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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0006" class="elsevierStylePara elsevierViewall">Non-alcoholic fatty liver disease &#40;NAFLD&#41; may be defined as liver abnormalities caused by the accumulation of &#62;5&#37; of lipids in the cytoplasm of hepatocytes in patients with no history of excessive alcohol consumption&#44; viral hepatitis&#44; or autoimmune disease&#46; It is an important cause of morbidity and mortality associated with liver disease&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> The prevalence of NAFLD has increased concomitantly with the increase in obesity and represents an important current public health problem&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> NAFLD is prevalent in all age groups&#44; with a higher prevalence in adults&#46; Schwimmer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> found steatosis &#40;&#62;5&#37; of liver fat&#41; in 13&#37; of liver tissue samples from necropsies of children and adolescents between two and 19 years of age&#59; it was predominant among obese children &#40;38&#37;&#41;&#46; Steatosis was found in 5&#46;3&#37; of the evaluated samples in a similar study from Poland&#44;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> and it was also frequently observed in overweight children &#40;55&#46;6&#37;&#41;&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">NAFLD may occur with increased liver enzyme and inflammatory cytokine levels&#44; which indicate hepatic tissue damage&#44; progression to steatosis&#44; steatohepatitis&#44; fibrosis&#44; and cirrhosis&#44; and consequently&#44; increased mortality among young adults&#46; Due to its evolution&#8213;which is often asymptomatic in the early stages&#8213;the detection of early liver changes is very important&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> NAFLD may evolve into remission in some cases&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">Liver biopsy is considered the gold standard method to diagnose NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> However&#44; magnetic resonance imaging with spectroscopy is less invasive and can also be used alternatively&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> More recently&#44; hepatic ultrasound has become an effective and widely used technique for diagnosis because it reduces the costs and risks of the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> In this method&#44; the hepatorenal index &#40;HRI&#41; is used and calculated by dividing the average brightness found in the image corresponding to the liver by the average brightness of the image corresponding to the right kidney&#46; This is a simple&#44; non-invasive&#44; reliable&#44; and objective technique for diagnosing NAFLD&#44; yielding results similar to those obtained by gold-standard methods and additionally confirmed in studies&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0009" class="elsevierStylePara elsevierViewall">Risk factors for NAFLD include age&#44; sex&#44; and race&#46; Increased abdominal fat&#44; body mass index &#40;BMI&#41;&#44; insulin resistance&#44; and family history are all associated with the development of NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> As per previous literature&#44; the other risk factors for NAFLD include obesity and other metabolic diseases such as type 2 diabetes mellitus&#44; hyperlipidemia&#44; and metabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Although the consumption of certain foods and nutrients&#44; such as excessive intake of glucose&#44; fructose&#44; saturated and trans fat&#44; has also been reported&#44; few studies have confirmed an association between NAFLD and specific dietary patterns&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a></p><p id="para0010" class="elsevierStylePara elsevierViewall">Phenylketonuria &#40;PKU&#41; &#40;OMIM &#35; <a href="omim:261600">261600</a>&#41; is an inborn autosomal recessive error in metabolism due to the lack or insufficient activity of the hepatic enzyme phenylalanine hydroxylase&#46; The phenylalanine hydroxylase enzyme is involved in the conversion of phenylalanine &#40;Phe&#41; into tyrosine&#46; Untreated&#44; PKU evolves into various clinical manifestations&#44; with intellectual disability being the most severe&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">The diet plays a key role in the treatment of PKU&#44; and the patients are recommended to consume a peculiar diet&#46; Dietary treatment includes natural protein restriction&#44; Phe-free-L-amino acid supplements&#44; low protein foods&#44; and complete restriction of animal protein sources&#44; such as meat&#44; eggs&#44; milk&#44; dairy products&#44; and beans&#46; For protein complementation&#44; a metabolic formula is offered to contain all amino acids except Phe&#44; along with vitamins and minerals&#46; The diet aims to maintain adequate levels of serum Phe&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> Non-adherence to dietary treatment may cause intellectual disability and neurological alterations&#46; Dieting with a restriction of most natural proteins&#44; however&#44; may pose a potential risk of excessive consumption of carbohydrates and fats to meet energy needs&#44; which may lead to obesity and other comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0012" class="elsevierStylePara elsevierViewall">The authors hypothesized that patients with PKU undergoing exclusive dietary treatment are at a higher risk of developing NAFLD&#46; However&#44; to our knowledge&#44; no studies have been reported on this topic so far&#46; Therefore&#44; the aim of the present study was to evaluate the occurrence of NAFLD in adolescents with PKU&#44; who were undergoing exclusive dietary treatment&#44; and the factors associated with it&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Material and methods</span><p id="para0013" class="elsevierStylePara elsevierViewall">This was a cross-sectional study involving adolescents between 10 and 20 years of age&#46; The patients who were diagnosed with PKU at an early stage and undergoing exclusive dietary treatment were enrolled in this study&#46; The patients were regularly monitored by a multidisciplinary team at a public hospital and a reference service that performs the diagnosis&#44; treatment&#44; and follow-up of all children screened for the disease in the state&#46;</p><p id="para0014" class="elsevierStylePara elsevierViewall">A total of 128 adolescents with an early diagnosis of PKU &#40;starting treatment before 21 days&#41; in the age group of interest were identified throughout the state&#46; Of these&#44; three were excluded&#58; one due to drug use&#59; one due to pregnancy&#59; and one for treatment abandonment&#46; Seven patients refused to perform the necessary procedures&#46; Seventeen patients could not be contacted because they had moved away from the addresses they had initially provided&#46; Patients with late diagnoses of the disease were excluded&#46; Ultimately&#44; the study was performed with 101 adolescents between 10 and 20 years of age&#46; Data were collected between January 2017 and December 2018&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">Weight and height were measured&#46; Nutritional status was assessed according to BMI&#44; which was calculated using the formula BMI&#160;&#61;&#160;weight &#40;kg&#41;&#47;height<span class="elsevierStyleSup">2</span> &#40;m<span class="elsevierStyleSup">2</span>&#41;&#46; Patients &#62;18 years of age were classified according to World Health Organization &#40;WHO&#41; criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> and patients &#60;18 years of age were classified according to the standards established by the WHO curves&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> The patients were classified based on Z-scores as overweight &#40;Z-scores &#62;1 and &#8804;2&#41;&#44; obese &#40;Z-score&#62;2&#41;&#44; eutrophic &#40;Z-scores &#8805;-2 and &#8804;1&#41;&#44; and with low BMI &#40;Z-score&#60; - 2&#41;&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">Food intake was assessed using the quantitative food frequency questionnaire &#40;FFQ&#41;&#44; validated by Colucci&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> FFQ calculations were performed using Diet Pro software version 5i&#44; with total calories&#44; carbohydrates&#44; proteins&#44; and lipids evaluated according to the Brazilian Table of Food Composition &#40;i&#46;e&#46;&#44; TACO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> Phe intake was evaluated using the North American Table &#40;United States Department of Agriculture&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> The consumption of macronutrients was classified as adequate&#44; inadequate&#44; or excessive according to values established by the dietary reference intake &#40;DRI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> Protein intake&#44; plus 50&#37;&#44; and Phe intake were evaluated according to the recommendations of Acosta and Yannicelli&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Biochemical evaluations included total cholesterol &#40;TC&#41; and fractions &#40;low-density lipoprotein cholesterol &#91;LDL-c&#93; and high-density lipoprotein cholesterol &#91;HDL-c&#93;&#41;&#44; triglycerides&#44; ultrasensitive C-reactive protein&#44; alanine aminotransferase&#44; aspartate aminotransferase &#40;AST&#41;&#44; gamma-glutamyltransferase&#44; alkaline phosphatase &#40;AP&#41;&#44; fasting glucose&#44; and basal insulin&#46; The Homeostasis Model Assessment of Insulin Resistance &#40;i&#46;e&#46;&#44; HOMA-IR&#41; was calculated according to the mathematical model described by Matthews et al&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a></p><p id="para0017" class="elsevierStylePara elsevierViewall">To evaluate disease control&#44; the mean values of 4&#44;447 serum Phe evaluations obtained from the patients during adolescence &#40;10 to &#60; 20 years of age&#41; were considered&#46; Levels were considered to be inadequate if the values were outside the reference values for the age group studied&#58; &#8805; 120 and &#8804; 700 &#956;mol&#47;L&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a></p><p id="para0018" class="elsevierStylePara elsevierViewall">The abdominal ultrasound was performed in a specialized clinic by a single experienced examiner&#44; who did not have access to the biochemical test results of the patients&#44; after a 6-h fast&#44; with adolescents positioned supine and arms elevated&#46; The Supersonic Aixplorer version 8&#46;5&#46;02 &#40;Aix-en-Provence&#44; France&#41; CONVEXA SC6-1 probe with an average frequency of 3&#46;5 MHz was used&#46; Images were evaluated based on the ratio of the echogenicity of the liver to that of the right kidney&#46; Average brightness was calculated using numerical values assigned to grayscale pixels&#46; The average brightness of the liver was divided by the average brightness of the kidney to generate the HRI&#46; The degree of hepatic steatosis was determined according to the HRI assessment and the cut-off value proposed by Martin-Rodriguez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> According to HRI classification&#44; two groups&#44; one with NAFLD and the other without&#44; were formed&#46;</p><p id="para0019" class="elsevierStylePara elsevierViewall">To verify whether the prevalence of overweight and obesity found in the present study population was similar to that in the general population&#44; the authors compared the nutritional status of 46 patients aged 13&#8211;17 years with that of healthy students of the same age from the PeNSE &#40;2015&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> This survey studied the frequency of overweight and obesity in all Brazilian states using a sample of 102&#44;301 students aged 13&#8211;15 years and 10&#44;926 students aged 16&#8211;17 years&#59; the maximum sampling error was 3&#37; with a 95&#37; confidence interval&#46; The prevalence rate of overweight and obesity in the survey was 23&#46;7&#37;&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">The data are expressed as numbers &#40;percentages&#41; and the mean &#177; standard deviations &#40;SD&#41;&#46; The Student&#39;s <span class="elsevierStyleItalic">t</span>-test was used to compare continuous variables&#44; while the chi-squared test was used for the comparison of categorical variables in the univariate analysis&#46; The multivariate logistic regression analysis was performed using variables with a p-value &#60; 0&#46;40 using the Wald chi-squared test&#46; To compare the nutritional status of patients aged 13&#8211;17 years with that of healthy students of the same age in the PeNSE &#40;2015&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> the authors used the chi-square test for adherence&#46; Differences with p &#60; 0&#46;05 were considered statistically significant&#46;</p><p id="para0021" class="elsevierStylePara elsevierViewall">This study was approved by the Research Ethics Committee&#44; and an informed consent form was obtained from the legal guardians&#46;</p></span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Results</span><p id="para0022" class="elsevierStylePara elsevierViewall">The present study included 101 adolescents&#44; corresponding to 79&#37; of adolescents with PKU in Minas Gerais&#46; There were 55 males &#40;54&#46;5&#37;&#41; and 46 females &#40;45&#46;5&#37;&#41;&#44; with a mean &#40;&#177; SD&#41; age of 14&#46;8 &#177; 3&#46;2 years&#46; Sixty-nine adolescents &#40;68&#46;3&#37;&#41; were eutrophic&#44; 16 &#40;15&#46;8&#37;&#41; overweight&#44; 12 &#40;11&#46;9&#37;&#41; obese&#44; and four &#40;4&#37;&#41; with low BMI&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">The presence of NAFLD was detected in 26 &#40;25&#46;7&#37;&#41; adolescents&#58; 14 &#40;53&#46;8&#37;&#41; males and 12 &#40;46&#46;2&#37;&#41; females &#40;p&#160;&#61;&#160;0&#46;942&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a> shows a comparison and analysis of the association between NAFLD and the variables that were examined&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0024" class="elsevierStylePara elsevierViewall">For the considered variables&#44; the univariate analysis showed that there were no significant differences between adolescents with and without NAFLD&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">Analyses related to adequacies in the intake of macronutrients and Phe are shown in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0026" class="elsevierStylePara elsevierViewall">Among the considered variables&#44; age&#44; mean serum Phe level&#44; AP&#44; TC&#44; LDL-c&#44; fasting glycemia&#44; and carbohydrate&#44; protein&#44; and lipid intake met the cut-off value for the multivariate analysis &#40;p &#60; 0&#46;4&#41;&#46; Although serum Phe values reached a p-value sufficient to enter into the logistic regression model&#44; it did not reach statistical significance in the initial model and&#44; as such&#44; was removed from the final model &#40;<a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia><p id="para0027" class="elsevierStylePara elsevierViewall">The final logistic regression model yielded a sensitivity of 26&#46;1&#37; and a specificity of 94&#46;7&#37;&#46; More specifically&#44; the model demonstrated a good ability to predict the absence of NAFLD&#44; although its ability to predict the presence of NAFLD was low&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0004">Table 4</a> shows the comparison of the prevalence of obesity and overweight in patients with PKU aged 13&#8211;17 years and in healthy students of the same age from the PeNSE&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> The equality hypothesis was not rejected &#40;p&#160;&#61;&#160;0&#46;488&#41;&#46;</p><elsevierMultimedia ident="tbl0004"></elsevierMultimedia></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Discussion</span><p id="para0029" class="elsevierStylePara elsevierViewall">Even though PKU is a rare disease&#44; it is the most common inborn error in metabolism of the amino acids&#46; It is the disease that newborns are screened for the most frequently&#46; Numerous countries screen for PKU&#44; thus&#44; thousands of patients are monitored globally&#46; It is important to evaluate not only the intellectual evolution of the patients but also the adverse effects of the treatments&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">Although there are different types of treatments&#44; diet plays a key role in all of them&#44; which includes natural protein restriction&#46; Restricting the consumption of most natural proteins can pose a potential risk of overconsumption of carbohydrates and fats to meet energy needs&#46; This may lead to obesity and other comorbidities&#46; Patients undergoing exclusive dietary treatment may be more susceptible to these risks&#46; Hence&#44; it was suspected that these patients were at a higher risk of developing NAFLD&#46; Unfortunately&#44; studies about NAFLD in patients with PKU or hepatic effects of the diet in these patients were not found in the literature&#46; Thus&#44; this is the first study to address this topic&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">The metabolic formula with free amino acids used by adolescents with PKU has faster absorption and leads to higher plasma concentrations&#44; however&#44; there is less effective nitrogen retention and greater hepatic oxidation of these amino acids when compared to natural protein intake&#46; The data in the literature on the digestibility and bioavailability of L-amino acids as well as the association of these amino acids&#8217; consumption with the development of NAFLD&#44; were found to be insufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">As hypothesized&#44; it was found that 26&#47;101 &#40;25&#46;7&#37;&#41; adolescents in this study following an exclusively PKU diet developed NAFLD&#44; which suggests the possibility of this comorbidity in the follow-up of these patients&#46;</p><p id="para0033" class="elsevierStylePara elsevierViewall">The prevalence of NAFLD found in this study &#40;25&#46;7&#37;&#41; was significantly higher than expected in adolescents&#46; It is much higher than that found in Brazilian adolescents with adequate weight &#40;3&#46;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> and in Australian adolescents &#40;15&#46;2&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> The overall prevalence of NAFLD has been estimated to be 25&#46;4&#37;&#44; with the highest in the Middle East and South America and the lowest in Africa&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> However&#44; this prevalence was also estimated in adults&#44; and the prevalence is more common among adults than in adolescents&#46;</p><p id="para0034" class="elsevierStylePara elsevierViewall">Some characteristics of this sample should be emphasized&#46; The study was performed in the only care center for patients with PKU in Minas Gerais&#44; the second most populous state in Brazil&#44; with more than 21 million inhabitants&#46; This means that the studied population had greater socio-environmental and cultural similarity and reduced research bias compared to multicenter studies&#46; All patients evaluated were&#44; and continue to be&#44; followed up on a regular basis in a unique referral center since birth&#44; and they were treated exclusively through diet&#46; For this reason&#44; any confounding factors that could result from a treatment using the diet associated with other available tools for the treatment of PKU were removed&#59; the sample comprises 79&#37; of all known patients diagnosed with PKU in the State of Minas Gerais&#44; until that&#46;</p><p id="para0035" class="elsevierStylePara elsevierViewall">The study was conducted exclusively among adolescents&#46; Since the disease can progress with age to hepatic steatosis&#44; which is more common in adults&#44;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> knowing its prevalence among adolescents with PKU will help prevent steatosis and liver cirrhosis&#44; possibly reducing the number of patients who are candidates for liver transplantation&#46;</p><p id="para0036" class="elsevierStylePara elsevierViewall">There are currently more recent recommendations<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> than those of Acosta and Yannicelli&#44;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> but those patients started treatment between 10 and 20 years ago when the recommendations of Acosta and Yannicelli<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> were the most used in the world&#46;</p><p id="para0037" class="elsevierStylePara elsevierViewall">Diet has been considered one of the risk factors for NAFLD&#46; However&#44; most studies have focused on individualized foods or nutrients&#44; which are consumed in different combinations&#46; A few studies have addressed the role of dietary patterns in NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> The dietary pattern of patients with PKU is unique&#44; and no studies have addressed the relationship between the PKU diet and NAFLD&#46; The results of the study may indicate some kind of relationship between PKU adolescents who were exclusively treated with diet and NAFLD&#46;</p><p id="para0038" class="elsevierStylePara elsevierViewall">Obesity is considered to be one of the most important risk factors for NAFLD&#44; and several studies have studied only obese patients or have observed a higher prevalence of the disease in overweight and obese patients&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> Since there was no control group of healthy adolescents&#44; it was only possible to compare the prevalence of obesity in adolescents aged 13&#8211;17 years with PKU with the prevalence of obesity in students of the same age participating in a large cohort carried out in all regions of Brazil&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> The hypothesis of equality was not ruled out by the chi-square test of adherence&#46;</p><p id="para0039" class="elsevierStylePara elsevierViewall">The association between obesity and NAFLD was not found in the present study&#44; and no significant difference in the prevalence of NAFLD was observed between obese and non-obese adolescents when considering weight &#40;p&#160;&#61;&#160;0&#46;86&#41;&#44; BMI &#40;p&#160;&#61;&#160;0&#46;89&#41;&#44; and abdominal circumference &#40;p&#160;&#61;&#160;0&#46;72&#41;&#46; This suggests that other factors&#44; such as PKU itself or the diet consumed by patients&#44; may play some role in its development&#46;</p><p id="para0040" class="elsevierStylePara elsevierViewall">Concerning other associated factors with NAFLD&#44; the role of sex is controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> In this study&#44; no difference was found in the distribution of NAFLD between the sexes&#44; similar to the results in previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a></p><p id="para0041" class="elsevierStylePara elsevierViewall">The final logistic regression model was not satisfactory&#46; The sensitivity was only 26&#46;1&#37;&#59; however&#44; its specificity &#40;94&#46;7&#37;&#41; was good&#44; indicating that the model is better for identifying patients who are less likely to develop the disease than those more likely to develop it&#46; This could mean that the variables used in the study were insufficient for the test&#46;</p><p id="para0042" class="elsevierStylePara elsevierViewall">The specificity of the final model suggests that NAFLD is less likely to occur in older PKU adolescents who have normal or high levels of AP&#44; lower carbohydrate intake&#44; and adequate protein and lipid intake&#46;</p><p id="para0043" class="elsevierStylePara elsevierViewall">In agreement with the indication of the specificity of the logistic regression model&#44; Suzuki et al&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> found a higher propensity for NAFLD and hepatic fibrosis in prepubescent adolescents&#44; compared to pubertal or post-pubertal adolescents&#46; Similarly&#44; adult studies suggest an increased risk of developing NAFLD in older individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a></p><p id="para0044" class="elsevierStylePara elsevierViewall">Additionally&#44; compatible with what was suggested by the specificity of the logistic regression model&#44; Couce et al&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> reported a higher carbohydrate intake in patients with PKU than in controls without the disease&#46; Interestingly&#44; some authors have demonstrated a positive relationship between excessive carbohydrate intake and excessive consumption of saturated or trans fats with the occurrence of NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> The authors did not find an association between protein consumption and the occurrence of NAFLD in the literature&#46;</p><p id="para0045" class="elsevierStylePara elsevierViewall">The protective role of normal or elevated levels of AP in the development of NAFLD suggested by the specificity of the final model could not be explained&#46; In contrast&#44; Almeida and Borges et al&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> reported higher levels of AP and other liver enzymes in patients with NAFLD&#46; Lira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> found no significant differences in AST and AP levels among obese adolescents with NAFLD and controls&#46;</p><p id="para0046" class="elsevierStylePara elsevierViewall">It is noteworthy that the prevalence of NAFLD in adolescents with PKU treated exclusively through diet was much higher than that reported in healthy Brazilian and Australian adolescents&#46; This prevalence may depend on the diet or the PKU itself&#46; Further studies are needed to verify whether this is a consistent finding to guide the treatment of adolescents with PKU&#46;</p></span></span>"
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            1 => "Inborn errors of metabolism"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objective</span><p id="spara024" class="elsevierStyleSimplePara elsevierViewall">This study aimed to investigate non-alcoholic fatty liver disease &#40;NAFLD&#41; occurrence and factors associated with the disease in phenylketonuria &#40;PKU&#41; patients undergoing exclusive dietary treatment&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Method</span><p id="spara025" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study included 101 adolescents 10 to &#60; 20 years of age with PKU&#44; who were undergoing exclusive dietary treatment and monitored since early diagnosis at a single reference service&#46; Anthropometric and biochemical assessments were performed and food intake was documented&#44; and an ultrasound diagnosis of NAFLD was established&#46; Data were evaluated using the Student&#39;s t-test for continuous variables&#44; the chi-square for categorical variables&#44; and logistic regression using the Wald chi-squared test&#59; differences with p &#60; 0&#46;05 were considered to be statistically significant&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara026" class="elsevierStyleSimplePara elsevierViewall">NAFLD was detected in 26 &#40;25&#46;7&#37;&#41; teenagers&#46; There was no difference in prevalence between the sexes or nutritional status&#46; The final logistic regression model revealed low sensitivity &#40;26&#46;1&#37;&#41; and high specificity &#40;94&#46;7&#37;&#41;&#46; The specificity suggested a lower likelihood of NAFLD in older adolescents&#44; in the presence of normal or high levels of alkaline phosphatase&#44; lower carbohydrate intake&#44; and adequate protein and lipid intake&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara027" class="elsevierStyleSimplePara elsevierViewall">The prevalence of NAFLD in adolescents with PKU was higher than that found in healthy Brazilian adolescents and similar to that found in obese Brazilian children&#44; suggesting a higher risk for NAFLD in patients with PKU treated exclusively by dietary modification&#46;</p></span>"
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          "leyenda" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">NAFLD&#44; non-alcoholic fatty liver disease&#59; ALT&#44; alanine aminotransferase&#59; AST&#44; aspartate aminotransferase&#59; CRP&#44; C-reactive protein&#59; AP&#44; alkaline phosphatase&#59; GGT&#44; gamma-glutamyltransferase&#59; HDL&#44; high-density lipoprotein&#59; LDL&#44; low-density lipoprotein&#59; HOMA-IR&#44; Homeostasis Model Assessment&#8211; Insulin Resistance&#46;</p><p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Data are presented as mean &#177; standard deviation unless otherwise indicated&#46;</p>"
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;9 &#177; 20&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;2 &#177; 15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleCrossOut">-</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Height &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154&#46;9 &#177; 17&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156&#46;0 &#177; 12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">-</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Body mass index &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;4 &#177; 5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;2 &#177; 4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;890&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Average phenylalanine during adolescence &#40;&#956;mol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">596&#46;1 &#177; 197&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">638&#46;1 &#177; 187&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Total cholesterol &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&#46;3 &#177; 24&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">136&#46;2 &#177; 39&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;377&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">LDL cholesterol &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;1 &#177; 23&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;5 &#177; 31&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">HDL cholesterol &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;8 &#177; 14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;7 &#177; 9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;730&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Triglycerides &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">112&#46;8 &#177; 65&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106&#46;5 &#177; 57&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;662&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CRP &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;8 &#177; 4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3 &#177; 4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;634&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">ALT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;8 &#177; 9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;7 &#177; 13&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;722&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">AST &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;7 &#177; 8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;7 &#177; 11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;971&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">GGT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;7 &#177; 20&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;2 &#177; 8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">AP &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142&#46;1 &#177; 66&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&#46;4 &#177; 86&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fasting glucose &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;7 &#177; 7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;0 &#177; 7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;332&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Basal insulin &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3 &#177; 21&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;7 &#177; 20&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">HOMA-IR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7 &#177; 4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;42 &#177; 4&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;761&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Calories ingested &#40;kcal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;918 &#177; 600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;950 &#177; 690&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;826&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Carbohydrate &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">338&#46;4 &#177; 112&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">334&#46;4 &#177; 111&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;877&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Protein &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;1 &#177; 21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;5 &#177; 26&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;755&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Lipid &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;1 &#177; 19&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;7 &#177; 30&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;488&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Phenylalanine &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15 &#177; 0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;19 &#177; 0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;660&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tb1fn1"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0004">Student&#39;s t-test for independent samples&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Comparative analysis and association between the presence of NAFLD and anthropometric variables&#44; biochemical tests&#44; and food intake&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">NAFLD&#44; non-alcoholic fatty liver disease&#46;</p><p id="spara006" class="elsevierStyleSimplePara elsevierViewall">Data are presented as n &#40;&#37;&#41;&#44; unless otherwise indicated&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "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"><a name="en0096"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable</th><a name="en0097"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Study group</th><a name="en0098"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0100"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NAFLD present &#40;n&#160;&#61;&#160;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0101"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NAFLD absent &#40;n&#160;&#61;&#160;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0098a"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Calories&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;21&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;78&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;770<a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;29&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;70&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;23&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;74&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Carbohydrate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;62&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;348<a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;23&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;76&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Protein&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficeint&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;23&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;76&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;307<a class="elsevierStyleCrossRef" href="#tb2fn2"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0141"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;84&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;32&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;68&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0147"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Lipids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0151"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;27&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;72&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;440<a class="elsevierStyleCrossRef" href="#tb2fn2"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0155"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;88&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Phenylalanine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;29&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0167"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;75&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spara008" class="elsevierStyleSimplePara elsevierViewall">AP&#44; alkaline phosphatase&#59; CI&#44; confidence interval&#59; OR&#44; odds ratio&#46;</p><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">Bolded values indicate statistically significant differences&#46;</p><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">Database&#58; 98 children &#40;23 cases WITH steatosis&#44; 75 cases WITHOUT steatosis&#41;&#46; Three outlier cases were removed from the study&#46; Sensitivity 26&#46;1&#47;&#37;&#59; Specificity&#58; 94&#46;7&#37;&#46;</p><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Subtitle&#58;</p><p id="spara012" class="elsevierStyleSimplePara elsevierViewall">AP &#40;classification&#41;&#58; 1&#160;&#61;&#160;Low AP&#59; 0&#160;&#61;&#160;Normal AP&#46;</p><p id="spara013" class="elsevierStyleSimplePara elsevierViewall">Carbohydrate &#40;classification&#41;&#58; 1&#160;&#61;&#160;Adequate&#59; 0&#160;&#61;&#160;Excessive&#46;</p><p id="spara014" class="elsevierStyleSimplePara elsevierViewall">Protein &#40;classification&#41;&#58;</p><p id="spara015" class="elsevierStyleSimplePara elsevierViewall">Excessive protein&#160;&#61;&#160;1 and Insufficient protein&#160;&#61;&#160;0 Excessive&#46;</p><p id="spara016" class="elsevierStyleSimplePara elsevierViewall">Excessive protein&#160;&#61;&#160;0 and Insufficient protein&#160;&#61;&#160;1 Insufficient&#46;</p><p id="spara017" class="elsevierStyleSimplePara elsevierViewall">Excessive protein&#160;&#61;&#160;0 and Insufficient protein&#160;&#61;&#160;0 Adequate&#46;</p><p id="spara018" class="elsevierStyleSimplePara elsevierViewall">Lipids &#40;classification&#41;&#58; 1&#160;&#61;&#160;Insufficient lipids and 0&#160;&#61;&#160;Adequate&#46;</p><p id="spara019" class="elsevierStyleSimplePara elsevierViewall">1&#160;&#61;&#160;NAFLD present&#59; 0&#160;&#61;&#160;NAFLD absent&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;3&#46;557&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;313&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#8212;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#8212;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Underage &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;0&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;879&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;027</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0188"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;0&#46;63&#8211;0&#46;97&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0189"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Low AP &#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0190"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;396&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0191"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;086&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0192"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0193"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0194"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;2&#46;31&#8211;52&#46;18&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0195"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive carbohydrate &#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0196"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;965&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0197"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;365&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0198"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0199"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0200"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;2&#46;90&#8211;129&#46;53&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0201"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive protein &#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0202"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0203"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;623&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0204"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;018</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0205"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0206"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;1&#46;47&#8211;59&#46;04&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0207"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficient protein &#160;&#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0208"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;396&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0209"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;822&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0210"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0211"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0212"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;0&#46;53&#8211;30&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0213"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficient lipids &#160;&#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0214"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;325&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0215"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0216"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;045</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0217"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0218"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;1&#46;08&#8211;716&#46;40&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Frequency</th><a name="en0220"></a><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Eutrophic&#47;low BMI</th></tr><tr title="table-row"><a name="en0227"></a><th class="td" title="\n
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              "nota" => "<p class="elsevierStyleNotepara" id="notep0024">Values extracted from reference article &#8220;The Brazilian National School Health Survey &#40;PeNSE&#44; 2015&#41;&#8221;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> in which the numbers were calculated based on the prevalence of overweight&#47;obesity of 23&#46;7&#37;&#46;</p> <p class="elsevierStyleNotepara" id="notep0025">BMI&#44; body mass index&#46;</p>"
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          "en" => "<p id="spara020" class="elsevierStyleSimplePara elsevierViewall">The observed and estimated results of the Brazilian National School Health Survey &#40;PeNSE&#44; 2015&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> with regard to the prevalence of overweight and obesity&#46;</p>"
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Original article
Nonalcoholic fatty liver disease in adolescents with phenylketonuria
Adriana Márcia Silveiraa,b,c,
Corresponding author
adrinutrick@gmail.com

Corresponding author.
, Poliane Lopes Limac, Michelle Rosa Andrade Alvesd, Rosângela Passos de Jesuse, Rogério Augusto Pinto-Silvaf, Valéria de Melo Rodriguesa, Ana Lúcia Pimenta Starlinga, Rocksane de Carvalho Nortong, Marcos José Burle de Aguiara
a Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
b Programa de Pós-Graduação em Ciências da Saúde - Saúde da Criança e do Adolescente, Belo Horizonte, MG, Brazil
c Faculdade de Minas (FAMINAS-BH), Departamento de Nutrição, Belo Horizonte, MG, Brazil
d Pontifícia Universidade Católica de Minas Gerais (PUC-Minas), Belo Horizonte, MG, Brazil
e Universidade Federal da Bahia (UFBA), Departamento de Nutrição, Salvador, BA, Brazil
f Clínica CEU Diagnósticos, Belo Horizonte, MG, Brazil
g Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0006" class="elsevierStylePara elsevierViewall">Non-alcoholic fatty liver disease &#40;NAFLD&#41; may be defined as liver abnormalities caused by the accumulation of &#62;5&#37; of lipids in the cytoplasm of hepatocytes in patients with no history of excessive alcohol consumption&#44; viral hepatitis&#44; or autoimmune disease&#46; It is an important cause of morbidity and mortality associated with liver disease&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> The prevalence of NAFLD has increased concomitantly with the increase in obesity and represents an important current public health problem&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> NAFLD is prevalent in all age groups&#44; with a higher prevalence in adults&#46; Schwimmer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> found steatosis &#40;&#62;5&#37; of liver fat&#41; in 13&#37; of liver tissue samples from necropsies of children and adolescents between two and 19 years of age&#59; it was predominant among obese children &#40;38&#37;&#41;&#46; Steatosis was found in 5&#46;3&#37; of the evaluated samples in a similar study from Poland&#44;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> and it was also frequently observed in overweight children &#40;55&#46;6&#37;&#41;&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">NAFLD may occur with increased liver enzyme and inflammatory cytokine levels&#44; which indicate hepatic tissue damage&#44; progression to steatosis&#44; steatohepatitis&#44; fibrosis&#44; and cirrhosis&#44; and consequently&#44; increased mortality among young adults&#46; Due to its evolution&#8213;which is often asymptomatic in the early stages&#8213;the detection of early liver changes is very important&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> NAFLD may evolve into remission in some cases&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">Liver biopsy is considered the gold standard method to diagnose NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> However&#44; magnetic resonance imaging with spectroscopy is less invasive and can also be used alternatively&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> More recently&#44; hepatic ultrasound has become an effective and widely used technique for diagnosis because it reduces the costs and risks of the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> In this method&#44; the hepatorenal index &#40;HRI&#41; is used and calculated by dividing the average brightness found in the image corresponding to the liver by the average brightness of the image corresponding to the right kidney&#46; This is a simple&#44; non-invasive&#44; reliable&#44; and objective technique for diagnosing NAFLD&#44; yielding results similar to those obtained by gold-standard methods and additionally confirmed in studies&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0009" class="elsevierStylePara elsevierViewall">Risk factors for NAFLD include age&#44; sex&#44; and race&#46; Increased abdominal fat&#44; body mass index &#40;BMI&#41;&#44; insulin resistance&#44; and family history are all associated with the development of NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> As per previous literature&#44; the other risk factors for NAFLD include obesity and other metabolic diseases such as type 2 diabetes mellitus&#44; hyperlipidemia&#44; and metabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Although the consumption of certain foods and nutrients&#44; such as excessive intake of glucose&#44; fructose&#44; saturated and trans fat&#44; has also been reported&#44; few studies have confirmed an association between NAFLD and specific dietary patterns&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a></p><p id="para0010" class="elsevierStylePara elsevierViewall">Phenylketonuria &#40;PKU&#41; &#40;OMIM &#35; <a href="omim:261600">261600</a>&#41; is an inborn autosomal recessive error in metabolism due to the lack or insufficient activity of the hepatic enzyme phenylalanine hydroxylase&#46; The phenylalanine hydroxylase enzyme is involved in the conversion of phenylalanine &#40;Phe&#41; into tyrosine&#46; Untreated&#44; PKU evolves into various clinical manifestations&#44; with intellectual disability being the most severe&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">The diet plays a key role in the treatment of PKU&#44; and the patients are recommended to consume a peculiar diet&#46; Dietary treatment includes natural protein restriction&#44; Phe-free-L-amino acid supplements&#44; low protein foods&#44; and complete restriction of animal protein sources&#44; such as meat&#44; eggs&#44; milk&#44; dairy products&#44; and beans&#46; For protein complementation&#44; a metabolic formula is offered to contain all amino acids except Phe&#44; along with vitamins and minerals&#46; The diet aims to maintain adequate levels of serum Phe&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> Non-adherence to dietary treatment may cause intellectual disability and neurological alterations&#46; Dieting with a restriction of most natural proteins&#44; however&#44; may pose a potential risk of excessive consumption of carbohydrates and fats to meet energy needs&#44; which may lead to obesity and other comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0012" class="elsevierStylePara elsevierViewall">The authors hypothesized that patients with PKU undergoing exclusive dietary treatment are at a higher risk of developing NAFLD&#46; However&#44; to our knowledge&#44; no studies have been reported on this topic so far&#46; Therefore&#44; the aim of the present study was to evaluate the occurrence of NAFLD in adolescents with PKU&#44; who were undergoing exclusive dietary treatment&#44; and the factors associated with it&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Material and methods</span><p id="para0013" class="elsevierStylePara elsevierViewall">This was a cross-sectional study involving adolescents between 10 and 20 years of age&#46; The patients who were diagnosed with PKU at an early stage and undergoing exclusive dietary treatment were enrolled in this study&#46; The patients were regularly monitored by a multidisciplinary team at a public hospital and a reference service that performs the diagnosis&#44; treatment&#44; and follow-up of all children screened for the disease in the state&#46;</p><p id="para0014" class="elsevierStylePara elsevierViewall">A total of 128 adolescents with an early diagnosis of PKU &#40;starting treatment before 21 days&#41; in the age group of interest were identified throughout the state&#46; Of these&#44; three were excluded&#58; one due to drug use&#59; one due to pregnancy&#59; and one for treatment abandonment&#46; Seven patients refused to perform the necessary procedures&#46; Seventeen patients could not be contacted because they had moved away from the addresses they had initially provided&#46; Patients with late diagnoses of the disease were excluded&#46; Ultimately&#44; the study was performed with 101 adolescents between 10 and 20 years of age&#46; Data were collected between January 2017 and December 2018&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">Weight and height were measured&#46; Nutritional status was assessed according to BMI&#44; which was calculated using the formula BMI&#160;&#61;&#160;weight &#40;kg&#41;&#47;height<span class="elsevierStyleSup">2</span> &#40;m<span class="elsevierStyleSup">2</span>&#41;&#46; Patients &#62;18 years of age were classified according to World Health Organization &#40;WHO&#41; criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> and patients &#60;18 years of age were classified according to the standards established by the WHO curves&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> The patients were classified based on Z-scores as overweight &#40;Z-scores &#62;1 and &#8804;2&#41;&#44; obese &#40;Z-score&#62;2&#41;&#44; eutrophic &#40;Z-scores &#8805;-2 and &#8804;1&#41;&#44; and with low BMI &#40;Z-score&#60; - 2&#41;&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">Food intake was assessed using the quantitative food frequency questionnaire &#40;FFQ&#41;&#44; validated by Colucci&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> FFQ calculations were performed using Diet Pro software version 5i&#44; with total calories&#44; carbohydrates&#44; proteins&#44; and lipids evaluated according to the Brazilian Table of Food Composition &#40;i&#46;e&#46;&#44; TACO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> Phe intake was evaluated using the North American Table &#40;United States Department of Agriculture&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> The consumption of macronutrients was classified as adequate&#44; inadequate&#44; or excessive according to values established by the dietary reference intake &#40;DRI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> Protein intake&#44; plus 50&#37;&#44; and Phe intake were evaluated according to the recommendations of Acosta and Yannicelli&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Biochemical evaluations included total cholesterol &#40;TC&#41; and fractions &#40;low-density lipoprotein cholesterol &#91;LDL-c&#93; and high-density lipoprotein cholesterol &#91;HDL-c&#93;&#41;&#44; triglycerides&#44; ultrasensitive C-reactive protein&#44; alanine aminotransferase&#44; aspartate aminotransferase &#40;AST&#41;&#44; gamma-glutamyltransferase&#44; alkaline phosphatase &#40;AP&#41;&#44; fasting glucose&#44; and basal insulin&#46; The Homeostasis Model Assessment of Insulin Resistance &#40;i&#46;e&#46;&#44; HOMA-IR&#41; was calculated according to the mathematical model described by Matthews et al&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a></p><p id="para0017" class="elsevierStylePara elsevierViewall">To evaluate disease control&#44; the mean values of 4&#44;447 serum Phe evaluations obtained from the patients during adolescence &#40;10 to &#60; 20 years of age&#41; were considered&#46; Levels were considered to be inadequate if the values were outside the reference values for the age group studied&#58; &#8805; 120 and &#8804; 700 &#956;mol&#47;L&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a></p><p id="para0018" class="elsevierStylePara elsevierViewall">The abdominal ultrasound was performed in a specialized clinic by a single experienced examiner&#44; who did not have access to the biochemical test results of the patients&#44; after a 6-h fast&#44; with adolescents positioned supine and arms elevated&#46; The Supersonic Aixplorer version 8&#46;5&#46;02 &#40;Aix-en-Provence&#44; France&#41; CONVEXA SC6-1 probe with an average frequency of 3&#46;5 MHz was used&#46; Images were evaluated based on the ratio of the echogenicity of the liver to that of the right kidney&#46; Average brightness was calculated using numerical values assigned to grayscale pixels&#46; The average brightness of the liver was divided by the average brightness of the kidney to generate the HRI&#46; The degree of hepatic steatosis was determined according to the HRI assessment and the cut-off value proposed by Martin-Rodriguez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> According to HRI classification&#44; two groups&#44; one with NAFLD and the other without&#44; were formed&#46;</p><p id="para0019" class="elsevierStylePara elsevierViewall">To verify whether the prevalence of overweight and obesity found in the present study population was similar to that in the general population&#44; the authors compared the nutritional status of 46 patients aged 13&#8211;17 years with that of healthy students of the same age from the PeNSE &#40;2015&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> This survey studied the frequency of overweight and obesity in all Brazilian states using a sample of 102&#44;301 students aged 13&#8211;15 years and 10&#44;926 students aged 16&#8211;17 years&#59; the maximum sampling error was 3&#37; with a 95&#37; confidence interval&#46; The prevalence rate of overweight and obesity in the survey was 23&#46;7&#37;&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">The data are expressed as numbers &#40;percentages&#41; and the mean &#177; standard deviations &#40;SD&#41;&#46; The Student&#39;s <span class="elsevierStyleItalic">t</span>-test was used to compare continuous variables&#44; while the chi-squared test was used for the comparison of categorical variables in the univariate analysis&#46; The multivariate logistic regression analysis was performed using variables with a p-value &#60; 0&#46;40 using the Wald chi-squared test&#46; To compare the nutritional status of patients aged 13&#8211;17 years with that of healthy students of the same age in the PeNSE &#40;2015&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> the authors used the chi-square test for adherence&#46; Differences with p &#60; 0&#46;05 were considered statistically significant&#46;</p><p id="para0021" class="elsevierStylePara elsevierViewall">This study was approved by the Research Ethics Committee&#44; and an informed consent form was obtained from the legal guardians&#46;</p></span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Results</span><p id="para0022" class="elsevierStylePara elsevierViewall">The present study included 101 adolescents&#44; corresponding to 79&#37; of adolescents with PKU in Minas Gerais&#46; There were 55 males &#40;54&#46;5&#37;&#41; and 46 females &#40;45&#46;5&#37;&#41;&#44; with a mean &#40;&#177; SD&#41; age of 14&#46;8 &#177; 3&#46;2 years&#46; Sixty-nine adolescents &#40;68&#46;3&#37;&#41; were eutrophic&#44; 16 &#40;15&#46;8&#37;&#41; overweight&#44; 12 &#40;11&#46;9&#37;&#41; obese&#44; and four &#40;4&#37;&#41; with low BMI&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">The presence of NAFLD was detected in 26 &#40;25&#46;7&#37;&#41; adolescents&#58; 14 &#40;53&#46;8&#37;&#41; males and 12 &#40;46&#46;2&#37;&#41; females &#40;p&#160;&#61;&#160;0&#46;942&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a> shows a comparison and analysis of the association between NAFLD and the variables that were examined&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0024" class="elsevierStylePara elsevierViewall">For the considered variables&#44; the univariate analysis showed that there were no significant differences between adolescents with and without NAFLD&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">Analyses related to adequacies in the intake of macronutrients and Phe are shown in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0026" class="elsevierStylePara elsevierViewall">Among the considered variables&#44; age&#44; mean serum Phe level&#44; AP&#44; TC&#44; LDL-c&#44; fasting glycemia&#44; and carbohydrate&#44; protein&#44; and lipid intake met the cut-off value for the multivariate analysis &#40;p &#60; 0&#46;4&#41;&#46; Although serum Phe values reached a p-value sufficient to enter into the logistic regression model&#44; it did not reach statistical significance in the initial model and&#44; as such&#44; was removed from the final model &#40;<a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia><p id="para0027" class="elsevierStylePara elsevierViewall">The final logistic regression model yielded a sensitivity of 26&#46;1&#37; and a specificity of 94&#46;7&#37;&#46; More specifically&#44; the model demonstrated a good ability to predict the absence of NAFLD&#44; although its ability to predict the presence of NAFLD was low&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0004">Table 4</a> shows the comparison of the prevalence of obesity and overweight in patients with PKU aged 13&#8211;17 years and in healthy students of the same age from the PeNSE&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> The equality hypothesis was not rejected &#40;p&#160;&#61;&#160;0&#46;488&#41;&#46;</p><elsevierMultimedia ident="tbl0004"></elsevierMultimedia></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Discussion</span><p id="para0029" class="elsevierStylePara elsevierViewall">Even though PKU is a rare disease&#44; it is the most common inborn error in metabolism of the amino acids&#46; It is the disease that newborns are screened for the most frequently&#46; Numerous countries screen for PKU&#44; thus&#44; thousands of patients are monitored globally&#46; It is important to evaluate not only the intellectual evolution of the patients but also the adverse effects of the treatments&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">Although there are different types of treatments&#44; diet plays a key role in all of them&#44; which includes natural protein restriction&#46; Restricting the consumption of most natural proteins can pose a potential risk of overconsumption of carbohydrates and fats to meet energy needs&#46; This may lead to obesity and other comorbidities&#46; Patients undergoing exclusive dietary treatment may be more susceptible to these risks&#46; Hence&#44; it was suspected that these patients were at a higher risk of developing NAFLD&#46; Unfortunately&#44; studies about NAFLD in patients with PKU or hepatic effects of the diet in these patients were not found in the literature&#46; Thus&#44; this is the first study to address this topic&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">The metabolic formula with free amino acids used by adolescents with PKU has faster absorption and leads to higher plasma concentrations&#44; however&#44; there is less effective nitrogen retention and greater hepatic oxidation of these amino acids when compared to natural protein intake&#46; The data in the literature on the digestibility and bioavailability of L-amino acids as well as the association of these amino acids&#8217; consumption with the development of NAFLD&#44; were found to be insufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">As hypothesized&#44; it was found that 26&#47;101 &#40;25&#46;7&#37;&#41; adolescents in this study following an exclusively PKU diet developed NAFLD&#44; which suggests the possibility of this comorbidity in the follow-up of these patients&#46;</p><p id="para0033" class="elsevierStylePara elsevierViewall">The prevalence of NAFLD found in this study &#40;25&#46;7&#37;&#41; was significantly higher than expected in adolescents&#46; It is much higher than that found in Brazilian adolescents with adequate weight &#40;3&#46;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> and in Australian adolescents &#40;15&#46;2&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> The overall prevalence of NAFLD has been estimated to be 25&#46;4&#37;&#44; with the highest in the Middle East and South America and the lowest in Africa&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> However&#44; this prevalence was also estimated in adults&#44; and the prevalence is more common among adults than in adolescents&#46;</p><p id="para0034" class="elsevierStylePara elsevierViewall">Some characteristics of this sample should be emphasized&#46; The study was performed in the only care center for patients with PKU in Minas Gerais&#44; the second most populous state in Brazil&#44; with more than 21 million inhabitants&#46; This means that the studied population had greater socio-environmental and cultural similarity and reduced research bias compared to multicenter studies&#46; All patients evaluated were&#44; and continue to be&#44; followed up on a regular basis in a unique referral center since birth&#44; and they were treated exclusively through diet&#46; For this reason&#44; any confounding factors that could result from a treatment using the diet associated with other available tools for the treatment of PKU were removed&#59; the sample comprises 79&#37; of all known patients diagnosed with PKU in the State of Minas Gerais&#44; until that&#46;</p><p id="para0035" class="elsevierStylePara elsevierViewall">The study was conducted exclusively among adolescents&#46; Since the disease can progress with age to hepatic steatosis&#44; which is more common in adults&#44;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> knowing its prevalence among adolescents with PKU will help prevent steatosis and liver cirrhosis&#44; possibly reducing the number of patients who are candidates for liver transplantation&#46;</p><p id="para0036" class="elsevierStylePara elsevierViewall">There are currently more recent recommendations<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> than those of Acosta and Yannicelli&#44;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> but those patients started treatment between 10 and 20 years ago when the recommendations of Acosta and Yannicelli<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> were the most used in the world&#46;</p><p id="para0037" class="elsevierStylePara elsevierViewall">Diet has been considered one of the risk factors for NAFLD&#46; However&#44; most studies have focused on individualized foods or nutrients&#44; which are consumed in different combinations&#46; A few studies have addressed the role of dietary patterns in NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> The dietary pattern of patients with PKU is unique&#44; and no studies have addressed the relationship between the PKU diet and NAFLD&#46; The results of the study may indicate some kind of relationship between PKU adolescents who were exclusively treated with diet and NAFLD&#46;</p><p id="para0038" class="elsevierStylePara elsevierViewall">Obesity is considered to be one of the most important risk factors for NAFLD&#44; and several studies have studied only obese patients or have observed a higher prevalence of the disease in overweight and obese patients&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> Since there was no control group of healthy adolescents&#44; it was only possible to compare the prevalence of obesity in adolescents aged 13&#8211;17 years with PKU with the prevalence of obesity in students of the same age participating in a large cohort carried out in all regions of Brazil&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> The hypothesis of equality was not ruled out by the chi-square test of adherence&#46;</p><p id="para0039" class="elsevierStylePara elsevierViewall">The association between obesity and NAFLD was not found in the present study&#44; and no significant difference in the prevalence of NAFLD was observed between obese and non-obese adolescents when considering weight &#40;p&#160;&#61;&#160;0&#46;86&#41;&#44; BMI &#40;p&#160;&#61;&#160;0&#46;89&#41;&#44; and abdominal circumference &#40;p&#160;&#61;&#160;0&#46;72&#41;&#46; This suggests that other factors&#44; such as PKU itself or the diet consumed by patients&#44; may play some role in its development&#46;</p><p id="para0040" class="elsevierStylePara elsevierViewall">Concerning other associated factors with NAFLD&#44; the role of sex is controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> In this study&#44; no difference was found in the distribution of NAFLD between the sexes&#44; similar to the results in previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a></p><p id="para0041" class="elsevierStylePara elsevierViewall">The final logistic regression model was not satisfactory&#46; The sensitivity was only 26&#46;1&#37;&#59; however&#44; its specificity &#40;94&#46;7&#37;&#41; was good&#44; indicating that the model is better for identifying patients who are less likely to develop the disease than those more likely to develop it&#46; This could mean that the variables used in the study were insufficient for the test&#46;</p><p id="para0042" class="elsevierStylePara elsevierViewall">The specificity of the final model suggests that NAFLD is less likely to occur in older PKU adolescents who have normal or high levels of AP&#44; lower carbohydrate intake&#44; and adequate protein and lipid intake&#46;</p><p id="para0043" class="elsevierStylePara elsevierViewall">In agreement with the indication of the specificity of the logistic regression model&#44; Suzuki et al&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> found a higher propensity for NAFLD and hepatic fibrosis in prepubescent adolescents&#44; compared to pubertal or post-pubertal adolescents&#46; Similarly&#44; adult studies suggest an increased risk of developing NAFLD in older individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a></p><p id="para0044" class="elsevierStylePara elsevierViewall">Additionally&#44; compatible with what was suggested by the specificity of the logistic regression model&#44; Couce et al&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> reported a higher carbohydrate intake in patients with PKU than in controls without the disease&#46; Interestingly&#44; some authors have demonstrated a positive relationship between excessive carbohydrate intake and excessive consumption of saturated or trans fats with the occurrence of NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> The authors did not find an association between protein consumption and the occurrence of NAFLD in the literature&#46;</p><p id="para0045" class="elsevierStylePara elsevierViewall">The protective role of normal or elevated levels of AP in the development of NAFLD suggested by the specificity of the final model could not be explained&#46; In contrast&#44; Almeida and Borges et al&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> reported higher levels of AP and other liver enzymes in patients with NAFLD&#46; Lira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> found no significant differences in AST and AP levels among obese adolescents with NAFLD and controls&#46;</p><p id="para0046" class="elsevierStylePara elsevierViewall">It is noteworthy that the prevalence of NAFLD in adolescents with PKU treated exclusively through diet was much higher than that reported in healthy Brazilian and Australian adolescents&#46; This prevalence may depend on the diet or the PKU itself&#46; Further studies are needed to verify whether this is a consistent finding to guide the treatment of adolescents with PKU&#46;</p></span></span>"
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    "fechaRecibido" => "2022-03-06"
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            0 => "Non-alcoholic fatty liver disease"
            1 => "Inborn errors of metabolism"
            2 => "Diet therapy"
            3 => "Body mass index"
            4 => "Adolescents"
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    "resumen" => array:1 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objective</span><p id="spara024" class="elsevierStyleSimplePara elsevierViewall">This study aimed to investigate non-alcoholic fatty liver disease &#40;NAFLD&#41; occurrence and factors associated with the disease in phenylketonuria &#40;PKU&#41; patients undergoing exclusive dietary treatment&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Method</span><p id="spara025" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study included 101 adolescents 10 to &#60; 20 years of age with PKU&#44; who were undergoing exclusive dietary treatment and monitored since early diagnosis at a single reference service&#46; Anthropometric and biochemical assessments were performed and food intake was documented&#44; and an ultrasound diagnosis of NAFLD was established&#46; Data were evaluated using the Student&#39;s t-test for continuous variables&#44; the chi-square for categorical variables&#44; and logistic regression using the Wald chi-squared test&#59; differences with p &#60; 0&#46;05 were considered to be statistically significant&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara026" class="elsevierStyleSimplePara elsevierViewall">NAFLD was detected in 26 &#40;25&#46;7&#37;&#41; teenagers&#46; There was no difference in prevalence between the sexes or nutritional status&#46; The final logistic regression model revealed low sensitivity &#40;26&#46;1&#37;&#41; and high specificity &#40;94&#46;7&#37;&#41;&#46; The specificity suggested a lower likelihood of NAFLD in older adolescents&#44; in the presence of normal or high levels of alkaline phosphatase&#44; lower carbohydrate intake&#44; and adequate protein and lipid intake&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara027" class="elsevierStyleSimplePara elsevierViewall">The prevalence of NAFLD in adolescents with PKU was higher than that found in healthy Brazilian adolescents and similar to that found in obese Brazilian children&#44; suggesting a higher risk for NAFLD in patients with PKU treated exclusively by dietary modification&#46;</p></span>"
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          "leyenda" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">NAFLD&#44; non-alcoholic fatty liver disease&#59; ALT&#44; alanine aminotransferase&#59; AST&#44; aspartate aminotransferase&#59; CRP&#44; C-reactive protein&#59; AP&#44; alkaline phosphatase&#59; GGT&#44; gamma-glutamyltransferase&#59; HDL&#44; high-density lipoprotein&#59; LDL&#44; low-density lipoprotein&#59; HOMA-IR&#44; Homeostasis Model Assessment&#8211; Insulin Resistance&#46;</p><p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Data are presented as mean &#177; standard deviation unless otherwise indicated&#46;</p>"
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                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">NAFLD</th><a name="en0003"></a><th class="td" title="\n
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                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">638&#46;1 &#177; 187&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Total cholesterol &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&#46;3 &#177; 24&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">136&#46;2 &#177; 39&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;377&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">LDL cholesterol &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;1 &#177; 23&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;5 &#177; 31&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">HDL cholesterol &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;8 &#177; 14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;7 &#177; 9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;730&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Triglycerides &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">112&#46;8 &#177; 65&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106&#46;5 &#177; 57&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;662&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CRP &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;8 &#177; 4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3 &#177; 4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;634&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">ALT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;8 &#177; 9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;7 &#177; 13&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;722&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">AST &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;7 &#177; 8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;7 &#177; 11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;971&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">GGT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;7 &#177; 20&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;2 &#177; 8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">AP &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142&#46;1 &#177; 66&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&#46;4 &#177; 86&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fasting glucose &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;7 &#177; 7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;0 &#177; 7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;332&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Basal insulin &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3 &#177; 21&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;7 &#177; 20&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">HOMA-IR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7 &#177; 4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;42 &#177; 4&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;761&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Calories ingested &#40;kcal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;918 &#177; 600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;950 &#177; 690&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;826&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Carbohydrate &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">338&#46;4 &#177; 112&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">334&#46;4 &#177; 111&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;877&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Protein &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;1 &#177; 21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;5 &#177; 26&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;755&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Lipid &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;1 &#177; 19&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;7 &#177; 30&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;488&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Phenylalanine &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15 &#177; 0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;19 &#177; 0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;660&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tb1fn1"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0004">Student&#39;s t-test for independent samples&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Comparative analysis and association between the presence of NAFLD and anthropometric variables&#44; biochemical tests&#44; and food intake&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">NAFLD&#44; non-alcoholic fatty liver disease&#46;</p><p id="spara006" class="elsevierStyleSimplePara elsevierViewall">Data are presented as n &#40;&#37;&#41;&#44; unless otherwise indicated&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "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"><a name="en0096"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable</th><a name="en0097"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Study group</th><a name="en0098"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0100"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NAFLD present &#40;n&#160;&#61;&#160;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0101"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NAFLD absent &#40;n&#160;&#61;&#160;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0098a"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Calories&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;21&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;78&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;770<a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;29&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;70&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;23&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;74&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Carbohydrate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;62&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;348<a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;23&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;76&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Protein&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficeint&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;23&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;76&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;307<a class="elsevierStyleCrossRef" href="#tb2fn2"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0141"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;84&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;32&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;68&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0147"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Lipids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0151"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;27&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;72&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;440<a class="elsevierStyleCrossRef" href="#tb2fn2"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0155"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;88&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Phenylalanine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;29&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;71&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;172<a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0167"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;24&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0169"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;75&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tb2fn1"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0007">Fisher&#39;s exact test&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tb2fn2"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0008">Pearson chi-square test&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Comparative and association analyses between adequacy of food intake and occurrence of NAFLD&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0003"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0003"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara008" class="elsevierStyleSimplePara elsevierViewall">AP&#44; alkaline phosphatase&#59; CI&#44; confidence interval&#59; OR&#44; odds ratio&#46;</p><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">Bolded values indicate statistically significant differences&#46;</p><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">Database&#58; 98 children &#40;23 cases WITH steatosis&#44; 75 cases WITHOUT steatosis&#41;&#46; Three outlier cases were removed from the study&#46; Sensitivity 26&#46;1&#47;&#37;&#59; Specificity&#58; 94&#46;7&#37;&#46;</p><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Subtitle&#58;</p><p id="spara012" class="elsevierStyleSimplePara elsevierViewall">AP &#40;classification&#41;&#58; 1&#160;&#61;&#160;Low AP&#59; 0&#160;&#61;&#160;Normal AP&#46;</p><p id="spara013" class="elsevierStyleSimplePara elsevierViewall">Carbohydrate &#40;classification&#41;&#58; 1&#160;&#61;&#160;Adequate&#59; 0&#160;&#61;&#160;Excessive&#46;</p><p id="spara014" class="elsevierStyleSimplePara elsevierViewall">Protein &#40;classification&#41;&#58;</p><p id="spara015" class="elsevierStyleSimplePara elsevierViewall">Excessive protein&#160;&#61;&#160;1 and Insufficient protein&#160;&#61;&#160;0 Excessive&#46;</p><p id="spara016" class="elsevierStyleSimplePara elsevierViewall">Excessive protein&#160;&#61;&#160;0 and Insufficient protein&#160;&#61;&#160;1 Insufficient&#46;</p><p id="spara017" class="elsevierStyleSimplePara elsevierViewall">Excessive protein&#160;&#61;&#160;0 and Insufficient protein&#160;&#61;&#160;0 Adequate&#46;</p><p id="spara018" class="elsevierStyleSimplePara elsevierViewall">Lipids &#40;classification&#41;&#58; 1&#160;&#61;&#160;Insufficient lipids and 0&#160;&#61;&#160;Adequate&#46;</p><p id="spara019" class="elsevierStyleSimplePara elsevierViewall">1&#160;&#61;&#160;NAFLD present&#59; 0&#160;&#61;&#160;NAFLD absent&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0172"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#946;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0173"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Chi-squared &#40;<span class="elsevierStyleItalic">Wald</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0174"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;3&#46;557&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;313&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#8212;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#8212;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0183"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Underage &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;0&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;879&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;027</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0188"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;0&#46;63&#8211;0&#46;97&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0189"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Low AP &#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0190"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;396&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0191"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;086&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0192"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0193"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0194"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;2&#46;31&#8211;52&#46;18&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0195"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive carbohydrate &#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0196"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;965&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0197"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;365&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0198"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0199"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0200"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;2&#46;90&#8211;129&#46;53&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0201"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Excessive protein &#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0202"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0203"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;623&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0204"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;018</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0205"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0206"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;1&#46;47&#8211;59&#46;04&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0207"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficient protein &#160;&#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0208"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;396&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0209"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;822&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0210"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0211"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0212"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;0&#46;53&#8211;30&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0213"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Insufficient lipids &#160;&#40;classification&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0214"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;325&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0215"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0216"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;045</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0217"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0218"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#40;1&#46;08&#8211;716&#46;40&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Final model derived from logistic regression analysis&#46;</p>"
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      ]
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        "identificador" => "tbl0004"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spara021" class="elsevierStyleSimplePara elsevierViewall">DATABASE&#58; 46 patients&#46;</p><p id="spara022" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Chi-square test for adherence&#58;</span> p&#160;&#61;&#160;0&#46;488&#46;</p><p id="spara023" class="elsevierStyleSimplePara elsevierViewall">Percentages were calculated in relation to the total of the cases and percentages&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Frequency</th><a name="en0220"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BMI Classification</th><a name="en0221"></a><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowgroup colgroup " rowspan="2" align="center" valign="top" scope="col" colspan="2" style="border-bottom: 2px solid black">TOTAL</th></tr><tr title="table-row"><a name="en0223"></a><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Overweight&#47;obesity</th><a name="en0224"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Eutrophic&#47;low BMI</th></tr><tr title="table-row"><a name="en0227"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0228"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0229"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0230"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0231"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0232"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0233"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0234"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0235"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0236"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0237"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">80&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0238"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">46</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0239"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">100&#46;0</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0240"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Estimated<a class="elsevierStyleCrossRef" href="#tb4fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0241"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spara020" class="elsevierStyleSimplePara elsevierViewall">The observed and estimated results of the Brazilian National School Health Survey &#40;PeNSE&#44; 2015&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> with regard to the prevalence of overweight and obesity&#46;</p>"
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Article information
ISSN: 00217557
Original language: English
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