Correlation of body mass index Z-scores with glucose and lipid profiles among overweight and obese children and adolescents

array:25 ["pii" => "S0021755717300360" "issn" => "00217557" "doi" => "10.1016/j.jped.2017.06.012" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "558" "copyright" => "Sociedade Brasileira de Pediatria" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2018;94:308-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 964 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 560 "PDF" => 285 ] ] "Traduccion" => array:1 [ "pt" => array:20 [ "pii" => "S2255553617301386" "issn" => "22555536" "doi" => "10.1016/j.jpedp.2017.09.024" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "558" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2018;94:308-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 948 "formatos" => array:3 [ "EPUB" => 121 "HTML" => 550 "PDF" => 277 ] ] "pt" => array:12 [ "idiomaDefecto" => true "cabecera" => "Artigo Original" "titulo" => "Correlation of body mass index Z‐scores with glucose and lipid profiles among overweight and obese children and adolescents" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "308" "paginaFinal" => "312" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Correlação dos escores‐z de IMC com os perfis glicêmico e lipídico entre crianças e adolescentes com sobrepeso e obesidade" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Alberto Nogueira‐de‐Almeida, Elza Daniel de Mello" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carlos Alberto" "apellidos" => "Nogueira‐de‐Almeida" ] 1 => array:2 [ "nombre" => "Elza Daniel de" "apellidos" => "Mello" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0021755717300360" "doi" => "10.1016/j.jped.2017.06.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755717300360?idApp=UINPBA000049" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553617301386?idApp=UINPBA000049" "url" => "/22555536/0000009400000003/v1_201805170408/S2255553617301386/v1_201805170408/pt/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S0021755716303965" "issn" => "00217557" "doi" => "10.1016/j.jped.2017.06.017" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "563" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2018;94:313-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1045 "formatos" => array:3 [ "EPUB" => 108 "HTML" => 677 "PDF" => 260 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Association between body mass index and individual characteristics and the school context: a multilevel study with Portuguese children" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "319" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Relação entre o índice de massa corporal e as características individuais e do contexto escolar: um estudo multinível com crianças portuguesas" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael S. Henrique, Thayse N. Gomes, Go Tani, José A.R. Maia" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Rafael S." "apellidos" => "Henrique" ] 1 => array:2 [ "nombre" => "Thayse N." "apellidos" => "Gomes" ] 2 => array:2 [ "nombre" => "Go" "apellidos" => "Tani" ] 3 => array:2 [ "nombre" => "José A.R." "apellidos" => "Maia" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2255553617301325" "doi" => "10.1016/j.jpedp.2017.09.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553617301325?idApp=UINPBA000049" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716303965?idApp=UINPBA000049" "url" => "/00217557/0000009400000003/v2_201805190418/S0021755716303965/v2_201805190418/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S0021755717301493" "issn" => "00217557" "doi" => "10.1016/j.jped.2017.05.014" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "552" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2018;94:300-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1338 "formatos" => array:3 [ "EPUB" => 144 "HTML" => 871 "PDF" => 323 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Clinical application of the Newborn Behavioral Observation (NBO) System to characterize the behavioral pattern of newborns at biological and social risk" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "300" "paginaFinal" => "307" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Aplicação clínica do Newborn Behavioral Observation (NBO) System para caracterizar o padrão comportamental dos recém-nascidos de risco biológico e social" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 959 "Ancho" => 2413 "Tamanyo" => 110655 ] ] "descripcion" => array:1 [ "en" => "Analysis of the mothers’ perception of their knowledge about their child's behavior before and after the Newborn Behavioral Observation (NBO) session, according to the newborn's gestational age." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marina Aguiar Pires Guimarães, Claudia Regina Lindgren Alves, Ana Amélia Cardoso, Márcia Gomes Penido, Lívia de Castro Magalhães" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Marina Aguiar Pires" "apellidos" => "Guimarães" ] 1 => array:2 [ "nombre" => "Claudia Regina Lindgren" "apellidos" => "Alves" ] 2 => array:2 [ "nombre" => "Ana Amélia" "apellidos" => "Cardoso" ] 3 => array:2 [ "nombre" => "Márcia Gomes" "apellidos" => "Penido" ] 4 => array:2 [ "nombre" => "Lívia de Castro" "apellidos" => "Magalhães" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2255553618300296" "doi" => "10.1016/j.jpedp.2018.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553618300296?idApp=UINPBA000049" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755717301493?idApp=UINPBA000049" "url" => "/00217557/0000009400000003/v2_201805190418/S0021755717301493/v2_201805190418/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Correlation of body mass index Z-scores with glucose and lipid profiles among overweight and obese children and adolescents" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "308" "paginaFinal" => "312" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Alberto Nogueira-de-Almeida, Elza Daniel de Mello" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Carlos Alberto" "apellidos" => "Nogueira-de-Almeida" "email" => array:1 [ 0 => "dr.nogueira@me.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Elza Daniel de" "apellidos" => "Mello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Universidade Federal de São Carlos (UFSCAR), São Carlos, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Correlação dos escores-z de IMC com os perfis glicêmico e lipídico entre crianças e adolescentes com sobrepeso e obesidade" ] ] "textoCompleto" => "IntroductionThe increasing prevalence of obesity in childhood and adolescence demands from researchers and stakeholders in public health the establishment of criteria to prioritize actions to address this problem.<a class="elsevierStyleCrossRef" href="#bib0120">1</a> Different authors have demonstrated the presence of cardiovascular risk factors associated with obesity, especially dyslipidemia<a class="elsevierStyleCrossRef" href="#bib0125">2</a> and insulin resistance<a class="elsevierStyleCrossRef" href="#bib0130">3</a>; however, the numbers are quite variable and the prevalence is not yet known.<a class="elsevierStyleCrossRef" href="#bib0135">4</a> For population studies, body mass index (BMI) has been used as indicator that is capable of reflecting body adiposity<a class="elsevierStyleCrossRef" href="#bib0140">5</a>; starting from the Z-score of +1, which defines overweight, it may be understood that the higher the value, the more severe the situation.<a class="elsevierStyleCrossRef" href="#bib0145">6</a> In this sense, it is relevant to know not only the prevalence, but also how the comorbidities related to overweight behave as the situation worsens, and what are the differences between boys and girls. Some authors have evaluated this issue. Ricco et al.<a class="elsevierStyleCrossRef" href="#bib0150">7</a> studied 34 overweight and 50 obese subjects aged 6–18 years comparing blood pressure, fasting glucose, second-hour blood glucose, total cholesterol (TC), HDL-c, LDL-c, and triglycerides (TG). Only HDL-c was slightly elevated in overweight patients (p=0.048), demonstrating that, for the parameters evaluated, having a higher BMI did not substantially impact on the comorbidities. Lima et al.<a class="elsevierStyleCrossRef" href="#bib0155">8</a> also found no impact in the lipid profile comparing overweight and obese children and adolescents. In turn, when considered as a continuum (assessed through elevation of BMI Z-scores), different results were observed. Bell et al.<a class="elsevierStyleCrossRef" href="#bib0160">9</a> demonstrated a correlation between increased obesity and acanthosis nigricans, depression, anxiety, headache, muscle pain, and sleep apnea. Correlations with dyslipidemia,<a class="elsevierStyleCrossRef" href="#bib0165">10</a> insulin resistance,<a class="elsevierStyleCrossRef" href="#bib0170">11</a> and steatosis have also been demonstrated.<a class="elsevierStyleCrossRef" href="#bib0175">12</a>This study intended to evaluate the prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents, and to assess the presence of a correlation between BMI Z-scores and indicators of comorbidities related to both profiles.MethodsThis was a multicenter cross-sectional study, conducted in two outpatient clinics: the Centro de Estudos em Saúde e Nutrologia Infantojuvenil (at the University of Ribeirão Preto (Cesni) and the Ambulatório de Obesidade Infantojuvenil do Serviço de Nutrologia of the Hospital de Clínicas of the Federal University of Rio Grande do Sul (AmO)). Both are academic services, where data collection follows rigorously standardized methodology. This study was approved by the ethics in research committees of the University of Ribeirão Preto (number 94/2003) and of the Hospital de Clínicas de Porto Alegre (number 07/258).Inclusion criteria were: all new cases of patients who attended the first visit between January 2008 and December 2012, aged 7–18 years, and with BM above the Z-score +1 (n=489 eligible).Exclusion criteria were: refusal to sign the informed consent form (n=2); impossibility of performing anthropometry (n=3); type 1 Diabetes mellitus (n=0); hypothyroidism (n=0); inborn errors of metabolism (n=1); impossibility to collect laboratory tests (n=41); special medical conditions, e.g. celiac disease (n=0); use of medical therapies or hormones (n=0); and incomplete data on medical record (n=25). After the criteria were applied, 417 subjects were included in the study, of whom 241 were attended to at Cesni and 176 at AmO.All subjects were instructed to fast for 12h, and anthropometric data and blood were collected at the time of the patient's first visit. Two 4mL-vials of blood were collected in a recipient containing no additive and sent to the laboratory within 2h for sample processing and biochemical and hormone analysis. The biological material was separated in a Bio Eng centrifuge (Bio Eng®, modelo BR 4000, SP, Brazil) running for 5min at 3500rpm between one and two-and-a-half hours after harvesting (sufficient time for blood clotting). Biochemical insulin was dosed in one of the aliquots on the same day of the collection, by the automated chemiluminescent method in Immulitte DPC Medlab analyzer (Medlab®, SP, Brazil). Glucose was measured by the enzymatic method of hexokinase with Cobas Mira Plus Roche (Roche®, SP, Brazil) automation equipment. The determination of homeostatic model assessment – insulin resistance (HOMA-IR) was done by applying the equation proposed by Matthews et al.<a class="elsevierStyleCrossRef" href="#bib0180">13</a>: plasma glucose (mol/dL)×plasma insulin (uUI/mL)/22.5.Hyperinsulinism was defined as insulin concentration (a marker for insulin resistance) was above 15μU/mL.<a class="elsevierStyleCrossRef" href="#bib0165">10</a> Another diagnostic method for IR was HOMA-IR, considered to be high when greater than 3.16.<a class="elsevierStyleCrossRef" href="#bib0170">11</a> The cut-off values used to define the presence of dyslipidemia and hyperglycemia were<a class="elsevierStyleCrossRef" href="#bib0180">13</a>: TC≥150mg/dL; LDL-C≥100mg/dL; HDL-C≤45mg/dL; TG≥100mg/dL; glycemia>99mg/dL.For statistical analysis, the computer program Graphpad Prism 5 (GraphPad Prism version 7.00 for Windows, CA, USA) was used. Fisher exact test was used for the comparison of frequencies of normal/abnormal values between genders. Simple correlations were assessed by the Spearman's test and multiple regression was used to assess the correlation between the BMI Z-score and insulin and HOMA corrected for age, since these two indicators vary according to the age group.<a class="elsevierStyleCrossRefs" href="#bib0185">14,15</a> For all analyses, a significance level of 5% was considered.ResultsThe mean values for the entire population were: age (years): 11.3 (±0.1); Z-BMI: +2.4 (±0.9); TC (mg/dL): 164.1 (±1.6); LDL-c (mg/dL): 97.7 (±1.5); HDL-c (mg/dL): 46.0 (±0.6); TG (mg/dL): 105.1 (±2.8); glycemia (mg/dL): 87.5 (±0.5); insulinemia (μU/mL): 16.0 (±0.7); and HOMA-IR: 3.5 (±0.2). No differences were observed between boys and girls.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> depicts the prevalence of abnormal values according to the established cut-offs, as well as gender comparison. The different types of dyslipidemia were quite prevalent, with values between 43.4% and 66.1%; no differences were observed between boys and girls. High glucose levels were the least prevalent alteration among the indicators studied, reaching a maximum of 7.4%, as found among boys, also with no statistical difference between genders. It should be noted that only one subject, a 15-year-old girl, presented glucose levels above 125mg/dL (160mg/dL, not shown in the table). Insulin resistance, as evaluated by the two indicators, plasma insulin and HOMA-IR, was present in 32.3% and 41.7% of the cases, respectively, with no statistical difference between boys and girls.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> depicts the correlations between the BMI Z-scores and the studied indicators. In general, correlations were present but weak. Regarding lipids, a correlation was observed for TG, found in the group as a whole and among girls; for HDL-c, only among girls. Glucose showed correlation for the whole group, but not when separated by gender. In turn, all indicators of insulin resistance were correlated with BMI, even when corrected for age. No statistically significant differences were observed between boys and girls.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionObesity is a complex, multifactorial disease with genetic, epigenetic, and environmental components. Therefore, it is expected that its impact on children's health will be quite variable. It is relevant to know to what extent an increase in excess weight also implies in the onset and worsening of comorbidities. A previous study<a class="elsevierStyleCrossRef" href="#bib0150">7</a> has already demonstrated that, comparing overweight or obese children, there was practically no difference in relation to the parameters evaluated, that is, in a way, comorbidities were already present in the overweight phase. Although the result was important, the simple stratification of overweight children into two categories, overweight and obese, could mask the continuous aspect of the variable, i.e., the model used was not able to demonstrate an occasional correlation between BMI and the evaluated parameters. This study aimed to assess precisely this aspect. As depicted in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, when overweight and obese children are grouped together, the prevalence of comorbidities is quite high. Regardless of gender, almost half of them have some type of dyslipidemia. Elevated LDL-c, which affected 45.3% of them, is highly concerning because of the risk associated with atherosclerosis. In fact, Garcia et al.<a class="elsevierStyleCrossRef" href="#bib0195">16</a> demonstrated in a recent study that even school-age children present thickening of the common carotid intima-media complex, denoting initial atherosclerotic process; Caixe et al.<a class="elsevierStyleCrossRef" href="#bib0200">17</a> also have demonstrated changes in heart geometry in this age group, caused by the increased myocardial effort to overcome high peripheral resistance due to arterial wall thickening. Due to the strong compensatory capacity of the young pancreas, even among children with important insulin resistance, elevated blood glucose levels are not frequent.<a class="elsevierStyleCrossRefs" href="#bib0185">14,18</a> In this study, only 6.2% of the sample presented glucose levels above 100mg/dL and only one subject had levels above 125mg/dL. In turn, the presence of insulin resistance was high, found in over one-third of the patients. The two indicators used, plasma insulin and HOMA-IR, both with fixed cut-offs, led to similar results, possibly due to the fact that, as demonstrated by other authors,<a class="elsevierStyleCrossRef" href="#bib0205">18</a> the variable that determines the value of HOMA-IR in children is basically plasma insulin, since little variation occurs in the glucose levels. It is known that peripheral resistance to insulin is highly correlated with metabolic syndrome,<a class="elsevierStyleCrossRefs" href="#bib0125">2,3</a> being possibly the triggering element of this condition. Therefore, among the children studied, it is possible to consider that, in addition to the proven dyslipidemia and the high risk for future diabetes (the natural progression of insulin resistance) other aspects such as arterial hypertension, non-alcoholic fatty liver disease, polycystic ovarian syndrome, atherosclerosis, and hyperuricemia, among others, may also be present.<a class="elsevierStyleCrossRef" href="#bib0210">19</a>Recent studies have shown that BMI is the best anthropometric indicator to identify cardiovascular risk factors in children.<a class="elsevierStyleCrossRef" href="#bib0215">20</a> de Onis et al.<a class="elsevierStyleCrossRef" href="#bib0220">21</a> demonstrated that the increase in BMI is accompanied by a reduction in HDL-c and elevation in plasma insulin, HOMA, TG, and LDL-c levels. Bell et al.<a class="elsevierStyleCrossRef" href="#bib0170">11</a> using centile groups, showed an increase in insulin across all centile groups in both sexes. An increase was found for HDL-c but mixed and, differently the present study, sex-discordant results were found for TG and glucose. Skinner et al.<a class="elsevierStyleCrossRef" href="#bib0165">10</a> using large amount of date from NHANEs, also found differences between sexes, with higher values of TC, TG, and glucose between males; using four classes of overweight degrees, they also found higher values of TC, TG, and glucose and lower values of HDL-c among the more obese children. In the present study, the assessment of the correlations between BMI and the indicators studied demonstrated different results for lipid and glucose profiles. Both TC and LDL-C did not show a positive correlation with BMI Z-score. When these data are considered in conjunction with the prevalence of TC and LDL-C above cut-off levels, it can be understood that overweight and obese children are severely affected. Regarding HDL-c, the rationale is practically the same, with the exception that, among girls, a weak negative correlation was observed, indicating that HDL-c tends to be slightly lower the higher the BMI. In general, it is considered that, within the lipid profile, TG is the indicator that changes the most in obese children. Although this was not found in terms of prevalence, a weak positive correlation was observed between Z-BMI and TG, particularly evident among girls.In the present study, pubertal status was not assessed, as the cut-off values of lipids and glucose are the same for all ages included and the insulinemic profile is more dependent on age than puberty stage.<a class="elsevierStyleCrossRef" href="#bib0225">22</a> Glucose values presented weak positive correlation with BMI, without, however, reaching the cut-off values in most patients. In turn, the indicators of insulin resistance had the strongest correlations among indicators studied; plasma insulin and values of HOMA-IR showed positive correlation with BMI Z-scores. Similar results were demonstrated by Mieldazis et al.<a class="elsevierStyleCrossRef" href="#bib0205">18</a> and Silva et al.<a class="elsevierStyleCrossRef" href="#bib0230">23</a> As previously demonstrated,<a class="elsevierStyleCrossRefs" href="#bib0185">14,15</a> plasma insulin and HOMA-IR values are influenced by age, presenting a significant increase with a peak close to the growth spurt. For this reason, multiple regression was conducted only for this indicator, in order to control the results for age and, although the correlation values decreased, they remained statistically significant. It should also be noted that the correlation values for plasma insulin and HOMA-IR are very similar, regardless of controlling for age. This corroborates the fact that, in childhood and adolescence, given the limitations related to the difficulty of evaluating the presence of insulin resistance in the laboratory, if the option is to use one of the two indicators studied, measuring insulin is sufficient, as the HOMA-IR variation basically reflects plasma insulin variation.The study has some limitations: it was a cross sectional study, which prevents the determination of cause and effect relations. Diet and body compositions were not evaluated. The sample comprised all patients that came for the first consultation at the two centers during the period of the study, but it is not possible to extrapolate the results for the entire population of overweight and obese children and adolescents, as this was a convenience sample.In conclusion, overweight and obesity lead to high prevalence of dyslipidemia and insulin resistance in boys and girls. BMI Z-scores showed a weak positive correlation with glucose and TG and a negative correlation with HDL-c. In turn, a strong positive correlation was found with insulin resistance indicators, even when adjusted for age.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1027102" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec984709" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1027103" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec984708" "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" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-13" "fechaAceptado" => "2017-05-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec984709" "palabras" => array:6 [ 0 => "Obesity" 1 => "Overweight" 2 => "Dyslipidemias" 3 => "Insulin resistance" 4 => "Child" 5 => "Adolescent" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec984708" "palabras" => array:6 [ 0 => "Obesidade" 1 => "Sobrepeso" 2 => "Dislipidemias" 3 => "Resistência à insulina" 4 => "Criança" 5 => "Adolescente" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo evaluate the prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents, and to assess the presence of a correlation between body mass index Z-scores and indicators of comorbidities related to both profiles. MethodsThis was a multicenter cross-sectional study conducted at two outpatient clinics. The study included all 417 comers for the first visit from 2008 to 2012, aged between 7 and 18 years, with BMI above the Z-score +1. Anthropometry and blood sampling were obtained. The prevalence of dyslipidemias, hyperglycemia, and insulin resistance were evaluated, together with the correlations of these variables with the increase of Z-BMI. ResultsDyslipidemia was observed in 43.4% of the boys and 66.1% of the girls, with no difference between genders. High glucose levels were detected in 6.2% of the individuals. Insulin resistance was present in 32.3% and 41.7% of the cases, with no statistical significance between boys and girls. Correlations between the Z-BMI were noted for triglycerides in the entire group and among girls; for HDL-c, only among girls; for glucose, a correlation was observed for the entire group, but not when stratified by gender. The indicators of insulin resistance were all correlated with Z-BMI, even when corrected for age. ConclusionsOverweight and obesity give origin to a high prevalence of dyslipidemia and insulin resistance. BMI Z-scores showed a weak positive correlation with glucose and triglyceride, and negative with HDL-c. In turn, the strongest positive correlation was found with insulin resistance indicators." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoAvaliar a prevalência de anormalidades nos perfis lipídico e glicêmico entre crianças e adolescentes com sobrepeso e obesidade e também verificar se existe correlação entre os escores-z de índice de massa corporal (z-IMC) e indicadores de comorbidades ligados a esses perfis. MétodosEstudo de corte transversal multicêntrico, incluiu 417 pacientes com idades entre 7 e 18 anos e IMC acima do escore-z>+1, que fizeram a consulta de caso novo entre 2008 e 2012. Antropometria e coleta de sangue foram realizadas. As prevalências de dislipidemia, hiperglicemia e resistência insulínica foram avaliadas, juntamente com as correlações entre essas variáveis e o z-IMC. ResultadosDislipidemia foi encontrada em 43,4% dos meninos e 66,1% das meninas, sem diferença entre os sexos. Hiperglicemia foi encontrada em 6,2% dos indivíduos. Resistência insulínica esteve presente entre 32,3 e 41,7% dos casos, sem diferença estatística entre os sexos. Foi observada correlação com z-IMC para triglicerídeos quando considerado o grupo todo e entre as meninas; e para HDL-c, apenas entre as meninas. A glicemia apresentou correlação quando considerado o grupo todo, mas não quando separados por sexo. Os indicadores de resistência insulínica estiveram todos correlacionados com IMC, mesmo quando se executou correção para a idade. ConclusõesSobrepeso e obesidade levam a prevalências elevadas de dislipidemia e resistência insulínica. Os escores z de IMC mostraram discreta correlação positiva com glicose e triglicerídeos e negativa com HDL-c. Por outro lado, correlação positiva mais forte foi observada com os indicadores de resistência insulínica." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Nogueira-de-Almeida CA, Mello ED. Correlation of BMI Z-scores with glucose and lipid profiles among overweight and obese children and adolescents. J Pediatr (Rio J). 2018;94:308–12." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Study conducted at Universidade Federal de São Carlos (UFSCAR), São Carlos, SP; and Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil." ] ] "multimedia" => array:2 [ 0 => 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" => "LDL-c, low-density lipoprotein cholesterol; HDL-c, high-density lipoprotein cholesterol; HOMA, homeostasis model assessment." "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Boys + girls (n=417) 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">Boys (n=189) n (% among boys) \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">Girls (n=228) n (% among Girls) \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">Boys vs. girls p<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total cholesterol>150mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">273 (65.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">125 (66.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">148 (64.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8364 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LDL-c>100mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">189 (45.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 (43.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106 (46.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6221 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HDL-c<45mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">199 (47.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 (43.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">117 (51.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1157 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Triglycerides>100mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">189 (45.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (44.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 (46.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7675 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose>100mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (6.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4187 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Plasma insulin>15μU/mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">156 (37.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (32.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 (41.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0537 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HOMA>3.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">161 (38.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (36.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (40.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4795 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1747498.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Fisher exact test." ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of abnormalities in the indicators studied." ] ] 1 => 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" => "LDL-c, low-density lipoprotein cholesterol; HDL-c, high-density lipoprotein cholesterol; HOMA, homeostasis model assessment; BMI, body mass index.Spearman's test and multiple regression for age-adjustment." "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Boys+Girls R (p) \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">Boys R (p) \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">Girls R (p) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total cholesterol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.01388 (0.7865) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05364 (0.4847) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.1031 (0.1354) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LDL-c \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.01994 (0.6973) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05797 (0.4500) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.08481 (0.2199) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HDL-c \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.08400 (0.1007) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.04759 (0.5353) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.1677 (0.0147) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Triglycerides \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1184 (0.0204) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07521 (0.3268) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1592 (0.0207) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1249 (0.0144) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1482 (0.0523) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06200 (0.3702) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Plasma insulin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3228 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3076 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4297 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HOMA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3292 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3139 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4233 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age-adjusted insulin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1578 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2627 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1078 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age-adjusted HOMA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1510 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2543 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0926 (<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1747499.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Correlation between BMI Z-scores and the indicators studied." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of overweight and obesity in children and adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Keating" 1 => "K. Backholer" 2 => "A. Peeters" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(14)62366-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "384" "paginaInicial" => "2107" "paginaFinal" => "2108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25497194" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0125" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome and cardiovascular risk factors in obese adolescent" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Mansour" 1 => "Y.E. Nassef" 2 => "M.A. Shady" 3 => "A.A. Aziz" 4 => "H.A. Malt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Mac J Med Sci" "fecha" => "2016" "volumen" => "4" "paginaInicial" => "118" "paginaFinal" => "121" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0130" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resistência à insulina em crianças e adolescentes obesos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.C. Romualdo" 1 => "F.J. de Nóbrega" 2 => "M.A. Escrivão" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr (Rio J)" "fecha" => "2014" "volumen" => "90" "paginaInicial" => "600" "paginaFinal" => "607" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0135" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ethnicity and cardiovascular risk factors: evaluation of 40[thinsp]921 normal-weight, overweight or obese children and adolescents living in Central Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Martin" 1 => "J. Oepen" 2 => "T. Reinehr" 3 => "M. Wabitsch" 4 => "G. Claussnitzer" 5 => "E. Waldeck" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "45" "paginaFinal" => "51" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0140" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "255–61.e2" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utility of body mass index in identifying excess adiposity in youth across the obesity spectrum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.R. Ryder" 1 => "A.M. Kaizer" 2 => "K.D. Rudser" 3 => "S.R. Daniels" 4 => "A.S. Kelly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Pediatr" "fecha" => "2006" "volumen" => "177" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0145" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of a WHO growth reference for school-aged children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. de Onis" 1 => "A.W. Onyango" 2 => "E. Borghi" 3 => "A. Siyam" 4 => "C. Nishida" 5 => "J. Siekmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Bull WHO" "fecha" => "2007" "volumen" => "85" "paginaInicial" => "660" "paginaFinal" => "667" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18026621" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0150" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudo comparativo de fatores de risco em crianças e adolescentes com diagnóstico antropométrico de sobrepeso ou obesidade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.C. Ricco" 1 => "R.G. Ricco" 2 => "C.A. Almeida" 3 => "A.P.P. Ramos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Paul Ped" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "320" "paginaFinal" => "325" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0155" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma lipid profile and lipid peroxidation in overweight or obese children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.C. Lima" 1 => "R.F. Arrais" 2 => "M.G. Almeida" 3 => "Z.M. Souza" 4 => "L.F. Pedrosa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr (Rio J)" "fecha" => "2004" "volumen" => "80" "paginaInicial" => "23" "paginaFinal" => "28" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0160" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing body mass index z-score is continuously associated with complications of overweight in children, even in the healthy weight range" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.M. Bell" 1 => "S. Byrne" 2 => "A. Thompson" 3 => "N. Ratnam" 4 => "E. Blair" 5 => "M. Bulsara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2006-1714" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2007" "volumen" => "92" "paginaInicial" => "517" "paginaFinal" => "522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17105842" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0165" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiometabolic risks and severity of obesity in children and young adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.C. Skinner" 1 => "E.M. Perrin" 2 => "L.A. Moss" 3 => "J.A. Skelton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1502821" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "1307" "paginaFinal" => "1317" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26422721" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0170" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body mass index and waist circumference: relationship to cardiometabolic risk factors in children – Busselton Health Study 2005–2007" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Bell" 1 => "J. Hung" 2 => "M. Knuiman" 3 => "M. Divitini" 4 => "J. Beilby" 5 => "M. Hunter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jpc.12298" "Revista" => array:6 [ "tituloSerie" => "J Paediatr Child Health" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "955" "paginaFinal" => "962" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23802746" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0175" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impacts of types and degree of obesity on non-alcoholic fatty liver disease and related dyslipidemia in Chinese school-age children?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Meng" 1 => "N. Luo" 2 => "J. Mi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3967/0895-3988.2011.01.003" "Revista" => array:6 [ "tituloSerie" => "Biomed Environ Sci" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "22" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21440836" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0180" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "I guidelines of prevention of atherosclerosis in childhood and adolescence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Back Giuliano Ide" 1 => "B. Caramelli" 2 => "L. Pellanda" 3 => "B. Duncan" 4 => "S. Mattos" 5 => "F.H. Fonseca" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2005" "volumen" => "85" "paginaInicial" => "4" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16597097" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0185" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determination of glycemia and insulinemia and the homeostasis model assessment (HOMA) in schoolchildren and adolescents with normal body mass index" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.A. Almeida" 1 => "A.P. Pinho" 2 => "R.G. Ricco" 3 => "M.T. Pepato" 4 => "I.L. Brunetti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr (Rio J)" "fecha" => "2008" "volumen" => "84" "paginaInicial" => "136" "paginaFinal" => "140" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0190" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Indice HOMA y QUICKI, insulina y peptido C en niños sanos. Puntos de corte de riesgo cardiovascular" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.G. Cuartero" 1 => "C.G. Lacalle" 2 => "C.J. Lobo" 3 => "A.G. Vergaz" 4 => "C.C. Rey" 5 => "M.J.A. Villar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "481" "paginaFinal" => "490" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0195" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "1165.3" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonographic assessment of the common carotid intima-media complex in normal weight children and in overweight/obese children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.A. Nogueira-de-Almeida" 1 => "J. Garcia" 2 => "S.H. Caixe" 3 => "A.C. Benedeti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1096/fj.201500137R" "Revista" => array:4 [ "tituloSerie" => "FASEB J" "fecha" => "2016" "volumen" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26929434" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0200" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of echocardiography as a marker of cardiovascular risk in obese children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.B. Caixe" 1 => "A.C. Saab" 2 => "J. Garcia" 3 => "W.P. Martins" 4 => "F. Mauad Filho" 5 => "L.A. Del Ciampo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Clin Pediatr" "fecha" => "2014" "volumen" => "3" "paginaInicial" => "7" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0205" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperinsulinism assessment in a sample of prepubescent children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.F. Mieldazis" 1 => "L.A. Azzalis" 2 => "V.B. Junqueira" 3 => "F.I. Souza" 4 => "R.O. Sarni" 5 => "F.L. Fonseca" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr (Rio J)" "fecha" => "2010" "volumen" => "86" "paginaInicial" => "245" "paginaFinal" => "249" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0210" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome in overweight/obese female adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.P. Pinho" 1 => "I.L. Brunetti" 2 => "M.T. Pepato" 3 => "C.A.N. Almeida" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Paul Ped" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "51" "paginaFinal" => "56" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0215" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body mass index is better than other anthropometric indices for identifying dyslipidemia in chinese children with obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Zhu" 1 => "Z. Shao" 2 => "J. Jing" 3 => "J. Ma" 4 => "Y. Chen" 5 => "X. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0149392" "Revista" => array:5 [ "tituloSerie" => "PLOS ONE" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "e0149392" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26963377" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0220" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between WHO cut-offs for childhood overweight and obesity and cardiometabolic risk" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. de Onis" 1 => "C. Martínez-Costa" 2 => "F. Núñez" 3 => "G. Nguefack-Tsague" 4 => "A. Montal" 5 => "J. Brines" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pub Health Nut" "fecha" => "2013" "volumen" => "16" "paginaInicial" => "625" "paginaFinal" => "630" "itemHostRev" => array:3 [ "pii" => "S1885585717301913" "estado" => "S300" "issn" => "18855857" ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0225" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age before stage: insulin resistance rises before the onset of puberty: a 9-year longitudinal study (EarlyBird 26)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.N. Jeffery" 1 => "B.S. Metcalf" 2 => "J. Hosking" 3 => "A.J. Streeter" 4 => "L.D. Voss" 5 => "T.J. Wilkin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc11-1281" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2012" "volumen" => "35" "paginaInicial" => "536" "paginaFinal" => "541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22279034" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0230" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Centripetal distribution of body fat, overweight and cardiorespiratory fitness: association with insulin sensitivity and metabolic alterations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.L. Silva" 1 => "D.S. Barbosa" 2 => "J.A. Oliveira" 3 => "D.P. Guedes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Bras Endocrinol Metabol" "fecha" => "2006" "volumen" => "50" "paginaInicial" => "1034" "paginaFinal" => "1040" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17221109" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00217557/0000009400000003/v2_201805190418/S0021755717300360/v2_201805190418/en/main.assets" "Apartado" => array:4 [ "identificador" => "10179" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00217557/0000009400000003/v2_201805190418/S0021755717300360/v2_201805190418/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755717300360?idApp=UINPBA000049"]

Statistics

Original article

Correlação dos escores-z de IMC com os perfis glicêmico e lipídico entre crianças e adolescentes com sobrepeso e obesidade

Carlos Alberto Nogueira-de-Almeidaa,

Corresponding author

dr.nogueira@me.com

Corresponding author.

, Elza Daniel de Mellob

a Universidade Federal de São Carlos (UFSCAR), São Carlos, SP, Brazil

b Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil

Read

3397

Times
was read the article

1453

Total PDF

1944

Total HTML

Share statistics

 array:25 [
  "pii" => "S0021755717300360"
  "issn" => "00217557"
  "doi" => "10.1016/j.jped.2017.06.012"
  "estado" => "S300"
  "fechaPublicacion" => "2018-05-01"
  "aid" => "558"
  "copyright" => "Sociedade Brasileira de Pediatria"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "J Pediatr &#40;Rio J&#41;. 2018;94:308-12"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 964
    "formatos" => array:3 [
      "EPUB" => 119
      "HTML" => 560
      "PDF" => 285
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S2255553617301386"
      "issn" => "22555536"
      "doi" => "10.1016/j.jpedp.2017.09.024"
      "estado" => "S300"
      "fechaPublicacion" => "2018-05-01"
      "aid" => "558"
      "copyright" => "Sociedade Brasileira de Pediatria"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "J Pediatr &#40;Rio J&#41;. 2018;94:308-12"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 948
        "formatos" => array:3 [
          "EPUB" => 121
          "HTML" => 550
          "PDF" => 277
        ]
      ]
      "pt" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>"
        "titulo" => "Correlation of body mass index Z&#8208;scores with glucose and lipid profiles among overweight and obese children and adolescents"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "308"
            "paginaFinal" => "312"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Correla&#231;&#227;o dos escores&#8208;z de IMC com os perfis glic&#234;mico e lip&#237;dico entre crian&#231;as e adolescentes com sobrepeso e obesidade"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Carlos Alberto Nogueira&#8208;de&#8208;Almeida, Elza Daniel de Mello"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "Carlos Alberto"
                "apellidos" => "Nogueira&#8208;de&#8208;Almeida"
              ]
              1 => array:2 [
                "nombre" => "Elza Daniel de"
                "apellidos" => "Mello"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0021755717300360"
          "doi" => "10.1016/j.jped.2017.06.012"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755717300360?idApp=UINPBA000049"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553617301386?idApp=UINPBA000049"
      "url" => "/22555536/0000009400000003/v1_201805170408/S2255553617301386/v1_201805170408/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0021755716303965"
    "issn" => "00217557"
    "doi" => "10.1016/j.jped.2017.06.017"
    "estado" => "S300"
    "fechaPublicacion" => "2018-05-01"
    "aid" => "563"
    "copyright" => "Sociedade Brasileira de Pediatria"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2018;94:313-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1045
      "formatos" => array:3 [
        "EPUB" => 108
        "HTML" => 677
        "PDF" => 260
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Association between body mass index and individual characteristics and the school context&#58; a multilevel study with Portuguese children"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "313"
          "paginaFinal" => "319"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Rela&#231;&#227;o entre o &#237;ndice de massa corporal e as caracter&#237;sticas individuais e do contexto escolar&#58; um estudo multin&#237;vel com crian&#231;as portuguesas"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Rafael S&#46; Henrique, Thayse N&#46; Gomes, Go Tani, Jos&#233; A&#46;R&#46; Maia"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Rafael S&#46;"
              "apellidos" => "Henrique"
            ]
            1 => array:2 [
              "nombre" => "Thayse N&#46;"
              "apellidos" => "Gomes"
            ]
            2 => array:2 [
              "nombre" => "Go"
              "apellidos" => "Tani"
            ]
            3 => array:2 [
              "nombre" => "Jos&#233; A&#46;R&#46;"
              "apellidos" => "Maia"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2255553617301325"
        "doi" => "10.1016/j.jpedp.2017.09.018"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553617301325?idApp=UINPBA000049"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716303965?idApp=UINPBA000049"
    "url" => "/00217557/0000009400000003/v2_201805190418/S0021755716303965/v2_201805190418/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0021755717301493"
    "issn" => "00217557"
    "doi" => "10.1016/j.jped.2017.05.014"
    "estado" => "S300"
    "fechaPublicacion" => "2018-05-01"
    "aid" => "552"
    "copyright" => "Sociedade Brasileira de Pediatria"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2018;94:300-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1338
      "formatos" => array:3 [
        "EPUB" => 144
        "HTML" => 871
        "PDF" => 323
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Clinical application of the Newborn Behavioral Observation &#40;NBO&#41; System to characterize the behavioral pattern of newborns at biological and social risk"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "300"
          "paginaFinal" => "307"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Aplica&#231;&#227;o cl&#237;nica do <span class="elsevierStyleItalic">Newborn Behavioral Observation &#40;NBO&#41; System</span> para caracterizar o padr&#227;o comportamental dos rec&#233;m-nascidos de risco biol&#243;gico e social"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 959
              "Ancho" => 2413
              "Tamanyo" => 110655
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Analysis of the mothers&#8217; perception of their knowledge about their child&#39;s behavior before and after the Newborn Behavioral Observation &#40;NBO&#41; session&#44; according to the newborn&#39;s gestational age&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Marina Aguiar Pires Guimar&#227;es, Claudia Regina Lindgren Alves, Ana Am&#233;lia Cardoso, M&#225;rcia Gomes Penido, L&#237;via de Castro Magalh&#227;es"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Marina Aguiar Pires"
              "apellidos" => "Guimar&#227;es"
            ]
            1 => array:2 [
              "nombre" => "Claudia Regina Lindgren"
              "apellidos" => "Alves"
            ]
            2 => array:2 [
              "nombre" => "Ana Am&#233;lia"
              "apellidos" => "Cardoso"
            ]
            3 => array:2 [
              "nombre" => "M&#225;rcia Gomes"
              "apellidos" => "Penido"
            ]
            4 => array:2 [
              "nombre" => "L&#237;via de Castro"
              "apellidos" => "Magalh&#227;es"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2255553618300296"
        "doi" => "10.1016/j.jpedp.2018.02.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553618300296?idApp=UINPBA000049"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755717301493?idApp=UINPBA000049"
    "url" => "/00217557/0000009400000003/v2_201805190418/S0021755717301493/v2_201805190418/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Correlation of body mass index <span class="elsevierStyleItalic">Z</span>-scores with glucose and lipid profiles among overweight and obese children and adolescents"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "308"
        "paginaFinal" => "312"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Carlos Alberto Nogueira-de-Almeida, Elza Daniel de Mello"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Carlos Alberto"
            "apellidos" => "Nogueira-de-Almeida"
            "email" => array:1 [
              0 => "dr&#46;nogueira&#64;me&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Elza Daniel de"
            "apellidos" => "Mello"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Universidade Federal de S&#227;o Carlos &#40;UFSCAR&#41;&#44; S&#227;o Carlos&#44; SP&#44; Brazil"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Universidade Federal do Rio Grande do Sul &#40;UFRGS&#41;&#44; Faculdade de Medicina&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Correla&#231;&#227;o dos escores-z de IMC com os perfis glic&#234;mico e lip&#237;dico entre crian&#231;as e adolescentes com sobrepeso e obesidade"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The increasing prevalence of obesity in childhood and adolescence demands from researchers and stakeholders in public health the establishment of criteria to prioritize actions to address this problem&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> Different authors have demonstrated the presence of cardiovascular risk factors associated with obesity&#44; especially dyslipidemia<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> and insulin resistance<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a>&#59; however&#44; the numbers are quite variable and the prevalence is not yet known&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> For population studies&#44; body mass index &#40;BMI&#41; has been used as indicator that is capable of reflecting body adiposity<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a>&#59; starting from the <span class="elsevierStyleItalic">Z</span>-score of &#43;1&#44; which defines overweight&#44; it may be understood that the higher the value&#44; the more severe the situation&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a> In this sense&#44; it is relevant to know not only the prevalence&#44; but also how the comorbidities related to overweight behave as the situation worsens&#44; and what are the differences between boys and girls&#46; Some authors have evaluated this issue&#46; Ricco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> studied 34 overweight and 50 obese subjects aged 6&#8211;18 years comparing blood pressure&#44; fasting glucose&#44; second-hour blood glucose&#44; total cholesterol &#40;TC&#41;&#44; HDL-c&#44; LDL-c&#44; and triglycerides &#40;TG&#41;&#46; Only HDL-c was slightly elevated in overweight patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41;&#44; demonstrating that&#44; for the parameters evaluated&#44; having a higher BMI did not substantially impact on the comorbidities&#46; Lima et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> also found no impact in the lipid profile comparing overweight and obese children and adolescents&#46; In turn&#44; when considered as a continuum &#40;assessed through elevation of BMI <span class="elsevierStyleItalic">Z</span>-scores&#41;&#44; different results were observed&#46; Bell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> demonstrated a correlation between increased obesity and <span class="elsevierStyleItalic">acanthosis nigricans</span>&#44; depression&#44; anxiety&#44; headache&#44; muscle pain&#44; and sleep apnea&#46; Correlations with dyslipidemia&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> insulin resistance&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> and steatosis have also been demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This study intended to evaluate the prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents&#44; and to assess the presence of a correlation between BMI <span class="elsevierStyleItalic">Z</span>-scores and indicators of comorbidities related to both profiles&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This was a multicenter cross-sectional study&#44; conducted in two outpatient clinics&#58; the Centro de Estudos em Sa&#250;de e Nutrologia Infantojuvenil &#40;at the University of Ribeir&#227;o Preto &#40;Cesni&#41; and the Ambulat&#243;rio de Obesidade Infantojuvenil do Servi&#231;o de Nutrologia of the Hospital de Cl&#237;nicas of the Federal University of Rio Grande do Sul &#40;AmO&#41;&#41;&#46; Both are academic services&#44; where data collection follows rigorously standardized methodology&#46; This study was approved by the ethics in research committees of the University of Ribeir&#227;o Preto &#40;number 94&#47;2003&#41; and of the Hospital de Cl&#237;nicas de Porto Alegre &#40;number 07&#47;258&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Inclusion criteria were&#58; all new cases of patients who attended the first visit between January 2008 and December 2012&#44; aged 7&#8211;18 years&#44; and with BM above the <span class="elsevierStyleItalic">Z</span>-score &#43;1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>489 eligible&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Exclusion criteria were&#58; refusal to sign the informed consent form &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#59; impossibility of performing anthropometry &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#59; type 1 Diabetes mellitus &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41;&#59; hypothyroidism &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41;&#59; inborn errors of metabolism &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#59; impossibility to collect laboratory tests &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41;&#59; special medical conditions&#44; <span class="elsevierStyleItalic">e&#46;g</span>&#46; celiac disease &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41;&#59; use of medical therapies or hormones &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41;&#59; and incomplete data on medical record &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&#46; After the criteria were applied&#44; 417 subjects were included in the study&#44; of whom 241 were attended to at Cesni and 176 at AmO&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">All subjects were instructed to fast for 12<span class="elsevierStyleHsp" style=""></span>h&#44; and anthropometric data and blood were collected at the time of the patient&#39;s first visit&#46; Two 4<span class="elsevierStyleHsp" style=""></span>mL-vials of blood were collected in a recipient containing no additive and sent to the laboratory within 2<span class="elsevierStyleHsp" style=""></span>h for sample processing and biochemical and hormone analysis&#46; The biological material was separated in a Bio Eng centrifuge &#40;Bio Eng<span class="elsevierStyleSup">&#174;</span>&#44; modelo BR 4000&#44; SP&#44; Brazil&#41; running for 5<span class="elsevierStyleHsp" style=""></span>min at 3500<span class="elsevierStyleHsp" style=""></span>rpm between one and two-and-a-half hours after harvesting &#40;sufficient time for blood clotting&#41;&#46; Biochemical insulin was dosed in one of the aliquots on the same day of the collection&#44; by the automated chemiluminescent method in Immulitte DPC Medlab analyzer &#40;Medlab<span class="elsevierStyleSup">&#174;</span>&#44; SP&#44; Brazil&#41;&#46; Glucose was measured by the enzymatic method of hexokinase with Cobas Mira Plus Roche &#40;Roche<span class="elsevierStyleSup">&#174;</span>&#44; SP&#44; Brazil&#41; automation equipment&#46; The determination of homeostatic model assessment &#8211; insulin resistance &#40;HOMA-IR&#41; was done by applying the equation proposed by Matthews et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>&#58; plasma glucose &#40;mol&#47;dL&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>plasma insulin &#40;uUI&#47;mL&#41;&#47;22&#46;5&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Hyperinsulinism was defined as insulin concentration &#40;a marker for insulin resistance&#41; was above 15<span class="elsevierStyleHsp" style=""></span>&#956;U&#47;mL&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> Another diagnostic method for IR was HOMA-IR&#44; considered to be high when greater than 3&#46;16&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> The cut-off values used to define the presence of dyslipidemia and hyperglycemia were<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>&#58; TC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; LDL-C<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; HDL-C<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; TG<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; glycemia<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>99<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">For statistical analysis&#44; the computer program Graphpad Prism 5 &#40;GraphPad Prism version 7&#46;00 for Windows&#44; CA&#44; USA&#41; was used&#46; Fisher exact test was used for the comparison of frequencies of normal&#47;abnormal values between genders&#46; Simple correlations were assessed by the Spearman&#39;s test and multiple regression was used to assess the correlation between the BMI <span class="elsevierStyleItalic">Z</span>-score and insulin and HOMA corrected for age&#44; since these two indicators vary according to the age group&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">14&#44;15</span></a> For all analyses&#44; a significance level of 5&#37; was considered&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The mean values for the entire population were&#58; age &#40;years&#41;&#58; 11&#46;3 &#40;&#177;0&#46;1&#41;&#59; <span class="elsevierStyleItalic">Z</span>-BMI&#58; &#43;2&#46;4 &#40;&#177;0&#46;9&#41;&#59; TC &#40;mg&#47;dL&#41;&#58; 164&#46;1 &#40;&#177;1&#46;6&#41;&#59; LDL-c &#40;mg&#47;dL&#41;&#58; 97&#46;7 &#40;&#177;1&#46;5&#41;&#59; HDL-c &#40;mg&#47;dL&#41;&#58; 46&#46;0 &#40;&#177;0&#46;6&#41;&#59; TG &#40;mg&#47;dL&#41;&#58; 105&#46;1 &#40;&#177;2&#46;8&#41;&#59; glycemia &#40;mg&#47;dL&#41;&#58; 87&#46;5 &#40;&#177;0&#46;5&#41;&#59; insulinemia &#40;&#956;U&#47;mL&#41;&#58; 16&#46;0 &#40;&#177;0&#46;7&#41;&#59; and HOMA-IR&#58; 3&#46;5 &#40;&#177;0&#46;2&#41;&#46; No differences were observed between boys and girls&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> depicts the prevalence of abnormal values according to the established cut-offs&#44; as well as gender comparison&#46; The different types of dyslipidemia were quite prevalent&#44; with values between 43&#46;4&#37; and 66&#46;1&#37;&#59; no differences were observed between boys and girls&#46; High glucose levels were the least prevalent alteration among the indicators studied&#44; reaching a maximum of 7&#46;4&#37;&#44; as found among boys&#44; also with no statistical difference between genders&#46; It should be noted that only one subject&#44; a 15-year-old girl&#44; presented glucose levels above 125<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;160<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; not shown in the table&#41;&#46; Insulin resistance&#44; as evaluated by the two indicators&#44; plasma insulin and HOMA-IR&#44; was present in 32&#46;3&#37; and 41&#46;7&#37; of the cases&#44; respectively&#44; with no statistical difference between boys and girls&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> depicts the correlations between the BMI <span class="elsevierStyleItalic">Z</span>-scores and the studied indicators&#46; In general&#44; correlations were present but weak&#46; Regarding lipids&#44; a correlation was observed for TG&#44; found in the group as a whole and among girls&#59; for HDL-c&#44; only among girls&#46; Glucose showed correlation for the whole group&#44; but not when separated by gender&#46; In turn&#44; all indicators of insulin resistance were correlated with BMI&#44; even when corrected for age&#46; No statistically significant differences were observed between boys and girls&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Obesity is a complex&#44; multifactorial disease with genetic&#44; epigenetic&#44; and environmental components&#46; Therefore&#44; it is expected that its impact on children&#39;s health will be quite variable&#46; It is relevant to know to what extent an increase in excess weight also implies in the onset and worsening of comorbidities&#46; A previous study<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> has already demonstrated that&#44; comparing overweight or obese children&#44; there was practically no difference in relation to the parameters evaluated&#44; that is&#44; in a way&#44; comorbidities were already present in the overweight phase&#46; Although the result was important&#44; the simple stratification of overweight children into two categories&#44; overweight and obese&#44; could mask the continuous aspect of the variable&#44; <span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; the model used was not able to demonstrate an occasional correlation between BMI and the evaluated parameters&#46; This study aimed to assess precisely this aspect&#46; As depicted in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; when overweight and obese children are grouped together&#44; the prevalence of comorbidities is quite high&#46; Regardless of gender&#44; almost half of them have some type of dyslipidemia&#46; Elevated LDL-c&#44; which affected 45&#46;3&#37; of them&#44; is highly concerning because of the risk associated with atherosclerosis&#46; In fact&#44; Garcia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> demonstrated in a recent study that even school-age children present thickening of the common carotid intima-media complex&#44; denoting initial atherosclerotic process&#59; Caixe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> also have demonstrated changes in heart geometry in this age group&#44; caused by the increased myocardial effort to overcome high peripheral resistance due to arterial wall thickening&#46; Due to the strong compensatory capacity of the young pancreas&#44; even among children with important insulin resistance&#44; elevated blood glucose levels are not frequent&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">14&#44;18</span></a> In this study&#44; only 6&#46;2&#37; of the sample presented glucose levels above 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and only one subject had levels above 125<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; In turn&#44; the presence of insulin resistance was high&#44; found in over one-third of the patients&#46; The two indicators used&#44; plasma insulin and HOMA-IR&#44; both with fixed cut-offs&#44; led to similar results&#44; possibly due to the fact that&#44; as demonstrated by other authors&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a> the variable that determines the value of HOMA-IR in children is basically plasma insulin&#44; since little variation occurs in the glucose levels&#46; It is known that peripheral resistance to insulin is highly correlated with metabolic syndrome&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2&#44;3</span></a> being possibly the triggering element of this condition&#46; Therefore&#44; among the children studied&#44; it is possible to consider that&#44; in addition to the proven dyslipidemia and the high risk for future diabetes &#40;the natural progression of insulin resistance&#41; other aspects such as arterial hypertension&#44; non-alcoholic fatty liver disease&#44; polycystic ovarian syndrome&#44; atherosclerosis&#44; and hyperuricemia&#44; among others&#44; may also be present&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Recent studies have shown that BMI is the best anthropometric indicator to identify cardiovascular risk factors in children&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a> de Onis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> demonstrated that the increase in BMI is accompanied by a reduction in HDL-c and elevation in plasma insulin&#44; HOMA&#44; TG&#44; and LDL-c levels&#46; Bell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> using centile groups&#44; showed an increase in insulin across all centile groups in both sexes&#46; An increase was found for HDL-c but mixed and&#44; differently the present study&#44; sex-discordant results were found for TG and glucose&#46; Skinner et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> using large amount of date from NHANEs&#44; also found differences between sexes&#44; with higher values of TC&#44; TG&#44; and glucose between males&#59; using four classes of overweight degrees&#44; they also found higher values of TC&#44; TG&#44; and glucose and lower values of HDL-c among the more obese children&#46; In the present study&#44; the assessment of the correlations between BMI and the indicators studied demonstrated different results for lipid and glucose profiles&#46; Both TC and LDL-C did not show a positive correlation with BMI <span class="elsevierStyleItalic">Z</span>-score&#46; When these data are considered in conjunction with the prevalence of TC and LDL-C above cut-off levels&#44; it can be understood that overweight and obese children are severely affected&#46; Regarding HDL-c&#44; the rationale is practically the same&#44; with the exception that&#44; among girls&#44; a weak negative correlation was observed&#44; indicating that HDL-c tends to be slightly lower the higher the BMI&#46; In general&#44; it is considered that&#44; within the lipid profile&#44; TG is the indicator that changes the most in obese children&#46; Although this was not found in terms of prevalence&#44; a weak positive correlation was observed between <span class="elsevierStyleItalic">Z</span>-BMI and TG&#44; particularly evident among girls&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the present study&#44; pubertal status was not assessed&#44; as the cut-off values of lipids and glucose are the same for all ages included and the insulinemic profile is more dependent on age than puberty stage&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> Glucose values presented weak positive correlation with BMI&#44; without&#44; however&#44; reaching the cut-off values in most patients&#46; In turn&#44; the indicators of insulin resistance had the strongest correlations among indicators studied&#59; plasma insulin and values of HOMA-IR showed positive correlation with BMI <span class="elsevierStyleItalic">Z</span>-scores&#46; Similar results were demonstrated by Mieldazis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a> and Silva et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> As previously demonstrated&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">14&#44;15</span></a> plasma insulin and HOMA-IR values are influenced by age&#44; presenting a significant increase with a peak close to the growth spurt&#46; For this reason&#44; multiple regression was conducted only for this indicator&#44; in order to control the results for age and&#44; although the correlation values decreased&#44; they remained statistically significant&#46; It should also be noted that the correlation values for plasma insulin and HOMA-IR are very similar&#44; regardless of controlling for age&#46; This corroborates the fact that&#44; in childhood and adolescence&#44; given the limitations related to the difficulty of evaluating the presence of insulin resistance in the laboratory&#44; if the option is to use one of the two indicators studied&#44; measuring insulin is sufficient&#44; as the HOMA-IR variation basically reflects plasma insulin variation&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The study has some limitations&#58; it was a cross sectional study&#44; which prevents the determination of cause and effect relations&#46; Diet and body compositions were not evaluated&#46; The sample comprised all patients that came for the first consultation at the two centers during the period of the study&#44; but it is not possible to extrapolate the results for the entire population of overweight and obese children and adolescents&#44; as this was a convenience sample&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In conclusion&#44; overweight and obesity lead to high prevalence of dyslipidemia and insulin resistance in boys and girls&#46; BMI <span class="elsevierStyleItalic">Z</span>-scores showed a weak positive correlation with glucose and TG and a negative correlation with HDL-c&#46; In turn&#44; a strong positive correlation was found with insulin resistance indicators&#44; even when adjusted for age&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres1027102"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec984709"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1027103"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#245;es"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec984708"
          "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" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-01-13"
    "fechaAceptado" => "2017-05-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec984709"
          "palabras" => array:6 [
            0 => "Obesity"
            1 => "Overweight"
            2 => "Dyslipidemias"
            3 => "Insulin resistance"
            4 => "Child"
            5 => "Adolescent"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec984708"
          "palabras" => array:6 [
            0 => "Obesidade"
            1 => "Sobrepeso"
            2 => "Dislipidemias"
            3 => "Resist&#234;ncia &#224; insulina"
            4 => "Crian&#231;a"
            5 => "Adolescente"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "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 prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents&#44; and to assess the presence of a correlation between body mass index <span class="elsevierStyleItalic">Z</span>-scores and indicators of comorbidities related to both profiles&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a multicenter cross-sectional study conducted at two outpatient clinics&#46; The study included all 417 comers for the first visit from 2008 to 2012&#44; aged between 7 and 18 years&#44; with BMI above the <span class="elsevierStyleItalic">Z</span>-score &#43;1&#46; Anthropometry and blood sampling were obtained&#46; The prevalence of dyslipidemias&#44; hyperglycemia&#44; and insulin resistance were evaluated&#44; together with the correlations of these variables with the increase of <span class="elsevierStyleItalic">Z</span>-BMI&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dyslipidemia was observed in 43&#46;4&#37; of the boys and 66&#46;1&#37; of the girls&#44; with no difference between genders&#46; High glucose levels were detected in 6&#46;2&#37; of the individuals&#46; Insulin resistance was present in 32&#46;3&#37; and 41&#46;7&#37; of the cases&#44; with no statistical significance between boys and girls&#46; Correlations between the <span class="elsevierStyleItalic">Z</span>-BMI were noted for triglycerides in the entire group and among girls&#59; for HDL-c&#44; only among girls&#59; for glucose&#44; a correlation was observed for the entire group&#44; but not when stratified by gender&#46; The indicators of insulin resistance were all correlated with <span class="elsevierStyleItalic">Z</span>-BMI&#44; even when corrected for age&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Overweight and obesity give origin to a high prevalence of dyslipidemia and insulin resistance&#46; BMI <span class="elsevierStyleItalic">Z</span>-scores showed a weak positive correlation with glucose and triglyceride&#44; and negative with HDL-c&#46; In turn&#44; the strongest positive correlation was found with insulin resistance indicators&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "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 preval&#234;ncia de anormalidades nos perfis lip&#237;dico e glic&#234;mico entre crian&#231;as e adolescentes com sobrepeso e obesidade e tamb&#233;m verificar se existe correla&#231;&#227;o entre os escores-z de &#237;ndice de massa corporal &#40;z-IMC&#41; e indicadores de comorbidades ligados a esses perfis&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo de corte transversal multic&#234;ntrico&#44; incluiu 417 pacientes com idades entre 7 e 18 anos e IMC acima do escore-z<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#43;1&#44; que fizeram a consulta de caso novo entre 2008 e 2012&#46; Antropometria e coleta de sangue foram realizadas&#46; As preval&#234;ncias de dislipidemia&#44; hiperglicemia e resist&#234;ncia insul&#237;nica foram avaliadas&#44; juntamente com as correla&#231;&#245;es entre essas vari&#225;veis e o z-IMC&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Dislipidemia foi encontrada em 43&#44;4&#37; dos meninos e 66&#44;1&#37; das meninas&#44; sem diferen&#231;a entre os sexos&#46; Hiperglicemia foi encontrada em 6&#44;2&#37; dos indiv&#237;duos&#46; Resist&#234;ncia insul&#237;nica esteve presente entre 32&#44;3 e 41&#44;7&#37; dos casos&#44; sem diferen&#231;a estat&#237;stica entre os sexos&#46; Foi observada correla&#231;&#227;o com z-IMC para triglicer&#237;deos quando considerado o grupo todo e entre as meninas&#59; e para HDL-c&#44; apenas entre as meninas&#46; A glicemia apresentou correla&#231;&#227;o quando considerado o grupo todo&#44; mas n&#227;o quando separados por sexo&#46; Os indicadores de resist&#234;ncia insul&#237;nica estiveram todos correlacionados com IMC&#44; mesmo quando se executou corre&#231;&#227;o para a idade&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sobrepeso e obesidade levam a preval&#234;ncias elevadas de dislipidemia e resist&#234;ncia insul&#237;nica&#46; Os escores z de IMC mostraram discreta correla&#231;&#227;o positiva com glicose e triglicer&#237;deos e negativa com HDL-c&#46; Por outro lado&#44; correla&#231;&#227;o positiva mais forte foi observada com os indicadores de resist&#234;ncia insul&#237;nica&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Nogueira-de-Almeida CA&#44; Mello ED&#46; Correlation of BMI <span class="elsevierStyleItalic">Z</span>-scores with glucose and lipid profiles among overweight and obese children and adolescents&#46; J Pediatr &#40;Rio J&#41;&#46; 2018&#59;94&#58;308&#8211;12&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Study conducted at Universidade Federal de S&#227;o Carlos &#40;UFSCAR&#41;&#44; S&#227;o Carlos&#44; SP&#59; and Universidade Federal do Rio Grande do Sul &#40;UFRGS&#41;&#44; Porto Alegre&#44; RS&#44; Brazil&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => 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" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">LDL-c&#44; low-density lipoprotein cholesterol&#59; HDL-c&#44; high-density lipoprotein cholesterol&#59; HOMA&#44; homeostasis model assessment&#46;</p>"
          "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="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Boys &#43; girls &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>417&#41;<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#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">Boys &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>189&#41;<br><span class="elsevierStyleItalic">n</span> &#40;&#37; among boys&#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">Girls &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>228&#41;<br><span class="elsevierStyleItalic">n</span> &#40;&#37; among Girls&#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">Boys <span class="elsevierStyleItalic">vs</span>&#46; girls<br><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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" title="table-entry  " align="left" valign="top">Total cholesterol<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">273 &#40;65&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">125 &#40;66&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">148 &#40;64&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8364&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LDL-c<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">189 &#40;45&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;43&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106 &#40;46&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HDL-c<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">199 &#40;47&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82 &#40;43&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117 &#40;51&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Triglycerides<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">189 &#40;45&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;44&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105 &#40;46&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7675&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucose<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;6&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Plasma insulin<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>&#956;U&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">156 &#40;37&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;32&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;41&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0537&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HOMA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">161 &#40;38&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;36&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;40&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4795&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1747498.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Fisher exact test&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Prevalence of abnormalities in the indicators studied&#46;</p>"
        ]
      ]
      1 => 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" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">LDL-c&#44; low-density lipoprotein cholesterol&#59; HDL-c&#44; high-density lipoprotein cholesterol&#59; HOMA&#44; homeostasis model assessment&#59; BMI&#44; body mass index&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Spearman&#39;s test and multiple regression for age-adjustment&#46;</p>"
          "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="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Boys<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Girls<br><span class="elsevierStyleItalic">R</span> &#40;<span class="elsevierStyleItalic">p</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">Boys<br><span class="elsevierStyleItalic">R</span> &#40;<span class="elsevierStyleItalic">p</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">Girls<br><span class="elsevierStyleItalic">R</span> &#40;<span class="elsevierStyleItalic">p</span>&#41;&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" title="table-entry  " align="left" valign="top">Total cholesterol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;01388 &#40;0&#46;7865&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05364 &#40;0&#46;4847&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;1031 &#40;0&#46;1354&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LDL-c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;01994 &#40;0&#46;6973&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05797 &#40;0&#46;4500&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;08481 &#40;0&#46;2199&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HDL-c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;08400 &#40;0&#46;1007&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;04759 &#40;0&#46;5353&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;1677 &#40;0&#46;0147&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Triglycerides&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1184 &#40;0&#46;0204&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07521 &#40;0&#46;3268&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1592 &#40;0&#46;0207&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1249 &#40;0&#46;0144&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1482 &#40;0&#46;0523&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06200 &#40;0&#46;3702&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Plasma insulin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3228 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3076 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4297 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HOMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3292 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3139 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4233 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age-adjusted insulin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1578 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2627 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1078 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age-adjusted HOMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1510 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2543 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0926 &#40;&#60;0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1747499.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation between BMI <span class="elsevierStyleItalic">Z</span>-scores and the indicators studied&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:23 [
            0 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of overweight and obesity in children and adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Keating"
                            1 => "K&#46; Backholer"
                            2 => "A&#46; Peeters"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)62366-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2014"
                        "volumen" => "384"
                        "paginaInicial" => "2107"
                        "paginaFinal" => "2108"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25497194"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic syndrome and cardiovascular risk factors in obese adolescent"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Mansour"
                            1 => "Y&#46;E&#46; Nassef"
                            2 => "M&#46;A&#46; Shady"
                            3 => "A&#46;A&#46; Aziz"
                            4 => "H&#46;A&#46; Malt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Mac J Med Sci"
                        "fecha" => "2016"
                        "volumen" => "4"
                        "paginaInicial" => "118"
                        "paginaFinal" => "121"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resist&#234;ncia &#224; insulina em crian&#231;as e adolescentes obesos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;C&#46; Romualdo"
                            1 => "F&#46;J&#46; de N&#243;brega"
                            2 => "M&#46;A&#46; Escriv&#227;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr &#40;Rio J&#41;"
                        "fecha" => "2014"
                        "volumen" => "90"
                        "paginaInicial" => "600"
                        "paginaFinal" => "607"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ethnicity and cardiovascular risk factors&#58; evaluation of 40&#91;thinsp&#93;921 normal-weight&#44; overweight or obese children and adolescents living in Central Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Martin"
                            1 => "J&#46; Oepen"
                            2 => "T&#46; Reinehr"
                            3 => "M&#46; Wabitsch"
                            4 => "G&#46; Claussnitzer"
                            5 => "E&#46; Waldeck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "paginaInicial" => "45"
                        "paginaFinal" => "51"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "255&#8211;61&#46;e2"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utility of body mass index in identifying excess adiposity in youth across the obesity spectrum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;R&#46; Ryder"
                            1 => "A&#46;M&#46; Kaizer"
                            2 => "K&#46;D&#46; Rudser"
                            3 => "S&#46;R&#46; Daniels"
                            4 => "A&#46;S&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2006"
                        "volumen" => "177"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of a WHO growth reference for school-aged children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; de Onis"
                            1 => "A&#46;W&#46; Onyango"
                            2 => "E&#46; Borghi"
                            3 => "A&#46; Siyam"
                            4 => "C&#46; Nishida"
                            5 => "J&#46; Siekmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Bull WHO"
                        "fecha" => "2007"
                        "volumen" => "85"
                        "paginaInicial" => "660"
                        "paginaFinal" => "667"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18026621"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudo comparativo de fatores de risco em crian&#231;as e adolescentes com diagn&#243;stico antropom&#233;trico de sobrepeso ou obesidade"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;C&#46; Ricco"
                            1 => "R&#46;G&#46; Ricco"
                            2 => "C&#46;A&#46; Almeida"
                            3 => "A&#46;P&#46;P&#46; Ramos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Paul Ped"
                        "fecha" => "2010"
                        "volumen" => "28"
                        "paginaInicial" => "320"
                        "paginaFinal" => "325"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Plasma lipid profile and lipid peroxidation in overweight or obese children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;C&#46; Lima"
                            1 => "R&#46;F&#46; Arrais"
                            2 => "M&#46;G&#46; Almeida"
                            3 => "Z&#46;M&#46; Souza"
                            4 => "L&#46;F&#46; Pedrosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr &#40;Rio J&#41;"
                        "fecha" => "2004"
                        "volumen" => "80"
                        "paginaInicial" => "23"
                        "paginaFinal" => "28"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increasing body mass index <span class="elsevierStyleItalic">z</span>-score is continuously associated with complications of overweight in children&#44; even in the healthy weight range"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Bell"
                            1 => "S&#46; Byrne"
                            2 => "A&#46; Thompson"
                            3 => "N&#46; Ratnam"
                            4 => "E&#46; Blair"
                            5 => "M&#46; Bulsara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2006-1714"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2007"
                        "volumen" => "92"
                        "paginaInicial" => "517"
                        "paginaFinal" => "522"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17105842"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiometabolic risks and severity of obesity in children and young adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;C&#46; Skinner"
                            1 => "E&#46;M&#46; Perrin"
                            2 => "L&#46;A&#46; Moss"
                            3 => "J&#46;A&#46; Skelton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1502821"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "373"
                        "paginaInicial" => "1307"
                        "paginaFinal" => "1317"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26422721"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Body mass index and waist circumference&#58; relationship to cardiometabolic risk factors in children &#8211; Busselton Health Study 2005&#8211;2007"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Bell"
                            1 => "J&#46; Hung"
                            2 => "M&#46; Knuiman"
                            3 => "M&#46; Divitini"
                            4 => "J&#46; Beilby"
                            5 => "M&#46; Hunter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jpc.12298"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Paediatr Child Health"
                        "fecha" => "2013"
                        "volumen" => "49"
                        "paginaInicial" => "955"
                        "paginaFinal" => "962"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23802746"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impacts of types and degree of obesity on non-alcoholic fatty liver disease and related dyslipidemia in Chinese school-age children&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Meng"
                            1 => "N&#46; Luo"
                            2 => "J&#46; Mi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3967/0895-3988.2011.01.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biomed Environ Sci"
                        "fecha" => "2011"
                        "volumen" => "24"
                        "paginaInicial" => "22"
                        "paginaFinal" => "30"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21440836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "I guidelines of prevention of atherosclerosis in childhood and adolescence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Back Giuliano Ide"
                            1 => "B&#46; Caramelli"
                            2 => "L&#46; Pellanda"
                            3 => "B&#46; Duncan"
                            4 => "S&#46; Mattos"
                            5 => "F&#46;H&#46; Fonseca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "2005"
                        "volumen" => "85"
                        "paginaInicial" => "4"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16597097"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determination of glycemia and insulinemia and the homeostasis model assessment &#40;HOMA&#41; in schoolchildren and adolescents with normal body mass index"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;A&#46; Almeida"
                            1 => "A&#46;P&#46; Pinho"
                            2 => "R&#46;G&#46; Ricco"
                            3 => "M&#46;T&#46; Pepato"
                            4 => "I&#46;L&#46; Brunetti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr &#40;Rio J&#41;"
                        "fecha" => "2008"
                        "volumen" => "84"
                        "paginaInicial" => "136"
                        "paginaFinal" => "140"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Indice HOMA y QUICKI&#44; insulina y peptido C en ni&#241;os sanos&#46; Puntos de corte de riesgo cardiovascular"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;G&#46; Cuartero"
                            1 => "C&#46;G&#46; Lacalle"
                            2 => "C&#46;J&#46; Lobo"
                            3 => "A&#46;G&#46; Vergaz"
                            4 => "C&#46;C&#46; Rey"
                            5 => "M&#46;J&#46;A&#46; Villar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2007"
                        "volumen" => "66"
                        "paginaInicial" => "481"
                        "paginaFinal" => "490"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "1165&#46;3"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonographic assessment of the common carotid intima-media complex in normal weight children and in overweight&#47;obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;A&#46; Nogueira-de-Almeida"
                            1 => "J&#46; Garcia"
                            2 => "S&#46;H&#46; Caixe"
                            3 => "A&#46;C&#46; Benedeti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1096/fj.201500137R"
                      "Revista" => array:4 [
                        "tituloSerie" => "FASEB J"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26929434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of echocardiography as a marker of cardiovascular risk in obese children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;B&#46; Caixe"
                            1 => "A&#46;C&#46; Saab"
                            2 => "J&#46; Garcia"
                            3 => "W&#46;P&#46; Martins"
                            4 => "F&#46; Mauad Filho"
                            5 => "L&#46;A&#46; Del Ciampo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Int J Clin Pediatr"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyperinsulinism assessment in a sample of prepubescent children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;F&#46; Mieldazis"
                            1 => "L&#46;A&#46; Azzalis"
                            2 => "V&#46;B&#46; Junqueira"
                            3 => "F&#46;I&#46; Souza"
                            4 => "R&#46;O&#46; Sarni"
                            5 => "F&#46;L&#46; Fonseca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr &#40;Rio J&#41;"
                        "fecha" => "2010"
                        "volumen" => "86"
                        "paginaInicial" => "245"
                        "paginaFinal" => "249"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic syndrome in overweight&#47;obese female adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;P&#46; Pinho"
                            1 => "I&#46;L&#46; Brunetti"
                            2 => "M&#46;T&#46; Pepato"
                            3 => "C&#46;A&#46;N&#46; Almeida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Paul Ped"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "51"
                        "paginaFinal" => "56"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Body mass index is better than other anthropometric indices for identifying dyslipidemia in chinese children with obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Zhu"
                            1 => "Z&#46; Shao"
                            2 => "J&#46; Jing"
                            3 => "J&#46; Ma"
                            4 => "Y&#46; Chen"
                            5 => "X&#46; Li"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0149392"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2016"
                        "volumen" => "11"
                        "paginaInicial" => "e0149392"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26963377"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between WHO cut-offs for childhood overweight and obesity and cardiometabolic risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; de Onis"
                            1 => "C&#46; Mart&#237;nez-Costa"
                            2 => "F&#46; N&#250;&#241;ez"
                            3 => "G&#46; Nguefack-Tsague"
                            4 => "A&#46; Montal"
                            5 => "J&#46; Brines"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pub Health Nut"
                        "fecha" => "2013"
                        "volumen" => "16"
                        "paginaInicial" => "625"
                        "paginaFinal" => "630"
                        "itemHostRev" => array:3 [
                          "pii" => "S1885585717301913"
                          "estado" => "S300"
                          "issn" => "18855857"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age before stage&#58; insulin resistance rises before the onset of puberty&#58; a 9-year longitudinal study &#40;EarlyBird 26&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;N&#46; Jeffery"
                            1 => "B&#46;S&#46; Metcalf"
                            2 => "J&#46; Hosking"
                            3 => "A&#46;J&#46; Streeter"
                            4 => "L&#46;D&#46; Voss"
                            5 => "T&#46;J&#46; Wilkin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc11-1281"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2012"
                        "volumen" => "35"
                        "paginaInicial" => "536"
                        "paginaFinal" => "541"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22279034"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Centripetal distribution of body fat&#44; overweight and cardiorespiratory fitness&#58; association with insulin sensitivity and metabolic alterations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; Silva"
                            1 => "D&#46;S&#46; Barbosa"
                            2 => "J&#46;A&#46; Oliveira"
                            3 => "D&#46;P&#46; Guedes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Endocrinol Metabol"
                        "fecha" => "2006"
                        "volumen" => "50"
                        "paginaInicial" => "1034"
                        "paginaFinal" => "1040"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17221109"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/00217557/0000009400000003/v2_201805190418/S0021755717300360/v2_201805190418/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "10179"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/00217557/0000009400000003/v2_201805190418/S0021755717300360/v2_201805190418/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755717300360?idApp=UINPBA000049"
]

Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2017.06.012

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	2	9
2024 October	23	26	49
2024 September	31	29	60
2024 August	41	23	64
2024 July	38	23	61
2024 June	21	16	37
2024 May	19	11	30
2024 April	29	17	46
2024 March	35	19	54
2024 February	28	22	50
2024 January	30	27	57
2023 December	11	20	31
2023 November	23	27	50
2023 October	40	41	81
2023 September	43	33	76
2023 August	20	14	34
2023 July	16	11	27
2023 June	68	15	83
2023 May	40	12	52
2023 April	29	16	45
2023 March	40	20	60
2023 February	22	12	34
2023 January	30	18	48
2022 December	51	34	85
2022 November	28	33	61
2022 October	55	30	85
2022 September	34	39	73
2022 August	35	33	68
2022 July	55	62	117
2022 June	38	38	76
2022 May	25	43	68
2022 April	47	41	88
2022 March	37	71	108
2022 February	31	36	67
2022 January	27	25	52
2021 December	13	24	37
2021 November	11	13	24
2021 October	24	24	48
2021 September	9	10	19
2021 August	6	6	12
2021 July	13	9	22
2021 June	11	5	16
2021 May	14	15	29
2021 April	13	8	21
2021 March	15	14	29
2021 February	7	6	13
2021 January	8	11	19
2020 December	10	6	16
2020 November	11	14	25
2020 October	7	7	14
2020 September	16	12	28
2020 August	6	6	12
2020 July	4	3	7
2020 June	8	4	12
2020 May	8	14	22
2020 April	9	9	18
2020 March	9	5	14
2020 February	19	13	32
2020 January	18	16	34
2019 December	14	6	20
2019 November	10	3	13
2019 October	13	10	23
2019 September	11	8	19
2019 August	11	7	18
2019 July	18	20	38
2019 June	13	30	43
2019 May	18	8	26
2019 April	20	9	29
2019 March	21	10	31
2019 February	21	9	30
2019 January	12	12	24
2018 December	21	7	28
2018 November	27	2	29
2018 October	109	19	128
2018 September	79	12	91
2018 August	27	8	35
2018 July	33	7	40
2018 June	28	12	40
2018 May	15	13	28
2018 April	1	4	5
2018 March	2	9	11
2018 February	1	7	8
2018 January	1	3	4
2017 December	1	3	4
2017 November	0	3	3
2017 October	1	10	11
2017 September	0	9	9

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter