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Clinical Sciences
Early weaning and other potential risk factors for overweight among preschool children
Geni BalabanI, Maria Eugênia Farias Almeida MottaII, Giselia Alves Pontes SilvaI,III
I Federal University of Ceará and School of Medicine of Juazeiro do Norte - Ceará/PE, Brazil
II Mother-Child Department of the Health Sciences Center, Federal University of Pernambuco - Recife/PE, Brazil
III Federal University of São Paulo/UNIFESP - São Paulo/SP, Brazil, Tel.: 55 81 2126.8514
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">In recent years&#44; a significant increase in the prevalence of obesity has been observed in many countries and across different age groups&#44; including children&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;2</a> The increase in the prevalence of childhood obesity is worrying because of obese children&#8217;s higher risk of becoming obese adults and because of the various morbid conditions associated with obesity&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Because obesity is a difficult-to-treat chronic disease that is associated with a variety of adverse consequences relating to morbidity and mortality&#44; special emphasis should be given to preventive measures&#46; Simple&#44; low-cost measures without potential adverse effects are particularly attractive&#46; Within this context&#44; several authors have raised the hypothesis that breastfeeding might have a protective effect against obesity&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib14">14</a></p><p id="para30" class="elsevierStylePara elsevierViewall">Epidemiological studies and experimental studies on animals have suggested that individuals&#8217; first nutritional experiences may affect their susceptibility to chronic diseases in adulthood&#44; such as obesity&#44; hypertension&#44; cardiovascular disease and type 2 diabetes&#46; This notion has been named &#8220;metabolic imprinting&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib15">15</a> This term describes a phenomenon through which an early nutritional experience during a critical and specific period of development might cause an enduring effect that continues throughout an individual&#8217;s life&#44; thereby predisposing him or her to certain diseases&#46;<a class="elsevierStyleCrossRef" href="#bib15">15</a></p><p id="para40" class="elsevierStylePara elsevierViewall">Breastfeeding represents newborns&#8217; first nutritional experience and provides continuity with the nutrition provided during intrauterine development&#46; Many bioactive factors are present in human milk&#44; including hormones and growth factors&#44; which affect the growth&#44; differentiation and functional maturation of specific organs&#44; thus affecting various aspects of development&#46;<a class="elsevierStyleCrossRef" href="#bib16">16</a> Therefore&#44; the unique composition of maternal milk might be implicated in the process of metabolic imprinting&#44; for example&#44; by changing the number and&#47;or size of adipocytes or by inducing the phenomenon of metabolic differentiation&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall">The etiology of obesity has a multifactorial nature&#46; A tendency for obesity to run in families can be seen such that children of obese parents have a higher risk of being obese themselves&#46; In addition to genetic factors&#44; parents and children usually share dietary habits and have similar physical activity levels&#44; thus contributing towards the greater risk of obesity in certain families&#46;<a class="elsevierStyleCrossRef" href="#bib17">17</a></p><p id="para60" class="elsevierStylePara elsevierViewall">High energy intake and low energy expenditure are among the main causal factors of obesity&#46;<a class="elsevierStyleCrossRef" href="#bib18">18</a> In addition to total caloric intake&#44; the composition of one&#8217;s diet is also important&#58; diets rich in simple carbohydrates and lipids are a risk factor for obesity&#46;<a class="elsevierStyleCrossRef" href="#bib18">18</a> Therefore&#44; in analyzing a possible protective role for breastfeeding against overweight and obesity&#44; it becomes necessary to take into consideration other variables that could be involved in this association&#46;</p><p id="para70" class="elsevierStylePara elsevierViewall">The aim of the present study was to investigate whether early weaning constitutes a risk factor for overweight at preschool age and to determine whether children&#8217;s current diet&#44; physical activity level and birth weight and their mothers&#8217; body mass index &#40;BMI&#41; are associated with overweight&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">METHODS</span><p id="para80" class="elsevierStylePara elsevierViewall">A case-control study was carried out among children of both sexes aged two to six years who attended private schools in 2003 and 2004&#46; The research project was assessed and approved by the research ethics committee&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">The sample size of 144 cases and 144 controls was calculated with the aid of the Statcalc program in the Epi-Info software&#44; version 6&#46;0&#44; using a confidence interval of 95&#37;&#44; a power of 80&#37;&#44; a ratio of 1&#58;1 between the numbers of cases and controls&#44; an expected frequency of the principal exposure in the control group &#40;early weaning&#41; of 40&#37; and an odds ratio of 2&#46;0&#44; in accordance with data in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib10">10</a> Assuming the prevalence of overweight to be 11&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib2">2</a> around 1&#44;309 children would need to be evaluated in order to identify 144 cases&#46;</p><p id="para100" class="elsevierStylePara elsevierViewall">A free and informed consent form was sent to all parents or guardians responsible for the children within the desired age group&#46; All children whose parents authorized their participation were included in the study &#40;1&#44;610 children&#41;&#46; Their heights and weights were measured&#44; and their BMIs were calculated&#46;</p><p id="para110" class="elsevierStylePara elsevierViewall">The case group was formed by the children who were overweight&#44; which was defined as BMI greater than or equal to the 85<span class="elsevierStyleSup">th</span> percentile for their age group&#46; The curves and tables of BMI percentiles of the Centers for Disease Control and Prevention &#40;CDC&#44; United States&#41;&#44; 2000 version &#40;revised version of the NCHS 1977 tables&#41;&#44; for individuals aged two to twenty years according to sex and age were used as the reference standard &#40;<a href="http://www.cdc.org/growthcharts">www&#46;cdc&#46;org&#47;growthcharts</a>&#59; accessed on Aug 12&#44; 2002&#41;&#46; The control group was formed by children whose BMIs were lower than the 85<span class="elsevierStyleSup">th</span> percentile&#46; Children presenting diseases or using medications capable of interfering with their weights and&#47;or heights were not included in the study&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">Among the 1&#44;610 preschool children assessed&#44; 183 cases were identified&#46; To make up the control group&#44; 183 children were randomly drawn from among the pupils attending the same schools as the cases&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">The main exposure studied was early weaning&#46; Children were considered to present this exposure if they had received exclusive breastfeeding or predominant breastfeeding &#40;i&#46;e&#46;&#44; maternal milk accompanied by water and&#47;or tea&#41; for a period of less than four months&#46; Other variables were also evaluated&#44; such as birth weight&#44; maternal BMI&#44; variables relating to the children&#8217;s current diet and variables relating to the children&#8217;s level of physical activity&#46; Socioeconomic variables were also gathered&#44; with the aim of characterizing the sample&#46;</p><p id="para140" class="elsevierStylePara elsevierViewall">The children&#8217;s current frequencies of intake of the following were analyzed&#58; fruits and greens&#47;vegetables &#40;variables used as markers for a healthier diet&#41;&#46; bread &#40;representing the intake of dough from grain&#41;&#44; soft drinks and biscuits &#40;representing the intake of carbohydrates and sweets&#47;candies&#41; and chips&#47;French fries &#40;representing the intake of fatty and fried foods&#41;&#46;</p><p id="para150" class="elsevierStylePara elsevierViewall">The following variables related to the children&#8217;s physical activity levels were analyzed&#58; average number of hours per day &#40;on weekdays&#41; of watching television&#44; average number of hours per day &#40;on weekdays&#41; of playing outside and their most frequent means of locomotion &#40;walking&#44; car&#44; motorcycle or bus&#41;&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall">The weights and heights of the children and their mothers were measured by a team of trained research assistants in accordance with standardized methods&#46;<a class="elsevierStyleCrossRef" href="#bib19">19</a> Each measurement was taken twice&#44; and the mean was used&#46; The BMI was calculated using the formula of weight &#40;in kilograms&#41; divided by the square of the height &#40;in meters&#41;&#46; Data relating to breastfeeding and the other variables were gathered by the same team by means of interviews with the children&#8217;s mothers&#46; This information was stored in a database using double data entry and correction of inconsistencies&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall">The data were analyzed using Epi-Info version 6&#46;0 and SPSS version 8&#46;0 software&#46; First&#44; each variable was evaluated separately to determine whether it was a risk factor for overweight&#44; with calculation of odds ratios and their 95&#37; confidence intervals&#46; Following this&#44; multivariate analysis was performed using the standard multiple regression method&#44; in which all variables are simultaneously entered into the model&#46; A statistical confidence level of 95&#37; was adopted&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">RESULTS</span><p id="para180" class="elsevierStylePara elsevierViewall">Among the 366 children studied&#44; 176 were male &#40;48&#46;2&#37;&#41; and 190 were female &#40;51&#46;9&#37;&#41;&#46; There was no statistically significant association between sex and overweight &#40;OR &#61; 1&#46;36&#59; 95&#37; CI&#58; 0&#46;88&#8211;2&#46;10&#59; p &#61; 0&#46;17&#41;&#46; The mothers&#8217; mean schooling level was 12&#46;5 years&#44; and the fathers&#8217; was 11&#46;6 years&#46; Most of the families had one or more cars &#40;67&#46;8&#37;&#41;&#44; were homeowners &#40;73&#46;2&#37;&#41; and had health insurance for their children &#40;51&#46;9&#37;&#41;&#46; There was no statistically significant association between overweight and any of these socioeconomic variables &#40;<a class="elsevierStyleCrossRef" href="#t1-cln_65p181">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="t1-cln_65p181"></elsevierMultimedia><p id="para190" class="elsevierStylePara elsevierViewall">The percentage of the children who had received exclusive or predominant breastfeeding for less than four months was 36&#46;2&#37; &#40;132&#47;366&#41;&#46; In univariate analysis&#44; the children who had received exclusive or predominant breastfeeding for less than four months presented a greater risk of overweight than did those who had received exclusive or predominant breastfeeding for four months or more &#40;OR &#61; 1&#46;69&#59; 95&#37; CI&#58; 1&#46;10&#8211;2&#46;60&#59; p &#61; 0&#46;02&#41;&#46;</p><p id="para200" class="elsevierStylePara elsevierViewall">Maternal overweight &#40;BMI &#8805; 25 kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; birth weight greater than or equal to 3&#44;500 g&#44; fruit intake less than twice a day&#44; greens and&#47;or vegetable intake less than three times a week&#44; consumption of one or more bread rolls per day&#44; consumption of soft drinks every day and consumption of biscuits every day constituted risk factors for overweight in the univariate analysis&#46; Furthermore&#44; in the univariate analysis&#44; it was observed that the children who played outside for an average of two or more hours a day on weekdays and those whose most frequent means of locomotion was walking presented lower risks of overweight&#46;</p><p id="para210" class="elsevierStylePara elsevierViewall">It was also observed that the children who consumed chips&#47;French fries every day and those who watched television for an average of five or more hours a day on weekdays presented higher risks of overweight&#46; However&#44; these associations were not statistically significant&#46;</p><p id="para220" class="elsevierStylePara elsevierViewall">In the multivariate analysis&#44; only maternal overweight&#44; birth weight greater than or equal to 3&#44;500 g&#44; playing outside for less than two hours a day and main means of locomotion other than walking remained as risk factors for overweight&#46; The association between early weaning &#40;receiving exclusive or predominant breastfeeding for less than four months&#41; and overweight did not reach statistical significance in the multivariate analysis&#46;</p><p id="para230" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#t2-cln_65p181">Table 2</a> presents the unadjusted and adjusted odds ratios with their respective 95&#37; confidence intervals&#46;</p><elsevierMultimedia ident="t2-cln_65p181"></elsevierMultimedia></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">DISCUSSION</span><p id="para240" class="elsevierStylePara elsevierViewall">In the present study&#44; the protective effect of breastfeeding against overweight was only shown in univariate analysis&#59; it did not persist after controlling for other variables&#46; It is possible that breastfeeding has only a small protective role against overweight in comparison to other variables of greater importance&#46;<a class="elsevierStyleCrossRefs" href="#bib11">11&#44;18</a></p><p id="para250" class="elsevierStylePara elsevierViewall">Different definitions of both the exposure and the outcome make it difficult to compare this study with similar studies in the literature&#46; The time that elapses between the exposure and the outcome also causes difficulty in analyzing this possible association&#46; It may give rise to recall bias&#44; or&#44; in the case of longitudinal studies&#44; it may impose high costs&#44; long study durations and operational difficulties&#46; Furthermore&#44; the extended time that elapses between the exposure and the outcome may make it difficult to take all the confounding variables into consideration&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib20">20</a>&#59;<a class="elsevierStyleCrossRef" href="#bib26">26</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib32">32</a></p><p id="para260" class="elsevierStylePara elsevierViewall">Dewey&#44;<a class="elsevierStyleCrossRef" href="#bib26">26</a> in a review article&#44; also reported that the protective effect of breastfeeding seemed to be small compared with the effects of other factors&#44; particularly having overweight parents&#46; Even so&#44; the effect of breastfeeding could be important from a public health point of view considering the present epidemic of obesity seen in many countries&#46;</p><p id="para270" class="elsevierStylePara elsevierViewall">Wadsworth et al&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a> did not find a significant association between breastfeeding and the prevalence of overweight at 6 years of age in an analysis of 3&#44;731 children in the United Kingdom&#46; In a cross-sectional study of 9&#44;357 German children aged 5 and 6 years&#44; von Kries et al&#46; &#40;<a class="elsevierStyleCrossRef" href="#bib15">15</a>&#41; found that the prevalence of obesity was 4&#46;5&#37; among children who had never been breastfed and 2&#46;8&#37; among those who had breastfed&#46; A dose-dependent effect of the duration of breastfeeding was observed&#46; After adjusting for potential confounding factors&#44; breastfeeding remained a protective factor against overweight and obesity&#46; Obesity was defined as BMI greater than the 97<span class="elsevierStyleSup">th</span> percentile&#44; whereas overweight was defined as BMI greater than the 90<span class="elsevierStyleSup">th</span> percentile&#46;</p><p id="para280" class="elsevierStylePara elsevierViewall">In the recent review by Owen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib30">30</a> the authors concluded that breastfeeding has a protective effect against obesity&#44; but that the magnitude of this effect is still poorly defined&#46; These authors found 61 articles analyzing the possible relationship between breastfeeding and the risk of obesity and concentrated their attention on the 28 studies that reported odds ratios that supported a protective effect of breastfeeding&#46; They observed that&#44; in several studies&#44; controlling for confounding variables led to a reduction of the protective effect of breastfeeding but did not eliminate it&#44; and they emphasized the need to carry out other studies to determine the roles of the confounding factors&#46;</p><p id="para290" class="elsevierStylePara elsevierViewall">In a wide-ranging meta-analysis&#44; Harder et al&#46;<a class="elsevierStyleCrossRef" href="#bib31">31</a> included 17 studies that reported odds ratios and 95&#37; confidence intervals or sufficient data to calculate them&#59; reported the duration of breastfeeding&#59; and included children fed exclusively with infant formula for comparison&#46; Based on these data&#44; these authors reported that the duration of breastfeeding was inversely associated with the risk of overweight&#44; independent of the definition of overweight used and the age of the participants in the studies&#46; One month of breastfeeding was associated with a 4&#37; decrease in the risk of obesity&#46;</p><p id="para300" class="elsevierStylePara elsevierViewall">Evaluation of food intake is a complex task&#44; which may at least partially explain the divergences in the literature&#46; Several methods have been used for such evaluations&#44; for example&#44; 24-hour recall&#44; food diaries&#44; direct weighing of foods&#44; home consumption of foods&#44; the food frequency questionnaire and dietary history&#46; Each of these has its advantages and limitations&#46;<a class="elsevierStyleCrossRef" href="#bib33">33</a> Evaluation of food intake among preschool children is an even more difficult task because there is little data on this age group&#46; Older age groups have been investigated much more thoroughly&#46;<a class="elsevierStyleCrossRef" href="#bib34">34</a>&#44; <a class="elsevierStyleCrossRef" href="#bib35">35</a> It is possible that information given by individuals about their own energy intake is not a valid measurement&#46;<a class="elsevierStyleCrossRef" href="#bib23">23</a> Moreover&#44; there is evidence that genetic factors are capable of modulating an organism&#8217;s response to variations in environmental factors such as diet and physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib36">36</a></p><p id="para310" class="elsevierStylePara elsevierViewall">In the same way as for energy intake&#44; measurement of physical activity is also a complex task&#46; Several methods can be used&#44; such as calorimetry&#44; systematic observation&#44; movement sensors&#44; heart rate monitors and questionnaires&#46;<a class="elsevierStyleCrossRef" href="#bib37">37</a> Questionnaires present several advantages&#44; such as low cost&#44; practicality&#44; lack of changes to individuals&#8217; behavior and possibility of adaptation of the questionnaire to the population in question&#46; However&#44; the literature is sparse regarding questionnaires for evaluating physical activity among preschool children&#46; Even the extensive collection of questionnaires presented by Kriska et al&#46;<a class="elsevierStyleCrossRef" href="#bib37">37</a> does not privilege this age group&#46;</p><p id="para320" class="elsevierStylePara elsevierViewall">The mechanisms through which maternal milk may play a protective role against obesity have not yet been determined&#46; In a review article&#44; Singhal &#38; Lanigan<a class="elsevierStyleCrossRef" href="#bib38">38</a> grouped potential protection mechanisms into two major groups&#58; those that were associated with behavioral factors and those related to the composition of maternal milk&#46;</p><p id="para330" class="elsevierStylePara elsevierViewall">It is possible that maternal milk is involved in the phenomenon of metabolic imprinting&#46; Waterland &#38; Garza<a class="elsevierStyleCrossRef" href="#bib21">21</a> put forward some potential mechanisms through which the phenomenon of metabolic imprinting could occur&#46; Among these are induction of variations in the structures of some organs&#44; changes in the number of cells&#44; and metabolic differentiation &#40;changes in the expression of certain genes causing variations in the production of enzymes&#44; hormones&#44; hormonal receptors&#44; transmembrane transporters&#44; etc&#41;&#46;</p><p id="para340" class="elsevierStylePara elsevierViewall">In terms of nutrients&#44; the composition of maternal milk differs qualitatively and quantitatively from infant formulas&#46; Moreover&#44; several bioactive factors are present in human milk&#44; including hormones like insulin&#44; adrenal steroids&#44; T3 and T4&#46;<a class="elsevierStyleCrossRef" href="#bib22">22</a> Casabiell et al&#46;<a class="elsevierStyleCrossRef" href="#bib39">39</a> identified the presence of leptin in human milk&#44; which could play a regulatory role in the newborn&#8217;s metabolism&#44; given that the hormone acts to inhibit appetite and anabolic pathways and to stimulate catabolic pathways&#46;<a class="elsevierStyleCrossRef" href="#bib40">40</a></p><p id="para350" class="elsevierStylePara elsevierViewall">Miralles et al&#46;<a class="elsevierStyleCrossRef" href="#bib41">41</a> analyzed the concentrations of leptin in samples of blood and maternal milk from 28 non-obese women and assessed the growth of their children&#44; who were breastfed for at least 6 months&#44; over their first years of life&#46; These authors observed a negative correlation between the concentration of leptin in maternal milk after one month of lactation and the children&#8217;s BMIs at the ages of 18 and 24 months&#46;</p><p id="para360" class="elsevierStylePara elsevierViewall">Lucas et al&#46;<a class="elsevierStyleCrossRef" href="#bib42">42</a> reported differences in endocrine responses with regard to the release of pancreatic and intestinal hormones between newborns breastfed with maternal milk and those fed with infant formula&#46; It is also possible that the newborns who were breastfed developed more effective mechanisms for regulating their energy intake&#46;<a class="elsevierStyleCrossRef" href="#bib43">43</a></p><p id="para370" class="elsevierStylePara elsevierViewall">Evidently&#44; even though no significant protective effect of maternal milk against overweight and obesity has been proven&#44; breastfeeding should continue to be strongly recommended because of its unquestionable nutritional&#44; immunological and psychological advantages&#46;</p><p id="para380" class="elsevierStylePara elsevierViewall">In summary&#44; the results of our study suggest that the possible protective effect of breastfeeding against overweight among preschool children is of a lower magnitude than the effects of genetic factors and other environmental factors&#46; Maternal overweight&#44; birth weight and sedentarism are important risk factors for overweight in this age group&#46;</p></span></span>"
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          "identificador" => "xpalclavsec1582529"
          "titulo" => "KEYWORDS&#58;"
        ]
        1 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "INTRODUCTION"
        ]
        2 => array:2 [
          "identificador" => "cesec20"
          "titulo" => "METHODS"
        ]
        3 => array:2 [
          "identificador" => "cesec30"
          "titulo" => "RESULTS"
        ]
        4 => array:2 [
          "identificador" => "cesec40"
          "titulo" => "DISCUSSION"
        ]
        5 => array:1 [
          "titulo" => "REFERENCES"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2009-10-13"
    "fechaAceptado" => "2009-11-26"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS&#58;"
          "identificador" => "xpalclavsec1582529"
          "palabras" => array:5 [
            0 => "Children"
            1 => "Overweight"
            2 => "Obesity"
            3 => "Breastfeeding"
            4 => "Risk factor"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVE</span><p id="spara50" class="elsevierStyleSimplePara elsevierViewall">To investigate whether early weaning constitutes a risk factor for overweight at preschool age and to identify other factors that affect this association&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS</span><p id="spara60" class="elsevierStyleSimplePara elsevierViewall">This was a case-control study of 366 children aged 2 to 6 years &#40;176 boys and 190 girls&#41; from three cities&#46; The case group comprised overweight children&#44; as defined by body mass index &#40;BMI&#41; for age greater than or equal to the 85<span class="elsevierStyleSup">th</span> percentile&#46; The main exposure analyzed was early weaning &#40;exclusive or predominant breastfeeding for less than four months&#41;&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">Early weaning was a significant risk factor for overweight in univariate analysis &#40;OR &#61; 1&#46;69&#59; 95&#37; CI&#58; 1&#46;10&#8211;2&#46;60&#59; p &#61; 0&#46;02&#41;&#44; but not in multivariate analysis &#40;OR &#61; 1&#46;42&#59; 95&#37; CI&#58; 0&#46;86&#8211;2&#46;34&#59; p &#61; 0&#46;17&#41;&#46; Maternal overweight&#44; birth weight &#8805; 3&#44;500 g and sedentarism were the main risk factors for overweight in multivariate analysis&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">DISCUSSION</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">In our study&#44; the protective effect of breastfeeding against overweight was only shown in univariate analysis&#59; it did not persist after controlling for other variables&#46; It is possible that breastfeeding has only a small protective role against overweight in comparison with other variables of greater importance&#46;</p></span> <span id="ceabs50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">CONCLUSION</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">Our results suggest that the potential protective effect of breastfeeding against overweight among preschool children is weaker than genetic and other environmental factors&#46;</p></span>"
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            "titulo" => "DISCUSSION"
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            "titulo" => "CONCLUSION"
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          "leyenda" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Note&#58; OR &#61; odds ratio&#59; 95&#37; CI &#61; 95&#37; confidence interval&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle" scope="col">Variables</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="middle" scope="col">Overweight</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="center" valign="middle" scope="col">Statistical analysis OR &#40;95&#37; CI&#41;</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="center" valign="middle" scope="col">Yes n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="middle" scope="col">No n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="middle" scope="col">Total n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Homeowner</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">132 &#40;49&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">136 &#40;50&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">268 &#40;73&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">OR &#61; 0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">51 &#40;52&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">47 &#40;48&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">98 &#40;26&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">&#40;0&#46;55&#8211;1&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Cars &#40;one or more&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">130 &#40;52&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">118 &#40;47&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">248 &#40;67&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">OR &#61; 1&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">No</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">53 &#40;44&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">65 &#40;55&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">118 &#40;32&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">&#40;0&#46;85&#8211;2&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Health insurance &#40;for the child&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">95 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">95 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">190 &#40;51&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">OR &#61; 1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">88 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">88 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">176 &#40;48&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">&#40;0&#46;65&#8211;1&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Socioeconomic variables and risk of overweight among pre-school children&#46;</p>"
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          "leyenda" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Note&#58; OR &#61; odds ratio&#59; 95&#37; CI &#61; 95&#37; confidence interval&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="top" scope="col">Variables</th><th class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="center" valign="top" scope="col">Unadjusted OR &#40;95&#37; CI&#41;</th><th class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="center" valign="top" scope="col">Adjusted OR &#40;95&#37; CI&#41;</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="center" valign="top" scope="col">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="top">&#8805; 4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; 4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;69 &#40;1&#46;10&#8211;2&#46;60&#41;p&#61;0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;42 &#40;0&#46;86&#8211;2&#46;34&#41;p&#61;0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top">Maternal BMI</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; 25 kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#8805; 25 kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;84 &#40;1&#46;72&#8211;4&#46;68&#41;p&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;39 &#40;1&#46;42&#8211;4&#46;02&#41;p&#61;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Birth weight &#40;g&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">3000&#8211;3499&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#8805; 3500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;21 &#40;1&#46;37&#8211;3&#46;58&#41;p&#61;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;00 &#40;1&#46;17&#8211;3&#46;42&#41;&#59;p&#61;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">2500&#8211;2999&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;73 &#40;0&#46;98&#8211;3&#46;07&#41;p&#61;0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;68 &#40;0&#46;90&#8211;3&#46;13&#41;&#59;p&#61;0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">1500&#8211;2499&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;00 &#40;0&#46;70&#8211;5&#46;69&#41;p&#61;0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;78 &#40;0&#46;54&#8211;5&#46;80&#41;&#59;p&#61;0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Fruit intake</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#8805; twice&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; twice&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;71 &#40;1&#46;09&#8211;2&#46;68&#41;p&#61;0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;49 &#40;0&#46;89&#8211;2&#46;49&#41;p&#61;0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Greens&#47;vegetable intake</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#8805; 3 times&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; 3 times&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;86 &#40;1&#46;23&#8211;2&#46;81&#41;p&#61;0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;57 &#40;0&#46;97&#8211;2&#46;54&#41;p&#61;0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Bread consumption</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; 1 roll&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#8805; 1 roll&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;65 &#40;1&#46;06&#8211;2&#46;59&#41;p&#61;0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;38 &#40;0&#46;85&#8211;2&#46;26&#41;p&#61;0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Soft drink consumption</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; 7 times&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Daily&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;91 &#40;1&#46;08&#8211;3&#46;40&#41;p&#61;0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;69 &#40;0&#46;92&#8211;3&#46;11&#41;p&#61;0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Biscuit consumption</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; 7 times&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Daily&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;64 &#40;1&#46;04&#8211;2&#46;59&#41;p&#61;0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;32 &#40;0&#46;81&#8211;2&#46;17&#41;p&#61;0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Consumption of chips&#47;French fries</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; 7 times&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Daily&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;57 &#40;0&#46;92&#8211;2&#46;69&#41;p&#61;0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;38 &#40;0&#46;79&#8211;2&#46;41&#41;p&#61;0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Number of hours of television &#40;weekdays&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; 5 h&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#8805; 5 h&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;79 &#40;0&#46;82&#8211;3&#46;92&#41;p&#61;0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;18 &#40;0&#46;51&#8211;2&#46;70&#41;p&#61;0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&#60; 2 h&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;47 &#40;1&#46;62&#8211;3&#46;78&#41;p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="top">2&#46;43 &#40;1&#46;52&#8211;3&#46;88&#41;p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">1&#46;82 &#40;1&#46;17&#8211;2&#46;84&#41;p&#61;0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                    0 => array:2 [
                      "titulo" => "Overweight prevalence and trends for children and adolescents- The National Health and Nutrition Examination Surveys&#44; 1963 to 1991"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              RP Troiano \n
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                              """
                            1 => """
                              KM Flegal \n
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                              """
                            2 => """
                              RJ Kukzmarski \n
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                              """
                            3 => """
                              SM Campbell \n
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                              """
                            4 => """
                              CL Johnson \n
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                              """
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                      "doi" => "10.1001/archpedi.1995.02170230039005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pediatr Adolesc Med"
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                        "volumen" => "149"
                        "paginaInicial" => "1085"
                        "paginaFinal" => "1091"
                        "link" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Increasing prevalence of overweight among US low-income preschool children&#58; The Centers for Disease Control and Prevention Pediatric Nutrition Surveillance&#44; 1983 to 1995"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              Z Mei \n
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                              """
                            1 => """
                              KS Scalon \n
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                              """
                            2 => """
                              LM Grummer-Strawn \n
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                            3 => """
                              DS Freedman \n
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                              FL Trowbridg \n
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                        "fecha" => "1998"
                        "volumen" => "101"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9417143"
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                      "titulo" => "Prevalence of overweight among preschool children in the United States&#44; 1971 through 1994"
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                              CL Ogden \n
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                              """
                            1 => """
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                              RR Briefel \n
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                              RJ Kuczmarski \n
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                              KM Flegal \n
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8989329"
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                      "titulo" => "Da desnutri&#231;&#227;o para a obesidade&#58; a transi&#231;&#227;o nutricional no Brasil"
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                        "editores" => "CAMonteiro"
                        "titulo" => "Velhos e novos males da sa&#250;de no Brasil- A evolu&#231;&#227;o do pa&#237;s e de suas doen&#231;as"
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                        "paginaFinal" => "255"
                        "serieFecha" => "1995"
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                      "titulo" => "Do obese children become obese adults&#63;- A review of the literature"
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                            0 => """
                              MK Serdula \n
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                              """
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                              T Byers \n
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                      "doi" => "10.1006/pmed.1993.1014"
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                        "tituloSerie" => "Prev Med"
                        "fecha" => "1993"
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                      "titulo" => "Morbidity and mortality associated with elevated body weight in children and adolescents"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              A Must \n
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                        "tituloSerie" => "Am J Clin Nutr"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8615339"
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                            0 => """
                              MS Kramer \n
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es en pt

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