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Uma recente proje&#231;&#227;o para a faixa entre&#160;2&#160;e&#160;19 anos mostra que a maioria dos jovens de hoje ser&#225; obeso aos 35&#160;anos&#46; Em crian&#231;as de 2&#160;anos&#44; a preval&#234;ncia da obesidade aumentou at&#233; a adolesc&#234;ncia&#44; quando se estabilizou&#44; por&#233;m continuou a aumentar ap&#243;s a adolesc&#234;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A preocupa&#231;&#227;o com o excesso de peso estende&#8208;se al&#233;m das condi&#231;&#245;es fisiol&#243;gicas&#44; pois o excesso de peso mostra&#8208;se com fator de interfer&#234;ncia para uma QVRS adequada entre adolescentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5</span></a> Portanto&#44; identificar e estudar adolescentes com excesso de peso &#233; importante para prevenir consequ&#234;ncias negativas sobre a QVRS&#44; que podem se estender em diversas dimens&#245;es da vida&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7</span></a> Nesse contexto&#44; o objetivo do presente estudo &#233; identificar a QVRS entre adolescentes com excesso de peso e verificar prov&#225;veis fatores associados como idade&#44; g&#234;nero e categorias de peso&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Estudo transversal&#44; descritivo&#44; de dados prim&#225;rios com adolescentes em sobrepeso e obesidade de ambos os sexos&#44; estudantes do ensino fundamental de uma escola do munic&#237;pio de Cachoeira do Sul&#47;RS &#40;CS&#41; e dados provenientes de um outro banco de dados com adolescentes em sobrepeso e obesidade de ambos os sexos&#44; estudantes da educa&#231;&#227;o b&#225;sica de Santa Cruz do Sul&#47;RS &#40;SCS&#41;&#46; As escolas participantes estavam situadas na regi&#227;o central e eram representativas das cidades&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Crit&#233;rios de inclus&#227;o e exclus&#227;o</span><p id="par0025" class="elsevierStylePara elsevierViewall">Os crit&#233;rios de inclus&#227;o foram os estudantes estarem regularmente matriculados nas escolas envolvidas no projeto&#44; entre&#160;10&#160;e&#160;17&#160;anos&#44; em sobrepeso e obesidade&#44; no caso do grupo de SCS&#46; Para o grupo de CS&#44; os alunos estarem matriculados no 6&#176;&#160;e 7&#176;&#160;ano de uma escola p&#250;blica&#44; com 9&#160;a&#160;18&#160;anos que apresentavam sobrepeso e obesidade&#46; Para CS e SCS&#44; foram inclu&#237;dos aqueles que concordaram e assinaram o Termo de Assentimento &#40;TA&#41; e cujos pais e&#47;ou respons&#225;veis&#44; que residiam na mesma casa&#44; assinassem o Termo de Consentimento Livre e Esclarecido &#40;TCLE&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Os crit&#233;rios de exclus&#227;o foram os mesmos para alunos de CS e SCS&#44; foram exclu&#237;dos aqueles sem condi&#231;&#245;es f&#237;sicas de se submeter &#224; avalia&#231;&#227;o antropom&#233;trica&#44; como cadeirantes&#44; com membros amputados ou engessados&#44; adolescentes gr&#225;vidas e alunos sem condi&#231;&#245;es mentais e&#47;ou em falta de compreens&#227;o para preencher os question&#225;rios&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A amostra foi obtida por conveni&#234;ncia&#44; considerando Intervalo de Confian&#231;a de 95&#37;&#44; margem de erro de 3&#44;5 e desvio&#8208;padr&#227;o de 18&#44;0&#59;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> chegou&#8208;se ao tamanho de amostra de 105&#160;adolescentes com sobrepeso e com Intervalo de Confian&#231;a de 95&#37;&#44; margem de erro de&#160;3&#44;5 e desvio&#8208;padr&#227;o de&#160;20&#44;1&#44; e ao tamanho de amostra de 130&#160;adolescentes obesos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Coleta de dados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Quanto aos dados prim&#225;rios&#44; os alunos que aceitaram participar e tinham o TA e o TCLE assinados foram submetidos &#224;s aferi&#231;&#245;es antropom&#233;tricas &#40;peso&#44; estatura e circunfer&#234;ncia da cintura &#91;CC&#93;&#41; pela pesquisadora&#44; autoavalia&#231;&#227;o do Estadiamento Puberal &#40;EP&#41; e <span class="elsevierStyleItalic">Pediatric Quality of Life Inventory</span>&#160;4&#46;0 &#40;PedsQL 4&#46;0&#41; para a avalia&#231;&#227;o da QV&#46; Idade e data de nascimento foram fornecidas pela escola&#46; A coleta de dados ocorreu em 2016 com tr&#234;s&#160;meses de dura&#231;&#227;o&#44; no qual foram coletados dados de 72&#160;alunos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Os dados provenientes de um banco de dados do projeto &#8220;Obesidade em adolescentes da educa&#231;&#227;o b&#225;sica&#58; um estudo de interven&#231;&#227;o interdisciplinar &#8211; Fase III&#8221; de SCS foram coletados de um banco inicialmente transversal de 25&#160;escolas&#44; dos quais os alunos tinha o TA e TCLE&#46; As escolas tinham semelhan&#231;a quanto &#224;s caracter&#237;sticas sociodemogr&#225;ficas&#46; As aferi&#231;&#245;es foram feitas na Universidade de Santa Cruz do Sul &#40;Unisc&#41;&#44; por equipe capacitada&#46; A pesquisa ocorreu entre 2015 e 2016&#44; na qual dados de 285&#160;adolescentes foram coletados&#46; Foram transferidos dados como peso&#44; altura&#44; idade&#44; cor da pele&#44; CC&#44; EP e PedsQL&#44; de adolescentes com sobrepeso e obesidade&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Instrumentos e medidas</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Estado nutricional</span><p id="par0050" class="elsevierStylePara elsevierViewall">Foram coletadas&#58; idade informada pela escola&#44; peso &#40;kg&#41;&#44; altura &#40;cm&#41;&#46; As medidas de peso e estatura foram usadas para o c&#225;lculo do &#205;ndice de Massa Corporal &#40;IMC&#41; &#40;peso&#160;&#91;kg&#93;&#47;estatura&#160;&#91;m<span class="elsevierStyleSup">2</span>&#93;&#41;&#46; Os adolescentes foram classificados como portadores de excesso de peso &#40;sobrepeso ou obesidade&#41; a partir do IMC&#47;idade expresso em escore z&#44; calculado com o aux&#237;lio do <span class="elsevierStyleItalic">software</span> WHO&#8208;Anthro Plus&#160;2007 &#40;<span class="elsevierStyleItalic">World Health Organization</span>&#41; e seguindo as recomenda&#231;&#245;es propostas pela OMS&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> A CC foi aferida no ponto m&#233;dio entre a &#250;ltima costela e a crista il&#237;aca&#46; Seguiram&#8208;se os pontos de corte que identificam obesidade abdominal quando CC for maior que P90&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Estadiamento puberal</span><p id="par0055" class="elsevierStylePara elsevierViewall">Para verificar o EP foi aplicado o question&#225;rio de autoavalia&#231;&#227;o de acordo com os crit&#233;rios de Tanner&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> no mesmo momento da avalia&#231;&#227;o antropom&#233;trica&#46; O adolescente estava em local reservado para evitar constrangimentos&#46; Usou&#8208;se autoavalia&#231;&#227;o dos adolescentes atrav&#233;s de imagens ilustrativas&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Qualidade de vida</span><p id="par0060" class="elsevierStylePara elsevierViewall">Aplicou&#8208;se o question&#225;rio gen&#233;rico PedsQL&#160;4&#46;0&#44; validado para a popula&#231;&#227;o brasileira&#44; com quatro subescalas e 23&#160;itens que abrangem&#58; 1&#41;&#160;Dimens&#227;o f&#237;sica&#44; 2&#41;&#160;Dimens&#227;o emocional&#44; 3&#41;&#160;Dimens&#227;o social e 4&#41;&#160;Dimens&#227;o escolar&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A an&#225;lise das respostas do PesdQL&#160;4&#46;0 deu&#8208;se da seguinte forma&#58; foram pontuados inversamente e transpostos linearmente para uma escala de 0&#8211;100 &#40;nunca<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#160;pontos&#59; quase nunca<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#160;pontos&#59; algumas vezes<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#160;pontos&#44; muitas vezes<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#160;pontos&#59; quase sempre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#160;pontos&#41;&#59; assim&#44; quanto maior o escore&#44; melhor a QVRS&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Foi criado um escore do sum&#225;rio psicossocial&#44; que demonstra a sa&#250;de psicossocial do escolar&#44; atrav&#233;s da m&#233;dia das somas dos itens&#58; dimens&#227;o social&#44; dimens&#227;o emocional e dimens&#227;o escolar&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Na presen&#231;a de dados ausentes&#44; os escores da escala foram computados como a soma dos itens dividida pelo n&#250;mero de itens respondidos&#46; Por&#233;m&#44; quando mais de 50&#37; dos itens da escala est&#227;o ausentes&#44; o escore da escala n&#227;o foi registrado&#46; A consist&#234;ncia dessa computa&#231;&#227;o &#233; similar &#224; de outras publica&#231;&#245;es arbitradas sobre o PedsQL&#44; assim como outras mensura&#231;&#245;es estabelecidas de QVRS&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lise estat&#237;stica</span><p id="par0080" class="elsevierStylePara elsevierViewall">Os dados categ&#243;ricos foram descritos por contagens e percentuais&#44; para vari&#225;veis como cidade&#44; sexo&#44; CC&#44; classifica&#231;&#227;o do IMC&#46; A idade foi descrita por m&#233;dia e desvio&#8208;padr&#227;o &#40;m<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41;&#46; A normalidade da distribui&#231;&#227;o foi verificada para todas as vari&#225;veis cont&#237;nuas por meio do teste de Kolmogorov&#8208;Smirnov&#46; Ao passo que a amostra n&#227;o apresentou uma distribui&#231;&#227;o normal&#44; para descrever as subescalas da QV foram usadas medianas e percentis&#160;25&#160;e&#160;75&#46; As compara&#231;&#245;es entre grupos de faixa et&#225;ria&#44; g&#234;nero e categoria de peso foram feitas por meio do teste de Mann&#8208;Whitney&#46; Os dados foram analisados por meio do <span class="elsevierStyleItalic">software</span> estat&#237;stico <span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span> &#40;SPSS&#41; IBM vers&#227;o&#160;20&#46;0</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Aspectos &#233;ticos</span><p id="par0085" class="elsevierStylePara elsevierViewall">O projeto inicial em SCS j&#225; contava com aprova&#231;&#227;o do CEP da Unisc&#44; sob CAAE&#160;n&#176;&#160;54985316&#46;0&#46;0000&#46;5343 e Parecer n&#176;&#160;1&#46;498&#46;330&#46; O estudo foi submetido ao Comit&#234; de &#201;tica da Universidade Federal do Rio Grande do Sul &#40;UFRGS&#41; para o uso dos dados coletados no munic&#237;pio de CS&#44; concomitante aos dados de SCS&#44; aprovada sob CAAE&#160;n&#176;&#160;71390416&#46;1&#46;0000&#46;5347 e Parecer n&#176;&#160;2&#46;395&#46;088&#44; e seguiu todos os preceitos &#233;ticos preconizados na Resolu&#231;&#227;o&#160;466&#47;12 do Conselho Nacional de Sa&#250;de&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><p id="par0090" class="elsevierStylePara elsevierViewall">Foram coletados dados de 298&#160;adolescentes&#46; Devido a dados incompletos foram exclu&#237;dos 22&#46; O estudo contou com 276&#160;adolescentes com excesso de peso&#44; ou seja&#44; portadores de sobrepeso &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>134&#41; e obesidade &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>142&#41;&#46; A idade m&#233;dia foi de 12&#44;8&#160;anos&#44; variou de&#160;9&#160;a&#160;18&#160;anos&#46; A maioria dos adolescentes encontrava&#8208;se com adiposidade abdominal normal &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; A mediana do escore total da QVRS dos adolescentes foi de 78&#44;3&#160;&#40;68&#44;5&#8211;87&#44;4&#41;&#46; A menor escala foi o &#8220;escore emocional&#8221; 65&#160;&#40;50&#8211;80&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Faixa et&#225;ria</span><p id="par0095" class="elsevierStylePara elsevierViewall">Foi analisado o efeito da faixa et&#225;ria sobre os escores das subescalas do PedsQL&#46; A mediana dos escores &#8220;f&#237;sico&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; e &#8220;social&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; foi significativamente menor na faixa menor de 14&#160;anos&#44; em compara&#231;&#227;o com adolescentes entre&#160;14&#160;e&#160;19&#160;anos&#46; Contudo&#44; n&#227;o houve diferen&#231;a entre as medianas dos escores emocional&#44; escolar&#44; sum&#225;rio psicossocial e total &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">G&#234;nero</span><p id="par0100" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> destaca as compara&#231;&#245;es entre g&#234;nero masculino e feminino dos adolescentes&#46; Analisando a QVRS nos diferentes grupos&#44; percebe&#8208;se uma diferen&#231;a estatisticamente significativa&#44; visto que a mediana da QVRS foi maior nos meninos em todos os escores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; exceto o &#8220;escolar&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;09&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Categorias de peso</span><p id="par0105" class="elsevierStylePara elsevierViewall">Os efeitos das vari&#225;veis sobrepeso e obesidade foram analisados na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#46; Os adolescentes obesos apresentaram diferen&#231;as significativas com rela&#231;&#227;o ao &#8220;escore f&#237;sico&#8221;&#160;&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#59; &#8220;escore escolar&#8221;&#160;&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41; e &#8220;escore total&#8221;&#160;&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; da QVRS&#44; quando comparadas com adolescentes em sobrepeso&#46; N&#227;o houve diferen&#231;a significativa entre os escores emocional&#44; social e psicossocial&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discuss&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">O presente estudo visa a descrever a QVRS de adolescentes com excesso de peso e comparar os prov&#225;veis fatores associados como faixa et&#225;ria&#44; g&#234;nero e categorias de peso &#40;sobrepeso e obesidade&#41;&#46; At&#233; o presente momento&#44; este &#233; o primeiro estudo que publica dados sobre a QVRS entre adolescentes&#44; com sobrepeso e obesidade&#44; de duas cidades do Rio Grande do Sul&#46; Ao analisar as subescalas do PedsQL&#44; encontramos uma mediana da QVRS de 78&#44;3&#160;&#40;68&#44;5&#8211;87&#44;4&#41; dos adolescentes com excesso de peso e obesidade&#46; O menor escore da subescala do PedsQL foi o &#8220;emocional&#8221;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Alguns estudos&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;12&#44;13</span></a> bem como o presente&#44; encontraram o escore emocional como o menor escore da subescala do PedsQL&#44; entre adolescentes com sobrepeso e obesidade&#44; alertaram que a obesidade pode ser um fator determinante para o decl&#237;nio da QVRS&#44; principalmente na dimens&#227;o emocional&#46; Dom&#237;nios emocionais menores preocupam principalmente quando se remetem &#224; popula&#231;&#227;o jovem com excesso de peso&#44; pois um recente estudo de revis&#227;o<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> mostra que o consumo alimentar motivado pelo estado emocional est&#225; associado ao desenvolvimento e &#224; manuten&#231;&#227;o do excesso de peso e obesidade&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Quando separamos adolescentes por faixa <span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>14&#160;anos e 14&#8211;19&#160;anos&#44; o grupo<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>14&#160;anos relatou menores pontua&#231;&#245;es no &#8220;escore f&#237;sico&#8221; e &#8220;escore social&#8221;&#46; O estudo de Su et al&#46; apontou que meninos obesos no 3&#176;&#160;e&#160;4&#176;&#160;ano escolar apresentaram maiores dificuldades relacionadas ao escore f&#237;sico do que seus pares de peso normal&#46; Por&#233;m&#44; os meninos do 5&#176;&#160;e 6&#176;&#160;ano n&#227;o mostraram essa diferen&#231;a&#44; o que se assemelha ao achado deste estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Uma hip&#243;tese para o achado &#233; que a percep&#231;&#227;o das crian&#231;as e adolescentes sobre a obesidade pode explicar essas menores pontua&#231;&#245;es quanto ao escore f&#237;sico&#44; visto que a percep&#231;&#227;o negativa diminui inversamente proporcional &#224; idade&#44; bem como a maioria dos adolescentes percebe que a obesidade cria limita&#231;&#245;es no desempenho f&#237;sico&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Contrariamente ao achado deste estudo&#44; a obesidade foi associada a maior QVRS em estudantes mais jovens &#40;12&#8211;14&#160;anos&#41;&#44; junto a maiores pontua&#231;&#245;es no funcionamento emocional&#44; escolar e bem&#8208;estar&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Quanto ao &#8220;escore social&#8221; afetado&#44; entre adolescentes mais jovens&#44; acredita&#8208;se que a faixa de&#160;14&#8211;19&#160;anos tem uma maior sociabiliza&#231;&#227;o&#44; pois frequentam mais festas&#44; comportamento t&#237;pico da adolesc&#234;ncia&#46; Os jovens obesos podem sofrer um decl&#237;nio no dom&#237;nio social e perceber esses n&#237;veis mais baixos do que a maioria da juventude&#46; Contudo&#44; o apoio social percebido dos colegas de classe&#44; em particular&#44; pode ter um efeito importante sobre os resultados de QVRS em longo prazo para os jovens que persistirem obesos&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">O g&#234;nero apresenta&#8208;se associado a uma menor QVRS em meninas&#46; No presente estudo&#44; os escores das subescalas do PedsQL foram significativamente menores nas meninas&#44; com exce&#231;&#227;o do &#8220;escore escolar&#8221;&#44; e esse achado corrobora alguns estudos&#44; nos quais essa associa&#231;&#227;o &#233; percebida em indiv&#237;duos eutr&#243;ficos e com excesso de peso&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;20&#8211;22</span></a> Acredita&#8208;se que o processo de transforma&#231;&#227;o do corpo atrelado ao ambiente &#40;m&#237;dias sociais&#44; fam&#237;lia e amigos&#41; &#233; mais impactante para a popula&#231;&#227;o feminina com excesso de peso&#46; Como consequ&#234;ncia disso&#44; pode estar relacionado aos baixos n&#237;veis de QVRS&#46; A supervaloriza&#231;&#227;o do peso e imagem corporal pode ser outro fator que influencia a QVRS especificamente entre as meninas&#44; al&#233;m de fatores f&#237;sicos como a puberdade &#40;por conta da menstrua&#231;&#227;o&#41;&#44; horm&#244;nios e padr&#245;es sociais e de beleza&#44; que s&#227;o dif&#237;ceis de atingir&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;20&#44;21</span></a> Meninas adolescentes&#44; com sobrepeso e obesidade &#40;autopercebida e medida&#41; necessitam de maior aten&#231;&#227;o&#44; devido aos fatores j&#225; citados e ainda pelo aumento da&#160;probabilidade de ideia suicida&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> Nesse contexto&#44; ressalta&#8208;se que o tratamento do sobrepeso e obesidade em adolescentes dever&#225; ser feito frequentemente e em longo prazo&#44; apoiar&#8208;se em metas de alvo de comportamento da dieta e n&#227;o do peso&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> prevenir que o tratamento feito de forma inadequada contribua para um maior decl&#237;nio da QVRS dessas adolescentes em excesso de peso&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Verificou&#8208;se que os adolescentes com obesidade relataram significativamente maiores preju&#237;zos nos dom&#237;nios f&#237;sico&#44; escolar e escore total da QVRS&#44; quando comparados com a categoria sobrepeso&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A respeito do dom&#237;nio f&#237;sico&#44; acredita&#8208;se que uso de internet entre os adolescentes obesos&#44; o isolamento social e o estado emocional pode contribuir para a diminui&#231;&#227;o da QVRS no dom&#237;nio f&#237;sico&#46; Um estudo que relaciona QVRS e v&#237;cio de internet encontrou que os adolescentes obesos t&#234;m uma taxa maior de v&#237;cio em internet&#44; atrelada a menor dom&#237;nio f&#237;sico e psicossocial&#46; Provavelmente o v&#237;cio na internet&#44; causado pelo mau funcionamento emocional&#44; contribua para a obesidade&#44; visto que atividades <span class="elsevierStyleItalic">online</span> afastam as atividades f&#237;sicas e essa diminui&#231;&#227;o contribui diretamente para obesidade&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Outro fator que pode explicar menores pontua&#231;&#245;es no escore f&#237;sico&#44; neste estudo&#44; &#233; o detrimento da sa&#250;de social e emocional causado pela obesidade&#44; ao passo que geralmente adolescentes obesos s&#227;o exclu&#237;dos de atividades competitivas que demandam esfor&#231;o f&#237;sico&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> &#201; importante destacar que os profissionais de sa&#250;de devem promover um refor&#231;o em rela&#231;&#227;o ao comportamento dos adolescentes&#44; que contemple o aumento de atividade f&#237;sica vigorosa e l&#250;dica &#40;pelo menos uma&#160;hora por dia&#41;&#44; no qual o adolescente sinta prazer em pratic&#225;&#8208;la e tamb&#233;m a redu&#231;&#227;o do uso de telas&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Foi encontrada uma consequ&#234;ncia acad&#234;mica associada a obesidade&#44; em que menores pontua&#231;&#245;es no escore escolar foram relatadas pelos adolescentes&#44; e esses preju&#237;zos corroboram os dados da literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#8211;28</span></a> Um estudo com adolescentes chineses sugere que os processos de aprendizagem e mem&#243;ria em adolescentes obesos s&#227;o diferentes das que est&#227;o na categoria de peso normal&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Este estudo encontrou uma associa&#231;&#227;o da obesidade com um desempenho acad&#234;mico inferior&#44; devido &#224; fraca capacidade b&#225;sica de mem&#243;ria de trabalho&#46; Os autores prop&#245;em que adolescentes obesos s&#227;o mais sens&#237;veis &#224; mem&#243;ria com materiais de marca de alimentos e bebidas e que o d&#233;ficit de mem&#243;ria funcional para adolescentes obesos pode ser espec&#237;fico do dom&#237;nio&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Ainda&#44; existe uma hip&#243;tese de que a obesidade tem sido associada a diferen&#231;as estruturais detect&#225;veis no c&#233;rebro em compara&#231;&#227;o com os c&#233;rebros de indiv&#237;duos de peso normal&#44; durante a inf&#226;ncia e adolesc&#234;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Um estudo recente&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> que envolveu crian&#231;as e adolescentes&#44; na Espanha&#44; encontrou uma associa&#231;&#227;o positiva entre os componentes da aptid&#227;o f&#237;sica&#44; com o volume de mat&#233;ria cinzenta nas estruturas corticais e subcorticais do c&#233;rebro em crian&#231;as com sobrepeso e obesidade&#46; Algumas dessas estruturas cerebrais estavam relacionadas ao melhor desempenho acad&#234;mico&#46; Os autores explicam que possivelmente a promo&#231;&#227;o da atividade f&#237;sica&#44; que acarreta a melhoria da aptid&#227;o cardiorrespirat&#243;ria e agilidade&#47;velocidade&#44; pode ser importante tamb&#233;m para a desenvolvimento de habilidades cerebrais e acad&#234;micas em adolescentes com sobrepeso e obesidade&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">O presente estudo encontrou um escore total da QVRS inferior em obesos&#44; quando comparados com os adolescentes em sobrepeso&#44; sugeriu que a categoria de peso maior est&#225; associada a uma menor QVRS geral&#46; No Brasil&#44; em S&#227;o Paulo&#44; adolescentes obesos apresentavam uma QVRS prejudicada no PedsQL que afetava os dom&#237;nios social&#44; emocional e de funcionamento psicossocial&#44; bem como a QVRS geral&#44; o que corroborou o presente achado&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Ainda&#44; outro estudo brasileiro em adolescentes com excesso de peso mostra o impacto negativo da QVRS percebida pelos pais&#44; nos aspectos f&#237;sico e psicossocial&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Acreditamos que esse achado pode estar relacionado com um efeito inversamente proporcional entre IMC e QVRS&#46; Uma metan&#225;lise que cont&#233;m estudos que usaram o PedsQL aponta que h&#225; evid&#234;ncias de que a QVRS diminui &#224; medida que o IMC aumenta&#44; um gradiente do peso normal&#44; com excesso de peso para a obesidade&#44; em adolescentes&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> Os estudos por muitas vezes separam adolescentes com e sem obesidade e mostram que aqueles com obesidade apresentam piores &#237;ndices de QVRS&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5</span></a> Com isso&#44; evidencia&#8208;se a import&#226;ncia de considerar os aspectos psicossociais envolvidos no excesso de peso em adolescentes&#46; &#201; preciso considerar a QVRS na preven&#231;&#227;o e no tratamento da obesidade&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">No entanto&#44; este estudo tem algumas limita&#231;&#245;es&#46; Trata&#8208;se de um estudo transversal&#44; portanto infer&#234;ncias causais n&#227;o podem ser feitas&#46; H&#225; o uso de escolas de duas cidades&#44; nas quais n&#227;o foi poss&#237;vel avaliar o estado socioecon&#244;mico&#46; Por&#233;m as escolas estavam situadas em uma &#225;rea socioecon&#244;mica semelhante&#44; o que possibilitou que as escolas fossem compar&#225;veis&#46; Quanto ao car&#225;ter autoavaliativo da QVRS&#44; o PedsQL j&#225; demonstrou validade e confiabilidade&#44; o que confere pouco impacto nas conclus&#245;es feitas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Esses achados destacam a necessidade de cl&#237;nicos e pesquisadores incorporarem a avalia&#231;&#227;o da QVRS entre adolescentes com sobrepeso e obesidade&#44; ao passo que as identifica&#231;&#245;es de dom&#237;nios mais prejudicados podem levar a novas interven&#231;&#245;es mais espec&#237;ficas para o tratamento do excesso de peso e obesidade infantil&#44; bem como a ades&#227;o ao tratamento&#46; Sugerimos interven&#231;&#245;es focadas no aspecto emocional dessa popula&#231;&#227;o&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">A partir da autoavalia&#231;&#227;o de adolescentes com sobrepeso e obesidade se pode concluir que h&#225; preju&#237;zos na QVRS&#44; em diferentes dom&#237;nios&#44; quando separamos por faixa et&#225;ria&#44; g&#234;nero e categoria de peso &#40;sobrepeso e obesidade&#41;&#46; A idade mostrou&#8208;se como um fator associado&#44; pois a menor faixa et&#225;ria &#40;&#60;&#160;14&#160;anos&#41; relatou preju&#237;zos no &#8220;escore f&#237;sico&#8221; e &#8220;escore social&#8221;&#46; As meninas relatam menores escores de QVRS na maioria dos dom&#237;nios&#44; com exce&#231;&#227;o do &#8220;escore escolar&#8221;&#46; Finalmente&#44; os adolescentes com obesidade relatam menores pontua&#231;&#245;es nos escores &#8220;f&#237;sico&#8221;&#44; &#8220;escolar&#8221; e &#8220;total&#8221; da QVRS do que aqueles em sobrepeso&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financiamento</span><p id="par0175" class="elsevierStylePara elsevierViewall">Universidade de Santa Cruz do Sul &#40;Unisc&#41;&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflitos de interesse</span><p id="par0180" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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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 identify health&#8208;related quality of life in adolescents with excess weight and associated factors&#44; such as gender&#44; age&#44; and weight categories&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross&#8208;sectional study with collected and secondary data from 276 adolescents aged between 10 and 19 years with overweight and obesity&#44; and whose parents or guardians authorized their participation&#46; Anthropometric data&#44; pubertal development&#44; and the PedsQL 4&#46;0 questionnaire were collected for the health&#8208;related quality of life assessment&#46; Categorical data were described as numbers and percentages&#46; For the description of health&#8208;related quality of life subscales&#44; medians and the 25<span class="elsevierStyleSup">th</span> and 75<span class="elsevierStyleSup">th</span> percentiles were used&#44; as well as the Mann&#8211;Whitney test for comparisons between age group&#44; gender&#44; and weight categories&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The median health&#8208;related quality of life total score was 78&#46;3 &#40;68&#46;5&#8211;87&#46;4&#41;&#46; The lowest scale was the &#8220;emotional score&#8221;&#44; 65 &#40;50&#8211;80&#41;&#46; Higher health&#8208;related quality of life was found in boys in most of the scores &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; except for the &#8220;school score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#46; Regarding the age group&#44; the median of the &#8220;physical scores&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; and &#8220;social score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; were significantly lower in the group younger than 14 years&#46; When separated according to weight categories&#44; it was verified that obese adolescents differed significantly in relation to the &#8220;physical score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00&#41;&#44; &#8220;school score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#44; and &#8220;total score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; of the health&#8208;related quality of life&#46; However&#44; there was no significant difference between the emotional&#44; social&#44; and psychosocial scores&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adolescents with overweight and obesity show losses in the health&#8208;related quality of life and also between the different domains&#44; when separated by age&#44; gender&#44; and weight categories&#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">Identificar a qualidade de vida relacionada &#224; sa&#250;de entre adolescentes com excesso de peso e fatores associados&#44; como g&#234;nero&#44; idade e categorias de peso&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal com dados coletados e secund&#225;rios de 276 adolescentes entre 10 e 19 anos&#44; com sobrepeso e obesidade&#44; cujos respons&#225;veis autorizaram a participa&#231;&#227;o&#46; Foram coletados dados antropom&#233;tricos&#44; desenvolvimento puberal e question&#225;rio PedsQL 4&#46;0 para a avalia&#231;&#227;o da qualidade de vida relacionada &#224; sa&#250;de&#46; Os dados categ&#243;ricos foram descritos por contagens e percentuais&#46; Para a descri&#231;&#227;o das subescalas da qualidade de vida relacionada &#224; sa&#250;de foram usadas medianas e percentis 25 e 75 e teste de Mann&#8208;Whitney para compara&#231;&#245;es entre grupos de faixa et&#225;ria&#44; g&#234;nero e categorias de peso&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A mediana do escore total da qualidade de vida relacionada &#224; sa&#250;de foi de 78&#44;3 &#40;68&#44;5&#8208;87&#44;4&#41;&#46; A menor escala foi o &#8220;escore emocional&#8221; 65 &#40;50&#8208;80&#41;&#46; Encontramos a qualidade de vida relacionada &#224; sa&#250;de maior nos meninos na maioria dos escores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; exceto o &#8220;escore escolar&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;09&#41;&#46; Quanto &#224; faixa et&#225;ria&#44; a mediana dos &#8220;escores f&#237;sico&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; e &#8220;escore social&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; foram significativamente menores no grupo menor de 14 anos&#46; Ao separar as categorias de peso&#44; percebe&#8208;se que os adolescentes obesos diferem significativamente com rela&#231;&#227;o ao &#8220;escore f&#237;sico&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#59; &#8220;escore escolar&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41; e &#8220;escore total&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; da qualidade de vida relacionada &#224; sa&#250;de&#46; Contudo&#44; n&#227;o houve diferen&#231;a significativa entre os escores emocional&#44; social e psicossocial&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Adolescentes com sobrepeso e obesidade t&#234;m preju&#237;zos na qualidade de vida relacionada &#224; sa&#250;de e tamb&#233;m entre os diferentes dom&#237;nios&#44; quando separados por faixa et&#225;ria&#44; g&#234;nero e categorias de peso&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Como citar este artigo&#58; D&#8217;avila HF&#44; Poll FA&#44; Reuter CP&#44; Burgos MS&#44; Mello ED&#46; Health&#8208;related quality of life in adolescents with excess weight&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;495&#8211;501&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \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">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \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">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>276&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo n &#40;&#37;&#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>Masculino&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">112 &#40;40&#44;6&#37;&#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="\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>Feminino&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">164 &#40;59&#44;4&#37;&#41;&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="2" 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-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="elsevierStyleItalic">Idade em anos m&#233;dia &#40;DP&#41;</span>&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">12&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>&#60;<span class="elsevierStyleHsp" style=""></span>14&#160;anos&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">178 &#40;64&#44;5&#37;&#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="\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>14&#8211;19 anos&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">98 &#40;35&#44;5&#37;&#41;&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="2" 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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estadiamento puberal</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>Imp&#250;bere&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">24 &#40;8&#44;7&#37;&#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="\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>P&#250;bere&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">190 &#40;68&#44;8&#37;&#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="\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>P&#243;s&#8208;p&#250;bere&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">25 &#40;9&#44;1&#37;&#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="\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>N&#227;o respondeu&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">37 &#40;13&#44;4&#37;&#41;&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="2" 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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CC n &#40;&#37;&#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">155 &#40;56&#44;2&#37;&#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="\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>Elevada&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">121 &#40;43&#44;8&#37;&#41;&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="2" 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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Classifica&#231;&#227;o IMC n &#40;&#37;&#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>Sobrepeso&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">134 &#40;48&#44;6&#37;&#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="\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>Obesidade&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">142 &#40;51&#44;4&#37;&#41;&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="2" 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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Qualidade de vida</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>Escore f&#237;sico&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">84&#44;4 &#40;68&#44;7&#8211;93&#44;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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>Escore emocional&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">65 &#40;50&#8211;80&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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>Escore social&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">90&#44;00 &#40;75&#8211;100&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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>Escore escolar&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">80 &#40;70&#8211;90&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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>Sum&#225;rio psicossocial&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">76&#44;67 &#40;66&#44;7&#8211;86&#44;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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>Escore total&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">78&#44;3 &#40;68&#44;5&#8211;87&#44;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\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">Qualidade de vida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#60;<span class="elsevierStyleHsp" style=""></span>14 anos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>178&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">14&#8211;19 anos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&#41;&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">p<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&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">Escore f&#237;sico<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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">81&#44;2 &#40;68&#44;5&#8211;91&#44;4&#41;&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">87&#44;5 &#40;75&#8211;93&#44;7&#41;&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;030<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&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">Escore emocional<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">65 &#40;50&#8211;80&#41;&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">65 &#40;55&#8211;85&#41;&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;606&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">Escore social<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">85 &#40;70&#8211;95&#41;&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">90 &#40;80&#8211;100&#41;&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;002<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&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">Escore escolar<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">80 &#40;70&#8211;90&#41;&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">80 &#40;68&#44;7&#8211;90&#41;&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;476&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">Sum&#225;rio psicossocial<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">76&#44;7&#40;65&#8211;86&#44;7&#41;&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">76&#44;7 &#40;67&#44;9&#8211;88&#44;3&#41;&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;380&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">Escore total<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">77&#44;2 &#40;67&#44;1&#8211;86&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#44;4 &#40;70&#44;4&#8211;90&#44;2&#41;&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;122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore f&#237;sico<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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">87 &#40;75&#44;8&#8211;96&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;65&#44;6&#8211;90&#44;6&#41;&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;000<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&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">Escore emocional<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;56&#44;2&#8211;88&#44;7&#41;&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">60 &#40;50&#8211;75&#41;&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;000<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&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">Escore social<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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">90 &#40;80&#8211;100&#41;&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">85 &#40;70&#8211;95&#41;&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;015<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&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">Escore escolar<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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">80 &#40;70&#8211;90&#41;&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">75 &#40;65&#8211;90&#41;&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;097&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">Sum&#225;rio psicossocial<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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">80 &#40;71&#44;7&#8211;88&#44;3&#41;&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">73&#44;3 &#40;63&#44;3&#8211;85&#41;&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;001<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&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">Escore total<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">82&#44;1 &#40;73&#44;1&#8211;89&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74&#44;4 &#40;65&#44;5&#8211;85&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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Artigo Original
Health‐related quality of life in adolescents with excess weight
Qualidade de vida relacionada à saúde em adolescentes com excesso de peso
Helen F. D’avilaa,
Autor para correspondência
helen14davila@hotmail.com

Autor para correspondência.
, Fabiana A. Pollb, Cézane P. Reuterb, Miria S. Burgosb,, Elza D. Melloa
a Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós‐Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brasil
b Universidade de Santa Cruz do Sul (UNISC), Departamento de Educação Física e Saúde, Santa Cruz do Sul, RS, Brasil
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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 defini&#231;&#227;o de qualidade de vida relacionada &#224; sa&#250;de &#40;QVRS&#41; pela Organiza&#231;&#227;o Mundial de Sa&#250;de &#40;OMS&#41; &#233; multidimensional&#44; existem tr&#234;s principais dimens&#245;es da sa&#250;de &#40;f&#237;sica&#44; psicol&#243;gica e social&#41; e pode servir como medida de resultado da sa&#250;de geral&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A preval&#234;ncia de excesso de peso na Regi&#227;o Sul do Brasil &#233; de 28&#44;2&#37; entre adolescentes de&#160;13&#160;a&#160;17&#160;anos e de 10&#44;2&#37; de obesidade&#44; supera a preval&#234;ncia de outras regi&#245;es do pa&#237;s&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Sabe&#8208;se que crian&#231;as e adolescentes com excesso de peso nessa fase da vida podem permanecer em excesso de peso na vida adulta&#46; Uma recente proje&#231;&#227;o para a faixa entre&#160;2&#160;e&#160;19 anos mostra que a maioria dos jovens de hoje ser&#225; obeso aos 35&#160;anos&#46; Em crian&#231;as de 2&#160;anos&#44; a preval&#234;ncia da obesidade aumentou at&#233; a adolesc&#234;ncia&#44; quando se estabilizou&#44; por&#233;m continuou a aumentar ap&#243;s a adolesc&#234;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A preocupa&#231;&#227;o com o excesso de peso estende&#8208;se al&#233;m das condi&#231;&#245;es fisiol&#243;gicas&#44; pois o excesso de peso mostra&#8208;se com fator de interfer&#234;ncia para uma QVRS adequada entre adolescentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5</span></a> Portanto&#44; identificar e estudar adolescentes com excesso de peso &#233; importante para prevenir consequ&#234;ncias negativas sobre a QVRS&#44; que podem se estender em diversas dimens&#245;es da vida&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7</span></a> Nesse contexto&#44; o objetivo do presente estudo &#233; identificar a QVRS entre adolescentes com excesso de peso e verificar prov&#225;veis fatores associados como idade&#44; g&#234;nero e categorias de peso&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Estudo transversal&#44; descritivo&#44; de dados prim&#225;rios com adolescentes em sobrepeso e obesidade de ambos os sexos&#44; estudantes do ensino fundamental de uma escola do munic&#237;pio de Cachoeira do Sul&#47;RS &#40;CS&#41; e dados provenientes de um outro banco de dados com adolescentes em sobrepeso e obesidade de ambos os sexos&#44; estudantes da educa&#231;&#227;o b&#225;sica de Santa Cruz do Sul&#47;RS &#40;SCS&#41;&#46; As escolas participantes estavam situadas na regi&#227;o central e eram representativas das cidades&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Crit&#233;rios de inclus&#227;o e exclus&#227;o</span><p id="par0025" class="elsevierStylePara elsevierViewall">Os crit&#233;rios de inclus&#227;o foram os estudantes estarem regularmente matriculados nas escolas envolvidas no projeto&#44; entre&#160;10&#160;e&#160;17&#160;anos&#44; em sobrepeso e obesidade&#44; no caso do grupo de SCS&#46; Para o grupo de CS&#44; os alunos estarem matriculados no 6&#176;&#160;e 7&#176;&#160;ano de uma escola p&#250;blica&#44; com 9&#160;a&#160;18&#160;anos que apresentavam sobrepeso e obesidade&#46; Para CS e SCS&#44; foram inclu&#237;dos aqueles que concordaram e assinaram o Termo de Assentimento &#40;TA&#41; e cujos pais e&#47;ou respons&#225;veis&#44; que residiam na mesma casa&#44; assinassem o Termo de Consentimento Livre e Esclarecido &#40;TCLE&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Os crit&#233;rios de exclus&#227;o foram os mesmos para alunos de CS e SCS&#44; foram exclu&#237;dos aqueles sem condi&#231;&#245;es f&#237;sicas de se submeter &#224; avalia&#231;&#227;o antropom&#233;trica&#44; como cadeirantes&#44; com membros amputados ou engessados&#44; adolescentes gr&#225;vidas e alunos sem condi&#231;&#245;es mentais e&#47;ou em falta de compreens&#227;o para preencher os question&#225;rios&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A amostra foi obtida por conveni&#234;ncia&#44; considerando Intervalo de Confian&#231;a de 95&#37;&#44; margem de erro de 3&#44;5 e desvio&#8208;padr&#227;o de 18&#44;0&#59;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> chegou&#8208;se ao tamanho de amostra de 105&#160;adolescentes com sobrepeso e com Intervalo de Confian&#231;a de 95&#37;&#44; margem de erro de&#160;3&#44;5 e desvio&#8208;padr&#227;o de&#160;20&#44;1&#44; e ao tamanho de amostra de 130&#160;adolescentes obesos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Coleta de dados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Quanto aos dados prim&#225;rios&#44; os alunos que aceitaram participar e tinham o TA e o TCLE assinados foram submetidos &#224;s aferi&#231;&#245;es antropom&#233;tricas &#40;peso&#44; estatura e circunfer&#234;ncia da cintura &#91;CC&#93;&#41; pela pesquisadora&#44; autoavalia&#231;&#227;o do Estadiamento Puberal &#40;EP&#41; e <span class="elsevierStyleItalic">Pediatric Quality of Life Inventory</span>&#160;4&#46;0 &#40;PedsQL 4&#46;0&#41; para a avalia&#231;&#227;o da QV&#46; Idade e data de nascimento foram fornecidas pela escola&#46; A coleta de dados ocorreu em 2016 com tr&#234;s&#160;meses de dura&#231;&#227;o&#44; no qual foram coletados dados de 72&#160;alunos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Os dados provenientes de um banco de dados do projeto &#8220;Obesidade em adolescentes da educa&#231;&#227;o b&#225;sica&#58; um estudo de interven&#231;&#227;o interdisciplinar &#8211; Fase III&#8221; de SCS foram coletados de um banco inicialmente transversal de 25&#160;escolas&#44; dos quais os alunos tinha o TA e TCLE&#46; As escolas tinham semelhan&#231;a quanto &#224;s caracter&#237;sticas sociodemogr&#225;ficas&#46; As aferi&#231;&#245;es foram feitas na Universidade de Santa Cruz do Sul &#40;Unisc&#41;&#44; por equipe capacitada&#46; A pesquisa ocorreu entre 2015 e 2016&#44; na qual dados de 285&#160;adolescentes foram coletados&#46; Foram transferidos dados como peso&#44; altura&#44; idade&#44; cor da pele&#44; CC&#44; EP e PedsQL&#44; de adolescentes com sobrepeso e obesidade&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Instrumentos e medidas</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Estado nutricional</span><p id="par0050" class="elsevierStylePara elsevierViewall">Foram coletadas&#58; idade informada pela escola&#44; peso &#40;kg&#41;&#44; altura &#40;cm&#41;&#46; As medidas de peso e estatura foram usadas para o c&#225;lculo do &#205;ndice de Massa Corporal &#40;IMC&#41; &#40;peso&#160;&#91;kg&#93;&#47;estatura&#160;&#91;m<span class="elsevierStyleSup">2</span>&#93;&#41;&#46; Os adolescentes foram classificados como portadores de excesso de peso &#40;sobrepeso ou obesidade&#41; a partir do IMC&#47;idade expresso em escore z&#44; calculado com o aux&#237;lio do <span class="elsevierStyleItalic">software</span> WHO&#8208;Anthro Plus&#160;2007 &#40;<span class="elsevierStyleItalic">World Health Organization</span>&#41; e seguindo as recomenda&#231;&#245;es propostas pela OMS&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> A CC foi aferida no ponto m&#233;dio entre a &#250;ltima costela e a crista il&#237;aca&#46; Seguiram&#8208;se os pontos de corte que identificam obesidade abdominal quando CC for maior que P90&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Estadiamento puberal</span><p id="par0055" class="elsevierStylePara elsevierViewall">Para verificar o EP foi aplicado o question&#225;rio de autoavalia&#231;&#227;o de acordo com os crit&#233;rios de Tanner&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> no mesmo momento da avalia&#231;&#227;o antropom&#233;trica&#46; O adolescente estava em local reservado para evitar constrangimentos&#46; Usou&#8208;se autoavalia&#231;&#227;o dos adolescentes atrav&#233;s de imagens ilustrativas&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Qualidade de vida</span><p id="par0060" class="elsevierStylePara elsevierViewall">Aplicou&#8208;se o question&#225;rio gen&#233;rico PedsQL&#160;4&#46;0&#44; validado para a popula&#231;&#227;o brasileira&#44; com quatro subescalas e 23&#160;itens que abrangem&#58; 1&#41;&#160;Dimens&#227;o f&#237;sica&#44; 2&#41;&#160;Dimens&#227;o emocional&#44; 3&#41;&#160;Dimens&#227;o social e 4&#41;&#160;Dimens&#227;o escolar&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A an&#225;lise das respostas do PesdQL&#160;4&#46;0 deu&#8208;se da seguinte forma&#58; foram pontuados inversamente e transpostos linearmente para uma escala de 0&#8211;100 &#40;nunca<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#160;pontos&#59; quase nunca<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#160;pontos&#59; algumas vezes<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#160;pontos&#44; muitas vezes<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#160;pontos&#59; quase sempre<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#160;pontos&#41;&#59; assim&#44; quanto maior o escore&#44; melhor a QVRS&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Foi criado um escore do sum&#225;rio psicossocial&#44; que demonstra a sa&#250;de psicossocial do escolar&#44; atrav&#233;s da m&#233;dia das somas dos itens&#58; dimens&#227;o social&#44; dimens&#227;o emocional e dimens&#227;o escolar&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Na presen&#231;a de dados ausentes&#44; os escores da escala foram computados como a soma dos itens dividida pelo n&#250;mero de itens respondidos&#46; Por&#233;m&#44; quando mais de 50&#37; dos itens da escala est&#227;o ausentes&#44; o escore da escala n&#227;o foi registrado&#46; A consist&#234;ncia dessa computa&#231;&#227;o &#233; similar &#224; de outras publica&#231;&#245;es arbitradas sobre o PedsQL&#44; assim como outras mensura&#231;&#245;es estabelecidas de QVRS&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lise estat&#237;stica</span><p id="par0080" class="elsevierStylePara elsevierViewall">Os dados categ&#243;ricos foram descritos por contagens e percentuais&#44; para vari&#225;veis como cidade&#44; sexo&#44; CC&#44; classifica&#231;&#227;o do IMC&#46; A idade foi descrita por m&#233;dia e desvio&#8208;padr&#227;o &#40;m<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41;&#46; A normalidade da distribui&#231;&#227;o foi verificada para todas as vari&#225;veis cont&#237;nuas por meio do teste de Kolmogorov&#8208;Smirnov&#46; Ao passo que a amostra n&#227;o apresentou uma distribui&#231;&#227;o normal&#44; para descrever as subescalas da QV foram usadas medianas e percentis&#160;25&#160;e&#160;75&#46; As compara&#231;&#245;es entre grupos de faixa et&#225;ria&#44; g&#234;nero e categoria de peso foram feitas por meio do teste de Mann&#8208;Whitney&#46; Os dados foram analisados por meio do <span class="elsevierStyleItalic">software</span> estat&#237;stico <span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span> &#40;SPSS&#41; IBM vers&#227;o&#160;20&#46;0</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Aspectos &#233;ticos</span><p id="par0085" class="elsevierStylePara elsevierViewall">O projeto inicial em SCS j&#225; contava com aprova&#231;&#227;o do CEP da Unisc&#44; sob CAAE&#160;n&#176;&#160;54985316&#46;0&#46;0000&#46;5343 e Parecer n&#176;&#160;1&#46;498&#46;330&#46; O estudo foi submetido ao Comit&#234; de &#201;tica da Universidade Federal do Rio Grande do Sul &#40;UFRGS&#41; para o uso dos dados coletados no munic&#237;pio de CS&#44; concomitante aos dados de SCS&#44; aprovada sob CAAE&#160;n&#176;&#160;71390416&#46;1&#46;0000&#46;5347 e Parecer n&#176;&#160;2&#46;395&#46;088&#44; e seguiu todos os preceitos &#233;ticos preconizados na Resolu&#231;&#227;o&#160;466&#47;12 do Conselho Nacional de Sa&#250;de&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><p id="par0090" class="elsevierStylePara elsevierViewall">Foram coletados dados de 298&#160;adolescentes&#46; Devido a dados incompletos foram exclu&#237;dos 22&#46; O estudo contou com 276&#160;adolescentes com excesso de peso&#44; ou seja&#44; portadores de sobrepeso &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>134&#41; e obesidade &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>142&#41;&#46; A idade m&#233;dia foi de 12&#44;8&#160;anos&#44; variou de&#160;9&#160;a&#160;18&#160;anos&#46; A maioria dos adolescentes encontrava&#8208;se com adiposidade abdominal normal &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; A mediana do escore total da QVRS dos adolescentes foi de 78&#44;3&#160;&#40;68&#44;5&#8211;87&#44;4&#41;&#46; A menor escala foi o &#8220;escore emocional&#8221; 65&#160;&#40;50&#8211;80&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Faixa et&#225;ria</span><p id="par0095" class="elsevierStylePara elsevierViewall">Foi analisado o efeito da faixa et&#225;ria sobre os escores das subescalas do PedsQL&#46; A mediana dos escores &#8220;f&#237;sico&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; e &#8220;social&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; foi significativamente menor na faixa menor de 14&#160;anos&#44; em compara&#231;&#227;o com adolescentes entre&#160;14&#160;e&#160;19&#160;anos&#46; Contudo&#44; n&#227;o houve diferen&#231;a entre as medianas dos escores emocional&#44; escolar&#44; sum&#225;rio psicossocial e total &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">G&#234;nero</span><p id="par0100" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> destaca as compara&#231;&#245;es entre g&#234;nero masculino e feminino dos adolescentes&#46; Analisando a QVRS nos diferentes grupos&#44; percebe&#8208;se uma diferen&#231;a estatisticamente significativa&#44; visto que a mediana da QVRS foi maior nos meninos em todos os escores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; exceto o &#8220;escolar&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;09&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Categorias de peso</span><p id="par0105" class="elsevierStylePara elsevierViewall">Os efeitos das vari&#225;veis sobrepeso e obesidade foram analisados na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#46; Os adolescentes obesos apresentaram diferen&#231;as significativas com rela&#231;&#227;o ao &#8220;escore f&#237;sico&#8221;&#160;&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#59; &#8220;escore escolar&#8221;&#160;&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41; e &#8220;escore total&#8221;&#160;&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; da QVRS&#44; quando comparadas com adolescentes em sobrepeso&#46; N&#227;o houve diferen&#231;a significativa entre os escores emocional&#44; social e psicossocial&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discuss&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">O presente estudo visa a descrever a QVRS de adolescentes com excesso de peso e comparar os prov&#225;veis fatores associados como faixa et&#225;ria&#44; g&#234;nero e categorias de peso &#40;sobrepeso e obesidade&#41;&#46; At&#233; o presente momento&#44; este &#233; o primeiro estudo que publica dados sobre a QVRS entre adolescentes&#44; com sobrepeso e obesidade&#44; de duas cidades do Rio Grande do Sul&#46; Ao analisar as subescalas do PedsQL&#44; encontramos uma mediana da QVRS de 78&#44;3&#160;&#40;68&#44;5&#8211;87&#44;4&#41; dos adolescentes com excesso de peso e obesidade&#46; O menor escore da subescala do PedsQL foi o &#8220;emocional&#8221;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Alguns estudos&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;12&#44;13</span></a> bem como o presente&#44; encontraram o escore emocional como o menor escore da subescala do PedsQL&#44; entre adolescentes com sobrepeso e obesidade&#44; alertaram que a obesidade pode ser um fator determinante para o decl&#237;nio da QVRS&#44; principalmente na dimens&#227;o emocional&#46; Dom&#237;nios emocionais menores preocupam principalmente quando se remetem &#224; popula&#231;&#227;o jovem com excesso de peso&#44; pois um recente estudo de revis&#227;o<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> mostra que o consumo alimentar motivado pelo estado emocional est&#225; associado ao desenvolvimento e &#224; manuten&#231;&#227;o do excesso de peso e obesidade&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Quando separamos adolescentes por faixa <span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>14&#160;anos e 14&#8211;19&#160;anos&#44; o grupo<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>14&#160;anos relatou menores pontua&#231;&#245;es no &#8220;escore f&#237;sico&#8221; e &#8220;escore social&#8221;&#46; O estudo de Su et al&#46; apontou que meninos obesos no 3&#176;&#160;e&#160;4&#176;&#160;ano escolar apresentaram maiores dificuldades relacionadas ao escore f&#237;sico do que seus pares de peso normal&#46; Por&#233;m&#44; os meninos do 5&#176;&#160;e 6&#176;&#160;ano n&#227;o mostraram essa diferen&#231;a&#44; o que se assemelha ao achado deste estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Uma hip&#243;tese para o achado &#233; que a percep&#231;&#227;o das crian&#231;as e adolescentes sobre a obesidade pode explicar essas menores pontua&#231;&#245;es quanto ao escore f&#237;sico&#44; visto que a percep&#231;&#227;o negativa diminui inversamente proporcional &#224; idade&#44; bem como a maioria dos adolescentes percebe que a obesidade cria limita&#231;&#245;es no desempenho f&#237;sico&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Contrariamente ao achado deste estudo&#44; a obesidade foi associada a maior QVRS em estudantes mais jovens &#40;12&#8211;14&#160;anos&#41;&#44; junto a maiores pontua&#231;&#245;es no funcionamento emocional&#44; escolar e bem&#8208;estar&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Quanto ao &#8220;escore social&#8221; afetado&#44; entre adolescentes mais jovens&#44; acredita&#8208;se que a faixa de&#160;14&#8211;19&#160;anos tem uma maior sociabiliza&#231;&#227;o&#44; pois frequentam mais festas&#44; comportamento t&#237;pico da adolesc&#234;ncia&#46; Os jovens obesos podem sofrer um decl&#237;nio no dom&#237;nio social e perceber esses n&#237;veis mais baixos do que a maioria da juventude&#46; Contudo&#44; o apoio social percebido dos colegas de classe&#44; em particular&#44; pode ter um efeito importante sobre os resultados de QVRS em longo prazo para os jovens que persistirem obesos&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">O g&#234;nero apresenta&#8208;se associado a uma menor QVRS em meninas&#46; No presente estudo&#44; os escores das subescalas do PedsQL foram significativamente menores nas meninas&#44; com exce&#231;&#227;o do &#8220;escore escolar&#8221;&#44; e esse achado corrobora alguns estudos&#44; nos quais essa associa&#231;&#227;o &#233; percebida em indiv&#237;duos eutr&#243;ficos e com excesso de peso&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;20&#8211;22</span></a> Acredita&#8208;se que o processo de transforma&#231;&#227;o do corpo atrelado ao ambiente &#40;m&#237;dias sociais&#44; fam&#237;lia e amigos&#41; &#233; mais impactante para a popula&#231;&#227;o feminina com excesso de peso&#46; Como consequ&#234;ncia disso&#44; pode estar relacionado aos baixos n&#237;veis de QVRS&#46; A supervaloriza&#231;&#227;o do peso e imagem corporal pode ser outro fator que influencia a QVRS especificamente entre as meninas&#44; al&#233;m de fatores f&#237;sicos como a puberdade &#40;por conta da menstrua&#231;&#227;o&#41;&#44; horm&#244;nios e padr&#245;es sociais e de beleza&#44; que s&#227;o dif&#237;ceis de atingir&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;20&#44;21</span></a> Meninas adolescentes&#44; com sobrepeso e obesidade &#40;autopercebida e medida&#41; necessitam de maior aten&#231;&#227;o&#44; devido aos fatores j&#225; citados e ainda pelo aumento da&#160;probabilidade de ideia suicida&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> Nesse contexto&#44; ressalta&#8208;se que o tratamento do sobrepeso e obesidade em adolescentes dever&#225; ser feito frequentemente e em longo prazo&#44; apoiar&#8208;se em metas de alvo de comportamento da dieta e n&#227;o do peso&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> prevenir que o tratamento feito de forma inadequada contribua para um maior decl&#237;nio da QVRS dessas adolescentes em excesso de peso&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Verificou&#8208;se que os adolescentes com obesidade relataram significativamente maiores preju&#237;zos nos dom&#237;nios f&#237;sico&#44; escolar e escore total da QVRS&#44; quando comparados com a categoria sobrepeso&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A respeito do dom&#237;nio f&#237;sico&#44; acredita&#8208;se que uso de internet entre os adolescentes obesos&#44; o isolamento social e o estado emocional pode contribuir para a diminui&#231;&#227;o da QVRS no dom&#237;nio f&#237;sico&#46; Um estudo que relaciona QVRS e v&#237;cio de internet encontrou que os adolescentes obesos t&#234;m uma taxa maior de v&#237;cio em internet&#44; atrelada a menor dom&#237;nio f&#237;sico e psicossocial&#46; Provavelmente o v&#237;cio na internet&#44; causado pelo mau funcionamento emocional&#44; contribua para a obesidade&#44; visto que atividades <span class="elsevierStyleItalic">online</span> afastam as atividades f&#237;sicas e essa diminui&#231;&#227;o contribui diretamente para obesidade&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Outro fator que pode explicar menores pontua&#231;&#245;es no escore f&#237;sico&#44; neste estudo&#44; &#233; o detrimento da sa&#250;de social e emocional causado pela obesidade&#44; ao passo que geralmente adolescentes obesos s&#227;o exclu&#237;dos de atividades competitivas que demandam esfor&#231;o f&#237;sico&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> &#201; importante destacar que os profissionais de sa&#250;de devem promover um refor&#231;o em rela&#231;&#227;o ao comportamento dos adolescentes&#44; que contemple o aumento de atividade f&#237;sica vigorosa e l&#250;dica &#40;pelo menos uma&#160;hora por dia&#41;&#44; no qual o adolescente sinta prazer em pratic&#225;&#8208;la e tamb&#233;m a redu&#231;&#227;o do uso de telas&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Foi encontrada uma consequ&#234;ncia acad&#234;mica associada a obesidade&#44; em que menores pontua&#231;&#245;es no escore escolar foram relatadas pelos adolescentes&#44; e esses preju&#237;zos corroboram os dados da literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#8211;28</span></a> Um estudo com adolescentes chineses sugere que os processos de aprendizagem e mem&#243;ria em adolescentes obesos s&#227;o diferentes das que est&#227;o na categoria de peso normal&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Este estudo encontrou uma associa&#231;&#227;o da obesidade com um desempenho acad&#234;mico inferior&#44; devido &#224; fraca capacidade b&#225;sica de mem&#243;ria de trabalho&#46; Os autores prop&#245;em que adolescentes obesos s&#227;o mais sens&#237;veis &#224; mem&#243;ria com materiais de marca de alimentos e bebidas e que o d&#233;ficit de mem&#243;ria funcional para adolescentes obesos pode ser espec&#237;fico do dom&#237;nio&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Ainda&#44; existe uma hip&#243;tese de que a obesidade tem sido associada a diferen&#231;as estruturais detect&#225;veis no c&#233;rebro em compara&#231;&#227;o com os c&#233;rebros de indiv&#237;duos de peso normal&#44; durante a inf&#226;ncia e adolesc&#234;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Um estudo recente&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> que envolveu crian&#231;as e adolescentes&#44; na Espanha&#44; encontrou uma associa&#231;&#227;o positiva entre os componentes da aptid&#227;o f&#237;sica&#44; com o volume de mat&#233;ria cinzenta nas estruturas corticais e subcorticais do c&#233;rebro em crian&#231;as com sobrepeso e obesidade&#46; Algumas dessas estruturas cerebrais estavam relacionadas ao melhor desempenho acad&#234;mico&#46; Os autores explicam que possivelmente a promo&#231;&#227;o da atividade f&#237;sica&#44; que acarreta a melhoria da aptid&#227;o cardiorrespirat&#243;ria e agilidade&#47;velocidade&#44; pode ser importante tamb&#233;m para a desenvolvimento de habilidades cerebrais e acad&#234;micas em adolescentes com sobrepeso e obesidade&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">O presente estudo encontrou um escore total da QVRS inferior em obesos&#44; quando comparados com os adolescentes em sobrepeso&#44; sugeriu que a categoria de peso maior est&#225; associada a uma menor QVRS geral&#46; No Brasil&#44; em S&#227;o Paulo&#44; adolescentes obesos apresentavam uma QVRS prejudicada no PedsQL que afetava os dom&#237;nios social&#44; emocional e de funcionamento psicossocial&#44; bem como a QVRS geral&#44; o que corroborou o presente achado&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Ainda&#44; outro estudo brasileiro em adolescentes com excesso de peso mostra o impacto negativo da QVRS percebida pelos pais&#44; nos aspectos f&#237;sico e psicossocial&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Acreditamos que esse achado pode estar relacionado com um efeito inversamente proporcional entre IMC e QVRS&#46; Uma metan&#225;lise que cont&#233;m estudos que usaram o PedsQL aponta que h&#225; evid&#234;ncias de que a QVRS diminui &#224; medida que o IMC aumenta&#44; um gradiente do peso normal&#44; com excesso de peso para a obesidade&#44; em adolescentes&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> Os estudos por muitas vezes separam adolescentes com e sem obesidade e mostram que aqueles com obesidade apresentam piores &#237;ndices de QVRS&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;5</span></a> Com isso&#44; evidencia&#8208;se a import&#226;ncia de considerar os aspectos psicossociais envolvidos no excesso de peso em adolescentes&#46; &#201; preciso considerar a QVRS na preven&#231;&#227;o e no tratamento da obesidade&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">No entanto&#44; este estudo tem algumas limita&#231;&#245;es&#46; Trata&#8208;se de um estudo transversal&#44; portanto infer&#234;ncias causais n&#227;o podem ser feitas&#46; H&#225; o uso de escolas de duas cidades&#44; nas quais n&#227;o foi poss&#237;vel avaliar o estado socioecon&#244;mico&#46; Por&#233;m as escolas estavam situadas em uma &#225;rea socioecon&#244;mica semelhante&#44; o que possibilitou que as escolas fossem compar&#225;veis&#46; Quanto ao car&#225;ter autoavaliativo da QVRS&#44; o PedsQL j&#225; demonstrou validade e confiabilidade&#44; o que confere pouco impacto nas conclus&#245;es feitas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Esses achados destacam a necessidade de cl&#237;nicos e pesquisadores incorporarem a avalia&#231;&#227;o da QVRS entre adolescentes com sobrepeso e obesidade&#44; ao passo que as identifica&#231;&#245;es de dom&#237;nios mais prejudicados podem levar a novas interven&#231;&#245;es mais espec&#237;ficas para o tratamento do excesso de peso e obesidade infantil&#44; bem como a ades&#227;o ao tratamento&#46; Sugerimos interven&#231;&#245;es focadas no aspecto emocional dessa popula&#231;&#227;o&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">A partir da autoavalia&#231;&#227;o de adolescentes com sobrepeso e obesidade se pode concluir que h&#225; preju&#237;zos na QVRS&#44; em diferentes dom&#237;nios&#44; quando separamos por faixa et&#225;ria&#44; g&#234;nero e categoria de peso &#40;sobrepeso e obesidade&#41;&#46; A idade mostrou&#8208;se como um fator associado&#44; pois a menor faixa et&#225;ria &#40;&#60;&#160;14&#160;anos&#41; relatou preju&#237;zos no &#8220;escore f&#237;sico&#8221; e &#8220;escore social&#8221;&#46; As meninas relatam menores escores de QVRS na maioria dos dom&#237;nios&#44; com exce&#231;&#227;o do &#8220;escore escolar&#8221;&#46; Finalmente&#44; os adolescentes com obesidade relatam menores pontua&#231;&#245;es nos escores &#8220;f&#237;sico&#8221;&#44; &#8220;escolar&#8221; e &#8220;total&#8221; da QVRS do que aqueles em sobrepeso&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financiamento</span><p id="par0175" class="elsevierStylePara elsevierViewall">Universidade de Santa Cruz do Sul &#40;Unisc&#41;&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflitos de interesse</span><p id="par0180" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            2 => "Obesity"
            3 => "Adolescent"
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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 identify health&#8208;related quality of life in adolescents with excess weight and associated factors&#44; such as gender&#44; age&#44; and weight categories&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross&#8208;sectional study with collected and secondary data from 276 adolescents aged between 10 and 19 years with overweight and obesity&#44; and whose parents or guardians authorized their participation&#46; Anthropometric data&#44; pubertal development&#44; and the PedsQL 4&#46;0 questionnaire were collected for the health&#8208;related quality of life assessment&#46; Categorical data were described as numbers and percentages&#46; For the description of health&#8208;related quality of life subscales&#44; medians and the 25<span class="elsevierStyleSup">th</span> and 75<span class="elsevierStyleSup">th</span> percentiles were used&#44; as well as the Mann&#8211;Whitney test for comparisons between age group&#44; gender&#44; and weight categories&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The median health&#8208;related quality of life total score was 78&#46;3 &#40;68&#46;5&#8211;87&#46;4&#41;&#46; The lowest scale was the &#8220;emotional score&#8221;&#44; 65 &#40;50&#8211;80&#41;&#46; Higher health&#8208;related quality of life was found in boys in most of the scores &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; except for the &#8220;school score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#46; Regarding the age group&#44; the median of the &#8220;physical scores&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; and &#8220;social score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; were significantly lower in the group younger than 14 years&#46; When separated according to weight categories&#44; it was verified that obese adolescents differed significantly in relation to the &#8220;physical score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00&#41;&#44; &#8220;school score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#44; and &#8220;total score&#8221; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; of the health&#8208;related quality of life&#46; However&#44; there was no significant difference between the emotional&#44; social&#44; and psychosocial scores&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adolescents with overweight and obesity show losses in the health&#8208;related quality of life and also between the different domains&#44; when separated by age&#44; gender&#44; and weight categories&#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">Identificar a qualidade de vida relacionada &#224; sa&#250;de entre adolescentes com excesso de peso e fatores associados&#44; como g&#234;nero&#44; idade e categorias de peso&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal com dados coletados e secund&#225;rios de 276 adolescentes entre 10 e 19 anos&#44; com sobrepeso e obesidade&#44; cujos respons&#225;veis autorizaram a participa&#231;&#227;o&#46; Foram coletados dados antropom&#233;tricos&#44; desenvolvimento puberal e question&#225;rio PedsQL 4&#46;0 para a avalia&#231;&#227;o da qualidade de vida relacionada &#224; sa&#250;de&#46; Os dados categ&#243;ricos foram descritos por contagens e percentuais&#46; Para a descri&#231;&#227;o das subescalas da qualidade de vida relacionada &#224; sa&#250;de foram usadas medianas e percentis 25 e 75 e teste de Mann&#8208;Whitney para compara&#231;&#245;es entre grupos de faixa et&#225;ria&#44; g&#234;nero e categorias de peso&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A mediana do escore total da qualidade de vida relacionada &#224; sa&#250;de foi de 78&#44;3 &#40;68&#44;5&#8208;87&#44;4&#41;&#46; A menor escala foi o &#8220;escore emocional&#8221; 65 &#40;50&#8208;80&#41;&#46; Encontramos a qualidade de vida relacionada &#224; sa&#250;de maior nos meninos na maioria dos escores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; exceto o &#8220;escore escolar&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;09&#41;&#46; Quanto &#224; faixa et&#225;ria&#44; a mediana dos &#8220;escores f&#237;sico&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; e &#8220;escore social&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; foram significativamente menores no grupo menor de 14 anos&#46; Ao separar as categorias de peso&#44; percebe&#8208;se que os adolescentes obesos diferem significativamente com rela&#231;&#227;o ao &#8220;escore f&#237;sico&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#59; &#8220;escore escolar&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41; e &#8220;escore total&#8221; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; da qualidade de vida relacionada &#224; sa&#250;de&#46; Contudo&#44; n&#227;o houve diferen&#231;a significativa entre os escores emocional&#44; social e psicossocial&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Adolescentes com sobrepeso e obesidade t&#234;m preju&#237;zos na qualidade de vida relacionada &#224; sa&#250;de e tamb&#233;m entre os diferentes dom&#237;nios&#44; quando separados por faixa et&#225;ria&#44; g&#234;nero e categorias de peso&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
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    "NotaPie" => array:2 [
      0 => array:3 [
        "etiqueta" => "&#8224;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0060">Em mem&#243;ria&#46;</p>"
        "identificador" => "fn0005"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Como citar este artigo&#58; D&#8217;avila HF&#44; Poll FA&#44; Reuter CP&#44; Burgos MS&#44; Mello ED&#46; Health&#8208;related quality of life in adolescents with excess weight&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;495&#8211;501&#46;</p>"
      ]
    ]
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            "detalle" => "Tabela "
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>276&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">112 &#40;40&#44;6&#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">164 &#40;59&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&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="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>14&#160;anos&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">178 &#40;64&#44;5&#37;&#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="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>14&#8211;19 anos&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">98 &#40;35&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\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>Imp&#250;bere&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">24 &#40;8&#44;7&#37;&#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="\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>P&#250;bere&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">190 &#40;68&#44;8&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&#243;s&#8208;p&#250;bere&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">25 &#40;9&#44;1&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o respondeu&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">37 &#40;13&#44;4&#37;&#41;&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="2" 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
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">CC n &#40;&#37;&#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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">155 &#40;56&#44;2&#37;&#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="\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>Elevada&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">121 &#40;43&#44;8&#37;&#41;&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="2" 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
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\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">134 &#40;48&#44;6&#37;&#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="\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
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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">142 &#40;51&#44;4&#37;&#41;&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="2" 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
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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>Escore f&#237;sico&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">84&#44;4 &#40;68&#44;7&#8211;93&#44;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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
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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">65 &#40;50&#8211;80&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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
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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">90&#44;00 &#40;75&#8211;100&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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
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                  \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">80 &#40;70&#8211;90&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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>Sum&#225;rio psicossocial&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">76&#44;67 &#40;66&#44;7&#8211;86&#44;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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>Escore total&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">78&#44;3 &#40;68&#44;5&#8211;87&#44;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Qualidade de vida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#60;<span class="elsevierStyleHsp" style=""></span>14 anos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>178&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \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">14&#8211;19 anos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \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">p<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Escore f&#237;sico<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">81&#44;2 &#40;68&#44;5&#8211;91&#44;4&#41;&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">87&#44;5 &#40;75&#8211;93&#44;7&#41;&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;030<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&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">Escore emocional<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">65 &#40;50&#8211;80&#41;&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">65 &#40;55&#8211;85&#41;&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;606&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">Escore social<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">85 &#40;70&#8211;95&#41;&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">90 &#40;80&#8211;100&#41;&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;002<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&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">Escore escolar<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">80 &#40;70&#8211;90&#41;&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">80 &#40;68&#44;7&#8211;90&#41;&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;476&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">Sum&#225;rio psicossocial<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">76&#44;7&#40;65&#8211;86&#44;7&#41;&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">76&#44;7 &#40;67&#44;9&#8211;88&#44;3&#41;&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;380&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">Escore total<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">77&#44;2 &#40;67&#44;1&#8211;86&#44;9&#41;&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">80&#44;4 &#40;70&#44;4&#8211;90&#44;2&#41;&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;122&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Qualidade de vida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Masculino &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>112&#41;&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">p<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Escore f&#237;sico<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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">87 &#40;75&#44;8&#8211;96&#44;1&#41;&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">78 &#40;65&#44;6&#8211;90&#44;6&#41;&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;000<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&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">Escore emocional<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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">70 &#40;56&#44;2&#8211;88&#44;7&#41;&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">60 &#40;50&#8211;75&#41;&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;000<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&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">Escore social<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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">90 &#40;80&#8211;100&#41;&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">85 &#40;70&#8211;95&#41;&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;015<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&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">Escore escolar<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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">80 &#40;70&#8211;90&#41;&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">75 &#40;65&#8211;90&#41;&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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ISSN: 22555536
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