Hyperuricemia is associated with low cardiorespiratory fitness levels and excess weight in schoolchildren

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"apellidos" => "Burgos" "email" => array:1 [ 0 => "mburgos@unisc.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0030" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidade de Santa Cruz do Sul (UNISC), Programa de Pós-graduação em Promoção da Saúde. Departamento de Biologia e Farmácia, Santa Cruz do Sul, RS, Brazil" "etiqueta" => "b" "identificador" => "aff0015" ] 2 => array:3 [ "entidad" => "Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil" "etiqueta" => "c" "identificador" => "aff0020" ] 3 => array:3 [ "entidad" => "Universidade de Santa Cruz do Sul (UNISC), Departamento de Educação Física e Saúde, Santa Cruz do Sul, RS, Brazil" "etiqueta" => "d" "identificador" => "aff0025" ] 4 => array:3 [ "entidad" => "Universidade de Santa Cruz do Sul (UNISC), Programa de Pós-graduação em Promoção da Saúde, Departamento de Educação Física e Saúde, Santa Cruz do Sul, RS, Brazil" "etiqueta" => "e" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionCardiorespiratory fitness (CRF) is a strong predictor of mortality in adults. Its levels in adolescence are related to CRF in adulthood.<a class="elsevierStyleCrossRef" href="#bib0105">1</a> Additionally, the incidence of low levels of CRF in children and adolescents has increased.<a class="elsevierStyleCrossRef" href="#bib0110">2</a>Currently, CRF has been associated with the presence of metabolic syndrome in schoolchildren.<a class="elsevierStyleCrossRef" href="#bib0115">3</a> It is known that low levels of CRF in childhood are predictors of metabolic risk; therefore, maintaining adequate levels of CRF since childhood is critical to reduce the incidence of metabolic syndrome in adulthood.<a class="elsevierStyleCrossRef" href="#bib0120">4</a>Low levels of CRF have been associated with the classic parameters of metabolic syndrome in schoolchildren.<a class="elsevierStyleCrossRef" href="#bib0125">5</a> Other non-traditional metabolic risk markers, such as uric acid, have also been associated with low levels of CRF, demonstrating that children and adolescents with low CRF levels have higher levels of this marker.<a class="elsevierStyleCrossRef" href="#bib0130">6</a>However, the literature is scarce on the association between hyperuricemia, CRF levels, and the presence of overweight/obesity in children and adolescents, especially in Brazil. The identification of a nontraditional marker, such as uric acid, associated with low levels of CRF and excess weight in childhood and adolescence, may help pediatricians to make an early diagnosis, as well as other health professionals, particularly physical education and nutrition professionals, to create interventions aimed at preventing the occurrence of metabolic risk in adulthood. Moreover, the present study brings a new approach, as it jointly evaluates the levels of CRF and BMI of schoolchildren. The scarcity of information and the importance of the subject justified the development of the present study, which aimed to evaluate a possible association between hyperuricemia and cardiorespiratory fitness levels with nutritional status, grouped into a single variable, in schoolchildren.MethodsA total of 2335 schoolchildren of both genders, stratified by conglomerates, participated in the study, of whom 80.3% lived in the urban area. Age ranged from 7 to 17 years (mean=11.5 years, standard deviation=2.8 years). All of them were elementary school students in the municipality of Santa Cruz do Sul, Rio Grande do Sul, Brazil, which has a total of 52 elementary and high schools, of which 19 are state, 29 are municipal, and four are private schools, with a population of 20,380 students. These data were obtained from the official municipal government agencies.The present study is part of a larger research project entitled “Schoolchildren's Health – Phase III”, approved by the Research Ethics Committee (REC) of Universidade de Santa Cruz do Sul (UNISC) under CAAE No. 31576714.6.0000.5343, according to Resolution 466/12 of the National Health Council. All evaluations were conducted in the University grounds, by professionals qualified for each function. The schoolchildren were enrolled in the study only after their parents or guardians signed the informed consent form, and children older than 12 years also agreed to collaborate through a term of assent; the study only included those who had no restrictions on blood collection.To calculate sample size, the G*Power 3.1 program (Heinrich-Heine-Universität – Düsseldorf, Germany) was used, considering Poisson regression as a statistical test (presence versus absence of hyperuricemia as a dependent variable). A test power (1−β)=0.95, significance level of α=0.05, and an effect size of 0.30, as indicated by Faul et al.,<a class="elsevierStyleCrossRef" href="#bib0135">7</a> were considered. Therefore, a minimum sample of 655 students was estimated to comprise the sample.In total, 25 schools public and private schools, both rural and urban, participated in the study. The assessed schools were selected by drawing lots, following the proportionality of the schoolchildren population density, according to the city region (Center, North, South, East, and West) and urban and rural area. Subsequently, the lists of students were obtained from the selected schools, and the students were drawn by lots for the signing of the informed consent form.Schoolchildren enrolled in the selected schools, of both genders, aged between 7 and 17 years and who returned the signed consent form and term of assent were included in the study, totaling 2502 students. Of these, 167 subjects were excluded due to the inability to have blood collected and undergo the CRF test, or due to removal of discrepant data (outliers) from the database, after verification in the exploratory analysis.The BMI was calculated through the formula BMI=weight/height2 (kg/m2). To assess weight and height, the students were measured/weighed barefoot and wearing light clothing. The BMI was classified according to the percentile curves by age and gender.<a class="elsevierStyleCrossRef" href="#bib0140">8</a> The values obtained were reclassified into two categories: low-normal weight and overweight-obesity. CRF was evaluated by the 6-minute walk/run test. The students were previously advised to wear appropriate footwear and light clothing to undergo the test. The results were obtained in meters covered by the schoolchild and classified according to the tables of the Brazilian Sports Project (Projeto Esporte Brasil [PROESP-BR]) for gender and age, as in the healthy range (good CRF levels, fit) or in the risk range (low CRF; unfit).<a class="elsevierStyleCrossRef" href="#bib0145">9</a>The nutritional status/CRF variable was categorized using the BMI and CRF data, obtained separately. The results were classified into four categories: (1) low-normal weight/fit; (2) low-normal weight/unfit; (3) overweight-obese/fit and (4) overweight-obese/unfit.Pubertal stage was classified based on pubic hair in five categories as Tanner stage I (prepubertal), stage II (initial development), stage III (continuing maturation 1), stage IV (continuing maturation 2), or stage V (matured).<a class="elsevierStyleCrossRef" href="#bib0150">10</a> A survey card with figures it was presented to the schoolchildren, where the subjects indicated the one that most closely resembled their stage of development.Blood for uric acid measurement was collected from the brachial vein after a 12-hour fasting; the collection was made at the UNISC Exercise Biochemistry Laboratory by trained professionals (pharmacists and nursing technicians of the University), following biosafety standards. Uric acid levels in the serum of each patient were determined by the photometric enzymatic method, using a conventional reagent Kovalent and the Miura 200 automated system (I.S.E., Rome, Italy). Uric acid levels<5.5mg/dL were considered normal; levels ≥5.5mg/dL were considered hyperuricemia.The data were analyzed using the statistical program SPSS (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 23.0, NY, USA). First, the Shapiro–Wilks test was used to test the normality of the continuous data. Descriptive analyses were expressed as frequencies and percentages. The chi-squared test was used to compare the descriptive characteristics of the students by gender. The association between the outcome variable (hyperuricemia) and the categorized variable nutritional status/CRF was tested using Poisson regression, using prevalence ratios (PR) and 95% confidence intervals (CI). The analyses were stratified by gender, being adjusted for the age group and pubertal stage. Differences were considered significant at p<0.05.ResultsA total of 2335 students were evaluated. Regarding the association between the nutritional status and CRF, 21.9% of the boys and 27.3% of the girls were classified in the group overweight-obesity/unfit (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>When hyperuricemia was separately associated with nutritional status, it was observed that overweight or obese male students had a higher prevalence of hyperuricemia when compared was students with low or normal weight (PR: 1.07, p<0.001). This association was also verified among girls, this (PR: 1.06, p<0.001). When associated with CRF, unfit girls had higher prevalence of hyperuricemia than fit girls (PR: 1.06, p<0.001; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>An association, albeit small, was observed between hyperuricemia and nutritional status/CRF grouped into a single variable, adjusted for age and pubertal stage (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Unfit male schoolchildren with excess weight had a higher prevalence of hyperuricemia when compared with fit individuals with normal weight (PR: 1.07, p=0.007). Similar values were found for boys with excess weight, but who had good CRF (PR: 1.08, p=0.002). Among the assessed girls, significant differences were found only when comparing overweight and poor CRF with normal weight and good CRF levels (PR: 1.10, p<0.001).DiscussionThe present study demonstrated, albeit subtly, that the presence of hyperuricemia was more prevalent in overweight and obese schoolchildren, in both boys and girls, as well as in girls with poor CRF. Moreover, a higher prevalence of hyperuricemia was observed in schoolchildren of both genders who had both overweight/obesity and low levels of CRF.It is noteworthy that, although this association is small, it is relevant, since the sample comprised children and adolescents and changes in uric acid levels are more frequently observed in the adult population. It is known that, in these individuals, serum uric acid levels are associated with several cardiometabolic risk factors, and hyperuricemia is predictive of obesity development.<a class="elsevierStyleCrossRef" href="#bib0155">11</a> Although uric acid has an antioxidant function in the extracellular environment, it has detrimental effects when it enters the cells. Its detrimental impact includes endothelial function inhibition, platelet aggregation induction, and chronic systemic inflammation, among others.<a class="elsevierStyleCrossRefs" href="#bib0160">12,13</a>Based on the results found, it a higher prevalence of hyperuricemia was observed in schoolchildren of both genders with excess weight, corroborating the current literature. Lee et al.,<a class="elsevierStyleCrossRef" href="#bib0170">14</a> when assessing 2284 children aged 6–12 years in 104 schools in 13 cities in Taiwan, found that hyperuricemia is associated with metabolic syndrome, mainly with obesity and abdominal fat. In a study of 2614 school-aged children (4–18 years) in the city of Bogalusa, United States, Sun et al.<a class="elsevierStyleCrossRef" href="#bib0165">13</a> evaluated the association between uric acid and the individual components of the metabolic syndrome; elevated levels of uric acid showed a stronger association with BMI.One explanation for the association between body fat and hyperuricemia would be the increase in the production of keto acids during the night in individuals with more body fat, which would cause competition between the acids for renal excretion, in addition to a possible genetic predisposition to lower excretion of uric acid in some ethnic groups.<a class="elsevierStyleCrossRef" href="#bib0170">14</a> Nishida et al. explained the association of excess weight with hyperuricemia due to increased production of uric acid together with the synthesis of triglycerides and decreased excretion of uric acid as a result of hyperinsulinemia, which accompanies obesity.<a class="elsevierStyleCrossRef" href="#bib0160">12</a>The present study showed that only girls who are in the CRF risk zone had a higher prevalence of hyperuricemia. No significant associations were found in the male gender, which corroborates a study carried out with individuals of all ages treated at the Cardiovascular Healthare Program of Universidade Federal de Viçosa, Minas Gerais, Brazil, which indicated differences between the genders when uric acid alterations are associated with biomarkers of cardiometabolic risk, such as excess weight and sedentary lifestyle.<a class="elsevierStyleCrossRef" href="#bib0175">15</a>These alterations may be associated with the fact that boys and girls differ in several parameters, such as insulin resistance, inflammatory markers, and amino acid catabolism products.<a class="elsevierStyleCrossRef" href="#bib0180">16</a> Additionally, girls have a higher percentage of body fat, lower levels of CRF, and are less active,<a class="elsevierStyleCrossRef" href="#bib0185">17</a> which may influence the obtained results.When associated with CRF and nutritional status, the prevalence of hyperuricemia is higher in individuals with excess weight combined with low levels of CRF. This was observed in both boys and girls. In the male gender, it was observed that students with excess weight and with good levels of CRF also have a higher prevalence of hyperuricemia. Thus, excess weight appears to carry a higher health risk behavior than adequate levels of CRF. Nonetheless, Barnett et al., in a study of 1045 children (aged 7–12 years) in New York, United States, associated inadequate levels of CRF with obesity, considering both as risk factors for cardiovascular diseases; moreover, CRF classified in the risk zone in adolescence was associated with high percentages of body fat in adulthood.<a class="elsevierStyleCrossRef" href="#bib0190">18</a>In Spain, a study has shown that children with low levels of CRF have higher levels of uric acid.<a class="elsevierStyleCrossRef" href="#bib0130">6</a> Notwithstanding, little is known about the influence of physical fitness, since there are few studies associating physical exercise and serum uric acid levels in children and adolescents.Nishida et al.,<a class="elsevierStyleCrossRef" href="#bib0160">12</a> in Nabeshima, Japan, verified the influence of physical activity intensity and aerobic fitness on uric acid concentration in 71 obese adult men. Moderate physical activity intensity was associated with lower levels of uric acid. Villegas et al.<a class="elsevierStyleCrossRef" href="#bib0195">19</a> verified the prevalence and risk factors of hyperuricemia in 3978 adult men (40–74 years) in Shanghai, China. Physical activity was inversely associated with hyperuricemia prevalence, whereas BMI and weight gain were positively associated. Williams,<a class="elsevierStyleCrossRef" href="#bib0200">20</a> in the United States, analyzed the distance covered per week and coronary risk factors in 8282 male runners (15–80 years). The data were obtained through a questionnaire, while the levels of biochemical data, including uric acid, were obtained from data provided by the runners’ physicians. Among the conclusions, it was observed that individuals who ran greater distances had lower levels of uric acid, which may be associated with better levels of CRF.Studies with children and adolescents that associated CRF and uric acid levels are very scarce. The present study brings important contributions to the understanding of uric acid behavior in relation to clinical and metabolic variables. It is noteworthy the representative number of subjects, children and adolescents, whose data were scarcely available to date. The authors believe it is important to add the measurement of serum uric acid levels to the evaluation protocols in children and adolescents, as it may allow the assessment of possible cardiovascular complications in the beginning of their development. Barnett et al. also emphasize the importance of physical education classes at school as a way to increase the CRF levels in children and adolescents. This can be achieved by promoting not only their participation in physical activity classes, but also in activities that lead to CRF improvement, bringing benefits both in childhood and adolescence, as well as in adult life.<a class="elsevierStyleCrossRef" href="#bib0190">18</a>The present study contributes with knowledge in the area, since the association of uric acid levels with CRF and excess weight in children and adolescents is still poorly established, especially in Brazil. The association between elevated uric acid levels with CRF and nutritional status may help healthcare professionals in the diagnosis, treatment, and prevention of metabolic risk conditions in childhood. Additionally, the study brings a new approach by grouping the CRF and BMI variables into a single one. Another strength of the study is the fact that it contains a representative sample of a population that lacks research.However, the study has limitations. Due to its cross-sectional design, it is not possible to establish cause and effect associations, but only associations between variables, which may be influenced by intervening factors, such as the students’ food consumption and the presence of arterial hypertension, not assessed in the present study; these variables could indirectly influence serum uric acid levels. It is also known that obesity is a multifactorial condition, which can also be influenced by other inflammatory markers.The use of BMI should also be considered, since it is not the best parameter to evaluate obesity. Although useful in studies with a representative sample, as in the present study, it does not differentiate between lean and fat body mass. Further studies that can correlate the intensity of exercise with changes in serum uric acid levels are suggested, so that it may be possible to explore the beneficial effects of an active lifestyle on hyperuricemia.Hyperuricemia showed a slight association with the presence of excess weight and low levels of CRF, when assessed together. The measurement of uric acid in childhood may be a useful public healthcare measure for early intervention and prevention of future cardiovascular complications.FundingUniversidade de Santa Cruz do Sul (UNISC).Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres904148" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec884756" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres904147" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec884757" "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" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-25" "fechaAceptado" => "2016-11-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec884756" "palabras" => array:5 [ 0 => "Hyperuricemia" 1 => "Physical fitness" 2 => "Overweight" 3 => "Child" 4 => "Adolescent" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec884757" "palabras" => array:5 [ 0 => "Hiperuricemia" 1 => "Aptidão física" 2 => "Excesso de peso" 3 => "Criança" 4 => "Adolescente" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo evaluate the possible association between hyperuricemia and cardiorespiratory fitness levels/nutritional profile, grouped into a single variable, in schoolchildren. MethodCross-sectional study of 2335 students from Elementary schools, aged 7–17 years of both genders, stratified by conglomerates of a municipality in Southern Brazil. Body mass index (BMI) was calculated and cardiorespiratory fitness (CRF) was assessed by the 6-minute run/walk test. The BMI and CRF were grouped into a single variable, considering: (1) low and normal weight/fit; (2) low and normal weight/unfit; (3) overweight-obesity/fit; (4) overweight-obesity/unfit. The Poisson regression (prevalence ratio, PR) was used for the association between hyperuricemia and BMI/CRF ratio with 95% confidence intervals and differences were considered significant when p<0.05. ResultsThere is an association, although subtle, between the presence of hyperuricemia with low levels of CRF and the presence of excess weight, when grouped into a single variable. Boys and girls with this condition have higher prevalence of hyperuricemia (PR: 1.07; p=0.007 for boys; PR: 1.10; p<0.001 for girls). ConclusionTogether, excess weight and low levels of cardiorespiratory fitness are associated with the presence of hyperuricemia in schoolchildren." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoAvaliar a possível relação entre hiperuricemia com aptidão cardiorrespiratória e o estado nutricional, agrupados, em escolares. MétodoEstudo transversal com 2335 escolares da educação básica de 7 a 17 anos, de ambos os sexos, estratificados por conglomerados de um munícipio do sul do Brasil. Foi calculado o índice de massa corporal (IMC) e a aptidão cardiorrespiratória (APCR) foi avaliada pelo teste de corrida/caminhada de 6 minutos. O IMC e a APCR foram agrupados em uma única variável, considerando: 1) baixo peso-normal/apto; 2) baixo peso-normal/inapto; 3) sobrepeso-obesidade/apto; 4) sobrepeso-obesidade/inapto. A regressão de Poisson (razão de prevalência; RP) foi utilizada para associação entre hiperuricemia e a relação APCR/IMC com intervalos de confiança de 95% e diferenças significativas consideradas para p<0,05. ResultadosObserva-se associação, embora sutil, entre a presença de hiperuricemia com baixos níveis de APCR e a presença de excesso de peso, de forma agrupada. Meninos e meninas, com esta condição, têm maior prevalência de hiperuricemia (RP: 1,07; p=0,007; RP: 1,10; p<0,001, respectivamente), em comparação aos seus pares com bons níveis de APCR e estado nutricional adequado. ConclusãoDe forma conjunta, o excesso de peso e os baixos níveis de aptidão cardiorrespiratória estão associados com a presença de hiperuricemia em escolares." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Reis LN, Renner JD, Reuter CP, Horta JA, Paiva DN, Valim AR, et al. Hyperuricemia is associated with low cardiorespiratory fitness levels and excess weight in schoolchildren. J Pediatr (Rio J). 2017;93:538–43." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Study carried out at Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, 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:2 [ "leyenda" => "BMI, body mass index; CRF, cardiorespiratory fitness; chi-squared test, considering the comparison between genders." "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">Male (n=1033) 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">Female (n=1302) 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">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 " colspan="4" align="left" valign="top">Age range</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Child (6–9 years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">289 (28.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">342 (26.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top">0.190</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Adolescent (10–17 years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">744 (72.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">960 (73.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">BMI classification</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-normal weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">606 (58.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">795 (61.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top">0.129</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight-obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">427 (41.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">507 (38.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">CRF classification</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Healthy range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">600 (58.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">487 (37.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><0.001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Risk range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">433 (41.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">815 (62.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Nutritional status/CRF</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-normal weight/Fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">399 (38.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">335 (25.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="4" align="char" valign="top"><0.001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-normal weight/Unfit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">207 (20.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">460 (35.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight-obesity/Fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">201 (19.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">152 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight-obesity/Unfit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">226 (21.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">355 (27.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Pubertal stage</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">262 (25.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">308 (23.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="5" align="char" valign="top">0.018</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">244 (23.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">326 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">189 (18.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">297 (22.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">262 (25.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">272 (20.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 (7.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Uric acid</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">844 (81.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1192 (91.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><0.001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperuricemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">189 (18.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110 (8.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Ethnicity</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">825 (75.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1051 (74.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Black \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 (9.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="4" align="char" valign="top">0.430</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mixed race \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142 (13.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">215 (15.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Native Brazilian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Place of residence</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urban \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">806 (78.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1068 (82.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top">0.009</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">227 (22.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">234 (18.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1520186.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sample description. Santa Cruz do Sul, Brazil, 2014–2015." ] ] 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" => "PR, prevalence ratio; CI, confidence interval; analysis adjusted for age and pubertal stage; BMI, body mass index; CRF, cardiorespiratory fitness." "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">Hyperuricemia PR (95%CI) \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">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 " colspan="3" align="left" valign="top">Males</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">BMI classification</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-normal weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight-obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07 (1.03–1.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">CRF classification</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Healthy range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Risk range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02 (0.98–1.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.385 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Nutritional status/CRF</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-normal weight/fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-normal weight/unfit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.01 (0.96–1.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.553 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight-obesity/fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.08 (1.03–1.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight-obesity/unfit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07 (1.02–1.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Females</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">BMI classification</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-normal weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight-obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.06 (1.03–1.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">CRF classification</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Healthy range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Risk range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.06 (1.02–1.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Nutritional status/CRF</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-normal weight/fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-normal weight/unfit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03 (0.99–1.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.072 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight-obesity/fit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03 (0.98–1.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.231 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight-obesity/unfit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10 (1.06–1.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1520185.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Association between hyperuricemia and CRF with BMI." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood physical fitness tests: predictor of adult physical activity levels?" 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Luiza N. Reisa, Jane D.P. Rennerb, Cézane P. Reuterc,d, Jorge A. Hortab, Dulciane N. Paivae, Andréia R. de M. Valimb, Ana P. Sehna, Elza D. de Melloc, Miria S. Burgose,

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mburgos@unisc.br

Corresponding author.

a Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil

b Universidade de Santa Cruz do Sul (UNISC), Programa de Pós-graduação em Promoção da Saúde. Departamento de Biologia e Farmácia, Santa Cruz do Sul, RS, Brazil

c Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil

d Universidade de Santa Cruz do Sul (UNISC), Departamento de Educação Física e Saúde, Santa Cruz do Sul, RS, Brazil

e Universidade de Santa Cruz do Sul (UNISC), Programa de Pós-graduação em Promoção da Saúde, Departamento de Educação Física e Saúde, Santa Cruz do Sul, RS, Brazil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiorespiratory fitness &#40;CRF&#41; is a strong predictor of mortality in adults&#46; Its levels in adolescence are related to CRF in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> Additionally&#44; the incidence of low levels of CRF in children and adolescents has increased&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Currently&#44; CRF has been associated with the presence of metabolic syndrome in schoolchildren&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> It is known that low levels of CRF in childhood are predictors of metabolic risk&#59; therefore&#44; maintaining adequate levels of CRF since childhood is critical to reduce the incidence of metabolic syndrome in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Low levels of CRF have been associated with the classic parameters of metabolic syndrome in schoolchildren&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Other non-traditional metabolic risk markers&#44; such as uric acid&#44; have also been associated with low levels of CRF&#44; demonstrating that children and adolescents with low CRF levels have higher levels of this marker&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">However&#44; the literature is scarce on the association between hyperuricemia&#44; CRF levels&#44; and the presence of overweight&#47;obesity in children and adolescents&#44; especially in Brazil&#46; The identification of a nontraditional marker&#44; such as uric acid&#44; associated with low levels of CRF and excess weight in childhood and adolescence&#44; may help pediatricians to make an early diagnosis&#44; as well as other health professionals&#44; particularly physical education and nutrition professionals&#44; to create interventions aimed at preventing the occurrence of metabolic risk in adulthood&#46; Moreover&#44; the present study brings a new approach&#44; as it jointly evaluates the levels of CRF and BMI of schoolchildren&#46; The scarcity of information and the importance of the subject justified the development of the present study&#44; which aimed to evaluate a possible association between hyperuricemia and cardiorespiratory fitness levels with nutritional status&#44; grouped into a single variable&#44; in schoolchildren&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 2335 schoolchildren of both genders&#44; stratified by conglomerates&#44; participated in the study&#44; of whom 80&#46;3&#37; lived in the urban area&#46; Age ranged from 7 to 17 years &#40;mean<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;5 years&#44; standard deviation<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;8 years&#41;&#46; All of them were elementary school students in the municipality of Santa Cruz do Sul&#44; Rio Grande do Sul&#44; Brazil&#44; which has a total of 52 elementary and high schools&#44; of which 19 are state&#44; 29 are municipal&#44; and four are private schools&#44; with a population of 20&#44;380 students&#46; These data were obtained from the official municipal government agencies&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The present study is part of a larger research project entitled &#8220;Schoolchildren&#39;s Health &#8211; Phase III&#8221;&#44; approved by the Research Ethics Committee &#40;REC&#41; of Universidade de Santa Cruz do Sul &#40;UNISC&#41; under CAAE No&#46; 31576714&#46;6&#46;0000&#46;5343&#44; according to Resolution 466&#47;12 of the National Health Council&#46; All evaluations were conducted in the University grounds&#44; by professionals qualified for each function&#46; The schoolchildren were enrolled in the study only after their parents or guardians signed the informed consent form&#44; and children older than 12 years also agreed to collaborate through a term of assent&#59; the study only included those who had no restrictions on blood collection&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">To calculate sample size&#44; the G&#42;Power 3&#46;1 program &#40;Heinrich-Heine-Universit&#228;t &#8211; D&#252;sseldorf&#44; Germany&#41; was used&#44; considering Poisson regression as a statistical test &#40;presence <span class="elsevierStyleItalic">versus</span> absence of hyperuricemia as a dependent variable&#41;&#46; A test power &#40;1<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#946;</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;95&#44; significance level of <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; and an effect size of 0&#46;30&#44; as indicated by Faul et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> were considered&#46; Therefore&#44; a minimum sample of 655 students was estimated to comprise the sample&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In total&#44; 25 schools public and private schools&#44; both rural and urban&#44; participated in the study&#46; The assessed schools were selected by drawing lots&#44; following the proportionality of the schoolchildren population density&#44; according to the city region &#40;Center&#44; North&#44; South&#44; East&#44; and West&#41; and urban and rural area&#46; Subsequently&#44; the lists of students were obtained from the selected schools&#44; and the students were drawn by lots for the signing of the informed consent form&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Schoolchildren enrolled in the selected schools&#44; of both genders&#44; aged between 7 and 17 years and who returned the signed consent form and term of assent were included in the study&#44; totaling 2502 students&#46; Of these&#44; 167 subjects were excluded due to the inability to have blood collected and undergo the CRF test&#44; or due to removal of discrepant data &#40;outliers&#41; from the database&#44; after verification in the exploratory analysis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The BMI was calculated through the formula BMI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>weight&#47;height<span class="elsevierStyleSup">2</span> &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; To assess weight and height&#44; the students were measured&#47;weighed barefoot and wearing light clothing&#46; The BMI was classified according to the percentile curves by age and gender&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> The values obtained were reclassified into two categories&#58; low-normal weight and overweight-obesity&#46; CRF was evaluated by the 6-minute walk&#47;run test&#46; The students were previously advised to wear appropriate footwear and light clothing to undergo the test&#46; The results were obtained in meters covered by the schoolchild and classified according to the tables of the Brazilian Sports Project &#40;Projeto Esporte Brasil &#91;PROESP-BR&#93;&#41; for gender and age&#44; as in the healthy range &#40;good CRF levels&#44; fit&#41; or in the risk range &#40;low CRF&#59; unfit&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The nutritional status&#47;CRF variable was categorized using the BMI and CRF data&#44; obtained separately&#46; The results were classified into four categories&#58; &#40;1&#41; low-normal weight&#47;fit&#59; &#40;2&#41; low-normal weight&#47;unfit&#59; &#40;3&#41; overweight-obese&#47;fit and &#40;4&#41; overweight-obese&#47;unfit&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Pubertal stage was classified based on pubic hair in five categories as Tanner stage I &#40;prepubertal&#41;&#44; stage II &#40;initial development&#41;&#44; stage III &#40;continuing maturation 1&#41;&#44; stage IV &#40;continuing maturation 2&#41;&#44; or stage V &#40;matured&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> A survey card with figures it was presented to the schoolchildren&#44; where the subjects indicated the one that most closely resembled their stage of development&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Blood for uric acid measurement was collected from the brachial vein after a 12-hour fasting&#59; the collection was made at the UNISC Exercise Biochemistry Laboratory by trained professionals &#40;pharmacists and nursing technicians of the University&#41;&#44; following biosafety standards&#46; Uric acid levels in the serum of each patient were determined by the photometric enzymatic method&#44; using a conventional reagent Kovalent and the Miura 200 automated system &#40;I&#46;S&#46;E&#46;&#44; Rome&#44; Italy&#41;&#46; Uric acid levels<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL were considered normal&#59; levels &#8805;5&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL were considered hyperuricemia&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The data were analyzed using the statistical program SPSS &#40;IBM Corp&#46; Released 2013&#46; IBM SPSS Statistics for Windows&#44; Version 23&#46;0&#44; NY&#44; USA&#41;&#46; First&#44; the Shapiro&#8211;Wilks test was used to test the normality of the continuous data&#46; Descriptive analyses were expressed as frequencies and percentages&#46; The chi-squared test was used to compare the descriptive characteristics of the students by gender&#46; The association between the outcome variable &#40;hyperuricemia&#41; and the categorized variable nutritional status&#47;CRF was tested using Poisson regression&#44; using prevalence ratios &#40;PR&#41; and 95&#37; confidence intervals &#40;CI&#41;&#46; The analyses were stratified by gender&#44; being adjusted for the age group and pubertal stage&#46; Differences were considered significant at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 2335 students were evaluated&#46; Regarding the association between the nutritional status and CRF&#44; 21&#46;9&#37; of the boys and 27&#46;3&#37; of the girls were classified in the group overweight-obesity&#47;unfit &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">When hyperuricemia was separately associated with nutritional status&#44; it was observed that overweight or obese male students had a higher prevalence of hyperuricemia when compared was students with low or normal weight &#40;PR&#58; 1&#46;07&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; This association was also verified among girls&#44; this &#40;PR&#58; 1&#46;06&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; When associated with CRF&#44; unfit girls had higher prevalence of hyperuricemia than fit girls &#40;PR&#58; 1&#46;06&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">An association&#44; albeit small&#44; was observed between hyperuricemia and nutritional status&#47;CRF grouped into a single variable&#44; adjusted for age and pubertal stage &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Unfit male schoolchildren with excess weight had a higher prevalence of hyperuricemia when compared with fit individuals with normal weight &#40;PR&#58; 1&#46;07&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#46; Similar values were found for boys with excess weight&#44; but who had good CRF &#40;PR&#58; 1&#46;08&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; Among the assessed girls&#44; significant differences were found only when comparing overweight and poor CRF with normal weight and good CRF levels &#40;PR&#58; 1&#46;10&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The present study demonstrated&#44; albeit subtly&#44; that the presence of hyperuricemia was more prevalent in overweight and obese schoolchildren&#44; in both boys and girls&#44; as well as in girls with poor CRF&#46; Moreover&#44; a higher prevalence of hyperuricemia was observed in schoolchildren of both genders who had both overweight&#47;obesity and low levels of CRF&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">It is noteworthy that&#44; although this association is small&#44; it is relevant&#44; since the sample comprised children and adolescents and changes in uric acid levels are more frequently observed in the adult population&#46; It is known that&#44; in these individuals&#44; serum uric acid levels are associated with several cardiometabolic risk factors&#44; and hyperuricemia is predictive of obesity development&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> Although uric acid has an antioxidant function in the extracellular environment&#44; it has detrimental effects when it enters the cells&#46; Its detrimental impact includes endothelial function inhibition&#44; platelet aggregation induction&#44; and chronic systemic inflammation&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Based on the results found&#44; it a higher prevalence of hyperuricemia was observed in schoolchildren of both genders with excess weight&#44; corroborating the current literature&#46; Lee et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> when assessing 2284 children aged 6&#8211;12 years in 104 schools in 13 cities in Taiwan&#44; found that hyperuricemia is associated with metabolic syndrome&#44; mainly with obesity and abdominal fat&#46; In a study of 2614 school-aged children &#40;4&#8211;18 years&#41; in the city of Bogalusa&#44; United States&#44; Sun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> evaluated the association between uric acid and the individual components of the metabolic syndrome&#59; elevated levels of uric acid showed a stronger association with BMI&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">One explanation for the association between body fat and hyperuricemia would be the increase in the production of keto acids during the night in individuals with more body fat&#44; which would cause competition between the acids for renal excretion&#44; in addition to a possible genetic predisposition to lower excretion of uric acid in some ethnic groups&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> Nishida et al&#46; explained the association of excess weight with hyperuricemia due to increased production of uric acid together with the synthesis of triglycerides and decreased excretion of uric acid as a result of hyperinsulinemia&#44; which accompanies obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The present study showed that only girls who are in the CRF risk zone had a higher prevalence of hyperuricemia&#46; No significant associations were found in the male gender&#44; which corroborates a study carried out with individuals of all ages treated at the Cardiovascular Healthare Program of Universidade Federal de Vi&#231;osa&#44; Minas Gerais&#44; Brazil&#44; which indicated differences between the genders when uric acid alterations are associated with biomarkers of cardiometabolic risk&#44; such as excess weight and sedentary lifestyle&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">These alterations may be associated with the fact that boys and girls differ in several parameters&#44; such as insulin resistance&#44; inflammatory markers&#44; and amino acid catabolism products&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> Additionally&#44; girls have a higher percentage of body fat&#44; lower levels of CRF&#44; and are less active&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> which may influence the obtained results&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When associated with CRF and nutritional status&#44; the prevalence of hyperuricemia is higher in individuals with excess weight combined with low levels of CRF&#46; This was observed in both boys and girls&#46; In the male gender&#44; it was observed that students with excess weight and with good levels of CRF also have a higher prevalence of hyperuricemia&#46; Thus&#44; excess weight appears to carry a higher health risk behavior than adequate levels of CRF&#46; Nonetheless&#44; Barnett et al&#46;&#44; in a study of 1045 children &#40;aged 7&#8211;12 years&#41; in New York&#44; United States&#44; associated inadequate levels of CRF with obesity&#44; considering both as risk factors for cardiovascular diseases&#59; moreover&#44; CRF classified in the risk zone in adolescence was associated with high percentages of body fat in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In Spain&#44; a study has shown that children with low levels of CRF have higher levels of uric acid&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> Notwithstanding&#44; little is known about the influence of physical fitness&#44; since there are few studies associating physical exercise and serum uric acid levels in children and adolescents&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Nishida et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> in Nabeshima&#44; Japan&#44; verified the influence of physical activity intensity and aerobic fitness on uric acid concentration in 71 obese adult men&#46; Moderate physical activity intensity was associated with lower levels of uric acid&#46; Villegas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> verified the prevalence and risk factors of hyperuricemia in 3978 adult men &#40;40&#8211;74 years&#41; in Shanghai&#44; China&#46; Physical activity was inversely associated with hyperuricemia prevalence&#44; whereas BMI and weight gain were positively associated&#46; Williams&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> in the United States&#44; analyzed the distance covered per week and coronary risk factors in 8282 male runners &#40;15&#8211;80 years&#41;&#46; The data were obtained through a questionnaire&#44; while the levels of biochemical data&#44; including uric acid&#44; were obtained from data provided by the runners&#8217; physicians&#46; Among the conclusions&#44; it was observed that individuals who ran greater distances had lower levels of uric acid&#44; which may be associated with better levels of CRF&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Studies with children and adolescents that associated CRF and uric acid levels are very scarce&#46; The present study brings important contributions to the understanding of uric acid behavior in relation to clinical and metabolic variables&#46; It is noteworthy the representative number of subjects&#44; children and adolescents&#44; whose data were scarcely available to date&#46; The authors believe it is important to add the measurement of serum uric acid levels to the evaluation protocols in children and adolescents&#44; as it may allow the assessment of possible cardiovascular complications in the beginning of their development&#46; Barnett et al&#46; also emphasize the importance of physical education classes at school as a way to increase the CRF levels in children and adolescents&#46; This can be achieved by promoting not only their participation in physical activity classes&#44; but also in activities that lead to CRF improvement&#44; bringing benefits both in childhood and adolescence&#44; as well as in adult life&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The present study contributes with knowledge in the area&#44; since the association of uric acid levels with CRF and excess weight in children and adolescents is still poorly established&#44; especially in Brazil&#46; The association between elevated uric acid levels with CRF and nutritional status may help healthcare professionals in the diagnosis&#44; treatment&#44; and prevention of metabolic risk conditions in childhood&#46; Additionally&#44; the study brings a new approach by grouping the CRF and BMI variables into a single one&#46; Another strength of the study is the fact that it contains a representative sample of a population that lacks research&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">However&#44; the study has limitations&#46; Due to its cross-sectional design&#44; it is not possible to establish cause and effect associations&#44; but only associations between variables&#44; which may be influenced by intervening factors&#44; such as the students&#8217; food consumption and the presence of arterial hypertension&#44; not assessed in the present study&#59; these variables could indirectly influence serum uric acid levels&#46; It is also known that obesity is a multifactorial condition&#44; which can also be influenced by other inflammatory markers&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The use of BMI should also be considered&#44; since it is not the best parameter to evaluate obesity&#46; Although useful in studies with a representative sample&#44; as in the present study&#44; it does not differentiate between lean and fat body mass&#46; Further studies that can correlate the intensity of exercise with changes in serum uric acid levels are suggested&#44; so that it may be possible to explore the beneficial effects of an active lifestyle on hyperuricemia&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Hyperuricemia showed a slight association with the presence of excess weight and low levels of CRF&#44; when assessed together&#46; The measurement of uric acid in childhood may be a useful public healthcare measure for early intervention and prevention of future cardiovascular complications&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">Universidade de Santa Cruz do Sul &#40;UNISC&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2016-08-25"
    "fechaAceptado" => "2016-11-29"
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            0 => "Hyperuricemia"
            1 => "Physical fitness"
            2 => "Overweight"
            3 => "Child"
            4 => "Adolescent"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec884757"
          "palabras" => array:5 [
            0 => "Hiperuricemia"
            1 => "Aptid&#227;o f&#237;sica"
            2 => "Excesso de peso"
            3 => "Crian&#231;a"
            4 => "Adolescente"
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        "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 possible association between hyperuricemia and cardiorespiratory fitness levels&#47;nutritional profile&#44; grouped into a single variable&#44; in schoolchildren&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study of 2335 students from Elementary schools&#44; aged 7&#8211;17 years of both genders&#44; stratified by conglomerates of a municipality in Southern Brazil&#46; Body mass index &#40;BMI&#41; was calculated and cardiorespiratory fitness &#40;CRF&#41; was assessed by the 6-minute run&#47;walk test&#46; The BMI and CRF were grouped into a single variable&#44; considering&#58; &#40;1&#41; low and normal weight&#47;fit&#59; &#40;2&#41; low and normal weight&#47;unfit&#59; &#40;3&#41; overweight-obesity&#47;fit&#59; &#40;4&#41; overweight-obesity&#47;unfit&#46; The Poisson regression &#40;prevalence ratio&#44; PR&#41; was used for the association between hyperuricemia and BMI&#47;CRF ratio with 95&#37; confidence intervals and differences were considered significant when <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There is an association&#44; although subtle&#44; between the presence of hyperuricemia with low levels of CRF and the presence of excess weight&#44; when grouped into a single variable&#46; Boys and girls with this condition have higher prevalence of hyperuricemia &#40;PR&#58; 1&#46;07&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007 for boys&#59; PR&#58; 1&#46;10&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for girls&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Together&#44; excess weight and low levels of cardiorespiratory fitness are associated with the presence of hyperuricemia in schoolchildren&#46;</p></span>"
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            "titulo" => "Objective"
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            "titulo" => "Method"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar a poss&#237;vel rela&#231;&#227;o entre hiperuricemia com aptid&#227;o cardiorrespirat&#243;ria e o estado nutricional&#44; agrupados&#44; em escolares&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal com 2335 escolares da educa&#231;&#227;o b&#225;sica de 7 a 17 anos&#44; de ambos os sexos&#44; estratificados por conglomerados de um mun&#237;cipio do sul do Brasil&#46; Foi calculado o &#237;ndice de massa corporal &#40;IMC&#41; e a aptid&#227;o cardiorrespirat&#243;ria &#40;APCR&#41; foi avaliada pelo teste de corrida&#47;caminhada de 6 minutos&#46; O IMC e a APCR foram agrupados em uma &#250;nica vari&#225;vel&#44; considerando&#58; 1&#41; baixo peso-normal&#47;apto&#59; 2&#41; baixo peso-normal&#47;inapto&#59; 3&#41; sobrepeso-obesidade&#47;apto&#59; 4&#41; sobrepeso-obesidade&#47;inapto&#46; A regress&#227;o de Poisson &#40;raz&#227;o de preval&#234;ncia&#59; RP&#41; foi utilizada para associa&#231;&#227;o entre hiperuricemia e a rela&#231;&#227;o APCR&#47;IMC com intervalos de confian&#231;a de 95&#37; e diferen&#231;as significativas consideradas para p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Observa-se associa&#231;&#227;o&#44; embora sutil&#44; entre a presen&#231;a de hiperuricemia com baixos n&#237;veis de APCR e a presen&#231;a de excesso de peso&#44; de forma agrupada&#46; Meninos e meninas&#44; com esta condi&#231;&#227;o&#44; t&#234;m maior preval&#234;ncia de hiperuricemia &#40;RP&#58; 1&#44;07&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#59; RP&#58; 1&#44;10&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; respectivamente&#41;&#44; em compara&#231;&#227;o aos seus pares com bons n&#237;veis de APCR e estado nutricional adequado&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">De forma conjunta&#44; o excesso de peso e os baixos n&#237;veis de aptid&#227;o cardiorrespirat&#243;ria est&#227;o associados com a presen&#231;a de hiperuricemia em escolares&#46;</p></span>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Reis LN&#44; Renner JD&#44; Reuter CP&#44; Horta JA&#44; Paiva DN&#44; Valim AR&#44; et al&#46; Hyperuricemia is associated with low cardiorespiratory fitness levels and excess weight in schoolchildren&#46; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;538&#8211;43&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study carried out at Universidade de Santa Cruz do Sul &#40;UNISC&#41;&#44; Santa Cruz do Sul&#44; RS&#44; Brazil&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; CRF&#44; cardiorespiratory fitness&#59; chi-squared test&#44; considering the comparison between genders&#46;</p>"
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                  \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">Male &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1033&#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">Female &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1302&#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"><span class="elsevierStyleItalic">p</span>&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  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Age range</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Child &#40;6&#8211;9 years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">289 &#40;28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">342 &#40;26&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">0&#46;190</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adolescent &#40;10&#8211;17 years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">744 &#40;72&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">960 &#40;73&#46;7&#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  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">BMI classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low-normal weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">606 &#40;58&#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">795 &#40;61&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">0&#46;129</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Overweight-obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">427 &#40;41&#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">507 &#40;38&#46;9&#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  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">CRF classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Healthy range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">600 &#40;58&#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">487 &#40;37&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">&#60;0&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Risk range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">433 &#40;41&#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">815 &#40;62&#46;6&#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  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Nutritional status&#47;CRF</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low-normal weight&#47;Fit&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">335 &#40;25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="4" align="char" valign="top">&#60;0&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low-normal weight&#47;Unfit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">207 &#40;20&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">460 &#40;35&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Overweight-obesity&#47;Fit&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152 &#40;11&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Overweight-obesity&#47;Unfit&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">355 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">262 &#40;25&#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">308 &#40;23&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="5" align="char" valign="top">0&#46;018</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">244 &#40;23&#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">326 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&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;18&#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">297 &#40;22&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">262 &#40;25&#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">272 &#40;20&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#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">99 &#40;7&#46;6&#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  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Uric acid</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">844 &#40;81&#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">1192 &#40;91&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">&#60;0&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hyperuricemia&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;18&#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">110 &#40;8&#46;4&#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  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Ethnicity</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Caucasian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">825 &#40;75&#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">1051 &#40;74&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Black&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;9&#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">115 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="4" align="char" valign="top">0&#46;430</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mixed race&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">142 &#40;13&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">215 &#40;15&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Native Brazilian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;0&#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">10 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asian&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;1&#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">16 &#40;1&#46;1&#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  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Place of residence</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urban&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">806 &#40;78&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1068 &#40;82&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">0&#46;009</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">227 &#40;22&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">234 &#40;18&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">PR&#44; prevalence ratio&#59; CI&#44; confidence interval&#59; analysis adjusted for age and pubertal stage&#59; BMI&#44; body mass index&#59; CRF&#44; cardiorespiratory fitness&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" 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">Hyperuricemia PR &#40;95&#37;CI&#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"><span class="elsevierStyleItalic">p</span>&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  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Males</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMI classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Low-normal weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Overweight-obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;07 &#40;1&#46;03&#8211;1&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CRF classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Healthy range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Risk range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;02 &#40;0&#46;98&#8211;1&#46;06&#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;385&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nutritional status&#47;CRF</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Low-normal weight&#47;fit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Low-normal weight&#47;unfit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01 &#40;0&#46;96&#8211;1&#46;07&#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;553&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Overweight-obesity&#47;fit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;08 &#40;1&#46;03&#8211;1&#46;14&#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;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Overweight-obesity&#47;unfit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;07 &#40;1&#46;02&#8211;1&#46;13&#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;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Females</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMI classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Low-normal weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Overweight-obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;06 &#40;1&#46;03&#8211;1&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CRF classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Healthy range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Risk range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;06 &#40;1&#46;02&#8211;1&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nutritional status&#47;CRF</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Low-normal weight&#47;fit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Low-normal weight&#47;unfit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;03 &#40;0&#46;99&#8211;1&#46;07&#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;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Overweight-obesity&#47;fit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;03 &#40;0&#46;98&#8211;1&#46;07&#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;231&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2016.11.011

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	1	3
2024 October	15	16	31
2024 September	17	21	38
2024 August	31	26	57
2024 July	63	32	95
2024 June	26	13	39
2024 May	40	8	48
2024 April	21	23	44
2024 March	38	19	57
2024 February	33	19	52
2024 January	12	22	34
2023 December	13	22	35
2023 November	16	27	43
2023 October	16	30	46
2023 September	19	29	48
2023 August	16	13	29
2023 July	14	13	27
2023 June	9	14	23
2023 May	19	10	29
2023 April	15	4	19
2023 March	25	16	41
2023 February	12	14	26
2023 January	18	15	33
2022 December	32	22	54
2022 November	23	28	51
2022 October	22	32	54
2022 September	17	25	42
2022 August	21	38	59
2022 July	29	33	62
2022 June	20	31	51
2022 May	19	28	47
2022 April	35	34	69
2022 March	22	38	60
2022 February	10	14	24
2022 January	9	14	23
2021 December	9	20	29
2021 November	7	11	18
2021 October	8	19	27
2021 September	3	9	12
2021 August	3	13	16
2021 July	3	3	6
2021 June	8	7	15
2021 May	9	14	23
2021 April	6	13	19
2021 March	5	10	15
2021 February	4	7	11
2021 January	4	10	14
2020 December	7	6	13
2020 November	4	15	19
2020 October	7	5	12
2020 September	5	11	16
2020 August	3	10	13
2020 July	3	5	8
2020 June	3	5	8
2020 May	1	19	20
2020 April	5	23	28
2020 March	3	9	12
2020 February	9	12	21
2020 January	9	13	22
2019 December	3	4	7
2019 November	2	5	7
2019 October	6	8	14
2019 September	4	8	12
2019 August	8	9	17
2019 July	10	8	18
2019 June	6	14	20
2019 May	3	3	6
2019 April	10	11	21
2019 March	3	3	6
2019 February	3	6	9
2019 January	3	4	7
2018 December	3	6	9
2018 November	5	5	10
2018 October	38	14	52
2018 September	29	5	34
2018 August	6	7	13
2018 July	9	5	14
2018 June	27	7	34
2018 May	16	5	21
2018 April	8	1	9
2018 March	18	7	25
2018 February	11	5	16
2018 January	14	5	19
2017 December	5	2	7
2017 November	27	13	40
2017 October	26	19	45
2017 September	6	10	16
2017 August	1	4	5
2017 July	1	1	2
2017 June	0	7	7
2017 May	0	9	9

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