Effect on the lipid parameters of an intervention to reduce weight in overweight and obese patients | Clínica e Investigación en Arteriosclerosis (English Edition)

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G1: grupo consulta; G2: grupo telemedicina; G3: grupo en el que se recomienda perder peso. El valor de p se ha calculado aplicando la prueba de Friedman a cada uno de los 3 grupos, obteniendo el mismo valor para los 3 (p<0,001)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Loreto Tárraga Marcos, Josefa María Panisello Royo, Julio A. Carbayo Herencia, Nuria Rosich Domenech, Josep Alins Presas, Pedro J. Tárraga López" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M. Loreto" "apellidos" => "Tárraga Marcos" ] 1 => array:2 [ "nombre" => "Josefa María" "apellidos" => "Panisello Royo" ] 2 => array:2 [ "nombre" => "Julio A." "apellidos" => "Carbayo Herencia" ] 3 => array:2 [ "nombre" => "Nuria" "apellidos" => "Rosich Domenech" ] 4 => array:2 [ "nombre" => "Josep" "apellidos" => "Alins Presas" ] 5 => array:2 [ "nombre" => "Pedro J." 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Loreto Tárraga Marcos, Josefa María Panisello Royo, Julio A. Carbayo Herencia, Nuria Rosich Domenech, Josep Alins Presas, Pedro J. Tárraga López" "autores" => array:6 [ 0 => array:3 [ "nombre" => "M. Loreto" "apellidos" => "Tárraga Marcos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Josefa María" "apellidos" => "Panisello Royo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Julio A." "apellidos" => "Carbayo Herencia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Nuria" "apellidos" => "Rosich Domenech" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Josep" "apellidos" => "Alins Presas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:4 [ "nombre" => "Pedro J." "apellidos" => "Tárraga López" "email" => array:1 [ 0 => "pjtarraga@sescam.jccm.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Residencia geriátrica Los Álamos, Albacete, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Medicina Interna, Fundación Fomento de la Salud (Fufosa), Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad Lípidos, Clínica Quirón Salud, Albacete, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Nutricionista, Fundación Fomento de la Salud (Fufosa), Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "ABS ABRERA, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Facultad de Medicina de Albacete, Universidad Castilla la Mancha, Albacete, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto sobre los parámetros lipídicos de una intervención para reducir peso en pacientes con sobrepeso y obesidad" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1310 "Ancho" => 1639 "Tamanyo" => 130042 ] ] "descripcion" => array:1 [ "en" => "Evolution of body mass index in the 3 intervention groups. G1: consultation group; G2: telemedicine group; G3: group recommended to lose weight. The p value for each of the 3 groups was calculated using the Friedman test, with the same value being obtained for all 3 (p<0.001)." ] ] ] "textoCompleto" => "IntroductionObesity is a significant global public health issue. One of the most harmful metabolic disorders associated with this condition is the dyslipidaemia which frequently accompanies it: The typical dyslipidaemia phenotype is pre-prandial hypertriglyceridaemia, decrease in high-density lipoprotein cholesterol (HDL-C), non-HDL post-prandial hyperlipidaemia, and the real increase in the production of small, dense low-density lipoprotein particles. Comprehensive treatment of dyslipidaemia in obese patients should always include an intense approach to addressing obesity and the identification and management of risk factors that interact with the condition, as well as a pharmacological risk-benefit assessment.<a class="elsevierStyleCrossRefs" href="#bib0150">1–3</a>In our environment, obesity and dyslipidaemia are frequently linked; therefore, it is very likely that there will be a dyslipidaemia phenotype when the body mass index is between 25.2 and 26.6kg/m2, as corroborated by numerous studies, among which is the United States National Health and Nutrition Examination Survey (NHANES).<a class="elsevierStyleCrossRefs" href="#bib0165">4–6</a> The separate reports on dyslipidaemia in men and women and in different ethnic groups reflect a common dyslipidaemia pattern: the significant increase in the real quantity of triglycerides (TG) (mainly very low density lipoproteins, total cholesterol and low HDL-C). The NHANES data has shown that the levels of total cholesterol (TC) are greater in young obese men and women than in non-obese people. The NHANES III study has also demonstrated that in patients with metabolic syndrome the rates of obesity, hypertriglyceridaemia and hypercholesterolaemia are greater than 75%.<a class="elsevierStyleCrossRefs" href="#bib0165">4–9</a>It is well-known that treatment for dyslipidaemia, both in overweight and obese patients, must start with weight loss.<a class="elsevierStyleCrossRefs" href="#bib0190">9,10</a> Accordingly, the interventions that are focused on changing dietary habits and increasing daily physical activity for the purposes of promoting a healthy lifestyle are the best options for tackling this problem; not forgetting that other interventions such as cognitive-behavioural therapy have proven useful when included in overweight and obesity programmes for the purpose of improving their effectiveness and helping maintain the results obtained.<a class="elsevierStyleCrossRef" href="#bib0195">10</a>Furthermore, regarding the effectiveness of these interventions to reduce weight, the evidence has shown satisfactory results, with reductions of between 8% and 10% of the initial weight being achieved.<a class="elsevierStyleCrossRefs" href="#bib0200">11,12</a> However, when considering the maintenance of the weight loss over time, the results obtained are not so encouraging. Scientific evidence shows weight regain in between 30–35% of patients during the first year following the end of the intervention. Over a five-year follow-up period, the regain is more than 50% of the weight lost with regard to the first evaluation phase.<a class="elsevierStyleCrossRef" href="#bib0210">13</a>Our group designed a motivational group intervention for obese patients, conducted by a nurse who had previously been trained by psychological experts, combined with their routine treatment and with a 2-year follow-up period. The results were then published, with 36% of patients achieving weight loss ≥5%. This intervention was subsequently replicated in another region of Spain with the same results. As previously stated, an hour-long motivational group intervention every two weeks from weeks 1 to 12, following the Lifestyle, Exercise, Attitudes, Relationships, Nutrition (LEARN)<a class="elsevierStyleCrossRefs" href="#bib0215">14–16</a> programme guidelines, and then monthly from weeks 13 to 32, following the instructions of the Weight Maintenance Survival Guide programme was added to routine treatment.<a class="elsevierStyleCrossRef" href="#bib0220">15</a> With this protocol, the losses were in the first study and in the second study. Although the results were highly satisfactory, the protocol added a cost of 32h more for every 10 patients, i.e. 3.2h per patient per year.In fact, all the interventions that have proved to be useful need to be intensive, well-structured, and cover multiple aspects, which involves a significant investment in temporary and human resources, of which there is no surplus in our healthcare system rather, there is a lack of these resources. It is for this reason that we need to find strategies that allow for effective approaches, in both the short term and the medium and long term, which consume less resources, allowing us to treat a greater number of people (a larger population). Furthermore, communication and information technologies, and specifically the Internet, are emerging as a new strategy; these technologies have different potentialities, capable of tackling the limitations of traditional programmes, not only for the purpose of losing weight, but also for maintaining the results obtained once the intervention has ended. Communication technologies, which are available to a large part of the population, can be accessed from home or in other contexts, thereby enabling treatment using an intervention method that is better suited to their personal needs and which reduces the costs associated with traditional protocols. Furthermore, these technologies would improve adherence to both diet and treatments for concomitant illnesses,<a class="elsevierStyleCrossRefs" href="#bib0230">17,18</a> also having demonstrated their usefulness in the approach to excess weight and obesity.Therefore, the main objective of this study was to evaluate the evolution of the main lipid parameters related to weight gain (TC, TG and HDL-C), through a clinical trial designed to reduce weight gain, and to evaluate the effectiveness of these interventions according to the number of patients who reduce both their TC and TG and increase their HDL-C after one year of follow-up.Material and methodsThe study is designed as a randomised, double-blind, controlled, 3-arm clinical trial monitored over 12 months with a 1:1:1 allocation ratio. The inclusion criteria were as follows: present a BMI greater than 24.9kg/m2 and less than 40kg/m2 on the occupational health report and the patients, both male and female, must be between 30 and 70 years old. The exclusion criteria were as follows: patients with severe illnesses (bed-ridden, affected by neoplasia, cognitive disorders, etc.), patients with secondary obesity (hypothyroidism, Cushing's disease, etc.), patients with severe sensory illnesses that interfere with motivational intervention such as uncorrected visual or auditory impairments, etc., and patients with severe psychiatric illnesses.The data was collected between March 2015 and June 2016 in 3 basic health areas in Barcelona. The patients included in the study signed an informed consent form approved by the regional ethics committee.InterventionsThe patients were randomly sorted into 3 intervention groups: motivational obesity intervention with a previously trained nurse (G1), lower intensity consultation intervention, with no motivational group, and with digital platform support (G2), and a third group who were recommended to lose weight and regularly monitor weight loss (G3).The protocol applied in G1 followed the previously published IMOAP method.<a class="elsevierStyleCrossRefs" href="#bib0220">15,16</a> In short, this consisted of an hour-long motivational group intervention every two weeks from weeks 1 to 12, following the LEARN programme guidelines, and then monthly from weeks 13 to 32, following the instructions of the Weight Maintenance Survival Guide programme and those of the SEEDO’2000 Consensus Guide for Prevention and Treatment of Overweight and Obesity.<a class="elsevierStyleCrossRefs" href="#bib0230">17–20</a> For G2, after the initial visit, visits were scheduled after 15 days, 1 month, 3 months, 6 months and one year. In each of the visits the anthropometric data were obtained and the level of physical activity and adherence to the Mediterranean diet were reviewed using the data recorded by the patient on the digital platform. In order to determine adherence to the Mediterranean diet, this platform uses a short, specific questionnaire consisting of 14 questions validated for the Spanish population and used by the PREDIMED group (Prevention with a Mediterranean Diet),<a class="elsevierStyleCrossRefs" href="#bib0245">20–22</a> encouraging the patient to improve their level of adherence. Weight loss was recommended to G3. This weight-loss recommendation included information on 3 different aspects, with the patients being provided with self-monitoring tools. First concept: “Monitoring your weight may help you achieve your weight loss goal”. With this in mind, patients were offered the possibility of periodically recording it at the healthcare centre, with the same frequency as in the G2 group. Second concept: “Following a Mediterranean diet helps you reach an appropriate body weight and helps you maintain it”. Third concept: “Following a Mediterranean diet entails adhering to diet recommendations as well as maintaining an active lifestyle”.<a class="elsevierStyleCrossRef" href="#bib0260">23</a> Both adherence to the Mediterranean diet and physical activity can be measured using digital tools which are available to the users of which they are made aware.The anthropometric measurements were collected as follows: Weight was measured in kilograms (kg), in underwear, using a digital scale (range between 0.1 and 150kg, precision of 0.1kg), height was measured in metres (m) with the patient barefoot and using a Harpenden digital stadiometer (range 0.7–2.05m and precision of 1mm), and BMI was calculated (kg/m2). The BMI was interpreted using the SEEDO 2000 weight classification.<a class="elsevierStyleCrossRef" href="#bib0245">20</a> A BMI of between 25 and 29.9 was considered overweight and a BMI greater than or equal to 30 was considered obese. The waist circumference was measured with a flexible, inextensible metric tape with a range of between 0.1cm and 2m. The circumference was measured at the mid-point between the lower edge of the rib and the iliac crest. Blood pressure was measured using an automated and calibrated electronic device, according to the recommendations of the Spanish Society of Arterial Hypertension.<a class="elsevierStyleCrossRef" href="#bib0265">24</a> All the extractions were carried out by qualified professional who took special care in maintaining the same posture (always seated) and ensuring minimum venous stasis in the patients, for the purpose of preventing factors that could have an influence as sources of extra-analytical variation, after a fasting period of at least 12h.Statistical analysis of the data was performed with SPSS software, version 19.0. Both the quantitative and qualitative variables are expressed accordingly, i.e. average and standard deviation for the former, and precise number and percentage for the latter. The ANOVA test was used to verify that the randomisation was performed correctly between the 3 groups. If there had been any significant differences between the groups, the Bonferroni method would be applied a posteriori. To compare the averages throughout the follow-up period, a repeated measures analysis of variance was used. When the normality and sphericity criteria were not met, the non-parametric Friedman test was used. When the quantitative variables in the same group were compared at two different points in time, the differences between the averages were calculated using the Student's t-test for paired data. After the interventions, the groups were compared using clinical significance indicators, i.e. relative risk (RR), absolute risk reduction (ARR), relative risk reduction (RRR) and number needed to treat (NNT). The analysis was performed using intention to treat. Comparisons with a p value ≤0.05 were considered statistically significant.Results180 patients participated in the study, 60 of whom were randomly allocated to G1, 61 to G2, and 59 to G3. There were no drop-outs in G1 or G2 during the follow-up period, however 4 patients left G3 for personal reasons, leaving this group with 55 patients.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows how after the randomisation, there were no significant differences in any of the variables compared, both anthropometric and analytical, across the 3 groups, which indicates that the randomisation was successful. 20.92% of patients were overweight while 79.08% were classed as obese.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the average of the differences in the anthropometric measurements at the beginning and at the end of the follow-up year in each group. A significant drop was observed in all of these except for waist circumference in G3 (p=0.317) with G1 experiencing a greater reduction that the other groups. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the evolution of the BMI at the various points at which it was measured. It can be seen that in each review, the BMI progressively decreased up to 6 months, with a slight increase being observed in the following 6 months, although this reduction was greater in G1, followed by G2 and then G3. In this case, G3 presents 47 patients since 8 individuals in this group did not determine their weight or their waist circumference in the interim reviews, only at the beginning and end.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>The differences observed in the lipid parameters are expressed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, with significant differences observed in all parameters, although the reduction in TC and the increase in HDL-C are greater in G1, with the reduction of TG being similar to that of G2. The absolute figures, supplementary to <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, can be seen in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. Both the drops in TC and TG and the increase in HDL-C are modest, therefore those patients in the 3 groups who experienced a positive change in their data during the follow-up period (the TC and/or TG decreased and/or HDL-C increased) were analysed and compared to those who did not experience these changes. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> shows how a significant percentage of patients improve these parameters in the 3 interventions, with the dyslipidaemia typical of obesity (increased TG and decreased HDL-C) standing out as having changed significantly, more so in G1, and less so in the other groups. Given that this is a clinical trial, the intention was to evaluate the clinical significance indicators between the 3 groups for the change observed in both the TC and the TG and HDL-C. These indicators can be seen in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. As regards the TC, there were no significant differences among the 3 groups (the RR is excluded from the confidence interval [CI]). A comparison of G1 and G3 showed some differences in the change in TG (RR: 1.42; CI 95%: 1.11–1.80), NNT=5, but not when G2 was included, indicating that it would be necessary to treat 5 overweight or obese patients for a year with consultation in order to achieve an additional case where the TG decreased with respect to G3 (control or regular treatment group). In the case of the change from the emergence of a new case where the HDL-C increases, the NNT is 5 when comparing G1 and G2, however these changes were not significant between G1 and G3.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThis study has shown that one year after applying 3 weight-loss methods, all 3 were successful, although weight loss was more extreme in the intervention groups (G1 and G2) than in the control group. Meanwhile, without any other kind of intervention, it was observed that the majority of patients with dyslipidaemia linked to obesity progressed positively (decrease in TC and TG and increase in HDL-C) and a small number did not, although the average values decreased significantly, with these values being greatest in the group who experienced the greatest weight loss, which is in line with these results. In other words, weight loss results in a positive change in the lipid parameters linked to obesity and this change is more extreme the more weight is lost. On average, this was based on a population with TC and TG above the optimum cut-off values (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) and the changes observed were equally greater in the intervention groups (G1 and G2) than in the recognised control group (G3). Given that the changes in weight were modest, but still significant, small changes in the lipid parameters may also be expected, however it is possible that there will be no change. For this reason it was considered necessary to evaluate the number of patients who improved their lipid profile after one year using clinical significance indicators and to compare them across the 3 groups. In doing so, it was observed that, on average, there were significant positive changes after one year in all the groups, except with regard to TG in G3 (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). On examining the clinical significance indicators, there were no significant differences in the percentage of patients who improved their lipid profile across the 3 groups (non-significant RR), however, there were differences when comparing changes in TG between G1 and G3 (RR: 1.42; 95% CI: 1.11–1.80; NNT=5), in line with the weight loss observed in G1. Similarly, the G1 group showed a greater percentage of change in HDL-C compared with G2 (RR: 1.32; 95% CI: 1.07–1.63; NNT=5). Therefore, weight loss after one year of follow-up is accompanied by a decrease in the level of TG and an increase in HDL-C in the group who were subject to motivational intervention with a nurse (G1), with this method being considered the best for reducing weight and improving dyslipidaemia linked to obesity. Our results coincide with those presented in the study by Vetter et al.,<a class="elsevierStyleCrossRef" href="#bib0270">25</a> who also observed a significant increase in HDL-C and a substantial decrease in TG in the most intensive intervention.Obesity is the most prevalent metabolic disease in developed countries<a class="elsevierStyleCrossRef" href="#bib0240">19</a> and it results in significant cardiovascular and overall mortality rates, whether directly or due to its link to multiple cardiovascular risk factors.<a class="elsevierStyleCrossRef" href="#bib0230">17</a> Various studies have demonstrated this relationship between obesity and cardiovascular disease and it has been estimated that 20–30% of the global cardiovascular mortality rate is attributable to excess body weight.<a class="elsevierStyleCrossRefs" href="#bib0250">21,22,26–28</a> Hence, the search for effective weight loss methods must become a priority. Our group presents two of these, which have proven to be effective for weight loss after one year of follow-up, accompanied by an improvement in dyslipidaemia linked to obesity (TG and HDL-C, with a smaller change in TC).<a class="elsevierStyleCrossRef" href="#bib0290">29</a>In our study we can see how the groups with the greatest weight loss also have the greatest reduction in TG and increase in HDL-C, which are not proportional to the drop in TC, which confirms that the lipid parameters most associated with obesity are TG and HDL-C.Strengths and limitationsThe main strength is that the 3 methods used to reduce weight are compared through a double-blind, randomised clinical trial, thereby reducing systematic errors and thus being able to allocate the effects measured in the intervention. Expressing the results as clinical significance indicators is clearer and helps the clinic to make decisions. With respect to the limitations, the 4 drop-outs mentioned belonged to the same group, representing 6.8%, however this was not considered to have invalidated the results. It could be argued that the motivational group intervention performed in G1 and the use of a digital platform in G2 offered sufficient novel means of participation, which may have played a part in the fact that there were no drop-outs in these 2 groups.ConclusionsTo conclude, we can confirm that G1, with intensive, permanent treatment, presents better results than G2 and G3, although telemedicine opens up an interesting opportunity; the use of new information technologies in the field of healthcare (already accessible for almost all patients), which may produce some inferior clinical results but which are much more cost effective, could be a great help, particularly in primary care consultations.Ethical responsibilitiesProtection of people and animalsThe authors declare that no experiments were conducted on human beings or animals for this research.Confidentiality of dataThe authors declare that they have followed the protocols of their work site regarding the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data is contained in this article.Conflicts of interestNo conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres852177" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec846737" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres852178" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec846736" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Interventions" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Strengths and limitations" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 11 => array:3 [ "identificador" => "sec0040" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Right to privacy and informed consent" ] ] ] 12 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-22" "fechaAceptado" => "2017-01-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec846737" "palabras" => array:6 [ 0 => "Cholesterol" 1 => "Triglycerides" 2 => "Obesity" 3 => "Telemedicine" 4 => "Motivational intervention" 5 => "Primary care" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec846736" "palabras" => array:6 [ 0 => "Colesterol" 1 => "Triglicéridos" 2 => "Obesidad" 3 => "Telemedicina" 4 => "Intervención motivacional" 5 => "Atencion primaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo assess the effect on lipid parameters most associated with excess weight (triglycerides [TG], cholesterol, and high density lipoprotein [HDL-C]) of an intervention to reduce weight in overweight and obese patients. MethodsA randomised, controlled, double blind clinical trial, with three groups, and a follow-up of 12 months.Patients included in the study were randomised into three intervention groups: Obesity motivational intervention group with previously trained nurse (G1), lower intensity consultation, non-motivational group, with digital platform support (G2), and a third group that received a recommendation to lose weight and usual follow-up (G3). The anthropometric variables measured were height, weight, and abdominal/waist circumference, and laboratory results, total cholesterol, TG and HDL cholesterol). ResultsThe study includes 176 patients, of whom 60 were randomised to G1, 61 to G2, and 59 to G3. All groups significantly decreased body weight at the end of the study, with a decrease in G1 (−5.6kg), followed by G2 (−4.3kg), and G3 (−1.7kg), with an overall mean loss of −3.9kg. There was also a significant decrease (p<0.05) in total cholesterol and TG, and an increased HDL-C. These changes were more marked in the G1 group (the group that lost more weight). The clinical relevance indicators that were significant were: in the case of TG: G1/G3: relative risk: 1.42 (95% CI: 1.11–1.80); relative risk reduction: 41.7% (11.4–80.2); absolute risk reduction: 25% (9.2–40.8) and NNT: 5 (3–11). In the case of G1/G2 HDL-C: relative risk: 1.32 (1.07–1.63); relative risk reduction: 32.2% (7.4–62.6); absolute risk reduction: 21.1% (6.4–35.8) and NNT: 5 (3–16). ConclusionsWeight reduction is accompanied by favourable changes in the lipid parameters related to overweight and obesity, being more intense the greater the weight loss." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoValorar el efecto sobre los parámetros lipídicos más relacionados con el exceso de peso (triglicéridos [TG] y colesterol de las lipoproteínas de alta densidad [cHDL]) de una intervención para reducir peso en pacientes con sobrepeso y obesidad. MétodosEnsayo clínico, aleatorizado y controlado, doble ciego, con 3 brazos y un seguimiento de 12 meses.Los pacientes incluidos en el estudio fueron aleatorizados en 3 grupos de intervención: Intervención motivacional de obesidad con enfermera entrenada previamente (G1), intervención en consulta de menor intensidad, sin grupo motivacional, con apoyo de plataforma digital (G2) y un tercer grupo que recibía recomendación de perder peso y seguimiento habitual (G3). Las variables antropométricas medidas fueron estatura, peso y perímetro de cintura abdominal y las analíticas, colesterol total, TG y cHDL). ResultadosHan participado en el estudio 176 pacientes de los que 60 fueron aleatorizados al G1, 61 al G2 y 59 al G3. Todos los grupos disminuyeron significativamente el peso al final del estudio, siendo más intensa la disminución en el G1 (−5,6kg), seguido del G2 (−4,3kg) y del G3 (−1,7kg), media en su conjunto: −3,9kg. También todos los grupos disminuyeron significativamente (p<0,05) el colesterol total y los TG y aumentaron el cHDL, siendo estos cambios más intensos en el grupo G1, el grupo que más peso perdió. Los indicadores de relevancia clínica que resultaron significativos fueron: en el caso de los TG: G1/G3: riesgo relativo: 1,42 (IC 95%: 1,11-1,80); reducción relativa del riesgo: 41,7% (11,4-80,2); reducción absoluta del riesgo: 25% (9,2-40,8) y NNT: 5 (3-11). En el caso del cHDL G1/G2: riesgo relativo: 1,32 (1,07-1,63); reducción relativa del riesgo: 32,2% (7,4-62,6); reducción absoluta del riesgo: 21,1% (6,4-35,8) y NNT: 5 (3-16). ConclusionesLa reducción de peso se acompaña de cambios favorables en los parámetros lipídicos relacionados con el sobrepeso y la obesidad, siendo más intensos cuanto mayor es la pérdida de peso." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Tárraga Marcos ML, Panisello Royo JM, Carbayo Herencia JA, Rosich Domenech N, Alins Presas J, Tárraga López PJ. Efecto sobre los parámetros lipídicos de una intervención para reducir peso en pacientes con sobrepeso y obesidad. Clin Invest Arterioscler. 2017;29:103–110." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1310 "Ancho" => 1639 "Tamanyo" => 130042 ] ] "descripcion" => array:1 [ "en" => "Evolution of body mass index in the 3 intervention groups. G1: consultation group; G2: telemedicine group; G3: group recommended to lose weight. The p value for each of the 3 groups was calculated using the Friedman test, with the same value being obtained for all 3 (p<0.001)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1130 "Ancho" => 2320 "Tamanyo" => 117633 ] ] "descripcion" => array:1 [ "en" => "Evolution of the analytical parameters at the beginning and end of the study. HDL-C: cholesterol and high-density lipoproteins; TC: total cholesterol; TG: triglycerides; G1 (n=60): consultation with motivational intervention; G2 (I=61): lower intensity consultation+telemedicine; G3 (n=55): recommendation to lose weight following regular treatment with consultation. The averages at the beginning and after the 12-month follow-up period were compared using the Student's t-test for paired data (p<0.05 in all the groups except for the TG in G3 [p=0.710]). The exact significance value can be seen in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 966 "Ancho" => 1627 "Tamanyo" => 65971 ] ] "descripcion" => array:1 [ "en" => "Percentage of patients whose TC and TG decreased and whose HDL-C increased after a 12-month follow-up period. HDL-C: cholesterol and high-density lipoproteins; TC: total cholesterol; TG: triglycerides. G1: consultation group; G2: consultation+telemedicine group; G3: group recommended to lose weight. Significant differences (Chi-square test) in TG (p=0.008) and in HDL-C (p=0.025) were observed between the 3 groups, but not in TC (p=0.653)." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "cm: centimetres; G1: consultation group; G2: consultation+telemedicine group; G3: group recommended to lose weight; BMI: body mass index; kg: kilograms; kg/m2: kilograms divided by height in metres squared; mg/dL: milligrams per decilitre.The results are expressed as an average and (standard deviation) or as a precise number and (percentage).The averages were compared using path variance analysis and the proportions were compared using the Chi-square test." "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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G1 (n=60) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G2 (n=61) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G3 (n=55) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female (n; %) Male (n; %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (33.3) 26 (35.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (34.3) 26 (35.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (32.4) 22 (29.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"> 0.931 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.1 (7.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.7 (6.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.8 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.946 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86.1 (13.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88.2 (14.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84.4 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.329 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.3 (3.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.8 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.7 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.735 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Waist circumference (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85 (9.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85.2 (9.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">87.7 (7.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.202 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total cholesterol (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">246.8 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">242.1 (38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">250.3 (25.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.366 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triglycerides (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">172.6 (62.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">172.3 (72.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">157.2 (70.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.400 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDL-C (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.8 (12.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.1 (11.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45.7 (9.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.147 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1438611.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline sample data by group." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "cm: centimetres; G1: consultation group; G2: consultation+telemedicine group; G3: group recommended to lose weight; BMI: body mass index; kg: kilograms; kg/m2: kilograms divided by height in metres squared. WC: waist circumference.The averages were compared using the Student's t-test for paired groups." "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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in weight (kg) Final−Initial \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in BMI (kg/m2) Final−Initial \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in WC (cm) Final−Initial \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G1 (n=60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−5.6 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.0 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.6 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G2 (n=61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−4.3 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.5 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.5 (5.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G3 (n=55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.7 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.6 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.7 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.317 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total (n=176) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.9 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.4 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.7 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1438612.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Decrease in weight, body mass index and waist circumference between the initial and final evaluation." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "HDL-C: cholesterol and high-density lipoproteins; TC: total cholesterol; G1: consultation group; G2: consultation group+telemedicine; G3: group recommended to lose weight; TG: triglycerides.The averages were compared using the Student's t-test for paired data." "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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in TC (mg/dL) Final−Initial \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in TG (mg/dL) Final−Initial \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in HDL-C (mg/dL) Final−Initial \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G1 (n=60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−10.1 (24.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−19.0 (32.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G2 (n=61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−4.7 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.027 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−19.2 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G3 (n=55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−6.3 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.4 (28.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.710 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total (n=176) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−7 (19.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−13.6 (38.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1438613.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Decrease in total cholesterol and triglycerides, and increase in high-density lipoprotein cholesterol between the initial and final evaluation." ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "HDL-C: cholesterol and high-density lipoproteins; TC: total cholesterol; CI: confidence interval; NNT: number needed to treat; ARR: absolute risk reduction; RR: relative risk; RRR: relative risk reduction; TG: triglycerides; TM: telemedicine.The analysis was performed using intention to treat." "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comparison groups \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative risk (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RRR (95% CI) (in %) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ARR (95% CI) (in %) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NNT (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Clinical significance indicators relating to the number of patients who managed to decrease TC after a one-year follow-up period</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation/control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10 (0.89 to 1.37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.5 (−10.9 to 37.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.4 (−8.5 to 23.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (5 to −12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation+TM/control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.04 (0.83 to 1.30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 (−17.0 to 30.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9 (−13.4 to 19.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (6 to −8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation/consultation+TM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.06 (0.87 to 1.30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2 (−13.1 to 29.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6 (−10.6 to 19.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (6 to −10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Clinical significance indicators relating to the number of patients who managed to decrease TG after a one-year follow-up period</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation/control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.42 (1.11 to 1.80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.7 (11.4 to 80.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.0 (9.2 to 40.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3 to 11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation+TM/control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.28 (0.99 to 1.66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.4 (−0.5 to 65.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.0 (0.3 to 33.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3 to 334) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation/consultation+TM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10 (0.93 to 1.31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.3 (−7.2 to 31.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0 (−5.9 to 21.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (5 to −17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Clinical significance indicators relating to the number of patients who managed to increase HDL-C after a one-year follow-up period</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation/control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.13 (0.95 to 1.36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.5 (−5.0 to 35.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.3 (−3.8 to 24.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5 to −27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation+TM/control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86 (0.68 to 1.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−14.1 (−32.0 to 8.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−10.8 (−27.2 to 5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−10 (18 to −4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation/consultation+TM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.32 (1.07 to 1.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.2 (7.4 to 62.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.1 (6.4 to 35.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3 to 16) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1438610.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical significance indicators across the 3 groups for the change observed in both the TC and the TG and HDL-C." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between serum triglycerides and skinfold thickness in obese subjects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.J. 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Original article

Effect on the lipid parameters of an intervention to reduce weight in overweight and obese patients

Efecto sobre los parámetros lipídicos de una intervención para reducir peso en pacientes con sobrepeso y obesidad

M. Loreto Tárraga Marcosa, Josefa María Panisello Royob, Julio A. Carbayo Herenciac, Nuria Rosich Domenechd, Josep Alins Presase, Pedro J. Tárraga Lópezf,

Corresponding author

pjtarraga@sescam.jccm.es

Corresponding author.

a Residencia geriátrica Los Álamos, Albacete, Spain

b Medicina Interna, Fundación Fomento de la Salud (Fufosa), Barcelona, Spain

c Unidad Lípidos, Clínica Quirón Salud, Albacete, Spain

d Nutricionista, Fundación Fomento de la Salud (Fufosa), Barcelona, Spain

e ABS ABRERA, Barcelona, Spain

f Facultad de Medicina de Albacete, Universidad Castilla la Mancha, Albacete, Spain

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obesity and dyslipidaemia are frequently linked&#59; therefore&#44; it is very likely that there will be a dyslipidaemia phenotype when the body mass index is between 25&#46;2 and 26&#46;6<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; as corroborated by numerous studies&#44; among which is the United States National Health and Nutrition Examination Survey &#40;NHANES&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4&#8211;6</span></a> The separate reports on dyslipidaemia in men and women and in different ethnic groups reflect a common dyslipidaemia pattern&#58; the significant increase in the real quantity of triglycerides &#40;TG&#41; &#40;mainly very low density lipoproteins&#44; total cholesterol and low HDL-C&#41;&#46; The NHANES data has shown that the levels of total cholesterol &#40;TC&#41; are greater in young obese men and women than in non-obese people&#46; The NHANES III study has also demonstrated that in patients with metabolic syndrome the rates of obesity&#44; hypertriglyceridaemia and hypercholesterolaemia are greater than 75&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4&#8211;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It is well-known that treatment for dyslipidaemia&#44; both in overweight and obese patients&#44; must start with weight loss&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;10</span></a> Accordingly&#44; the interventions that are focused on changing dietary habits and increasing daily physical activity for the purposes of promoting a healthy lifestyle are the best options for tackling this problem&#59; not forgetting that other interventions such as cognitive-behavioural therapy have proven useful when included in overweight and obesity programmes for the purpose of improving their effectiveness and helping maintain the results obtained&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Furthermore&#44; regarding the effectiveness of these interventions to reduce weight&#44; the evidence has shown satisfactory results&#44; with reductions of between 8&#37; and 10&#37; of the initial weight being achieved&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11&#44;12</span></a> However&#44; when considering the maintenance of the weight loss over time&#44; the results obtained are not so encouraging&#46; Scientific evidence shows weight regain in between 30&#8211;35&#37; of patients during the first year following the end of the intervention&#46; Over a five-year follow-up period&#44; the regain is more than 50&#37; of the weight lost with regard to the first evaluation phase&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Our group designed a motivational group intervention for obese patients&#44; conducted by a nurse who had previously been trained by psychological experts&#44; combined with their routine treatment and with a 2-year follow-up period&#46; The results were then published&#44; with 36&#37; of patients achieving weight loss &#8805;5&#37;&#46; This intervention was subsequently replicated in another region of Spain with the same results&#46; As previously stated&#44; an hour-long motivational group intervention every two weeks from weeks 1 to 12&#44; following the Lifestyle&#44; Exercise&#44; Attitudes&#44; Relationships&#44; Nutrition &#40;LEARN&#41;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">14&#8211;16</span></a> programme guidelines&#44; and then monthly from weeks 13 to 32&#44; following the instructions of the Weight Maintenance Survival Guide programme was added to routine treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> With this protocol&#44; the losses were in the first study and in the second study&#46; Although the results were highly satisfactory&#44; the protocol added a cost of 32<span class="elsevierStyleHsp" style=""></span>h more for every 10 patients&#44; i&#46;e&#46; 3&#46;2<span class="elsevierStyleHsp" style=""></span>h per patient per year&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In fact&#44; all the interventions that have proved to be useful need to be intensive&#44; well-structured&#44; and cover multiple aspects&#44; which involves a significant investment in temporary and human resources&#44; of which there is no surplus in our healthcare system rather&#44; there is a lack of these resources&#46; It is for this reason that we need to find strategies that allow for effective approaches&#44; in both the short term and the medium and long term&#44; which consume less resources&#44; allowing us to treat a greater number of people &#40;a larger population&#41;&#46; Furthermore&#44; communication and information technologies&#44; and specifically the Internet&#44; are emerging as a new strategy&#59; these technologies have different potentialities&#44; capable of tackling the limitations of traditional programmes&#44; not only for the purpose of losing weight&#44; but also for maintaining the results obtained once the intervention has ended&#46; Communication technologies&#44; which are available to a large part of the population&#44; can be accessed from home or in other contexts&#44; thereby enabling treatment using an intervention method that is better suited to their personal needs and which reduces the costs associated with traditional protocols&#46; Furthermore&#44; these technologies would improve adherence to both diet and treatments for concomitant illnesses&#44;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;18</span></a> also having demonstrated their usefulness in the approach to excess weight and obesity&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Therefore&#44; the main objective of this study was to evaluate the evolution of the main lipid parameters related to weight gain &#40;TC&#44; TG and HDL-C&#41;&#44; through a clinical trial designed to reduce weight gain&#44; and to evaluate the effectiveness of these interventions according to the number of patients who reduce both their TC and TG and increase their HDL-C after one year of follow-up&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">The study is designed as a randomised&#44; double-blind&#44; controlled&#44; 3-arm clinical trial monitored over 12 months with a 1&#58;1&#58;1 allocation ratio&#46; The inclusion criteria were as follows&#58; present a BMI greater than 24&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> and less than 40<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> on the occupational health report and the patients&#44; both male and female&#44; must be between 30 and 70 years old&#46; The exclusion criteria were as follows&#58; patients with severe illnesses &#40;bed-ridden&#44; affected by neoplasia&#44; cognitive disorders&#44; etc&#46;&#41;&#44; patients with secondary obesity &#40;hypothyroidism&#44; Cushing&#39;s disease&#44; etc&#46;&#41;&#44; patients with severe sensory illnesses that interfere with motivational intervention such as uncorrected visual or auditory impairments&#44; etc&#46;&#44; and patients with severe psychiatric illnesses&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The data was collected between March 2015 and June 2016 in 3 basic health areas in Barcelona&#46; The patients included in the study signed an informed consent form approved by the regional ethics committee&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Interventions</span><p id="par0050" class="elsevierStylePara elsevierViewall">The patients were randomly sorted into 3 intervention groups&#58; motivational obesity intervention with a previously trained nurse &#40;G1&#41;&#44; lower intensity consultation intervention&#44; with no motivational group&#44; and with digital platform support &#40;G2&#41;&#44; and a third group who were recommended to lose weight and regularly monitor weight loss &#40;G3&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The protocol applied in G1 followed the previously published IMOAP method&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;16</span></a> In short&#44; this consisted of an hour-long motivational group intervention every two weeks from weeks 1 to 12&#44; following the LEARN programme guidelines&#44; and then monthly from weeks 13 to 32&#44; following the instructions of the Weight Maintenance Survival Guide programme and those of the SEEDO&#8217;2000 Consensus Guide for Prevention and Treatment of Overweight and Obesity&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#8211;20</span></a> For G2&#44; after the initial visit&#44; visits were scheduled after 15 days&#44; 1 month&#44; 3 months&#44; 6 months and one year&#46; In each of the visits the anthropometric data were obtained and the level of physical activity and adherence to the Mediterranean diet were reviewed using the data recorded by the patient on the digital platform&#46; In order to determine adherence to the Mediterranean diet&#44; this platform uses a short&#44; specific questionnaire consisting of 14 questions validated for the Spanish population and used by the PREDIMED group &#40;Prevention with a Mediterranean Diet&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">20&#8211;22</span></a> encouraging the patient to improve their level of adherence&#46; Weight loss was recommended to G3&#46; This weight-loss recommendation included information on 3 different aspects&#44; with the patients being provided with self-monitoring tools&#46; First concept&#58; &#8220;Monitoring your weight may help you achieve your weight loss goal&#8221;&#46; With this in mind&#44; patients were offered the possibility of periodically recording it at the healthcare centre&#44; with the same frequency as in the G2 group&#46; Second concept&#58; &#8220;Following a Mediterranean diet helps you reach an appropriate body weight and helps you maintain it&#8221;&#46; Third concept&#58; &#8220;Following a Mediterranean diet entails adhering to diet recommendations as well as maintaining an active lifestyle&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Both adherence to the Mediterranean diet and physical activity can be measured using digital tools which are available to the users of which they are made aware&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The anthropometric measurements were collected as follows&#58; Weight was measured in kilograms &#40;kg&#41;&#44; in underwear&#44; using a digital scale &#40;range between 0&#46;1 and 150<span class="elsevierStyleHsp" style=""></span>kg&#44; precision of 0&#46;1<span class="elsevierStyleHsp" style=""></span>kg&#41;&#44; height was measured in metres &#40;m&#41; with the patient barefoot and using a Harpenden digital stadiometer &#40;range 0&#46;7&#8211;2&#46;05<span class="elsevierStyleHsp" style=""></span>m and precision of 1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; and BMI was calculated &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; The BMI was interpreted using the SEEDO 2000 weight classification&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> A BMI of between 25 and 29&#46;9 was considered overweight and a BMI greater than or equal to 30 was considered obese&#46; The waist circumference was measured with a flexible&#44; inextensible metric tape with a range of between 0&#46;1<span class="elsevierStyleHsp" style=""></span>cm and 2<span class="elsevierStyleHsp" style=""></span>m&#46; The circumference was measured at the mid-point between the lower edge of the rib and the iliac crest&#46; Blood pressure was measured using an automated and calibrated electronic device&#44; according to the recommendations of the Spanish Society of Arterial Hypertension&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> All the extractions were carried out by qualified professional who took special care in maintaining the same posture &#40;always seated&#41; and ensuring minimum venous stasis in the patients&#44; for the purpose of preventing factors that could have an influence as sources of extra-analytical variation&#44; after a fasting period of at least 12<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Statistical analysis of the data was performed with SPSS software&#44; version 19&#46;0&#46; Both the quantitative and qualitative variables are expressed accordingly&#44; i&#46;e&#46; average and standard deviation for the former&#44; and precise number and percentage for the latter&#46; The ANOVA test was used to verify that the randomisation was performed correctly between the 3 groups&#46; If there had been any significant differences between the groups&#44; the Bonferroni method would be applied a posteriori&#46; To compare the averages throughout the follow-up period&#44; a repeated measures analysis of variance was used&#46; When the normality and sphericity criteria were not met&#44; the non-parametric Friedman test was used&#46; When the quantitative variables in the same group were compared at two different points in time&#44; the differences between the averages were calculated using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired data&#46; After the interventions&#44; the groups were compared using clinical significance indicators&#44; i&#46;e&#46; relative risk &#40;RR&#41;&#44; absolute risk reduction &#40;ARR&#41;&#44; relative risk reduction &#40;RRR&#41; and number needed to treat &#40;NNT&#41;&#46; The analysis was performed using intention to treat&#46; Comparisons with a <span class="elsevierStyleItalic">p</span> value &#8804;0&#46;05 were considered statistically significant&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">180 patients participated in the study&#44; 60 of whom were randomly allocated to G1&#44; 61 to G2&#44; and 59 to G3&#46; There were no drop-outs in G1 or G2 during the follow-up period&#44; however 4 patients left G3 for personal reasons&#44; leaving this group with 55 patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows how after the randomisation&#44; there were no significant differences in any of the variables compared&#44; both anthropometric and analytical&#44; across the 3 groups&#44; which indicates that the randomisation was successful&#46; 20&#46;92&#37; of patients were overweight while 79&#46;08&#37; were classed as obese&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the average of the differences in the anthropometric measurements at the beginning and at the end of the follow-up year in each group&#46; A significant drop was observed in all of these except for waist circumference in G3 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;317&#41; with G1 experiencing a greater reduction that the other groups&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the evolution of the BMI at the various points at which it was measured&#46; It can be seen that in each review&#44; the BMI progressively decreased up to 6 months&#44; with a slight increase being observed in the following 6 months&#44; although this reduction was greater in G1&#44; followed by G2 and then G3&#46; In this case&#44; G3 presents 47 patients since 8 individuals in this group did not determine their weight or their waist circumference in the interim reviews&#44; only at the beginning and end&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The differences observed in the lipid parameters are expressed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; with significant differences observed in all parameters&#44; although the reduction in TC and the increase in HDL-C are greater in G1&#44; with the reduction of TG being similar to that of G2&#46; The absolute figures&#44; supplementary to <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; can be seen in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; Both the drops in TC and TG and the increase in HDL-C are modest&#44; therefore those patients in the 3 groups who experienced a positive change in their data during the follow-up period &#40;the TC and&#47;or TG decreased and&#47;or HDL-C increased&#41; were analysed and compared to those who did not experience these changes&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows how a significant percentage of patients improve these parameters in the 3 interventions&#44; with the dyslipidaemia typical of obesity &#40;increased TG and decreased HDL-C&#41; standing out as having changed significantly&#44; more so in G1&#44; and less so in the other groups&#46; Given that this is a clinical trial&#44; the intention was to evaluate the clinical significance indicators between the 3 groups for the change observed in both the TC and the TG and HDL-C&#46; These indicators can be seen in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; As regards the TC&#44; there were no significant differences among the 3 groups &#40;the RR is excluded from the confidence interval &#91;CI&#93;&#41;&#46; A comparison of G1 and G3 showed some differences in the change in TG &#40;RR&#58; 1&#46;42&#59; CI 95&#37;&#58; 1&#46;11&#8211;1&#46;80&#41;&#44; NNT<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44; but not when G2 was included&#44; indicating that it would be necessary to treat 5 overweight or obese patients for a year with consultation in order to achieve an additional case where the TG decreased with respect to G3 &#40;control or regular treatment group&#41;&#46; In the case of the change from the emergence of a new case where the HDL-C increases&#44; the NNT is 5 when comparing G1 and G2&#44; however these changes were not significant between G1 and G3&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">This study has shown that one year after applying 3 weight-loss methods&#44; all 3 were successful&#44; although weight loss was more extreme in the intervention groups &#40;G1 and G2&#41; than in the control group&#46; Meanwhile&#44; without any other kind of intervention&#44; it was observed that the majority of patients with dyslipidaemia linked to obesity progressed positively &#40;decrease in TC and TG and increase in HDL-C&#41; and a small number did not&#44; although the average values decreased significantly&#44; with these values being greatest in the group who experienced the greatest weight loss&#44; which is in line with these results&#46; In other words&#44; weight loss results in a positive change in the lipid parameters linked to obesity and this change is more extreme the more weight is lost&#46; On average&#44; this was based on a population with TC and TG above the optimum cut-off values &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; and the changes observed were equally greater in the intervention groups &#40;G1 and G2&#41; than in the recognised control group &#40;G3&#41;&#46; Given that the changes in weight were modest&#44; but still significant&#44; small changes in the lipid parameters may also be expected&#44; however it is possible that there will be no change&#46; For this reason it was considered necessary to evaluate the number of patients who improved their lipid profile after one year using clinical significance indicators and to compare them across the 3 groups&#46; In doing so&#44; it was observed that&#44; on average&#44; there were significant positive changes after one year in all the groups&#44; except with regard to TG in G3 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; On examining the clinical significance indicators&#44; there were no significant differences in the percentage of patients who improved their lipid profile across the 3 groups &#40;non-significant RR&#41;&#44; however&#44; there were differences when comparing changes in TG between G1 and G3 &#40;RR&#58; 1&#46;42&#59; 95&#37; CI&#58; 1&#46;11&#8211;1&#46;80&#59; NNT<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; in line with the weight loss observed in G1&#46; Similarly&#44; the G1 group showed a greater percentage of change in HDL-C compared with G2 &#40;RR&#58; 1&#46;32&#59; 95&#37; CI&#58; 1&#46;07&#8211;1&#46;63&#59; NNT<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#46; Therefore&#44; weight loss after one year of follow-up is accompanied by a decrease in the level of TG and an increase in HDL-C in the group who were subject to motivational intervention with a nurse &#40;G1&#41;&#44; with this method being considered the best for reducing weight and improving dyslipidaemia linked to obesity&#46; Our results coincide with those presented in the study by Vetter et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> who also observed a significant increase in HDL-C and a substantial decrease in TG in the most intensive intervention&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Obesity is the most prevalent metabolic disease in developed countries<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> and it results in significant cardiovascular and overall mortality rates&#44; whether directly or due to its link to multiple cardiovascular risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> Various studies have demonstrated this relationship between obesity and cardiovascular disease and it has been estimated that 20&#8211;30&#37; of the global cardiovascular mortality rate is attributable to excess body weight&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">21&#44;22&#44;26&#8211;28</span></a> Hence&#44; the search for effective weight loss methods must become a priority&#46; Our group presents two of these&#44; which have proven to be effective for weight loss after one year of follow-up&#44; accompanied by an improvement in dyslipidaemia linked to obesity &#40;TG and HDL-C&#44; with a smaller change in TC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In our study we can see how the groups with the greatest weight loss also have the greatest reduction in TG and increase in HDL-C&#44; which are not proportional to the drop in TC&#44; which confirms that the lipid parameters most associated with obesity are TG and HDL-C&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Strengths and limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">The main strength is that the 3 methods used to reduce weight are compared through a double-blind&#44; randomised clinical trial&#44; thereby reducing systematic errors and thus being able to allocate the effects measured in the intervention&#46; Expressing the results as clinical significance indicators is clearer and helps the clinic to make decisions&#46; With respect to the limitations&#44; the 4 drop-outs mentioned belonged to the same group&#44; representing 6&#46;8&#37;&#44; however this was not considered to have invalidated the results&#46; It could be argued that the motivational group intervention performed in G1 and the use of a digital platform in G2 offered sufficient novel means of participation&#44; which may have played a part in the fact that there were no drop-outs in these 2 groups&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">To conclude&#44; we can confirm that G1&#44; with intensive&#44; permanent treatment&#44; presents better results than G2 and G3&#44; although telemedicine opens up an interesting opportunity&#59; the use of new information technologies in the field of healthcare &#40;already accessible for almost all patients&#41;&#44; which may produce some inferior clinical results but which are much more cost effective&#44; could be a great help&#44; particularly in primary care consultations&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical responsibilities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of people and animals</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were conducted on human beings or animals for this research&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work site regarding the publication of patient data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no patient data is contained in this article&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">No conflict of interest&#46;</p></span></span>"
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              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        12 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicts of interest"
        ]
        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-08-22"
    "fechaAceptado" => "2017-01-03"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec846737"
          "palabras" => array:6 [
            0 => "Cholesterol"
            1 => "Triglycerides"
            2 => "Obesity"
            3 => "Telemedicine"
            4 => "Motivational intervention"
            5 => "Primary care"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec846736"
          "palabras" => array:6 [
            0 => "Colesterol"
            1 => "Triglic&#233;ridos"
            2 => "Obesidad"
            3 => "Telemedicina"
            4 => "Intervenci&#243;n motivacional"
            5 => "Atencion primaria"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the effect on lipid parameters most associated with excess weight &#40;triglycerides &#91;TG&#93;&#44; cholesterol&#44; and high density lipoprotein &#91;HDL-C&#93;&#41; of an intervention to reduce weight in overweight and obese patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A randomised&#44; controlled&#44; double blind clinical trial&#44; with three groups&#44; and a follow-up of 12 months&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients included in the study were randomised into three intervention groups&#58; Obesity motivational intervention group with previously trained nurse &#40;G1&#41;&#44; lower intensity consultation&#44; non-motivational group&#44; with digital platform support &#40;G2&#41;&#44; and a third group that received a recommendation to lose weight and usual follow-up &#40;G3&#41;&#46; The anthropometric variables measured were height&#44; weight&#44; and abdominal&#47;waist circumference&#44; and laboratory results&#44; total cholesterol&#44; TG and HDL cholesterol&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The study includes 176 patients&#44; of whom 60 were randomised to G1&#44; 61 to G2&#44; and 59 to G3&#46; All groups significantly decreased body weight at the end of the study&#44; with a decrease in G1 &#40;&#8722;5&#46;6<span class="elsevierStyleHsp" style=""></span>kg&#41;&#44; followed by G2 &#40;&#8722;4&#46;3<span class="elsevierStyleHsp" style=""></span>kg&#41;&#44; and G3 &#40;&#8722;1&#46;7<span class="elsevierStyleHsp" style=""></span>kg&#41;&#44; with an overall mean loss of &#8722;3&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#46; There was also a significant decrease &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; in total cholesterol and TG&#44; and an increased HDL-C&#46; These changes were more marked in the G1 group &#40;the group that lost more weight&#41;&#46; The clinical relevance indicators that were significant were&#58; in the case of TG&#58; G1&#47;G3&#58; relative risk&#58; 1&#46;42 &#40;95&#37; CI&#58; 1&#46;11&#8211;1&#46;80&#41;&#59; relative risk reduction&#58; 41&#46;7&#37; &#40;11&#46;4&#8211;80&#46;2&#41;&#59; absolute risk reduction&#58; 25&#37; &#40;9&#46;2&#8211;40&#46;8&#41; and NNT&#58; 5 &#40;3&#8211;11&#41;&#46; In the case of G1&#47;G2 HDL-C&#58; relative risk&#58; 1&#46;32 &#40;1&#46;07&#8211;1&#46;63&#41;&#59; relative risk reduction&#58; 32&#46;2&#37; &#40;7&#46;4&#8211;62&#46;6&#41;&#59; absolute risk reduction&#58; 21&#46;1&#37; &#40;6&#46;4&#8211;35&#46;8&#41; and NNT&#58; 5 &#40;3&#8211;16&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Weight reduction is accompanied by favourable changes in the lipid parameters related to overweight and obesity&#44; being more intense the greater the weight loss&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Valorar el efecto sobre los par&#225;metros lip&#237;dicos m&#225;s relacionados con el exceso de peso &#40;triglic&#233;ridos &#91;TG&#93; y colesterol de las lipoprote&#237;nas de alta densidad &#91;cHDL&#93;&#41; de una intervenci&#243;n para reducir peso en pacientes con sobrepeso y obesidad&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ensayo cl&#237;nico&#44; aleatorizado y controlado&#44; doble ciego&#44; con 3 brazos y un seguimiento de 12 meses&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los pacientes incluidos en el estudio fueron aleatorizados en 3 grupos de intervenci&#243;n&#58; Intervenci&#243;n motivacional de obesidad con enfermera entrenada previamente &#40;G1&#41;&#44; intervenci&#243;n en consulta de menor intensidad&#44; sin grupo motivacional&#44; con apoyo de plataforma digital &#40;G2&#41; y un tercer grupo que recib&#237;a recomendaci&#243;n de perder peso y seguimiento habitual &#40;G3&#41;&#46; Las variables antropom&#233;tricas medidas fueron estatura&#44; peso y per&#237;metro de cintura abdominal y las anal&#237;ticas&#44; colesterol total&#44; TG y cHDL&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Han participado en el estudio 176 pacientes de los que 60 fueron aleatorizados al G1&#44; 61 al G2 y 59 al G3&#46; Todos los grupos disminuyeron significativamente el peso al final del estudio&#44; siendo m&#225;s intensa la disminuci&#243;n en el G1 &#40;&#8722;5&#44;6<span class="elsevierStyleHsp" style=""></span>kg&#41;&#44; seguido del G2 &#40;&#8722;4&#44;3<span class="elsevierStyleHsp" style=""></span>kg&#41; y del G3 &#40;&#8722;1&#44;7<span class="elsevierStyleHsp" style=""></span>kg&#41;&#44; media en su conjunto&#58; &#8722;3&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#46; Tambi&#233;n todos los grupos disminuyeron significativamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; el colesterol total y los TG y aumentaron el cHDL&#44; siendo estos cambios m&#225;s intensos en el grupo G1&#44; el grupo que m&#225;s peso perdi&#243;&#46; Los indicadores de relevancia cl&#237;nica que resultaron significativos fueron&#58; en el caso de los TG&#58; G1&#47;G3&#58; riesgo relativo&#58; 1&#44;42 &#40;IC 95&#37;&#58; 1&#44;11-1&#44;80&#41;&#59; reducci&#243;n relativa del riesgo&#58; 41&#44;7&#37; &#40;11&#44;4-80&#44;2&#41;&#59; reducci&#243;n absoluta del riesgo&#58; 25&#37; &#40;9&#44;2-40&#44;8&#41; y NNT&#58; 5 &#40;3-11&#41;&#46; En el caso del cHDL G1&#47;G2&#58; riesgo relativo&#58; 1&#44;32 &#40;1&#44;07-1&#44;63&#41;&#59; reducci&#243;n relativa del riesgo&#58; 32&#44;2&#37; &#40;7&#44;4-62&#44;6&#41;&#59; reducci&#243;n absoluta del riesgo&#58; 21&#44;1&#37; &#40;6&#44;4-35&#44;8&#41; y NNT&#58; 5 &#40;3-16&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La reducci&#243;n de peso se acompa&#241;a de cambios favorables en los par&#225;metros lip&#237;dicos relacionados con el sobrepeso y la obesidad&#44; siendo m&#225;s intensos cuanto mayor es la p&#233;rdida de peso&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; T&#225;rraga Marcos ML&#44; Panisello Royo JM&#44; Carbayo Herencia JA&#44; Rosich Domenech N&#44; Alins Presas J&#44; T&#225;rraga L&#243;pez PJ&#46; Efecto sobre los par&#225;metros lip&#237;dicos de una intervenci&#243;n para reducir peso en pacientes con sobrepeso y obesidad&#46; Clin Invest Arterioscler&#46; 2017&#59;29&#58;103&#8211;110&#46;</p>"
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        "identificador" => "fig0005"
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            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evolution of body mass index in the 3 intervention groups&#46; G1&#58; consultation group&#59; G2&#58; telemedicine group&#59; G3&#58; group recommended to lose weight&#46; The <span class="elsevierStyleItalic">p</span> value for each of the 3 groups was calculated using the Friedman test&#44; with the same value being obtained for all 3 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Evolution of the analytical parameters at the beginning and end of the study&#46; HDL-C&#58; cholesterol and high-density lipoproteins&#59; TC&#58; total cholesterol&#59; TG&#58; triglycerides&#59; G1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41;&#58; consultation with motivational intervention&#59; G2 &#40;I<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;&#58; lower intensity consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>telemedicine&#59; G3 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&#58; recommendation to lose weight following regular treatment with consultation&#46; The averages at the beginning and after the 12-month follow-up period were compared using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired data &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 in all the groups except for the TG in G3 &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;710&#93;&#41;&#46; The exact significance value can be seen in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p>"
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      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients whose TC and TG decreased and whose HDL-C increased after a 12-month follow-up period&#46; HDL-C&#58; cholesterol and high-density lipoproteins&#59; TC&#58; total cholesterol&#59; TG&#58; triglycerides&#46; G1&#58; consultation group&#59; G2&#58; consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>telemedicine group&#59; G3&#58; group recommended to lose weight&#46; Significant differences &#40;Chi-square test&#41; in TG &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41; and in HDL-C &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;025&#41; were observed between the 3 groups&#44; but not in TC &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;653&#41;&#46;</p>"
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">cm&#58; centimetres&#59; G1&#58; consultation group&#59; G2&#58; consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>telemedicine group&#59; G3&#58; group recommended to lose weight&#59; BMI&#58; body mass index&#59; kg&#58; kilograms&#59; kg&#47;m<span class="elsevierStyleSup">2</span>&#58; kilograms divided by height in metres squared&#59; mg&#47;dL&#58; milligrams per decilitre&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The results are expressed as an average and &#40;standard deviation&#41; or as a precise number and &#40;percentage&#41;&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The averages were compared using path variance analysis and the proportions were compared using the Chi-square test&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G3 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female &#40;n&#59; &#37;&#41;<br>Male &#40;n&#59; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;33&#46;3&#41;<br>26 &#40;35&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;34&#46;3&#41;<br>26 &#40;35&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;32&#46;4&#41;<br>22 &#40;29&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><br>0&#46;931&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;1 &#40;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;7 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;8 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;946&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&#46;1 &#40;13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#46;2 &#40;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#46;4 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;329&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;3 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;8 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;7 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;735&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Waist circumference &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#46;2 &#40;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&#46;7 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;202&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total cholesterol &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">246&#46;8 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">242&#46;1 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">250&#46;3 &#40;25&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;366&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triglycerides &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">172&#46;6 &#40;62&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">172&#46;3 &#40;72&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">157&#46;2 &#40;70&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDL-C &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;8 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#46;1 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#46;7 &#40;9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1438611.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Baseline sample data by group&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">cm&#58; centimetres&#59; G1&#58; consultation group&#59; G2&#58; consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>telemedicine group&#59; G3&#58; group recommended to lose weight&#59; BMI&#58; body mass index&#59; kg&#58; kilograms&#59; kg&#47;m<span class="elsevierStyleSup">2</span>&#58; kilograms divided by height in metres squared&#46; WC&#58; waist circumference&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">The averages were compared using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired groups&#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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in weight &#40;kg&#41;<br>Final<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>Initial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<br>Final<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>Initial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in WC &#40;cm&#41;<br>Final<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>Initial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;5&#46;6 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;0 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;6 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;4&#46;3 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;5 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;5 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G3 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;7 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;6 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;7 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;317&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>176&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;9 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;4 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;7 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1438612.png"
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            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Decrease in weight&#44; body mass index and waist circumference between the initial and final evaluation&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">HDL-C&#58; cholesterol and high-density lipoproteins&#59; TC&#58; total cholesterol&#59; G1&#58; consultation group&#59; G2&#58; consultation group<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>telemedicine&#59; G3&#58; group recommended to lose weight&#59; TG&#58; triglycerides&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">The averages were compared using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired data&#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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in TC &#40;mg&#47;dL&#41;<br>Final<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>Initial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in TG &#40;mg&#47;dL&#41;<br>Final<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>Initial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference in HDL-C &#40;mg&#47;dL&#41;<br>Final<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>Initial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;10&#46;1 &#40;24&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;19&#46;0 &#40;32&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;4&#46;7 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;19&#46;2 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G3 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;6&#46;3 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;4 &#40;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;710&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>176&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;7 &#40;19&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;13&#46;6 &#40;38&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1438613.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Decrease in total cholesterol and triglycerides&#44; and increase in high-density lipoprotein cholesterol between the initial and final evaluation&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">HDL-C&#58; cholesterol and high-density lipoproteins&#59; TC&#58; total cholesterol&#59; CI&#58; confidence interval&#59; NNT&#58; number needed to treat&#59; ARR&#58; absolute risk reduction&#59; RR&#58; relative risk&#59; RRR&#58; relative risk reduction&#59; TG&#58; triglycerides&#59; TM&#58; telemedicine&#46;</p><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">The analysis was performed using intention to treat&#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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comparison groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative risk &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RRR &#40;95&#37; CI&#41; &#40;in &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ARR &#40;95&#37; CI&#41; &#40;in &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NNT &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Clinical significance indicators relating to the number of patients who managed to decrease TC after a one-year follow-up period</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consultation&#47;control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;10 &#40;0&#46;89 to 1&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;5 &#40;&#8722;10&#46;9 to 37&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4 &#40;&#8722;8&#46;5 to 23&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;5 to &#8722;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TM&#47;control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;04 &#40;0&#46;83 to 1&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;6 to &#8722;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consultation&#47;consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;06 &#40;0&#46;87 to 1&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;2 &#40;&#8722;13&#46;1 to 29&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6 &#40;&#8722;10&#46;6 to 19&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;6 to &#8722;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Clinical significance indicators relating to the number of patients who managed to decrease TG after a one-year follow-up period</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consultation&#47;control&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TM&#47;control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;28 &#40;0&#46;99 to 1&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;4 &#40;&#8722;0&#46;5 to 65&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;0 &#40;0&#46;3 to 33&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;3 to 334&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consultation&#47;consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;10 &#40;0&#46;93 to 1&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;3 &#40;&#8722;7&#46;2 to 31&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0 &#40;&#8722;5&#46;9 to 21&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;5 to &#8722;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Clinical significance indicators relating to the number of patients who managed to increase HDL-C after a one-year follow-up period</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consultation&#47;control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;13 &#40;0&#46;95 to 1&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;5 &#40;&#8722;5&#46;0 to 35&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;5 to &#8722;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TM&#47;control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86 &#40;0&#46;68 to 1&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;10&#46;8 &#40;&#8722;27&#46;2 to 5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;10 &#40;18 to &#8722;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consultation&#47;consultation<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;32 &#40;1&#46;07 to 1&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;2 &#40;7&#46;4 to 62&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;1 &#40;6&#46;4 to 35&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3 to 16&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Clinical significance indicators across the 3 groups for the change observed in both the TC and the TG and HDL-C&#46;</p>"
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Article information

ISSN: 25299123
Original language: English

DOI:10.1016/j.artere.2017.01.004

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Year/Month	Html	Pdf	Total

2024 November	2	0	2
2024 October	9	8	17
2024 September	14	6	20
2024 August	13	3	16
2024 July	8	6	14
2024 June	8	6	14
2024 May	9	6	15
2024 April	11	3	14
2024 March	12	10	22
2024 February	16	5	21
2024 January	10	1	11
2023 December	5	3	8
2023 November	7	7	14
2023 October	13	4	17
2023 September	4	2	6
2023 August	5	5	10
2023 July	8	6	14
2023 June	4	5	9
2023 May	9	3	12
2023 April	5	2	7
2023 March	9	6	15
2023 February	12	3	15
2023 January	10	10	20
2022 December	22	3	25
2022 November	16	7	23
2022 October	11	5	16
2022 September	17	7	24
2022 August	16	51	67
2022 July	11	12	23
2022 June	6	5	11
2022 May	13	13	26
2022 April	11	6	17
2022 March	19	6	25
2022 February	8	5	13

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