Association between type two diabetes and non-alcoholic fatty liver disease in youth

array:24 ["pii" => "S1665268119318265" "issn" => "16652681" "doi" => "10.1016/S1665-2681(19)31826-5" "estado" => "S300" "fechaPublicacion" => "2009-01-01" "aid" => "71488" "copyright" => "Fundación Clínica Médica Sur, A.C." "copyrightAnyo" => "2009" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2009;8 Supl 1:S44-50" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 66 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 25 "PDF" => 31 ] ] "itemSiguiente" => array:19 [ "pii" => "S1665268119318277" "issn" => "16652681" "doi" => "10.1016/S1665-2681(19)31827-7" "estado" => "S300" "fechaPublicacion" => "2009-01-01" "aid" => "71489" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2009;8 Supl 1:S51-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 71 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 37 "PDF" => 24 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Treatment regimens for non-alcoholic fatty liver disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S51" "paginaFinal" => "S59" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Brian P. Lam, Zobair M. Younossi" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Brian P." "apellidos" => "Lam" ] 1 => array:2 [ "nombre" => "Zobair M." "apellidos" => "Younossi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119318277?idApp=UINPBA00004N" "url" => "/16652681/00000008000000S1/v1_201906260858/S1665268119318277/v1_201906260858/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268119318253" "issn" => "16652681" "doi" => "10.1016/S1665-2681(19)31825-3" "estado" => "S300" "fechaPublicacion" => "2009-01-01" "aid" => "71487" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2009;8 Supl 1:S40-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 72 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 30 "PDF" => 35 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Nonalcoholic fatty liver disease and its association with cardiovascular disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S40" "paginaFinal" => "S43" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 680 "Ancho" => 977 "Tamanyo" => 41026 ] ] "descripcion" => array:1 [ "en" => "The prevalence of CVD in patients with NAFLD associated to type 2 diabetes mellitus." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier Lizardi-Cervera, Daniel Aguilar-Zapata" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Lizardi-Cervera" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Aguilar-Zapata" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119318253?idApp=UINPBA00004N" "url" => "/16652681/00000008000000S1/v1_201906260858/S1665268119318253/v1_201906260858/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "titulo" => "Association between type two diabetes and non-alcoholic fatty liver disease in youth" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S44" "paginaFinal" => "S50" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Anna Alisi, Melania Manco, Nadia Panera, Valerio Nobili" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Anna" "apellidos" => "Alisi" "email" => array:1 [ 0 => "annaalisi@opbg.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Melania" "apellidos" => "Manco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "2" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Nadia" "apellidos" => "Panera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Valerio" "apellidos" => "Nobili" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Liver Unit" "etiqueta" => "1" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Scientific Directorate Bambino Gesù Paediatric Hospital and Research Institute; Rome Italy" "etiqueta" => "2" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Address for correspondence:" ] ] ] ] "textoCompleto" => "IntroductionEstimates from population-and hospital-based studies indicate that the number of children and adolescents with type two diabetes mellitus (T2DM) has been increasing in the last decades.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> This is likely to occur since the number of adolescents and young adults affected by insulin resistance-associated morbidities is increasing.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In fact, T2DM is characterized by the simultaneous occurrence of both insulin-resistance and relative insulin-deficiency.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> During puberty, insulin resistance represents a physiological condition aimed to favor growth. Obesity may exacerbate this condition. It has been shown that up to one in third obese adolescents with insulin resistance will keep this condition until the adulthood, whilst the remaining two will recover normal insulin sensitivity as it happens for all the normal weight adolescents.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Subjects with severe insulin resistance which persists over the puberty are candidate to develop type 2 diabetes mellitus, when their beta cell activity fails to compensate for increased and long term insulin resistance.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>T2DM in youth is usually not an isolated condition, but it is often accompanied by other metabolic abnormalities which represent cardiovascular risk factors and cluster together in the metabolic syndrome (MetS),<a class="elsevierStyleCrossRef" href="#bib0030">6</a> i.e. obesity, dyslipidemia, hypertension and low-grade inflammation.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Recent evidence suggests a close association also between T2DM and two other condition of insulin resistance, namely the polycystic ovary syndrome and the non-alcoholic fatty liver disease (NAFLD).<a class="elsevierStyleCrossRef" href="#bib0040">8</a>,<a class="elsevierStyleCrossRef" href="#bib0045">9</a>NAFLD has a broad spectrum of manifestations, ranging from simple steatosis to its inflammatory representation of nonalcoholic steatohepatitis (NASH). The boundaries between NAFLD and NASH are defined only by liver biopsy and prediction is difficult using any single or combined clinical or laboratory test.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> A small proportion of patients with NAFLD progresses to cirrhosis, hepato-cellular carcinoma and liver failure.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>,<a class="elsevierStyleCrossRef" href="#bib0060">12</a>Pediatric NAFLD is becoming the leading cause for referral to liver clinics especially in overweigh/obese children from Western country.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> The occurrence of NAFLD in these children who are already at cardiovascular risk, is particularly worrisome, since the disease appears to be a per se independent cardiovascular risk.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Patients with NAFLD seem also prone to develop more frequently an impairment of the carbohydrate metabolism varying from a condition of pre-diabetes to overt T2DM. In our series of children and adolescents with biopsy proven NAFLD, we observed a prevalence of pre-diabetes and diabetes as high as 10-12%,<a class="elsevierStyleCrossRef" href="#bib0070">14</a>,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> and, in most of them the impaired glucose metabolism will likely track to the adulthood.The meaning of this association remains unclear. The question is whether NAFLD is per sè a determinant of diabetes or its effect is mediated by more severe obesity and insulin resistance.In the present review, we will try to verify the occurrence of this association in youth by resuming the most recent epidemiological data on prevalence/incidence of both diseases, thus highlighting their common trends; and considering pathogenetic mechanisms which may underlie both. The epidemic of T2DM and NAFLD will bear fruit in forthcoming decades, putting further stress on the healthcare system and, probably, leading to increased morbidity and a shorter lifespan for future generations.Epidemiology of T2DMPrediabetes and T2DM are serious adverse consequences of obesity and pediatric metabolic syndrome, more likely to manifest in adolescence and early adulthood than clinical atherosclerotic diseases.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>The American Diabetes Association defines diabetes as occurring if one of three criteria are present: 1) a casual plasma glucose of > 200 mg/dL in some one with symptoms of diabetes; fasting plasma glucose of ≥ 126 mg/ dL; 3) 2 hr plasma glucose of ≥ 200 as part of an oral glucose tolerance test.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> The dose of glucose used as load is of 1.75 g/kg to a maximum of 75 g, although the precise pediatric dose is not well validated.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) characterize prediabetes.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Most data on the epidemiology of diabetes comes from national surveys. However, they provide data on incidence and prevalence of the disease based on the number of cases referred by physicians or self reported by patients. For instance, the Search for diabetes in Youth is a 6-center observational study conducting population-based ascertainment of physician diagnosed diabetes in youth.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> The National Health and Nutrition Examination Survey (NHANES) is a stratified, multistage probability sample of the civilian non-institutionalized US population and diagnosis of diabetes was self reported. To estimate prevalence and incidence of diabetes, the adolescents of the NHANES study (N = 4,370, age 12-19 years) were simply asked about having or not the disease. Then, they underwent measurement of fasting glucose. Subjects without self reported diabetes but presenting with IFG (N = 1,496) were considered diabetic as well.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> In a longitudinal study, performed in the United Kingdom to evaluate the incidence of T2DM in subjects < 17 years of age, the estimate of cases was based on active monthly reporting of cases by consultant pediatricians, as described above.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Therefore, the major limit of this survey studies is related to the fact that they do not estimate the rate of prediabetes assessed by the impaired glucose tolerance, which is, on the contrary the most frequent form of impairment in the carbohydrate metabolism in the youth. Therefore, large surveys such as the SEARCH and the NHANES are likely to see just the top of the iceberg, and to severely underestimate a more common phenomenon. On the other hand, surveys offer the opportunity to evaluate the effect of several factors, mainly age, sex and races.Both prevalence and incidence of T2DM vary among races, with the highest prevalence and incidence in minorities.<a class="elsevierStyleCrossRefs" href="#bib0100">20</a>-<a class="elsevierStyleCrossRef" href="#bib0110">22</a> The SEARCH found that overall prevalence ranged from 6% in non Hispanic white youth to 76% in American Indians; incidence from 17 in Hispanic to 49.9 in American-Indian per x 100,000-1 x year-<a class="elsevierStyleCrossRef" href="#bib0005">1</a> in 15-19 year olds. In the same range of age, incidence for non-Hispanic white was 5.6.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Data from NHANES found an incidence of 8.1 x 100,000-1 in 10-14-year-olds and 11.8 x 100,000-1 in 15-19-year-olds in 2002-2003. The estimated incidence of T2DM in the Bostonian Youth varies from 0.79 x 1000-1 in children < 9 years of age to 1.74 x 1000-1 in adolescents (age 10-19 years).<a class="elsevierStyleCrossRef" href="#bib0115">23</a> In the UK study, a total of 168 confirmed cases of non-type 1 diabetes were reported, resulting in a national incidence of 1.3 x 100,000-1 x year-1. Of these, 40% were diagnosed with type 2 diabetes giving a minimum incidence of 0.53 x 100,000-1 x year-1.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> In New Zeeland, a 6 year study, which included 1,095.074 children of < 14 years old estimated incidence of impaired glucose tolerance (IGT) was 0.72 x100000-1 x year-1 in subjects of < 14 years and 2.27 x100000-1 in those of 10-14 years. Type 2 DM had a rate of 0.84 x 100,000-1 x year-1.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> In Chinese youth, a nationally representative cross-sectional survey enrolling 44 880 children aged 7-17.9 years, showed an incidence of diseases, varying from 0.2 in subjects 7-12 year old to 0.4 in 12-18 year olds.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>To obtain data on rates of IGT we have to look to small size studies, often performed in high risk populations, i.e. including obese individuals with co-morbidities and/or familiar history of diabetes. We resume in <a class="elsevierStyleCrossRef" href="#t0005">Table 1</a> the most significant among those conducted and published in the last 5 years, and using the oral glucose tolerance test to diagnose diabetes.<a class="elsevierStyleCrossRefs" href="#bib0130">26</a>-<a class="elsevierStyleCrossRef" href="#bib0180">36</a> Of note, even in samples of individuals with severe obesity and familiarity for diabetes and cardiovascular disease, European rates were not as high as those in US studies. In Europe, T2DM remains a rarity, accounting only for 1% to 2% of all cases of diabetes mellitus. Although, differences in obesity rates between US and European youth are likely contributors, the full explanation for this discrepancies remains uncertain.<elsevierMultimedia ident="t0005"></elsevierMultimedia>Epidemiology of NAFLDThe real prevalence of NAFLD/NASH remains unknown in the general population because prospective studies lack and the information available in a given population strictly depend on the diagnostic criteria used.<a class="elsevierStyleCrossRef" href="#bib0185">37</a> NAFLD, as estimated on the basis of ultrasonography and increased levels of liver enzymes, seems to be very common, occurring in persons of all ages and ethnic groups.Population-based studies suggest that, as in the adults, its prevalence has been increasing over the past three decades also in children and adolescents, and that the disease represents a worldwide problem with case series described in North and South America, Europe, Australia and Asia.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>,<a class="elsevierStyleCrossRef" href="#bib0185">37</a> These studies indicate that prevalence increases with age, ranging from 0.7% for ages 2 to 4 up to 17.3% for ages 15 to 19 years, but these rates are likely to be underestimated and all these reports do not discriminate between simple steatosis, necro-inflammation and fibrosis.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>,<a class="elsevierStyleCrossRef" href="#bib0185">37</a>,<a class="elsevierStyleCrossRef" href="#bib0190">38</a>The most prominent risk factor for fatty liver is obesity and the disease is most common in males adolescents.<a class="elsevierStyleCrossRefs" href="#bib0195">39</a>-<a class="elsevierStyleCrossRef" href="#bib0205">41</a> In a recent study on 909 Korean obese children (boys 613, girls 296) the prevalence of NAFLD, measured as surrogate of alanine aminotransferases (ALT), was 33.4% in boys, and 19.6% in girls respectively.<a class="elsevierStyleCrossRef" href="#bib0210">42</a> Race, ethnicity and degree of obesity significantly predicted the presence of fatty liver, with Hispanics having the highest and African Americans the lowest figure.<a class="elsevierStyleCrossRef" href="#bib0215">43</a> One study with 181 consecutive asymptomatic obese children demonstrated that 8% had an elevated ALT suggestive of NAFLD, but the prevalence decreased in black individuals.<a class="elsevierStyleCrossRef" href="#bib0220">44</a>As shown in <a class="elsevierStyleCrossRef" href="#t0010">table II,</a> studies on prevalence of NAFLD in overweigh/obese children report values ranging from 8% to 80% (USA), depending upon the methods used for the diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0225">45</a>-<a class="elsevierStyleCrossRef" href="#bib0250">50</a> Unfortunately, most studies have been limited to the use of indirect measures such as elevated serum (ALT) and ultrasound to predict histological outcome,<a class="elsevierStyleCrossRef" href="#bib0255">51</a> but up to a 20% of young patients have normal values of liver enzyme at the time of biopsy, despite having histological proven NASH and/or fibrosis.<a class="elsevierStyleCrossRef" href="#bib0260">52</a> Data from NHANES in 2450 adolescents found elevated ALT in 6% of overweight and 10% of obese subjects.<a class="elsevierStyleCrossRef" href="#bib0265">53</a> Similarly, the 1998 Korean National Health and Nutrition Examination Survey found a prevalence of elevated ALT as high as 3.2%.<a class="elsevierStyleCrossRef" href="#bib0270">54</a> In a sample of Mexican obese/overweight children from an elementary school, elevated ALT were observed in 42% of subjects.<a class="elsevierStyleCrossRef" href="#bib0275">55</a><elsevierMultimedia ident="t0010"></elsevierMultimedia>Based on ultrasonography evidence of fatty liver, NAFLD was diagnosed in 2.6% of Japanese children and occurrence of disease correlated significantly with indices of obesity such as the body mass index;<a class="elsevierStyleCrossRef" href="#bib0280">56</a> 42% of 375, and 44% of 268 morbidly obese Italian children had hepatic steatosis;<a class="elsevierStyleCrossRef" href="#bib0285">57</a>,<a class="elsevierStyleCrossRef" href="#bib0290">58</a> among 123 obese Chinese children, 99 subjects showed abnormal hepatic sonograms and 54 were diagnosed as NASH.<a class="elsevierStyleCrossRef" href="#bib0295">59</a> Some studies combine data from ultrasonography and elevated ALT; for instance a study demonstrating that 52.4% of obese Turkish children had fatty liver by ultrasonography and 13.8% had high ALT levels.<a class="elsevierStyleCrossRef" href="#bib0300">60</a> According to an Italian survey in 195 obese children, 55% had liver steatosis by ultrasonography, 20% had elevated ALT and AST levels, and 15% had both.<a class="elsevierStyleCrossRef" href="#bib0305">61</a>Type 2 diabetes: pathogenetic mechanismsT2DM is caused by a combination of increased insulin resistance and decreased insulin secretion. Peripheral insulin-resistance is tightly coupled with obesity in children and seems to be the major driving force of deteriorating glucose metabolism, and is also associated with lipid partitioning in specific compartments (i.e., viscera, muscle and liver). On the other hand, the reduction of insulin secretion is probably a secondary event evolving gradually.<a class="elsevierStyleCrossRef" href="#bib0310">62</a>Insulin resistance is an impairment of the physiologic effects of insulin on glucose.<a class="elsevierStyleCrossRef" href="#bib0315">63</a> Normal glycemic control requires the pancreatic β-cell sensing of glucose concentration, synthesis and release of insulin, binding of insulin to receptors with a consequent activation of several signaling proteins. The activation of multiple signaling cascade causes increased glucose uptake by muscles, fat, and liver and decreased glucose production by the liver.<a class="elsevierStyleCrossRef" href="#bib0320">64</a> These molecular mechanisms are all altered in T2DM, causing insulin resistance in muscle tissue, decreased pancreatic insulin secretion, and increased hepatic glucose output.<a class="elsevierStyleCrossRef" href="#bib0325">65</a>In children and adolescents with T2DM, defects of glucose metabolism are characterized by a decline in the first phase sensitivity of the β-cell coupled with the decline of both first and second phase sensitivity.<a class="elsevierStyleCrossRef" href="#bib0330">66</a> The dynamics of the impaired glucose metabolism in childhood seem to be faster than in adults, representing a limited window of opportunity for successful preventive intervention. Early identification of children with altered glucose metabolism is important in order to quantify public health needs and to allocate resources for appropriate prevention programs.The risk factors for developing type 2 diabetes in youth include a genetic predisposition and certain environmental characteristics.<a class="elsevierStyleCrossRef" href="#bib0335">67</a> The majority of diabetes in both adults and children is polygenic.<a class="elsevierStyleCrossRef" href="#bib0340">68</a> Thus, the family history of diabetes represents the most important risk factor of developing T2DM with respect to the general population.<a class="elsevierStyleCrossRef" href="#bib0345">69</a>Ethnicity is another important factor predisposing to T2DM development. The increased incidence of T2DM in youth of color was identified first in the Pima Indians of the southwest. Children of Pima Indian were found to have high rates of morbid obesity and from 1980 the research has focused on this group as well as other ethnic and racial groups with high rates of diabetes.<a class="elsevierStyleCrossRef" href="#bib0350">70</a> Low birth-weight, maternal diabetes and the intrauterine environment also are important areas to consider in risk for the development of T2DM in youth.<a class="elsevierStyleCrossRef" href="#bib0355">71</a> Puberty coupled with insulin resistance provides a strong basis for the development of pre-diabetes and T2DM in youth with overweight or frank obesity.<a class="elsevierStyleCrossRef" href="#bib0360">72</a>The changing environment during the past several decades provided a further contribution of the dramatic increase in T2DM in youth. There has been a movement toward a positive energy balance due to diet intake, decreased physical activity and increased sedentary activity. Fast food consumption and portion sizes have increased from 30 years ago, leading to caloric intake in excess of metabolic need, and youth are the major consumers of fast food meals. Moreover, youth are increasingly inactive, reducing their physical activity and using sedentary screen activities, such as television viewing and playing video games, for an average of 5.5 hours daily.<a class="elsevierStyleCrossRef" href="#bib0335">67</a>All these evidence demonstrate that development of T2DM in youth is complex and requires astute health care providers who understand the pathophysiology, patient history, family history, and genetic predisposition, coupled with environmental factors, to manage each youth at the appropriate intervention level.NAFLD: pathogenetic mechanismsThe pathogenesis of NAFLD is not yet completely understood, however a currently favored hypothesis is that «two hits» are required for a subject to develop the disease.<a class="elsevierStyleCrossRef" href="#bib0365">73</a> A first hit that provokes steatosis (i.e. fat accumulation in liver and/or insulin resistance) and predisposes the liver to a second hit which leads to necro-inflammation and fibrosis. This second hit includes the alteration of several signaling pathways regulating oxidative stress, mitochondrial dysfunctions and production of pro-inflammatory and pro-fibrotic cytokines and their signaling. Recent advances demonstrate that fatty liver and its progressive development in NASH is a more complex phenomenon which originates by multiple hits.<a class="elsevierStyleCrossRef" href="#bib0370">74</a>,<a class="elsevierStyleCrossRef" href="#bib0375">75</a> In fact, the subsequent development of fibrosis requires probably the coexistence of multiple factors, including host (genes) and environmental factors as well as those related to lifestyles and behaviors.<a class="elsevierStyleCrossRef" href="#bib0380">76</a>,<a class="elsevierStyleCrossRef" href="#bib0385">77</a>All today theories consider insulin resistance as an important driving force, which promotes lipolysis of peripheral adipose tissue which, in turn, increases free fatty acid (FFA) influx into the liver.<a class="elsevierStyleCrossRef" href="#bib0390">78</a> Hyperinsulinemia and hyperglycemia promote de novo lipogenesis and inhibit simultaneously FFA oxidation.<a class="elsevierStyleCrossRef" href="#bib0395">79</a> Fatty deposition at the liver side is also favored by defective incorporation of triglyceride into apolipoprotein carrier proteins and lipid export.<a class="elsevierStyleCrossRef" href="#bib0400">80</a>Fatty loaded hepatocytes are susceptible of additional insults, which may lead to hepatocyte injury, inflammation, and fibrosis. Also the role of oxidative stress is well documented in NASH., There is accumulating evidence that oxidative stress and mitochondrial dysfunction play a key role in the physiopathology of NAFLD/NASH whatever its initial cause.<a class="elsevierStyleCrossRef" href="#bib0405">81</a> Moreover, there is a close interaction between development of mitochondrial dysfunction, insulin resistance and cytokines in many liver diseases.<a class="elsevierStyleCrossRef" href="#bib0410">82</a> Conversely, many forms of oxidative stress lead to antioxidant depletion, which then further enhances oxidative stress and cytokine-mediated hepatoxicity.<a class="elsevierStyleCrossRef" href="#bib0415">83</a> In addition, although the exact mechanisms promoting progressive liver injury are not well defined, also substrates derived from adipose tissue such as FFA, tumor necrosis factor alpha, leptin, and adiponectin have been implicated.<a class="elsevierStyleCrossRef" href="#bib0420">84</a>,<a class="elsevierStyleCrossRef" href="#bib0425">85</a>Taken together, all discussed evidences highlight the complicated network of interactions existing among the several molecules and signaling pathways which contribute do development of NAFLD/NASH. Thus, today it is impossible to distinguish between causes or effects during NAFLD/NASH development and progression.More than a clinical associationThe NHANES found NAFLD to be more prevalent in obese race minorities, with T2DM, hypertension and hyperlipidemia.<a class="elsevierStyleCrossRef" href="#bib0430">86</a> These associations have led to the hypothesis that NAFLD may precede the onset of type 2 diabetes in some individuals. But, why should NAFLD associate with diabetes? The links between the two diseases reflect processes related to insulin action or resistance which may be mediated through the location and function of fat, excess total body fatness or hepatic fat. Otherwise, the risk for new onset diabetes may be mediated by components of the MetS which occur very frequently in NAFLD.NAFLD, as estimated by elevated ALT levels, and pre-diabetes or T2DM were found to be associated independently of confounders, including obesity in adults.<a class="elsevierStyleCrossRef" href="#bib0435">87</a> The West of Scotland Coronary Prevention Study, consistently with a number of other studies, found that compared with men with values for baseline ALT in the bottom quartile (< 17 U/L), those with levels in the top quartile (> 29 U/L) had an adjusted odds ratio of 2.04 (95% CI 1.16-3.58) for incident diabetes.<a class="elsevierStyleCrossRef" href="#bib0440">88</a> In the British Hearth Regional Study, the risk of type 2 diabetes increased significantly with increasing levels of ALT and gamma-glutamil-transpeptidase (GGT), even after adjustment for a range of confounders, again including BMI (top vs bottom quartile, ALT: RR 2.72, 95% CI 1.47-5.02; GGT: RR 3.68, 95% CI 1.68-8.04) or with further additional adjustment for insulin resistance.<a class="elsevierStyleCrossRef" href="#bib0445">89</a>Data on the association between T2DM and NAFLD in paediatric settings are poor, but nevertheless very strong. In the San Diego series of biopsy proven NAFLD, 6 out of 43 children had type 2 diabetes mellitus (14%).<a class="elsevierStyleCrossRef" href="#bib0245">49</a>,<a class="elsevierStyleCrossRef" href="#bib0450">90</a> In our series of 120 babies,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> all subjects underwent oral glucose tolerance test and diagnosis of impaired glucose tolerance or T2DM was done according to the criteria of the American diabetes Association. We observed a prevalence of IGT as high as 9% and T2DM of 2%. The degree of insulin resistance was not correlated with liver histology in terms of grade of steatosis, inflammation or fibrosis. Subjects with IGT/T2DM did differ from normo-tolerant individuals neither in anthropometrics or liver histology. Conversely the prevalence of overt MetS was higher in subjects presenting with fibrosis and/or NASH.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> The limited number of subjects with impaired carbohydrate metabolism did not allow excluding that visceral adiposity (i.e. through reduced levels of adiponectin or increased pro-inflammatory adipocytokines) mediates both derangements in liver histology and carbohydrate metabolism.ConclusionAlso in youth, T2DM and NAFLD seem to be significantly associated. The meaning and the causative relation of this finding is still unclear. It is likely that the insulin resistant phenotype, charactering non alcoholic fatty liver disease, contributes to anticipate significantly the onset of type 2 diabetes from mature adulthood to youth. This observation may translate into the worrisome anticipation of all cardiovascular abnormalities linked to T2DM. In addiction, NAFLD may represent an independent risk factor which augments further the total cardiovascular risk. Therefore, both NAFLD and T2DM embody a growing healthcare burden which will boost health related costs in the next future.Abbreviations:Type two diabetes mellitus (T2DM), metabolic syndrome (MetS), non-alcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), National Health and Nutrition Examination Survey (NHANES), alanine aminotransferases (ALT), aspartate aminotransferase (AST), free fatty acid (FFA), Gamma-Glutamil-Transpeptidasi (GGT)." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1212006" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abs0010" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1128076" "titulo" => "Key words" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiology of T2DM" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Epidemiology of NAFLD" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Type 2 diabetes: pathogenetic mechanisms" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "NAFLD: pathogenetic mechanisms" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "More than a clinical association" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec1040" "titulo" => "Abbreviations:" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-12-23" "fechaAceptado" => "2008-12-23" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec1128076" "palabras" => array:5 [ 0 => "Aminotransferases" 1 => "glucose" 2 => "insulin resistance" 3 => "non alcoholic steatohepatitis" 4 => "obesity" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "In the last three decades prevalence of insulin related diseases has been growing worldwide with epidemic obesity, type 2 diabetes mellitus and non alcoholic fatty liver disease. In children such epidemics are particularly worrisome, since metabolic abnormalities track to the adulthood with significant implications for the health care system. Epidemiological studies support a close association between type 2 diabetes and fatty liver disease. We review the most recent epidemiological data on prevalence of both diseases in youth and their association." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "t0005" "etiqueta" => "Table I" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "We included exclusively data from studies published in the list five years and using standard glucose tolerance test to assess impaired glucose tolerance (IGT) and type 2 diabetes mellitus according to the ADA criteria. In few studies diagnosis was made according to the WHO criteria. (‡). Some articles were not accessible through the website, therefore the abstract alone was available." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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="middle" scope="col">Country \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col">Study and population \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col">Prevalence/incidence% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col">Ref. \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="middle">Argentina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 427 obese/overweight subjects, Age 10.7 ± 3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">IGT: 7%, T2DM: 1.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">26 \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="middle">Costa Rica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 214 obese and normal weight subjects, Age 8-10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">IGT : 6.5%, T2DM 0.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">27 \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="middle">Germany \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 520 obese/overweight subjects, Age 8.9-20.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">IGT: 5.2%, T2DM: 1.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">28 \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="middle">Germany \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 102 with Metabolic syndrome, Age 7-18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">IGT: 36%, T2DM: 6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">29 \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="middle">Germany \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">IFG 0.41%, T2DM 0.83% (lean individuals) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 721 school-leaving boys, mean age 15.5 ± 0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">‡IGT, T2DM 2.5% (obese/overweight) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">30 \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="middle">Hungary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 250 obese/overweight subjects, Age not provided \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">‡IGT 13.6%, T2DM 1.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">31 \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="middle">Israel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 234 obese/overweight subjects, Age 5-22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">IGT, T2DM: 13.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">32 \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="middle">Italy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Retrospective study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 514 obese/overweight subjects, Age 13.6-14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">IGT 5.4%, T2DM 0.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">33 \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="middle">Turkey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 105 obese and normal weight subjects, Age 10-18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">IGT 15.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">34 \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="middle">Turkey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 196 obese subjects, Age 7-18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">IGT 18%, T2DM 3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">35 \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="middle">Turkey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Cross-sectional study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Prepubertal IGT 19%, T2DM 2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">N = 169 obese subjects, Age 7-18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">Pubertal IGT 27.5%, T2DM 4.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="middle">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2069124.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prevalence/incidence of type 2 diabetes mellitus in youth." ] ] 1 => array:7 [ "identificador" => "t0010" "etiqueta" => "Table II." "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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="middle" scope="col">Country \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="middle" scope="col">Number of children<a class="elsevierStyleCrossRef" href="#tab1tfn0010">§</a> \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="middle" scope="col">NAFLD/NASH prevalence \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="middle" scope="col">Ref. \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="middle">USA \t\t\t\t\t\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="middle">181 \t\t\t\t\t\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="middle">8% \t\t\t\t\t\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="middle">44 \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="middle">USA \t\t\t\t\t\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="middle">315 \t\t\t\t\t\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="middle">16% \t\t\t\t\t\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="middle">53 \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="middle">USA \t\t\t\t\t\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="middle">127 \t\t\t\t\t\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="middle">23% \t\t\t\t\t\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="middle">43 \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="middle">USA \t\t\t\t\t\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="middle">320 \t\t\t\t\t\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="middle">81% \t\t\t\t\t\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="middle">49 \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="middle">México \t\t\t\t\t\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="middle">80 \t\t\t\t\t\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="middle">42% \t\t\t\t\t\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="middle">55 \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="middle">Japan \t\t\t\t\t\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="middle">299 \t\t\t\t\t\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="middle">12% \t\t\t\t\t\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="middle">45 \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="middle">Japan \t\t\t\t\t\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="middle">228 \t\t\t\t\t\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="middle">24.1% \t\t\t\t\t\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="middle">46 \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="middle">Japan \t\t\t\t\t\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="middle">310 \t\t\t\t\t\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="middle">25% \t\t\t\t\t\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="middle">47 \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="middle">Cina \t\t\t\t\t\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="middle">113 \t\t\t\t\t\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="middle">55.7% \t\t\t\t\t\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="middle">48 \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="middle">Cina \t\t\t\t\t\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="middle">84 \t\t\t\t\t\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="middle">77% (24%)<a class="elsevierStyleCrossRef" href="#tab1tfn0015">*</a> \t\t\t\t\t\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="middle">40 \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="middle">Cina \t\t\t\t\t\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="middle">123 \t\t\t\t\t\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="middle">80.5% (43.9%)<a class="elsevierStyleCrossRef" href="#tab1tfn0015">*</a> \t\t\t\t\t\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="middle">59 \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="middle">Korea \t\t\t\t\t\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="middle">909 \t\t\t\t\t\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="middle">19.6%<a class="elsevierStyleCrossRef" href="#tab1tfn0020">º</a> and 33.4%<a class="elsevierStyleCrossRef" href="#tab1tfn0025">^</a> \t\t\t\t\t\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="middle">42 \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="middle">Italy \t\t\t\t\t\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="middle">375 \t\t\t\t\t\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="middle">42% \t\t\t\t\t\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="middle">57 \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="middle">Italy \t\t\t\t\t\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="middle">268 \t\t\t\t\t\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="middle">44% \t\t\t\t\t\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="middle">58 \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="middle">Italy \t\t\t\t\t\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="middle">72 \t\t\t\t\t\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="middle">53% (25%)<a class="elsevierStyleCrossRef" href="#tab1tfn0015">*</a> \t\t\t\t\t\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="middle">41 \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="middle">Italy \t\t\t\t\t\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="middle">175 \t\t\t\t\t\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="middle">55(%) (15%)<a class="elsevierStyleCrossRef" href="#tab1tfn0015">*</a> \t\t\t\t\t\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="middle">60 \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="middle">Turkey \t\t\t\t\t\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="middle">101 \t\t\t\t\t\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="middle">52.4% \t\t\t\t\t\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="middle">61 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2069125.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tab1tfn0010" "etiqueta" => "§" "nota" => "Number of overweight/obese children included in the study." ] 1 => array:3 [ "identificador" => "tab1tfn0015" "etiqueta" => "*" "nota" => "Percentage of presumed NASH." ] 2 => array:3 [ "identificador" => "tab1tfn0020" "etiqueta" => "º" "nota" => "Girls" ] 3 => array:3 [ "identificador" => "tab1tfn0025" "etiqueta" => "^" "nota" => "Boys" ] ] ] "descripcion" => array:1 [ "en" => "Data of prevalence of NAFLD/NASH in obese children from different countries." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:90 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of childhood type 2 diabetes and obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Shaw" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-5448.2007.00329.x" "Revista" => array:7 [ "tituloSerie" => "Pediatr Diabetes" "fecha" => "2007" "volumen" => "8" "numero" => "Suppl 9" "paginaInicial" => "7" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17991128" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.D. De Ferranti" 1 => "SK. Osganian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3132/dvdr.2007.055" "Revista" => array:6 [ "tituloSerie" => "Diab Vasc Dis Res" "fecha" => "2007" "volumen" => "4" "paginaInicial" => "285" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18158698" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type 2 diabetes in childhood: epidemiological and clinical aspects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "KA. Matyka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bmb/ldn018" "Revista" => array:6 [ "tituloSerie" => "Br Med Bull" "fecha" => "2008" "volumen" => "86" "paginaInicial" => "59" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18515272" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance; an adaptation for weight maintenance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "RE. Eckel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0140-6736(92)92791-d" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1992" "volumen" => "340" "paginaInicial" => "1542" "paginaFinal" => "1543" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1361622" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pancreatic alpha-cell dysfunction in diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R Burcelin" 1 => "C Knauf" 2 => "PD. Cani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1262-3636(08)73395-0" "Revista" => array:7 [ "tituloSerie" => "Diabetes Metab" "fecha" => "2008" "volumen" => "34" "numero" => "Suppl 2" "paginaInicial" => "S49" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18640586" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pediatric metabolic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Morrison" 1 => "E.S. Ford" 2 => "J. Steinberger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Minerva Med" "fecha" => "2008" "volumen" => "99" "paginaInicial" => "269" "paginaFinal" => "287" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18497725" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2468781218300985" "estado" => "S300" "issn" => "24687812" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dyslipidemia in children with type 2 diabetes vs. obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.S. Newfield" 1 => "A.K. Dewan" 2 => "S. Jain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-5448.2007.00345.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Diabetes" "fecha" => "2008" "volumen" => "9" "paginaInicial" => "115" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18221437" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polycystic ovary syndrome in adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Franks" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes (Lond)" "fecha" => "2008" "volumen" => "32" "paginaInicial" => "1035" "paginaFinal" => "1041" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "G Targher" 1 => "L Bertolini" 2 => "R Padovani" 3 => "S Rodella" 4 => "R Tessari" 5 => "L Zenari" 6 => "C Day" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc06-2247" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "1212" "paginaFinal" => "1218" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17277038" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D Preiss" 1 => "N. Sattar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Sci (Lond)" "fecha" => "2008" "volumen" => "115" "paginaInicial" => "141" "paginaFinal" => "150" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathology of nonalcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.M. Yeh" 1 => "EM. Brunt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1309/RTPM1PY6YGBL2G2R" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol" "fecha" => "2007" "volumen" => "128" "paginaInicial" => "837" "paginaFinal" => "847" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17951208" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonalcoholic fatty liver disease: from ste-atosis to cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.C. Farrell" 1 => "CZ. Larter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20973" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2006" "volumen" => "43" "numero" => "2 Suppl 1" "paginaInicial" => "S99" "paginaFinal" => "S112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16447287" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review article: epidemiology, pathogenesis and potential treatments of paediatric non-alcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.J. Barshop" 1 => "C.B. Sirlin" 2 => "J.B. Schwimmer" 3 => "JE. Lavine" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2008.03703.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2008" "volumen" => "28" "paginaInicial" => "13" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18397387" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome and liver histology in paediatric non-alcoholic steatohepatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M Manco" 1 => "M Marcellini" 2 => "R Devito" 3 => "D Comparcola" 4 => "M.R. Sartorelli" 5 => "V. Nobili" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes (Lond)" "fecha" => "2008" "volumen" => "32" "paginaInicial" => "381" "paginaFinal" => "387" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "M Manco" 1 => "G Bedogni" 2 => "M Marcellini" 3 => "R Devito" 4 => "P Ciampalini" 5 => "M.R. Sartorelli" 6 => "D Comparcola" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.2007.142919" "Revista" => array:7 [ "tituloSerie" => "Gut" "fecha" => "2008" "volumen" => "57" "paginaInicial" => "1283" "paginaFinal" => "1287" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18218674" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0161642017305791" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type 2 diabetes in children: a growing epidemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "TF. Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ky Nurse" "fecha" => "2007" "volumen" => "55" "paginaInicial" => "7" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18200782" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type 2 diabetes in children and adolescents (Consensus Statement)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "American Diabetes Association." "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/diacare.23.3.381" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2000" "volumen" => "23" "paginaInicial" => "381" "paginaFinal" => "389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10868870" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type 2 diabetes in the young: the evolving epidemic: the international diabetes federation consensus workshop" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G Alberti" 1 => "P Zimmet" 2 => "J Shaw" 3 => "Z Bloomgarden" 4 => "F Kaufman" 5 => "M. Silink" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/diacare.27.7.1798" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2004" "volumen" => "27" "paginaInicial" => "1798" "paginaFinal" => "1811" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15220270" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediabetes and type 2 diabetes in youth: an emerging epidemic disease?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.M. Cali" 1 => "S. Caprio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MED.0b013e3282f57251" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Endocrinol Diabetes Obes" "fecha" => "2008" "volumen" => "15" "paginaInicial" => "123" "paginaFinal" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18316946" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "SEARCH for Diabetes in Youth Study Group" "etal" => false "autores" => array:7 [ 0 => "A.D. Liese" 1 => "R.B. D’Agostino" 2 => "R.F. Hamman" 3 => "P.D. Kilgo" 4 => "J.M. Lawrence" 5 => "L.L. Liu" 6 => "B Loots" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2006-0690" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2006" "volumen" => "118" "paginaInicial" => "1510" "paginaFinal" => "1518" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17015542" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of diabetes and impaired fasting glucose levels among US adolescents: National Health and Nutrition Examination Survey, 1999-2002" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "GE. Duncan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archpedi.160.5.523" "Revista" => array:6 [ "tituloSerie" => "Arch Pediatr Adolesc Med" "fecha" => "2006" "volumen" => "160" "paginaInicial" => "523" "paginaFinal" => "528" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16651496" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rising incidence of type 2 diabetes in children in the U.K" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L Haines" 1 => "K.C. Wan" 2 => "R Lynn" 3 => "T.G. Barrett" 4 => "JP. Shield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc06-1813" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "1097" "paginaFinal" => "1101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17259470" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of diabetes in youth in the United States" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Writing Group for the SEARCH for Diabetes in Youth Study Group" "etal" => false "autores" => array:7 [ 0 => "D Dabelea" 1 => "R.A. Bell" 2 => "R.B. D’Agostino" 3 => "G Imperatore" 4 => "J.M. Johansen" 5 => "B Linder" 6 => "L.L. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "2007" "volumen" => "27" "paginaInicial" => "2716" "paginaFinal" => "2724" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective incidence study of diabetes mel-litus in New Zealand children aged 0 to 14 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.L. Campbell-Stokes" 1 => "BJ. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00125-005-1952-7" "Revista" => array:6 [ "tituloSerie" => "Diabetologia" "fecha" => "2005" "volumen" => "48" "paginaInicial" => "2442" "paginaFinal" => "2443" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16195865" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood obesity and its health consequence in China" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Y Li" 1 => "X Yang" 2 => "F Zhai" 3 => "J Piao" 4 => "W Zhao" 5 => "J Zhang" 6 => "G. Ma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1467-789X.2007.00444.x" "Revista" => array:7 [ "tituloSerie" => "Obes Rev" "fecha" => "2008" "volumen" => "9" "numero" => "Suppl 1" "paginaInicial" => "82" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18307705" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in obeseArgentinean children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.S. Mazza" 1 => "B Ozuna" 2 => "A.G. Krochik" 3 => "MB. Araujo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Endocrinol Metab" "fecha" => "2005" "volumen" => "18" "paginaInicial" => "491" "paginaFinal" => "498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15921179" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance and impaired glucose tolerance in overweight and obese Costa Rican schoolchildren" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/156482650802900206" "Revista" => array:6 [ "tituloSerie" => "Food Nutr Bull" "fecha" => "2008" "volumen" => "29" "paginaInicial" => "123" "paginaFinal" => "131" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.ijo.0802555" "Revista" => array:6 [ "tituloSerie" => "Int J Obes Relat Metab Disord" "fecha" => "2004" "volumen" => "28" "paginaInicial" => "307" "paginaFinal" => "313" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impaired glucose tolerance and type 2 diabetes mellitus: a new field for pediatrics in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Obes (Lond)" "fecha" => "2005" "volumen" => "29" "numero" => "Suppl 2" "paginaInicial" => "S136" "paginaFinal" => "42" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of impaired glucose regulation in German school-leaving students" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes (Lond)" "fecha" => "2007" "volumen" => "3" "paginaInicial" => "1086" "paginaFinal" => "1088" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "association with insulin resistance and hyperinsulinemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr Endocrinol Metab" "fecha" => "2008" "volumen" => "2" "paginaInicial" => "847" "paginaFinal" => "853" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance and impaired glucose tolerance in obese children and adolescents referred to a tertiary-care center in Israel" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes (Lond)" "fecha" => "2005" "volumen" => "2" "paginaInicial" => "571" "paginaFinal" => "578" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Period prevalence of abnormal glucose tolerance and cardiovascular risk factors among obese children attending an obesity centre in Italy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.numecd.2005.10.001" "Revista" => array:6 [ "tituloSerie" => "Nutr Metab Cardiovasc Dis" "fecha" => "2006" "volumen" => "16" "paginaInicial" => "256" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of glucose intolerance in adolescents relative to adults with type 2 diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Endocrinol Metab" "fecha" => "2006" "volumen" => "19" "paginaInicial" => "1319" "paginaFinal" => "1326" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of abnormal glucose homeostasis and insulin resistance in Turkish obese children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1463-1326.2006.00601.x" "Revista" => array:6 [ "tituloSerie" => "Diabetes Obes Metab" "fecha" => "2007" "volumen" => "9" "paginaInicial" => "304" "paginaFinal" => "310" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of metabolic syndrome in obese Turkish children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diabres.2005.10.021" "Revista" => array:6 [ "tituloSerie" => "Diabetes Res Clin Pract" "fecha" => "2006" "volumen" => "72" "paginaInicial" => "315" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "GI epidemiology: nonalcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2007.03246.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2007" "volumen" => "25" "paginaInicial" => "883" "paginaFinal" => "889" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The utility of radiological imaging in nonalcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2002" "volumen" => "123" "paginaInicial" => "745" "paginaFinal" => "750" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The obesity epidemic and nonalcoholic fatty liver disease in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Gastroenterol Rep" "fecha" => "2008" "volumen" => "10" "paginaInicial" => "67" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatic steatosis in obese Chinese children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.ijo.0802734" "Revista" => array:6 [ "tituloSerie" => "Int J Obes Relat Metab Disord" "fecha" => "2004" "volumen" => "28" "paginaInicial" => "1257" "paginaFinal" => "1263" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonography and liver enzyme levels at diagnosis and during follow-up in an Italian population" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Liver involvement in obese children" "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "1997" "volumen" => "42" "paginaInicial" => "1428" "paginaFinal" => "1432" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between insulin resistance and serum alanine aminotransferase as a surrogate of NAFLD (nonalcoholic fatty liver disease) in obese Korean children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diabres.2008.05.006" "Revista" => array:7 [ "tituloSerie" => "Diabetes Res Clin Pract" "fecha" => "2008" "volumen" => "81" "paginaInicial" => "321" "paginaFinal" => "326" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S2468781218300985" "estado" => "S300" "issn" => "24687812" ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2004-1832" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2005" "volumen" => "115" "paginaInicial" => "e561" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Decreased prevalence of nonalcoholic fatty liver disease in black obese children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr Gastroenderol Nutr" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "426" "paginaFinal" => "429" ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatty liver and its fibrous changes found in simple obesity of children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "1984" "volumen" => "3" "paginaInicial" => "408" "paginaFinal" => "414" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between fatty liver and hyperinsulinemia in obese Japanese children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "1997" "volumen" => "24" "paginaInicial" => "317" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum alanine aminotransferases activity in obese children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Acta Paediatr" "fecha" => "1997" "volumen" => "86" "paginaInicial" => "238" "paginaFinal" => "241" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0161642018301829" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum adiponectin, resistin levels and non-alcoholic fatty liver disease in obese children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Endocr J" "fecha" => "2005" "volumen" => "52" "paginaInicial" => "519" "paginaFinal" => "524" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of fatty liver in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2006-1212" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2006" "volumen" => "118" "paginaInicial" => "1388" "paginaFinal" => "1393" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0250" "etiqueta" => "50." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on non-alcoholic fatty liver disease in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clnu.2007.02.002" "Revista" => array:5 [ "tituloSerie" => "Clin Nutr" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "409." "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0255" "etiqueta" => "51." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric nonalcoholic fatty liver disease: a critical appraisal of current data and implications for future research" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.mpg.0000239995.58388.56" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2006" "volumen" => "43" "paginaInicial" => "413." "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S016164201732732X" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0260" "etiqueta" => "52." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of severe liver disease in NAFLD with normal ALT levels. A pediatric report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.510240222" "Revista" => array:3 [ "tituloSerie" => "Hepatology" "fecha" => "2008" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0265" "etiqueta" => "53." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2000" "volumen" => "136" "paginaInicial" => "727" "paginaFinal" => "733" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0270" "etiqueta" => "54." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ajcn/82.5.1046" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Nutr" "fecha" => "2005" "volumen" => "82" "paginaInicial" => "1046" "paginaFinal" => "1051" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0275" "etiqueta" => "55." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frequency of increased aminotransferases levels and associated metabolic abnormalities in obese and overweight children of an elementary school in Mexico City" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2005" "volumen" => "4" "paginaInicial" => "279" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0280" "etiqueta" => "56." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "n epidemiological ultrasonographic survey" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Prevalence of fatty liver in Japanese children and relationship to obesity" "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "1995" "volumen" => "40" "paginaInicial" => "2002" "paginaFinal" => "2009" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0285" "etiqueta" => "57." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liver steatosis in juvenile obesity: correlations with lipid profile, hepatic biochemical parameters and glycemic and insulinemic responses to an oral glucose tolerance test" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Obes Relat Metab Disord" "fecha" => "2000" "volumen" => "24" "paginaInicial" => "772" "paginaFinal" => "776" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0290" "etiqueta" => "58." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of non-alcoholic fatty liver disease in obese children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.ejcn.1602588" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Nutr" "fecha" => "2007" "volumen" => "61" "paginaInicial" => "877" "paginaFinal" => "883" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0295" "etiqueta" => "59." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonalcoholic steatohepatitis in obese children: the prevalence and possible mechanism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Zhejiang Da Xue Xue Bao Yi Xue Ban" "fecha" => "2006" "volumen" => "35" "paginaInicial" => "64" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0300" "etiqueta" => "60." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors related to non-alcoholic fatty liver disease in obese children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "The Turkish Journal of Gastroenterology" "fecha" => "2008" "volumen" => "19" "paginaInicial" => "85" "paginaFinal" => "91" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0305" "etiqueta" => "61." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Italian multicenter study on liver damage in pediatric obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes Relat Metab Disord" "fecha" => "1998" "volumen" => "22" "paginaInicial" => "S22." "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0310" "etiqueta" => "62." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of type 2 diabetes in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Minerva Med" "fecha" => "2006" "volumen" => "97" "paginaInicial" => "263" "paginaFinal" => "269" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0315" "etiqueta" => "63." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The development of insulin resistance in Type 2 diabetes: insights from knockout studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Sci Prog" "fecha" => "2008" "volumen" => "91" "paginaInicial" => "285" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S016164201732732X" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0320" "etiqueta" => "64." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protein kinase C function in muscle, liver, and beta-cells and its therapeutic implications for type 2 diabetes." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/db07-1769" "Revista" => array:6 [ "tituloSerie" => "Diabetes" "fecha" => "2008" "volumen" => "57" "paginaInicial" => "1774" "paginaFinal" => "1783" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0325" "etiqueta" => "65." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IRS proteins and the common path to diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/ajpendo.00514.2001" "Revista" => array:6 [ "tituloSerie" => "Am J Physiol Endocrinol Metab" "fecha" => "2002" "volumen" => "283" "paginaInicial" => "E413" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0330" "etiqueta" => "66." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patho-physiology and dynamics of altered glucose metabolism in obese children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/17477160802404640" "Revista" => array:7 [ "tituloSerie" => "Int J Pediatr Obes" "fecha" => "2008" "volumen" => "3" "numero" => "Suppl 1" "paginaInicial" => "15" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0335" "etiqueta" => "67." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Understanding the development and prevention of type 2 diabetes in youth (part 1)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pedhc.2005.08.009" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Health Care" "fecha" => "2006" "volumen" => "20" "paginaInicial" => "3" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0340" "etiqueta" => "68." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type 2 diabetes in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Urr Diab Rep" "fecha" => "2001" "volumen" => "1" "paginaInicial" => "19" "paginaFinal" => "27" ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0345" "etiqueta" => "69." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genetics and type 2 diabetes in youth" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-5448.2007.00331.x" "Revista" => array:7 [ "tituloSerie" => "Pediatr Diabetes" "fecha" => "2007" "volumen" => "8" "numero" => "Suppl 9" "paginaInicial" => "42" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0350" "etiqueta" => "70." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changing patterns of type 2 diabetes incidence among Pima Indians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc06-2010" "Revista" => array:7 [ "tituloSerie" => "Diabetes Care" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "1758" "paginaFinal" => "1763" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0161642017319930" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib0355" "etiqueta" => "71." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of weight at birth and at diagnosis of childhood-onset type 2 diabetes mellitus in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Pediatr Diabetes" "fecha" => "2008" "volumen" => "8" "numero" => "9" "paginaInicial" => "285" "paginaFinal" => "290" "itemHostRev" => array:3 [ "pii" => "S0161642016001810" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib0360" "etiqueta" => "72." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adolescent obesity and puberty: the «perfect storm»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1196/annals.1429.009" "Revista" => array:6 [ "tituloSerie" => "Ann N Y Acad Sci" "fecha" => "2008" "volumen" => "1135" "paginaInicial" => "265" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 72 => array:3 [ "identificador" => "bib0365" "etiqueta" => "73." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Steatohepatitis: A tale of two «hits»?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "1998" "volumen" => "14" "paginaInicial" => "842" "paginaFinal" => "845" "itemHostRev" => array:3 [ "pii" => "S0161642016319923" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 73 => array:3 [ "identificador" => "bib0370" "etiqueta" => "74." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "NASH-related liver failure: one hit too many?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2002" "volumen" => "7" "paginaInicial" => "1872" "paginaFinal" => "1874" ] ] ] ] ] ] 74 => array:3 [ "identificador" => "bib0375" "etiqueta" => "75." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive indices of fibrosis in NAFLD: starting to think about a three hit (at least) phenomenon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2006.01039.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2007" "volumen" => "102" "paginaInicial" => "409" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 75 => array:3 [ "identificador" => "bib0380" "etiqueta" => "76." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genes or environment to determine alcoholic liver disease and non-alcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1478-3231.2006.01323.x" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2006" "volumen" => "26" "paginaInicial" => "1021" "paginaFinal" => "1028" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 76 => array:3 [ "identificador" => "bib0385" "etiqueta" => "77." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular basis and mechanisms of progression of non-alcoholic steatohepatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.molmed.2007.12.003" "Revista" => array:6 [ "tituloSerie" => "Trends Mol Med" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "72" "paginaFinal" => "81" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 77 => array:3 [ "identificador" => "bib0390" "etiqueta" => "78." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatty liver and non-alcoholic steatohepatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2169/internalmedicine.46.1784" "Revista" => array:6 [ "tituloSerie" => "Intern Med" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "101" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 78 => array:3 [ "identificador" => "bib0395" "etiqueta" => "79." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance: cause or consequence of nonalcoholic steatohepatitis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2006.11.048" "Revista" => array:7 [ "tituloSerie" => "Gastroenterology" "fecha" => "2007" "volumen" => "132" "paginaInicial" => "444" "paginaFinal" => "446" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0161642017319930" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 79 => array:3 [ "identificador" => "bib0400" "etiqueta" => "80." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apolipoprotein synthesis in nonalcoholic steatohepatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhep.2002.32527" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2002" "volumen" => "35" "paginaInicial" => "898" "paginaFinal" => "904" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0161642018301829" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 80 => array:3 [ "identificador" => "bib0405" "etiqueta" => "81." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mitochondrial dysfunction in NASH: causes, consequences and possible means to prevent it" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mito.2005.10.004" "Revista" => array:6 [ "tituloSerie" => "Mitochondrion" "fecha" => "2006" "volumen" => "6" "paginaInicial" => "1" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 81 => array:3 [ "identificador" => "bib0410" "etiqueta" => "82." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/gast.2001.23256" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2001" "volumen" => "120" "paginaInicial" => "1183" "paginaFinal" => "1192" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 82 => array:3 [ "identificador" => "bib0415" "etiqueta" => "83." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mitochondrial dysfunction in NASH: causes, consequences and possible means to prevent it" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mito.2005.10.004" "Revista" => array:7 [ "tituloSerie" => "Mitochondrion" "fecha" => "2006" "volumen" => "6" "paginaInicial" => "1" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0161642017305791" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 83 => array:3 [ "identificador" => "bib0420" "etiqueta" => "84." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Free fatty acids promote hepatic lipotoxicity by stimulating TNF-alpha expression via a lysosomal pathway" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20283" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "185" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 84 => array:3 [ "identificador" => "bib0425" "etiqueta" => "85." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Beyond insulin resistance in NASH: TNF-alpha or adiponectin?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20280" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "46" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 85 => array:3 [ "identificador" => "bib0430" "etiqueta" => "86." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2008.06.018" "Revista" => array:7 [ "tituloSerie" => "J Hepatol" "fecha" => "2008" "volumen" => "49" "paginaInicial" => "608" "paginaFinal" => "612" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S1529943014002988" "estado" => "S300" "issn" => "15299430" ] ] ] ] ] ] ] 86 => array:3 [ "identificador" => "bib0435" "etiqueta" => "87." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/dmrr.666" "Revista" => array:6 [ "tituloSerie" => "Diabetes Metab Res Rev" "fecha" => "2006" "volumen" => "22" "paginaInicial" => "437" "paginaFinal" => "443" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 87 => array:3 [ "identificador" => "bib0440" "etiqueta" => "88." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevated alanine aminotransferase predicts new-onset type 2 diabetes independently of classical risk factors, metabolic syndrome, and C-reactive protein in the west of Scotland coronary prevention study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ …7] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/diabetes.53.11.2855" "Revista" => array:6 [ "tituloSerie" => "Diabetes" "fecha" => "2004" "volumen" => "53" "paginaInicial" => "2855" "paginaFinal" => "2860" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 88 => array:3 [ "identificador" => "bib0445" "etiqueta" => "89." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatic enzymes, the metabolic syndrome, and the risk of type 2 diabetes in older men" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/diacare.28.12.2913" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "2913" "paginaFinal" => "2918" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 89 => array:3 [ "identificador" => "bib0450" "etiqueta" => "90." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity, insulin resistance, and other clinicopatho-logical correlates of pediatric nonalcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/S0022-3476(03)00325-1" "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2003" "volumen" => "143" "paginaInicial" => "500" "paginaFinal" => "505" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/00000008000000S1/v1_201906260858/S1665268119318265/v1_201906260858/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/16652681/00000008000000S1/v1_201906260858/S1665268119318265/v1_201906260858/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119318265?idApp=UINPBA00004N"]

Statistics

Anna Alisi1,

Corresponding author

annaalisi@opbg.net

Address for correspondence:

, Melania Manco2, Nadia Panera1, Valerio Nobili1

1 Liver Unit

2 Scientific Directorate Bambino Gesù Paediatric Hospital and Research Institute; Rome Italy

Read

2570

Times
was read the article

514

Total PDF

2056

Total HTML

Share statistics

 array:24 [
  "pii" => "S1665268119318265"
  "issn" => "16652681"
  "doi" => "10.1016/S1665-2681(19)31826-5"
  "estado" => "S300"
  "fechaPublicacion" => "2009-01-01"
  "aid" => "71488"
  "copyright" => "Fundaci&#243;n Cl&#237;nica M&#233;dica Sur&#44; A&#46;C&#46;"
  "copyrightAnyo" => "2009"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Ann Hepatol. 2009;8 Supl 1:S44-50"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 66
    "formatos" => array:3 [
      "EPUB" => 10
      "HTML" => 25
      "PDF" => 31
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1665268119318277"
    "issn" => "16652681"
    "doi" => "10.1016/S1665-2681(19)31827-7"
    "estado" => "S300"
    "fechaPublicacion" => "2009-01-01"
    "aid" => "71489"
    "copyright" => "Fundaci&#243;n Cl&#237;nica M&#233;dica Sur&#44; A&#46;C&#46;"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Ann Hepatol. 2009;8 Supl 1:S51-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 71
      "formatos" => array:3 [
        "EPUB" => 10
        "HTML" => 37
        "PDF" => 24
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Treatment regimens for non-alcoholic fatty liver disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "S51"
          "paginaFinal" => "S59"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Brian P&#46; Lam, Zobair M&#46; Younossi"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Brian P&#46;"
              "apellidos" => "Lam"
            ]
            1 => array:2 [
              "nombre" => "Zobair M&#46;"
              "apellidos" => "Younossi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119318277?idApp=UINPBA00004N"
    "url" => "/16652681/00000008000000S1/v1_201906260858/S1665268119318277/v1_201906260858/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1665268119318253"
    "issn" => "16652681"
    "doi" => "10.1016/S1665-2681(19)31825-3"
    "estado" => "S300"
    "fechaPublicacion" => "2009-01-01"
    "aid" => "71487"
    "copyright" => "Fundaci&#243;n Cl&#237;nica M&#233;dica Sur&#44; A&#46;C&#46;"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Ann Hepatol. 2009;8 Supl 1:S40-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 72
      "formatos" => array:3 [
        "EPUB" => 7
        "HTML" => 30
        "PDF" => 35
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "titulo" => "Nonalcoholic fatty liver disease and its association with cardiovascular disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "S40"
          "paginaFinal" => "S43"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "f0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 680
              "Ancho" => 977
              "Tamanyo" => 41026
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">The prevalence of CVD in patients with NAFLD associated to type 2 diabetes mellitus&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Javier Lizardi-Cervera, Daniel Aguilar-Zapata"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Lizardi-Cervera"
            ]
            1 => array:2 [
              "nombre" => "Daniel"
              "apellidos" => "Aguilar-Zapata"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119318253?idApp=UINPBA00004N"
    "url" => "/16652681/00000008000000S1/v1_201906260858/S1665268119318253/v1_201906260858/en/main.assets"
  ]
  "en" => array:16 [
    "idiomaDefecto" => true
    "titulo" => "Association between type two diabetes and non-alcoholic fatty liver disease in youth"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "S44"
        "paginaFinal" => "S50"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Anna Alisi, Melania Manco, Nadia Panera, Valerio Nobili"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Anna"
            "apellidos" => "Alisi"
            "email" => array:1 [
              0 => "annaalisi@opbg.net"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "aff1"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Melania"
            "apellidos" => "Manco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">2</span>"
                "identificador" => "aff2"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Nadia"
            "apellidos" => "Panera"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "aff1"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Valerio"
            "apellidos" => "Nobili"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "aff1"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Liver Unit"
            "etiqueta" => "1"
            "identificador" => "aff1"
          ]
          1 => array:3 [
            "entidad" => "Scientific Directorate Bambino Ges&#249; Paediatric Hospital and Research Institute&#59; Rome Italy"
            "etiqueta" => "2"
            "identificador" => "aff2"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "&#42;"
            "correspondencia" => "Address for correspondence&#58;"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Estimates from population-and hospital-based studies indicate that the number of children and adolescents with type two diabetes mellitus &#40;T2DM&#41; has been increasing in the last decades&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This is likely to occur since the number of adolescents and young adults affected by insulin resistance-associated morbidities is increasing&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In fact&#44; T2DM is characterized by the simultaneous occurrence of both insulin-resistance and relative insulin-deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> During puberty&#44; insulin resistance represents a physiological condition aimed to favor growth&#46; Obesity may exacerbate this condition&#46; It has been shown that up to one in third obese adolescents with insulin resistance will keep this condition until the adulthood&#44; whilst the remaining two will recover normal insulin sensitivity as it happens for all the normal weight adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Subjects with severe insulin resistance which persists over the puberty are candidate to develop type 2 diabetes mellitus&#44; when their beta cell activity fails to compensate for increased and long term insulin resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">T2DM in youth is usually not an isolated condition&#44; but it is often accompanied by other metabolic abnormalities which represent cardiovascular risk factors and cluster together in the metabolic syndrome &#40;MetS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> i&#46;e&#46; obesity&#44; dyslipidemia&#44; hypertension and low-grade inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Recent evidence suggests a close association also between T2DM and two other condition of insulin resistance&#44; namely the polycystic ovary syndrome and the non-alcoholic fatty liver disease &#40;NAFLD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">NAFLD has a broad spectrum of manifestations&#44; ranging from simple steatosis to its inflammatory representation of nonalcoholic steatohepatitis &#40;NASH&#41;&#46; The boundaries between NAFLD and NASH are defined only by liver biopsy and prediction is difficult using any single or combined clinical or laboratory test&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> A small proportion of patients with NAFLD progresses to cirrhosis&#44; hepato-cellular carcinoma and liver failure&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">Pediatric NAFLD is becoming the leading cause for referral to liver clinics especially in overweigh&#47;obese children from Western country&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The occurrence of NAFLD in these children who are already at cardiovascular risk&#44; is particularly worrisome&#44; since the disease appears to be a <span class="elsevierStyleItalic">per se</span> independent cardiovascular risk&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Patients with NAFLD seem also prone to develop more frequently an impairment of the carbohydrate metabolism varying from a condition of pre-diabetes to overt T2DM&#46; In our series of children and adolescents with biopsy proven NAFLD&#44; we observed a prevalence of pre-diabetes and diabetes as high as 10-12&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and&#44; in most of them the impaired glucose metabolism will likely track to the adulthood&#46;</p><p id="p0025" class="elsevierStylePara elsevierViewall">The meaning of this association remains unclear&#46; The question is whether NAFLD is <span class="elsevierStyleItalic">per s&#232;</span> a determinant of diabetes or its effect is mediated by more severe obesity and insulin resistance&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">In the present review&#44; we will try to verify the occurrence of this association in youth by resuming the most recent epidemiological data on prevalence&#47;incidence of both diseases&#44; thus highlighting their common trends&#59; and considering pathogenetic mechanisms which may underlie both&#46; The epidemic of T2DM and NAFLD will bear fruit in forthcoming decades&#44; putting further stress on the healthcare system and&#44; probably&#44; leading to increased morbidity and a shorter lifespan for future generations&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Epidemiology of T2DM</span><p id="p0035" class="elsevierStylePara elsevierViewall">Prediabetes and T2DM are serious adverse consequences of obesity and pediatric metabolic syndrome&#44; more likely to manifest in adolescence and early adulthood than clinical atherosclerotic diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="p0040" class="elsevierStylePara elsevierViewall">The American Diabetes Association defines diabetes as occurring if one of three criteria are present&#58; 1&#41; a casual plasma glucose of &#62; 200 mg&#47;dL in some one with symptoms of diabetes&#59; fasting plasma glucose of &#8805; 126 mg&#47; dL&#59; 3&#41; 2 hr plasma glucose of &#8805; 200 as part of an oral glucose tolerance test&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The dose of glucose used as load is of 1&#46;75 g&#47;kg to a maximum of 75 g&#44; although the precise pediatric dose is not well validated&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Impaired fasting glucose &#40;IFG&#41; or impaired glucose tolerance &#40;IGT&#41; characterize prediabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="p0045" class="elsevierStylePara elsevierViewall">Most data on the epidemiology of diabetes comes from national surveys&#46; However&#44; they provide data on incidence and prevalence of the disease based on the number of cases referred by physicians or self reported by patients&#46; For instance&#44; the Search for diabetes in Youth is a 6-center observational study conducting population-based ascertainment of physician diagnosed diabetes in youth&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The National Health and Nutrition Examination Survey &#40;NHANES&#41; is a stratified&#44; multistage probability sample of the civilian non-institutionalized US population and diagnosis of diabetes was self reported&#46; To estimate prevalence and incidence of diabetes&#44; the adolescents of the NHANES study &#40;N &#61; 4&#44;370&#44; age 12-19 years&#41; were simply asked about having or not the disease&#46; Then&#44; they underwent measurement of fasting glucose&#46; Subjects without self reported diabetes but presenting with IFG &#40;N &#61; 1&#44;496&#41; were considered diabetic as well&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> In a longitudinal study&#44; performed in the United Kingdom to evaluate the incidence of T2DM in subjects &#60; 17 years of age&#44; the estimate of cases was based on active monthly reporting of cases by consultant pediatricians&#44; as described above&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Therefore&#44; the major limit of this survey studies is related to the fact that they do not estimate the rate of prediabetes assessed by the impaired glucose tolerance&#44; which is&#44; on the contrary the most frequent form of impairment in the carbohydrate metabolism in the youth&#46; Therefore&#44; large surveys such as the SEARCH and the NHANES are likely to see just the top of the iceberg&#44; and to severely underestimate a more common phenomenon&#46; On the other hand&#44; surveys offer the opportunity to evaluate the effect of several factors&#44; mainly age&#44; sex and races&#46;</p><p id="p0050" class="elsevierStylePara elsevierViewall">Both prevalence and incidence of T2DM vary among races&#44; with the highest prevalence and incidence in minorities&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The SEARCH found that overall prevalence ranged from 6&#37; in non Hispanic white youth to 76&#37; in American Indians&#59; incidence from 17 in Hispanic to 49&#46;9 in American-Indian per x 100&#44;000<span class="elsevierStyleSup">-1</span> x year-<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 15-19 year olds&#46; In the same range of age&#44; incidence for non-Hispanic white was 5&#46;6&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Data from NHANES found an incidence of 8&#46;1 x 100&#44;000<span class="elsevierStyleSup">-1</span> in 10-14-year-olds and 11&#46;8 x 100&#44;000<span class="elsevierStyleSup">-1</span> in 15-19-year-olds in 2002-2003&#46; The estimated incidence of T2DM in the Bostonian Youth varies from 0&#46;79 x 1000<span class="elsevierStyleSup">-1</span> in children &#60; 9 years of age to 1&#46;74 x 1000<span class="elsevierStyleSup">-1</span> in adolescents &#40;age 10-19 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In the UK study&#44; a total of 168 confirmed cases of non-type 1 diabetes were reported&#44; resulting in a national incidence of 1&#46;3 x 100&#44;000<span class="elsevierStyleSup">-1</span> x year<span class="elsevierStyleSup">-1</span>&#46; Of these&#44; 40&#37; were diagnosed with type 2 diabetes giving a minimum incidence of 0&#46;53 x 100&#44;000<span class="elsevierStyleSup">-1</span> x year<span class="elsevierStyleSup">-</span>1&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In New Zeeland&#44; a 6 year study&#44; which included 1&#44;095&#46;074 children of &#60; 14 years old estimated incidence of impaired glucose tolerance &#40;IGT&#41; was 0&#46;72 x100000<span class="elsevierStyleSup">-1</span> x year<span class="elsevierStyleSup">-1</span> in subjects of &#60; 14 years and 2&#46;27 x100000<span class="elsevierStyleSup">-1</span> in those of 10-14 years&#46; Type 2 DM had a rate of 0&#46;84 x 100&#44;000<span class="elsevierStyleSup">-1</span> x year<span class="elsevierStyleSup">-1</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> In Chinese youth&#44; a nationally representative cross-sectional survey enrolling 44 880 children aged 7-17&#46;9 years&#44; showed an incidence of diseases&#44; varying from 0&#46;2 in subjects 7-12 year old to 0&#46;4 in 12-18 year olds&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="p0055" class="elsevierStylePara elsevierViewall">To obtain data on rates of IGT we have to look to small size studies&#44; often performed in high risk populations&#44; i&#46;e&#46; including obese individuals with co-morbidities and&#47;or familiar history of diabetes&#46; We resume in <a class="elsevierStyleCrossRef" href="#t0005">Table 1</a> the most significant among those conducted and published in the last 5 years&#44; and using the oral glucose tolerance test to diagnose diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Of note&#44; even in samples of individuals with severe obesity and familiarity for diabetes and cardiovascular disease&#44; European rates were not as high as those in US studies&#46; In Europe&#44; T2DM remains a rarity&#44; accounting only for 1&#37; to 2&#37; of all cases of diabetes mellitus&#46; Although&#44; differences in obesity rates between US and European youth are likely contributors&#44; the full explanation for this discrepancies remains uncertain&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Epidemiology of NAFLD</span><p id="p0060" class="elsevierStylePara elsevierViewall">The real prevalence of NAFLD&#47;NASH remains unknown in the general population because prospective studies lack and the information available in a given population strictly depend on the diagnostic criteria used&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> NAFLD&#44; as estimated on the basis of ultrasonography and increased levels of liver enzymes&#44; seems to be very common&#44; occurring in persons of all ages and ethnic groups&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">Population-based studies suggest that&#44; as in the adults&#44; its prevalence has been increasing over the past three decades also in children and adolescents&#44; and that the disease represents a worldwide problem with case series described in North and South America&#44; Europe&#44; Australia and Asia&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> These studies indicate that prevalence increases with age&#44; ranging from 0&#46;7&#37; for ages 2 to 4 up to 17&#46;3&#37; for ages 15 to 19 years&#44; but these rates are likely to be underestimated and all these reports do not discriminate between simple steatosis&#44; necro-inflammation and fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p><p id="p0070" class="elsevierStylePara elsevierViewall">The most prominent risk factor for fatty liver is obesity and the disease is most common in males adolescents&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> In a recent study on 909 Korean obese children &#40;boys 613&#44; girls 296&#41; the prevalence of NAFLD&#44; measured as surrogate of alanine aminotransferases &#40;ALT&#41;&#44; was 33&#46;4&#37; in boys&#44; and 19&#46;6&#37; in girls respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> Race&#44; ethnicity and degree of obesity significantly predicted the presence of fatty liver&#44; with Hispanics having the highest and African Americans the lowest figure&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> One study with 181 consecutive asymptomatic obese children demonstrated that 8&#37; had an elevated ALT suggestive of NAFLD&#44; but the prevalence decreased in black individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a></p><p id="p0075" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#t0010"><span class="elsevierStyleItalic">table II&#44;</span></a> studies on prevalence of NAFLD in overweigh&#47;obese children report values ranging from 8&#37; to 80&#37; &#40;USA&#41;&#44; depending upon the methods used for the diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> Unfortunately&#44; most studies have been limited to the use of indirect measures such as elevated serum &#40;ALT&#41; and ultrasound to predict histological outcome&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> but up to a 20&#37; of young patients have normal values of liver enzyme at the time of biopsy&#44; despite having histological proven NASH and&#47;or fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> Data from NHANES in 2450 adolescents found elevated ALT in 6&#37; of overweight and 10&#37; of obese subjects&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> Similarly&#44; the 1998 Korean National Health and Nutrition Examination Survey found a prevalence of elevated ALT as high as 3&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> In a sample of Mexican obese&#47;overweight children from an elementary school&#44; elevated ALT were observed in 42&#37; of subjects&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a></p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0080" class="elsevierStylePara elsevierViewall">Based on ultrasonography evidence of fatty liver&#44; NAFLD was diagnosed in 2&#46;6&#37; of Japanese children and occurrence of disease correlated significantly with indices of obesity such as the body mass index&#59;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> 42&#37; of 375&#44; and 44&#37; of 268 morbidly obese Italian children had hepatic steatosis&#59;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a> among 123 obese Chinese children&#44; 99 subjects showed abnormal hepatic sonograms and 54 were diagnosed as NASH&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> Some studies combine data from ultrasonography and elevated ALT&#59; for instance a study demonstrating that 52&#46;4&#37; of obese Turkish children had fatty liver by ultrasonography and 13&#46;8&#37; had high ALT levels&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> According to an Italian survey in 195 obese children&#44; 55&#37; had liver steatosis by ultrasonography&#44; 20&#37; had elevated ALT and AST levels&#44; and 15&#37; had both&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Type 2 diabetes&#58; pathogenetic mechanisms</span><p id="p0085" class="elsevierStylePara elsevierViewall">T2DM is caused by a combination of increased insulin resistance and decreased insulin secretion&#46; Peripheral insulin-resistance is tightly coupled with obesity in children and seems to be the major driving force of deteriorating glucose metabolism&#44; and is also associated with lipid partitioning in specific compartments &#40;i&#46;e&#46;&#44; viscera&#44; muscle and liver&#41;&#46; On the other hand&#44; the reduction of insulin secretion is probably a secondary event evolving gradually&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a></p><p id="p0090" class="elsevierStylePara elsevierViewall">Insulin resistance is an impairment of the physiologic effects of insulin on glucose&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a> Normal glycemic control requires the pancreatic <span class="elsevierStyleItalic">&#946;</span>-cell sensing of glucose concentration&#44; synthesis and release of insulin&#44; binding of insulin to receptors with a consequent activation of several signaling proteins&#46; The activation of multiple signaling cascade causes increased glucose uptake by muscles&#44; fat&#44; and liver and decreased glucose production by the liver&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> These molecular mechanisms are all altered in T2DM&#44; causing insulin resistance in muscle tissue&#44; decreased pancreatic insulin secretion&#44; and increased hepatic glucose output&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a></p><p id="p0095" class="elsevierStylePara elsevierViewall">In children and adolescents with T2DM&#44; defects of glucose metabolism are characterized by a decline in the first phase sensitivity of the <span class="elsevierStyleItalic">&#946;</span>-cell coupled with the decline of both first and second phase sensitivity&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> The dynamics of the impaired glucose metabolism in childhood seem to be faster than in adults&#44; representing a limited window of opportunity for successful preventive intervention&#46; Early identification of children with altered glucose metabolism is important in order to quantify public health needs and to allocate resources for appropriate prevention programs&#46;</p><p id="p0100" class="elsevierStylePara elsevierViewall">The risk factors for developing type 2 diabetes in youth include a genetic predisposition and certain environmental characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a> The majority of diabetes in both adults and children is polygenic&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a> Thus&#44; the family history of diabetes represents the most important risk factor of developing T2DM with respect to the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a></p><p id="p0105" class="elsevierStylePara elsevierViewall">Ethnicity is another important factor predisposing to T2DM development&#46; The increased incidence of T2DM in youth of color was identified first in the Pima Indians of the southwest&#46; Children of Pima Indian were found to have high rates of morbid obesity and from 1980 the research has focused on this group as well as other ethnic and racial groups with high rates of diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a> Low birth-weight&#44; maternal diabetes and the intrauterine environment also are important areas to consider in risk for the development of T2DM in youth&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">71</span></a> Puberty coupled with insulin resistance provides a strong basis for the development of pre-diabetes and T2DM in youth with overweight or frank obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">72</span></a></p><p id="p0110" class="elsevierStylePara elsevierViewall">The changing environment during the past several decades provided a further contribution of the dramatic increase in T2DM in youth&#46; There has been a movement toward a positive energy balance due to diet intake&#44; decreased physical activity and increased sedentary activity&#46; Fast food consumption and portion sizes have increased from 30 years ago&#44; leading to caloric intake in excess of metabolic need&#44; and youth are the major consumers of fast food meals&#46; Moreover&#44; youth are increasingly inactive&#44; reducing their physical activity and using sedentary screen activities&#44; such as television viewing and playing video games&#44; for an average of 5&#46;5 hours daily&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a></p><p id="p0115" class="elsevierStylePara elsevierViewall">All these evidence demonstrate that development of T2DM in youth is complex and requires astute health care providers who understand the pathophysiology&#44; patient history&#44; family history&#44; and genetic predisposition&#44; coupled with environmental factors&#44; to manage each youth at the appropriate intervention level&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">NAFLD&#58; pathogenetic mechanisms</span><p id="p0120" class="elsevierStylePara elsevierViewall">The pathogenesis of NAFLD is not yet completely understood&#44; however a currently favored hypothesis is that &#171;two hits&#187; are required for a subject to develop the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">73</span></a> A first hit that provokes steatosis &#40;i&#46;e&#46; fat accumulation in liver and&#47;or insulin resistance&#41; and predisposes the liver to a second hit which leads to necro-inflammation and fibrosis&#46; This second hit includes the alteration of several signaling pathways regulating oxidative stress&#44; mitochondrial dysfunctions and production of pro-inflammatory and pro-fibrotic cytokines and their signaling&#46; Recent advances demonstrate that fatty liver and its progressive development in NASH is a more complex phenomenon which originates by multiple hits&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">74</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">75</span></a> In fact&#44; the subsequent development of fibrosis requires probably the coexistence of multiple factors&#44; including host &#40;genes&#41; and environmental factors as well as those related to lifestyles and behaviors&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">76</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">77</span></a></p><p id="p0125" class="elsevierStylePara elsevierViewall">All today theories consider insulin resistance as an important driving force&#44; which promotes lipolysis of peripheral adipose tissue which&#44; in turn&#44; increases free fatty acid &#40;FFA&#41; influx into the liver&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">78</span></a> Hyperinsulinemia and hyperglycemia promote <span class="elsevierStyleItalic">de novo</span> lipogenesis and inhibit simultaneously FFA oxidation&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a> Fatty deposition at the liver side is also favored by defective incorporation of triglyceride into apolipoprotein carrier proteins and lipid export&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">80</span></a></p><p id="p0130" class="elsevierStylePara elsevierViewall">Fatty loaded hepatocytes are susceptible of additional insults&#44; which may lead to hepatocyte injury&#44; inflammation&#44; and fibrosis&#46; Also the role of oxidative stress is well documented in NASH&#46;&#44; There is accumulating evidence that oxidative stress and mitochondrial dysfunction play a key role in the physiopathology of NAFLD&#47;NASH whatever its initial cause&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a> Moreover&#44; there is a close interaction between development of mitochondrial dysfunction&#44; insulin resistance and cytokines in many liver diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">82</span></a> Conversely&#44; many forms of oxidative stress lead to antioxidant depletion&#44; which then further enhances oxidative stress and cytokine-mediated hepatoxicity&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">83</span></a> In addition&#44; although the exact mechanisms promoting progressive liver injury are not well defined&#44; also substrates derived from adipose tissue such as FFA&#44; tumor necrosis factor alpha&#44; leptin&#44; and adiponectin have been implicated&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a></p><p id="p0135" class="elsevierStylePara elsevierViewall">Taken together&#44; all discussed evidences highlight the complicated network of interactions existing among the several molecules and signaling pathways which contribute do development of NAFLD&#47;NASH&#46; Thus&#44; today it is impossible to distinguish between causes or effects during NAFLD&#47;NASH development and progression&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">More than a clinical association</span><p id="p0140" class="elsevierStylePara elsevierViewall">The NHANES found NAFLD to be more prevalent in obese race minorities&#44; with T2DM&#44; hypertension and hyperlipidemia&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a> These associations have led to the hypothesis that NAFLD may precede the onset of type 2 diabetes in some individuals&#46; But&#44; why should NAFLD associate with diabetes&#63; The links between the two diseases reflect processes related to insulin action or resistance which may be mediated through the location and function of fat&#44; excess total body fatness or hepatic fat&#46; Otherwise&#44; the risk for new onset diabetes may be mediated by components of the MetS which occur very frequently in NAFLD&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">NAFLD&#44; as estimated by elevated ALT levels&#44; and pre-diabetes or T2DM were found to be associated independently of confounders&#44; including obesity in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a> The West of Scotland Coronary Prevention Study&#44; consistently with a number of other studies&#44; found that compared with men with values for baseline ALT in the bottom quartile &#40;&#60; 17 U&#47;L&#41;&#44; those with levels in the top quartile &#40;&#62; 29 U&#47;L&#41; had an adjusted odds ratio of 2&#46;04 &#40;95&#37; CI 1&#46;16-3&#46;58&#41; for incident diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">88</span></a> In the British Hearth Regional Study&#44; the risk of type 2 diabetes increased significantly with increasing levels of ALT and g<span class="elsevierStyleBold">amma-</span>g<span class="elsevierStyleBold">lutamil</span>-transpeptidase &#40;GGT&#41;&#44; even after adjustment for a range of confounders&#44; again including BMI &#40;top <span class="elsevierStyleItalic">vs</span> bottom quartile&#44; ALT&#58; RR 2&#46;72&#44; 95&#37; CI 1&#46;47-5&#46;02&#59; GGT&#58; RR 3&#46;68&#44; 95&#37; CI 1&#46;68-8&#46;04&#41; or with further additional adjustment for insulin resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">89</span></a></p><p id="p0150" class="elsevierStylePara elsevierViewall">Data on the association between T2DM and NAFLD in paediatric settings are poor&#44; but nevertheless very strong&#46; In the San Diego series of biopsy proven NAFLD&#44; 6 out of 43 children had type 2 diabetes mellitus &#40;14&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">90</span></a> In our series of 120 babies&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> all subjects underwent oral glucose tolerance test and diagnosis of impaired glucose tolerance or T2DM was done according to the criteria of the American diabetes Association&#46; We observed a prevalence of IGT as high as 9&#37; and T2DM of 2&#37;&#46; The degree of insulin resistance was not correlated with liver histology in terms of grade of steatosis&#44; inflammation or fibrosis&#46; Subjects with IGT&#47;T2DM did differ from normo-tolerant individuals neither in anthropometrics or liver histology&#46; Conversely the prevalence of overt MetS was higher in subjects presenting with fibrosis and&#47;or NASH&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The limited number of subjects with impaired carbohydrate metabolism did not allow excluding that visceral adiposity &#40;i&#46;e&#46; through reduced levels of adiponectin or increased pro-inflammatory adipocytokines&#41; mediates both derangements in liver histology and carbohydrate metabolism&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="p0155" class="elsevierStylePara elsevierViewall">Also in youth&#44; T2DM and NAFLD seem to be significantly associated&#46; The meaning and the causative relation of this finding is still unclear&#46; It is likely that the insulin resistant phenotype&#44; charactering non alcoholic fatty liver disease&#44; contributes to anticipate significantly the onset of type 2 diabetes from mature adulthood to youth&#46; This observation may translate into the worrisome anticipation of all cardiovascular abnormalities linked to T2DM&#46; In addiction&#44; NAFLD may represent an independent risk factor which augments further the total cardiovascular risk&#46; Therefore&#44; both NAFLD and T2DM embody a growing healthcare burden which will boost health related costs in the next future&#46;</p></span><span id="sec1040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1050">Abbreviations&#58;</span><p id="p0185" class="elsevierStylePara elsevierViewall">Type two diabetes mellitus &#40;T2DM&#41;&#44; metabolic syndrome &#40;MetS&#41;&#44; non-alcoholic fatty liver disease &#40;NAFLD&#41;&#44; nonalcoholic steatohepatitis &#40;NASH&#41;&#44; impaired fasting glucose &#40;IFG&#41;&#44; impaired glucose tolerance &#40;IGT&#41;&#44; National Health and Nutrition Examination Survey &#40;NHANES&#41;&#44; alanine aminotransferases &#40;ALT&#41;&#44; aspartate aminotransferase &#40;AST&#41;&#44; free fatty acid &#40;FFA&#41;&#44; Gamma-Glutamil-Transpeptidasi &#40;GGT&#41;&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1212006"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abs0010"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1128076"
          "titulo" => "Key words"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Epidemiology of T2DM"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Epidemiology of NAFLD"
        ]
        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Type 2 diabetes&#58; pathogenetic mechanisms"
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "NAFLD&#58; pathogenetic mechanisms"
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "More than a clinical association"
        ]
        8 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec1040"
          "titulo" => "Abbreviations&#58;"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2008-12-23"
    "fechaAceptado" => "2008-12-23"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec1128076"
          "palabras" => array:5 [
            0 => "Aminotransferases"
            1 => "glucose"
            2 => "insulin resistance"
            3 => "non alcoholic steatohepatitis"
            4 => "obesity"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="asp0005" class="elsevierStyleSimplePara elsevierViewall">In the last three decades prevalence of insulin related diseases has been growing worldwide with epidemic obesity&#44; type 2 diabetes mellitus and non alcoholic fatty liver disease&#46; In children such epidemics are particularly worrisome&#44; since metabolic abnormalities track to the adulthood with significant implications for the health care system&#46; Epidemiological studies support a close association between type 2 diabetes and fatty liver disease&#46; We review the most recent epidemiological data on prevalence of both diseases in youth and their association&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "t0005"
        "etiqueta" => "Table I"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="npara1010" class="elsevierStyleSimplePara elsevierViewall">We included exclusively data from studies published in the list five years and using standard glucose tolerance test to assess impaired glucose tolerance &#40;IGT&#41; and type 2 diabetes mellitus according to the ADA criteria&#46; In few studies diagnosis was made according to the WHO criteria&#46; &#40;&#8225;&#41;&#46; Some articles were not accessible through the website&#44; therefore the abstract alone was available&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                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="middle" scope="col">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="middle" scope="col">Study and population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="middle" scope="col">Prevalence&#47;incidence&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="middle" scope="col">Ref&#46;&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="middle">Argentina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 427 obese&#47;overweight subjects&#44; Age 10&#46;7 &#177; 3&#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="left" valign="middle">IGT&#58; 7&#37;&#44; T2DM&#58; 1&#46;6&#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="left" valign="middle">26&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="middle">Costa Rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 214 obese and normal weight subjects&#44; Age 8-10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">IGT &#58; 6&#46;5&#37;&#44; T2DM 0&#46;5&#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="left" valign="middle">27&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="middle">Germany&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 520 obese&#47;overweight subjects&#44; Age 8&#46;9-20&#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="left" valign="middle">IGT&#58; 5&#46;2&#37;&#44; T2DM&#58; 1&#46;5&#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="left" valign="middle">28&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="middle">Germany&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 102 with Metabolic syndrome&#44; Age 7-18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">IGT&#58; 36&#37;&#44; T2DM&#58; 6&#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="left" valign="middle">29&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="middle">Germany&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">IFG 0&#46;41&#37;&#44; T2DM 0&#46;83&#37; &#40;lean individuals&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 721 school-leaving boys&#44; mean age 15&#46;5 &#177; 0&#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="left" valign="middle">&#8225;IGT&#44; T2DM 2&#46;5&#37; &#40;obese&#47;overweight&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">30&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="middle">Hungary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 250 obese&#47;overweight subjects&#44; Age not provided&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">&#8225;IGT 13&#46;6&#37;&#44; T2DM 1&#46;2&#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="left" valign="middle">31&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="middle">Israel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 234 obese&#47;overweight subjects&#44; Age 5-22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">IGT&#44; T2DM&#58; 13&#46;5&#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="left" valign="middle">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="middle">Italy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Retrospective study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 514 obese&#47;overweight subjects&#44; Age 13&#46;6-14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">IGT 5&#46;4&#37;&#44; T2DM 0&#46;5&#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="left" valign="middle">33&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="middle">Turkey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 105 obese and normal weight subjects&#44; Age 10-18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">IGT 15&#46;2&#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="left" valign="middle">34&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="middle">Turkey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 196 obese subjects&#44; Age 7-18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">IGT 18&#37;&#44; T2DM 3&#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="left" valign="middle">35&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="middle">Turkey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Cross-sectional study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Prepubertal IGT 19&#37;&#44; T2DM 2&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">N &#61; 169 obese subjects&#44; Age 7-18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Pubertal IGT 27&#46;5&#37;&#44; T2DM 4&#46;3&#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="left" valign="middle">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2069124.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Prevalence&#47;incidence of type 2 diabetes mellitus in youth&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "t0010"
        "etiqueta" => "<span class="elsevierStyleBold">Table II&#46;</span>"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                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="middle" scope="col">Country&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="middle" scope="col">Number of children<a class="elsevierStyleCrossRef" href="#tab1tfn0010"><span class="elsevierStyleSup">&#167;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="middle" scope="col">NAFLD&#47;NASH prevalence&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="middle" scope="col">Ref&#46;&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="middle">USA&nbsp;\t\t\t\t\t\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="middle">181&nbsp;\t\t\t\t\t\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="middle">8&#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="middle">44&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="middle">USA&nbsp;\t\t\t\t\t\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="middle">315&nbsp;\t\t\t\t\t\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="middle">16&#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="middle">53&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="middle">USA&nbsp;\t\t\t\t\t\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="middle">127&nbsp;\t\t\t\t\t\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="middle">23&#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="middle">43&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="middle">USA&nbsp;\t\t\t\t\t\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="middle">320&nbsp;\t\t\t\t\t\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="middle">81&#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="middle">49&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="middle">M&#233;xico&nbsp;\t\t\t\t\t\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="middle">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">42&#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="middle">55&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="middle">Japan&nbsp;\t\t\t\t\t\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="middle">299&nbsp;\t\t\t\t\t\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="middle">12&#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="middle">45&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="middle">Japan&nbsp;\t\t\t\t\t\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="middle">228&nbsp;\t\t\t\t\t\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="middle">24&#46;1&#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="middle">46&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="middle">Japan&nbsp;\t\t\t\t\t\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="middle">310&nbsp;\t\t\t\t\t\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="middle">25&#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="middle">47&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="middle">Cina&nbsp;\t\t\t\t\t\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="middle">113&nbsp;\t\t\t\t\t\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="middle">55&#46;7&#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="middle">48&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="middle">Cina&nbsp;\t\t\t\t\t\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="middle">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">77&#37; &#40;24&#37;&#41;<a class="elsevierStyleCrossRef" href="#tab1tfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">40&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="middle">Cina&nbsp;\t\t\t\t\t\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="middle">123&nbsp;\t\t\t\t\t\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="middle">80&#46;5&#37; &#40;43&#46;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#tab1tfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">59&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="middle">Korea&nbsp;\t\t\t\t\t\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="middle">909&nbsp;\t\t\t\t\t\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="middle">19&#46;6&#37;<a class="elsevierStyleCrossRef" href="#tab1tfn0020"><span class="elsevierStyleSup">&#186;</span></a> and 33&#46;4&#37;<a class="elsevierStyleCrossRef" href="#tab1tfn0025"><span class="elsevierStyleSup">&#94;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">42&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="middle">Italy&nbsp;\t\t\t\t\t\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="middle">375&nbsp;\t\t\t\t\t\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="middle">42&#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="middle">57&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="middle">Italy&nbsp;\t\t\t\t\t\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="middle">268&nbsp;\t\t\t\t\t\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="middle">44&#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="middle">58&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="middle">Italy&nbsp;\t\t\t\t\t\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="middle">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">53&#37; &#40;25&#37;&#41;<a class="elsevierStyleCrossRef" href="#tab1tfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">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="middle">Italy&nbsp;\t\t\t\t\t\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="middle">175&nbsp;\t\t\t\t\t\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="middle">55&#40;&#37;&#41; &#40;15&#37;&#41;<a class="elsevierStyleCrossRef" href="#tab1tfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">60&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="middle">Turkey&nbsp;\t\t\t\t\t\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="middle">101&nbsp;\t\t\t\t\t\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="middle">52&#46;4&#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="middle">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2069125.png"
              ]
            ]
          ]
          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tab1tfn0010"
              "etiqueta" => "&#167;"
              "nota" => "<p class="elsevierStyleNotepara" id="npara0010">Number of overweight&#47;obese children included in the study&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tab1tfn0015"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npara0015">Percentage of presumed NASH&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tab1tfn0020"
              "etiqueta" => "&#186;"
              "nota" => "<p class="elsevierStyleNotepara" id="npara0020">Girls</p>"
            ]
            3 => array:3 [
              "identificador" => "tab1tfn0025"
              "etiqueta" => "&#94;"
              "nota" => "<p class="elsevierStyleNotepara" id="npara0025">Boys</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Data of prevalence of NAFLD&#47;NASH in obese children from different countries&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:90 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of childhood type 2 diabetes and obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Shaw"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-5448.2007.00329.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Diabetes"
                        "fecha" => "2007"
                        "volumen" => "8"
                        "numero" => "Suppl 9"
                        "paginaInicial" => "7"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17991128"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;D&#46; De Ferranti"
                            1 => "SK&#46; Osganian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3132/dvdr.2007.055"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diab Vasc Dis Res"
                        "fecha" => "2007"
                        "volumen" => "4"
                        "paginaInicial" => "285"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18158698"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Type 2 diabetes in childhood&#58; epidemiological and clinical aspects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "KA&#46; Matyka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bmb/ldn018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br Med Bull"
                        "fecha" => "2008"
                        "volumen" => "86"
                        "paginaInicial" => "59"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18515272"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Insulin resistance&#59; an adaptation for weight maintenance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "RE&#46; Eckel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0140-6736(92)92791-d"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1992"
                        "volumen" => "340"
                        "paginaInicial" => "1542"
                        "paginaFinal" => "1543"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1361622"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pancreatic alpha-cell dysfunction in diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R Burcelin"
                            1 => "C Knauf"
                            2 => "PD&#46; Cani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1262-3636(08)73395-0"
                      "Revista" => array:7 [
                        "tituloSerie" => "Diabetes Metab"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "S49"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18640586"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pediatric metabolic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Morrison"
                            1 => "E&#46;S&#46; Ford"
                            2 => "J&#46; Steinberger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Minerva Med"
                        "fecha" => "2008"
                        "volumen" => "99"
                        "paginaInicial" => "269"
                        "paginaFinal" => "287"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18497725"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2468781218300985"
                          "estado" => "S300"
                          "issn" => "24687812"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dyslipidemia in children with type 2 diabetes vs&#46; obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;S&#46; Newfield"
                            1 => "A&#46;K&#46; Dewan"
                            2 => "S&#46; Jain"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-5448.2007.00345.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Diabetes"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "115"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18221437"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Polycystic ovary syndrome in adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Franks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2008"
                        "volumen" => "32"
                        "paginaInicial" => "1035"
                        "paginaFinal" => "1041"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "G Targher"
                            1 => "L Bertolini"
                            2 => "R Padovani"
                            3 => "S Rodella"
                            4 => "R Tessari"
                            5 => "L Zenari"
                            6 => "C Day"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc06-2247"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2007"
                        "volumen" => "30"
                        "paginaInicial" => "1212"
                        "paginaFinal" => "1218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17277038"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-alcoholic fatty liver disease&#58; an overview of prevalence&#44; diagnosis&#44; pathogenesis and treatment considerations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D Preiss"
                            1 => "N&#46; Sattar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Sci &#40;Lond&#41;"
                        "fecha" => "2008"
                        "volumen" => "115"
                        "paginaInicial" => "141"
                        "paginaFinal" => "150"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathology of nonalcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;M&#46; Yeh"
                            1 => "EM&#46; Brunt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1309/RTPM1PY6YGBL2G2R"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Pathol"
                        "fecha" => "2007"
                        "volumen" => "128"
                        "paginaInicial" => "837"
                        "paginaFinal" => "847"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17951208"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonalcoholic fatty liver disease&#58; from ste-atosis to cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;C&#46; Farrell"
                            1 => "CZ&#46; Larter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20973"
                      "Revista" => array:7 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2006"
                        "volumen" => "43"
                        "numero" => "2 Suppl 1"
                        "paginaInicial" => "S99"
                        "paginaFinal" => "S112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16447287"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Review article&#58; epidemiology&#44; pathogenesis and potential treatments of paediatric non-alcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46;J&#46; Barshop"
                            1 => "C&#46;B&#46; Sirlin"
                            2 => "J&#46;B&#46; Schwimmer"
                            3 => "JE&#46; Lavine"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2036.2008.03703.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "2008"
                        "volumen" => "28"
                        "paginaInicial" => "13"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18397387"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic syndrome and liver histology in paediatric non-alcoholic steatohepatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M Manco"
                            1 => "M Marcellini"
                            2 => "R Devito"
                            3 => "D Comparcola"
                            4 => "M&#46;R&#46; Sartorelli"
                            5 => "V&#46; Nobili"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2008"
                        "volumen" => "32"
                        "paginaInicial" => "381"
                        "paginaFinal" => "387"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "M Manco"
                            1 => "G Bedogni"
                            2 => "M Marcellini"
                            3 => "R Devito"
                            4 => "P Ciampalini"
                            5 => "M&#46;R&#46; Sartorelli"
                            6 => "D Comparcola"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/gut.2007.142919"
                      "Revista" => array:7 [
                        "tituloSerie" => "Gut"
                        "fecha" => "2008"
                        "volumen" => "57"
                        "paginaInicial" => "1283"
                        "paginaFinal" => "1287"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18218674"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642017305791"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Type 2 diabetes in children&#58; a growing epidemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "TF&#46; Jones"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ky Nurse"
                        "fecha" => "2007"
                        "volumen" => "55"
                        "paginaInicial" => "7"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18200782"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Type 2 diabetes in children and adolescents &#40;Consensus Statement&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American Diabetes Association&#46;"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/diacare.23.3.381"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2000"
                        "volumen" => "23"
                        "paginaInicial" => "381"
                        "paginaFinal" => "389"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10868870"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Type 2 diabetes in the young&#58; the evolving epidemic&#58; the international diabetes federation consensus workshop"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G Alberti"
                            1 => "P Zimmet"
                            2 => "J Shaw"
                            3 => "Z Bloomgarden"
                            4 => "F Kaufman"
                            5 => "M&#46; Silink"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/diacare.27.7.1798"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2004"
                        "volumen" => "27"
                        "paginaInicial" => "1798"
                        "paginaFinal" => "1811"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15220270"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediabetes and type 2 diabetes in youth&#58; an emerging epidemic disease&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;M&#46; Cali"
                            1 => "S&#46; Caprio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MED.0b013e3282f57251"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Endocrinol Diabetes Obes"
                        "fecha" => "2008"
                        "volumen" => "15"
                        "paginaInicial" => "123"
                        "paginaFinal" => "127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18316946"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The burden of diabetes mellitus among US youth&#58; prevalence estimates from the SEARCH for Diabetes in Youth Study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "SEARCH for Diabetes in Youth Study Group"
                          "etal" => false
                          "autores" => array:7 [
                            0 => "A&#46;D&#46; Liese"
                            1 => "R&#46;B&#46; D&#8217;Agostino"
                            2 => "R&#46;F&#46; Hamman"
                            3 => "P&#46;D&#46; Kilgo"
                            4 => "J&#46;M&#46; Lawrence"
                            5 => "L&#46;L&#46; Liu"
                            6 => "B Loots"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2006-0690"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2006"
                        "volumen" => "118"
                        "paginaInicial" => "1510"
                        "paginaFinal" => "1518"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17015542"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of diabetes and impaired fasting glucose levels among US adolescents&#58; National Health and Nutrition Examination Survey&#44; 1999-2002"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "GE&#46; Duncan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archpedi.160.5.523"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pediatr Adolesc Med"
                        "fecha" => "2006"
                        "volumen" => "160"
                        "paginaInicial" => "523"
                        "paginaFinal" => "528"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16651496"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rising incidence of type 2 diabetes in children in the U&#46;K"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L Haines"
                            1 => "K&#46;C&#46; Wan"
                            2 => "R Lynn"
                            3 => "T&#46;G&#46; Barrett"
                            4 => "JP&#46; Shield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc06-1813"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2007"
                        "volumen" => "30"
                        "paginaInicial" => "1097"
                        "paginaFinal" => "1101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17259470"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of diabetes in youth in the United States"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Writing Group for the SEARCH for Diabetes in Youth Study Group"
                          "etal" => false
                          "autores" => array:7 [
                            0 => "D Dabelea"
                            1 => "R&#46;A&#46; Bell"
                            2 => "R&#46;B&#46; D&#8217;Agostino"
                            3 => "G Imperatore"
                            4 => "J&#46;M&#46; Johansen"
                            5 => "B Linder"
                            6 => "L&#46;L&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2007"
                        "volumen" => "27"
                        "paginaInicial" => "2716"
                        "paginaFinal" => "2724"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective incidence study of diabetes mel-litus in New Zealand children aged 0 to 14 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;L&#46; Campbell-Stokes"
                            1 => "BJ&#46; Taylor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00125-005-1952-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetologia"
                        "fecha" => "2005"
                        "volumen" => "48"
                        "paginaInicial" => "2442"
                        "paginaFinal" => "2443"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16195865"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood obesity and its health consequence in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Y Li"
                            1 => "X Yang"
                            2 => "F Zhai"
                            3 => "J Piao"
                            4 => "W Zhao"
                            5 => "J Zhang"
                            6 => "G&#46; Ma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1467-789X.2007.00444.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Obes Rev"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "82"
                        "paginaFinal" => "86"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18307705"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in obeseArgentinean children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;S&#46; Mazza"
                            1 => "B Ozuna"
                            2 => "A&#46;G&#46; Krochik"
                            3 => "MB&#46; Araujo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Endocrinol Metab"
                        "fecha" => "2005"
                        "volumen" => "18"
                        "paginaInicial" => "491"
                        "paginaFinal" => "498"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15921179"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Insulin resistance and impaired glucose tolerance in overweight and obese Costa Rican schoolchildren"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/156482650802900206"
                      "Revista" => array:6 [
                        "tituloSerie" => "Food Nutr Bull"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "123"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ijo.0802555"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Obes Relat Metab Disord"
                        "fecha" => "2004"
                        "volumen" => "28"
                        "paginaInicial" => "307"
                        "paginaFinal" => "313"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impaired glucose tolerance and type 2 diabetes mellitus&#58; a new field for pediatrics in Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2005"
                        "volumen" => "29"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "S136"
                        "paginaFinal" => "42"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of impaired glucose regulation in German school-leaving students"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2007"
                        "volumen" => "3"
                        "paginaInicial" => "1086"
                        "paginaFinal" => "1088"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "association with insulin resistance and hyperinsulinemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr Endocrinol Metab"
                        "fecha" => "2008"
                        "volumen" => "2"
                        "paginaInicial" => "847"
                        "paginaFinal" => "853"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Insulin resistance and impaired glucose tolerance in obese children and adolescents referred to a tertiary-care center in Israel"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2005"
                        "volumen" => "2"
                        "paginaInicial" => "571"
                        "paginaFinal" => "578"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Period prevalence of abnormal glucose tolerance and cardiovascular risk factors among obese children attending an obesity centre in Italy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.numecd.2005.10.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Metab Cardiovasc Dis"
                        "fecha" => "2006"
                        "volumen" => "16"
                        "paginaInicial" => "256"
                        "paginaFinal" => "262"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of glucose intolerance in adolescents relative to adults with type 2 diabetes mellitus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Endocrinol Metab"
                        "fecha" => "2006"
                        "volumen" => "19"
                        "paginaInicial" => "1319"
                        "paginaFinal" => "1326"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of abnormal glucose homeostasis and insulin resistance in Turkish obese children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1463-1326.2006.00601.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Obes Metab"
                        "fecha" => "2007"
                        "volumen" => "9"
                        "paginaInicial" => "304"
                        "paginaFinal" => "310"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of metabolic syndrome in obese Turkish children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.diabres.2005.10.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Res Clin Pract"
                        "fecha" => "2006"
                        "volumen" => "72"
                        "paginaInicial" => "315"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "GI epidemiology&#58; nonalcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2036.2007.03246.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "2007"
                        "volumen" => "25"
                        "paginaInicial" => "883"
                        "paginaFinal" => "889"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The utility of radiological imaging in nonalcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2002"
                        "volumen" => "123"
                        "paginaInicial" => "745"
                        "paginaFinal" => "750"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The obesity epidemic and nonalcoholic fatty liver disease in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Gastroenterol Rep"
                        "fecha" => "2008"
                        "volumen" => "10"
                        "paginaInicial" => "67"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatic steatosis in obese Chinese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ijo.0802734"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Obes Relat Metab Disord"
                        "fecha" => "2004"
                        "volumen" => "28"
                        "paginaInicial" => "1257"
                        "paginaFinal" => "1263"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonography and liver enzyme levels at diagnosis and during follow-up in an Italian population"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Liver involvement in obese children"
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "1997"
                        "volumen" => "42"
                        "paginaInicial" => "1428"
                        "paginaFinal" => "1432"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between insulin resistance and serum alanine aminotransferase as a surrogate of NAFLD &#40;nonalcoholic fatty liver disease&#41; in obese Korean children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.diabres.2008.05.006"
                      "Revista" => array:7 [
                        "tituloSerie" => "Diabetes Res Clin Pract"
                        "fecha" => "2008"
                        "volumen" => "81"
                        "paginaInicial" => "321"
                        "paginaFinal" => "326"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2468781218300985"
                          "estado" => "S300"
                          "issn" => "24687812"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of gender&#44; race&#44; and ethnicity on suspected fatty liver in obese adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2004-1832"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2005"
                        "volumen" => "115"
                        "paginaInicial" => "e561"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decreased prevalence of nonalcoholic fatty liver disease in black obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr Gastroenderol Nutr"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "paginaInicial" => "426"
                        "paginaFinal" => "429"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fatty liver and its fibrous changes found in simple obesity of children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "1984"
                        "volumen" => "3"
                        "paginaInicial" => "408"
                        "paginaFinal" => "414"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between fatty liver and hyperinsulinemia in obese Japanese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "1997"
                        "volumen" => "24"
                        "paginaInicial" => "317"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum alanine aminotransferases activity in obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "1997"
                        "volumen" => "86"
                        "paginaInicial" => "238"
                        "paginaFinal" => "241"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642018301829"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum adiponectin&#44; resistin levels and non-alcoholic fatty liver disease in obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocr J"
                        "fecha" => "2005"
                        "volumen" => "52"
                        "paginaInicial" => "519"
                        "paginaFinal" => "524"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of fatty liver in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2006-1212"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2006"
                        "volumen" => "118"
                        "paginaInicial" => "1388"
                        "paginaFinal" => "1393"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update on non-alcoholic fatty liver disease in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clnu.2007.02.002"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Nutr"
                        "fecha" => "2007"
                        "volumen" => "26"
                        "paginaInicial" => "409&#46;"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric nonalcoholic fatty liver disease&#58; a critical appraisal of current data and implications for future research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.mpg.0000239995.58388.56"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2006"
                        "volumen" => "43"
                        "paginaInicial" => "413&#46;"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S016164201732732X"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of severe liver disease in NAFLD with normal ALT levels&#46; A pediatric report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.510240222"
                      "Revista" => array:3 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2008"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2000"
                        "volumen" => "136"
                        "paginaInicial" => "727"
                        "paginaFinal" => "733"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ajcn/82.5.1046"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Nutr"
                        "fecha" => "2005"
                        "volumen" => "82"
                        "paginaInicial" => "1046"
                        "paginaFinal" => "1051"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Frequency of increased aminotransferases levels and associated metabolic abnormalities in obese and overweight children of an elementary school in Mexico City"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Hepatol"
                        "fecha" => "2005"
                        "volumen" => "4"
                        "paginaInicial" => "279"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "n epidemiological ultrasonographic survey"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Prevalence of fatty liver in Japanese children and relationship to obesity"
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "1995"
                        "volumen" => "40"
                        "paginaInicial" => "2002"
                        "paginaFinal" => "2009"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Liver steatosis in juvenile obesity&#58; correlations with lipid profile&#44; hepatic biochemical parameters and glycemic and insulinemic responses to an oral glucose tolerance test"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Obes Relat Metab Disord"
                        "fecha" => "2000"
                        "volumen" => "24"
                        "paginaInicial" => "772"
                        "paginaFinal" => "776"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of non-alcoholic fatty liver disease in obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ejcn.1602588"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Nutr"
                        "fecha" => "2007"
                        "volumen" => "61"
                        "paginaInicial" => "877"
                        "paginaFinal" => "883"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonalcoholic steatohepatitis in obese children&#58; the prevalence and possible mechanism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Zhejiang Da Xue Xue Bao Yi Xue Ban"
                        "fecha" => "2006"
                        "volumen" => "35"
                        "paginaInicial" => "64"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "60&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors related to non-alcoholic fatty liver disease in obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "The Turkish Journal of Gastroenterology"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "paginaInicial" => "85"
                        "paginaFinal" => "91"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "61&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Italian multicenter study on liver damage in pediatric obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes Relat Metab Disord"
                        "fecha" => "1998"
                        "volumen" => "22"
                        "paginaInicial" => "S22&#46;"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "62&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of type 2 diabetes in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Minerva Med"
                        "fecha" => "2006"
                        "volumen" => "97"
                        "paginaInicial" => "263"
                        "paginaFinal" => "269"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "63&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The development of insulin resistance in Type 2 diabetes&#58; insights from knockout studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Sci Prog"
                        "fecha" => "2008"
                        "volumen" => "91"
                        "paginaInicial" => "285"
                        "paginaFinal" => "316"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S016164201732732X"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "64&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protein kinase C function in muscle&#44; liver&#44; and beta-cells and its therapeutic implications for type 2 diabetes&#46;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/db07-1769"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes"
                        "fecha" => "2008"
                        "volumen" => "57"
                        "paginaInicial" => "1774"
                        "paginaFinal" => "1783"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "65&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "IRS proteins and the common path to diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1152/ajpendo.00514.2001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Physiol Endocrinol Metab"
                        "fecha" => "2002"
                        "volumen" => "283"
                        "paginaInicial" => "E413"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "66&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patho-physiology and dynamics of altered glucose metabolism in obese children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/17477160802404640"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Pediatr Obes"
                        "fecha" => "2008"
                        "volumen" => "3"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "15"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "67&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding the development and prevention of type 2 diabetes in youth &#40;part 1&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pedhc.2005.08.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Health Care"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "3"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "68&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Type 2 diabetes in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Urr Diab Rep"
                        "fecha" => "2001"
                        "volumen" => "1"
                        "paginaInicial" => "19"
                        "paginaFinal" => "27"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "69&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genetics and type 2 diabetes in youth"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-5448.2007.00331.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Diabetes"
                        "fecha" => "2007"
                        "volumen" => "8"
                        "numero" => "Suppl 9"
                        "paginaInicial" => "42"
                        "paginaFinal" => "47"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "70&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changing patterns of type 2 diabetes incidence among Pima Indians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc06-2010"
                      "Revista" => array:7 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2007"
                        "volumen" => "30"
                        "paginaInicial" => "1758"
                        "paginaFinal" => "1763"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642017319930"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "71&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of weight at birth and at diagnosis of childhood-onset type 2 diabetes mellitus in Japan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Diabetes"
                        "fecha" => "2008"
                        "volumen" => "8"
                        "numero" => "9"
                        "paginaInicial" => "285"
                        "paginaFinal" => "290"
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642016001810"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "72&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adolescent obesity and puberty&#58; the &#171;perfect storm&#187;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1196/annals.1429.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann N Y Acad Sci"
                        "fecha" => "2008"
                        "volumen" => "1135"
                        "paginaInicial" => "265"
                        "paginaFinal" => "279"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "73&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Steatohepatitis&#58; A tale of two &#171;hits&#187;&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1998"
                        "volumen" => "14"
                        "paginaInicial" => "842"
                        "paginaFinal" => "845"
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642016319923"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "74&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NASH-related liver failure&#58; one hit too many&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2002"
                        "volumen" => "7"
                        "paginaInicial" => "1872"
                        "paginaFinal" => "1874"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            74 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "75&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive indices of fibrosis in NAFLD&#58; starting to think about a three hit &#40;at least&#41; phenomenon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2006.01039.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2007"
                        "volumen" => "102"
                        "paginaInicial" => "409"
                        "paginaFinal" => "411"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            75 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "76&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genes or environment to determine alcoholic liver disease and non-alcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1478-3231.2006.01323.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Liver Int"
                        "fecha" => "2006"
                        "volumen" => "26"
                        "paginaInicial" => "1021"
                        "paginaFinal" => "1028"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            76 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "77&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular basis and mechanisms of progression of non-alcoholic steatohepatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.molmed.2007.12.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Trends Mol Med"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "72"
                        "paginaFinal" => "81"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            77 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "78&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fatty liver and non-alcoholic steatohepatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2169/internalmedicine.46.1784"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Med"
                        "fecha" => "2007"
                        "volumen" => "46"
                        "paginaInicial" => "101"
                        "paginaFinal" => "113"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            78 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "79&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Insulin resistance&#58; cause or consequence of nonalcoholic steatohepatitis&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2006.11.048"
                      "Revista" => array:7 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2007"
                        "volumen" => "132"
                        "paginaInicial" => "444"
                        "paginaFinal" => "446"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642017319930"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            79 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "80&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Apolipoprotein synthesis in nonalcoholic steatohepatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jhep.2002.32527"
                      "Revista" => array:7 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2002"
                        "volumen" => "35"
                        "paginaInicial" => "898"
                        "paginaFinal" => "904"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642018301829"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            80 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "81&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mitochondrial dysfunction in NASH&#58; causes&#44; consequences and possible means to prevent it"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mito.2005.10.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mitochondrion"
                        "fecha" => "2006"
                        "volumen" => "6"
                        "paginaInicial" => "1"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            81 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "82&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonalcoholic steatohepatitis&#58; association of insulin resistance and mitochondrial abnormalities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/gast.2001.23256"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2001"
                        "volumen" => "120"
                        "paginaInicial" => "1183"
                        "paginaFinal" => "1192"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            82 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "83&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mitochondrial dysfunction in NASH&#58; causes&#44; consequences and possible means to prevent it"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mito.2005.10.004"
                      "Revista" => array:7 [
                        "tituloSerie" => "Mitochondrion"
                        "fecha" => "2006"
                        "volumen" => "6"
                        "paginaInicial" => "1"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642017305791"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            83 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "84&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Free fatty acids promote hepatic lipotoxicity by stimulating TNF-alpha expression via a lysosomal pathway"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20283"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "185"
                        "paginaFinal" => "194"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            84 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "85&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beyond insulin resistance in NASH&#58; TNF-alpha or adiponectin&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20280"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "46"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            85 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "86&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhep.2008.06.018"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2008"
                        "volumen" => "49"
                        "paginaInicial" => "608"
                        "paginaFinal" => "612"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1529943014002988"
                          "estado" => "S300"
                          "issn" => "15299430"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            86 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "87&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/dmrr.666"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Metab Res Rev"
                        "fecha" => "2006"
                        "volumen" => "22"
                        "paginaInicial" => "437"
                        "paginaFinal" => "443"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            87 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "88&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elevated alanine aminotransferase predicts new-onset type 2 diabetes independently of classical risk factors&#44; metabolic syndrome&#44; and C-reactive protein in the west of Scotland coronary prevention study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [ …7]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/diabetes.53.11.2855"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes"
                        "fecha" => "2004"
                        "volumen" => "53"
                        "paginaInicial" => "2855"
                        "paginaFinal" => "2860"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            88 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "89&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatic enzymes&#44; the metabolic syndrome&#44; and the risk of type 2 diabetes in older men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/diacare.28.12.2913"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2005"
                        "volumen" => "28"
                        "paginaInicial" => "2913"
                        "paginaFinal" => "2918"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            89 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "90&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity&#44; insulin resistance&#44; and other clinicopatho-logical correlates of pediatric nonalcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/S0022-3476(03)00325-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2003"
                        "volumen" => "143"
                        "paginaInicial" => "500"
                        "paginaFinal" => "505"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/16652681/00000008000000S1/v1_201906260858/S1665268119318265/v1_201906260858/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/16652681/00000008000000S1/v1_201906260858/S1665268119318265/v1_201906260858/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119318265?idApp=UINPBA00004N"
]

Article information

ISSN: 16652681
Original language: English

DOI:10.1016/S1665-2681(19)31826-5

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	0	8
2024 October	40	8	48
2024 September	43	5	48
2024 August	34	14	48
2024 July	51	9	60
2024 June	42	6	48
2024 May	62	14	76
2024 April	65	7	72
2024 March	64	15	79
2024 February	70	14	84
2024 January	65	9	74
2023 December	62	25	87
2023 November	46	12	58
2023 October	59	11	70
2023 September	38	8	46
2023 August	48	5	53
2023 July	36	11	47
2023 June	58	9	67
2023 May	77	6	83
2023 April	68	4	72
2023 March	89	10	99
2023 February	61	13	74
2023 January	29	13	42
2022 December	25	4	29
2022 November	18	8	26
2022 October	14	5	19
2022 September	11	3	14
2022 August	17	5	22
2022 July	19	9	28
2022 June	10	6	16
2022 May	9	6	15
2022 April	24	11	35
2022 March	37	13	50
2022 February	66	5	71
2022 January	42	9	51
2021 December	28	11	39
2021 November	13	12	25
2021 October	25	13	38
2021 September	10	11	21
2021 August	19	4	23
2021 July	41	8	49
2021 June	15	7	22
2021 May	17	12	29
2021 April	150	34	184
2021 March	57	12	69
2021 February	28	6	34
2021 January	27	14	41
2020 December	7	4	11
2020 November	8	3	11
2020 October	22	3	25
2020 September	12	2	14
2020 August	9	2	11
2020 July	8	0	8
2020 June	2	1	3
2020 May	10	3	13
2020 April	7	4	11
2020 March	4	5	9
2020 February	6	3	9
2020 January	8	6	14
2019 December	5	7	12
2019 November	1	1	2
2019 October	2	2	4
2019 September	3	0	3
2019 August	1	3	4
2019 July	2	3	5
2019 June	2	6	8

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter