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The product of triglycerides and glucose as biomarker for screening simple steatosis and NASH in asymptomatic women
Luis E. Simental-Mendía*,**, Esteban Simental-Mendía*, Heriberto Rodríguez-Hernández***, Martha Rodríguez-Morán*, Fernando Guerrero-Romero
,
Corresponding author
guerrero.romero@gmail.com

Correspondence and reprint request:
* Biomedical Research Unit of the Mexican Social Security Institute at Durango, Durango, Dgo., Mexico
** Universidad Autónoma España de Durango, Durango, Dgo., Mexico
*** Faculty of Medicine and Nutrition, Juarez University of Durango State, Durango, Dgo., Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Non-alcoholic fatty liver disease &#40;NAFLD&#41; is the most frequent liver disorder&#44; reaching a prevalence of 15&#8211;30&#37; in Western populations&#59;<a class="elsevierStyleCrossRefs" href="#bib0005">1</a>-<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> prevalence that rises to 58&#37; and 98&#37; in overweight and obese individuals&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">Insulin resistance&#44; that increases lipolysis<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and stimulates <span class="elsevierStyleItalic">de novo</span> lipogenesis promoting the production and storage of triglycerides in the liver&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> as well as fat stores&#44; which are directly associated with liver inflammation&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> play an important role in the pathogenesis of NAFLD&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Given that&#44; typically&#44; individuals with NAFLD are asymptomatic and that among individuals with liver fat storage greater than 33&#37; diagnosis of NAFLD usually is a casual finding&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> the early diagnosis of NAFLD remains as an important challenge&#46; On this regard&#44; several non-invasive tests such as the elevated ALT and AST levels&#44; AST&#58;ALT ratio greater than 1&#44; the ALT&#58; triglycerides ratio greater then 7&#46;0&#44; fatty Liver Index&#44; the NAFLD fibrosis score&#44; the FibroMeter&#44; hepatic ultrasonography&#44; computed tomography&#44; nuclear magnetic resonance imaging&#44; the Fibroscan&#44; and transient elastograph&#44; have been proposed for the early recognition of NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">Recently&#44; we proposed<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and validated versus the euglycemic insulin clamp&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> an index for screening insulin resistance&#44; the product of fasting triglycerides and glucose levels &#40;TyG&#41;&#46; Since it was proposed&#44; the TyG index has been evaluated in Mexican-American&#44; Caucasian&#44; Koreans&#44; Chinese&#44; Argentine&#44; Italians&#44; Brazilians&#44; and Mexican adults&#44;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> consistently showing that the TyG index properly identifies the presence and severity of insulin resistance in apparently healthy subjects&#46;</p><p id="p0025" class="elsevierStylePara elsevierViewall">Taking into account that insulin resistance is involved in the pathogenesis of NAFLD<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and that the TyG index is a well-marker for screening insulin resistance&#44; objectives of this study were to evaluate the efficacy of the TyG index for the screening of simple steatosis and non-alcoholic steatohepatitis &#40;NASH&#41; in asymptomatic women&#44; and compare its efficacy <span class="elsevierStyleItalic">vs&#46;</span> other proposed clinical biomarkers&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Material and Methods</span><p id="p0030" class="elsevierStylePara elsevierViewall">With the approval of protocol by the Mexican Social Security Institute Research Committee&#44; and after obtaining the subject informed written consent&#44; a cross-sectional study was carried out in accordance with the principles of the Declaration of Helsinki as reviewed in 2000&#46;</p><p id="p0035" class="elsevierStylePara elsevierViewall">The sampling strategy was based on advertising to general population of Durango&#44; city in northern M&#233;xico&#44; to invite women to participate&#46; The eligible population was of asymptomatic women aged 20 to 65 years&#46; All women underwent anthropometric measurements&#44; routine blood chemistry&#44; and hepatic biopsy&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">Alcohol consumption equal or greater than 20 g per day&#44; smoking&#44; positive markers of viral or autoimmune hepatitis&#44; previous diagnosis of acute or chronic liver disease&#44; renal failure&#44; neoplasia&#44; cardiovascular disease&#44; pregnancy&#44; and intake of contraceptives or hepatotoxic drugs were exclusion criteria&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">Liver biopsy was performed using tru-cut needle guided by ultrasound&#59; two expert pathologists&#44; who were blinded to clinical and laboratory data&#44; performed the histological interpretation&#46;</p><p id="p0050" class="elsevierStylePara elsevierViewall">Women of the control group were eligible among women without hepatic symptoms and signs&#44; who required upper abdominal surgery by any other health problem &#40;e&#46;g&#46; cholecystectomy&#44; the most frequent&#41;&#59; previous signed informed consent&#44; liver biopsy was performed during surgical procedure&#46;</p><p id="p0055" class="elsevierStylePara elsevierViewall">According to the biopsy report&#44; women were included into the groups with normal liver&#44; simple steatosis and NASH&#46;</p><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Definitions</span><p id="p0060" class="elsevierStylePara elsevierViewall">Based on liver biopsy&#44; normal liver was defined by no significant histological changes&#59; simple steatosis&#44; by the presence of hepatic steatosis with no evidence of hepatocellular injury in the form of ballooning of the hepatocytes&#59; and NASH by the presence of hepatic steatosis&#44; inflammation&#44; and ballooning&#44; with or without fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="p0065" class="elsevierStylePara elsevierViewall">The TyG index was defined as the Ln&#91;fasting triglycerides &#40;mg&#47;dL&#41; x fasting glucose &#40;mg&#47;dL&#41;&#47;2&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="p0070" class="elsevierStylePara elsevierViewall">The efficacy of TyG index for the screening of simple steatosis and NASH was compared with the following clinical biomarkers&#44; all of them validated versus hepatic biopsy&#58; SteatoTest&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> NashTest&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Fatty liver index&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and Algorithm by Lin&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Measurements</span><p id="p0075" class="elsevierStylePara elsevierViewall">Using a fixed scale with stadimeter &#40;Tanita TBF-215&#44; Tokyo&#44; Japan&#41;&#44; with the women in the standing position&#44; in light clothing and without shoes&#44; the weight and height were measured&#46; The precisions of weight and height measurements were 0&#46;1 kg and 0&#46;01 m&#46; Body mass index &#40;BMI&#41; was calculated as weight &#40;kilograms&#41; divided by height &#40;meters&#41; squared&#46; The waist circumference was measured to the nearest centimeter using a flexible tape measure&#59; with the subjects in the standing position&#44; the anatomical landmarks were the midway between the lowest portion of the rib cage and iliac crest&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Assays</span><p id="p0080" class="elsevierStylePara elsevierViewall">A venous whole blood sample was collected after 8&#8211;10 h of fasting&#46; Plasma glucose was assessed by glucose-oxidase method&#59; the inter- and intra-assay coefficients of variation &#40;CV&#41; were 2&#46;1&#44; and 1&#46;5&#37;&#46; Total-cholesterol &#40;inter- and intra-assay CV of 3&#46;0 and 2&#46;5&#37;&#41; and serum triglycerides &#40;inter- and intra-assay CV of 3&#46;5&#44; and 3&#46;0&#37;&#41; were determined by enzymatic methods&#46; The alanine aminotransferase levels were determined by ultra violet kinetic methods &#40;Erlic&#44; Tlalnepantla&#44; Estado de M&#233;xico&#44; M&#233;x&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="p0085" class="elsevierStylePara elsevierViewall">All measurements were performed using an Express 500 clinical chemistry autoanalyzer &#40;Ciba Corning&#44; Diagnostic Corp&#46;&#44; Overling&#44; Ohio&#41;&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Statistical analysis</span><p id="p0090" class="elsevierStylePara elsevierViewall">Differences between the groups were estimated using Mann-Whitney U test for quantitative variables and &#967;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> test &#40;Fisher&#8217;s exact test&#41; for qualitative variables&#46;</p><p id="p0095" class="elsevierStylePara elsevierViewall">The optimal values of TyG index for screening simple steatosis and NASH were established on a Receiver Operating Characteristic scatter plot curve&#44; for both simple steatosis and NASH&#59; sensitivity&#44; specificity as well as the positive and negative likelihood ratios of TyG index&#44; were estimated versus liver biopsy&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="p0100" class="elsevierStylePara elsevierViewall">To compare the efficacy of TyG index&#44; for screening simple steatosis and NASH&#44; <span class="elsevierStyleItalic">vs&#46;</span> other well-known biomarkers&#44; we used a chart in which sensitivity and 1-specificity are plotted in the y and x axis&#44; respectively&#59; from the 0&#44;0 point a line crossing the point of biomarker with the best sensitivity and specificity is drawn&#46; In the same way&#44; a line is drawn from the point 1&#44;1&#46; In this way&#44; the chart is separated into 4 quadrants&#58; the upper-left quadrant indicates the area of tests with best efficacy for diagnosis and screening&#59; the upper-right quadrant is the area for tests with best screening efficacy&#59; the lower-right quadrant is the area for tests with low efficacy for diagnosis and screening&#59; and the lower-left quadrant is the area for the tests with the best efficacy for diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="p0105" class="elsevierStylePara elsevierViewall">A p value of &#60; 0&#46;05 defined statistical significance&#46; Data were analyzed using the statistical package SPSS 15&#46;0&#46; &#40;SPSS Inc&#46;&#44; Chicago IL&#44; USA&#41;&#46;</p></span></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Results</span><p id="p0110" class="elsevierStylePara elsevierViewall">A total of 50 asymptomatic women with average age and BMI of 41&#46;7 &#177; 12&#46;3 years and 33&#46;0 &#177; 7&#46;1 kg&#47;m<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> were enrolled&#46;</p><p id="p0115" class="elsevierStylePara elsevierViewall">A total of 18 &#40;36&#46;0&#37;&#41; women had diagnosis of simple steatosis&#44; 16 &#40;32&#46;0&#37;&#41; NASH&#44; and 16 &#40;32&#46;0&#37;&#41; showed no changes in hepatic histology&#46;</p><p id="p0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#t0005">Table 1</a> shows the clinical and biochemical characteristics of target population&#46; Women with simple steatosis and NASH exhibited the highest percentage of obesity and TyG index&#44; whereas women with NASH had higher cholesterol and triglycerides levels than women with normal liver&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0125" class="elsevierStylePara elsevierViewall">The best cutoff point of TyG index for screening simple steatosis was 4&#46;58 &#40;sensitivity 0&#46;94&#44; specificity 0&#46;69&#41;&#59; in addition&#44; the best cutoff point of TyG index for screening NASH was 4&#46;59 &#40;sensitivity 0&#46;87&#44; specificity 0&#46;69&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>&#41;&#46; The positive and negative likelihood ratios were 3&#46;03 and 0&#46;08 for simple steatosis&#44; and 2&#46;80 and 0&#46;18 for NASH&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0130" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#t0010">Table 2</a> shows the diagnostic characteristics of the clinical biomarkers that have been evaluated versus hepatic biopsy&#46; The Algorithm&#44; showed the best sensitivity and specificity&#59; thus&#44; it was the reference for drawing the chart to compare the efficacy of clinical biomarkers for recognizing NAFLD&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0135" class="elsevierStylePara elsevierViewall">The TyG index was the best test for screening simple steatosis and NASH&#46; NashTest was the best test for diagnosing NAFLD&#46; The SteatoTest the worst test for diagnosing and screening NAFLD &#40;<a class="elsevierStyleCrossRef" href="#f0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Discussion</span><p id="p0140" class="elsevierStylePara elsevierViewall">Results of this study demonstrate that the TyG index has high sensitivity and low negative likelihood ratio&#44; strongly suggesting that the TyG index may be a useful clinical biomarker for screening simple steatosis and NASH in asymptomatic women&#46; As compared with other well-known clinical biomarkers for NAFLD&#44; the TyG index was the best test for screening simple steatosis and NASH&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">Hepatic fat accumulation is associated with insulin resistance&#44; a common finding in patients with NAFLD&#59;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> in addition&#44; the NAFLD is characterized by the increase of adipose peripheral tissue&#44;<a class="elsevierStyleCrossRefs" href="#bib0210">42</a>-<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> insulin resistance at adipocyte level&#44;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> and inhibition of fatty acid oxidation&#44; findings suggesting that insulin resistance plays an important role in the pathogenesis of hepatic steatosis&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> On this regard&#44; biomarkers of insulin resistance emerge as promising tool for screening NAFLD&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">In agree with the abovementioned statement&#44; the TyG index&#44; a biomarker to identify insulin resistance&#44; showed its efficacy as a tool for screening simple steatosis and NASH&#46; Keeping in mind that objective of screening is the early detection of disease&#44; our results suggests that TyG index&#44; with the highest sensitivity and lowest negative likelihood ratio&#44; may be useful for screening simple steatosis and NASH&#46;</p><p id="p0155" class="elsevierStylePara elsevierViewall">Several index have been proposed for the early recognition of NAFLD&#46; Among them&#44; the SteatoTest and NashTest&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> which are expensive and not available in most laboratories of undeveloped countries&#46; In addition&#44; fatty liver index and algorithm&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> which although are accessible&#44; involve numerous variables and complex calculations&#44; which limit its use in the clinical setting&#46; As compared <span class="elsevierStyleItalic">vs&#46;</span> these biomarkers&#44; the TyG index showed to be the best test for screening simple steatosis and NASH&#44; with the advantage that TyG index is a simple&#44; inexpensive&#44; reliable&#44; and reproducible biomarker&#44; based on routine laboratory tests available in all clinical laboratories&#46;</p><p id="p0160" class="elsevierStylePara elsevierViewall">Recently&#44; Fedchuk&#44; <span class="elsevierStyleItalic">et al</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> evaluate the diagnostic value of TyG index in patients with suspected NAFLD&#46; The AUC of TyG index reported by Fedchuk&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> was similar to the AUC of our study&#44; supporting the statement that the TyG could be a useful index to identify NAFLD&#46;</p><p id="p0165" class="elsevierStylePara elsevierViewall">Several limitations of our study deserve to be mentioned&#58;<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0170" class="elsevierStylePara elsevierViewall">Because the required liver biopsy among healthy participants of control group was performed during upper abdominal surgery due to cholecystectomy&#44; procedure indicated in women but not in men&#44; our data cannot be applied to men&#46; Further studies are needed to validate the efficacy of TyG index for early detection of simple steatosis and NASH in men&#46;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0175" class="elsevierStylePara elsevierViewall">The small sample size could be a source of bias&#59; however&#44; women in the control group&#44; showed a significantly lower BMI&#44; waist circumference&#44; diastolic blood pressure&#44; total cholesterol&#44; triglycerides&#44; and TyG index than women with simple steatosis or NASH&#44; data indicating that a possible type II error in analysis of data was avoided and supports the appropriate power of sample size&#46;</p></li></ul></p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Conclusions</span><p id="p0180" class="elsevierStylePara elsevierViewall">Compared versus liver biopsy&#44; the TyG index&#44; as clinical biomarker for screening simple steatosis and NASH in asymptomatic women&#44; has high sensitivity and low negative likelihood ratio&#46; As compared with other clinical biomarkers for recognizing NAFLD&#44; the TyG index showed to be the best test for screening simple steatosis and NASH&#46;</p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Abbreviations</span><p id="p0185" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">AUC&#58;</span> area under curve&#46;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">BMI&#58;</span> body mass index&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">NAFLD&#58;</span> non-alcoholic fatty liver disease&#46;</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">TyG&#58;</span> product of triglyceride and glucose levels&#46;</p></li></ul></p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Conflict of Interest</span><p id="p0210" class="elsevierStylePara elsevierViewall">Authors have none conflict of interest declared within the manuscript&#46;</p></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Financial Support</span><p id="p0215" class="elsevierStylePara elsevierViewall">This work was supported by grants from the Mexican Social Security Institute Foundation&#44; Civil Association&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Material and Methods"
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            1 => array:2 [
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              "titulo" => "Assays"
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              "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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          "identificador" => "s0045"
          "titulo" => "Conclusions"
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          "identificador" => "s0050"
          "titulo" => "Abbreviations"
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        8 => array:2 [
          "identificador" => "s0055"
          "titulo" => "Conflict of Interest"
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        9 => array:2 [
          "identificador" => "s0060"
          "titulo" => "Financial Support"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2015-08-31"
    "fechaAceptado" => "2016-01-26"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1116634"
          "palabras" => array:4 [
            0 => "Efficacy"
            1 => "Screening"
            2 => "Sensitivity"
            3 => "Specificity"
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    "resumen" => array:1 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction and aim&#46;</span> Given that early identification of non-alcoholic fatty liver disease &#40;NAFLD&#41; is an important issue for primary prevention of hepatic disease&#44; the objectives of this study were to evaluate the efficacy of the product of triglyceride and glucose levels &#40;TyG&#41; for screening simple steatosis and non-alcoholic steatohepatitis &#40;NASH&#41; in asymptomatic women&#44; and to compare its efficacy vs&#46; other biomarkers for recognizing NAFLD&#46;</p><p id="sp7040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material and methods&#46;</span> Asymptomatic women aged 20 to 65 years were enrolled into a cross-sectional study&#46; The optimal values of TyG&#44; for screening simple steatosis and NASH were established on a Receiver Operating Characteristic scatter plot&#59; the sensitivity&#44; specificity&#44; and likelihood ratios of TyG index were estimated versus liver biopsy&#46; According sensitivity and specificity&#44; the efficacy of TyG was compared versus the well-known clinical biomarkers for recognizing NAFLD&#46;</p><p id="sp2040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#46;</span> A total of 50 asymptomatic women were enrolled&#46; The best cutoff point of TyG for screening simple steatosis was 4&#46;58 &#40;sensitivity 0&#46;94&#44; specificity 0&#46;69&#41;&#59; in addition&#44; the best cutoff point of TyG index for screening NASH was 4&#46;59 &#40;sensitivity 0&#46;87&#44; specificity 0&#46;69&#41;&#46; The positive and negative likelihood ratios were 3&#46;03 and 0&#46;08 for simple steatosis&#44; and 2&#46;80 and 0&#46;18 for NASH&#46; As compared versus SteatoTest&#44; NashTest&#44; Fatty liver index&#44; and Algorithm&#44; the TyG showed to be the best test for screening&#46;</p><p id="sp6025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions&#46;</span> TyG has high sensitivity and low negative likelihood ratio&#59; as compared with other clinical biomarkers&#44; the TyG showed to be the best test for screening simple steatosis and NASH&#46;</p></span>"
      ]
    ]
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          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curve&#46; Sensitivity represents true-positive results&#44; and 1-specificity&#44; false-positive results&#46; The best cutoff point of TyG index for identify simple steatosis and NASH were 4&#46;58 and 4&#46;59&#44; respectively&#44; which showed the highest sensitivity and specifcity&#46;</p>"
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          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Usefulness of clinical diagnostic tests to identify NAFLD&#46; The Algorithm test&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> was the reference test for drawing the chart&#46; TyG index to identify simple steatosis and NASH are presented as white square and black square&#44; respectively&#46;</p>"
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        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="np0005" class="elsevierStyleSimplePara elsevierViewall">Data are mean &#177; standard deviation&#59; AST&#44; aspartate aminotransferase&#59; ALT&#44; alanine aminotransferase&#59; TyG index&#44; Ln&#91;fasting triglycerides &#40;mg&#47;dL&#41; X fasting glucose &#40;mg&#47;dL&#41;&#47;2&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">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="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal liver 16&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="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Simple steatosis 18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NASH 16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">39&#46;6 &#177; 14&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">45&#46;7 &#177; 11&#46;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="center" valign="\n
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                  \t\t\t\t">39&#44;31 10&#44;756&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="center" valign="\n
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                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Normal weight&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">4 &#40;25&#46;0&#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="center" valign="\n
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                  \t\t\t\t">1 &#40;5&#46;5&#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="center" valign="\n
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                  \t\t\t\t">1 &#40;6&#46;2&#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="center" valign="\n
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                  \t\t\t\t">0&#46;04<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Overweight&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;25&#46;0&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obesity&#44; n &#40;&#37;&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;83&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;68&#46;8&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Body mass index&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;4 &#177; 5&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;4 &#177; 7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;6 &#177; 5&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Waist circumference&#44; cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;0 &#177; 13&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&#46;8 &#177; 19&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104&#46;4 &#177; 11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systolic blood pressure&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114&#46;3 &#177; 24&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&#46;1 &#177; 14&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;3 &#177; 20&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diastolic blood pressure&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;3 &#177; 12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;9 &#177; 11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;3 &#177; 18&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&#44;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fasting glucose&#44; mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;3 &#177; 2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;7 &#177; 1&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;7 &#177; 3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total cholesterol&#44; mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;4 &#177; 0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;8 &#177; 1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triglycerides&#44; mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;1 &#177; 0&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;6 &#177; 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AST&#44; U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;7 &#177; 21&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;0 &#177; 29&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;8 &#177; 153&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT&#44; U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;7 &#177; 24&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46; 9 &#177; 30&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102&#46;5 &#177; 192&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TyG index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;50 &#177; 0&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;85 &#177; 0&#46;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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;95 &#177; 0&#46; 37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&#44;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnostic test&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sensitivity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Specificity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                    0 => array:2 [
                      "titulo" => "Hepatic steatosis and type 2 diabetes mellitus"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:2 [
                            0 => "Clark J&#46;M&#46;"
                            1 => "Diehl A&#46;M&#46;"
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                    0 => array:1 [
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                        "tituloSerie" => "Curr Diab Rep"
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                        "paginaInicial" => "210"
                        "paginaFinal" => "215"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of and risk factors for nonalcoholic fatty liver disease&#58; the Dionysos nutrition and liver study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Bedogni G&#46;"
                            1 => "Miglioli L&#46;"
                            2 => "Masutti F&#46;"
                            3 => "Tiribelli C&#46;"
                            4 => "Marchesini G&#46;"
                            5 => "Bellentani S&#46;"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20734"
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                        "tituloSerie" => "Hepatology"
                        "fecha" => "2005"
                        "volumen" => "42"
                        "paginaInicial" => "44"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15895401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of hepatic steatosis in an urban population in the United States&#58; impact of ethnicity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
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                            2 => "Dobbins R&#46;"
                            3 => "Nuremberg P&#46;"
                            4 => "Horton J&#46;D&#46;"
                            5 => "Cohen J&#46;C&#46;"
                            6 => "Grundy S&#46;M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                        "paginaFinal" => "1395"
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                        "paginaFinal" => "285"
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                            "web" => "Medline"
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              "referencia" => array:1 [
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                      "autores" => array:1 [
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                          "autores" => array:3 [
                            0 => "Machado M&#46;"
                            1 => "Marques-Vidal P&#46;"
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                      ]
                    ]
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                        "fecha" => "2006"
                        "volumen" => "45"
                        "paginaInicial" => "600"
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                        "link" => array:1 [
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                          "autores" => array:7 [
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                            3 => "Cua I&#46;H&#46;"
                            4 => "Vanni E&#46;"
                            5 => "Rizzetto M&#46;"
                            6 => "George J&#46;"
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                            1 => "Muratore C&#46;"
                            2 => "Craxi A&#46;"
                          ]
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                        "fecha" => "2009"
                        "volumen" => "41"
                        "paginaInicial" => "615"
                        "paginaFinal" => "625"
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              "identificador" => "bib0040"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Visceral fat&#58; a key mediator of steatohepatitis in metabolic liver disease"
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                          "autores" => array:7 [
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                            1 => "Milner K&#46;L&#46;"
                            2 => "Hui J&#46;"
                            3 => "Hodge A&#46;"
                            4 => "Trenell M&#46;I&#46;"
                            5 => "Kench J&#46;G&#46;"
                            6 => "London R&#46;"
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                        "tituloSerie" => "World J Gastroenterol"
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                        "paginaFinal" => "1723"
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                          "autores" => array:4 [
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                            3 => "Hong K&#46;"
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                          0 => array:2 [
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                        "paginaFinal" => "1231"
                        "link" => array:1 [
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                            3 => "Diehl A&#46;M&#46;"
                            4 => "Brunt E&#46;M&#46;"
                            5 => "Cusi K&#46;"
                            6 => "Charlton M&#46;"
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                      "doi" => "10.1002/hep.25762"
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                        "tituloSerie" => "Hepatology"
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                        "volumen" => "55"
                        "paginaInicial" => "2005"
                        "paginaFinal" => "2023"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22488764"
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                      "titulo" => "The utility of radiological imaging in nonalcoholic fatty liver disease"
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                          "autores" => array:7 [
                            0 => "Saadeh S&#46;"
                            1 => "Younossi Z&#46;M&#46;"
                            2 => "Remer E&#46;M&#46;"
                            3 => "Gramlich T&#46;"
                            4 => "Ong J&#46;P&#46;"
                            5 => "Hurley M&#46;"
                            6 => "Mullen K&#46;D&#46;"
                          ]
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                        "paginaInicial" => "745"
                        "paginaFinal" => "750"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12198701"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Interobserver and intraobserver variability in the sonographic assessment of fatty liver"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "Strauss S&#46;"
                            1 => "Gavish E&#46;"
                            2 => "Gottlieb P&#46;"
                            3 => "Katsnelson L&#46;"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
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                      "doi" => "10.2214/AJR.07.2123"
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                        "tituloSerie" => "AJR"
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                        "volumen" => "189"
                        "paginaInicial" => "W320"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18029843"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "The alanine aminotransferase to triglycerides ratio as a marker to identify nonalcoholic fatty liver disease"
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                          "autores" => array:4 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Gastroenterol Hepatol"
                        "fecha" => "2012"
                        "volumen" => "24"
                        "paginaInicial" => "1173"
                        "paginaFinal" => "1177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22735606"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The product of triglycerides and glucose&#44; a simple measure of insulin sensitivity&#46; Comparison with the euglycemic-hyperinsulinemic clamp"
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                          "etal" => true
                          "autores" => array:7 [
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                            2 => "Gonz&#225;lez-Ortiz M&#46;"
                            3 => "Mart&#237;nez-Abundis E&#46;"
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                            5 => "Hern&#225;ndez-Gonz&#225;lez S&#46;O&#46;"
                            6 => "Jacques-Camarena O&#46;"
                          ]
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                        "tituloSerie" => "J Clin Endocrinol Metab"
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                        "volumen" => "95"
                        "paginaInicial" => "3347"
                        "paginaFinal" => "3351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20484475"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
                      "titulo" => "The Product of Triglycerides and Glucose as index of insulin resistance&#46; Validation in the SAM study"
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                          "etal" => false
                          "autores" => array:3 [
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                            1 => "Folli F&#46;"
                            2 => "DeFronzo R&#46;A&#46;"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
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                    0 => array:2 [
                      "titulo" => "Predicting the Development of Diabetes Using the Product of Triglycerides and Glucose"
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                          "etal" => true
                          "autores" => array:7 [
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                            1 => "Kwon H&#46;S&#46;"
                            2 => "Park Y&#46;M&#46;"
                            3 => "Ha H&#46;S&#46;"
                            4 => "Jeong S&#46;H&#46;"
                            5 => "Yang H&#46;K&#46;"
                            6 => "Lee J&#46;H&#46;"
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                        "tituloSerie" => "The Chungju Metabolic Disease Cohort &#40;CMC&#41; Study&#46; PLoS One"
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                        "paginaInicial" => "e90430"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24587359"
                            "web" => "Medline"
                          ]
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                      "titulo" => "Identifying subgroups of obesity using the product of triglycerides and glucose&#58; the Korea National Health and Nutrition Examination Survey&#44; 2008-2010"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
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                            1 => "Han K&#46;"
                            2 => "Yang H&#46;K&#46;"
                            3 => "Kim M&#46;K&#46;"
                            4 => "Yoon K&#46;H&#46;"
                            5 => "Kwon H&#46;S&#46;"
                            6 => "Park Y&#46;M&#46;"
                          ]
                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Endocrinol &#40;Oxf&#41;"
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                        "paginaInicial" => "213"
                        "paginaFinal" => "220"
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                      "titulo" => "Clinical usefulness of lipid ratios&#44; visceral adiposity indicators&#44; and the triglycerides and glucose index as risk markers of insulin resistance"
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                          "etal" => false
                          "autores" => array:6 [
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                            1 => "Yuan G&#46;"
                            2 => "Zhang M&#46;"
                            3 => "Zhou X&#46;"
                            4 => "Sun X&#46;"
                            5 => "Yu X&#46;"
                          ]
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                    ]
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                        "tituloSerie" => "Cardiovasc Diabetol"
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                        "volumen" => "13"
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                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                            3 => "Villase&#241;or-Romero J&#46;P&#46;"
                            4 => "Hern&#225;ndez-Gonz&#225;lez S&#46;O&#46;"
                            5 => "Gonz&#225;lez-Ortiz M&#46;"
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                        "tituloSerie" => "J Investig Med"
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                        "paginaInicial" => "247"
                        "paginaFinal" => "250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25503090"
                            "web" => "Medline"
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                          "autores" => array:4 [
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                        "paginaInicial" => "533"
                        "paginaFinal" => "540"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25174769"
                            "web" => "Medline"
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                            4 => "Bertazzi P&#46;A&#46;"
                            5 => "Riboldi L&#46;"
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                  "host" => array:1 [
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                        "paginaInicial" => "748"
                        "paginaFinal" => "749"
                        "link" => array:1 [
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                            "web" => "Medline"
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                      "titulo" => "TyG index performs better than HOMA in a Brazilian population&#58; a hyperglycemic clamp validated study"
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                            4 => "Yamanaka A&#46;"
                            5 => "Pareja J&#46;C&#46;"
                            6 => "Tambascia M&#46;A&#46;"
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                          0 => array:2 [
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                            "web" => "Medline"
                          ]
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                        "tituloSerie" => "Rev Invest Clin"
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                            6 => "Capron D&#46;"
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                          "autores" => array:7 [
                            0 => "Poynard T&#46;"
                            1 => "Ratziu V&#46;"
                            2 => "Charlotte F&#46;"
                            3 => "Messous D&#46;"
                            4 => "Munteanu M&#46;"
                            5 => "Imbert-Bismut F&#46;"
                            6 => "Massard J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-230X-6-34"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Gastroenterol"
                        "fecha" => "2006"
                        "volumen" => "6"
                        "paginaInicial" => "34"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17096854"
                            "web" => "Medline"
                          ]
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                ]
              ]
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            29 => array:3 [
              "identificador" => "bib0150"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Fatty Liver Index&#58; a simple and accurate predictor of hepatic steatosis in the general population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Bedogni G&#46;"
                            1 => "Bellentani S&#46;"
                            2 => "Miglioli L&#46;"
                            3 => "Masutti F&#46;"
                            4 => "Passalacqua M&#46;"
                            5 => "Castiglione A&#46;"
                            6 => "Tiribelli C&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-230X-6-33"
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                        "tituloSerie" => "BMC Gastroenterol"
                        "fecha" => "2006"
                        "volumen" => "6"
                        "paginaInicial" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17081293"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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            30 => array:3 [
              "identificador" => "bib0155"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors and predictors of non-alcoholic fatty liver disease in Taiwan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Lin Y&#46;C&#46;"
                            1 => "Chou S&#46;C&#46;"
                            2 => "Huang P&#46;T&#46;"
                            3 => "Chiou H&#46;Y&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Hepatol"
                        "fecha" => "2011"
                        "volumen" => "10"
                        "paginaInicial" => "125"
                        "paginaFinal" => "132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21502673"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonalcoholic fatty liver disease in asymptomatic obese women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Rodriguez-Hernandez H&#46;"
                            1 => "Cervantes-Huerta M&#46;"
                            2 => "Gonzalez J&#46;L&#46;"
                            3 => "Marquez-Ramirez M&#46;D&#46;"
                            4 => "Rodriguez-Moran M&#46;"
                            5 => "Guerrero-Romero F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Hepatol"
                        "fecha" => "2010"
                        "volumen" => "9"
                        "paginaInicial" => "144"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20526006"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0090429515009516"
                          "estado" => "S300"
                          "issn" => "00904295"
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                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical Epidemiology and Biostatistics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Kramer M&#46;S&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:6 [
                        "titulo" => "A Primer for investigators and Decision-Makers"
                        "fecha" => "1998"
                        "paginaInicial" => "201"
                        "paginaFinal" => "210"
                        "editorial" => "Springer-Verlag Press"
                        "editorialLocalizacion" => "Berlin"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic tests&#46; 1&#58; Sensitivity and specificity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Altman D&#46;G&#46;"
                            1 => "Bland J&#46;M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.308.6943.1552"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "1994"
                        "volumen" => "308"
                        "paginaInicial" => "1552"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8019315"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0302283815003127"
                          "estado" => "S300"
                          "issn" => "03022838"
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                    ]
                  ]
                ]
              ]
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            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NASH and insulin resistance&#58; insulin hypersecretion and specific association with the insulin resistance syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Chitturi S&#46;"
                            1 => "Abeygunasekera S&#46;"
                            2 => "Farrell G&#46;C&#46;"
                            3 => "Holmes-Walker J&#46;"
                            4 => "Hui J&#46;M&#46;"
                            5 => "Fung C&#46;"
                            6 => "Karim R&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jhep.2002.30692"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2002"
                        "volumen" => "35"
                        "paginaInicial" => "373"
                        "paginaFinal" => "379"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11826411"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic and anthropometric evaluation of insulin resistance in nondiabetic patients with nonalcoholic steatohepatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Chalasani N&#46;"
                            1 => "Deeg M&#46;A&#46;"
                            2 => "Persohn S&#46;"
                            3 => "Crabb D&#46;W&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2003.07619.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2003"
                        "volumen" => "98"
                        "paginaInicial" => "1849"
                        "paginaFinal" => "1855"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12907343"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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            36 => array:3 [
              "identificador" => "bib0185"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary habits and their relations to insulin resistance and postprandial lipemia in nonalcoholic steatohepatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Musso G&#46;"
                            1 => "Gambino R&#46;"
                            2 => "De Michieli F&#46;"
                            3 => "Cassader M&#46;"
                            4 => "Rizzetto M&#46;"
                            5 => "Durazzo M&#46;"
                            6 => "Faga E&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jhep.2003.50132"
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                        "tituloSerie" => "Hepatology"
                        "fecha" => "2003"
                        "volumen" => "37"
                        "paginaInicial" => "909"
                        "paginaFinal" => "916"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12668986"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0190"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postprandial triglyceride-rich lipoprotein metabolism and insulin sensitivity in nonalcoholic steatohepatitis patients"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Cassader M&#46;"
                            1 => "Gambino R&#46;"
                            2 => "Musso G&#46;"
                            3 => "Depetris N&#46;"
                            4 => "Mecca F&#46;"
                            5 => "Cavallo-Perin P&#46;"
                            6 => "Pacini G&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lipids"
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                        "paginaInicial" => "1117"
                        "paginaFinal" => "1124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11768156"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0195"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Ninety patients with nonalcoholic steatohepatitis&#58; insulin resistance&#44; familial tendency&#44; and severity of disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "Waters B&#46;"
                            2 => "Patil S&#46;R&#46;"
                            3 => "Reuben A&#46;"
                            4 => "Morelli J&#46;"
                            5 => "Riely C&#46;A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2001.04667.x"
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                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2001"
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                        "paginaInicial" => "2957"
                        "paginaFinal" => "2961"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11693332"
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                          ]
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                          "pii" => "S0022534712034118"
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                          "issn" => "00225347"
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                      "titulo" => "Liver-fat accumulation and insulin resistance in obese women with previous gestational diabetes"
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                          "etal" => true
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                            0 => "Tiikkainen M&#46;"
                            1 => "Tamminen M&#46;"
                            2 => "Hakkinen A&#46;M&#46;"
                            3 => "Bergholm R&#46;"
                            4 => "Vehkavaara S&#46;"
                            5 => "Halavaara J&#46;"
                            6 => "Teramo K&#46;"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1038/oby.2002.118"
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                        "tituloSerie" => "Obes Res"
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                        "volumen" => "10"
                        "paginaInicial" => "859"
                        "paginaFinal" => "867"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12226133"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Nonalcoholic steatohepatitis&#58; association of insulin resistance and mitochondrial abnormalities"
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                          "etal" => true
                          "autores" => array:7 [
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                            1 => "Campbell-Sargent C&#46;"
                            2 => "Mirshahi F&#46;"
                            3 => "Rizzo W&#46;B&#46;"
                            4 => "Contos M&#46;J&#46;"
                            5 => "Sterling R&#46;K&#46;"
                            6 => "Luketic V&#46;A&#46;"
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                        ]
                      ]
                    ]
                  ]
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                        "paginaInicial" => "1183"
                        "paginaFinal" => "1192"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11266382"
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                          ]
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                          "issn" => "00225347"
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              "identificador" => "bib0210"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Nonalcoholic fatty liver disease&#58; a feature of the metabolic syndrome"
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                          "autores" => array:7 [
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                            1 => "Brizi M&#46;"
                            2 => "Bianchi G&#46;"
                            3 => "Tomassetti S&#46;"
                            4 => "Bugianesi E&#46;"
                            5 => "Lenzi M&#46;"
                            6 => "McCullough A&#46;J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "volumen" => "50"
                        "paginaInicial" => "1844"
                        "paginaFinal" => "1850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11473047"
                            "web" => "Medline"
                          ]
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                ]
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                0 => array:2 [
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                      "titulo" => "Insulin resistance in non-diabetic patients with non-alcoholic fatty liver disease&#58; sites and mechanisms"
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                          "etal" => true
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                            1 => "Gastaldelli A&#46;"
                            2 => "Vanni E&#46;"
                            3 => "Gambino R&#46;"
                            4 => "Cassader M&#46;"
                            5 => "Baldi S&#46;"
                            6 => "Ponti V&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "fecha" => "2005"
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                        "paginaInicial" => "634"
                        "paginaFinal" => "642"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15747110"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0220"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
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                            1 => "Vehkavaara S&#46;"
                            2 => "Hakkinen A&#46;M&#46;"
                            3 => "Goto T&#46;"
                            4 => "Westerbacka J&#46;"
                            5 => "Sovijarvi A&#46;"
                            6 => "Halavaara J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jcem.87.7.8638"
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                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2002"
                        "volumen" => "87"
                        "paginaInicial" => "3023"
                        "paginaFinal" => "3028"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12107194"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            44 => array:3 [
              "identificador" => "bib0225"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Prevalence and trends in obesity among US adults&#44; 1999-2000"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Flegal K&#46;M&#46;"
                            1 => "Carroll M&#46;D&#46;"
                            2 => "Ogden C&#46;L&#46;"
                            3 => "Johnson C&#46;L&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2002"
                        "volumen" => "288"
                        "paginaInicial" => "1723"
                        "paginaFinal" => "1727"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12365955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Steatohepatitis in obese children&#58; a cause of chronic liver dysfunction"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Moran J&#46;R&#46;"
                            1 => "Ghishan F&#46;K&#46;"
                            2 => "Halter S&#46;A&#46;"
                            3 => "Greene H&#46;L&#46;"
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                    0 => array:1 [
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                        "paginaInicial" => "374"
                        "paginaFinal" => "377"
                        "link" => array:1 [
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                            3 => "Higgins L&#46;"
                            4 => "Lavine J&#46;E&#46;"
                          ]
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                      ]
                    ]
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                        "tituloSerie" => "J Pediatr"
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                        "volumen" => "127"
                        "paginaInicial" => "700"
                        "paginaFinal" => "704"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7472819"
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                    0 => array:2 [
                      "titulo" => "Review&#58; The role of insulin resistance in nonalcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Utzschneider K&#46;M&#46;"
                            1 => "Kahn S&#46;E&#46;"
                          ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1210/jc.2006-0587"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2006"
                        "volumen" => "91"
                        "paginaInicial" => "4753"
                        "paginaFinal" => "4761"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16968800"
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                          ]
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                      ]
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                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Performance and limitations of steatosis biomarkers in patients with nonalcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "LIDO Study Group"
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Fedchuk L&#46;"
                            1 => "Nascimbeni F&#46;"
                            2 => "Pais R&#46;"
                            3 => "Charlotte F&#46;"
                            4 => "Housset C&#46;"
                            5 => "Ratziu V&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/apt.12963"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "paginaInicial" => "1209"
                        "paginaFinal" => "1222"
                        "link" => array:1 [
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ISSN: 16652681
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