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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A s&#237;ndrome metab&#243;lica &#40;SM&#41; foi descrita a primeira vez em 1988 e &#233; compreendida como um conjunto de dist&#250;rbios metab&#243;licos que se relacionam ao ac&#250;mulo de gordura central e resist&#234;ncia &#224; insulina&#44; resulta em aumento do risco cardiovascular&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a> Entre os adolescentes&#44; a preval&#234;ncia de SM varia&#44; depende do crit&#233;rio adotado e de caracter&#237;sticas da popula&#231;&#227;o avaliada&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> O conjunto de doen&#231;as adquirido durante a inf&#226;ncia&#47;adolesc&#234;ncia tende a persistir na vida adulta&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A estrutura&#231;&#227;o diagn&#243;stica da SM iniciou&#8208;se na d&#233;cada de 1980&#44; compreende v&#225;rios crit&#233;rios&#44; entre eles a classifica&#231;&#227;o da <span class="elsevierStyleItalic">International Diabetes Federation</span> &#40;IDF&#41;&#44; proposta em 2005&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Essa admite como crit&#233;rios da SM a presen&#231;a de altera&#231;&#245;es glic&#234;micas&#44; lip&#237;dicas e press&#243;ricas e considera a obesidade central&#44; determinada pela medida da circunfer&#234;ncia abdominal &#40;CA&#41;&#44; o mais importante marcador&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o da obesidade central pela medida da CA &#233; simples e n&#227;o invasiva&#46; Entretanto&#44; tem como desvantagem a variabilidade intra e interexaminador&#44; bem como a incapacidade de diferenciar o tecido adiposo intra&#8208;abdominal do subcut&#226;neo&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> Novos m&#233;todos t&#234;m sido propostos para a mensura&#231;&#227;o do componente adiposo&#44; como a investiga&#231;&#227;o das dobras cut&#226;neas<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> e os exames de imagem &#40;imagiologia&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Os exames de imagem s&#227;o ferramentas adequadas na diferencia&#231;&#227;o e na quantifica&#231;&#227;o de gordura intra&#8208;abdominal &#40;GA&#41; e subcut&#226;nea &#40;GSC&#41;&#46; A precis&#227;o na caracteriza&#231;&#227;o desses tecidos oferece subs&#237;dio para a quantifica&#231;&#227;o do risco de doen&#231;as cr&#244;nicas&#44; &#233; poss&#237;vel por meio de ultrassonografia &#40;USG&#41;&#44; tomografia computadorizada &#40;TC&#41; e resson&#226;ncia magn&#233;tica &#40;RM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A TC do abdome &#233; considerada o padr&#227;o&#8208;ouro na quantifica&#231;&#227;o da gordura abdominal&#46; A RM tamb&#233;m pode estimar a gordura intra&#8208;abdominal com boa acur&#225;cia&#44; por&#233;m est&#225; sujeita a maior variabilidade e a um maior n&#250;mero de artefatos&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Armellini et al&#46; salientam a boa correla&#231;&#227;o entre as medidas do tecido adiposo intra&#8208;abdominal feitas por ultrassom e pela tomografia computadorizada&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Stolk et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> detectaram forte correla&#231;&#227;o das medidas da ultrassonografia&#44; da tomografia computadorizada e da ultrassonografia com a medida da CA do tecido adiposo intra&#8208;abdominal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A presen&#231;a da SM na faixa et&#225;ria pedi&#225;trica e em adolescentes est&#225; ligada ao aumento do risco de ocorr&#234;ncia de dist&#250;rbios metab&#243;licos e cardiovasculares na vida adulta&#46; Profissionais de sa&#250;de t&#234;m nos exames de ultrassom uma ferramenta bastante &#250;til que favorece o diagn&#243;stico precoce da SM&#46; Mesmo sendo um exame simples&#44; n&#227;o invasivo&#44; livre dos riscos das radia&#231;&#245;es ionizantes e de baixo custo&#44; a ultrassonografia tem sido pouco usada para a avalia&#231;&#227;o da obesidade central e&#44; consequentemente&#44; da SM&#46; At&#233; nosso conhecimento&#44; n&#227;o existem pontos de corte da espessura da gordura intra&#8208;abdominal medida por ultrassonografia que possam ser empregados na predi&#231;&#227;o de SM em adolescentes&#46; Nesse sentido&#44; os objetivos deste estudo foram relacionar a espessura da gordura intra&#8208;abdominal medida pela ultrassonografia com indicadores cl&#237;nicos e laboratoriais usados no diagn&#243;stico da SM e apontar poss&#237;veis pontos de corte que possam identificar indiv&#237;duos com maior chance de apresentar s&#237;ndrome metab&#243;lica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes e m&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudo seccional feito de mar&#231;o a junho de 2016&#44; com adolescentes entre 14 e 19 anos&#44; matriculados em escolas estaduais da regi&#227;o central do munic&#237;pio de Divin&#243;polis&#8208;MG&#44; Brasil&#46; A pesquisa foi conduzida dentro de um estudo maior&#44; que visou a estimar fatores associados ao excesso de peso nos adolescentes&#46; A amostra estimada no estudo base &#40;330 adolescentes&#41; considerou a preval&#234;ncia de excesso de peso em adolescentes &#40;27&#44;47&#37;&#41; registrada no Sistema de Vigil&#226;ncia Alimentar e Nutricional no munic&#237;pio&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> al&#233;m de um erro amostral e de um n&#237;vel de signific&#226;ncia de 5&#37;&#46; Para a defini&#231;&#227;o da amostra do presente estudo&#44; tendo em vista que a preval&#234;ncia de s&#237;ndrome metab&#243;lica em adolescentes &#233; de cerca de 7&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> optou&#8208;se por um erro amostral absoluto menor &#40;1&#44;5&#37;&#41;&#44; o que resultou em um quantitativo de 1&#46;100 estudantes&#46; Desses&#44; 563 recusaram&#8208;se e 114 atendiam aos crit&#233;rios de exclus&#227;o&#44; o que resultou na popula&#231;&#227;o de 423 participantes no fim da investiga&#231;&#227;o&#46; Para a representatividade da popula&#231;&#227;o de estudantes da regi&#227;o central do munic&#237;pio&#44; cada estrato foi determinado proporcionalmente em rela&#231;&#227;o ao n&#250;mero de matriculados em cada escola&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A pesquisa foi aprovada pelo Comit&#234; de &#201;tica em Pesquisa da Universidade Federal de S&#227;o Jo&#227;o Del&#8208;Rei &#40;parecer n&#250;mero 938&#46;058 de 19 de 2015&#41;&#46; Os pais ou respons&#225;veis pelos participantes foram informados sobre a pesquisa&#46; Os alunos com interesse em participar do estudo receberam os termos de assentimento e consentimento livre e esclarecido para assinatura de seus pais ou respons&#225;veis&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Exames laboratoriais&#44; medidas antropom&#233;tricas e question&#225;rios</span><p id="par0050" class="elsevierStylePara elsevierViewall">Os exames laboratoriais foram coletados na pr&#243;pria escola em que o adolescente encontrava&#8208;se matriculado&#44; ap&#243;s jejum de no m&#237;nimo 12 horas&#44; por profissional treinado&#44; em data previamente agendada&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Os valores de glicemia&#44; HDL e triglicer&#237;deos foram interpretados de acordo com os par&#226;metros dos crit&#233;rios espec&#237;ficos para diagn&#243;stico de SM<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> preconizados pela IDF&#44; que determinam como altera&#231;&#245;es&#58; para indiv&#237;duos entre 10 e 16 anos&#58; n&#237;vel de triglicer&#237;deos &#62; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; HDL&#8208;colesterol &#60; 40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; glicemia de jejum &#8805; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; J&#225;&#44; para aqueles com mais de 16 anos&#58; adotam&#8208;se os crit&#233;rios diagn&#243;sticos empregados na avalia&#231;&#227;o de adultos &#40;HDL&#8208;colesterol com valor &#8804; 35<span class="elsevierStyleHsp" style=""></span>mg&#47;dL para homens e &#8804; 40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL para mulheres&#59; n&#237;vel de triglicer&#237;deos &#62; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; e glicemia de jejum &#8805; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46; Considera&#8208;se positivo o diagn&#243;stico de SM na presen&#231;a de adiposidade central associada &#224; altera&#231;&#227;o de dois ou mais outros par&#226;metros&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A antropometria e as medidas da press&#227;o arterial foram feitas de acordo com uma rotina do exame pr&#233;&#8208;estabelecida&#44; foram feitas em triplicata pelo mesmo examinador e adotou&#8208;se como valor a m&#233;dia das tr&#234;s medidas&#46; A circunfer&#234;ncia da cintura foi medida com fita inel&#225;stica&#44; usou&#8208;se como refer&#234;ncia o ponto m&#233;dio entre o &#250;ltimo arco costal e as cristas il&#237;acas&#44; em pele descoberta&#46; Os dados de circunfer&#234;ncia de cintura foram avaliados de acordo com aqueles fornecidos por McCarthy et al&#46; &#40;2001&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> e indicados em estudo anterior&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">O peso foi medido em balan&#231;as eletr&#244;nicas digitais&#44; marca Tanita<span class="elsevierStyleSup">&#174;</span>&#44; modelo <span class="elsevierStyleItalic">HD 313</span>&#44; e a altura medida com estadi&#244;metro vertical port&#225;til da marca Alturaexata<span class="elsevierStyleSup">&#174;</span>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A press&#227;o arterial foi aferida com manguito com o uso do aparelho autom&#225;tico de press&#227;o arterial Omron<span class="elsevierStyleSup">&#174;</span> modelo HEM 711&#44; ap&#243;s cinco minutos de repouso&#44; de acordo a t&#233;cnica recomendada pela Sociedade Brasileira de Cardiologia&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> Consideraram&#8208;se valores press&#243;ricos elevados superiores a 130<span class="elsevierStyleHsp" style=""></span>mmHg de press&#227;o arterial sist&#243;lica e 85<span class="elsevierStyleHsp" style=""></span>mmHg de press&#227;o arterial diast&#243;lica&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Exame ultrassonogr&#225;fico</span><p id="par0075" class="elsevierStylePara elsevierViewall">As medidas da espessura da gordura intra&#8208;abdominal foram obtidas em equipamento de ultrassom port&#225;til Samsung Medson<span class="elsevierStyleSup">&#174;</span>&#44; modelo PICO&#44; com transdutor convexo de 3&#44;5 a 5<span class="elsevierStyleHsp" style=""></span>MHz por meio da t&#233;cnica descrita por Stolk et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> As medidas foram feitas em triplicata&#44; sempre pelo mesmo operador&#44; com padroniza&#231;&#227;o t&#233;cnica pr&#233;via e compara&#231;&#227;o estat&#237;stica por meio de estudo&#8208;piloto feito com dois operadores distintos&#46; Para todas as imagens&#44; o transdutor foi posicionado na linha m&#233;dia&#44; sobre uma linha reta transversal&#44; tra&#231;ada a partir do ponto m&#233;dio entre o &#250;ltimo arco costal e a crista il&#237;aca&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lise estat&#237;stica</span><p id="par0080" class="elsevierStylePara elsevierViewall">Os dados foram analisados com o aux&#237;lio do&#160;programa&#160;<span class="elsevierStyleItalic">MedCalc</span>&#44; vers&#227;o 18&#46;2&#46;1&#46; Para testar a normalidade das vari&#225;veis quantitativas&#44; aplicou&#8208;se o teste de normalidade de Shapiro&#8208;Wilk&#46; A compara&#231;&#227;o dos valores da gordura intra&#8208;abdominal entre os grupos das vari&#225;veis sociodemogr&#225;ficas foi avaliada pelo teste de Mann&#8208;Whitney&#46; A rela&#231;&#227;o da gordura abdominal com as vari&#225;veis quantitativas foi analisada por meio de correla&#231;&#245;es de Spearman&#46; Foram constru&#237;dos modelos de regress&#227;o log&#237;stica&#44; ajustados por sexo&#44; idade&#44; etnia e n&#237;vel socioecon&#244;mico&#44; para a an&#225;lise da associa&#231;&#227;o entre as medidas quantitativas de gordura abdominal em rela&#231;&#227;o &#224; SM e a presen&#231;a de altera&#231;&#245;es nos triglicer&#237;deos&#44; glicemia&#44; press&#227;o arterial&#44; HDL&#44; medidas de circunfer&#234;ncia de cintura e IMC&#46; Modelos de regress&#227;o log&#237;stica foram usados para a an&#225;lise da associa&#231;&#227;o entre os pontos de corte da gordura intra&#8208;abdominal &#40;percentis 80&#44; 85&#44; 90 e 95&#41; e a ocorr&#234;ncia de SM&#46; Nesse caso&#44; os modelos foram estratificados por g&#234;nero e em diferentes faixas et&#225;rias&#46; Os percentis da gordura intra&#8208;abdominal foram obtidos com o ordenamento dos valores de cada grupo et&#225;rio &#40;14&#44; 15&#44; 16&#44; 17 ou &#62; 18 anos&#41;&#44; separadamente para os g&#234;neros masculino e feminino&#46; A validade da informa&#231;&#227;o obtida pelos pontos de corte&#44; em rela&#231;&#227;o ao diagn&#243;stico da SM&#44; foi analisada por meio do c&#225;lculo de sensibilidade e especificidade&#46; Construiu&#8208;se ainda uma curva ROC global &#40;n&#227;o estratificada por g&#234;nero e idade&#41; dos pontos de corte de gordura intra&#8208;abdominal para a predi&#231;&#227;o da SM&#46; O melhor ponto de corte foi aquele com maior m&#233;dia aritm&#233;tica dos valores de sensibilidade e de especificidade&#46; A qualidade do ajuste dos modelos de regress&#227;o aos dados foi verificada por meio do teste de Hosmer e Lemeshow&#46; O n&#237;vel de signific&#226;ncia estat&#237;stica foi estabelecido em 5&#37; para todos os procedimentos&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Estudo&#8208;piloto</span><p id="par0085" class="elsevierStylePara elsevierViewall">Para os procedimentos de coleta de dados&#44; aplica&#231;&#227;o de question&#225;rios&#44; medidas antropom&#233;tricas e medidas de press&#227;o arterial&#44; desenvolveu&#8208;se estudo&#8208;piloto pr&#233;vio&#44; em escola municipal de menor porte&#46; Foram avaliados 66 adolescentes na faixa et&#225;ria da pesquisa&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">No caso das medidas por ultrassom&#44; as mensura&#231;&#245;es da gordura intra&#8208;abdominal foram feitas em triplicata por dois m&#233;dicos radiologistas&#44; membros titulares do Col&#233;gio Brasileiro de Radiologia e com mais de 10 anos de experi&#234;ncia&#44; em cego&#46; Obteve&#8208;se a concord&#226;ncia intraobservador para o primeiro examinador ICC de 0&#44;941 &#40;0&#44;913&#59; 0&#44;962&#41;&#46; A concord&#226;ncia intraobservador do segundo examinador foi ICC de 0&#44;961 &#40;0&#44;943&#59; 0&#44;975&#41;&#46; A concord&#226;ncia interobservador obteve o ICC de 0&#44;976 &#40;0&#44;961&#59; 0&#44;985&#41;&#44; mostrou alta reprodutibilidade intra e interobservador nas medidas da gordura intra&#8208;abdominal pela ultrassonografia&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">Participaram do presente estudo 423 estudantes&#44; dos quais 284 &#40;67&#44;1&#37;&#41; eram do sexo feminino&#46; A m&#233;dia da idade foi de 16&#44;1 anos &#40;DP &#177; 1&#44;11&#41;&#46; Indiv&#237;duos autodeclarados negros&#47;pardos&#47;ind&#237;genas perfizeram 222 &#40;56&#44; 1&#37;&#41; e brancos&#44; 174 &#40;43&#44;9&#37;&#41;&#46; A preval&#234;ncia de SM foi de 1&#44;9&#37;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Quanto &#224; espessura da gordura intra&#8208;abdominal avaliada por meio do exame ultrassonogr&#225;fico&#44; a mediana encontrada foi de 3&#44;3<span class="elsevierStyleHsp" style=""></span>cm &#40;p25 &#61; 2&#44;8 e p75 &#61; 3&#44;9&#41;&#44; foi de 4&#44;03<span class="elsevierStyleHsp" style=""></span>cm entre os participantes do sexo masculino e de 3&#44;10<span class="elsevierStyleHsp" style=""></span>cm no feminino&#46; A espessura do tecido adiposo intra&#8208;abdominal foi significativamente maior entre os homens em rela&#231;&#227;o &#224;s mulheres &#40;4&#44;06 <span class="elsevierStyleItalic">x</span> 3&#44;1&#59; p &#60; 0&#44;001&#41; e na popula&#231;&#227;o de n&#227;o brancos &#40;3&#44;51 <span class="elsevierStyleItalic">x</span> 3&#44;1&#59; p &#60; 0&#44;001&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A medida da gordura intra&#8208;abdominal por ultrassonografia apresentou correla&#231;&#227;o positiva e estatisticamente significativa com a press&#227;o arterial diast&#243;lica &#40;p &#61; 0&#44;023&#41;&#44; triglicer&#237;deos &#40;p &#61; 0&#44;012&#41;&#44; IMC &#40;p &#60; 0&#44;001&#41; e circunfer&#234;ncia da cintura &#40;p &#60; 0&#44;001&#41;&#46; Houve uma rela&#231;&#227;o inversa entre a gordura intra&#8208;abdominal e o HDL &#40;p &#61; 0&#44;034&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nos modelos de regress&#227;o log&#237;stica&#44; verificou&#8208;se que a medida da gordura intra&#8208;abdominal esteve associada com o diagn&#243;stico de SM &#40;p &#61; 0&#44;037&#41; e tamb&#233;m com a ocorr&#234;ncia de altera&#231;&#245;es nas medidas do HDL &#40;p &#61; 0&#44;033&#41;&#44; da circunfer&#234;ncia da cintura &#40;p &#60; 0&#44;001&#41; e do IMC &#40;p &#61; 0&#44;004&#41;&#46; Na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> s&#227;o apresentadas as raz&#245;es de chance e os respectivos intervalos de confian&#231;a de todas as vari&#225;veis analisadas&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Foi verificada correla&#231;&#227;o positiva entre a gordura intra&#8208;abdominal e a idade dos adolescentes &#40;r &#61;0&#44;167&#44; p &#60; 0&#44;001&#41;&#46; Por meio dos percentis da gordura intra&#8208;abdominal &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; foram constru&#237;dos pontos de cortes&#46; Aqueles estabelecidos nos percentis p85&#44; p90 e p95 apresentaram signific&#226;ncia estat&#237;stica na associa&#231;&#227;o com a SM&#44; foi poss&#237;vel notar aumento gradual na raz&#227;o de chance a cada aumento de percentil&#46; O melhor par&#226;metro de predi&#231;&#227;o da SM foi o p95 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a> exp&#245;e a an&#225;lise da validade da informa&#231;&#227;o obtida pela gordura intra&#8208;abdominal categorizada segundo os pontos de corte de percentis para o diagn&#243;stico de SM&#46; Em todos os casos&#44; a sensibilidade calculada manteve&#8208;se &#40;42&#44;8&#41;&#44; por&#233;m o percentil p95 apresentou melhor especificidade &#40;95&#44;7&#37;&#41;&#46; A curva ROC&#44; constru&#237;da com os dados de gordura intra&#8208;abdominal de todos os participantes&#44; apresentou capacidade significativa na predi&#231;&#227;o da SM &#40;p &#61; 0&#44;034&#41;&#44; com uma &#225;rea sob a curva de 0&#44;73&#46; O melhor ponto de corte foi de 3&#44;67<span class="elsevierStyleHsp" style=""></span>cm&#44; com sensibilidade de 85&#44;7 e especificidade de 68&#44;3&#46; O ponto de corte de 3&#44;93<span class="elsevierStyleHsp" style=""></span>cm foi considerado o segundo melhor e apresentou boa rela&#231;&#227;o entre a sensibilidade &#40;71&#44;4&#41; e a especificidade &#40;75&#44;5&#41;&#46; O ponto de corte de 4&#44;47<span class="elsevierStyleHsp" style=""></span>cm apresentou a mesma sensibilidade obtida no m&#233;todo dos percentis &#40;42&#44;8&#41;&#44; por&#233;m obteve menor especificidade &#40;86&#44;17&#41;&#46; Os demais pontos de corte acima desse e que obtiveram especificidades superiores apresentaram valores baixos de sensibilidade &#40;menores do que 0&#44;15&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discuss&#227;o</span><p id="par0125" class="elsevierStylePara elsevierViewall">O presente estudo demonstrou a associa&#231;&#227;o entre a espessura da gordura intra&#8208;abdominal medida pela ultrassonografia e os fatores ligados &#224; s&#237;ndrome metab&#243;lica e identificou pontos de corte da medida da gordura intra&#8208;abdominal associados com uma maior chance de SM em adolescentes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">No Brasil&#44; a preval&#234;ncia de SM varia entre diferentes inqu&#233;ritos e &#233; dependente do crit&#233;rio diagn&#243;stico usado&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;20&#44;21</span></a> No presente estudo&#44; a preval&#234;ncia de SM foi menor do que a obtida em estudos anteriores&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> A n&#227;o concord&#226;ncia entre os crit&#233;rios de diagn&#243;stico de SM&#44; por sua vez&#44; ressalta a necessidade do uso de m&#233;todos padronizados para detec&#231;&#227;o da SM&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Uma vantagem do uso da ultrassonografia na avalia&#231;&#227;o da obesidade central&#44; bem como dos demais exames de imagem&#44; est&#225; na possibilidade da diferencia&#231;&#227;o de qual reservat&#243;rio de tecido adiposo produz o aumento do volume abdominal&#46; A maneira comumente usada para avalia&#231;&#227;o da obesidade central&#44; a medida da circunfer&#234;ncia abdominal&#44; invariavelmente avalia um somat&#243;rio de todos os compartimentos de dep&#243;sito de tecido adiposo no abdome&#44; o que n&#227;o &#233; desej&#225;vel&#44; j&#225; que esses t&#234;m pap&#233;is diferentes no metabolismo e na fisiopatologia da SM&#46; Autores<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> demonstraram que o IMC e a circunfer&#234;ncia da cintura podem n&#227;o representar de forma acurada a gordura intra&#8208;abdominal&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Considerando&#8208;se o cen&#225;rio atual de sa&#250;de&#44; com crescente n&#250;mero de indiv&#237;duos acima do peso e os benef&#237;cios dos exames de imagem&#44; avaliamos a medida da gordura intra&#8208;abdominal por meio da ultrassonografia&#46; O m&#233;todo mostrou ser bastante reprodut&#237;vel na avalia&#231;&#227;o da obesidade central em adolescentes&#44; apresentou elevados coeficientes de correla&#231;&#227;o intra e interobservador&#44; assim como verificado anteriormente por Diniz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> e Mauad et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> A precis&#227;o das medidas de concord&#226;ncia obtidas no presente estudo est&#225; intimamente relacionada com a ado&#231;&#227;o de t&#233;cnicas padronizadas&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Leite et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> mostraram a capacidade da medida de GA na predi&#231;&#227;o de fatores ligados ao risco cardiovascular&#44; como os n&#237;veis press&#243;ricos&#44; lip&#237;dicos e glic&#234;micos&#46; No presente trabalho&#44; foi demonstrada associa&#231;&#227;o significativa da gordura intra&#8208;abdominal com a PAD&#44; com HDL&#44; com triglicer&#237;deos&#44; com a circunfer&#234;ncia da cintura e com o IMC&#46; Frente &#224; capacidade de predi&#231;&#227;o da medida da gordura abdominal n&#227;o s&#243; do diagn&#243;stico da SM e de risco cardiovascular&#44; mas tamb&#233;m se associando aos fatores isolados que comp&#245;em a SM&#44; justifica&#8208;se o emprego dessa medida na pr&#225;tica cl&#237;nica e sua poss&#237;vel inclus&#227;o nos protocolos de exames de imagem&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">O aumento do tecido adiposo intra&#8208;abdominal com a eleva&#231;&#227;o da idade &#233; discutido por Maurovich&#8208;Horvat et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Eles determinaram que o quociente da gordura subcut&#226;nea&#47;gordura intra&#8208;abdominal &#40;GSC&#47;GA&#41; decresce ao longo das faixas et&#225;rias&#44; indica mais expressiva participa&#231;&#227;o da adiposidade intra&#8208;abdominal na SM&#46; Esses autores constataram essa rela&#231;&#227;o mais baixa entre os homens&#44; atentaram para o fato de que os homens t&#234;m relativamente maiores quantidades de gordura intra&#8208;abdominal&#46; Nosso estudo corrobora tais informa&#231;&#245;es&#44; indica aumento da gordura abdominal e consequentemente dos pontos de corte encontrados com o aumento da faixa et&#225;ria em ambos os sexos&#46; A discut&#237;vel influ&#234;ncia da gordura subcut&#226;nea na determina&#231;&#227;o da SM em crian&#231;as parece perder import&#226;ncia na vida adulta&#44; per&#237;odo em que a gordura intra&#8208;abdominal tem mais expressividade&#46; A adolesc&#234;ncia&#44; como momento de transforma&#231;&#245;es corporais importantes&#44; poderia&#44; ent&#227;o&#44; colocar&#8208;se como ponto de transi&#231;&#227;o da influ&#234;ncia desses diferentes reservat&#243;rios de tecido adiposo&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#8211;29</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">O presente estudo apontou pontos de corte da gordura intra&#8208;abdominal possivelmente associados com a SM em diferentes faixas et&#225;rias&#46; Leite et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> que examinaram adultos&#44; encontraram como ponto de corte de 8<span class="elsevierStyleHsp" style=""></span>cm de espessura da gordura intra&#8208;abdominal para a predi&#231;&#227;o de risco cardiovascular em mulheres e 9<span class="elsevierStyleHsp" style=""></span>cm entre os homens&#46; Eifler&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> que tamb&#233;m examinou adultos&#44; encontrou a espessura de 9<span class="elsevierStyleHsp" style=""></span>cm em mulheres e 10<span class="elsevierStyleHsp" style=""></span>cm em homens como pontos de corte da espessura associado com uma maior chance de desenvolvimento de esteatose hep&#225;tica&#46; N&#227;o foram encontrados na literatura estudos que avaliassem pontos de corte da gordura intra&#8208;abdominal em adolescentes&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Em nosso estudo&#44; na determina&#231;&#227;o de um valor de corte associado com a SM entre os adolescentes&#44; calcularam&#8208;se os percentis 80&#44; 85&#44; 90 e 95<span class="elsevierStyleHsp" style=""></span>da gordura intra&#8208;abdominal&#44; estratificados por sexo e idade&#46; O percentil 95 foi o que apresentou maior for&#231;a de associa&#231;&#227;o com a ocorr&#234;ncia de SM e um maior valor de especificidade&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">De acordo com os pontos de corte evidenciados nesta pesquisa&#44; a chance de desenvolvimento da SM aumenta significativamente quando o indiv&#237;duo se encontra no percentil 95 de diferentes idades&#46; O elevado valor de especificidade desse percentil &#233; um argumento favor&#225;vel a seu uso&#44; mesmo com sensibilidade moderada&#46; Na an&#225;lise da curva ROC&#44; o ponto de corte de 3&#44;67<span class="elsevierStyleHsp" style=""></span>cm obteve boa sensibilidade&#44; por&#233;m baixa especificidade&#46; Desse modo&#44; sua ado&#231;&#227;o poderia causar um efeito negativo relevante na pr&#225;tica cl&#237;nica&#44; haja vista o n&#250;mero elevado de casos falsos positivos&#46; O ponto de corte de 3&#44;93<span class="elsevierStyleHsp" style=""></span>cm&#44; que teve sensibilidade de 71&#44;4 e especificidade de cerca de 75&#44;5&#37;&#44; embora de modo menos intenso&#44; tamb&#233;m produziria um elevado n&#250;mero de falso&#8208;positivos&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">&#201; importante ressaltar que o presente estudo pode ter sido limitado devido ao quantitativo amostral examinado&#46; Houve um n&#250;mero relevante de recusas&#44; o que diminuiu a precis&#227;o das estimativas obtidas e impossibilitou a constru&#231;&#227;o de curvas ROC estratificadas&#46; De modo positivo&#44; usou&#8208;se uma classifica&#231;&#227;o da GA baseada em percentis estratificados por sexo e idade&#44; que permitiu a obten&#231;&#227;o de pontos de corte espec&#237;ficos para esses grupos e que obteve uma elevada especificidade&#46; Al&#233;m disso&#44; observou&#8208;se que as recusas n&#227;o foram influenciadas por fatores como sexo&#44; idade&#44; turma e escola dos adolescentes&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A facilidade de execu&#231;&#227;o da medida da gordura intra&#8208;abdominal por meio do ultrassom favorece sua inclus&#227;o nos exames abdominais de rotina&#44; al&#233;m de sua associa&#231;&#227;o com par&#226;metros bioqu&#237;micos da SM e possibilidade de detec&#231;&#227;o precoce&#46; Os pontos de corte apontados no presente estudo&#44; se analisados considerando os contextos epidemiol&#243;gicos locais e em conjunto com os dados de outros testes f&#237;sicos e laboratoriais&#44; podem ser ferramentas &#250;teis para a tomada de decis&#245;es na pr&#225;tica cl&#237;nica&#46; Ressalta&#8208;se que novas pesquisas&#44; a serem conduzidas em situa&#231;&#245;es sociodemogr&#225;ficas diversas e que busquem confirmar ou aprimorar os pontos de corte identificados&#44; devem ser obrigat&#243;rias em estudos futuros&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Financiamento</span><p id="par0180" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o de Amparo &#224; Pesquisa de Minas Gerais &#40;Fapemig&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflitos de interesse</span><p id="par0185" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            0 => "Gordura intra&#8208;abdominal"
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            2 => "S&#237;ndrome metab&#243;lica"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To associate intra&#8208;abdominal fat thickness measured by ultrasonography to the factors related to metabolic syndrome and to determine cutoff points of intra&#8208;abdominal fat measurement associated with a greater chance of metabolic syndrome in adolescents&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a cross&#8208;sectional study&#44; with 423 adolescents from public schools&#46; Intra&#8208;abdominal fat was measured by ultrasonography&#46; Anthropometric data were collected&#44; and biochemical analyses were performed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intra&#8208;abdominal fat was measured by ultrasonography&#44; showing a statistically significant association with the diagnosis of metabolic syndrome &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;037&#41;&#44; body mass index &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; elevated triglyceride levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41;&#44; decreased plasma HDL levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;034&#41;&#44; and increased systemic blood pressure values &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41;&#46; Cutoff values of intra&#8208;abdominal fat thickness measurements were calculated by ultrasound to estimate the individuals most likely to develop metabolic syndrome&#46; In the logistic regression models&#44; the cutoff values that showed the highest association with metabolic syndrome in males were 4&#46;50&#44; 5&#46;35&#44; 5&#46;46&#44; 6&#46;24&#44; and 6&#46;50<span class="elsevierStyleHsp" style=""></span>cm for the ages of 14&#44; 15&#44; 16&#44; 17&#44; and 18&#47;19 years&#44; respectively&#46; In the female gender&#44; the cutoff values defined for the same age groups were 4&#46;46&#44; 4&#46;55&#44; 4&#46;45&#44; 4&#46;90&#44; and 6&#46;46<span class="elsevierStyleHsp" style=""></span>cm&#46; In an overall analysis using the ROC curve&#44; without gender and age stratification&#44; the cut&#8208;off of 3&#46;67<span class="elsevierStyleHsp" style=""></span>cm showed good sensitivity&#44; but low specificity&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ultrasonography is a useful method to estimate intra&#8208;abdominal adipose tissue in adolescents&#44; which is associated with the main factors related to obesity and metabolic syndrome&#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">Relacionar a espessura da gordura intra&#8208;abdominal medida pela ultrassonografia aos fatores ligados &#224; s&#237;ndrome metab&#243;lica&#46; Determinar pontos de corte da medida da gordura intra&#8208;abdominal associados a uma maior chance de s&#237;ndrome metab&#243;lica em 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">Estudo seccional&#44; com 423 adolescentes de escolas p&#250;blicas&#46; A gordura intra&#8208;abdominal foi medida pela ultrassonografia&#46; Foram coletados dados antropom&#233;tricos e feitas an&#225;lises bioqu&#237;micas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">As medidas da gordura intra&#8208;abdominal por ultrassonografia apresentaram associa&#231;&#227;o estatisticamente significativa com o diagn&#243;stico de s&#237;ndrome metab&#243;lica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41;&#44; &#237;ndice de massa corporal &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; n&#237;veis elevados de triglicer&#237;deos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41;&#44; redu&#231;&#227;o dos n&#237;veis plasm&#225;ticos de HDL &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#41; e aumento da press&#227;o arterial sist&#234;mica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#46; Calcularam&#8208;se pontos de corte da medida da espessura da gordura intra&#8208;abdominal por ultrassom&#44; para estimar os indiv&#237;duos com mais chance para o desenvolvimento de s&#237;ndrome metab&#243;lica&#46; Em modelos de regress&#227;o log&#237;stica&#44; os pontos de corte que apresentaram maior associa&#231;&#227;o com a s&#237;ndrome metab&#243;lica no sexo masculino foram de 4&#44;50&#44; 5&#44;35&#44; 5&#44;46&#44; 6&#44;24 e 6&#44;50<span class="elsevierStyleHsp" style=""></span>cm para as idades de 14&#44; 15&#44; 16&#44; 17 e 18&#47;19 anos&#44; respectivamente&#46; No sexo feminino&#44; os pontos de corte definidos para as mesmas faixas et&#225;rias foram de 4&#44;46&#44; 4&#44;55&#44; 4&#44;45&#44; 4&#44;90 e 6&#44;46<span class="elsevierStyleHsp" style=""></span>cm&#46; Em an&#225;lise global por meio da curva ROC&#44; sem estratifica&#231;&#245;es por sexo e idade&#44; o ponto de corte de 3&#44;67<span class="elsevierStyleHsp" style=""></span>cm teve boa sensibilidade&#44; por&#233;m apresentou baixa especificidade&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A ultrassonografia &#233; um m&#233;todo &#250;til para a estimativa do tecido adiposo intra&#8208;abdominal em adolescentes&#44; est&#225; associada com os principais fatores relacionados &#224; obesidade e &#224; s&#237;ndrome metab&#243;lica&#46;</p></span>"
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            "titulo" => "Objetivo"
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            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
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            "identificador" => "abst0040"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Novais RL&#44; Caf&#233; AC&#44; Morais AA&#44; Bila WC&#44; Santos GD&#44; Lopes CA&#44; et al&#46; Intra&#8208;abdominal fat measurement by ultrasonography&#58; association with anthropometry and metabolic syndrome in adolescents&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;342&#8211;9&#46;</p>"
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      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Estudo vinculado &#224; Universidade Federal de S&#227;o Jo&#227;o Del&#8208;Rei&#44; S&#227;o Jo&#227;o Del&#8208;Rei&#44; MG&#44; Brasil&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Vari&#225;veis de desfecho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Percentis 80&#44; 85&#44; 90 e 95 das medidas gordura intra&#8208;abdominal &#40;cm&#41; segundo sexo e idade dos adolescentes</p>"
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                  \t\t\t\t" scope="col">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Valor p<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gordura intra&#8208;abdominal &#40;p80&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aumentada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63&#8208;56&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;118&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gordura intra&#8208;abdominal &#40;p85&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aumentada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">25&#44;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;18&#8208;551&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gordura intra&#8208;abdominal &#40;p90&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aumentada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;37&#8208;763&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gordura intra&#8208;abdominal &#40;p95&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aumentada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;80&#8208;7416&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gordura intra&#8208;abdominal &#40;p85&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">342 &#40;98&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aumentada&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">359 &#40;98&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aumentada&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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