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A esse respeito&#44; cerca de 40 a 45&#37; da massa &#243;ssea presente na vida adulta s&#227;o adquiridos durante a adolesc&#234;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Nesse contexto&#44; deve&#8208;se lembrar que os contraceptivos s&#227;o prescritos em idades cada vez mais jovens para proteger o p&#250;blico jovem de gravidezes n&#227;o intencionais no in&#237;cio da atividade sexual&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> Essa pr&#225;tica levantou d&#250;vidas quanto &#224; quantidade de estrog&#234;nio na formula&#231;&#227;o ser adequada para essa faixa et&#225;ria&#44; com rela&#231;&#227;o ao desenvolvimento &#243;sseo e ao atingimento de um pico de massa &#243;ssea adequado&#46; A maior parte das pesquisas publicadas inclui uma ampla gama de mulheres de diferentes idades&#44; inclusive adolescentes&#44; pessoas jovens e at&#233; mesmo adultos jovens&#44; bem como diversos momentos do crescimento e mineraliza&#231;&#227;o &#243;ssea&#44; cria dificuldades ao interpretar os resultados de aumentos da massa &#243;ssea&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Estudos recentes que envolvem meninos e meninas jovens demonstraram uma rela&#231;&#227;o entre os marcadores &#243;sseos como preditores do desenvolvimento de conte&#250;do mineral &#243;sseo &#40;CMO&#41; e DMO durante o per&#237;odo de maior ganho de massa &#243;ssea&#46; Os resultados mostraram que as concentra&#231;&#245;es de marcadores de forma&#231;&#227;o &#243;ssea e reabsor&#231;&#227;o s&#227;o maiores nos primeiros anos da puberdade do que os est&#225;gios avan&#231;ados de desenvolvimento p&#250;bere&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#8211;7</span></a> Os poss&#237;veis efeitos dos contraceptivos sobre o ganho de massa &#243;ssea podem causar doen&#231;as de remodela&#231;&#227;o &#243;ssea&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A import&#226;ncia dos contraceptivos hormonais para o ganho de massa &#243;ssea e sua participa&#231;&#227;o na remodela&#231;&#227;o &#243;ssea destacam a necessidade de fazer estudos prospectivos que abordem especificamente a adolesc&#234;ncia&#44; um per&#237;odo caracterizado por maior aquisi&#231;&#227;o de massa &#243;ssea&#44; para avaliar os efeitos desses medicamentos sobre a sa&#250;de &#243;ssea nessa faixa et&#225;ria e os poss&#237;veis resultados futuros na vida adulta e velhice&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Assim&#44; o objetivo deste estudo foi avaliar prospectivamente se haveria quaisquer efeitos e poss&#237;veis diferen&#231;as entre o uso de dois tipos de contraceptivos orais &#40;CO&#41; de baixa dosagem&#44; com 20<span class="elsevierStyleHsp" style=""></span>&#956;g etinilestradiol &#40;EE&#41;&#47;150<span class="elsevierStyleHsp" style=""></span>&#956;g desogestrel ou 30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona&#44; por um ano sobre o metabolismo &#243;sseo das adolescentes e comparar os resultados com os obtidos para adolescentes saud&#225;veis que n&#227;o usaram COs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este foi um estudo quase experimento aprovado pelo Comit&#234; de &#201;tica em Pesquisa da Faculdade de Medicina de Botucatu&#44; S&#227;o Paulo&#44; Brasil&#46; A amostra consistiu de adolescentes saud&#225;veis com estatura entre o percentil 5 e 95 para a idade e &#237;ndice de massa corporal &#40;IMC&#41; entre percentil 5 e 95&#44; de acordo com o Centro de Controle e Preven&#231;&#227;o de Doen&#231;as&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> As adolescentes que disseram ter vida sexual ativa e quiseram iniciar o m&#233;todo contraceptivo foram inclu&#237;das nos grupos de exposi&#231;&#227;o a CO e dois tipos de COs foram oferecidos&#46; Aquelas que n&#227;o pediram COs foram direcionadas para o grupo de controle&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As participantes foram divididas em tr&#234;s grupos&#46; O Grupo 1 &#40;CO1&#41; consistiu em adolescentes saud&#225;veis entre 12 anos completos e 20 anos incompletos no p&#243;s&#8208;menarca&#44; puberdade tardia&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> As adolescentes foram registradas na cl&#237;nica ambulatorial de Medicina do Adolescente do Hospital Universit&#225;rio e foram encaminhadas para orienta&#231;&#227;o e prescri&#231;&#227;o de um m&#233;todo contraceptivo&#44; devido &#224; vida sexual ativa&#46; Esses indiv&#237;duos &#40;n &#61; 42&#41; receberam um contraceptivo oral &#40;CO&#41; combinado de baixa dosagem que cont&#233;m etinilestradiol &#40;EE&#41; e 150<span class="elsevierStyleHsp" style=""></span>&#956;g de desogestrel&#46; O grupo 2 &#40;CO2&#41; consistiu em adolescentes da mesma faixa et&#225;ria e com as mesmas caracter&#237;sticas que as do CO1&#46; Esses indiv&#237;duos &#40;n &#61; 66&#41; receberam outra formula&#231;&#227;o de CO combinado de baixa dosagem que cont&#233;m 30<span class="elsevierStyleHsp" style=""></span>&#956;g EE e 3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona&#46; O grupo de controle consistiu em 70 adolescentes pareadas para os outros dois grupos&#44; que n&#227;o usaram COs&#46; Todas as adolescentes do estudo e dos grupos de controle estavam no p&#243;s&#8208;menarca&#44; apresentaram ciclos menstruais regulares e n&#227;o apresentaram oligomenorreia&#47;amenorreia&#46; Todas as participantes n&#227;o bebiam e n&#227;o fumavam e n&#227;o praticavam atividades esportivas al&#233;m das duas horas de atividade f&#237;sica por semana durante o hor&#225;rio escolar&#46; Os crit&#233;rios de exclus&#227;o relacionados &#224; sa&#250;de adotados para o estudo foram&#58; hist&#243;rico de prematuridade ou baixo peso ao nascer&#59; tratamento prolongado com esteroides ou uso de suplementos de c&#225;lcio ou ferro nos 12 meses anteriores ao estudo&#59; diabetes <span class="elsevierStyleItalic">mellitus</span>&#59; desnutri&#231;&#227;o aguda ou cr&#244;nica&#59; doen&#231;as &#243;sseas cong&#234;nitas ou adquiridas&#59; m&#225; absor&#231;&#227;o gastrointestinal&#59; hist&#243;rico de nefropatia com ou sem insufici&#234;ncia renal&#59; endocrinopatias&#59; puberdade precoce ou tardia&#59; uso cr&#244;nico de drogas&#59; fibrose c&#237;stica e doen&#231;a cel&#237;aca&#46; Outros crit&#233;rios de exclus&#227;o foram uso de medicamentos conhecidos por afetar negativamente o metabolismo &#243;sseo&#44; aquelas que usaram anteriormente um CO ou outro m&#233;todo de contraceptivo hormonal inclusive acetato de medroxiprogesterona de dep&#243;sito&#44; indiv&#237;duos que trocaram de m&#233;todos durante o estudo&#44; ser vegetariana ou consumir dieta ricas em fibras e consumo di&#225;rio de mais de 300<span class="elsevierStyleHsp" style=""></span>mg de cafe&#237;na ou mais de 500<span class="elsevierStyleHsp" style=""></span>mL de refrigerantes &#224; base de cola&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Todas as adolescentes foram submetidas a avalia&#231;&#227;o antropom&#233;trica&#46; O IMC foi calculado e o est&#225;gio puberal foi avaliado com os crit&#233;rios de Tanner&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> A idade &#243;ssea foi determinada pelo m&#233;todo de Greulich e Pyle<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> no in&#237;cio do estudo e ap&#243;s 12 meses de acompanhamento&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As adolescentes que conclu&#237;ram todas as etapas anteriores foram submetidas a avalia&#231;&#227;o da massa &#243;ssea no in&#237;cio do uso do CO e no t&#233;rmino do acompanhamento &#40;ap&#243;s um ano&#41;&#46; A massa &#243;ssea foi medida densitometricamente por absorciometria de dupla energia de raios X &#40;DXA&#41; com um aparelho Hologic QDR 4500 Discovery A &#40;Hologic&#44; Inc&#46;&#44; Bedford&#44; MA&#44; EUA&#41;&#46; Os biomarcadores de osteocalcina e fosfatase alcalina &#243;ssea &#40;FAO&#41; foram avaliados antes e depois de 12 meses do uso do CO&#46; As dosagens foram medidas com o ensaio da Metra&#8482; Biosystems &#40;Quidel Corporation&#44; CA&#44; EUA&#41;&#44; com os coeficientes de varia&#231;&#227;o intraensaio e interensaio de 8 e 7&#44;6&#37;&#44; respectivamente&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">O estudo prop&#244;s um acompanhamento dos tr&#234;s grupos durante um ano&#59; contudo&#44; no momento do acompanhamento&#44; h&#225; dificuldades com rela&#231;&#227;o &#224;s adolescentes no grupo de controle&#44; no momento em que elas foram submetidas &#224; nova densitometria mineral &#243;ssea e coletas de sangue&#44; procedimentos semelhantes aos propostos para os usu&#225;rios dos contraceptivos&#46; Essas dificuldades inclu&#237;ram o que segue&#58; muitas n&#227;o voltaram no dia agendado para a coleta de sangue ou densitometria&#44; come&#231;ar a usar uma medica&#231;&#227;o que estava entre os crit&#233;rios de exclus&#227;o e&#44; por fim&#44; um grande percentual solicitou a prescri&#231;&#227;o de um m&#233;todo contraceptivo&#46; Por esse motivo&#44; foi tomada a decis&#227;o de excluir o grupo de controle e fazer uma an&#225;lise de regress&#227;o linear com uma resposta normal com observa&#231;&#245;es independentes entre as adolescentes do grupo de controle&#44; o que possibilitou uma estimativa do efeito anual sobre nossos resultados e compensou a aus&#234;ncia de um acompanhamento de um ano entre as adolescentes no grupo de controle&#46; Com essa t&#233;cnica&#44; conseguimos comparar os grupos indiretamente durante um ano de acompanhamento&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lise estat&#237;stica</span><p id="par0055" class="elsevierStylePara elsevierViewall">O teste de Kruskal&#8208;Wallis foi usado para comparar as vari&#225;veis de base entre os grupos de controle&#44; CO1 e CO2 e o teste de Mann&#8208;Whitney para compara&#231;&#227;o entre os grupos de CO1 e CO2&#46; O teste Anova foi usado para as vari&#225;veis IMC&#44; escore z do IMC e o percentil do IMC &#40;valores apresentados como m&#233;dia&#41;&#44; pois essas vari&#225;veis apresentaram distribui&#231;&#227;o sim&#233;trica&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Os efeitos da idade sobre as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e sobre as concentra&#231;&#245;es de marcadores &#243;sseos no grupo de controle foram avaliados por regress&#227;o linear simples com uma resposta normal&#46; O teste de Wilcoxon foi usado para comparar as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e os marcadores &#243;sseos no in&#237;cio e ap&#243;s 12 meses no grupo de CO1 e CO2&#46; Para o IMC&#44; o escore z do IMC e o percentil do IMC&#44; foi usado o teste pareado&#46; As diferen&#231;as e as associa&#231;&#245;es foram consideradas significativas quando p &#60; 0&#44;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">No grupo de CO1&#44; 36 indiv&#237;duos conclu&#237;ram o estudo e seis foram exclu&#237;dos por optarem por n&#227;o continuar com o CO&#44; devido a motivos pessoais&#46; Dos 66 indiv&#237;duos inclu&#237;dos no grupo de CO2&#44; cinco foram exclu&#237;dos pelos mesmos motivos pessoais&#46; A compara&#231;&#227;o das vari&#225;veis antropom&#233;tricas e densitom&#233;tricas&#44; da composi&#231;&#227;o corporal obtida por densitometria e das concentra&#231;&#245;es de FAO e osteocalcina no in&#237;cio n&#227;o revelou diferen&#231;as significativas entre os tr&#234;s grupos&#44; indicou a homogeneidade entre os grupos no momento da inclus&#227;o&#44; exceto percentual de gordura corporal&#46; Essa vari&#225;vel foi maior no grupo de CO2 em compara&#231;&#227;o com os grupos de controle e CO1&#46; Contudo&#44; nenhum dos pacientes estava obeso &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A an&#225;lise de regress&#227;o linear simples foi usada para estudar&#44; indiretamente&#44; o efeito de cada ano adicional da idade cronol&#243;gica sobre as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e sobre os marcadores &#243;sseos no grupo de controle&#46; Para cada ano adicional de idade cronol&#243;gica&#44; a idade &#243;ssea aumentou 1&#44;04 ano&#44; o peso em 3&#44;42<span class="elsevierStyleHsp" style=""></span>kg e IMC em 1&#44;33<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; O efeito anual estatisticamente significativo sobre a estatura &#40;aumento de 0&#44;1 m por ano&#41; n&#227;o est&#225; de acordo com o efeito biologicamente esperado&#46; Assim&#44; esse efeito foi reavaliado com um modelo de regress&#227;o linear com inser&#231;&#227;o de um intercepto&#44; que resultou em um efeito biologicamente mais sens&#237;vel sobre a estatura de praticamente zero &#40;p &#61; 0&#44;953&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A an&#225;lise das vari&#225;veis densitom&#233;tricas no grupo de controle mostrou diferen&#231;as estatisticamente significativas na DMO da coluna lombar&#44; na DMO de todo o corpo e na DMO subtotal&#44; com aumentos de 0&#44;060&#44; 0&#44;064 e 0&#44;056<span class="elsevierStyleHsp" style=""></span>g&#47;cm<span class="elsevierStyleSup">2</span> em cada ano adicional&#44; respectivamente&#46; Aumentos tamb&#233;m foram observados no CMO da coluna lombar&#44; no CMO de todo o corpo e no CMO subtotal &#40;3&#44;22&#59; 117&#44;21 e 89&#44;36<span class="elsevierStyleHsp" style=""></span>g&#44; respectivamente&#59; p &#60; 0&#44;001&#41;&#46; A massa gorda e a massa magra apresentaram um aumento de 1045&#44;85 e 2238&#44;40<span class="elsevierStyleHsp" style=""></span>g&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A respeito dos biomarcadores &#243;sseos&#44; houve uma redu&#231;&#227;o estatisticamente significativa no grupo de controle com rela&#231;&#227;o &#224; concentra&#231;&#227;o de FAO &#40;&#8722;5&#44;19 U&#47;L&#41; com cada ano adicional da idade cronol&#243;gica&#46; N&#227;o foi observada diferen&#231;a significativa para osteocalcina &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">N&#227;o foram encontradas diferen&#231;as significativas para as seguintes vari&#225;veis&#58; DMO lombar&#44; CMO lombar&#44; DMO de todo o corpo&#44; CMO de todo o corpo&#44; DMO subtotal e CMO subtotal no grupo de CO2 e as mesmas vari&#225;veis no grupo de CO1&#44; exceto IMC de todo o corpo &#40;p &#61; 0&#44;001&#41;&#46; Diferen&#231;as significativas foram observadas na massa gorda e na percentual de gordura corporal entre o in&#237;cio e os 12 meses nas duas formula&#231;&#245;es de contraceptivos&#46; N&#227;o foi observada diferen&#231;a significativa na massa magra entre o in&#237;cio e ap&#243;s 12 meses no grupo de CO2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Houve uma redu&#231;&#227;o nos n&#237;veis medianos de FAO&#44; passaram de 53&#44;92 U&#47;L no in&#237;cio para 41&#44;48U&#47;L ap&#243;s 12 meses de uso no grupo de CO1 &#40;p &#61; 0&#44;080&#41; e de 43&#44;10 para 27&#44;14U&#47;L no grupo de CO2 &#40;p &#60; 0&#44;001&#41;&#46; Foram observadas redu&#231;&#245;es das concentra&#231;&#245;es de osteocalcina&#44; passaram de 8&#44;0 ng&#47;mL no in&#237;cio para 4&#44;69 ng&#47;mL ap&#243;s 12 meses no grupo de CO1 &#40;p &#61; 0&#44;002&#41; e de 10&#44;43 para 1&#44;47 ng&#47;mL no grupo de CO2 &#40;p &#60; 0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discuss&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">As adolescentes saud&#225;veis na faixa de 12 anos completos a 20 anos incompletos&#44; que n&#227;o usaram contraceptivos hormonais orais&#44; de acordo com a an&#225;lise de regress&#227;o linear usada para verificar o efeito de um ano de idade cronol&#243;gica sobre as vari&#225;veis analisadas&#44; mostraram um aumento significativo na massa &#243;ssea quando analisadas por densitometria &#243;ssea nos locais do esqueleto propostos&#46; A respeito dos marcadores de forma&#231;&#227;o &#243;ssea&#44; foi observado um aumento das concentra&#231;&#245;es&#44; o que coincidiu com o momento de pico de velocidade de crescimento &#40;PVC&#41;&#44; confirmou&#8208;se o paralelismo entre esses eventos&#46; Esse aumento foi acompanhado por uma redu&#231;&#227;o nos n&#237;veis dos biomarcadores&#44; que acompanharam a expectativa de desacelera&#231;&#227;o do PVC&#46; Assim&#44; apesar de os valores de DMO terem aumentado com a antecipa&#231;&#227;o dos eventos de matura&#231;&#227;o&#44; as concentra&#231;&#245;es dos tr&#234;s biomarcadores reduziram com a idade no fim da adolesc&#234;ncia&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7&#44;13</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">No in&#237;cio&#44; os tr&#234;s grupos estuados foram homog&#234;neos em termos de caracter&#237;sticas antropom&#233;tricas e densitom&#233;tricas&#44; bem como os marcadores de forma&#231;&#227;o &#243;ssea&#46; As usu&#225;rias dos dois tipos de CO mostraram menor incremento &#243;sseo entre o in&#237;cio e os 12 meses que o estimado para o grupo de controle&#44; de acordo com os resultados obtidos por meio da an&#225;lise de regress&#227;o linear&#44; demonstraram um menor aumento da massa &#243;ssea em adolescentes que tomaram as duas formula&#231;&#245;es de contraceptivos&#46; Deve&#8208;se enfatizar que esse per&#237;odo da vida&#44; que abrange a segunda d&#233;cada&#44; &#233; considerado &#250;nico e fundamental para a sa&#250;de &#243;ssea futura&#44; pois 92&#37; da massa &#243;ssea total s&#227;o adquiridos at&#233; aproximadamente 18 anos de idade e 99&#37; at&#233; os 26 anos&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">14&#8211;16</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Sabe&#8208;se que as mulheres que fazem uso de COs n&#227;o t&#234;m as altas concentra&#231;&#245;es de estrog&#234;nio end&#243;geno observadas no ciclo m&#233;dio&#44; uma caracter&#237;stica de ciclos espont&#226;neos&#44; bem como as oscila&#231;&#245;es vistas durante as diferentes fases dos ciclos menstruais&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> Os esfor&#231;os para reduzir os efeitos colaterais&#44; principalmente as complica&#231;&#245;es cardiovasculares resultantes do uso de COs&#44; levou a uma redu&#231;&#227;o gradual nas concentra&#231;&#245;es de estrog&#234;nio nas formula&#231;&#245;es dos contraceptivos&#44; um fato que pode ter causado um efeito delet&#233;rio sobre a DMO&#46; Devido &#224; menor concentra&#231;&#227;o de esteroides sexuais na circula&#231;&#227;o&#44; foi observado um aumento menor do pico de massa &#243;ssea adquirida na adolesc&#234;ncia&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> apesar de outros &#243;rg&#227;os e sistemas serem protegidos por essa redu&#231;&#227;o nas concentra&#231;&#245;es de EE nos contraceptivos&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ao compararmos os resultados deste estudo com os dados na literatura&#44; podemos confirmar que o uso de COs precipita um menor aumento da massa &#243;ssea nas adolescentes&#44; pois a an&#225;lise de regress&#227;o linear mostrou um aumento da DMO e do CMO em todos os locais do esqueleto analisados nos indiv&#237;duos de controle&#46; Esses resultados est&#227;o em linha com o relatado no estudo de Polatti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> nos quais a DMO aumentou 7&#44;8&#37; nos controles&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">18&#44;19</span></a> Em contrapartida&#44; neste estudo&#44; a an&#225;lise do ganho de massa &#243;ssea por densitometria revelou um aumento muito discreto das usu&#225;rias de COs ap&#243;s 12 meses&#44; em compara&#231;&#227;o com o in&#237;cio&#44; por&#233;m a diferen&#231;a n&#227;o foi estatisticamente significativa&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Cromer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> avaliaram a evolu&#231;&#227;o da massa &#243;ssea em 370 adolescentes entre 12 e 18 anos&#44; divididas em uso e n&#227;o uso de COs&#44; em de 12 meses&#46; As usu&#225;rias de acetato de medroxiprogesterona mostraram uma redu&#231;&#227;o m&#233;dia de 1&#44;4&#37; na DMO da coluna lombar &#40;p &#60; 0&#44;001&#41;&#44; ao passo que aquelas que usam CO com 20<span class="elsevierStyleHsp" style=""></span>&#956;g de EE e 100<span class="elsevierStyleHsp" style=""></span>&#956;g de levonorgestrel ganharam 2&#44;3&#37; de DMO na coluna lombar&#46; Contudo&#44; esse aumento foi de 3&#44;8&#37; no grupo de controle&#46; O aumento da DMO encontrado nas usu&#225;rias de COs observado no estudo de Polatti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> e neste estudo &#233; digno de nota&#58; contudo&#44; esse aumento foi menor do que o esperado para o grupo de n&#227;o usu&#225;rias de CO&#46; Esses resultados sugerem que os ganhos moderados na DMO em adolescentes que usam COs de baixa dosagem permitem certo ganho de massa &#243;ssea&#44; por&#233;m n&#227;o o pico de mineraliza&#231;&#227;o &#243;ssea necess&#225;rio para servir como um &#8220;banco &#243;sseo&#8221; para a vida adulta e a velhice&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9&#44;18&#8211;20</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Al&#233;m dos efeitos relacionados ao estrog&#234;nio&#44; o impacto dos progestog&#234;nios sobre a massa &#243;ssea tamb&#233;m deve ser considerado&#44; com diferentes mecanismos subjacentes&#46; Primeiro&#44; os efeitos bem estabelecidos confirmam que as doses elevadas de progesterona atuam sobre o eixo hipot&#225;lamo&#8208;hip&#243;fise&#8208;gonadal&#44; causam hipoestrogenismo&#44; remodela&#231;&#227;o &#243;ssea antecipada e r&#225;pida perda de massa &#243;ssea&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">21&#44;22</span></a> Outra possibilidade &#233; que a progesterona exer&#231;a um efeito estimulador por meio dos receptores de progesterona e andr&#243;genos&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> Os receptores de progesterona e andr&#243;genos s&#227;o expressos em osteoblastos e osteoclastos e a ativa&#231;&#227;o desses dois receptores foi demonstrada por um aumento da massa &#243;ssea&#44; aumentou a atividade dos osteoblastos e reduziu a reabsor&#231;&#227;o &#243;ssea resultante do est&#237;mulo dos osteoclastos&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">18&#44;24</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Muitos progestog&#234;nios comprometidos com os receptores de andr&#243;genos&#44; como a drospirenona e o desogestrel encontrados nos COs usados neste estudo&#44; ativam os receptores de andr&#243;genos por inibi&#231;&#227;o competitiva&#44; bloquearam&#44; assim&#44; a a&#231;&#227;o androg&#234;nica end&#243;gena&#46; Esse mecanismo de a&#231;&#227;o resulta em importantes efeitos antiandrog&#234;nicos sobre o metabolismo &#243;sseo&#44; pois a testosterona desempenha um papel fundamental na obten&#231;&#227;o de massa &#243;ssea&#46; Diante do pequeno n&#250;mero de estudos que investigam a influ&#234;ncia dos progestog&#234;nios presentes nas formula&#231;&#245;es os COs&#44; &#233; dif&#237;cil distinguir se os efeitos sobre o metabolismo &#243;sseo resultam da progesterona ou dos n&#237;veis reduzidos de estrog&#234;nio&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Observa&#8208;se um aumento nos marcadores &#243;sseos durante o per&#237;odo de acelera&#231;&#227;o do crescimento nas meninas&#44; corresponde ao est&#225;gio 2 de Tanner&#46; A massa &#243;ssea tamb&#233;m aumenta e o pico de concentra&#231;&#227;o dos marcadores coincide com o PVC observado no est&#225;gio 3 de Tanner&#46; Posteriormente&#44; no momento da desacelera&#231;&#227;o do crescimento&#44; os marcadores de metabolismo &#243;sseo caem&#44; ao passo que a massa &#243;ssea continua a aumentar&#44; devido&#44; provavelmente&#44; aos n&#237;veis elevados de esteroides sexuais e ao fator de crescimento semelhante &#224; insulina tipo 1&#46; Esse fen&#244;meno foi relatado por Tobiume et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> Em vista dessas considera&#231;&#245;es e como todas as adolescentes desta amostra estavam na puberdade tardia&#44; acreditamos que a redu&#231;&#227;o nas concentra&#231;&#245;es dos marcadores de forma&#231;&#227;o &#243;ssea foi influenciada pelo uso de COs&#46; Assim&#44; os resultados dos marcadores &#243;sseos obtidos neste estudo n&#227;o aparecem ser influenciados somente pela idade&#44; mas tamb&#233;m pelas diferentes concentra&#231;&#245;es de EE nas duas formula&#231;&#245;es&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A respeito dos marcadores de forma&#231;&#227;o &#243;ssea&#44; este estudo demonstrou uma redu&#231;&#227;o nas concentra&#231;&#245;es s&#233;ricas desses marcadores nos dois grupos ap&#243;s 12 meses de uso dos COs&#44; com redu&#231;&#245;es de 20 a 37&#37; na FAO e 40 a 86&#37; na osteocalcina&#46; Resultados semelhantes foram relatados no estudo de Paoletti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> que comparou 28 mulheres entre 20 e 30 anos que usaram CO com 30<span class="elsevierStyleHsp" style=""></span>&#956;g de EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona com n&#227;o usu&#225;rias da mesma faixa et&#225;ria&#46; As concentra&#231;&#245;es s&#233;ricas dos marcadores de forma&#231;&#227;o &#243;ssea analisados ca&#237;ram 20 a 30&#37; nas usu&#225;rias de CO&#44; por&#233;m continuaram inalteradas nos controles&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A redu&#231;&#227;o observada nos biomarcadores de forma&#231;&#227;o &#243;ssea pode ser atribu&#237;da ao uso de COs&#44; o que foi confirmado pela demonstra&#231;&#227;o das diferen&#231;as significativas nos n&#237;veis de FAO e osteocalcina nas adolescentes ap&#243;s um ano de acompanhamento&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">As limita&#231;&#245;es deste estudo foram o curto per&#237;odo de acompanhamento das usu&#225;rias de CO e o pequeno n&#250;mero de participantes&#46; Al&#233;m disso&#44; enfrentamos dificuldades de acompanhar as adolescentes no grupo de controle&#44; devido ao grande n&#250;mero de meninas que n&#227;o voltou nas datas agendadas para fazer as avalia&#231;&#245;es propostas&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Por outro lado&#44; os pontos fortes deste estudo s&#227;o seu modelo prospectivo e que a densitometria &#243;ssea e as medi&#231;&#245;es dos biomarcadores &#243;sseos foram feitas por um &#250;nico t&#233;cnico cego para a atribui&#231;&#227;o de grupo&#46; Al&#233;m disso&#44; o uso das duas formula&#231;&#245;es de COs de baixa dose por um ano foi associado a menor aumento da massa &#243;ssea&#44; com ganhos de DMO e CMO abaixo do estimado para essa faixa et&#225;ria&#46; H&#225; comprova&#231;&#227;o de que a introdu&#231;&#227;o desses contraceptivos na segunda d&#233;cada de vida est&#225; relacionada a n&#237;veis sistematicamente menores dos marcadores de forma&#231;&#227;o &#243;ssea&#44; confirma&#8208;se o menor aumento da massa &#243;ssea demonstrado por densitometria&#46; Acompanhar esses adolescentes por um tempo maior de exposi&#231;&#227;o aos COs combinados &#233; necess&#225;rio para melhor entender os efeitos desses medicamentos sobre os biomarcadores de massa &#243;ssea e forma&#231;&#227;o &#243;ssea&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiamento</span><p id="par0165" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo &#40;Fapesp&#41;&#44; bolsas 07&#47;07731&#8208;0&#44; 2011&#47;05991&#8208;0 e 2015&#47;04040&#8208;2&#44; e Pr&#243;&#8208;Reitoria de Pesquisa da Universidade Estadual Paulista &#40;Unesp&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflitos de interesse</span><p id="par0170" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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    "fechaRecibido" => "2018-01-18"
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          "palabras" => array:6 [
            0 => "Adolescents"
            1 => "Oral contraceptives"
            2 => "Bone density"
            3 => "Osteocalcin"
            4 => "Bone remodeling"
            5 => "Prospective study"
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            0 => "Adolescentes"
            1 => "Contraceptivos orais"
            2 => "Densidade &#243;ssea"
            3 => "Osteocalcina"
            4 => "Remodela&#231;&#227;o &#243;ssea"
            5 => "Estudo prospectivo"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of this study was to evaluate the effects of two low&#8208;dose combined oral contraceptives on bone metabolism in adolescents for one year&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a quasi&#8208;experimental study&#46; The adolescents were divided into three groups&#58; oral contraceptives 1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41; &#40;20<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;150<span class="elsevierStyleHsp" style=""></span>&#956;g desogestrel&#41;&#44; oral contraceptives 2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&#41; &#40;30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg drospirenone&#41;&#44; and a control group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;&#46; Adolescents underwent anthropometric assessment and densitometry &#40;dual&#8208;energy X&#8208;ray&#41;&#46; Bone age and bone formation markers &#40;osteocalcin and bone alkaline phosphatase&#41; were evaluated&#46; The oral contraceptives users were evaluated again after 12 months&#46; Linear regression analysis was used to indirectly study the effect of each additional year of chronological age on anthropometric and densitometric variables as well as on bone markers in the control group&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">At study entry&#44; no significant differences were observed between the oral contraceptives 1&#44; oral contraceptives 2&#44; and controls in the analyzed variables&#46; Linear regression analysis showed an increase in bone mineral density and bone mineral content for each additional year&#46; There was a significant reduction in bone alkaline phosphatase levels&#59; no significant difference was observed for osteocalcin in control individuals&#46; Comparison of dual&#8208;energy X&#8208;ray variables at baseline and after one year showed no significant differences in the oral contraceptives 1 or oral contraceptives 2 groups&#46; A significant reduction in bone alkaline phosphatase and osteocalcin levels was observed in both the oral contraceptives 1 and oral contraceptives 2 groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adolescent women gain peak bone mass during this phase of life&#46; Two low&#8208;dose combined oral hormonal contraceptives were associated with lower bone gain and lower bone formation markers than in untreated controls&#46;</p></span>"
        "secciones" => array:4 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O objetivo deste estudo foi avaliar os efeitos de dois contraceptivos orais combinados de baixa dosagem por um ano sobre o metabolismo &#243;sseo em adolescentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este foi um estudo quase experimental&#46; As adolescentes foram divididas em tr&#234;s grupos&#58; contraceptivos orais 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41; &#40;20<span class="elsevierStyleHsp" style=""></span>&#956;g de EE&#47;150<span class="elsevierStyleHsp" style=""></span>&#956;g de desogestrel&#41;&#44; contraceptivos orais 2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&#41; &#40;30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona&#41; e grupo controle &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;&#46; As adolescentes foram submetidas &#224; avalia&#231;&#227;o antropom&#233;trica e densitometria &#40;raio-X de dupla energia&#41;&#46; Foram avaliados a idade &#243;ssea e os marcadores de forma&#231;&#227;o &#243;ssea &#40;osteocalcina e fosfatase alcalina &#243;ssea&#41;&#46; As usu&#225;rias de contraceptivos orais foram novamente avaliadas ap&#243;s 12 meses&#46; A an&#225;lise de regress&#227;o linear foi utilizada para estudar&#44; indiretamente&#44; o efeito de cada ano adicional da idade cronol&#243;gica sobre as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e sobre os marcadores &#243;sseos no grupo de controle&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No in&#237;cio do estudo&#44; n&#227;o foram observadas diferen&#231;as significativas nas vari&#225;veis analisadas entre as usu&#225;rias de contraceptivos orais 1&#44; contraceptivos orais 2 e o grupo controle&#46; A an&#225;lise de regress&#227;o linear mostrou um aumento na densidade mineral &#243;ssea e no conte&#250;do mineral &#243;sseo para cada ano adicional&#46; Houve uma redu&#231;&#227;o significativa nos n&#237;veis de fosfatase alcalina &#243;ssea e n&#227;o foi observada diferen&#231;a significativa para osteocalcina nos indiv&#237;duos controles&#46; A compara&#231;&#227;o das vari&#225;veis do raio-X de dupla energia no in&#237;cio e ap&#243;s um ano n&#227;o mostrou diferen&#231;a significativa no grupo de contraceptivos orais 1 ou contraceptivos orais 2&#46; Foi observada uma redu&#231;&#227;o significativa nos n&#237;veis de fosfatase alcalina &#243;ssea e osteocalcina nos dois grupos contraceptivos orais 1 e contraceptivos orais 2&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">As adolescentes atingiram o pico de massa &#243;ssea durante essa fase da vida&#46; Duas formula&#231;&#245;es de contraceptivos hormonais orais de baixa dosagem&#44; ap&#243;s um ano de uso&#44; se associaram a menor incremento na densidade mineral &#243;ssea e menor concentra&#231;&#227;o de marcadores de forma&#231;&#227;o &#243;ssea quando confrontados com resultados de adolescentes n&#227;o usu&#225;rias de contraceptivos&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Como citar este artigo&#58; Rizzo AC&#44; Goldberg TB&#44; Biason TP&#44; Kurokawa CS&#44; Silva CC&#44; Corrente JE&#44; et al&#46; One&#8208;year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;567&#8211;74&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CO1&#44; adolescentes que recebem contraceptivos orais que cont&#234;m 20<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;150<span class="elsevierStyleHsp" style=""></span>g de desogestrel&#59; CO2&#44; adolescentes que recebem contraceptivos orais que cont&#234;m 30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona&#46;</p>"
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controle &#40;n &#61; 70&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CO1 &#40;n &#61; 36&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CO2 &#40;n &#61; 61&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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">Mediana&#47;m&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Mediana&#47;m&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Mediana&#47;m&#233;dia&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">M&#237;n&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">M&#225;x&#46;&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="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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="#tblfn0010"><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">Idade &#40;anos&#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">16&#44;00&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;00&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">19&#44;40&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">15&#44;00&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">11&#44;00&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">20&#44;00&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">15&#44;00&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;00&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">18&#44;00&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;663&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;182&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">Idade &#243;ssea &#40;anos&#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">17&#44;00&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">14&#44;00&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">19&#44;00&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">16&#44;00&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">14&#44;00&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">18&#44;00&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">17&#44;00&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">14&#44;00&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">21&#44;00&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;245&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;402&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">Peso &#40;kg&#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">52&#44;55&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">41&#44;00&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">69&#44;90&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">54&#44;00&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">39&#44;00&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;40&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">54&#44;00&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">38&#44;50&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">69&#44;00&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;855&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;971&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">Altura &#40;m&#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">1&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;71&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;862&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;212&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">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</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">20&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;44&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">26&#44;78&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">21&#44;35&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">17&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;512&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">0&#44;052&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 z para IMC<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</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
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                  \t\t\t\t">&#8722;0&#44;02&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">&#8722;1&#44;40&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;1&#44;73&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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;840&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">0&#44;113&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">IMC &#40;Percentil&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</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">0&#44;066&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">DMO lombar &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">CMO lombar &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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 z para lombar&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</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">DMO de todo o corpo &#40;g&#47;cm&#41;<span class="elsevierStyleSup">2</span>&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">1&#44;205&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;995&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Escore z de todo o corpo&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">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;37&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 z para IMC&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;01&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;342&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">&#8722;0&#44;01&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;02&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">IMC &#40;Percentil&#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">3&#44;31&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; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;68&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">DMO lombar &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#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;060&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; 0&#44;001&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;058&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;06&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">CMO lombar &#40;g&#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">3&#44;223&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; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;086&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;36&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 z para lombar&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">&#8722;0&#44;012&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;105&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">&#8722;0&#44;026&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;00&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">DMO de todo o corpo &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#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;064&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; 0&#44;001&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;062&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;07&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">CMO de todo o corpo &#40;g&#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">117&#44;21&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; 0&#44;001&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">113&#44;150&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&#44;27&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">DMO subtotal &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#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;056&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; 0&#44;001&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;055&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;06&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">CMO subtotal &#40;g&#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">89&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&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">86&#44;041&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">92&#44;68&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">Massa gorda &#40;g&#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">1&#44;045&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&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">974&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;117&#44;16&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">Massa magra &#40;g&#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">2&#44;238&#44;40&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; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;150&#44;19&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">2&#44;326&#44;62&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">&#37; de gordura corporal 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">1&#44;910&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; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;00&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">FAO &#40;U&#47;L&#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">&#8722;5&#44;19&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; 0&#44;001&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">&#8722;7&#44;24&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">&#8722;3&#44;14&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">Osteocalcina &#40;ng&#47;mL&#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">&#8722;0&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;540&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">&#8722;1&#44;23&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;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab2139637.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise de regress&#227;o linear para avaliar o efeito da idade sobre as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e os marcadores de forma&#231;&#227;o &#243;ssea em adolescentes que n&#227;o usam contraceptivos orais &#40;grupo de controle&#41;</p>"
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        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
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            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CO1&#44; adolescentes que recebem contraceptivos orais que cont&#234;m 20<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;150<span class="elsevierStyleHsp" style=""></span>g de desogestrel&#59; CO2&#44; adolescentes que recebem contraceptivos orais que cont&#234;m 30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Teste de Wilcoxon para compara&#231;&#227;o entre os pontos de tempo nos grupos de CO1 e CO2&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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  " colspan="8" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CO1</th><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">In&#237;cio &#40;n &#61; 36&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">12 meses &#40;n &#61; 36&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">In&#237;cio &#40;n &#61; 61&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">12 meses &#40;n &#61; 61&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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">Mediana&#47;M&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Mediana&#47;M&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Z&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">p&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">Mediana&#47;M&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Mediana&#47;M&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Z&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&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">Idade &#40;anos&#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">15&#44;00&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">11&#44;00&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">20&#44;00&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">16&#44;00&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;00&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">19&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;4&#44;4&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&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">15&#44;00&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;00&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">18&#44;00&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">16&#44;00&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">13&#44;00&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">21&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;5&#44;6&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&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">Idade &#243;ssea &#40;anos&#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">16&#44;00&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">14&#44;00&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">18&#44;00&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">18&#44;00&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">15&#44;00&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">18&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&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">17&#44;00&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">14&#44;00&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">18&#44;00&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">17&#44;00&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">15&#44;00&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">18&#44;00&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">&#8208;4&#44;9&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">Peso &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Altura &#40;m&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Escore z do IMC<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">IMC &#40;Percentil&#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">&#8208;0&#44;9&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">0&#44;908&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">DMO lombar &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8208;1&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8208;1&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \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">CMO lombar &#40;g&#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">&#8208;1&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \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 z para lombar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8208;2&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;005&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">DMO de todo o corpo &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#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">&#8208;1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CMO de todo o corpo &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Escore z de Todo o Corpo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">DMO subtotal &#40;g&#47;cm<span class="elsevierStyleSup">2&#92;</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CMO subtotal &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Massa magra &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#37; de gordura corporal total&nbsp;\t\t\t\t\t\t\n
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Artigo Original
One‐year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives
Alterações na densidade mineral óssea e nos marcadores de formação óssea em adolescentes usuárias ou não de contraceptivos hormonais orais combinados por período de um ano
Anapaula da Conceição Bisi Rizzoa, Tamara Beres Lederer Goldberga,
Autor para correspondência
tamara@fmb.unesp.br

Autor para correspondência.
, Talita Poli Biasona, Cilmery Suemi Kurokawab, Carla Cristiane da Silvac, José Eduardo Corrented, Helio Rubens Carvalho Nunese
a Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Programa de Pós‐graduação em Ginecologia, Obstetrícia e Mastologia, Botucatu, SP, Brasil
b Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Centro de Pesquisa Pediátrica Clínica e Experimental, Botucatu, SP, Brasil
c Universidade Norte do Paraná, Departamento de Educação Física, Jacarezinho, PR, Brasil
d Universidade Estadual Paulista (UNESP), Instituto de Biociências, Departamento de Estatística, Botucatu, SP, Brasil
e Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
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um per&#237;odo caracterizado por maior aquisi&#231;&#227;o de massa &#243;ssea&#44; para avaliar os efeitos desses medicamentos sobre a sa&#250;de &#243;ssea nessa faixa et&#225;ria e os poss&#237;veis resultados futuros na vida adulta e velhice&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Assim&#44; o objetivo deste estudo foi avaliar prospectivamente se haveria quaisquer efeitos e poss&#237;veis diferen&#231;as entre o uso de dois tipos de contraceptivos orais &#40;CO&#41; de baixa dosagem&#44; com 20<span class="elsevierStyleHsp" style=""></span>&#956;g etinilestradiol &#40;EE&#41;&#47;150<span class="elsevierStyleHsp" style=""></span>&#956;g desogestrel ou 30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona&#44; por um ano sobre o metabolismo &#243;sseo das adolescentes e comparar os resultados com os obtidos para adolescentes saud&#225;veis que n&#227;o usaram COs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este foi um estudo quase experimento aprovado pelo Comit&#234; 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Os crit&#233;rios de exclus&#227;o relacionados &#224; sa&#250;de adotados para o estudo foram&#58; hist&#243;rico de prematuridade ou baixo peso ao nascer&#59; tratamento prolongado com esteroides ou uso de suplementos de c&#225;lcio ou ferro nos 12 meses anteriores ao estudo&#59; diabetes <span class="elsevierStyleItalic">mellitus</span>&#59; desnutri&#231;&#227;o aguda ou cr&#244;nica&#59; doen&#231;as &#243;sseas cong&#234;nitas ou adquiridas&#59; m&#225; absor&#231;&#227;o gastrointestinal&#59; hist&#243;rico de nefropatia com ou sem insufici&#234;ncia renal&#59; endocrinopatias&#59; puberdade precoce ou tardia&#59; uso cr&#244;nico de drogas&#59; fibrose c&#237;stica e doen&#231;a cel&#237;aca&#46; Outros crit&#233;rios de exclus&#227;o foram uso de medicamentos conhecidos por afetar negativamente o metabolismo &#243;sseo&#44; aquelas que usaram anteriormente um CO ou outro m&#233;todo de contraceptivo hormonal inclusive acetato de medroxiprogesterona de dep&#243;sito&#44; indiv&#237;duos que trocaram de m&#233;todos durante o estudo&#44; ser vegetariana ou consumir dieta ricas em fibras e consumo di&#225;rio de mais de 300<span class="elsevierStyleHsp" style=""></span>mg de cafe&#237;na ou mais de 500<span class="elsevierStyleHsp" style=""></span>mL de refrigerantes &#224; base de cola&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Todas as adolescentes foram submetidas a avalia&#231;&#227;o antropom&#233;trica&#46; O IMC foi calculado e o est&#225;gio puberal foi avaliado com os crit&#233;rios de Tanner&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> A idade &#243;ssea foi determinada pelo m&#233;todo de Greulich e Pyle<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> no in&#237;cio do estudo e ap&#243;s 12 meses de acompanhamento&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As adolescentes que conclu&#237;ram todas as etapas anteriores foram submetidas a avalia&#231;&#227;o da massa &#243;ssea no in&#237;cio do uso do CO e no t&#233;rmino do acompanhamento &#40;ap&#243;s um ano&#41;&#46; A massa &#243;ssea foi medida densitometricamente por absorciometria de dupla energia de raios X &#40;DXA&#41; com um aparelho Hologic QDR 4500 Discovery A &#40;Hologic&#44; Inc&#46;&#44; Bedford&#44; MA&#44; EUA&#41;&#46; Os biomarcadores de osteocalcina e fosfatase alcalina &#243;ssea &#40;FAO&#41; foram avaliados antes e depois de 12 meses do uso do CO&#46; As dosagens foram medidas com o ensaio da Metra&#8482; Biosystems &#40;Quidel Corporation&#44; CA&#44; EUA&#41;&#44; com os coeficientes de varia&#231;&#227;o intraensaio e interensaio de 8 e 7&#44;6&#37;&#44; respectivamente&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">O estudo prop&#244;s um acompanhamento dos tr&#234;s grupos durante um ano&#59; contudo&#44; no momento do acompanhamento&#44; h&#225; dificuldades com rela&#231;&#227;o &#224;s adolescentes no grupo de controle&#44; no momento em que elas foram submetidas &#224; nova densitometria mineral &#243;ssea e coletas de sangue&#44; procedimentos semelhantes aos propostos para os usu&#225;rios dos contraceptivos&#46; Essas dificuldades inclu&#237;ram o que segue&#58; muitas n&#227;o voltaram no dia agendado para a coleta de sangue ou densitometria&#44; come&#231;ar a usar uma medica&#231;&#227;o que estava entre os crit&#233;rios de exclus&#227;o e&#44; por fim&#44; um grande percentual solicitou a prescri&#231;&#227;o de um m&#233;todo contraceptivo&#46; Por esse motivo&#44; foi tomada a decis&#227;o de excluir o grupo de controle e fazer uma an&#225;lise de regress&#227;o linear com uma resposta normal com observa&#231;&#245;es independentes entre as adolescentes do grupo de controle&#44; o que possibilitou uma estimativa do efeito anual sobre nossos resultados e compensou a aus&#234;ncia de um acompanhamento de um ano entre as adolescentes no grupo de controle&#46; Com essa t&#233;cnica&#44; conseguimos comparar os grupos indiretamente durante um ano de acompanhamento&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lise estat&#237;stica</span><p id="par0055" class="elsevierStylePara elsevierViewall">O teste de Kruskal&#8208;Wallis foi usado para comparar as vari&#225;veis de base entre os grupos de controle&#44; CO1 e CO2 e o teste de Mann&#8208;Whitney para compara&#231;&#227;o entre os grupos de CO1 e CO2&#46; O teste Anova foi usado para as vari&#225;veis IMC&#44; escore z do IMC e o percentil do IMC &#40;valores apresentados como m&#233;dia&#41;&#44; pois essas vari&#225;veis apresentaram distribui&#231;&#227;o sim&#233;trica&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Os efeitos da idade sobre as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e sobre as concentra&#231;&#245;es de marcadores &#243;sseos no grupo de controle foram avaliados por regress&#227;o linear simples com uma resposta normal&#46; O teste de Wilcoxon foi usado para comparar as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e os marcadores &#243;sseos no in&#237;cio e ap&#243;s 12 meses no grupo de CO1 e CO2&#46; Para o IMC&#44; o escore z do IMC e o percentil do IMC&#44; foi usado o teste pareado&#46; As diferen&#231;as e as associa&#231;&#245;es foram consideradas significativas quando p &#60; 0&#44;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">No grupo de CO1&#44; 36 indiv&#237;duos conclu&#237;ram o estudo e seis foram exclu&#237;dos por optarem por n&#227;o continuar com o CO&#44; devido a motivos pessoais&#46; Dos 66 indiv&#237;duos inclu&#237;dos no grupo de CO2&#44; cinco foram exclu&#237;dos pelos mesmos motivos pessoais&#46; A compara&#231;&#227;o das vari&#225;veis antropom&#233;tricas e densitom&#233;tricas&#44; da composi&#231;&#227;o corporal obtida por densitometria e das concentra&#231;&#245;es de FAO e osteocalcina no in&#237;cio n&#227;o revelou diferen&#231;as significativas entre os tr&#234;s grupos&#44; indicou a homogeneidade entre os grupos no momento da inclus&#227;o&#44; exceto percentual de gordura corporal&#46; Essa vari&#225;vel foi maior no grupo de CO2 em compara&#231;&#227;o com os grupos de controle e CO1&#46; Contudo&#44; nenhum dos pacientes estava obeso &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A an&#225;lise de regress&#227;o linear simples foi usada para estudar&#44; indiretamente&#44; o efeito de cada ano adicional da idade cronol&#243;gica sobre as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e sobre os marcadores &#243;sseos no grupo de controle&#46; Para cada ano adicional de idade cronol&#243;gica&#44; a idade &#243;ssea aumentou 1&#44;04 ano&#44; o peso em 3&#44;42<span class="elsevierStyleHsp" style=""></span>kg e IMC em 1&#44;33<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; O efeito anual estatisticamente significativo sobre a estatura &#40;aumento de 0&#44;1 m por ano&#41; n&#227;o est&#225; de acordo com o efeito biologicamente esperado&#46; Assim&#44; esse efeito foi reavaliado com um modelo de regress&#227;o linear com inser&#231;&#227;o de um intercepto&#44; que resultou em um efeito biologicamente mais sens&#237;vel sobre a estatura de praticamente zero &#40;p &#61; 0&#44;953&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A an&#225;lise das vari&#225;veis densitom&#233;tricas no grupo de controle mostrou diferen&#231;as estatisticamente significativas na DMO da coluna lombar&#44; na DMO de todo o corpo e na DMO subtotal&#44; com aumentos de 0&#44;060&#44; 0&#44;064 e 0&#44;056<span class="elsevierStyleHsp" style=""></span>g&#47;cm<span class="elsevierStyleSup">2</span> em cada ano adicional&#44; respectivamente&#46; Aumentos tamb&#233;m foram observados no CMO da coluna lombar&#44; no CMO de todo o corpo e no CMO subtotal &#40;3&#44;22&#59; 117&#44;21 e 89&#44;36<span class="elsevierStyleHsp" style=""></span>g&#44; respectivamente&#59; p &#60; 0&#44;001&#41;&#46; A massa gorda e a massa magra apresentaram um aumento de 1045&#44;85 e 2238&#44;40<span class="elsevierStyleHsp" style=""></span>g&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A respeito dos biomarcadores &#243;sseos&#44; houve uma redu&#231;&#227;o estatisticamente significativa no grupo de controle com rela&#231;&#227;o &#224; concentra&#231;&#227;o de FAO &#40;&#8722;5&#44;19 U&#47;L&#41; com cada ano adicional da idade cronol&#243;gica&#46; N&#227;o foi observada diferen&#231;a significativa para osteocalcina &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">N&#227;o foram encontradas diferen&#231;as significativas para as seguintes vari&#225;veis&#58; DMO lombar&#44; CMO lombar&#44; DMO de todo o corpo&#44; CMO de todo o corpo&#44; DMO subtotal e CMO subtotal no grupo de CO2 e as mesmas vari&#225;veis no grupo de CO1&#44; exceto IMC de todo o corpo &#40;p &#61; 0&#44;001&#41;&#46; Diferen&#231;as significativas foram observadas na massa gorda e na percentual de gordura corporal entre o in&#237;cio e os 12 meses nas duas formula&#231;&#245;es de contraceptivos&#46; N&#227;o foi observada diferen&#231;a significativa na massa magra entre o in&#237;cio e ap&#243;s 12 meses no grupo de CO2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Houve uma redu&#231;&#227;o nos n&#237;veis medianos de FAO&#44; passaram de 53&#44;92 U&#47;L no in&#237;cio para 41&#44;48U&#47;L ap&#243;s 12 meses de uso no grupo de CO1 &#40;p &#61; 0&#44;080&#41; e de 43&#44;10 para 27&#44;14U&#47;L no grupo de CO2 &#40;p &#60; 0&#44;001&#41;&#46; Foram observadas redu&#231;&#245;es das concentra&#231;&#245;es de osteocalcina&#44; passaram de 8&#44;0 ng&#47;mL no in&#237;cio para 4&#44;69 ng&#47;mL ap&#243;s 12 meses no grupo de CO1 &#40;p &#61; 0&#44;002&#41; e de 10&#44;43 para 1&#44;47 ng&#47;mL no grupo de CO2 &#40;p &#60; 0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discuss&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">As adolescentes saud&#225;veis na faixa de 12 anos completos a 20 anos incompletos&#44; que n&#227;o usaram contraceptivos hormonais orais&#44; de acordo com a an&#225;lise de regress&#227;o linear usada para verificar o efeito de um ano de idade cronol&#243;gica sobre as vari&#225;veis analisadas&#44; mostraram um aumento significativo na massa &#243;ssea quando analisadas por densitometria &#243;ssea nos locais do esqueleto propostos&#46; A respeito dos marcadores de forma&#231;&#227;o &#243;ssea&#44; foi observado um aumento das concentra&#231;&#245;es&#44; o que coincidiu com o momento de pico de velocidade de crescimento &#40;PVC&#41;&#44; confirmou&#8208;se o paralelismo entre esses eventos&#46; Esse aumento foi acompanhado por uma redu&#231;&#227;o nos n&#237;veis dos biomarcadores&#44; que acompanharam a expectativa de desacelera&#231;&#227;o do PVC&#46; Assim&#44; apesar de os valores de DMO terem aumentado com a antecipa&#231;&#227;o dos eventos de matura&#231;&#227;o&#44; as concentra&#231;&#245;es dos tr&#234;s biomarcadores reduziram com a idade no fim da adolesc&#234;ncia&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7&#44;13</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">No in&#237;cio&#44; os tr&#234;s grupos estuados foram homog&#234;neos em termos de caracter&#237;sticas antropom&#233;tricas e densitom&#233;tricas&#44; bem como os marcadores de forma&#231;&#227;o &#243;ssea&#46; As usu&#225;rias dos dois tipos de CO mostraram menor incremento &#243;sseo entre o in&#237;cio e os 12 meses que o estimado para o grupo de controle&#44; de acordo com os resultados obtidos por meio da an&#225;lise de regress&#227;o linear&#44; demonstraram um menor aumento da massa &#243;ssea em adolescentes que tomaram as duas formula&#231;&#245;es de contraceptivos&#46; Deve&#8208;se enfatizar que esse per&#237;odo da vida&#44; que abrange a segunda d&#233;cada&#44; &#233; considerado &#250;nico e fundamental para a sa&#250;de &#243;ssea futura&#44; pois 92&#37; da massa &#243;ssea total s&#227;o adquiridos at&#233; aproximadamente 18 anos de idade e 99&#37; at&#233; os 26 anos&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">14&#8211;16</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Sabe&#8208;se que as mulheres que fazem uso de COs n&#227;o t&#234;m as altas concentra&#231;&#245;es de estrog&#234;nio end&#243;geno observadas no ciclo m&#233;dio&#44; uma caracter&#237;stica de ciclos espont&#226;neos&#44; bem como as oscila&#231;&#245;es vistas durante as diferentes fases dos ciclos menstruais&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> Os esfor&#231;os para reduzir os efeitos colaterais&#44; principalmente as complica&#231;&#245;es cardiovasculares resultantes do uso de COs&#44; levou a uma redu&#231;&#227;o gradual nas concentra&#231;&#245;es de estrog&#234;nio nas formula&#231;&#245;es dos contraceptivos&#44; um fato que pode ter causado um efeito delet&#233;rio sobre a DMO&#46; Devido &#224; menor concentra&#231;&#227;o de esteroides sexuais na circula&#231;&#227;o&#44; foi observado um aumento menor do pico de massa &#243;ssea adquirida na adolesc&#234;ncia&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> apesar de outros &#243;rg&#227;os e sistemas serem protegidos por essa redu&#231;&#227;o nas concentra&#231;&#245;es de EE nos contraceptivos&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ao compararmos os resultados deste estudo com os dados na literatura&#44; podemos confirmar que o uso de COs precipita um menor aumento da massa &#243;ssea nas adolescentes&#44; pois a an&#225;lise de regress&#227;o linear mostrou um aumento da DMO e do CMO em todos os locais do esqueleto analisados nos indiv&#237;duos de controle&#46; Esses resultados est&#227;o em linha com o relatado no estudo de Polatti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> nos quais a DMO aumentou 7&#44;8&#37; nos controles&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">18&#44;19</span></a> Em contrapartida&#44; neste estudo&#44; a an&#225;lise do ganho de massa &#243;ssea por densitometria revelou um aumento muito discreto das usu&#225;rias de COs ap&#243;s 12 meses&#44; em compara&#231;&#227;o com o in&#237;cio&#44; por&#233;m a diferen&#231;a n&#227;o foi estatisticamente significativa&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Cromer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> avaliaram a evolu&#231;&#227;o da massa &#243;ssea em 370 adolescentes entre 12 e 18 anos&#44; divididas em uso e n&#227;o uso de COs&#44; em de 12 meses&#46; As usu&#225;rias de acetato de medroxiprogesterona mostraram uma redu&#231;&#227;o m&#233;dia de 1&#44;4&#37; na DMO da coluna lombar &#40;p &#60; 0&#44;001&#41;&#44; ao passo que aquelas que usam CO com 20<span class="elsevierStyleHsp" style=""></span>&#956;g de EE e 100<span class="elsevierStyleHsp" style=""></span>&#956;g de levonorgestrel ganharam 2&#44;3&#37; de DMO na coluna lombar&#46; Contudo&#44; esse aumento foi de 3&#44;8&#37; no grupo de controle&#46; O aumento da DMO encontrado nas usu&#225;rias de COs observado no estudo de Polatti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> e neste estudo &#233; digno de nota&#58; contudo&#44; esse aumento foi menor do que o esperado para o grupo de n&#227;o usu&#225;rias de CO&#46; Esses resultados sugerem que os ganhos moderados na DMO em adolescentes que usam COs de baixa dosagem permitem certo ganho de massa &#243;ssea&#44; por&#233;m n&#227;o o pico de mineraliza&#231;&#227;o &#243;ssea necess&#225;rio para servir como um &#8220;banco &#243;sseo&#8221; para a vida adulta e a velhice&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9&#44;18&#8211;20</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Al&#233;m dos efeitos relacionados ao estrog&#234;nio&#44; o impacto dos progestog&#234;nios sobre a massa &#243;ssea tamb&#233;m deve ser considerado&#44; com diferentes mecanismos subjacentes&#46; Primeiro&#44; os efeitos bem estabelecidos confirmam que as doses elevadas de progesterona atuam sobre o eixo hipot&#225;lamo&#8208;hip&#243;fise&#8208;gonadal&#44; causam hipoestrogenismo&#44; remodela&#231;&#227;o &#243;ssea antecipada e r&#225;pida perda de massa &#243;ssea&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">21&#44;22</span></a> Outra possibilidade &#233; que a progesterona exer&#231;a um efeito estimulador por meio dos receptores de progesterona e andr&#243;genos&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> Os receptores de progesterona e andr&#243;genos s&#227;o expressos em osteoblastos e osteoclastos e a ativa&#231;&#227;o desses dois receptores foi demonstrada por um aumento da massa &#243;ssea&#44; aumentou a atividade dos osteoblastos e reduziu a reabsor&#231;&#227;o &#243;ssea resultante do est&#237;mulo dos osteoclastos&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">18&#44;24</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Muitos progestog&#234;nios comprometidos com os receptores de andr&#243;genos&#44; como a drospirenona e o desogestrel encontrados nos COs usados neste estudo&#44; ativam os receptores de andr&#243;genos por inibi&#231;&#227;o competitiva&#44; bloquearam&#44; assim&#44; a a&#231;&#227;o androg&#234;nica end&#243;gena&#46; Esse mecanismo de a&#231;&#227;o resulta em importantes efeitos antiandrog&#234;nicos sobre o metabolismo &#243;sseo&#44; pois a testosterona desempenha um papel fundamental na obten&#231;&#227;o de massa &#243;ssea&#46; Diante do pequeno n&#250;mero de estudos que investigam a influ&#234;ncia dos progestog&#234;nios presentes nas formula&#231;&#245;es os COs&#44; &#233; dif&#237;cil distinguir se os efeitos sobre o metabolismo &#243;sseo resultam da progesterona ou dos n&#237;veis reduzidos de estrog&#234;nio&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Observa&#8208;se um aumento nos marcadores &#243;sseos durante o per&#237;odo de acelera&#231;&#227;o do crescimento nas meninas&#44; corresponde ao est&#225;gio 2 de Tanner&#46; A massa &#243;ssea tamb&#233;m aumenta e o pico de concentra&#231;&#227;o dos marcadores coincide com o PVC observado no est&#225;gio 3 de Tanner&#46; Posteriormente&#44; no momento da desacelera&#231;&#227;o do crescimento&#44; os marcadores de metabolismo &#243;sseo caem&#44; ao passo que a massa &#243;ssea continua a aumentar&#44; devido&#44; provavelmente&#44; aos n&#237;veis elevados de esteroides sexuais e ao fator de crescimento semelhante &#224; insulina tipo 1&#46; Esse fen&#244;meno foi relatado por Tobiume et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> Em vista dessas considera&#231;&#245;es e como todas as adolescentes desta amostra estavam na puberdade tardia&#44; acreditamos que a redu&#231;&#227;o nas concentra&#231;&#245;es dos marcadores de forma&#231;&#227;o &#243;ssea foi influenciada pelo uso de COs&#46; Assim&#44; os resultados dos marcadores &#243;sseos obtidos neste estudo n&#227;o aparecem ser influenciados somente pela idade&#44; mas tamb&#233;m pelas diferentes concentra&#231;&#245;es de EE nas duas formula&#231;&#245;es&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A respeito dos marcadores de forma&#231;&#227;o &#243;ssea&#44; este estudo demonstrou uma redu&#231;&#227;o nas concentra&#231;&#245;es s&#233;ricas desses marcadores nos dois grupos ap&#243;s 12 meses de uso dos COs&#44; com redu&#231;&#245;es de 20 a 37&#37; na FAO e 40 a 86&#37; na osteocalcina&#46; Resultados semelhantes foram relatados no estudo de Paoletti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> que comparou 28 mulheres entre 20 e 30 anos que usaram CO com 30<span class="elsevierStyleHsp" style=""></span>&#956;g de EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona com n&#227;o usu&#225;rias da mesma faixa et&#225;ria&#46; As concentra&#231;&#245;es s&#233;ricas dos marcadores de forma&#231;&#227;o &#243;ssea analisados ca&#237;ram 20 a 30&#37; nas usu&#225;rias de CO&#44; por&#233;m continuaram inalteradas nos controles&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A redu&#231;&#227;o observada nos biomarcadores de forma&#231;&#227;o &#243;ssea pode ser atribu&#237;da ao uso de COs&#44; o que foi confirmado pela demonstra&#231;&#227;o das diferen&#231;as significativas nos n&#237;veis de FAO e osteocalcina nas adolescentes ap&#243;s um ano de acompanhamento&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">As limita&#231;&#245;es deste estudo foram o curto per&#237;odo de acompanhamento das usu&#225;rias de CO e o pequeno n&#250;mero de participantes&#46; Al&#233;m disso&#44; enfrentamos dificuldades de acompanhar as adolescentes no grupo de controle&#44; devido ao grande n&#250;mero de meninas que n&#227;o voltou nas datas agendadas para fazer as avalia&#231;&#245;es propostas&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Por outro lado&#44; os pontos fortes deste estudo s&#227;o seu modelo prospectivo e que a densitometria &#243;ssea e as medi&#231;&#245;es dos biomarcadores &#243;sseos foram feitas por um &#250;nico t&#233;cnico cego para a atribui&#231;&#227;o de grupo&#46; Al&#233;m disso&#44; o uso das duas formula&#231;&#245;es de COs de baixa dose por um ano foi associado a menor aumento da massa &#243;ssea&#44; com ganhos de DMO e CMO abaixo do estimado para essa faixa et&#225;ria&#46; H&#225; comprova&#231;&#227;o de que a introdu&#231;&#227;o desses contraceptivos na segunda d&#233;cada de vida est&#225; relacionada a n&#237;veis sistematicamente menores dos marcadores de forma&#231;&#227;o &#243;ssea&#44; confirma&#8208;se o menor aumento da massa &#243;ssea demonstrado por densitometria&#46; Acompanhar esses adolescentes por um tempo maior de exposi&#231;&#227;o aos COs combinados &#233; necess&#225;rio para melhor entender os efeitos desses medicamentos sobre os biomarcadores de massa &#243;ssea e forma&#231;&#227;o &#243;ssea&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiamento</span><p id="par0165" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo &#40;Fapesp&#41;&#44; bolsas 07&#47;07731&#8208;0&#44; 2011&#47;05991&#8208;0 e 2015&#47;04040&#8208;2&#44; e Pr&#243;&#8208;Reitoria de Pesquisa da Universidade Estadual Paulista &#40;Unesp&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflitos de interesse</span><p id="par0170" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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    "fechaRecibido" => "2018-01-18"
    "fechaAceptado" => "2018-05-03"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Adolescents"
            1 => "Oral contraceptives"
            2 => "Bone density"
            3 => "Osteocalcin"
            4 => "Bone remodeling"
            5 => "Prospective study"
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          "palabras" => array:6 [
            0 => "Adolescentes"
            1 => "Contraceptivos orais"
            2 => "Densidade &#243;ssea"
            3 => "Osteocalcina"
            4 => "Remodela&#231;&#227;o &#243;ssea"
            5 => "Estudo prospectivo"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of this study was to evaluate the effects of two low&#8208;dose combined oral contraceptives on bone metabolism in adolescents for one year&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a quasi&#8208;experimental study&#46; The adolescents were divided into three groups&#58; oral contraceptives 1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41; &#40;20<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;150<span class="elsevierStyleHsp" style=""></span>&#956;g desogestrel&#41;&#44; oral contraceptives 2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&#41; &#40;30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg drospirenone&#41;&#44; and a control group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;&#46; Adolescents underwent anthropometric assessment and densitometry &#40;dual&#8208;energy X&#8208;ray&#41;&#46; Bone age and bone formation markers &#40;osteocalcin and bone alkaline phosphatase&#41; were evaluated&#46; The oral contraceptives users were evaluated again after 12 months&#46; Linear regression analysis was used to indirectly study the effect of each additional year of chronological age on anthropometric and densitometric variables as well as on bone markers in the control group&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">At study entry&#44; no significant differences were observed between the oral contraceptives 1&#44; oral contraceptives 2&#44; and controls in the analyzed variables&#46; Linear regression analysis showed an increase in bone mineral density and bone mineral content for each additional year&#46; There was a significant reduction in bone alkaline phosphatase levels&#59; no significant difference was observed for osteocalcin in control individuals&#46; Comparison of dual&#8208;energy X&#8208;ray variables at baseline and after one year showed no significant differences in the oral contraceptives 1 or oral contraceptives 2 groups&#46; A significant reduction in bone alkaline phosphatase and osteocalcin levels was observed in both the oral contraceptives 1 and oral contraceptives 2 groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adolescent women gain peak bone mass during this phase of life&#46; Two low&#8208;dose combined oral hormonal contraceptives were associated with lower bone gain and lower bone formation markers than in untreated controls&#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">O objetivo deste estudo foi avaliar os efeitos de dois contraceptivos orais combinados de baixa dosagem por um ano sobre o metabolismo &#243;sseo em adolescentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este foi um estudo quase experimental&#46; As adolescentes foram divididas em tr&#234;s grupos&#58; contraceptivos orais 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41; &#40;20<span class="elsevierStyleHsp" style=""></span>&#956;g de EE&#47;150<span class="elsevierStyleHsp" style=""></span>&#956;g de desogestrel&#41;&#44; contraceptivos orais 2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&#41; &#40;30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona&#41; e grupo controle &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;&#46; As adolescentes foram submetidas &#224; avalia&#231;&#227;o antropom&#233;trica e densitometria &#40;raio-X de dupla energia&#41;&#46; Foram avaliados a idade &#243;ssea e os marcadores de forma&#231;&#227;o &#243;ssea &#40;osteocalcina e fosfatase alcalina &#243;ssea&#41;&#46; As usu&#225;rias de contraceptivos orais foram novamente avaliadas ap&#243;s 12 meses&#46; A an&#225;lise de regress&#227;o linear foi utilizada para estudar&#44; indiretamente&#44; o efeito de cada ano adicional da idade cronol&#243;gica sobre as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e sobre os marcadores &#243;sseos no grupo de controle&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No in&#237;cio do estudo&#44; n&#227;o foram observadas diferen&#231;as significativas nas vari&#225;veis analisadas entre as usu&#225;rias de contraceptivos orais 1&#44; contraceptivos orais 2 e o grupo controle&#46; A an&#225;lise de regress&#227;o linear mostrou um aumento na densidade mineral &#243;ssea e no conte&#250;do mineral &#243;sseo para cada ano adicional&#46; Houve uma redu&#231;&#227;o significativa nos n&#237;veis de fosfatase alcalina &#243;ssea e n&#227;o foi observada diferen&#231;a significativa para osteocalcina nos indiv&#237;duos controles&#46; A compara&#231;&#227;o das vari&#225;veis do raio-X de dupla energia no in&#237;cio e ap&#243;s um ano n&#227;o mostrou diferen&#231;a significativa no grupo de contraceptivos orais 1 ou contraceptivos orais 2&#46; Foi observada uma redu&#231;&#227;o significativa nos n&#237;veis de fosfatase alcalina &#243;ssea e osteocalcina nos dois grupos contraceptivos orais 1 e contraceptivos orais 2&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">As adolescentes atingiram o pico de massa &#243;ssea durante essa fase da vida&#46; Duas formula&#231;&#245;es de contraceptivos hormonais orais de baixa dosagem&#44; ap&#243;s um ano de uso&#44; se associaram a menor incremento na densidade mineral &#243;ssea e menor concentra&#231;&#227;o de marcadores de forma&#231;&#227;o &#243;ssea quando confrontados com resultados de adolescentes n&#227;o usu&#225;rias de contraceptivos&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Como citar este artigo&#58; Rizzo AC&#44; Goldberg TB&#44; Biason TP&#44; Kurokawa CS&#44; Silva CC&#44; Corrente JE&#44; et al&#46; One&#8208;year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;567&#8211;74&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CO1&#44; adolescentes que recebem contraceptivos orais que cont&#234;m 20<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;150<span class="elsevierStyleHsp" style=""></span>g de desogestrel&#59; CO2&#44; adolescentes que recebem contraceptivos orais que cont&#234;m 30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona&#46;</p>"
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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">Idade &#40;anos&#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">16&#44;00&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;00&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">19&#44;40&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">15&#44;00&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">11&#44;00&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">20&#44;00&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">15&#44;00&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;00&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">18&#44;00&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;663&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;182&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">Idade &#243;ssea &#40;anos&#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">17&#44;00&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">14&#44;00&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">19&#44;00&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">16&#44;00&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">14&#44;00&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">18&#44;00&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">17&#44;00&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">14&#44;00&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">21&#44;00&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;245&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;402&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">Peso &#40;kg&#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">52&#44;55&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">41&#44;00&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">69&#44;90&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">54&#44;00&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">39&#44;00&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;40&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">54&#44;00&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">38&#44;50&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">69&#44;00&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;855&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;971&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">Altura &#40;m&#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">1&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;71&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;862&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;212&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">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</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">20&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;44&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;78&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;35&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">17&#44;1&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">26&#44;78&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">21&#44;50&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">15&#44;82&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;86&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;512&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">0&#44;052&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 z para IMC<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</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\ttop\n
                  \t\t\t\t">&#8722;0&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;113&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">IMC &#40;Percentil&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</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">48&#44;89&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">8&#44;07&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">87&#44;46&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">58&#44;72&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">8&#44;21&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">89&#44;78&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">59&#44;89&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">8&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">89&#44;22&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;692&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;066&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">DMO lombar &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#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;951&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">0&#44;724&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">1&#44;174&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">0&#44;963&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;770&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">1&#44;169&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;955&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">0&#44;744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;242&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;987&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;874&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">CMO lombar &#40;g&#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">51&#44;00&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">29&#44;94&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">76&#44;64&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">49&#44;82&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">38&#44;54&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">72&#44;99&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">50&#44;19&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">34&#44;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;854&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 z para lombar&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">&#8722;0&#44;300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&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">&#8722;1&#44;400&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;900&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&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">&#8722;1&#44;800&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;400&nbsp;\t\t\t\t\t\t\n
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                  \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">0&#44;637&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">DMO de todo o corpo &#40;g&#47;cm&#41;<span class="elsevierStyleSup">2</span>&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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;859&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">1&#44;205&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">0&#44;995&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">0&#44;845&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;213&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">CMO de todo o corpo &#40;g&#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">1886&#44;75&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">1260&#44;69&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">2473&#44;26&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">1848&#44;59&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">1291&#44;25&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">2130&#44;32&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">1804&#44;57&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1377&#44;30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2719&#44;86&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;620&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">0&#44;743&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Escore z de todo o corpo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#37; de gordura corporal total&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
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                  \t\t\t\t">CMO lombar &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DMO de todo o corpo &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">CMO de todo o corpo &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">DMO subtotal &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">CMO subtotal &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#37; de gordura corporal total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">FAO &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Osteocalcina &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise de regress&#227;o linear para avaliar o efeito da idade sobre as vari&#225;veis antropom&#233;tricas e densitom&#233;tricas e os marcadores de forma&#231;&#227;o &#243;ssea em adolescentes que n&#227;o usam contraceptivos orais &#40;grupo de controle&#41;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CO1&#44; adolescentes que recebem contraceptivos orais que cont&#234;m 20<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;150<span class="elsevierStyleHsp" style=""></span>g de desogestrel&#59; CO2&#44; adolescentes que recebem contraceptivos orais que cont&#234;m 30<span class="elsevierStyleHsp" style=""></span>&#956;g EE&#47;3<span class="elsevierStyleHsp" style=""></span>mg de drospirenona&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Teste de Wilcoxon para compara&#231;&#227;o entre os pontos de tempo nos grupos de CO1 e CO2&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">In&#237;cio &#40;n &#61; 36&#41;</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">12 meses &#40;n &#61; 36&#41;</th><th class="td" title="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">12 meses &#40;n &#61; 61&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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">Mediana&#47;M&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Mediana&#47;M&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Z&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">p&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">Mediana&#47;M&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Mediana&#47;M&#233;dia&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">M&#237;n&#46;&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">M&#225;x&#46;&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">Z&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&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">Idade &#40;anos&#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">15&#44;00&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">11&#44;00&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">20&#44;00&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">16&#44;00&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;00&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">19&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;4&#44;4&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&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">15&#44;00&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;00&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">18&#44;00&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">16&#44;00&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">13&#44;00&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">21&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;5&#44;6&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&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">Idade &#243;ssea &#40;anos&#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">16&#44;00&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">14&#44;00&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">18&#44;00&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">18&#44;00&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">15&#44;00&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">18&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&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">17&#44;00&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">14&#44;00&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">18&#44;00&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">17&#44;00&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">15&#44;00&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">18&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;4&#44;9&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&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">Peso &#40;kg&#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">54&#44;00&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">39&#44;00&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;40&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">54&#44;10&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">39&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;3&#44;2&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;001&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">54&#44;00&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">38&#44;50&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">69&#44;00&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">54&#44;45&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">39&#44;50&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">73&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;2&#44;9&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;004&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">Altura &#40;m&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Escore z do IMC<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">IMC &#40;Percentil&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DMO lombar &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8208;1&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \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">CMO lombar &#40;g&#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">34&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65&#44;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8208;1&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \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 z para lombar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;005&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">DMO de todo o corpo &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#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">0&#44;102&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">CMO de todo o corpo &#40;g&#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">1&#44;848&#44;59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;291&#44;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;130&#44;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;153&#44;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8208;3&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Escore z de Todo o Corpo&nbsp;\t\t\t\t\t\t\n
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                  \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">11&#44;719&#44;50&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">28&#44;551&#44;00&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">&#8208;4&#44;1&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</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">Massa magra &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37&#44;105&#44;10&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">48&#44;669&#44;10&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">28&#44;945&#44;30&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">53&#44;000&#44;10&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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \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
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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
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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">&#8208;0&#44;2&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;873&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">&#37; de gordura corporal 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">29&#44;100&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">20&#44;000&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">&#8208;3&#44;2&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  " align="left" valign="\n
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                  \t\t\t\t">32&#44;550&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  " align="left" valign="\n
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                  \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</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</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">&#8208;4&#44;0&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&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">FAO &#40;U&#47;L&#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">53&#44;92&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">3&#44;94&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">11&#44;70&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  " align="left" valign="\n
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                  \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  " align="left" valign="\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">&#8208;4&#44;1&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">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2139636.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
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