Association between dietary pattern and cardiometabolic risk in children and adolescents: a systematic review

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array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1612 "Ancho" => 2171 "Tamanyo" => 247151 ] ] "descripcion" => array:1 [ "en" => "Study selection, evaluation, and inclusion process." ] ] ] "textoCompleto" => "IntroductionOverweight in childhood and adolescence is a major concern worldwide.<a class="elsevierStyleCrossRefs" href="#bib0165">1,2</a> Little is known about the complications that early-onset obesity can cause in the long term.<a class="elsevierStyleCrossRefs" href="#bib0175">3,4</a> Given the uncertainties, many associations have been made to better understand the consequences of overweight and obesity for the onset of cardiometabolic complications in early life.<a class="elsevierStyleCrossRefs" href="#bib0165">1,5</a>Some established associations between the genesis of obesity and alterations in cardiovascular risk markers – such as inflammatory cytokines, C-reactive protein, traditional biochemical parameters (total cholesterol, triglycerides, glucose, insulin), diet, and physical activity – have been evaluated in studies with adults and much is already known about the direction of these relations.<a class="elsevierStyleCrossRefs" href="#bib0180">4,6</a> However, it can be observed that these studies are not very common in children and adolescents, and more consistent information is still necessary about the behavior of cardiometabolic and inflammatory risk factors in this period.<a class="elsevierStyleCrossRefs" href="#bib0175">3,5</a>Diet is an important modifiable risk factor in the etiology of diseases, given the increasing number of epidemiological studies that address its relation with the onset of chronic diseases.<a class="elsevierStyleCrossRefs" href="#bib0195">7–9</a> The methodology of identification of the dietary pattern of specific populations has been widely used in observational studies, and has been useful to identify the association between diet and cardiometabolic risk factors.<a class="elsevierStyleCrossRefs" href="#bib0200">8,10,11</a>Dietary patterns can better inform about diet-disease associations than the assessment of isolated foods or nutrients, because they consider the total dietary intake and the interrelationships between many foods and nutrients, as well as their synergistic effects.<a class="elsevierStyleCrossRefs" href="#bib0195">7,9</a> They have been widely used due to the understanding that nutrients are rarely consumed in isolation, and that nutrient-only investigations underestimate the possible interactions between nutrients or between foods and other diet components.<a class="elsevierStyleCrossRef" href="#bib0200">8</a>The identification of dietary patterns considered to be unhealthy may be related to changes in body composition and biochemical and inflammatory parameters in children and adolescents.<a class="elsevierStyleCrossRefs" href="#bib0195">7,10</a> Considering that childhood is a phase during which eating habits are formed, the adoption of healthy eating practices in this period can have favorable consequences for the rest of life.In this sense, the aim of this systematic review article was to evaluate the association found between dietary patterns and cardiometabolic risk factors in studies of children and adolescents. The hypothesis was that unhealthy dietary patterns are associated with alterations in these risk markers in the assessed group.MethodsThe systematic review was carried out according to the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), which aims to guide systematic reviews and meta-analyses in the health area.<a class="elsevierStyleCrossRef" href="#bib0220">12</a> The article search strategy included searches in the electronic databases MEDLINE (National Library of Medicine, USA) via PubMed, Scopus, LILACS (Latin American and Caribbean Literature in Health Sciences), and SciELO (Scientific Electronic Library Online), with no publication date limitations.Article identification and selection in all databases were simultaneously performed by two researchers during a three-month period between February and April 2016. The words used as descriptors were: diet, dietary, patterns, risk, cardiovascular, biomarkers, children, adolescent, and health. The descriptors were used in English according to the Medical Subject Headings (MeSH) and in Portuguese according to the Descriptors in Health Sciences (in Portuguese, Descritores em Ciências da Saúde [DeCS]).The searches in the databases were performed using the keywords with Boolean operators represented by the connector terms AND, OR, and NOT. Thus, the following combinations were used: dietary patterns AND risk AND cardiovascular AND adolescent; dietary patterns AND risk AND cardiovascular AND children; dietary patterns AND biomarkers AND cardiovascular AND adolescent; dietary patterns AND biomarkers AND cardiovascular AND children; dietary patterns AND health AND cardiovascular AND adolescent; dietary patterns AND health AND cardiovascular AND children; diet AND risk AND cardiovascular AND adolescent; diet AND risk AND cardiovascular AND children. These combinations were also used for the terms OR and NOT, respectively, in all searched databases.The review searched for studies that evaluated dietary patterns using the a posteriori methodology only, which uses multivariate analysis techniques to extract the patterns,<a class="elsevierStyleCrossRef" href="#bib0225">13</a> and that associated the pattern found with cardiometabolic risk factors in children and/or adolescents. The articles that considered only food pattern identification or that only associated the pattern with anthropometric measurements were not included, as the objective was to detect how much a food pattern classified as “unhealthy” could influence the biochemical and inflammatory markers in this population.As non-inclusion criteria, the authors highlight studies conducted with adults, pregnant women, children under 2 years of age, review articles, experts’ comments, and those published in languages other than Portuguese and English.Article selection and identification in the databases were independently and systematically performed by two researchers, who carried out the initial identification through the titles of the publications found by the descriptors and, later, by the abstracts obtained by electronic search. After the selection of publications by titles and abstracts, a new assessment was made by the two researchers, who consensually determined the studies to be read in full and included in the review. The references of the selected studies were assessed, aiming to include other articles of potential interest.ResultsA total of 364 articles were identified on this topic. Of the 50 publications selected for reading of the abstract and of the full text, only seven articles met the established criteria for this systematic review, and two were found through the references of the first selected articles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The main characteristics of the studies, such as location, year of publication, design, age of the participants, statistical analysis used for food pattern derivation, and the other assessed variables, are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The articles differ regarding the type of design and in terms of the sample age, with most (78%) being cross-sectional studies.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the identified confounding factors that were included in the regression models, the identified food patterns named according to the definition of each author, and the main results of the articles. Confounding factors were described because they are important for the necessary adjustments in statistical analyses to increase the accuracy of the association strength. In most publications, the authors performed the analyses divided into models adjusted first for gender and age and then for other variables that could influence the characteristics of the food pattern and the association with cardiometabolic risk markers, such as parental level of schooling, level of physical activity, income, pubertal stage, and total energy intake.<a class="elsevierStyleCrossRefs" href="#bib0210">10,14,15</a><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>During the reading of the articles, the authors described the difficulty of approaching the association between dietary patterns and cardiometabolic risk factors in the group of children and adolescents, since there is little information available on the effects of dietary patterns on cardiometabolic alterations in the pediatric group.<a class="elsevierStyleCrossRefs" href="#bib0205">9,10,16</a> However, it is important to evaluate the association between dietary patterns and chronic noncommunicable diseases in childhood and adolescence, since cardiometabolic alterations can influence the current and future health of this group.<a class="elsevierStyleCrossRef" href="#bib0245">17</a>The identification of the food pattern varied little in relation to the statistical analysis used. Principal component analysis (PCA) was the most predominant (78%), which represents an alternative approach for the evaluation of food and nutrient intake, being useful to assess the diet-disease association.<a class="elsevierStyleCrossRef" href="#bib0195">7</a> Unhealthy eating patterns were defined as “Western” by most studies (55%), also using the terms “fast food,”<a class="elsevierStyleCrossRef" href="#bib0205">9</a> “high consumption of protein and fat,”<a class="elsevierStyleCrossRef" href="#bib0235">15</a> and “high in fat.”<a class="elsevierStyleCrossRef" href="#bib0210">10</a> Only one study did not name the identified patterns, maintaining only the names of the foods that belonged to each group.<a class="elsevierStyleCrossRef" href="#bib0200">8</a>In the methodology of four studies, parents or guardians assisted in the evaluation of children's food consumption.<a class="elsevierStyleCrossRefs" href="#bib0210">10,14,15,18</a> In 2013, Park et al.<a class="elsevierStyleCrossRef" href="#bib0230">14</a> performed the dietary assessment in a subgroup of their sample (503 participants); the authors explained that this practice was adopted due to practical difficulties in collecting the data.In general, a positive association was observed in the studies between an “unhealthy” eating pattern and increased cardiometabolic risk.<a class="elsevierStyleCrossRefs" href="#bib0195">7–10,14–18</a>According to Apannah et al., in 2015,<a class="elsevierStyleCrossRef" href="#bib0210">10</a> the pattern identified as energetically dense, high in fat, and low in fiber was associated with cardiometabolic alterations, such as high insulin concentration and insulin resistance in both genders. In contrast, Karatzi et al., in 2014<a class="elsevierStyleCrossRef" href="#bib0200">8</a> found that, of the five identified food patterns, only the pattern characterized by “margarine, sweets, and snacks” was associated with insulin resistance after the adjustments for confounding factors.Bibiloni et al.,<a class="elsevierStyleCrossRef" href="#bib0240">16</a> in a 2013 study with 219 girls aged 12–19, identified that the Western dietary pattern was associated with a higher concentration of adiponectin and interleukin-6 (IL-6). However, the authors observed that inflammation was more influenced by body mass index (BMI) and waist-to-height ratio (WtHR) than by the identified food pattern.Park et al.,<a class="elsevierStyleCrossRef" href="#bib0230">14</a> in a 2013 study with Korean prepubertal children, identified two eating patterns (“balanced” and “Western”), and found no association with metabolic alterations in boys. In girls, the mean concentration of triglycerides decreased at the highest quintile of the balanced pattern of consumption (mean: 72.6, SD: 8.27, p=0.032). The “Western” pattern showed a higher score in the category with more than one risk factor for metabolic syndrome (MS) in the group of girls (mean: 29.5, SD: 1.37, p=0.026).In 2013, Shang et al.,<a class="elsevierStyleCrossRef" href="#bib0245">17</a> when evaluating 5267 children and adolescents aged 6–13 years of age, found that the “Western pattern” was associated with a higher chance of obesity and that children and adolescents with higher scores in the “Western” and “transition” patterns had a higher chance of abdominal obesity. There was no association between the identified dietary patterns and hypertension, hypertriglyceridemia, hypercholesterolemia, dyslipidemia, and MS. However, the “Western” pattern had higher mean values of weight, BMI, waist circumference, and systolic and diastolic pressure, and higher concentrations of glucose, LDL-c, and triglycerides, and was inversely associated with HDL-c concentration when compared to the “healthy” pattern.In 2012, Romero-Polvo et al.<a class="elsevierStyleCrossRef" href="#bib0235">15</a> found that children and adolescents with “Western” food patterns had a 1.92-fold higher chance of insulin resistance. In 2011, Dishchekenian et al.<a class="elsevierStyleCrossRef" href="#bib0205">9</a> found a positive association between the “transition” pattern, based predominantly on the consumption of rice, pasta, beans, oil, red meats, processed meats, and sweets, and increased concentrations of insulin, glucose, triglycerides, and diastolic blood pressure levels. In the “fast food” pattern, the authors found a positive association with the concentration of LDL-c, and systolic and diastolic blood pressure levels, and a negative association with HDL-c.In 2010, Ambrosini et al.,<a class="elsevierStyleCrossRef" href="#bib0195">7</a> when studying the components of the metabolic syndrome (MS) in adolescents, divided their sample into two groups: high metabolic risk and low metabolic risk, aiming to investigate the association between dietary pattern and risk markers for MS and cardiovascular disease. The authors observed that the “Western” pattern was associated with increased risk of metabolic syndrome and its increased components, such as total serum cholesterol, BMI, and waist circumference among female adolescents. The “healthy” dietary pattern was associated with lower glucose concentrations in male and female adolescents.In 2007, Mikkilä et al.,<a class="elsevierStyleCrossRef" href="#bib0250">18</a> when evaluating the food intake of children and adolescents in a cohort study, identified the “traditional” and “health-conscious” dietary patterns. The second dietary pattern was inversely associated with cardiovascular risk factors; however, the results suggest that this dietary pattern is more of an indicator of an overall healthy lifestyle than just adequate dietary choices.DiscussionThe results of the studies showed a positive association between unhealthy eating patterns and cardiometabolic alterations.<a class="elsevierStyleCrossRefs" href="#bib0195">7–10,14–18</a> However, it is important to understand that, in several studies, the strength of this association for some risk markers was reduced, while others lost it after the adjustments for confounding factors or interaction variables.<a class="elsevierStyleCrossRefs" href="#bib0195">7,9,10,14–17</a>These results are noteworthy, as several factors associated with dietary intake and cardiometabolic alterations – such as income, gender, age, birth weight, parental level of schooling, physical activity level, and food availability at home – may alter the association between diet and disease, being of the utmost importance to evaluate them.The inability to identify positive associations between some risk factors and unhealthy foods in cross-sectional studies may be partly explained by changes in eating habits or dietary restrictions when body composition alterations already exist in children/adolescents, such as overweight and obesity, known as reverse causality.<a class="elsevierStyleCrossRefs" href="#bib0215">11,19</a> Another inability to identify positive associations is the fact that estimating true dietary intake is often complicated, as underreporting may occur in records, when the information is forgotten. This inaccuracy makes it difficult to analyze energy and macro- and micronutrient intake, as well as their associations with cardiometabolic alterations.<a class="elsevierStyleCrossRef" href="#bib0260">20</a>Most of the studies identified the pattern characterized as unhealthy, consisting of the consumption of ultraprocessed foods, poor in fiber and rich in sodium, fat, and refined carbohydrates.<a class="elsevierStyleCrossRefs" href="#bib0195">7–10,14–18</a>It is observed that the high consumption of foods with higher energetic density, rich in fats and refined sugars, is directly associated to the increase of lipogenesis, the secretion of very low density lipoproteins, and the reduced oxidation and greater accumulation of fatty acids in the tissues and blood.<a class="elsevierStyleCrossRef" href="#bib0265">21</a> The substitution of traditional and healthy food consumption by ultraprocessed and ready-to-eat foods and beverages is associated with the increase in the prevalence of overweight and chronic diseases already present in pediatric patients.<a class="elsevierStyleCrossRefs" href="#bib0270">22,23</a> In contrast, adequate consumption of healthy foods helps to reduce nutritional deficiencies and contributes to the maintenance of body weight and the prevention of chronic diseases,<a class="elsevierStyleCrossRef" href="#bib0280">24</a> thus it is essential to stimulate children and adolescents not only regarding the daily consumption of adequate foods, but also the reduction in the consumption of ultraprocessed foods.The articles selected for this review were those that addressed only the a posteriori methodology. This, in turn, consists in an exploratory method that uses multivariate analysis techniques to extract dietary patterns. In this approach, the most relevant patterns of the assessed population are identified from correlations between the collected data in the food surveys.<a class="elsevierStyleCrossRefs" href="#bib0225">13,25</a> This food consumption assessment methodology allows addressing the interactions between nutrients, food, and other diet components.Dietary patterns offer a new approach in nutritional epidemiology, with results that can be more easily translated into advice for the population, since food-orientated guidelines are more easily interpreted and practiced by the population than nutrient-related ones.<a class="elsevierStyleCrossRef" href="#bib0250">18</a>Despite the importance of studies with dietary patterns, few studies were performed with children and adolescents. Some difficulties are reported, such as the need to evaluate food intake in the presence of parents and the fact that the diseases are not yet established at this stage, which decreases the interest in investigating healthy populations.<a class="elsevierStyleCrossRefs" href="#bib0185">5,10,25</a> Additionally, many cardiometabolic risk factors that can be used to verify associations between diet and disease do not have established cutoffs for children and adolescents.<a class="elsevierStyleCrossRefs" href="#bib0185">5,6,26</a> This is what occurs with the definition of metabolic syndrome, which does not have well-established criteria to date and, therefore, it is difficult to assess its real prevalence in the pediatric population.<a class="elsevierStyleCrossRefs" href="#bib0230">14,27</a>It can be observed that some risk markers widely used in adults are still not frequently assessed in children and adolescents, as is the case of C-reactive protein, thus it is necessary to define cutoffs and their association with cardiometabolic alterations in the early stages of life.<a class="elsevierStyleCrossRef" href="#bib0185">5</a>There are also limitations related to the investigation of food consumption in relation to the methods used, the lack of tool validation, food composition tables that frequently do not include the analyzed foods, diversity in the composition of industrialized products, the interviewees’ difficulty in measuring food and beverage portions, as well as underreporting of the data.<a class="elsevierStyleCrossRefs" href="#bib0205">9,28</a>Irrespective of the complexity of this association, assessments of dietary patterns and other cardiometabolic risk factors in children and adolescents should be performed, since this population is easily influenced by the environment in which they live, by food advertisers, by peers, family, and by the adopted sociocultural values.<a class="elsevierStyleCrossRefs" href="#bib0205">9,17,29</a> Recognizing that the prevalence of overweight and obesity is increasing in developed and developing countries, and that this increase in overweight has raised the economic costs of countries and the families affected by the problem, information on food consumption and changes in cardiometabolic risk factors should always be evaluated.<a class="elsevierStyleCrossRefs" href="#bib0170">2,17,30</a>Some studies have described that childhood obesity can induce early changes in metabolism, leading to dyslipidemia and glucose intolerance, in parallel with changes in the oxidative and inflammatory system, as well as the early onset of obesity, which may determine a more severe pro-inflammatory phenotype than the adult obesity.<a class="elsevierStyleCrossRefs" href="#bib0180">4,27,31</a>In 2013, Bibiloni et al.<a class="elsevierStyleCrossRef" href="#bib0240">16</a> reported that the inflammatory process exists in the adipose tissue of obese children, representing an early alteration in humans. From this perspective, the identification and prevention, preferably in childhood, of risk factors associated with cardiometabolic alterations may be the best strategy to prevent the progression and involvement of other undesirable health effects.<a class="elsevierStyleCrossRef" href="#bib0170">2</a>Because diet is one of the modifiable and important risk factors in the etiology of chronic diseases, the identification of eating patterns characterized by consumption of “unhealthy” foods in childhood and adolescence can be useful for the development of strategies that improve eating habits and, consequently, reduce the prevalence of these risk factors throughout life.<a class="elsevierStyleCrossRef" href="#bib0195">7</a>The authors report that dietary patterns are specific to particular populations, since they may vary with gender, age, culture, ethnicity, socioeconomic status, and food availability, and it is important to analyze them in different groups to verify their actual applicability.<a class="elsevierStyleCrossRefs" href="#bib0205">9,11</a>The specificity of the population regarding the type of consumed dietary pattern, related to sociocultural characteristics, causes difficulties in comparisons, even though some similarities can be observed.<a class="elsevierStyleCrossRefs" href="#bib0215">11,18</a> Therefore, caution should be exercised when comparing the studies, since many of them differ in terms of sample size, number of follow-ups, statistical methods, and food consumption assessment methods.<a class="elsevierStyleCrossRef" href="#bib0320">32</a>ConclusionThere was a positive association between “unhealthy” dietary patterns and cardiometabolic alterations by most studies with children and adolescents. Some associations that could not be confirmed may be related to the specific difficulty of evaluating food consumption. Some points should be considered in assessing the diet-disease association, such as limitations of the selected dietary survey, incomplete food composition tables, under-notifications due to omissions or forgetfulness, and even the need for parental or caregiver assistance to provide the information.Given the complexity of this association, it is important to evaluate the dietary patterns in different populations of interest, since they may vary according to gender, age, availability of food at home, and sociocultural differences, among others. As similar as the results may seem, the comparisons and extrapolations of the data to other populations are uncertain.Studies with dietary patterns and their associations with cardiometabolic risk factors should be performed in children and adolescents, since the prevalence of obesity and associated comorbidities is increasing in this population, so that early interventions can be performed with the objective of reducing short-and-long term health damage, as well as the reduction of costs involved in the care of health complications.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres838071" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Data source" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Data synthesis" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec833800" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres838070" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Fonte dos dados" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Síntese dos dados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec833799" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-11" "fechaAceptado" => "2016-11-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec833800" "palabras" => array:5 [ 0 => "Dietary" 1 => "Patterns" 2 => "Cardiovascular" 3 => "Children" 4 => "Adolescent" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec833799" "palabras" => array:5 [ 0 => "Alimentação" 1 => "Padrões" 2 => "Cardiovascular" 3 => "Crianças" 4 => "Adolescente" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo evaluate the association between dietary patterns and cardiometabolic risk factors in children and adolescents. Data sourceThis article followed the recommendations of PRISMA, which aims to guide review publications in the health area. The article search strategy included searches in the electronic databases MEDLINE via PubMed, Scopus, and LILACS. There was no date limitation for publications. The descriptors were used in English according to MeSH and in Portuguese according to DeCS. Only articles on dietary patterns extracted by the a posteriori methodology were included. The question to be answered was: how much can an “unhealthy” dietary pattern influence biochemical and inflammatory markers in this population? Data synthesisThe studies showed an association between dietary patterns and cardiometabolic alterations. The patterns were characterized as unhealthy when associated to the consumption of ultraprocessed products, poor in fiber and rich in sodium, fat, and refined carbohydrates. Despite the associations, in several studies, the strength of this association for some risk markers was reduced or lost after adjusting for confounding variables. ConclusionThere was a positive association between “unhealthy” dietary patterns and cardiometabolic alterations in children and adolescents. Some unconfirmed associations may be related to the difficulty of assessing food consumption. Nevertheless, studies involving dietary patterns and their association with risk factors should be performed in children and adolescents, aiming at interventions and early changes in dietary habits considered to be inadequate." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Data source" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Data synthesis" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoAvaliar a associação encontrada nos estudos entre padrão alimentar e fatores de risco cardiometabólicos em crianças e adolescentes. Fonte dos dadosEste artigo seguiu as recomendações do PRISMA, que objetiva orientar as publicações de revisão na área da saúde. A estratégia de busca dos artigos incluiu pesquisas nas bases eletrônicas Medline via PubMed, Scopus e Lilacs. Não houve data limite de publicação. Os descritores foram usados em inglês de acordo com MeSH e em português segundo os DeCS. Apenas artigos de padrão alimentar extraídos pela metodologia a posteriori foram incluídos. A pergunta a ser respondida foi: quanto um padrão alimentar “não saudável” pode influenciar nos marcadores bioquímicos e inflamatórios dessa população. Síntese dos dadosOs estudos demonstraram haver associação entre os padrões alimentares e alterações cardiometabólicas. Os padrões caracterizados como não saudáveis eram marcados pelo consumo de produtos ultraprocessados, pobres em fibras e ricos em sódio, gordura e carboidratos refinados. Apesar das associações, em vários estudos, a força dessa associação para alguns marcadores de risco era reduzida ou perdida após os ajustes para as variáveis de confusão. ConclusãoHouve associação positiva entre os padrões alimentares “não saudáveis” e as alterações cardiometabólicas em crianças e adolescentes. Algumas associações não confirmadas podem estar relacionadas a própria dificuldade de avaliar o consumo alimentar. Apesar disso, estudos envolvendo padrões alimentares e sua associação a fatores de risco devem ser realizados em crianças e adolescentes objetivando intervenções e modificações precoces nos hábitos alimentares tidos como não adequados." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Fonte dos dados" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Síntese dos dados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Rocha NP, Milagres LC, Longo GZ, Ribeiro AQ, Novaes JF. Association between dietary pattern and cardiometabolic risk in children and adolescents: a systematic review. J Pediatr (Rio J). 2017;93:214–22." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1612 "Ancho" => 2171 "Tamanyo" => 247151 ] ] "descripcion" => array:1 [ "en" => "Study selection, evaluation, and inclusion process." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "FFQ, food frequency questionnaire; BMI, body mass index; WC, waist circumference; TG, triglycerides; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; HOMA-IR, homeostasis model assessment – insulin resistance; PAI-1, plasminogen activator inhibitor-1; IL-6, interleukin 6; WtHR, waist to height ratio; TC, total cholesterol; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; Apo A1, apolipoprotein A1; ApoB, apolipoprotein B; DXA, dual-energy X-ray absorptiometry." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author/year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference method \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Statistical analysis<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anthropometry \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tests \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Appannah et al., 2015<a class="elsevierStyleCrossRef" href="#bib0210">10</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Australia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (n=1611) and 17 years (n=1009) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Semi-quantitative FFQ related to previous 12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reduced rank regression<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Height, weight, BMI, WC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Insulin, glucose, TG, HDL-c, LDL-c, HOMA-ir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Karatzi et al., 2014<a class="elsevierStyleCrossRef" href="#bib0200">8</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Greece \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cross-sectional \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9–13 years (n=1912) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24-h food record (two days a week and one weekend) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Principal component analysis<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Weight, height, WC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Insulin, glucose, HOMA-ir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Biblioni et al., 2013<a class="elsevierStyleCrossRef" href="#bib0240">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cross-sectional \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12–17 years (n=219) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Validated semi-quantitative FFQ related to previous 12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Principal component analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Weight, height, WC, WtHR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adiponectin, leptin, TNF-α, PAI-1, IL-6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Park et al., 2013<a class="elsevierStyleCrossRef" href="#bib0230">14</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Korea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cross-sectional \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8–9 years (n=1008) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24-h food record (performed in three days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Principal component analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">WC, BMI, blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucose, TC, TG, HDL-c, ALT, AST and CT/HDL-c, TG/HDL-c \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shang et al., 2012<a class="elsevierStyleCrossRef" href="#bib0245">17</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">China \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cross-sectional \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6–13 years (n=5267) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24-h food record (two days a week and one weekend) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grouping analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Weight, height, BMI, blood pressure, WC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucose, TC, TG, HDL-c, LDL-c \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Romero-Polvo et al., 2012<a class="elsevierStyleCrossRef" href="#bib0235">15</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mexico \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cross-sectional. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7–18 years (n=916) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Semi-quantitative FFQ related to previous 12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Principal component analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Weight, height, BMI, WC, body fat% (DXA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucose, insulin, HOMA-ir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dishchekenian et al., 2011<a class="elsevierStyleCrossRef" href="#bib0205">9</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Brazil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cross-sectional \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14–19 years (n=76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Four-day food record (three days a week and one weekend) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Principal component analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Weight, height, blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TC, LDL-c, HDL-c, TG, glycemia, insulin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ambrosini et al., 2010<a class="elsevierStyleCrossRef" href="#bib0195">7</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Australia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohort cross-sectional \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 years (n=1139) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Semi-quantitative FFQ related to previous 12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Principal component analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Weight, height, WC, blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TC, LDL-c, HDL-c TG, glycemia and insulin, HOMA-ir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mikkilä et al., 2007<a class="elsevierStyleCrossRef" href="#bib0250">18</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Finland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3–39 years (n=1200) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48-h food record \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Principal component analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Height, weight, BMI, blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CRP, TC, LDL-c, HDL-c, VLDL-c, Apo A1s, Apo B, triacylglycerol, insulin, homocysteine \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414526.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Statistical analysis used to determine the dietary pattern." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Reduced rank regression (RRR)." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Principal component analysis." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the evaluated studies." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "OR, odds ratio; β, regression coefficient β; 95% CI, 95% confidence interval; F, female; M, male; BMI, body mass index; WC, waist circumference; HOMA-IR, homeostasis model assessment – insulin resistance; WtHR, waist to height ratio; TC, total cholesterol; LDL-c, low-density lipoprotein cholesterol; Apo B, apolipoprotein B; CRP, C-reactive protein; TG, triglycerides; HDL-c, high-density lipoprotein cholesterol; SBP, systolic blood pressure; DBP, diastolic blood pressure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author/year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Confounding/interaction factors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Identified patterns \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main results \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Appannah et al., 2015<a class="elsevierStyleCrossRef" href="#bib0210">10</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Physical activity, smoking status, gender, age, dietary underreporting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Energetically dense. 2. High in fat. 3. Poor in fiber. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">High scores on dietary patterns were associated with higher chance of belonging to the high metabolic risk group for boys (OR: 1.20, 95% CI: 1.01–1.41), but not for girls (OR: 1.03, 95% CI: 0.87–1.22) when adjusted for physical activity and smoking status. Higher scores on dietary patterns were associated with higher insulin levels (F and M-β: 3.0, 95% CI: 1–7%) and HOMA-IR (F and M-β: 4.0, 95% CI: 1–7%) in both genders. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Karatzi et al., 2014<a class="elsevierStyleCrossRef" href="#bib0200">8</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gender, breakfast consumption, pubertal stage, waist circumference, parents’ BMI, socioeconomic status, birth weight, physical activity. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Fried potatoes, red meat, and sweetened drinks. 2. Processed meats and cheese. 3. Margarine, sweets, and savory snacks. 4. Vegetables and fruits. 5. Increased egg consumption and lower consumption of fish. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The dietary pattern containing margarines, sweets, and snacks was positively associated with HOMA-IR (β=0.08; p=0.02) after adjustment for confounding factors. Children who had higher adherence to this eating pattern (consumption in the highest tertile) were 2.51 times more likely to have insulin resistance compared to children in the first tertile (95% CI: 1.30–4.90). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bibiloni et al., 2013<a class="elsevierStyleCrossRef" href="#bib0240">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Age, physical activity, smoking, energy intake, BMI, WtHR. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Mediterranean diet. 2. Western diet. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Western diet score was inversely related to plasma concentrations of adiponectin and IL-6 after control for possible confounding factors (β=−0.177, p<0.050 and β=0.183, p<0.050, respectively) and with additional adjustment for the BMI and WtHR (β=−0.168, p=0.050 and β=0.177, p<0.050, respectively). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Park et al., 2013<a class="elsevierStyleCrossRef" href="#bib0230">14</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Age, gender, energy intake, height, blood pressure. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Balanced pattern. 2. Western pattern. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">In girls, the mean concentration of triglycerides decreased in the highest consumption quintile of the balanced pattern (mean: 72.6, SD: 8.27, p=0.032). The highest score in the Western pattern was present in the girls who had more than one risk factor for MS (mean: 29.5, SD: 1.37, p=0.026). No association was found for the male gender. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shang et al., 2012<a class="elsevierStyleCrossRef" href="#bib0245">17</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gender, age, birth weight, eating profile in the 4th month after birth, total energy intake, physical activity, parents’ weight, level of schooling, income. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Healthy dietary pattern. 2. Transition pattern. 3. Western pattern. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The fasting glucose level was higher in the western food pattern than in the healthy pattern (4.53mmol/L vs. 4.46mmol/L, p=0.0082). Children with the Western pattern had higher concentrations of LDL-c (2.156mmol/L vs. 2.07mmol/L, p=0.0023) and lower HDL-c concentrations (p<0.001) compared to those with the healthy pattern. Children with the Western pattern profile were 1.80 times (95% CI: 1.15– 2.81) more likely to be obese than those with the healthy pattern. Transition (OR: 1.31, 95% CI: 1.09–1.56) and Western (OR: 1.71, 95% CI: 1.13–2.56) food patterns were associated with abdominal obesity. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Romero-Polvo et al., 2012<a class="elsevierStyleCrossRef" href="#bib0235">15</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gender, age, sexual maturation, BMI, physical activity, screen time, energy intake, use of medication, supplements, multivitamins. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Western pattern. 2. Prudent pattern. 3. High protein/fat consumption pattern. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Insulin resistance was associated with the highest consumption quintiles of the Western dietary pattern (OR: 1.92; 95% CI: 1.08–3.43). The other identified patterns showed no significant association. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dishchekenian et al., 2011<a class="elsevierStyleCrossRef" href="#bib0205">9</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gender, age, ethnicity, income, maternal schooling, BMI. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Traditional pattern. 2. Transition pattern 3. Fast food pattern. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The traditional pattern had a positive association with insulin (β=0.156, p<0.001), glycemia (β=0.329, p=0.027), and TG (β=0.513, p<0.001), and negative association with HDL-=−0.297; p=0.020) after adjusting for confounding factors. The fast food pattern was associated with insulin (β=0.176; p<0.001) when adjusted only by gender and ethnicity. When adjusted by income, maternal education, and BMI, this pattern showed a positive association with LDL-c (β=0.334, p<0.001), SBP (β=0.469, p<0.001), and DBP (β=0.615, p<0.001), and a negative one with HDL-c (β: −0.250, p<0.001). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ambrosini et al., 2010<a class="elsevierStyleCrossRef" href="#bib0195">7</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gender, energy intake, physical activity, screen time, maternal schooling, parents’ marital status, BMI, WC. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Western pattern. 2. Healthy pattern. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The mean BMI and WC did not vary according to the quartiles for each dietary pattern. For girls, the chances of metabolic risk were approximately 2.5 times higher (p<0.05; 95% CI: 1.05–5.98) in the highest quartile of the “Western” food pattern when compared to the lowest. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mikkilä et al., 2007<a class="elsevierStyleCrossRef" href="#bib0250">18</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Age, smoking status, total energy consumption, smoking, physical activity, years of follow-up in the study. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Traditional pattern. 2. Health-conscious pattern. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The health-conscious pattern was associated with lower risk factors, but mainly among females. The levels of TC (β: −0.06, p=0.02), LDL-c (β: −0.07, p=0.01), Apo B (β: −0.07, p=0.03), and CRP (β: −0.09;=0.04) showed a negative association with the score of the health-conscious pattern in females, all affected by the BMI insertion in the final model. Additionally, the score of the health-conscious pattern showed an independent inverse association with homocysteine levels (F-β: −0.11, p=0.03 and M-β: −0.14; p<0.01) in both genders. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414525.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Confounding/interaction factors, identified patterns, and main results of the evaluated articles." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0165" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Associations of apolipoprotein A, high-sensitivity C-reactive protein and fasting plasma insulin in obese children with and without family history of cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Z. Karabouta" 1 => "D. Papandreou" 2 => "A. Makedou" 3 => "I. Rousso" 4 => "F. Athanassiadou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.14740/jocmr2531w" "Revista" => array:6 [ "tituloSerie" => "J Clin Med Res" "fecha" => "2016" "volumen" => "8" "paginaInicial" => "431" "paginaFinal" => "436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27222670" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0170" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of diet on cardiometabolic health in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.N. Funtikova" 1 => "E. Navarro" 2 => "R.A. Bawaked" 3 => "M. Fíto" 4 => "H. Schröder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12937-015-0107-z" "Revista" => array:5 [ "tituloSerie" => "Nutr J" "fecha" => "2015" "volumen" => "14" "paginaInicial" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26574072" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0175" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of childhood obesity on inflammation, innate immune cell frequency, and metabolic microRNA expression" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Carolan" 1 => "A.E. Hogan" 2 => "M. Corrigan" 3 => "G. Gaotswe" 4 => "J. O’Connell" 5 => "M. Foley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2014" "volumen" => "99" "paginaInicial" => "474" "paginaFinal" => "478" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0180" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased oxidative stress and altered substrate metabolism in obese children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.R. Oliver" 1 => "J.S. Rosa" 2 => "G.L. Milne" 3 => "A.M. Pontello" 4 => "H.L. Borntrager" 5 => "S. Heydari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/17477160903545163" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Obes" "fecha" => "2010" "volumen" => "5" "paginaInicial" => "436" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20233149" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0185" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and low-grade inflammation: a pediatric perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.S. Tam" 1 => "K. Clément" 2 => "L.A. Baur" 3 => "J. Tordjman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1467-789X.2009.00674.x" "Revista" => array:6 [ "tituloSerie" => "Obes Rev" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "118" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19845868" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0190" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nontraditional risk factors and biomarkers for cardiovascular disease: mechanistic, research, and clinical considerations for youth" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Balagopal" 1 => "S.D. Ferranti" 2 => "S. Cook" 3 => "S.R. Daniels" 4 => "S.S. Gidding" 5 => "L.L. Hayman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0b013e31821c7c64" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2011" "volumen" => "123" "paginaInicial" => "2749" "paginaFinal" => "2769" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21555711" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0195" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary patterns and markers for the metabolic syndrome in Australian adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.L. Ambrosini" 1 => "R.C. Huang" 2 => "T.A. Mori" 3 => "B.P. Hands" 4 => "T.A. O'Sullivan" 5 => "N.H. Klerk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.numecd.2009.03.024" "Revista" => array:6 [ "tituloSerie" => "Nutr Metab Cardiovasc Dis" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "274" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19748245" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0200" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary patterns and breakfast consumption in relation to insulin resistance in children. The Healthy Growth Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Karatzi" 1 => "G. Moschonis" 2 => "A.A. Barouti" 3 => "C. Lionis" 4 => "G.P. Chrousos" 5 => "Y. Manios" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S1368980013003327" "Revista" => array:6 [ "tituloSerie" => "Public Health Nutr" "fecha" => "2014" "volumen" => "17" "paginaInicial" => "2790" "paginaFinal" => "2797" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24477051" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0205" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Padrões alimentares de adolescents obesos e diferentes repercussões metabólicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V.R. Dishchekenian" 1 => "M.A. Escrivão" 2 => "D. Palma" 3 => "F. Ancona-Lopez" 4 => "E.A. Araújo" 5 => "J.A. Taddei" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Nutr" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "17" "paginaFinal" => "29" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0210" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of a dietary pattern associated with greater cardiometabolic risk in adolescence" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Appannah" 1 => "G.K. Pot" 2 => "R.C. Huang" 3 => "W.H. Oddy" 4 => "L.J. Beilin" 5 => "T.A. Mori" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.numecd.2015.04.007" "Revista" => array:6 [ "tituloSerie" => "Nutr Metab Cardiovasc Dis" "fecha" => "2015" "volumen" => "25" "paginaInicial" => "643" "paginaFinal" => "650" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26026208" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0215" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eating patterns and overweight in 9- to 10-year-old children in Telemark County, Norway: a cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I.M. Oellingrath" 1 => "M.V. Svendsen" 2 => "A.L. Brantsæter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ejcn.2010.152" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Nutr" "fecha" => "2010" "volumen" => "64" "paginaInicial" => "1272" "paginaFinal" => "1279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20717128" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0220" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PRISMA declaration: a proposal to improve the publication of systematic reviews and meta-analyses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Urrútia" 1 => "X. Bonfill" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2010" "volumen" => "135" "paginaInicial" => "507" "paginaFinal" => "511" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0225" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metodologias de identificação de padrões alimentares a posteriori em crianças brasileiras: revisão sistemática" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.A. Carvalho" 1 => "P.C. Fonsêca" 2 => "L.N. Nobre" 3 => "S.E. Priore" 4 => "S.C. Franceschini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/1413-81232015211.18962014" "Revista" => array:6 [ "tituloSerie" => "Cien Saude Colet" "fecha" => "2016" "volumen" => "21" "paginaInicial" => "143" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26816172" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0230" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gender specific effect of major dietary patterns on the metabolic syndrome risk in Korean pre-pubertal children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.J. Park" 1 => "S.M. Lee" 2 => "S.M. Kim" 3 => "M. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4162/nrp.2013.7.2.139" "Revista" => array:6 [ "tituloSerie" => "Nutr Res Pract" "fecha" => "2013" "volumen" => "7" "paginaInicial" => "139" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23610607" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0235" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between dietary patterns and insulin resistance in mexican children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Romero-Polvo" 1 => "E. Denova-Gutiérrez" 2 => "B. Rivera-Paredez" 3 => "S. Castañón" 4 => "K. Gallegos-Carrillo" 5 => "E. Halley-Castillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000341493" "Revista" => array:6 [ "tituloSerie" => "Ann Nutr Metab" "fecha" => "2012" "volumen" => "61" "paginaInicial" => "142" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23037180" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0240" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary factors associated with subclinical inflammation among girls" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.M. Bibiloni" 1 => "C. Maffeis" 2 => "I. Llompart" 3 => "A. Pons" 4 => "J.A. Tur" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ejcn.2013.196" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Nutr" "fecha" => "2013" "volumen" => "67" "paginaInicial" => "1264" "paginaFinal" => "1270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24149444" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0245" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary pattern and its association with the prevalence of obesity and related cardiometabolic risk factors among Chinese children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Shang" 1 => "Y. Li" 2 => "A. Liu" 3 => "Q. Zhang" 4 => "X. Hu" 5 => "S. Du" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0043183" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "e43183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22905228" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0250" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Major dietary patterns and cardiovascular risk factors from childhood to adulthood. The Cardiovascular Risk in Young Finns Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V. Mikkilä" 1 => "L. Räsänen" 2 => "O.T. Raitakari" 3 => "J.M.P. Pietinen" 4 => "T. Rönnemmaa" 5 => "J. Viikari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0007114507691831" "Revista" => array:6 [ "tituloSerie" => "Br J Nutr" "fecha" => "2007" "volumen" => "98" "paginaInicial" => "218" "paginaFinal" => "225" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17367571" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0255" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consumo de alimentos ultraprocessados e impacto na dieta de adultos jovens" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.M. Bielemann" 1 => "J.V.S. Motta" 2 => "G.C. Mintem" 3 => "B.L. Horta" 4 => "D.P. Gigante" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Saude Publica" "fecha" => "2015" "volumen" => "49" "paginaInicial" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26018785" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0260" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of a dietary pattern prospectively associated with increased adiposity during childhood and adolescence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.L. Ambrosini" 1 => "P.M. Emmett" 2 => "K. Northstone" 3 => "L.D. Howe" 4 => "K. Tilling" 5 => "S.A. Jebb" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes" "fecha" => "2012" "volumen" => "36" "paginaInicial" => "1299" "paginaFinal" => "1305" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0265" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consumption of ultra-processed food products and its effects on children's lipid profiles: a longitudinal study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Rauber" 1 => "P.D. Campagnolo" 2 => "D.J. Hoffman" 3 => "M.R. Vitolo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.numecd.2014.08.001" "Revista" => array:6 [ "tituloSerie" => "Nutr Metab Cardiovasc Dis" "fecha" => "2015" "volumen" => "25" "paginaInicial" => "116" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25240690" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0270" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determinants of childhood obesity: ANIBES study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Aranceta-Bartrina" 1 => "C. Pérez-Rodrigo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.20960/nh.v33i1.17" "Revista" => array:6 [ "tituloSerie" => "Nutr Hosp" "fecha" => "2016" "volumen" => "33" "paginaInicial" => "17" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27019244" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0275" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultra-processed food consumption in children from a Basic Health Unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Sparrenberger" 1 => "R.R. Friedrich" 2 => "M.D. Schiffner" 3 => "I. Schuch" 4 => "M.B. Wagner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr" "fecha" => "2015" "volumen" => "91" "paginaInicial" => "535" "paginaFinal" => "542" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0280" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Padrões alimentares e fatores associados entre crianças de um a seis anos de um município do Sul do Brasil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.L. Souza" 1 => "S.W. Madruga" 2 => "D.P. Gigante" 3 => "I.S. Santos" 4 => "A.J. Barros" 5 => "M.C. Assunção" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cad Saude Publica" "fecha" => "2013" "volumen" => "29" "paginaInicial" => "2416" "paginaFinal" => "2426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24356688" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0285" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Application of a new statistical method to derive dietary patterns in nutritional epidemiology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Hoffmann" 1 => "M.B. Schulze" 2 => "A. Schienkiewitz" 3 => "U. Nöthlings" 4 => "H. Boeing" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Epidemiol" "fecha" => "2004" "volumen" => "159" "paginaInicial" => "935" "paginaFinal" => "944" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15128605" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0290" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "C-reactive protein concentration in children: relationship to adiposity and other cardiovascular risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.G. Cook" 1 => "M.A. Mendall" 2 => "P.H. Whincup" 3 => "I.M. Carey" 4 => "L. Ballam" 5 => "J.E. Morris" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Atherosclerosis" "fecha" => "2000" "volumen" => "149" "paginaInicial" => "139" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10704625" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0295" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recently discovered adipokines and cardio-metabolic comorbidities in childhood obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.M. Barraco" 1 => "R. Luciano" 2 => "M. Semeraro" 3 => "P.L. Prieto-Hontoria" 4 => "M. Manco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/ijms151119760" "Revista" => array:6 [ "tituloSerie" => "Int J Mol Sci" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "19760" "paginaFinal" => "19776" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25356508" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0300" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eficácia dos inquéritos alimentares na avaliação do consumo alimentar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.A. Pierre" 1 => "J.N. Zago" 2 => "R.C. Mendes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Revista Brasileira de Ciencia da Saúde" "fecha" => "2015" "volumen" => "19" "paginaInicial" => "91" "paginaFinal" => "100" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0305" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influência da mídia e das relações sociais na obesidade de escolares" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.C. Teixeira" 1 => "S.P. Costa" 2 => "G.V. Oliveira" 3 => "F.N. Candido" 4 => "L.M. Rafael" 5 => "M.L. Filho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cinergis" "fecha" => "2016" "volumen" => "17" "paginaInicial" => "162" "paginaFinal" => "167" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0310" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influência do excesso de peso e obesidade nos gastos em saúde nos domicílios brasileiros" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.S. Canela" 1 => "H.M. Novaes" 2 => "R.B. 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Review article

Naruna Pereira Rochaa,

Corresponding author

narunarocha@hotmail.com

Corresponding author.

, Luana Cupertino Milagresa, Giana Zarbato Longob, Andréia Queiroz Ribeirob, Juliana Farias de Novaesb

a Universidade Federal de Viçosa (UFV), Programa de Pós-Graduação em Ciência da Nutrição, Viçosa, MG, Brazil

b Universidade Federal de Viçosa (UFV), Departamento de Nutrição e Saúde, Viçosa, MG, Brazil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Overweight in childhood and adolescence is a major concern worldwide&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;2</span></a> Little is known about the complications that early-onset obesity can cause in the long term&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3&#44;4</span></a> Given the uncertainties&#44; many associations have been made to better understand the consequences of overweight and obesity for the onset of cardiometabolic complications in early life&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Some established associations between the genesis of obesity and alterations in cardiovascular risk markers &#8211; such as inflammatory cytokines&#44; C-reactive protein&#44; traditional biochemical parameters &#40;total cholesterol&#44; triglycerides&#44; glucose&#44; insulin&#41;&#44; diet&#44; and physical activity &#8211; have been evaluated in studies with adults and much is already known about the direction of these relations&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">4&#44;6</span></a> However&#44; it can be observed that these studies are not very common in children and adolescents&#44; and more consistent information is still necessary about the behavior of cardiometabolic and inflammatory risk factors in this period&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Diet is an important modifiable risk factor in the etiology of diseases&#44; given the increasing number of epidemiological studies that address its relation with the onset of chronic diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#8211;9</span></a> The methodology of identification of the dietary pattern of specific populations has been widely used in observational studies&#44; and has been useful to identify the association between diet and cardiometabolic risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8&#44;10&#44;11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Dietary patterns can better inform about diet-disease associations than the assessment of isolated foods or nutrients&#44; because they consider the total dietary intake and the interrelationships between many foods and nutrients&#44; as well as their synergistic effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#44;9</span></a> They have been widely used due to the understanding that nutrients are rarely consumed in isolation&#44; and that nutrient-only investigations underestimate the possible interactions between nutrients or between foods and other diet components&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The identification of dietary patterns considered to be unhealthy may be related to changes in body composition and biochemical and inflammatory parameters in children and adolescents&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#44;10</span></a> Considering that childhood is a phase during which eating habits are formed&#44; the adoption of healthy eating practices in this period can have favorable consequences for the rest of life&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this sense&#44; the aim of this systematic review article was to evaluate the association found between dietary patterns and cardiometabolic risk factors in studies of children and adolescents&#46; The hypothesis was that unhealthy dietary patterns are associated with alterations in these risk markers in the assessed group&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">The systematic review was carried out according to the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses &#40;PRISMA&#41;&#44; which aims to guide systematic reviews and meta-analyses in the health area&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> The article search strategy included searches in the electronic databases MEDLINE &#40;National Library of Medicine&#44; USA&#41; via PubMed&#44; Scopus&#44; LILACS &#40;Latin American and Caribbean Literature in Health Sciences&#41;&#44; and SciELO &#40;Scientific Electronic Library Online&#41;&#44; with no publication date limitations&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Article identification and selection in all databases were simultaneously performed by two researchers during a three-month period between February and April 2016&#46; The words used as descriptors were&#58; diet&#44; dietary&#44; patterns&#44; risk&#44; cardiovascular&#44; biomarkers&#44; children&#44; adolescent&#44; and health&#46; The descriptors were used in English according to the Medical Subject Headings &#40;MeSH&#41; and in Portuguese according to the Descriptors in Health Sciences &#40;in Portuguese&#44; Descritores em Ci&#234;ncias da Sa&#250;de &#91;DeCS&#93;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The searches in the databases were performed using the keywords with Boolean operators represented by the connector terms AND&#44; OR&#44; and NOT&#46; Thus&#44; the following combinations were used&#58; dietary patterns AND risk AND cardiovascular AND adolescent&#59; dietary patterns AND risk AND cardiovascular AND children&#59; dietary patterns AND biomarkers AND cardiovascular AND adolescent&#59; dietary patterns AND biomarkers AND cardiovascular AND children&#59; dietary patterns AND health AND cardiovascular AND adolescent&#59; dietary patterns AND health AND cardiovascular AND children&#59; diet AND risk AND cardiovascular AND adolescent&#59; diet AND risk AND cardiovascular AND children&#46; These combinations were also used for the terms OR and NOT&#44; respectively&#44; in all searched databases&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The review searched for studies that evaluated dietary patterns using the <span class="elsevierStyleItalic">a posteriori</span> methodology only&#44; which uses multivariate analysis techniques to extract the patterns&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> and that associated the pattern found with cardiometabolic risk factors in children and&#47;or adolescents&#46; The articles that considered only food pattern identification or that only associated the pattern with anthropometric measurements were not included&#44; as the objective was to detect how much a food pattern classified as &#8220;unhealthy&#8221; could influence the biochemical and inflammatory markers in this population&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As non-inclusion criteria&#44; the authors highlight studies conducted with adults&#44; pregnant women&#44; children under 2 years of age&#44; review articles&#44; experts&#8217; comments&#44; and those published in languages other than Portuguese and English&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Article selection and identification in the databases were independently and systematically performed by two researchers&#44; who carried out the initial identification through the titles of the publications found by the descriptors and&#44; later&#44; by the abstracts obtained by electronic search&#46; After the selection of publications by titles and abstracts&#44; a new assessment was made by the two researchers&#44; who consensually determined the studies to be read in full and included in the review&#46; The references of the selected studies were assessed&#44; aiming to include other articles of potential interest&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 364 articles were identified on this topic&#46; Of the 50 publications selected for reading of the abstract and of the full text&#44; only seven articles met the established criteria for this systematic review&#44; and two were found through the references of the first selected articles &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The main characteristics of the studies&#44; such as location&#44; year of publication&#44; design&#44; age of the participants&#44; statistical analysis used for food pattern derivation&#44; and the other assessed variables&#44; are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The articles differ regarding the type of design and in terms of the sample age&#44; with most &#40;78&#37;&#41; being cross-sectional studies&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the identified confounding factors that were included in the regression models&#44; the identified food patterns named according to the definition of each author&#44; and the main results of the articles&#46; Confounding factors were described because they are important for the necessary adjustments in statistical analyses to increase the accuracy of the association strength&#46; In most publications&#44; the authors performed the analyses divided into models adjusted first for gender and age and then for other variables that could influence the characteristics of the food pattern and the association with cardiometabolic risk markers&#44; such as parental level of schooling&#44; level of physical activity&#44; income&#44; pubertal stage&#44; and total energy intake&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">10&#44;14&#44;15</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">During the reading of the articles&#44; the authors described the difficulty of approaching the association between dietary patterns and cardiometabolic risk factors in the group of children and adolescents&#44; since there is little information available on the effects of dietary patterns on cardiometabolic alterations in the pediatric group&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;10&#44;16</span></a> However&#44; it is important to evaluate the association between dietary patterns and chronic noncommunicable diseases in childhood and adolescence&#44; since cardiometabolic alterations can influence the current and future health of this group&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The identification of the food pattern varied little in relation to the statistical analysis used&#46; Principal component analysis &#40;PCA&#41; was the most predominant &#40;78&#37;&#41;&#44; which represents an alternative approach for the evaluation of food and nutrient intake&#44; being useful to assess the diet-disease association&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> Unhealthy eating patterns were defined as &#8220;Western&#8221; by most studies &#40;55&#37;&#41;&#44; also using the terms &#8220;fast food&#44;&#8221;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a> &#8220;high consumption of protein and fat&#44;&#8221;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> and &#8220;high in fat&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a> Only one study did not name the identified patterns&#44; maintaining only the names of the foods that belonged to each group&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In the methodology of four studies&#44; parents or guardians assisted in the evaluation of children&#39;s food consumption&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">10&#44;14&#44;15&#44;18</span></a> In 2013&#44; Park et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> performed the dietary assessment in a subgroup of their sample &#40;503 participants&#41;&#59; the authors explained that this practice was adopted due to practical difficulties in collecting the data&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In general&#44; a positive association was observed in the studies between an &#8220;unhealthy&#8221; eating pattern and increased cardiometabolic risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#8211;10&#44;14&#8211;18</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">According to Apannah et al&#46;&#44; in 2015&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a> the pattern identified as energetically dense&#44; high in fat&#44; and low in fiber was associated with cardiometabolic alterations&#44; such as high insulin concentration and insulin resistance in both genders&#46; In contrast&#44; Karatzi et al&#46;&#44; in 2014<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> found that&#44; of the five identified food patterns&#44; only the pattern characterized by &#8220;margarine&#44; sweets&#44; and snacks&#8221; was associated with insulin resistance after the adjustments for confounding factors&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Bibiloni et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> in a 2013 study with 219 girls aged 12&#8211;19&#44; identified that the Western dietary pattern was associated with a higher concentration of adiponectin and interleukin-6 &#40;IL-6&#41;&#46; However&#44; the authors observed that inflammation was more influenced by body mass index &#40;BMI&#41; and waist-to-height ratio &#40;WtHR&#41; than by the identified food pattern&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Park et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> in a 2013 study with Korean prepubertal children&#44; identified two eating patterns &#40;&#8220;balanced&#8221; and &#8220;Western&#8221;&#41;&#44; and found no association with metabolic alterations in boys&#46; In girls&#44; the mean concentration of triglycerides decreased at the highest quintile of the balanced pattern of consumption &#40;mean&#58; 72&#46;6&#44; SD&#58; 8&#46;27&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032&#41;&#46; The &#8220;Western&#8221; pattern showed a higher score in the category with more than one risk factor for metabolic syndrome &#40;MS&#41; in the group of girls &#40;mean&#58; 29&#46;5&#44; SD&#58; 1&#46;37&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In 2013&#44; Shang et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a> when evaluating 5267 children and adolescents aged 6&#8211;13 years of age&#44; found that the &#8220;Western pattern&#8221; was associated with a higher chance of obesity and that children and adolescents with higher scores in the &#8220;Western&#8221; and &#8220;transition&#8221; patterns had a higher chance of abdominal obesity&#46; There was no association between the identified dietary patterns and hypertension&#44; hypertriglyceridemia&#44; hypercholesterolemia&#44; dyslipidemia&#44; and MS&#46; However&#44; the &#8220;Western&#8221; pattern had higher mean values of weight&#44; BMI&#44; waist circumference&#44; and systolic and diastolic pressure&#44; and higher concentrations of glucose&#44; LDL-c&#44; and triglycerides&#44; and was inversely associated with HDL-c concentration when compared to the &#8220;healthy&#8221; pattern&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In 2012&#44; Romero-Polvo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> found that children and adolescents with &#8220;Western&#8221; food patterns had a 1&#46;92-fold higher chance of insulin resistance&#46; In 2011&#44; Dishchekenian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a> found a positive association between the &#8220;transition&#8221; pattern&#44; based predominantly on the consumption of rice&#44; pasta&#44; beans&#44; oil&#44; red meats&#44; processed meats&#44; and sweets&#44; and increased concentrations of insulin&#44; glucose&#44; triglycerides&#44; and diastolic blood pressure levels&#46; In the &#8220;fast food&#8221; pattern&#44; the authors found a positive association with the concentration of LDL-c&#44; and systolic and diastolic blood pressure levels&#44; and a negative association with HDL-c&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In 2010&#44; Ambrosini et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> when studying the components of the metabolic syndrome &#40;MS&#41; in adolescents&#44; divided their sample into two groups&#58; high metabolic risk and low metabolic risk&#44; aiming to investigate the association between dietary pattern and risk markers for MS and cardiovascular disease&#46; The authors observed that the &#8220;Western&#8221; pattern was associated with increased risk of metabolic syndrome and its increased components&#44; such as total serum cholesterol&#44; BMI&#44; and waist circumference among female adolescents&#46; The &#8220;healthy&#8221; dietary pattern was associated with lower glucose concentrations in male and female adolescents&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In 2007&#44; Mikkil&#228; et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a> when evaluating the food intake of children and adolescents in a cohort study&#44; identified the &#8220;traditional&#8221; and &#8220;health-conscious&#8221; dietary patterns&#46; The second dietary pattern was inversely associated with cardiovascular risk factors&#59; however&#44; the results suggest that this dietary pattern is more of an indicator of an overall healthy lifestyle than just adequate dietary choices&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">The results of the studies showed a positive association between unhealthy eating patterns and cardiometabolic alterations&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#8211;10&#44;14&#8211;18</span></a> However&#44; it is important to understand that&#44; in several studies&#44; the strength of this association for some risk markers was reduced&#44; while others lost it after the adjustments for confounding factors or interaction variables&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#44;9&#44;10&#44;14&#8211;17</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">These results are noteworthy&#44; as several factors associated with dietary intake and cardiometabolic alterations &#8211; such as income&#44; gender&#44; age&#44; birth weight&#44; parental level of schooling&#44; physical activity level&#44; and food availability at home &#8211; may alter the association between diet and disease&#44; being of the utmost importance to evaluate them&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The inability to identify positive associations between some risk factors and unhealthy foods in cross-sectional studies may be partly explained by changes in eating habits or dietary restrictions when body composition alterations already exist in children&#47;adolescents&#44; such as overweight and obesity&#44; known as reverse causality&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;19</span></a> Another inability to identify positive associations is the fact that estimating true dietary intake is often complicated&#44; as underreporting may occur in records&#44; when the information is forgotten&#46; This inaccuracy makes it difficult to analyze energy and macro- and micronutrient intake&#44; as well as their associations with cardiometabolic alterations&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Most of the studies identified the pattern characterized as unhealthy&#44; consisting of the consumption of ultraprocessed foods&#44; poor in fiber and rich in sodium&#44; fat&#44; and refined carbohydrates&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#8211;10&#44;14&#8211;18</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">It is observed that the high consumption of foods with higher energetic density&#44; rich in fats and refined sugars&#44; is directly associated to the increase of lipogenesis&#44; the secretion of very low density lipoproteins&#44; and the reduced oxidation and greater accumulation of fatty acids in the tissues and blood&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a> The substitution of traditional and healthy food consumption by ultraprocessed and ready-to-eat foods and beverages is associated with the increase in the prevalence of overweight and chronic diseases already present in pediatric patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">22&#44;23</span></a> In contrast&#44; adequate consumption of healthy foods helps to reduce nutritional deficiencies and contributes to the maintenance of body weight and the prevention of chronic diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">24</span></a> thus it is essential to stimulate children and adolescents not only regarding the daily consumption of adequate foods&#44; but also the reduction in the consumption of ultraprocessed foods&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The articles selected for this review were those that addressed only the <span class="elsevierStyleItalic">a posteriori</span> methodology&#46; This&#44; in turn&#44; consists in an exploratory method that uses multivariate analysis techniques to extract dietary patterns&#46; In this approach&#44; the most relevant patterns of the assessed population are identified from correlations between the collected data in the food surveys&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13&#44;25</span></a> This food consumption assessment methodology allows addressing the interactions between nutrients&#44; food&#44; and other diet components&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Dietary patterns offer a new approach in nutritional epidemiology&#44; with results that can be more easily translated into advice for the population&#44; since food-orientated guidelines are more easily interpreted and practiced by the population than nutrient-related ones&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Despite the importance of studies with dietary patterns&#44; few studies were performed with children and adolescents&#46; Some difficulties are reported&#44; such as the need to evaluate food intake in the presence of parents and the fact that the diseases are not yet established at this stage&#44; which decreases the interest in investigating healthy populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5&#44;10&#44;25</span></a> Additionally&#44; many cardiometabolic risk factors that can be used to verify associations between diet and disease do not have established cutoffs for children and adolescents&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5&#44;6&#44;26</span></a> This is what occurs with the definition of metabolic syndrome&#44; which does not have well-established criteria to date and&#44; therefore&#44; it is difficult to assess its real prevalence in the pediatric population&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">14&#44;27</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">It can be observed that some risk markers widely used in adults are still not frequently assessed in children and adolescents&#44; as is the case of C-reactive protein&#44; thus it is necessary to define cutoffs and their association with cardiometabolic alterations in the early stages of life&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">There are also limitations related to the investigation of food consumption in relation to the methods used&#44; the lack of tool validation&#44; food composition tables that frequently do not include the analyzed foods&#44; diversity in the composition of industrialized products&#44; the interviewees&#8217; difficulty in measuring food and beverage portions&#44; as well as underreporting of the data&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;28</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Irrespective of the complexity of this association&#44; assessments of dietary patterns and other cardiometabolic risk factors in children and adolescents should be performed&#44; since this population is easily influenced by the environment in which they live&#44; by food advertisers&#44; by peers&#44; family&#44; and by the adopted sociocultural values&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;17&#44;29</span></a> Recognizing that the prevalence of overweight and obesity is increasing in developed and developing countries&#44; and that this increase in overweight has raised the economic costs of countries and the families affected by the problem&#44; information on food consumption and changes in cardiometabolic risk factors should always be evaluated&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">2&#44;17&#44;30</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Some studies have described that childhood obesity can induce early changes in metabolism&#44; leading to dyslipidemia and glucose intolerance&#44; in parallel with changes in the oxidative and inflammatory system&#44; as well as the early onset of obesity&#44; which may determine a more severe pro-inflammatory phenotype than the adult obesity&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">4&#44;27&#44;31</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">In 2013&#44; Bibiloni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> reported that the inflammatory process exists in the adipose tissue of obese children&#44; representing an early alteration in humans&#46; From this perspective&#44; the identification and prevention&#44; preferably in childhood&#44; of risk factors associated with cardiometabolic alterations may be the best strategy to prevent the progression and involvement of other undesirable health effects&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Because diet is one of the modifiable and important risk factors in the etiology of chronic diseases&#44; the identification of eating patterns characterized by consumption of &#8220;unhealthy&#8221; foods in childhood and adolescence can be useful for the development of strategies that improve eating habits and&#44; consequently&#44; reduce the prevalence of these risk factors throughout life&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">The authors report that dietary patterns are specific to particular populations&#44; since they may vary with gender&#44; age&#44; culture&#44; ethnicity&#44; socioeconomic status&#44; and food availability&#44; and it is important to analyze them in different groups to verify their actual applicability&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;11</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">The specificity of the population regarding the type of consumed dietary pattern&#44; related to sociocultural characteristics&#44; causes difficulties in comparisons&#44; even though some similarities can be observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;18</span></a> Therefore&#44; caution should be exercised when comparing the studies&#44; since many of them differ in terms of sample size&#44; number of follow-ups&#44; statistical methods&#44; and food consumption assessment methods&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0215" class="elsevierStylePara elsevierViewall">There was a positive association between &#8220;unhealthy&#8221; dietary patterns and cardiometabolic alterations by most studies with children and adolescents&#46; Some associations that could not be confirmed may be related to the specific difficulty of evaluating food consumption&#46; Some points should be considered in assessing the diet-disease association&#44; such as limitations of the selected dietary survey&#44; incomplete food composition tables&#44; under-notifications due to omissions or forgetfulness&#44; and even the need for parental or caregiver assistance to provide the information&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Given the complexity of this association&#44; it is important to evaluate the dietary patterns in different populations of interest&#44; since they may vary according to gender&#44; age&#44; availability of food at home&#44; and sociocultural differences&#44; among others&#46; As similar as the results may seem&#44; the comparisons and extrapolations of the data to other populations are uncertain&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Studies with dietary patterns and their associations with cardiometabolic risk factors should be performed in children and adolescents&#44; since the prevalence of obesity and associated comorbidities is increasing in this population&#44; so that early interventions can be performed with the objective of reducing short-and-long term health damage&#44; as well as the reduction of costs involved in the care of health complications&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "identificador" => "abst0005"
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              "titulo" => "Conclusion"
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          "titulo" => "Keywords"
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          "titulo" => "Resumo"
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              "titulo" => "Fonte dos dados"
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            2 => array:2 [
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              "titulo" => "S&#237;ntese dos dados"
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          "titulo" => "Introduction"
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          "titulo" => "Conflicts of interest"
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          "titulo" => "References"
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    "tienePdf" => true
    "fechaRecibido" => "2016-10-11"
    "fechaAceptado" => "2016-11-03"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:5 [
            0 => "Dietary"
            1 => "Patterns"
            2 => "Cardiovascular"
            3 => "Children"
            4 => "Adolescent"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec833799"
          "palabras" => array:5 [
            0 => "Alimenta&#231;&#227;o"
            1 => "Padr&#245;es"
            2 => "Cardiovascular"
            3 => "Crian&#231;as"
            4 => "Adolescente"
          ]
        ]
      ]
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the association between dietary patterns and cardiometabolic risk factors in children and adolescents&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Data source</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This article followed the recommendations of PRISMA&#44; which aims to guide review publications in the health area&#46; The article search strategy included searches in the electronic databases MEDLINE via PubMed&#44; Scopus&#44; and LILACS&#46; There was no date limitation for publications&#46; The descriptors were used in English according to MeSH and in Portuguese according to DeCS&#46; Only articles on dietary patterns extracted by the <span class="elsevierStyleItalic">a posteriori</span> methodology were included&#46; The question to be answered was&#58; how much can an &#8220;unhealthy&#8221; dietary pattern influence biochemical and inflammatory markers in this population&#63;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Data synthesis</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The studies showed an association between dietary patterns and cardiometabolic alterations&#46; The patterns were characterized as unhealthy when associated to the consumption of ultraprocessed products&#44; poor in fiber and rich in sodium&#44; fat&#44; and refined carbohydrates&#46; Despite the associations&#44; in several studies&#44; the strength of this association for some risk markers was reduced or lost after adjusting for confounding variables&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There was a positive association between &#8220;unhealthy&#8221; dietary patterns and cardiometabolic alterations in children and adolescents&#46; Some unconfirmed associations may be related to the difficulty of assessing food consumption&#46; Nevertheless&#44; studies involving dietary patterns and their association with risk factors should be performed in children and adolescents&#44; aiming at interventions and early changes in dietary habits considered to be inadequate&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Data source"
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            "identificador" => "abst0015"
            "titulo" => "Data synthesis"
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            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar a associa&#231;&#227;o encontrada nos estudos entre padr&#227;o alimentar e fatores de risco cardiometab&#243;licos em crian&#231;as e adolescentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Fonte dos dados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este artigo seguiu as recomenda&#231;&#245;es do PRISMA&#44; que objetiva orientar as publica&#231;&#245;es de revis&#227;o na &#225;rea da sa&#250;de&#46; A estrat&#233;gia de busca dos artigos incluiu pesquisas nas bases eletr&#244;nicas Medline via PubMed&#44; Scopus e Lilacs&#46; N&#227;o houve data limite de publica&#231;&#227;o&#46; Os descritores foram usados em ingl&#234;s de acordo com MeSH e em portugu&#234;s segundo os DeCS&#46; Apenas artigos de padr&#227;o alimentar extra&#237;dos pela metodologia <span class="elsevierStyleItalic">a posteriori</span> foram inclu&#237;dos&#46; A pergunta a ser respondida foi&#58; quanto um padr&#227;o alimentar &#8220;n&#227;o saud&#225;vel&#8221; pode influenciar nos marcadores bioqu&#237;micos e inflamat&#243;rios dessa popula&#231;&#227;o&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">S&#237;ntese dos dados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os estudos demonstraram haver associa&#231;&#227;o entre os padr&#245;es alimentares e altera&#231;&#245;es cardiometab&#243;licas&#46; Os padr&#245;es caracterizados como n&#227;o saud&#225;veis eram marcados pelo consumo de produtos ultraprocessados&#44; pobres em fibras e ricos em s&#243;dio&#44; gordura e carboidratos refinados&#46; Apesar das associa&#231;&#245;es&#44; em v&#225;rios estudos&#44; a for&#231;a dessa associa&#231;&#227;o para alguns marcadores de risco era reduzida ou perdida ap&#243;s os ajustes para as vari&#225;veis de confus&#227;o&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Houve associa&#231;&#227;o positiva entre os padr&#245;es alimentares &#8220;n&#227;o saud&#225;veis&#8221; e as altera&#231;&#245;es cardiometab&#243;licas em crian&#231;as e adolescentes&#46; Algumas associa&#231;&#245;es n&#227;o confirmadas podem estar relacionadas a pr&#243;pria dificuldade de avaliar o consumo alimentar&#46; Apesar disso&#44; estudos envolvendo padr&#245;es alimentares e sua associa&#231;&#227;o a fatores de risco devem ser realizados em crian&#231;as e adolescentes objetivando interven&#231;&#245;es e modifica&#231;&#245;es precoces nos h&#225;bitos alimentares tidos como n&#227;o adequados&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Fonte dos dados"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "S&#237;ntese dos dados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Rocha NP&#44; Milagres LC&#44; Longo GZ&#44; Ribeiro AQ&#44; Novaes JF&#46; Association between dietary pattern and cardiometabolic risk in children and adolescents&#58; a systematic review&#46; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;214&#8211;22&#46;</p>"
      ]
    ]
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Study selection&#44; evaluation&#44; and inclusion process&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">FFQ&#44; food frequency questionnaire&#59; BMI&#44; body mass index&#59; WC&#44; waist circumference&#59; TG&#44; triglycerides&#59; HDL-c&#44; high-density lipoprotein cholesterol&#59; LDL-c&#44; low-density lipoprotein cholesterol&#59; HOMA-IR&#44; homeostasis model assessment &#8211; insulin resistance&#59; PAI-1&#44; plasminogen activator inhibitor-1&#59; IL-6&#44; interleukin 6&#59; WtHR&#44; waist to height ratio&#59; TC&#44; total cholesterol&#59; ALT&#44; alanine aminotransferase&#59; AST&#44; aspartate aminotransferase&#59; CRP&#44; C-reactive protein&#59; Apo A1&#44; apolipoprotein A1&#59; ApoB&#44; apolipoprotein B&#59; DXA&#44; dual-energy X-ray absorptiometry&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author&#47;year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference method&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Statistical analysis<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anthropometry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Appannah et al&#46;&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Australia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1611&#41; and 17 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Semi-quantitative FFQ related to previous 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reduced rank regression<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Height&#44; weight&#44; BMI&#44; WC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Insulin&#44; glucose&#44; TG&#44; HDL-c&#44; LDL-c&#44; HOMA-ir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Karatzi et al&#46;&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greece&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cross-sectional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#8211;13 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1912&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24-h food record &#40;two days a week and one weekend&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Principal component analysis<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Weight&#44; height&#44; WC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Insulin&#44; glucose&#44; HOMA-ir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Biblioni et al&#46;&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cross-sectional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#8211;17 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>219&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Validated semi-quantitative FFQ related to previous 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Principal component analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Weight&#44; height&#44; WC&#44; WtHR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Adiponectin&#44; leptin&#44; TNF-&#945;&#44; PAI-1&#44; IL-6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Park et al&#46;&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Korea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cross-sectional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#8211;9 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24-h food record &#40;performed in three days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Principal component analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">WC&#44; BMI&#44; blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucose&#44; TC&#44; TG&#44; HDL-c&#44; ALT&#44; AST and CT&#47;HDL-c&#44; TG&#47;HDL-c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shang et al&#46;&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cross-sectional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#8211;13 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5267&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24-h food record &#40;two days a week and one weekend&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Grouping analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Weight&#44; height&#44; BMI&#44; blood pressure&#44; WC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucose&#44; TC&#44; TG&#44; HDL-c&#44; LDL-c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Romero-Polvo et al&#46;&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mexico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cross-sectional&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#8211;18 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>916&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Semi-quantitative FFQ related to previous 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Principal component analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Weight&#44; height&#44; BMI&#44; WC&#44; body fat&#37; &#40;DXA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucose&#44; insulin&#44; HOMA-ir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dishchekenian et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Brazil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cross-sectional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#8211;19 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Four-day food record &#40;three days a week and one weekend&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Principal component analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Weight&#44; height&#44; blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TC&#44; LDL-c&#44; HDL-c&#44; TG&#44; glycemia&#44; insulin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ambrosini et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Australia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohort cross-sectional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1139&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Semi-quantitative FFQ related to previous 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Principal component analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Weight&#44; height&#44; WC&#44; blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TC&#44; LDL-c&#44; HDL-c TG&#44; glycemia and insulin&#44; HOMA-ir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mikkil&#228; et al&#46;&#44; 2007<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Finland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#8211;39 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1200&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48-h food record&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Principal component analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Height&#44; weight&#44; BMI&#44; blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CRP&#44; TC&#44; LDL-c&#44; HDL-c&#44; VLDL-c&#44; Apo A1s&#44; Apo B&#44; triacylglycerol&#44; insulin&#44; homocysteine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">OR&#44; odds ratio&#59; <span class="elsevierStyleItalic">&#946;</span>&#44; regression coefficient <span class="elsevierStyleItalic">&#946;</span>&#59; 95&#37; CI&#44; 95&#37; confidence interval&#59; F&#44; female&#59; M&#44; male&#59; BMI&#44; body mass index&#59; WC&#44; waist circumference&#59; HOMA-IR&#44; homeostasis model assessment &#8211; insulin resistance&#59; WtHR&#44; waist to height ratio&#59; TC&#44; total cholesterol&#59; LDL-c&#44; low-density lipoprotein cholesterol&#59; Apo B&#44; apolipoprotein B&#59; CRP&#44; C-reactive protein&#59; TG&#44; triglycerides&#59; HDL-c&#44; high-density lipoprotein cholesterol&#59; SBP&#44; systolic blood pressure&#59; DBP&#44; diastolic blood pressure&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author&#47;year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Confounding&#47;interaction factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Identified patterns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Appannah et al&#46;&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Physical activity&#44; smoking status&#44; gender&#44; age&#44; dietary underreporting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Energetically dense&#46;<br>2&#46; High in fat&#46;<br>3&#46; Poor in fiber&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High scores on dietary patterns were associated with higher chance of belonging to the high metabolic risk group for boys &#40;OR&#58; 1&#46;20&#44; 95&#37; CI&#58; 1&#46;01&#8211;1&#46;41&#41;&#44; but not for girls &#40;OR&#58; 1&#46;03&#44; 95&#37; CI&#58; 0&#46;87&#8211;1&#46;22&#41; when adjusted for physical activity and smoking status&#46; Higher scores on dietary patterns were associated with higher insulin levels &#40;F and M-&#946;&#58; 3&#46;0&#44; 95&#37; CI&#58; 1&#8211;7&#37;&#41; and HOMA-IR &#40;F and M-&#946;&#58; 4&#46;0&#44; 95&#37; CI&#58; 1&#8211;7&#37;&#41; in both genders&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Karatzi et al&#46;&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gender&#44; breakfast consumption&#44; pubertal stage&#44; waist circumference&#44; parents&#8217; BMI&#44; socioeconomic status&#44; birth weight&#44; physical activity&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Fried potatoes&#44; red meat&#44; and sweetened drinks&#46;<br>2&#46; Processed meats and cheese&#46;<br>3&#46; Margarine&#44; sweets&#44; and savory snacks&#46;<br>4&#46; Vegetables and fruits&#46;<br>5&#46; Increased egg consumption and lower consumption of fish&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The dietary pattern containing margarines&#44; sweets&#44; and snacks was positively associated with HOMA-IR &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; after adjustment for confounding factors&#46; Children who had higher adherence to this eating pattern &#40;consumption in the highest tertile&#41; were 2&#46;51 times more likely to have insulin resistance compared to children in the first tertile &#40;95&#37; CI&#58; 1&#46;30&#8211;4&#46;90&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bibiloni et al&#46;&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Age&#44; physical activity&#44; smoking&#44; energy intake&#44; BMI&#44; WtHR&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Mediterranean diet&#46;<br>2&#46; Western diet&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Western diet score was inversely related to plasma concentrations of adiponectin and IL-6 after control for possible confounding factors &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;177&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;050 and <span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;183&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;050&#44; respectively&#41; and with additional adjustment for the BMI and WtHR &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;168&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;050 and <span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;177&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;050&#44; respectively&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Park et al&#46;&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Age&#44; gender&#44; energy intake&#44; height&#44; blood pressure&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Balanced pattern&#46;<br>2&#46; Western pattern&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In girls&#44; the mean concentration of triglycerides decreased in the highest consumption quintile of the balanced pattern &#40;mean&#58; 72&#46;6&#44; SD&#58; 8&#46;27&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032&#41;&#46; The highest score in the Western pattern was present in the girls who had more than one risk factor for MS &#40;mean&#58; 29&#46;5&#44; SD&#58; 1&#46;37&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#41;&#46; No association was found for the male gender&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shang et al&#46;&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gender&#44; age&#44; birth weight&#44; eating profile in the 4th month after birth&#44; total energy intake&#44; physical activity&#44; parents&#8217; weight&#44; level of schooling&#44; income&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Healthy dietary pattern&#46;<br>2&#46; Transition pattern&#46;<br>3&#46; Western pattern&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The fasting glucose level was higher in the western food pattern than in the healthy pattern &#40;4&#46;53<span class="elsevierStyleHsp" style=""></span>mmol&#47;L <span class="elsevierStyleItalic">vs&#46;</span> 4&#46;46<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0082&#41;&#46; Children with the Western pattern had higher concentrations of LDL-c &#40;2&#46;156<span class="elsevierStyleHsp" style=""></span>mmol&#47;L <span class="elsevierStyleItalic">vs&#46;</span> 2&#46;07<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0023&#41; and lower HDL-c concentrations &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; compared to those with the healthy pattern&#46; Children with the Western pattern profile were 1&#46;80 times &#40;95&#37; CI&#58; 1&#46;15&#8211; 2&#46;81&#41; more likely to be obese than those with the healthy pattern&#46; Transition &#40;OR&#58; 1&#46;31&#44; 95&#37; CI&#58; 1&#46;09&#8211;1&#46;56&#41; and Western &#40;OR&#58; 1&#46;71&#44; 95&#37; CI&#58; 1&#46;13&#8211;2&#46;56&#41; food patterns were associated with abdominal obesity&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Romero-Polvo et al&#46;&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gender&#44; age&#44; sexual maturation&#44; BMI&#44; physical activity&#44; screen time&#44; energy intake&#44; use of medication&#44; supplements&#44; multivitamins&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Western pattern&#46;<br>2&#46; Prudent pattern&#46;<br>3&#46; High protein&#47;fat consumption pattern&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Insulin resistance was associated with the highest consumption quintiles of the Western dietary pattern &#40;OR&#58; 1&#46;92&#59; 95&#37; CI&#58; 1&#46;08&#8211;3&#46;43&#41;&#46; The other identified patterns showed no significant association&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dishchekenian et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gender&#44; age&#44; ethnicity&#44; income&#44; maternal schooling&#44; BMI&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Traditional pattern&#46;<br>2&#46; Transition pattern<br>3&#46; Fast food pattern&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The traditional pattern had a positive association with insulin &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;156&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; glycemia &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;329&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41;&#44; and TG &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;513&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and negative association with HDL-<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;297&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;020&#41; after adjusting for confounding factors&#46; The fast food pattern was associated with insulin &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;176&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; when adjusted only by gender and ethnicity&#46; When adjusted by income&#44; maternal education&#44; and BMI&#44; this pattern showed a positive association with LDL-c &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;334&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; SBP &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;469&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and DBP &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;615&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and a negative one with HDL-c &#40;<span class="elsevierStyleItalic">&#946;</span>&#58; &#8722;0&#46;250&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ambrosini et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gender&#44; energy intake&#44; physical activity&#44; screen time&#44; maternal schooling&#44; parents&#8217; marital status&#44; BMI&#44; WC&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Western pattern&#46;<br>2&#46; Healthy pattern&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The mean BMI and WC did not vary according to the quartiles for each dietary pattern&#46; For girls&#44; the chances of metabolic risk were approximately 2&#46;5 times higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#59; 95&#37; CI&#58; 1&#46;05&#8211;5&#46;98&#41; in the highest quartile of the &#8220;Western&#8221; food pattern when compared to the lowest&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mikkil&#228; et al&#46;&#44; 2007<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Age&#44; smoking status&#44; total energy consumption&#44; smoking&#44; physical activity&#44; years of follow-up in the study&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46; Traditional pattern&#46;<br>2&#46; Health-conscious pattern&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The health-conscious pattern was associated with lower risk factors&#44; but mainly among females&#46; The levels of TC &#40;<span class="elsevierStyleItalic">&#946;</span>&#58; &#8722;0&#46;06&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#44; LDL-c &#40;<span class="elsevierStyleItalic">&#946;</span>&#58; &#8722;0&#46;07&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; Apo B &#40;<span class="elsevierStyleItalic">&#946;</span>&#58; &#8722;0&#46;07&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#44; and CRP &#40;<span class="elsevierStyleItalic">&#946;</span>&#58; &#8722;0&#46;09&#59;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41; showed a negative association with the score of the health-conscious pattern in females&#44; all affected by the BMI insertion in the final model&#46; Additionally&#44; the score of the health-conscious pattern showed an independent inverse association with homocysteine levels &#40;F-<span class="elsevierStyleItalic">&#946;</span>&#58; &#8722;0&#46;11&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03 and M-<span class="elsevierStyleItalic">&#946;</span>&#58; &#8722;0&#46;14&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; in both genders&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Confounding&#47;interaction factors&#44; identified patterns&#44; and main results of the evaluated articles&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:32 [
            0 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Associations of apolipoprotein A&#44; high-sensitivity C-reactive protein and fasting plasma insulin in obese children with and without family history of cardiovascular disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Z&#46; Karabouta"
                            1 => "D&#46; Papandreou"
                            2 => "A&#46; Makedou"
                            3 => "I&#46; Rousso"
                            4 => "F&#46; Athanassiadou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.14740/jocmr2531w"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Med Res"
                        "fecha" => "2016"
                        "volumen" => "8"
                        "paginaInicial" => "431"
                        "paginaFinal" => "436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27222670"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of diet on cardiometabolic health in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;N&#46; Funtikova"
                            1 => "E&#46; Navarro"
                            2 => "R&#46;A&#46; Bawaked"
                            3 => "M&#46; F&#237;to"
                            4 => "H&#46; Schr&#246;der"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12937-015-0107-z"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutr J"
                        "fecha" => "2015"
                        "volumen" => "14"
                        "paginaInicial" => "118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26574072"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of childhood obesity on inflammation&#44; innate immune cell frequency&#44; and metabolic microRNA expression"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Carolan"
                            1 => "A&#46;E&#46; Hogan"
                            2 => "M&#46; Corrigan"
                            3 => "G&#46; Gaotswe"
                            4 => "J&#46; O&#8217;Connell"
                            5 => "M&#46; Foley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2014"
                        "volumen" => "99"
                        "paginaInicial" => "474"
                        "paginaFinal" => "478"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased oxidative stress and altered substrate metabolism in obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;R&#46; Oliver"
                            1 => "J&#46;S&#46; Rosa"
                            2 => "G&#46;L&#46; Milne"
                            3 => "A&#46;M&#46; Pontello"
                            4 => "H&#46;L&#46; Borntrager"
                            5 => "S&#46; Heydari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/17477160903545163"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Pediatr Obes"
                        "fecha" => "2010"
                        "volumen" => "5"
                        "paginaInicial" => "436"
                        "paginaFinal" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20233149"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and low-grade inflammation&#58; a pediatric perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;S&#46; Tam"
                            1 => "K&#46; Cl&#233;ment"
                            2 => "L&#46;A&#46; Baur"
                            3 => "J&#46; Tordjman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1467-789X.2009.00674.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obes Rev"
                        "fecha" => "2010"
                        "volumen" => "11"
                        "paginaInicial" => "118"
                        "paginaFinal" => "126"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19845868"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontraditional risk factors and biomarkers for cardiovascular disease&#58; mechanistic&#44; research&#44; and clinical considerations for youth"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Balagopal"
                            1 => "S&#46;D&#46; Ferranti"
                            2 => "S&#46; Cook"
                            3 => "S&#46;R&#46; Daniels"
                            4 => "S&#46;S&#46; Gidding"
                            5 => "L&#46;L&#46; Hayman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e31821c7c64"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2011"
                        "volumen" => "123"
                        "paginaInicial" => "2749"
                        "paginaFinal" => "2769"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21555711"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary patterns and markers for the metabolic syndrome in Australian adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;L&#46; Ambrosini"
                            1 => "R&#46;C&#46; Huang"
                            2 => "T&#46;A&#46; Mori"
                            3 => "B&#46;P&#46; Hands"
                            4 => "T&#46;A&#46; O&#39;Sullivan"
                            5 => "N&#46;H&#46; Klerk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.numecd.2009.03.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Metab Cardiovasc Dis"
                        "fecha" => "2010"
                        "volumen" => "20"
                        "paginaInicial" => "274"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19748245"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary patterns and breakfast consumption in relation to insulin resistance in children&#46; The Healthy Growth Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Karatzi"
                            1 => "G&#46; Moschonis"
                            2 => "A&#46;A&#46; Barouti"
                            3 => "C&#46; Lionis"
                            4 => "G&#46;P&#46; Chrousos"
                            5 => "Y&#46; Manios"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S1368980013003327"
                      "Revista" => array:6 [
                        "tituloSerie" => "Public Health Nutr"
                        "fecha" => "2014"
                        "volumen" => "17"
                        "paginaInicial" => "2790"
                        "paginaFinal" => "2797"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24477051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Padr&#245;es alimentares de adolescents obesos e diferentes repercuss&#245;es metab&#243;licas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46;R&#46; Dishchekenian"
                            1 => "M&#46;A&#46; Escriv&#227;o"
                            2 => "D&#46; Palma"
                            3 => "F&#46; Ancona-Lopez"
                            4 => "E&#46;A&#46; Ara&#250;jo"
                            5 => "J&#46;A&#46; Taddei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Nutr"
                        "fecha" => "2011"
                        "volumen" => "24"
                        "paginaInicial" => "17"
                        "paginaFinal" => "29"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identification of a dietary pattern associated with greater cardiometabolic risk in adolescence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Appannah"
                            1 => "G&#46;K&#46; Pot"
                            2 => "R&#46;C&#46; Huang"
                            3 => "W&#46;H&#46; Oddy"
                            4 => "L&#46;J&#46; Beilin"
                            5 => "T&#46;A&#46; Mori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.numecd.2015.04.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Metab Cardiovasc Dis"
                        "fecha" => "2015"
                        "volumen" => "25"
                        "paginaInicial" => "643"
                        "paginaFinal" => "650"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26026208"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eating patterns and overweight in 9- to 10-year-old children in Telemark County&#44; Norway&#58; a cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46;M&#46; Oellingrath"
                            1 => "M&#46;V&#46; Svendsen"
                            2 => "A&#46;L&#46; Brants&#230;ter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ejcn.2010.152"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Nutr"
                        "fecha" => "2010"
                        "volumen" => "64"
                        "paginaInicial" => "1272"
                        "paginaFinal" => "1279"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20717128"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PRISMA declaration&#58; a proposal to improve the publication of systematic reviews and meta-analyses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Urr&#250;tia"
                            1 => "X&#46; Bonfill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin"
                        "fecha" => "2010"
                        "volumen" => "135"
                        "paginaInicial" => "507"
                        "paginaFinal" => "511"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "13"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metodologias de identifica&#231;&#227;o de padr&#245;es alimentares <span class="elsevierStyleItalic">a posteriori</span> em crian&#231;as brasileiras&#58; revis&#227;o sistem&#225;tica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;A&#46; Carvalho"
                            1 => "P&#46;C&#46; Fons&#234;ca"
                            2 => "L&#46;N&#46; Nobre"
                            3 => "S&#46;E&#46; Priore"
                            4 => "S&#46;C&#46; Franceschini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/1413-81232015211.18962014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cien Saude Colet"
                        "fecha" => "2016"
                        "volumen" => "21"
                        "paginaInicial" => "143"
                        "paginaFinal" => "154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26816172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gender specific effect of major dietary patterns on the metabolic syndrome risk in Korean pre-pubertal children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;J&#46; Park"
                            1 => "S&#46;M&#46; Lee"
                            2 => "S&#46;M&#46; Kim"
                            3 => "M&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4162/nrp.2013.7.2.139"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Res Pract"
                        "fecha" => "2013"
                        "volumen" => "7"
                        "paginaInicial" => "139"
                        "paginaFinal" => "145"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23610607"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between dietary patterns and insulin resistance in mexican children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Romero-Polvo"
                            1 => "E&#46; Denova-Guti&#233;rrez"
                            2 => "B&#46; Rivera-Paredez"
                            3 => "S&#46; Casta&#241;&#243;n"
                            4 => "K&#46; Gallegos-Carrillo"
                            5 => "E&#46; Halley-Castillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000341493"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Nutr Metab"
                        "fecha" => "2012"
                        "volumen" => "61"
                        "paginaInicial" => "142"
                        "paginaFinal" => "150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23037180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary factors associated with subclinical inflammation among girls"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;M&#46; Bibiloni"
                            1 => "C&#46; Maffeis"
                            2 => "I&#46; Llompart"
                            3 => "A&#46; Pons"
                            4 => "J&#46;A&#46; Tur"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ejcn.2013.196"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Nutr"
                        "fecha" => "2013"
                        "volumen" => "67"
                        "paginaInicial" => "1264"
                        "paginaFinal" => "1270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24149444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary pattern and its association with the prevalence of obesity and related cardiometabolic risk factors among Chinese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "X&#46; Shang"
                            1 => "Y&#46; Li"
                            2 => "A&#46; Liu"
                            3 => "Q&#46; Zhang"
                            4 => "X&#46; Hu"
                            5 => "S&#46; Du"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0043183"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "e43183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22905228"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Major dietary patterns and cardiovascular risk factors from childhood to adulthood&#46; The Cardiovascular Risk in Young Finns Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; Mikkil&#228;"
                            1 => "L&#46; R&#228;s&#228;nen"
                            2 => "O&#46;T&#46; Raitakari"
                            3 => "J&#46;M&#46;P&#46; Pietinen"
                            4 => "T&#46; R&#246;nnemmaa"
                            5 => "J&#46; Viikari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0007114507691831"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Nutr"
                        "fecha" => "2007"
                        "volumen" => "98"
                        "paginaInicial" => "218"
                        "paginaFinal" => "225"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17367571"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consumo de alimentos ultraprocessados e impacto na dieta de adultos jovens"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;M&#46; Bielemann"
                            1 => "J&#46;V&#46;S&#46; Motta"
                            2 => "G&#46;C&#46; Mintem"
                            3 => "B&#46;L&#46; Horta"
                            4 => "D&#46;P&#46; Gigante"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Saude Publica"
                        "fecha" => "2015"
                        "volumen" => "49"
                        "paginaInicial" => "28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26018785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identification of a dietary pattern prospectively associated with increased adiposity during childhood and adolescence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46;L&#46; Ambrosini"
                            1 => "P&#46;M&#46; Emmett"
                            2 => "K&#46; Northstone"
                            3 => "L&#46;D&#46; Howe"
                            4 => "K&#46; Tilling"
                            5 => "S&#46;A&#46; Jebb"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes"
                        "fecha" => "2012"
                        "volumen" => "36"
                        "paginaInicial" => "1299"
                        "paginaFinal" => "1305"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consumption of ultra-processed food products and its effects on children&#39;s lipid profiles&#58; a longitudinal study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Rauber"
                            1 => "P&#46;D&#46; Campagnolo"
                            2 => "D&#46;J&#46; Hoffman"
                            3 => "M&#46;R&#46; Vitolo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.numecd.2014.08.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Metab Cardiovasc Dis"
                        "fecha" => "2015"
                        "volumen" => "25"
                        "paginaInicial" => "116"
                        "paginaFinal" => "122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25240690"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determinants of childhood obesity&#58; ANIBES study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Aranceta-Bartrina"
                            1 => "C&#46; P&#233;rez-Rodrigo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.20960/nh.v33i1.17"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Hosp"
                        "fecha" => "2016"
                        "volumen" => "33"
                        "paginaInicial" => "17"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27019244"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultra-processed food consumption in children from a Basic Health Unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Sparrenberger"
                            1 => "R&#46;R&#46; Friedrich"
                            2 => "M&#46;D&#46; Schiffner"
                            3 => "I&#46; Schuch"
                            4 => "M&#46;B&#46; Wagner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2015"
                        "volumen" => "91"
                        "paginaInicial" => "535"
                        "paginaFinal" => "542"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Padr&#245;es alimentares e fatores associados entre crian&#231;as de um a seis anos de um munic&#237;pio do Sul do Brasil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;L&#46; Souza"
                            1 => "S&#46;W&#46; Madruga"
                            2 => "D&#46;P&#46; Gigante"
                            3 => "I&#46;S&#46; Santos"
                            4 => "A&#46;J&#46; Barros"
                            5 => "M&#46;C&#46; Assun&#231;&#227;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cad Saude Publica"
                        "fecha" => "2013"
                        "volumen" => "29"
                        "paginaInicial" => "2416"
                        "paginaFinal" => "2426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24356688"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0285"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Application of a new statistical method to derive dietary patterns in nutritional epidemiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Hoffmann"
                            1 => "M&#46;B&#46; Schulze"
                            2 => "A&#46; Schienkiewitz"
                            3 => "U&#46; N&#246;thlings"
                            4 => "H&#46; Boeing"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "2004"
                        "volumen" => "159"
                        "paginaInicial" => "935"
                        "paginaFinal" => "944"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15128605"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "C-reactive protein concentration in children&#58; relationship to adiposity and other cardiovascular risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;G&#46; Cook"
                            1 => "M&#46;A&#46; Mendall"
                            2 => "P&#46;H&#46; Whincup"
                            3 => "I&#46;M&#46; Carey"
                            4 => "L&#46; Ballam"
                            5 => "J&#46;E&#46; Morris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Atherosclerosis"
                        "fecha" => "2000"
                        "volumen" => "149"
                        "paginaInicial" => "139"
                        "paginaFinal" => "150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10704625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0295"
              "etiqueta" => "27"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recently discovered adipokines and cardio-metabolic comorbidities in childhood obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;M&#46; Barraco"
                            1 => "R&#46; Luciano"
                            2 => "M&#46; Semeraro"
                            3 => "P&#46;L&#46; Prieto-Hontoria"
                            4 => "M&#46; Manco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/ijms151119760"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Mol Sci"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "19760"
                        "paginaFinal" => "19776"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25356508"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0300"
              "etiqueta" => "28"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efic&#225;cia dos inqu&#233;ritos alimentares na avalia&#231;&#227;o do consumo alimentar"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Pierre"
                            1 => "J&#46;N&#46; Zago"
                            2 => "R&#46;C&#46; Mendes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Revista Brasileira de Ciencia da Sa&#250;de"
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                        "volumen" => "19"
                        "paginaInicial" => "91"
                        "paginaFinal" => "100"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "29"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Influ&#234;ncia da m&#237;dia e das rela&#231;&#245;es sociais na obesidade de escolares"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;C&#46; Teixeira"
                            1 => "S&#46;P&#46; Costa"
                            2 => "G&#46;V&#46; Oliveira"
                            3 => "F&#46;N&#46; Candido"
                            4 => "L&#46;M&#46; Rafael"
                            5 => "M&#46;L&#46; Filho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cinergis"
                        "fecha" => "2016"
                        "volumen" => "17"
                        "paginaInicial" => "162"
                        "paginaFinal" => "167"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influ&#234;ncia do excesso de peso e obesidade nos gastos em sa&#250;de nos domic&#237;lios brasileiros"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;S&#46; Canela"
                            1 => "H&#46;M&#46; Novaes"
                            2 => "R&#46;B&#46; Levy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/0102-311X00184214"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cad Saude Publica"
                        "fecha" => "2015"
                        "volumen" => "31"
                        "paginaInicial" => "2331"
                        "paginaFinal" => "2341"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26840813"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
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Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2017.01.002

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Year/Month	Html	Pdf	Total

2024 November	4	2	6
2024 October	21	50	71
2024 September	15	36	51
2024 August	25	46	71
2024 July	42	31	73
2024 June	23	14	37
2024 May	18	16	34
2024 April	20	27	47
2024 March	18	15	33
2024 February	17	24	41
2024 January	17	14	31
2023 December	9	22	31
2023 November	19	40	59
2023 October	14	33	47
2023 September	18	38	56
2023 August	15	19	34
2023 July	20	12	32
2023 June	17	9	26
2023 May	21	25	46
2023 April	14	13	27
2023 March	36	20	56
2023 February	26	15	41
2023 January	15	14	29
2022 December	30	19	49
2022 November	28	28	56
2022 October	34	30	64
2022 September	17	20	37
2022 August	19	34	53
2022 July	21	29	50
2022 June	21	31	52
2022 May	15	26	41
2022 April	29	37	66
2022 March	19	42	61
2022 February	15	26	41
2022 January	19	15	34
2021 December	15	30	45
2021 November	14	22	36
2021 October	22	21	43
2021 September	11	6	17
2021 August	10	15	25
2021 July	13	9	22
2021 June	11	7	18
2021 May	16	14	30
2021 April	40	13	53
2021 March	9	6	15
2021 February	9	13	22
2021 January	8	5	13
2020 December	9	9	18
2020 November	11	12	23
2020 October	4	5	9
2020 September	11	12	23
2020 August	11	5	16
2020 July	8	5	13
2020 June	6	2	8
2020 May	8	5	13
2020 April	11	9	20
2020 March	7	3	10
2020 February	15	9	24
2020 January	13	16	29
2019 December	14	4	18
2019 November	12	2	14
2019 October	17	13	30
2019 September	9	7	16
2019 August	17	8	25
2019 July	18	9	27
2019 June	12	11	23
2019 May	13	5	18
2019 April	12	8	20
2019 March	8	6	14
2019 February	7	4	11
2019 January	7	5	12
2018 December	5	6	11
2018 November	2	4	6
2018 October	13	13	26
2018 September	4	1	5
2018 August	9	6	15
2018 July	5	2	7
2018 June	9	5	14
2018 May	19	10	29
2018 April	6	2	8
2018 March	8	3	11
2018 February	5	0	5
2018 January	10	5	15
2017 December	0	1	1
2017 November	12	3	15
2017 October	13	1	14
2017 September	4	3	7
2017 August	13	7	20
2017 July	20	9	29
2017 June	30	12	42
2017 May	32	17	49
2017 April	2	13	15
2017 March	0	8	8

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