of Medical Sciences, Center for Diabetes and Endocrine Care, Peking University First Hospital, Jiangsu Provincial Center for Disease Control and Prevention, Sun Yat-sen University, West Kazakhstan Medical University, Inner Mongolia Medical University, University of Ghana, Maria Lc Iurilli , Bin Zhou , James E Bennett , Rodrigo M Carrillo-Larco , Marisa K Sophiea , Andrea Rodriguez-Martinez , Honor Bixby , Bethlehem D Solomon , Cristina Taddei , Goodarz Danaei , Mariachiara Di Cesare , Gretchen A Stevens , Leanne M Riley , Stefan Savin , Melanie J Cowan , Pascal Bovet , Albertino Damasceno , Adela Chirita-Emandi , Alison J Hayes , Nayu Ikeda , Rod T Jackson , Young-Ho Khang , Avula Laxmaiah , Jing 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Chiara Donfrancesco , Silvana P Donoso , Angela Döring , Maria Dorobantu , Ahmad Reza Dorosty , Kouamelan Doua , Nico Dragano , Wojciech Drygas , Jia Li Duan , Charmaine A Duante , Priscilla Duboz , Rosemary B Duda , Vesselka Duleva , Virginija Dulskiene , Samuel C Dumith , Anar Dushpanova , Vilnis Dzerve , Elzbieta Dziankowska-Zaborszczyk , Ricky Eddie , Ebrahim Eftekhar , Eruke E Egbagbe , Robert Eggertsen , Sareh Eghtesad , Gabriele Eiben , Ulf Ekelund , Mohammad El-Khateeb , Jalila El Ati , Denise Eldemire-Shearer , Marie Eliasen , Paul Elliott , Reina Engle-Stone , Macia Enguerran , Rajiv T Erasmus , Raimund Erbel , Cihangir Erem , Louise Eriksen , Johan G Eriksson , Jorge Escobedo-de la Peña , Saeid Eslami , Ali Esmaeili , Alun Evans , David Faeh , Albina A Fakhretdinova , Caroline H Fall , Elnaz Faramarzi , Mojtaba Farjam , Victoria Farrugia Sant'Angelo , Farshad Farzadfar , Mohammad Reza Fattahi , Asher Fawwad , Francisco J Felix-Redondo , Trevor S Ferguson , Romulo A Fernandes , Daniel Fernández-Bergés , Daniel Ferrante , Thomas Ferrao , Marika Ferrari , Marco M Ferrario , Catterina Ferreccio , Eldridge Ferrer , Jean Ferrieres , Thamara Hubler Figueiró , Anna Fijalkowska , Günther Fink , Krista Fischer , Leng Huat Foo , Maria Forsner , Heba M Fouad , Damian K Francis , Maria do Carmo Franco , Ruth Frikke-Schmidt , Guillermo Frontera , Flavio D Fuchs , Sandra C Fuchs , Isti I Fujiati , Yuki Fujita , Matsuda Fumihiko , Takuro Furusawa , Zbigniew Gaciong , Mihai Gafencu , Andrzej Galbarczyk , Henrike Galenkamp , Daniela Galeone , Myriam Galfo , Fabio Galvano , Jingli Gao , Manoli Garcia-de-la-Hera , Marta García-Solano , Dickman Gareta , Sarah P Garnett , Jean-Michel Gaspoz , Magda Gasull , Adroaldo Cesar Araujo Gaya , Anelise Reis Gaya , Andrea Gazzinelli , Ulrike Gehring , Harald Geiger , Johanna M Geleijnse , Ali Ghanbari , Erfan Ghasemi , Oana-Florentina Gheorghe-Fronea , Simona Giampaoli , Francesco Gianfagna , Tiffany K Gill , Jonathan Giovannelli , Glen 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, Zhanna Kalmatayeva , Ofra Kalter-Leibovici , Yves Kameli , Freja B Kampmann , Kodanda R Kanala , Srinivasan Kannan , Efthymios Kapantais , Argyro Karakosta , Line L Kårhus , Khem B Karki , Marzieh Katibeh , Joanne Katz , Peter T Katzmarzyk , Jussi Kauhanen , Prabhdeep Kaur , Maryam Kavousi , Gyulli M Kazakbaeva , Ulrich Keil , Lital Keinan Boker , Sirkka Keinänen-Kiukaanniemi , Roya Kelishadi , Cecily Kelleher , Han Cg Kemper , Andre P Kengne , Maryam Keramati , Alina Kerimkulova , Mathilde Kersting , Timothy Key , Yousef Saleh Khader , Davood Khalili , Kay-Tee Khaw , Bahareh Kheiri , Motahareh Kheradmand , Alireza Khosravi , Ilse Msl Khouw , Ursula Kiechl-Kohlendorfer , Stefan Kiechl , Japhet Killewo , Dong Wook Kim , Hyeon Chang Kim , Jeongseon Kim , Jenny M Kindblom , Heidi Klakk , Magdalena Klimek , Jeannette Klimont , Jurate Klumbiene , Michael Knoflach , Bhawesh Koirala , Elin Kolle , Patrick Kolsteren , Jürgen König , Raija Korpelainen , Paul Korrovits , Magdalena Korzycka , 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, Luxia Zhang , Zhen-Yu Zhang , Dong Zhao , Ming-Hui Zhao , Wenhua Zhao , Shiqi Zhen , Wei Zheng , Yingfeng Zheng , Bekbolat Zholdin , Maigeng Zhou , Dan Zhu , Marie Zins , Emanuel Zitt , Yanina Zocalo , Julio Zuñiga Cisneros , Monika Zuziak , Majid Ezzati , Sarah Filippi, Epidemiology, Iurilli, Maria LC, Zhou, Bin, Bennett, James E, Carrillo-Larco, Rodrigo M, Sophiea, Marisa K, Rodriguez-Martinez, Andrea, Bixby, Honor, Solomon, Bethlehem D, Taddei, Cristina, Danaei, Goodarz, Di Cesare, Mariachiara, Stevens, Gretchen A, Riley, Leanne M, Savin, Stefan, Cowan, Melanie J, Bovet, Pascal, Damasceno, Albertino, Chirita-Emandi, Adela, Hayes, Alison J, Ikeda, Nayu, Jackson, Rod T, Khang, Young-Ho, Laxmaiah, Avula, Liu, Jing, Miranda, J Jaime, Saidi, Olfa, Sebert, Sylvain, Sorić, Maroje, Starc, Gregor, Gregg, Edward W, Abarca-Gómez, Leandra, Abdeen, Ziad A, Abdrakhmanova, Shynar, Ghaffar, Suhaila Abdul, Rahim, Hanan F Abdul, Abu-Rmeileh, Niveen M, Garba, Jamila Abubakar, Acosta-Cazares, 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Poudyal, Anil, Poulimeneas, Dimitrio, Pouraram, Hamed, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J, Price, Jacqueline F, Providencia, Rui, Puder, Jardena J, Pudule, Iveta, Puhakka, Soile E, Puiu, Maria, Punab, Margu, Qasrawi, Radwan F, Qorbani, Mostafa, Bao, Tran Quoc, Radic, Ivana, Radisauskas, Ricarda, Rahimikazerooni, Salar, Rahman, Mahfuzar, Rahman, Mahmudur, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina, Rakhmatulloev, Sherali, Rakovac, Ivo, Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramke, Jacqueline, Ramos, Elisabete, Ramos, Rafel, Rampal, Lekhraj, Rampal, Sanjay, Rarra, Vayia, Rascon-Pacheco, Ramon A, Rasmussen, Mette, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M, Regecová, Valéria, Revilla, Lui, Rezaianzadeh, Abba, Ribas-Barba, Lourde, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, Rinaldo, Natascia, de Wit, Tobias F Rinke, Rito, Ana, Ritti-Dias, Raphael M, Rivera, Juan A, Robitaille, Cynthia, Roccaldo, Romana, Rodrigues, Daniela, Rodríguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, María, Rodríguez-Villamizar, Laura A, Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Rojroongwasinkul, Nipa, Romaguera, Dora, Romeo, Elisabetta L, Rosario, Rafaela V, Rosengren, Annika, Rouse, Ian, Roy, Joel GR, Rubinstein, Adolfo, Rühli, Frank J, Ruidavets, Jean-Bernard, Ruiz-Betancourt, Blanca Sandra, Ruiz-Castell, Maria, Moreno, Emma Ruiz, Rusakova, Iuliia A, Jonsson, Kenisha Russell, Russo, Paola, Rust, Petra, Rutkowski, Marcin, Sabanayagam, Charumathi, Sacchini, Elena, Sachdev, Harshpal S, Sadjadi, Alireza, Safarpour, Ali Reza, Safiri, Saeid, Saki, Nader, Salanave, Benoit, Martinez, Eduardo Salazar, Salmerón, Diego, Salomaa, Veikko, Salonen, Jukka T, Salvetti, Massimo, Samoutian, Margarita, Sánchez-Abanto, Jose, Sandjaja, null, Sans, Susana, Marina, Loreto Santa, Santos, Diana A, Santos, Ina S, Santos, Lèlita C, Santos, Maria Paula, Santos, Osvaldo, Santos, Rute, Sanz, Sara Santo, Saramies, Jouko L, Sardinha, Luis B, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savva, Savy, Mathilde, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D, Rosario, Angelika Schaffrath, Schargrodsky, Herman, Schienkiewitz, Anja, Schipf, Sabine, Schmidt, Carsten O, Schmidt, Ida Maria, Schnohr, Peter, Schöttker, Ben, Schramm, Sara, Schramm, Stine, Schröder, Helmut, Schultsz, Constance, Schutte, Aletta E, Sein, Aye Aye, Selamat, Rusidah, Sember, Vedrana, Sen, Abhijit, Senbanjo, Idowu O, Sepanlou, Sadaf G, Sequera, Victor, Serra-Majem, Lui, Servais, Jennifer, Ševcíková, Ludmila, Shalnova, Svetlana A, Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K, Shaw, Jonathan E, Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shengelia, Lela, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Subjects: Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed
Published: 2021

18. Childhood overweight and obesity in Europe: Changes from 2007 to 2017

Author: Marta Buoncristiano, Angela Spinelli, Julianne Williams, João Breda, Napoleón Pérez-Farinós, Aušra Petrauskienė, Marie Kunešová, Ana Isabel Rito, Knut-Inge Klepp, Paola Nardone, Marta García-Solano, Vesselka Duleva, Ivo Rakovac, Cecily Kelleher, Gregor Starc, Saion Chatterjee, Enrique Gutiérrez-González, Iveta Pudule, Else Karin Grøholt, and Maria Hassapidou
Subjects: Male, obesity, Pediatric Obesity, temporal trend, Endocrinology, Diabetes and Metabolism, prevalence, Psychological intervention, Overweight, World Health Organization, Childhood obesity, World health, Body Mass Index, Childhood Obesity Surveillance Initiative, children, Environmental health, Prevalence, medicine, Humans, Child, Schools, High prevalence, Portugal, business.industry, Public Health, Environmental and Occupational Health, medicine.disease, Obesity, Europe, Eastern european, Childhood Overweight, Female, COSI, medicine.symptom, business, Estilos de Vida e Impacto na Saúde
Abstract: The Childhood Obesity Surveillance Initiative (COSI) routinely measures height andweight of primary school children aged 6–9 years and calculates overweight andobesity prevalence within the World Health Organization (WHO) European Regionusing a standard methodology. This study examines the trends in the prevalence ofoverweight and obesity from the first round of COSI carried out in 2007/2008 to thelatest of 2015/2017 in 11 European countries in which data were collected for atleast three rounds. In total 303,155 children were measured. In general, the preva-lence of overweight and obesity among boys and girls decreased in countries withhigh prevalence (Southern Europe) and remained stable or slightly increased in North-ern European and Eastern European countries included in the analysis. Among boys, the highest decrease in overweight (including obesity) was observed in Portugal (from40.5% in 2007/2008 to 28.4 in 2015/2017) and in Greece for obesity (from 30.5% in2009/2010 to 21.7% in 2015/2017). Lithuania recorded the strongest increase in theproportion of boys with overweight (from 24.8% to 28.5%) and obesity (from 9.4% to12.2%). The trends were similar for boys and girls in most countries. Several countriesin Europe have successfully implemented policies and interventions to counteract theincrease of overweight and obesity, but there is still much to be done. The authors gratefully acknowledge support through a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. The Ministries of health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation provided financial support for the meetings at which the protocol, data collection procedures, and analyses were discussed. Data collection in the countries included in this study was made possible through funding from: Bulgaria: Ministry of Health, National Center of Public Health and Analyses, and WHO Regional Office for Europe; Czechia: WHO grants AZV MZČR 17-31670 A MZČR-RVO EÚ 00023761, World Health Organization Regional Office for Europe, and WHO country office; Greece: International Hellenic University and Hellenic Medical Association for Obesity; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Latvia: Ministry of Health and Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences, Lithuanian Science Council, and WHO; Norway: Ministry of Health and Norwegian Institute of Public Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates, and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Slovenia: Ministry of Education and Science and Sport of the Republic of Slovenia within the SLOfit surveillance system; and Spain: Spanish Agency for Food Safety and Nutrition (AESAN). info:eu-repo/semantics/publishedVersion
Published: 2021

19. Socioeconomic disparities in physical activity, sedentary behavior and sleep patterns among 6‐ to 9‐year‐old children from 24 countries in the WHO European region

Author: Giulia Rathmes, Julianne Williams, Sergej M. Ostojic, Eha Nurk, Mahmut S. Yardim, Igor Spiroski, Lela Shengelia, Shynar Abdrakhmanova, João Breda, Päivi Mäki, Vesselka Duleva, Maya Tanrygulyyeva, Khadichamo Boymatova, Angela Spinelli, Tatjana Hejgaard, Enrique Gutiérrez-González, Valentina Peterkova, Anna Fijałkowska, Paola Nardone, Marta Buoncristiano, Victoria Farrugia Sant'Angelo, Maja Bæksgaard Jørgensen, Ausra Petrauskiene, Ivo Rakovac, Jolanda Hyska, Wolfgang Ahrens, Sanja Musić Milanović, Ingunn Holden Bergh, Alexandra Cucu, Andrea Gualtieri, Enisa Kujundžić, Iveta Pudule, Harry Rutter, Lacramioara Aurelia Brinduse, Daniel Weghuber, Hana Zamrazilová, Cecily Kelleher, Kenisha Russell Jonsson, Helena Križan, Stephen Whiting, Ana Isabel Rito, Benoît Salanave, Marina Melkumova, Zhamilya Usupova, and Marta García-Solano
Subjects: Pediatric Obesity, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Physical activity, physical activity, Child Behavior, Saúde Pública, World Health Organization, Childhood obesity, Pediatric Obesity / epidemiology, Screen time, Childhood Obesity Surveillance Initiative, SDG 3 - Good Health and Well-being, sedentary behavior, medicine, Humans, Social inequality, Child, Exercise, Socioeconomic status, media_common, sleep hygiene, Sleep hygiene, Portugal, social inequalities, business.industry, Public Health, Environmental and Occupational Health, Sedentary behavior, medicine.disease, Europe, Cross-Sectional Studies, Social Class, Socioeconomic Factors, COSI, Sedentary Behavior, Sleep, business, Estilos de Vida e Impacto na Saúde, Demography, Diversity (politics)
Abstract: Physical activity, sedentary behavior, and sleep are important predictors of children's health. This paper aimed to investigate socioeconomic disparities in physical activity, sedentary behavior, and sleep across the WHO European region. This cross-sectional study used data on 124,700 children aged 6 to 9 years from 24 countries participating in the WHO European Childhood Obesity Surveillance Initiative between 2015 and 2017. Socioeconomic status (SES) was measured through parental education, parental employment status, and family perceived wealth. Overall, results showed different patterns in socioeconomic disparities in children's movement behaviors across countries. In general, high SES children were more likely to use motorized transportation. Low SES children were less likely to participate in sports clubs and more likely to have more than 2 h/day of screen time. Children with low parental education had a 2.24 [95% CI 1.94-2.58] times higher risk of practising sports for less than 2 h/week. In the pooled analysis, SES was not significantly related to active play. The relationship between SES and sleep varied by the SES indicator used. Importantly, results showed that low SES is not always associated with a higher prevalence of "less healthy" behaviors. There is a great diversity in SES patterns across countries which supports the need for country-specific, targeted public health interventions. The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding from: Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe. Albania: World Health Organization (WHO) Country Office Albania and the WHO Regional Office for Europe. Bulgaria: WHO Regional Office for Europe. Czech Republic: Ministry of Health of the Czech Republic, grant nr. AZV MZČR 17-31670 A and MZČR–RVO EÚ 00023761. Denmark: The Danish Ministry of Health. France: Santé publique France, the French Agency for Public Health. Georgia: WHO. Ireland: Health Service Executive. Italy: Italian Ministry of Health; Italian National Institute of Health (Istituto Superiore di Sanità). Kazakhstan: the Ministry of Health of the Republic of Kazakhstan within the scientific and technical program. Kyrgyzstan: World Health Organization. Latvia: Centre for Disease Prevention and Control, Ministry of Health, Latvia. Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO. Malta: Ministry of Health. Montenegro: WHO and Institute of Public Health of Montenegro. Poland: National Health Programme, Ministry of Health. Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS). Romania: Ministry of Health. Russian Federation: WHO. San Marino: Health Ministry. Spain: the Spanish Agency for Food Safety & Nutrition. Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection; Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health. Turkey: Turkish Ministry of Health and World Bank. Austria: Federal Ministry of Labor, Social Affairs, Health and Consumer Protection of Austria. info:eu-repo/semantics/publishedVersion
Published: 2021

20. Trends in mortality from cutaneous malignant melanoma in Spain (1982–2016): sex‐specific age‐cohort‐period effects

Author: Roberto Pastor-Barriuso, María José Sánchez, Beatriz Pérez-Gómez, Enrique Gutiérrez-González, Marina Pollán, Gonzalo López-Abente, and Nuria Aragonés
Subjects: Adult, Male, Skin Neoplasms, Population, Dermatology, Cohort Studies, Young Adult, 030207 dermatology & venereal diseases, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, medicine, Humans, Mortality, Young adult, education, Melanoma, education.field_of_study, business.industry, Mortality rate, Age Factors, Middle Aged, medicine.disease, Infectious Diseases, Cohort effect, Spain, 030220 oncology & carcinogenesis, Cohort, Female, business, Sex ratio, Demography, Cohort study
Abstract: Background Mortality from malignant cutaneous melanoma increased alarmingly during the second half of the 20th century in Spain and other European countries. Objective The aim was to analyse sex- and age-specific trends in melanoma mortality in Spain in the period 1982-2016. Methods European age-standardized melanoma mortality rates during the period 1982-2016 were calculated from mortality figures provided by the National Statistics Institute. Joinpoint regressions were used to identify significant points of change in trends and to compute average annual per cent change (AAPC). Age-cohort-period models were fitted to explore the effect of these variables on mortality. Results During the period 1982-2016, age-standardized melanoma mortality rates increased in Spain from 0.90 to 1.80 deaths per 100 000 people in men and from 0.64 to 1.11 per 100 000 in women, rising noticeably from 1982 to 1995 in both sexes and in all age groups. From the mid-90s different trends were observed depending on sex and age: there was a decrease in mortality in the population younger than 45 years (AAPC -2 in both sexes) and aged 45-64 years (AAPC -1 among men and -0.2 among women), but in the group over 64 years rates continued to increase (AAPC 1.7 and 0.2, respectively, for men and women). The mortality sex ratio decreased in the younger population but increased in older individuals. A cohort effect was observed with lower mortality in the cohorts born after 1943 in men and 1956 in women. There was also a period effect with decreased mortality rates at the beginning of the 1990s. Conclusions Melanoma mortality rates in Spain increased during the last decades of the 20th century; however, later they stabilized in women and began to decrease in younger cohorts and middle-aged men. Promotion of primary and secondary prevention measures should continue, with particular emphasis on males over 65 years.
Published: 2019

21. Serratia marcescens outbreak in a neonatology unit of a Spanish tertiary hospital: Risk factors and control measures

Author: Sara Gallego-Lombardo, Felix Omeñaca, Inés Fernández-Jiménez, Ana Robustillo-Rodela, Dolores Elorza-Fernández, Enrique Gutiérrez-González, Isabel San Juan-Sanz, Adelina Pellicer-Martínez, Laura Sánchez-García, Lidia Redondo-Bravo, and Guillermo Ruiz-Carrascoso
Subjects: Male, Microbiological Techniques, medicine.medical_specialty, Epidemiology, Hospital Departments, Disease Outbreaks, Serratia Infections, law.invention, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, law, Intensive care, Health care, Disease Transmission, Infectious, Environmental Microbiology, medicine, Humans, Infection control, 030212 general & internal medicine, Neonatology, Serratia marcescens, Infection Control, 0303 health sciences, 030306 microbiology, business.industry, Health Policy, Infant, Newborn, Rectum, Public Health, Environmental and Occupational Health, Outbreak, Odds ratio, Intensive care unit, Infectious Diseases, Spain, Case-Control Studies, Emergency medicine, Pharynx, Female, business
Abstract: Background We describe the investigation undertaken and the measures adopted to control a Serratia marcescens outbreak in the neonatology unit of La Paz University Hospital in Madrid, Spain. Methods Weekly rectal and pharyngeal screenings for S marcescens were performed in the neonates starting after detection of the outbreak. Environmental samples and samples from health care workers (HCWs) were obtained for microbiological analysis. An unmatched case-control study was carried out to investigate risk factors for infection/colonization. Results The outbreak began in June 2016 and ended in March 2017, affecting a total of 59 neonates. Twenty-five (42.37%) neonates sustained an infection, most frequently conjunctivitis and sepsis. Multivariate logistic regression identified the following risk factors: parenteral nutrition (odds ratio [OR], 103.4; 95% confidence interval [CI], 11.9-894.8), history of previous radiography (OR, 15.3; 95% CI, 2.4-95.6), and prematurity (OR, 5.65; 95% CI, 1.5-21.8). Various measures were adopted to control the outbreak, such as strict contact precautions, daily multidisciplinary team meetings, cohorting, allocation of dedicated staff, unit disinfection, and partial closure. Hands of HCWs were the main suspected mechanism of transmission, based on the inconclusive results of the environmental investigation and the high number of HCWs and procedures performed in the unit. Conclusions S marcescens spreads easily in neonatology units, mainly in neonatal intensive care units, and is often difficult to control, requiring a multidisciplinary approach. Strict measures, including cohorting and medical attention by exclusive staff, are often needed to get these outbreaks under control.
Published: 2019

22. Physical activity, screen time, and sleep duration of children aged 6-9 years in 25 countries:An analysis within the WHO european childhood obesity surveillance initiative (COSI) 2015-2017

Author: Mette Rasmussen, Tatjana Hejgaard, Kenisha Russell Jonsson, Ivo Rakovac, Aida Filipović Hadžiomeragić, Sanja Musić Milanović, Stephen Whiting, Anne Siri Fismen, Zulfinissio Abdurrahmonova, Marta García-Solano, Paola Nardone, Wolfgang Ahrens, Ana Isabel Rito, Khadichamo Boymatova, Eha Nurk, Maria Hassapidou, Shynar Abdrakhmanova, Gregor Starc, Peter Gelius, Lela Shengelia, Dragana Stojisavljević, Enrique Gutiérrez-González, Maya Tanrygulyyeva, Angela Spinelli, Sergej M. Ostojic, Victoria Farrugia Sant'Angelo, Nazan Yardim, Igor Spiroski, Ausra Petrauskiene, Karin Schindler, Mirjam M. Heinen, Ingunn Holden Bergh, Akbota Abildina, Andrea Gualtieri, Lubica Ticha, Vesselka Duleva, Mary Pattison, Julianne Williams, Cecily Kelleher, Alexandra Cucu, Eliza Markidou Ionnaidu, Enisa Kujundzic, Anna Fijałkowska, Karim Abu-Omar, Marta Buoncristiano, Iveta Pudule, Valentina Peterkova, Harry Rutter, Lacramioara Aurelia Brinduse, Jolanda Hyska, Zhamyila Usuopva, Hana Zamrazilová, João Breda, Stevo Popovic, Viktoria Anna Kovacs, Romeu Mendes, Daniel Weghuber, Gulmira Aitmurzaeva, and Instituto de Saúde Pública da Universidade do Porto
Subjects: Male, Parents, 0301 basic medicine, Gerontology, Pediatric Obesity, Health (social science), 0302 clinical medicine, Duration (project management), Child, Children, lcsh:RC620-627, Physical inactivity, Sedentary behaviour, Active transport, active play, Surveillance, Schools, Europe, lcsh:Nutritional diseases. Deficiency diseases, surveillance, Female, COSI, Club, Europa, lcsh:Nutrition. Foods and food supply, Research Article, Sports, Sleep duration, 030209 endocrinology & metabolism, lcsh:TX341-641, Motor Activity, World Health Organization, Childhood obesity, Health(social science), Screen Time, 03 medical and health sciences, Screen time, Leisure Activities, SDG 3 - Good Health and Well-being, Physiology (medical), sedentary behaviour, active transport, active play, medicine, Humans, Exercise, Recreation, 030109 nutrition & dietetics, Portugal, business.industry, medicine.disease, Mental health, WHO European Childhood Obesity Surveillance Initiative, physical inactivity, Active play, Sleep, business, Active transport, Estilos de Vida e Impacto na Saúde
Abstract: Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). Method: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration. Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for 1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for
Published: 2021

23. Socioeconomic inequalities in overweight and obesity among 6- to 9-year-old children in 24 countries from the World Health Organization European region

Author: Ana Isabel Rito, Enrique Gutiérrez-González, Ausra Petrauskiene, Shynar Abdrakhmanova, Eha Nurk, João Breda, Katharina Maruszczak, Andrea Gualtieri, Benoît Salanave, Dragana Stojisavljević, Enisa Kujundžić, Igor Spiroski, Tatjana Hejgaard, Gregor Starc, Marta García-Solano, Anna Fijałkowska, Philippa Simmonds, Stefanie Vandevijvere, Sanja Musić Milanović, Mahmut S. Yardim, Vesselka Duleva, Kremlin Wickramasinghe, Sergej M. Ostojic, Zhamilya Usupova, Iveta Pudule, Angela Spinelli, Maya Tanrygulyyeva, Ingunn Holden Bergh, Marta Buoncristiano, Harry Rutter, Paola Nardone, Julianne Williams, Constanta Huidumac-Petrescu, Radka Taxová Braunerová, Lela Shengelia, Zulfiya Abdurrahmonova, Wolfgang Ahrens, Valentina Peterkova, Jolanda Hyska, Päivi Mäki, Kenisha Russell Jonsson, Victoria Farrugia Sant'Angelo, Cecily Kelleher, and Elena Sacchini
Subjects: Pediatric Obesity, Inequality, children, obesity, overweight, socioeconomic status, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Population, Psychological intervention, 030209 endocrinology & metabolism, Context (language use), Overweight, Saúde Pública, World Health Organization, World health, 03 medical and health sciences, 0302 clinical medicine, Childhood Obesity Surveillance Initiative, Environmental health, medicine, Prevalence, Humans, 030212 general & internal medicine, Obesity, education, Child, Socioeconomic status, Children, media_common, education.field_of_study, Portugal, Public Health, Environmental and Occupational Health, medicine.disease, Socioeconomic Status, Europe, Cross-Sectional Studies, Social Class, Socioeconomic Factors, COSI, medicine.symptom, Psychology, Estilos de Vida e Impacto na Saúde
Abstract: Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6–9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities. The authors gratefully acknowledge support through a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. The Ministries of health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation provided financial support for the meetings at which the protocol, data collection procedures, and analyses were discussed. Data collection in the countries was made possible through funding from: Albania: World Health Organization (WHO) Country Office Albania and the WHO Regional Office for Europe. Bulgaria: WHO Regional Office for Europe. Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe. Czechia: Ministry of Health of the Czech Republic, grant nr. 17-31670A and MZCR—RVO EU 00023761. Denmark: The Danish Ministry of Health. France: Santé publique France, the French Agency for Public Health. Georgia: WHO. Ireland: Health Service Executive. Italy: Italian Ministry of Health; Italian National Institute of Health (Istituto Superiore di Sanità). Kazakhstan: the Ministry of Health of the Republic of Kazakhstan within the scientific and technical program. Kyrgyzstan: World Health Organization. Latvia: Centre for Disease Prevention and Control, Ministry of Health, Latvia. Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO. Malta: Ministry of Health; Montenegro: WHO and Institute of Public Health of Montenegro. Poland, National Health Program, Ministry of Health. Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS). Romania: Ministry of Health; Russian Federation: WHO. San Marino: Health Ministry, Educational Ministry, Social Security Institute and Health Authority. Spain: the Spanish Agency for Food Safety & Nutrition. Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection. Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health. Turkey: Turkish Ministry of Health and World Bank. info:eu-repo/semantics/publishedVersion
Published: 2021

24. Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017

Author: Petur Benedikt Juliusson, Mirjam M. Heinen, Ana Isabel Rito, Victoria Farrugia Sant'Angelo, Vesselka Duleva, Anna Fijałkowska, Kenisha Russell Jonsson, Julianne Williams, Akbota Abildina, Daniel Weghuber, João Breda, Stevo Popovic, Cecily Kelleher, Bai Li, Viktoria Anna Kovacs, Radka Taxová Braunerová, Maya Tanrygulyyeva, Sanja Musić Milanović, Lela Shengelia, Angela Spinelli, Ivo Rakovac, Genc Burazeri, Päivi Mäki, Iveta Pudule, Harry Rutter, Sergej M. Ostojic, Lacramioara Aurelia Brinduse, Marie Kunešová, Enisa Kujundzic, Alexandra Cucu, Sanavbar Rakhmatullaeva, Maryam Kebbe, Khadichamo Boymatova, Dilorom Akhmedova, Enrique Gutiérrez-González, Marta Buoncristiano, Ausra Petrauskiene, Andrea Gualtieri, Nathalie Farpour-Lambert, Mette Rasmussen, Shynar Abdrakhmanova, Kremlin Wickramasinghe, Nazan Yardim, Gregor Starc, Zhamyila Usuopva, Tatjana Hejgaard, Jolanda Hyska, Elena Bogova, Ximena Ramos Salas, Paola Nardone, Marta García Solano, and Valentina Peterkova
Subjects: Male, Parents, Pediatric Obesity, Health Knowledge, Attitudes, Practice, Health (social science), Pediatric Obesity* / epidemiology, Overweight, Body Mass Index, Childhood Obesity Surveillance Initiative, Pediatric Obesity* / diagnosis, Surveys and Questionnaires, Medicine, TX341-641, parental perceptions, Nutritional diseases. Deficiency diseases, Child, Pediatric Obesity/diagnosis, Europe, Parental Perceptions, COSI, medicine.symptom, Underweight, childhood obesity, Research Article, RC620-627, Childhood Obesity, World Health Organization/Europe, Overweight/epidemiology, World Health Organization, Childhood obesity, childhood obesity surveillance initiative, Physiology (medical), Humans, Parental perception, world health organization/europe, Portugal, Nutrition. Foods and food supply, Overweight / epidemiology, business.industry, Body Weight, weight, medicine.disease, Weight, Obesity, Confidence interval, Rural area, business, Body mass index, Demography, Estilos de Vida e Impacto na Saúde
Abstract: Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child’s weight status. The purpose of this study was to measure parental perceptions of their child’s weight status and to identify predictors of potential parental misperceptions. Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children’s weight status as “underweight,” “normal weight,” “a little overweight,” or “extremely overweight.” We categorized children’s (6–9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child’s weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1. Results: Overall, 64.1% of parents categorized their child’s weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child’s weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child’s weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28–1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26–1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98–1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99–1.24). Overall, parents’ BMI was not strongly associated with the underestimation of children’s weight status, but there was a stronger association in some countries. Discussion/Conclusion: Our study supplements the current literature on factors that influence parental perceptions of their child’s weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents’ knowledge and perceptions, as well as the sociocultural contexts in which children and families live. The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding by: Albania: World Health Organization through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry of Health, National Center of Public Health and Analyses, World Health Organization Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and World Health Organization Regional Office for Europe; Czechia: Grants AZV MZČR 17-31670 A and MZČR – RVO EÚ 00023761; Denmark: Danish Ministry of Health; France: French Public Health Agency; Georgia: World Health Organization; Ireland: Health Service Executive; Italy: Ministry of Health; Istituto Superiore di sanità (National Institute of Health); Kazakhstan: Ministry of Health of the Republic of Kazakhstan and World Health Organization Country Office; Latvia: n/a; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and World Health Organization; Malta: Ministry of Health; Montenegro: World Health Organization and Institute of Public Health of Montenegro; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support of Center for Studies and Research on Social Dynamics and Health (CEIDSS); Romania: Ministry of Health; Russia (Moscow): n/a; San Marino: Health Ministry; Educational Ministry; Social Security Institute; the Health Authority; Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: World Health Organization Country Office in Tajikistan and Ministry of Health and Social Protection; and Turkmenistan: World Health Organization Country Office in Turkmenistan and Ministry of Health. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. info:eu-repo/semantics/publishedVersion
Published: 2021

25. Weight status in the 6- to 9-year-old school population in Spain: results of the ALADINO 2019 Study

Author: Laura María Bermejo López, María José Yusta-Boyo, María Araceli García-López, Enrique Gutiérrez-González, Aránzazu Aparicio, Ana M. López-Sobaler, Teresa Robledo de Dios, Miguel Ruiz-Álvarez, María Ángeles Dal Re Saavedra, Marta García-Solano, and Carmen Villar Villalba
Subjects: Male, medicine.medical_specialty, Population, Medicine (miscellaneous), Healthy eating, Overweight, Childhood obesity, medicine, Humans, Child, education, Weight status, Abdominal obesity, Gynecology, education.field_of_study, Schools, Nutrition and Dietetics, Anthropometry, business.industry, Body Weight, medicine.disease, Obesity, Spanish population, Cross-Sectional Studies, Spain, Female, medicine.symptom, business
Abstract: espanolIntroduccion: la obesidad infantil es un problema de salud publica cuya prevalencia no ha dejado de crecer en las ultimas decadas. Objetivo: describir la situacion ponderal de los escolares de 6 a 9 anos en Espana en 2019, y sus factores asociados. Metodos: ALADINO es un estudio transversal en escolares de 6 a 9 anos, representativo de la poblacion espanola, aplicando la metodologia dela Child Obesity Surveillance Initative de la Oficina Regional para Europa de la OMS. Se midieron el peso, la talla y el perimetro abdominal de los participantes, definiendo la situacion ponderal segun diferentes estandares (OMS, IOTF y Orbegozo). Se paso a los progenitores un cuestionarios obre estilo de vida y caracteristicas sociodemograficas. Resultados: se midieron 16.665 escolares de 276 colegios. El 40,6 % presentaban exceso de peso –23,3 % sobrepeso y 17,3 % obesidad—,siendo la obesidad mas prevalente en los ninos y el sobrepeso en las ninas, y aumentando ambos con la edad. La prevalencia de la obesidad abdominal era del 22,6 %. El exceso de peso disminuyo 3,9 puntos porcentuales desde 2011, principalmente el sobrepeso de los ninos. La obesidad permanecio estable. El exceso de peso fue mas prevalente en los escolares con habitos menos saludables de alimentacion y actividad fisica, y en las familias con menor nivel socioeconomico. Conclusiones: la prevalencia del exceso de peso es elevada, aunque ha descendido desde 2011 y permanece estable desde 2015 entre los escolares de 6 a 9 anos en Espana, debiendose esta reduccion fundamentalmente al descenso del sobrepeso en los ninos. Es necesario seguir fomentando habitos saludables desde las etapas mas tempranas, reduciendo las desigualdades en salud. EnglishIntroduction: childhood obesity is a public health problem whose prevalence has grown steadily in recent decades. Objective: to describe the weight status of schoolchildren aged 6 to 9 years in Spain in 2019, and their associated factors. Methods: ALADINO is a cross-sectional study in schoolchildren aged 6 to 9 years, representative of the Spanish population, and aligned with the Child Obesity Surveillance Initative of the WHO Regional Office for Europe. Participants’ weight, height, and abdominal circumference were measured, defining weight status according to different standards (WHO, IOTF, and Orbegozo). A questionnaire on lifestyle and socio-demographic characteristics was administered to parents. Results: a total of 16,665 schoolchildren from 276 schools were measured. Excess weight was observed in 40.6 %: 23.3 % overweight and 17.3 % obesity, with obesity being more prevalent in boys and overweight in girls, both increasing with age. The prevalence of abdominal obesity was 22.6 %. Excess weight decreased by 3.9 percentage points since 2011, mainly due to overweight in boys. Obesity remained stable. Excess weight was more prevalent in schoolchildren with less healthy eating and physical activity habits, and in families with a lower socioeconomic status. Conclusions: the prevalence of excess weight is high, although it has declined since 2011 and remains stable since 2015 among schoolchildren aged 6-9 years in Spain, this reduction being mainly due to a decrease in overweight in children. It is necessary to continue promoting healthy habits from the earliest stages of life, thus reducing health inequalities.
Published: 2021

26. Waist circumference and waist-to-height ratio in 7-year-old children-WHO Childhood Obesity Surveillance Initiative

Author: Cecily Kelleher, Tereza Metelcová, Julianne Williams, Lauren Lissner, Radka Taxová Braunerová, Ingunn Holden Bergh, Enrique Gutiérrez-González, João Breda, Mirjam M. Heinen, Ivo Rakovac, Vesselka Duleva, Iveta Pudule, Harry Rutter, Agneta Sjöberg, Marta Buoncristiano, J. Vignerova, Hana Zamrazilová, Agneta Yngve, Marie Kunešová, Maria Hassapidou, Aušra Petrauskienė, Marek Brabec, Igor Spiroski, V Hainer, and Philippa Simmonds
Subjects: Male, Percentile, Pediatric Obesity, Waist, Endocrinology, Diabetes and Metabolism, World Health Organization, Childhood obesity, Body Mass Index, medicine, Humans, Child, Abdominal obesity, Waist-to-height ratio, Waist-Height Ratio, business.industry, Public Health, Environmental and Occupational Health, medicine.disease, Circumference, Obesity, Body Height, Obesity, Abdominal, Female, medicine.symptom, Waist Circumference, business, Body mass index, Demography
Abstract: Childhood obesity is a serious global health problem. Waist circumference (WC) and waist-to-height ratio (WHtR) reflect body fat distribution in children. The objectives of this study were to assess WC and WHtR in 7-year-old children and to determine body mass index (BMI), WC, and WHtR differences in children from 10 selected countries across Europe (Bulgaria, Czechia, Greece, Ireland, Latvia, Lithuania, North Macedonia, Norway, Spain, and Sweden) participating in the World Health Organization (WHO) Europe Childhood Obesity Surveillance Initiative (COSI). The 50th and 90th percentile of WC (according to COSI and "Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS" (IDEFICS) cutoff values) and WHtR above 0.5 were used as measures of abdominal obesity in a unique sample of 38,975 children aged 7.00-7.99 years. Southern European countries, including Greece and Spain, showed significantly higher BMI, WC, and WHtRin both genders (p < 0.0001) than Eastern and Northern Europe. The highest values for WC were observed in Greece (60.8 ± 7.36 cm boys; 60.3 ± 7.48 cm girls), North Macedonia (60.4 ± 7.91 cm boys; 59.0 ± 8.01 cm girls), and Spain (59.7 ± 6.96 cm boys; 58.9 ± 6.77 cm girls). WC and WHtRin may add an information about the occurrence of central obesity in children.
Published: 2020

27. Author response: Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Zahra Mohammadi, Abdul Basit, Helena I. S. Nogueira, Soile E. Puhakka, Hongsheng Bi, Ari Voutilainen, Davood Khalili, Bin Zhou, Dermot O'Reilly, Natascia Rinaldo, Paulo A. Lotufo, Bahareh Kheiri, Thein Thein Htay, Simona Giampaoli, Goodarz Danaei, M. Fernanda Lima-Costa, Simona Bo, Peter Schnohr, Jerzy Chudek, Francesco Panza, Ling Yang, Katia Vergetti Bloch, Vincenzo Capuano, Holly E. Syddall, Dong Zhao, Indah Suci Widyahening, Maria Lorenza Muiesan, Leng Huat Foo, Mohsen Azimi-Nezhad, Merete Osler, Laura Torres-Collado, Manu Raj, Adroaldo Cesar Araujo Gaya, Susi Kriemler, Ali Akbar Shayesteh, Aneta Grajda, Anette Varbo, Kazem Mohammad, Leila Beltrami Moreira, Shu Ti Chiou, Iuliia A Rusakova, Jyh Eiin Wong, Torben Jørgensen, Lela Sturua, Lubica Ticha, Hamid Hakimi, Hazzaa M. Al-Hazzaa, Yanina Zócalo, Freda Pitakaka, Savvas C. Savva, Rajeev Gupta, Jennifer Servais, Marie Kunešová, Johanna M. Geleijnse, Elysée Claude Bika Lele, Yannis Manios, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Sibel Gogen, Viviane Cunha Cardoso, Kristine H. Allin, Ana Azevedo, Line Tang Møllehave, Vincent Jr DeGennaro, Novie O. Younger-Coleman, Gretchen A Stevens, Dickman Gareta, Holger Theobald, Anja Schienkiewitz, Bekbolat Zholdin, Janice Luisa Lukrafka, Adela Chirita-Emandi, Ulla Roggenbuck, Kenisha Russell Jonsson, Robespierre Ribeiro, Gabriele Eiben, Eero Kajantie, Sounnia Mediene Benchekor, Fariborz Mansour-Ghanaei, Mary Simon, Prakash C. Gupta, Mohammad Esmaeel Motlagh, Emanuela Gualdi-Russo, María Elena Díaz-Sánchez, Pilar Guallar-Castillón, Bee Koon Poh, Cristina Padez, Azaliia M Tuliakova, Sarah P. Garnett, William R. Tebar, Yingfeng Zheng, Suhad Bahijri, Christina Mavrogianni, Mihaela Vladulescu, Jan A. Staessen, Paula Duarte de Oliveira, Rui Ornelas, Michael Sjöström, Charles Agyemang, Slawomir Koziel, Shohreh Naderimagham, Jari Jokelainen, Stephen T. McGarvey, Patrick Pasquet, Farnam Mohebi, Nader Saki, Aida Pilav, Azim Nejatizadeh, Marianna Noale, Habiba Ben Romdhane, Luís B. Sardinha, Laura Lauria, Jun Hata, Kodanda R Kanala, Gert B. M. Mensink, Nils Lehmann, Elio Riboli, Carolina Tarqui-Mamani, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Luis Serra-Majem, Martina Müller-Nurasyid, Felipe Vogt Cureau, Lekhraj Rampal, Zhamilya Battakova, Ludmila Sevcikova, Suhaila Abdul Ghaffar, Fikru Tullu, Aung Soe Htet, Angel R. Gonzalez, Annette J. Dobson, Kavumpurathu Raman Thankappan, Hélène Delisle, Francisco J. Félix-Redondo, Ramón Suárez-Medina, Annika Rosengren, Sania Nishtar, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Maria Cecília Formoso Assunção, Kazi M. Jamil, Stefano Marventano, Wenbin Wei, Norsyamlina Che Abdul Rahim, Shukri F. Mohamed, Bente Sparboe-Nilsen, Soon-Woo Park, Ana Isabel Rito, David Goltzman, W. M. Monique Verschuren, Catterina Ferreccio, Marta Buoncristiano, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Edward D Janus, Laetitia Huiart, Ala'a Alkerwi, Lorenza Pilotto, Mohannad Al Nsour, Daan Kromhout, Marius B. Bjertness, Oanh T. H. Trinh, Nico Dragano, Angélica Ochoa-Avilés, Ingunn Holden Bergh, Yuki Fujita, Juraci Almeida Cesar, Hajer Aounallah-Skhiri, Maria Dorobantu, Jordi Sunyer, Wolfgang Kratzer, Susanne R. de Rooij, Drude Molbo, Rebecca Goldsmith, Jean Woo, Mohammad El-khateeb, Tiffany K. Gill, Nish Chaturvedi, Benjamin Acosta-Cazares, Erik Lykke Mortensen, Nikhil D. Patel, Francesco Pistelli, Yuan He, Ivana Radic, Yi Zeng, Ilse Khouw, Reynaldo Martorell, Ching-Yu Cheng, Stine Schramm, Hana Shimizu-Furusawa, Jacek Jóźwiak, Radwan Qasrawi, Isti Ilmiati Fujiati, Charles Sossa Jérome, Ben Schöttker, Mikhail Benet, Anastasia Markaki, Christopher T. Cowell, Bharathi Viswanathan, Renata Kuciene, Jose Eugenio Lozano, Pedro J Ortiz, Delphine De Smedt, Elaine M. Murtagh, Kamel Ajlouni, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Xiangjun Wang, Lars Lind, Macia Enguerran, Marjeta Mišigoj-Duraković, Bo Werner, Jean-Michel Gaspoz, Kyungwon Oh, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Felix Kaducu, Ramon O. Jimenez, Jonathan E. Shaw, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Parvina Mukhtorova, Eha Nurk, Bhawesh Koirala, Óscar Lopes, Ana Jelakovic, Karolina Milkowska, Magda Gasull, Regina Heidinger-Felso, Marcela González-Gross, Belong Cho, Daphne Mirkopoulou, Salvador Villalpando, Tran Quoc Bao, José Boggia, Daniela Galeone, Josep Redon, Matthias Bopp, Abbas Rezaianzadeh, Dusko Bjelica, Amir Houshang Mehrparvar, Felipe F. Casanueva, Khairil Si-Ramlee, Soheir H Ahmed, Maria Nordendahl, Luciana Zaccagni, Mahboubeh Parsaeian, Rod Jackson, Jorge Motta, Keiu Nelis, Fernando Rigo, Andrzej Pajak, Christa Meisinger, Clara Homs, Namuna Shrestha, Mar Alvarez-Pedrerol, Xun Tang, Johann Willeit, Motahareh Kheradmand, Jean Dallongeville, Jean-Bernard Ruidavets, Anne Tjønneland, Diana A. Santos, Lynne M. Boddy, Jie Hao, David Alejandro González-Chica, Elin Kolle, Jingli Gao, Małgorzata Mossakowska, Isabel O. Oliveira, Giuseppe Grosso, Seongjun Ha, Olfa Saidi, Albina A Fakhretdinova, Oye Gureje, Raluca Pop, Iulia Jurca Simina, Nuno Lunet, Maria Forsner, Peter Bjerregaard, Rachael McLean, Antonio Cabrera de León, Guy De Backer, José A. Casajús, Guang Ning, Emmanuella Magriplis, Laura Censi, Graziella Bruno, Valentina Peterkova, Angelique Chan, Yvonne T. van der Schouw, Charalambos Hadjigeorgiou, Anjani Kumar Jha, Toomas Veidebaum, Thamara Hubler Figueiró, Jana Kratenova, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ya Xing Wang, Oscar Noboa, Romana Roccaldo, Sara Magnacca, Johan Sundström, Peter Stehle, Tania Lopez, Francis Delpeuch, Julianne Williams, Ellisiv B. Mathiesen, Leanne M. Riley, Claudia M. Hormiga, Joanne Katz, Ekaterina Stoyanova, Heloisa Bettiol, Gabriele Nagel, Alireza Khosravi, Lars Bo Andersen, João Breda, Jørgen Meisfjord, Ahmad Faudzi Yusoff, Marjeta Majer, Robert Beaglehole, Caleb Ochimana, Shynar Abdrakhmanova, George S. Stergiou, Blanca Sandra Ruiz-Betancourt, Leon A. Simons, Eng Joo Tan, Victoria Farrugia Sant'Angelo, Gry Skodje, Maryam Keramati, Liv Elin Torheim, Seppo Koskinen, Assembekov Batyrbek, Jaakko Tuomilehto, Marjo-Riitta Järvelin, Ming-Hui Zhao, Krista Fischer, Tobias F. 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Minderico, Betina H. Thuesen, Queenie Chan, Ulf Ekelund, Laura A. Rodríguez-Villamizar, Line Lund Kårhus, Cihangir Erem, Amina Barkat, Maria Paula Santos, Fernanda Cunha Soares, Constanta Huidumac Petrescu, Allan G. Hill, Honor Bixby, Benoît Salanave, Joana Carvalho, Maigeng Zhou, Ofra Kalter-Leibovici, Roy A Wong-McClure, Kim F. Michaelsen, Doris Stöckl, Rosalynn Siantar, Jouko Saramies, José R. Banegas, Quang Ngoc La, Uruwan Yamborisut, Parinaz Mehdipour, Farhad Pourfarzi, Sudha Ramachandra Rao, Katsuyasu Kouda, Chien-Jen Chen, Rafael dos Santos Henrique, Martin Nankap, Allan Linneberg, Ronald D. Gregor, Rudolf Kaaks, Maria do Carmo Franco, Marta García-Solano, Beata Gurzkowska, Bahman Cheraghian, Stefaan De Henauw, Daniel Ferrante, Johanna A. Otero, Jamila Abubakar Garba, Antonio Pedro Graça, Sumit Bharadwaj, Shiqi Zhen, Xiu-Hua Guo, Prashant Mathur, Raphael Mendes Ritti-Dias, Kouamelan Doua, Esteban Carmuega, Majid Shirani, Przemyslaw Slusarczyk, Petra Rust, Visnja Djordjic, Farahnaz Joukar, Johanna Gunnlaugsdottir, Leila Houti, Nayu Ikeda, Imperia Brajkovich, Amirabbas Momenan, Erik J. Timmermans, Marcin Rutkowski, Biruta Velika, Joana Araújo, Jostein Steene-Johannessen, Christa L. Lilly, Per Tynelius, Michael Tornaritis, Anne Juolevi, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Espen Bjertness, Ana P. Ortiz, Joel G. R. Roy, Himanshu K. Chaturvedi, Michelle Holdsworth, Niels Wedderkopp, Johan Van der Heyden, Mukharram M. 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Capanzana, Con Burns, Emanuela Pettenuzzo, Ming-Dong Wang, Jonathan Giovannelli, Stela McLachlan, Ellis Owusu-Dabo, Stefania Toselli, Maria Teresa Anselmo Olinto, Senthil K Vasan, Sara Schramm, Xenophon Theodoridis, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Dongfeng Gu, Tomas Vega, Hynek Pikhart, Päivi Mäki, Heba Fouad, Vilnis Dzerve, Christina Howitt, Seyed Mohammad Hashemi-Shahri, Jenny M. Kindblom, Marjolijn C. E. Bragt, G. K. Mini, Qian Wang, Liufu Cui, Andrzej Galbarczyk, Sylvain Sebert, Vilmundur Gudnason, Loreto Santa Marina, Kairat Davletov, Afshin Ostovar, Niloofar Peykari, Nicholas J. Wareham, Wilma M. Hopman, Karl-Heinz Jöckel, Jussi Kauhanen, Breige A. McNulty, Alina Kerimkulova, Youcef Laid, Claes Ohlsson, Stefan Kiechl, Alicia Matijasevich, Boban Mugoša, Srinivasan Kannan, Jyrki K. Virtanen, Mohan Deepa, Mangesh S. Pednekar, Shahla AlDhukair, Cynthia M. Pérez, Vera Lanska, Tint Swe Latt, Dominique Hange, João Luiz Bastos, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Maya Tanrygulyyeva, Reza Malekzadeh, Dimitrios Poulimeneas, Pedro Ordunez, Thomas Waldhör, Ioannis Pagkalos, Carlo M. Barbagallo, Abla M. Sibai, Peter Vollenweider, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Santosh K. Bhargava, Patrick Kolsteren, Aya Mostafa, Fangfang Chen, Flavio Nervi, Imre Janszky, Arvind Pandey, Renata Cifkova, Alexandre C. Pereira, Alejandro Diaz, Alireza Ansari-Moghaddam, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Rusidah Selamat, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paul Korrovits, Paola Nardone, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Alberto Barceló, Camilla T. Damsgaard, Constance Schultsz, Frank J Rühli, Santiago F. 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Levitt, Miquel Porta, Vesna Jureša, Alexander D. Deev, Son Thai Pham, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, David Faeh, Antonio Bernabe-Ortiz, Giota Touloumi, Maryam Kavousi, Sanja Musić Milanović, Jalila El Ati, Sauli Herrala, Liang Xu, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Yi Song, Jianfeng Wu, Jeannette Klimont, Jean Ferrières, Farhad Zamani, Shina Avi, Luis Paulo Gomes Mascarenhas, Aluísio J D Barros, Reecha Sofat, Koen Van Herck, Hoang Van Minh, Enrique Gutiérrez-González, Martine Vrijheid, Susana Cararo Confortin, Antonis Zampelas, Bogdan Wojtyniak, Ausra Petrauskiene, Juha Auvinen, Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Young-Ho Khang, Ellina Rakhimova, Magdalena Klimek, Luís Lopes, Erkin M. Mirrakhimov, Maria Lc Iurilli, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Rainford J. Wilks, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Li Juan Wu, Adrian Richter, Licia Iacoviello, Hanno Ulmer, Deepak Amarapurkar, Mohsen Ibrahim, Hamed Pouraram, Massimo Salvetti, Hung-Kwan So, Yonghua Hu, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Sabina Zambon, Angelika Schaffrath Rosario, Lauren Lissner, Kamarul Imran Musa, Deepa Weerasekera, Bihungum Bista, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Irene G. M. van Valkengoed, Anna Fijałkowska, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Nasheeta Peer, Radka Taxová Braunerová, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Eliza Cinteza, Ha Tp Do, and Alison J. Hayes
Subjects: education.field_of_study, business.industry, Population, Distribution (economics), medicine.disease, Obesity, Geography, medicine, Underweight, medicine.symptom, education, business, Body mass index, Demography
Published: 2020

28. Selenium and impaired physical function in US and Spanish older adults

Author: M. Carrasco-Rios, M. Sotos Prieto, José R. Banegas, Esther García-Esquinas, Ana Navas-Acien, R. Ortolá, Enrique Gutiérrez-González, Pablo Olmedo, Fernando Gil, R. Queipo, Roberto Pastor-Barriuso, Fernando Rodríguez-Artalejo, Maria Tellez-Plaza, Beatriz Pérez-Gómez, Instituto de Salud Carlos III, Agencia Estatal de Investigación (España), Ministerio de Ciencia, Innovación y Universidades (España), European Commission, European Regional Development Fund (ERDF/FEDER), and Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF)
Subjects: Bioquímica, inorganic chemicals, 0301 basic medicine, Weakness, Activities of daily living, Clinical Biochemistry, Biochemistry, Physical performance, 03 medical and health sciences, Grip strength, Selenium, Selenio, 0302 clinical medicine, Risk Factors, Activities of Daily Living, Medicine, Humans, Prospective Studies, lcsh:QH301-705.5, Aged, lcsh:R5-920, Disability, Adulto, business.industry, Organic Chemistry, Confounding, food and beverages, Muscle weakness, Odds ratio, Middle Aged, Nutrition Surveys, Discapacidad intelectual, Confidence interval, Biomarcadores, 030104 developmental biology, Cross-Sectional Studies, lcsh:Biology (General), Spain, Older adults, Cohort, medicine.symptom, lcsh:Medicine (General), business, 030217 neurology & neurosurgery, Biomarkers, Demography, Research Paper
Abstract: [Background]: Selenium (Se) is a trace element with a narrow safety margin., [Objectives]: To evaluate the cross-sectional and longitudinal dose-response association between Se exposure and measures of impaired physical function and disability in older adults., [Design]: NHANES 2011–2014 cross-sectional (US, n = 1733, age ≥60 years) and Seniors-ENRICA-2 2017–2019 cross-sectional and longitudinal (Spain, n = 2548 and 1741, respectively, age ≥65 years) data were analyzed. Whole blood and serum Se levels were measured using inductively coupled plasma-mass spectrometry. Lower-extremity performance was assessed with the Short Physical Performance Battery, and muscle weakness with a dynamometer. Incident mobility and agility limitations, and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including physical activity. Results across studies were pooled using random-effects meta-analysis., [Results]: Meta-analyzed odds ratios (95% confidence interval) per log2 increase in whole blood Se were 0.54 (0.32; 0.76) for weakness, 0.59 (0.34; 0.83) for impaired lower-extremity performance, 0.48 (0.31; 0.68) for mobility limitations, 0.71 (0.45; 0.97) for agility limitations, and 0.34 (0.12; 0.56) for disability in at least one IADL. Analyses for serum Se in NHANES showed similar results. Findings suggest the inverse association with grip strength is progressive below 140 μg/L (p-value for non-linear trend in the Seniors-ENRICA-2 study = 0.13), and above 140 μg/L (p-value for non-linear trend in NHANES = 0.11). In the Seniors-ENRICA-2 cohort, with a 2.2 year follow-up period, a doubling in baseline Se levels were associated with a lower incidence of weakness [odds ratio (95% confidence interval): 0.45 (0.22; 0.91)], impaired lower-extremity performance [0.63 (0.32; 1.23)], mobility [0.43 (0.21; 0.91)] and agility [0.38 (0.18; 0.78)] limitations., [Discussion]: In US and Spanish older adults, Se concentrations were inversely associated with physical function limitations. Further studies are needed to elucidate underlying mechanisms., This work has been supported by grants PI18/287 and 16/609 from the Instituto de Salud Carlos III, State Secretary of R + D + I, and FEDER/FSE; and by PID2019-108973RB-C21/C22 from the State Secretary of R + D + I.
Published: 2020

29. Toenails as a biomarker of exposure to arsenic: A review

Author: Jorge J. López-Moreno, Margaret R. Karagas, Francisco Rodríguez-Cabrera, Miguel García-Villarino, Roberto Pastor-Barriuso, Enrique Gutiérrez-González, Beatriz Pérez-Gómez, Elena Varea-Jiménez, Marina Pollán, Antonio J. Signes-Pastor, and Ana Navas-Acien
Subjects: inorganic chemicals, Asia, chemistry.chemical_element, Urine arsenic, 010501 environmental sciences, 01 natural sciences, Biochemistry, Article, Arsenic, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Biomonitoring, Asian country, Medicine, 030212 general & internal medicine, ARSENIC EXPOSURE, 0105 earth and related environmental sciences, General Environmental Science, integumentary system, business.industry, Reproducibility of Results, Environmental Exposure, Chronic disease, Nails, chemistry, Biomarker (medicine), Occupational exposure, business, Biomarkers
Abstract: This systematic review summarizes the current evidence related to the reliability of toenail total arsenic concentrations (thereafter “arsenic”) as a biomarker of long-term exposure. Specifically, we reviewed literature on consistency of repeated measures over time, association with other biomarkers and metal concentrations, factors influencing concentrations, and associations with health effects. We identified 129 papers containing quantitative original data on arsenic in toenail samples covering populations from 29 different countries. We observed geographic differences in toenail arsenic concentrations, with highest median or mean concentrations in Asian countries. Arsenic-contaminated drinking water, occupational exposure or living in specific industrial areas were associated with an increased toenail arsenic content. The effects of other potential determinants and sources of arsenic exposure including diet, gender and age on the concentrations in toenails need further investigations. Toenail arsenic was correlated with the concentrations in hair and fingernails, and with urine arsenic mainly among highly exposed populations with a toenail mean or median ≥1 μg/g. Overall, there is a growing body of evidence suggesting that arsenic content from a single toenail sample may reflect long-term internal dose-exposure. Toenail arsenic can serve as a reliable measure of toxic inorganic arsenic exposure in chronic disease research, particularly promising for cancer and cardiovascular conditions.
Published: 2021

30. Toenails as biomarker of exposure to essential trace metals: A review

Author: Ana Navas-Acien, Enrique Gutiérrez-González, Roberto Pastor, Nerea Fernández de Larrea-Baz, Marina Pollán, Virginia Lope, Beatriz Pérez-Gómez, José Luis Gómez-Ariza, Inmaculada Salcedo-Bellido, Esther García-Esquinas, Instituto de Salud Carlos III, UAM. Departamento de Medicina Preventiva y Salud Pública y Microbiología, and Instituto de Salud Carlos III - ISCIII
Subjects: Medicina, chemistry.chemical_element, Dietary factors, 010501 environmental sciences, 01 natural sciences, Biochemistry, Article, essential trace essential metals, Exposure, Selenium, 03 medical and health sciences, Health problems, 0302 clinical medicine, Exposure level, systematic review, Environmental health, Humans, Medicine, Trace metal, 030212 general & internal medicine, Toenail, 0105 earth and related environmental sciences, General Environmental Science, integumentary system, business.industry, toenail, Essential trace essential metals, Reproducibility of Results, Biomarker, Environmental Exposure, Trace Elements, Nails, chemistry, exposure, Metals, biomonitoring, Biomonitoring, Systematic review, biomarker, Biomarker (medicine), Sample collection, Occupational exposure, business, Biomarkers
Abstract: Health problems associated with essential trace metals can result from both inadequate (i.e., low intake) and excessive exposures (i.e., from environmental and/or occupational source). Thus, measuring the exposure level is a real challenge for epidemiologists. Among non-invasive biomarkers that intend to measure long-term exposure to essential trace metals, the toenail is probably the biological matrix with the greatest potential. This systematic review collects the current evidence regarding the validity of toenail clippings as exposure biomarker for trace metals such as boron, cobalt, copper, iron, manganese, molybdenum, selenium, silicon, vanadium and zinc. Special attention was paid to the time-window of exposure reflected by the toenail, the intraindividual variability in exposure levels over time in this matrix, and the relationship of toenail with other biomarkers, personal characteristics and environmental sources. Our search identified 139 papers, with selenium and zinc being the most studied elements. The variability among studies suggests that toenail levels may reflect different degrees of exposure and probably correspond to exposures occurred 3–12 months before sampling (i.e., for manganese/selenium). Few studies assessed the reproducibility of results over time and, for samples obtained 1–6 years apart, the correlation coefficient were between 0.26 and 0.66. Trace metal levels in toenails did not correlate well with those in the blood and urine and showed low-moderate correlation with those in the hair and fingernails. Available data suggests that for some elements (Se, Mn, Zn) toenail concentrations reflect long-term external exposures in fairly reproducible levels, while for other metals, this association has not yet been assessed. Among dietary factors, only toenail selenium showed clear associations with the intake of supplements or specific foods. The toenail levels could also represent occupational exposure, for instance, Mn exposure in welders. The scarcity of information on other essential trace elements, together with the great heterogeneity among studies makes the validation of the usage of toenails as biomarkers of exposure to these elements difficult. Standardization of sample collection, quality control, analytical techniques and reporting procedures might facilitate further research focused on the clear understanding of the significance of essential levels in this promising matrix and would enhance its utility in epidemiological research, This work was supported by FIS grants PI12/00150, PI17CIII/00034 & PI18/00287 (Instituto de Salud Carlos III, State Secretary of R + D + I and European Union (ERDF/ESF, "Investing in your future"))
Published: 2019

31. Dietary Zinc and Risk of Prostate Cancer in Spain: MCC-Spain Study

Author: Esther García-Esquinas, Juan Alguacil, Adela Castelló, Esther Gracia-Lavedan, Inmaculada Salcedo-Bellido, Pablo Fernández-Navarro, Gemma Castaño-Vinyals, Nuria Aragonés, Dora Romaguera, Guillermo Fernández-Tardón, Pilar Amiano, Enrique Gutiérrez-González, Inés Gómez-Acebo, Manolis Kogevinas, Dolores Salas, Marina Pollán, Beatriz Pérez-Gómez, Javier Llorca, Instituto de Salud Carlos III, Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Fundación Marqués de Valdecilla, Gobierno de Andalucía, Generalitat Valenciana (España), Basque Government (España), Fundación Caja de Ahorros de Asturias, University of Oviedo (España), Ministerio de Economía y Competitividad (España), and Universidad de Cantabria
Subjects: 0301 basic medicine, Oncology, Male, humanos, encuestas sobre dietas, Prostate cancer, Risk Factors, Odds Ratio, mediana edad, education.field_of_study, anciano, Nutrition and Dietetics, dieta, zinc, Middle Aged, prostate cancer, cociente de probabilidades relativas, Zinc, lcsh:Nutrition. Foods and food supply, medicine.medical_specialty, Population, estudios de casos y controles, chemistry.chemical_element, Single-nucleotide polymorphism, lcsh:TX341-641, Diet Surveys, Article, 03 medical and health sciences, Internal medicine, dietary zinc, medicine, Genetic predisposition, ingesta energética, Genetic susceptibility, SNP, factores de riesgo, Humans, education, Aged, 030109 nutrition & dietetics, Dietary zinc, business.industry, Prostatic Neoplasms, Odds ratio, medicine.disease, Confidence interval, Diet, chemistry, Spain, Case-Control Studies, neoplasias de la próstata, business, Energy Intake, diet, Food Science, genetic susceptibility
Abstract: Zinc is a key trace element in normal prostate cell metabolism, and is decreased in neoplastic cells. However, the association between dietary zinc and prostate cancer (PC) in epidemiologic studies is a conflicting one. Our aim was to explore this association in an MCC-Spain case-control study, considering tumor aggressiveness and extension, as well as genetic susceptibility to PC. 733 incident cases and 1228 population-based controls were included for this study. Dietary zinc was assessed using a food frequency questionnaire, and genetic susceptibility was assessed with a single nucleotide polymorphisms (SNP)-based polygenic risk score (PRS). The association between zinc intake and PC was evaluated with mixed logistic and multinomial regression models. They showed an increased risk of PC in those with higher intake of zinc (Odds Ratio (OR) tertile 3vs1: 1.39, 95% Confidence interval (CI):1.00&ndash, 1.95). This association was mainly observed in low grade PC (Gleason = 6 RRR tertile 3vs1: 1.76, 95% CI:1.18&ndash, 2.63) as well as in localized tumors (cT1-cT2a RRR tertile 3vs1: 1.40, 95% CI:1.00&ndash, 1.95) and among those with higher PRS (OR tertile 3vs1: 1.50, 95% CI:0.89&ndash, 2.53). In conclusion, a higher dietary zinc intake could increase the risk of low grade and localized tumors. Men with higher genetic susceptibility might also have a higher risk of PC associated with this nutrient intake.
Published: 2018
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32. Readmission Due to Exacerbation of COPD: Associated Factors

Author: Enrique Gutiérrez González, César Llorente Parrado, Alicia Cerezo Lajas, Luis Puente Maestu, and Javier de Miguel-Díez
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Multivariate analysis, Time Factors, Exacerbation, Vital Capacity, Pulmonary disease, Comorbidity, Patient Readmission, Risk Assessment, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Sex Factors, Risk Factors, Internal medicine, Diabetes mellitus, Forced Expiratory Volume, medicine, Diabetes Mellitus, Prevalence, Humans, 030212 general & internal medicine, Lung, Lung function, Aged, Aged, 80 and over, Heart Failure, COPD, business.industry, After discharge, Length of Stay, Middle Aged, medicine.disease, Dyspnea, Phenotype, 030228 respiratory system, Pulmonary Emphysema, Spain, Heart failure, Disease Progression, Female, business
Abstract: To compare characteristics of patients readmitted after discharge by chronic obstructive pulmonary disease (COPD) exacerbation with those who were not readmitted and to identify factors associated with readmission risk. We randomly selected a group of 40 COPD patients with high frequency of readmissions (HFR), who had ≥ 2 admissions by COPD exacerbation within 30 days after the last admission in 2015, and another group of 40 COPD patients with low frequency of readmissions (LFR), with 0–1 admissions in that period. Patients of the HFR group, compared to those in LFR group, were more frequently males (p = 0.009), older (p = 0.022), had a higher degree of dyspnea (p = 0.044), worse lung function (p = 0.049), belonged more frequently to exacerbator emphysema phenotype (p
Published: 2017

33. Photosensitivity Due to Thiazides

Author: J. Toribio, María Teresa Rodríguez-Granados, S. Gómez-Bernal, Enrique Gutiérrez-González, Adriana Álvarez-Pérez, and Laura Rodríguez-Pazos
Subjects: medicine.medical_specialty, Histology, business.industry, Photosensitivity reactions, Dermatology, Drug-induced photosensitivity, Pharmacology, Pathology and Forensic Medicine, Photosensitivity, Phototesting, Medicine, Abnormal results, business
Abstract: Thiazides are widely used diuretics that first became available in the 1950s. The first reports of photosensitivity reactions to thiazides were published shortly after the introduction of these drugs, but few cases have been described since. We review all the cases of photosensitivity due to thiazides published up to December 2011. We found 62 cases, 33 in women and 29 in men. The most common presentation was eczematous lesions in a photodistributed pattern, and the most common causative agent was hydrochloroth- iazide. The results of photobiological studies were published in only some of the cases reviewed. In most cases, phototesting revealed an abnormal response to UV-A alone or to both UV-A and UV- B. In some cases, the results of phototesting were normal and only photopatch testing yielded abnormal results. Diagnosis of photosensitivity due to thiazides requires a high degree of suspicion. Ideally, diagnosis should be confirmed by a photobiological study. © 2012 Elsevier Espana, S.L. and AEDV. All rights reserved.
Published: 2014

34. Elastolytic Actinic Giant Cell Granuloma

Author: Enrique Gutiérrez-González, Jaime Toribio, and Manuel Pereiro
Subjects: medicine.medical_specialty, Pathology, Systemic disease, business.industry, Spontaneous remission, Dermatology, Giant Cell Granuloma, medicine.disease, Elastic Tissue, Immune system, Actinic granuloma, Giant cell, Granuloma, Giant Cell, Diabetes Mellitus, Medicine, Humans, Annular elastolytic giant-cell granuloma, Photosensitivity Disorders, business, Granuloma annulare, Skin
Abstract: Actinic granuloma and annular elastolytic giant cell granuloma are different terms used to define skin lesions characterized by elastolysis, elastophagocytosis, and multinucleated giant cell infiltrate. The clinical appearance varies from papules to annular plaques. Although elastolytic actinic giant cell granuloma shares some clinical features with granuloma annulare, they can be differentiated by histopathologic findings. The disease is initiated by an immune response triggered by different factors that alter the elastic tissue. The course tends to be chronic, with variable response to treatments, although spontaneous remission may occur. Diabetes mellitus is the systemic disease most frequently associated with this condition.
Published: 2015

35. Basal cell carcinoma on the vermilion lip

Author: Daniel de la Mano, Enrique Gutiérrez-González, Ana Batalla, and Ana Isabel Encinas-Muñiz
Subjects: Pathology, medicine.medical_specialty, business.industry, fungi, Dermatology, Anatomy, medicine.disease, Asymptomatic, Lesion, medicine.anatomical_structure, Medicine, Basal cell carcinoma, Histopathology, Vermilion border, Vermilion, Skin cancer, Differential diagnosis, medicine.symptom, business
Abstract: The vermilion and vermilion border are rare locations for basal cell carcinoma. We report a case of a 72-year-old woman, who presented with an asymptomatic erosive lesion on the vermilion area of the upper lip. Histopathology examination was consistent with basal cell carcinoma. We suggest that basal cell carcinoma should be included in the differential diagnosis of erosive/ulcerative lesions arising on the vermilion area of the lip.
Published: 2015

36. Adult-onset verrucous nevus lipomatosus cutaneous superficialis

Author: Jaime Toribio, Iria Montero, Dolores Sánchez-Aguilar, Enrique Gutiérrez-González, and Manuel Ginarte
Subjects: Pathology, medicine.medical_specialty, business.industry, medicine, Dermatology, business, Verrucous Nevus
Published: 2012

37. Sweet’s syndrome and acute parvovirus B19 infection

Author: Adriana Álvarez-Pérez, Jaime Toribio, Dolores Sánchez-Aguilar, and Enrique Gutiérrez-González
Subjects: Sweet's syndrome, biology, Parvovirus, business.industry, medicine, Dermatology, medicine.disease, biology.organism_classification, business, Virology
Published: 2012

38. Acrodermatitis Enteropathica in a Breast-Fed Infant

Author: J. Toribio, M. Loureiro, Enrique Gutiérrez-González, Adriana Álvarez-Pérez, and Dolores Sánchez-Aguilar
Subjects: medicine.medical_specialty, Histology, business.industry, Acrodermatitis enteropathica, Dermatology, medicine.disease, Gastroenterology, Intestinal absorption, Pathology and Forensic Medicine, Internal medicine, medicine, Zinc deficiency, business, Breast feeding
Published: 2012

39. Calcifilaxia atípica secundaria al tratamiento con acenocumarol

Author: Enrique Gutiérrez-González, Dolores Sánchez-Aguilar, Adriana Álvarez-Pérez, and J. Toribio
Subjects: medicine.medical_specialty, business.industry, Medicine, General Medicine, business, Dermatology
Published: 2012

40. Atypical Calciphylaxis Secondary to Treatment With Acenocoumarol

Author: Adriana Álvarez-Pérez, Dolores Sánchez-Aguilar, Enrique Gutiérrez-González, and J. Toribio
Subjects: Polypharmacy, medicine.medical_specialty, Acenocoumarol, Calciphylaxis, Histology, business.industry, MEDLINE, Dermatology, medicine.disease, Pathology and Forensic Medicine, Hypertension complications, medicine, business, medicine.drug
Published: 2012

41. Granuloma annulare photoinduced by paroxetine

Author: M Teresa Rodríguez-Granados, Adriana Álvarez-Pérez, S. Gómez-Bernal, Jaime Toribio, and Enrique Gutiérrez-González
Subjects: medicine.medical_specialty, Pathology, business.industry, Immunology, Dermatology, General Medicine, medicine.disease, Paroxetine, Photosensitivity, Photosensitivity Disorder, medicine, Immunology and Allergy, Radiology, Nuclear Medicine and imaging, business, Granuloma annulare, medicine.drug
Abstract: Granuloma annulare (GA) is a benign granulomatous skin disease with several clinical manifestations and characteristic histological findings. GA located in photoexposed areas is a rare finding and its association to a drug-induced systemic photosensitivity is even less common. To the best of our knowledge, only one case of systemic drug photosensitivity manifesting as a GA has been reported. We describe a patient with systemic photosensitivity to paroxetine with clinical and histological manifestations of GA, which was confirmed by the photobiological study. The phototest revealed a reduction of the minimal erythematous dose for UVB while taking the paroxetine and its normalization after its withdrawal, which was accompanied by the clinical resolution of the skin eruption. The manifestation of systemic drug photosensitivity as a GA like in our case is exceptional.
Published: 2011

42. Photosensitivity induced by naproxen

Author: Jaime Toribio, Laura Rodríguez-Pazos, Enrique Gutiérrez-González, and María Teresa Rodríguez-Granados
Subjects: Drug, Naproxen, medicine.medical_specialty, Nonsteroidal, business.industry, media_common.quotation_subject, Photopatch test, Immunology, Dermatology, General Medicine, medicine.disease, chemistry.chemical_compound, Photodermatitis, chemistry, Photosensitivity, Lichenoid eruption, Immunology and Allergy, Medicine, Radiology, Nuclear Medicine and imaging, Erythema multiforme, business, media_common, medicine.drug
Abstract: We present two cases of systemic photosensitivity due to naproxen that presented as photodistributed erythema multiforme (EM) and lichenoid photodermatitis (LP). Although naproxen is a commonly used nonsteroidal antinflammatory drug and has the capacity of causing systemic photosensitivity, there are very few reports about it in the literature. The diagnosis was suspected by the recent ingestion of the drug and the photodistribution of the lesions. A positive photopatch test in the first patient and the normalization of the MED-UVB after discontinuing naproxen in the second patient supported the diagnosis.
Published: 2011

43. Variable expression of naevoid basal cell carcinoma syndrome in a family with a novel mutation in the PTCH1 gene

Author: J. Alonso-González, Enrique Gutiérrez-González, Ana Vega-Gliemmo, Virginia Fernández-Redondo, and Jaime Toribio
Subjects: Genetics, Variable Expression, Naevoid basal cell carcinoma syndrome, business.industry, Cancer research, Medicine, Dermatology, PTCH1 Gene, business, Novel mutation
Published: 2011

44. Photoletter to the editor: Basal cell carcinoma on the vermilion lip

Author: Ana, Batalla, Ana Isabel, Encinas-Muñiz, Enrique, Gutiérrez-González, and Daniel, de la Mano
Subjects: fungi, Article
Abstract: The vermilion and vermilion border are rare locations for basal cell carcinoma. We report a case of a 72-year-old woman, who presented with an asymptomatic erosive lesion on the vermilion area of the upper lip. Histopathology examination was consistent with basal cell carcinoma. We suggest that basal cell carcinoma should be included in the differential diagnosis of erosive/ulcerative lesions arising on the vermilion area of the lip.
Published: 2013

45. Cefuroxime-induced cutaneous pustular leukocytoclastic vasculitis with Koebner phenomenon on the donor area of a skin graft

Author: Dolores Sánchez-Aguilar, Jaime Toribio, Iria Montero, Adriana Álvarez-Pérez, Manuel Ginarte, and Enrique Gutiérrez-González
Subjects: medicine.medical_specialty, business.industry, Koebner phenomenon, Dermatology, Thigh, medicine.disease, Skin transplantation, Surgery, medicine.anatomical_structure, Transplant Donor Site, Leukocytoclastic vasculitis, medicine, business, Vasculitis, Cefuroxime, medicine.drug
Published: 2015

46. [Corkscrew-like hair and perifollicular purpura as a vitamin C deficiency sign]

Author: Ana, Batalla, Enrique, Gutiérrez-González, and Daniel, de la Mano
Subjects: Male, Humans, Scurvy, Middle Aged, Hair Diseases, Hair Follicle, Purpura
Published: 2013

47. [Diagnosis of Lafora disease by armpit cutaneous biopsy]

Author: Enrique, Gutiérrez-González, Javier, Labandeira-García, Ignacio, Requena, and Jaime, Toribio
Subjects: Male, Apocrine Glands, Adolescent, Lafora Disease, Biopsy, Axilla, Humans, Eccrine Glands, Periodic Acid-Schiff Reaction
Published: 2013

48. Annular elastolytic giant cell granuloma associated to late-onset X-linked dominant protoporphyria

Author: Jaime Toribio, Marta Santamariña, Francisco Javier García-Martínez, J. Alonso-González, María Teresa Rodríguez-Granados, Ana Vega, and Enrique Gutiérrez-González
Subjects: Male, Pathology, medicine.medical_specialty, Protoporphyria, Erythropoietic, Protoporphyrins, Dermatology, Hand Dermatoses, Frameshift mutation, chemistry.chemical_compound, Feces, Granuloma, Giant Cell, Internal medicine, Medicine, Humans, Photosensitivity Disorders, Aged, 80 and over, business.industry, Genetic disorder, Genetic Diseases, X-Linked, medicine.disease, ALAS2, Endocrinology, medicine.anatomical_structure, chemistry, Granuloma, Protoporphyrin, Annular elastolytic giant-cell granuloma, Erythropoietic protoporphyria, business, Sunscreening Agents, Elastic fiber, Facial Dermatoses, 5-Aminolevulinate Synthetase
Abstract: X-linked dominant protoporphyria (XLDPP) is a genetic disorder that affects the synthesis of the heme group due to an increase in delta-aminolaevulinate synthase 2 (ALAS2) enzyme activity. Moreover, annular elastolytic giant-cell granuloma (AEGCG) is a rare reactive granulomatous dermatosis, usually associated with actinic damage. An 86-year-old man presented with edematous-erythematous lesions in photoexposed areas of the face and on the dorsum of both hands. Protoporphyrin levels in serum and feces were significantly elevated and a heterozygous frameshift mutation in the exon 11 of the ALAS2 gene: c.1706-1709del (p.Glu569GlyfsX24) was identified. Concomitantly, we observed an annular plaque with raised borders on the back of his right hand, clinically and histologically compatible with a diagnosis of AEGCG. Skin lesions disappeared only upon use of a physical sunscreen. We report two rare photodermatoses in an elderly patient and discuss the significance of dermal elastic fiber damage induced by the XLDPP as a main triggering factor of AEGCG.
Published: 2013

49. Elastolytic giant cell granuloma: clinic-pathologic review of twenty cases

Author: Jaime Toribio, Dolores Sánchez-Aguilar, Enrique Gutiérrez-González, S. Gómez-Bernal, and Adriana Álvarez-Pérez
Subjects: Adult, Male, Actinic granuloma, elastolytic giant cell granuloma, elastophagocytosis, elastosis, diabetes mellitus, Pathology, medicine.medical_specialty, Skin Neoplasms, Biopsy, Dermatology, Disease, Giant Cell Granuloma, Diabetes Complications, Age Distribution, Granuloma, Giant Cell, Diabetes mellitus, medicine, Humans, Sex Distribution, Aged, medicine.diagnostic_test, business.industry, Extremities, General Medicine, Middle Aged, medicine.disease, Actinic granuloma, Giant cell, Granuloma, Age distribution, Female, business
Abstract: Background: O’Brien described four histopathological patterns of actinic granuloma (AG). Since then, only single cases and a few series have been reported in the literature, most corresponding to cases of the giant cell type. Methods: We reviewed all the cases diagnosed as AG or elastolytic giant cell granuloma (EGCG) in our department from 1988 until 2010. The biopsies were classified into the four patterns previously described. Results: Giant cell pattern was found to be the most frequent (70% of the cases). In four cases, the biopsies showed more than one histopathologic pattern. All the lesions were located on sun-exposed areas or were related to chronic heat exposure. Diabetes mellitus was associated in 40 % of the cases. Conclusions: The giant cell pattern of EGCG is the most frequent. Some cases may share histopathologic features of more than one variant and thus, we consider they may be categorized as mixed patterns. Diabetes mellitus is the most common associated disease and should always be ruled out.
Published: 2013

50. Granuloma annulare photoinduced by paroxetine

Author: Adriana, Álvarez-Pérez, Silvia, Gómez-Bernal, Enrique, Gutiérrez-González, M Teresa, Rodríguez-Granados, and Jaime, Toribio
Subjects: Granuloma Annulare, Paroxetine, Antidepressive Agents, Second-Generation, Humans, Female, Photosensitivity Disorders, Aged
Abstract: Granuloma annulare (GA) is a benign granulomatous skin disease with several clinical manifestations and characteristic histological findings. GA located in photoexposed areas is a rare finding and its association to a drug-induced systemic photosensitivity is even less common. To the best of our knowledge, only one case of systemic drug photosensitivity manifesting as a GA has been reported. We describe a patient with systemic photosensitivity to paroxetine with clinical and histological manifestations of GA, which was confirmed by the photobiological study. The phototest revealed a reduction of the minimal erythematous dose for UVB while taking the paroxetine and its normalization after its withdrawal, which was accompanied by the clinical resolution of the skin eruption. The manifestation of systemic drug photosensitivity as a GA like in our case is exceptional.
Published: 2012

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