Objective: Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6 -7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. Design and setting: Cross-sectional anthropometric and dietary survey in four cities in Spain. Subjects: A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. Outcome measures: Body mass index (BMI), overweight (BMI > 17.6 kg=m 2 ), obesity (BMI > 20.1 kg=m 2 ) and intake of food and nutrients. Results: Children in the four cities showed a high prevalence of overweight (range across cities, 28.9 -34.5%) and obesity (8.5 -15.7%). They also had a moderately hypercaloric diet (range, 2078 -2218 kcal=day), marked by an excessive intake of lipids (45.0 -47.3% kcal), particularly saturated fats (16.6 -16.9% kcal), proteins (17.0 -17.3% kcal), sugars (20.0 -21.9% kcal) and cholesterol (161.6 -182.9 mg=1000 kcal=day), and a low intake of complex carbohydrates (17.5 -18.1% kcal) and fibre (19.6 -19.9 g=day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg=m 2 ; P ¼ 0.0001) and ponderal index (0.58 kg=m 3 ; P ¼ 0.0001) and a higher intake of energy (104 kcal=day; P ¼ 0.007), cholesterol (16.00 mg=1000 kcal=day; P ¼ 0.0001) and sodium (321 mg=day; P ¼ 0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. Conclusions: Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences.

Objective: To compare the diet of Spanish children against the nutrient and food intake guidelines. To calculate an index of overall diet quality and check its validity against nutrient intake. Design and setting: Cross-sectional study in four cities in Spain, where information on food and nutrient intake was obtained from schoolchildren through a food frequency questionnaire. Participants: The sample included 1112 children (overall response rate of 85%) attending public and private schools and aged 6-7 y. Children were selected through random cluster sampling in schools, and stratified by sex and socioeconomic level. Main Outcome Measures: Mean nutrient intake, number of food servings, and the percentage of children who meet recommended nutrient and food-serving intake levels. The overall dietary quality was assessed using the Healthy Eating Index (HEI). Results: Mean micronutrient intake exceeded 100% of the recommended dietary allowances, except for vitamin B6, which registered a mean intake of 77.1%. For almost all children, intake of saturated fat was above, and that of carbohydrate below, the recommended level, in contrast to the relatively high compliance with the recommendations for poly-and monounsaturated fatty acid, salt and fiber intake (69.7, 43.7, 40.7, and 30.1%, respectively). Consumption of food servings for each of the five American pyramid food groups came close to or exceeded USDA guidelines, with the exception of cereals, with 5.4 servings per day. The mean score obtained in the HEI was 64.6. Children who complied with all the food guide pyramid recommendations registered a higher dietary variety and a healthier nutritional profile. Conclusions: Children aged 6-7 y show scant compliance with the macronutrient goals for healthy eating. Micronutrient intake is adequate in general, yet there are small groups of children with risk of deficient intake of vitamins B6 and D. While Spanish children's eating habits are reasonably in line with American food guide pyramid guidelines, consumptions of cereals and fruit should be improved.

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