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Uma triagem&#44; quando feita em ambientes de grande concentra&#231;&#227;o de jovens&#44; como &#233; o caso das escolas&#44; alcan&#231;a quantidade elevada de adolescentes&#44; em especial aqueles que apresentam dificuldade de acesso ou n&#227;o procuram o sistema de sa&#250;de&#46; Dessa maneira&#44; uma vez identificados os adolescentes com maior probabilidade de apresentar SMet&#44; esses podem ser encaminhados para acompanhamento m&#233;dico especializado&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Em adultos existe consenso quanto ao crit&#233;rio diagn&#243;stico para classificar o sobrepeso e a obesidade a partir do IMC&#59; por&#233;m&#44; esse n&#227;o &#233; o caso em crian&#231;as e adolescentes&#46; Considerando implica&#231;&#245;es relacionadas aos processos de crescimento f&#237;sico e matura&#231;&#227;o biol&#243;gica que surgem nessa fase de desenvolvimento&#44; o significado do IMC para sa&#250;de dos jovens solicita diferencia&#231;&#245;es mais complexas do que aquelas atribu&#237;das aos adultos&#46; Nesse particular&#44; foram propostos e t&#234;m sido usados diferentes crit&#233;rios diagn&#243;sticos a partir do IMC para identificar o excesso de peso corporal em jovens&#46; No contexto internacional destacam&#8208;se as propostas da <span class="elsevierStyleItalic">World Health Organization</span> &#40;WHO&#41;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;11</span></a> e da <span class="elsevierStyleItalic">International Obesity Task Force</span> &#40;IOTF&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">12&#44;13</span></a> enquanto para uso espec&#237;fico na popula&#231;&#227;o jovem brasileira a proposta de Conde &#38; Monteiro<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> tem recebido aten&#231;&#227;o especial&#46; No entanto&#44; n&#227;o existe consenso sobre a proposta a ser usada e&#44; desse modo&#44; surgem discuss&#245;es quanto &#224; validade de cada crit&#233;rio diagn&#243;stico para uso em popula&#231;&#245;es espec&#237;ficas&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Portanto&#44; o objetivo do presente estudo foi analisar o desempenho dos tr&#234;s diferentes crit&#233;rios diagn&#243;sticos de sobrepeso e obesidade a partir do IMC &#40;WHO&#44; IOTF&#44; Conde &#38; Monteiro&#41; como preditores da SMet em uma amostra representativa de adolescentes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">O estudo est&#225; vinculado a um projeto maior&#44; que teve como objetivo estimar a preval&#234;ncia de SMet e fatores associados em adolescentes&#46; Para tanto&#44; fez&#8208;se levantamento de corte transversal de base populacional que envolveu escolares da cidade de Jacarezinho&#44; Paran&#225;&#46; A coleta dos dados se estendeu de agosto a novembro de 2014&#46; Os protocolos de interven&#231;&#227;o usados foram aprovados pelo Comit&#234; de &#201;tica em Pesquisa da Universidade Norte do Paran&#225; &#40;Unopar&#41; &#40;Parecer 1&#46;302&#46;963&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Amostra e sele&#231;&#227;o dos sujeitos</span><p id="par0035" class="elsevierStylePara elsevierViewall">A popula&#231;&#227;o de refer&#234;ncia incluiu adolescentes de ambos os sexos&#44; entre 12 e 20 anos&#44; matriculados em escolas p&#250;blicas e privadas de 2&#176; ciclo do ensino fundamental &#40;6&#176; ao 9&#176; ano&#41; e ensino m&#233;dio &#40;1&#176; ao 3&#176; ano&#41;&#46; Inicialmente&#44; o tamanho da amostra foi estabelecido para atender ao objetivo de estimar a preval&#234;ncia de SMet e fatores associados&#44; assumiram&#8208;se intervalo de confian&#231;a de 95&#37;&#44; erro amostral de 3 pontos percentuais e acr&#233;scimo de 10&#37; para atender eventuais casos de perdas e como o planejamento amostral envolveu conglomerados &#40;estrutura escolar&#44; sexo&#44; turno e ano de estudo&#41;&#44; adicionou&#8208;se efeito de delineamento &#40;<span class="elsevierStyleItalic">deff</span>&#41; equivalente a 1&#44;5&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">De acordo com procedimentos empregados para c&#225;lculo do tamanho de amostras em estudos que envolvem teste diagn&#243;stico&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> identificou&#8208;se que essa amostra&#44; que reuniu 1&#46;035 adolescentes&#44; permite identificar adequadamente as propriedades de sensibilidade e especificidade&#46; O poder estat&#237;stico da amostra&#44; estratificado por sexo &#40;565 mo&#231;as e 470 rapazes&#41;&#44; foi calculado <span class="elsevierStyleItalic">a posteriori</span> e permite considerar&#44; com poder de 80&#37; e signific&#226;ncia de 5&#37;&#44; &#225;reas sob a curva ROC &#40;<span class="elsevierStyleItalic">Receiver Operating Characteristic</span>&#41; de&#44; pelo menos&#44; 0&#44;53 e 0&#44;56 para mo&#231;as e rapazes&#44; respectivamente&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Coleta dos dados</span><p id="par0045" class="elsevierStylePara elsevierViewall">A idade cronol&#243;gica foi estabelecida em anos e meses&#44; a partir da confronta&#231;&#227;o entre data de coleta dos dados e data de nascimento&#46; No entanto&#44; para feito de an&#225;lise dos dados&#44; foram constitu&#237;dos dois grupos et&#225;rios&#58; 12 a 15 anos e 16 a 20 anos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">O IMC foi calculado mediante a raz&#227;o entre medida do peso corporal&#44; expressa em quilogramas&#44; e da estatura&#44; expressa em metros quadrados &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; a partir dos procedimentos apresentados pela Organiza&#231;&#227;o Mundial da Sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> O sobrepeso e a obesidade foram identificados com os tr&#234;s crit&#233;rios diagn&#243;sticos espec&#237;ficos para sexo e idade&#58; WHO&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> IOTF<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> e Conde &#38; Monteiro&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> conforme explicitados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">A SMet foi identificada a partir da an&#225;lise do teor sangu&#237;neo de lip&#237;deos plasm&#225;ticos &#40;triglicer&#237;deos e lipoprote&#237;nas de alta densidade &#8211; HDL&#8208;colesterol&#41; e glicemia&#44; da press&#227;o arterial em repouso &#40;sist&#243;lica e diast&#243;lica&#41; e do ac&#250;mulo de gordura abdominal &#40;circunfer&#234;ncia de cintura&#41;&#44; de acordo com crit&#233;rios propostos pela <span class="elsevierStyleItalic">International Diabetes Federation</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> Nesse caso&#44; a SMet &#233; definida pela presen&#231;a obrigat&#243;ria da circunfer&#234;ncia de cintura elevada &#40;&#60; 16 anos&#58; ambos os sexos &#8805; percentil 90&#59; &#8805; 16 anos&#58; rapazes &#8805; 90<span class="elsevierStyleHsp" style=""></span>cm e mo&#231;as &#8805; 80<span class="elsevierStyleHsp" style=""></span>cm&#41; e&#44; pelo menos&#44; mais dois componentes comprometidos&#58; triglicer&#237;deos aumentados &#40;&#8805; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; HDL&#8208;colesterol diminu&#237;do &#40;&#60; 16 anos&#58; ambos os sexos<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; &#8805; 16 anos&#58; rapazes<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL e mo&#231;as<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; glicemia de jejum elevada &#40;&#8805; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; e press&#227;o arterial alterada &#40;sist&#243;lica &#8805; 130<span class="elsevierStyleHsp" style=""></span>mmHg ou diast&#243;lica &#8805; 85<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">As dosagens de lip&#237;deos plasm&#225;ticos e glicemia foram feitas mediante coleta de amostras de sangue por pun&#231;&#227;o venosa&#44; ap&#243;s 12 horas de jejum&#44; de acordo com t&#233;cnicas laboratoriais convencionais&#46; Os n&#237;veis de press&#227;o arterial sist&#243;lica e diast&#243;lica foram aferidos pelo m&#233;todo auscultat&#243;rio com aux&#237;lio de esfigmoman&#244;metro de coluna de merc&#250;rio&#44; com o adolescente sentado&#44; ap&#243;s per&#237;odo m&#237;nimo de cinco minutos de repouso&#46; Foram feitas duas medidas&#44; considerou&#8208;se o valor m&#233;dio de ambas as medidas para efeito de c&#225;lculo&#46; As medidas de circunfer&#234;ncia de cintura foram determinadas no ponto m&#233;dio entre a &#250;ltima costela e a crista&#8208;il&#237;aca&#44; com uma trena antropom&#233;trica inextens&#237;vel&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Tratamento estat&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">O tratamento estat&#237;stico foi feito mediante o <span class="elsevierStyleItalic">software</span> SPSS&#44; vers&#227;o 22 &#40;IBM Corp&#46; Released 2013&#46; IBM SPSS Statistics para Windows&#44; NY&#44; EUA&#41;&#46; Foram estimadas as propor&#231;&#245;es circunstanciais e respectivos intervalos de confian&#231;a de 95&#37; dos desfechos de interesse &#40;sobrepeso&#44; obesidade e SMet&#41; estratificados para sexo e idade&#46; Diferen&#231;as estat&#237;sticas entre os estratos sob investiga&#231;&#227;o foram analisadas com o teste de qui&#8208;quadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; para tend&#234;ncia linear&#46; O desempenho dos tr&#234;s crit&#233;rios diagn&#243;sticos de sobrepeso e obesidade &#40;WHO&#44; IOTF e Conde &#38; Monteiro&#41; como preditores da SMet foi analisado mediante propriedades de sensibilidade&#44; especificidade e acur&#225;cia global&#44; identificadas pelo m&#233;todo da curva ROC &#40;<span class="elsevierStyleItalic">Receiver Operating Characteristic</span>&#41;&#44; acompanhadas dos respectivos intervalos de confian&#231;a a 95&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> Poss&#237;veis diferen&#231;as significativas relacionadas &#224;s propriedades de sensibilidade&#44; especificidade e acur&#225;cia global foram identificadas mediante estat&#237;stica de McNemar &#40;&#967;<span class="elsevierStyleSup">2</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> mostra as preval&#234;ncias de sobrepeso&#44; obesidade e SMet na popula&#231;&#227;o de adolescentes analisada no estudo&#46; As preval&#234;ncias mais elevadas foram observadas mediante o uso do crit&#233;rio diagn&#243;stico Conde &#38; Monteiro&#59; fundamentalmente&#44; nos adolescentes entre 16 e 20 anos&#46; Por outro lado&#44; o crit&#233;rio diagn&#243;stico IOTF apontou preval&#234;ncias significativamente menores&#44; sobretudo nos rapazes&#46; A presen&#231;a de SMet foi identificada em 4&#44;5&#37; &#91;IC95&#37; 3&#44;8&#8208;5&#44;4&#93; da amostra&#44; significativamente maior nos rapazes e nos adolescentes com mais idade&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">O desempenho dos tr&#234;s crit&#233;rios diagn&#243;sticos de sobrepeso e obesidade como preditores de SMet &#233; apresentado na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; De maneira geral&#44; tanto no caso do sobrepeso como da obesidade&#44; constatam&#8208;se sensibilidades similares em ambos os sexos&#59; contudo&#44; valores mais elevados nos adolescentes com mais idade&#46; Quanto &#224; especificidade&#44; observa&#8208;se tend&#234;ncia para os valores apresentados pelas mo&#231;as se destacarem em compara&#231;&#227;o com os apresentados pelos rapazes&#44; n&#227;o foram identificadas diferen&#231;as importantes em rela&#231;&#227;o &#224; idade&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Em ambos os sexos&#44; independentemente da idade&#44; e nos tr&#234;s crit&#233;rios diagn&#243;sticos&#44; a sensibilidade equivalente &#224; obesidade se mostrou mais elevada&#44; enquanto maior especificidade foi observada para o sobrepeso&#46; Em todos os estratos considerados o crit&#233;rio diagn&#243;stico IOTF foi o que demonstrou maior sensibilidade&#46; Em contrapartida&#44; menor sensibilidade foi observada mediante o crit&#233;rio diagn&#243;stico Conde &#38; Monteiro&#46; Quanto &#224; especificidade&#44; os tr&#234;s crit&#233;rios diagn&#243;sticos apresentaram valores semelhantes e pr&#243;ximos de 90&#37;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">No que se refere &#224; propriedade de acur&#225;cia global&#44; com varia&#231;&#245;es entre 0&#44;52 e 0&#44;89&#44; visualizam&#8208;se diferen&#231;as mais acentuadas entre idades do que entre sexo&#46; Com rela&#231;&#227;o aos crit&#233;rios diagn&#243;sticos&#44; a proposta Conde &#38; Monteiro apontou acur&#225;cia global significativamente menor do que as propostas WHO e IOTF&#46; O uso do crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apontou valores &#8804; 0&#44;69&#44; o que sugere baixa acur&#225;cia global&#46; Por outro lado&#44; o uso dos crit&#233;rios diagn&#243;stico WHO e IOTF indicou valores entre 0&#44;70 e 0&#44;89&#44; com significativa vantagem para o crit&#233;rio diagn&#243;stico IOTF&#44; revelou&#8208;se&#44; desse modo&#44; moderada acur&#225;cia global&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0090" class="elsevierStylePara elsevierViewall">Independentemente do crit&#233;rio diagn&#243;stico usado&#44; um em cada quatro adolescentes analisados no estudo apresentou excesso de peso corporal &#40;&#8776; 25&#37;&#41;&#46; Essa propor&#231;&#227;o &#233; similar &#224; encontrada em estudo representativo do conjunto de munic&#237;pios brasileiros de m&#233;dio e grande porte&#59;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> contudo&#44; discretamente inferior &#224; de pa&#237;ses desenvolvidos e pr&#243;ximo de duas vezes maior do que a encontrada na popula&#231;&#227;o jovem de pa&#237;ses em desenvolvimento&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> Mediante o uso do mesmo crit&#233;rio diagn&#243;stico &#40;IDF&#41;&#44; a propor&#231;&#227;o de adolescentes com SMet &#233; superior &#224; encontrada recentemente na popula&#231;&#227;o jovem brasileira &#40;4&#44;5&#37; <span class="elsevierStyleItalic">vs</span>&#46; 2&#44;6&#37;&#41;&#59;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> por&#233;m&#44; inferior &#224; descrita em adolescentes americanos e europeus&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">O crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apresentou a menor capacidade para discriminar adolescentes portadores e n&#227;o portadores de SMet&#46; Estimativas relativas &#224; acur&#225;cia global revelaram que as chances de identificar corretamente a presen&#231;a de SMet mediante o uso desse crit&#233;rio diagn&#243;stico se aproximou de 50&#8208;60&#37; &#40;&#225;rea sob a curva ROC entre 0&#44;52 e 0&#44;64&#41;&#46; Nesse contexto&#44; se por um lado as especificidades alcan&#231;adas mediante o uso do crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apresentaram valores &#8805; 90&#37;&#44; por outro as sensibilidades n&#227;o ultrapassaram 55&#37;&#46; Logo&#44; ao empregar esse crit&#233;rio diagn&#243;stico para identificar SMet&#44; existe grande probabilidade dos adolescentes eutr&#243;ficos serem identificados como n&#227;o portadores de SMet&#59; por&#233;m&#44; as chances de detectar SMet diminuem acentuadamente entre aqueles adolescentes que apresentam sobrepeso ou s&#227;o obesos&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">As capacidades preditivas dos crit&#233;rios diagn&#243;stico WHO e IOTF para presen&#231;a de SMet se mostraram mais elevadas e com menores diferen&#231;as entre si&#59; contudo&#44; o crit&#233;rio diagn&#243;stico IOTF apresentou sensibilidades significativamente maiores do que os crit&#233;rios diagn&#243;sticos WHO e Conde &#38; Monteiro&#46; Nesse sentido&#44; o uso do crit&#233;rio diagn&#243;stico IOTF para identificar corretamente SMet resultou em 5&#8208;10&#37; e 13&#8208;22&#37; menos casos falso&#8208;negativos do que os crit&#233;rios diagn&#243;sticos WHO e Conde &#38; Monteiro&#44; respectivamente&#46; Em valores probabil&#237;sticos&#44; mediante o uso dos crit&#233;rios diagn&#243;sticos WHO e IOTF&#44; de cada dez adolescentes com excesso de peso corporal surgiram igualmente indica&#231;&#245;es de que por volta de sete a nove deles foram corretamente identificados com SMet &#40;&#225;rea sob a curva ROC entre 0&#44;70 e 0&#44;89&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">De maneira geral&#44; ao considerar os tr&#234;s crit&#233;rios diagn&#243;sticos como preditores da SMet&#44; as mo&#231;as e os adolescentes entre 12 e 15 anos apresentaram menor acur&#225;cia global&#46; Provavelmente esse fato possa ser reflexo do surto de crescimento puberal que ocorre nessa idade&#44; sobretudo entre as mo&#231;as&#46; Nesse caso&#44; devido &#224;s diferen&#231;as no <span class="elsevierStyleItalic">timing</span> da puberdade&#44; constata&#8208;se mais elevada variabilidade na associa&#231;&#227;o entre ac&#250;mulo de gordura corporal&#44; propor&#231;&#227;o de massa isenta de gordura e mudan&#231;as nos valores de IMC&#44; o que impacta diretamente na identifica&#231;&#227;o do sobrepeso e da obesidade&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Apesar de terem sido encontradas diferen&#231;as significativas equivalentes &#224;s propriedades de sensibilidade&#44; especificidade e acur&#225;cia global&#44; os achados do presente estudo confirmaram que os tr&#234;s crit&#233;rios diagn&#243;sticos apresentam capacidade de predizer SMet&#44; com indicadores de validade mais adequados nos adolescentes tidos como obesos&#46; Nesse contexto&#44; &#233; importante mencionar que os tr&#234;s crit&#233;rios diagn&#243;sticos t&#234;m em comum o fato de usarem pontos de corte arbitr&#225;rios&#44; alicer&#231;ados&#44; sobretudo&#44; em pressupostos estat&#237;sticos&#46; Logo&#44; essas diferen&#231;as podem&#44; em parte&#44; ser explicadas pelas diferentes metodologias empregadas em suas proposi&#231;&#245;es e&#44; principalmente&#44; pelas preval&#234;ncias de sobrepeso e obesidade e tend&#234;ncia secular do IMC da popula&#231;&#227;o de refer&#234;ncia usada para o conjunto de dados da amostra&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A proposta da WHO baseia&#8208;se em dados de jovens americanos coletados em 1971&#8208;74 e reprocessados mais recentemente&#44; para atenuar limita&#231;&#245;es detectadas em proposta anterior&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> Embora possam existir evid&#234;ncias no sentido de que&#44; na &#250;ltima d&#233;cada&#44; as preval&#234;ncias de sobrepeso e obesidade na popula&#231;&#227;o jovem dos Estados Unidos t&#234;m apresentado tend&#234;ncia de estabiliza&#231;&#227;o&#44; esse n&#227;o &#233; o caso quando da compara&#231;&#227;o entre dados da d&#233;cada de 1970 e de gera&#231;&#245;es mais recentes&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Por outro lado&#44; a proposta IOTF prov&#233;m de levantamentos nacionais representativos de jovens de seis pa&#237;ses &#40;Estados Unidos&#44; Inglaterra&#44; Brasil&#44; Cingapura&#44; Holanda e Hong&#8208;Kong&#41;&#46; Os levantamentos foram feitos em momentos diferentes&#44; entre 1973 e 1993&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">12&#44;13</span></a> o que dificulta a an&#225;lise da tend&#234;ncia secular do IMC na proposi&#231;&#227;o desse crit&#233;rio diagn&#243;stico&#46; A proposta Conde &#38; Monteiro usou dados extra&#237;dos da Pesquisa Nacional de Sa&#250;de e Nutri&#231;&#227;o&#44; envolveu amostra com representatividade nacional de jovens brasileiros&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> Os dados foram coletados em 1989&#44; momento em que a preval&#234;ncia de sobrepeso e obesidade da popula&#231;&#227;o jovem no Brasil era significativamente menor do que nos dias atuais&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Ainda&#44; ressalta&#8208;se que&#44; quando da sele&#231;&#227;o de um crit&#233;rio diagn&#243;stico espec&#237;fico&#44; torna&#8208;se prudente levar em conta a influ&#234;ncia de componentes &#233;tnicos&#46; Neste sentido&#44; para uso em adolescentes brasileiros&#44; a princ&#237;pio&#44; o crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apresenta grande vantagem e&#44; pelo contr&#225;rio&#44; mesmo assumindo o perfil multi&#233;tnico da popula&#231;&#227;o jovem norte&#8208;americana&#44; dever&#225; ser contabilizada importante limita&#231;&#227;o na sele&#231;&#227;o do crit&#233;rio diagn&#243;stico WHO&#46; O crit&#233;rio diagn&#243;stico IOTF parece ser mais adequado para garantir uma aplica&#231;&#227;o multi&#233;tnica&#44; uma vez que &#233; baseado em seis conjuntos de dados&#44; inclusive o Brasil&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Quanto &#224;s diferentes metodologias empregadas para identificar os pontos de corte&#44; a proposta WHO usou recursos probabil&#237;sticos em que valores de IMC equivalentes aos percentis 85 e 95 foram apontados para identificar aqueles adolescentes com sobrepeso e obesos&#44; respectivamente&#46; Portanto&#44; assumiu&#8208;se que&#44; na popula&#231;&#227;o de refer&#234;ncia&#44; independentemente de qualquer outra informa&#231;&#227;o adicional&#44; exatamente 15&#37; dos jovens de cada sexo e idade apresentavam sobrepeso e 5&#37; obesidade&#46; Limita&#231;&#227;o importante dessa metodologia &#233; considerar que valores mais elevados de IMC na distribui&#231;&#227;o de percentil da popula&#231;&#227;o de refer&#234;ncia possam representar a presen&#231;a de sobrepeso e obesidade&#44; em vez de apenas indicar os jovens que s&#227;o mais pesados em compara&#231;&#227;o com seus pares&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Pelo contr&#225;rio&#44; as propostas IOTF e Conde &#38; Monteiro foram idealizadas de forma independente da distribui&#231;&#227;o de percentil do IMC na popula&#231;&#227;o de refer&#234;ncia&#46; Nesse caso&#44; os pontos de corte foram definidos mediante crit&#233;rio epidemiol&#243;gico&#44; a partir de ajustes de modelos matem&#225;ticos espec&#237;ficos para sexo e idade&#44; em que aos 18 anos apresentavam intercep&#231;&#227;o com valores de IMC representativos de riscos aumentados para presen&#231;a de desfechos de sa&#250;de no in&#237;cio da vida adulta&#44; em consequ&#234;ncia do sobrepeso e da obesidade&#44; ou seja&#44; 25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> e 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; respectivamente&#46; No entanto&#44; o procedimento metodol&#243;gico adotado pelas duas propostas n&#227;o est&#225; isento de cr&#237;tica&#46; Embora n&#227;o sejam dependentes da distribui&#231;&#227;o de percentil&#44; presumiu&#8208;se que a propor&#231;&#227;o de jovens da popula&#231;&#227;o de refer&#234;ncia com sobrepeso e obesidade era a mesma em ambos os sexos e em todas as idades&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Os resultados reunidos no estudo corroboram achados da literatura que apontam elevada especificidade acompanhada de razo&#225;vel sensibilidade para identificar risco cardiometab&#243;lico em jovens mediante o uso de crit&#233;rios diagn&#243;sticos a partir do IMC&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#8211;9</span></a> Contudo&#44; de alguma maneira&#44; discordam parcialmente dos resultados encontrados em estudo que envolveu crian&#231;as brasileiras que procurou identificar a capacidade preditiva de crit&#233;rios diagn&#243;sticos especificamente para presen&#231;a de press&#227;o arterial elevada&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> No estudo foram encontrados indicadores equivalentes &#224; acur&#225;cia global similares para os crit&#233;rios diagn&#243;sticos Conde &#38; Monteiro e IOTF&#46; Possivelmente&#44; o uso isolado do componente press&#227;o arterial elevada&#44; em vez do conglomerado de componentes que define a SMet&#44; e a menor idade dos sujeitos reunidos no estudo &#40;entre seis e 13 anos&#41; possam explicar eventuais discord&#226;ncia entre ambos os estudos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O presente estudo apresenta algumas limita&#231;&#245;es que devem ser consideradas&#46; Mesmo que tenha assumido a baixa taxa de recusa para a tomada das medidas &#40;&#8776; 8&#37;&#41;&#44; n&#227;o se pode descartar a possibilidade de ter ocorrido vi&#233;s de sele&#231;&#227;o&#44; tendo em vista que n&#227;o foi poss&#237;vel comparar dados dos adolescentes participantes e n&#227;o participantes&#46; Tamb&#233;m &#233; importante referir que&#44; por n&#227;o haver um crit&#233;rio universal para defini&#231;&#227;o de SMet&#44; optou&#8208;se por usar crit&#233;rio proposto pela IDF e&#44; nesse sentido&#44; as estimativas de preval&#234;ncia de SMet podem variar de acordo com o crit&#233;rio empregado&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Concluindo&#44; evid&#234;ncias encontradas no estudo contribuem para o conhecimento da &#225;rea e mostram que&#44; dos tr&#234;s crit&#233;rios diagn&#243;stico de sobrepeso e obesidade a partir do IMC &#40;WHO&#44; IOTF e Conde &#38; Monteiro&#41;&#44; o IOTF demonstrou capacidade preditiva significativamente mais elevada para presen&#231;a de SMet&#46; Contudo&#44; tendo em vista que o IMC &#233; um preditor importante para presen&#231;a de SMet em adolescentes&#44; o grande desafio continua a ser ajustar pontos de corte que possam minimizar a quantidade de casos falso&#8208;negativos &#40;maiores &#237;ndices de sensibilidade&#41; e maximizar a quantidade de casos verdadeiro&#8208;negativos &#40;maiores &#237;ndices de especificidade&#41;&#44; como j&#225; observados nos tr&#234;s crit&#233;rios diagn&#243;sticos considerados no estudo&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiamento</span><p id="par0155" class="elsevierStylePara elsevierViewall">Dartagnan Pinto Guedes &#233; bolsista de Produtividade em Pesquisa do Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico &#40;CNPq&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflitos de interesse</span><p id="par0160" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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    "fechaRecibido" => "2016-07-22"
    "fechaAceptado" => "2016-11-25"
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            0 => "Body mass index"
            1 => "Diagnosis"
            2 => "Accuracy"
            3 => "Cardiovascular risk"
            4 => "Youth"
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            0 => "&#205;ndice de massa corporal"
            1 => "Diagn&#243;stico"
            2 => "Acur&#225;cia"
            3 => "Risco cardiovascular"
            4 => "Jovens"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the performance of three different diagnostic criteria of overweight and obesity &#40;WHO&#44; IOTF and Conde and Monteiro&#41; using body mass index &#40;BMI&#41; as predictors of metabolic syndrome &#40;MetS&#41; in a representative sample of adolescents&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A sample of 1035 adolescents aged 12&#8211;20 years &#40;565 girls and 470 boys&#41; was used in the study&#46; BMI was calculated through the quotient of weight &#40;kg&#41;&#47;height squared &#40;m&#41;<span class="elsevierStyleSup">2</span>&#44; and MetS was defined according to the criteria of the International Diabetes Federation&#46; Sensitivity&#44; specificity&#44; and overall accuracy &#40;area under the curve&#41; were estimated using the receiver operating characteristic &#40;ROC&#41; curves method and used to describe the predictive performance&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The three diagnostic criteria showed higher absolute values of sensitivity and specificity for predicting MetS in boys and older adolescents&#46; The highest sensitivity to identify MetS was found using the IOTF criterion &#40;60&#8211;85&#37;&#41;&#44; while specificity values &#8805; 90&#37; were found for the three criteria&#46; The Conde and Monteiro diagnostic criterion pointed to a significantly lower overall accuracy &#40;0&#46;52&#8211;0&#46;64&#41; than that of the WHO &#40;0&#46;70&#8211;0&#46;84&#41; and IOTF &#40;0&#46;75&#8211;0&#46;89&#41; diagnostic criterion&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Overweight and obesity using BMI showed a moderate association with MetS&#44; regardless of the diagnostic criteria used&#46; However&#44; the IOTF criterion showed better predictive capacity for the presence of MetS than the WHO and the Conde and Monteiro criteria&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analisar o desempenho de tr&#234;s diferentes crit&#233;rios diagn&#243;sticos de sobrepeso e obesidade &#40;WHO&#44; IOTF e Conde &#38; Monteiro&#41; a partir do &#237;ndice de massa corporal &#40;IMC&#41; como preditores da s&#237;ndrome metab&#243;lica &#40;SMet&#41; em amostra representativa de adolescentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A amostra foi constitu&#237;da por 1&#46;035 adolescentes &#40;565 mo&#231;as e 470 rapazes&#41; entre 12 e 20 anos&#46; O IMC foi calculado mediante quociente entre peso &#40;kg&#41;&#47;altura &#40;m&#41;<span class="elsevierStyleSup">2</span> e SMet foi definida atrav&#233;s dos crit&#233;rios da <span class="elsevierStyleItalic">International Diabetes Federation</span>&#46; Desempenho preditivo foi descrito a partir das estimativas de sensibilidade&#44; especificidade e acur&#225;cia global &#40;&#225;rea sob a curva&#41; com o m&#233;todo de curvas <span class="elsevierStyleItalic">Receiver Operating Characteristic</span>&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os tr&#234;s crit&#233;rios diagn&#243;sticos apresentaram maiores valores absolutos de sensibilidade e especificidade para predi&#231;&#227;o da SMet nos rapazes e nos adolescentes com mais idade&#46; Maior sensibilidade para identificar SMet foi observada com o crit&#233;rio IOTF &#40;60&#37; a 85&#37;&#41;&#44; enquanto especificidade &#8805; 90&#37; foi observada mediante o uso dos tr&#234;s crit&#233;rios diagn&#243;sticos&#46; O crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apontou acur&#225;cia global &#40;0&#44;52 a 0&#44;64&#41; significativamente menor do que os crit&#233;rios diagn&#243;sticos WHO &#40;0&#44;70 a 0&#44;84&#41; e IOTF &#40;0&#44;75 a 0&#44;89&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sobrepeso e obesidade a partir do IMC mostraram uma moderada associa&#231;&#227;o com SMet&#44; independentemente do crit&#233;rio diagn&#243;stico empregado&#46; Contudo&#44; o crit&#233;rio IOTF demonstrou melhor capacidade preditiva para presen&#231;a de SMet do que os crit&#233;rios WHO e Conde &#38; Monteiro&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Oliveira RG&#44; Guedes DP&#46; Performance of different diagnostic criteria of overweight and obesity as predictors of metabolic syndrome in adolescents&#46; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;525&#8211;31&#46;</p>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Crit&#233;rios diagn&#243;sticos para identificar excesso de peso corporal em jovens a partir do &#237;ndice de massa corporal &#40;IMC&#41; de acordo com a <span class="elsevierStyleItalic">World Health Organization</span> &#40;WHO&#41;&#44; <span class="elsevierStyleItalic">International Obesity Task Force</span> &#40;IOTF&#41; e Conde &#38; Monteiro</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mo&#231;as</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Rapazes</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Teste &#967;<span class="elsevierStyleSup">2</span></th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Idade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Sobrepeso</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;5 &#40;15&#44;1&#8208;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;5 &#40;18&#44;6&#8208;22&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;1 &#40;15&#44;6&#8208;19&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;8 &#40;17&#44;2&#8208;20&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;5 &#40;14&#44;2&#8208;17&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;2 &#40;16&#44;7&#8208;19&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;2 &#40;12&#44;9&#8208;15&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;3 &#40;14&#44;9&#8208;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;9 &#40;15&#44;4&#8208;18&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;8 &#40;20&#44;7&#8208;25&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;9 &#40;16&#44;2&#8208;19&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;0 &#40;19&#44;0&#8208;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Obesidade</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;2 &#40;4&#44;3&#8208;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;5 &#40;5&#44;6&#8208;7&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;9 &#40;5&#44;1&#8208;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;6 &#40;5&#44;7&#8208;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;9 &#40;4&#44;1&#8208;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;8 &#40;5&#44;0&#8208;6&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;7 &#40;4&#44;0&#8208;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;0 &#40;4&#44;2&#8208;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;3 &#40;4&#44;3&#8208;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;2 &#40;6&#44;2&#8208;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;1 &#40;5&#44;1&#8208;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;3 &#40;6&#44;3&#8208;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Sobrepeso &#43; obesidade</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;7 &#40;19&#44;7&#8208;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;0 &#40;24&#44;8&#8208;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;1 &#40;21&#44;1&#8208;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;5 &#40;23&#44;3&#8208;27&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;4 &#40;18&#44;5&#8208;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;0 &#40;22&#44;0&#8208;26&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;9 &#40;17&#44;1&#8208;20&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;4 &#40;19&#44;4&#8208;23&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;2 &#40;20&#44;1&#8208;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#44;1 &#40;27&#44;7&#8208;32&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;0 &#40;21&#44;8&#8208;26&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;3 &#40;26&#44;0&#8208;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">S&#237;ndrome metab&#243;lica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;3 &#40;2&#44;6&#8208;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;1 &#40;3&#44;2&#8208;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;3 &#40;3&#44;4&#8208;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;9 &#40;4&#44;9&#8208;7&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;046&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncias &#40;95&#37; de intervalo de confian&#231;a&#41; de sobrepeso e obesidade estimadas pelos tr&#234;s crit&#233;rios diagn&#243;sticos e s&#237;ndrome metab&#243;lica na popula&#231;&#227;o de adolescentes escolares analisada no estudo</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">WHO&#44; <span class="elsevierStyleItalic">World Health Organization</span>&#59; IOTF&#44; <span class="elsevierStyleItalic">International Obesity Task Force</span>&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensibilidade &#40;IC95&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Especificidade &#40;IC95&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Acur&#225;cia global &#40;IC95&#37;&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleBold">Sobrepeso</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mo&#231;as</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#44;9 &#40;51&#44;8&#8208;56&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#44;0 &#40;58&#44;7&#8208;63&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#44;1 &#40;92&#44;0&#8208;98&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&#44;6 &#40;89&#44;2&#8208;95&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;70 &#40;0&#44;66&#8208;0&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;76 &#40;0&#44;71&#8208;0&#44;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#44;4 &#40;57&#44;2&#8208;61&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#44;1 &#40;64&#44;7&#8208;69&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;6 &#40;90&#44;6&#8208;96&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;1 &#40;90&#44;1&#8208;96&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;75 &#40;0&#44;71&#8208;0&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;82 &#40;0&#44;77&#8208;0&#44;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;2 &#40;44&#44;4&#8208;48&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;6 &#40;48&#44;6&#8208;52&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&#44;4 &#40;91&#44;2&#8208;97&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;9 &#40;90&#44;8&#8208;97&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;52 &#40;0&#44;49&#8208;0&#44;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;57 &#40;0&#44;54&#8208;0&#44;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Rapazes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;8 &#40;52&#44;8&#8208;56&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#44;1 &#40;61&#44;8&#8208;66&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;5 &#40;87&#44;6&#8208;93&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#44;8 &#40;86&#44;9&#8208;92&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;71 &#40;0&#44;67&#8208;0&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;78 &#40;0&#44;73&#8208;0&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#44;1 &#40;58&#44;0&#8208;62&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#44;6 &#40;68&#44;2&#8208;71&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#44;0 &#40;88&#44;2&#8208;93&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#44;4 &#40;85&#44;6&#8208;91&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;79 &#40;0&#44;75&#8208;0&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;86 &#40;0&#44;81&#8208;0&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;2 &#40;45&#44;4&#8208;49&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;7 &#40;49&#44;6&#8208;54&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&#44;8 &#40;89&#44;7&#8208;96&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;5 &#40;87&#44;5&#8208;93&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;54 &#40;0&#44;51&#8208;0&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;59 &#40;0&#44;55&#8208;0&#44;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleBold">Obesidade</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mo&#231;as</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#44;8 &#40;74&#44;0&#8208;79&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;3 &#40;74&#44;5&#8208;80&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;6 &#40;87&#44;6&#8208;93&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#44;5 &#40;85&#44;7&#8208;91&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;73 &#40;0&#44;69&#8208;0&#44;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;84 &#40;0&#44;79&#8208;0&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#44;0 &#40;81&#44;0&#8208;87&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#44;9 &#40;80&#44;0&#8208;85&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#44;8 &#40;88&#44;7&#8208;94&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#44;0 &#40;86&#44;1&#8208;91&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;78 &#40;0&#44;78&#8208;0&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;88 &#40;0&#44;83&#8208;0&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;5 &#40;49&#44;4&#8208;53&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;1 &#40;51&#44;7&#8208;56&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;1 &#40;90&#44;0&#8208;96&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;7 &#40;87&#44;8&#8208;93&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;54 &#40;0&#44;51&#8208;0&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;64 &#40;0&#44;40&#8208;0&#44;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Rapazes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;2 &#40;69&#44;6&#8208;74&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;0 &#40;75&#44;2&#8208;80&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#44;1 &#40;86&#44;3&#8208;91&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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Artigo Original
Performance of different diagnostic criteria of overweight and obesity as predictors of metabolic syndrome in adolescents
Raphael Gonçalves de Oliveira, Dartagnan Pinto Guedes
Autor para correspondência
darta@sercomtel.com.br

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Universidade Norte do Paraná (Unopar), Centro de Pesquisa em Ciências da Saúde, Londrina, PR, Brasil
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adipocinas&#44; chemocinas&#44; indicadores de inflama&#231;&#227;o derivados de hepat&#243;citos e algumas enzimas espec&#237;ficas&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> Contudo&#44; em idades jovens&#44; ainda prevalece o uso de biomarcadores de risco ditos tradicionais&#44; com destaque para a s&#237;ndrome metab&#243;lica &#40;<span class="elsevierStyleItalic">SMet</span>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">No entanto&#44; a complexidade dos procedimentos necess&#225;rios para identificar a SMet dificulta sua inclus&#227;o em rotinas de monitoramento do estado de sa&#250;de dos jovens&#44; o que solicita a proposi&#231;&#227;o de op&#231;&#245;es mais pr&#225;ticas e de uso imediato&#46; Nessa dire&#231;&#227;o&#44; estudos anteriores t&#234;m apresentado evid&#234;ncias no sentido de que o sobrepeso e a obesidade&#44; identificados por interm&#233;dio do &#237;ndice de massa corporal &#40;IMC&#41;&#44; s&#227;o definidos como poss&#237;veis preditores da SMet&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#8211;9</span></a> Portanto&#44; a classifica&#231;&#227;o adequada do sobrepeso e da obesidade pode constituir&#8208;se em importante instrumento complementar de triagem para presen&#231;a da SMet em crian&#231;as e adolescentes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">O uso de um crit&#233;rio diagn&#243;stico de sobrepeso e obesidade a partir do IMC como forma de triagem de SMet em adolescentes justifica&#8208;se como op&#231;&#227;o acess&#237;vel&#44; de f&#225;cil manuseio&#44; interpreta&#231;&#227;o imediata e bom custo&#8208;efetividade&#46; Contudo&#44; em nenhum momento busca substituir a interven&#231;&#227;o m&#233;dica&#44; considerando que n&#227;o exclui a necessidade de monitorar os componentes individuais para confirmar o diagn&#243;stico da SMet&#46; Uma triagem&#44; quando feita em ambientes de grande concentra&#231;&#227;o de jovens&#44; como &#233; o caso das escolas&#44; alcan&#231;a quantidade elevada de adolescentes&#44; em especial aqueles que apresentam dificuldade de acesso ou n&#227;o procuram o sistema de sa&#250;de&#46; Dessa maneira&#44; uma vez identificados os adolescentes com maior probabilidade de apresentar SMet&#44; esses podem ser encaminhados para acompanhamento m&#233;dico especializado&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Em adultos existe consenso quanto ao crit&#233;rio diagn&#243;stico para classificar o sobrepeso e a obesidade a partir do IMC&#59; por&#233;m&#44; esse n&#227;o &#233; o caso em crian&#231;as e adolescentes&#46; Considerando implica&#231;&#245;es relacionadas aos processos de crescimento f&#237;sico e matura&#231;&#227;o biol&#243;gica que surgem nessa fase de desenvolvimento&#44; o significado do IMC para sa&#250;de dos jovens solicita diferencia&#231;&#245;es mais complexas do que aquelas atribu&#237;das aos adultos&#46; Nesse particular&#44; foram propostos e t&#234;m sido usados diferentes crit&#233;rios diagn&#243;sticos a partir do IMC para identificar o excesso de peso corporal em jovens&#46; No contexto internacional destacam&#8208;se as propostas da <span class="elsevierStyleItalic">World Health Organization</span> &#40;WHO&#41;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;11</span></a> e da <span class="elsevierStyleItalic">International Obesity Task Force</span> &#40;IOTF&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">12&#44;13</span></a> enquanto para uso espec&#237;fico na popula&#231;&#227;o jovem brasileira a proposta de Conde &#38; Monteiro<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> tem recebido aten&#231;&#227;o especial&#46; No entanto&#44; n&#227;o existe consenso sobre a proposta a ser usada e&#44; desse modo&#44; surgem discuss&#245;es quanto &#224; validade de cada crit&#233;rio diagn&#243;stico para uso em popula&#231;&#245;es espec&#237;ficas&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Portanto&#44; 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&#40;Parecer 1&#46;302&#46;963&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Amostra e sele&#231;&#227;o dos sujeitos</span><p id="par0035" class="elsevierStylePara elsevierViewall">A popula&#231;&#227;o de refer&#234;ncia incluiu adolescentes de ambos os sexos&#44; entre 12 e 20 anos&#44; matriculados em escolas p&#250;blicas e privadas de 2&#176; ciclo do ensino fundamental &#40;6&#176; ao 9&#176; ano&#41; e ensino m&#233;dio &#40;1&#176; ao 3&#176; ano&#41;&#46; Inicialmente&#44; o tamanho da amostra foi estabelecido para atender ao objetivo de estimar a preval&#234;ncia de SMet e fatores associados&#44; assumiram&#8208;se intervalo de confian&#231;a de 95&#37;&#44; erro amostral de 3 pontos percentuais e acr&#233;scimo de 10&#37; para atender eventuais casos de perdas e como o planejamento amostral envolveu conglomerados &#40;estrutura escolar&#44; sexo&#44; turno e ano de estudo&#41;&#44; adicionou&#8208;se efeito de delineamento &#40;<span class="elsevierStyleItalic">deff</span>&#41; equivalente a 1&#44;5&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">De acordo com procedimentos empregados para c&#225;lculo do tamanho de amostras em estudos que envolvem teste diagn&#243;stico&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> identificou&#8208;se que essa amostra&#44; que reuniu 1&#46;035 adolescentes&#44; permite identificar adequadamente as propriedades de sensibilidade e especificidade&#46; O poder estat&#237;stico da amostra&#44; estratificado por sexo &#40;565 mo&#231;as e 470 rapazes&#41;&#44; foi calculado <span class="elsevierStyleItalic">a posteriori</span> e permite considerar&#44; com poder de 80&#37; e signific&#226;ncia de 5&#37;&#44; &#225;reas sob a curva ROC &#40;<span class="elsevierStyleItalic">Receiver Operating Characteristic</span>&#41; de&#44; pelo menos&#44; 0&#44;53 e 0&#44;56 para mo&#231;as e rapazes&#44; respectivamente&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Coleta dos dados</span><p id="par0045" class="elsevierStylePara elsevierViewall">A idade cronol&#243;gica foi estabelecida em anos e meses&#44; a partir da confronta&#231;&#227;o entre data de coleta dos dados e data de nascimento&#46; No entanto&#44; para feito de an&#225;lise dos dados&#44; foram constitu&#237;dos dois grupos et&#225;rios&#58; 12 a 15 anos e 16 a 20 anos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">O IMC foi calculado mediante a raz&#227;o entre medida do peso corporal&#44; expressa em quilogramas&#44; e da estatura&#44; expressa em metros quadrados &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; a partir dos procedimentos apresentados pela Organiza&#231;&#227;o Mundial da Sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> O sobrepeso e a obesidade foram identificados com os tr&#234;s crit&#233;rios diagn&#243;sticos espec&#237;ficos para sexo e idade&#58; WHO&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> IOTF<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> e Conde &#38; Monteiro&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> conforme explicitados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">A SMet foi identificada a partir da an&#225;lise do teor sangu&#237;neo de lip&#237;deos plasm&#225;ticos &#40;triglicer&#237;deos e lipoprote&#237;nas de alta densidade &#8211; HDL&#8208;colesterol&#41; e glicemia&#44; da press&#227;o arterial em repouso &#40;sist&#243;lica e diast&#243;lica&#41; e do ac&#250;mulo de gordura abdominal &#40;circunfer&#234;ncia de cintura&#41;&#44; de acordo com crit&#233;rios propostos pela <span class="elsevierStyleItalic">International Diabetes Federation</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> Nesse caso&#44; a SMet &#233; definida pela presen&#231;a obrigat&#243;ria da circunfer&#234;ncia de cintura elevada &#40;&#60; 16 anos&#58; ambos os sexos &#8805; percentil 90&#59; &#8805; 16 anos&#58; rapazes &#8805; 90<span class="elsevierStyleHsp" style=""></span>cm e mo&#231;as &#8805; 80<span class="elsevierStyleHsp" style=""></span>cm&#41; e&#44; pelo menos&#44; mais dois componentes comprometidos&#58; triglicer&#237;deos aumentados &#40;&#8805; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; HDL&#8208;colesterol diminu&#237;do &#40;&#60; 16 anos&#58; ambos os sexos<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; &#8805; 16 anos&#58; rapazes<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL e mo&#231;as<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; glicemia de jejum elevada &#40;&#8805; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; e press&#227;o arterial alterada &#40;sist&#243;lica &#8805; 130<span class="elsevierStyleHsp" style=""></span>mmHg ou diast&#243;lica &#8805; 85<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">As dosagens de lip&#237;deos plasm&#225;ticos e glicemia foram feitas mediante coleta de amostras de sangue por pun&#231;&#227;o venosa&#44; ap&#243;s 12 horas de jejum&#44; de acordo com t&#233;cnicas laboratoriais convencionais&#46; Os n&#237;veis de press&#227;o arterial sist&#243;lica e diast&#243;lica foram aferidos pelo m&#233;todo auscultat&#243;rio com aux&#237;lio de esfigmoman&#244;metro de coluna de merc&#250;rio&#44; com o adolescente sentado&#44; ap&#243;s per&#237;odo m&#237;nimo de cinco minutos de repouso&#46; Foram feitas duas medidas&#44; considerou&#8208;se o valor m&#233;dio de ambas as medidas para efeito de c&#225;lculo&#46; As medidas de circunfer&#234;ncia de cintura foram determinadas no ponto m&#233;dio entre a &#250;ltima costela e a crista&#8208;il&#237;aca&#44; com uma trena antropom&#233;trica inextens&#237;vel&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Tratamento estat&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">O tratamento estat&#237;stico foi feito mediante o <span class="elsevierStyleItalic">software</span> SPSS&#44; vers&#227;o 22 &#40;IBM Corp&#46; Released 2013&#46; IBM SPSS Statistics para Windows&#44; NY&#44; EUA&#41;&#46; Foram estimadas as propor&#231;&#245;es circunstanciais e respectivos intervalos de confian&#231;a de 95&#37; dos desfechos de interesse &#40;sobrepeso&#44; obesidade e SMet&#41; estratificados para sexo e idade&#46; Diferen&#231;as estat&#237;sticas entre os estratos sob investiga&#231;&#227;o foram analisadas com o teste de qui&#8208;quadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; para tend&#234;ncia linear&#46; O desempenho dos tr&#234;s crit&#233;rios diagn&#243;sticos de sobrepeso e obesidade &#40;WHO&#44; IOTF e Conde &#38; Monteiro&#41; como preditores da SMet foi analisado mediante propriedades de sensibilidade&#44; especificidade e acur&#225;cia global&#44; identificadas pelo m&#233;todo da curva ROC &#40;<span class="elsevierStyleItalic">Receiver Operating Characteristic</span>&#41;&#44; acompanhadas dos respectivos intervalos de confian&#231;a a 95&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> Poss&#237;veis diferen&#231;as significativas relacionadas &#224;s propriedades de sensibilidade&#44; especificidade e acur&#225;cia global foram identificadas mediante estat&#237;stica de McNemar &#40;&#967;<span class="elsevierStyleSup">2</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> mostra as preval&#234;ncias de sobrepeso&#44; obesidade e SMet na popula&#231;&#227;o de adolescentes analisada no estudo&#46; As preval&#234;ncias mais elevadas foram observadas mediante o uso do crit&#233;rio diagn&#243;stico Conde &#38; Monteiro&#59; fundamentalmente&#44; nos adolescentes entre 16 e 20 anos&#46; Por outro lado&#44; o crit&#233;rio diagn&#243;stico IOTF apontou preval&#234;ncias significativamente menores&#44; sobretudo nos rapazes&#46; A presen&#231;a de SMet foi identificada em 4&#44;5&#37; &#91;IC95&#37; 3&#44;8&#8208;5&#44;4&#93; da amostra&#44; significativamente maior nos rapazes e nos adolescentes com mais idade&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">O desempenho dos tr&#234;s crit&#233;rios diagn&#243;sticos de sobrepeso e obesidade como preditores de SMet &#233; apresentado na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; De maneira geral&#44; tanto no caso do sobrepeso como da obesidade&#44; constatam&#8208;se sensibilidades similares em ambos os sexos&#59; contudo&#44; valores mais elevados nos adolescentes com mais idade&#46; Quanto &#224; especificidade&#44; observa&#8208;se tend&#234;ncia para os valores apresentados pelas mo&#231;as se destacarem em compara&#231;&#227;o com os apresentados pelos rapazes&#44; n&#227;o foram identificadas diferen&#231;as importantes em rela&#231;&#227;o &#224; idade&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Em ambos os sexos&#44; independentemente da idade&#44; e nos tr&#234;s crit&#233;rios diagn&#243;sticos&#44; a sensibilidade equivalente &#224; obesidade se mostrou mais elevada&#44; enquanto maior especificidade foi observada para o sobrepeso&#46; Em todos os estratos considerados o crit&#233;rio diagn&#243;stico IOTF foi o que demonstrou maior sensibilidade&#46; Em contrapartida&#44; menor sensibilidade foi observada mediante o crit&#233;rio diagn&#243;stico Conde &#38; Monteiro&#46; Quanto &#224; especificidade&#44; os tr&#234;s crit&#233;rios diagn&#243;sticos apresentaram valores semelhantes e pr&#243;ximos de 90&#37;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">No que se refere &#224; propriedade de acur&#225;cia global&#44; com varia&#231;&#245;es entre 0&#44;52 e 0&#44;89&#44; visualizam&#8208;se diferen&#231;as mais acentuadas entre idades do que entre sexo&#46; Com rela&#231;&#227;o aos crit&#233;rios diagn&#243;sticos&#44; a proposta Conde &#38; Monteiro apontou acur&#225;cia global significativamente menor do que as propostas WHO e IOTF&#46; O uso do crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apontou valores &#8804; 0&#44;69&#44; o que sugere baixa acur&#225;cia global&#46; Por outro lado&#44; o uso dos crit&#233;rios diagn&#243;stico WHO e IOTF indicou valores entre 0&#44;70 e 0&#44;89&#44; com significativa vantagem para o crit&#233;rio diagn&#243;stico IOTF&#44; revelou&#8208;se&#44; desse modo&#44; moderada acur&#225;cia global&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0090" class="elsevierStylePara elsevierViewall">Independentemente do crit&#233;rio diagn&#243;stico usado&#44; um em cada quatro adolescentes analisados no estudo apresentou excesso de peso corporal &#40;&#8776; 25&#37;&#41;&#46; Essa propor&#231;&#227;o &#233; similar &#224; encontrada em estudo representativo do conjunto de munic&#237;pios brasileiros de m&#233;dio e grande porte&#59;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> contudo&#44; discretamente inferior &#224; de pa&#237;ses desenvolvidos e pr&#243;ximo de duas vezes maior do que a encontrada na popula&#231;&#227;o jovem de pa&#237;ses em desenvolvimento&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> Mediante o uso do mesmo crit&#233;rio diagn&#243;stico &#40;IDF&#41;&#44; a propor&#231;&#227;o de adolescentes com SMet &#233; superior &#224; encontrada recentemente na popula&#231;&#227;o jovem brasileira &#40;4&#44;5&#37; <span class="elsevierStyleItalic">vs</span>&#46; 2&#44;6&#37;&#41;&#59;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> por&#233;m&#44; inferior &#224; descrita em adolescentes americanos e europeus&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">O crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apresentou a menor capacidade para discriminar adolescentes portadores e n&#227;o portadores de SMet&#46; Estimativas relativas &#224; acur&#225;cia global revelaram que as chances de identificar corretamente a presen&#231;a de SMet mediante o uso desse crit&#233;rio diagn&#243;stico se aproximou de 50&#8208;60&#37; &#40;&#225;rea sob a curva ROC entre 0&#44;52 e 0&#44;64&#41;&#46; Nesse contexto&#44; se por um lado as especificidades alcan&#231;adas mediante o uso do crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apresentaram valores &#8805; 90&#37;&#44; por outro as sensibilidades n&#227;o ultrapassaram 55&#37;&#46; Logo&#44; ao empregar esse crit&#233;rio diagn&#243;stico para identificar SMet&#44; existe grande probabilidade dos adolescentes eutr&#243;ficos serem identificados como n&#227;o portadores de SMet&#59; por&#233;m&#44; as chances de detectar SMet diminuem acentuadamente entre aqueles adolescentes que apresentam sobrepeso ou s&#227;o obesos&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">As capacidades preditivas dos crit&#233;rios diagn&#243;stico WHO e IOTF para presen&#231;a de SMet se mostraram mais elevadas e com menores diferen&#231;as entre si&#59; contudo&#44; o crit&#233;rio diagn&#243;stico IOTF apresentou sensibilidades significativamente maiores do que os crit&#233;rios diagn&#243;sticos WHO e Conde &#38; Monteiro&#46; Nesse sentido&#44; o uso do crit&#233;rio diagn&#243;stico IOTF para identificar corretamente SMet resultou em 5&#8208;10&#37; e 13&#8208;22&#37; menos casos falso&#8208;negativos do que os crit&#233;rios diagn&#243;sticos WHO e Conde &#38; Monteiro&#44; respectivamente&#46; Em valores probabil&#237;sticos&#44; mediante o uso dos crit&#233;rios diagn&#243;sticos WHO e IOTF&#44; de cada dez adolescentes com excesso de peso corporal surgiram igualmente indica&#231;&#245;es de que por volta de sete a nove deles foram corretamente identificados com SMet &#40;&#225;rea sob a curva ROC entre 0&#44;70 e 0&#44;89&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">De maneira geral&#44; ao considerar os tr&#234;s crit&#233;rios diagn&#243;sticos como preditores da SMet&#44; as mo&#231;as e os adolescentes entre 12 e 15 anos apresentaram menor acur&#225;cia global&#46; Provavelmente esse fato possa ser reflexo do surto de crescimento puberal que ocorre nessa idade&#44; sobretudo entre as mo&#231;as&#46; Nesse caso&#44; devido &#224;s diferen&#231;as no <span class="elsevierStyleItalic">timing</span> da puberdade&#44; constata&#8208;se mais elevada variabilidade na associa&#231;&#227;o entre ac&#250;mulo de gordura corporal&#44; propor&#231;&#227;o de massa isenta de gordura e mudan&#231;as nos valores de IMC&#44; o que impacta diretamente na identifica&#231;&#227;o do sobrepeso e da obesidade&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Apesar de terem sido encontradas diferen&#231;as significativas equivalentes &#224;s propriedades de sensibilidade&#44; especificidade e acur&#225;cia global&#44; os achados do presente estudo confirmaram que os tr&#234;s crit&#233;rios diagn&#243;sticos apresentam capacidade de predizer SMet&#44; com indicadores de validade mais adequados nos adolescentes tidos como obesos&#46; Nesse contexto&#44; &#233; importante mencionar que os tr&#234;s crit&#233;rios diagn&#243;sticos t&#234;m em comum o fato de usarem pontos de corte arbitr&#225;rios&#44; alicer&#231;ados&#44; sobretudo&#44; em pressupostos estat&#237;sticos&#46; Logo&#44; essas diferen&#231;as podem&#44; em parte&#44; ser explicadas pelas diferentes metodologias empregadas em suas proposi&#231;&#245;es e&#44; principalmente&#44; pelas preval&#234;ncias de sobrepeso e obesidade e tend&#234;ncia secular do IMC da popula&#231;&#227;o de refer&#234;ncia usada para o conjunto de dados da amostra&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A proposta da WHO baseia&#8208;se em dados de jovens americanos coletados em 1971&#8208;74 e reprocessados mais recentemente&#44; para atenuar limita&#231;&#245;es detectadas em proposta anterior&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> Embora possam existir evid&#234;ncias no sentido de que&#44; na &#250;ltima d&#233;cada&#44; as preval&#234;ncias de sobrepeso e obesidade na popula&#231;&#227;o jovem dos Estados Unidos t&#234;m apresentado tend&#234;ncia de estabiliza&#231;&#227;o&#44; esse n&#227;o &#233; o caso quando da compara&#231;&#227;o entre dados da d&#233;cada de 1970 e de gera&#231;&#245;es mais recentes&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Por outro lado&#44; a proposta IOTF prov&#233;m de levantamentos nacionais representativos de jovens de seis pa&#237;ses &#40;Estados Unidos&#44; Inglaterra&#44; Brasil&#44; Cingapura&#44; Holanda e Hong&#8208;Kong&#41;&#46; Os levantamentos foram feitos em momentos diferentes&#44; entre 1973 e 1993&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">12&#44;13</span></a> o que dificulta a an&#225;lise da tend&#234;ncia secular do IMC na proposi&#231;&#227;o desse crit&#233;rio diagn&#243;stico&#46; A proposta Conde &#38; Monteiro usou dados extra&#237;dos da Pesquisa Nacional de Sa&#250;de e Nutri&#231;&#227;o&#44; envolveu amostra com representatividade nacional de jovens brasileiros&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> Os dados foram coletados em 1989&#44; momento em que a preval&#234;ncia de sobrepeso e obesidade da popula&#231;&#227;o jovem no Brasil era significativamente menor do que nos dias atuais&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Ainda&#44; ressalta&#8208;se que&#44; quando da sele&#231;&#227;o de um crit&#233;rio diagn&#243;stico espec&#237;fico&#44; torna&#8208;se prudente levar em conta a influ&#234;ncia de componentes &#233;tnicos&#46; Neste sentido&#44; para uso em adolescentes brasileiros&#44; a princ&#237;pio&#44; o crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apresenta grande vantagem e&#44; pelo contr&#225;rio&#44; mesmo assumindo o perfil multi&#233;tnico da popula&#231;&#227;o jovem norte&#8208;americana&#44; dever&#225; ser contabilizada importante limita&#231;&#227;o na sele&#231;&#227;o do crit&#233;rio diagn&#243;stico WHO&#46; O crit&#233;rio diagn&#243;stico IOTF parece ser mais adequado para garantir uma aplica&#231;&#227;o multi&#233;tnica&#44; uma vez que &#233; baseado em seis conjuntos de dados&#44; inclusive o Brasil&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Quanto &#224;s diferentes metodologias empregadas para identificar os pontos de corte&#44; a proposta WHO usou recursos probabil&#237;sticos em que valores de IMC equivalentes aos percentis 85 e 95 foram apontados para identificar aqueles adolescentes com sobrepeso e obesos&#44; respectivamente&#46; Portanto&#44; assumiu&#8208;se que&#44; na popula&#231;&#227;o de refer&#234;ncia&#44; independentemente de qualquer outra informa&#231;&#227;o adicional&#44; exatamente 15&#37; dos jovens de cada sexo e idade apresentavam sobrepeso e 5&#37; obesidade&#46; Limita&#231;&#227;o importante dessa metodologia &#233; considerar que valores mais elevados de IMC na distribui&#231;&#227;o de percentil da popula&#231;&#227;o de refer&#234;ncia possam representar a presen&#231;a de sobrepeso e obesidade&#44; em vez de apenas indicar os jovens que s&#227;o mais pesados em compara&#231;&#227;o com seus pares&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Pelo contr&#225;rio&#44; as propostas IOTF e Conde &#38; Monteiro foram idealizadas de forma independente da distribui&#231;&#227;o de percentil do IMC na popula&#231;&#227;o de refer&#234;ncia&#46; Nesse caso&#44; os pontos de corte foram definidos mediante crit&#233;rio epidemiol&#243;gico&#44; a partir de ajustes de modelos matem&#225;ticos espec&#237;ficos para sexo e idade&#44; em que aos 18 anos apresentavam intercep&#231;&#227;o com valores de IMC representativos de riscos aumentados para presen&#231;a de desfechos de sa&#250;de no in&#237;cio da vida adulta&#44; em consequ&#234;ncia do sobrepeso e da obesidade&#44; ou seja&#44; 25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> e 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; respectivamente&#46; No entanto&#44; o procedimento metodol&#243;gico adotado pelas duas propostas n&#227;o est&#225; isento de cr&#237;tica&#46; Embora n&#227;o sejam dependentes da distribui&#231;&#227;o de percentil&#44; presumiu&#8208;se que a propor&#231;&#227;o de jovens da popula&#231;&#227;o de refer&#234;ncia com sobrepeso e obesidade era a mesma em ambos os sexos e em todas as idades&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Os resultados reunidos no estudo corroboram achados da literatura que apontam elevada especificidade acompanhada de razo&#225;vel sensibilidade para identificar risco cardiometab&#243;lico em jovens mediante o uso de crit&#233;rios diagn&#243;sticos a partir do IMC&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#8211;9</span></a> Contudo&#44; de alguma maneira&#44; discordam parcialmente dos resultados encontrados em estudo que envolveu crian&#231;as brasileiras que procurou identificar a capacidade preditiva de crit&#233;rios diagn&#243;sticos especificamente para presen&#231;a de press&#227;o arterial elevada&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> No estudo foram encontrados indicadores equivalentes &#224; acur&#225;cia global similares para os crit&#233;rios diagn&#243;sticos Conde &#38; Monteiro e IOTF&#46; Possivelmente&#44; o uso isolado do componente press&#227;o arterial elevada&#44; em vez do conglomerado de componentes que define a SMet&#44; e a menor idade dos sujeitos reunidos no estudo &#40;entre seis e 13 anos&#41; possam explicar eventuais discord&#226;ncia entre ambos os estudos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O presente estudo apresenta algumas limita&#231;&#245;es que devem ser consideradas&#46; Mesmo que tenha assumido a baixa taxa de recusa para a tomada das medidas &#40;&#8776; 8&#37;&#41;&#44; n&#227;o se pode descartar a possibilidade de ter ocorrido vi&#233;s de sele&#231;&#227;o&#44; tendo em vista que n&#227;o foi poss&#237;vel comparar dados dos adolescentes participantes e n&#227;o participantes&#46; Tamb&#233;m &#233; importante referir que&#44; por n&#227;o haver um crit&#233;rio universal para defini&#231;&#227;o de SMet&#44; optou&#8208;se por usar crit&#233;rio proposto pela IDF e&#44; nesse sentido&#44; as estimativas de preval&#234;ncia de SMet podem variar de acordo com o crit&#233;rio empregado&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Concluindo&#44; evid&#234;ncias encontradas no estudo contribuem para o conhecimento da &#225;rea e mostram que&#44; dos tr&#234;s crit&#233;rios diagn&#243;stico de sobrepeso e obesidade a partir do IMC &#40;WHO&#44; IOTF e Conde &#38; Monteiro&#41;&#44; o IOTF demonstrou capacidade preditiva significativamente mais elevada para presen&#231;a de SMet&#46; Contudo&#44; tendo em vista que o IMC &#233; um preditor importante para presen&#231;a de SMet em adolescentes&#44; o grande desafio continua a ser ajustar pontos de corte que possam minimizar a quantidade de casos falso&#8208;negativos &#40;maiores &#237;ndices de sensibilidade&#41; e maximizar a quantidade de casos verdadeiro&#8208;negativos &#40;maiores &#237;ndices de especificidade&#41;&#44; como j&#225; observados nos tr&#234;s crit&#233;rios diagn&#243;sticos considerados no estudo&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiamento</span><p id="par0155" class="elsevierStylePara elsevierViewall">Dartagnan Pinto Guedes &#233; bolsista de Produtividade em Pesquisa do Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico &#40;CNPq&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflitos de interesse</span><p id="par0160" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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              "titulo" => "Tratamento estat&#237;stico"
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          "titulo" => "Refer&#234;ncias"
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    "fechaRecibido" => "2016-07-22"
    "fechaAceptado" => "2016-11-25"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec884900"
          "palabras" => array:5 [
            0 => "Body mass index"
            1 => "Diagnosis"
            2 => "Accuracy"
            3 => "Cardiovascular risk"
            4 => "Youth"
          ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras&#8208;chave"
          "identificador" => "xpalclavsec884899"
          "palabras" => array:5 [
            0 => "&#205;ndice de massa corporal"
            1 => "Diagn&#243;stico"
            2 => "Acur&#225;cia"
            3 => "Risco cardiovascular"
            4 => "Jovens"
          ]
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the performance of three different diagnostic criteria of overweight and obesity &#40;WHO&#44; IOTF and Conde and Monteiro&#41; using body mass index &#40;BMI&#41; as predictors of metabolic syndrome &#40;MetS&#41; in a representative sample of adolescents&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A sample of 1035 adolescents aged 12&#8211;20 years &#40;565 girls and 470 boys&#41; was used in the study&#46; BMI was calculated through the quotient of weight &#40;kg&#41;&#47;height squared &#40;m&#41;<span class="elsevierStyleSup">2</span>&#44; and MetS was defined according to the criteria of the International Diabetes Federation&#46; Sensitivity&#44; specificity&#44; and overall accuracy &#40;area under the curve&#41; were estimated using the receiver operating characteristic &#40;ROC&#41; curves method and used to describe the predictive performance&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The three diagnostic criteria showed higher absolute values of sensitivity and specificity for predicting MetS in boys and older adolescents&#46; The highest sensitivity to identify MetS was found using the IOTF criterion &#40;60&#8211;85&#37;&#41;&#44; while specificity values &#8805; 90&#37; were found for the three criteria&#46; The Conde and Monteiro diagnostic criterion pointed to a significantly lower overall accuracy &#40;0&#46;52&#8211;0&#46;64&#41; than that of the WHO &#40;0&#46;70&#8211;0&#46;84&#41; and IOTF &#40;0&#46;75&#8211;0&#46;89&#41; diagnostic criterion&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Overweight and obesity using BMI showed a moderate association with MetS&#44; regardless of the diagnostic criteria used&#46; However&#44; the IOTF criterion showed better predictive capacity for the presence of MetS than the WHO and the Conde and Monteiro criteria&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0005"
            "titulo" => "Objective"
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            "identificador" => "abst0010"
            "titulo" => "Methods"
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            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusions"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analisar o desempenho de tr&#234;s diferentes crit&#233;rios diagn&#243;sticos de sobrepeso e obesidade &#40;WHO&#44; IOTF e Conde &#38; Monteiro&#41; a partir do &#237;ndice de massa corporal &#40;IMC&#41; como preditores da s&#237;ndrome metab&#243;lica &#40;SMet&#41; em amostra representativa de adolescentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A amostra foi constitu&#237;da por 1&#46;035 adolescentes &#40;565 mo&#231;as e 470 rapazes&#41; entre 12 e 20 anos&#46; O IMC foi calculado mediante quociente entre peso &#40;kg&#41;&#47;altura &#40;m&#41;<span class="elsevierStyleSup">2</span> e SMet foi definida atrav&#233;s dos crit&#233;rios da <span class="elsevierStyleItalic">International Diabetes Federation</span>&#46; Desempenho preditivo foi descrito a partir das estimativas de sensibilidade&#44; especificidade e acur&#225;cia global &#40;&#225;rea sob a curva&#41; com o m&#233;todo de curvas <span class="elsevierStyleItalic">Receiver Operating Characteristic</span>&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os tr&#234;s crit&#233;rios diagn&#243;sticos apresentaram maiores valores absolutos de sensibilidade e especificidade para predi&#231;&#227;o da SMet nos rapazes e nos adolescentes com mais idade&#46; Maior sensibilidade para identificar SMet foi observada com o crit&#233;rio IOTF &#40;60&#37; a 85&#37;&#41;&#44; enquanto especificidade &#8805; 90&#37; foi observada mediante o uso dos tr&#234;s crit&#233;rios diagn&#243;sticos&#46; O crit&#233;rio diagn&#243;stico Conde &#38; Monteiro apontou acur&#225;cia global &#40;0&#44;52 a 0&#44;64&#41; significativamente menor do que os crit&#233;rios diagn&#243;sticos WHO &#40;0&#44;70 a 0&#44;84&#41; e IOTF &#40;0&#44;75 a 0&#44;89&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sobrepeso e obesidade a partir do IMC mostraram uma moderada associa&#231;&#227;o com SMet&#44; independentemente do crit&#233;rio diagn&#243;stico empregado&#46; Contudo&#44; o crit&#233;rio IOTF demonstrou melhor capacidade preditiva para presen&#231;a de SMet do que os crit&#233;rios WHO e Conde &#38; Monteiro&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Oliveira RG&#44; Guedes DP&#46; Performance of different diagnostic criteria of overweight and obesity as predictors of metabolic syndrome in adolescents&#46; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;525&#8211;31&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crit&#233;rio diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Levantamento de refer&#234;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sobrepeso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obesidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Jovens americanos&#46; Dados coletados em 1971&#8208;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Distribui&#231;&#227;o de percentil considerando IMC entre os percentis 85 e 95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Distribui&#231;&#227;o de percentil considerando IMC acima do percentil 95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Jovens de seis pa&#237;ses &#40;Estados Unidos&#44; Inglaterra&#44; Brasil&#44; Cingapura&#44; Holanda e Hong&#8208;Kong&#41;&#46; Dados coletados entre 1973 e 1993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ponto de corte mediante ajuste matem&#225;tico considerando IMC adulto entre 25 e 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ponto de corte mediante ajuste matem&#225;tico considerando IMC adulto acima de 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Jovens brasileiros&#46; Dados coletados em 1989&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ponto de corte mediante ajuste matem&#225;tico considerando IMC adulto entre 25 e 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ponto de corte mediante ajuste matem&#225;tico considerando IMC adulto acima de 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Crit&#233;rios diagn&#243;sticos para identificar excesso de peso corporal em jovens a partir do &#237;ndice de massa corporal &#40;IMC&#41; de acordo com a <span class="elsevierStyleItalic">World Health Organization</span> &#40;WHO&#41;&#44; <span class="elsevierStyleItalic">International Obesity Task Force</span> &#40;IOTF&#41; e Conde &#38; Monteiro</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">WHO&#44; <span class="elsevierStyleItalic">World Health Organization&#59;</span> IOTF<span class="elsevierStyleItalic">&#44; International Obesity Task Force</span>&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mo&#231;as</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Rapazes</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Teste &#967;<span class="elsevierStyleSup">2</span></th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Sobrepeso</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;5 &#40;15&#44;1&#8208;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;5 &#40;18&#44;6&#8208;22&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;1 &#40;15&#44;6&#8208;19&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;8 &#40;17&#44;2&#8208;20&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;5 &#40;14&#44;2&#8208;17&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;2 &#40;16&#44;7&#8208;19&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;2 &#40;12&#44;9&#8208;15&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;3 &#40;14&#44;9&#8208;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;9 &#40;15&#44;4&#8208;18&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;8 &#40;20&#44;7&#8208;25&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;9 &#40;16&#44;2&#8208;19&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;0 &#40;19&#44;0&#8208;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Obesidade</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;2 &#40;4&#44;3&#8208;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;5 &#40;5&#44;6&#8208;7&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;9 &#40;5&#44;1&#8208;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;6 &#40;5&#44;7&#8208;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;9 &#40;4&#44;1&#8208;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;8 &#40;5&#44;0&#8208;6&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;7 &#40;4&#44;0&#8208;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;0 &#40;4&#44;2&#8208;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;3 &#40;4&#44;3&#8208;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;2 &#40;6&#44;2&#8208;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;1 &#40;5&#44;1&#8208;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;3 &#40;6&#44;3&#8208;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Sobrepeso &#43; obesidade</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;7 &#40;19&#44;7&#8208;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;0 &#40;24&#44;8&#8208;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;1 &#40;21&#44;1&#8208;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;5 &#40;23&#44;3&#8208;27&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;4 &#40;18&#44;5&#8208;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;0 &#40;22&#44;0&#8208;26&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;9 &#40;17&#44;1&#8208;20&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;4 &#40;19&#44;4&#8208;23&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;2 &#40;20&#44;1&#8208;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#44;1 &#40;27&#44;7&#8208;32&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;0 &#40;21&#44;8&#8208;26&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;3 &#40;26&#44;0&#8208;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">S&#237;ndrome metab&#243;lica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;3 &#40;2&#44;6&#8208;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;1 &#40;3&#44;2&#8208;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;3 &#40;3&#44;4&#8208;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;9 &#40;4&#44;9&#8208;7&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;046&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncias &#40;95&#37; de intervalo de confian&#231;a&#41; de sobrepeso e obesidade estimadas pelos tr&#234;s crit&#233;rios diagn&#243;sticos e s&#237;ndrome metab&#243;lica na popula&#231;&#227;o de adolescentes escolares analisada no estudo</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">WHO&#44; <span class="elsevierStyleItalic">World Health Organization</span>&#59; IOTF&#44; <span class="elsevierStyleItalic">International Obesity Task Force</span>&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensibilidade &#40;IC95&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Especificidade &#40;IC95&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Acur&#225;cia global &#40;IC95&#37;&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">12&#8211;15 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">16&#8211;20 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleBold">Sobrepeso</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mo&#231;as</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#44;9 &#40;51&#44;8&#8208;56&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#44;0 &#40;58&#44;7&#8208;63&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#44;1 &#40;92&#44;0&#8208;98&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&#44;6 &#40;89&#44;2&#8208;95&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;70 &#40;0&#44;66&#8208;0&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;76 &#40;0&#44;71&#8208;0&#44;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#44;4 &#40;57&#44;2&#8208;61&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#44;1 &#40;64&#44;7&#8208;69&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;6 &#40;90&#44;6&#8208;96&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;1 &#40;90&#44;1&#8208;96&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;75 &#40;0&#44;71&#8208;0&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;82 &#40;0&#44;77&#8208;0&#44;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;2 &#40;44&#44;4&#8208;48&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;6 &#40;48&#44;6&#8208;52&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&#44;4 &#40;91&#44;2&#8208;97&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;9 &#40;90&#44;8&#8208;97&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;52 &#40;0&#44;49&#8208;0&#44;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;57 &#40;0&#44;54&#8208;0&#44;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Rapazes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;8 &#40;52&#44;8&#8208;56&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#44;1 &#40;61&#44;8&#8208;66&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;5 &#40;87&#44;6&#8208;93&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#44;8 &#40;86&#44;9&#8208;92&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;71 &#40;0&#44;67&#8208;0&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;78 &#40;0&#44;73&#8208;0&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#44;1 &#40;58&#44;0&#8208;62&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#44;6 &#40;68&#44;2&#8208;71&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#44;0 &#40;88&#44;2&#8208;93&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#44;4 &#40;85&#44;6&#8208;91&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;79 &#40;0&#44;75&#8208;0&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;86 &#40;0&#44;81&#8208;0&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;2 &#40;45&#44;4&#8208;49&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;7 &#40;49&#44;6&#8208;54&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&#44;8 &#40;89&#44;7&#8208;96&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;5 &#40;87&#44;5&#8208;93&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;54 &#40;0&#44;51&#8208;0&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;59 &#40;0&#44;55&#8208;0&#44;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleBold">Obesidade</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mo&#231;as</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#44;8 &#40;74&#44;0&#8208;79&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;3 &#40;74&#44;5&#8208;80&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;6 &#40;87&#44;6&#8208;93&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#44;5 &#40;85&#44;7&#8208;91&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;73 &#40;0&#44;69&#8208;0&#44;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;84 &#40;0&#44;79&#8208;0&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#44;0 &#40;81&#44;0&#8208;87&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#44;9 &#40;80&#44;0&#8208;85&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#44;8 &#40;88&#44;7&#8208;94&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#44;0 &#40;86&#44;1&#8208;91&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;78 &#40;0&#44;78&#8208;0&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;88 &#40;0&#44;83&#8208;0&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;5 &#40;49&#44;4&#8208;53&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;1 &#40;51&#44;7&#8208;56&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;1 &#40;90&#44;0&#8208;96&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;7 &#40;87&#44;8&#8208;93&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;54 &#40;0&#44;51&#8208;0&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;64 &#40;0&#44;40&#8208;0&#44;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Rapazes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>WHO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;2 &#40;69&#44;6&#8208;74&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;0 &#40;75&#44;2&#8208;80&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#44;1 &#40;86&#44;3&#8208;91&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&#44;7 &#40;84&#44;9&#8208;90&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;78 &#40;0&#44;73&#8208;0&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;84 &#40;0&#44;78&#8208;0&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IOTF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#44;6 &#40;78&#44;8&#8208;84&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#44;2 &#40;81&#44;1&#8208;87&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#44;5 &#40;86&#44;6&#8208;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#44;2 &#40;85&#44;4&#8208;91&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;85 &#40;0&#44;79&#8208;0&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;89 &#40;0&#44;84&#8208;0&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Conde &#38; Monteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#44;2 &#40;50&#44;0&#8208;54&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;4 &#40;51&#44;6&#8208;57&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#44;6 &#40;88&#44;5&#8208;94&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;4 &#40;85&#44;5&#8208;91&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;56 &#40;0&#44;52&#8208;0&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;63 &#40;0&#44;59&#8208;0&#44;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teste &#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Desempenho dos crit&#233;rios diagn&#243;sticos WHO&#44; IOTF e Conde e Monteiro de sobrepeso e obesidade como preditores de s&#237;ndrome metab&#243;lica</p>"
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                    0 => array:2 [
                      "titulo" => "Global&#44; regional&#44; and national prevalence of overweight and obesity in children and adults during 1980&#8211;2013&#58; a systematic analysis for the Global Burden of Disease Study 2013"
                      "autores" => array:1 [
                        0 => array:2 [
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                            0 => "M&#46; Ng"
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                            2 => "M&#46; Robinson"
                            3 => "B&#46; Thomson"
                            4 => "N&#46; Graetz"
                            5 => "C&#46; Margono"
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                      "doi" => "10.1016/S0140-6736(14)60460-8"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2014"
                        "volumen" => "384"
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                        "paginaFinal" => "781"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24880830"
                            "web" => "Medline"
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                      "titulo" => "The health risk of obesity &#8211; better metrics imperative"
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                        0 => array:2 [
                          "etal" => false
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