Proposition of decision limits for serum lipids in Brazilian children aged one to 13 years

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Fontes, Maria Eduarda Slhessarenko, Raymundo S. Azevedo, Adagmar Andriolo" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Natasha" "apellidos" => "Slhessarenko" "email" => array:2 [ 0 => "ronama@terra.com.br" 1 => "natasha.barreto@dasa.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Cor J.F." "apellidos" => "Fontes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Maria Eduarda" "apellidos" => "Slhessarenko" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Raymundo S." "apellidos" => "Azevedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Adagmar" "apellidos" => "Andriolo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Universidade Federal de Mato Grosso (UFMT), Faculdade de Medicina, Departamento de Pediatria, Cuiabá, MT, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidade Federal de Mato Grosso (UFMT), Faculdade de Medicina, Departamento de Clínica Médica, Cuiabá, MT, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universidade de São Paulo (USP), Faculdade de Medicina, São Paulo, SP, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Proposição de limites de decisão dos lipídeos séricos para crianças brasileiras de um a 13 anos de idade" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3272 "Ancho" => 2523 "Tamanyo" => 336133 ] ] "descripcion" => array:1 [ "en" => "Distribution of total cholesterol (A), non-HDL cholesterol (B), LDL-cholesterol (C), triglycerides (D), and HDL-cholesterol levels in mg/dL, at the P10, P50, P75, and P95 percentiles in the age ranges defined for each analyte. SD, standard deviation." ] ] ] "textoCompleto" => "IntroductionCoronary disease, secondary to atherosclerosis, is the main cause of current mortality.<a class="elsevierStyleCrossRefs" href="#bib0150">1,2</a> Although it is a significant cause of death in adults, atherosclerotic manifestations are rarely observed in children. The lifestyle that causes this disease usually begins in childhood, with the ingestion of caloric foods and a sedentary lifestyle, which leads to obesity, an important risk factor.<a class="elsevierStyleCrossRefs" href="#bib0160">3–5</a> According to the Family Budget Survey,<a class="elsevierStyleCrossRef" href="#bib0175">6</a> one in three Brazilian children aged 5–9 years is overweight. Among adolescents, this picture is also of concern.<a class="elsevierStyleCrossRef" href="#bib0175">6</a>Another risk factor is dyslipidemia, whose prevalence in pediatrics is described as high in Brazil,<a class="elsevierStyleCrossRefs" href="#bib0180">7,8</a> especially in the ERICA<a class="elsevierStyleCrossRef" href="#bib0190">9</a> (Study of Cardiovascular Risks in Adolescents), as also shown in international publications.<a class="elsevierStyleCrossRefs" href="#bib0155">2,10,11</a> Studies indicate that 50% of children with dyslipidemia will present the disease during adulthood.<a class="elsevierStyleCrossRef" href="#bib0205">12</a>In Brazil, the values that define serum lipid levels for children and adolescents have been proposed based on studies performed in the North American pediatric population for almost three decades<a class="elsevierStyleCrossRefs" href="#bib0155">2,13</a> and are considered in the I Guideline for Atherosclerosis Prevention in Childhood and Adolescence (I Diretriz sobre Prevenção da Aterosclerose na Infância e na Adolescência [IDPAIA]),<a class="elsevierStyleCrossRef" href="#bib0160">3</a> in the I Brazilian Guideline for Familial Hypercholesterolemia (I Diretriz Brasileira de Hipercolesterolemia Familiar [IDBHF]),<a class="elsevierStyleCrossRef" href="#bib0215">14</a> and, recently, in the update of the Brazilian Guideline for Dyslipidemia and Atherosclerosis prevention (Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose [ADBDPA]).<a class="elsevierStyleCrossRef" href="#bib0220">15</a>In the IDPAIA,<a class="elsevierStyleCrossRef" href="#bib0160">3</a> serum lipids were categorized as desirable, borderline and increased decision limits (DL), considering the P50, P75, and P90 percentiles, respectively. In other guidelines,<a class="elsevierStyleCrossRefs" href="#bib0215">14,15</a> including the North American,<a class="elsevierStyleCrossRef" href="#bib0155">2</a> the same classification is equivalent to P75, between P75 and P95, and above P95.In the ADBDPA,<a class="elsevierStyleCrossRef" href="#bib0220">15</a> the values are described considering the presence or absence of fasting. For serum lipids, except for triglycerides (TG), the values are the same regardless of fasting, and there is only a reference to the desirable DL.In all guidelines, lipid values were defined in a single age range, except for TG, which are presented in two age groups in the IDBHF<a class="elsevierStyleCrossRef" href="#bib0215">14</a> and the ADBDPA<a class="elsevierStyleCrossRef" href="#bib0220">15</a>: 0–9 years and 10–19 years.Serum lipid measurement is part of the pediatric assessment routine.<a class="elsevierStyleCrossRefs" href="#bib0160">3,14,16</a> Adequate interpretation of levels of total cholesterol (TC), high-density lipoprotein (HDL-c), non-high-density lipoprotein (NHDL-c), low-density lipoprotein (LDL-c), and triglycerides (TG) is crucial for the diagnosis of dyslipidemia and for adequate decision-making.The reports issued by the laboratories show the reference intervals (RIs) next to the result, for test interpretation. Usually, RIs are obtained from the test package inserts, literature data, or the RI validation from other laboratories; ideally, however, laboratories should establish their own RIs.<a class="elsevierStyleCrossRefs" href="#bib0230">17,18</a>Establishing the laboratory's own RIs is an arduous task, but it is the best method, as it reflects the characteristics of the population to which the tests will be applied daily.<a class="elsevierStyleCrossRefs" href="#bib0230">17–19</a> As 70% of medical decisions are based on laboratory results,<a class="elsevierStyleCrossRef" href="#bib0245">20</a> it is important to have adequate RIs.Considering that, in Brazil, DL for serum lipids in pediatrics were established based on data from North American children,<a class="elsevierStyleCrossRefs" href="#bib0160">3,14,15</a> disregarding genetic, environmental, cultural, and demographic differences, the present study aimed to establish DL for lipids in healthy children and adolescents in the city of Cuiabá.MethodsThe study was carried out in Cuiabá, capital city of the state of Mato Grosso. The ethnic composition of the population resulted from intense race-mixing at two different moments: the first between populations from the state of São Paulo, Native Brazilians and blacks, during the colonial period; and the second, from 1970 onwards, when there was intense migration originating mainly from the South and Southeast regions of Brazil. The municipality is divided into four large regions, which include 83 municipal schools and 48 municipal public daycare centers, in which 38,934 children were enrolled in 2012.<a class="elsevierStyleCrossRef" href="#bib0250">21</a>Children and adolescents aged 1 year up to 12 years, 11 months, and 29 days, enrolled in municipal daycare centers or schools of Cuiabá were eligible for the study. The number of classrooms in schools was similar between the regions (approximately 13 classrooms), with approximately 30 students per room. The daycare centers had only one class and the number of children did not exceed 15. Due to this homogeneity, a cluster sampling procedure was used, with five schools and five daycare centers being chosen per region by drawing lots. Since not all daycare centers had a nursery, all five daycare centers that had a nursery were added to the clusters that had been drawn. Thus, a total of 20 schools and 25 daycare centers were selected.The sample calculation was based on the Clinical and Laboratory Standards Institute (CLSI) document, which recommends that at least 120 reference individuals per age group are necessary to define the RI.<a class="elsevierStyleCrossRef" href="#bib0230">17</a> Therefore, the drawing of five students/classroom was initially proposed to meet the goal. The resulting number was 1420 students. However, to correct the effect of the cluster sample design and to compensate for losses (absence, refusal), this number was increased by 40%, which resulted in a sample of 1988 students. This sample represented 1.5% of the population of the municipality in the study's age group.<a class="elsevierStyleCrossRef" href="#bib0255">22</a>Children and adolescents without any known underlying disease, with no clinical signs or symptoms, and no health complaints at the time of collection were included in the study. Participants did not use any type of medication on a regular basis, except for prophylactic ferrous sulfate.Three workstations were set up in each institution: in the first station, the questionnaire was filled out and the informed consent form was signed. Anthropometric measurements were obtained in the second workstation,<a class="elsevierStyleCrossRef" href="#bib0260">23</a> and blood was collected in the third workstation. The questionnaire contained questions about ethnicity, which was self-reported or characterized by the respondent.<a class="elsevierStyleCrossRef" href="#bib0265">24</a>Weight was measured using a digital scale (Bioland EB 9015, SP, Brazil) and the length/height was measured using an anthropometric ruler for patients aged up to 2 years, whereas older children and adolescents were measured in the standing position using an anthropometer.<a class="elsevierStyleCrossRef" href="#bib0260">23</a> Subsequently, these results were analyzed using age Z-scores by body mass index.<a class="elsevierStyleCrossRef" href="#bib0270">25</a> For the age range of 1–2 years, weight/length Z-scores were used.<a class="elsevierStyleCrossRef" href="#bib0270">25</a> After obtaining the Z-score results, nutritional status was classified as normal weight; risk of overweight (up to 5 years); overweight; obesity; severe obesity (5 years and older); underweight; and severe underweight (WHO Anthro and WHO Anthro Plus, version 3.2.2, WHO Headquarters, Geneva, Switzerland).Since the aim of the study was to establish DLs for clinical practice, it was decided to include children and adolescents from all nutritional categories, provided they did not show any evidence of comorbidity. Thus, nutritional deviations were not considered as an exclusion criterion. In Brazil, 33% of children aged 5–9 years are overweight or obese.<a class="elsevierStyleCrossRef" href="#bib0170">5</a>A total of 8mL of blood was collected in a single tube. For children younger than 2 years, a 3-h fast was recommended; for those aged 2–5 years, a 6-h fast; and for those older than 5 years and adolescents, a 12- to 14-h fast.TC and TG were measured using the colorimetric method and HDL-c was measured using the homogeneous colorimetric method. NHDL-c and LDL-c were estimated by calculations: NHDL-c was calculated by subtracting the HDL-c from the TC, whereas LDL-c was calculated using the Friedewald formula. The analyses were carried out on the Cobas 6000 equipment (Roche®, CA, USA), at the Cedilab Laboratory of the DASA network in Cuiabá.The statistical analysis of each serum lipid was performed to establish the DLs. Initially, variance homogeneity in the 12 age groups was analyzed using Bartlett's test. Then, the analysis of variance (ANOVA) test was used for homogeneous variances. For non-homogeneous variances, the Kruskal–Wallis test was applied. Subsequently, the Bonferroni post hoc test was used, which adjusted the level of significance for multiple comparisons in 2 by 2 groups, which allowed grouping the age ranges.Once grouped into age ranges for each serum lipid, Bartlett's test was repeated, and the ANOVA or Kruskal–Wallis tests were applied. While keeping the age groups, outliers were excluded by calculating the mean plus or minus three standard deviations.<a class="elsevierStyleCrossRef" href="#bib0275">26</a> After outlier exclusion, the distribution was carried out in percentiles, considering, as the classical criterion, the distribution of values up to P75 as desirable.<a class="elsevierStyleCrossRefs" href="#bib0155">2,14</a> Values ranging from P75 to P95 were considered as borderline and values ≥P95, as elevated. These percentiles were used for the analysis of serum lipids, except HDL-c, for which P10 was used as the lower limit, with P50 corresponding to the desirable level.<a class="elsevierStyleCrossRef" href="#bib0155">2</a> The level of significance was set at 5% (alpha=0.05). These analyses were performed using the MINITAB, version 15 (MINITAB Inc., United Kingdom) and SPSS, version 16 (SPSS for Windows, Version 16.0., Chicago, USA).Study participation occurred only after meeting the inclusion criteria and signing of the informed consent. The study was approved by the Research Ethics Committees of Hospital Universitário Julio Muller (947/2010) and Faculdade de Medicina da USP (318/2011).ResultsThe sociodemographic and nutritional characteristics of the 1866 children and adolescents who participated in this study are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>For the TC analysis, 1858 children and adolescents were divided into three age groups: 1 to <3 years, ≥3 to <9 years, and ≥9 to <13 years. The percentile distribution of TC levels is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The NHDL-c was analyzed in 1854 individuals in a single age group, from 1 to <13 years, whose parameters are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B. The values corresponding to P10, P50, P75, and P95 were 76mg/dL, 105mg/dL, 122mg/dL, and 150mg/dL, respectively. Chart representation of this variable was not possible.As for LDL-c, 1856 children and adolescents were studied and stratified into the age groups from 1 to <9 years and ≥9 to <13 years (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).For the 1839 children and adolescents analyzed for TG, it was possible to identify three age groups of significant variation: 1 to <2 years, ≥2 to <6 years, and ≥6 to <13 years. The percentile distribution is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D.Four age groups were defined for the analysis of HDL-c in 1848 individuals: 1 to <2 years, ≥2 to <3 years, ≥3 to <4 years, and ≥4 to <13 years. The percentile distribution is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E.The DLs found in this population for serum lipids are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The comparison of the desirable DLs of the present study with those described in the different guidelines is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionWhen comparing test results of the Brazilian population with DLs obtained from other populations, erroneous interpretations may occur. The diagnosis of dyslipidemia can be made more accurately using DLs obtained from the local population.<a class="elsevierStyleCrossRef" href="#bib0230">17</a>The results of this study demonstrated a difference in serum lipid levels between the age groups, which is contrary to the recommendations of the guidelines that show DL for a single pediatric age group, except for TG, which is presented in different levels for the age groups of 0–9 years and 10–19 years.<a class="elsevierStyleCrossRefs" href="#bib0215">14,15</a> Only the desirable DLs of serum lipids will be discussed.Regarding TC, the DLs of the present study were higher than those proposed by the IDPAIA.<a class="elsevierStyleCrossRef" href="#bib0160">3</a> In the age group of 1–2 years, they were lower, but identical in the age range of 3–8 years, when compared with the other guidelines.<a class="elsevierStyleCrossRefs" href="#bib0155">2,14,15</a> In the 9–12 years age range, the values of the present study were higher than those shown in the guidelines.<a class="elsevierStyleCrossRefs" href="#bib0155">2,14,15</a> Elevated CT levels have been correlated as an important risk factor for atherosclerotic cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0160">3</a>As for NHDL-c, a powerful predictor of atherosclerosis, the DL obtained in this study was lower to that suggested in the IDBH<a class="elsevierStyleCrossRef" href="#bib0215">14</a> and higher than that proposed by the NHLBI.<a class="elsevierStyleCrossRef" href="#bib0155">2</a> The other guidelines<a class="elsevierStyleCrossRefs" href="#bib0160">3,15</a> do not address this parameter.For LDL-c, the DLs found were lower than those proposed by all the guidelines,<a class="elsevierStyleCrossRefs" href="#bib0155">2,14,15</a> except the IDBPAIA.<a class="elsevierStyleCrossRef" href="#bib0160">3</a> For a long time, this parameter, together with TC, was deemed very important for cardiovascular risk evaluation.As for TG, this parameter is approached in a single age group (2–19 years) in IDPAIA,<a class="elsevierStyleCrossRef" href="#bib0160">3</a> whereas in the other guidelines, they are shown from 0 to 9 years and from 10 to 19 years.<a class="elsevierStyleCrossRefs" href="#bib0155">2,14,15</a> The present study proposes the division into three age groups. The DLs were higher than those shown in the IDBHF<a class="elsevierStyleCrossRef" href="#bib0215">14</a> and the NHLBI<a class="elsevierStyleCrossRef" href="#bib0155">2</a> in all age groups. In subjects aged ≥2 to <6 years and ≥6 to <13 years, the values were compatible with those proposed in the ADBDPA<a class="elsevierStyleCrossRef" href="#bib0220">15</a> without fasting. When compared with the IDPAIA,<a class="elsevierStyleCrossRef" href="#bib0160">3</a> the values obtained here were lower in the age groups from ≥2 to <6 years and from ≥6 to <13 years. The higher TG levels found in this study in children aged <2 years are certainly due to the shorter fasting time.Because of the improved accuracy of laboratory techniques, lipemia has ceased to interfere with many laboratory tests. Moreover, the postprandial state predominates most of the time; thus, the measurement of fasting serum lipids would not reflect the daily mean of lipids in blood and would not indicate the real impact on cardiovascular risk assessment.<a class="elsevierStyleCrossRef" href="#bib0280">27</a> Currently, the flexibilization of fasting is recommended, due to the need to assess patients’ cardiac risk in their usual diet status.<a class="elsevierStyleCrossRef" href="#bib0285">28</a>As for HDL-c, it has been observed that its levels tend to increase over the years. The evaluation of this analyte deserves special attention, since the value of medical interest is the lower limit. The IDBHF<a class="elsevierStyleCrossRef" href="#bib0215">14</a> adopted P5, whereas the NHLBI<a class="elsevierStyleCrossRef" href="#bib0155">2</a> has adopted P10. The other Brazilian guidelines have proposed only the desirable values (P50).<a class="elsevierStyleCrossRefs" href="#bib0160">3,15</a>HDL-c values, considering the P10, were 24mg/dL, 28mg/dL, 32mg/dL, and 36mg/dL for the four defined age groups, respectively. When considering the P5, the values obtained were 21mg/dL, 25mg/dL, 29mg/dL, and 32mg/dL. In both situations, the lower limit values found in this study were lower than those proposed by the IDBHF<a class="elsevierStyleCrossRef" href="#bib0215">14</a> and the NHLBI.<a class="elsevierStyleCrossRef" href="#bib0155">2</a>Considering the desirable DL, in the age range of <4 years, the values found herein were lower than those suggested by the guidelines.<a class="elsevierStyleCrossRefs" href="#bib0155">2,3,14,15</a> For those aged ≥4 years, it was higher than that recommended by all the guidelines.<a class="elsevierStyleCrossRefs" href="#bib0155">2,3,14,15</a>The serum lipid levels recommended by the Brazilian guidelines were observed in North American children and adolescents, with different genetic profiles and eating habits, with the aggravation of having been performed 30 years ago, when eating habits were better.<a class="elsevierStyleCrossRefs" href="#bib0155">2,3,13–15</a>Even though the information of the present study originated from a regional population, the social and demographic characteristics of this population make them very close to those of the rest of the Brazilian population. The current Cuiabá population resulted from an intense migratory movement. The population of Cuiabá has increased from 100,860 in 1970 to 590,118 in the year 2017.<a class="elsevierStyleCrossRef" href="#bib0255">22</a> Therefore, although regional, the assessed population is potentially more similar to the Brazilian population than those used for the creation of the national guidelines.The present study has limitations, such as the selection bias, as individuals from private schools were not included in the sample. Another limitation refers to the shorter duration of fasting for younger children, which could overestimate TG values. However, as previously mentioned, fasting is not currently required to assess the lipid profile.<a class="elsevierStyleCrossRefs" href="#bib0280">27,28</a> Finally, there is the concern about the exclusion of outliers. Considering the frequency of outlier exclusion of less than 4% in the sample,<a class="elsevierStyleCrossRef" href="#bib0290">29</a> there is little chance they have interfered with the obtained limits, as shown in other studies.<a class="elsevierStyleCrossRef" href="#bib0275">26</a>The values that allow the diagnosis of dyslipidemias must be reliable. Ideally, each country should establish its own RIs and DLs.<a class="elsevierStyleCrossRef" href="#bib0230">17</a> The values of the parameters evaluated in the present study may represent the DLs for the Brazilian pediatric population, contributing to improve the diagnostic accuracy in this population group.FundingAll exams were carried out at Diagnósticos da América, DASA, in Cuiabá and in Alphavile, São Paulo, at no cost to the researchers. The author received a grant from CAPES.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1170064" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1094986" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1170063" "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" => "xpalclavsec1094987" "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:2 [ "identificador" => "xack399888" "titulo" => "Acknowledgement" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-11" "fechaAceptado" => "2018-01-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1094986" "palabras" => array:5 [ 0 => "Children" 1 => "Adolescents" 2 => "Reference intervals" 3 => "Decision limits" 4 => "Serum lipids" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1094987" "palabras" => array:5 [ 0 => "Crianças" 1 => "Adolescentes" 2 => "Intervalos de referência" 3 => "Limites de decisão" 4 => "Lípides séricos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo determine decision limits for total cholesterol, LDL-cholesterol, non-HDL cholesterol, HDL-cholesterol, and triglycerides in healthy children and adolescents from Cuiabá, Brazil. MethodsThis was a cross-sectional study of 1866 healthy children and adolescents randomly selected from daycare centers and public schools in Cuiabá. The desirable levels of serum lipids were defined using the classic criteria, i.e., total cholesterol, LDL-cholesterol, non-HDL cholesterol, and triglycerides levels below the P75 percentile, and HDL-c above the P10 percentile. ResultsFor CT, P75 was: 160mg/dL for the age range of 1 to <3 years, 170mg/dL for ≥3 to <9 years, and 176mg/dL for ≥9 to <13 years. For non-HDL cholesterol, it was 122mg/dL for the age range of 1 to <13 years. For LDL-c, it was 104mg/dL at the age range of 1 to <9 years and 106mg/dL from ≥9 to <13 years. For TG, it was 127mg/dL from 1 to <2 years; 98mg/dL from ≥2 to <6 years; and 92mg/dL from ≥6 to <13 years. As for HDL-cholesterol, P10 was 24mg/dL, 28mg/dL, 32mg/dL, and 36mg/dL, for the age ranges of 1 to <2 years, ≥2 to <3 years, ≥3 to <4 years, and ≥4 to <13 years, respectively. ConclusionThe decision limits for the serum lipid levels defined in this study differed from those observed in the current Brazilian and North-American guidelines, especially because it differentiates between the age ranges. Using these decision limits in clinical practice will certainly contribute to improve the diagnostic accuracy for dyslipidemia in this population group." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoDeterminar limites de decisão (LD) para o colesterol total (CT), LDL-colesterol (LDL-c), colesterol não-HDL (c-NHDL), HDL-colesterol (HDL-c) e triglicérides (TG) em crianças e adolescentes saudáveis de Cuiabá. MétodoEstudo transversal envolvendo 1.866 crianças e adolescentes saudáveis de creches e escolas municipais públicas de Cuiabá, aleatoriamente selecionadas. Os LD desejáveis dos lipídeos séricos foram definidos pelos critérios clássicos, isto é, níveis de CT, LDL-c, c-NHDL, TG abaixo do percentil 75, e de HDL-c acima do percentil 10. ResultadosOs P75 para CT foram: 160mg/dL para a faixa etária de 1 a < 3 anos, 170mg/dL para ≥ 3 a < 9 anos e 176mg/dL para ≥ 9 a < 13 anos. Para o c-NHDL, de 122mg/dL na faixa etária de 1 a <13 anos. LDL-c: 104mg/dL na faixa etária de 1 a < 9 anos e 106mg/dL de ≥ 9 a < 13 anos. TG: 127mg/dL entre 1 a < 2 anos; 98mg/dL de ≥ 2 a < 6 anos; e 92mg/dL de ≥ 6 a < 13 anos. Quanto ao HDL-c, o P10, foi de 24mg/dL, 28mg/dL, 32mg/dL e 36mg/dL, para as faixas etárias de 1 a < 2 anos, ≥ 2 a < 3 anos, ≥ 3 a < 4 anos e ≥ 4 a < 13 anos, respectivamente. ConclusãoOs LD dos níveis séricos de lipídeos definidos neste estudo diferem daqueles apresentados nas diretrizes brasileiras e americanas atuais, especialmente por fazer a diferenciação entre as idades. Utilizar tais LD em nossa prática clínica certamente contribuirá para melhorar a acurácia do diagnóstico de dislipidemia nesse grupo populacional." "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: Slhessarenko N, Fontes CJ, Slhessarenko ME, Azevedo RS, Andriolo A. Proposition of decision limits for serum lipids in Brazilian children aged one to 13 years. J Pediatr (Rio J). 2019;95:173–79." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Institution or service where the study was carried out for indexing at the Index Medicus/MEDLINE: Universidade Federal de Mato Grosso, Universidade de São Paulo (USP), São Paulo, SP, Brazil." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3272 "Ancho" => 2523 "Tamanyo" => 336133 ] ] "descripcion" => array:1 [ "en" => "Distribution of total cholesterol (A), non-HDL cholesterol (B), LDL-cholesterol (C), triglycerides (D), and HDL-cholesterol levels in mg/dL, at the P10, P50, P75, and P95 percentiles in the age ranges defined for each analyte. SD, standard deviation." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Obs, variation in n due to lack of information for the variable." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \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">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">% \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">Gender</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">947 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.8 \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">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">919 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.2 \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">Age range (years)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">181 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.7 \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">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">248 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.3 \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">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">280 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.0 \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">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">162 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.7 \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">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.0 \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">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">177 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 \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">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">152 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1 \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">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0 \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">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.0 \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">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.1 \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">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 \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">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Ethnicity (n=1854)</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">1202 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.4 \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">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">366 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Black \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">233 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5 \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">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.8 \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 (n=1864)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1368 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.4 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">176 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4 \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 of overweight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">117 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 \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">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.9 \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">Underweight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 \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">Severe obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1 \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">Severe underweight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1997329.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic and nutritional characterization of 1866 healthy children and adolescents participating in the study, Cuiabá, MT, Brazil. 2012." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biochemical parameters (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age range (years) \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">Desirable \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">Borderline P75 to \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">Elevated ≥P95 \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 " rowspan="3" align="left" valign="top">Total cholesterol</td><td class="td" title="table-entry " align="left" valign="top">1 to <3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><160 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160–188 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≥189 \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">3 to <9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><170 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">170–198 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≥199 \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">9 to <13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><176 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">176–204 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≥205 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-HDL cholesterol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 to <13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><122 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">122–149 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≥150 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">LDL-cholesterol</td><td class="td" title="table-entry " align="left" valign="top">1 to <9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104–131 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≥132 \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">9 to <13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106–138 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≥139 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Triglycerides</td><td class="td" title="table-entry " align="left" valign="top">1 to <2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><127 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127–188 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≥189 \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">2 to <6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98–138 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≥139 \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">6 to <13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92–138 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≥139 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1997327.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biochemical parameters (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age range (years) \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">Desirable >P50 \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">Borderline P10 to P50 \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">Low P10 \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 " rowspan="4" align="left" valign="top">HDL-cholesterol</td><td class="td" title="table-entry " align="left" valign="top">1 to <2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25–34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≤24 \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">≥2 to <3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29–39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≤28 \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">≥3 to <4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33–42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≤32 \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">≥4 to <13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37–48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">≤36 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1997326.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Desirable, borderline, and altered concentrations of TC, NHDL-c, LDL-c, TG, and HDL-c for healthy children and adolescents in the municipality of Cuiabá, Mato Grosso, Brazil." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "I DPAIA, I Diretriz de Prevenção da Aterosclerose na Infância e na Adolescência, 2005; I DBHF, I Diretriz Brasileira de Hipercolesterolemia Familiar, 2012; ADBDPA, Atualização da Diretriz Brasileira de Dislipidemia e Prevenção da Aterosclerose, 2017; NHLBI, National Heart, Lung and Blood Institute, 2012." "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Guideline \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="10" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Serum lipids (mg/dL)</th></tr><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 " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total cholesterol</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-HDL cholesterol</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LDL-cholesterol</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Triglycerides</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HDL-cholesterol (≥P50)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Present study (P75)</td><td class="td" title="table-entry " align="left" valign="top">1 to <3: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><160 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 to <13: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><122 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 to <9: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 to <2: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><127 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 to <2: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>34 \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">≥ 3 to <9: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><170 \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><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">≥9 to <13: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">≥2 to <6: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">≥2 to <3: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>39 \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">≥ 9 to <13: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><176 \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">≥ 6 to <13: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">≥3 to <4: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>42 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="left" valign="top">≥4 to <13: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I DPAIA (P50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><150</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">–</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><100</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><100</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">≥45</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I DBHF (P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><170</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><123</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><110</td><td class="td" title="table-entry " align="left" valign="top">0 to 9: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">>45</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 to 19: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><90 \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><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" title="table-entry " colspan="11" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ADBDPA (P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><170</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">–</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><110</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">0 to 9: <75</td><td class="td" title="table-entry " align="" valign="top"> \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" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">10 to 19: <90</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">>45</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NHLBI (P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><170</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><120</td><td class="td" title="table-entry " colspan="2" align="center" valign="top"><110</td><td class="td" title="table-entry " align="left" valign="top">0 to 9: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">>45</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 to 19: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><90 \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><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1997328.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of the desirable decision limits for CT, HDL-c, NHDL-c, LDL-c, and TG in children and adolescents from the Cuiabá study with the pediatric guidelines." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatores de risco para aterosclerose em crianças e adolescentes com história familiar de doença arterial coronariana prematura" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.C. 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"vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00217557/0000009500000002/v1_201903260615/S0021755717304515/v1_201903260615/en/main.assets" "Apartado" => array:4 [ "identificador" => "10179" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00217557/0000009500000002/v1_201903260615/S0021755717304515/v1_201903260615/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755717304515?idApp=UINPBA000049"]

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Proposição de limites de decisão dos lipídeos séricos para crianças brasileiras de um a 13 anos de idade

Natasha Slhessarenkoa,

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ronama@terra.com.br
natasha.barreto@dasa.com.br

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, Cor J.F. Fontesb, Maria Eduarda Slhessarenkoc, Raymundo S. Azevedod, Adagmar Andrioloe

a Universidade Federal de Mato Grosso (UFMT), Faculdade de Medicina, Departamento de Pediatria, Cuiabá, MT, Brazil

b Universidade Federal de Mato Grosso (UFMT), Faculdade de Medicina, Departamento de Clínica Médica, Cuiabá, MT, Brazil

c Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil

d Universidade de São Paulo (USP), Faculdade de Medicina, São Paulo, SP, Brazil

e Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, 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">Coronary disease&#44; secondary to atherosclerosis&#44; is the main cause of current mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;2</span></a> Although it is a significant cause of death in adults&#44; atherosclerotic manifestations are rarely observed in children&#46; The lifestyle that causes this disease usually begins in childhood&#44; with the ingestion of caloric foods and a sedentary lifestyle&#44; which leads to obesity&#44; an important risk factor&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3&#8211;5</span></a> According to the Family Budget Survey&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a> one in three Brazilian children aged 5&#8211;9 years is overweight&#46; Among adolescents&#44; this picture is also of concern&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Another risk factor is dyslipidemia&#44; whose prevalence in pediatrics is described as high in Brazil&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7&#44;8</span></a> especially in the ERICA<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> &#40;Study of Cardiovascular Risks in Adolescents&#41;&#44; as also shown in international publications&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;10&#44;11</span></a> Studies indicate that 50&#37; of children with dyslipidemia will present the disease during adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In Brazil&#44; the values that define serum lipid levels for children and adolescents have been proposed based on studies performed in the North American pediatric population for almost three decades<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;13</span></a> and are considered in the I Guideline for Atherosclerosis Prevention in Childhood and Adolescence &#40;I Diretriz sobre Preven&#231;&#227;o da Aterosclerose na Inf&#226;ncia e na Adolesc&#234;ncia &#91;IDPAIA&#93;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> in the I Brazilian Guideline for Familial Hypercholesterolemia &#40;I Diretriz Brasileira de Hipercolesterolemia Familiar &#91;IDBHF&#93;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> and&#44; recently&#44; in the update of the Brazilian Guideline for Dyslipidemia and Atherosclerosis prevention &#40;Atualiza&#231;&#227;o da Diretriz Brasileira de Dislipidemias e Preven&#231;&#227;o da Aterosclerose &#91;ADBDPA&#93;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the IDPAIA&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> serum lipids were categorized as desirable&#44; borderline and increased decision limits &#40;DL&#41;&#44; considering the P50&#44; P75&#44; and P90 percentiles&#44; respectively&#46; In other guidelines&#44;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">14&#44;15</span></a> including the North American&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> the same classification is equivalent to P75&#44; between P75 and P95&#44; and above P95&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the ADBDPA&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> the values are described considering the presence or absence of fasting&#46; For serum lipids&#44; except for triglycerides &#40;TG&#41;&#44; the values are the same regardless of fasting&#44; and there is only a reference to the desirable DL&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In all guidelines&#44; lipid values were defined in a single age range&#44; except for TG&#44; which are presented in two age groups in the IDBHF<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> and the ADBDPA<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a>&#58; 0&#8211;9 years and 10&#8211;19 years&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Serum lipid measurement is part of the pediatric assessment routine&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3&#44;14&#44;16</span></a> Adequate interpretation of levels of total cholesterol &#40;TC&#41;&#44; high-density lipoprotein &#40;HDL-c&#41;&#44; non-high-density lipoprotein &#40;NHDL-c&#41;&#44; low-density lipoprotein &#40;LDL-c&#41;&#44; and triglycerides &#40;TG&#41; is crucial for the diagnosis of dyslipidemia and for adequate decision-making&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The reports issued by the laboratories show the reference intervals &#40;RIs&#41; next to the result&#44; for test interpretation&#46; Usually&#44; RIs are obtained from the test package inserts&#44; literature data&#44; or the RI validation from other laboratories&#59; ideally&#44; however&#44; laboratories should establish their own RIs&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Establishing the laboratory&#39;s own RIs is an arduous task&#44; but it is the best method&#44; as it reflects the characteristics of the population to which the tests will be applied daily&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#8211;19</span></a> As 70&#37; of medical decisions are based on laboratory results&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> it is important to have adequate RIs&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Considering that&#44; in Brazil&#44; DL for serum lipids in pediatrics were established based on data from North American children&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3&#44;14&#44;15</span></a> disregarding genetic&#44; environmental&#44; cultural&#44; and demographic differences&#44; the present study aimed to establish DL for lipids in healthy children and adolescents in the city of Cuiab&#225;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study was carried out in Cuiab&#225;&#44; capital city of the state of Mato Grosso&#46; The ethnic composition of the population resulted from intense race-mixing at two different moments&#58; the first between populations from the state of S&#227;o Paulo&#44; Native Brazilians and blacks&#44; during the colonial period&#59; and the second&#44; from 1970 onwards&#44; when there was intense migration originating mainly from the South and Southeast regions of Brazil&#46; The municipality is divided into four large regions&#44; which include 83 municipal schools and 48 municipal public daycare centers&#44; in which 38&#44;934 children were enrolled in 2012&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Children and adolescents aged 1 year up to 12 years&#44; 11 months&#44; and 29 days&#44; enrolled in municipal daycare centers or schools of Cuiab&#225; were eligible for the study&#46; The number of classrooms in schools was similar between the regions &#40;approximately 13 classrooms&#41;&#44; with approximately 30 students per room&#46; The daycare centers had only one class and the number of children did not exceed 15&#46; Due to this homogeneity&#44; a cluster sampling procedure was used&#44; with five schools and five daycare centers being chosen per region by drawing lots&#46; Since not all daycare centers had a nursery&#44; all five daycare centers that had a nursery were added to the clusters that had been drawn&#46; Thus&#44; a total of 20 schools and 25 daycare centers were selected&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The sample calculation was based on the Clinical and Laboratory Standards Institute &#40;CLSI&#41; document&#44; which recommends that at least 120 reference individuals per age group are necessary to define the RI&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> Therefore&#44; the drawing of five students&#47;classroom was initially proposed to meet the goal&#46; The resulting number was 1420 students&#46; However&#44; to correct the effect of the cluster sample design and to compensate for losses &#40;absence&#44; refusal&#41;&#44; this number was increased by 40&#37;&#44; which resulted in a sample of 1988 students&#46; This sample represented 1&#46;5&#37; of the population of the municipality in the study&#39;s age group&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Children and adolescents without any known underlying disease&#44; with no clinical signs or symptoms&#44; and no health complaints at the time of collection were included in the study&#46; Participants did not use any type of medication on a regular basis&#44; except for prophylactic ferrous sulfate&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Three workstations were set up in each institution&#58; in the first station&#44; the questionnaire was filled out and the informed consent form was signed&#46; Anthropometric measurements were obtained in the second workstation&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> and blood was collected in the third workstation&#46; The questionnaire contained questions about ethnicity&#44; which was self-reported or characterized by the respondent&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Weight was measured using a digital scale &#40;Bioland EB 9015&#44; SP&#44; Brazil&#41; and the length&#47;height was measured using an anthropometric ruler for patients aged up to 2 years&#44; whereas older children and adolescents were measured in the standing position using an anthropometer&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Subsequently&#44; these results were analyzed using age <span class="elsevierStyleItalic">Z</span>-scores by body mass index&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> For the age range of 1&#8211;2 years&#44; weight&#47;length <span class="elsevierStyleItalic">Z</span>-scores were used&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> After obtaining the <span class="elsevierStyleItalic">Z</span>-score results&#44; nutritional status was classified as normal weight&#59; risk of overweight &#40;up to 5 years&#41;&#59; overweight&#59; obesity&#59; severe obesity &#40;5 years and older&#41;&#59; underweight&#59; and severe underweight &#40;WHO Anthro and WHO Anthro Plus&#44; version 3&#46;2&#46;2&#44; WHO Headquarters&#44; Geneva&#44; Switzerland&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Since the aim of the study was to establish DLs for clinical practice&#44; it was decided to include children and adolescents from all nutritional categories&#44; provided they did not show any evidence of comorbidity&#46; Thus&#44; nutritional deviations were not considered as an exclusion criterion&#46; In Brazil&#44; 33&#37; of children aged 5&#8211;9 years are overweight or obese&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">A total of 8<span class="elsevierStyleHsp" style=""></span>mL of blood was collected in a single tube&#46; For children younger than 2 years&#44; a 3-h fast was recommended&#59; for those aged 2&#8211;5 years&#44; a 6-h fast&#59; and for those older than 5 years and adolescents&#44; a 12- to 14-h fast&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">TC and TG were measured using the colorimetric method and HDL-c was measured using the homogeneous colorimetric method&#46; NHDL-c and LDL-c were estimated by calculations&#58; NHDL-c was calculated by subtracting the HDL-c from the TC&#44; whereas LDL-c was calculated using the Friedewald formula&#46; The analyses were carried out on the Cobas 6000 equipment &#40;Roche<span class="elsevierStyleSup">&#174;</span>&#44; CA&#44; USA&#41;&#44; at the Cedilab Laboratory of the DASA network in Cuiab&#225;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The statistical analysis of each serum lipid was performed to establish the DLs&#46; Initially&#44; variance homogeneity in the 12 age groups was analyzed using Bartlett&#39;s test&#46; Then&#44; the analysis of variance &#40;ANOVA&#41; test was used for homogeneous variances&#46; For non-homogeneous variances&#44; the Kruskal&#8211;Wallis test was applied&#46; Subsequently&#44; the Bonferroni <span class="elsevierStyleItalic">post hoc</span> test was used&#44; which adjusted the level of significance for multiple comparisons in 2 by 2 groups&#44; which allowed grouping the age ranges&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Once grouped into age ranges for each serum lipid&#44; Bartlett&#39;s test was repeated&#44; and the ANOVA or Kruskal&#8211;Wallis tests were applied&#46; While keeping the age groups&#44; outliers were excluded by calculating the mean plus or minus three standard deviations&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> After outlier exclusion&#44; the distribution was carried out in percentiles&#44; considering&#44; as the classical criterion&#44; the distribution of values up to P75 as desirable&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;14</span></a> Values ranging from P75 to P95 were considered as borderline and values &#8805;P95&#44; as elevated&#46; These percentiles were used for the analysis of serum lipids&#44; except HDL-c&#44; for which P10 was used as the lower limit&#44; with P50 corresponding to the desirable level&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> The level of significance was set at 5&#37; &#40;alpha<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; These analyses were performed using the MINITAB&#44; version 15 &#40;MINITAB Inc&#46;&#44; United Kingdom&#41; and SPSS&#44; version 16 &#40;SPSS for Windows&#44; Version 16&#46;0&#46;&#44; Chicago&#44; USA&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Study participation occurred only after meeting the inclusion criteria and signing of the informed consent&#46; The study was approved by the Research Ethics Committees of Hospital Universit&#225;rio Julio Muller &#40;947&#47;2010&#41; and Faculdade de Medicina da USP &#40;318&#47;2011&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">The sociodemographic and nutritional characteristics of the 1866 children and adolescents who participated in this study are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">For the TC analysis&#44; 1858 children and adolescents were divided into three age groups&#58; 1 to &#60;3 years&#44; &#8805;3 to &#60;9 years&#44; and &#8805;9 to &#60;13 years&#46; The percentile distribution of TC levels is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The NHDL-c was analyzed in 1854 individuals in a single age group&#44; from 1 to &#60;13 years&#44; whose parameters are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#46; The values corresponding to P10&#44; P50&#44; P75&#44; and P95 were 76<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 105<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 122<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; and 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; respectively&#46; Chart representation of this variable was not possible&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">As for LDL-c&#44; 1856 children and adolescents were studied and stratified into the age groups from 1 to &#60;9 years and &#8805;9 to &#60;13 years &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">For the 1839 children and adolescents analyzed for TG&#44; it was possible to identify three age groups of significant variation&#58; 1 to &#60;2 years&#44; &#8805;2 to &#60;6 years&#44; and &#8805;6 to &#60;13 years&#46; The percentile distribution is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Four age groups were defined for the analysis of HDL-c in 1848 individuals&#58; 1 to &#60;2 years&#44; &#8805;2 to &#60;3 years&#44; &#8805;3 to &#60;4 years&#44; and &#8805;4 to &#60;13 years&#46; The percentile distribution is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The DLs found in this population for serum lipids are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The comparison of the desirable DLs of the present study with those described in the different guidelines is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">When comparing test results of the Brazilian population with DLs obtained from other populations&#44; erroneous interpretations may occur&#46; The diagnosis of dyslipidemia can be made more accurately using DLs obtained from the local population&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The results of this study demonstrated a difference in serum lipid levels between the age groups&#44; which is contrary to the recommendations of the guidelines that show DL for a single pediatric age group&#44; except for TG&#44; which is presented in different levels for the age groups of 0&#8211;9 years and 10&#8211;19 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">14&#44;15</span></a> Only the desirable DLs of serum lipids will be discussed&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Regarding TC&#44; the DLs of the present study were higher than those proposed by the IDPAIA&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> In the age group of 1&#8211;2 years&#44; they were lower&#44; but identical in the age range of 3&#8211;8 years&#44; when compared with the other guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;14&#44;15</span></a> In the 9&#8211;12 years age range&#44; the values of the present study were higher than those shown in the guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;14&#44;15</span></a> Elevated CT levels have been correlated as an important risk factor for atherosclerotic cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">As for NHDL-c&#44; a powerful predictor of atherosclerosis&#44; the DL obtained in this study was lower to that suggested in the IDBH<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> and higher than that proposed by the NHLBI&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> The other guidelines<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3&#44;15</span></a> do not address this parameter&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">For LDL-c&#44; the DLs found were lower than those proposed by all the guidelines&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;14&#44;15</span></a> except the IDBPAIA&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> For a long time&#44; this parameter&#44; together with TC&#44; was deemed very important for cardiovascular risk evaluation&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">As for TG&#44; this parameter is approached in a single age group &#40;2&#8211;19 years&#41; in IDPAIA&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> whereas in the other guidelines&#44; they are shown from 0 to 9 years and from 10 to 19 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;14&#44;15</span></a> The present study proposes the division into three age groups&#46; The DLs were higher than those shown in the IDBHF<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> and the NHLBI<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> in all age groups&#46; In subjects aged &#8805;2 to &#60;6 years and &#8805;6 to &#60;13 years&#44; the values were compatible with those proposed in the ADBDPA<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> without fasting&#46; When compared with the IDPAIA&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> the values obtained here were lower in the age groups from &#8805;2 to &#60;6 years and from &#8805;6 to &#60;13 years&#46; The higher TG levels found in this study in children aged &#60;2 years are certainly due to the shorter fasting time&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Because of the improved accuracy of laboratory techniques&#44; lipemia has ceased to interfere with many laboratory tests&#46; Moreover&#44; the postprandial state predominates most of the time&#59; thus&#44; the measurement of fasting serum lipids would not reflect the daily mean of lipids in blood and would not indicate the real impact on cardiovascular risk assessment&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> Currently&#44; the flexibilization of fasting is recommended&#44; due to the need to assess patients&#8217; cardiac risk in their usual diet status&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">As for HDL-c&#44; it has been observed that its levels tend to increase over the years&#46; The evaluation of this analyte deserves special attention&#44; since the value of medical interest is the lower limit&#46; The IDBHF<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> adopted P5&#44; whereas the NHLBI<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> has adopted P10&#46; The other Brazilian guidelines have proposed only the desirable values &#40;P50&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3&#44;15</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">HDL-c values&#44; considering the P10&#44; were 24<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 28<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 32<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; and 36<span class="elsevierStyleHsp" style=""></span>mg&#47;dL for the four defined age groups&#44; respectively&#46; When considering the P5&#44; the values obtained were 21<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 25<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 29<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; and 32<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; In both situations&#44; the lower limit values found in this study were lower than those proposed by the IDBHF<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> and the NHLBI&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Considering the desirable DL&#44; in the age range of &#60;4 years&#44; the values found herein were lower than those suggested by the guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;3&#44;14&#44;15</span></a> For those aged &#8805;4 years&#44; it was higher than that recommended by all the guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;3&#44;14&#44;15</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">The serum lipid levels recommended by the Brazilian guidelines were observed in North American children and adolescents&#44; with different genetic profiles and eating habits&#44; with the aggravation of having been performed 30 years ago&#44; when eating habits were better&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;3&#44;13&#8211;15</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Even though the information of the present study originated from a regional population&#44; the social and demographic characteristics of this population make them very close to those of the rest of the Brazilian population&#46; The current Cuiab&#225; population resulted from an intense migratory movement&#46; The population of Cuiab&#225; has increased from 100&#44;860 in 1970 to 590&#44;118 in the year 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> Therefore&#44; although regional&#44; the assessed population is potentially more similar to the Brazilian population than those used for the creation of the national guidelines&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The present study has limitations&#44; such as the selection bias&#44; as individuals from private schools were not included in the sample&#46; Another limitation refers to the shorter duration of fasting for younger children&#44; which could overestimate TG values&#46; However&#44; as previously mentioned&#44; fasting is not currently required to assess the lipid profile&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">27&#44;28</span></a> Finally&#44; there is the concern about the exclusion of outliers&#46; Considering the frequency of outlier exclusion of less than 4&#37; in the sample&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> there is little chance they have interfered with the obtained limits&#44; as shown in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">The values that allow the diagnosis of dyslipidemias must be reliable&#46; Ideally&#44; each country should establish its own RIs and DLs&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> The values of the parameters evaluated in the present study may represent the DLs for the Brazilian pediatric population&#44; contributing to improve the diagnostic accuracy in this population group&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">All exams were carried out at Diagn&#243;sticos da Am&#233;rica&#44; DASA&#44; in Cuiab&#225; and in Alphavile&#44; S&#227;o Paulo&#44; at no cost to the researchers&#46; The author received a grant from <span class="elsevierStyleGrantSponsor" id="gs1">CAPES</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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          "palabras" => array:5 [
            0 => "Children"
            1 => "Adolescents"
            2 => "Reference intervals"
            3 => "Decision limits"
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          "palabras" => array:5 [
            0 => "Crian&#231;as"
            1 => "Adolescentes"
            2 => "Intervalos de refer&#234;ncia"
            3 => "Limites de decis&#227;o"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine decision limits for total cholesterol&#44; LDL-cholesterol&#44; non-HDL cholesterol&#44; HDL-cholesterol&#44; and triglycerides in healthy children and adolescents from Cuiab&#225;&#44; Brazil&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a cross-sectional study of 1866 healthy children and adolescents randomly selected from daycare centers and public schools in Cuiab&#225;&#46; The desirable levels of serum lipids were defined using the classic criteria&#44; <span class="elsevierStyleItalic">i&#46;e</span>&#46;&#44; total cholesterol&#44; LDL-cholesterol&#44; non-HDL cholesterol&#44; and triglycerides levels below the P75 percentile&#44; and HDL-c above the P10 percentile&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">For CT&#44; P75 was&#58; 160<span class="elsevierStyleHsp" style=""></span>mg&#47;dL for the age range of 1 to &#60;3 years&#44; 170<span class="elsevierStyleHsp" style=""></span>mg&#47;dL for &#8805;3 to &#60;9 years&#44; and 176<span class="elsevierStyleHsp" style=""></span>mg&#47;dL for &#8805;9 to &#60;13 years&#46; For non-HDL cholesterol&#44; it was 122<span class="elsevierStyleHsp" style=""></span>mg&#47;dL for the age range of 1 to &#60;13 years&#46; For LDL-c&#44; it was 104<span class="elsevierStyleHsp" style=""></span>mg&#47;dL at the age range of 1 to &#60;9 years and 106<span class="elsevierStyleHsp" style=""></span>mg&#47;dL from &#8805;9 to &#60;13 years&#46; For TG&#44; it was 127<span class="elsevierStyleHsp" style=""></span>mg&#47;dL from 1 to &#60;2 years&#59; 98<span class="elsevierStyleHsp" style=""></span>mg&#47;dL from &#8805;2 to &#60;6 years&#59; and 92<span class="elsevierStyleHsp" style=""></span>mg&#47;dL from &#8805;6 to &#60;13 years&#46; As for HDL-cholesterol&#44; P10 was 24<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 28<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 32<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; and 36<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; for the age ranges of 1 to &#60;2 years&#44; &#8805;2 to &#60;3 years&#44; &#8805;3 to &#60;4 years&#44; and &#8805;4 to &#60;13 years&#44; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The decision limits for the serum lipid levels defined in this study differed from those observed in the current Brazilian and North-American guidelines&#44; especially because it differentiates between the age ranges&#46; Using these decision limits in clinical practice will certainly contribute to improve the diagnostic accuracy for dyslipidemia in this population group&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar limites de decis&#227;o &#40;LD&#41; para o colesterol total &#40;CT&#41;&#44; LDL-colesterol &#40;LDL-c&#41;&#44; colesterol n&#227;o-HDL &#40;c-NHDL&#41;&#44; HDL-colesterol &#40;HDL-c&#41; e triglic&#233;rides &#40;TG&#41; em crian&#231;as e adolescentes saud&#225;veis de Cuiab&#225;&#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 envolvendo 1&#46;866 crian&#231;as e adolescentes saud&#225;veis de creches e escolas municipais p&#250;blicas de Cuiab&#225;&#44; aleatoriamente selecionadas&#46; Os LD desej&#225;veis dos lip&#237;deos s&#233;ricos foram definidos pelos crit&#233;rios cl&#225;ssicos&#44; isto &#233;&#44; n&#237;veis de CT&#44; LDL-c&#44; c-NHDL&#44; TG abaixo do percentil 75&#44; e de HDL-c acima do percentil 10&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os P75 para CT foram&#58; 160<span class="elsevierStyleHsp" style=""></span>mg&#47;dL para a faixa et&#225;ria de 1 a &#60; 3 anos&#44; 170<span class="elsevierStyleHsp" style=""></span>mg&#47;dL para &#8805; 3 a &#60; 9 anos e 176<span class="elsevierStyleHsp" style=""></span>mg&#47;dL para &#8805; 9 a &#60; 13 anos&#46; Para o c-NHDL&#44; de 122<span class="elsevierStyleHsp" style=""></span>mg&#47;dL na faixa et&#225;ria de 1 a &#60;13 anos&#46; LDL-c&#58; 104<span class="elsevierStyleHsp" style=""></span>mg&#47;dL na faixa et&#225;ria de 1 a &#60; 9 anos e 106<span class="elsevierStyleHsp" style=""></span>mg&#47;dL de &#8805; 9 a &#60; 13 anos&#46; TG&#58; 127<span class="elsevierStyleHsp" style=""></span>mg&#47;dL entre 1 a &#60; 2 anos&#59; 98<span class="elsevierStyleHsp" style=""></span>mg&#47;dL de &#8805; 2 a &#60; 6 anos&#59; e 92<span class="elsevierStyleHsp" style=""></span>mg&#47;dL de &#8805; 6 a &#60; 13 anos&#46; Quanto ao HDL-c&#44; o P10&#44; foi de 24<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 28<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 32<span class="elsevierStyleHsp" style=""></span>mg&#47;dL e 36<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; para as faixas et&#225;rias de 1 a &#60; 2 anos&#44; &#8805; 2 a &#60; 3 anos&#44; &#8805; 3 a &#60; 4 anos e &#8805; 4 a &#60; 13 anos&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Os LD dos n&#237;veis s&#233;ricos de lip&#237;deos definidos neste estudo diferem daqueles apresentados nas diretrizes brasileiras e americanas atuais&#44; especialmente por fazer a diferencia&#231;&#227;o entre as idades&#46; Utilizar tais LD em nossa pr&#225;tica cl&#237;nica certamente contribuir&#225; para melhorar a acur&#225;cia do diagn&#243;stico de dislipidemia nesse grupo populacional&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Slhessarenko N&#44; Fontes CJ&#44; Slhessarenko ME&#44; Azevedo RS&#44; Andriolo A&#46; Proposition of decision limits for serum lipids in Brazilian children aged one to 13 years&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;173&#8211;79&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Institution or service where the study was carried out for indexing at the Index Medicus&#47;MEDLINE&#58; Universidade Federal de Mato Grosso&#44; Universidade de S&#227;o Paulo &#40;USP&#41;&#44; S&#227;o Paulo&#44; SP&#44; Brazil&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of total cholesterol &#40;A&#41;&#44; non-HDL cholesterol &#40;B&#41;&#44; LDL-cholesterol &#40;C&#41;&#44; triglycerides &#40;D&#41;&#44; and HDL-cholesterol levels in mg&#47;dL&#44; at the P10&#44; P50&#44; P75&#44; and P95 percentiles in the age ranges defined for each analyte&#46; SD&#44; standard deviation&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;0&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>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;1&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>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5&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>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1&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="elsevierStyleItalic">Ethnicity &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1854&#41;</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>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">1202&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;4&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>White&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">366&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><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">233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&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">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8&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="elsevierStyleItalic">Nutritional status &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1864&#41;</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 weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1368&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;4&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;4&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>Risk of overweight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3&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>Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&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>Underweight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&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>Severe obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&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>Severe underweight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&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;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic and nutritional characterization of 1866 healthy children and adolescents participating in the study&#44; Cuiab&#225;&#44; MT&#44; Brazil&#46; 2012&#46;</p>"
        ]
      ]
      2 => array:8 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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            "identificador" => "at2"
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        "tabla" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biochemical parameters &#40;mg&#47;dL&#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">Age range &#40;years&#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">Desirable&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">Borderline<br>P75 to&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">Elevated<br>&#8805;P95&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  " rowspan="3" align="left" valign="top">Total cholesterol</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">160&#8211;188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8805;189&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">3 to &#60;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">170&#8211;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8805;199&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">9 to &#60;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">176&#8211;204&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8805;205&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-HDL cholesterol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&#8211;149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8805;150&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">LDL-cholesterol</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104&#8211;131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8805;132&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">9 to &#60;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106&#8211;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8805;139&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Triglycerides</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127&#8211;188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8805;189&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">2 to &#60;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#8211;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8805;139&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">6 to &#60;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#8211;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8805;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biochemical parameters &#40;mg&#47;dL&#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">Age range &#40;years&#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">Desirable<br>&#62;P50&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">Borderline<br>P10 to P50&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">Low<br>P10&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  " rowspan="4" align="left" valign="top">HDL-cholesterol</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#8211;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8804;24&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">&#8805;2 to &#60;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#8211;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8804;28&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">&#8805;3 to &#60;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#8211;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8804;32&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">&#8805;4 to &#60;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#8211;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8804;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Desirable&#44; borderline&#44; and altered concentrations of TC&#44; NHDL-c&#44; LDL-c&#44; TG&#44; and HDL-c for healthy children and adolescents in the municipality of Cuiab&#225;&#44; Mato Grosso&#44; Brazil&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => false
        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">I DPAIA&#44; I Diretriz de Preven&#231;&#227;o da Aterosclerose na Inf&#226;ncia e na Adolesc&#234;ncia&#44; 2005&#59; I DBHF&#44; I Diretriz Brasileira de Hipercolesterolemia Familiar&#44; 2012&#59; ADBDPA&#44; Atualiza&#231;&#227;o da Diretriz Brasileira de Dislipidemia e Preven&#231;&#227;o da Aterosclerose&#44; 2017&#59; NHLBI&#44; National Heart&#44; Lung and Blood Institute&#44; 2012&#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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Guideline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="10" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Serum lipids &#40;mg&#47;dL&#41;</th></tr><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  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total cholesterol</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-HDL cholesterol</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LDL-cholesterol</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Triglycerides</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HDL-cholesterol &#40;&#8805;P50&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Present study &#40;P75&#41;</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;3&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;13&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;9&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;2&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 to &#60;2&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;34&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">&#8805; 3 to &#60;9&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;170&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;9 to &#60;13&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;2 to &#60;6&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;2 to &#60;3&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;39&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">&#8805; 9 to &#60;13&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;176&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805; 6 to &#60;13&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;3 to &#60;4&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="left" valign="top">&#8805;4 to &#60;13&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;48&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="11" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I DPAIA &#40;P50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;150</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#8211;</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;100</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;100</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#8805;45</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="11" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I DBHF &#40;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;170</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;123</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;110</td><td class="td" title="table-entry  " align="left" valign="top">0 to 9&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#62;45</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 to 19&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;90&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><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" title="table-entry  " colspan="11" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ADBDPA &#40;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;170</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#8211;</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;110</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">0 to 9&#58; &#60;75</td><td class="td" title="table-entry  " align="" valign="top">&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" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">10 to 19&#58; &#60;90</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#62;45</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="11" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NHLBI &#40;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;170</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;120</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#60;110</td><td class="td" title="table-entry  " align="left" valign="top">0 to 9&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#62;45</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 to 19&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;90&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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      "titulo" => "References"
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        0 => array:2 [
          "identificador" => "bibs0015"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fatores de risco para aterosclerose em crian&#231;as e adolescentes com hist&#243;ria familiar de doen&#231;a arterial coronariana prematura"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;C&#46; Romaldini"
                            1 => "H&#46; Issler"
                            2 => "A&#46;L&#46; Cardoso"
                            3 => "J&#46; Diament"
                            4 => "N&#46; Forti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr &#40;Rio J&#41;"
                        "fecha" => "2004"
                        "volumen" => "80"
                        "paginaInicial" => "135"
                        "paginaFinal" => "140"
                      ]
                    ]
                  ]
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            1 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;NIH publication no&#46; 12-7486A&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Expert panel on integrated guidelines for cardiovascular health and human reduction in children and adolescents&#46; Summary report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "National Heart&#44; Lung and Blood Institute &#40;NHLBI&#41;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2012"
                        "editorial" => "U&#46;S&#46; Department of Health and Human Services&#44; National Institutes of Health&#44; National Heart Lung and Blood Institute"
                        "editorialLocalizacion" => "Bethesda&#44; MD"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;I guidelines of prevention of atherosclerosis in childhood and adolescence&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46;de C&#46; Back Giuliano"
                            1 => "B&#46; Caramelli"
                            2 => "L&#46; Pellanda"
                            3 => "B&#46; Duncan"
                            4 => "S&#46; Mattos"
                            5 => "F&#46;H&#46; Fonseca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "2005"
                        "volumen" => "85"
                        "paginaInicial" => "4"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16597097"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0165"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults&#46; The Bogalusa Heart Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46;S&#46; Berenson"
                            1 => "S&#46;R&#46; Srinivasan"
                            2 => "W&#46; Bao"
                            3 => "W&#46;P&#46; Newman 3rd"
                            4 => "R&#46;E&#46; Tracy"
                            5 => "W&#46;A&#46; Wattigney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199806043382302"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1998"
                        "volumen" => "338"
                        "paginaInicial" => "1650"
                        "paginaFinal" => "1656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9614255"
                            "web" => "Medline"
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              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Doen&#231;a card&#237;aca isqu&#234;mica&#58; a preven&#231;&#227;o inicia durante a inf&#226;ncia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;C&#46; Pellanda"
                            1 => "L&#46; Echenique"
                            2 => "L&#46;M&#46; Barcellos"
                            3 => "J&#46; Maccari"
                            4 => "F&#46;K&#46; Borges"
                            5 => "B&#46;L&#46; Zen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2018.01.003

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Year/Month	Html	Pdf	Total

2024 November	3	8	11
2024 October	36	32	68
2024 September	44	28	72
2024 August	42	36	78
2024 July	30	63	93
2024 June	18	23	41
2024 May	22	22	44
2024 April	36	31	67
2024 March	55	23	78
2024 February	17	28	45
2024 January	17	35	52
2023 December	17	30	47
2023 November	33	40	73
2023 October	36	39	75
2023 September	36	46	82
2023 August	21	19	40
2023 July	15	18	33
2023 June	18	15	33
2023 May	24	19	43
2023 April	15	11	26
2023 March	48	20	68
2023 February	22	10	32
2023 January	18	20	38
2022 December	51	30	81
2022 November	22	26	48
2022 October	49	45	94
2022 September	23	40	63
2022 August	27	30	57
2022 July	28	30	58
2022 June	20	29	49
2022 May	22	28	50
2022 April	32	35	67
2022 March	23	28	51
2022 February	10	23	33
2022 January	13	17	30
2021 December	9	25	34
2021 November	9	15	24
2021 October	12	21	33
2021 September	3	9	12
2021 August	6	12	18
2021 July	7	12	19
2021 June	11	7	18
2021 May	9	15	24
2021 April	34	21	55
2021 March	11	14	25
2021 February	4	7	11
2021 January	7	12	19
2020 December	12	7	19
2020 November	8	16	24
2020 October	5	10	15
2020 September	19	11	30
2020 August	5	6	11
2020 July	3	3	6
2020 June	13	9	22
2020 May	5	11	16
2020 April	4	7	11
2020 March	5	14	19
2020 February	19	14	33
2020 January	9	18	27
2019 December	9	6	15
2019 November	7	7	14
2019 October	12	12	24
2019 September	12	9	21
2019 August	15	10	25
2019 July	12	8	20
2019 June	25	12	37
2019 May	34	11	45
2019 April	43	19	62
2019 March	20	14	34
2019 February	14	4	18
2019 January	12	10	22
2018 December	11	7	18
2018 November	50	5	55
2018 October	250	15	265
2018 September	67	10	77
2018 August	12	13	25
2018 July	13	8	21
2018 June	10	3	13
2018 May	0	17	17
2018 April	0	28	28

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